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"Do not inject our babies": a social listening analysis of public opinion about authorizing pediatric COVID-19 vaccines. "不要给我们的婴儿注射"：关于授权小儿 COVID-19 疫苗的公众意见社会倾听分析。

Health affairs scholar Pub Date : 2024-07-08 eCollection Date: 2024-07-01 DOI: 10.1093/haschl/qxae082

Aleksandra M Golos, Sharath-Chandra Guntuku, Alison M Buttenheim

{"title":"\"Do not inject our babies\": a social listening analysis of public opinion about authorizing pediatric COVID-19 vaccines.","authors":"Aleksandra M Golos, Sharath-Chandra Guntuku, Alison M Buttenheim","doi":"10.1093/haschl/qxae082","DOIUrl":"10.1093/haschl/qxae082","url":null,"abstract":"Designing effective childhood vaccination counseling guidelines, public health campaigns, and school-entry mandates requires a nuanced understanding of the information ecology in which parents make vaccination decisions. However, evidence is lacking on how best to \"catch the signal\" about the public's attitudes, beliefs, and misperceptions. In this study, we characterize public sentiment and discourse about vaccinating children against SARS-CoV-2 with mRNA vaccines to identify prevalent concerns about the vaccine and to understand anti-vaccine rhetorical strategies. We applied computational topic modeling to 149 897 comments submitted to regulations.gov in October 2021 and February 2022 regarding the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee's emergency use authorization of the COVID-19 vaccines for children. We used a latent Dirichlet allocation topic modeling algorithm to generate topics and then used iterative thematic and discursive analysis to identify relevant domains, themes, and rhetorical strategies. Three domains emerged: (1) specific concerns about the COVID-19 vaccines; (2) foundational beliefs shaping vaccine attitudes; and (3) rhetorical strategies deployed in anti-vaccine arguments. Computational social listening approaches can contribute to misinformation surveillance and evidence-based guidelines for vaccine counseling and public health promotion campaigns.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560571","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

One year of publishing: onward and upward. 出版一年：勇往直前。

Health affairs scholar Pub Date : 2024-06-28 eCollection Date: 2024-07-01 DOI: 10.1093/haschl/qxae085

Kathryn A Phillips

引用次数: 0

Physicians working with physician assistants and nurse practitioners: perceived effects on clinical practice. 医生与医生助理和护士合作：对临床实践的影响。

Health affairs scholar Pub Date : 2024-06-25 eCollection Date: 2024-06-01 DOI: 10.1093/haschl/qxae070

Xiaochu Hu, Bettie Coplan, Hilary Barnes, Noël Smith, Alison Essary, Michael Dill

{"title":"Physicians working with physician assistants and nurse practitioners: perceived effects on clinical practice.","authors":"Xiaochu Hu, Bettie Coplan, Hilary Barnes, Noël Smith, Alison Essary, Michael Dill","doi":"10.1093/haschl/qxae070","DOIUrl":"10.1093/haschl/qxae070","url":null,"abstract":"Physicians in the United States are increasingly working with physician assistants (PAs) and nurse practitioners (NPs), but little is known about how they perceive working with PAs and NPs affects their clinical practice. We used a new national survey to examine physicians' perceptions of working with PAs and/or NPs on their patient volume, care quality, time use, and workload. Among our analytical sample of 5823 physicians, 59% reported working with PAs and/or NPs. Most reported that PAs and NPs positively affected their clinical practice. Among several findings, physicians working in medical schools and with higher incomes were more likely to indicate that PAs improve their clinical practices in all 4 aspects, while being in specialties with higher women's representation was associated with lower ratings for working with PAs. Native Hawaiian and Pacific Islander physicians and those with higher incomes were more likely to signify that NPs improved their clinical practices in all 4 aspects. These findings provide valuable insights, from the physicians' perspective, on care delivery reform.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452462","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

Acquisitions of safety-net hospitals from 2016-2021: a case series. 2016-2021 年收购安全网医院：案例系列。

Health affairs scholar Pub Date : 2024-06-24 eCollection Date: 2024-06-01 DOI: 10.1093/haschl/qxae056

Christian Wood, Xinwei Chen, William Schpero, Paula Chatterjee

{"title":"Acquisitions of safety-net hospitals from 2016-2021: a case series.","authors":"Christian Wood, Xinwei Chen, William Schpero, Paula Chatterjee","doi":"10.1093/haschl/qxae056","DOIUrl":"10.1093/haschl/qxae056","url":null,"abstract":"Safety-net hospitals have recently become targets of acquisition by health systems with the stated purpose of improving their financial solvency and preserving access to safety-net services. Whether acquisition achieves these goals is unknown. In this descriptive case series, we sought to determine the factors that contribute to safety-net hospital acquisition, and identify whether safety-net services are preserved after acquisition. We examined 22 acquisitions of safety-net hospitals from 2016 to 2021 and described characteristics of the acquired safety-net hospitals, their acquiring systems, and the operational fate of acquired hospitals. Relative to other hospitals in the same Hospital Referral Region in the year prior to acquisition, acquired safety-net hospitals tended to be smaller and have lower occupancy rates. Acquiring systems were geographically concentrated, with only 6 of 20 systems operating in more than 1 state. Safety-net hospitals frequently offered typical safety-net services prior to acquisition. However, after acquisition, 2 of the 22 acquired safety-net hospitals lost safety-net services, 3 hospitals ceased inpatient services, and 1 hospital closed entirely. These findings suggest that acquisition of safety-net hospitals may be associated with trade-offs related to the provision of safety-net services for the communities that stand to benefit from them most.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447876","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

The medical competence of health care providers in sub-Saharan Africa: Evidence from 16 127 providers across 11 countries. 撒哈拉以南非洲医疗服务提供者的医疗能力：来自 11 个国家 16 127 名医疗服务提供者的证据。

Health affairs scholar Pub Date : 2024-06-07 eCollection Date: 2024-06-01 DOI: 10.1093/haschl/qxae066

Benjamin Daniels, Andres Yi Chang, Roberta Gatti, Jishnu Das

{"title":"The medical competence of health care providers in sub-Saharan Africa: Evidence from 16 127 providers across 11 countries.","authors":"Benjamin Daniels, Andres Yi Chang, Roberta Gatti, Jishnu Das","doi":"10.1093/haschl/qxae066","DOIUrl":"10.1093/haschl/qxae066","url":null,"abstract":"Despite a consensus that quality of care is critically deficient in low-income countries, few nationally representative studies provide comparable measures of quality of care across countries. To address this gap, we used nationally representative data from in-person administrations of clinical vignettes to measure the competence of 16 127 health care providers across 11 sub-Saharan African countries. Rather than large variations across countries, we found that 81% of the variation in competence is within countries and the characteristics of health care providers do not explain most of this variation. Professional qualifications-including cadre and education-are only weakly associated with competence: across our sample, one-third of nurses are more competent than the average doctor in the same country and one-quarter of doctors are less competent than the average nurse. Finally, while younger cohorts do tend to be more competent, perhaps reflecting improvements in medical education, it would take 25 decades of turnover to improve care by 10 percentage points, on average, if we were to rely on such improvements alone. These patterns necessitate a fundamentally different approach to health care human resource management, calling into question typical staffing policies based on qualifications and seniority rather than directly measured quality.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11157171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297616","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

Quantifying public and private investment in European biopharmaceutical research and development. 量化欧洲生物制药研发领域的公共和私人投资。

Health affairs scholar Pub Date : 2024-05-31 eCollection Date: 2024-06-01 DOI: 10.1093/haschl/qxae060

Annabelle Fowler, Kathleen Grieve, Andreas Maos, Tim Wilsdon

{"title":"Quantifying public and private investment in European biopharmaceutical research and development.","authors":"Annabelle Fowler, Kathleen Grieve, Andreas Maos, Tim Wilsdon","doi":"10.1093/haschl/qxae060","DOIUrl":"10.1093/haschl/qxae060","url":null,"abstract":"Robust biopharmaceutical research and development (R&D) ecosystems require investment from both the public and private sectors. In Europe, there is an interest in growing biopharmaceutical R&D given its contribution to public health and the economy, which requires an understanding of current public and private investment. In addition, recent European draft legislation has focused on the public sector's contributions to biopharmaceutical R&D to inform pharmaceutical prices. However, there is little empirical evidence on the specifics of public and private funding for medicine R&D in Europe. This paper performs aggregative data collection to quantify 2019 investment in biopharmaceutical R&D by the public and private sectors in 6 countries: Belgium, France, Germany, Norway, Poland, and the United Kingdom. We find that, across these countries, the private sector accounts for just under two-thirds of investment. We contrast results to those obtained using high-level R&D indicators from the Organization for Economic Co-operation and Development (OECD) and contextualize differences. We then provide 2013-2019 estimates for Belgium, France, Germany, and the United Kingdom (countries with data to support such analysis), and show that total spending grew over those years, although proportions attributable to each sector remained stable. These findings should provide further evidence for debates on policies to effectively grow the biopharmaceutical R&D sector.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11141779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201626","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

Medicare Advantage enrollees' reports of unfair treatment during health care encounters. 医疗保险优势计划参保者关于在就医过程中受到不公平待遇的报告。

Health affairs scholar Pub Date : 2024-05-29 eCollection Date: 2024-05-01 DOI: 10.1093/haschl/qxae063

Megan Mathews, Megan K Beckett, Steven C Martino, Julie A Brown, Nate Orr, Sarah Gaillot, Marc N Elliott

{"title":"Medicare Advantage enrollees' reports of unfair treatment during health care encounters.","authors":"Megan Mathews, Megan K Beckett, Steven C Martino, Julie A Brown, Nate Orr, Sarah Gaillot, Marc N Elliott","doi":"10.1093/haschl/qxae063","DOIUrl":"10.1093/haschl/qxae063","url":null,"abstract":"We investigated unfair treatment among 1863 Medicare Advantage (MA) enrollees from 21 MA plans using 2022 survey data (40% response rate) in which respondents indicated whether they were treated unfairly in a health care setting based on any of 10 personal characteristics. We calculated reported unfair treatment rates overall and by enrollee characteristics. Nine percent of respondents reported any unfair treatment, most often based on health condition (6%), disability (3%), or age (2%). Approximately 40% of those reporting any unfair treatment endorsed multiple categories. People who qualified for Medicare via disability reported unfair treatment by disability, age, income, race and ethnicity, sex, sexual orientation, and gender/gender identity more often than those who qualified via age. Enrollees dually eligible for Medicare and Medicaid or eligible for a Low-Income Subsidy (DE/LIS) reported unfair treatment by disability, income, language/accent, race and ethnicity, culture/religion, and sex more often than non-DE/LIS enrollees. Compared with White respondents, racial and ethnic minority respondents more often reported unfair treatment by race and ethnicity, language/accent, culture/religion, and income. Female respondents were more likely than male respondents to report unfair treatment based on age and sex.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11135643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141177135","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

Multi-cancer early detection (MCED) tests: prioritizing equity from bench to bedside. 多种癌症早期检测（MCED）试验：从工作台到病床优先考虑公平性。

Health affairs scholar Pub Date : 2024-05-23 eCollection Date: 2024-05-01 DOI: 10.1093/haschl/qxae039

Sarah J Miller, Jamilia R Sly, Christian Rolfo, Philip Mack, Augusto Villanueva, Melissa Mazor, Ellerie Weber, Jenny J Lin, Cardinale B Smith, Emanuela Taioli

引用次数: 0

Implementing automated Medicaid eligibility renewals was not associated with higher levels of program participation 实施自动医疗补助资格更新与计划参与度的提高无关

Health affairs scholar Pub Date : 2024-05-22 DOI: 10.1093/haschl/qxae071

Daniel B Nelson, Phillip M Singer, Vicki Fung

{"title":"Implementing automated Medicaid eligibility renewals was not associated with higher levels of program participation","authors":"Daniel B Nelson, Phillip M Singer, Vicki Fung","doi":"10.1093/haschl/qxae071","DOIUrl":"https://doi.org/10.1093/haschl/qxae071","url":null,"abstract":"\u0000 Increasing participation in Medicaid among eligible individuals is critical for improving access to care among low-income populations. The administrative burdens of enrolling and renewing eligibility are a major barrier to participation. To reduce these burdens, the Affordable Care Act required states to adopt automated renewal processes that use available databases to verify ongoing eligibility. By 2019, nearly all states adopted automated renewals, but little is known about how this policy affected Medicaid participation rates. Using the 2015-2019 American Community Survey, we found that participation rates among non-disabled, non-elderly adults and children varied widely by state with an average of 70.8% and 90.7%, respectively. Among Medicaid-eligible adults, participation was lower among younger adults, males, unmarried individuals, childless households, and those living in non-expansion states compared with their counterparts. State adoption of automated renewals varied over time, but participation rates were not associated with adoption. This finding could reflect limitations to current automated renewal processes or barriers to participation outside of the eligibility renewal process, which will be important to address as additional states expand Medicaid and pandemic-era protections on enrollment expire.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141108113","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

Towards a Coordinated Approach for Managing Accelerated Patient Access to Potentially Beneficial Medicines: reporting the perspectives of a multi-stakeholder, international workshop 采用协调方法管理患者加速获得具有潜在益处的药物：报告多方利益相关者国际研讨会的观点

Health affairs scholar Pub Date : 2024-05-22 DOI: 10.1093/haschl/qxae069

Marie Phillips, Patricia Synnott, Chris Henshall, Sean Tunis, Lloyd Sansom, Daniel Ollendorf

{"title":"Towards a Coordinated Approach for Managing Accelerated Patient Access to Potentially Beneficial Medicines: reporting the perspectives of a multi-stakeholder, international workshop","authors":"Marie Phillips, Patricia Synnott, Chris Henshall, Sean Tunis, Lloyd Sansom, Daniel Ollendorf","doi":"10.1093/haschl/qxae069","DOIUrl":"https://doi.org/10.1093/haschl/qxae069","url":null,"abstract":"\u0000 Accelerated and conditional regulatory pathways for drug approvals are intended to enable earlier patient access to potentially life-saving treatments, or treatments that provide benefits in addressing a significant unmet need. However, there are questions about how well such pathways work, how appropriately they are applied, and how the work of regulators can be better coordinated with that of health technology assessment (HTA) and payer bodies, providers and health systems, and other stakeholders. In June 2023, a multi-stakeholder, international workshop was convened in Adelaide, Australia to deliberate the challenges, goals, and opportunities to improve accelerated access pathways. Workshop attendees included representatives from patient organizations, regulators, HTA/payer bodies, universities (ethicists, health economists), and companies developing and marketing new medicines from Australia, Asia, Europe, and North America. We reviewed the contents of this workshop to identify areas of agreement and disagreement, report the key themes of the discussion, and delineate next steps for improving accelerated access pathways. We found that there was general agreement among workshop attendees that accelerated access could be improved significantly by strengthening processes for stakeholder coordination, and that coordinated efforts will be required to implement meaningful change moving forward.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141110844","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