Health affairs scholar最新文献

Diabetes Self-Management Education and Support (DSMES) programs are an effective, yet underutilized, resource to improve health outcomes and behaviors for people with diabetes. We examined the attendance and referral rates for people with diabetes to DSMES classes at an academic medical center, noting a 10% referral rate and 37% completion rate for those referred. We identified barriers to DSMES care at patient, provider, and health system levels. Current technology platforms and training fail to prioritize referrals to diabetes education; providers and people with diabetes are often unfamiliar with program content and benefits. Scheduling mechanisms often delay or lose interested patients in receiving vital education. Existing Medicare reimbursement strategies limit expansion of DSMES programs, generating significant wait times and limit capabilities for Diabetes Care and Education Specialists. We identify potential policy solutions and recommend alterations to existing referral and scheduling systems to expand existing technology platforms for DSMES programs and shift reimbursement policies to individualize and better support care for persons with diabetes.

In late 2023, the Office of the National Coordinator for Health Information Technology launched the Trusted Exchange Framework and Common Agreement (TEFCA) to enable nationwide health information exchange. Regional, local, and state health information organizations (HIOs) will be key components of nationwide exchange, and TEFCA could broaden HIOs' access to information. However, HIOs can choose whether to participate. We conducted a national survey of HIOs in 2023 to assess their plans to participate in TEFCA and broader measures of maturity. We identified 76 operational HIOs, down from 89 in 2019. These HIOs operated in 47 states and contained over 600 million patient records, indicating some duplication. Sixty-three percent of HIOs planned to participate in TEFCA, up 7 percentage points from 2019, and 32% of HIOs indicated that they did not know if they would participate. Health information organizations already engaged in exchange with other networks were more likely to plan to participate. The most common barrier (44%) was having not developed a strategic plan for TEFCA participation. While TEFCA appears to have successfully engaged the majority of HIOs, achieving nationwide exchange will require policy efforts to either attract the remaining HIOs or ensure that nonparticipating HIOs' providers have another option for TEFCA participation.

The COVID-19 public health emergency (PHE) caused significant disruptions in the delivery of care, with in-person visits decreasing and telehealth use increasing. We investigated the impact of these changes on mental health services for Medicaid-enrolled adults and youth in Washington State. Among enrollees with existing mental health conditions, the first year of the PHE was associated with a surge in specialty outpatient mental health visits (13% higher for adults and 7% higher for youth), returning to pre-PHE levels in the second year. Conversely, youth with new mental health needs experienced a decline in specialty outpatient visit rates by ∼15% and 37% in the first and second years of the PHE, respectively. These findings indicate that while mental health service use was maintained or improved for established patients, these patterns did not extend to Medicaid-enrolled youth with new mental health needs, potentially due to barriers such as difficulty in finding providers and establishing new patient-provider relationships remotely. To bridge this gap, there is a need for a multi-faceted approach that includes improving service accessibility, enhancing provider availability, and optimizing initial care encounters, whether in-person or virtual, to better support new patients.

To address physician shortages in the United States, Congress created the Conrad 30 visa waiver program allowing non-citizen international medical graduates to obtain visas to practice medicine in underserved areas. There is little information on whether states have effectively used the program. To fill the gap, we examined the growth and distribution of Conrad physicians between 2001 and 2020. We found that the number of states filling all of their annual allocated Conrad slots increased over the last two decades, yet one-half of the states still did not fill their allowed slots in 2020. Our analysis also revealed substantial variations across states in the number of Conrad physicians by specialty (eg, primary care physicians and psychiatrists), geography (eg, rural vs urban areas and physician shortage vs non-shortage areas). Our findings suggest that states can better use the Conrad program to meet healthcare needs across specialties and geographic areas.

Concern has been raised about the effectiveness of the Hospital Price Transparency Rule to facilitate a clear understanding of health care prices due to poor reporting by hospitals. However, the relationship between what services the hospital provides and what prices they report is not clear. We assessed reported prices in the Turquoise Health database and compared them at the hospital level with the CMS Provider of Services File to identify if a shoppable service was provided at a hospital. We found significant mismatch between the hospital prices being reported and the services being provided. For example, 56% of hospitals providing at least 1 shoppable service that requires public price reporting did not report any prices. Of hospitals reporting prices, most hospitals (66%) reported prices for only a portion of the services they provide. In addition, 12% of hospitals reported prices for services they do not provide. Only 6% of hospitals had complete concordance with price reporting and services they actually provide. Current compliance enforcement and penalties do not appear to be adequate to achieve the goals of the Hospital Price Transparency Rule.

Marginalized racial and ethnic groups and rural and lower income communities experience significant cancer inequities. Blood-based multi-cancer early detection tests (MCEDs) provide a simple and less invasive method to screen for multiple cancers at a single access point and may be an important strategy to reduce cancer inequities. In this qualitative study, we explored barriers and facilitators to MCED adoption among communities facing health care access barriers in Alaska, California, and Oregon. We used reflexive thematic analysis to analyze general barriers to cancer screening, MCED-specific barriers, facilitators of MCED adoption, and MCED communication strategies. We found barriers and facilitators to MCED adoption across 4 levels of the social-ecological model: (1) individual, (2) interpersonal, (3) health care system, and (4) societal. These included adverse psychological impacts, positive perceptions of MCEDs, information and knowledge about cancer screening, the quality of the patient-provider relationship, a lack of health care system trustworthiness, logistical accessibility, patient supports, and financial accessibility. Optimal MCED communication strategies included information spread through the medical environment and the community. These findings underscore the importance of understanding and addressing the multilevel factors that may influence MCED adoption among communities facing health care access barriers to advance health equity.

Cannabis legalization continues to spread, with 38 states permitting the use of medical marijuana, 22 states permitting recreational use, and growing political momentum for federal legalization. The last time the Food and Drug Administration (FDA) was tasked with regulating a new product occurred with 2009's Family Smoking Prevention and Tobacco Control Act, which created the Center for Tobacco Products (CTP). Thus, the time is ripe to review the history of CTP with particular attention to difficulties the nascent center faced in regulating novel products such as e-cigarettes or electronic nicotine delivery systems (ENDS). Specifically, FDA has struggled with defining its scope of authority, determining which review pathway(s) to utilize, and promulgating timely and transparent product standards for marketing authorization-all of which offer lessons for improving cannabis product oversight and enforcement.

During the COVID-19 pandemic, the federal government and many state governments instituted expanded coverage for telehealth (TH) services and since have maintained it. Using data from the Minnesota All Payer Claims Database and publicly available data sources, we examined TH use among commercially insured and Medicare Advantage (MA) patients in Minnesota. In 2022, 30.4% of commercially insured patients and 24.4% of MA patients used TH services. Living in a metropolitan area, an area with a high proportion of Black, Indigenous, and People of Color residents, having greater disease burden, and being younger were associated with a greater likelihood of using TH. Living in an area with limited broadband access reduced the likelihood of TH use. Two patient subgroups more likely to use TH-younger patients in metropolitan areas and high-risk patients with depression-received a similar proportion of ambulatory visits via TH.