{"title":"Effective Roles of Primary Care Clinics in Lowering Total Cost of Care Among Commercially Insured Populations: A Systematic Review.","authors":"Arindam Debbarma, Roshani Dahal, Bryan E Dowd","doi":"10.1177/10775587251323636","DOIUrl":"10.1177/10775587251323636","url":null,"abstract":"<p><p>Proposals to reduce the cost of health care services and improve the quality of care often involve ambitious expectations for the role of primary care clinics (PCCs). We systematically reviewed the literature to identify interventions PCCs could undertake to reduce avoidable emergency department visits and ambulatory care-sensitive admissions. Database searches resulted in only seven studies that met the inclusion criteria for this review. Very few studies identified interventions that primary care physicians could undertake to reduce total cost of care, possibly because relatively few PCCs are held responsible for total cost of care. Evidence-based interventions to reduce ACS admissions and ED use included case-management models, clinical decision-support tools, & care plans integrated into patients' electronic medical records. The interventions highlighted a heightened role for PCCs in care coordination and access to care that could lead to patients actively engaging in care management and consulting PCCs before seeking urgent care.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"287-300"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kyla F Woodward, LaTonya Trotter, Janette Dill, Bianca Frogner
{"title":"New Opportunities or More of the Same? Health Industry Entrants in the Post-Pandemic Era.","authors":"Kyla F Woodward, LaTonya Trotter, Janette Dill, Bianca Frogner","doi":"10.1177/10775587251320684","DOIUrl":"10.1177/10775587251320684","url":null,"abstract":"<p><p>This cross-sectional study examines shifts in health industry entry and sector choice among women, racially minoritized workers, and immigrants during the pandemic era. Using data from the Annual Social and Economic Supplement of the Current Population Survey (2018-2023), we compare entrant characteristics before and during the pandemic era, focusing on demographic composition and sector choice. Results show minimal shifts by gender, race, or education but highlight a rise in entrants from outside the labor force, particularly among White women and racially minoritized men. There were changes in sector choice: ambulatory care saw the greatest increase in racially minoritized entrants, with small increases for hospitals and a decrease for long-term care. Despite these sector-specific shifts, overall opportunities for minoritized workers did not expand, nor did workforce diversity significantly improve. These findings underscore the need for research that examines how policies outside the workplace shape worker behavior, particularly among marginalized groups.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"346-353"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12197824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicole Dussault, Dorian Ho, Haripriya Dukkipati, Judith B Vick, Lesley A Skalla, Jessica Ma, Christopher A Jones, Brystana G Kaufman
{"title":"Provider Perspectives on Implementation of Adult Community-Based Palliative Care: A Scoping Review.","authors":"Nicole Dussault, Dorian Ho, Haripriya Dukkipati, Judith B Vick, Lesley A Skalla, Jessica Ma, Christopher A Jones, Brystana G Kaufman","doi":"10.1177/10775587241303963","DOIUrl":"10.1177/10775587241303963","url":null,"abstract":"<p><p>While community-based palliative care (CBPC) programs have been expanding, there remain important obstacles to widespread use. Since provider perspectives on CBPC remain underexplored, we conducted a scoping review to summarize provider perspectives regarding barriers and facilitators to implementation of adult CBPC in the United States. We systematically searched OVID, MEDLINE, and CINAHL for peer-reviewed qualitative research published from January 1, 2010 to January 9, 2024, then used PRISM framework synthesis to organize themes into provider, organization, and external environment levels. Thirty-four articles were included. At the provider level, barriers included misperceptions of palliative care (PC) by referring providers and poor communication, while facilitators included multidisciplinary teams and referring provider education. At the organizational level, time constraints were barriers, while leadership buy-in and co-located clinics were facilitators. At the external environment level, limited PC workforce and inadequate reimbursement were barriers. Our findings suggest that efforts aimed at scaling CBPC must address factors at the provider, organizational, and policy levels.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"301-318"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura Barrie Smith, Timothy A Waidmann, Kyle J Caswell, Keqin Wei
{"title":"The Effects of Care Coordination on Service Utilization for Individuals Dually Enrolled in Medicare and Medicaid: Evidence From the Washington Health Home Managed Fee-For-Service Demonstration.","authors":"Laura Barrie Smith, Timothy A Waidmann, Kyle J Caswell, Keqin Wei","doi":"10.1177/10775587251321607","DOIUrl":"10.1177/10775587251321607","url":null,"abstract":"<p><p>Individuals dually enrolled in Medicare and Medicaid often experience fragmented care that fails to meet their health care needs and is unduly expensive due to a lack of coordination between Medicare and Medicaid programs. Washington state's Health Home Managed Fee-For-Service demonstration, part of the Financial Alignment Initiative, sought to improve care and reduce costs for high-cost, high-risk dual enrollees through care coordination. Using Medicare and Medicaid administrative claims data from 2016 to 2019, we evaluate the impact of the Washington demonstration on health care utilization using a modified regression discontinuity design. We find that for relatively healthy enrollees on the margin of eligibility for the demonstration, enrollment in the demonstration modestly reduced emergency department visits, ambulatory care visits, and some types of home and community-based service (HCBS) use and reduced nursing facility stays for older enrollees, but did not impact inpatient or skilled nursing facility admissions. Addressing the fragmentation of coverage, care, and financing for dual enrollees remains an important policy and research priority.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"336-345"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hospital Entry Improves Quality: Evidence From Common Medical Conditions.","authors":"Matthew C Baker, Thomas Stratmann","doi":"10.1177/10775587251321208","DOIUrl":"10.1177/10775587251321208","url":null,"abstract":"<p><p>To analyze the determinants and effects of hospital entry, we compare entrants' quality of care to incumbent hospitals. Using national hospital-level patient mortality measures from July 2005 to June 2019 for Medicare patients with common medical conditions (heart attack, heart failure, and pneumonia), we establish that entrant hospitals experience 0.27 to 0.76 fewer deaths per 100 patients than incumbent hospitals in the same markets. We further show that new hospitals enter markets where they can provide higher quality care than incumbent hospitals.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"319-335"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Impact of Rural Hospital Closures and Mergers on Health System Ecologies: A Scoping Review.","authors":"Alison Coates, Janice Probst, Kanika Sarwal, Suhaib Riaz, Agnes Grudniewicz","doi":"10.1177/10775587251355671","DOIUrl":"https://doi.org/10.1177/10775587251355671","url":null,"abstract":"<p><p>Despite playing a pivotal role in rural community health services delivery and in local economies, rural hospitals in the United States have closed or merged with larger health networks at alarming rates. This scoping review examines what is known about the impacts of rural hospital closures and mergers since 2010. Using the literature, we inductively derived a new Health System Ecologies Impact Matrix research tool to assess knowledge related to health system changes. Most of the included studies examined closures, primarily reporting on community impacts. Knowledge gaps remain related to financial-, workforce-, and utilization-related outcomes, and little is known about impacts on neighboring hospitals and communities. Few studies report effects of rural hospital mergers, primarily focusing on financial and utilization outcomes for the merged hospital. No studies examined the impacts of rural hospital mergers on patients or individuals and their social environments.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251355671"},"PeriodicalIF":2.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alex Schulte, Becky Staiger, Hector P Rodriguez, Amanda L Brewster
{"title":"Mission vs. Margin: The Effects of Catholic Health System Ownership on Hospital Operations.","authors":"Alex Schulte, Becky Staiger, Hector P Rodriguez, Amanda L Brewster","doi":"10.1177/10775587251355541","DOIUrl":"https://doi.org/10.1177/10775587251355541","url":null,"abstract":"<p><p>The number of Catholic hospitals grew by 28% between 2001 and 2020, and today almost one-fifth of U.S. nonprofit hospitals are Catholic. Catholic systems face conflicting institutional pressures to provide mission-oriented services while remaining financially competitive. Using 2009-2022 data from the American Hospital Association (<i>n</i> = 33,552 hospital-years), we applied difference-in-differences methods to compare changes in hospital operations after acquisition by Catholic and non-Catholic systems relative to the control group of never-acquired hospitals. Catholic-acquired hospitals were more likely to offer some mission-oriented services, including chaplaincy and charity care (average treatment effect on the treated, ATT, 10.41 percentage-point [pp] and 3.97 pp, respectively), while non-Catholic-acquired hospitals were less likely to operate an obstetrics unit (ATT -3.45 pp) after acquisition relative to the control group. Hospitals experienced similar cost-cutting measures after acquisition relative to the control group, including reduced operating expenses and employment, regardless of system ownership type. Our findings provide rigorous empirical evidence to inform ongoing policy debates regarding the expansion of Catholic health care.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251355541"},"PeriodicalIF":2.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan K Beckett, Christopher W Cohea, Debra Saliba, Paul D Cleary, Laura A Giordano, Marc N Elliott
{"title":"Hospital Patient Experience Worsened With the COVID-19 Pandemic, Especially for Older Adults, and Remains Worse than Before.","authors":"Megan K Beckett, Christopher W Cohea, Debra Saliba, Paul D Cleary, Laura A Giordano, Marc N Elliott","doi":"10.1177/10775587251349053","DOIUrl":"https://doi.org/10.1177/10775587251349053","url":null,"abstract":"<p><p>Adults age 75+ report worse inpatient experiences than patients 55 to 74. Older adults may have been especially vulnerable to changes such as family access and reduced staffing during the COVID-19 pandemic. We examined 2018-2023 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys from 14,760,049 respondents discharged from 4,462 hospitals. We examined changes in an HCAHPS summary score (HCAHPS-SS), controlling for pre-pandemic quarterly and linear trends. HCAHPS-SS declined 4.1pp, a medium-to-large drop by Q3/2022, recovering only slightly by Q4/2023 (to -3.5pp). HCAHPS-SS decreased fastest for patients 75+ and least for maternity patients, even controlling for age. Differences by age may reflect older patients' greater need for instrumental support and differential impacts of visitor restrictions. Hospitals' quality improvement efforts should focus on understanding the need for patient support and on restoring prior patient experience gains. The failure to return to pre-pandemic levels points to the need to understand and address the residual factors that continue to alter patient experience.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251349053"},"PeriodicalIF":2.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hankyung Jun, Fangli Geng, Brian E McGarry, Momotazur Rahman, Elizabeth M White, Emily A Gadbois, David C Grabowski
{"title":"Immigrant Staff in Nursing Homes: Mitigating Staffing Shortages During the COVID-19 Pandemic.","authors":"Hankyung Jun, Fangli Geng, Brian E McGarry, Momotazur Rahman, Elizabeth M White, Emily A Gadbois, David C Grabowski","doi":"10.1177/10775587251349064","DOIUrl":"https://doi.org/10.1177/10775587251349064","url":null,"abstract":"<p><p>The COVID-19 pandemic exacerbated staffing shortages in U.S. nursing homes. Staff who are immigrants may have stronger tendencies to remain in their jobs than U.S.-born staff, but evidence is lacking. In this study, we predicted the share of immigrant staff and used a difference-in-differences regression to investigate whether nursing homes with a higher vs. lower proportion of immigrant certified nursing assistants (CNAs) experienced lesser declines in staff hours per resident day (HPRD) during the pandemic. We found that facilities with a larger-than-median predicted share of immigrant staff exhibited a relatively smaller decrease in CNA HPRD by 0.03 HPRD, equivalent to a 1.4% difference of the sample mean. We further found that CNA turnover rates during the pandemic were lower in facilities with relatively higher shares of immigrant staff. Our findings suggest that nursing homes with more immigrant staff may be more resilient in meeting staffing needs during crises.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251349064"},"PeriodicalIF":2.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Denise A Tyler, Emily A Gadbois, Joan F Brazier, Amal N Trivedi
{"title":"Medicare Advantage Plan and Chronic Kidney Disease Care Management Company Partnerships After the 21st Century Cures Act.","authors":"Denise A Tyler, Emily A Gadbois, Joan F Brazier, Amal N Trivedi","doi":"10.1177/10775587251349298","DOIUrl":"https://doi.org/10.1177/10775587251349298","url":null,"abstract":"<p><p>The 21st Century Cures Act opened Medicare Advantage (MA) enrollment to people with end-stage renal disease (ESRD). Previously, most Medicare beneficiaries with ESRD were only permitted to enroll in traditional Medicare. The purpose of our study was to determine how MA plans responded to this policy change. We conducted 48 interviews with representatives from MA plans, dialysis provider organizations, and chronic kidney disease (CKD) care management companies. One major theme that emerged from our interviews was MA plans partnered with CKD care management companies to manage the care of ESRD patients. Plans partnered because they had little experience with and were wary of the costs of this population, and sought to improve the value and quality of services. MA plans varied in how they contracted with these organizations, and the CKD care management companies employed several methods for managing patients. Participants reported both benefits and challenges related to these partnerships.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251349298"},"PeriodicalIF":2.4,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}