Health Services Research最新文献

{"title":"Engaging healthcare teams to increase access to medications for opioid use disorder","authors":"Rebecca S. Oberman MSW, MPH, Alexis K. Huynh PhD, MPH, Kelsey Cummings MS, Adam Resnick PhD, Stephanie L. Taylor PhD, Alicia A. Bergman PhD, Evelyn T. Chang MD, MSHS","doi":"10.1111/1475-6773.14371","DOIUrl":"10.1111/1475-6773.14371","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the effectiveness of evidence-based quality improvement (EBQI) as an implementation strategy to expand the use of medications for opioid use disorder (MOUD) within nonspecialty settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources and Study Setting</h3>\u0000 \u0000 <p>We studied eight facilities in one Veteran Health Administration (VHA) region from October 2015 to September 2022 using administrative data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Initially a pilot, we sequentially engaged seven of eight facilities from April 2018 to September 2022 using EBQI, consisting of multilevel stakeholder engagement, technical support, practice facilitation, and data feedback. We established facility-level interdisciplinary quality improvement (QI) teams and a regional-level cross-facility collaborative. We used a nonrandomized stepped wedge design with repeated cross sections to accommodate the phased implementation. Using aggregate facility-level data from October 2015 to September 2022, we analyzed changes in patients receiving MOUD using hierarchical multiple logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection/Extraction Methods</h3>\u0000 \u0000 <p>Eligible patients had an opioid use disorder (OUD) diagnosis from an outpatient or inpatient visit in the previous year. Receiving MOUD was defined as having been prescribed an opioid agonist or antagonist treatment or a visit to an opioid substitution clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Findings</h3>\u0000 \u0000 <p>The probability of patients with OUD receiving MOUD improved significantly over time for all eight facilities (average marginal effect [AME]: 0.0057, 95% CI: 0.0044, 0.0070) due to ongoing VHA initiatives, with the probability of receiving MOUD increasing by 0.577 percentage points, on average, each quarter, totaling 16 percentage points during the evaluation period. The seven facilities engaging in EBQI experienced, on average, an additional 5.25 percentage point increase in the probability of receiving MOUD (AME: 0.0525, 95%CI: 0.0280, 0.0769). EBQI duration was not associated with changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EBQI was effective for expanding access to MOUD in nonspecialty settings, resulting in increases in patients receiving MOUD exceeding those associated with temporal trends. Additional research is needed due to re","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 S2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156752","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":"Are suicides underreported? The impact of coroners versus medical examiners on suicide reporting.","authors":"Jose Manuel Fernandez, Jayani Jayawardhana","doi":"10.1111/1475-6773.14381","DOIUrl":"https://doi.org/10.1111/1475-6773.14381","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate if state death investigation systems affect the reporting of suicides, particularly when comparing medical examiners to coroners.</p><p><strong>Data sources and study setting: </strong>We used restricted-access state mortality data from National Vital Statistics System between the years 1959 to 2016. These data were matched with state-level changes in death investigation systems reported by the Centers for Disease Control and Prevention database on the Public Health Law Program: Coroner/ME Laws.</p><p><strong>Study design: </strong>We used difference-in-differences and event study methods for the analysis. We estimated the relative per capita changes in suicides, accidental deaths, and homicides when comparing coroner-only states with other death investigation types. Sub-analyses estimated differences by sex, race, and if coroners were required to receive training.</p><p><strong>Data collection/extraction methods: </strong>Not Applicable.</p><p><strong>Principal findings: </strong>Coroners-only states underreported suicides by 17.4% (p < 0.05) and performed 20.4% (p < 0.05) fewer autopsies compared to states with county coroners and a state medical examiner. This pattern is consistent by sex and race. Required coroner training did not affect death determination significantly.</p><p><strong>Conclusion: </strong>Coroners-only states underreported suicides compared to states with county coroners and a state medical examiner. The disparity in the use of autopsies is a potential mechanism for underreporting of suicides by coroners. If all coroners-only states adopted a state medical examiner, suicide reporting would increase by 2243-3100 deaths in the United States annually.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146915","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":"Racial inequities in cesarean use among high- and low-risk deliveries: An analysis of childbirth hospitalizations in New Jersey from 2000 to 2015.","authors":"Alecia J McGregor, David Garman, Peiyin Hung, Motunrayo Tosin-Oni, Kaitlyn Camacho Orona, Rose L Molina, Katrina J Ciraldo, Katy Backes Kozhimannil","doi":"10.1111/1475-6773.14375","DOIUrl":"https://doi.org/10.1111/1475-6773.14375","url":null,"abstract":"<p><strong>Objective: </strong>To examine racial inequities in low-risk and high-risk (or \"medically appropriate\") cesarean delivery rates in New Jersey during the era surrounding the United States cesarean surge and peak.</p><p><strong>Study setting and design: </strong>This retrospective repeated cross-sectional study examined the universe of childbirth hospitalizations in New Jersey from January 1, 2000 through September 30, 2015. We estimate the likelihood of cesarean delivery by maternal race and ethnicity, with mixed-level logistic regression models, stratified by cesarean risk level designated by the Society of Maternal Fetal Medicine (SMFM).</p><p><strong>Data sources and analytic sample: </strong>We used all-payer hospital discharge data from the Healthcare Cost and Utilization Project's State Inpatient Discharge Database and linked this data to the American Hospital Association Annual Survey. ZIP-code Tabulation Area (ZCTA)-level racialized economic segregation index data were from the 2007-2011 American Community Survey. We identified 1,604,976 statewide childbirth hospitalizations using International Classification of Diseases-9-CM (ICD-9) diagnosis and procedure codes and Diagnosis-Related Group codes, and created an indicator of cesarean delivery using ICD-9 codes.</p><p><strong>Principal findings: </strong>Among low-risk deliveries, Black patients, particularly those in the age group of 35-39 years, had higher predicted probabilities of giving birth via cesarean than White people in the same age categories (Black-adjusted predicted probability = 24.0%; vs. White-adjusted predicted probability = 17.3%). Among high-risk deliveries, Black patients aged 35 to 39 years had a lower predicted probability (by 2.7 percentage points) of giving birth via cesarean compared with their White counterparts.</p><p><strong>Conclusions: </strong>This study uncovered a lack of medically appropriate cesarean delivery for Black patients, with low-risk Black patients at higher odds of cesarean delivery and high-risk Black patients at lower odds of cesarean than their White counterparts. The significant Black-White inequities highlight the need to address misalignment of evidence-based cesarean delivery practice in the efforts to improve maternal health equity. Quality metrics that track whether cesareans are provided when medically needed may contribute to clinical and policy efforts to prevent disproportionate maternal morbidity and mortality among Black patients.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146916","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":"Tracking implementation strategies in real-world settings: VA Office of Rural Health enterprise-wide initiative portfolio","authors":"Heather Schacht Reisinger PhD,&nbsp;Sheila Barron PhD,&nbsp;Erin Balkenende MPH,&nbsp;Melissa Steffen MPH,&nbsp;Kenda Steffensmeier PhD,&nbsp;Chris Richards MA,&nbsp;Dan Ball PhD,&nbsp;Emily E. Chasco PhD,&nbsp;Jennifer Van Tiem PhD,&nbsp;Nicole L. Johnson PhD,&nbsp;DeShauna Jones PhD,&nbsp;Julia E. Friberg MPH,&nbsp;Rachael Kenney MA, PMP,&nbsp;Jane Moeckli PhD,&nbsp;Kanika Arora PhD,&nbsp;Borsika Rabin PhD, MPH, PharmD","doi":"10.1111/1475-6773.14377","DOIUrl":"10.1111/1475-6773.14377","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 use a practical approach to examining the use of Expert Recommendations for Implementing Change (ERIC) strategies by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) dimensions for rural health innovations using annual reports on a diverse array of initiatives.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Sources and Study Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The Veterans Affairs (VA) Office of Rural Health (ORH) funds initiatives designed to support the implementation and spread of innovations and evidence-based programs and practices to improve the health of rural Veterans. This study draws on the annual evaluation reports submitted for fiscal years 2020–2022 from 30 of these enterprise-wide initiatives (EWIs).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Content analysis was guided by the RE-AIM framework conducted by the Center for the Evaluation of Enterprise-Wide Initiatives (CEEWI), a Quality Enhancement Research Initiative (QUERI)-ORH partnered evaluation initiative.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Collection and Extraction Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;CEEWI analysts conducted a content analysis of EWI annual evaluation reports submitted to ORH. Analysis included cataloguing reported implementation strategies by Reach, Adoption, Implementation, and Maintenance (RE-AIM) dimensions (i.e., identifying strategies that were used to support each dimension) and labeling strategies using ERIC taxonomy. Descriptive statistics were conducted to summarize data.&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;A total of 875 implementation strategies were catalogued in 73 reports. Across these strategies, 66 unique ERIC strategies were reported. EWIs applied an average of 12 implementation strategies (range 3–22). The top three ERIC clusters across all 3 years were &lt;i&gt;Develop stakeholder relationships&lt;/i&gt; (21%), &lt;i&gt;Use evaluative/iterative strategies&lt;/i&gt; (20%), and &lt;i&gt;Train/educate stakeholders&lt;/i&gt; (19%). Most strategies were reported within the Implementation dimension. Strategy use among EWIs meeting the rurality benchmark were also compared.&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;Combining the dimensions from the RE-AIM framework and the ERIC strategies allows for understanding the use of implementation strategies across each RE-AIM dimension. This analysis will support ORH efforts to spread and sust","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 S2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121214","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":"Addressing immortal time bias in precision medicine: Practical guidance and methods development.","authors":"Deirdre Weymann, Emanuel Krebs, Dean A Regier","doi":"10.1111/1475-6773.14376","DOIUrl":"https://doi.org/10.1111/1475-6773.14376","url":null,"abstract":"<p><strong>Objective: </strong>To compare theoretical strengths and limitations of common immortal time adjustment methods, propose a new approach using multiple imputation (MI), and provide practical guidance for using MI in precision medicine evaluations centered on a real-world case study.</p><p><strong>Study setting and design: </strong>Methods comparison, guidance, and real-world case study based on previous literature. We compared landmark analysis, time-distribution matching, time-dependent analysis, and our proposed MI application. Guidance for MI spanned (1) selecting the imputation method; (2) specifying and applying the imputation model; and (3) conducting comparative analysis and pooling estimates. Our case study used a matched cohort design to evaluate overall survival benefits of whole-genome and transcriptome analysis, a precision medicine technology, compared to usual care for advanced cancers, and applied both time-distribution matching and MI. Bootstrap simulation characterized imputation sensitivity to varying data missingness and sample sizes.</p><p><strong>Data sources and analytic sample: </strong>Case study used population-based administrative data and single-arm precision medicine program data from British Columbia, Canada for the study period 2012 to 2015.</p><p><strong>Principal findings: </strong>While each method described can reduce immortal time bias, MI offers theoretical advantages. Compared to alternative approaches, MI minimizes information loss and better characterizes statistical uncertainty about the true length of the immortal time period, avoiding false precision. Additionally, MI explicitly considers the impacts of patient characteristics on immortal time distributions, with inclusion criteria and follow-up period definitions that do not inadvertently risk biasing evaluations. In the real-world case study, survival analysis results did not substantively differ across MI and time distribution matching, but standard errors based on MI were higher for all point estimates. Mean imputed immortal time was stable across simulations.</p><p><strong>Conclusions: </strong>Precision medicine evaluations must employ immortal time adjustment methods for unbiased, decision-grade real-world evidence generation. MI is a promising solution to the challenge of immortal time bias.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121213","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":"On the motivation for pharmaceutical manufacturer coupons: Brand loyalty or customer acquisition?","authors":"Jason Brian Gibbons, Manuel Hermosilla, Antonio Trujillo","doi":"10.1111/1475-6773.14379","DOIUrl":"https://doi.org/10.1111/1475-6773.14379","url":null,"abstract":"<p><strong>Objective: </strong>To generate evidence regarding the offensive (customer acquisition) versus defensive (customer retention) motivation for pharmaceutical manufacturer coupons.</p><p><strong>Data sources and study setting: </strong>Retail prescriptions from IQVIA's Formulary Impact Analyzer data between 2017 and 2019.</p><p><strong>Study design: </strong>Ordinary least squares regression models with person, therapeutic class, drug, and time-fixed effects to measure the association between switching medications and coupon usage as well as the association between patient out-of-pocket spending and switching to a drug and using a coupon. To study switching type heterogeneity, reanalysis of associations for any type of switch, generic-brand switches, and brand-brand switches. Reestimation of baseline analyses for sodium-glucose cotransporter-2 inhibitors, anticoagulants, and inhaled corticosteroids/long-acting beta2-agonists to assess heterogeneity by drug class and market maturity.</p><p><strong>Data collection: </strong>1,167,132 privately insured patients that utilized at least one coupon between 2017 and 2019 for one or more prescriptions.</p><p><strong>Principal findings: </strong>Coupon usage was associated with a 1.0 percentage point reduction in any kind of drug switch in the full sample and by 0.65-2.9 percentage points for the drug class subgroups. However, these estimates are governed by market dynamics; the probability of switching increased by 40% on the first coupon usage before declining by more than 50% on subsequent coupons. Switching after the first coupon use may be explained by systematic savings implied by coupon use; we find coupons reduced patient out-of-pocket spending by $45.00 (i.e., the majority of patient out-of-pocket costs). In subgroup analyses, coupon savings were $6.43 larger than average for anticoagulants, characterized by the highest levels of brand and generic competition among the considered therapeutic classes.</p><p><strong>Conclusions: </strong>Pharmaceutical manufacturers may be using coupons to acquire customers and then build brand loyalty, especially in markets with more generic competition. Antitrust authorities and other regulators should scrutinize the impact of coupons on market competitiveness and drug spending.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114946","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":"Capturing the care of complex community-based health center patients: A comparison of multimorbidity indices and clinical classification software.","authors":"Suparna M Navale, Siran Koroukian, Nicole Cook, Anna Templeton, Brenda M McGrath, Laura Crocker, Wyatt P Bensken, Ana R Quiñones, Nicholas K Schiltz, Melissa Y Wei, Kurt C Stange","doi":"10.1111/1475-6773.14378","DOIUrl":"10.1111/1475-6773.14378","url":null,"abstract":"<p><strong>Objective: </strong>To compare morbidity burden captured from multimorbidity indices and aggregated measures of clinically meaningful categories captured in primary care community-based health center (CBHC) patients.</p><p><strong>Data sources and study setting: </strong>Electronic health records of patients seen in 2019 in OCHIN's national network of CBHCs serving patients in rural and underserved communities.</p><p><strong>Study design: </strong>Age-stratified analyses comparing the most common conditions captured by the Charlson, Elixhauser, and Multimorbidity Weighted (MWI) indices, and Classification Software Refined (CCSR) and Chronic Condition Indicator (CCI) algorithms.</p><p><strong>Data collection/extraction methods: </strong>Active ICD-10 conditions on patients' problem list in 2019.</p><p><strong>Principal findings: </strong>Approximately 35%-56% of patients with at least one condition are not captured by the Charlson, Elixhauser, and MWI indices. When stratified by age, this range broadens to 9%-90% with higher percentages in younger patients. The CCSR and CCI reflect a broader range of acute and chronic conditions prevalent among CBHC patients.</p><p><strong>Conclusion: </strong>Three commonly used indices to capture morbidity burden reflect conditions most prevalent among older adults, but do not capture those on problem lists for younger CBHC patients. An index with an expanded range of care conditions is needed to understand the complex care provided to primary care populations across the lifespan.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114945","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":"Eliciting patient past experiences of healthcare discrimination as a potential pathway to reduce health disparities: A qualitative study of primary care staff.","authors":"Dharma E Cortés, Ana M Progovac, Frederick Lu, Esther Lee, Nathaniel M Tran, Margo A Moyer, Varshini Odayar, Caryn R R Rodgers, Leslie Adams, Valeria Chambers, Jonathan Delman, Deborah Delman, Selma de Castro, María José Sánchez Román, Natasha A Kaushal, Timothy B Creedon, Rajan A Sonik, Catherine Rodriguez Quinerly, Ora Nakash, Afsaneh Moradi, Heba Abolaban, Tali Flomenhoft, Ruth Nabisere, Ziva Mann, Sherry Shu-Yeu Hou, Farah N Shaikh, Michael W Flores, Dierdre Jordan, Nicholas Carson, Adam C Carle, Benjamin Lé Cook, Danny McCormick","doi":"10.1111/1475-6773.14373","DOIUrl":"https://doi.org/10.1111/1475-6773.14373","url":null,"abstract":"<p><strong>Objective: </strong>To understand whether and how primary care providers and staff elicit patients' past experiences of healthcare discrimination when providing care.</p><p><strong>Data sources/study setting: </strong>Twenty qualitative semi-structured interviews were conducted with healthcare staff in primary care roles to inform future interventions to integrate data about past experiences of healthcare discrimination into clinical care.</p><p><strong>Study design: </strong>Qualitative study.</p><p><strong>Data collection/extraction methods: </strong>Data were collected via semi-structured qualitative interviews between December 2018 and January 2019, with health care staff in primary care roles at a hospital-based clinic within an urban safety-net health system that serves a patient population with significant racial, ethnic, and linguistic diversity.</p><p><strong>Principal findings: </strong>Providers did not routinely, or in a structured way, elicit information about past experiences of healthcare discrimination. Some providers believed that information about healthcare discrimination experiences could allow them to be more aware of and responsive to their patients' needs and to establish more trusting relationships. Others did not deem it appropriate or useful to elicit such information and were concerned about challenges in collecting and effectively using such data.</p><p><strong>Conclusions: </strong>While providers see value in eliciting past experiences of discrimination, directly and systematically discussing such experiences with patients during a primary care encounter is challenging for them. Collecting this information in primary care settings will likely require implementation of multilevel systematic data collection strategies. Findings presented here can help identify clinic-level opportunities to do so.</p>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":" ","pages":"e14373"},"PeriodicalIF":3.1,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082665","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":"Primary care mental health integration to improve early treatment engagement for veterans who screen positive for depression","authors":"Lucinda B. Leung MD, PhD, MPH,&nbsp;Karen Chu MS,&nbsp;Danielle E. Rose PhD,&nbsp;Susan E. Stockdale PhD,&nbsp;Edward P. Post MD, PhD,&nbsp;Jennifer S. Funderburk PhD,&nbsp;Lisa V. Rubenstein MD, MSPH","doi":"10.1111/1475-6773.14354","DOIUrl":"10.1111/1475-6773.14354","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 examine the relationship between the penetration (or reach) of a national program aiming to integrate mental health clinicians into all primary care clinics (PC-MHI) and rates of guideline-concordant follow-up and treatment among clinic patients newly identified with depression in the Veterans Health Administration (VA).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Sources/Study Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;15,155 screen-positive patients 607,730 patients with 2-item Patient Health Questionnaire scores in 82 primary care clinics, 2015–2019.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this retrospective cohort study, we used established depression care quality measures to assess primary care patients who (a) newly screened positive (score ≥3) and (b) were identified with depression by clinicians via diagnosis and/or medication (&lt;i&gt;n&lt;/i&gt; = 15,155; 15,650 patient-years). Timely follow-up included ≥3 mental health, ≥3 psychotherapy, or ≥3 primary care visits for depression. Minimally appropriate treatment included ≥4 mental health visits, ≥3 psychotherapy, or ≥60 days of medication. In multivariate regressions, we examined whether higher rates of PC-MHI penetration in clinic (proportion of total primary care patients in a clinic who saw any PC-MHI clinician) were associated with greater depression care quality among cohort patients, adjusting for year, healthcare system, and patient and clinic characteristics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Collection/Extraction Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Electronic health record data from 82 VA clinics across three states.&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;A median of 9% of all primary care patients were seen by any PC-MHI clinician annually. In fully adjusted models, greater PC-MHI penetration was associated with timely depression follow-up within 84 days (∆&lt;i&gt;P&lt;/i&gt; = 0.5; SE = 0.1; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and 180 days (∆&lt;i&gt;P&lt;/i&gt; = 0.3; SE = 0.1; &lt;i&gt;p&lt;/i&gt; = 0.01) of a positive depression screen. Completion of at least minimal treatment within 12 months was high (77%), on average, and not associated with PC-MHI penetration.&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;Greater PC-MHI program penetration was associated with early depression treatment engagement at 84−/180-days among clinic patients newly identified with depression, with no effect on already high rates of co","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 S2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019635","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":"Evolution of the Veterans Health Administration Learning Health System: 25 years of QUERI","authors":"Melissa M. Garrido PhD,&nbsp;Amy M. Kilbourne PhD MPH","doi":"10.1111/1475-6773.14372","DOIUrl":"10.1111/1475-6773.14372","url":null,"abstract":"&lt;p&gt;The Veterans Health Administration (VHA) is among the nation's largest integrated health systems and among the largest learning health systems. A learning health system combines institution-specific data generation and evaluation with context from the broader research, clinical, and policy communities to inform and implement approaches to improve access to, quality, efficiency, and cost of care.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Instrumental to the establishment of the VHA as a learning health system was the founding of the national Quality Enhancement Research Initiative (QUERI) program, an operational evaluation and quality improvement program. QUERI was established in 1998, and in the years since its founding, initiatives have evolved from implementation of guideline-based care for specific conditions to the conduct of system-wide quality improvement and implementation science efforts to the support of evidence-based policymaking.&lt;span&gt;&lt;sup&gt;3-5&lt;/sup&gt;&lt;/span&gt; This special issue highlights scientific contributions and real-world impacts emanating from 25 years of initiatives stemming from QUERI that reflect rapid translation of research into practice.&lt;/p&gt;&lt;p&gt;QUERI was established with a goal of becoming “…a national system to translate research discoveries and innovations into patient care and health systems improvement”.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Initial translation efforts were focused on nine conditions or groups of conditions that are prevalent among veterans: heart disease, cerebrovascular disease, type II diabetes, colorectal cancer, prostate disease, spinal cord injury, HIV/AIDS, mental health conditions, and substance use disorders. This initial focus laid the groundwork for projects featured in an article in this issue by Damschroder, Hamilton, and colleagues, who summarize the far-reaching impacts from a decade of diabetes-focused QUERI projects.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Evaluations of the implementation of the VA's Diabetes Prevention Program led to insights into how to improve the reach of other, related programs; the effectiveness of an online version of the program; and the importance of gender-specific tailoring of prevention programs.&lt;/p&gt;&lt;p&gt;In the past decade, QUERI has expanded its focus to address broader health system issues that affect multiple conditions and veterans' overall well-being.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The Veterans Access, Choice, and Accountability Act of 2014 (Choice Act) mandated the creation of a commission to examine methods to improve veterans' access to care. In their report, the Commission on Care recommended that the VA leverage data and continuous improvement principles to ensure equitable access to high-quality care.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; Around the same time, the Office of Management and Budget urged federal agencies to use evidence to support budget and operational decisions.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; QUERI's expanded focus was in response to these recommendations, notably by using a learning health system","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 S2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019634","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}