Medical Care最新文献

{"title":"Development and Evaluation of Messages for Reducing Overscreening of Breast Cancer in Older Women.","authors":"Nancy L Schoenborn, Sarah E Gollust, Mara A Schonberg, Craig E Pollack, Cynthia M Boyd, Qian-Li Xue, Rebekah H Nagler","doi":"10.1097/MLR.0000000000001993","DOIUrl":"10.1097/MLR.0000000000001993","url":null,"abstract":"<p><strong>Background: </strong>Many older women are screened for breast cancer beyond guideline-recommended thresholds. One contributor is pro-screening messaging from health care professionals, media, and family/friends. In this project, we developed and evaluated messages for reducing overscreening in older women.</p><p><strong>Methods: </strong>We surveyed women ages 65+ who were members of a nationally representative online panel. We constructed 8 messages describing reasons to consider stopping mammograms, including guideline recommendations, false positives, overdiagnosis, and diminishing benefits from screening due to competing risks. Messages varied in their format; some presented statistical evidence, and some described short anecdotes. Each participant was randomized to read 4 of 8 messages. We also randomized participants to one of 3 message sources (clinician, family member, and news story). We assessed whether the message would make participants \"want to find out more information\" and \"think carefully\" about mammograms.</p><p><strong>Results: </strong>Participants (N=790) had a mean age of 73.5 years; 25.8% were non-White. Across all messages, 73.0% of the time, participants agreed that the messages would make them seek more information (range among different messages=64.2%-78.2%); 46.5% of the time participants agreed that the messages would make them think carefully about getting mammograms (range =36.7%-50.7%). Top-rated messages mentioned false-positive anecdotes and overdiagnosis evidence. Ratings were similar for messages from clinicians and news sources, but lower from the family member source.</p><p><strong>Conclusions: </strong>Overall, participants positively evaluated messages designed to reduce breast cancer overscreening regarding perceived effects on information seeking and deliberation. Combining the top-rated messages into messaging interventions may be a novel approach to reduce overscreening.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10997450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158464","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":"Occupational Injuries in the US Nursing Homes.","authors":"Hari Sharma, Lili Xu","doi":"10.1097/MLR.0000000000001991","DOIUrl":"10.1097/MLR.0000000000001991","url":null,"abstract":"<p><strong>Background: </strong>Workplace injuries adversely affect worker well-being and may worsen staffing shortages and turnover in nursing homes. A better understanding of the trends in injuries in nursing homes including organizational factors associated with injuries can help improve our efforts in addressing worker injuries.</p><p><strong>Objective: </strong>To summarize the trends in injuries and organizational correlates of injuries in US nursing homes.</p><p><strong>Research design: </strong>We combine national injury tracking data from the Occupational Safety and Health Administration (2016-2019) with nursing home characteristics from Nursing Home Compare. Our outcomes include the proportion of nursing homes reporting any injuries, the mean number of injuries, and the mean number of injuries or illnesses with days away from work, or job transfer or restriction, or both (DART). We descriptively summarize trends in injuries over time. We also estimate the association between nursing home characteristics and injuries using multivariable regressions.</p><p><strong>Results: </strong>We find that approximately 93% of nursing homes reported at least 1 occupational injury in any given year. Injuries had a substantial impact on productivity with 4.1 DART injuries per 100 full-time employees in 2019. Higher bed size, occupancy, RN staffing, and chain ownership are associated with increased DART rates whereas higher overall nursing home star ratings and for-profit status are associated with decreased DART rates.</p><p><strong>Conclusions: </strong>A high proportion of nursing homes report occupational injuries that can affect staff well-being, productivity, and quality of care. Injury prevention policies should target the types of injuries occurring in nursing homes and OSHA should monitor nursing homes reporting high and repeated injuries.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306168","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":"Enhancing Patient Experience: The Associations of Nursing Factors With HCAHPS Ratings.","authors":"Mona Al-Amin","doi":"10.1097/MLR.0000000000001996","DOIUrl":"10.1097/MLR.0000000000001996","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288428","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 Nudging Effect of a Reminder Letter to Reduce Duplicated Medications: A Randomized Controlled Trial.","authors":"Shou-Hsia Cheng, Kuo-Piao Chung, Ying-Chieh Wang, Hsin-Yun Tsai","doi":"10.1097/MLR.0000000000001989","DOIUrl":"10.1097/MLR.0000000000001989","url":null,"abstract":"<p><strong>Background: </strong>The increasing trend of multiple chronic conditions across the world has worsened the problem of medication duplication in health care systems without gatekeeping or referral requirement. Thus, to overcome this problem, a reminder letter has been developed in Taiwan to nudge patients to engage in medication management.</p><p><strong>Objective: </strong>To evaluate the effect of reminder letter on reducing duplicated medications.</p><p><strong>Research design: </strong>A 2-arm randomized controlled trial design.</p><p><strong>Subjects: </strong>Patients with duplicated medications in the first quarter of 2019.</p><p><strong>Measures: </strong>The Taiwanese single-payer National Health Insurance Administration identified the eligible patients for this study. A postal reminder letter regarding medication duplication was mailed to the patients in the study group, and no information was provided to the comparison group. Generalized estimation equation models with a difference-in-differences analysis were used to estimate the effects of the reminder letters.</p><p><strong>Results: </strong>Each group included 11,000 patients. Those who had received the reminder letter were less likely to receive duplicated medications in the subsequent 2 quarters (postintervention 1: odds ratio [OR]=0.95, 95% CI=0.87-1.03; postintervention_2: OR=0.99, 95% CI=0.90-1.08) and had fewer days of duplicated medications (postintervention 1: β=-0.115, P =0.015; postintervention 2 (β=-0.091, P =0.089) than those who had not received the reminder letter, showing marginal but significant differences.</p><p><strong>Conclusions: </strong>A one-off reminder letter nudge could mildly decrease the occurrence of duplicated medications. Multiple nudges or nudges incorporating behavioral science insights may be further considered to improve medication safety in health systems without gatekeeping.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158467","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":"Performance of a Claims-Based Frailty Proxy Using Varying Frailty Ascertainment Lookback Windows.","authors":"Emilie D Duchesneau, Til Stürmer, Dae Hyun Kim, Katherine Reeder-Hayes, Jessie K Edwards, Keturah R Faurot, Jennifer L Lund","doi":"10.1097/MLR.0000000000001994","DOIUrl":"10.1097/MLR.0000000000001994","url":null,"abstract":"<p><strong>Background: </strong>Frailty is an aging-related syndrome of reduced physiological reserve to maintain homeostasis. The Faurot frailty index has been validated as a Medicare claims-based proxy for predicting frailty using billing information from a user-specified ascertainment window.</p><p><strong>Objectives: </strong>We assessed the validity of the Faurot frailty index as a predictor of the frailty phenotype and 1-year mortality using varying frailty ascertainment windows.</p><p><strong>Research design: </strong>We identified older adults (66+ y) in Round 5 (2015) of the National Health and Aging Trends Study with Medicare claims linkage. Gold standard frailty was assessed using the frailty phenotype. We calculated the Faurot frailty index using 3, 6, 8, and 12 months of claims prior to the survey or all-available lookback. Model performance for each window in predicting the frailty phenotype was assessed by quantifying calibration and discrimination. Predictive performance for 1-year mortality was assessed by estimating risk differences across claims-based frailty strata.</p><p><strong>Results: </strong>Among 4253 older adults, the 6 and 8-month windows had the best frailty phenotype calibration (calibration slopes: 0.88 and 0.87). All-available lookback had the best discrimination (C-statistic=0.780), but poor calibration. Mortality associations were strongest using a 3-month window and monotonically decreased with longer windows. Subgroup analyses revealed worse performance in Black and Hispanic individuals than counterparts.</p><p><strong>Conclusions: </strong>The optimal ascertainment window for the Faurot frailty index may depend on the clinical context, and researchers should consider tradeoffs between discrimination, calibration, and mortality. Sensitivity analyses using different durations can enhance the robustness of inferences. Research is needed to improve prediction across racial and ethnic groups.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10997449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158466","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":"Medicare Advantage and Home Health Care: A Systematic Review.","authors":"Chenjuan Ma, Martha Rajewski, Jamie M Smith","doi":"10.1097/MLR.0000000000001992","DOIUrl":"10.1097/MLR.0000000000001992","url":null,"abstract":"<p><strong>Objectives: </strong>Home health care serves millions of Americans who are \"Aging in Place,\" including the rapidly growing population of Medicare Advantage (MA) enrollees. This study systematically reviewed extant evidence illustrating home health care (HHC) services to MA enrollees.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in 6 electronic databases to identify eligible studies, which resulted in 386 articles. Following 2 rounds of screening, 30 eligible articles were identified. Each study was also assessed independently for study quality using a validated quality assessment checklist.</p><p><strong>Results: </strong>Of the 30 studies, nearly half (n=13) were recently published between January 1, 2017 - January 6, 2022. Among various issues related to HHC to MA enrollees examined, which were often compared with Traditional Medicare (TM) enrollees, the 2 most studied issues were HHC use rate (including access) and care dosage/intensity. Inconsistencies were common in findings across reviewed studies, with slight variations in the level of inconsistency by studied outcomes. Several critical issues, such as heterogeneity of MA plans, influence of MA-specific features, and program response to policy and quality improvement initiatives, were only examined by 1 or 2 studies. The depth and scope of scientific investigation were also limited by the scale and details available in MA data in addition to other methodological limits.</p><p><strong>Conclusions: </strong>Wild variations and conflicting findings on HHC to MA beneficiaries exist across studies. More research with rigorous designs and robust MA encounter data is warranted to determine home health care for MA enrollees and the relevant outcomes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10997464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306167","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":"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.0000000000001987","DOIUrl":"10.1097/MLR.0000000000001987","url":null,"abstract":"<p><strong>Background: </strong>Involving patients in the health-care delivery innovation has many benefits. Open social innovation (OSI) presents a fitting lens to examine and advance patient engagement in innovation. OSI offers a participatory approach to innovation, in which diverse groups of participants collaboratively generate ideas and scale solutions on complex social challenges.</p><p><strong>Purpose: </strong>This study: (1) describes a pilot application of OSI, in which individuals serving on a hospital's patients and family advisory councils (PFACs) were invited to participate in an innovation contest; and (2) explores the extent to which patients' beliefs about their role in innovation relate to their participation in the contest.</p><p><strong>Methodology/approach: </strong>We conducted an innovation contest that invited PFAC members to share ideas that would improve patient experiences and then vote on and select the ideas that they wanted to see move forward. We measured patients' beliefs about their role in innovation in a survey before the contest.</p><p><strong>Results: </strong>Twenty individuals submitted 27 ideas. Patients who expressed preference for more involvement in innovation were more likely to participate.</p><p><strong>Conclusions: </strong>Using OSI may help expand patient engagement in innovation, particularly among those who want to be more involved but do not feel authorized to voice ideas in traditional advisory committees.</p><p><strong>Practical implications: </strong>OSI spurred collaboration among patients, clinicians, quality improvement staff, hospital administrators, and other stakeholders in idea generation, elaboration, and implementation. More experimentation and research are needed to understand how OSI can be leveraged to capture patients' voice and incorporate them in care delivery innovation.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158465","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":"Use of Sequential Hot-Deck Imputation for Missing Health Care Systems Data for Population Health Research.","authors":"Ella A Chrenka, Steven P Dehmer, Michael V Maciosek, Inih J Essien, Bjorn C Westgard","doi":"10.1097/MLR.0000000000001995","DOIUrl":"10.1097/MLR.0000000000001995","url":null,"abstract":"<p><p>Electronic medical record (EMR) data present many opportunities for population health research. The use of EMR data for population risk models can be impeded by the high proportion of missingness in key patient variables. Common approaches like complete case analysis and multiple imputation may not be appropriate for some population health initiatives that require a single, complete analytic data set. In this study, we demonstrate a sequential hot-deck imputation (HDI) procedure to address missingness in a set of cardiometabolic measures in an EMR data set. We assessed the performance of sequential HDI within the individual variables and a commonly used composite risk score. A data set of cardiometabolic measures based on EMR data from 2 large urban hospitals was used to create a benchmark data set with simulated missingness. Sequential HDI was applied, and the resulting data were used to calculate atherosclerotic cardiovascular disease risk scores. The performance of the imputation approach was assessed using a set of metrics to evaluate the distribution and validity of the imputed data. Of the 567,841 patients, 65% had at least 1 missing cardiometabolic measure. Sequential HDI resulted in the distribution of variables and risk scores that reflected those in the simulated data while retaining correlation. When stratified by age and sex, risk scores were plausible and captured patterns expected in the general population. The use of sequential HDI was shown to be a suitable approach to multivariate missingness in EMR data. Sequential HDI could benefit population health research by providing a straightforward, computationally nonintensive approach to missing EMR data that results in a single analytic data set.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10997447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306169","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":"Evolution of Hospitals' Community Benefits: Addressing Social Determinants of Health through Investments in Housing Security.","authors":"Tatiane Santos, Gary J Young","doi":"10.1097/MLR.0000000000002007","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002007","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671491","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":"Identifying Sources of Inter-hospital Variation in Episode Spending for Sepsis Care.","authors":"Roshun Sankaran, Baris Gulseren, Hallie C Prescott, Kenneth M Langa, Thuy Nguyen, Andrew M Ryan","doi":"10.1097/mlr.0000000000002000","DOIUrl":"https://doi.org/10.1097/mlr.0000000000002000","url":null,"abstract":"To evaluate inter-hospital variation in 90-day total episode spending for sepsis, estimate the relative contributions of each component of spending, and identify drivers of spending across the distribution of episode spending on sepsis care.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617082","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}