Health Services Research最新文献

{"title":"Eliciting patient past experiences of healthcare discrimination as a potential pathway to reduce health disparities: A qualitative study of primary care staff.","authors":"Dharma E Cortés, Ana M Progovac, Frederick Lu, Esther Lee, Nathaniel M Tran, Margo A Moyer, Varshini Odayar, Caryn R R Rodgers, Leslie Adams, Valeria Chambers, Jonathan Delman, Deborah Delman, Selma de Castro, María José Sánchez Román, Natasha A Kaushal, Timothy B Creedon, Rajan A Sonik, Catherine Rodriguez Quinerly, Ora Nakash, Afsaneh Moradi, Heba Abolaban, Tali Flomenhoft, Ruth Nabisere, Ziva Mann, Sherry Shu-Yeu Hou, Farah N Shaikh, Michael W Flores, Dierdre Jordan, Nicholas Carson, Adam C Carle, Benjamin Lé Cook, Danny McCormick","doi":"10.1111/1475-6773.14373","DOIUrl":"https://doi.org/10.1111/1475-6773.14373","url":null,"abstract":"<p><strong>Objective: </strong>To understand whether and how primary care providers and staff elicit patients' past experiences of healthcare discrimination when providing care.</p><p><strong>Data sources/study setting: </strong>Twenty qualitative semi-structured interviews were conducted with healthcare staff in primary care roles to inform future interventions to integrate data about past experiences of healthcare discrimination into clinical care.</p><p><strong>Study design: </strong>Qualitative study.</p><p><strong>Data collection/extraction methods: </strong>Data were collected via semi-structured qualitative interviews between December 2018 and January 2019, with health care staff in primary care roles at a hospital-based clinic within an urban safety-net health system that serves a patient population with significant racial, ethnic, and linguistic diversity.</p><p><strong>Principal findings: </strong>Providers did not routinely, or in a structured way, elicit information about past experiences of healthcare discrimination. Some providers believed that information about healthcare discrimination experiences could allow them to be more aware of and responsive to their patients' needs and to establish more trusting relationships. Others did not deem it appropriate or useful to elicit such information and were concerned about challenges in collecting and effectively using such data.</p><p><strong>Conclusions: </strong>While providers see value in eliciting past experiences of discrimination, directly and systematically discussing such experiences with patients during a primary care encounter is challenging for them. Collecting this information in primary care settings will likely require implementation of multilevel systematic data collection strategies. Findings presented here can help identify clinic-level opportunities to do so.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14373"},"PeriodicalIF":3.1,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care mental health integration to improve early treatment engagement for veterans who screen positive for depression","authors":"Lucinda B. Leung MD, PhD, MPH,&nbsp;Karen Chu MS,&nbsp;Danielle E. Rose PhD,&nbsp;Susan E. Stockdale PhD,&nbsp;Edward P. Post MD, PhD,&nbsp;Jennifer S. Funderburk PhD,&nbsp;Lisa V. Rubenstein MD, MSPH","doi":"10.1111/1475-6773.14354","DOIUrl":"10.1111/1475-6773.14354","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To examine the relationship between the penetration (or reach) of a national program aiming to integrate mental health clinicians into all primary care clinics (PC-MHI) and rates of guideline-concordant follow-up and treatment among clinic patients newly identified with depression in the Veterans Health Administration (VA).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Sources/Study Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;15,155 screen-positive patients 607,730 patients with 2-item Patient Health Questionnaire scores in 82 primary care clinics, 2015–2019.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this retrospective cohort study, we used established depression care quality measures to assess primary care patients who (a) newly screened positive (score ≥3) and (b) were identified with depression by clinicians via diagnosis and/or medication (&lt;i&gt;n&lt;/i&gt; = 15,155; 15,650 patient-years). Timely follow-up included ≥3 mental health, ≥3 psychotherapy, or ≥3 primary care visits for depression. Minimally appropriate treatment included ≥4 mental health visits, ≥3 psychotherapy, or ≥60 days of medication. In multivariate regressions, we examined whether higher rates of PC-MHI penetration in clinic (proportion of total primary care patients in a clinic who saw any PC-MHI clinician) were associated with greater depression care quality among cohort patients, adjusting for year, healthcare system, and patient and clinic characteristics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Collection/Extraction Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Electronic health record data from 82 VA clinics across three states.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Principal Findings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A median of 9% of all primary care patients were seen by any PC-MHI clinician annually. In fully adjusted models, greater PC-MHI penetration was associated with timely depression follow-up within 84 days (∆&lt;i&gt;P&lt;/i&gt; = 0.5; SE = 0.1; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and 180 days (∆&lt;i&gt;P&lt;/i&gt; = 0.3; SE = 0.1; &lt;i&gt;p&lt;/i&gt; = 0.01) of a positive depression screen. Completion of at least minimal treatment within 12 months was high (77%), on average, and not associated with PC-MHI penetration.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Greater PC-MHI program penetration was associated with early depression treatment engagement at 84−/180-days among clinic patients newly identified with depression, with no effect on already high rates of co","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 S2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of the Veterans Health Administration Learning Health System: 25 years of QUERI","authors":"Melissa M. Garrido PhD,&nbsp;Amy M. Kilbourne PhD MPH","doi":"10.1111/1475-6773.14372","DOIUrl":"10.1111/1475-6773.14372","url":null,"abstract":"&lt;p&gt;The Veterans Health Administration (VHA) is among the nation's largest integrated health systems and among the largest learning health systems. A learning health system combines institution-specific data generation and evaluation with context from the broader research, clinical, and policy communities to inform and implement approaches to improve access to, quality, efficiency, and cost of care.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Instrumental to the establishment of the VHA as a learning health system was the founding of the national Quality Enhancement Research Initiative (QUERI) program, an operational evaluation and quality improvement program. QUERI was established in 1998, and in the years since its founding, initiatives have evolved from implementation of guideline-based care for specific conditions to the conduct of system-wide quality improvement and implementation science efforts to the support of evidence-based policymaking.&lt;span&gt;&lt;sup&gt;3-5&lt;/sup&gt;&lt;/span&gt; This special issue highlights scientific contributions and real-world impacts emanating from 25 years of initiatives stemming from QUERI that reflect rapid translation of research into practice.&lt;/p&gt;&lt;p&gt;QUERI was established with a goal of becoming “…a national system to translate research discoveries and innovations into patient care and health systems improvement”.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Initial translation efforts were focused on nine conditions or groups of conditions that are prevalent among veterans: heart disease, cerebrovascular disease, type II diabetes, colorectal cancer, prostate disease, spinal cord injury, HIV/AIDS, mental health conditions, and substance use disorders. This initial focus laid the groundwork for projects featured in an article in this issue by Damschroder, Hamilton, and colleagues, who summarize the far-reaching impacts from a decade of diabetes-focused QUERI projects.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Evaluations of the implementation of the VA's Diabetes Prevention Program led to insights into how to improve the reach of other, related programs; the effectiveness of an online version of the program; and the importance of gender-specific tailoring of prevention programs.&lt;/p&gt;&lt;p&gt;In the past decade, QUERI has expanded its focus to address broader health system issues that affect multiple conditions and veterans' overall well-being.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The Veterans Access, Choice, and Accountability Act of 2014 (Choice Act) mandated the creation of a commission to examine methods to improve veterans' access to care. In their report, the Commission on Care recommended that the VA leverage data and continuous improvement principles to ensure equitable access to high-quality care.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Around the same time, the Office of Management and Budget urged federal agencies to use evidence to support budget and operational decisions.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; QUERI's expanded focus was in response to these recommendations, notably by using a learning health system","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 S2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The foundational science of learning health systems","authors":"Amy M. Kilbourne PhD, MPH,&nbsp;Amanda E. Borsky DrPH, MPP,&nbsp;Robert W. O'Brien PhD,&nbsp;Melissa Z. Braganza MPH,&nbsp;Melissa M. Garrido PhD","doi":"10.1111/1475-6773.14374","DOIUrl":"10.1111/1475-6773.14374","url":null,"abstract":"&lt;p&gt;The National Academy of Medicine's &lt;i&gt;Future of Health Services Research&lt;/i&gt; report&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; called for researchers to better address the system-level priorities facing health-care organizations, patients, and communities to achieve meaningful impacts on population health outcomes. The report strongly recommended that future research initiatives support close partnerships with health-care organization leaders and the end-users they serve (e.g., patients, providers, and communities) to ensure their priorities are addressed. When aligned with health-care organization and end-user priorities, health services research has great potential to facilitate the translation of research into practice that supports population health goals (e.g., access, outcomes, equity, experience, and value) in health-care organizations and communities.&lt;/p&gt;&lt;p&gt;Moreover, U.S. health-care organizations are increasingly embracing learning health systems&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt; and the Quintuple Aim framework (improve access, outcomes, equity, experience, and value of care) to better align research with health-care organization goals.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; The National Academy of Medicine defined learning health systems (LHSs) as when “science, informatics, incentives, and culture are aligned to support continuous improvement, innovation, and seamlessly embed knowledge and best practices into research and care delivery.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;” An LHS is led by a learning community comprised of health-care organization leaders, investigators, end-users, and other affected groups who identify shared health priority goals and support continuous, standardized processes that curate multi-level data for ongoing research and quality improvement initiatives that support meeting these goals.&lt;/p&gt;&lt;p&gt;Funding priorities therefore need to be aligned with these NAM recommendations to incentivize investigators to conduct partnered LHS research focused on Quintuple Aim goals. Nonetheless, LHSs are impeded by a lack of funding sources to enable their development and investigator involvement.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Differences in research and quality improvement timelines and regulations also impede their ability to sustain research and quality improvement initiatives over time.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; LHSs require upfront administrative and data analytics infrastructure to enable involved parties to set priorities, plan and conduct the research and quality improvement initiatives, curate and maintain primary and secondary data over time, and ensure compliance with research and quality improvement regulations.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; While investigators can garner external research funding, this typically supports hypothesis-driven scientific inquiry but not the required infrastructure to enable ongoing administration and data curation to optimize LHS functions. Moreover, research and quality improvement efforts are siloed due to different regulations regarding da","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 6","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program","authors":"Courtney Harold Van Houtven PhD,&nbsp;Cynthia J. Coffman PhD,&nbsp;Kasey Decosimo MPH,&nbsp;Janet M. Grubber MSPH,&nbsp;Joshua Dadolf MSW,&nbsp;Caitlin Sullivan MS,&nbsp;Matthew Tucker BA,&nbsp;Rebecca Bruening MPH,&nbsp;Nina R. Sperber PhD,&nbsp;Karen M. Stechuchak MS,&nbsp;Megan Shepherd-Banigan PhD,&nbsp;Nathan Boucher DrPH,&nbsp;Jessica E. Ma MD,&nbsp;Brystana G. Kaufman PhD,&nbsp;Cathleen S. Colón-Emeric MD, MHS,&nbsp;George L. Jackson PhD, MHA,&nbsp;Teresa M. Damush PhD,&nbsp;Leah Christensen MSW,&nbsp;Virginia Wang PhD,&nbsp;Kelli D. Allen PhD,&nbsp;Susan N. Hastings MD, MHS","doi":"10.1111/1475-6773.14326","DOIUrl":"10.1111/1475-6773.14326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days <i>not</i> at home and family caregiver well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Study Setting</h3>\u0000 \u0000 <p>Participants included Veterans referred to home- and community-based services with an identified caregiver across 8 medical centers and confirmed family caregivers of eligible Veterans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval for starting iHI-FIVES and received standardized implementation support. The primary outcome, number of Veteran “days <i>not</i> at home,” and secondary outcomes, changes over 3 months in measures of caregiver well-being, were compared between pre- and post-iHI-FIVES intervals using generalized linear models including covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection/Extraction Methods</h3>\u0000 \u0000 <p>Patient data were extracted from the electronic health record. Caregiver data were collected from 2 telephone-based surveys.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Overall, <i>n</i> = 898 eligible Veterans were identified across pre-iHI-FIVES (<i>n</i> = 327) and post-iHI-FIVES intervals (<i>n</i> = 571). Just under one fifth (17%) of Veterans in post-iHI-FIVES intervals had a caregiver enroll in iHI-FIVES. Veteran and caregiver demographics in pre-iHI-FIVES intervals were similar to those in post-iHI-FIVES intervals. In adjusted models, the estimated rate of days <i>not</i> at home over 6-months was 42% lower (rate ratio = 0.58 [95% confidence interval: 0.31–1.09; <i>p</i> = 0.09]) post-iHI-FIVES compared with pre-iHI-FIVES. The estimated mean days <i>not</i> at home over a 6-month period was 13.0 days pre-iHI-FIVES and 7.5 post-iHI-FIVES. There were no differences between pre- and post-iHI-FIVES in change over 3 months in caregiver well-being measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Reducing days <i>not</i> at home is consistent with effectiveness because more time at home increases quality of life. In this study, after adjusting for Veteran characteristics, we did not find evidence that implementation of a caregiver training program yielded a reduction in Veteran's days <i>not</i> at home.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 6","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of telehealth cost-sharing on healthcare utilization: Evidence from high-deductible health plans","authors":"Risha Gidwani DrPH,&nbsp;Veronica Yank MD,&nbsp;Lane Burgette PhD,&nbsp;Aaron Kofner MS, MA,&nbsp;Steven M. Asch MD, MPH,&nbsp;Zachary Wagner PhD","doi":"10.1111/1475-6773.14343","DOIUrl":"10.1111/1475-6773.14343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Evaluate whether cost-sharing decreases led high-deductible health plans (HDHP) enrollees to increase their use of healthcare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources, Study Setting</h3>\u0000 \u0000 <p>National sample of chronically-ill patients age 18–64 from 2018 to 2020 (<i>n</i> = 1,318,178).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Difference-in-differences analyses using entropy-balancing weights were used to evaluate the effect of a policy shift to $0 cost-sharing for telehealth on utilization for HDHP compared with non-HDHP enrollees. Due to this shock, HDHP enrollees experienced substantial declines in cost-sharing for telehealth, while non-HDHP enrollees experienced small declines. Event study models were also used to evaluate changes over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection/Extraction Methods</h3>\u0000 \u0000 <p>Outcomes included use of any outpatient care; use of $0 telehealth; use of $0 telehealth as a proportion of all outpatient care; and use of any telehealth. To test whether any differences were due to preferences for care modality versus cost-sharing, we further evaluated use of non-$0 telehealth as a placebo test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>There was no difference in change in overall outpatient visits (<i>p</i> = 0.84), with chronicall-ill HDHP enrollees using less care both before and after the policy shift. However, compared with non-HDHP enrollees, HDHP enrollees increased their use of $0 telehealth by 0.08 visits over a 9-month period, a 27% increase (95% CI 0.07–0.09, <i>p</i> &lt; 0.001) and shifted 1.2 percentage points more of their care to $0 telehealth, a 15% increase (<i>ß</i> = 0.01, 95% CI 0.01, 0.01, <i>p</i> &lt; 0.001). However, HDHP enrollees had lower uptake of non-$0 telehealth than non-HDHP enrollees (<i>ß</i> = −0.01, 95%CI −0.02, 0.00, <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Recent-but-expiring federal legislation exempts telehealth from HDHP deductibles for care provided in 2023 and 2024. Our results indicate that extending the protections provided by this legislation could help reduce the gap in access to care for chronically-ill persons enrolled in HDHPs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 6","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes","authors":"Austin S. Kilaru MD MSHP,&nbsp;Joshua M. Liao MD MSc,&nbsp;Erkuan Wang MA,&nbsp;Yueming Zhao MPH,&nbsp;Jingsan Zhu MS MBA,&nbsp;Grace Ng MD MSHP,&nbsp;Torrey Shirk BA,&nbsp;Deborah S. Cousins MSPH,&nbsp;Genevieve P. Kanter PhD,&nbsp;Said Ibrahim MD MPH MBA,&nbsp;Amol S. Navathe MD PhD","doi":"10.1111/1475-6773.14369","DOIUrl":"10.1111/1475-6773.14369","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Sources and Study Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a retrospective observational study using a differences-in-differences method to compare changes in outcome disparities between dual-eligible and non-dual eligible beneficiaries after hospital participation in the Comprehensive Care for Joint Replacement (CJR) program. The primary outcome was LEJR complications. Secondary outcomes included 90-day readmissions and mortality.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Extraction Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We identified hospitals in the US market areas eligible for CJR. We included beneficiaries in the intervention group who received joint replacement at hospitals in markets randomized to participate in CJR. The comparison group included patients who received joint replacement at hospitals in markets who were eligible for CJR but randomized to control.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Principal Findings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The study included 1,603,555 Medicare beneficiaries (mean age, 74.6 years, 64.3% women, 11.0% dual-eligible). Among participant hospitals, complications decreased between baseline and intervention periods from 11.0% to 10.1% for dual-eligible and 7.0% to 6.4% for non-dual-eligible beneficiaries. Among nonparticipant hospitals, complications decreased from 10.3% to 9.8% for dual-eligible and 6.7% to 6.0% for non-dual-eligible beneficiaries. In adjusted analysis, CJR participation was associated with a reduced difference in complications between dual-eligible and non-dual-eligible beneficiaries (−0.9 percentage points, 95% CI −1.6 to −0.1). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model. There were no differential changes in 90-day readmissions or mortality.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Mandatory participation in a bundled payment program was associated with reduced disparities in joint replacement complications for Medic","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 5","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.14369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Availability of behavioral health crisis care and associated changes in emergency department utilization.","authors":"Ashlyn Burns, Joshua R Vest, Nir Menachemi, Olena Mazurenko, Paul I Musey, Michelle P Salyers, Valerie A Yeager","doi":"10.1111/1475-6773.14368","DOIUrl":"10.1111/1475-6773.14368","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether availability of behavioral health crisis care services is associated with changes in emergency department (ED) utilization.</p><p><strong>Data sources and study setting: </strong>We used longitudinal panel data (2016-2021) on ED utilization from the Healthcare Cost and Utilization Project's State ED Databases and a novel dataset on crisis care services compiled using information from the Substance Abuse and Mental Health Services Administration's National Directories of Mental Health Treatment Facilities. A total of 1002 unique zip codes from Arizona, Florida, Kentucky, Maryland, and Wisconsin were included in our analyses.</p><p><strong>Study design: </strong>To estimate the effect of crisis care availability on ED utilization, we used a linear regression model with zip code and year fixed effects and standard errors accounting for clustering at the zip code-level. ED utilization related to mental, behavioral, and neurodevelopmental (MBD) disorders served as our primary outcome. We also examined pregnancy-related ED utilization as a nonequivalent dependent variable to assess residual bias in effect estimates.</p><p><strong>Data collection/extraction methods: </strong>We extracted data on crisis care services offered by mental health treatment facilities (n = 14,726 facility-years) from the National Directories. MBD-related ED utilization was assessed by applying the Clinical Classification Software Refined from the Healthcare Cost and Utilization Project to the primary ICD-10-CM diagnosis code on each ED encounter (n = 101,360,483). All data were aggregated to the zip code-level (n = 6012 zip-years).</p><p><strong>Principal findings: </strong>The overall rate of MBD-related ED visits between 2016 and 2021 was 1610 annual visits per 100,000 population. Walk-in crisis stabilization services were associated with reduced MBD-related ED utilization (coefficient = -0.028, p = 0.009), but were not significantly associated with changes in pregnancy-related ED utilization.</p><p><strong>Conclusions: </strong>Walk-in crisis stabilization services were associated with reductions in MBD-related ED utilization. Decision-makers looking to reduce MBD-related ED utilization should consider increasing access to this promising alternative model.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation outcomes from a multi-site stepped wedge cluster randomized family caregiver skills training trial","authors":"Courtney Harold Van Houtven PhD,&nbsp;Kasey Decosimo MPH,&nbsp;Connor Drake PhD,&nbsp;Rebecca Bruening MPH,&nbsp;Nina R. Sperber PhD,&nbsp;Joshua Dadolf MSW,&nbsp;Matthew Tucker BA,&nbsp;Cynthia J. Coffman PhD,&nbsp;Janet M. Grubber MSPH,&nbsp;Karen M. Stechuchak MS,&nbsp;Swetha Kota BA, MPH,&nbsp;Leah Christensen MSW,&nbsp;Cathleen Colón-Emeric MD, MHS,&nbsp;George L. Jackson PhD, MHA,&nbsp;Emily Franzosa DrPH,&nbsp;Leah L. Zullig PhD,&nbsp;Kelli D. Allen PhD,&nbsp;Susan N. Hastings MD, MHS,&nbsp;Virginia Wang PhD","doi":"10.1111/1475-6773.14361","DOIUrl":"10.1111/1475-6773.14361","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess whether a team collaboration strategy (CONNECT) improves implementation outcomes of a family caregiver skills training program (iHI-FIVES).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Study Setting</h3>\u0000 \u0000 <p>iHI-FIVES was delivered to caregivers at eight Veterans Affairs (VA) medical centers. Data sources were electronic health records, staff surveys, and interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval start date for iHI-FIVES launch. Sites were then randomized 1:1 to either (i) CONNECT, a team collaboration training strategy plus Replicating Effective Programs (REP), brief technical support training for staff, or (ii) REP only (non-CONNECT arm). Implementation outcomes included reach (proportion of eligible caregivers enrolled) and fidelity (proportion of expected trainings delivered). Staff interviews and surveys assessed team function including communication, implementation experience, and their relation to CONNECT and iHI-FIVES implementation outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection/Extraction Methods</h3>\u0000 \u0000 <p>The sample for assessing implementation outcomes included 571 Veterans referred to VA home- and community-based services and their family caregivers eligible for iHI-FIVES. Prior to iHI-FIVES launch, staff completed 65 surveys and 62 interviews. After the start of iHI-FIVES, staff completed 52 surveys and 38 interviews. Mixed methods evaluated reach and fidelity by arm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Fidelity was high overall with 88% of expected iHI-FIVES trainings delivered, and higher among REP only (non-CONNECT) compared with CONNECT sites (95% vs. 80%). Reach was 18% (average proportion of reach across eight sites) and higher among non-CONNECT compared with CONNECT sites (22% vs. 14%). Qualitative interviews revealed strong leadership support at high-reach sites. CONNECT did not influence self-reported team function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A team collaboration strategy (CONNECT), added to REP, required more resources to implement iHI-FIVES than REP only and did not substantially enhance reach or fidelity. Leadership support was a key condition of implementation success and may be an important factor for improving iHI-FIVES reach with national expansion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 6","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Medicaid Accountable Care Organizations on children's access to and utilization of health services","authors":"Joanne Constantin PhD, MPH,&nbsp;George L. Wehby PhD, MPH","doi":"10.1111/1475-6773.14370","DOIUrl":"10.1111/1475-6773.14370","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the effects of Medicaid Accountable Care Organizations (ACOs) on children's access to and utilization of health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Setting and Design</h3>\u0000 \u0000 <p>This study employs difference-in-differences models comparing ACO and non-ACO states from 2018 through 2021. Access measures are indicators for preventive and sick care sources, unmet healthcare needs, and having a personal doctor or nurse. Utilization measures are preventive and dental care, mental healthcare, specialist visits, emergency department visits, and hospital admissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Analytic Sample</h3>\u0000 \u0000 <p>Secondary, de-identified data come from the 2016–2021 National Survey of Children's Health. The sample includes children with public insurance and ranges between 21,452 and 37,177 depending on the outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>Medicaid ACO implementation was associated with an increase in children's likelihood of having a personal doctor or nurse by about 4 percentage-points concentrated among states that implemented ACOs in 2018. Medicaid ACOs were also associated with an increase in specialist care use and decline in emergency visits by about 5 percentage-points (the latter being concentrated among states that implemented ACOs in 2020). There were no discernable or robust associations with other pediatric outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is mixed evidence on the associations of Medicaid ACOs with pediatric access and utilization outcomes. Examining effects over longer periods post-ACO implementation is important.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 5","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.14370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}