Medical Care最新文献

{"title":"Facility-Level Differences in Antipsychotic Drug Use: Impact on Quality Outcomes for Nursing Home Residents.","authors":"Amanda C Chen, David C Grabowski","doi":"10.1097/MLR.0000000000002111","DOIUrl":"10.1097/MLR.0000000000002111","url":null,"abstract":"<p><strong>Objective: </strong>To quantify quality of care following an admission to a nursing home with low or high antipsychotic drug use.</p><p><strong>Background: </strong>Misuse of antipsychotics in U.S. nursing homes is a huge concern for policymakers.</p><p><strong>Methods: </strong>We utilized an instrumental variable approach to estimate the effect of facility-level antipsychotic use on patient outcomes. The instrument was the differential distance to the nearest low-use antipsychotic nursing home relative to the nearest high-use antipsychotic nursing home. Post-acute care short-stay and long-stay residents in U.S. nursing homes were identified using Medicare administrative claims and the Minimum Dataset 3.0 (2014-2019). Outcomes included hospitalizations, falls, pressure ulcers, physical restraint use, medication use, and diagnosis of schizophrenia, bipolar disease, anxiety, or depression.</p><p><strong>Results: </strong>Among long-stay residents, receiving care from a low-use facility reduced the diagnosis of schizophrenia, use of restraints, and hospitalizations. There was also a reduction in the hospitalization rate [-0.9 percentage point (pp)], likelihood of long-stay status (-1.8 pp), and diagnosis of schizophrenia (-0.2 pp) at 90 days among short-stay residents. We also observed larger reductions among residents with dementia and serious mental illness.</p><p><strong>Conclusions: </strong>Admission to a nursing home with a low use of antipsychotics led to decreased hospitalizations, restraint use, and diagnosis of schizophrenia. Curbing the high use of antipsychotics remains a priority of policymakers as the centers for medicare and medicaid services conducts off-site audits to assess whether nursing homes accurately code residents with schizophrenia. It will be important to monitor if centers for medicare and medicaid services downgrades any quality star ratings due to inappropriate coding and assess the implications on quality of care.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"202-210"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910010","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":"Patient-Physician Communication Experience Modifies Racial/Ethnic Health Care Disparities Among Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems Participants With Colorectal Cancer and Multiple Chronic Conditions.","authors":"Stephanie Navarro, Jessica Le, Jennifer Tsui, Afsaneh Barzi, Mariana C Stern, Trevor Pickering, Albert J Farias","doi":"10.1097/MLR.0000000000002112","DOIUrl":"10.1097/MLR.0000000000002112","url":null,"abstract":"<p><strong>Purpose: </strong>After cancer diagnosis, non-White patients and those with multimorbidity use less primary care and more acute care than non-Hispanic White (NHW) patients and those lacking comorbidities. Yet, positive patient experiences with physician communication (PC) are associated with more appropriate health care use. In a multimorbid cohort, we measured associations between PC experience, race and ethnicity, and health care use following colorectal cancer (CRC) diagnosis.</p><p><strong>Participants and methods: </strong>We identified 2606 participants using Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Health Care Providers and Systems (CAHPS) data who were diagnosed with CRC from 2001 to 2017 with pre-existing chronic conditions. Self-reported PC experiences were derived from Medicare CAHPS surveys. Chronic condition care, emergency department, and hospital use following CRC diagnosis were identified from Medicare claims. Simple survey-weighted multivariable logistic regression stratified by experiences with care analyzed associations between race and ethnicity and health care use.</p><p><strong>Results: </strong>Among patients reporting excellent PC experience, non-Hispanic Black (NHB), Hispanic, and non-Hispanic Asian (NHA) patients were more likely to use sufficient chronic condition care than NHW patients (NHB: OR=1.48, 99.38% CI=1.38-1.58; Hispanic: OR=1.34, 99.38% CI=1.26-1.42; NHA: OR=2.31, 99.38% CI=2.12-2.51). NHB and NHA patients were less likely than NHW patients to visit the emergency department when reporting excellent PC experience (NHB: OR=0.66, 99.38% CI=0.63-0.69; NHA: OR=0.67, 99.38% CI=0.64-0.71). Among patients reporting excellent PC, NHB, Hispanic, and NHA patients were less likely than NHW patients to be hospitalized (NHB: OR=0.93, 99.38% CI=0.87-0.99; Hispanic: OR=0.93, 99.38% CI=0.87-0.99; NHA: OR=0.20, 99.38% CI=0.19-0.22).</p><p><strong>Conclusion: </strong>Improving patient experiences with PC, particularly among older racial and ethnic minority cancer survivors with chronic conditions, may help reduce disparities in adverse healthcare use following CRC diagnosis.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"256-265"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910012","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":"Unchained Care: A Public Health Perspective on Ending Shackling of Incarcerated Patients Seeking Health Care, a Policy Statement Adopted by the American Public Health Association.","authors":"Ankita Patil, Marissa Brash, Lauren Brunet, Joy C Eckert, Renee Odom-Konja, Anisha Patel, Spencer Piston, Tiffani Than, Ben King","doi":"10.1097/MLR.0000000000002106","DOIUrl":"10.1097/MLR.0000000000002106","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"185-188"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008188","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":"High-Intensity End-of-Life Care Among Young and Middle-Aged Hispanic Adults With Cancer in Puerto Rico.","authors":"Jessica Velazquez, Maira A Castañeda-Avila, Axel Gierbolini-Bermúdez, María R Ramos-Fernández, Karen J Ortiz-Ortiz","doi":"10.1097/MLR.0000000000002115","DOIUrl":"10.1097/MLR.0000000000002115","url":null,"abstract":"<p><strong>Background: </strong>Timely palliative and hospice care, along with advanced care planning, can reduce avoidable high-intensity care and improve quality of life at the end of life (EoL).</p><p><strong>Objective: </strong>We examined patterns of care at EoL and evaluated predictors of high-intensity care at EoL among adults aged 18-64 with cancer.</p><p><strong>Methods: </strong>Using data from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database, we examined 1359 patients diagnosed with cancer in 2010-2019, who died of cancer between 2017 and 2019 at 64 years and younger, and who were enrolled in Medicaid or private health insurance in last 30 days before death. We used composite measures for high-intensity and recommended EoL care using claims-based indicators in the last 30 days before death. Multivariable logistic regression was used to examine predictors associated with high-intensity EoL care.</p><p><strong>Results: </strong>About 70.3% of young and middle-aged Hispanic cancer patients received high-intensity EoL care, whereas only 20.6% received recommended EoL care. Patients without recommended EoL care were more likely to receive high-intensity EoL care (aOR=4.23; 95% CI=3.18-5.61). High-intensity EoL care was more likely in female patients (aOR=1.43; 95% CI=1.11-1.85) and patients with hematologic cancers (aOR=1.91; 95% CI=1.13-3.20) and less likely in patients who survived >12 months after cancer diagnosis (aOR=0.55; 95% CI=0.43-0.71).</p><p><strong>Conclusions: </strong>A high proportion of Hispanic adults with cancer in Puerto Rico receive high-intensity EoL care and have unmet needs at EoL. Tailored interventions can reduce high-intensity EoL care and increase recommended EoL care. Recommended EoL care can ease pain, reduce distress, honor personal preferences, and cut unnecessary medical costs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"193-201"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008136","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":"Knowledge of Medical Interpretation Rights Among Individuals With Non-English Language Preference: A Cross-Sectional Study.","authors":"Miguel Linares, Stuart Lipsitz, Shimon Shaykevich, Lipika Samal, Jorge A Rodriguez","doi":"10.1097/MLR.0000000000002109","DOIUrl":"10.1097/MLR.0000000000002109","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to identify demographic, acculturation, and health care factors associated with self-reported knowledge of the right to medical interpretation among individuals with non-English language preference (NELP) in California.</p><p><strong>Background: </strong>NELP is a significant social determinant of health contributing to adverse health outcomes through barriers in communication, limited health literacy, and biases in care delivery. The ability of patients with NELP to self-advocate for interpreter services is crucial yet hindered by various factors, including a lack of knowledge about their rights.</p><p><strong>Methods: </strong>This cross-sectional study used pooled data from the California Health Interview Survey from 2012 to 2021. Subjects were 12,219 adults with NELP, representing 2,516,157 individuals in California. The primary outcome was self-reported knowledge of the right to medical interpretation. Covariates included demographic, acculturation, and health care factors.</p><p><strong>Results: </strong>Of the participants, 28.6% were unaware of their rights to interpretation. Married females had higher odds of knowledge, while recent immigrants (≤5 y in the United States), those with mixed language households, no doctor visits in the past year, no insurance, and self-reported poorer health had lower odds. Sociodemographic factors like age, race, ethnicity, education, and geography showed no significant association.</p><p><strong>Conclusions: </strong>Nearly one-third of individuals with NELP lack awareness of their right to medical interpretation. Factors such as recent immigration, poor health, and limited health care contact are significant barriers. In addition to system and policy level changes, interventions targeting these vulnerable groups are needed to improve health equity and empower patients to use interpreter services.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"249-255"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910011","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":"Fighting to Eliminate Burnout: A 3-Decade Journey and the Path Forward.","authors":"Mark Linzer","doi":"10.1097/MLR.0000000000002120","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002120","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 3","pages":"183-184"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414670","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":"Trends in Obesity Care Among US Adults, 2010-2021.","authors":"Meghan I Podolsky, Rafeya Raquib, Katherine Hempstead, Andrew C Stokes","doi":"10.1097/MLR.0000000000002113","DOIUrl":"10.1097/MLR.0000000000002113","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a major contributor to mortality in the United States. Clinical guidelines emphasize the need for multimodal treatment, but novel treatments may be changing care-seeking behavior.</p><p><strong>Objective: </strong>To characterize obesity treatment access patterns and factors associated with obesity care from 2010 to 2021 in the United States.</p><p><strong>Research design: </strong>This multiyear cross-sectional study was conducted using Medical Expenditure Panel Survey data, covering respondents from 2010 to 2021.</p><p><strong>Subjects: </strong>We defined individuals with a body mass index ≥30 or those with any health care event linked to a diagnosis of obesity as being clinically eligible for obesity treatment.</p><p><strong>Measures: </strong>The primary outcome was the proportion of individuals assumed eligible for obesity treatment who accessed obesity treatment or were prescribed medication to treat obesity in each calendar year from 2010 to 2021.</p><p><strong>Results: </strong>The population of individuals eligible for obesity treatment was 82,729. In total, 1311 (1.6%) reported receiving treatment for obesity. The proportion of participants receiving a prescription for obesity increased from 0.3% (0.2%, 0.6%) in 2010 to 1.8% (1.3%, 2.5%) in 2021. Multivariable logistic regression found that female individuals, older individuals, and those with higher levels of education had higher odds of accessing obesity medication or any obesity treatment.</p><p><strong>Conclusions: </strong>Utilization of pharmaceutical and nonpharmaceutical obesity treatment has increased from 2010 to 2021 but remains low. The likelihood of receiving treatment was lower for groups with lower socioeconomic status. As more effective obesity therapies become available, efforts should be made to ensure equitable access.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"234-240"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008180","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":"Using Z Codes to Document Social Risk Factors in the Electronic Health Record: A Scoping Review.","authors":"Kelley M Baker, Mary A Hill, Debora G Goldberg, Panagiota Kitsantas, Kristen E Miller, Kelly M Smith, Alicia Hong","doi":"10.1097/MLR.0000000000002101","DOIUrl":"10.1097/MLR.0000000000002101","url":null,"abstract":"<p><strong>Introduction: </strong>Individual-level social risk factors have a significant impact on health. Social risks can be documented in the electronic health record using ICD-10 diagnosis codes (the \"Z codes\"). This study aims to summarize the literature on using Z codes to document social risks.</p><p><strong>Methods: </strong>A scoping review was conducted using the PubMed, Medline, CINAHL, and Web of Science databases for papers published before June 2024. Studies were included if they were published in English in peer-reviewed journals and reported a Z code utilization rate with data from the United States.</p><p><strong>Results: </strong>Thirty-two articles were included in the review. In studies based on patient-level data, patient counts ranged from 558 patients to 204 million, and the Z code utilization rate ranged from 0.4% to 17.6%, with a median of 1.2%. In studies that examined encounter-level data, sample sizes ranged from 19,000 to 2.1 billion encounters, and the Z code utilization rate ranged from 0.1% to 3.7%, with a median of 1.4%. The most reported Z codes were Z59 (housing and economic circumstances), Z63 (primary support group), and Z62 (upbringing). Patients with Z codes were more likely to be younger, male, non-White, seeking care in an urban teaching facility, and have higher health care costs and utilizations.</p><p><strong>Discussion: </strong>The use of Z codes to document social risks is low. However, the research interest in Z codes is growing, and a better understanding of Z code use is beneficial for developing strategies to increase social risk documentation, with the goal of improving health outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"211-221"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682230","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":"Chronic Disease and Future Perceptions of Financial Control: Results From the Midlife in the United States Cohort Study.","authors":"Victoria H Davis, Guanghao Zhang, Minal R Patel","doi":"10.1097/MLR.0000000000002126","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002126","url":null,"abstract":"<p><strong>Objective: </strong>Rising health care costs and chronic disease prevalence have increased concerns about health-related financial burden. This study examined how baseline chronic disease burden was associated with subsequent perceptions of financial control ∼9 years later.</p><p><strong>Methods: </strong>Data came from the Midlife in the United States (MIDUS) cohort, with MIDUS 1 and 2 used as baseline predictors for future perceived financial control outcomes at MIDUS 3. Adjusted mixed effect models examined the relationship between baseline chronic disease burden on 4 variables representing future perceptions of financial control.</p><p><strong>Results: </strong>A total of 3297 participants [mean (SD) age: 54 (11.36) y] were included. Greater chronic disease burden and medication use at baseline were associated with a higher likelihood of inadequate resources [adjusted odds ratio (AOR) = 1.22; 95% CI: 1.07-1.38; P = 0.001 and AOR = 1.29; 95% CI: 1.13-1.46; P = 0.001, respectively]. Having more chronic conditions predicted reduced feelings of financial control (AOR=0.85; 95% CI, 0.78-0.93; P<0.001) and a more pessimistic financial outlook (AOR = 0.87; 95% CI: 0.79-0.97; P < 0.01). Higher baseline cholesterol levels showed mixed associations: better perception of current finances (AOR = 1.36; 95% CI: 1.22-1.51; P=0.001) but reduced sense of financial control (AOR = 0.86; 95% CI: 0.78-0.95; P < 0.001) and more negative financial outlook (AOR = 0.69; 95% CI: 0.62-0.77; P < 0.001). No baseline factors predicted bill payment capability.</p><p><strong>Conclusion: </strong>The findings suggest a need for additional strategies to reduce the financial burden of chronic diseases.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080541","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":"Medicare Accountable Care Organization Treatment of Serious Mental Illness: Associations Between Behavioral Health Integration Activities and Outcomes.","authors":"Helen Newton, Carrie H Colla, Susan H Busch, Marisa Tomaino, Brianna Hardy, Mary F Brunette, Devang Agravat, Ellen Meara","doi":"10.1097/MLR.0000000000002102","DOIUrl":"10.1097/MLR.0000000000002102","url":null,"abstract":"<p><strong>Objective: </strong>Characterize the association between Medicare Accountable Care Organizations' (ACOs) behavioral health integration capability and quality and utilization among adults with serious mental illness (SMI).</p><p><strong>Background: </strong>Controlled research supports the efficacy of integrating physical and mental health care for adults with SMI, yet little is known about the organizations integrating care and associations between integration capability and quality.</p><p><strong>Methods: </strong>We surveyed Medicare ACOs (2017-2018 National Survey of ACOs, response rate 69%) and linked responses to 2016-2017 fee-for-service Medicare claims for beneficiaries with SMI. We examined the cross-sectional association between ACO-reported integration capability (tertiles of a 14-item index) and 7 patient-level quality and utilization outcomes. We fit generalized linear models for each outcome as a function of ACO integration capability, adjusting for ACO and beneficiary characteristics.</p><p><strong>Results: </strong>Study sample included 274,928 beneficiary years (199,910 unique beneficiaries) attributed to 265 Medicare ACOs. ACOs with high behavioral health integration capability (top-tertile) served more dual-eligible beneficiaries (67.8%) than bottom-tertile (63.7%) and middle-tertile ACOs (63.3%). Most beneficiaries received follow-up 30 days after mental health hospitalization and chronic disease monitoring-exceeding national quality benchmarks-but beneficiaries receiving care from top-tertile (vs bottom-tertile) ACOs were modestly less likely to receive follow-up [-2.17 percentage points (pp), P < 0.05], diabetes monitoring (-2.19 pp, P < 0.05), and cardiovascular disease monitoring (-6.07 pp, P < 0.05). Integration capability was not correlated with utilization.</p><p><strong>Conclusions: </strong>ACOs serving adults with substantial physical and mental health needs were more likely to report comprehensive integration capability but were not yet meeting the primary care needs of many adults with SMI.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"123-132"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770425","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}