Health Services Research最新文献

{"title":"Concordance Indices for Risk Scores With Policy Evaluations.","authors":"Nicholas Hartman","doi":"10.1111/1475-6773.14619","DOIUrl":"https://doi.org/10.1111/1475-6773.14619","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the differences between concordance index (C-index) methodologies and clarify the appropriate usage for risk score evaluations in health services applications.</p><p><strong>Study setting and design: </strong>We performed a methodological comparison of C-index metrics and illustrated the consequences of these differences through a study of liver failure patients.</p><p><strong>Data sources and analytic sample: </strong>We analyzed secondary adult liver transplant registry data from the Organ Procurement and Transplantation Network (OPTN), including all waitlist registrations from 2002 to 2022.</p><p><strong>Principal findings: </strong>The recommended concordance metric based on Gerds' weighting was higher for the original model for end-stage liver disease (MELD) than Harrell's C-Index, Uno's C-Index, and naïve binary outcome metrics (0.864 [95% confidence interval (CI): 0.840, 0.888] versus 0.854 [95% CI: 0.844, 0.864], 0.832 [95% CI: 0.819, 0.844], and 0.727 [95% CI: 0.715, 0.740]), and it did not increase after the latest MELD formula update (0.874 [95% CI: 0.859, 0.889] to 0.869 [95% CI: 0.853, 0.885]).</p><p><strong>Conclusions: </strong>The concordance indices that are often used in health services applications have important deficiencies under policy-related dependent censoring, and researchers must apply appropriate weighting schemes to avoid bias. The findings uncover new interpretations of past evaluation results that have shaped national liver transplant policies.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14619"},"PeriodicalIF":3.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722483","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":"Association of COVID-19 Continuous Enrollment With Self-Reported Postpartum Medicaid Continuity and Coverage Inequities.","authors":"Erica L Eliason, Sarah H Gordon, Maria W Steenland","doi":"10.1111/1475-6773.14618","DOIUrl":"https://doi.org/10.1111/1475-6773.14618","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of extended postpartum Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) on self-reported postpartum insurance status among prenatal Medicaid recipients, and differences by state Medicaid expansion status and race, and ethnicity.</p><p><strong>Study setting and design: </strong>We used a global polynomial linear regression discontinuity design (RDD) approach to estimate the effect of extended postpartum Medicaid eligibility during the FFCRA on changes in self-reported postpartum Medicaid, private coverage, and uninsurance. This approach compares individuals who gave birth before FFCRA exposure with those who gave birth during extended postpartum Medicaid eligibility, using birth timing to determine FFCRA exposure. We estimated RDD models overall, by state Medicaid expansion status, and by race and ethnicity.</p><p><strong>Data sources and analytic sample: </strong>This study used 2018-2021 Pregnancy Risk Assessment Monitoring System data, a multi-state survey of individuals with a recent live birth, and a sample of prenatal Medicaid recipients age 20 or older in 29 study jurisdictions.</p><p><strong>Principal findings: </strong>In adjusted RDD models, extended Medicaid eligibility was associated with a 10.7 percentage point (pp) (95% CI: 8.7, 12.6) increase in postpartum Medicaid, a 3.5 pp (95% CI: -5.2, -1.8) decrease in postpartum private coverage, and a 6.5 pp (95% CI: -8.0, -5.0) decrease in postpartum uninsurance. In stratified RDD models, we found larger increases in postpartum Medicaid and larger decreases in uninsurance in non-expansion states than in Medicaid expansion states. In RDD models by race and ethnicity, we found similar increases in postpartum Medicaid and similar decreases in postpartum uninsurance among non-Hispanic Black respondents, Hispanic respondents, and non-Hispanic White respondents.</p><p><strong>Conclusions: </strong>We found significant improvements in postpartum Medicaid continuity and reductions in uninsurance during extended postpartum Medicaid eligibility. Postpartum Medicaid extensions under the American Rescue Plan could help maintain some coverage gains under the FFCRA.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14618"},"PeriodicalIF":3.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712202","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":"Medical Care for Patients With Mental Health and/or Substance-Use Disorders: A Qualitative Investigation of Emergency Department Patient Experiences and Recommendations.","authors":"Linda M Isbell, Van Le, Nathan R Huff, Kendall Beals, Julia B Tager, Ezekiel Kimball, Summer Whillock, Edwin D Boudreaux","doi":"10.1111/1475-6773.14617","DOIUrl":"https://doi.org/10.1111/1475-6773.14617","url":null,"abstract":"<p><strong>Objectives: </strong>(1) To investigate the healthcare experiences of individuals with mental health and/or substance use disorders (SUDs) who seek medical care in the emergency department (ED) for physical health concerns (e.g., abdominal pain), and (2) to explore recommendations for improving these patients' care experiences. Although this population suffers from a high disease burden and disproportionately seeks care in the ED, surprisingly little research has examined their experiences.</p><p><strong>Study setting and design: </strong>Qualitative study employing grounded theory and semi-structured interviews with patients with mental health and/or SUD(s) (identified via health records) seeking care for a physical health concern during an ED visit to an academic medical center in the Northeastern USA. Longer follow-up interviews were conducted via telephone. Interviews occurred between February 2018 and January 2019.</p><p><strong>Data sources and analytical sample: </strong>We transcribed and coded digital recordings of interviews with 50 patients at two time periods. We used constant comparative analysis throughout interviewing, coding, and analysis.</p><p><strong>Principal findings: </strong>Most participants were White (80%), non-Hispanic (84%), and female (72%). Three key themes emerged, revealing a broad range of negative and positive patient care experiences that are influenced by provider, treatment, and healthcare system factors. Findings demonstrate that stigma and perceived biases due to mental health and/or SUDs extend to medical care experiences not directly related to these conditions (e.g., dismissive, rushed, unprofessional care, medical errors). Participants also identified positive care experiences (e.g., attentive, communicative, efficient, quality care), which informed recommendations for improving care.</p><p><strong>Conclusions: </strong>Understanding care experiences of vulnerable patient populations is critically important for informing interventions to improve their healthcare quality and safety. Findings underscore the need for additional education and training for providers, integrated behavioral healthcare, and widespread changes to the healthcare system. Localized interventions that target stigma and mismatches between patients' care expectations and ED capabilities are also needed.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14617"},"PeriodicalIF":3.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712203","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":"Health, Housing, and Justice: Two-Year Implementation Evaluation of a Health System's Multi-State Medical-Legal Partnership to Address Housing Instability.","authors":"Natasha Arora, Sarah Terry, Holly R Stevens, Vanessa W Davis, Gerson Sorto, Bethany Hamilton, Marisa Conner, Alejandra Cabrera, Shane R Mueller, Maria Casoni, Hiba Elkhatib, Ellen Lawton, Elizabeth Tobin-Tyler","doi":"10.1111/1475-6773.14620","DOIUrl":"https://doi.org/10.1111/1475-6773.14620","url":null,"abstract":"<p><strong>Objective: </strong>To assess reach and identify facilitators of and barriers to the implementation of housing-focused medical-legal partnerships (MLPs) within a large healthcare system.</p><p><strong>Study setting and design: </strong>In 2021, Kaiser Permanente (KP) launched the Health, Housing, and Justice (HHJ) Initiative to embed MLPs within five medical centers across four states. KP invested in the capacity of five publicly funded legal aid providers to collaborate with healthcare teams and focus on housing stability. This paper summarizes findings from a mixed-methods implementation evaluation conducted from 2021 to 2023 on staff and system capacity, operational facilitators and barriers, and lessons learned.</p><p><strong>Data sources and analytic sample: </strong>Data sources included key informant interviews with healthcare and legal staff, surveys of social workers and care navigators, and administrative data on 857 legal referrals made by medical staff in 2022-2023 for housing-related legal support.</p><p><strong>Principal findings: </strong>Implementation characteristics and the rate of referrals varied across each of the six sites engaged in the multisite MLP. Attorneys reported that the MLP enabled access to legal resources for clients who typically would not have access. Most cases (82%) were addressed with fewer than 5 h of attorney time. Key implementation facilitators included clinical champions in the partnering medical team, staff training with a focus on knowledge of housing-related legal issues and MLP referral criteria, and existing social screening processes. Key implementation barriers were associated with information sharing, orienting legal partners to a complex medical system, and mismatches in service delivery areas between KP and the legal aid organizations.</p><p><strong>Conclusions: </strong>Embedding MLPs upstream in healthcare systems can enable access to legal resources for underserved clients. Attention to key implementation factors can support the spread of MLPs within other large healthcare systems.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14620"},"PeriodicalIF":3.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732602","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":"Highlights and Areas of Inquiry in the HSR Special Issue: Social Care and the US Health Care Sector.","authors":"Margarita Alegría, Carrie Fry, Mara Xiong, Laura Gottlieb","doi":"10.1111/1475-6773.14613","DOIUrl":"https://doi.org/10.1111/1475-6773.14613","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14613"},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702375","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":"It's the Healthcare Production Function Dummy… (And Still the Prices Stupid)!","authors":"Dennis P Scanlon, Yunfeng Shi, Lawton Robert Burns","doi":"10.1111/1475-6773.14611","DOIUrl":"https://doi.org/10.1111/1475-6773.14611","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14611"},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702378","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":"Bringing Lived Expertise to Academic Publishing Through Community Reviewers.","authors":"Danielle Hessler Jones, Yuri Cartier, Rebekah Angove","doi":"10.1111/1475-6773.14616","DOIUrl":"https://doi.org/10.1111/1475-6773.14616","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14616"},"PeriodicalIF":3.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694512","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":"\"When There Are Enough Cracks, Everyone Steps on Them\": Administrative Burdens in the US Health Care System.","authors":"Paul R Shafer","doi":"10.1111/1475-6773.14602","DOIUrl":"https://doi.org/10.1111/1475-6773.14602","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14602"},"PeriodicalIF":3.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665403","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":"Assessing Equitable Implementation of a Social Care Initiative Integrating Medical and Social Services for Medicaid Members.","authors":"Nadia Safaeinili, Emmeline Chuang, Elizabeth Hernandez, Emily Esteban, Mark Fleming, Shoba Ramanadhan, Amanda Brewster","doi":"10.1111/1475-6773.14603","DOIUrl":"https://doi.org/10.1111/1475-6773.14603","url":null,"abstract":"<p><strong>Objective: </strong>To assess the equitable implementation of a case management program integrating medical and social services for Medicaid members.</p><p><strong>Study setting and design: </strong>This qualitative study assessed the equitable implementation of a case management program in Contra Costa County, CA. Study participants were identified using purposive sampling. Semi-structured interviews were conducted in person or by phone.</p><p><strong>Data sources and analytic sample: </strong>Primary data were collected between Fall 2019 and Spring 2021 and included 92 semi-structured interviews with patients (n = 31), case managers (n = 47), and county administrators (n = 14). Data were coded using an inductive-deductive framework analysis approach informed by the Health Equity Implementation Framework (HEIF).</p><p><strong>Principal findings: </strong>Characteristics of the innovation influencing equitable implementation included experienced public health nursing leadership and inclusion of social risk factors in a predictive algorithm determining patient program eligibility. Recipient factors included inequitable emotional demands of medical and social service integration work on case management teams from diverse racial/ethnic and training backgrounds, and patient experiences of mistreatment from medical and social service institutions. Clinical encounter factors highlighted the necessity for trust building between patients and case managers and the importance of multidisciplinary expertise to address patients' interconnected medical and social needs. Contextual factors described organizational readiness in the form of multidisciplinary teams with reduced hierarchical power imbalances, system-wide investments in a universal data infrastructure and data insights team, and strong intra- and inter-organizational partnerships. Societal factors included systemic discrimination and racism, insufficient affordable housing and public transit, pervasive administrative barriers in accessing health and social services, and federal funding for holistic approaches to integrated care.</p><p><strong>Conclusions: </strong>Case management programs aiming to equitably integrate social and medical services should invest in multidisciplinary case management teams, organizational readiness for equitable implementation via committed, experienced leadership, and interventions to address systemic factors hindering the engagement of historically marginalized groups.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14603"},"PeriodicalIF":3.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665405","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":"Does Low-Value Care Explain Health Care Utilization Inequities Among Asian and Latino Populations?","authors":"Sungchul Park, Jie Chen, Arturo Vargas Bustamante, Alexander N Ortega","doi":"10.1111/1475-6773.14610","DOIUrl":"https://doi.org/10.1111/1475-6773.14610","url":null,"abstract":"<p><strong>Objectives: </strong>To examine differences in the utilization of low-value care among Asian and Latino subpopulations compared to the White population.</p><p><strong>Study setting and design: </strong>We analyzed data from a repeated cross-sectional national survey.</p><p><strong>Data sources and analytical sample: </strong>Our sample included a non-Latino White population and Asian and Latino subpopulation groups using data from the 2013-2021 Medical Expenditure Panel Survey.</p><p><strong>Principal findings: </strong>Asian and Latino subpopulations used health care services less frequently than the White population, with adjusted differences ranging from -3.2% points (95% CI: -3.9, -2.4) to -9.4 (-10.1, -8.7) for outpatient visits, -5.2 (-5.9, -4.5) to -12.4 (-15.2, -9.6) for office-based provider visits, and -5.2 (-6.7, -3.8) to -19.1 (-21.6, -16.7) for prescription drug fills. Although certain low-value services were reported less among Asian and Latino subpopulations, there were no differences in almost six out of twelve services when compared to the White population. These patterns were notable among Asian subpopulations (Indians, Chinese, Filipinos, and other Asians). Additionally, Asian and Latino subpopulation groups had distinct patterns in the use of low-value care. Compared to the White population, Asian subpopulation groups had lower utilization of low-value medications including benzodiazepines for depression (-11.5 [-15.1, -8.0] to -13.8 [-24.4, -3.3]) and opioids for back pain (-4.4 [-8.5, -0.3] to -10.1 [-13.6, -6.7]). Latino subpopulation groups had higher utilization of low-value cervical cancer screening (5.7 [3.0-8.4] to 24.5 [16.9-32.1]) and lower utilization of magnetic resonance imaging/computed tomography for back pain (-1.6 [-2.4, -0.8] to -4.9 [-7.1, -2.6]) than the White population.</p><p><strong>Conclusions: </strong>Despite lower overall health care utilization, Asian and Latino subpopulations do not necessarily use the low-value care examined in this study less than the White population. This suggests that lower overall health care utilization among Asian and Latino subpopulations may not solely be attributed to lower use of low-value care.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14610"},"PeriodicalIF":3.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665407","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}