Medical Care[JOURNAL]
Sun
200 papers
Assessing Racial and Ethnic Disparities in Receipt of Tele-Emergency Care.
Faiz J, Toyama J, Yuan AH … +7 more , Jackson N, Patel N, Zhao L, Vashi AA, Fermin P, Washington DL, Cordasco KM
Med Care · 2025 Nov · PMID 40971558 · Full text
BACKGROUND: In 2021, the Veterans Health Administration (VA) initiated a Tele-Emergency Care (TEC) program, where care is provided through phone or video by an emergency medicine provider to Veterans with urgent, unsched...
BACKGROUND: In 2021, the Veterans Health Administration (VA) initiated a Tele-Emergency Care (TEC) program, where care is provided through phone or video by an emergency medicine provider to Veterans with urgent, unscheduled medical concerns. Early data suggest TEC effectively resolves Veterans' care concerns and decreases low-value emergency department visits. Equity of TEC receipt has yet to be assessed. OBJECTIVE: To assess differences, by race and ethnicity, of Veterans' receipt of TEC. RESEARCH DESIGN: Cross-sectional study. SUBJECTS: Veterans who used TEC and/or low-acuity in-person VA emergency care in Southern California, Arizona, and New Mexico, from March 1, 2021 to May 1, 2023. MEASURES: TEC and/or low-acuity in-person VA care use. RESULTS: Veterans who only had TEC visits were less likely than those who only had in-person visits to be of racial and ethnic minority groups, namely Asian (1.38% vs. 3.54%, P <0.001), Black (12.2% vs. 18.1%, P <0.001), and Hispanic (15.7 vs. 19.1%, P <0.001). These findings persisted once adjusting for covariates; having only TEC visits was less likely than only having in-person care for Veterans who were Asian [relative risk (RR): 0.47, P <0.001], Black (RR: 0.61, P <0.001) or Hispanic (RR: 0.87, P <0.001), compared with White Veterans. CONCLUSIONS: Receipt of TEC, or both TEC and in-person care, rather than exclusively in-person care, is lower among Asian, Black, and Hispanic Veterans compared with White Veterans, independent of covariates. To promote equity, future work should determine and address root causes of disparities, including digital device access, triage processes, and Veteran experiences.
Loneliness and Risk of 30-Day Hospital Readmission After Acute Myocardial Infarction.
Acker C, Soroka O, Sterling MR … +3 more , Goyal P, Safford MM, Pinheiro LC
Med Care · 2025 Dec · PMID 40971549 · Full text
BACKGROUND: Poor social health is linked to incident cardiovascular disease, but less is known about how loneliness affects health care utilization after an acute myocardial infarction (AMI). OBJECTIVE: Determine the ass...
BACKGROUND: Poor social health is linked to incident cardiovascular disease, but less is known about how loneliness affects health care utilization after an acute myocardial infarction (AMI). OBJECTIVE: Determine the association between loneliness and 30-day emergency department (ED) visit or readmission after AMI hospitalization. RESEARCH DESIGN: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national prospective cohort of 30,239 U.S. adults aged 45 years or older. MEASURES: We examined the association between loneliness and 30-day post-AMI ED visit or readmission. SUBJECTS: Seven hundred forty-nine Medicare fee-for-service beneficiaries in REGARDS were discharged alive after an adjudicated AMI. RESULTS: The mean age was 77 years. Twenty-eight percent self-identified as non-Hispanic Black and 39% as women. Twenty percent reported loneliness. Twenty-nine percent had a 30-day ED visit or readmission. Lonely individuals had 61% increased risk of 30-day ED visit or readmission (RR: 1.61; 95% CI: 1.27-2.04; P <0.001), which remained significant after adjustment for sociodemographic and clinical factors (aRR: 1.48; 95% CI: 1.12-1.95; P =0.006). Stratified analyses demonstrated significant association for those aged 65-74 (aRR 2.48; 95% CI, 1.57-3.91; P <0.001), White adults (aRR: 1.86; 95% CI: 1.35-2.58; P <0.001), and men (aRR: 2.19; 95% CI: 1.59-3.01; P <0.001) but not for those 75+ (aRR: 0.94; 95% CI: 0.63-1.40; P =0.75), Black adults (aRR: 0.89; 95% CI: 0.53-1.49; P =0.660), or women (aRR: 0.81; 95% CI: 0.51-1.30; P =0.380). CONCLUSIONS: Loneliness, even measured years before AMI, was associated with an increased risk of 30-day ED visit or readmission, specifically for those aged 65-74, White participants, and men. These findings may inform discharge strategies to reduce readmissions.
Grading Hospitals Using Multivariate Matching.
Silber JH, Rosenbaum PR, Reiter JG … +5 more , Ramadan OI, Jain S, Hill AS, Brumberg K, Fleisher LA
Med Care · 2025 Nov · PMID 40971546 · Publisher ↗
BACKGROUND AND OBJECTIVES: To improve upon existing hospital grading systems, we developed a new report card based on multivariate matching. RESEARCH DESIGN: Matched cohorts. For each focal hospital patient, we match 10...
BACKGROUND AND OBJECTIVES: To improve upon existing hospital grading systems, we developed a new report card based on multivariate matching. RESEARCH DESIGN: Matched cohorts. For each focal hospital patient, we match 10 control patients treated at "well-resourced" hospitals with excellent hospital characteristics from across the nation, and 10 control patients treated at "typical" hospitals, on over 300 patient characteristics from Medicare Claims. Grades were based on outcome differences between patients at the focal hospital and their matched controls. We also create an "Analogous" match that is comprised of multiple control patients matched to each focal hospital patient with similar patient characteristics who were treated at hospitals with similar characteristics to the focal hospital, answering the question, "How would patients who looked like my patients and who were treated at hospitals like my hospital fare, compared to how my patients fared." We also report outcomes by multimorbidity status. SUBJECTS: Medicare admissions from 2017 to 2019 for heart attack, heart failure and pneumonia. To illustrate our methods, we report on 4 hospitals in the same region: a well-known "Flagship" teaching Hospital, an Affiliated Hospital within the same flagship system, a Poor-Performing Hospital that is not part of the flagship system, and a Small Hospital with unstable estimates. MEASURES: Thirty-day mortality and revisit rates. RESULTS: Report cards for each example hospital. CONCLUSIONS: Matched report cards allow users to better benchmark hospitals and see those types of patients where a specific hospital is performing poorly compared to other hospitals treating very similar patients.
Prescriber-Level Responses to the 2018-2019 Valsartan, Irbesartan, and Losartan Recalls and Drug Shortages: A National Study.
Callaway Kim K, Donohue JM, Roberts ET … +3 more , Good CB, Sabik LM, Suda KJ
Med Care · 2025 Nov · PMID 40971534 · Publisher ↗
BACKGROUND: Global shortages for 3 angiotensin receptor-II blockers (ARBs)-valsartan, losartan, and irbesartan-occurred in 2018-2019 after recalls due to ingredient impurities. Provider-level responses to the ARB shortag...
BACKGROUND: Global shortages for 3 angiotensin receptor-II blockers (ARBs)-valsartan, losartan, and irbesartan-occurred in 2018-2019 after recalls due to ingredient impurities. Provider-level responses to the ARB shortages in the United States and spillovers to other antihypertensive classes are unknown. OBJECTIVE: To estimate changes in provider-level prescribing for ARBs and non-ARB antihypertensives up to 18 months after the 2018-2019 recalls and shortages. RESEARCH DESIGN: National cohort study of prescribers using all-payer pharmacy claims. Mixed interrupted time series models quantified changes in prescribing postshortages and heterogeneous changes by specialty, region, medical school graduation cohort, sex, and level of prerecall prescribing. PATIENTS AND METHODS: Active providers exposed to the 2018-2019 valsartan, irbesartan, and losartan shortages (defined as top-25th percentile for these drugs in 2017). MEASURES: Within-class changes in prescribing for ARBs (recalled and nonrecalled). Between-class substitutions to non-ARB antihypertensives (ACE-Is, alpha- and beta-adrenergic blockers, calcium channel blockers, diuretics, and other agents). RESULTS: Among 138,032 prescribers who met the inclusion criteria, per-prescriber fills for valsartan decreased by 57%-59% after it was recalled in July 2018. We observed concurrent increases for losartan and irbesartan fills and no change in overall ARB prescribing. There were no significant changes in fills for ACE-Is or for other antihypertensives. Absolute decreases in valsartan fills were greatest among providers with higher levels of prescribing at baseline. However, relative changes did not differ by prescriber characteristics. CONCLUSIONS: In this prescriber level, national study, substitutions to other ARBs mitigated decreases in valsartan fills after it was recalled. There were no spillovers to non-ARB anti-hypertensives. The availability of close substitutes during drug shortages may mitigate gaps in access for prescribers and their patients.
Associations of Co-Occurring Substance Use Disorder With Diabetes Care Quality, Complications, and Hospitalizations.
Knox MJ, Hodgkin D, Slama NE … +4 more , Sterling SA, Gilliam LK, Asyyed A, Iturralde E
Med Care · 2025 Jun · PMID 40956599 · Full text
BACKGROUND: Substance use disorder (SUD) is a risk factor for diabetes complications and hospitalizations, though a full continuum of diabetes care quality and health outcomes has not been examined among patients with di...
BACKGROUND: Substance use disorder (SUD) is a risk factor for diabetes complications and hospitalizations, though a full continuum of diabetes care quality and health outcomes has not been examined among patients with diabetes accessing substance use treatment. OBJECTIVE: To improve care delivery, this study compared patients with diabetes and co-occurring SUD to those with diabetes and no SUD. POPULATION: In all, 4325 patients with diabetes and a SUD specialty treatment visit versus 255,652 patients with diabetes and no SUD diagnosis in a large, integrated delivery system from 2016 to 2021 were included. RESEARCH DESIGN: Retrospective cohort study using electronic health record data. Modified Poisson regression models estimated relationships for co-occurring SUD and each outcome, adjusting for sociodemographic and clinical factors. MEASURES: Care quality measures included HbA1c, blood pressure, retinal and cholesterol screening, HbA1c < 8%, blood pressure < 140/90 mm Hg, and LDL-cholesterol < 100 mg/dL. Diabetes complications included cardiovascular, cerebrovascular, retinopathy, and lower limb conditions. Hospitalization types included diabetes-related and other conditions, for example, chronic liver disease, and psychiatric. RESULTS: Patients with co-occurring SUD, compared with those without SUD, were more often male, younger, non-Hispanic White, and had a mood disorder. Co-occurring SUD was associated with more HbA1c screening and higher prevalence of HbA1c <8, yet also with elevated risks for nearly all complication types, and all but one hospitalization type, especially chronic liver disease and chronic pain-related hospitalization. CONCLUSIONS: Despite comparable or better diabetes care quality, elevated risk of complications and hospitalization persisted among patients with co-occurring SUD. Both biopsychosocial and system-based mechanisms likely contribute to these elevated risks. Silo-bridging care coordination may help address multifaceted health needs.
Evaluating Dynamic Trends in Veteran Enrollment and Health Care Utilization in the Veterans Health Administration From 2018 to 2021.
Ferguson JM, Van Cleve R, Mulcahy A … +1 more , Osborne TF
Med Care · 2025 Jun · PMID 40956598 · Publisher ↗
BACKGROUND: The impact of the COVID-19 pandemic on Veteran enrollment and health care utilization within the United States Veterans Health Administration (VHA) remains uncertain. OBJECTIVE: To evaluate drivers of enrollm...
BACKGROUND: The impact of the COVID-19 pandemic on Veteran enrollment and health care utilization within the United States Veterans Health Administration (VHA) remains uncertain. OBJECTIVE: To evaluate drivers of enrollment and utilization of health care services at VHA with an emphasis on differences before and during the COVID-19 pandemic. METHODS: We included 14,107,785 Veterans from the US Veterans Eligibility Trends and Statistics (USVETS) FY2017-2021 annual datasets in a repeat cross-sectional design. We assessed the adjusted incidence of VHA enrollment, and the probability of utilizing VHA health care by fiscal year among social determinants of health, including number of children, attained education, income, marital status, household size, and rurality of residence. RESULTS: Contrary to prepandemic years, Veterans with adverse or negative social determinants of health that can lead to poor health (eg, lower income and lower attained education) were less likely than other groups to enroll in FY2021. However, among those enrolled, the probability of using VHA health care service increased by (1%-2%) in FY2021 across all social determinants of health. The largest increases in the probability of VHA health care use were among Veterans with higher income, higher education, and those living in urban areas. CONCLUSIONS: Veterans with adverse social determinants of health, that could lead to poor health, showed decreased VHA enrollment during FY2021. During the same time period, the largest utilization increases occurred among Veterans facing fewer adverse social determinants of health, highlighting nuanced socioeconomic dynamics and need for dedicated programs to ensure equitable care and access during significant societal disruptions.
Defining Pharmacy Access: A Review of Pharmacy-Level Research in the United States.
Duru EE, Ben-Umeh KC, Anderson KE … +1 more , Mattingly TJ
Med Care · 2025 Oct · PMID 40954190 · Publisher ↗
BACKGROUND: Access to pharmacy services is a critical determinant of health care equity, as it directly impacts medication adherence, chronic disease management, and overall health outcomes. Despite the important role of...
BACKGROUND: Access to pharmacy services is a critical determinant of health care equity, as it directly impacts medication adherence, chronic disease management, and overall health outcomes. Despite the important role of community pharmacies in the United States, disparities in access persist, particularly among rural, minority, and low-income populations. However, there is no consensus on how pharmacy access should be defined or measured, and how these definitions relate to health outcomes. OBJECTIVE: This review evaluates how pharmacy access is defined and measured in US-based studies and examines its implications on health outcomes, quality of care, and health care costs. METHODS: We conducted a scoping review of US-based studies published over the past 20 years, identifying patterns in definitions and measurements of pharmacy access, as well as associated health outcomes. The review followed Arksey and O'Malley's framework and PRISMA-ScR guidelines. RESULTS: Sixteen studies met the inclusion criteria, most of which used cross-sectional designs. Definitions of pharmacy access varied, with metrics including distance to the nearest pharmacy, pharmacy density, and the concept of pharmacy deserts. Limited pharmacy access was associated with lower medication adherence, poorer chronic disease management, increased health care costs, and higher hospitalization rates. CONCLUSIONS: Efforts to improve pharmacy access should focus on standardizing measurement approaches and implementing targeted interventions to sustain pharmacies in underserved areas. These strategies have the potential to enhance medication adherence, reduce health care costs, and address health disparities across vulnerable communities.
The Effect of Medicaid Expansion on Care for Patients With Diabetes by Primary Care Provider Supply.
Manouchehri Amoli M, Cunningham PJ, Masoud Bahnamiri M … +3 more , Najafi MJ, Mortazavi Milani A, Dahman B
Med Care · 2025 Oct · PMID 40954189 · Publisher ↗
OBJECTIVE: We examined whether Medicaid expansion led to improvements in health, access, and preventive care for low-income adults with diabetes, varying by primary care provider (PCP) supply. RESEARCH DESIGN AND METHODS...
OBJECTIVE: We examined whether Medicaid expansion led to improvements in health, access, and preventive care for low-income adults with diabetes, varying by primary care provider (PCP) supply. RESEARCH DESIGN AND METHODS: Using 2011-2021 Behavioral Risk Factor Surveillance System data and a difference-in-differences approach, we compared outcomes before and after expansion in states classified by PCP supply. The sample included 85,375 adults aged 18-64 with incomes below 138% of the federal poverty level and a diabetes diagnosis. Outcomes were self-reported: health insurance coverage, personal doctor, cost-related delays in care, routine checkups, flu shots, and days with poor mental or physical health. RESULTS: Across all states, Medicaid expansion was associated with a 3.2 and 3.5 percentage-point (pp) increase in insurance coverage and checkup visits, respectively. High-PCP-supply states realized larger gains in coverage (6.4 pp) as well as improvements in routine checkups (3.3 pp) and flu vaccination (3.5 pp). They also showed a reduction of nearly one day of poor mental health per month. In contrast, low-PCP-supply states experienced a marginally significant increase in poor mental health days. CONCLUSIONS: Medicaid expansion improved coverage, preventive care, and mental health outcomes for low-income adults with diabetes, with more pronounced benefits in high-PCP-supply states. These findings underscore the importance of adequate PCP capacity to optimize the impact of coverage expansions in managing chronic conditions such as diabetes. Policymakers aiming to enhance care for vulnerable patients with diabetes should consider investing in primary care infrastructure alongside coverage expansions.
How Organizational Inclusion Shapes Patient Satisfaction in Magnet Hospitals.
Yu H, Brom H, Bauermeister JA … +4 more , Reich J, McHugh MD, Hanneman T, Aiken LH
Med Care · 2025 Nov · PMID 40853206 · Full text
OBJECTIVE: Magnet hospitals exhibit higher patient satisfaction than non-Magnet hospitals, yet the underlying mechanisms driving these differences remain underexplored. This study examined the associations between Magnet...
OBJECTIVE: Magnet hospitals exhibit higher patient satisfaction than non-Magnet hospitals, yet the underlying mechanisms driving these differences remain underexplored. This study examined the associations between Magnet status, hospitals' inclusion efforts for diverse populations, and patient satisfaction, and whether inclusion efforts explain Magnet hospitals' higher satisfaction. METHODS: This cross-sectional study analyzed 2023 secondary data from 4 sources: the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), the Healthcare Equality Index (HEI), the American Hospital Association Annual Survey, and the list of Magnet-recognized organizations. The sample included 708 hospitals (216 Magnet, 492 non-Magnet) participating in both HCAHPS and HEI. HEI scores, which assess hospitals' inclusion efforts for lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) populations, were used as a proxy for overall inclusion. Patient satisfaction was measured using 8 HCAHPS indicators. Mediation analyses tested whether HEI scores explained the association between Magnet designation and patient satisfaction. RESULTS: Magnet hospitals had higher HEI scores (M=92.0, SD=12.2) compared with non-Magnet hospitals (M=88.5, SD=13.3). They also had higher hospital ratings (M=88.4, SD=2.4 vs. M=87.6, SD=3.3) and patient recommendations (M=88.4, SD=3.2 vs. M=86.8, SD=4.1). Magnet status had direct effects on hospital ratings (b=1.75, P <0.001) and recommendations (b=2.37, P <0.001), as well as indirect effects through HEI performance on hospital ratings (b=0.07, P =0.022) and recommendations (b=0.10, P =0.026), resulting in total effects on hospital ratings (b=1.82, P <0.001) and recommendations (b=2.47, P <0.001). CONCLUSIONS: The findings underscore the importance of organizational priorities and policies that promote patient-centeredness and inclusion for the satisfaction of all patients.
Nonprofit Hospital CEO Compensation: Does Quality Matter?
Jenkins D, Short M, Ho V
Med Care · 2025 Oct · PMID 40846652 · Full text
BACKGROUND: Past research has documented that increases in profits and health system size, as well as increases in the reward generosity for improving these metrics play an important role in explaining increases in nonpr...
BACKGROUND: Past research has documented that increases in profits and health system size, as well as increases in the reward generosity for improving these metrics play an important role in explaining increases in nonprofit hospital CEO pay between 2012 and 2019. OBJECTIVES: To test whether hospital quality measures play a supplemental role in determining CEO pay. RESEARCH DESIGN: We estimated linear regressions for 2012 and 2019 of the log of CEO wages on system or independent hospital characteristics, including quality. The regressions were used to construct a Oaxaca decomposition of factors associated with CEO compensation. SUBJECTS: One thousand forty-seven nonprofit health systems and independent hospitals in 2012 and 812 in 2019. MEASURES: CEO compensation, hospital profits, charity care, hospital size, teaching status, system status, 30-day mortality rate for pneumonia patients, hospital-wide 30-day readmission rate. RESULTS: We find that better quality was more closely associated with higher pay among hospital CEOs in 2012 versus 2019. The inclusion of these quality measures in the analysis somewhat reduced the observed relative return for leading larger hospitals or health systems in 2012, but not in 2019. The link between quality and CEO pay is weaker in 2019 than in 2012. CONCLUSIONS: The results suggest that nonprofit hospital CEOs are being rewarded more for leading large hospitals or systems, but not for providing higher quality care.
Claims-Based Measures of Care Coordination and Long-Term Health Among Older Women With Endometrial Cancer.
Anderson C, Lund JL, Bae-Jump V … +2 more , Trogdon JG, Nichols HB
Med Care · 2025 Nov · PMID 40846651 · Publisher ↗
BACKGROUND: Coordination of care between providers may help ensure that cancer survivors receive the appropriate health care services to improve their long-term health. We examined associations between a claims-based mea...
BACKGROUND: Coordination of care between providers may help ensure that cancer survivors receive the appropriate health care services to improve their long-term health. We examined associations between a claims-based measure of care coordination and several health outcomes among older endometrial cancer survivors. METHODS: Using SEER-Medicare data, we identified women with endometrial cancer at ages 66+ during 2009-2015 (N=13,696). Medicare claims during years 1-3 postdiagnosis were used to calculate care density, a measure of care coordination, as the ratio of the number of patients shared among a woman's outpatient providers to the number of provider pairs seen by that patient. We estimated associations between care density tertile and hospitalizations, emergency room (ER) visits, and all-cause mortality from 3 years postdiagnosis on, and adherence to guideline-recommended follow-up during years 3-5 postdiagnosis. RESULTS: No clear trends were observed for risk of all-cause mortality, hospitalizations or ER visits according to care density category. However, for hospitalizations (HR=0.93; 95% CI: 0.87-0.99) and ER visits (HR=0.93; 95% CI: 0.88-0.98), there was a slightly lower risk in the highest care density tertile compared with the lowest. Women in the middle (OR=1.67; 95% CI: 1.40-2.00) and highest care density tertiles (OR=1.63; 95% CI: 1.36-1.96) were more likely to be adherent to follow-up recommendations than those in the lowest tertile. CONCLUSIONS: Greater care coordination during the early survivorship period may be associated with a slightly lower risk of hospitalization and ER visits and better adherence to surveillance recommendations after endometrial cancer.
Revisiting the Valuation of Child Health-Related Quality of Life: Replacing Paired Comparisons With Kaizen Tasks and QALY Scaling With Experience Scaling.
Jumamyradov M, Craig BM, Jakubczyk M
Med Care · 2025 Oct · PMID 40846650 · Full text
OBJECTIVES: In 2013, the EQ-5D-Y-3L valuation study conducted by Craig and colleagues (ie, the original study) of child health-related quality of life (HRQoL) revealed that U.S. respondents often found it burdensome and...
OBJECTIVES: In 2013, the EQ-5D-Y-3L valuation study conducted by Craig and colleagues (ie, the original study) of child health-related quality of life (HRQoL) revealed that U.S. respondents often found it burdensome and guilt-inducing to choose between hypothetical health problems of children. This study introduces an alternative approach where respondents sequentially relieve the health problems of a 10-year-old child for 1 week. METHODS: We conducted a discrete choice experiment (DCE) survey (N=631) with paired comparisons and kaizen tasks. Each kaizen task displayed a single profile of a child's HRQoL using the EQ-5D-Y-3L descriptive system and asked respondents to select first, second, and third improvements for the child's problems. Combining the preference evidence, a conditional logit model was estimated to produce EQ-5D-Y-3L values on an "experience" scale, where positive values signify experiences better than "being in a coma" and negative values worse. RESULTS: All 10 main effects were statistically significant ( P <0.01), with the highest value placed on alleviating pain and discomfort. The worst-case scenario (33333) had a value of -0.337 on the experience scale, indicating it is worse than a coma. These new estimates highly correlate with the original U.S. EQ-5D-Y-3L values (Pearson correlation=0.726; Spearman correlation=0.794). CONCLUSION: This innovative approach to child health valuation replaces paired comparisons with Kaizen tasks, reducing respondent burden and study costs. Its use of experience scaling, instead of QALYs, aligns with U.S. guidelines (eg, the Inflation Reduction Act of 2022) and summarizes child HRQoL gains for health technology assessment.
Hospital Leader Views on the Family-Centeredness of Pediatric Care: A Global Survey.
Franck LS, Mehra R, Johnson BH … +3 more , Abraham M, Rubin N, Hoffmann TJ
Med Care · 2025 Oct · PMID 40846640 · Full text
BACKGROUND: Family-centered care (FCC) contributes to improved health care delivery and outcomes in pediatrics. OBJECTIVE: To conduct a global survey of hospital leaders' views on FCC culture, policies, and practices in...
BACKGROUND: Family-centered care (FCC) contributes to improved health care delivery and outcomes in pediatrics. OBJECTIVE: To conduct a global survey of hospital leaders' views on FCC culture, policies, and practices in health care organizations serving children, including in the post-COVID-19 pandemic era. RESEARCH DESIGN: A cross-sectional electronic survey. RESULTS: Surveys were received from 256 leaders from 215 hospitals in 38 countries. Preliminary psychometric analysis yielded a 44-item instrument wherein a higher total score indicated leaders had more positive views of their hospital's FCC. A majority reported high levels of FCC culture at bedside and supportive policies for family presence and participation. Fewer leaders reported family partnership at the organizational level, health professional education on FCC, or organizational accountability for FCC. In multivariable analyses, having an active patient and family advisory council (PFAC) was associated with higher FCC scores. Free-text comments reflected respondents' commitment to family presence and participation in care and decision-making, factors that facilitated or impeded active PFACs, variability in FCC practices, and the COVID-19 pandemic's impact on FCC. CONCLUSIONS: These findings suggest a commitment to FCC by leaders in hospitals providing pediatric care globally, and that an active PFAC is associated with higher ratings of hospital FCC culture, policies, and practices. Expanded adoption of PFACs, along with standardized measurement and quality improvement monitoring, may improve the family-centeredness of pediatric health care, and thereby contribute to quality and safety. Barriers such as a lack of organizational accountability for FCC must be addressed so that FCC can function optimally in pediatric settings.
Association Between Paid Sick Leave and Dental Services Utilization Among Working Adults in the United States.
Lamsal R, Tak HJ, Wilson FA … +3 more , Tibbits MK, Chen LW, Palm D
Med Care · 2025 Nov · PMID 40846639 · Publisher ↗
BACKGROUND: Timely access to regular dental visits allows the detection of preventable conditions at an earlier stage. Nonetheless, 37% of adults aged 18 and above had no dental visits in 2020. Various factors affect uti...
BACKGROUND: Timely access to regular dental visits allows the detection of preventable conditions at an earlier stage. Nonetheless, 37% of adults aged 18 and above had no dental visits in 2020. Various factors affect utilization, but little is known about the influence of job characteristics. This study examined the association between paid sick leave (PSL) and different types of dental services utilization among working adults aged 18-64 in the United States. METHODS: The study sample population included employed adults aged 18-64 in the 2019 Medical Expenditure Panel Survey (N=7645). The four outcome variables were a binary variable of having any dental care, including preventive, diagnostic, and treatment dental care in the past 12 months. The primary independent variable was having PSL as a job benefit. A multivariable logistic model was used, adjusting for demographics, socioeconomic status, and general health status. All analyses were adjusted for complex survey design. RESULTS: Seventy-three percent of working adults had paid sick leave benefits. Availability of PSL was significantly associated with higher utilization of any dental visits [Adjusted odds ratio (aOR): 1.38, 95% CI: 1.17-1.63], preventive dental care (aOR: 1.33, 95% CI: 1.12-1.57), and diagnostic dental care (aOR: 1.31, 95% CI: 1.11-1.55). CONCLUSIONS: PSL is associated with a significant increase in dental services, preventive dental, and diagnostic dental visits. The study offers insights for medical practitioners and policymakers aiming to prevent adverse oral health outcomes, reduce disparities, and manage health care costs.
Supplemental Items Reduce HCAHPS Response Rates, but Response Rates Do Not Affect HCAHPS Scores: A Randomized Experiment.
Beckett MK, Hambarsoomian K, Brown J … +4 more , Cleary PD, Abel GA, Giordano LA, Elliott MN
Med Care · 2025 Oct · PMID 40846638 · Publisher ↗
BACKGROUND: Longer surveys can reduce response rates (RRs). Observational data suggest a positive hospital-level association between RRs and HCAHPS scores, but a negative patient-level relationship. There is no experimen...
BACKGROUND: Longer surveys can reduce response rates (RRs). Observational data suggest a positive hospital-level association between RRs and HCAHPS scores, but a negative patient-level relationship. There is no experimental evidence of whether a hospital's RR affects its HCAHPS scores. OBJECTIVES: Estimate the effect of the 59-item versus 32-item survey on RR by survey mode; assess whether any reductions in RR change HCAHPS scores. RESEARCH DESIGN: Patients randomized within hospitals to 4 survey protocols [mail-only, mixed mode (MM; mail with telephone follow-up of nonrespondents)] and survey length [32-item or 59-item (32 core + 27 supplemental items)]. Regression models predicted (1) whether a patient responded to a survey and (2) responses to patient experience measures within hospital and survey mode from survey length, controlling for patient characteristics. SUBJECTS: A total of 10,099 adult patients from 51 nationally representative US hospitals participating in a randomized HCAHPS mode experiment. PRINCIPAL FINDINGS: Adjusted MM RRs were 21.9 percentage points higher than mail-only RR for the 32-item survey. The adjusted RR for the 59-item survey was 5.6 percentage points lower than the 32-item survey in MM and 2.9 percentage points lower in mail-only mode. The lower RR caused by greater length had no effect on standard adjusted HCAHPS scores in either mode. CONCLUSIONS: A longer survey reduced RRs, especially by telephone follow-up after a mail survey. HCAHPS hospitals and vendors may want to consider trade-offs when adding many supplemental items and the RR advantage of MM. Reducing RRs within a hospital does not change standard adjusted HCAHPS scores.
Incorporating the Present-on-Admission Indicator to Predict In-hospital Mortality Through Elixhauser Measures: A Medicare Data Analysis.
Liu J, Bilazarian A, Pollifrone MM … +3 more , Yoon S, Siegel R, Poghosyan L
Med Care · 2025 Dec · PMID 40846637 · Publisher ↗
BACKGROUND: In 2021, the Agency for Health Care Research and Quality (AHRQ) updated its guidelines for using the Present-on-Admission (POA) indicator in the Elixhauser comorbidity index. This update helps distinguish pre...
BACKGROUND: In 2021, the Agency for Health Care Research and Quality (AHRQ) updated its guidelines for using the Present-on-Admission (POA) indicator in the Elixhauser comorbidity index. This update helps distinguish pre-existing comorbidities from complications that arise after hospital admission, improving the validity of hospital performance assessments and more accurately measuring patients' severity of illness upon admission. OBJECTIVE: To evaluate differences in comorbidity prevalence and the predictive performance of the Elixhauser Comorbidity Index for in-hospital mortality at admission under 3 comorbidity coding guidelines, including one that ignores the POA indicator. RESEARCH DESIGN: A retrospective analysis of inpatient administrative data on Medicare beneficiaries. SUBJECTS: The dataset included 1,810,106 adult Medicare inpatient admissions across 6 U.S. states between 2017 and 2019. METHODS: Elastic net models were applied to predict in-hospital mortality using 3 approaches to coding comorbidities: (1) No-POA (including all conditions as admission comorbidities), (2) Full-POA (including only POA conditions as comorbidities), and (3) the 2021 AHRQ Partial-POA (applying POA to a subset of conditions to code comorbidities). Results: C-statistics were 0.800 (0.797-0.804), 0.768 (0.763-0.771), and 0.786 (0.781-0.790) for No-POA, full-POA, and 2021 AHRQ partial-POA guidelines, respectively. CONCLUSION: Ignoring the POA inflated model performance by misclassifying complications as admission comorbidities. The 2021 Partial-POA guidelines achieved intermediate C-statistics while ensuring internal validity by accurately measuring illness severity at admission. This supports improved hospital evaluations, care quality, resource allocation, tailored intervention, and reimbursement. The elastic net model shows promise as a standard for predicting in-hospital mortality with the Elixhauser comorbidity measure.
Indian Health Service, Health Status, and Financial Barriers to Care.
Hubbard S
Med Care · 2025 Dec · PMID 40846636 · Publisher ↗
OBJECTIVE: To better understand financial barriers to care facing American Indian and Alaska Native households, this study builds on previous findings that these communities have a higher likelihood of having medical deb...
OBJECTIVE: To better understand financial barriers to care facing American Indian and Alaska Native households, this study builds on previous findings that these communities have a higher likelihood of having medical debt and engaging in cost avoidance. This study aims to build on those findings by controlling for health status, insurance type, and Indian Health Service (IHS) eligibility. DESIGN: This study uses data from the National Health Information Survey in binomial logistic regression models to examine the likelihood of American Indian and Alaska Native households having medical debt and engaging in cost avoidance. RESULTS: The results of the logistic regression analysis found that while health status and IHS eligibility significantly contribute to the likelihood of having medical debt or engaging in cost avoidance, racial disparities remain for American Indian and Alaska Native communities. CONCLUSIONS: Despite access to the Indian Health Service and Tribal care, American Indian and Alaska Native households face disparities in financial barriers to care. These results suggest that, rather than the proposed cuts to the Indian Health Service, additional funding is needed to address shortcomings in the IHS/Tribal system of care in American Indian and Alaska Native communities.
Response to Letter to the Editor by Drs Goyal and Taylor.
You SB, Song J, Hsu JY … +1 more , Bowles KH
Med Care · 2025 Sep · PMID 40793919 · Publisher ↗
Abstract loading — click title to view on PubMed.
Is Home Health Care Associated With "Good" or "Bad" Readmissions After Sepsis?
Goyal A, Taylor S
Med Care · 2025 Sep · PMID 40793918 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Impact of Integrated Home-Based Primary Care on Continuity and Outcomes of Care Among the Community Homebound Older Adults in Taiwan.
Li MT, Tung YC, Kuo KL
Med Care · 2025 Sep · PMID 40793917 · Publisher ↗
OBJECTIVES: The homebound older adults are often at risk of poor care outcomes due to disability and limited access to health care. Home health care services have been developed to improve various outcomes of care. Since...
OBJECTIVES: The homebound older adults are often at risk of poor care outcomes due to disability and limited access to health care. Home health care services have been developed to improve various outcomes of care. Since the initiation of the integrated home-based primary care (iHBPC) program in Taiwan, this study aimed to evaluate the effect of the iHBPC program on continuity and outcomes of care among the homebound older adults. METHODS: Electronic medical records of all homebound older adults receiving home health care services from March 1, 2016 to April 30, 2022, in a hospital system in Taiwan were analyzed. Continuity and outcomes of care 12 months before and after participation in the iHBPC program were observed and compared with the control group by the propensity score matching method. Multivariate generalized estimating equation regression with the difference-in-difference method was performed after adjustment for patient characteristics to evaluate the impact of the iHBPC program on the number of physicians seen, emergency department visits, hospitalizations, and inpatient days. RESULTS: A total of 912 patients were included. After propensity score matching, the intervention group participating in the iHBPC program for 12 months decreased the number of physicians seen, emergency department visits, hospitalizations, and inpatient days compared with the control group. CONCLUSIONS: The iHBPC program under Taiwan's universal health care system improved continuity and outcomes of care for the homebound older adults by enhancing the accessibility, comprehensiveness, and coordination of health care. The promotion of this feasible and effective policy is anticipated to create additional benefits in the future.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe