Health Services Research最新文献

{"title":"Hospital Mergers and Acquisitions From 2010 to 2019: Creating a Valid Public Use Database.","authors":"Hyesung Oh, Vincent Mor, Daeho Kim, Andrew Foster, Momotazur Rahman","doi":"10.1111/1475-6773.14642","DOIUrl":"https://doi.org/10.1111/1475-6773.14642","url":null,"abstract":"<p><strong>Objective: </strong>To create, analyze, and distribute the Strategic Hospital Mergers & Acquisitions (M&A) Database, a detailed resource of hospital M&As from 2010 to 2019.</p><p><strong>Study setting and design: </strong>We conducted more than 2000 Internet searches to supplement, verify, and correct M&A identifications of American Hospital Association (AHA) survey data. We assessed the accuracy of the AHA survey and performed staggered difference-in-differences analyses to estimate the impact of measurement error on treatment effects capturing shifts in our measure of hospital market power.</p><p><strong>Data sources and analytic sample: </strong>We analyzed 1537 M&A-related ownership changes from 2010 to 2019 from our analytic sample of 4896 unique acute care general hospitals or critical access hospitals derived from the AHA Annual Survey dataset.</p><p><strong>Principal findings: </strong>The AHA survey dataset correctly identified the M&A deal completion year for only 40.1% of M&A-related ownership changes. The improved accuracy and granular treatment indicators of our database corrected for underestimations of the impact of hospital consolidation on hospital market power, yielding an effect estimate over 200% higher than the uncorrected data.</p><p><strong>Conclusions: </strong>By reducing errors in hospital M&A identification, our database can enhance the quality of studies investigating the effects of hospital consolidation on healthcare access and health outcomes.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14642"},"PeriodicalIF":3.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046746","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":"State Bans on Sexual Orientation and Gender Identity Change Efforts and Youth Suicidality.","authors":"Lindsay N Overhage, Benjamin Lê Cook, Meredith B Rosenthal, Laura A Hatfield, Alex McDowell","doi":"10.1111/1475-6773.14635","DOIUrl":"https://doi.org/10.1111/1475-6773.14635","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of state legislation banning healthcare workers from using sexual orientation and gender identity change efforts with minors (attempts to convert sexual and gender diverse individuals to be heterosexual and/or cisgender; also known as \"conversion therapies\") on adolescent suicidality.</p><p><strong>Study setting and design: </strong>We used high school student responses to the 2011-2019 Youth Risk Behavior Survey. Using a quasi-experimental stacked difference-in-differences (DID) approach, we estimated the association between bans and rates of seriously considering suicide in the past year. In states that included sexual orientation survey questions, we assessed the association between bans and considering suicide for sexual minority and heterosexual youth.</p><p><strong>Data sources and analytic sample: </strong>Retrospective analysis of 181,950 youth across four treatment states (Illinois, Connecticut, Rhode Island, and Maryland) and 240,268 youth across 25 control states. Treatment states included those that: (1) passed bans during the study period, (2) passed bans independent of antibullying and nondiscrimination laws, and (3) participated in the Youth Risk Behavior Survey for one wave before and one wave after passing a ban. For secondary analyses by sexual identity, 11 control states were available.</p><p><strong>Principal findings: </strong>Among respondents, 17% reported seriously considering suicide in the prior year. In the 2 years following sexual orientation and gender identity change effort bans, rates of considering suicide were 2.9 percentage points lower (95% CI: -4.2, -1.6) in states with bans compared to control states. Improvements appeared to be larger for lesbian, gay, and bisexual youth (4.6 percentage point reduction; 95% CI: -6.4, -2.8) than for heterosexual youth. Reductions were statistically significant in Illinois, Connecticut, and Rhode Island compared to control states, but not in Maryland.</p><p><strong>Conclusions: </strong>State laws banning sexual orientation and gender identity change efforts by healthcare providers for minors were associated with reduced rates of considering suicide among high school students.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14635"},"PeriodicalIF":3.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045155","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":"Price-Shifting? Spillovers of Medicare Advantage Network Inclusion on Hospital Prices Paid by Commercial Insurers.","authors":"Jeffrey Marr, Daniel Polsky, Mark K Meiselbach","doi":"10.1111/1475-6773.14640","DOIUrl":"https://doi.org/10.1111/1475-6773.14640","url":null,"abstract":"<p><strong>Objective: </strong>To compare inpatient hospital prices in the commercial insurance market between insurers that do and do not include hospitals in their Medicare Advantage (MA) networks.</p><p><strong>Study setting and design: </strong>We compared inpatient negotiated commercial prices between insurers at the same hospital that do not include the hospital in their MA network and those that do. We used Poisson regression with hospital fixed effects, adjusting for insurer fixed effects and insurer-market covariates.</p><p><strong>Data sources and analytic sample: </strong>Using data from Turquoise Health, the American Hospital Association survey, and Clarivate DRG, we identified 5654 insurer-hospital pairs for seven large insurers that participate in both the commercial and MA markets.</p><p><strong>Principal findings: </strong>Insurers pay 4.7% higher commercial prices for major joint replacements when the hospital is in their MA network (95% confidence interval: 2.0, 7.5%). The average adjusted negotiated commercial price in our sample was $28,889.91 when the insurer did not have the hospital in its MA network but $30,249.16 when it did. We find similar magnitudes for the four other \"shoppable service\" diagnosis related groups commonly reported in the transparency data.</p><p><strong>Conclusion: </strong>On average, insurers pay higher commercial prices to hospitals that are in their MA network.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14640"},"PeriodicalIF":3.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033949","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":"Delaying Screening Until Covered? Changes in Lung Cancer Screening at the Age of Nearly-Universal Medicare Insurance.","authors":"Marcelo C Perraillon, Adam Warren, Lenka Goldman, Jamie L Studts, Rebecca M Myerson","doi":"10.1111/1475-6773.14638","DOIUrl":"https://doi.org/10.1111/1475-6773.14638","url":null,"abstract":"<p><strong>Objective: </strong>To estimate changes in lung cancer screening at age 65, the age of nearly universal Medicare coverage.</p><p><strong>Study setting and design: </strong>Screening reduces lung cancer mortality but is underutilized. We used a regression discontinuity design to measure the impact of nearly universal Medicare coverage at age 65 on first-time receipt of screening (primary outcome) and the proportion of screened individuals with detected lung cancer (secondary outcome).</p><p><strong>Data sources and analytic sample: </strong>First-time screens at age 60-69 in the American College of Radiology's Lung Cancer Screening Registry data, 2015-2020.</p><p><strong>Principal findings: </strong>Nearly-universal access to Medicare at 65 increased first-time lung cancer screening by 5450 per year (CI 4911-5990), a 41% increase compared to age 64. Eighty-nine percent of additional screens were among people who met screening eligibility criteria. Increases at age 65 were larger in rural areas than nonrural areas (52% vs. 39%) and were similar for men and women (41% and 42%). There was no statistically significant change in the proportion of screened individuals with lung cancer detected.</p><p><strong>Conclusion: </strong>First-time receipt of lung cancer screening increases at age 65, particularly among people in rural areas. Cancer detection rates did not worsen, suggesting screening remained well targeted as it increased.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14638"},"PeriodicalIF":3.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049336","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":"Patterns of Lesbian, Gay, Bisexual, Transgender, and Queer Patient Experiences and Receipt of Preventive Services.","authors":"Nathaniel M Tran, Gilbert Gonzales, Carrie E Fry, Stacie B Dusetzina, Tara McKay","doi":"10.1111/1475-6773.14632","DOIUrl":"https://doi.org/10.1111/1475-6773.14632","url":null,"abstract":"<p><strong>Objective: </strong>To identify patterns of LGBTQ+ patient experiences, to identify sociodemographic characteristics associated with patterns of LGBTQ+ patient experiences, and to assess the relationship between LGBTQ+ patient experience and receipt of preventive services.</p><p><strong>Study setting and design: </strong>This observational cohort study included adults across the U.S. South. We conducted latent class analysis of seven indicators of clinical and cultural competency to identify patterns of LGBTQ+ patient experiences. Outcomes included the proportion of respondents with lifetime and recent influenza vaccination, HIV testing, and colorectal cancer screening.</p><p><strong>Data sources and analytic sample: </strong>Data come from Waves 1 and 2 of the LGBTQ+ Social Networks, Aging, and Policy Study collected between April 2020 and October 2022. The sample included 954 LGBTQ+ adults ages 50-76 living in Tennessee, Georgia, Alabama, or North Carolina at baseline.</p><p><strong>Principal findings: </strong>We identified three patterns of LGBTQ+ patient experiences. 34% of the sample reported LGBTQ+ affirming care, 60% reported neutral care, and 6% reported discriminatory care. Gender identity, sexual orientation, race and ethnicity, state of residence, and HIV status predicted patterns of patient experiences (all p < 0.01). Compared to patients with affirming care, patients with neutral care were 12.4 percentage points less likely to have ever been tested for HIV (p < 0.0001) and 17.1 percentage points less likely to have been recently tested for HIV (p < 0.0001); patients reporting discriminatory care were 12.2 percentage points less likely to have recently received an influenza vaccination (p = 0.024) and 14.8 percentage points less likely to have recently completed a colorectal cancer screening (p = 0.035).</p><p><strong>Conclusions: </strong>In the absence of explicitly LGBTQ+ affirming patient experiences, LGBTQ+ midlife and older adults are less likely to receive preventive services such as colorectal cancer screenings, influenza vaccinations, and HIV testing. Interventions to increase the capacity of health systems to provide LGBTQ+ affirming care are needed to advance health equity.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14632"},"PeriodicalIF":3.1,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060373","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":"Navigating New Waters: How Did MACRA 2015 Transform Practices Among Medicare Part B Physicians?","authors":"Mahmoud Manouchehri Amoli, Bassam Dahman","doi":"10.1111/1475-6773.14631","DOIUrl":"https://doi.org/10.1111/1475-6773.14631","url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether physicians participating in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) exhibit different billing behaviors and practice patterns compared to non-participating physicians after MACRA implementation.</p><p><strong>Study setting and design: </strong>A quasi-experimental staggered difference-in-difference design was used to compare pre-and post-MACRA changes among participants and non-participants from 2013 to 2021. Primary outcomes included annual submitted charges, annual Medicare payments, and charge-to-payment ratios. Secondary outcomes were average charges and payments per beneficiary, total services, and the number of beneficiaries served.</p><p><strong>Data sources and analytic sample: </strong>The study analyzed secondary data from Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service Provider Utilization and Payment Data (2013-2021), providing outcome measures and control variables; Quality Payment Program (QPP) Experience Reports (2017-2021), the National Plan and Provider Enumeration System, and Medicare Geographic Variation Public Use File. The analytic sample included 4,924,118 physician-year observations (749,129 unique physicians), with 50.2% participating in MACRA.</p><p><strong>Principal findings: </strong>MACRA participation was associated with significant annual increases of $36,677 (95% CI: 28,918, 44,436) in total submitted charges and $9164 (95% CI: 7288, 11,041) in total Medicare payments compared to non-participation. However, these increases appeared primarily driven by a substantial increase in the total number of Medicare beneficiaries served per physician (29.77 beneficiaries; 95% CI: 20.75, 32.79) rather than by increases in spending per beneficiary, which were modest (average payment increase per beneficiary of $2.10; 95% CI: 0.22, 3.97). The charge-to-payment ratio decreased by 0.04 percentage points (95% CI: -0.08, -0.00) among MACRA participants, suggesting potential improvements in billing efficiency.</p><p><strong>Conclusions: </strong>MACRA participation is associated with increased billing and payment among Medicare Part B physicians, primarily driven by physicians treating a greater number of Medicare beneficiaries. However, modest changes in per-beneficiary spending suggest limited changes in care intensity. Further research is needed to explore factors influencing patient volumes and payer mix under MACRA.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14631"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051103","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":"Ten Healthcare Delivery Trends and Their Measurement and Methodological Implications for Cancer Health Services Research.","authors":"Sallie J Weaver, Sandra A Mitchell","doi":"10.1111/1475-6773.14637","DOIUrl":"https://doi.org/10.1111/1475-6773.14637","url":null,"abstract":"","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14637"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Coding Intensity in Medicare Advantage Through Switchers.","authors":"Paul D Jacobs, Timothy J Layton","doi":"10.1111/1475-6773.14628","DOIUrl":"https://doi.org/10.1111/1475-6773.14628","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the extent of differential coding of health risk in traditional Medicare (TM) compared with Medicare Advantage (MA).</p><p><strong>Study setting and design: </strong>Payments to MA plans are based on reported medical conditions, and research has shown the number and severity of diagnoses are larger when beneficiaries are enrolled in MA plans rather than TM. We compare the risk scores of Medicare beneficiaries who switch from TM into MA over the 2013-2021 period to the scores of beneficiaries who stay in TM, incorporating heterogeneous treatment effects across switching cohorts and over time.</p><p><strong>Data sources and analytic sample: </strong>We use a 10% sample of Centers for Medicare and Medicaid Services data containing individual risk scores and enrollment status for 2012-21. After applying exclusion criteria, our sample consists of 1,911,968 beneficiaries with data available for each year. We also link administrative data to the Medicare Current Beneficiary Survey to assess measures of health status.</p><p><strong>Principal findings: </strong>We find the risk scores of switchers to MA were 0.120 points (12.4%; 95% confidence interval [CI]: 12.0%-12.8%) higher than stayers in the second year, 0.166 points (17.2%; 95% CI: 16.7%-17.6%) higher in the third year, and 0.216 points (22.3%; 95% CI: 21.7%-22.9%) higher by the sixth year after switching. Averaged over all MA enrollees in 2021, our estimates suggest coding intensity in MA led to risk scores that were 18.6% higher than for comparable enrollees in TM.</p><p><strong>Conclusions: </strong>Our estimates of coding intensity are at the higher end of the range in the prior literature while addressing concerns of endogenous switching. Our estimates of increasing coding over time and across enrollment cohorts can help inform decisions regarding adjustments to MA payments for coding intensity.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14628"},"PeriodicalIF":3.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033948","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":"CHOICE: A Comprehensive and Coordinated Colorectal Cancer Screening Program in a Large Urban Health System.","authors":"Emma Ghalili, Tsion Tmariam, Parth D Trivedi, Lina Jandorf","doi":"10.1111/1475-6773.14629","DOIUrl":"https://doi.org/10.1111/1475-6773.14629","url":null,"abstract":"<p><strong>Objective: </strong>To develop a coordinated colorectal cancer (CRC) screening program within a large urban health system, with the ultimate goal of increasing system-wide screening rates of eligible patients and reducing no-show rates while increasing colonoscopy completion rates.</p><p><strong>Study setting: </strong>A large urban academic health system comprising 8 hospitals and over 400 ambulatory practices.</p><p><strong>Study design: </strong>The CHOICE Program combined patient navigation, electronic medical record (EMR) optimization, and system-wide practice changes to improve CRC screening completion by colonoscopy. The program incorporates provider and patient education, standardization of documentation and protocols, increased outreach by navigators, and streamlining of patient scheduling. The primary outcome is colonoscopy completion.</p><p><strong>Data collection: </strong>All health system patients between the ages of 45 and 75 and at average risk of CRC are the target population for the intervention. A review of screen-eligible patients' completion of colonoscopy was performed to assess program success.</p><p><strong>Principal findings: </strong>During a 2-year period (March 2022 to February 2024), 18,119 people were referred into the program, and 79% of scheduled patients completed the colonoscopy. The CHOICE program operationalized and standardized the CRC screening efforts of a large health system and offers a template that can be implemented or adapted by other hospital systems and provider networks.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14629"},"PeriodicalIF":3.1,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022930","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":"Correction to “SIREN 2025 National Research Meeting: Advancing the Science of Social Care”","authors":"","doi":"10.1111/1475-6773.14630","DOIUrl":"https://doi.org/10.1111/1475-6773.14630","url":null,"abstract":"<p>Health Services Research, 2025; 60(Suppl. 1): e14614.</p><p>The copyright lines for all articles in this issue have been updated online to 2025 Wiley Periodicals LLC. This is to reflect the change in the ownership which took effect before the issue was published. We apologize for this error.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"60 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.14630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}