Medical Care最新文献

{"title":"The Impact of Racial/Ethnic Concordance in Patient-Reported Shared Decision-Making and Communication During the COVID-19 Era.","authors":"J B Eyring, Brandon M Hemeyer, Fernando A Wilson","doi":"10.1097/MLR.0000000000002165","DOIUrl":"10.1097/MLR.0000000000002165","url":null,"abstract":"<p><strong>Background: </strong>Patient-provider racial/ethnic concordance may mitigate disparities, which is likely due in part to improved communication. The COVID-19 pandemic exacerbated disparities and raised questions on communication, warranting further exploration to inform equitable care.</p><p><strong>Objectives: </strong>This study aimed to investigate the influence of patient-provider racial/ethnic concordance on patient-reported shared decision-making and communication during the early stages of the pandemic.</p><p><strong>Research design: </strong>Stepwise logit models were constructed of short-term non-modifiable factors (race/ethnicity, education, age, marital status), modifiable factors (health insurance, poverty status), and self-reported health status predicting communication outcomes-whether the provider included the patient in decision-making and communicated treatment options.</p><p><strong>Subjects: </strong>Adults from the 2020 US Medical Expenditure Panel Survey (N=9634), weighted consistent with complex sampling.</p><p><strong>Measures: </strong>Shared decision-making and communication of treatment options by the primary care provider were assessed by patient surveys. Demographic characteristics included race/ethnicity, poverty status, age, marital status, education, and insurance status.</p><p><strong>Results: </strong>Concordance was associated with greater age and socioeconomic status, and being married, White, and in good health. Concordance was associated with patient-reported shared decision-making and communication of treatment options. The associations between demographic characteristics and communication outcomes differed significantly by concordance status, which further differed by race/ethnicity. For example, shared decision-making was predicted by education for discordant Hispanic patients and marital status for discordant White patients, but neither were predictive among concordant patients.</p><p><strong>Conclusions: </strong>The findings suggest a potential association between concordance on shared decision-making and communication dynamics, emphasizing the need for additional research to clarify how similarities and differences may influence health care interactions.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"579-587"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989648","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 Expanding Medicaid Dental Coverage on General Health Status of Low-Income Adults.","authors":"George L Wehby, Wei Lyu, Julie Reynolds, Steven M Levy","doi":"10.1097/MLR.0000000000002162","DOIUrl":"10.1097/MLR.0000000000002162","url":null,"abstract":"<p><strong>Background: </strong>Oral health is considered a key component of general health. However, causal evidence examining the effects of dental coverage on general health is sparse.</p><p><strong>Objectives: </strong>To examine the effects of the Affordable Care Act (ACA) Medicaid expansions with extensive dental benefits versus less generous dental benefits on the general health status of individuals with low income.</p><p><strong>Research design: </strong>A difference-in-differences design comparing states that expanded Medicaid eligibility in 2014 by whether they offered extensive or less generous dental benefits.</p><p><strong>Subjects: </strong>Adults aged 18-64 years below 138% of the federal poverty level who participated in the 2011-2022 Behavioral Risk Factor Surveillance System surveys.</p><p><strong>Outcome measures: </strong>Self-rated general health status and number of days not in good physical health or good mental health in the past 30 days.</p><p><strong>Results: </strong>The likelihood of fair/poor rated health status declined with extensive dental benefits, including by 2.3 (95% CI: -3.90 to -0.69) percentage-points when aggregating 2014-2022, with declines first observed in 2015 and almost all years after. There were no statistically significant effects on days not in good physical or mental health when aggregating 2014-2022. There were fewer mentally unhealthy days with extensive dental benefits by 0.93 days in 2019 and 2021 (95% CI: -1.80 to -0.06 and -1.70 to -0.15, respectively).</p><p><strong>Conclusion: </strong>The findings suggest that extensive dental coverage improves self-rated general health status among low-income adults. There is suggestive evidence of improved mental health in 2 but not all years and no discernable effect on days not in good physical health.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"606-613"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971429","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":"Impact of Maryland's 2015 Nurse Practitioner Full Scope of Practice Law on Statewide Rates of Outpatient Potentially Harmful Medication Prescribing to Older Adults.","authors":"Jessica Lipori, Joshua Thorpe","doi":"10.1097/MLR.0000000000002163","DOIUrl":"10.1097/MLR.0000000000002163","url":null,"abstract":"<p><strong>Background: </strong>Since 2010, there has been an increase in Full Scope of Practice (FSP) laws allowing nurse practitioners (NPs) to practice independently. We aimed to utilize synthetic control models to examine the impact of a 2015 NP FSP laws on outpatient potentially harmful medication (PHM) prescribing to older adults (65 years and above) in Maryland.</p><p><strong>Methods: </strong>We utilized Medicare Public Use Files to measure statewide rates of outpatient PHM prescribing to older adults with Part D from fiscal year 2013-2019. An interrupted time series analysis was performed, and geographic and health access covariates were used to create synthetic control models. Placebo tests were used to test differences in PHM prescribing after the policy change.</p><p><strong>Results: </strong>The interrupted time series analysis was not significant. Maryland's synthetic control model chose a weighted average of New Jersey, Delaware, and Massachusetts. There was no significant difference in PHM prescribing after the passage of Maryland's FSP law compared with synthetic control.</p><p><strong>Discussion: </strong>We found that Maryland's FSP law did not impact statewide rates of PHM prescribing. State-wide prescribing trends should be considered in states debating changes in nurse practitioner scope of practice.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"588-593"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225875","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":"Award-Winning Student Manuscripts From the American Public Health Association 2023.","authors":"Linda D Green, Katherine S Virgo, Julie M Zito","doi":"10.1097/MLR.0000000000002166","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002166","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 8","pages":"563-564"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742672","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":"Change Over Time in Hospital Care for Medicaid Beneficiaries: Analysis of Hospitalizations From 2016-2019.","authors":"Jacqueline Xu, Jeffrey D Hodis, Kary Calderon, Paul J Chung, Robert S Nocon","doi":"10.1097/MLR.0000000000002124","DOIUrl":"10.1097/MLR.0000000000002124","url":null,"abstract":"<p><strong>Background: </strong>Historically, access to high-quality care has been a central challenge for Medicaid programs. Prior single-year analyses demonstrated that Medicaid beneficiaries account for disproportionately high patient volumes at low-quality hospitals. Given major Medicaid shifts including expansion and increased managed care, we examined recent trends in low-quality hospital use for Medicaid beneficiaries.</p><p><strong>Methods: </strong>Using Healthcare Cost and Utilization Project State Inpatient Databases, we compiled adult hospital discharges from 15 states in years 2016-2019 (N=32,788,446). Hospital quality was assessed with the Agency for Healthcare Research and Quality (AHRQ) Composite Inpatient Quality Indicator, reflecting risk-adjusted mortality for prevalent conditions. We constructed a logistic regression modeling odds of discharge from a low-quality hospital (bottom 20 th percentile by year), with payer-year interactions and covariates for patient demographics (sex, age, race/ethnicity, income), comorbidities, state, and hospitalization type.</p><p><strong>Results: </strong>Overall, patients with Medicaid [adjusted odds ratio (aOR)=1.11, P <0.01] or Medicare (aOR=1.03, P <0.01) were more likely to be hospitalized in low-quality hospitals, compared with private insurance (reference). The likelihood of admission to low-quality hospitals over time varied by payer. Patients insured by Medicaid were 2% less likely to be admitted to low-quality hospitals each additional year (aOR=0.98, P <0.01). Medicare-insured patients did not show significant changes longitudinally, and privately insured patients were 3% more likely to be admitted to low-quality hospitals each year (aOR=1.03, P <0.01).</p><p><strong>Conclusions: </strong>This is one of the first studies examining associations between payer and inpatient care quality over time, critical for our rapidly changing payment environment. Although Medicaid-insured patients remain more likely to be discharged from low-quality hospitals as compared with other payers, we find promising recent trends of improving hospital quality over time for Medicaid beneficiaries.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"573-578"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008131","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":"Improving Patient Experience With Provider Communication: Systematic Review of Interventions, Implementation Strategies, and Their Effectiveness.","authors":"Tiago S Jesus, Manrui Zhang, Dongwook Lee, Brocha Z Stern, Jan Struhar, Allen W Heinemann, Neil Jordan, Anne Deutsch","doi":"10.1097/MLR.0000000000002158","DOIUrl":"10.1097/MLR.0000000000002158","url":null,"abstract":"<p><strong>Background: </strong>Provider communication with patients may be improved through training, shadow coaching, and other in-service interventions. We aim to synthesize these interventions, implementation strategies, and their impact on the patient experience.</p><p><strong>Methods: </strong>A systematic review of contemporary evidence (2015-2023). Six scientific databases, specialty journals, and snowballing searches identified training, shadow coaching, and other in-service interventions for improving provider communication with patients, evaluated by standardized patient experience measures. Studies without inferential statistics were excluded. Two independent reviewers assessed the studies' eligibility and methodological quality and mapped the implementation strategies against a widely used taxonomy of 73 strategies.</p><p><strong>Results: </strong>Of 1237 papers screened, 14 were included: 10 controlled studies (5 randomized) and 4 prepost. Nine studies were on communication skills training and 3 on shadow coaching; all but one of these used a train-the-trainer implementation strategy. Eight studies (controlled n=4) used 5.5-8 hours of communication training and showed significant improvements in selected experience outcomes. Brief (45 min) communication training showed no significant results. Two controlled studies showed that shadow coaching and recoaching achieve short-term improvements but eroded without booster sessions. The use of transparent surgeon masks improved selected communication outcomes, but periodic reminders sent to clinicians on communication etiquette did not.</p><p><strong>Discussion: </strong>In-service communication training (≥5.5 h) or shadow (re-)coaching by trained peers can improve patients' experience with provider-patient communication. To implement such interventions, organizations need to identify and train trainers/coaches, intentionally support the program, monitor effectiveness, and add boosters as needed. Brief communication etiquette training or simple reminders did not improve the patients' experiences with provider-patient communication.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"545-554"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001238","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":"Is a Distressed Birth Associated With Physical and Mental Health Problems as an Adult?: Evidence From Panel Data.","authors":"Michael T French, Karoline Mortensen","doi":"10.1097/MLR.0000000000002156","DOIUrl":"10.1097/MLR.0000000000002156","url":null,"abstract":"<p><strong>Background: </strong>A considerable amount of research has examined the short-term health outcomes associated with distressed births. Most studies have focused on the survival of the newborn, health complications, and medical care utilization. Comparatively little research has considered the longer-term physical and mental health outcomes of distressed births that survive into adulthood.</p><p><strong>Objectives: </strong>The primary objective is to determine whether 3 common types of distressed births-low birth weight (LBW), preterm delivery, neonatal intensive care unit (NICU) admission-are significantly related to physical (ie, self-reported overall health status, number of chronic health conditions) and mental (ie, number of mental health disorders) health among young and middle-aged adults.</p><p><strong>Subjects: </strong>Respondents to Waves IV (2008-2009; N=15,701) and V (2016-2018; N=12,300) of the National Longitudinal Survey of Adolescent to Adult Health (Add Health) provide the data for our research.</p><p><strong>Research design: </strong>Our empirical approach estimates numerous multivariate regression models for Waves IV and V separately, and mixed-effects models for both waves combined. Each subgroup (LBW, preterm delivery, and NICU admission) was analyzed separately in comparison to those without a distressed birth.</p><p><strong>Results: </strong>All 3 distressed birth measures are negatively and significantly ( P <0.05) associated with physical and mental health status in adulthood.</p><p><strong>Conclusions: </strong>The primary implication is that clinicians, public health advocates, and policy makers at all levels of government can use these findings to secure additional resources for the prevention of future distressed births. Prevention initiatives can include teenage family planning, prenatal checkups and related care, and incentives for healthy behaviors during pregnancy.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"624-636"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003408","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 Cognitive Behavioral Therapy on Chronic Uncontrolled Diabetes: A Randomized Clinical Trial in a Shared Primary Care Setting.","authors":"Ryan Bellacov, Yvonne Novasio","doi":"10.1097/MLR.0000000000002170","DOIUrl":"10.1097/MLR.0000000000002170","url":null,"abstract":"<p><strong>Background: </strong>In the context of escalating diabetes prevalence worldwide, this study investigates the efficacy of integrating cognitive behavioral therapy (CBT) within primary care visits for managing uncontrolled diabetes.</p><p><strong>Design: </strong>The randomized clinical trial in an integrated health care clinic in Oregon involved 72 adults aged 20-89 with uncontrolled diabetes. Participants were enrolled and randomly assigned to 2 groups: one receiving both cognitive behavioral health (n=36) and the other receiving traditional primary care (n=36).</p><p><strong>Results: </strong>The study primarily measured clinical improvements in hemoglobin A1C levels for a year. Results indicated significant improvements in the cognitive behavioral health group compared with the traditional care group at various intervals up to 51 weeks, with notable enhancements in hemoglobin A1C and secondary outcomes of patient satisfaction scores. During the 36 th and 51st weeks, the shared visit group demonstrated significantly lower hemoglobin A1c levels (36 wk: 9.22±0.2 vs. 10.02±0.2, P <0.001; 51 wk: 9.22±0.1 vs. 10.91±0.2, P <0.001), indicating improved long-term glycemic control.</p><p><strong>Conclusions: </strong>Combining cognitive behavioral health with primary care visits significantly outperformed traditional care in improving clinical outcomes and patient satisfaction among adults with uncontrolled diabetes. The percentage of participants with clinically meaningful improvement in 36 weeks was 22.2% in the CBT versus 0.0% in the traditional primary care visit group. The positive outcomes suggest that integrated cognitive behavioral therapy can effectively contribute to diabetes management strategies, highlighting the importance of innovative approaches in addressing the diabetes epidemic.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"539-544"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225874","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":"A Text Message Outreach Intervention to Increase Health Insurance Enrollment for Self-Pay Patients.","authors":"Yan Lu, Kevin J Craten, Caitlin T Thompson, Robert Scroggins, Jeff Claassen, Joshua Manning, Rohit P Ojha","doi":"10.1097/MLR.0000000000002157","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002157","url":null,"abstract":"<p><strong>Background: </strong>Self-pay patients may be unaware of their eligibility for health insurance coverage through government or hospital-based medical assistance programs.</p><p><strong>Objectives: </strong>We aimed to evaluate the effect of behaviorally informed text message outreach on insurance enrollment among self-pay patients discharged from the emergency department (ED) at a safety-net hospital.</p><p><strong>Research design: </strong>We emulated a single-arm trial with a historical comparison. Our eligible population included self-pay ED patients aged 18-64 years who were discharged between October 31 and November 24, 2022 (outreach group) or between April 1 and July 31, 2022 (historical comparison). We used entropy balancing weights to adjust for baseline characteristics and estimated overall and race/ethnicity-specific risk ratios (RR), risk differences (RD), and 95% confidence limits (CL) for the effect of the text outreach on insurance enrollment.</p><p><strong>Results: </strong>The study population comprised 748 patients in the intervention and 6199 in the comparison group. The median age was 36 years (interquartile range=28-47), 58% were male, and 65% were racial/ethnic minorities. Overall outreach effect on any coverage enrollment (RR=1.4, 95% CL: 1.2, 1.6; RD=7.1%, 95% CL: 3.7%, 10%) was larger than the effect on hospital-based medical assistance program and Medicaid enrollment (RR=1.2, 95% CL: 1.0, 1.4; RD=2.7%, 95% CL: -0.24%, 5.7%). The latter effect was largest in the Hispanic population.</p><p><strong>Conclusions: </strong>Our results suggest behaviorally informed text outreach increases insurance enrollment among self-pay patients discharged from the ED at a safety-net hospital and may complement broader strategies to increase health insurance enrollment. Future studies should compare different text message strategies.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 8","pages":"600-605"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742671","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":"Developing and Validating Models to Predict Suboptimal Early Glycemic Control Among Individuals With Younger Onset Type 2 Diabetes.","authors":"Anjali Gopalan, Christine A Board, Stacey E Alexeeff, Joshua R Nugent, Pranita Mishra, Andrew J Karter, Richard W Grant","doi":"10.1097/MLR.0000000000002164","DOIUrl":"10.1097/MLR.0000000000002164","url":null,"abstract":"<p><strong>Objective: </strong>Younger age at the time of type 2 diabetes onset increases individuals' future complication risk. Proactively identifying younger-onset individuals at increased risk of not achieving early glycemic goals can support targeted initial care.</p><p><strong>Design and methods: </strong>Individuals (ages 21-44) newly diagnosed with type 2 diabetes were identified and randomly assigned to training (70%) and validation (30%) datasets. Least absolute shrinkage and selection operator regression models were specified to identify key predictors (assessed at diagnosis) of suboptimal glycemic control (HbA1c≥8%) within 1 year after diagnosis using the training dataset. The full model included 48 candidate predictors. We also developed additional more streamlined models using more widely available predictors (transferable model), a smaller number of available predictors (simplified transferable model), and a bivariate model with HbA1c as the sole predictor (HbA1c-only model). Model-based predicted risk scores were used to stratify individuals in the validation dataset.</p><p><strong>Results: </strong>The cohort included 10,879 individuals. All of the models, including the HbA1c-only model, performed comparably. All had good discrimination (C-statistics ranging from 0.71 to 0.73) in the validation dataset.</p><p><strong>Conclusions: </strong>When predicting the risk of not achieving glycemic goals, the HbA1c-only model had comparable performance to the more complex prediction models. This simple risk stratification requires no computation and could be implemented simply by looking at the diagnosis HbA1c value. This practical approach can be used to identify newly diagnosed younger adults who may need extra attention during the critical early period after diagnosis.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"614-623"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110781","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}