Health affairs scholar最新文献_第8页

Surprise billing in intensive care unit (ICU) hospitalizations. 重症监护室（ICU）住院的突击收费。

Health affairs scholar Pub Date : 2024-02-27 eCollection Date: 2024-03-01 DOI: 10.1093/haschl/qxae025

Sneha Kannan, Zirui Song

{"title":"Surprise billing in intensive care unit (ICU) hospitalizations.","authors":"Sneha Kannan, Zirui Song","doi":"10.1093/haschl/qxae025","DOIUrl":"10.1093/haschl/qxae025","url":null,"abstract":"<p><p>Intensive care unit (ICU) care is expensive for patients and providers, and utilization and spending on ICU resources have increased. The No Surprises Act, passed in 2022, specifically prohibits balance billing by ICU specialists (intensivists) for emergency and most non-emergency care. The potential economic impact of this remains unclear, given few data exist on the magnitude of balance billing in the ICU. Using the MarketScan Commercial (IBM) database, we studied hospitalizations in which ICU care was provided (\"ICU hospitalizations\") between 2010 and 2019. Hospitalizations were characterized as fully in-network, fully out-of-network, or \"mixed\" (contained both in- and out-of-network services). The share of \"mixed\" hospitalizations among all ICU hospitalizations rose from 26% to 33% over the study period. Over half of these mixed hospitalizations contained out-of-network services specifically delivered within the ICU. Total hospitalization spending averaged $81 047, with ICU spending averaging $15 799. On average, 11% of ICU spending within these hospitalizations was out-of-network. Patients were plausibly balance-billed in approximately one-third of ICU hospitalizations, for thousands of dollars per hospitalization. Given that the No Surprises Act prevents this type of balance billing, the portended revenue loss may lead to changes in provider negotiations with insurers concerning network status and prices, which could affect the care patients receive.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10932732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133606","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

(Dis)honorably discharged: identifying policy gaps in military-civilian reintegration. (不)光荣退伍：确定军民重返社会的政策差距。

Health affairs scholar Pub Date : 2024-02-16 eCollection Date: 2024-02-01 DOI: 10.1093/haschl/qxae021

Tavis Reid, Kaitlyn M Sims

引用次数: 0

Caregiving for Dementia: Trends pre-post onset and predictive factors of family caregiving (2002-2018) 痴呆症的护理：痴呆症发病前后的趋势和家庭护理的预测因素（2002-2018 年）

Health affairs scholar Pub Date : 2024-02-16 DOI: 10.1093/haschl/qxae020

Bailey C Ingraham, D. Barthold, Paul Fishman, Norma B Coe

{"title":"Caregiving for Dementia: Trends pre-post onset and predictive factors of family caregiving (2002-2018)","authors":"Bailey C Ingraham, D. Barthold, Paul Fishman, Norma B Coe","doi":"10.1093/haschl/qxae020","DOIUrl":"https://doi.org/10.1093/haschl/qxae020","url":null,"abstract":"\u0000 Persons living with Alzheimer’s and other related forms of Dementia rely heavily on care from family and friends for assistance with daily activities (“family care”), but little is known about care transitions over time. We analyzed data from the Health and Retirement Study to describe caregiving patterns, from 2 years before dementia onset and up to 6 years after. Using socio-demographic data from the interview prior to dementia onset, we determine if there are significant factors that predict receipt of family care at dementia onset. We found that a third (33%) of people living with dementia were receiving help with daily activities two years prior to their first positive dementia screen and this increased to 60% during the first positive screen. Nearly all of those receiving assistance received family care. We found multiple significant predictors of receiving family care at onset, including race, education, access to private health insurance, number of activities of daily living that were difficult, number of chronic conditions, and already receiving help. This demonstrates potential gaps in dementia care, and which subpopulations may benefit most from targeted interventions for household members that do not have adequate caregiving resources or programs that provide additional formal care.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139960996","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

American Clusters: Using Machine Learning to Understand Health and Health Care Disparities in the United States 美国集群：利用机器学习了解美国的健康和医疗差距

Health affairs scholar Pub Date : 2024-02-14 DOI: 10.1093/haschl/qxae017

Diana M Bowser, Kaili Maurico, Brielle A Ruscitti, William H Crown

{"title":"American Clusters: Using Machine Learning to Understand Health and Health Care Disparities in the United States","authors":"Diana M Bowser, Kaili Maurico, Brielle A Ruscitti, William H Crown","doi":"10.1093/haschl/qxae017","DOIUrl":"https://doi.org/10.1093/haschl/qxae017","url":null,"abstract":"\u0000 Health and health care access in the U.S. is plagued by high inequality. While machine learning (ML) is increasingly used in clinical settings to inform health care delivery decisions and predict health care utilization, using ML as a research tool to understand health care disparities in the U.S. and how these are connected to health outcomes, access to health care, and health system organization is less common. We utilized over 650 variables from 24 different databases aggregated by the Agency for Healthcare Research and Quality (AHRQ) in their Social Determinant of Health Database (SDOH). We used k-means–a non-hierarchical ML clustering method–to cluster county level data. Principal factor analysis created county level index values for each SDOH domain and two health care domains–health care infrastructure and health care access. Logistic regression classification was used to identify the primary drivers of cluster classification. The most efficient cluster classification consists of 3 distinct clusters in the U.S.; the cluster having the highest life expectancy comprised only 10% of counties. The most efficient ML clusters do not identify the clusters with the widest health care disparities. ML clustering, using county level data, shows that health care infrastructure and access are the primary drivers of cluster composition.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139963541","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

Allocating Health Care Resources in Jails and Prisons During COVID-19: A Qualitative Study of Carceral Decision-makers 在 COVID-19 期间分配监狱中的医疗资源：对监狱决策者的定性研究

Health affairs scholar Pub Date : 2024-02-14 DOI: 10.1093/haschl/qxae015

Brandon Doan, Camille Kramer, Brendan Saloner, Minna Song, Carolyn B Sufrin, Leonard S Rubenstein, G. Eber

{"title":"Allocating Health Care Resources in Jails and Prisons During COVID-19: A Qualitative Study of Carceral Decision-makers","authors":"Brandon Doan, Camille Kramer, Brendan Saloner, Minna Song, Carolyn B Sufrin, Leonard S Rubenstein, G. Eber","doi":"10.1093/haschl/qxae015","DOIUrl":"https://doi.org/10.1093/haschl/qxae015","url":null,"abstract":"\u0000 COVID-19 created acute demands on health resources in jails and prisons, burdening health care providers and straining capacity. However, little is known about how carceral decision-makers balanced the allocation of scarce resources to optimize access to and quality of care for incarcerated individuals. This study analyzes a national sample of semi-structured interviews with health care and custody officials (n = 32) with decision-making authority in one or more carceral facilities during the COVID-19 pandemic. Interviews took place between May-October 2021. We coded transcripts using a directed content analysis approach and analyzed data for emergent themes. Participants reported that facilities distributed personal protective equipment to staff before incarcerated populations due to staff’s unique role as potential vectors of COVID-19. The use of testing reflected not only an initial imperative to preserve limited supplies, but also more complex decision-making about the value of test results to facility operations. Participants also emphasized the difficulties caused by limited physical space, insufficient staff, and stress from modifying job roles. The rapid onset of COVID-19 confronted decision-makers with unprecedented resource allocation decisions, often with life-or-death consequences. Planning for future resource allocation decisions now may promote more equitable decisions when confronted with a future pandemic event.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139964163","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

Immigrants to the US Contribute to Society. Here are Three Ways to Support Their Transition 移民到美国为社会做出贡献。以下是支持他们过渡的三种方法

Health affairs scholar Pub Date : 2024-02-14 DOI: 10.1093/haschl/qxae019

Rita Hamad

引用次数: 0

State Scope of Practice Restrictions and Nurse Practitioner Practice in Nursing Homes: 2012-2019 州执业范围限制与护理院执业护士：2012-2019 年

Health affairs scholar Pub Date : 2024-02-12 DOI: 10.1093/haschl/qxae018

K. Ryskina, Junning Liang, Ashley Z Ritter, J. Spetz, Hilary Barnes

{"title":"State Scope of Practice Restrictions and Nurse Practitioner Practice in Nursing Homes: 2012-2019","authors":"K. Ryskina, Junning Liang, Ashley Z Ritter, J. Spetz, Hilary Barnes","doi":"10.1093/haschl/qxae018","DOIUrl":"https://doi.org/10.1093/haschl/qxae018","url":null,"abstract":"\u0000 Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, healthcare workforce characteristics, state fixed effects, and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least one NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139784487","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

State Scope of Practice Restrictions and Nurse Practitioner Practice in Nursing Homes: 2012-2019 州执业范围限制与护理院执业护士：2012-2019 年

Health affairs scholar Pub Date : 2024-02-12 DOI: 10.1093/haschl/qxae018

K. Ryskina, Junning Liang, Ashley Z Ritter, J. Spetz, Hilary Barnes

{"title":"State Scope of Practice Restrictions and Nurse Practitioner Practice in Nursing Homes: 2012-2019","authors":"K. Ryskina, Junning Liang, Ashley Z Ritter, J. Spetz, Hilary Barnes","doi":"10.1093/haschl/qxae018","DOIUrl":"https://doi.org/10.1093/haschl/qxae018","url":null,"abstract":"\u0000 Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, healthcare workforce characteristics, state fixed effects, and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least one NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139844296","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

Has the Fall of Roe Changed Contraceptive Access and Use? New Research from Four US States Offers Critical Insights 罗伊法案的废除是否改变了避孕药具的获取和使用？来自美国四个州的新研究提供了重要见解

Health affairs scholar Pub Date : 2024-02-08 DOI: 10.1093/haschl/qxae016

M. Kavanaugh, Amy Friedrich-Karnik

{"title":"Has the Fall of Roe Changed Contraceptive Access and Use? New Research from Four US States Offers Critical Insights","authors":"M. Kavanaugh, Amy Friedrich-Karnik","doi":"10.1093/haschl/qxae016","DOIUrl":"https://doi.org/10.1093/haschl/qxae016","url":null,"abstract":"\u0000 The overturning of Roe v. Wade in the 2022 Dobbs v. Jackson Women’s Health decision has had vast impacts on abortion access across the United States, but less is known about the wider impacts on people’s contraceptive access. We draw on cross-sectional survey data representative of reproductive-aged women in Arizona, Iowa, New Jersey, and Wisconsin at two timepoints, one prior to and one following the Dobbs decision. We examined changes between these two timepoints in key sexual and reproductive health metrics and, at the post-Dobbs timepoint, differences in these metrics across age, sexual and gender minority status, nativity, and income status. Between these two timepoints, we find statistically significant evidence that sexual activity declined, barriers to accessing contraception increased, reports of receiving high-quality contraceptive care decreased, and condom use increased. As continued fallouts of the Dobbs decision on access to abortion occur, this research makes clear that access to broader contraceptive care is worsening. Policies that promote meaningful access to all forms of sexual and reproductive health care must be advanced to support all individuals’ right to reproductive autonomy while mitigating inequity and inequality.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139794153","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

Has the Fall of Roe Changed Contraceptive Access and Use? New Research from Four US States Offers Critical Insights 罗伊法案的废除是否改变了避孕药具的获取和使用？来自美国四个州的新研究提供了重要见解

Health affairs scholar Pub Date : 2024-02-08 DOI: 10.1093/haschl/qxae016

M. Kavanaugh, Amy Friedrich-Karnik

{"title":"Has the Fall of Roe Changed Contraceptive Access and Use? New Research from Four US States Offers Critical Insights","authors":"M. Kavanaugh, Amy Friedrich-Karnik","doi":"10.1093/haschl/qxae016","DOIUrl":"https://doi.org/10.1093/haschl/qxae016","url":null,"abstract":"\u0000 The overturning of Roe v. Wade in the 2022 Dobbs v. Jackson Women’s Health decision has had vast impacts on abortion access across the United States, but less is known about the wider impacts on people’s contraceptive access. We draw on cross-sectional survey data representative of reproductive-aged women in Arizona, Iowa, New Jersey, and Wisconsin at two timepoints, one prior to and one following the Dobbs decision. We examined changes between these two timepoints in key sexual and reproductive health metrics and, at the post-Dobbs timepoint, differences in these metrics across age, sexual and gender minority status, nativity, and income status. Between these two timepoints, we find statistically significant evidence that sexual activity declined, barriers to accessing contraception increased, reports of receiving high-quality contraceptive care decreased, and condom use increased. As continued fallouts of the Dobbs decision on access to abortion occur, this research makes clear that access to broader contraceptive care is worsening. Policies that promote meaningful access to all forms of sexual and reproductive health care must be advanced to support all individuals’ right to reproductive autonomy while mitigating inequity and inequality.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139854144","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