Medical Care最新文献

{"title":"Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting.","authors":"Chiara M Bettale, Melyrene Pomales, Angie Boy, Tim Moran, Maneesha Agarwal, Abigail Powers","doi":"10.1097/MLR.0000000000002065","DOIUrl":"10.1097/MLR.0000000000002065","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied.</p><p><strong>Objectives: </strong>To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening.</p><p><strong>Research design: </strong>Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs.</p><p><strong>Subjects: </strong>Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic).</p><p><strong>Measures: </strong>The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening.</p><p><strong>Results: </strong>Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21).</p><p><strong>Conclusions: </strong>Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1","pages":"38-42"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789646","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":"Mental Health Care Needs and Access to Care for Adults With Intellectual Disabilities.","authors":"Jean A Frazier, Laura Hanratty, Amy K Weinstock","doi":"10.1097/MLR.0000000000002089","DOIUrl":"10.1097/MLR.0000000000002089","url":null,"abstract":"<p><strong>Background: </strong>Adults with intellectual disabilities (IDs) are at greater risk for psychiatric disorders than the general population. Yet, they have limited access to mental health services.</p><p><strong>Objectives: </strong>To examine the prevalence of psychiatric disorders in adults with ID. To describe evidence-based interventions for this population, their access to mental health care, and outline opportunities for improved access.</p><p><strong>Design: </strong>This manuscript summarizes literature regarding psychiatric disorders in adults with ID and their access to behavioral health care. We considered articles referencing mental health care for adults with ID. PubMed and a variety of search terms were used. Studies published in English from 2010 to the date of the searches were included. Quantitative and qualitative study designs, review articles, program descriptions, and opinion papers were considered for inclusion. Additional references from the selected articles were also considered.</p><p><strong>Results: </strong>We identified 2864 records. One hundred two records were included, consisting of work commenting on mental health and ID and access to care in the United States. The articles describe increased psychiatric comorbidities in adults with ID. They highlight the few evidence-based interventions for psychiatric comorbidities and the limited access to care.</p><p><strong>Conclusions: </strong>Our mental health care providers generally have minimal training and experience with people with ID, limiting access to appropriate care for these individuals. Improved access could be created by increasing education and experiences with these populations for mental health providers. Aligning policies, financing, and adequate insurance reimbursement to develop a continuum of care will be critical for these individuals.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1 Suppl 1","pages":"S8-S14"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789654","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":"Higher Percentage of Virtual Primary Care Associated With Minimal Differences in Achievement of Quality Metrics.","authors":"Jodi B Segal, Lisa Yanek, Leah Jager, Ebele Okoli, Elham Hatef, Maqbool Dada, K Davina Frick","doi":"10.1097/MLR.0000000000002094","DOIUrl":"10.1097/MLR.0000000000002094","url":null,"abstract":"<p><strong>Objective: </strong>To test the impact of virtual care usage on quality metrics used for performance measurement.</p><p><strong>Background: </strong>Virtual care improves access to primary care; however, the quality of care must not be adversely impacted by its use.</p><p><strong>Methods: </strong>This is a mixed-design etiologic study using data from patients receiving primary care in a large, regional health system from January 2020 through December 2021. Eligible patients had at least one primary care contact. Eligible physicians had 10 or more patient contacts. The quartile of virtual visits per physician per month is calculated as the percentage of total visits conducted by phone or video (Q1 is the lowest). Six metrics used for value-based reimbursement were chosen for modeling with generalized linear mixed models.</p><p><strong>Results: </strong>The data included 200,090 patients of 683 physicians in 42 clinics over 24 months. Virtual care usage peaked in April 2020 at 78% and then stabilized at 18%. The blood pressure metric was met in 66% (95% CI: 63%-69%) of physician months in Q1 and 65% (95% CI: 63%-68%) in Q4 ( P = 0.003). The hemoglobin A1c metric was met in 73% (95% CI: 70%-76%) of physician months in Q1 and 72% (95% CI: 69%-75%) in Q4, not a significant difference. Breast cancer screening completion and colon cancer screening completion did not differ across virtual care quartiles. Medicare annual wellness visits were completed in 55% (95% CI: 50%-60%) of Q1 physician months and 54% in each of Q2, Q3, and Q4 ( P < 0.0001).</p><p><strong>Conclusions: </strong>Some quality metrics were modestly impacted by high virtual primary care usage; the absolute differences in rates were small. This may provide reassurance to physicians and their health systems that telemedicine use may not adversely impact quality metrics.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"70-76"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623598","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 Trainee's Role in Curriculum Advocacy Within Disability Medical Education.","authors":"Jessica A Prokup, Lauren Clarke, Shannon Strader","doi":"10.1097/MLR.0000000000001988","DOIUrl":"10.1097/MLR.0000000000001988","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1 Suppl 1","pages":"S31-S39"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789470","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":"Adult Pharmacy Costs and Characteristics of Very High-Cost Prescription Drug Users in the United States, 2018-2022.","authors":"Jennifer L Nguyen, Duy Do, Elizabeth C Swart, Tiffany Lee, Samuel K Peasah, Urvashi Patel, Chester B Good","doi":"10.1097/MLR.0000000000002045","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002045","url":null,"abstract":"<p><strong>Objective: </strong>This study sought to identify: (1) the demographic and clinical characteristics of very high-cost users (defined as patients with pharmaceutical expenditures that were equal to or greater than the 99th percentile), (2) whether or not these characteristics changed over time, (3) sociodemographic and clinical correlates of being very high-cost users, (4) the average pharmaceutical costs of very-high cost users, and (5) the therapeutic classes and medications that contributed to these high costs.</p><p><strong>Background: </strong>There are growing public concerns about rising drug costs, in part due to increased availability, greater effectiveness, and market considerations. There is a concentrated portion of patients that accounts for a disproportionately large portion of pharmaceutical expenditures.</p><p><strong>Methods: </strong>A large serial cross-sectional study was conducted with De-identified, member-level pharmacy claims (n = 65,739,791) from a large, national pharmacy benefits manager from January 1, 2018 to December 31, 2022. The main outcome and measures were 2018-2022 pharmaceutical expenditures; amounts were adjusted for inflation to reflect 2022-dollar values.</p><p><strong>Results: </strong>Across the study period, the odds of being classified as a very high-cost user were 1.31 times as high for those 45-64 years old compared with those 18-44 years old (reference category); the odds were 1.42 times as high for males compared with females; 1.13 times as high before those identifying as non-Hispanic Black compared with non-Hispanic white; 1.11 times as high for those enrolled in a health care exchange plan compared with a commercial plan. In addition, very high-cost users lived in areas with higher social needs. Human immunodeficiency virus, inflammatory conditions, multiple sclerosis, and cancer accounted for the largest share of costs among this group.</p><p><strong>Conclusions: </strong>This study identified the unique characteristics of very high-cost pharmaceutical users and identified the top conditions and prescription drugs that drove high pharmaceutical expenditures among this population. These findings are essential to understanding rising pharmaceutical costs in the United States and can help identify the issues and solutions of specific cost drivers within our health care policies.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789642","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 Comparison of Delivery Modalities for Pregnancy Clinical Care Management: Telephonic Versus Video.","authors":"Kelly Williams, Mary Winger, Aisling McIntyre, Katie Domalakes, Heidi Stevenson, Natasha Khouri","doi":"10.1097/MLR.0000000000002066","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002066","url":null,"abstract":"<p><strong>Objective: </strong>Given the high prevalence of maternal morbidity and mortality, it is imperative that maternal health interventions are comprehensively evaluated, so they can be scaled with fidelity. Community-based care management models focused on perinatal health care are a priority for health care systems and payers. Alternative care management delivery modalities, such as video visits, are needed to expand program reach amidst growing system-level challenges. This evaluation explores the feasibility, acceptability, and impact of video versus telephonic care in perinatal care management.</p><p><strong>Methods: </strong>Using a mixed methods approach, we implemented a quality improvement project to learn about the integration and impact of video-enabled care into the UPMC Health Plan \"Pregnancy Clinical Support\" (PCS) care management delivery model. Focus groups were conducted with PCS care managers (CMs) to explore their perspectives on video-visit integration. Video-only members were propensity scores matched to telephonic-only members; statistical comparisons were conducted to assess between-group differences in engagement.</p><p><strong>Results: </strong>PCS CMs discussed ways to structure effective video-visit onboarding, strengths, and drawbacks of video-enabled care, workflow integration challenges, and best practices for introducing video visits to members. Video-only members had significantly (P < 0.0001) more clinical sessions (2.56 ± 1.57 vs 2.05 ± 1.52) and longer case duration measured in calendar days (209 ± 80 vs 169 ± 94) during the 17-month project period than telephonic-only members.</p><p><strong>Conclusion: </strong>Evidence generated provides direct guidance on successfully integrating video visits into workflows of community-based CMs while improving engagement in care across diverse member populations.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12","pages":"803-808"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605240","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":"Measuring What Matters Most: Considering the Well-Being of the Whole Person in Health Care.","authors":"Barbara G Bokhour, Dawne Vogt, Benjamin Kligler","doi":"10.1097/MLR.0000000000002088","DOIUrl":"10.1097/MLR.0000000000002088","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"62 12 Suppl 1","pages":"S1-S3"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605261","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":"Response to Letter to the Editor Regarding Our Paper, \"Patient-Centered Innovation: Involving Patients in Open Social Innovation\".","authors":"Olivia S Jung, Michael Anne Kyle, Paula McCree, Hiyam M Nadel","doi":"10.1097/MLR.0000000000002059","DOIUrl":"10.1097/MLR.0000000000002059","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"841-842"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391675","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":"Intensity of Social Needs Case Management Services and Changes in Hospital and Emergency Department Use Among Adult Medicaid Beneficiaries.","authors":"Crystal Guo, Timothy T Brown, Hector P Rodriguez, Margae Knox, Mark D Fleming, Elizabeth A Hernandez, Daniel M Brown, Amanda L Brewster","doi":"10.1097/MLR.0000000000002071","DOIUrl":"10.1097/MLR.0000000000002071","url":null,"abstract":"<p><strong>Objectives: </strong>We identify the association between high- and low-intensity case management services on hospital and emergency department (ED) use among CommunityConnect patients.</p><p><strong>Background: </strong>Social needs case management services vary in intensity, including the modality, workforce specialization, and maximum caseload. CommunityConnect is a social needs case management program implemented by Contra Costa Health, a county safety-net health system in California's San Francisco Bay Area.</p><p><strong>Methods: </strong>Due to the endogeneity of high-intensity services assigned to high-risk patients, we instrument for service intensity using the number of specialist case managers hired each month of enrollment. Zero-inflated negative binomial models with 2-stage residual inclusion estimated total and avoidable hospital admissions and ED visits 12 months post-enrollment for adult Medicaid beneficiaries enrolled between August 2017 and December 2018 (n = 19,782).</p><p><strong>Results: </strong>Compared with low-intensity case management, high-intensity services were associated with a reduction in the incidence rates of inpatient admissions [incidence rate ratio (IRR) = 0.341, 95% CI: 0.106-1.102; P = 0.072], ED visits (IRR = 0.608, 95% CI: 0.188-1.965; P = 0.058), and avoidable ED visits (IRR = 0.579, 95% CI: 0.179-1.872; P = 0.091). No significant association was found between service intensity and the likelihood of an event being an excess zero.</p><p><strong>Conclusions: </strong>High-intensity social needs case management may be more effective than low-intensity service at reducing health care use for individuals with non-zero use, suggesting that intensive case management may be especially helpful in supporting discharge and transitions of care.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"783-790"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469510","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":"Organizational Climate Related to Patient-Perpetrated Sexual Harassment: VA Primary Care Provider Perceptions.","authors":"Karissa M Fenwick, Susan M Frayne, Jeanette Shekelle, Diane V Carney, Elizabeth M Yano, Ruth Klap, Alison B Hamilton","doi":"10.1097/MLR.0000000000002075","DOIUrl":"10.1097/MLR.0000000000002075","url":null,"abstract":"<p><strong>Background: </strong>Patient-perpetrated sexual harassment toward health care providers is common and adversely affects provider well-being, workforce outcomes, and patient care. Organizational climate for sexual harassment-shared perceptions about an organization's practices, policies, and procedures-is one of the strongest predictors of harassment prevalence. We conducted a pilot survey assessing provider perceptions of the Veterans Health Administration (VA)'s climate related to patient-perpetrated sexual harassment.</p><p><strong>Research design: </strong>Responding providers completed a survey assessing: (1) experiences with patient-perpetrated sexual harassment; (2) beliefs about VA's responses to patient-perpetrated sexual harassment of staff; and (3) perceptions of VA's organizational climate related to sexual harassment for each of 4 perpetrator-target pairings (patient-perpetrated harassment of staff, patient-perpetrated harassment of patients, staff-perpetrated harassment of staff, and staff-perpetrated harassment of patients).</p><p><strong>Subjects: </strong>Respondents included 105 primary care providers (staff physicians, nurse practitioners, and physician assistants) at 15 facilities in the VA Women's Health Practice-Based Research Network.</p><p><strong>Results: </strong>Seventy-one percent of responding providers reported experiencing patient-perpetrated sexual harassment in the past 6 months. Respondent perceptions of VA's responses to patient-perpetrated harassment of staff were mixed (eg, indicating that VA creates an environment where harassment is safe to discuss but that it fails to offer adequate guidance for responding to harassment). Respondents rated organizational climate related to patient-perpetrated harassment of staff as significantly more negative compared with climate related to other perpetrator-target pairings.</p><p><strong>Conclusions: </strong>Future work with representative samples is needed to corroborate these findings, which have potential ramifications for VA's ongoing efforts to create a safe, inclusive environment of care.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"791-797"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469511","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}