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Journal of Nutritional Science 2023This scoping review aimed to identify the breadth of healthcare-based food assistance programmes in the United States and organize them into a typology of programmes to... (Review)
Review
This scoping review aimed to identify the breadth of healthcare-based food assistance programmes in the United States and organize them into a typology of programmes to provide implementation guidance to aspiring food assistance programmers in healthcare settings. We searched PubMed, Cochrane, and CINAHL databases for peer-reviewed articles published between 1 January 2010 and 31 December 2021, and mined reference lists. We used content analysis to extract programmatic details from each intervention and to qualitatively analyse intervention components to develop a typology for healthcare institutions in the United States. Eligible articles included descriptions of patient populations served and programmatic details. Articles were not required to include formal evaluations for inclusion in this scoping review. Our search resulted in 8706 abstracts, which yielded forty-three articles from thirty-five interventions. We identified three distinct programme types: direct food provision, referral, and voucher programmes. Programme type was influenced by programme goals, logistical considerations, such as staffing, food storage or refrigeration space, and existence of willing partner CBOs. Food provision programmes ( 13) were frequently permanent and leveraged partnerships with community-based organisations (CBOs) that provide food. Referral programmes ( 8) connected patients to CBOs for federal or local food assistance enrollment. Voucher programmes ( 14) prioritised provision of fruits and vegetables ( 10) and relied on a variety of clinic staff to refer patients to months-long programmes. Healthcare-based implementers can use this typology to design and maintain programmes that align with the needs of their sites and patient populations.
Topics: Humans; United States; Food Assistance; Delivery of Health Care; Health Facilities
PubMed: 38155805
DOI: 10.1017/jns.2023.111 -
The Milbank Quarterly Dec 2023Policy Points Employment is a key social determinant of health and well-being for the estimated 5.4 million autistic adults in the United States-just as it is for... (Review)
Review
UNLABELLED
Policy Points Employment is a key social determinant of health and well-being for the estimated 5.4 million autistic adults in the United States-just as it is for citizens without disabilities. Evaluation and monitoring of publicly funded employment services is paramount given the dramatic increases in adults with autism who need job supports. Vocational Rehabilitation agencies appeared to be absorbing short-term employment needs of autistic people, but Medicaid was severely lacking-and losing ground-in serving those who need longer-term employment services. Across both Vocational Rehabilitation and Medicaid, we estimated that only 1.1% of working-age autistic adults who potentially need employment services are actually receiving them-leaving an estimated 1.98 million autistic individuals without the employment services that are associated with achievement of well-being.
CONTEXT
Employment is a key social determinant of health. As such, high rates of unemployment, underemployment, and poverty across the rapidly growing autistic population are concerning. A web of publicly funded services exists to support the employment, and associated health and well-being, of United States citizens with autism and other intellectual and developmental disabilities, namely through Vocational Rehabilitation (VR) and Medicaid home- and community-based services (HCBS) waivers. Given an absence of overarching surveillance of employment services, this study aimed to characterize the distribution of autistic service users across Medicaid versus VR, understand the types of employment services utilized within these programs and expenditures, and assess overall capacity to provide employment services as needs continue to increase.
METHODS
This study examined the distribution of employment services among autistic people compared with those with intellectual disability using 2008-2016 data from the Centers for Medicare & Medicaid Services and the Rehabilitation Services Administration. Estimated need for employment services among autistic individuals was compared with capacity derived from VR service counts and a review of HCBS waivers.
FINDINGS
The number of autistic people served through VR tripled during the study years, whereas those served through Medicaid only increased slightly. VR spending increased by 384% over the study years, whereas Medicaid costs decreased by 29%. Across VR and Medicaid, we estimated that only 1.1% of working-age autistic adults who needed employment services received them.
CONCLUSIONS
Although VR appeared to be absorbing short-term employment needs of autistic individuals, Medicaid was severely lacking-and losing ground-in serving those who needed longer-term employment services. VR far outpaced Medicaid in both the number of autistic people served and total expenditures across the study years. However, an estimated 1.98 million autistic adults did not receive employment services that could be critical to improving their health and well-being.
Topics: Adult; Humans; Aged; United States; Autistic Disorder; Medicare; Employment; Health Expenditures; Disabled Persons; Medicaid
PubMed: 37526044
DOI: 10.1111/1468-0009.12666 -
Academic Psychiatry : the Journal of... Apr 2024
Topics: Humans; Medical Assistance; Canada
PubMed: 37919540
DOI: 10.1007/s40596-023-01893-4 -
BMC Public Health Sep 2023Despite growing interest in and commitment to integration, or integrated care, the concept is ill-defined and the resulting evidence base fragmented, particularly in... (Review)
Review
BACKGROUND
Despite growing interest in and commitment to integration, or integrated care, the concept is ill-defined and the resulting evidence base fragmented, particularly in low- and middle-income countries (LMICs). Underlying this challenge is a lack of coherent approaches to measure the extent of integration and how this influences desired outcomes. The aim of this scoping review is to identify measurement approaches for integration in LMICs and map them for future use.
METHODS
Arksey and O'Malley's framework for scoping reviews was followed. We conducted a systematic search of peer-reviewed literature measuring integration in LMICs across three databases and screened identified papers by predetermined inclusion and exclusion criteria. A modified version of the Rainbow Model for Integrated Care guided charting and analysis of the data.
RESULTS
We included 99 studies. Studies were concentrated in the Africa region and most frequently focused on the integration of HIV care with other services. A range of definitions and methods were identified, with no single approach for the measurement of integration dominating the literature. Measurement of clinical integration was the most common, with indicators focused on measuring receipt of two or more services provided at a single point of time. Organizational and professional integration indicators were focused on inter- and intra-organizational communication, collaboration, coordination, and continuity of care, while functional integration measured common information systems or patient records. Gaps were identified in measuring systems and normative integration. Few tools were validated or publicly available for future use.
CONCLUSION
We identified a wide range of recent approaches used to measure integration in LMICs. Our findings underscore continued challenges with lack of conceptual cohesion and fragmentation which limits how integration is understood in practice.
Topics: Humans; Government Programs; Medical Assistance; Communication; Africa; Developing Countries
PubMed: 37770887
DOI: 10.1186/s12889-023-16724-2 -
Dermatologic Clinics Oct 2023Cosmetic procedures can be a nice addition to many different types of dermatology practices. It is part of our specialty, and the author would encourage anyone... (Review)
Review
Cosmetic procedures can be a nice addition to many different types of dermatology practices. It is part of our specialty, and the author would encourage anyone interested to pursue adding a few procedures to their current practice. Why perform cosmetic procedures? It can be esthetically pleasing for many dermatologists, there is a growing demand for esthetic procedures, and it is a source of additional increased revenue not tied to Medicare.
Topics: Aged; United States; Humans; Dermatology; Medicare; Esthetics
PubMed: 37718025
DOI: 10.1016/j.det.2023.05.005 -
Journal of Vascular Surgery Feb 2024Practice consolidation by vertical and horizontal integration is a growing trend in surgery. Practice consolidation has not been previously examined in vascular surgery.
BACKGROUND
Practice consolidation by vertical and horizontal integration is a growing trend in surgery. Practice consolidation has not been previously examined in vascular surgery.
METHODS
The Medicare Provider Enrollment, Chain, and Ownership System data were used to identify vascular providers and vascular surgery practices in the United States in 2015 and 2020. Practices were categorized as solo (1 surgeon), small (2), medium (3-5), and large (≥6). The number of providers and the number of practices in each size group were determined. The Hirfendahl-Hirshman index (HHI), a measure of market consolidation, was calculated. Provider count, practice size, and HHI were additionally analyzed by urban and rural regions. All values were calculated for each time point and compared.
RESULTS
Vascular providers increased in number from 2929 to 3154 (7.7%) from 2015 to 2020. The number of practices decreased from 1351 to 1090 (19.3%). The number of large practices increased by 49.4%; the number of small or solo practices decreased by 42.1%. The mean HHI increased from 0.486 in 2015 to 0.498 in 2020. Both urban and rural regions had a decrease in solo practices (43.3% and 2.3%, respectively) and an increase in HHI (from 0.499 to 0.509 and 0.793 to 0.818, respectively). All changes were statistically significant.
CONCLUSIONS
From 2015 to 2020, there is a trend toward vascular providers working in larger practice groups and a corresponding increase in measures of market consolidation.
Topics: Aged; Humans; United States; Medicare; Vascular Surgical Procedures
PubMed: 37952782
DOI: 10.1016/j.jvs.2023.11.010 -
The American Journal of Bioethics : AJOB Nov 2023
Topics: Humans; Medicalization; Medical Assistance; Canada
PubMed: 37879012
DOI: 10.1080/15265161.2023.2256275 -
JAMA Nov 2023
Topics: Aged; Humans; Fee Schedules; Medicare; Medicare Part B; Physicians; Relative Value Scales; United States
PubMed: 37988095
DOI: 10.1001/jama.2023.18963 -
JAMA Nov 2023
Topics: Aged; Humans; Fee Schedules; Medicare; Medicare Part B; Physicians; Relative Value Scales; United States
PubMed: 37988089
DOI: 10.1001/jama.2023.18975 -
International Journal For Equity in... Aug 2023Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the...
BACKGROUND
Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively.
METHODS
We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment.
RESULTS
A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments.
CONCLUSIONS
A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective.
Topics: Male; Humans; Female; Aged; Public Assistance; Social Support; Cluster Analysis; Latent Class Analysis; Mental Disorders
PubMed: 37537561
DOI: 10.1186/s12939-023-01959-7