Health affairs scholar最新文献_第5页

Expanding options to recruit, grow, and retain the public health workforce. 扩大招聘、发展和留住公共卫生人力的选择。

Health affairs scholar Pub Date : 2024-12-04 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae115

Kate Beatty, Laura Hunt Trull, Christen Minnick, Kawther Al Ksir, Kristen Surles, Michael Meit

{"title":"Expanding options to recruit, grow, and retain the public health workforce.","authors":"Kate Beatty, Laura Hunt Trull, Christen Minnick, Kawther Al Ksir, Kristen Surles, Michael Meit","doi":"10.1093/haschl/qxae115","DOIUrl":"10.1093/haschl/qxae115","url":null,"abstract":"The public health workforce continues to atrophy due to mass and early retirement, under-funding, slow hiring processes, lack of advancement opportunities, and shifting policies. Organizational research into workforce sustainability is crucial for ensuring a robust, diverse staff capable of delivering essential public health services. We examined career ladders, a potential solution to workforce challenges, through interviews with 10 health departments (HDs) across seven states. Interview participants were recruited from HDs using or planning career ladders held administrative positions, and had a role in the hiring process. Many health department positions have traditionally included steps within certain job classifications that promote pay adjustments with increasing years of service. Career ladder approaches, however, specifically focus on providing opportunities for health continuing education, leadership development, or movement into formal leadership roles. Findings indicate that HDs have begun utilizing career ladders for professional development and critical role maintenance. Career ladders have been applied mostly for retention with limited impact on recruitment and increasing staff diversity. Challenges include civil service requirements, funding limitations, and complex recruitment that might exclude diverse candidates. This study emphasizes the importance of transparent development, engaging front-line staff, offering advancement pathways, and providing insights to enhance workforce recruitment and retention.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae115"},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815400","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

Low birthweight rate differences associated with distinct perinatal staffing mixes at federally funded health centers. 低出生体重率差异与联邦资助的保健中心不同的围产期人员组合有关。

Health affairs scholar Pub Date : 2024-12-04 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae113

Paula M Kett, Grace A Guenther, Marieke S van Eijk, Davis G Patterson, Bianca K Frogner

{"title":"Low birthweight rate differences associated with distinct perinatal staffing mixes at federally funded health centers.","authors":"Paula M Kett, Grace A Guenther, Marieke S van Eijk, Davis G Patterson, Bianca K Frogner","doi":"10.1093/haschl/qxae113","DOIUrl":"10.1093/haschl/qxae113","url":null,"abstract":"Health centers (sometimes referred to as \"federally qualified health centers\") can play an important role in addressing perinatal inequities. However, there is limited information on how different staffing models in health centers contribute to perinatal outcomes, including the availability of certified nurse midwives (CNMs). Using 2011-2021 Uniform Data System files, we examined 4 staffing models in 1385 health centers: those with no CNMs or obstetricians-gynecologists (OBs) (\"non-CNM/OB\"), CNM-only, OB-only, and both CNMs and OBs (\"CNM/OB\"). We predicted adjusted low birthweight (LBW) rates across these staffing types using a generalized linear model approach, adjusting for both time and center fixed effects as well as relevant patient, staffing, organizational, and community characteristics. We found that CNM-only health centers had the lowest LBW rates across all staffing models (7.6%) and non-CNM/OB centers had the highest (10.1%). Among Black births, LBW rates ranged from 10.1% (CNM-only) to 13.5% (non-CNM/OB). Findings indicate the importance of building and supporting the CNM workforce and ensuring adequate staffing at health centers, particularly as part of a comprehensive approach to addressing inequities in perinatal outcomes including addressing the scope of practice of CNMs, as more CNM-staff health centers were in areas with independent scope of practice.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae113"},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815403","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

Recent court ruling could increase the size and administrative complexity of the 340B program. 最近的法院裁决可能会增加 340B 计划的规模和管理复杂性。

Health affairs scholar Pub Date : 2024-12-03 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae157

Sayeh Nikpay, John P Bruno, Colleen Carey

{"title":"Recent court ruling could increase the size and administrative complexity of the 340B program.","authors":"Sayeh Nikpay, John P Bruno, Colleen Carey","doi":"10.1093/haschl/qxae157","DOIUrl":"10.1093/haschl/qxae157","url":null,"abstract":"The 340B program allows certain hospitals and clinics to use outpatient drugs purchased at substantial discounts on insured patients, generating profits to fund care. The size of these profits depends on the number of prescriptions filled by participating hospital or clinics' insured patients that also meet the Health Resources and Services Agency's definition of an eligible patient. A recent court case has challenged the Agency's longstanding definition of a patient, resulting in new definition that could significantly expand the size of the program and create conflicts when an insured patient satisfies the new definition for more than one hospital or clinic participating in the program. We use Medicare Part D data from 2018 to simulate the proportion of prescription drug fills eligible for 340B discounts and total program spending under both existing and new definitions. We found that the new definition could increase the share of 340B-eligible fills in Medicare Part D by 25%, from 12% of fills to 16%, and that the share of fills subject to a conflict could double, from 1% of fills to 1%-2%. Our results suggest that the new definition could increase covered entities' 340B profits by roughly a third.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae157"},"PeriodicalIF":0.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11642606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831510","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

Market segmentation by profit status: evidence from hospice. 按盈利状况划分市场：来自临终关怀的证据。

Health affairs scholar Pub Date : 2024-11-29 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae160

David A Rosenkranz, Lindsay White, Chuxuan Sun, Katherine E M Miller, Norma B Coe

引用次数: 0

The development of the Community Deprivation Index and its application to accountable care organizations. 社区剥夺指数的发展及其在责任医疗机构中的应用。

Health affairs scholar Pub Date : 2024-11-27 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae161

John Robst, Ryan Cogburn, Grayson Forlines, Lex Frazier, John Kautter

{"title":"The development of the Community Deprivation Index and its application to accountable care organizations.","authors":"John Robst, Ryan Cogburn, Grayson Forlines, Lex Frazier, John Kautter","doi":"10.1093/haschl/qxae161","DOIUrl":"10.1093/haschl/qxae161","url":null,"abstract":"There is strong interest among policymakers to adjust for area-level deprivation when making payments to providers because such areas have traditionally been underserved. The Medicare Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model provides higher payments to ACOs serving areas with greater deprivation. Area Deprivation Index (ADI) is the primary component to measure deprivation for ACO REACH. The ADI is a commonly used deprivation index, but there are concerns about its methodology, primarily its use of nonstandardized deprivation factors. Prior research indicates the ADI is mainly determined by home values, which does not allow it to adequately capture deprivation in urban areas. This paper revises and updates the ADI, using American Community Survey data to compute a census block group deprivation index, the Community Deprivation Index (CDI). The CDI standardizes the deprivation factors to be unit neutral, applies statistical shrinkage to account for the imprecise measurement of the factors, updates several factors, and reweights the factors using the most recently available data. Validation tests suggest the CDI exhibits higher correlations with several health outcome/utilization measures than the ADI. The CDI will better serve policymakers by improving identification of urban areas with higher deprivation.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae161"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815283","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

Lower obstetrician and gynecologist (OBGYN) supply in abortion-ban states, despite minimal state-level changes in the 2 years post-Dobbs. 禁止堕胎州的妇产科医生（OBGYN）供应量较低，尽管多布斯案后两年内州一级的变化很小。

Health affairs scholar Pub Date : 2024-11-27 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae162

Julia Strasser, Ellen Schenk, Qian Luo, Candice Chen

{"title":"Lower obstetrician and gynecologist (OBGYN) supply in abortion-ban states, despite minimal state-level changes in the 2 years post-Dobbs.","authors":"Julia Strasser, Ellen Schenk, Qian Luo, Candice Chen","doi":"10.1093/haschl/qxae162","DOIUrl":"10.1093/haschl/qxae162","url":null,"abstract":"Since the Dobbs v Jackson Women's Health Organization Supreme Court decision in June 2022, emerging reports suggest that the obstetrician and gynecologist (OBGYN) workforce is moving into states without abortion bans. Using a large national administrative database, we identified OBGYNs enrolling in new states from July 2017 through June 2024. We used difference-in-differences (DID) analyses to estimate the effect of Dobbs on enrollments by state abortion policy (ban vs no ban). Enrollments in ban states were lower than in no-ban states in most academic years (June-July) throughout the study period. In the 2 years post-Dobbs, DID models found no significant differences in enrollments in ban states relative to no-ban states. These findings indicate minimal state-level shifts in the OBGYN workforce following Dobbs. Past research has found that a complex constellation of factors drives physician movement, including state licensure, job availability, income, spousal job opportunities, and social support. While the effect of the Dobbs decision on the workforce are likely to be significant, the full impacts on the workforce will take years to fully unfold.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae162"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831506","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

Politicians, power, and the people's health: US elections and state health outcomes, 2012-2024. 政治家、权力和人民健康：2012-2024年美国选举和州健康结果。

Health affairs scholar Pub Date : 2024-11-27 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae163

Nancy Krieger, Soroush Moallef, Jarvis T Chen, Ruchita Balasubramanian, Tori L Cowger, Rita Hamad, Alecia J McGregor, William P Hanage, Loni Philip Tabb, Mary T Bassett

{"title":"Politicians, power, and the people's health: US elections and state health outcomes, 2012-2024.","authors":"Nancy Krieger, Soroush Moallef, Jarvis T Chen, Ruchita Balasubramanian, Tori L Cowger, Rita Hamad, Alecia J McGregor, William P Hanage, Loni Philip Tabb, Mary T Bassett","doi":"10.1093/haschl/qxae163","DOIUrl":"10.1093/haschl/qxae163","url":null,"abstract":"Our descriptive study examined current associations (2022-2024) between US state-level health outcomes and 4 US state-level political metrics: 2 rarely used in public health research (political ideology of elected representatives based on voting records; trifectas, where 1 party controls the executive and legislative branches) and 2 more commonly used (state policies enacted; voter political lean). The 8 health outcomes spanned the life course: infant mortality, premature mortality (death at age <65), health insurance (adults aged 35-64), vaccination for children and persons aged ≥65 (flu; COVID-19 booster), maternity care deserts, and food insecurity. For the first 3 outcomes, we also examined trends in associations (2012-2024). For all political metrics, higher state-level political conservatism was associated with worse health outcomes, especially for the metrics for political ideology and state trifectas. For example, in 2016, the premature mortality rate in states with Republican vs Democratic trifectas was higher by 55.4 deaths per 100 000 person-years (95% CI: 7.7, 103.1), and the slope of the rate of increase to 2021 was also higher, by 27.0 deaths per 100 000 person-years (95% CI: 24.4, 29.7). These results suggest elections, political ideology, and concentrations of political power matter for population health.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae163"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815277","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

Older adults in social housing: A systemically vulnerable population that needs to be prioritized. 社会住房中的老年人：需要优先考虑的系统性弱势群体。

Health affairs scholar Pub Date : 2024-11-27 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae154

Jasmine Dzerounian, Guneet Mahal, Leena AlShenaiber, Ricardo Angeles, Francine Marzanek, Melissa Pirrie, Gina Agarwal

{"title":"Older adults in social housing: A systemically vulnerable population that needs to be prioritized.","authors":"Jasmine Dzerounian, Guneet Mahal, Leena AlShenaiber, Ricardo Angeles, Francine Marzanek, Melissa Pirrie, Gina Agarwal","doi":"10.1093/haschl/qxae154","DOIUrl":"10.1093/haschl/qxae154","url":null,"abstract":"Older adults living in social housing are a vulnerable population with unique health challenges that often lead to poor health outcomes and high emergency service utilization. However, the needs of this population are frequently overlooked. This policy note describes the characteristics of older adults living in social housing in Canada and discusses why they are a vulnerable, underserved population in need of immediate attention and priority. Older adults in social housing have higher rates of chronic disease, lower quality of life, and lower health literacy and face challenges caused by various compounding social determinants of health. There is a large gap in research and tailored interventions focusing on this population. Based on these findings, the authors highlight the need for the allocation of resources to support this growing population, including dedicated funding, research, and programming. Proactively addressing the issues that exist in the health and social care of this high-needs population will also have larger implications for reducing healthcare system burden.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae154"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814895","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

Accountable care organization changes in equity of ambulatory care quality by patient race and ethnicity, 2019-2022. 问责制医疗机构对2019-2022年患者种族和民族门诊护理质量公平性的影响

Health affairs scholar Pub Date : 2024-11-21 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae155

Hector P Rodriguez, Shihan Xu, Amanda L Brewster, Timothy T Brown, Stacy Chen, Sarah D Epstein

{"title":"Accountable care organization changes in equity of ambulatory care quality by patient race and ethnicity, 2019-2022.","authors":"Hector P Rodriguez, Shihan Xu, Amanda L Brewster, Timothy T Brown, Stacy Chen, Sarah D Epstein","doi":"10.1093/haschl/qxae155","DOIUrl":"10.1093/haschl/qxae155","url":null,"abstract":"There is limited information about accountable care organization (ACO) variation in equity of ambulatory care quality. We examine whether equity of care changed for racial and ethnic minority patients from 2019 to 2022 and the extent to which equity of care performance varied for 11 ACOs in Massachusetts over time. We analyzed ACO-level changes in equity of care for 8 ambulatory care quality measures for Asian, Black, and Hispanic patients, measured as the percentage point difference between each group and the majority non-Hispanic White patient group. Cervical cancer screening (3.54 percentage point change, P < 0.001), colorectal cancer screening (3.54 percentage point change, P < 0.001), and eye exams for adults with diabetes (3.56 percentage point change, P = 0.008) had the largest performance declines. Equity of ambulatory care quality did not significantly change over time. The one exception was for breast cancer screening, where equity declined for Asian patients (3.52 percentage point change, P = 0.04). Although equity of care generally did not significantly change over time across ACOs, high variation in equity of care performance between ACOs highlights opportunities to identify and share the strategies that enable physician practices and healthcare systems to advance equity of care for racial and ethnic minority patients.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae155"},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815376","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

Health affairs scholar Pub Date : 2024-11-19 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae152

Jason Petroski, Kelly Strachan, Nicholas Schluterman, William Doss

{"title":"Non-cost-related sources of medication nonadherence in the Medicare population.","authors":"Jason Petroski, Kelly Strachan, Nicholas Schluterman, William Doss","doi":"10.1093/haschl/qxae152","DOIUrl":"10.1093/haschl/qxae152","url":null,"abstract":"Significant research and attention to date have focused on cost-related medication nonadherence as rising prescription drug prices worsen affordability and access for many Americans. This study investigated self-reported sources of medication nonadherence, measuring both cost- and non-cost-related medication nonadherence among community-dwelling Medicare Part D beneficiaries in 2022. A total of 13.7% of beneficiaries (4 589 843) reported some type of medication nonadherence; 7.5% reported medication nonadherence related to cost and 6.2% reported for non-cost reasons. Beneficiaries reporting food insecurity, poor functional status, and lack of understanding of the Part D benefit were more likely to report both types of medication nonadherence after adjustment for sociodemographic factors. Beneficiaries receiving the Low-Income Subsidy had lower odds of reporting cost-related but greater odds of reporting non-cost-related medication nonadherence. These findings suggest that non-cost-related sources of medication nonadherence, such as beneficiary preferences or beliefs, understanding of their health situation or insurance coverage, and ability to fill a prescription, are significant contributors to overall nonadherence. Non-cost-related medication nonadherence should be considered alongside recent changes to the Part D benefit and in future Part D Centers for Medicare and Medicaid Services (CMS) Innovation Center models, such as the proposed Medicare $2 Drug List Model, in order to maximize the impact of these initiatives.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae152"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815406","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