Health affairs scholar最新文献_第2页

Reconsidering risk: instrumental social support and 30-day utilization after discharge. 重新考虑风险：工具性社会支持和出院后30天的利用。

IF 2.7

Health affairs scholar Pub Date : 2025-09-04 eCollection Date: 2025-10-01 DOI: 10.1093/haschl/qxaf178

Andrea S Wallace, Sumin Park, Jia-Wen Guo, Erin P Johnson, Mackenzie Elliott, Catherine E Elmore, Alycia A Bristol

{"title":"Reconsidering risk: instrumental social support and 30-day utilization after discharge.","authors":"Andrea S Wallace, Sumin Park, Jia-Wen Guo, Erin P Johnson, Mackenzie Elliott, Catherine E Elmore, Alycia A Bristol","doi":"10.1093/haschl/qxaf178","DOIUrl":"10.1093/haschl/qxaf178","url":null,"abstract":"Introduction: In alignment with Centers for Medicare and Medicaid Services (CMS) requirements, hospitals increasingly screen for health-related social needs (HRSNs) such as housing, food, and transportation. However, these protocols often exclude instrumental social support-help with tasks like managing medications or attending appointments-which may influence post-discharge outcomes.Methods: We analyzed social risk data from 5 medical-surgical units at a US quaternary academic medical center. Among 413 inpatients (mean age 48.9 years; 52.1% male; 85.5% non-Hispanic White), we examined whether patient-reported instrumental social support and unmet HRSNs were associated with 30-day emergency department (ED) visits or rehospitalizations. Models were adjusted for LACE scores, a validated index of length of stay, admission acuity, comorbidity burden, and ED visits.Results: Within 30 days of discharge, 7.3% of patients had an ED visit, and 7.3% were rehospitalized. In adjusted models, higher instrumental social support was associated with lower odds of ED visits (OR = 0.76, 95% CI: 0.59-1.00). Unmet HRSNs were not significantly associated with either outcome. Higher LACE scores predicted increased utilization (ED visits, OR = 1.29, 95% CI: 1.15-1.45; rehospitalizations, OR = 1.21, 95% CI: 1.09-1.36).Conclusion: Instrumental social support may influence short-term post-discharge outcomes. Expanding CMS-aligned screening to include support availability could improve discharge planning and reduce unplanned utilization.Trial registration: Clinicaltrials.gov ID NCT04248738.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 10","pages":"qxaf178"},"PeriodicalIF":2.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Supporting older-adult behavioral health: building the first state Center of Excellence for Behavioral Health and Aging. 支持老年人行为健康：建立第一个国家行为健康和老龄化卓越中心。

IF 2.7

Health affairs scholar Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf175

Walter D Dawson, Allyson Stodola, Paula Carder, Karen Cellarius, Lindsey Smith, Leah Brandis, Mary Oschwald, Annette M Totten, Dana Womack, Vimal Aga, Julia Unsworth, Laura K Byerly, Joanne Spetz, Maureen Nash, Nirmala Dhar, Keren Brown Wilson, Teresa Hogue, Brenda Sulick, Robyn Stone, Frederic C Blow, Jordan P Lewis, Keith Chan, Erin E Emery-Tiburcio, Helen Lavretsky

{"title":"Supporting older-adult behavioral health: building the first state Center of Excellence for Behavioral Health and Aging.","authors":"Walter D Dawson, Allyson Stodola, Paula Carder, Karen Cellarius, Lindsey Smith, Leah Brandis, Mary Oschwald, Annette M Totten, Dana Womack, Vimal Aga, Julia Unsworth, Laura K Byerly, Joanne Spetz, Maureen Nash, Nirmala Dhar, Keren Brown Wilson, Teresa Hogue, Brenda Sulick, Robyn Stone, Frederic C Blow, Jordan P Lewis, Keith Chan, Erin E Emery-Tiburcio, Helen Lavretsky","doi":"10.1093/haschl/qxaf175","DOIUrl":"10.1093/haschl/qxaf175","url":null,"abstract":"Introduction: The behavioral health (BH) needs of older adults are unique, increasing, and, too often, poorly understood.Methods: Oregon established the first state-level center of excellence in the United States focused on the BH of older adults via a state-university-community partnership. Oregon's Center of Excellence for Behavioral Health and Aging (OCEBHA) was conceptualized by the state health authority and initially funded using a block grant from the Substance Abuse and Mental Health Services Administration.Results: OCEBHA seeks to expand the capacity of health and social programs and providers to deliver BH services for older adults with serious mental illness and substance use disorders through translational research, workforce development, and policy innovation.Conclusion: This review article describes the United States' and Oregon's BH and aging landscape, highlighting the disconnects between research evidence, clinical treatment/intervention, and policy implementation. It outlines the rationale for establishing centers like OCEBHA, which was designed to bridge these gaps. By detailing OCEBHA's structure and focus areas-translational research, workforce development, and policy innovation-the article shows how this model can help align evidence-based practices with service delivery and policy. It also offers a roadmap for other states seeking to strengthen support for older adults with BH needs.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf175"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Understanding burnout in physician assistants/associates through the lens of Conservation of Resources theory. 从资源保护理论的角度理解医师助理/助理的职业倦怠。

IF 2.7

Health affairs scholar Pub Date : 2025-09-02 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf176

Andrzej Kozikowski, Mirela Bruza-Augatis, Sarah Maddux, Kasey Puckett, Dawn Morton-Rias, Joshua Goodman

{"title":"Understanding burnout in physician assistants/associates through the lens of Conservation of Resources theory.","authors":"Andrzej Kozikowski, Mirela Bruza-Augatis, Sarah Maddux, Kasey Puckett, Dawn Morton-Rias, Joshua Goodman","doi":"10.1093/haschl/qxaf176","DOIUrl":"10.1093/haschl/qxaf176","url":null,"abstract":"Introduction: Burnout among clinicians can jeopardize their well-being, productivity, and quality of patient care. However, research on burnout of physician assistants/associates (PAs) is limited. This study investigates factors associated with burnout among PAs.Methods: Using the Conservation of Resources theory as a framework and robust national data (N = 122 360), we examined factors associated with PA burnout. Analyses included descriptives, bivariate statistics, and multivariate logistic regression with marginal effects.Results: A third (34.2%) reported experiencing at least one symptom of burnout; however, differences by specialty were observed, with emergency medicine PAs having the highest prevalence (42.2%) while dermatology PAs had the lowest (26.1%). Multivariate analysis revealed that the strongest factor associated with a 19.9 percentage point higher probability of burnout was a perceived decline in the quality of working conditions in the past year. PAs in emergency medicine were more likely than PAs in other specialties to report worsening conditions. Other factors associated with increased burnout included workload, understaffing, and educational debt.Conclusion: The declining quality of working conditions among PAs was the strongest factor associated with increased burnout, while satisfaction with work-life balance was protective. Strategies and policies focusing on maintaining quality working environments to reduce burnout risk should be prioritized.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf176"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Who chooses consumer-directed personal care? Characterizing users and switchers under New York Medicaid. 谁选择以消费者为导向的个人护理？纽约医疗补助计划下的使用者和转换者的特征。

IF 2.7

Health affairs scholar Pub Date : 2025-09-01 DOI: 10.1093/haschl/qxaf174

Julia G Burgdorf, David Russell, Jennifer M Reckrey

{"title":"Who chooses consumer-directed personal care? Characterizing users and switchers under New York Medicaid.","authors":"Julia G Burgdorf, David Russell, Jennifer M Reckrey","doi":"10.1093/haschl/qxaf174","DOIUrl":"10.1093/haschl/qxaf174","url":null,"abstract":"Introduction: Medicaid-funded personal care can be managed by an agency (agency-directed) or by the enrollee/their representative (consumer-directed). Despite its dramatic growth in New York, little is known about who chooses consumer-directed care.Methods: We compared characteristics of agency- vs consumer-directed care users and predicted likelihood of switching personal care source (from agency- to consumer-directed care or vice versa) using clinical assessment and claims data for 15 395 older, dually enrolled members of a large Managed Long-Term Care (MLTC) plan between 2018 and 2023.Results: Consumer-directed care users were younger and had more family support, with less functional and clinical care needs but greater cognitive impairment. Greater cognitive impairment, greater family caregiver availability, and attending college were significantly associated with switching to consumer-directed care, while fewer hours/week of personal care services predicted any switch in care model.Conclusion: Findings reveal differences in who uses consumer-directed vs agency-directed care and highlight the importance of cognitive, sociodemographic, and social/family contextual factors in influencing enrollees' choice to switch to consumer-directed care. Policies should ensure ongoing access to consumer-directed care for the diverse Medicaid enrollees who rely on this care model.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf174"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Opportunities for employers to address the opioid epidemic: results from a national survey. 雇主应对阿片类药物流行的机会：一项全国调查的结果。

IF 2.7

Health affairs scholar Pub Date : 2025-08-29 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf155

Gillian K SteelFisher, Brian C Castrucci, Mary G Findling, Emma C Prus, Jazmyne Sutton, Michael L Barnett

{"title":"Opportunities for employers to address the opioid epidemic: results from a national survey.","authors":"Gillian K SteelFisher, Brian C Castrucci, Mary G Findling, Emma C Prus, Jazmyne Sutton, Michael L Barnett","doi":"10.1093/haschl/qxaf155","DOIUrl":"10.1093/haschl/qxaf155","url":null,"abstract":"Introduction: Employers play a critical role in addressing the opioid crisis in the United States, so the federal government created the Recovery-Ready Workplace (RRW) framework, which suggests employer action in 4 areas: prevention and risk reduction, education, employment, and treatment.Methods: This study examines employees' views of RRW-related actions taken by their employers to address opioid misuse, using a national survey of 1010 U.S. employees.Results: Results showed significant shortfalls across RRW areas. Only 19% of employees said Narcan was available at work, and only 27% said their employer offered opioid prevention services. Moreover, 79% believed that most coworkers would not be very comfortable receiving opioid abuse prevention information from their employer. Majorities supported retaining co-workers in opioid treatment when they had strong performance records (72%), were monitored (64%), or never misused opioids during work (61%). However, one-third (33%) believed that if employees with good records sought treatment, their employer would be more likely to look for ways to fire rather than support the employee.Conclusion: More employer action is needed, with consideration for expanding Narcan availability, increasing employee access to prevention programs, enhancing employment practices to keep people in the workforce, and cultural shifts to reduce stigma.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf155"},"PeriodicalIF":2.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early impact of the Inflation Reduction Act on small molecule vs biologic post-approval oncology trials. 通货膨胀减少法案对小分子和生物批准后肿瘤试验的早期影响。

IF 2.7

Health affairs scholar Pub Date : 2025-08-28 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf152

Hanke Zheng, Julie A Patterson, Jonathan D Campbell

{"title":"Early impact of the Inflation Reduction Act on small molecule vs biologic post-approval oncology trials.","authors":"Hanke Zheng, Julie A Patterson, Jonathan D Campbell","doi":"10.1093/haschl/qxaf152","DOIUrl":"10.1093/haschl/qxaf152","url":null,"abstract":"Introduction: Under the Inflation Reduction Act (IRA), small molecule drugs are subject to a shorter timeline toward eligibility for selection to the Drug Price Negotiation Program (DPNP) than biologics (7 vs 11 years post-approval), raising concerns about incentives for post-approval clinical development.Methods: Using Citeline's Trialtrove database (7/2014-8/2024), this longitudinal study explored the impact of IRA's passage on industry-sponsored, post-approval phase I-III clinical trials in small molecule vs biologic oncology drugs, excluding vaccine-related trials. We used a difference-in-difference design to explore the impact of the IRA's differential DPNP timeline on small molecule trials in oncology by comparing changes in the number of newly initiated post-approval trials in small molecule drugs after the IRA (first difference) with changes in biological trials (second difference).Results: The monthly average of small molecule and biologic trials dropped by 45.3% (P < .01) and 32.5% (P < .01) post-IRA, respectively. Compared with biologics, small molecules were associated with an additional decrease of 4.5 trials/month (-4.5, 95% CI, -7.1 to -1.9; P < .01) after the IRA's passage.Conclusion: This finding supports hypotheses that the IRA's differential timelines toward DPNP eligibility for the 2 molecule types may disproportionately disincentivize post-approval research in small molecule drugs.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf152"},"PeriodicalIF":2.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12392883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Affordability trade-offs following a public option: learning from the Colorado Option. 公共选择后的负担能力权衡：从科罗拉多选择中学习。

IF 2.7

Health affairs scholar Pub Date : 2025-08-28 eCollection Date: 2025-08-01 DOI: 10.1093/haschl/qxaf160

Andrew Shermeyer

{"title":"Affordability trade-offs following a public option: learning from the Colorado Option.","authors":"Andrew Shermeyer","doi":"10.1093/haschl/qxaf160","DOIUrl":"10.1093/haschl/qxaf160","url":null,"abstract":"Introduction: In 2023, Colorado implemented a public option, called the Colorado Option, and required all insurers in its Affordable Care Act (ACA) Marketplace to offer plans following a uniform benefit design. While the Colorado Option aimed to lower the cost of Marketplace coverage, it is unclear whether the policy has had its intended effect. In this study, I examine how the affordability of Marketplace coverage changed after the Colorado Option for both subsidized and unsubsidized enrollees.Methods: This descriptive analysis used the HIX Compare Individual Market datasets from 2020 to 2025 to measure changes in benchmark Silver plan premiums and premium spreads (the difference in premium between the benchmark Silver plan and lowest-premium plan) in Colorado following the Colorado Option.Results: Between 2020 and 2025, benchmark Silver plan premiums in Colorado increased by $295.84 while premium spread increased by $79.53. These increases were greater than in comparison states.Conclusion: In the years following the Colorado Option, Marketplace coverage in Colorado became more affordable for subsidized enrollees but less affordable for unsubsidized ones. States considering public options should weigh this potential trade-off as they design and implement them to make sure the public option aligns with their policy goals.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 8","pages":"qxaf160"},"PeriodicalIF":2.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12392888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Making the "Birthing-Friendly" hospital designation better. 完善“分娩友好医院”称号。

IF 2.7

Health affairs scholar Pub Date : 2025-08-26 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf170

Amanda Bonheur, Kortney Floyd James, Megan Andrew

引用次数: 0

Systemic solutions to emergency department boarding: the hospitalist's perspective on the need for broader alignment and collaboration. 急诊科登机的系统解决方案：医院医生对更广泛的协调和协作需求的看法。

IF 2.7

Health affairs scholar Pub Date : 2025-08-26 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf168

Dahlia Rizk, Joshua Lapps, Jennifer B Cowart

引用次数: 0

Synthetic data and health equity: accounting for racism and sexism in health care delivery. 综合数据与卫生公平：解释卫生保健服务中的种族主义和性别歧视。

IF 2.7

Health affairs scholar Pub Date : 2025-08-19 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf165

Stephanie Teeple, Luis Emilio Muñoz, Jaya Aysola

{"title":"Synthetic data and health equity: accounting for racism and sexism in health care delivery.","authors":"Stephanie Teeple, Luis Emilio Muñoz, Jaya Aysola","doi":"10.1093/haschl/qxaf165","DOIUrl":"10.1093/haschl/qxaf165","url":null,"abstract":"Introduction: Synthetic data are a promising new tool for answering health service research questions, including those relevant to health equity. However, it is unclear whether synthetic data can accurately capture inequities in health care, which may perpetuate racial and ethnic health inequities when applied to the real world.Methods: In this study, we determine to what extent Synthea, a popular open-source synthetic electronic health record data generator captures racial, ethnic, and sex disparities in clinical practice and evaluate whether the data can be augmented by other publicly available data sources. We examine rates of intervention for 3 common medical conditions-myocardial infarction, chronic obstructive pulmonary disease, and type II diabetes mellitus.Results: For 2 of the 3 conditions, Synthea data showed higher rates of intervention for all patients and attenuated or no disparities in intervention, vs comparator literature. After incorporating data on race, ethnicity, and sex disparities from the Dartmouth Atlas, updated Synthea proportions approached their literature counterparts in both absolute and relative terms.Conclusion: If using synthetic data, researchers and policymakers can work to ensure such data accurately reflect downstream effects of social forces in order to mitigate inadvertent harm to minoritized populations.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf165"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0