Health Center Characteristics Associated With Hospital Care Among Medicare-Medicaid Dual Enrollees.

Using 2012-2018 Medicare claims and health center data, we identified factors associated with variation in rates of hospital care among Medicare-Medicaid dual enrollees receiving primary care at health centers. In our sample ( n = 5961 health center-years), we found no evidence that patient-centered medical home designation or other modifiable health center characteristics were associated with reductions in hospital care use, which depends more on health center patient mix. Thus, policymakers should target efforts to health centers serving the most disadvantaged and marginalized communities.

Racial and Ethnic Disparities in Hospital-Based Care Among Dual Eligibles Who Use Health Centers.

Introduction: Health center use may reduce hospital-based care among Medicare-Medicaid dual eligibles, but racial and ethnic disparities in this population have not been widely studied. We examined the extent of racial and ethnic disparities in hospital-based care among duals using health centers and the degree to which disparities occur within or between health centers.

Methods: We used 2012-2018 Medicare claims and health center data to model emergency department (ED) visits, observation stays, hospitalizations, and 30-day unplanned returns as a function of race and ethnicity among dual eligibles using health centers.

Primary care patterns among dual eligibles with Alzheimer's disease and related dementias.

Background: Primary care is essential for persons with Alzheimer's disease and related dementias (ADRD). Prior research suggests that the propensity to provide high-quality, continuous primary care varies by provider setting, but the settings used by Medicare-Medicaid dual-eligibles with ADRD have not been described at the population level.

Methods: Using 2012-2018 Medicare data, we identified dual-eligibles with ADRD.

Characterizing the Uptake of Newly Opened Health Centers by Individuals Dually Enrolled in Medicare and Medicaid.

Federally qualified health centers (FQHCs) increasingly provide high-quality, cost-effective primary care to individuals dually enrolled in Medicare and Medicaid. However, not everyone can access an FQHC. We used 2012 to 2018 Medicare claims and federally collected FQHC data to examine communities where an FQHC first opened and determine which dual eligibles used it.

The association between primary care use and potentially-preventable hospitalization among dual eligibles age 65 and over.

Background: Individuals dually-enrolled in Medicare and Medicaid (dual eligibles) are disproportionately sicker, have higher health care costs, and are hospitalized more often for ambulatory care sensitive conditions (ACSCs) than other Medicare beneficiaries. Primary care may reduce ACSC hospitalizations, but this has not been well studied among dual eligibles. We examined the relationship between primary care and ACSC hospitalization among dual eligibles age 65 and older.

Health center use and hospital-based care among individuals dually enrolled in Medicare and Medicaid, 2012-2018.

Objective: To examine the relationship between federally qualified health center (FQHC) use and hospital-based care among individuals dually enrolled in Medicare and Medicaid.

Data Sources: Data were obtained from 2012 to 2018 Medicare claims.

Study Design: We modeled hospital-based care as a function of FQHC use, person-level factors, a Medicare prospective payment system (PPS) indicator, and ZIP code fixed effects.

Nursing home care under Medicaid managed long-term services and supports.

Objective: To measure the impact of Medicaid managed long-term services and supports (MLTSS) on nursing home (NH) quality and rebalancing.

Data Sources/study Setting: This study analyzes secondary data from annual NH recertification surveys and the minimum dataset (MDS) in three states that implemented MLTSS: Massachusetts (2001-2007), Kansas and Ohio (2011-2017).

Study Design: We utilized a difference-in-difference approach comparing NHs in border counties of states that implemented MLTSS with a control group of NHs in neighboring border counties in states that did not implement MLTSS.

Interventions for Health: Why and How Health Care Systems Provide Programs to Benefit Unhoused Patients.

Individuals experiencing homelessness have poorer health than housed individuals, while also utilizing more emergency department care and fewer preventive services. Several interventions - including permanent supportive housing, medical respite, and mobile medical clinics - are cost-effective means to improve health outcomes for homeless populations, yet few health systems have invested in such programs. This study aimed to determine the reasons some health systems initiated these interventions, and the early experience of those health systems that did.

Factors Associated With Caregivers' Use of Support Services and Caregivers' Nonuse of Services Sought.

Informal caregivers may face barriers accessing services like respite care, training, and support groups. Using multinomial logistic regression, I modeled caregivers' probability of using all services sought ("all services used") and nonuse of any services sought ("any unused services") as a function of caregiver and care-recipient characteristics. Care-recipient health and function, especially dementia and need for medical task assistance, were associated with all services used and any unused services, and any unused services were more likely among adult children caring for their parents, caregivers of Black and Hispanic older adults, caregivers providing intensive care, caregivers living in metropolitan areas, and residents of states that spend more on increasing access to caregiver services under the National Family Caregiver Support Program.

Care Configurations and Unmet Care Needs in Older Men and Women.

Older adults frequently experience adverse consequences as the result of unmet care needs, including not getting dressed and going without food when hungry. Previous studies have noted that characteristics of the caregiver network may be associated with unmet needs. Using National Health and Aging Trends Study data, I modeled the association between care configurations and unmet needs for men and women.

The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries.

Purpose: High rates of potentially preventable hospitalizations and emergency department (ED) visits indicate limited primary care access. Rural Health Clinics (RHCs) are intended to increase access to primary care. The goal of this study was to evaluate the role of RHCs and their impact on potentially preventable hospitalizations and ED visits among Medicare beneficiaries based on actual individual-level utilization patterns.

Use of Federally Qualified Health Centers and Potentially Preventable Hospital Utilization Among Older Medicare-Medicaid Enrollees.

Using Medicare claims data from 2007 to 2010, we sought to determine whether dual eligibles 65 years and older who utilize federally qualified health centers (FQHCs) have lower rates of ambulatory care-sensitive hospitalizations and emergency department visits compared with nonusers. We found that FQHC use is associated with increased ambulatory care-sensitive hospitalization rates for whites and other races, but a decrease among blacks. Depending on race, FQHC use is associated with an increase of 24 to 43 ambulatory care-sensitive emergency department visits per thousand persons annually.

Younger Dual-Eligibles Who Use Federally Qualified Health Centers Have More Preventable Emergency Department Visits, but Some Have Fewer Hospitalizations.

Objective: To determine whether younger dual-eligibles receiving care at federally qualified health centers (FQHCs) have lower rates of ambulatory care sensitive (ACS) hospitalization and emergency department (ED) visits.

Data Sources: We used the 100% Medicare Part A and Part B institutional claims from 2007 to 2010 for dual-eligibles younger than 65 years, enrolled in traditional fee-for-service Medicare, who received care at an FQHC or lived in a primary care service area with an FQHC.

Methods: Our cross-sectional analysis used negative binomial regressions to model ACS hospitalizations and ED visits as a function of prior year FQHC use.

Iowa Wavering on Medicaid: From Expansion to Modernization.

Iowa is one of six states to expand Medicaid through section 1115 waivers. Iowa's alternative approach to Medicaid expansion, known as the Iowa Health and Wellness Plan, was the result of a bipartisan compromise, motivated by the pending expiration of a preexisting section 1115 waiver that served sixty-five thousand Iowans. The Iowa Health and Wellness Plan emphasizes personal responsibility and private involvement.

Federally Qualified Health Center Use Among Dual Eligibles: Rates Of Hospitalizations And Emergency Department Visits.

People who are eligible for both Medicare and Medicaid, known as "dual eligibles," disproportionately are members of racial or ethnic minority groups. They face barriers accessing primary care, which in turn increase the risk of potentially preventable hospitalizations and emergency department (ED) visits for ambulatory care-sensitive conditions. Federally qualified health centers provide services known to address barriers to primary care.

Prospective randomized trial of insulin glargine in acute management of diabetic ketoacidosis in the emergency department: a pilot study.

Objectives: The objective was to determine the efficacy of coadministration of subcutaneous (SQ) insulin glargine in combination with intravenous (IV) insulin for treating diabetic ketoacidosis (DKA).

Methods: This was a prospective, randomized, controlled trial comparing coadministration of insulin glargine and IV insulin (experimental) with IV insulin (standard care control). The setting was emergency departments (EDs) in two hospitals in Houston, Texas.

Factors Affecting Staff Perceptions of Tele-ICU Service in Rural Hospitals.

Introduction: Telemedicine is designed to increase access to specialist care, especially in settings distant from tertiary-care centers. One of the more established telemedicine applications in hospitals is the tele-intensive care unit (tele-ICU). Perceptions of tele-ICU users are not well studied.

Effect of tele-emergency services on recruitment and retention of US rural physicians.

Introduction: As competition for physicians intensifies in the USA, rural areas are at a disadvantage due to challenges unique to rural medical practice. Telemedicine improves access to care not otherwise available in rural settings. Previous studies have found that telemedicine also has positive effects on the work environment, suggesting that telemedicine may improve rural physician recruitment and retention, although few have specifically examined this.

Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest.

Structure-guided design of alpha-amino acid-derived Pin1 inhibitors.

The peptidyl prolyl cis/trans isomerase Pin1 is a promising molecular target for anti-cancer therapeutics. Here we report the structure-guided evolution of an indole 2-carboxylic acid fragment hit into a series of alpha-benzimidazolyl-substituted amino acids. Examples inhibited Pin1 activity with IC(50) <100nM, but were inactive on cells.

Structure-based drug design targeting an inactive RNA conformation: exploiting the flexibility of HIV-1 TAR RNA.

The targeting of RNA for the design of novel anti-viral compounds represents an area of vast potential. We have used NMR and computational methods to model the interaction of a series of synthetic inhibitors of the in vitro RNA binding activities of a peptide derived from the transcriptional activator protein, Tat, from human immunodeficiency virus type 1. Inhibition has been measured through the monitering of fluorescence resonance energy transfer between fluorescently labeled peptide and RNA components.

Rational design of inhibitors of HIV-1 TAR RNA through the stabilisation of electrostatic "hot spots".

The targeting of RNA for the design of novel anti-viral compounds has until now proceeded largely without incorporating direct input from structure-based design methodology, partly because of lack of structural data, and complications arising from substrate flexibility. We propose a paradigm to explain the physical mechanism for ligand-induced refolding of trans-activation response element (TAR RNA) from human immunodeficiency virus 1 (HIV-1). Based upon Poisson-Boltzmann analysis of the TAR structure, as bound by a peptide derived from the transcriptional activator protein, Tat, our hypothesis shows that two specific electrostatic interactions are necessary to stabilise the conformation.