Health Services Research最新文献

{"title":"Is frequent emergency department use a complement or substitute for other healthcare services? Evidence from South Carolina Medicaid enrollees.","authors":"Theodoros V Giannouchos, Ronald G Pirrallo, Brad Wright","doi":"10.1111/1475-6773.14430","DOIUrl":"https://doi.org/10.1111/1475-6773.14430","url":null,"abstract":"<p><strong>Objective: </strong>To compare healthcare services utilization across the healthcare system between frequent and non-frequent emergency department (ED) users among Medicaid enrollees in South Carolina.</p><p><strong>Study setting and design: </strong>We conducted a retrospective, longitudinal study of individuals with at least one ED visit in 2017 in South Carolina and identified their healthcare services visits over 730 days (2 years) after their first ED visit. We classified individuals based on intensity of ED use: superfrequent (≥9 ED visits/year), frequent (4-8 ED visits/year), and non-frequent ED users (≤3 visits/year). We estimated differences between the three groups of ED users and non-ED hospital and office-based visits using multivariable two-part regression models.</p><p><strong>Data sources and analytic sample: </strong>We used statewide Medicaid claims from January 2017 to December 2019 for ED users aged 18-64 years with continuous Medicaid enrollment. We analyzed data on all frequent and superfrequent users and selected a 4:1 random sample among all non-frequent users (~half of all non-frequent users).</p><p><strong>Principal findings: </strong>The study included 52,845 ED users, of whom 42,764 were non-frequent, 7677 frequent, and 2404 superfrequent users. Within 2 years from the date of their first ED visit, superfrequent ED users averaged 38.3 ED visits, frequent ED users 10.9 ED visits, and non-frequent ED users 2.6 ED visits (p < 0.001). Compared with non-frequent users, frequent and superfrequent ED users had more comorbidities and chronic conditions on average (1.6 vs. 3.5 vs. 6.4, p < 0.001). Both frequent and superfrequent users had more hospital visits beyond the ED overall (marginal effects: 0.23, 95% CI 0.18-0.27; 0.40, 95% CI 0.29-0.50), and more outpatient office visits overall (marginal effects: 4.39, 95% CI 2.52-6.27; 9.23, 95% CI 5.66-12.81), including primary care and most specialists' visits, compared with non-frequent users.</p><p><strong>Conclusions: </strong>Frequent ED users utilized non-ED hospital and outpatient office-based healthcare services significantly more than non-frequent ED users. These findings can guide tailored interventions using data across the healthcare system to efficiently coordinate care, contain costs, and improve health outcomes for these individuals.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14430"},"PeriodicalIF":3.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924118","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 a Veterans Affairs rapid rehousing and homelessness prevention program on long-term housing instability.","authors":"Alec B Chapman, Daniel Scharfstein, Thomas Byrne, Ann Elizabeth Montgomery, Ying Suo, Atim Effiong, Christa Shorter, Sophia Huebler, Tom Greene, Jack Tsai, Lillian Gelberg, Stefan G Kertesz, Richard E Nelson","doi":"10.1111/1475-6773.14428","DOIUrl":"https://doi.org/10.1111/1475-6773.14428","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of enrolling in Supportive Services for Veteran Families (SSVF) on short- and long-term housing outcomes among Veterans experiencing housing instability.</p><p><strong>Study setting and design: </strong>We analyzed data from the Department of Veterans Affairs (VA) electronic health record (EHR) between October 2015 and December 2018 using the target trial emulation framework. Veterans were included in one or more trials if they were 18 years or older, had recent evidence of housing instability, had received care in VA for at least 1 year, and had never before enrolled in SSVF. Patients who enrolled in SSVF after meeting eligibility were assigned to the treatment group, while patients who did not enroll in SSVF were assigned to a control group. We extracted patients' housing outcomes from the EHR and modeled the probability of being unstably housed each day while accounting for confounders and irregular visit times.</p><p><strong>Data sources and analytic sample: </strong>We extracted housing status and covariates from the VA Corporate Data Warehouse. Housing instability was ascertained using a combination of structured data elements and natural language processing.</p><p><strong>Principal findings: </strong>We identified 238,059 unique patients who met the eligibility criteria for one or more trials. The risk of housing instability decreased in both arms over the three years after initiating a trial but was lower among SSVF enrollees, with a risk difference of -12.9% (95% confidence band -14.6%, -11.2%) on Day 120 and an attenuated difference of -2.4% (-4.0%, -0.7%) on Day 1095.</p><p><strong>Conclusions: </strong>SSVF is one of the largest rapid rehousing and homelessness prevention programs in the nation. We found that SSVF improves housing outcomes over the three years following enrollment, but the effect reduces over time. These findings can inform policy and program design for improving housing outcomes for homeless-experienced individuals.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14428"},"PeriodicalIF":3.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911141","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":"Impact of medical and recreational cannabis laws on inpatient visits for asthma.","authors":"Jayani Jayawardhana, Jose Fernandez","doi":"10.1111/1475-6773.14427","DOIUrl":"https://doi.org/10.1111/1475-6773.14427","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of medical and recreational cannabis laws on inpatient visits for asthma and by payer-type.</p><p><strong>Study setting and design: </strong>Quasi-experimental difference-in-differences regression analysis was conducted while accounting for variations in cannabis laws implementation timing by states. Inpatient visits for asthma in states with a given type of cannabis law were compared with those in states that did not implement the specific law. Four different cannabis laws were examined in the study-initial passage of medical cannabis law, opening of a medical cannabis dispensary, home cultivation of medical cannabis, and recreational cannabis legalization.</p><p><strong>Data sources and analytic sample: </strong>State-level quarterly inpatient visit data for asthma patients were utilized from the Healthcare Cost and Utilization Project Fast Stats database. The primary analysis included inpatient visits for asthma by all payer adult patients aged 19 and above in 38 states from 2005 to 2017, and the secondary analysis included inpatient visits for asthma by payer-type (i.e., private, Medicare, Medicaid, uninsured).</p><p><strong>Principal findings: </strong>States with medical cannabis dispensaries and legalized recreational cannabis experienced 14.12% (2.14; 95% CI, 0.74-3.53; p < 0.01) and 20.45% (3.08; 95% CI, 1.47-4.69; p < 0.001) increases in inpatient visits for asthma compared with states without these policies, respectively. These increases in inpatient visits for asthma were primarily driven by populations covered by Medicare and private insurance, with Medicare population showing larger effects of both recreational cannabis laws and medical cannabis dispensaries.</p><p><strong>Conclusions: </strong>States with medical cannabis dispensaries and legalized recreational cannabis experienced higher rate of inpatient visits for asthma compared with states without these policies. Clinicians and policymakers should consider strategies to curb adverse health outcomes of cannabis, that is likely to result in increased costs of healthcare.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14427"},"PeriodicalIF":3.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911140","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":"Enrollment in Medicare is associated with fewer outpatient mental healthcare visits among those with mental health symptoms.","authors":"Grace McCormack, Erin Duffy, Josephine Rohrer, Adam Biener","doi":"10.1111/1475-6773.14423","DOIUrl":"https://doi.org/10.1111/1475-6773.14423","url":null,"abstract":"<p><strong>Objective: </strong>To test whether enrolling in traditional Medicare (TM) or Medicare Advantage (MA) at age 65 reduces mental healthcare utilization among individuals with mental health symptoms and low or moderate family incomes.</p><p><strong>Study setting and design: </strong>We employ a fuzzy regression discontinuity design, comparing the likelihood of having an outpatient mental health visit or a psychotropic drug fill among individuals younger than or older than the age 65 Medicare eligibility threshold.</p><p><strong>Data sources and analytic sample: </strong>We analyze 2014-2021 Medical Expenditure Panel Survey data. Our primary sample is restricted to individuals with probable mental health symptoms as indicated by their score on the Kessler K6 psychological distress scale (K6) and Patient Health Questionnaire-2 instrument (PHQ-2) and who have incomes less than 400% of the federal poverty level.</p><p><strong>Principal findings: </strong>Among individuals with probable mental health symptoms and low or moderate incomes, enrolling in Medicare (combining the effect of MA and TM) is associated with a 24.9 percentage point reduction (95% CI -49.1 to -0.8; p = 0.043) in the likelihood of having any type of outpatient mental health visit and a 31.3 percentage point reduction (95% CI -54.2 to -8.4; p = 0.008) in the likelihood of having a prescription drug fill for a psychotropic drug. Effects of MA and TM on mental healthcare utilization are not statistically different from each other. We observe no impact of enrolling in Medicare on the likelihood of having a visit to a primary care provider, having a visit to a non-mental healthcare specialist, or having a fill for a prescribed non-psychotropic drug.</p><p><strong>Conclusions: </strong>Enrolling in Medicare is associated with a reduction in the use of mental healthcare among individuals with probable mental health symptoms and low or moderate family incomes. Our findings suggest that the program poses access barriers specific to mental healthcare.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14423"},"PeriodicalIF":3.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911138","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":"Associations between rural hospital closures and acute and post-acute care access and outcomes.","authors":"Geoffrey J Hoffman, Jinkyung Ha, Zhaohui Fan, Jun Li","doi":"10.1111/1475-6773.14426","DOIUrl":"https://doi.org/10.1111/1475-6773.14426","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether rural hospital closures affected hospital and post-acute care (PAC) use and outcomes.</p><p><strong>Study setting and design: </strong>Using a staggered difference-in-differences design, we evaluated associations between 32 rural hospital closures and changes in county-level: (1) travel distances to and lengths of stay at hospitals; (2) functional limitations at and time from hospital discharge to start of PAC episode; (3) 30-day readmissions and mortality and hospitalizations for a fall-related injury; and (4) population-level hospitalization and death rates.</p><p><strong>Data sources and analytic sample: </strong>100% Medicare claims and home health and skilled nursing facility clinical data to identify approximately 3 million discharges for older fee-for-service Medicare beneficiaries.</p><p><strong>Principal findings: </strong>We found that hospitals that closed compared to those remaining open served more minoritized, lower-income populations, including more Medicaid and fewer commercial patients, and had lower profit margins. Following a closure, quarterly hospitalization rates (111.6 quarterly hospitalizations per 10,000 older adults; 95% CI: 53.4, 170.9) and average hospital lengths of stay increased (0.34 days; 95% CI: 0.13, 0.56 days). We observed no change in the average distance between patients' residential ZIP code and the hospital used (0.29 miles; 95% CI: -1.06, 1.64 miles); average number of standardized ADL limitations at PAC (0.08 SDs from the pre-closure average; 95% CI: -0.12, 0.28 SDs); or PAC time to start (0.02 days; 95% CI: -1.2, 1.2 days). Among more isolated hospitals, closures were associated with an increase in the likelihood of readmission (0.10 percentage-points; 95% CI: 0.00, 0.19).</p><p><strong>Conclusions: </strong>Closures were not associated with notably worsened health care access, function, or health, potentially because closures triggered care delivery adjustments involving increased numbers of patients seeking out higher quality care.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14426"},"PeriodicalIF":3.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911137","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 impact of 2011 tort reform limiting noneconomic damages in North Carolina and Tennessee on testing, imaging, and procedure utilization.","authors":"Michael I Ellenbogen, Scott Kaplan, Bijan A Niknam, Allen B Kachalia, Daniel J Brotman","doi":"10.1111/1475-6773.14424","DOIUrl":"https://doi.org/10.1111/1475-6773.14424","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of tort reform laws passed in 2011 capping noneconomic damages in North Carolina and Tennessee on rates and adjusted per user costs of tests, imaging, and procedures in the Medicare fee-for-service population.</p><p><strong>Study setting and design: </strong>State-level synthetic difference-in-differences, adjusting for the percent of FFS Medicare beneficiaries in the state who were female, had ever been on Medicare Advantage, were eligible for Medicaid for at least 1 month of the year, and total state risk-adjusted, standardized per-capita costs. Analyses of North Carolina and Tennessee were performed separately. We measured the average treatment effect on the treated.</p><p><strong>Data sources and analytic sample: </strong>Centers for Medicare and Medicaid Services Geographic Variation Public Use File, 2007-2019.</p><p><strong>Principal findings: </strong>Our analysis showed no economically significant impact of these laws in either state, though we found a small but statistically significant increase (average treatment effect on the treated: $46, 95% confidence interval: $6-$87) in adjusted per user cost of procedures in Tennessee.</p><p><strong>Conclusions: </strong>Our findings suggest that caps on noneconomic damages alone may be insufficient to modify physician practice habits and impact utilization. Future work should attempt to better understand the economic and noneconomic incentives that shape physician ordering decisions.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14424"},"PeriodicalIF":3.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900456","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":"Barriers and facilitators to caregiver comfort with health-related social needs data collection in the pediatric clinical setting.","authors":"Rachel Brown, Nadia Barouk, Katie McPeak, Joel Fein, Danielle Cullen","doi":"10.1111/1475-6773.14425","DOIUrl":"https://doi.org/10.1111/1475-6773.14425","url":null,"abstract":"<p><strong>Objective: </strong>To identify barriers and facilitators to family-level comfort with health-related social needs (HRSN) data collection and documentation in the pediatric clinical setting.</p><p><strong>Study setting and design: </strong>This qualitative study was nested within a pragmatic randomized controlled trial on social care integration in the pediatric clinical setting. We used a hybrid random-purposive strategy to sample 60 caregivers of pediatric patients ages 0-25 presenting at two primary care clinics and one emergency department affiliated with a large pediatric healthcare system between September 2022 and 2023. We developed an interview guide and codebook to explore caregiver experiences with and perceptions of HRSN data collection and documentation.</p><p><strong>Data sources and analytic sample: </strong>We conducted semi-structured telephone interviews in English and Spanish with 60 caregivers. Interviews were conducted until thematic saturation was achieved and were transcribed verbatim. We used thematic analysis with constant comparison to code interviews and identify emerging themes.</p><p><strong>Principal findings: </strong>Our analysis yielded several barriers to caregiver comfort with HRSN data collection and documentation: (1) stigmatization by providers and medical staff and risk of child protective services involvement, (2) providers presuming connections between documented HRSN and medical complaints, (3) permanency of documented HRSN, (4) visibility of HRSN data by pediatric patients and caregiver proxies, and (5) fear that documented HRSN could negatively impact future insurance cost and coverage. We identified four facilitators to caregiver comfort: (1) clear communication regarding the purpose of HRSN data collection and use, (2) respect for caregiver autonomy, for example, by providing the option to decline participation, (3) training of data collection personnel to ensure privacy and compassionate care, and (4) consideration of timing within the medical visit, delaying assessment until medical concerns are addressed.</p><p><strong>Conclusions: </strong>Caregiver-identified barriers and facilitators should be considered in clinically based HRSN data collection efforts to ensure that these programs are equitable and family-centered.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14425"},"PeriodicalIF":3.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900455","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":"Transporting difference-in-differences estimates to assess health equity impacts of payment and delivery models.","authors":"Katherine Ianni, Alyssa Chen, Daniela Rodrigues, Laura A Hatfield","doi":"10.1111/1475-6773.14419","DOIUrl":"10.1111/1475-6773.14419","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the use of transportability methods to extend findings from payment model evaluations to groups of historically underserved beneficiaries.</p><p><strong>Study setting and design: </strong>We used a simulation study to transport the effects of the Comprehensive Primary Care Plus (CPC+) model to a target population of Black fee-for-service (FFS) Medicare beneficiaries living outside the original 18 CPC+ regions. Our main outcome variable was total Medicare spending per beneficiary per year (pbpy).</p><p><strong>Data sources and analytic sample: </strong>We simulated practice-level spending in 18 CPC+ regions and 32 non-CPC+ regions (1200 practices per region). We calibrated the simulation parameters to values from the literature and then varied four key parameters to create 16 realistic simulation scenarios. These scenarios varied the representativeness of practices in CPC+ regions that joined CPC+ (i.e., the sample) relative to the target population by changing the distribution of Black beneficiaries across practices and the distribution of practices across regions. Practices were characterized by their experience with the Medicare Shared Savings Program (SSP) and system/hospital ownership because these are known to modify the effect of CPC+ on spending.</p><p><strong>Principal findings: </strong>Across the 16 simulation scenarios, transporting the treatment effect of CPC+ to Black FFS beneficiaries in non-CPC+ regions yielded median treatment effects that ranged from $15.5 pbpy smaller to $10 pbpy larger than in the sample. These differences are roughly the same magnitude as the estimated overall effect of $13 pbpy.</p><p><strong>Conclusions: </strong>The Center for Medicare and Medicaid Innovation has pledged to put equity at the center of its demonstration models. However, offering models in limited geographic areas with voluntary provider participation may result in unrepresentative samples. Naively generalizing CPC+ effects from geographically limited, voluntary samples to all Black FFS beneficiaries could be misleading. Under some circumstances, transportability methods can be used to estimate effects in this target population.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14419"},"PeriodicalIF":3.1,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866498","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":"Improving perinatal depression screening uptake: The impact of Medicaid reimbursement policy in Massachusetts.","authors":"Chanup Jeung, Laura B Attanasio, Kimberley H Geissler","doi":"10.1111/1475-6773.14420","DOIUrl":"10.1111/1475-6773.14420","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of the Massachusetts Medicaid program's reimbursement policy change for perinatal depression screening on utilization rates.</p><p><strong>Study setting and design: </strong>This study employed a difference-in-differences design to compare insurance-paid prenatal and postpartum depression screening rates as well as postpartum antidepressant receipt rates between Medicaid and privately insured individuals before and after policy implementation in May 2016.</p><p><strong>Data sources and analytic sample: </strong>Data are from the 2014-2020 Massachusetts All-Payer Claims Database. The study included individuals with a live birth from October 10, 2014, to December 31, 2019, who were continuously insured either by Medicaid or private insurance.</p><p><strong>Principal findings: </strong>Among 141,085 births, 42.6% were covered by Medicaid. Among those with Medicaid, 1.9% had a paid postpartum depression screening prior to the policy and 16.9% after (1.5% vs. 12.3% for prenatal screening); among privately insured, 3.8% had a paid postpartum screening prior to the policy and 10.6% after (0.9% vs. 6.7% for prenatal screening). Antidepressant receipt rose from 6.9% to 8.3% among Medicaid enrollees and from 3.3% to 4.9% among privately insured individuals after the policy. After regression adjustment, implementation of the Massachusetts Medicaid reimbursement policy was positively associated with perinatal depression screening rates with a differential increase of 10.0 percentage points (p < 0.001) for postpartum screening and 3.5 percentage points (p < 0.001) for prenatal screening among Medicaid enrollees versus privately insured. Despite increased depression screening, the policy was not associated with a statistically significant change in antidepressant receipt among Medicaid enrollees compared to privately insured individuals.</p><p><strong>Conclusions: </strong>Separate payment for perinatal depression screening significantly improved screening rates among Medicaid beneficiaries, highlighting Medicaid's critical role in identifying mental health needs for vulnerable populations. However, the persistence of sub-optimal screening rates among perinatal individuals underscores the need for a comprehensive approach to ensure universal screening and effective treatment for perinatal depression.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14420"},"PeriodicalIF":3.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840369","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":"Sustainability of California's Whole Person Care pilots integrating medical and social services for Medicaid enrollees via newly developed Medicaid benefits.","authors":"Nadia Safaeinili, Emmeline Chuang, Mark Fleming, Shoba Ramanadhan, Nadereh Pourat, Amanda Brewster","doi":"10.1111/1475-6773.14418","DOIUrl":"https://doi.org/10.1111/1475-6773.14418","url":null,"abstract":"<p><strong>Objective: </strong>To assess multi-level factors influencing the sustainability of 26 social care pilots integrating medical and social services for Medicaid enrollees across California in newly developed Medicaid benefits.</p><p><strong>Study setting and design: </strong>This qualitative study assessed the sustainability of Whole Person Care (WPC) pilots implemented between 2016 and 2021. Pilots (n = 26) represented a majority of counties in California.</p><p><strong>Data sources and analytic sample: </strong>Primary qualitative data were collected between June and August 2021 and included 58 hour-long, semi-structured individual and group interviews with administrators, middle managers, and frontline case management staff representing all WPC pilots. We used hybrid inductive-deductive thematic analysis to identify and analyze patterns, and outliers, in factors influencing sustainment. Deductive codes included established implementation science factors influencing the sustainability of new programs (e.g., innovation characteristics, capacity, processes and interactions, and context).</p><p><strong>Principal findings: </strong>Of 26 WPC pilots, 22 pilots sustained WPC by contracting with Medicaid managed care plans to provide services as part of newly developed Medicaid benefits. Three pilots chose not to sustain before the pilot period ended and one pilot decided not to sustain following completion of the full pilot. Factors influencing sustainability included: (1) program adaptability and flexibility; (2) funding structure and reimbursement requirements; (3) shared leadership with managed care plans; and (4) whether pilots chose to build out program infrastructure internally or contracted out core components to partner organizations. Many pilots, particularly those in rural areas, indicated that system and policy changes introduced as part of transitioning pilot services into Medicaid benefits reduced the sustainability of WPC for participating providers.</p><p><strong>Conclusions: </strong>Multi-level factors including program adaptability, funding, leadership, and capacity to build out infrastructure influenced the sustainability of WPC pilots. These findings have significant implications for health equity as equitable distribution of services, resources, and benefits from these programs can be supported through sustained implementation over time.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819941","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}