Health Services Research最新文献

{"title":"Breaking Barriers: Exploring Patient Satisfaction With the U.S. Healthcare System Among Iranian and Afghan Immigrants With Limited English Proficiency.","authors":"Sara Imanpour, Rifat Sultana, Victoria Williams","doi":"10.1111/1475-6773.70027","DOIUrl":"https://doi.org/10.1111/1475-6773.70027","url":null,"abstract":"<p><strong>Objective: </strong>To explore the satisfaction of limited English proficiency (LEP) Farsi- and Dari-speaking patients with the U.S. healthcare system using a qualitative approach.</p><p><strong>Study setting and design: </strong>We employed a grounded theory approach to analyze qualitative data collected from five focus groups involving 25 Farsi- and Dari-speaking immigrants with LEP.</p><p><strong>Data source and analytical sample: </strong>A total of 25 individuals with LEP participated in the focus group sessions, which were transcribed and analyzed using grounded theory methodology.</p><p><strong>Principal findings: </strong>Two primary categories influencing satisfaction with care emerged: systemic factors and individual factors. Individual factors encompassed cultural beliefs, cross-contextual comparisons, experiences of misdiagnosis, and language barriers. Systemic factors, including discrimination, the high cost of care, the complexity of the U.S. healthcare system, and a pharmaco-centric approach to care, were found to negatively impact satisfaction among immigrants with LEP.</p><p><strong>Conclusions: </strong>Although many Farsi- and Dari-speaking individuals with LEP expressed satisfaction with the structured aspects of the U.S. healthcare system, dissatisfaction with healthcare providers and interpersonal interactions persisted. Addressing these issues will require targeted interventions to enhance trust, communication, and cultural competency in healthcare delivery.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70027"},"PeriodicalIF":3.2,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838639","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":"The Impacts of 1115 Medicaid Substance Use Disorder Waivers on Medicaid-Paid Use of Residential Treatment and Other Types of Services in 20 States.","authors":"Stephan R Lindner, Kyle Hart, Brynna Manibusan, Kirbee A Johnston, Dennis McCarty, K John McConnell","doi":"10.1111/1475-6773.70022","DOIUrl":"10.1111/1475-6773.70022","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association between the implementation of 1115 Medicaid substance use disorder (SUD) waivers and changes in Medicaid-paid use of residential treatment and other types of services.</p><p><strong>Study setting and design: </strong>We compared 20 states with SUD waivers to 14 non-waiver states using a staggered difference-in-differences design. Primary outcomes were Medicaid-paid opioid-use disorder (OUD) related residential treatment stays and length of stay (LOS). Secondary outcomes included admissions and LOS for all-cause and OUD-related inpatient stays, psychiatric hospital admissions, emergency department (ED) visits, outpatient visits, and primary care visits.</p><p><strong>Data source and analytic sample: </strong>We used the 2016-2021 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). The analytic sample included Medicaid enrollees ages 18-64 with OUD.</p><p><strong>Principal findings: </strong>On average, waiver implementation was associated with an increase in residential treatment stays (estimate: 0.4%; 95% CI: 0.1%-0.7%), OUD-related inpatient visits LOS (estimate: 0.3 days; 95% CI: 0.0%-0.5%), psychiatric hospital LOS (estimate: 1.0 days; 95% CI: 0.6 days-1.4 days), primary care visits (estimate: 3.0%; 95% CI: 1.2%-4.7%), and OUD-related primary care visits (estimate: 2.7%; 95% CI: 0.9%-4.4%); and a decline in all-cause inpatient visits (estimate: -0.9%; 95% CI: -1.9% to -0.0%) and OUD-related inpatient visits (estimate: -0.8%; 95% CI: -1.6% to -0.0%). Results for psychiatric hospital LOS and OUD-related primary care visits were sensitive to adjusting for pre-trends. Among four early-adopting states (Indiana, Louisiana, New Jersey, Virginia), Medicaid-paid residential treatment increased 1-4 years following waiver implementation (e.g., 2-year estimate: 2.8%, 95% CI: 2.5%-3.0%), and inpatient visits declined 1-4 years following waiver implementation (e.g., 2-year estimate: -3.1%, 95% CI: -3.5% to -2.6%).</p><p><strong>Conclusions: </strong>SUD waivers were associated with a small increase in Medicaid-paid residential treatment and a decline in inpatient visits across states, with changes being concentrated among early-adopting states.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70022"},"PeriodicalIF":3.2,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790777","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}

{"title":"The Impact of Health Insurer Acquisitions of Physician Practices on Prices and Patient Visits.","authors":"Derek T Lake, Lawrence Casalino, Michael Richards, Sean Nicholson, Rahul Fernandez, Brendan O'Connell, Manyao Zhang, Robert Tyler Braun","doi":"10.1111/1475-6773.70025","DOIUrl":"https://doi.org/10.1111/1475-6773.70025","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether the acquisition of physician practices by Optum, a subsidiary of United Health Group (UHG), influences patient volume and service prices, particularly, for patients enrolled in health insurance plans competing with UHG.</p><p><strong>Study setting and design: </strong>We employed a novel database cataloging health insurer acquisitions of physician practices to identify those acquired by Optum-the nation's largest payvider (vertically integrated payer-provider)-from 2007 to 2023. These data were integrated with non-UHG commercial health insurance claims for practices acquired between 2015 and 2019. Using a stacked difference-in-differences design, we analyzed relative changes in prices and office visits across 12 Optum-acquired practices compared to a control group. Adjustments were made for physician profiles, practice characteristics, and calendar-year fixed effects to ensure robust estimates.</p><p><strong>Principal findings: </strong>From 2007 to 2023, Optum acquired 44 physician practices, employing 7828 physicians by 2023. Postacquisition, we found no statistically significant average change in prices for most acquired practices relative to controls. However, the single largest acquisition was associated with a relative price increase of 4.5% (95% CI: [1.2%, 7.8%]; p = 0.02) for established patient visits. Preacquisition trends showed prices at acquired practices rising faster than controls. Additionally, Optum acquisitions were linked to suggestive declines in claim volume 1-1.5 years postacquisition, though this shift was predominantly driven by the largest acquired practice, indicating variability in outcomes across the sample.</p><p><strong>Conclusions: </strong>Optum's acquisition of physician practices did not broadly result in significant price changes for evaluation and management services provided to patients with competing insurance plans, despite higher baseline prices at acquired practices. Suggestive reductions in patient volume emerged postacquisition, but effects were inconsistent. Extended follow-up research is warranted to evaluate whether these acquisitions reshape local healthcare market dynamics over time.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70025"},"PeriodicalIF":3.2,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790776","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 Pathways to Success Launch With Quality inBeneficiaries With Traditional Medicare.","authors":"Meiling Ying, Addison Shay, Richard A Hirth, John M Hollingsworth, Vahakn B Shahinian, Brent K Hollenbeck","doi":"10.1111/1475-6773.70024","DOIUrl":"https://doi.org/10.1111/1475-6773.70024","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between implementation of \"Pathways to Success\" and quality among beneficiaries cared for in Shared Savings Program accountable care organizations (ACOs).</p><p><strong>Study setting and design: </strong>Medicare initiated \"Pathways to Success\" in 2019 that required upside-risk only ACOs in Shared Savings Program to transition to a two-sided risk model and prior two-sided ACOs to assume even greater financial responsibility. We examined the association between Pathways and ACO-targeted (hospitalizations for congestive heart failure [CHF] and all-cause 30-day readmissions) and nontargeted (all-cause emergency department visits without hospitalization for CHF and hospital observation stays) quality measures, using a difference-in-differences framework.</p><p><strong>Data sources and analytic sample: </strong>Data were extracted from a 20% sample of national Medicare data from 2018 to 2020. This study included 810,070 beneficiary-quarters in 514 ACOs, and 813,855 beneficiary-quarters never attributed to an ACO (i.e., controls).</p><p><strong>Principal findings: </strong>Implementation of Pathways was not associated with significant relative changes in the quarterly number of CHF admissions (decreasing from 97.98 to 82.04 per 1000 beneficiaries in ACOs; differential change = 3.51 quarterly CHF admissions per 1000 beneficiaries, 95% CI, -4.82 to 11.85) or the quarterly number of emergency department visits for CHF (decreasing from 110.90 to 97.50 per 1000 beneficiaries in ACOs; differential change = 6.47 quarterly CHF emergency department visits per 1000 beneficiaries, 95% CI, -3.71 to 16.64). However, quarterly rates of 30-day all-cause readmissions increased slightly by 0.61% points (95% CI, 0.23 to 0.98; unadjusted readmissions increased from 14.49% to 14.81% in ACOs) after Pathways implementation. Observation stays remained unchanged (differential change = -0.16% points, 95% CI, -0.33 to 0.02; unadjusted observation stays increased from 3.64% to 3.94% in ACOs) after the launch of Pathways.</p><p><strong>Conclusions: </strong>Medicare's Pathways to Success, which introduced two-sided risk, was not associated with improvement in select quality measures.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70024"},"PeriodicalIF":3.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762371","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":"The Effect of Ending the Pandemic-Related Mandate of Continuous Medicaid Coverage on Health Insurance Coverage and Economic Well-Being.","authors":"Kabir Dasgupta, Keisha T Solomon","doi":"10.1111/1475-6773.70021","DOIUrl":"https://doi.org/10.1111/1475-6773.70021","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of the unwinding of the pandemic-related continuous Medicaid enrollment provision on health insurance coverage and economic hardship.</p><p><strong>Study setting and design: </strong>The termination of the continuous Medicaid enrollment provision during early 2023 and the subsequent state-level resumption of the standard renewal process prompted large-scale Medicaid disenrollments nationwide. Using state-month variation in the incidence of the first round of disenrollments, we estimate the effects of the unwinding process on health insurance coverage, including Medicaid enrollment, and the likelihood of experiencing economic hardship for the adult population.</p><p><strong>Data sources and analytic sample: </strong>We use state-level monthly Medicaid enrollment data from the Centers for Medicare and Medicaid Services and self-reported individual-level indicators of Medicaid coverage, being uninsured, and economic hardship from the U.S. Census Bureau's Household Pulse Survey. Our key findings are substantiated by evidence drawn from recent annual data from the Current Population Survey and the Survey of Household Economics and Decisionmaking.</p><p><strong>Principal findings: </strong>States' unwinding of the continuous Medicaid enrollment provision reduced state-level Medicaid enrollment by 4% [-0.071-0.004]. We do not, however, find statistically significant effects on changes in the probability of being without any health coverage and experiencing economic hardship for the overall adult population. However, further evidence reveals that the effects can be heterogeneous depending on demographic and educational characteristics.</p><p><strong>Conclusions: </strong>The unwinding of the continuous Medicaid enrollment provision reduced overall Medicaid enrollments. However, there is no evidence that these provisions changed the probability of being uninsured and experiencing economic hardship for the general adult population. This study opens an important research scope for investigating the long-term implications of unwinding large-scale pandemic-related relief measures.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70021"},"PeriodicalIF":3.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746006","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":"Evaluating the Completeness of Mortality Information in Medicaid Records.","authors":"Gina Li, Victoria Udalova","doi":"10.1111/1475-6773.70007","DOIUrl":"https://doi.org/10.1111/1475-6773.70007","url":null,"abstract":"<p><strong>Objective: </strong>To assess the quality and completeness of death records in Medicaid administrative data by comparing them with the U.S. Census Bureau Numerical Identification (Numident) file, a comprehensive and up-to-date database with mortality information.</p><p><strong>Study setting and design: </strong>We conduct a cross-comparison between Medicaid administrative records and the Census Numident file to identify the completeness of Medicaid death records and the misclassification of deaths. The analysis is stratified by state, year, and beneficiary characteristics.</p><p><strong>Data sources and analytic sample: </strong>We use the Transformed Medicaid Statistical Information System Analytic Files (TAF) Demographic and Eligibility File linked with the Census Numident file. Our base sample contains individuals enrolled in Medicaid/Children's Health Insurance Program (CHIP) and recorded as deceased in either the TAF or the Numident file from 2016 through 2022.</p><p><strong>Principal findings: </strong>We find that almost all deaths reported in the TAF are found in the Numident. On the other hand, 13.2% of deaths are reported in the Numident file but are missing in the TAF. This share varies considerably across states; indeed, many states have few missing death records and thus a high degree of completeness, while some are missing over half of deaths. Furthermore, this share varies by beneficiary characteristics, especially age. Conditional on a TAF-reported death, the TAF death dates match with the Numident death dates in almost all cases.</p><p><strong>Conclusions: </strong>Medicaid administrative data include death information, but these records underreport deaths. Deaths that are recorded in TAF data are largely accurate.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70007"},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735527","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":"Predicting Risk of Long-Term Institutionalization Among Community Dwelling Veterans Before the COVID-19 Pandemic.","authors":"Bruce Kinosian, Susan Schmitt, Matthew Augustine, Scotte Hartronft, Rajesh Makineni, Kimberly Judon, Gregory Krautner, Cheryl Schmitz, Mary K Goldstein, Ciaran S Phibbs, Orna Intrator","doi":"10.1111/1475-6773.70016","DOIUrl":"https://doi.org/10.1111/1475-6773.70016","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk of long-term institutionalization (LTI) among Veterans receiving care in the Veterans Health Administration (VA).</p><p><strong>Study setting and design: </strong>We developed the \"Predicted Long-term Institutionalization\" (PLI) risk model for Veterans alive in the community at the end of fiscal-year (FY) 2017 followed for LTI in nursing home (cumulative NH days allowing any acute care and up to 7 days in community > 90 days) during FY2018-FY2019.</p><p><strong>Data sources and analytic sample: </strong>PLI used demographics, diagnoses, prior hospital and nursing home (NH) use, and risk indices for death and frailty from VA and Medicare claims and Minimum Data Set data. Development of PLI used multiple iterations to maximize sensitivity, constrained by achieving a number needed to screen (≤ 8), including age normalization to minimize algorithmic bias. We combined the elevated risk (ER) and common risk (CR) strata-specific predictions from the logistic regression models to identify three tiers of PLI: low risk, moderate risk, and high risk. We describe Veterans' outcomes in FY2018/2019 (LTI, death, hospitalization and VA cost) across the three PLI tiers.</p><p><strong>Principal findings: </strong>For identifying Veterans in LTI, compared to a baseline model that used only VA data as predictors (sensitivity 23%, specificity 98%), calibrating separate ER and CR strata increased sensitivity to 30%, the addition of Medicare data increased sensitivity to 33%, and age-normalization with differential risk strata thresholds increased sensitivity to 41% (specificity 96.6%). The final PLI model (c-statistic = 0.87) identified 3.5% of Veterans in PLI-high risk (13% LTI rate), who accounted for 41% of new LTI, 22% of decedents, 19% of VA cost, and 11% of hospitalizations in FY2018-2019.</p><p><strong>Conclusions: </strong>The PLI score identifies Veterans at high risk of LTI for further assessment and targeting of resources to support continued community residence.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70016"},"PeriodicalIF":3.1,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719181","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 Health and Social Spending With Health Outcomes in OECD Countries.","authors":"Sungchul Park, Joseph L Dieleman, Rockli Kim, S V Subramanian","doi":"10.1111/1475-6773.14660","DOIUrl":"https://doi.org/10.1111/1475-6773.14660","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the associations of health and social spending with health outcomes, including Disability-Adjusted Life Years (DALY), Years of Life Lost (YLL), Years Lived with Disability (YLD), death, and life expectancy at birth among Organization for Economic Cooperation and Development (OECD) member countries from 2000 to 2019.</p><p><strong>Study setting and design: </strong>We conducted a retrospective longitudinal study.</p><p><strong>Data sources and analytical sample: </strong>Our sample included 36 OECD member countries as of 2019 using data from the Global Burden of Disease Study 2021, the OECD, and the World Bank.</p><p><strong>Principal findings: </strong>Fixed-effect analysis revealed significant associations of health and social spending with health outcomes, but the patterns varied. Specifically, a one-percentage-point increase in health spending was associated with a 1.43% (95% CI: -1.86, -1.01) decrease in the death rate per 100,000 population and a 0.68% (0.56, 0.79) increase in YLD per 100,000 population. In contrast, a one-percentage-point increase in social spending was associated with a 0.29% (-0.45, -0.12) reduction in DALYs, primarily driven by a 0.30% (-0.37, -0.23) decrease in YLDs and a 0.07% (0.03, 0.12) increase in life expectancy. No significant associations were found for the remaining outcomes. These associations remained robust when incorporating one- and two-year lagged effects.</p><p><strong>Conclusions: </strong>These findings highlight the distinct mechanisms through which health and social spending impact health outcomes. Health spending predominantly influenced mortality, while social spending was more closely associated with improvements in quality-of-life measures. Policymakers should consider these complementary effects when designing interventions to optimize health outcomes.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14660"},"PeriodicalIF":3.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709972","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":"Influence of Admitting Clinician on Outcomes in Post-Acute Facilities.","authors":"Amanda C Chen, J Michael McWilliams","doi":"10.1111/1475-6773.70017","DOIUrl":"https://doi.org/10.1111/1475-6773.70017","url":null,"abstract":"<p><strong>Objective: </strong>To compare outcomes between patients admitted to different clinicians within skilled nursing facilities for post-acute care, leveraging the plausibly random distribution of patients to admitting clinicians in the case of clinicians who specialize in nursing facility care (SNFists). We also compare patient outcomes between SNFists who are physicians versus advanced practice providers (APPs).</p><p><strong>Study setting and design: </strong>We used multi-level modeling to estimate within-SNF variation in the characteristics and outcomes of patients admitted to different SNFists and linear regression to compare patient characteristics and outcomes between physician and APP SNFists. Our main outcomes were 30-day hospitalizations, 30-day mortality, and antipsychotic use.</p><p><strong>Data sources and analytic sample: </strong>We analyzed claims data for a 20% sample of traditional Medicare beneficiaries admitted to a SNF for post-acute care from 2016 to 2019.</p><p><strong>Principal findings: </strong>The sample included 81,789 post-acute patients seen by 6273 SNFists at 1479 facilities between 2016 and 2019. Within-facility variation in patient characteristics across admitting SNFists was modest and substantially greater across admitting clinicians who were not SNFists, consistent with our key assumption that patients are distributed in a more balanced fashion across admitting clinicians who are SNFists. With patient-level confounding limited by this focus on SNFists, there was minimal to modest variation in the rates of mortality (adjusted standard deviation: -0.14), hospitalization (0.40), and antipsychotic use (1.10) across admitting clinicians. Outcomes also did not differ between APP and physician admitting SNFists (mortality: 0.001 [95% CI: -0.001, 0.003]; hospitalization: 0.004 [95% CI: -0.001, 0.010], antipsychotic use: -0.001 [95% CI: -0.006, 0.003]). In contrast, outcomes varied substantially across admitting clinicians who were not SNFists.</p><p><strong>Conclusions: </strong>Quasi-experimental assignment of patients to clinicians in SNFs reveals that the admitting clinician appears to have little influence on key outcomes in the post-acute setting, in contrast with similar research conducted in other care settings. An analysis of non-SNFists might falsely conclude that the impact of clinician factors is large because of evident non-random sorting of patients to non-SNFist clinicians in SNFs.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70017"},"PeriodicalIF":3.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700420","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":"An Assessment of the Association Between Wages and Fringe Benefits on Nurse Aide Turnover in Nursing Homes.","authors":"Christopher S Brunt, John R Bowblis, Robert Applebaum","doi":"10.1111/1475-6773.70019","DOIUrl":"https://doi.org/10.1111/1475-6773.70019","url":null,"abstract":"<p><strong>Objective: </strong>To assess cost-effective strategies to reduce nurse aide turnover, this study examines the relationship between turnover and compensation, including wage rates, spending on fringe benefits, and specific fringe benefit offerings.</p><p><strong>Study setting and design: </strong>The study uses national data from 2022 and 2023, a period following major COVID-19 labor market disruptions. The analysis uses regression models to assess the impact of wages and fringe benefits on turnover, with additional subgroup analyses by ownership type (for-profit, not-for-profit, and government).</p><p><strong>Data sources and analytic sample: </strong>Data were sourced from Medicare Cost Reports, the Payroll-Based Journal Public Use Employee Detail File, and Care Compare archives. After excluding nursing homes with missing observations and applying exclusions for outliers, the final analytic sample included 19,238 nursing home-year observations from 12,116 unique nursing homes.</p><p><strong>Principal findings: </strong>The results indicate that higher wages and fringe benefit spending are both associated with slightly lower nurse aide turnover. A 10% increase in wages was linked to a 0.28 (95% CI: 0.04, 0.53) to 0.39 (95% CI: 0.09, 0.70) percentage point reduction in turnover, an effect primarily driven by for-profit nursing homes. Fringe benefit spending was significantly associated with lower turnover among for-profits and not-for-profits, with a 1-percentage-point increase in fringe rates reducing turnover by 0.08 (95% CI: 0.01, 0.15) to 0.28 (95% CI: 0.23, 0.34) percentage points. Specific fringe benefits, such as daycare assistance and accident/disability insurance, were associated with lower turnover. A simulation analysis suggests that investments in fringe benefits are more effective at reducing turnover than equivalent investments in wages.</p><p><strong>Conclusions: </strong>Nursing homes seeking to reduce nurse aide turnover should consider enhancing fringe benefits in addition to increasing wages. Given the higher cost-effectiveness of fringe benefits in reducing turnover, policymakers and nursing home administrators should refine these strategies to improve workforce stability and care quality.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e70019"},"PeriodicalIF":3.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700419","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}