Medical Care Research and Review最新文献

While cancer screening guidelines increasingly recommend incorporating life expectancy estimates to inform screening decisions for older adults, little is known about how this happens in practice. This review summarizes current knowledge about primary care clinician and older adult (65+) perspectives about use of life expectancy to guide cancer screening decisions. Clinicians report operational barriers, uncertainty, and hesitation around use of life expectancy in screening decisions. They recognize it may help them more accurately weigh benefits and harms but are unsure how to estimate life expectancy for individual patients. Older adults face conceptual barriers and are generally unconvinced of the benefits of considering their life expectancy when making screening decisions. Life expectancy will always be a difficult topic for clinicians and patients, but there are advantages to incorporating it in cancer screening decisions. We highlight key takeaways from both clinician and older adult perspectives to guide future research.

Health centers (HCs) play a crucial and integral role in addressing social determinants of health (SDOH) among vulnerable and underserved populations, yet data on SDOH assessment and subsequent actions is limited. We conducted a systematic review to understand the existing evidence of integration of SDOH into HC primary-care practices. Database searches yielded 3,516 studies, of which 41 articles met the inclusion criteria. A majority of studies showed that HCs primarily captured patient-level rather than community-level SDOH data. Studies also showed that HCs utilized SDOH in electronic health records but capabilities varied widely. A few studies indicated that HCs measured health-related outcomes of integrating SDOH data. The review highlighted that many knowledge gaps exist in the collection, use, and assessment of impact of these data on outcomes, and future research is needed to address this knowledge gap.

Nonprofit hospitals have been required to conduct Community Health Needs Assessments and develop implementation strategies for almost a decade, yet little is known about this process on the national level. Using a nationally representative dataset of 2019 to 2021 nonprofit hospital community benefit reports, we assessed patterns in hospital identification of community health needs and investments in corresponding programs. The five most common needs identified by hospitals were mental health (identified by 87% of hospitals), substance use (76%), access (73%), social determinants of health (69%), and chronic disease (67%). The five most common needs addressed were: mental health (87%), access (81%), substance use (77%), chronic disease (72%), and obesity (71%). Institutional and community-level factors were associated with whether hospitals identified and addressed health needs. Hospitals often addressed needs that they did not identify, particularly related to the provision of medical services-which has important implications for population health improvement.

The Primary Care Incentive Payment Program (PCIP) provided a 10% bonus payment for Evaluation and Management (E&M) visits for eligible primary care providers (PCPs) from 2011 to 2015. Using a 2012 to 2017 sample of continuously eligible PCPs (the treatment group) and ineligible specialists with historically similar provision of billed services (the control group), this study is the first to examine how PCPs responded to the program's termination. Using inverse probability of treatment weighted difference-in-differences models that control for inter-temporal changes in provider-specific beneficiary characteristics, individual provider fixed effects, and zip code by year fixed effects, it finds that providers responded to the removal of the 10% bonus payments by increasing their billing of bonus payment eligible E&M relative value units (RVUs) by 3.7%. This response is consistent with supplier-induced demand and suggests a 46% offsetting response consistent with actuarial assumptions by the Centers for Medicare & Medicaid Services when assessing reimbursement reductions.

While purpose-oriented networks are widely recognized as organizational forms to address wicked problems in health care such as increasing demands and expenditure, the associated literature is fragmented. We therefore reviewed empirical studies to identify the determinants of the effectiveness of these networks. Our search yielded 3,657 unique articles, of which 19 met our eligibility criteria. After backward snowballing and expert consultation, 33 articles were included. Results reveal no less than 283 determinants of effective health care networks. The majority of these determinants are processual and involving professionals from the operational level is particularly salient. In addition, most studies relate determinants to process outcomes (e.g., improved collaboration or sustainability of the network) and only a few to members' perception of whether the network attains its goals. We urge future research to adopt configurational approaches to identify which sets of determinants are associated with networks' ability to attain their goal of addressing wicked problems.

Retail health clinics (RHCs) have been described as a disruptive model of care delivery. We describe RHC market presence in the United States from 2008 to 2016 with a focus on the characteristics of counties where new clinics open. We merge national data on RHC openings and closings from Merchant Medicine with the Area Health Resources File. We examined county-level counts and ownership of RHCs over time. From 2008 to 2016, we found increasing ownership of RHCs by retail pharmacies, and, contrary to earlier predictions, RHCs continue to be located in affluent counties and did not open in underserved or provider shortage areas. Most new clinics opened in counties where RHCs already had a presence, and these counties also had greater primary care physician, nurse practitioner, and physician assistant density per capita (100,000). As RHCs expand and offer more services, they may place new competitive pressures on nearby primary care providers and practices.

The health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study is the first to look at the association between missed nursing care and mortality, morbidity, and length of stay (LOS) for VLBW infants in a U.S. NICU sample. We used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. The 190 sample hospitals were from 19 states in all regions. Missed clinical nursing care was significantly associated with higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage. With further research, these results may motivate the development of interventions to reduce missed clinical nursing care in the NICU.

Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses "American Hospital Associations' 2020 Annual Survey" data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, "the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives" plays in hospitals' choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA.

The COVID-19 pandemic hit long-term care, and particularly nursing homes hard. We aimed to explore how crisis management goals and tasks evolve during such a prolonged crisis, using the crisis management tasks as identified by Boin and 't Hart as a starting point. This longitudinal, qualitative study comprises 47 interviews with seven Dutch nursing home directors and a focus group. We identified two phases to the crisis response: an acute phase with a linear, rational perspective of saving lives and compliancy to centralized decision-making and an adaptive phase characterized by more decentralized decision-making, reflection, and competing values and perspectives. This study confirms the usability of Boin and 't Hart's typology of crisis management tasks and shows that these tasks "changed color" in the second phase. We also revealed three types of additional work in managing such a crisis: resilience work, emotion work, and normative work.