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Strengthening Primary Care Workforce Capacity in Dementia Diagnosis and Care: A Qualitative Study of Project Alzheimer's Disease-ECHO. 加强痴呆症诊断和护理方面的基层医疗队伍能力：阿尔茨海默氏症-ECHO 项目定性研究》。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-10-01 Epub Date: 2024-05-31 DOI: 10.1177/10775587241251868
Alissa B Sideman, Alma Hernandez de Jesus, Cecilia Alagappan, Melissa Ma, Christopher J Koenig, Loren I Alving, Freddi Segal-Gidan, Rachel Goldberger, Dana Sohmer, Howie Rosen
{"title":"Strengthening Primary Care Workforce Capacity in Dementia Diagnosis and Care: A Qualitative Study of Project Alzheimer's Disease-ECHO.","authors":"Alissa B Sideman, Alma Hernandez de Jesus, Cecilia Alagappan, Melissa Ma, Christopher J Koenig, Loren I Alving, Freddi Segal-Gidan, Rachel Goldberger, Dana Sohmer, Howie Rosen","doi":"10.1177/10775587241251868","DOIUrl":"10.1177/10775587241251868","url":null,"abstract":"<p><p>Primary care practitioners (PCPs) are the first point of contact for most patients with suspected dementia and have identified a need for more training and support around dementia diagnosis and care. This qualitative study examined the Alzheimer's Disease-Extension for Community Healthcare Outcomes (AD-ECHO) program. AD-ECHO was designed to strengthen PCP capacity in dementia through bimonthly virtual meetings with a team of dementia experts. We conducted 24 hr of direct observations at AD-ECHO sessions and interviewed 14 participants about their experiences participating. Using thematic analysis, we found that participants valued the supportive learning environment and resources; knowledge gained empowered them to take more action around dementia; they identified ways of disseminating knowledge gained into their practice settings, and many desired ongoing AD-ECHO engagement. However, most identified time as a barrier to participation. AD-ECHO has the potential to strengthen the primary care workforce's knowledge and confidence around dementia care.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"384-394"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11389049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141184775","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}
引用次数: 0
Engaging Interdisciplinary Innovation Teams in Federally Qualified Health Centers. 让跨学科创新团队参与联邦合格医疗中心。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-10-01 Epub Date: 2024-03-07 DOI: 10.1177/10775587241235244
Olivia S Jung, Patricia Satterstrom, Sara J Singer
{"title":"Engaging Interdisciplinary Innovation Teams in Federally Qualified Health Centers.","authors":"Olivia S Jung, Patricia Satterstrom, Sara J Singer","doi":"10.1177/10775587241235244","DOIUrl":"10.1177/10775587241235244","url":null,"abstract":"<p><p>To foster bottom-up innovations, health care organizations are leveraging interdisciplinary frontline innovation teams. These teams include workers across hierarchical levels and professional backgrounds, pooling diverse knowledge sources to develop innovations that improve patient and worker experiences and care quality, equity, and costs. Yet, these frontline innovation teams experience barriers, such as time constraints, being new to innovation, and team-based role hierarchies. We investigated the practices that such teams in federally qualified health centers (FQHCs) used to overcome these barriers. Our 20-month study of two FQHC innovation teams provides one of the first accounts of how practices that sustained worker engagement in innovation and supported their ideas to implementation evolve over time. We also show the varied quantity of engagement practices used at different stages of the innovation process. At a time when FQHCs face pressure to innovate amid staff shortages, our study provides recommendations to support their work.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"370-383"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11389058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050944","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}
引用次数: 0
Motivators, Barriers, and Facilitators to Choosing Care in VA Facilities Versus VA-Purchased Care. 选择退伍军人机构护理与退伍军人机构购买护理的动机、障碍和促进因素。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-10-01 Epub Date: 2024-07-29 DOI: 10.1177/10775587241264594
Christopher G Slatore, Jennifer Y Scott, Elizabeth R Hooker, Natalie Disher, Sara Golden, Diana Govier, Denise M Hynes
{"title":"Motivators, Barriers, and Facilitators to Choosing Care in VA Facilities Versus VA-Purchased Care.","authors":"Christopher G Slatore, Jennifer Y Scott, Elizabeth R Hooker, Natalie Disher, Sara Golden, Diana Govier, Denise M Hynes","doi":"10.1177/10775587241264594","DOIUrl":"10.1177/10775587241264594","url":null,"abstract":"<p><p>Many Veterans receive Department of Veterans Affairs (VA)-purchased care from non-VA facilities but little is known about factors that Veterans consider for this choice. Between May 2020 and August 2021, we surveyed VA-purchased care-eligible VA patients about barriers and facilitators to choosing where to receive care. We examined the association between travel time to their VA facility and their choice of VA-purchased care (VA-paid health care received in non-VA settings) versus VA facility and whether this association was modified by distrust. We received 1,662 responses and 692 (42%) chose a VA facility. Eighty percent reported quality care was in their top three factors that influenced their decision. Respondents with the highest distrust and who lived >1 hr from the nearest VA facility had the lowest predicted probability (PP) of choosing VA (PP 15%; 95% confidence interval: 10%-20%). Veterans value quality of care. VA and other health care systems should consider patient-centered ways to improve and publicize quality and reduce distrust.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"395-407"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793987","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}
引用次数: 0
Medicaid Reimbursement for Doula Care: Policy Considerations From a Scoping Review. 杜拉护理的医疗补助报销：范围审查的政策考虑因素。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-08-01 Epub Date: 2023-12-20 DOI: 10.1177/10775587231215221
Cara B Safon, Lois McCloskey, Sarah H Gordon, Megan B Cole, Jack Clark
{"title":"Medicaid Reimbursement for Doula Care: Policy Considerations From a Scoping Review.","authors":"Cara B Safon, Lois McCloskey, Sarah H Gordon, Megan B Cole, Jack Clark","doi":"10.1177/10775587231215221","DOIUrl":"10.1177/10775587231215221","url":null,"abstract":"<p><p>Evidence suggests that perinatal doula care can support maternal health and reduce racial inequities among low-income pregnant and postpartum people, prompting growing interest by state Medicaid agencies to reimburse for doula services. Emerging peer-reviewed and gray literature document factors facilitating or impeding that reimbursement. We conducted a scoping review of that literature (2012-2022) to distill key policy considerations for policymakers and advocates in the inclusion of doula care as a Medicaid-covered benefit. Fifty-three reports met the inclusion criteria. Most (53%) were published in 2021 or 2022. Their stated objectives were advocating for expanded access to doula care (17%), describing barriers to policy implementation, and/or offering recommendations to overcome the barriers (17%). A primary policy consideration among states was prioritizing partnership with doulas and doula advocates to inform robust and equitable policymaking to sustain the doula profession.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"311-326"},"PeriodicalIF":2.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832859","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}
引用次数: 0
Differential Privacy Protections in 2020 U.S. Decennial Census Data Do Not Impede Measurement of Racial and Ethnic Disparities. 2020 年美国十年一次人口普查数据中的隐私保护差异不会妨碍对种族和民族差异的测量。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-08-01 Epub Date: 2024-05-14 DOI: 10.1177/10775587241251870
Joshua Snoke, Ann Haas, Steven C Martino, Marc N Elliott
{"title":"Differential Privacy Protections in 2020 U.S. Decennial Census Data Do Not Impede Measurement of Racial and Ethnic Disparities.","authors":"Joshua Snoke, Ann Haas, Steven C Martino, Marc N Elliott","doi":"10.1177/10775587241251870","DOIUrl":"10.1177/10775587241251870","url":null,"abstract":"<p><p>Census data are vital to health care research but must also protect respondents' confidentiality. The 2020 decennial Census employs a new Differential Privacy framework; this study examines its effect on the accuracy of an important tool for measuring health disparities, the Bayesian Improved Surname and Geocoding (BISG) algorithm, which uses Census Block Group data to estimate race and ethnicity when self-reported data are unavailable. Using self-reported race and ethnicity data as our standard, we compared the accuracy of BISG estimates calculated using the original 2010 Census counts to the accuracy of estimates calculated using 2010 data but with 2020 Differential Privacy in place. The Differential Privacy methodology slightly decreases BISG accuracy for American Indian and Alaska Native people but has little effect for other groups, suggesting that the methodology will not impede health disparities research that employs BISG and similar methods.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"346-350"},"PeriodicalIF":2.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922745","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}
引用次数: 0
The Consequences of Unmet Needs for Assistance With Daily Life Activities Among Older Adults: A Systematic Review. 老年人日常生活活动援助需求得不到满足的后果：系统回顾
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-08-01 Epub Date: 2024-03-07 DOI: 10.1177/10775587241233798
Jing Huang, Xingxing Qian, Edmond Pui Hang Choi, Pui Hing Chau
{"title":"The Consequences of Unmet Needs for Assistance With Daily Life Activities Among Older Adults: A Systematic Review.","authors":"Jing Huang, Xingxing Qian, Edmond Pui Hang Choi, Pui Hing Chau","doi":"10.1177/10775587241233798","DOIUrl":"10.1177/10775587241233798","url":null,"abstract":"<p><p>Many older adults are experiencing unmet needs for assistance with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Such unmet needs might threaten their physical and psychosocial well-being. We conducted a systematic review to provide a comprehensive picture of the health consequences of unmet ADL/IADL needs among older adults. Twenty-eight published articles were included for qualitative synthesis. We found that unmet ADL/IADL needs were consistently associated with higher health care utilization (e.g., hospitalization, medical spending) and adverse psychosocial consequences (e.g., anxiety, depression), while the findings of falls and mortality remain inconsistent. More studies are needed to draw firm conclusions and to allow for quantitative synthesis. This review advocates for more coordinated and comprehensive long-term care services for older adults. Future studies should explore how the adverse health outcomes identified in this review can be prevented or improved by adequately meeting older adults' needs for assistance.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"295-310"},"PeriodicalIF":2.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050888","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}
引用次数: 0
Health care Utilization and Expenditures in Health Professional Shortage Areas. 卫生专业人员短缺地区的医疗保健使用和支出。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-08-01 Epub Date: 2024-03-14 DOI: 10.1177/10775587241235705
Chandler B McClellan
{"title":"Health care Utilization and Expenditures in Health Professional Shortage Areas.","authors":"Chandler B McClellan","doi":"10.1177/10775587241235705","DOIUrl":"10.1177/10775587241235705","url":null,"abstract":"<p><p>Healthcare provider shortages are associated with adverse health outcomes, presumably stemming from the lack of access to primary care. This study examines the impact of Health Professional Shortage Areas (HPSAs) on healthcare utilization and spending across different types of care. Using the Medical Expenditure Panel Survey from 2002 to 2019, this study estimates the difference in healthcare utilization in HPSAs compared with non-HPSAs using a generalized random forest, which allows for more complex modeling of the outcome and a principled examination of heterogenous treatment effects. The results indicate HPSAs are associated with a 5% reduction in medical office visits, but no reduction in hospital-based care. These effects are concentrated in older persons living in urban areas, Black persons, and Medicaid beneficiaries. No statistically significant effects on annual spending were observed. These results offer insight into potential areas for further policy efforts aimed at reducing provider shortages.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"335-345"},"PeriodicalIF":2.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133197","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}
引用次数: 0
State-Level Adverse Outcomes Among Long-Term Services and Supports Users With Alzheimer's Disease and Related Dementias. 长期服务和支持阿尔茨海默病及相关痴呆症患者的州级不良结果。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-06-01 Epub Date: 2023-10-23 DOI: 10.1177/10775587231207668
Hyunjee Kim, Angela Senders, Erika Simeon, Clint Sergi, Sean Shenghsiu Huang, Hiroko H Dodge, K John McConnell
{"title":"State-Level Adverse Outcomes Among Long-Term Services and Supports Users With Alzheimer's Disease and Related Dementias.","authors":"Hyunjee Kim, Angela Senders, Erika Simeon, Clint Sergi, Sean Shenghsiu Huang, Hiroko H Dodge, K John McConnell","doi":"10.1177/10775587231207668","DOIUrl":"10.1177/10775587231207668","url":null,"abstract":"<p><p>Home- and community-based services (HCBS) users, on average, experience hospitalizations more frequently than nursing facility residents. However, little is known about state-level variation in such adverse events among these groups. Using 2018 Medicare and Medicaid claims for dual-eligible beneficiaries with Alzheimer's disease and related dementias, we described hospitalization and emergency department (ED) visit rates among HCBS users and nursing facility residents and observed substantial state-level variation. In addition, consistent with prior evidence, we found more frequent hospitalizations and ED visits among HCBS users than nursing facility residents. The magnitude of this difference varied considerably across states, and the degree of variation was greatest among beneficiaries with six or more comorbid conditions. Our findings represent a crucial initial exploration of the state-level variation in adverse events among HCBS users and nursing facility residents, paving the way for further investigations into factors that contribute to this variability.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"271-279"},"PeriodicalIF":2.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693745","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}
引用次数: 0
Managing Surges in Demand: A Grounded Conceptual Framework of Surge Management Capability. 管理需求激增：浪涌管理能力的基础概念框架。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-06-01 Epub Date: 2024-01-25 DOI: 10.1177/10775587241226485
Jeffrey D Larson, Alden Yuanhong Lai, Matthew J DePuccio, Brian Hilligoss
{"title":"Managing Surges in Demand: A Grounded Conceptual Framework of Surge Management Capability.","authors":"Jeffrey D Larson, Alden Yuanhong Lai, Matthew J DePuccio, Brian Hilligoss","doi":"10.1177/10775587241226485","DOIUrl":"10.1177/10775587241226485","url":null,"abstract":"<p><p>Surge management is important to hospital operations, yet surge literature has mostly focused on the addition of resources (e.g., 25% more beds) during events like pandemics. Such views are limiting, as meeting surge demands requires hospitals to engage in practices tailored to a surge's unique contingencies. We argue that a dynamic view of surge management should include surge management capability, which refers to how resources are deployed to respond to surge contingencies. To understand this capability, we qualitatively studied five hospital systems experiencing multiple surges due to COVID-19 between April 2020 and March 2022. We develop a framework showing that managing surges involves preserving capacity, expanding capacity, smoothing capacity demand, and enabling surge management. We contribute to surge literature by identifying practices hospitals can adopt to address surges and offering a better understanding of surge conditions (e.g., degree of novelty) that make some surge management practices more appropriate than others.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"245-258"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547726","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}
引用次数: 0
Social Risk Factors and Racial and Ethnic Disparities in Health Care Resource Utilization Among Medicare Advantage Beneficiaries With Psychiatric Disorders. 有精神障碍的医疗保险优势受益人在医疗资源利用方面的社会风险因素及种族和民族差异。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-06-01 Epub Date: 2024-01-18 DOI: 10.1177/10775587231222583
Benjamin Lê Cook, Jeremiah Rastegar, Nikesh Patel
{"title":"Social Risk Factors and Racial and Ethnic Disparities in Health Care Resource Utilization Among Medicare Advantage Beneficiaries With Psychiatric Disorders.","authors":"Benjamin Lê Cook, Jeremiah Rastegar, Nikesh Patel","doi":"10.1177/10775587231222583","DOIUrl":"10.1177/10775587231222583","url":null,"abstract":"<p><p>The intersection of social risk and race and ethnicity on mental health care utilization is understudied. This study examined disparities in health care treatment, adjusting for clinical need, among 25,780 Medicare Advantage beneficiaries with a diagnosis of a psychiatric disorder. We assessed contributions to disparities from racial and ethnic differences in the composition and returns of social risk variables. Black and Hispanic beneficiaries had lower rates of mental health outpatient visits than Whites. Assessing composition, Black and Hispanic beneficiaries experienced greater financial, food, and housing insecurity than White beneficiaries, factors associated with greater mental health treatment. Assessing returns, food insecurity was associated with an exacerbation of Hispanic-White disparities. Health care systems need to address the financial, food and housing insecurity of racial and ethnic minority groups with psychiatric disorder. Accounting for racial and ethnic differences in social risk adjustment-based payment reforms has significant implications for provider reimbursement and outcomes.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"209-222"},"PeriodicalIF":2.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11168608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486802","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}
引用次数: 0
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