Massachusetts Medicaid ACO Program May Have Improved Care Use And Quality For Pregnant And Postpartum Enrollees.

Value-based care models, such as Medicaid accountable care organizations (ACOs), have the potential to improve access to and quality of care for pregnant and postpartum Medicaid enrollees. We leveraged a natural experiment in Massachusetts to evaluate the effects of Medicaid ACOs on quality-of-care-sensitive measures and care use across the prenatal, delivery, and postpartum periods. Using all-payer claims data on Medicaid-covered live deliveries in Massachusetts, we used a difference-in-differences approach to compare measures before (the first quarter of 2016 through the fourth quarter of 2017) and after (the third quarter of 2018 through the fourth quarter of 2020) Medicaid ACO implementation among ACO and non-ACO patients.

Insurance Instability for Patients With Opioid Use Disorder in the Year After Diagnosis.

Importance: Transitions in insurance coverage may be associated with worse health care outcomes. Little is known about insurance stability for individuals with opioid use disorder (OUD).

Objective: To examine insurance transitions among adults with newly diagnosed OUD in the 12 months after diagnosis.

Health Professionals Organizing for Climate Action: A Novel Community Organizing Fellowship.

Problem: Climate change is a public health and health equity crisis. Health professionals are well positioned to advance solutions but may lack the training and self-efficacy needed to achieve them.

Approach: The Center for Health Equity Education and Advocacy at Cambridge Health Alliance, a Harvard Medical School Teaching Hospital, developed a novel, longitudinal fellowship that taught health professionals about health and health equity effects of climate change, as well as community organizing practices that may help them mitigate these effects.

Telemedicine and Inequities in Health Care Access: The Example of Transgender Health.

Due to concerns about the risk of infectious exposures during the coronavirus disease 2019 (COVID-19) pandemic, the uptake of telemedicine has increased rapidly, aided by increased acceptance by clinicians and patients and a reduction in regulatory and reimbursement hurdles. The increased access to telemedicine may have benefits beyond the reduction in contagious risk, especially for vulnerable populations. By breaking down some of the common barriers to care for vulnerable populations, the broad implementation of telemedicine may help reduce some inequities in health care access, but telemedicine does raise other challenges that need to be considered and addressed.

Assessing and Addressing the Risk of Venous Thromboembolism Across the Spectrum of Gender Affirming Care: A Review.

Objective: Accumulating evidence demonstrates that gender affirming hormone therapy (GAHT) improves mental health outcomes in transgender persons. Data specific to the risks associated with GAHT for transgender persons continue to emerge, allowing for improvements in understanding, predicting, and mitigating adverse outcomes while informing discussion about desired effects. Of particular concern is the risk of venous thromboembolism (VTE) in the context of both longitudinal GAHT and the perioperative setting.

Benefits and Risks of Testosterone Treatment of Older Men with Hypogonadism.

Total and free testosterone levels decline in men with advancing age due to defects at all levels of the hypothalamic-pituitary-testicular axis. Testosterone treatment of older men with low testosterone levels is associated with improvements in sexual activity, sexual desire, and erectile function; lean body mass, muscle strength, and stair climbing power, and self-reported mobility; areal and volumetric bone mineral density, and estimated bone strength; depressive symptoms; and anemia. Long-term risks of cardiovascular events and prostate cancer during testosterone treatment remain unknown.

Accurate measurement of total and free testosterone levels for the diagnosis of androgen disorders.

The circulating concentrations of total and free testosterone vary substantially in people over time due to biologic factors as well as due to measurement variation. Accurate measurement of total and free testosterone is essential for making the diagnosis of androgen disorders. Total testosterone should ideally be measured in a fasting state in the morning using a reliable assay, such as liquid chromatography tandem mass spectrometry, in a laboratory that is certified by an accuracy-based benchmark.

Coverage Disruptions and Transitions Across the ACA's Medicaid/Marketplace Income Cutoff.

Background: The Affordable Care Act takes a "patchwork" approach to expanding coverage: Medicaid covers individuals with incomes 138% of the federal poverty level (FPL) in expansion states, while subsidized Marketplace insurance is available to those above this income cutoff.

Objective: To characterize the magnitude of churning between Medicaid and Marketplace coverage and to examine the impact of the 138% FPL income cutoff on stability of coverage.

Design: We measured the incidence of transitions between Medicaid and Marketplace coverage.

Optimized Use of the Electronic Health Record and Other Clinical Resources to Enhance the Management of Hypogonadal Men.

Electronic health records (EHRs) have enabled electronic documentation of a tremendous amount of clinical data. EHRs have the potential to improve communication between patients and their providers, facilitate quality improvement and outcomes research, and reduce medical errors. Conversely, EHRs have also increased clinician burnout, information clutter, and depersonalization of the interactions between patients and their providers.

Strategies to optimize management of incidental radiographic findings in the primary care setting: A mixed methods study.

Background: Incidental adrenal masses (IAMs) are common. Primary care providers (PCPs) are frequently responsible for incidentaloma evaluations. We evaluated whether PCPs view this paradigm effective, barriers faced, and strategies to optimize care delivery.

Allosterically Coupled Multisite Binding of Testosterone to Human Serum Albumin.

Human serum albumin (HSA) acts as a carrier for testosterone, other sex hormones, fatty acids, and drugs. However, the dynamics of testosterone's binding to HSA and the structure of its binding sites remain incompletely understood. Here, we characterize the dynamics of testosterone's binding to HSA and the stoichiometry and structural location of the binding sites using 2-dimensional nuclear magnetic resonance (2D NMR), fluorescence spectroscopy, 4,4'-dianilino-1,1'-binaphthyl-5,5'-disulfonic acid dipotassium salt partitioning, and equilibrium dialysis, complemented by molecular modeling.

Coordinatively unsaturated metal sites (open metal sites) in metal-organic frameworks: design and applications.

Metal-organic frameworks (MOFs) can contain open metal sites (OMS) or coordinatively unsaturated sites (CUS) or open coordination sites (OCS) when vacant Lewis acid sites on the metal ions or cluster nodes have been generated. This review combines for the first time all aspects of OMS in MOFs, starting from different preparation strategies over theoretical studies on the effects of OMS with host-guest interactions up to distinct OMS-MOF applications. In the experimental part the focus of this review is on MOFs with proven OMS formation which are not only invoked but are clearly verified by analytical methods.

Among Low-Income Adults Enrolled In Medicaid, Churning Decreased After The Affordable Care Act.

Coverage disruptions and coverage loss occur frequently among Medicaid enrollees and are associated with delayed health care access and reduced medication adherence. Little is known about the effect on churning of the expansion of eligibility for Medicaid under the Affordable Care Act (ACA), which had the potential to reduce coverage disruptions as a result of increased outreach and more generous income eligibility criteria. We used a difference-in-differences framework to compare rates of coverage disruption in expansion versus nonexpansion states, and in subgroups of states that used alternative expansion strategies.

Acetylenedicarboxylate and In Situ Generated Chlorofumarate-Based Hafnium(IV)-Metal-Organic Frameworks: Synthesis, Structure, and Sorption Properties.

New acetylenedicarboxylate (ADC) and chlorofumarate (Fum-Cl) based hafnium-metal-organic frameworks have been synthesized by alternatively reacting acetylenedicarboxylic acid in DMF or water with appropriate hafnium salt, in the presence of acetic acid modulator. The two materials of respective ideal formulas [HfO(OH)(ADC)] (Hf-HHU-1) and [HfO(OH)(Fum-Cl)] (Hf-HHU-2) have been structurally characterized by powder X-ray diffraction to be UiO-66 isostructural, consisting of octahedral [HfO(OH)] secondary building units each connected to other units by 12 ADC or Fum-Cl linkers into a microporous network with topology. This structure was confirmed by Rietveld refinement.

The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States.

Background: Persons with comprehensive health insurance use more hospital care than those who are uninsured or have high-deductible plans. Consequently, analysts generally assume that expanding coverage will increase society-wide use of inpatient services. However, a limited supply of beds might constrain this growth.

Blue-Collar Workers Had Greatest Insurance Gains After ACA Implementation.

Analyzing national survey data, we found that workers in traditionally blue-collar industries (service jobs, farming, construction, and transportation) experienced the largest gains in health insurance after implementation of the Affordable Care Act (ACA) in 2014. Compared to other occupations, these had lower employer-based coverage rates before the ACA. Most of the post-ACA coverage gains came from Medicaid and directly purchased nongroup insurance.