Health affairs scholar最新文献_第10页

Increasing Equity in Adult Immunization through Community-Level Action 通过社区一级的行动提高成人免疫接种的公平性

Health affairs scholar Pub Date : 2023-12-08 DOI: 10.1093/haschl/qxad071

Ram Koppaka, Melinda Wharton, Megan C Lindley, Jitinder Kohli, Julie Morita

引用次数: 0

The Mortality Experience of Disabled Persons in the United States During the COVID-19 Pandemic COVID-19 大流行期间美国残疾人的死亡经历

Health affairs scholar Pub Date : 2023-12-08 DOI: 10.1093/haschl/qxad082

David A Weaver

{"title":"The Mortality Experience of Disabled Persons in the United States During the COVID-19 Pandemic","authors":"David A Weaver","doi":"10.1093/haschl/qxad082","DOIUrl":"https://doi.org/10.1093/haschl/qxad082","url":null,"abstract":"\u0000 New data from the Social Security Administration suggests there were 260,000 excess deaths in the United States among current or former disability beneficiaries during the first 22 months of the COVID-19 pandemic. These beneficiaries accounted for 26 percent of all excess deaths in the US during this period. The pattern of deaths among disabled beneficiaries corresponds closely with known milestones in the pandemic’s history. Disabled beneficiaries in New York, particularly those residing in institutions, had extremely elevated mortality with the onset of the pandemic in the spring of 2020. Across all regions in the US, mortality among disability beneficiaries increased sharply with the onset of the winter of 2020-2021 and with the emergence of the Delta and Omicron variants in 2021. Elevated mortality was observed for persons with intellectual, mental, and physical impairments. Future public information campaigns about vaccines and other measures may be more successful if they include specific efforts to directly target disability beneficiaries. In addition, clinical trials and other research should consider including disabled persons as specific study groups as the severity of their underlying health impairments is likely comparable to that of persons of advanced age.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138586457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Barriers Primary Care Clinic Leaders Face to Improving Value in a Consumer Choice Health Plan Design 初级保健诊所领导者在消费者选择医疗计划设计中提高价值时面临的障碍

Health affairs scholar Pub Date : 2023-12-07 DOI: 10.1093/haschl/qxad065

Tim McDonald, Arindam Debbarma, Christopher Whaley, Rachel Reid, Bryan Dowd

引用次数: 0

Characterizing Hospitalization Trajectories in the High-Need, High-Cost Population using Electronic Health Record Data 利用电子健康记录数据描述高需求、高成本人群的住院轨迹

Health affairs scholar Pub Date : 2023-12-06 DOI: 10.1093/haschl/qxad077

Scott S. Lee, Benjamin French, Francis Balucan, Michael D McCann, Eduard E Vasilevskis

{"title":"Characterizing Hospitalization Trajectories in the High-Need, High-Cost Population using Electronic Health Record Data","authors":"Scott S. Lee, Benjamin French, Francis Balucan, Michael D McCann, Eduard E Vasilevskis","doi":"10.1093/haschl/qxad077","DOIUrl":"https://doi.org/10.1093/haschl/qxad077","url":null,"abstract":"\u0000 High utilization by a minority of patients accounts for a large share of healthcare costs, but the dynamics of this utilization remain poorly understood. We sought to characterize longitudinal trajectories of hospitalization among adult patients at an academic medical center from 2017 to 2023. Among 3,404 patients meeting eligibility criteria, following an initial “rising-risk” period of three hospitalizations in six months, growth mixture modeling discerned four clusters of subsequent hospitalization trajectories: no further utilization, low chronic utilization, persistently high utilization with a slow rate of increase, and persistently high utilization with a fast rate of increase. Baseline factors associated with higher-order hospitalization trajectories included: admission to a non-surgical service, full code status, ICU-level care, opioid administration, discharge home, and comorbid cardiovascular disease, end-stage kidney or liver disease, or cancer. Characterizing hospitalization trajectories and their correlates in this manner lays groundwork for early identification of those most likely to become high-need, high-cost patients.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138595054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical Advice Lines Offering On-Demand Access to Providers Reduced Emergency Department Visits 医疗咨询热线按需提供医疗服务，减少了急诊室就诊人次

Health affairs scholar Pub Date : 2023-12-06 DOI: 10.1093/haschl/qxad079

Linda Diem Tran, Liam Rose, Ken Suzuki, Tracy Urech, Anita Vashi

{"title":"Medical Advice Lines Offering On-Demand Access to Providers Reduced Emergency Department Visits","authors":"Linda Diem Tran, Liam Rose, Ken Suzuki, Tracy Urech, Anita Vashi","doi":"10.1093/haschl/qxad079","DOIUrl":"https://doi.org/10.1093/haschl/qxad079","url":null,"abstract":"\u0000 Instant access to clinicians through virtual care is designed to allow patients to receive care they need while avoiding high-cost visits in acute care settings. This study investigates the effect of offering patients the option to instantly connect with emergency care providers instead of being referred to the emergency department (ED) following calls to a medical advice line. We employed a staggered rollout design to assess the effects of implementing this program on key outcomes among Veterans Affairs (VA) enrollees. Analyzing over one million calls from 2019 to 2022, we found that access to a provider reduced the proportion of patients who subsequently visited the ED compared to those with access to the standard medical advice line (38% vs. 36%). There was no significant difference observed in subsequent inpatient admissions or 30-day mortality. We found that a majority of callers (65%) achieved issue resolution or were directed to lower acuity settings for further evaluation. Although substantial direct cost savings were not evident, our findings demonstrate that on-demand to a virtual provider can effectively decrease ED visits.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138594673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How Policymakers Innovate Around Behavioral Health: Adoption of the New Mexico “No Behavioral Health Cost-sharing” Law 政策制定者如何围绕行为健康进行创新：通过新墨西哥州 "无行为健康费用分担 "法

Health affairs scholar Pub Date : 2023-12-06 DOI: 10.1093/haschl/qxad081

Samantha J. Harris, Ezra Golberstein, Johanna Catherine Maclean, Bradley D Stein, S. Ettner, Brendan Saloner

引用次数: 0

A National Overview of Nonprofit Hospital Community Benefit Programs to Address the Social Determinants of Health 非营利性医院社区福利计划应对健康的社会决定因素全国概览

Health affairs scholar Pub Date : 2023-12-06 DOI: 10.1093/haschl/qxad078

Berkeley Franz, Ashlyn Burns, Kristin Kueffner, Meeta Bhardwaj, Valerie A Yeager, Simone Singh, Neeraj Puro, Cory E. Cronin

{"title":"A National Overview of Nonprofit Hospital Community Benefit Programs to Address the Social Determinants of Health","authors":"Berkeley Franz, Ashlyn Burns, Kristin Kueffner, Meeta Bhardwaj, Valerie A Yeager, Simone Singh, Neeraj Puro, Cory E. Cronin","doi":"10.1093/haschl/qxad078","DOIUrl":"https://doi.org/10.1093/haschl/qxad078","url":null,"abstract":"\u0000 Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes, yet strategies to address these upstream factors remain elusive. The aim of this study was to understand the extent to which US nonprofit hospitals invest in SDOH at either the community or individual patient level and to provide examples of programs in each area. We analyzed data from a national dataset of 613 hospital community health needs assessments and corresponding implementation strategies. Among sample hospitals, 69.3% (n = 373) of identified SDOH as a top-five health need in their community and 60.6% (n = 326) reported investments in SDOH. Of hospitals with investments in SDOH, 44% of programs addressed health-related social needs of individual patients while the remaining 56% of programs addressed SDOH at the community-level. Hospitals that were major teaching organizations, those in the Western region of the US, and hospitals in counties with more severe housing problems had greater odds of investing in SDOH at the community level. Although many nonprofit hospitals have integrated SDOH-related activities into their community benefit work, stronger policies are necessary to encourage greater investments at the community-level that move beyond the needs of individual patients.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138594236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Massachusetts’ Opioid Limit Law Associated with a Reduction in Post-Operative Opioid Duration Among Orthopedic Patients 马萨诸塞州的阿片类药物限制法与骨科患者术后阿片类药物使用时间缩短有关

Health affairs scholar Pub Date : 2023-12-04 DOI: 10.1093/haschl/qxad068

Bryant Shuey, Fang Zhang, Edward Rosen, Brian Goh, Nicolas K. Trad, J. Wharam, Hefei Wen

{"title":"Massachusetts’ Opioid Limit Law Associated with a Reduction in Post-Operative Opioid Duration Among Orthopedic Patients","authors":"Bryant Shuey, Fang Zhang, Edward Rosen, Brian Goh, Nicolas K. Trad, J. Wharam, Hefei Wen","doi":"10.1093/haschl/qxad068","DOIUrl":"https://doi.org/10.1093/haschl/qxad068","url":null,"abstract":"\u0000 Post-operative orthopedic patients are a high-risk group for receiving long-duration, large-dosage opioid prescriptions. Rigorous evaluation of state opioid duration limit laws, enacted throughout the country in response to the opioid overdose epidemic, is lacking among this high-risk group. We took advantage of Massachusetts’ early implementation of a 2016 7-day limit law that occurred before other statewide or plan-wide policies took affect and used commercial insurance claims from 2014-2017 to study its association with post-operative opioid prescriptions greater than 7-days duration among Massachusetts orthopedic patients relative to a New Hampshire control group. Our sample included 14,097 commercially insured opioid-naïve adults aged 18 and older undergoing elective orthopedic procedures. We found that the Massachusetts 7-day limit was associated with an immediate 4.23-percentage point absolute reduction (95% CI 8.12 to 0.33 percentage points) and a 33.27% relative reduction (95% CI 55.36% to 11.19%) in the percentage of initial fills greater than 7-days in the Massachusetts relative to the control group. Seven-day limit laws may be an important state level tool to mitigate longer duration prescribing to high-risk post-operative populations.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138604230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Making Care Primary: Medicare’s Latest Attempt at Value-Based Primary Care 使护理成为基础护理：医疗保险在基于价值的基础护理方面的最新尝试

Health affairs scholar Pub Date : 2023-12-04 DOI: 10.1093/haschl/qxad072

Wasan M. Kumar, Bob Kocher, Eli Y Adashi

引用次数: 0

Health affairs scholar Pub Date : 2023-12-04 DOI: 10.1093/haschl/qxad069

Megan Hyland, Colleen Carey

{"title":"Biosimilars Engage in Low Levels of Direct-to-Physician Marketing Relative to Reference Biologics","authors":"Megan Hyland, Colleen Carey","doi":"10.1093/haschl/qxad069","DOIUrl":"https://doi.org/10.1093/haschl/qxad069","url":null,"abstract":"\u0000 Biosimilars have the potential to greatly reduce U.S. spending on biologic drugs, but uptake of these competitor products varies. We used Open Payments data from 2014 to 2022 to proxy for direct-to-physician marketing and compared levels of activity between biologic and biosimilar drugs. Our analysis focused on six reference biologics that recently faced competition in the years immediately before and after the launch of the first biosimilar. We used Medicare Part B dosage units to measure market penetration of biosimilars and its relationship with biosimilar marketing activity. Lastly, we conducted a sensitivity test, comparing payments for primarily office- or hospital-based physicians, using affiliations constructed from Medicare carrier claims. Reference biologics greatly reduced the amount of direct-to-physician marketing in the post-launch period. Biosimilars generally engaged in low levels of activity relative to the historic performance of reference biologics. These trends were consistent across office- and hospital-based physicians. The intensity of biosimilars’ direct-to-physician marketing also had no apparent relationship with achieved market penetration. Our findings demonstrate that persistently high market shares of reference biologics cannot be explained by ongoing direct-to-physician marketing activities. At the same time, while such activities could educate physicians or induce switching, biosimilar entrants engaged in little direct-to-physician marketing.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138603551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0