Health affairs scholar最新文献

There is growing attention to community-based services for preventing adverse health care outcomes among people aging with dementia. We explored whether the availability of dementia-centered programming within older adult centers (ie, senior centers)-specifically, adult day services (ADS), social adult day centers (SADCs), memory cafes, and caregiver support-is associated with reduced hospitalization, emergency room use, and total Medicare costs for community-dwelling individuals ages 75 and older with Alzheimer's disease and related dementias (ADRD), and whether associations differ by the relative size of the local jurisdiction. We used a novel dataset that links Medicare claims data with data from an organizational census of municipally based Massachusetts older adult centers. Living in a community with an older adult center that facilitates access to ADS and/or SADCs was associated with reduced hospital utilization and costs among residents in smaller jurisdictions. We found no evidence for associations concerning memory cafes or support groups. These findings underscore the potential of older adult centers in curbing health care costs and acute care usage among individuals with ADRD, particularly in smaller communities with centers that provide access to ADS.

During the COVID-19 pandemic, all US states provided emergency allotments (EA) to enrollees of the Supplemental Nutrition Assistance Program (SNAP) to alleviate rising food insecurity. However, 18 states opted out of the SNAP-EA program before its official expiration in February 2023. Using a staggered difference-in-differences model to account for state-level variation in the timing of the SNAP-EA opt-out decisions, we analyzed SNAP and SNAP-EA data from the US Department of Agriculture Food and Nutrition Service to quantify the impact of state opt-out decisions on SNAP benefit size and enrollment. We found that the average SNAP monthly benefit among 18 SNAP opt-out states was reduced by $183 (95% confidence interval [CI]: -$214, -$152) per beneficiary. The percentage of the state population enrolled in the SNAP program among the opt-out states modestly decreased by 0.35 (95% CI: -0.61, -0.10) percentage points. Additionally, we employed logistic regression models to associate state opt-out decisions with state-level characteristics. We found that the state governor's political party being Republican was the only significant predictor for the state's opt-out decisions. Our findings help explain why opting out of SNAP-EA has been associated with higher food insufficiency and shed light on the impact of political decisions to opt out of SNAP-EA on the lives of millions of Americans.

Interest in personalized nutrition among researchers and industry has grown rapidly in recent years and shows no signs of abating. In this paper, we discuss the growth of the personalized nutrition market, the evidence for the approach, and the regulatory landscape for personalized nutrition products. We found that regulatory gaps have led to market growth of products with unknown efficacy that are making bold, and possibly unsubstantiated, claims. As personalized nutrition products and related treatments continue to enter the market without regulation, unreliable products may cause consumers financial, psychological, and physical harm. Stronger regulation will help engender trust in these products among consumers and ensure their safety and effectiveness.

Millions of US children and adolescents live in homes with loaded firearms, with only half of these homes securing their guns. Firearm-related deaths among youth have doubled over the past decade, making firearms the leading cause of death for children and adolescents in the United States. The recent advisory by the US Surgeon General, identifying firearm violence as a public health crisis, underscores the urgent need for responsible firearm ownership, including safe firearm storage. However, the healthcare community currently lacks durable medical equipment (DME) codes for firearm storage devices, limiting the ability of healthcare providers to support responsible gun ownership. We propose the establishment of DME codes for firearm storage and safety devices, which would facilitate insurance coverage of these vital prevention measures. Durable medical equipment codes would empower physicians and other healthcare providers to integrate anticipatory guidance and lethal means counseling of firearm safety into routine care and support hospital- and community-based efforts to prevent firearm-related injuries and deaths among children and adolescents.

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.

The US Census Bureau has used the American Community Survey six-question set (ACS-6) to identify disabled people since 2008. In late 2023, the Census Bureau proposed changes to these questions that would have reduced disability prevalence estimates by 42%. Because these estimates inform funding and programs that support the health and independence of people with disabilities, many disability researchers and advocates feared this change in data collection would lead to reductions in funding and services. While the Census has paused-but not ruled out-the proposed changes, it is critical that alternate, more inclusive disability questions be identified and tested. We used data from the 2023/2024 National Survey on Health and Disability to explore alternative questions to identify disabled people in national surveys. A single broad question about conditions identified 11.2% more people with disabilities, and missed significantly fewer people with psychiatric disabilities compared to the current ACS-6 questions. A combination of a broad question and the existing ACS-6 questions may be necessary to more accurately and inclusively identify people with disabilities.

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.