Health Services Research最新文献

{"title":"Practice-Level Clustering of Industry Payments to Clinicians.","authors":"Max J Hyman, Micah T Prochaska, Parth K Modi","doi":"10.1111/1475-6773.70004","DOIUrl":"https://doi.org/10.1111/1475-6773.70004","url":null,"abstract":"<p><strong>Objective: </strong>To test whether industry payments to clinicians are clustered at the level of the medical practice.</p><p><strong>Study setting and design: </strong>We performed a cross-sectional study of clinicians who billed Medicare Part B in 2021 to test whether the receipt of an industry payment, log total value of industry payments, or log total number of industry payments to clinicians were clustered at the level of the medical practice. We used mixed effects linear regression to analyze practice-level clustering, controlling for clinician sex, age, urbanicity, state, and specialty, as well as practice size and specialty.</p><p><strong>Data source and analytic sample: </strong>We used the 2021 Medicare Data on Provider Practice and Specialty file to assign clinicians to medical practices, and the 2021 General Payment Data from the Open Payments Program to calculate the total value and number of industry payments to each clinician.</p><p><strong>Principal findings: </strong>We identified 996,982 clinicians who billed Medicare Part B in 2021, of whom 679,577 (68.2%) were physicians and 317,305 (31.8%) were advanced practice clinicians. These clinicians worked across 109,952 medical practices. In total, 474,312 (47.6%) clinicians received an industry payment in 2021. The average total value of industry payments was $1497 (SD $54,823), and the average total number of industry payments was 9.4 (SD 27.5). Regression analysis of each outcome identified significant clustering at the level of the medical practice, including 24.8% of the variation in the receipt of an industry payment, 36.8% in the log total value of industry payments, and 60.5% in the log total number of industry payments.</p><p><strong>Conclusions: </strong>Industry payments to clinicians are strongly clustered by medical practice. Future research should examine the role of the medical practice in facilitating financial conflicts of interest between industry and clinicians.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70004"},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509517","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":"System-Level Predictors of Long-Acting Reversible Contraception Provision in the Veterans Health Administration.","authors":"Zoe H Pleasure, Siobhan S Mahorter, Rachel Hunter-Merrill, Jonathan G Shaw, Kavita Vinekar, Maria K Mor, Susan M Frayne, Lisa S Callegari","doi":"10.1111/1475-6773.14650","DOIUrl":"https://doi.org/10.1111/1475-6773.14650","url":null,"abstract":"<p><strong>Objective: </strong>To examine the provision of long-acting reversible contraceptive (LARC) methods across the Veterans Health Administration's (VA) 140 regional healthcare systems and investigate system-level correlates of low provision as an indicator of potential access barriers.</p><p><strong>Study setting and design: </strong>We conducted a cross-sectional analysis of national VA electronic health record (EHR) data. For each regional healthcare system, we calculated the percentage of pregnancy-capable Veterans who received a LARC method (intrauterine device or contraceptive implant). We categorized healthcare systems in the bottom quartile as low-provision. We examined associations between low-provision and system-level factors, including gynecologist staffing per pregnancy-capable Veteran, Women's Health Medical Director protected time, percent of pregnancy-capable Veterans visiting a women's health clinic, and LARC provision at ≥ 1 community-based outpatient clinic (CBOC).</p><p><strong>Data sources and analytic sample: </strong>We performed a secondary analysis of EHR data for female pregnancy-capable Veterans ages 18-44 who visited VA primary care or gynecology in 2019. We evaluated associations with chi-squared tests and multivariable logistic regression adjusting for Veteran-level factors.</p><p><strong>Principal findings: </strong>The median percentage of Veterans receiving LARC methods across healthcare systems was 4.9%, varying from 0% to 12.0%. In multivariable modeling, each 5% increase in gynecologist half-days per 100 pregnancy-capable Veterans was associated with an average two-percentage point decrease in the probability of being a low-provision system (average marginal effect [AME] = -0.02, 95% CI: -0.02, -0.01). LARC provision at ≥ 1 CBOCs was associated with an average 17-percentage point decrease in the probability of being a low-provision system (AME = -0.17, 95% CI: -0.29, -0.05).</p><p><strong>Conclusions: </strong>We found significant variation in LARC provision across the VA's 140 regional healthcare systems. Importantly, this EHR analysis is limited as it does not incorporate patient demand for methods. Our findings, however, indicate potential access barriers. Interventions, such as increasing gynecologist staffing and investing in LARC provision in CBOCs, could help ensure access to these methods.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14650"},"PeriodicalIF":3.1,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487195","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":"Regionalization of Hip Fracture Care in Five High-Income Countries.","authors":"Pieter Bakx, Carlos Godoy, Saeed Al-Azazi, Amitava Banerjee, Nitzan Burrack, David Ehlig, Christina Fu, Laura A Hatfield, Asa R Hartman, Nicole Huang, Dennis T Ko, Lisa M Lix, Dominik Moser, Victor Novack, Laura Pasea, Feng Qiu, Kieran L Quinn, Bheeshma Ravi, Therese A Stukel, Carin A Uyl-de Groot, Bruce E Landon, Peter Cram","doi":"10.1111/1475-6773.70002","DOIUrl":"https://doi.org/10.1111/1475-6773.70002","url":null,"abstract":"<p><strong>Objective: </strong>To describe differences in regionalization of hip fracture care and the volume-outcome relationship in five countries.</p><p><strong>Study setting and design: </strong>We conducted a population-based cross-sectional cohort study in Canada, Israel, the Netherlands, Taiwan, and the United States. Within each country, we stratified patients into quintiles based upon the volume of hip fractures in the hospital where they were treated. We measured regionalization by the proportion of acute-care hospitals that treated patients with hip fractures and summarized the hospital volume distribution by the ratio of hip fracture volumes for high-volume hospitals versus low-volume hospitals. We then examined age- and sex-standardized outcomes and treatment for patients treated at high-volume and low-volume hospitals.</p><p><strong>Data sources and analytic sample: </strong>We used nationally representative administrative data on adults aged ≥ 66 years hospitalized with hip fracture from 2011 to 2019. We followed them until death or 365 days after the discharge date.</p><p><strong>Principal findings: </strong>Across countries, the percentage of all acute-care hospitals that treated hip fractures differed widely (from 37.0% in Canada to 82.8% in Israel), with high-volume hospitals treating 4-14 times as many hip fractures as low-volume hospitals. The absolute risk-adjusted difference in 30-day mortality for high-volume compared to low-volume hospitals ranged between (-1.9% [95% CI, -2.2 to -1.7] in Canada and +1.1% [95% CI, 0.4-1.8] in the Netherlands). The proportion of patients receiving non-operative fracture treatment was lower in high-volume hospitals than low-volume hospitals in all countries (-5.4% [95% CI, -6.5 to -4.3] in Israel to -0.1% [95% CI, -0.5 to 0.3] in the Netherlands).</p><p><strong>Conclusions: </strong>Hip fracture regionalization differed substantially across countries. The direction and the magnitude of association between greater regionalization and improved patient outcomes were inconsistent across countries.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70002"},"PeriodicalIF":3.1,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477945","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 the Veterans Crisis Line Caring Letters Project With Health Services Utilization and Health Outcomes Among Veterans With Elevated Psychiatric Risk.","authors":"Samantha G Auty, Melissa M Garrido, Aaron Legler, Sivagaminathan Palani, Caitlin Manchester, MaryGrace Lauver, Jolie E Bourgeois, Mark A Reger","doi":"10.1111/1475-6773.14657","DOIUrl":"https://doi.org/10.1111/1475-6773.14657","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether the Veterans Crisis Line (VCL) Caring Letters (CL) intervention impacted outcomes among Veterans at elevated psychiatric risk.</p><p><strong>Study setting and design: </strong>This secondary analysis of a randomized clinical trial examined the association of CL, an evidence-based suicide prevention intervention, among Veterans who contacted the VCL from June 2020 to June 2021.</p><p><strong>Data sources and analytic sample: </strong>Data on Veterans was obtained from the Veterans Health Administration's (VHA) Corporate Data Warehouse (N = 186,514). Time-to-event models stratified by indicators of psychiatric risk were used to assess the association of CL with outcomes.</p><p><strong>Principal findings: </strong>Receipt of CL, regardless of psychiatric risk status, was associated with increased utilization of outpatient mental health services. Among those with no indicators of psychiatric risk, receipt of CL was associated with increased use of all-cause outpatient and inpatient services. The intervention did not have a significant impact on all-cause mortality among those with or without indicators of psychiatric risk.</p><p><strong>Conclusions: </strong>CL was associated with increased use of VHA services among those with and without indicators of psychiatric risk. Increased use of VHA services may represent appropriate use of high-value mental health services for Veterans who are experiencing crises.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14657"},"PeriodicalIF":3.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327820","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":"HIV Clinic Visit Attendance Among People With HIV Aged 50+ Years: Exploring the Role of Increasing Age, Comorbidity Burden, and the COVID-19 Pandemic.","authors":"Rohini Dasan, Elisabeth Andersen, Morgan Byrne, Jessica Helm, Alan E Greenberg, Amanda D Castel, Anne K Monroe","doi":"10.1111/1475-6773.14659","DOIUrl":"https://doi.org/10.1111/1475-6773.14659","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of advancing age, comorbidity burden, and the COVID-19 pandemic on HIV clinic visit attendance.</p><p><strong>Study setting and design: </strong>We implemented a repeated cross-sectional study using an ongoing longitudinal cohort of people with HIV (PWH) receiving care in Washington, DC.</p><p><strong>Data sources and analytic sample: </strong>Our primary exposures of interest were older age categories (60-69 and 70+ compared with 50-59 years), Veterans Aging Cohort Study (VACS) Index (surrogate for comorbidity burden), calendar year (with the three time points of 2018, 2020, and 2022 representing pre-, peri- and post-COVID). Our outcome was the number of HIV clinic visits (including telehealth) in 2018, 2020, and 2022. Associations were assessed using zero-inflated negative binomial modeling.</p><p><strong>Principal findings: </strong>4041 (72.7% men, 59.3% ages 50-59; 78.8% Black) DC Cohort participants aged 50+ years were included. In 2018, mean VACS indices for participants aged 50-59, 60-69, and 70+ years were 27.5 (standard deviation [SD] 15.8), 36.9 (SD 17.8), and 50.7 (SD 15.5) respectively. Increase in VACS Index was associated with increase in HIV clinic visits (Rate ratio: 1.03, 95% CI 1.01, 1.05). A VACS Index-calendar year interaction term was significant, indicating the relationship between VACS Index and visits was attenuated in the post-COVID time period. All age groups experienced a decrease in visits from 2018 to 2022. HIV RNA suppression remained stable.</p><p><strong>Conclusions: </strong>These findings underscore the pandemic's impact on accessing healthcare among the most vulnerable, that is, the oldest participants with the most comorbidities. Developing differential care models for PWH to target services to their local context, clinical status, and preferences may point to a broader public health approach to mitigate post-pandemic changes in HIV care utilization.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14659"},"PeriodicalIF":3.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318766","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":"COVID-19-Related Financial Hardship and Adherence to Adjuvant Endocrine Therapy Among Women With Early-Stage Breast Cancer.","authors":"Sara Arshad, Xin Hu, Rebecca A Krukowski, Teresa M Waters, Gregory A Vidal, Lee Schwartzberg, Joseph Lipscomb, Ilana Graetz","doi":"10.1111/1475-6773.14658","DOIUrl":"https://doi.org/10.1111/1475-6773.14658","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between COVID-19-related hardship and 1-year adjuvant endocrine therapy (AET) adherence among women with early-stage hormone-receptor-positive breast cancer.</p><p><strong>Study setting and design: </strong>This post hoc analysis utilized data from the THRIVE trial, which tested a 6-month remote monitoring intervention on 1-year AET adherence, measured using an electronic pillbox. The 1-year follow-up survey included questions about pandemic-related hardship, including financial loss, changes/gaps in health insurance, and difficulty accessing basic needs. Participants reporting any of these were categorized as experiencing pandemic-related hardship. Logistic regressions estimated the association between patient characteristics and pandemic-related hardship, and between hardship and AET adherence (≥ 80% proportion of days covered), controlling for patient characteristics and randomization group.</p><p><strong>Data sources and analytic sample: </strong>We included 217 women diagnosed with early-stage breast cancer prescribed AET at a large cancer center who enrolled in THRIVE between April 2019 and June 2021.</p><p><strong>Principal findings: </strong>Overall, 39.6% of participants reported any pandemic-related hardship: 34.6% reported financial loss, 10.6% reported changes/gaps in insurance, and 11.1% reported difficulty accessing basic needs. In adjusted analyses, having an income ≤ 100% of federal poverty level or prior chemotherapy or radiation was associated with a 41.4 (95% CI: 9.8-73.0) and 13.8 (95% CI: 0.3-27.2) percentage-point higher likelihood, respectively, of having any pandemic-related hardship. Over half (52%) of participants were AET adherent. In adjusted analyses, 40.1% of those with any pandemic-related hardship were AET adherent, compared with 59.5% of those without hardship, a 19.3 percentage-point lower likelihood (95% CI: -33.0 to -5.7).</p><p><strong>Conclusions: </strong>Pandemic-related hardship was more common among individuals with lower income or prior radiation or chemotherapy, and was associated with lower AET adherence, with possible impacts on cancer progression and survival. These findings highlight the need for routine financial screening and targeted support, particularly among lower-income patients on long-term AET.</p><p><strong>Trial registration: </strong>NCT03592771.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14658"},"PeriodicalIF":3.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318765","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":"Insulin Out-of-Pocket Spending Caps and Employer-Sponsored Insurance: Changes in Out-of-Pocket and Total Costs for Insulin and Healthcare.","authors":"Khrysta A Baig, Carrie E Fry, Melinda B Buntin, Alvin C Powers, Stacie B Dusetzina","doi":"10.1111/1475-6773.14656","DOIUrl":"https://doi.org/10.1111/1475-6773.14656","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the impact of state-level insulin out-of-pocket caps on changes in out-of-pocket and total costs of insulin and healthcare for insulin users with employer-sponsored insurance.</p><p><strong>Study setting and design: </strong>We evaluated changes in costs using a quasi-experimental (triple difference-in-differences; \"DDD\") design to analyze multi-carrier claims from insulin users enrolled in fully insured (state-regulated) and self-funded (generally exempt) employer-sponsored plans in 10 states with caps by January 2021 compared to no-cap states pre-/post-cap implementation. Primary outcomes were changes in insulin out-of-pocket spending, total (plan + member) paid for insulin, and total healthcare costs. Secondary outcomes were intermediary (e.g., pharmaceutical) changes in out-of-pocket and total costs.</p><p><strong>Data sources and analytic sample: </strong>In the policy year (no-cap states: 2021), we identified 218,441 insulin-users in the Health Care Cost Institute 2.0 Dataset (cap states: 27,834 in fully insured and 22,131 in self-funded plans; no-cap states: 97,239 in fully insured and 71,237 in self-funded plans) and 215,635 in the year prior.</p><p><strong>Principal findings: </strong>We found evidence of modest decreases in 30-day standardized (DDD: -$5 [95% CI: -$6 to -$4]; p < 0.001) and annual (DDD: -$67 [95% CI: -$82 to -$51]; p < 0.001) insulin out-of-pocket spending. Savings increased by spending quantile (e.g., 95th-percentile change:-$347 [95% CI: -$460 to $233]). Difference-in-differences (DiD) comparing fully insured to self-funded plans within cap-states showed larger changes (e.g., 95th-percentile annual insulin out-of-pocket:-$484 [95% CI: -$651 to -$318]), likely due to policy spillover effects (i.e., fully insured plans decreased out-of-pocket in no-cap states). Change in annual total paid for healthcare was not statistically significant (DDD:-$1082 [95% CI: -$2918 to $755]; p < 0.25). We saw no evidence of caps increasing out-of-pocket or total spending on insulin, prescriptions, or healthcare.</p><p><strong>Conclusions: </strong>Our findings suggest early caps had modest effects on out-of-pocket spending among fully insured insulin users, with larger savings for those at the top of the spending distribution and no total cost increases. Policy effects may be greater than observed; they likely lag implementation and develop over time.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14656"},"PeriodicalIF":3.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318767","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":"Importance of Prior Patient Interactions With the Healthcare System to Engaging With Pretest Cancer Genetic Services via Digital Health Tools Among Unaffected Primary Care Patients: Findings From the BRIDGE Trial.","authors":"Lingzi Zhong, Jemar R Bather, Melody S Goodman, Lauren Kaiser-Jackson, Molly Volkmar, Richard L Bradshaw, Rachelle Lorenz Chambers, Daniel Chavez-Yenter, Sarah V Colonna, Whitney Maxwell, Michael Flynn, Amanda Gammon, Rachel Hess, Devin M Mann, Rachel Monahan, Yang Yi, Meenakshi Sigireddi, David W Wetter, Kensaku Kawamoto, Guilherme Del Fiol, Saundra S Buys, Kimberly A Kaphingst","doi":"10.1111/1475-6773.14652","DOIUrl":"https://doi.org/10.1111/1475-6773.14652","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether patient sociodemographic and clinical characteristics and prior interactions with the healthcare system were associated with opening patient portal messages related to cancer genetic services and beginning services.</p><p><strong>Study setting and design: </strong>The trial was conducted in the University of Utah Health (UHealth) and NYU Langone Health (NYULH) systems. Between 2020 and 2023, 3073 eligible primary care patients aged 25-60 years meeting family history-based criteria for cancer genetic evaluation were randomized 1:1 to receive a patient portal message with a hyperlink to a pretest genetics education chatbot or information about scheduling a pretest standard of care (SOC) appointment.</p><p><strong>Data sources and analytic sample: </strong>Primary data were collected. Eligible patients had a primary care visit in the previous 3 years, a patient portal account, no prior cancer diagnosis except nonmelanoma skin cancer, no prior cancer genetic services, and English or Spanish as their preferred language. Multivariable models identified predictors of opening patient portal messages by site and beginning pretest genetic services by site and experimental condition.</p><p><strong>Principal findings: </strong>Number of previous patient portal logins (UHealth average marginal effect [AME]: 0.32; 95% CI: 0.27, 0.38; NYULH AME: 0.33; 95% CI: 0.27, 0.39), having a recorded primary care provider (NYULH AME: 0.15; 95% CI: 0.08, 0.22), and more primary care visits in the previous 3 years (NYULH AME: 0.09; 95% CI: 0.02, 0.16) were associated with opening patient portal messages about genetic services. Number of previous patient portal logins (UHealth AME: 0.14; 95% CI: 0.08, 0.21; NYULH AME: 0.18; 95% CI: 0.12, 0.23), having a recorded primary care provider (NYULH AME: 0.08; 95% CI: 0.01, 0.14), and more primary care visits in the previous 3 years (NYULH AME: 0.07; 95% CI: 0.01, 0.13) were associated with beginning pretest genetic services. Patient sociodemographic and clinical characteristics were not significantly associated with either outcome.</p><p><strong>Conclusions: </strong>As system-level initiatives aim to reach patients eligible for cancer genetic services, patients already interacting with the healthcare system may be most likely to respond. Addressing barriers to accessing healthcare and technology may increase engagement with genetic services.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14652"},"PeriodicalIF":3.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267915","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":"Staff Experiences With Implementation of the Referral Coordination Initiative.","authors":"Ashley C Mog, Anna Woolery, Kelty Fehling, Makkawi Makkawi, Colin I O'Donnell, Edward O'Brien, Paul L Hebert, Brian N Palen, David H Au, Lisa M Arfons, David Winchester, Lucas M Donovan","doi":"10.1111/1475-6773.14654","DOIUrl":"https://doi.org/10.1111/1475-6773.14654","url":null,"abstract":"<p><strong>Objective: </strong>To understand VHA staff experiences with the referral coordination initiative (RCI) following nationwide dissemination.</p><p><strong>Study setting and design: </strong>RCI uses a team-based approach to improve the timeliness, efficiency, and patient-centeredness of specialty care referrals, while redistributing the time-intensive triage tasks from specialist providers to nurses. To assess frontline experiences with RCI, we purposively sampled four VHA sites for qualitative interviews, ensuring variability around the use of nurses in triage and the organization of scheduling staff within three high-volume specialties: cardiology, gastroenterology, and pulmonary. From May to December 2023, we conducted semi-structured interviews with 68 VHA staff members who engaged in various aspects of referral coordination, including interviews with nurses, schedulers, specialists, and referring providers.</p><p><strong>Data sources and analytic sample: </strong>We asked staff about challenges and facilitators to RCI implementation and maintenance. If certain RCI elements (e.g., nurse triage) were not implemented, we asked about anticipated challenges and facilitators. We analyzed qualitative data concurrently with data collection using a rapid matrix analysis approach.</p><p><strong>Principal findings: </strong>Staff expressed varying perceptions around the effects of RCI and its impacts on specialist burden and clinic staffing. We identified challenges to RCI, including (1) inconsistent staff perceptions around program goals, (2) mixed perceptions around the appropriateness of nurse triage, (3) lack of clear specialty-specific triage guidelines, and (4) limited coordination with schedulers. Key facilitators of RCI included (1) leveraging existing relationships and nurses with existing specialty-specific expertise, and (2) building relationships and clear triage guidelines with specialties.</p><p><strong>Conclusions: </strong>To streamline patient-centered referrals, health systems should foster working relationships between referral management teams and specialties. While nurse-led triage can improve efficiency, concerted efforts are necessary to train nurses and develop clear triage criteria.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14654"},"PeriodicalIF":3.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250881","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":"Where Can Artificial Intelligence Assist Cancer Care?: Examining Patient-Centered Communication Dimension Effects.","authors":"Qiwei Luna Wu, Yue Liao, Grace Ellen Brannon","doi":"10.1111/1475-6773.14653","DOIUrl":"https://doi.org/10.1111/1475-6773.14653","url":null,"abstract":"<p><strong>Objective: </strong>To explore how aspects of patient-centered communication (PCC) may directly or indirectly predict patients' preferences for artificial intelligences (AIs) versus human medical professionals, based on the stimulus-organism-response model.</p><p><strong>Study setting and design: </strong>As AI gains popularity and researchers explore its application in the medical context, it is important to understand how current patient-provider dynamics involving high technology (e.g., telehealth communication) may shape patients' perceptions of future use of AI, especially in the context of cancer care where patient satisfaction and sense of care continuity are important. Participants were recruited from an online panel in China (June 2024). Structural equation modeling analyzed the relationships among variables, including six PCC dimensions (i.e., exchanging information, fostering healing relationships, making decisions, managing uncertainty, responding to emotions, and enabling patient self-management), communication outcomes (i.e., patient satisfaction, sense of care continuity), and patients' preference of AIs vs. human medical professionals.</p><p><strong>Data sources and analytic sample: </strong>Primary data were collected from an online panel of 495 Chinese cancer patients in China, representative of the gender and age distribution of the overall Chinese population due to quota sampling.</p><p><strong>Principal findings: </strong>Direct predictors of preference for replacing human medical professionals with AIs included lower patient satisfaction (β = -11, p < 0.05), lower ease of use (β = -0.1, p < 0.05), better care continuity (β = 0.15, p < 0.01), providers' attending to emotions (β = 0.17, p < 0.05), and less enablement in self-management (β = -0.17, p < 0.01). Patient satisfaction, ease of use, and care continuity mediated the relationships between different PCC dimensions and patients' preferences for AI use.</p><p><strong>Conclusions: </strong>PCC and communication outcomes are associated with cancer patients' preferences in future AI use. Our study sheds light on how clinicians may improve their communication to educate patients on navigating the cancer care continuum using AI technology.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14653"},"PeriodicalIF":3.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235980","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}