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JACC. Advances Oct 2023Cardiac rehabilitation (CR) is strongly recommended for a spectrum of cardiovascular conditions and procedures including aortic valve replacement.
BACKGROUND
Cardiac rehabilitation (CR) is strongly recommended for a spectrum of cardiovascular conditions and procedures including aortic valve replacement.
OBJECTIVES
The purpose of this study was to characterize patient and hospital factors associated with CR participation after transcatheter aortic valve replacement (TAVR) and determine which factors explain hospital-level variation in CR participation.
METHODS
We linked clinical and administrative claims data from patients who underwent TAVR at 24 Michigan hospitals between January 1, 2016 and June 30, 2020 and obtained rates of CR enrollment within 90 days of discharge. Sequential mixed models were fit to evaluate hospital variation in 90-day post-TAVR CR participation.
RESULTS
Among 3,372 patients, 30.6% participated in CR within 90-days after discharge. Several patient factors were negatively associated with CR participation after TAVR including older age, Medicaid insurance, atrial fibrillation/flutter, dialysis use, and slower baseline 5-m walk times. There was substantial hospital variation in CR participation after TAVR ranging from 5% to 60% across 24 hospitals. Patient case mix did not explain hospital variation in CR across hospitals with median OR numerically increasing from 2.11 (95% CI: 1.62-2.67) to 2.13 (95% CI: 1.61-2.68) after accounting for patient-level factors.
CONCLUSIONS
Less than 1 in 3 patients who underwent TAVR in Michigan participated in CR within 90-days of discharge. Although several patient factors are associated with CR participation, hospital-level variation in CR participation after TAVR is not explained by patient case mix. Identifying hospital processes of care that promote CR participation after TAVR will be critical to improving CR participation after TAVR.
PubMed: 38938330
DOI: 10.1016/j.jacadv.2023.100581 -
JACC. Advances Jun 2023Despite the high prevalence of atrial fibrillation (AF), the incidence and impact of care fragmentation (CF) following hospitalization for this condition remain...
BACKGROUND
Despite the high prevalence of atrial fibrillation (AF), the incidence and impact of care fragmentation (CF) following hospitalization for this condition remain unstudied.
OBJECTIVES
The present study used a national database to determine the incidence of and risk factors associated with CF. Outcomes following CF were also examined.
METHODS
All adults who were discharged alive following hospitalization for AF (index facility) were identified within the 2016 to 2019 Nationwide Readmissions Database. Patients requiring nonelective rehospitalization within 30 days of discharge were categorized into 2 groups. The CF cohort included those readmitted to a nonindex facility, while others were classified as noncare fragmentation. Multivariable regression was used to evaluate factors associated with CF, as well as its impact on in-hospital mortality, length of stay, and costs at rehospitalization.
RESULTS
Of an estimated 686,942 patients who met study criteria and survived to discharge, 13.6% (n = 93,376) experienced unplanned readmission within 30 days. Among those readmitted, 21.3% (n = 19,906) were readmitted to a nonindex facility. Patients who experienced CF were younger, more commonly male and less frequently readmitted for AF. Upon multivariable adjustment, male sex, Medicaid insurance (ref: private), and transfer status were associated with increased odds of CF. Upon readmission, CF was associated with a 18% increment in relative odds of in-hospital mortality, a 0.3-day increment in length of stay, and an additional $1,500 in hospitalization costs.
CONCLUSIONS
CF was associated with significant clinical and financial burden. Further studies are needed to address factors which contribute to increased mortality and resource use following CF.
PubMed: 38938260
DOI: 10.1016/j.jacadv.2023.100375 -
Telemedicine Journal and E-health : the... Jun 2024Patient portals can improve access to electronic health information and enhance patient engagement. However, disparities in patient portal utilization remain, affecting...
Patient portals can improve access to electronic health information and enhance patient engagement. However, disparities in patient portal utilization remain, affecting disadvantaged communities disproportionately. This study examined patient- and provider-level factors associated with portal usage among Medicaid recipients in a large federally qualified health center (FQHC) network in Texas. Deidentified electronic medical records of patients 18 years or older from a large Texas FQHC network were analyzed. The dependent variable was a binary flag indicating portal usage during the study period. Independent variables included patient- and provider-level factors. Patient-level factors included sociodemographic, geographic, and clinical characteristics. Provider characteristics included primary service line, provider type, provider language, and years in practice. Because the analysis was at the individual level, a multivariable logistic regression model focused on adjusted associations between independent variables and portal usage. The analytic sample consisted of 9,271 individuals. Compared with individuals 18-39 years, patients 50 years and older had lower odds (50-64 OR: 0.60, < 0.001; 65+ OR: 0.51, < 0.001) of portal usage. Males were less likely to use portals (OR: 0.44, = 0.03), and compared to Non-Hispanic Whites, Non-Hispanic Black (OR: 0.86, = 0.02) and Hispanics (OR: 0.83, < 0.001) were significantly less likely to use portals. Individuals with 1 or more telemedicine consults had a two-times greater odds of portal usage (OR: 1.97, < 0.001). Compared to individuals who had clinic visits in December 2018, portal usage was significantly higher in the pandemic months (March 2020-November 2020, all 's < 0.01). Importantly, the behavioral health service line had the greatest odds (OR: 1.52, < 0.001), whereas the dental service line had the lowest odds (OR: 0.69, = 0.01) compared to family practice. No other provider characteristics were significant. Our finding of significant patient-level factors is important and can contribute to developing appropriate patient-focused health information technology approaches to ensure equitable access and maximize the potential benefits of patient portals in health care delivery.
PubMed: 38938215
DOI: 10.1089/tmj.2024.0194 -
Telemedicine Journal and E-health : the... Jun 2024To compare telemedicine versus office visit use at two Medicaid-focused pediatric primary care clinics. Retrospective cohort study from March 15, 2020 - March 15, 2021...
To compare telemedicine versus office visit use at two Medicaid-focused pediatric primary care clinics. Retrospective cohort study from March 15, 2020 - March 15, 2021 at two Medicaid-focused pediatric primary care clinics. Site A and Site B care for different populations (Site B care for mostly immigrant families with preferred language Spanish). Outcomes included the percent of visits conducted through telemedicine and reason for visit. Descriptive statistics, univariable and multivariable mixed multilevel logistic regression, were used to assess relationship between patient demographics and telemedicine use. Out of 17,142 total visits, 13% of encounters at Site A ( = 987) and 25% of encounters at Site B ( = 2,421) were conducted using telemedicine. Around 13.8% of well-child care ( = 1,515/10,997), 36.2% of mental health care ( = 572/1,581), and 25.0% of acute care/follow-up ( = 1,893/7,562) were telemedicine visits. After adjustment for covariates, there was no difference in odds of a patient having any telemedicine use by preferred language, sex, or payor. Patients 1-4 years of age had the lowest odds of telemedicine use. At Site A, patients who identified as Non-Hispanic Black (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.24-0.45), Hispanic/Latinx (OR = 0.40, 95% CI = 0.24-0.66), or other race/ethnicity (OR = 0.35, 95% CI = 0.23-0.55) had lower odds of telemedicine use in comparison to Non-Hispanic White. Telemedicine was successfully accessed by Medicaid enrollees for different types of pediatric primary care. There was no difference in telemedicine use by preferred language and payor. However, differences existed by age at both sites and by race/ethnicity at one site. Future research should explore operational factors that improve telemedicine access for marginalized groups.
PubMed: 38938205
DOI: 10.1089/tmj.2023.0707 -
Psychiatric Services (Washington, D.C.) Jun 2024Algorithms for guiding health care decisions have come under increasing scrutiny for being unfair to certain racial and ethnic groups. The authors describe their...
Algorithms for guiding health care decisions have come under increasing scrutiny for being unfair to certain racial and ethnic groups. The authors describe their multistep process, using data from 3,465 individuals, to reduce racial and ethnic bias in an algorithm developed to identify state Medicaid beneficiaries experiencing homelessness and chronic health needs who were eligible for coordinated health care and housing supports. Through an iterative process of adjusting inputs, reviewing outputs with diverse stakeholders, and performing quality assurance, the authors developed an algorithm that achieved racial and ethnic parity in the selection of eligible Medicaid beneficiaries.
PubMed: 38938093
DOI: 10.1176/appi.ps.20230359 -
The Senior Care Pharmacist Jul 2024
Topics: United States; Humans; Centers for Medicare and Medicaid Services, U.S.; Personnel Staffing and Scheduling; Medicaid
PubMed: 38937890
DOI: 10.4140/TCP.n.2024.277 -
Journal of Orthopaedic Surgery and... Jun 2024Innovation has fueled the shift from inpatient to outpatient care for orthopaedic joint arthroplasty. Given this transformation, it becomes imperative to understand what...
BACKGROUND
Innovation has fueled the shift from inpatient to outpatient care for orthopaedic joint arthroplasty. Given this transformation, it becomes imperative to understand what factors help assign care-settings to specific patients for the same procedure. While the comorbidities suffered by patients are important considerations, recent research may point to a more complex determination. Differences in reimbursement structures and patient characteristics across various insurance statuses could potentially influence these decisions.
METHODS
Retrospective binary logistic and ordinary least square (OLS) regression analyses were employed on de-identified inpatient and outpatient orthopaedic arthroplasty data from Albany Medical Center from 2018 to 2022. Data elements included surgical setting (inpatient vs. outpatient), covariates (age, sex, race, obesity, smoking status), Elixhauser comorbidity indices, and insurance status.
RESULTS
Patients insured by Medicare were significantly more likely to be placed in inpatient care-settings for total hip, knee, and ankle arthroplasty when compared to their privately insured counterparts even after Centers for Medicare and Medicaid Services (CMS) removed each individual surgery from its inpatient-only-list (1.65 (p < 0.05), 1.27 (p < 0.05), and 12.93 (p < 0.05) times more likely respectively). When compared to patients insured by the other payers, Medicare patients did not have the most comorbidities (p < 0.05).
CONCLUSIONS
Medicare patients were more likely to be placed in inpatient care-settings for hip, knee, and ankle arthroplasty. However, Medicaid patients were shown to have the most comorbidities. It is of value to note Medicare patients billed for outpatient services experience higher coinsurance rates.
LEVEL OF EVIDENCE
III.
Topics: Humans; Retrospective Studies; Male; Female; Insurance Coverage; United States; Inpatients; Middle Aged; Aged; Medicare; Medicaid; Orthopedic Procedures; Outpatients
PubMed: 38937773
DOI: 10.1186/s13018-024-04734-8 -
Journal of General Internal Medicine Jun 2024Following the Centers for Medicare and Medicaid Services' approval of the Acute Hospital Care at Home waiver, an increasing number of health care organizations launched...
BACKGROUND
Following the Centers for Medicare and Medicaid Services' approval of the Acute Hospital Care at Home waiver, an increasing number of health care organizations launched Home Hospital (HH) programs in the USA. Ongoing barriers include access to HH expertise and a standard, comprehensive set of implementation tools. We created the HH Early Adopters Accelerator to bring together a network of health care organizations to develop tools ("knowledge products") necessary for HH implementation.
OBJECTIVE
To demonstrate the feasibility of the Accelerator approach for generating and implementing relevant, high-quality knowledge products.
DESIGN
Mixed methods evaluation of the Accelerator. Surveys and qualitative interviews of Accelerator participants were conducted. Surveys elicited feedback on the knowledge products, including time spent on development, perceived utility and quality, and implementation success. The qualitative interviews gathered more in-depth information on topics covered in the surveys.
PARTICIPANTS
Eighteen healthcare organizations and 105 individuals participated in the Accelerator.
KEY RESULTS
The Accelerator reached its goal and developed 20 knowledge products in 32 working weeks (more efficient than expected). Participants agreed that the knowledge products were useful (developers: 98.1%; stakeholders: 93.8%), of high quality (developers: 96.8%), and would improve patient care if implemented in their HH program (developers: 91.7%; stakeholders: 91.2%). Two thirds (66.7%) of the participating organizations who had implemented knowledge products at 3 months continued utilizing knowledge products in their HH program at 1 year. Agreement that knowledge products improve patient care persisted (92% strongly agreed or agreed) at 1 year. Several programs created new tools, policies, and workflows as a result of implementing the knowledge products.
CONCLUSIONS
The Accelerator created high-quality, comprehensive knowledge products that healthcare organizations found useful for safe HH implementation 1 year later. The Accelerator approach can feasibly help healthcare organizations safely bridge the gap between innovation and standard practice.
PubMed: 38937363
DOI: 10.1007/s11606-024-08869-6 -
Journal of General Internal Medicine Jun 2024In 2023, approximately 650,000 people experienced homelessness (PEH) nightly in the United States, the highest number recorded in the country's history. This alarming...
In 2023, approximately 650,000 people experienced homelessness (PEH) nightly in the United States, the highest number recorded in the country's history. This alarming statistic has made homelessness a key issue in the 2024 elections, especially with the White House's goal to reduce homelessness by 25% by 2025. Despite efforts and investments, homelessness remains a persistent public health challenge. The recent inclusion of street medicine services in Center for Medicare and Medicaid Services (CMS) billing codes represents a significant step forward. Street medicine, defined by CMS as healthcare provided in non-permanent locations to unsheltered individuals, now qualifies for Medicare reimbursement. This policy change, alongside state-level initiatives, aims to improve healthcare access for the unhoused, particularly older adults. However, challenges remain in establishing adequate fee schedules and integrating care management. Despite these obstacles, the integration of healthcare and housing services is crucial for addressing homelessness effectively, promoting stability, and improving health outcomes for PEH. This manuscript explores the history, practical guidance, and potential impacts of these developments on homelessness and public health.
PubMed: 38937362
DOI: 10.1007/s11606-024-08880-x -
JCO Global Oncology Jun 2024Cervical cancer fight gains momentum as funders meet in Cartagena with the aim of closing gaps in screening, access to vaccines and treatment.
Cervical cancer fight gains momentum as funders meet in Cartagena with the aim of closing gaps in screening, access to vaccines and treatment.
Topics: Uterine Cervical Neoplasms; Humans; Female; Developing Countries; Papillomavirus Vaccines; Early Detection of Cancer; Papillomavirus Infections
PubMed: 38935885
DOI: 10.1200/GO.24.00147