Medical Care[JOURNAL]
Sun
200 papers
Hepatitis C Virus Cascade of Care in Florida Emergency Departments.
Hernandez-Con P, Jang SC, Smith SM … +5 more , Jenjai C, Guirgis F, Petrauskis MC, Gage C, Park H
Med Care · 2026 Jul · PMID 42377905 · Publisher ↗
BACKGROUND: Florida has the second-highest rate of acute hepatitis C virus (HCV) infection cases in the United States. However, HCV care cascade outcomes among individuals seeking care in Florida emergency departments (E...
BACKGROUND: Florida has the second-highest rate of acute hepatitis C virus (HCV) infection cases in the United States. However, HCV care cascade outcomes among individuals seeking care in Florida emergency departments (EDs) remain unknown. OBJECTIVES: To assess HCV care cascade outcomes and identify HCV infection predictors among individuals tested for HCV in Florida EDs. RESEARCH STUDY DESIGN: This retrospective study used electronic health records (2016-2023) linked to the Agency for Healthcare Research and Quality on Social Determinants of Health regional data. SUBJECTS: Adults aged 18-79 years tested for HCV infection in Florida EDs. MEASURES: Outcomes included the proportions of individuals completing each HCV care cascade step: (1) HCV screening; (2) HCV diagnosis; (3) linkage to care; and (4) treatment initiation. A multivariable logistic regression model was used to identify predictors of HCV infection. RESULTS: Among individuals seeking care in EDs, 4.98% (n=18,444) were tested for HCV, of whom 4.97% were confirmed HCV-positive. Among HCV-positive individuals, 11.24% were linked to care, and 2.84% initiated treatment. Significant predictors of HCV infection included having Medicaid insurance (OR=1.53, 95% CI: 1.14-2.07) or being uninsured (OR=2.88, 95% CI: 2.02-4.12), coinfection with human immunodeficiency virus (OR=28.99, 95% CI: 22.31-37.67), opioid injection drug use (OR=3.62, 95% CI: 2.76-4.75), opioid overdose (OR=3.89, 95% CI: 2.32-6.52), and residing in communities characterized by lower educational attainment (fourth quartile OR=1.95, 95% CI: 1.27-2.98). CONCLUSIONS: Significant gaps persist across the HCV care cascade among individuals tested in Florida EDs. Innovative public health interventions are needed to support these vulnerable populations.
Association of Neighborhood Socioeconomic Disadvantage and Uptake of Diabetes Prevention Interventions.
Buchongo P, Chen J, Nguyen Q … +3 more , White-Whilby K, Kleinman D, Franzini L
Med Care · 2026 Jun · PMID 42377443 · Publisher ↗
BACKGROUND: Intensive lifestyle change intervention (LCI) programs and metformin are recommended to prevent the progression of prediabetes to type 2 diabetes. While social drivers of health are known to influence access...
BACKGROUND: Intensive lifestyle change intervention (LCI) programs and metformin are recommended to prevent the progression of prediabetes to type 2 diabetes. While social drivers of health are known to influence access to preventive health care the impact of neighborhood socioeconomic disadvantage on the uptake of diabetes prevention interventions remains underexplored. OBJECTIVE: Examine the relationship between the social deprivation index and the use of diabetes prevention interventions among people with prediabetes. METHODS: We analyzed commercial and Medicaid claims data from the Maryland Medical Care Data Base (2017-2019) to identify claims for LCIs and metformin prescriptions and Social Deprivation Index (SDI) 2015 data to measure enrollees' neighborhood socioeconomic disadvantage and examine associations between one or more diabetes prevention interventions. An adjusted multinomial logistic regression model estimating relative risk ratios was used to compare the relationship between SDI quintiles and use of LCI only, LCI and metformin, and metformin only (reference). RESULTS: Among enrollees who used any intervention those living in neighborhoods with SDI scores in the fifth quintile had a significantly higher relative risk (RRR: 1.49; 95% CI: 1.12-1.99) of using LCI only versus metformin only compared with those living in neighborhoods with SDI scores in the first quintile. CONCLUSION: Enrollees with prediabetes living in neighborhoods with higher levels of socioeconomic disadvantage were more likely to use LCI and more likely to use LCI only compared with metformin only as a diabetes prevention intervention. These findings are relevant for states targeting diabetes prevention in communities of high need.
Machine Learning for Evaluating the Heterogeneous Effects of Intensive In-Hospital Rehabilitation During the Postacute Phase After Hip Fracture Surgery on Activities of Daily Living.
Ikeda T, Tani T, Cooray U … +6 more , Suzuki Y, Kimura Y, Miyata K, Murakami M, Osaka K, Fushimi K
Med Care · 2026 Jun · PMID 42370454 · Publisher ↗
BACKGROUND: It remains unclear which patient subgroups benefit most from intensive rehabilitation therapy. OBJECTIVES: This study aimed to examine the heterogeneity in the effects of intensive postacute rehabilitation af...
BACKGROUND: It remains unclear which patient subgroups benefit most from intensive rehabilitation therapy. OBJECTIVES: This study aimed to examine the heterogeneity in the effects of intensive postacute rehabilitation after hip fracture surgery on activities of daily living and to identify its potential sources. RESEARCH DESIGN: A retrospective observational study. SUBJECTS: Patients aged 50 years or older who underwent hip fracture surgery within 2 days of admission and were transferred to a rehabilitation ward between 7 and 30 days after surgery. MEASURES: Exposure was defined as the average daily rehabilitation time within 30 days posttransfer, dichotomized as ≥120 versus <120 minutes/day. The outcome was the motor domain score of the Functional Independence Measure (FIM) at 60 days posttransfer. Heterogeneity of treatment effects was assessed using conditional average treatment effects (CATEs) estimated through the causal forest approach. The models were adjusted for relevant covariates, including age, sex, and FIM score at the time of transfer to the rehabilitation ward. RESULTS: The causal forest approach revealed heterogeneous effects-the estimated CATE for the top 20% high-benefit subgroup was 3.89 (95% CI: 2.32-5.46). The high-benefit subgroup was older and had lower FIM scores for the self-care, mobility, transfers, and excretion control domains at the time of transfer, compared with the low-benefit subgroup (the bottom 20% of the estimated CATEs). CONCLUSIONS: Heterogeneity exists in the association between intensive in-hospital rehabilitation therapy and functional status among older patients undergoing early hip fracture surgery during the postacute rehabilitation phase.
Hospital-Physician Integration and Differences in the Use of Orthopedic Care Across Race and Ethnicity.
Post B, Chowhury P, Harris A … +4 more , Alinezhad F, Kennedy W, Ferdows N, Young GJ
Med Care · 2026 Jun · PMID 42350339 · Publisher ↗
OBJECTIVES: To determine if hospital-orthopedist integration is associated with larger or smaller race and ethnicity gaps in the utilization of total knee arthroplasty (knee replacement) and physical therapy among Medica...
OBJECTIVES: To determine if hospital-orthopedist integration is associated with larger or smaller race and ethnicity gaps in the utilization of total knee arthroplasty (knee replacement) and physical therapy among Medicare beneficiaries. DATA SOURCES AND STUDY SETTING: Inpatient and outpatient Medicare claims data from 2015 to 2021. STUDY DESIGN: Retrospective study of patients newly diagnosed with osteoarthritis. We compared utilization among patients of hospital-integrated orthopedists and independent orthopedists. PRINCIPAL FINDINGS: A total of 18% of patients received knee replacements, and 32% received physical therapy within 12 months of an initial osteoarthritis diagnosis. Black patients were less likely to receive knee replacements (-6.6 percentage points, 95% CI: -7.6 to -5.6) and physical therapy (-9.3, 95% CI: -10.5 to -8.0) than White patients. Hispanic patients' likelihood of knee replacements and physical therapy was not statistically different from that of White patients. Hospital-orthopedist integration was not associated with receipt of knee replacements but was negatively associated with receipt of physical therapy (-9.5 percentage points, 95% CI: -10.1 to -8.8). Race/ethnicity differences persisted across practice settings: the interaction between orthopedist integration status and race/ethnicity did not affect the likelihood of receiving knee replacements or physical therapy. CONCLUSIONS: Disparities persisted across both hospital-integrated and independent settings for Black patients. As large integrated health systems become dominant, policymakers may need to create incentives that harness their strengths to close care gaps.
Temporal Misalignment and Selection Bias in "Burn Pit Smoke Exposure and Sleep Apnea in US Veterans.
Wang Z, Shao L
Med Care · 2026 Jun · PMID 42350338 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Impact of an Oncology Hospital at Home Program on Health Care Costs.
Nelson RE, O'Neil B, Kirchhoff AC … +3 more , Huber J, Yoo M, Mooney K
Med Care · 2026 Jun · PMID 42319970 · Publisher ↗
INTRODUCTION: Hospital-at-home is an initiative to move health care services that have traditionally been provided in a hospital setting to a patient's home. The objective of this study was to assess the impact of the on...
INTRODUCTION: Hospital-at-home is an initiative to move health care services that have traditionally been provided in a hospital setting to a patient's home. The objective of this study was to assess the impact of the oncology Huntsman at Home (HH) hospital-at-home program on health care costs from the health care system's perspective. METHODS: Using a difference-in-difference approach, we compared health care costs between 169 oncology patients enrolled in HH and 198 similar patients who would have been eligible for HH but lived outside the HH service area. Costs were measured from the health system perspective using an innovative cost-accounting tool. We constructed longitudinal datasets spanning the 2 patient-quarters before enrollment and the 2 patient-quarters following an acute episode. Outcomes were total direct medical costs of health care encounters as well as subcategories of cost, including facility, imaging, supplies, pharmacy, labs, and other. We ran fixed effects linear regression models to assess the impact of HH on health care cost outcomes. RESULTS: We found that HH was associated with a statistically significant reduction in cost for the 6 months post-admission (total -$8,337, P=0.012) and the first quarter post-admission (-$10,516, P=0.009), with significant reductions in pharmacy, facility, and other costs. We also examined a subset of patients with gastrointestinal or gynecologic cancers as exemplars of patients at considerable risk for extended complications and found similar cost reductions 6 months (-$8006, P=0.006) and in the first quarter (-$10,438, P=0.004). CONCLUSION: We found that an oncology hospital at home lowers health care costs, particularly during the 3 months following a care episode.
In the Shadows: Health Utilization Outcomes Among Black Undocumented Immigrants.
Nwadiuko J, Planey AM, Zewde N … +1 more , Bustamante AV
Med Care · 2026 Jun · PMID 42295749 · Publisher ↗
INTRODUCTION: Black undocumented immigrants face dual barriers to care access based on their legal status and due to structural racism in US society. Prior work has shown that Black immigrants (and particularly undocumen...
INTRODUCTION: Black undocumented immigrants face dual barriers to care access based on their legal status and due to structural racism in US society. Prior work has shown that Black immigrants (and particularly undocumented immigrants) are less likely to be insured than the general population. However, less is known about other dimensions of health care access for Black undocumented immigrants. METHODS: This study analyzes nationally representative data from the National Health Interview Survey (NHIS) from 1999 to 2018 to examine health care access and outcomes along the axes of legal status (undocumented, documented, naturalized citizen, and US-born citizen) among Black individuals aged 40 and above. We analyzed clinician visits over the past 2 years and overnight hospitalizations over the past year (the latter for individuals aged 40 y and older). Non-Hispanic White US-born citizens (NHWC) were used as the reference category. RESULTS: Among Black individuals across legal strata, Black undocumented immigrants had higher odds of uninsurance (OR: 4.7 95% CI: 3.6, 6.0), having no recent physician encounters in the previous 2 years (OR: 1.7; 95% CI: 1.2, 2.3), including lower odds of emergency room visits (OR: 0.7, 95% CI: 0.5, 0.9) and overnight hospital visits (OR: 0.5; 95% CI: 0.4, 0.7) in the past year. They also had lower odds of any blood pressure measurements (OR: 0.5; 95% CI: 0.38, 0.77) in the past year, and women aged 40 had lower odds of ever having received cervical cancer screening (OR: 0.1; 95% CI: 0.1, 0.2). Across all categories, utilization decreased with less secure legal status. Causal mediation analysis showed that insurance status played an important role in the relationship between undocumented status and having had a recent physician visit, mediating 2.7 (95% CI: 1.2%, 4.0%) of the 5.1-point gap (95% CI: 1.7%, 8.7%) between Black undocumented adults and NHWC. CONCLUSIONS: The relationship between race and legal status is complex. Legal status is significantly associated with access to insurance and outpatient care among Black immigrants.
Where are They Now: Analysis of 10- and 20-Year Cohorts of Homeless Veterans Served by the Veterans Affairs Health Care System.
Tsai J, Szymkowiak D
Med Care · 2026 Jun · PMID 42262391 · Publisher ↗
BACKGROUND: The U.S. Department of Veterans Affairs (VA) has invested billions of dollars to address homelessness, but there has been limited analysis of long-term outcomes. OBJECTIVES: This retrospective study followed...
BACKGROUND: The U.S. Department of Veterans Affairs (VA) has invested billions of dollars to address homelessness, but there has been limited analysis of long-term outcomes. OBJECTIVES: This retrospective study followed 2 cohorts of homeless veterans over 2 decades to identify long-term trajectories and predictors of mortality and continued VA homeless program use. RESEARCH DESIGN: National VA administrative data were analyzed from 2004 to 2024. SUBJECTS: A 2004 cohort of 85,533 homeless veterans and a 2014 cohort of 222,974 homeless veterans. MEASURES: Primary outcomes were mortality and continued use of VA homeless programs. RESULTS: A total of 50% of the first cohort died within 20 years (mean=63.9 y old) and about one-quarter of the second cohort died within 10 years (mean=65.3 y old). Of surviving veterans, 25% in both cohorts used VA homeless programs, and 32%-36% used VA emergency department/urgent care in 2024. In both cohorts, predictors of mortality included being older, non-Hispanic White, male, having medical comorbidities, and alcohol use disorder. Predictors of continued use of VA homeless programs included non-Hispanic Black, male, unmarried, low-enrollment priority group, military sexual trauma, and drug use disorder. In both cohorts, 61%-81% with substance use disorders received substance use treatment, but generally of short duration. CONCLUSIONS: In a homeless population with access to comprehensive health care, there is a long-term need to address premature mortality, substance use disorders, and pathways to independence. These findings signal the work that remains in the VA, and the broader challenges that may lie ahead in other national efforts to address homelessness.
Associations Between Hospital Mergers and Hospital-Level Nursing Factors, Nurse Well-Being, and Nurse-Sensitive Patient Safety and Quality-of-Care Outcomes: A Scoping Review.
Fitzpatrick Rosenbaum KE, Habib AR, Schlesinger M … +2 more , Batten J, Costa DK
Med Care · 2026 Aug · PMID 42262372 · Publisher ↗
BACKGROUND: Hospital mergers have proliferated across the United States, yet a comprehensive understanding of how mergers affect nurses and patients is lacking. OBJECTIVE: Determine the known associations between US hosp...
BACKGROUND: Hospital mergers have proliferated across the United States, yet a comprehensive understanding of how mergers affect nurses and patients is lacking. OBJECTIVE: Determine the known associations between US hospital mergers and hospital-level factors that influence nursing, nurse well-being, and nurse-sensitive patient safety and quality-of-care outcomes. RESEARCH DESIGN: A scoping review of systematically searching 10 databases comprised of business and health care literature up to January 2025. RESULTS: We found 1775 articles; 10 met our inclusion criteria and were included in the analysis: 5 quantitative, 3 qualitative, 2 multimethods. Only 3 studies analyzed data from 2003 or later. Although data were sparse and older, we found that hospital mergers introduced organizational changes in nursing-nurse staffing, leadership, and operations. Whether nurse-sensitive patient safety and quality-of-care outcomes improved post-merger was equivocal. Qualitatively, nurses described poor communication, a perceived lack of trust in leadership, a loss of identity and unity, decreased morale, increased fear or uncertainty, and issues with equal and/or respectful treatment. Employed study methods and designs, as well as a dearth of recent studies, influenced the ability to draw strong causal and/or detailed conclusions, especially about newly emerging issues in today's health care system. CONCLUSIONS: Our findings suggest that hospital mergers may impact nurses and the nursing workforce. As hospital mergers continue to increase, future research with recent data and rigorous methods is needed to develop timely and applicable policy to mitigate any potential harms and leverage potential benefits of hospital mergers for nurses and patients.
Patient Race/Ethnicity, Socioeconomic Status, and Acute Myocardial Infarction Mortality: Between-Hospital Versus Within-Hospital Disparities.
Farzana S, Moghtaderi A, Yuan AY … +3 more , Luo QE, Kini V, Black B
Med Care · 2026 Aug · PMID 42262371 · Publisher ↗
BACKGROUND: Prior work often finds racial/ethnic differences in mortality following acute myocardial infarction (AMI), but is subject to selection bias. Similar selection issues arise for differences associated with soci...
BACKGROUND: Prior work often finds racial/ethnic differences in mortality following acute myocardial infarction (AMI), but is subject to selection bias. Similar selection issues arise for differences associated with socioeconomic status (SES). OBJECTIVES: Re-examine the association between patient race/ethnicity, area-level socioeconomic status (area-SES), and post-AMI mortality using a data source that limits patient selection of hospital or cardiologist, or vice-versa, and which lets us distinguish between-hospital from within-hospital sources of differences. RESEARCH DESIGN: We compare mortality disparities with no controls, with controls typical of the prior literature ("typical controls"), and more extensive controls, including hospital, cardiologist, and calendar quarter fixed effects (FEs). SUBJECTS: The study uses a 100% sample of 681,000 Medicare Fee-for-Service patients aged 68+ hospitalized for incident (first) AMI over 2008-2019. MEASURES: Post-AMI mortality in-hospital, within 30 days after discharge and over periods up to 3 years post-discharge. We study patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (nSTEMI) separately. RESULTS: With no or typical controls, Blacks, Hispanics, and Asians have higher in-hospital mortality than Whites; lower SES also predicts higher mortality. However, higher mortality is substantially explained by between-hospital differences in mortality rates. Longer-term mortality is higher for Black patients, consistent with the importance of post-discharge pathways. CONCLUSIONS: Post-AMI disparities in outcomes can be strongly affected by selection effects, especially the tendency for poor and minority persons to be treated at lower-quality hospitals. Disparities measurement and policy discussions should distinguish access-related hospital sorting from within-hospital processes and pay greater attention to post-discharge pathways.
Clinical Standardization Across a National Health System: Perspectives From the Veterans Affairs' Electronic Health Record Transition.
Brunner J, Bilodeau C, Molloy-Paolillo B … +9 more , Helfrich CD, Dashtestani K, Cohen-Bearak A, Hauck JD, Herout J, Fuller H, Nebeker JR, Cutrona SL, Rinne ST
Med Care · 2026 Jul · PMID 42262367 · Publisher ↗
BACKGROUND: Clinical standardization is widely debated. Advocates emphasize its potential to reduce unwarranted variation and improve quality, while critics warn it may constrain professional judgment or undermine local...
BACKGROUND: Clinical standardization is widely debated. Advocates emphasize its potential to reduce unwarranted variation and improve quality, while critics warn it may constrain professional judgment or undermine local innovation. These tensions become especially salient during enterprise-wide electronic health record (EHR) transitions, when configuration and workflow decisions can institutionalize practices across facilities. The Department of Veterans Affairs (VA), undertaking the largest EHR transition in history, provides a critical case for understanding how frontline staff perceive system-wide standardization. OBJECTIVES: To assess VA employee attitudes toward care process standardization during VA's enterprise-wide EHR transition and identify implementation challenges and opportunities. RESEARCH DESIGN: Cross-sectional survey with mixed-methods analysis of a survey fielded in September 2024. SUBJECTS: We surveyed n=1748 EHR users at the first 5 VA sites implementing a new EHR. MEASURES: Awareness of and support for VA's Enterprise Standardization Initiative, assessed using 5-point Likert items; free-text comments were analyzed thematically to identify perspectives on standardization. RESULTS: Among respondents, 43% reported awareness of VA's standardization initiative, and 65% supported standardizing care processes across facilities. Qualitative analysis revealed 3 themes: (1) support for standardization as complementary to EHR transition; (2) preference for decoupling standardization from technical change; and (3) emphasis on appropriately targeting standardization to preserve innovation capacity. CONCLUSIONS: VA employees expressed support for standardization with important caveats about implementation approach and scope. Findings support iterative standardization that balances consistency with local adaptation, while carefully sequencing standardization relative to technical change.
A Novel Method to Apply Race and Ethnicity Observation for Nursing Home Residents Using Multiple Medicare Administrative Datasets.
Cohen CC, Dick AW, Estrada LV … +1 more , Stone PW
Med Care · 2026 Aug · PMID 42258359 · Publisher ↗
BACKGROUND: Nursing homes (NHs) in the United States serve about 1.2 million residents. Different NH resident groups, including by race and ethnicity (R/E), experience different health outcomes in this setting. Multiple...
BACKGROUND: Nursing homes (NHs) in the United States serve about 1.2 million residents. Different NH resident groups, including by race and ethnicity (R/E), experience different health outcomes in this setting. Multiple R/E measures exist for this population, but all have drawbacks. It is known that some R/E groups are underrepresented by these measures. Missing and inaccurate R/E classification in national data hinders research efforts to understand health outcomes. OBJECTIVE: We developed a method to improve R/E classification of NH residents using multiple datasets for enhanced accuracy and completeness. RESEARCH DESIGN: This was a retrospective, observational study using 2011-2022 data from the Minimum Data Set 3.0 (MDS) and the Master Beneficiary Summary File (MBSF). We assessed missingness and consistency of variables and created a nuanced, mutually exclusive R/E measure based on the MDS race variables and added information from the MBSF RTI race variable. SUBJECTS: All Medicare-eligible residents in CMS-certified NHs are identifiable in the MDS and MBSF data (2011-2022). RESULTS: The merged data included 19,491,681 individuals and 206,985,444 assessments. Individual residents in the MDS had low missingness (1.74%) and high consistency (97.29%) on R/E data. Integrating MBSF and MDS data reduced missingness (0.03%) and increased Hispanic resident representation (3.92%-6.12%). New categorization of White and Black, Hispanic and Black, and White and other races reduced the "other/multiracial" category from 2.14% to 0.67%. CONCLUSIONS: Using multiple data sources for R/E classification enhances the identification of NH demographics, which is important for researchers to have more accurate data. The increase in Hispanic residents after imputing RTI race suggests potential correction for self-underreporting. This method retains self-reporting standards while improving data completeness.
Consistency of a Dementia Diagnosis Between Systems for Patients Receiving Care Through the VA, Traditional Medicare, and Medicare Advantage.
Lei L, Krein SL, Petzold K … +6 more , Kim HM, Intrator O, Van Houtven CH, Min L, Strominger J, Maust DT
Med Care · 2026 Aug · PMID 42240107 · Full text
BACKGROUND: Older Veterans receive care through the Department of Veterans Affairs (VA) and Medicare, including Medicare Advantage (MA). We assessed the extent to which a dementia diagnosis recorded in one system is refl...
BACKGROUND: Older Veterans receive care through the Department of Veterans Affairs (VA) and Medicare, including Medicare Advantage (MA). We assessed the extent to which a dementia diagnosis recorded in one system is reflected in the other and factors associated with discordance among dual users. DESIGN: Parallel cohort study of patients with dementia identified in the VA or Medicare, both overall and separated into traditional Medicare (TM) and MA. PARTICIPANTS: Patients aged 65 years or older enrolled in VA and Medicare with a 2018 face-to-face dementia diagnosis encounter in the VA (N=68,092; VA dementia cohort) or Medicare (N=76,622; Medicare dementia cohort). MEASURES: In both cohorts, our primary outcome was whether the dementia diagnosis was absent at each professional encounter in the other system during 1-year follow-up. Characteristics considered included patient sex, age, race, ethnicity, rurality, priority group, dementia type, and clinician specialty during follow-up. RESULTS: For VA and Medicare cohorts, dementia diagnosis was absent in 88.7% and 80.5%, respectively, of follow-up encounters in the other system. For the VA cohort, the diagnosis was absent in 89.2% and 71.8% of TM and MA encounters, respectively. Encounters with a psychiatrist or neurologist (vs. primary care physician) were linked to lower absence during follow-up (eg, 25.3 and 20.3 percentage points lower for the VA cohort during Medicare follow-up; P <0.001 for both); those in TM (vs. MA) were 14.5 percentage points more likely to have an absent diagnosis. CONCLUSIONS: Absent dementia diagnoses across VA and Medicare among dual users was common, associated with clinician specialty and Medicare type.
Designing Research With a Veteran Research Engagement Panel: Lessons Learned From Eight Years of Partnering.
Gierisch JM, Thompson E, Tucker M … +3 more , Koss L, White B, Boucher NA
Med Care · 2026 Aug · PMID 42224052 · Publisher ↗
BACKGROUND: While community engagement is an evidence-based strategy, less is known about how longstanding community engagement panels are used in practice, and how their input is incorporated by researchers. OBJECTIVE:...
BACKGROUND: While community engagement is an evidence-based strategy, less is known about how longstanding community engagement panels are used in practice, and how their input is incorporated by researchers. OBJECTIVE: To describe the types of consultations requested from a community engagement panel comprised of veterans and veteran caregivers, the research stages at which consultation was sought, and the ways investigators reported using panel feedback. METHODS: We conducted a retrospective descriptive content analysis of administrative documents from 52 panel consultations completed between 2017 and 2022 at a VA health systems research center. Data sources included consultation requests, structured meeting notes, and 6 or 12-month follow-up reports, when available. We classified each consultation by research phase and characterized the focus of recommendations. RESULTS: Most consultations occurred during study development (52%), followed by intervention delivery (23%). Fewer consultations focused primarily on outreach, outcomes, or dissemination. No consultations centered on enrollment/consent or data analysis/interpretation. Panel recommendations most often addressed communication, project focus and goals, tailoring to Veteran preferences, barriers to participation, and study material accessibility. In 12 projects with follow-up reports, investigators described VetREP feedback as relevant, specific, and action-oriented. Investigators reported using panel feedback to revise materials, refine protocols, strengthen grant applications, and inform subsequent projects. CONCLUSIONS: Our longstanding Veteran engagement panel most often informed research during study development and intervention planning. These findings support longstanding panels that consult across multiple studies as a practical consultation mechanism for improving patient-centeredness in research design. Our study also highlights gaps in later-stage patient engagement and the need for more systematic documentation of engagement impacts over time to advance engagement science.
Letter to the Editor Regarding Risk for Acute Care Utilization in Housing-Insecure Adults: A National Study of a Hot Spotter Program in the US Veterans Health Administration.
Singh N, Srivastav M
Med Care · 2026 Aug · PMID 42224050 · Publisher ↗
Abstract loading — click title to view on PubMed.
Considerations for Risk Stratification in Hot Spotter Programs: Reply to Singh and Srivastav.
Blonigen DM, Macia KS, Raikov I … +2 more , Yoon J, Weber J
Med Care · 2026 Aug · PMID 42224045 · Publisher ↗
Abstract loading — click title to view on PubMed.
A Novel Medicare Claims-Based Approach to Identifying Tele-ICU Capability and Utilization Across US Hospitals.
Rai K, Mehta AB, Burke JF … +1 more , Brummel NE
Med Care · 2026 Aug · PMID 42139072 · Publisher ↗
BACKGROUND: Tele-ICU adoption has expanded, yet no validated claims-based method exists to identify tele-ICU capability or utilization. Reliance on self-reported survey data limits national assessment of delivery models...
BACKGROUND: Tele-ICU adoption has expanded, yet no validated claims-based method exists to identify tele-ICU capability or utilization. Reliance on self-reported survey data limits national assessment of delivery models and outcomes. OBJECTIVES: To develop a Medicare claims-based approach to identify tele-ICU capability and utilization, evaluate concordance with the American Hospital Association Annual Survey Database (AHAASD), and describe hospital and patient characteristics. RESEARCH DESIGN: Retrospective cross-sectional study using 2021 Medicare 5% Limited Data Set Part A and B claims and the 2021 AHAASD. Tele-ICU-capable hospitals were identified using tele-ICU claims among Medicare beneficiaries during inpatient hospitalizations and emergency department visits and defined as hospitals with ≥1 claim. We compared these hospitals with hospitals reporting tele-ICU capability in the AHAASD. RESULTS: We identified 1193 tele-ICU claims from 344 hospitals. Among 3932 AHA respondents, 947 reported tele-ICU capability; 110 hospitals were identified by both methods. Relative to AHAASD, claims exhibited 11.6% sensitivity, 95.0% specificity, and 42.6% positive predictive value. Most hospitals submitted 1-2 claims, while a minority generated most claims. Compared with tele-ICU hospitals identified by AHAASD, hospitals identified only by claims were more likely to be rural, for-profit, noncritical access, and had more ICU beds and ventilators but fewer intensivists. Among 1,008,106 ICU patients, 680 (0.1%) had tele-ICU claims and demonstrated higher acuity. CONCLUSIONS: Tele-ICU claims identify a small, specific subset of hospitals actively billing for tele-ICU care and capture clinically meaningful encounters. Combining claims with survey data may improve national measurement of tele-ICU adoption and inform operational and policy assessments.
Consistent Enrollment in a Health Care Coverage Program Is Associated With Fewer Type 2 Diabetes-Related Emergency Department Visits for Uninsured Immigrants.
Ro AE, Villalba Madrid M, Haro Ramos A … +5 more , Axeen S, Gorman A, Jiang L, Roby D, Schneberk T
Med Care · 2026 Jun · PMID 42117908 · Publisher ↗
BACKGROUND: Undocumented immigrants face significant barriers maintaining regular health care, which could lead to emergency department (ED) visits for chronic diseases such as type 2 diabetes (T2D). Local health coverag...
BACKGROUND: Undocumented immigrants face significant barriers maintaining regular health care, which could lead to emergency department (ED) visits for chronic diseases such as type 2 diabetes (T2D). Local health coverage programs like MyHealthLA (MHLA) in Los Angeles County can improve disease management by providing regular access to care. This study examines the relationship between enrollment patterns in MHLA and ED utilization for T2D-related conditions, focusing on how the duration of enrollment impacts the likelihood of ED visits. RESEARCH DESIGN: We analyzed 115,690 ED encounters from 44,333 MHLA patients in the Los Angeles Department of Health Service (LADHS) between 2016 and 2020. There were 5 categories based on enrollment 12 months before the ED encounter: (1) continuously enrolled ≥6 months, (2) newly enrolled for <6 months, (3) consistently unenrolled for ≥6 months, (4) newly unenrolled <6 months, and (5) never enrolled, who visited the ED before ever enrolling in MHLA. RESULTS: Patients continuously enrolled in MHLA were less likely to visit the ED for short-term T2D complications, suggesting that consistent primary care helps manage chronic conditions and reduce ED use. Conversely, patients newly enrolled or unenrolled had higher odds of T2D-related ED visits, indicating that enrollment lapses may worsen disease management. CONCLUSIONS: These findings highlight the importance of continuous access to primary care and the potential benefits of Medicaid expansion for undocumented adults in California. Health systems should prioritize continuity of care to improve chronic disease management and reduce avoidable ED visits in underserved populations.
Geographic Variation in Missing Race and Ethnicity Data in Minimum Data Set 3.0.
Tjia J, Troiani FL, Wyndham A … +3 more , Tanikella S, Rumbut J, Castaneda-Avila MA
Med Care · 2026 Aug · PMID 42100939 · Publisher ↗
BACKGROUND: Race and ethnicity measures in administrative data can vary geographically. The extent of this challenge in US nursing homes is not well described. OBJECTIVES: To describe geographic variation in missing race...
BACKGROUND: Race and ethnicity measures in administrative data can vary geographically. The extent of this challenge in US nursing homes is not well described. OBJECTIVES: To describe geographic variation in missing race and ethnicity data in the Minimum Data Set (MDS) 3.0 and Medicare claims, and to compare discrepancies across data sources. RESEARCH DESIGN: Cross-sectional study. SUBJECTS: Medicare beneficiaries with MDS 3.0 records between 2014 and 2018. The Medicare Beneficiary Summary File provided demographic information. MEASURES: Missingness of MDS race and ethnicity data by state, and misclassification of Medicare race and ethnicity enrollment database (EDB) and Research Triangle Institute (RTI) variables compared with MDS. We calculate the sensitivity, specificity, and positive predictive value of the EDB and RTI variables relative to the MDS. RESULTS: Among 18.1 million nursing home residents pooled across 2014-2018, geographic variation in missing race and ethnicity in the MDS 3.0 ranged from 1.2% to 14.7%. Compared with MDS, misclassification of residents classified as Hispanic in MDS ranged from 48.1% to 89.2% for EDB and 0.5% to 44.8% for RTI. Misclassification of residents classified as Asian American/Pacific Islander in MDS ranged from 29.4% to 77.2% for EDB and 12.7% to 65.4% for RTI. Misclassification of residents classified as Black ranged from 0% to 14.2% for EDB and 0% to 16.2% for RTI. Overall, the RTI variables provided better sensitivity and specificity of race and ethnicity than the EDB. CONCLUSION: Missing race and ethnicity data in the MDS varies geographically, as do discrepancies between MDS and EDB and RTI variables. Thoughtful consideration of these issues is recommended when handling missing MDS race and ethnicity data.
Medicaid Home-Based and Community-Based Services Long-Term Care Expenditures: Evaluation of the Balancing Incentive Program.
Ghosh-Dastidar B, Robbins MW, Friedman EM … +2 more , Qureshi N, Shih RA
Med Care · 2026 Jul · PMID 42081280 · Full text
OBJECTIVE: The Balancing Incentive Program (BIP), legislated in the 2010 Affordable Care Act, offered states financial incentives to increase access to Medicaid home-based and community-based services (HCBS). Despite the...
OBJECTIVE: The Balancing Incentive Program (BIP), legislated in the 2010 Affordable Care Act, offered states financial incentives to increase access to Medicaid home-based and community-based services (HCBS). Despite the major infrastructure changes required by BIP, no evaluation to date has quantified the increase in spending attributable to BIP, which is of concern to Medicaid HCBS policymakers, providers, and consumers. This is the first causal estimate of BIP's effects, including the timing of implementation in each state, compared with a counterfactual. DESIGN: Using state-level expenditure data, we estimated the change in HCBS spending as a percentage of long-term services and supports (LTSS) spending in 17 BIP participant states compared with a counterfactual or synthetic control calculated as a weighted average of the outcome in 17 BIP eligible, nonparticipant states. Synthetic control weights were estimated using pre-BIP characteristics. To assess how BIP effects evolved over time, we estimated cumulative change in the outcome in multiple post-BIP years (2013, 2016, and 2019). RESULTS: Our primary analysis indicates that cumulatively from FY 2013 to 2019, BIP states increased their HCBS spending as a percentage of LTSS spending by an average of 5.2 percentage points (95% CI: 0.0, 9.8), compared with the synthetic control. IMPLICATIONS: Although many state-run programs have sought to increase HCBS access, our study's causal estimate of BIP effects in 17 states, compared with 17 states that did not, represents a more substantial growth than findings of prior studies.
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