Health affairs scholar最新文献_第6页

Dobbs-driven expansion of perinatal palliative care: a scoping review of the evidence and its limits. 多布斯驱动的围产期姑息治疗的扩展：证据的范围审查及其局限性。

Health affairs scholar Pub Date : 2025-04-15 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf081

Abigail B Wilpers, Kathie Kobler, Robyn Schafer, Melissa Wilpers, Molly Zeme, Janene Batten, Lucinda Canty, Scott A Lorch

{"title":"Dobbs-driven expansion of perinatal palliative care: a scoping review of the evidence and its limits.","authors":"Abigail B Wilpers, Kathie Kobler, Robyn Schafer, Melissa Wilpers, Molly Zeme, Janene Batten, Lucinda Canty, Scott A Lorch","doi":"10.1093/haschl/qxaf081","DOIUrl":"https://doi.org/10.1093/haschl/qxaf081","url":null,"abstract":"As abortion care restrictions increase, a growing population is continuing pregnancies complicated by life-limiting fetal conditions, making it more critical than ever to evaluate the state of the evidence in perinatal palliative care (PPC). Perinatal palliative care provides interdisciplinary, person-centered care, integrating medical management with psychosocial and bereavement support to enable values-driven decision-making. This scoping review evaluates US-based evidence on the safety, effectiveness, acceptability, and equity of PPC, assessing how these findings relate to growing abortion restrictions. Analysis of 13 studies found that US PPC programs are understudied, with limited evidence on maternal health and neonatal comfort outcomes. Studies lacked use rates for all eligible individuals, preventing assessment of overall PPC uptake. Most PPC patients reported high satisfaction, citing compassionate care, emotional support, and parental validation. However, studies lacked diversity. None examined the experience of receiving PPC due to abortion restrictions. Existing PPC evidence is limited, leaving critical gaps in safety, effectiveness, acceptability, and equity-key factors in assessing whether PPC meets its intended goals and serves diverse populations. Our review highlights that evidence is insufficient to determine whether PPC can adequately support the growing, vulnerable patient population now directed into it by policy rather than choice.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf081"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055247","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 at a crossroads: A conversation with Dr. Mark McClellan on program reforms and the growth of Medicare Advantage. 十字路口的医疗保险：与马克·麦克莱伦博士就项目改革和医疗保险优势的发展进行对话。

Health affairs scholar Pub Date : 2025-04-15 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf084

Mark McClellan, Benedic Ippolito

引用次数: 0

Insights from crowdfunding campaigns for medical hardship. 来自医疗困难众筹活动的见解。

Health affairs scholar Pub Date : 2025-04-15 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf085

Erin L Duffy, Samantha Randall, Sumedha Raghu, Nicholas Wong, Nina Linh Nguyen, Erin Trish

引用次数: 0

Health affairs scholar Pub Date : 2025-04-15 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf082

Simon F Haeder, Wendy Y Xu

引用次数: 0

Beyond regulation: a conversation with Dr. Robert Califf on the challenges facing healthcare and innovating community-based solutions: How can the United States harness technological innovation to transform its healthcare system to improve population health outcomes? 超越监管：与Robert Califf博士就医疗保健面临的挑战和创新社区解决方案进行对话：美国如何利用技术创新改变其医疗保健系统以改善人口健康结果？

Health affairs scholar Pub Date : 2025-04-12 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf075

Robert M Califf, Danea M Horn, Kathryn A Phillips

{"title":"Beyond regulation: a conversation with Dr. Robert Califf on the challenges facing healthcare and innovating community-based solutions: How can the United States harness technological innovation to transform its healthcare system to improve population health outcomes?","authors":"Robert M Califf, Danea M Horn, Kathryn A Phillips","doi":"10.1093/haschl/qxaf075","DOIUrl":"https://doi.org/10.1093/haschl/qxaf075","url":null,"abstract":"Dr. Robert M. Califf recently ended his second tenure as the Commissioner of the Food and Drug Administration (FDA). Our conversation occurred on his 1-month anniversary of becoming a private citizen again. In our conversation, Dr. Califf shares his perspective on pressing healthcare challenges following his second tenure as FDA Commissioner. Dr. Califf discusses the balancing act between accelerated drug approvals and evidence generation, emphasizing the need for robust postmarket studies and the health system's role in evidence generation. He also advocates for a fundamental shift toward prevention-focused, community-based healthcare supported by technology to address the paradox of spending and health outcomes in the United States. As healthcare leadership in the new administration shifts health priorities, Dr. Califf highlights critical vulnerabilities in pharmaceutical supply chains and the urgent need to combat health misinformation in the digital age.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf075"},"PeriodicalIF":0.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060617","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

Use of Long COVID Clinics in the Veterans Health Administration: Implications for the path forward. 在退伍军人健康管理局使用长COVID诊所：对前进道路的影响。

Health affairs scholar Pub Date : 2025-04-11 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf080

David P Bui, Elizabeth Bast, Hanh Trinh, Alexandra Fox, Theodore S Z Berkowitz, Ana Palacio, Pandora L Wander, Ann M O'Hare, Edward J Boyko, George N Ioannou, Matthew L Maciejewski, Denise M Hynes

{"title":"Use of Long COVID Clinics in the Veterans Health Administration: Implications for the path forward.","authors":"David P Bui, Elizabeth Bast, Hanh Trinh, Alexandra Fox, Theodore S Z Berkowitz, Ana Palacio, Pandora L Wander, Ann M O'Hare, Edward J Boyko, George N Ioannou, Matthew L Maciejewski, Denise M Hynes","doi":"10.1093/haschl/qxaf080","DOIUrl":"https://doi.org/10.1093/haschl/qxaf080","url":null,"abstract":"Long COVID is a serious chronic illness that can present in many forms and impact daily functioning and quality of life. Without curative treatments, management of long COVID requires coordination and ongoing access to multidisciplinary care. Starting in 2020, the Veterans Health Administration (VHA), established a national network of Long COVID Clinics (LCCs). In this retrospective cohort study of 494 547 veterans with documented SARS-CoV-2 infection in the VHA from March 2020 to April 2022 (n = 494 547), we examined trends in ICD-10 U09.9 diagnosis code use for long COVID and LCC use in the VHA up to May 2024. Overall, 5.9% (n = 29 195) of patients in our cohort had a documented U09.9 code and 2% had at least 1 LCC visit. Among veterans with a U09.9 code, 17.4% (n = 5089) used LCCs. LCC use rates were low across all patient subgroups. LCCs were more available to veterans residing in the South census region (28% vs <7% use rate) than veterans in other regions. Developing evidence about LCC effectiveness and ensuring equitable access to LCCs within and beyond the VHA will be critical in meeting the evolving needs of people with long COVID.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf080"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046255","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

What methods do patients use to schedule medical appointments? 病人用什么方法安排医疗预约？

Health affairs scholar Pub Date : 2025-04-09 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf077

Simon F Haeder, Wendy Y Xu

引用次数: 0

Association between pre-pandemic wealth and material hardships during the COVID-19 pandemic: how racial and ethnic wealth inequities shape household vulnerability to national crises. 大流行前的财富与COVID-19大流行期间的物质困难之间的关系：种族和民族财富不平等如何影响家庭对国家危机的脆弱性。

Health affairs scholar Pub Date : 2025-04-09 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf078

Alexandra Skinner, Nicole C McCann, Chanelle J Howe, Kathryn M Leifheit, Lorraine T Dean, Yareliz Diaz, Catherine K Ettman, Julia Raifman, Paul R Shafer

{"title":"Association between pre-pandemic wealth and material hardships during the COVID-19 pandemic: how racial and ethnic wealth inequities shape household vulnerability to national crises.","authors":"Alexandra Skinner, Nicole C McCann, Chanelle J Howe, Kathryn M Leifheit, Lorraine T Dean, Yareliz Diaz, Catherine K Ettman, Julia Raifman, Paul R Shafer","doi":"10.1093/haschl/qxaf078","DOIUrl":"https://doi.org/10.1093/haschl/qxaf078","url":null,"abstract":"The COVID-19 pandemic was characterized by large racial and ethnic inequities in acute material hardships. Pre-pandemic economic conditions, including household wealth, may have contributed to these disparities. We used longitudinal data from the Understanding America Study surveys to (1) describe racial and ethnic differences in pre-pandemic household wealth; and to (2) evaluate the association between pre-pandemic household wealth and acute material hardships during the pandemic. We found large racial and ethnic inequities in pre-pandemic wealth, with 48.3% of non-Hispanic White households reporting wealth greater than $100,000, compared to 16.4% and 29.8% for non-Hispanic Black and Hispanic/Latino households, respectively. Adjusted Poisson regression models clustered by household revealed that, during the pandemic, households with less than $100,000 in pre-pandemic wealth had 1.7-3.0 times higher prevalence of food insufficiency and 1.4-2.0 times higher prevalence of housing insecurity compared with households with more than $100,000 in pre-pandemic wealth. Wealth inequities, which are racially patterned in the United States, shape vulnerability to material hardships such as food insufficiency and housing insecurity during economic crises.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf078"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033212","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

Opioid and alcohol use disorder medication availability in outpatient care: national estimates & potential policy levers. 门诊护理中阿片类药物和酒精使用障碍药物的可得性：国家估计和潜在的政策杠杆。

Health affairs scholar Pub Date : 2025-04-09 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf040

Alisa B Busch, Sharon-Lise T Normand, Constance M Horgan, Shelly F Greenfield, Haiden A Huskamp, Sharon Reif

{"title":"Opioid and alcohol use disorder medication availability in outpatient care: national estimates & potential policy levers.","authors":"Alisa B Busch, Sharon-Lise T Normand, Constance M Horgan, Shelly F Greenfield, Haiden A Huskamp, Sharon Reif","doi":"10.1093/haschl/qxaf040","DOIUrl":"https://doi.org/10.1093/haschl/qxaf040","url":null,"abstract":"Medications for opioid and alcohol use disorder (MOUD/MAUD) are efficacious, important components of relapse prevention care, and markedly underused. Yet, not all programs treating substance use disorders (SUD) offer them. Using the Substance Abuse and Mental Health Services Administration's 2022 National Substance Use and Mental Health Services Survey (N-SUMHSS), for outpatient programs (excluding opioid treatment programs) that provided \"primarily SUD services\" (SUD) or \"primarily mental health but also SUD services\" (MH/SUD; N = 9921 programs), we identified program characteristics associated with providing MOUD or MAUD, focusing on potential policy levers (state licensure/certification, national organization accreditation) that could increase MOUD/MAUD access. We found that only approximately half (51%) provide MOUD and fewer (45%) provide MAUD. State licensure/certification was negatively associated with providing these medications, while national organization accreditation was positively associated. However, states varied widely in these associations. Additionally, SUD programs were less likely to offer MOUD/MAUD compared with MH/SUD programs. These findings demonstrate missed policy opportunities for states and national accreditation organizations to move SUD care into evidence-based practice.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf040"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060027","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

Characteristics of accountable care organizations offering methadone to patients with opioid use disorder. 向阿片类药物使用障碍患者提供美沙酮的负责任医疗机构的特点。

Health affairs scholar Pub Date : 2025-04-09 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf074

Maia Crawford, Benjamin A Barsky, Haiden A Huskamp, Mary F Brunette, Ellen Meara

{"title":"Characteristics of accountable care organizations offering methadone to patients with opioid use disorder.","authors":"Maia Crawford, Benjamin A Barsky, Haiden A Huskamp, Mary F Brunette, Ellen Meara","doi":"10.1093/haschl/qxaf074","DOIUrl":"10.1093/haschl/qxaf074","url":null,"abstract":"Understanding whether organizations with Medicare and Medicaid accountable care organization (ACO) contracts offer methadone provides important context about how organizations invested in payment and delivery system reform address the needs of patients with substance use disorders. We used data from the 2021-2022 National Survey of Accountable Care Organizations to assess whether organizations with ACO contracts, which are held accountable for the cost and quality of care for an assigned patient population, offered methadone to patients with opioid use disorder (OUD), and the organizational and contextual characteristics associated with doing so. We found that 28.3% of survey respondents reported that clinicians in their organizations offered methadone via an opioid treatment program. In adjusted analyses, organizations with a Medicaid ACO contract but no Medicare contract were more likely to offer methadone (46.0%, P < 0.05) than organizations with a Medicare-only contract (19.6%) or a Medicare and Medicaid contract (30.3%). Despite incentives to prioritize population health, most ACO-affiliated organizations were not offering individuals with OUD the full range of recommended medications and should work to enhance treatment options for this patient population.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf074"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12015604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063605","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