Health Services Research最新文献

{"title":"Correction to “Co-Creating a Theory of Change to Advance COVID-19 Testing and Vaccine Uptake in Underserved Communities”","authors":"","doi":"10.1111/1475-6773.14641","DOIUrl":"10.1111/1475-6773.14641","url":null,"abstract":"<p>\u0000 \u0000 <span>Stadnick, NA</span>, <span>Cain, KL</span>, <span>Oswald, W</span>, et al. “ <span>Co-Creating a Theory of Change to Advance COVID-19 Testing and Vaccine Uptake in Underserved Communities</span>.” <i>Health Serv Res</i> <span>2022</span>; <span>57</span>(<span>Suppl. 1</span>): <span>149</span>–<span>157</span>. https://doi.org/10.1111/1475-6773.13910.\u0000 </p><p>In the published version of this article, the following funding acknowledgment should be added to the Funding section:</p><p>“This research was, in part, funded by the National Institutes of Health (NIH) Agreement OT2HL158287. The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressed or implied, of the NIH.”We apologize for this error.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"60 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1475-6773.14641","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019374","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":"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":"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":"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":"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}

{"title":"Clinician and Patient Responses to US Health Insurers' Policies: A Qualitative Study of Higher Risk Patients","authors":"Tammy L. Eaton,&nbsp;Valerie Danesh,&nbsp;Abigail C. Jones,&nbsp;Christine C. Kimpel,&nbsp;Carla M. Sevin,&nbsp;Han Su,&nbsp;Kelly M. Toth,&nbsp;Thomas S. Valley,&nbsp;Theodore J. Iwashyna,&nbsp;Leanne M. Boehm,&nbsp;Joanne McPeake","doi":"10.1111/1475-6773.14615","DOIUrl":"10.1111/1475-6773.14615","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To identify specific ways in which US health insurance triggered changes in care and interrupted the encounter between clinicians and patients in post-intensive care unit (ICU) clinics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Setting and Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This naturalistic qualitative study was nested within a randomized controlled trial that evaluated the feasibility and preliminary efficacy of a telemedicine ICU recovery clinic intervention. Adult participants were referred to a multidisciplinary ICU recovery clinic after septic shock or acute respiratory distress syndrome (ARDS) in a Southeastern US academic medical center.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Sources and Analytic Sample&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Data were collected from 2019 to 2021. Telemedicine ICU recovery visits within the intervention group were used in this analysis. ICU recovery visits at 3- and 12-week intervals after hospital discharge were recorded and analyzed based upon the constant comparative method. Responses were initially open coded and then consolidated with the Donabedian Model of assessing healthcare quality by two investigators to organize themes and subthemes, with discrepancies in coding resolved by consensus.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Principal Findings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Thirty-three clinic visit transcripts from 19 patients revealed health insurance-related issues commonly elicited by clinicians. One in three patients raised health insurance-related issues during their clinical encounter. Structural barriers to ICU recovery included high out-of-pocket spending, the complexity of interfacing with health insurance companies, and health insurance literacy. Patients initiated modifications to intended care to overcome insurance-related barriers to recovery, including nonadherence to prescribed medications and treatments and crafting unsafe “workarounds” to recommended healthcare, with consequences to their recovery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We found that health insurance complexity and high out-of-pocket costs compromise the quality of care and recovery experienced by ICU survivors. These findings emphasize the need for solutions at the policy, payor, and healthcare system levels to mitigate barriers to ICU recovery created by health insurance, which can adversely influence affordable, timely, and appropriate critical illness survivor care.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;\u0000 &lt;b&gt;Trial Registration:&lt;/b&gt; NCT","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/10.1111/1475-6773.14615","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996091","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":"Examining the Impact of ACA Medicaid Expansion on Insurance Coverage, Access to Care and Health of Low-Income Parents.","authors":"Elena Andreyeva, Hannah I Rochford, Daniel J Marthey","doi":"10.1111/1475-6773.14625","DOIUrl":"https://doi.org/10.1111/1475-6773.14625","url":null,"abstract":"<p><strong>Objective: </strong>To examine longer-term effects of Medicaid expansion on insurance coverage, access to care, and health, and investigate heterogeneous effects across demographic characteristics of low-income parents.</p><p><strong>Study setting and design: </strong>We estimated linear probability models for having healthcare coverage and access to care and reporting days of not good physical and mental health in the past 30 days. We adjusted for individual- and state-level factors, and state and year fixed effects. Our treatment group included low-income parents residing in Medicaid expansion states, and our control group included high-income parents residing in Medicaid expansion states and ineligible for any Affordable Care Act (ACA) subsidies. We used difference-in-differences and event-study designs.</p><p><strong>Data sources and analytic sample: </strong>Nationally representative secondary data on self-reported insurance, access, and health status from the core component (2011-2019) of the Behavioral Risk Factor Surveillance System (BRFSS) among respondents aged 26-54 with at least one child living in the household.</p><p><strong>Principal findings: </strong>Medicaid expansion was associated with a 13.4 percentage point (pp) increase in the probability of reporting any health insurance (p < 0.001), an 11.3 pp decline in the probability of reporting a cost barrier (p < 0.001), and a 2.4 pp decrease in the probability of reporting days in poor mental health (p = 0.028) among low-income parents. Our results also suggest parents who were married and those identifying as non-Hispanic white (relative to Hispanic and non-Hispanic other/multiple race) experienced the largest increases in health insurance coverage.</p><p><strong>Conclusions: </strong>While Medicaid expansions improved insurance coverage, access to care, and health status among low-income parents, disparities persisted and, in some cases, widened. These findings have significant implications for policymakers as they consider policies aimed at increasing access to care.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14625"},"PeriodicalIF":3.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053225","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}