Evidence on trends in uptake of childhood vaccines and association with COVID-19 vaccination rates.

Importance: Childhood vaccination rates have declined in recent years; there is also concern that resistance to COVID-19 vaccines could spill over to childhood vaccines.

Objectives: To use local-level data to study trends in childhood vaccination rates and heterogeneity in local rates; including how many areas are below herd-immunity thresholds, and assess the association between COVID-19 vaccine hesitancy and childhood vaccination.

Design: We report, for 11 states with available data, vaccination rates for measles, mumps, rubella (MMR), and diphtheria, tetanus, acellular pertussis (DTaP) vaccines, including percentage of schools/counties with rates ≥95 %, 90-95 %, 80-90 %, and < 80 %.

Overlapping markets and quality competition among community health centers.

Objective: To examine the response of community health center (CHC) quality to quality levels at neighboring CHCs in the presence of non-price competition.

Data Setting And Design: A quasi-experimental study of US community health centers. Outcome variables were indices that measured overall quality of CHC care.

The Medical Costs of Determining Eligibility and Waiting for a Kidney Transplantation.

Background: Recent efforts to increase access to kidney transplant (KTx) in the United States include increasing referrals to transplant programs, leading to more pretransplant services. Transplant programs reconcile the costs of these services through the Organ Acquisition Cost Center (OACC).

Objective: The aim of this study was to determine the costs associated with pretransplant services by applying microeconomic methods to OACC costs reported by transplant hospitals.

The impact of Facebook's vaccine misinformation policy on user endorsements of vaccine content: An interrupted time series analysis.

Objectives: To evaluate the impact of Facebook's vaccine misinformation policy in March 2019 on user endorsements of vaccine content on its platform.

Methods: We identified 172 anti- and pro-vaccine Facebook Pages and collected posts from these Pages six months before and after the policy. Using interrupted time series regression models, we evaluated the policy impact on user endorsements (i.

Financial impacts of the Medicaid expansion on community health centers.

Objective: To determine the impacts of the Medicaid expansion on revenues, costs, assets, and liabilities of federally funded community health centers.

Data Sources: We combined data from the Uniform Data System, Internal Revenue Service nonprofit tax returns, and county-level characteristics from the Census Bureau. Our final dataset included 5841 center-year observations.

Quality and Cost in Community Health Centers.

Background: Quantifying health care quality has long presented a challenge to identifying the relationship between provider level quality and cost. However, growing focus on quality improvement has led to greater interest in organizational performance, prompting payers to collect various indicators of quality that can be combined at the provider level.

Objective: To explore the relationship between quality and average cost of medical visits provided in US Community Health Centers (CHCs) using composite measures of quality.

The organ procurement costs of expanding deceased donor organ acceptance criteria: Evidence from a cost function model.

A potential solution to the deceased donor organ shortage is to expand donor acceptability criteria. The procurement cost implications of using nonstandard donors is unknown. Using 5 years of US organ procurement organization (OPO) data, we built a cost function model to make cost projections: the total cost was the dependent variable; production outputs, including the number of donors and organs procured, were the independent variables.

Optimal staffing in community health centers to improve quality of care.

Objective: To explore optimal workforce configurations in the production of care quality in community health centers (CHCs), accounting for interactions among occupational categories, as well as contributions to the volume of services.

Data Sources: We linked the Uniform Data System from 2014 to 2016 with Internal Revenue Service nonprofit tax return data. The final database contained 3139 center-year observations from 1178 CHCs.

The Impact of Nursing Staff on Satisfaction Scores for U.S. Hospitals: A Production Function Approach.

Hospitals have increasingly relied on nurse assistants to support nurses in the provision of patient care, yet knowledge about their contributions to the patient experience in U.S. hospitals is limited.

Do All Hospital Systems Have Market Power? Association Between Hospital System Types and Cardiac Surgery Prices.

Objective: This study explores the price implications of hospital systems by analyzing the association of system characteristics with selected cardiac surgery pricing.

Data Source: Using a large private insurance claim database, the authors identified 11 282 coronary artery bypass graft (CABG) cases and 49 866 percutaneous coronary intervention (PCI) cases from 2002 to 2007.

Study Design: We conducted a retrospective observational study using generalized linear models.

Hospital Response to CMS Public Reports of Hospital Charge Information.

Background: In an effort to increase price transparency, the Centers for Medicare and Medicaid Services (CMS) began reporting charges for Medicare inpatients treated in ∼3400 hospitals online in 2013. As of 2019, CMS began to require hospitals themselves to publicize a more comprehensive list of their underlying procedure charges.

Objective: The objective of this study was to assess the responses of hospitals to broad-scale public reporting of their charges for inpatient services.

Immunization and Moral Hazard: The HPV Vaccine and Uptake of Cancer Screening.

Immunization can lead to moral hazard by reducing the cost of risky behaviors and reducing preventive efforts. In this study, we examine the effect of HPV (human papillomavirus) vaccination on participation in the Pap test, which is a diagnostic screening test to detect HPV and non-HPV-related cancerous processes. The HPV vaccination is explicitly recommended for women up to age 26 years who were not previously vaccinated.

Association of Medical Liability Reform With Clinician Approach to Coronary Artery Disease Management.

Importance: Physicians often report practicing defensive medicine to reduce malpractice risk, including performing expensive but marginally beneficial tests and procedures. Although there is little evidence that malpractice reform affects overall health care spending, it may influence physician behavior for specific conditions involving clinical uncertainty.

Objective: To examine whether reducing malpractice risk is associated with clinical decisions involving coronary artery disease testing and treatment.

Cost-effectiveness of an Evidence-Based Childhood Asthma Intervention in Real-World Primary Care Settings.

We present an incremental cost-effectiveness analysis of an evidence-based childhood asthma intervention (Community Healthcare for Asthma Management and Prevention of Symptoms [CHAMPS]) to usual management of childhood asthma in community health centers. Data used in the analysis include household surveys, Medicaid insurance claims, and community health center expenditure reports. We combined our incremental cost-effectiveness analysis with a difference-in-differences multivariate regression framework.

Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992-2011.

Background: Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results.

Objective: To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time.

Design: Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and health outcomes between MCEs and FFSBs across 3 time periods: 1992-1998, 1999-2004, and 2005-2011.

Multimorbidity: constellations of conditions across subgroups of midlife and older individuals, and related Medicare expenditures.

Introduction: The Department of Health and Human Services' 2010 Strategic Framework on Multiple Chronic Conditions called for the identification of common constellations of conditions in older adults.

Objectives: To analyze patterns of conditions constituting multimorbidity (CCMM) and expenditures in a US representative sample of midlife and older adults (50-64 and ≥65 years of age, respectively).

Design: A cross-sectional study of the 2010 Health and Retirement Study (HRS; =17,912).

Cancer preventive services, socioeconomic status, and the Affordable Care Act.

Background: Out-of-pocket expenditures are thought to be an important barrier to the receipt of cancer preventive services, especially for those of a lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. The objective of this study was to determine changes in the uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation.

The Impact of State Tort Reforms on Imaging Utilization.

Purpose: Defensive medicine, broadly defined as medical practices that protect physicians from malpractice lawsuits without providing benefits to patients, can lead to wasteful use of health care resources and higher cost. Although physicians cite malpractice liability as an important factor driving their decisions to order imaging tests, little research has been done to examine the systematic impact of liability pressure on overall imaging. The authors examined the extent to which radiography use is influenced by malpractice liability pressure among office-based physicians.

Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach.

Background: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood.

Objective: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization.

Design: Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims.

The Relationship of Financial Pressures and Community Characteristics to Closure of Private Safety Net Clinics.

In order to better understand what threatens vulnerable populations' access to primary care, it is important to understand the factors associated with closing safety net clinics. This article examines how a clinic's financial position, productivity, and community characteristics are associated with its risk of closure. We examine patterns of closures among private-run primary care clinics (PCCs) in California between 2006 and 2012.

Changes in Receipt of Cancer Screening in Medicare Beneficiaries Following the Affordable Care Act.

Background: The Affordable Care Act (ACA) removed copayments for screening mammography and colonoscopy in Medicare beneficiaries, but its clinical impact is unknown.

Methods: Using a 5% random sample of Medicare claims from 2009 through 2012 in individuals age 70 years or older who were due for screening, we examined claims for screening mammography and screening or surveillance colonoscopy for two years prior to ACA (2009-2010) and two years post-ACA (2011-2012). Receipt of the procedures at the patient level was compared across years using generalized estimating equations.

Comparing Cost-Effectiveness of HIV Testing Strategies: Targeted and Routine Testing in Washington, DC.

Background: Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006.