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Health Services Research Aug 2023To illustrate the association between the sociodemographic characteristics of hospital markets and the geographic patterns of Medicare hospital value-based purchasing...
OBJECTIVE
To illustrate the association between the sociodemographic characteristics of hospital markets and the geographic patterns of Medicare hospital value-based purchasing (HVBP) scores.
DATA SOURCES AND STUDY SETTING
This is a secondary analysis of United States hospitals with a HVBP Total Performance Score (TPS) for 2019 in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare database (4/2021 release) and American Community Survey (ACS) data for 2015-2019.
STUDY DESIGN
This is a cross-sectional study using spatial multivariable autoregressive models with HVBP TPS and component domain scores as dependent variables and hospital market demographics as the independent variables.
DATA COLLECTION/EXTRACTION METHODS
We calculated hospital market demographics using ZIP code level data from the ACS, weighted the 2019 CMS inpatient Hospital Service Area file.
PRINCIPAL FINDINGS
Spatial autoregressive models using eight nearest neighbors with diversity index, race and ethnicity distribution, families in poverty, unemployment, and lack of health insurance among residents ages 19-64 years provided the best model fit. Diversity index had the highest statistically significant contribution to lower TPS (ß = -12.79, p < 0.0001), followed by the percent of the population coded to "non-Hispanic, some other race" (ß = -2.59, p < 0.0023), and the percent of families in poverty (ß = -0.26, p < 0.0001). Percent of the population was non-Hispanic American Indian/Alaskan Native (ß = 0.35, p < 0.0001) and percent non-Hispanic Asian (ß = 0.12, p < 0.02071) were associated with higher TPS. Lower predicted TPS was observed in large urban cities throughout the US as well as in states throughout the Southeastern US. Similar geographic patterns were observed for the predicted Patient Safety, Person and Community Engagement, and Efficiency and Cost Reduction domain scores but are not for predicted Clinical Outcomes scores.
CONCLUSIONS
The lower predicted scores seen in cities and in the Southeastern region potentially reflect an inherent-that is, structural-association between market sociodemographics and HVBP scores.
Topics: Aged; Humans; United States; Value-Based Purchasing; Cross-Sectional Studies; Medicare; Hospitals; Demography; Geography
PubMed: 36755373
DOI: 10.1111/1475-6773.14141 -
Nutrients Dec 2023Social Determinants of Health (SDOH) impact nearly half of health outcomes, surpassing the influence of human behavior, clinical care, and the physical environment. SDOH... (Review)
Review
Social Determinants of Health (SDOH) impact nearly half of health outcomes, surpassing the influence of human behavior, clinical care, and the physical environment. SDOH has five domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Any adversity arising out of these interlinked domains predominantly affects children due to their greater susceptibility, and the adverse outcomes may span generations. Unfavorable SDOH may cause food insecurity, malnutrition, unbalanced gut microbiome, acute and chronic illnesses, inadequate education, unemployment, and lower life expectancy. Systematic screening by health care workers and physicians utilizing currently available tools and questionnaires can identify children susceptible to adverse childhood experiences, but there is a deficiency with respect to streamlined approach and institutional support. Additionally, current ameliorating supplemental food programs fall short of pediatric nutritional requirements. We propose a nutrition-based Surveillance, Screening, Referral, and Reevaluation (SSRR) plan encompassing a holistic approach to SDOH with a core emphasis on food insecurity, coupled with standardizing outcome-based interventions. We also propose more inclusive use of Food Prescription Programs, tailored to individual children's needs, with emphasis on education and access to healthy food.
Topics: Humans; Child; Social Determinants of Health; Educational Status; Adverse Childhood Experiences; Policy; Outcome Assessment, Health Care
PubMed: 38201835
DOI: 10.3390/nu16010005 -
BMC Nephrology Feb 2024There is a lack of prognostic information to guide the prediction of short-term all-cause mortality in patients with end-stage renal disease (ESRD). The aim was to... (Review)
Review
OBJECTIVES
There is a lack of prognostic information to guide the prediction of short-term all-cause mortality in patients with end-stage renal disease (ESRD). The aim was to review the risk factors that influenced the risk of short-term all-cause mortality in patients with ESRD.
METHODS
MEDLINE, Embase, PubMed, CINAHL, the Cochrane Library and Web of Science databases were searched for articles published between 2000 and 2020. Articles describing risk factors predicting short-term mortality (≤ 3 years) in patients with ESRD were included. Four reviewers independently performed title, abstract, full text screening and data extraction. Assessment of risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool checklist.
RESULTS
20,840 articles were identified and 113 papers were included for this review. Of the 113 papers, 6.2% included only peritoneal dialysis (PD) patients, 67.3% included only hemodialysis (HD) patients, 20.4% included both PD and HD patients, with the remaining papers featuring patients on conservative management or awaiting renal transplant. Risk factors were categorised into 13 domains: 1)demographics/ lifestyle, 2) comorbidities 3)intradialytic blood pressure, 4)biomarkers, 5)cardiovascular measurements, 6)frailty status, 7)medications, 8)treatment related indicators, 9)renal related parameters, 10)health status, 11)cause of ESRD, 12)access to healthcare care/ information and, 13)proxy measures for poor health. C-reactive protein(CRP), age, and functional status were observed to have higher percentage of instances of being significantly associated with all-cause mortality.
CONCLUSION
Commonly examined risk factors observed from this review may be used to build a general prognostic model for patients with ESRD, with specific treatment related risk factors added on to enhance the accuracy of the models.
Topics: Humans; Kidney Failure, Chronic; Renal Dialysis; Risk Factors; Peritoneal Dialysis; Health Status
PubMed: 38413903
DOI: 10.1186/s12882-024-03503-3 -
Ophthalmology Oct 2023To evaluate the association of social determinants of health (SDoH) with eye care utilization among people with diabetes mellitus using the 2013-2017 National Health...
PURPOSE
To evaluate the association of social determinants of health (SDoH) with eye care utilization among people with diabetes mellitus using the 2013-2017 National Health Interview Survey (NHIS).
DESIGN
Retrospective cross-sectional study.
PARTICIPANTS
Participants ≥ 18 years of age with self-reported diabetes.
METHODS
The SDoH in the following domains were used: (1) economic stability; (2) neighborhood, physical environment, and social cohesion; (3) community and social context; (4) food environment; (5) education; and (6) health care system. An aggregate SDoH score was calculated and divided into quartiles, with Q4 representing those with the highest adverse SDoH burden. Survey-weighted multivariable logistic regression models evaluated the association of SDoH quartile with eye care utilization in the preceding 12 months. A linear trend test was conducted. Domain-specific mean SDoH scores were calculated, and the performance of domain-specific models was compared using area under the curve (AUC).
MAIN OUTCOME MEASURE
Eye care utilization in the preceding 12 months.
RESULTS
Of 20 807 adults with diabetes, 43% had not used eye care. Greater adverse SDoH burden was associated with decrements in odds of eye care utilization (P < 0.001 for trend). Participants in the highest quartile of adverse SDoH burden (Q4) had a 58% lower odds (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.37-0.47) of eye care utilization than those in Q1. The domain-specific model using economic stability had the highest performing AUC (0.63; 95% CI, 0.62-0.64).
CONCLUSIONS
Among a national sample of people with diabetes, adverse SDoH were associated with decreased eye care utilization. Evaluating and intervening upon the effects of adverse SDoH may be a means by which to improve eye care utilization and prevent vision loss.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Adult; Humans; Social Determinants of Health; Cross-Sectional Studies; Retrospective Studies; Diabetes Mellitus; Educational Status
PubMed: 37329902
DOI: 10.1016/j.ophtha.2023.06.007 -
BMC Geriatrics Oct 2023Intrinsic capacity (IC) can better reflect the physical functioning of older adults. However, few studies have been able to systematically and thoroughly examine its...
BACKGROUND
Intrinsic capacity (IC) can better reflect the physical functioning of older adults. However, few studies have been able to systematically and thoroughly examine its influencing factors and provide limited evidence for the improvement of intrinsic capacity. The objective of this study was to provide a comprehensive description of the overall decline in intrinsic capacity among older persons in the community. Additionally, the study aimed to analyze the composition of the five domains of reduction, compare the rate of decline among older adults and investigate the factors that influence this decline.
METHODS
This was a cross-sectional study conducted in the Chinese community. The self-designed general characteristics questionnaire was created based on the healthy aging framework and a systematic review. Intrinsic capacity was assessed with the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Community Health Record Management System (CHRMS), Mini Nutritional Assessment Brief Form (MNA-SF), and Short Physical Performance Battery (SPPB). The influencing factors of intrinsic capacity were investigated using stepwise logistic regression.
RESULTS
A total of 968 older adults with a mean age of 71.00 (68.00, 76.75) were examined, and 704 older adults (72.7%) showed a decline in intrinsic capacity. There was a decline in at least one domain in 39.3% of older adults, with reductions in each domain ranging from 5.3% (psychological) to 52.4% (sensory). The study examined the composition of domains that experienced a decline in intrinsic capacity. It was found that a combination of sensory and locomotor domains showed the most significant decrease in 44.5% (n = 106) of individuals who experienced a decline in the two domains. Furthermore, a combination of sensory, cognitive, and locomotor domains exhibited a significant decrease in 51.3% (n = 44) of individuals who experienced a reduction in three domains. Lastly, a combination of sensory, vitality, cognitive, and locomotor domains showed the most significant decline in four domains, accounting for 60.0% (n = 15) of the population. Older adults had a higher risk of intrinsic capacity decline if they were older (95% CI:1.158-2.310), had lower education, lived alone (95% CI: 1.133-3.216), smoked (95% CI: 1.163-3.251), high Charlson Comorbidity Index (95% CI: 1.243-1.807) scores, did not regular exercise (95% CI:1.150-3.084), with lower handgrip strength (95% CI: 0.945-0.982).
CONCLUSIONS
We found a relatively high prevalence of intrinsic capacity; more attention should be paid to older adults who are older, less educated, live alone, and have more comorbidities. It is imperative to prioritize a healthy lifestyle among older persons who exhibit smoking habits, lack regular exercise, and possess inadequate handgrip strength.
Topics: Aged; Aged, 80 and over; Humans; Comorbidity; Cross-Sectional Studies; Exercise; Geriatric Assessment; Hand Strength; Healthy Aging
PubMed: 37817083
DOI: 10.1186/s12877-023-04362-7 -
GeroScience Oct 2023Many individuals, both in the public and within the field of psychology, often perceive aging as a burden that negatively impacts intellectual and mental health. Our... (Review)
Review
Many individuals, both in the public and within the field of psychology, often perceive aging as a burden that negatively impacts intellectual and mental health. Our present study aims to challenge this notion by identifying the crucial components of positive mental health in later life. These components not only promote positive mental health but also actively contribute to it, even under difficult circumstances. To accomplish this, we first offer a concise review of well-being and mental health models that highlight the psychological aspects of flourishing in late life. We then introduce a psychological competence-based model for positive mental health, which aligns with the concept of positive aging. Subsequently, we present a measurement tool suitable for practical applications. Finally, we provide a comprehensive overview of positive aging, drawing on methodological guidelines and existing research findings concerning sustainable positive mental health in later life. We examine the evidence indicating that psychological resilience (the capacity to adapt and recover from adversity or stress) and competence (skills and abilities to effectively cope with challenges across various life domains) significantly contribute to slowing down biological aging processes. Furthermore, we discuss insights into the relationship between psychological factors and aging derived from research on Blue Zones (regions characterized by a higher proportion of individuals experiencing longer, healthier lives).
Topics: Humans; Resilience, Psychological; Mental Health; Aging; Health Status
PubMed: 37418098
DOI: 10.1007/s11357-023-00856-9 -
JAMA Network Open Apr 2024Despite a growing population of survivors of lung cancer, there is limited understanding of the survivorship journey. Survivors of lung cancer experience unmet physical,...
IMPORTANCE
Despite a growing population of survivors of lung cancer, there is limited understanding of the survivorship journey. Survivors of lung cancer experience unmet physical, social, emotional, and medical needs regardless of stage at diagnosis or treatment modalities.
OBJECTIVE
To investigate the association of unmet needs with quality of life (QOL) and financial toxicity (FT) among survivors of lung cancer.
DESIGN, SETTING, AND PARTICIPANTS
This survey study was conducted at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center thoracic oncology clinics between December 1, 2020, and September 30, 2021, to assess needs (physical, social, emotional, and medical), QOL, and FT among survivors of lung cancer. Patients had non-small cell lung cancer of any stage and were alive longer than 1 year from diagnosis. A cross-sectional survey was administered, which consisted of an adapted needs survey developed by the Mayo Survey Research Center, the Comprehensive Score for Financial Toxicity measure, and the European Organization for Research and Treatment of Cancer QLQ-C30 QOL scale. Demographic and clinical information was obtained through retrospective medical record review. Data analysis was performed between May 9 and December 8, 2022.
MAIN OUTCOMES AND MEASURES
Separate multiple linear regression models, treating QOL and FT as dependent variables, were performed to assess the adjusted association of total number of unmet needs and type of unmet need (physical, emotional, social, or medical) with QOL and FT.
RESULTS
Of the 360 survivors of lung cancer approached, 232 completed the survey and were included in this study. These 232 respondents had a median age of 69 (IQR, 60.5-75.0) years. Most respondents were women (144 [62.1%]), were married (165 [71.1%]), and had stage III or IV lung cancer (140 [60.3%]). Race and ethnicity was reported as Black (33 [14.2%]), White (172 [74.1%]), or other race or ethnicity (27 [11.6%]). A higher number of total unmet needs was associated with lower QOL (β [SE], -1.37 [0.18]; P < .001) and higher FT (β [SE], -0.33 [0.45]; P < .001). In the context of needs domains, greater unmet physical needs (β [SE], -1.24 [0.54]; P = .02), social needs (β [SE], -3.60 [1.34]; P = .01), and medical needs (β [SE], -2.66 [0.98]; P = .01) were associated with lower QOL, whereas only greater social needs was associated with higher FT (β [SE], -3.40 [0.53]; P < .001).
CONCLUSIONS AND RELEVANCE
The findings of this survey study suggest that among survivors of lung cancer, unmet needs were associated with lower QOL and higher FT. Future studies evaluating targeted interventions to address these unmet needs may improve QOL and FT among survivors of lung cancer.
Topics: Humans; Female; Middle Aged; Aged; Male; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Quality of Life; Cross-Sectional Studies; Financial Stress; Retrospective Studies; Survivors
PubMed: 38630475
DOI: 10.1001/jamanetworkopen.2024.6872 -
Frontiers in Public Health 2024Mucopolysaccharidoses (MPS) constitute a group of progressive and multisystemic inherited metabolic diseases that profoundly affect both the mental health of patients...
INTRODUCTION
Mucopolysaccharidoses (MPS) constitute a group of progressive and multisystemic inherited metabolic diseases that profoundly affect both the mental health of patients and the wellbeing of their families. This study aims to evaluate the impact of MPS on family functioning and related factors.
METHODS AND RESULTS
Twenty-five patients with MPS, including types I ( = 4), II ( = 11), IIIB ( = 2), IVA ( = 3), and VI ( = 5), and their families participated in this study. The mean patient age was 13 years [standard deviation (SD): 7.7 years]. Behavioral and emotional problems were noted in 9.1% of all patients. While the type of MPS did not directly influence mental problems, the presence of neuronal involvement did ( = 0.006). Patients with MPS III exhibited difficulties primarily in emotional areas, conduct, hyperactivity, and peer problems. Importantly, both patients with MPS II and those with MPS III experienced a significant impact on communication [mean scores for communication domain: MPS II, 35.6 (SD: 24.3); MPS III, 35.0 (SD: 22.6)]; poorer communication was directly linked to worse adaptive behavior ( = 0.012), and worse adaptive behavior was associated with lower quality of life ( = 0.001). Quality of life and caregiver burden among family members did not significantly differ across MPS types; however, higher caregiver burden was negatively associated with quality of life ( = 0.002). Concerning family functioning, the most impacted domains included independence, intellectual/cultural orientation, activity/recreation, and expressiveness. Domain scores did not vary based on MPS type, treatment, or neurological involvement. Quality-of-life scores were positively associated with the cultural/intellectual domain score.
CONCLUSION
The impacts of quality of life and family extend beyond clinical characteristics and MPS type, strongly influenced by patient cognition and communication, as well as type of family functioning, especially those with greater cultural/intellectual skills of their family members. A multidisciplinary approach addressing the broader needs of individuals with MPS becomes essential. Techniques aimed at improving communication, including prompt interventions such as speech therapy and augmentative and alternative communication strategies, can contribute to overall family functioning improvement.
Topics: Humans; Adolescent; Quality of Life; Mucopolysaccharidoses; Family; Mental Disorders; Mental Health
PubMed: 38327584
DOI: 10.3389/fpubh.2024.1305878 -
BMC Medical Research Methodology Jul 2023Adversity occurring during development is associated with detrimental health and quality of life outcomes, not just following exposure but throughout the lifespan....
BACKGROUND
Adversity occurring during development is associated with detrimental health and quality of life outcomes, not just following exposure but throughout the lifespan. Despite increased research, there exists both overlapping and distinct definitions of early life adversity exposure captured by over 30 different empirically validated tools. A data-driven approach to defining and cataloging exposure is needed to better understand associated outcomes and advance the field.
METHODS
We utilized baseline data on 11,566 youth enrolled in the ABCD Study to catalog youth and caregiver-reported early life adversity exposure captured across 14 different measures. We employed an exploratory factor analysis to identify the factor domains of early life adversity exposure and conducted a series of regression analyses to examine its association with problematic behavioral outcomes.
RESULTS
The exploratory factor analysis yielded a 6-factor solution corresponding to the following distinct domains: 1) physical and sexual violence; 2) parental psychopathology; 3) neighborhood threat; 4) prenatal substance exposure; 5) scarcity; and 6) household dysfunction. The prevalence of exposure among 9-and 10-year-old youth was largely driven by the incidence of parental psychopathology. Sociodemographic characteristics significantly differed between youth with adversity exposure and controls, depicting a higher incidence of exposure among racial and ethnic minoritized youth, and among those identifying with low socioeconomic status. Adversity exposure was significantly associated with greater problematic behaviors and largely driven by the incidence of parental psychopathology, household dysfunction and neighborhood threat. Certain types of early life adversity exposure were more significantly associated with internalizing as opposed to externalizing problematic behaviors.
CONCLUSIONS
We recommend a data-driven approach to define and catalog early life adversity exposure and suggest the incorporation of more versus less data to capture the nuances of exposure, e.g., type, age of onset, frequency, duration. The broad categorizations of early life adversity exposure into two domains, such as abuse and neglect, or threat and deprivation, fail to account for the routine co-occurrence of exposures and the duality of some forms of adversity. The development and use of a data-driven definition of early life adversity exposure is a crucial step to lessening barriers to evidence-based treatments and interventions for youth.
Topics: Female; Adolescent; Pregnancy; Humans; Child; Adverse Childhood Experiences; Quality of Life
PubMed: 37420169
DOI: 10.1186/s12874-023-01983-9 -
Frontiers in Public Health 2023The study aims to examine the impact of the wave of seismic activity in the northern region of Oltenia (Gorj County, Romania) in February 2023 and the belief in 'fake...
PURPOSE
The study aims to examine the impact of the wave of seismic activity in the northern region of Oltenia (Gorj County, Romania) in February 2023 and the belief in 'fake news' (circulated regarding causality, manifestations, and future developments of the seismic activity) on the quality of life of the affected population. It was considered opportune to conduct this study, given the novelty of such a situation, as the mentioned geographical area is not known to have a high seismic risk.
METHODS
The study was built based on the questionnaire to which 975 respondents, present/residing in Gorj County during the earthquakes and at least 14 days after, and with a minimum age of 18 years, responded. The data was collected between February 27, 2023, and March 31, 2023, at a reasonable time interval from the recording of the first seismic event in the region, assuming that the respondents' opinions regarding the negative impact of seismic events on societal life are well crystallized. The aim was to obtain information and analyze it in order to establish the respondents' perception regarding the negative effects of seismic activity and the elements of "fake news" promoted in this context on the quality of life of individuals in the region.
RESULTS
Our study indicates that individuals who are not concerned, due to their disbelief in "fake news" information, about the possibility of new strong earthquakes in the mentioned area feel the best physically, having an average satisfaction level of 82.80 (with a standard deviation of 19.70) on the WHOQOL-BREF scale. On the other hand, those who believed in the fake news experienced the lowest levels of psychological well-being, with an average satisfaction of 60.80 (and a standard deviation of 21.98). The WHOQOL-BREF is an instrument that assesses the quality of life across four distinct domains, and this study emphasizes the importance of accurate and trustworthy information for people's well-being.
CONCLUSION
The results of the study highlight that the quality of life indicators of people in the geographic area affected by the wave of seismic movements are negatively impacted due to the release of "fake news" in the public domain regarding the cause of seismic movements in Gorj county (and the previous earthquakes in Turkey) and their future manifestations and developments (the possibility of high magnitude seismic movements), as well as the lack of information provided by the public authorities on the issue at hand (causes, effects, future manifestations, management measures).
Topics: Humans; Adolescent; Earthquakes; Disinformation; Quality of Life; Romania; Surveys and Questionnaires
PubMed: 38106906
DOI: 10.3389/fpubh.2023.1244564