Tracing value from social determinant solutions.

We develop and illustrate a framework to trace value from social determinants of health (SDOH) interventions across 4 dimensions: health, cost and quality, engagement, and equity. To provide context, we begin by estimating the societal value lost to premature deaths from homelessness and food insecurity, using recent longitudinal methods that offer greater precision. We then apply the value tracing framework to 2 example interventions: permanent supportive housing for chronically homeless people and medically tailored meals for dual eligibles.

Actual vs Documented Advance Care Planning in a Primary Care Clinic.

Introduction: Advance care planning (ACP) is a complex and multifaceted entity that has significant impact on patient care. ACP takes many forms, may be underbilled, and can have significant ramifications on quality care metrics. We performed a retrospective chart review for patients over 70 years in age in our family medicine resident clinic to evaluate the ways in which ACP is charted and the gap between billed and nonbilled ACP.

Evaluation of the Reliability of Medicare Spending Per Beneficiary for Post-Acute Care.

Background: A measure of episode spending, such as Medicare Spending Per Beneficiary (MSPB) is increasingly used to evaluate provider performance. Yet if the measure is unreliable, as is often true for low-volume providers, it cannot distinguish "good" from "poor" performance.

Objective: The objective of this study was to evaluate the reliability of a uniformly calculated MSPB measure for post-acute care (PAC) and the tradeoffs involved in setting a minimum case count threshold.

A Student Telephone Intervention for Primary Care Patient Safety During the COVID-19 Pandemic.

Background And Objectives: During the COVID-19 pandemic, medical students were unable to participate in clinical learning for several weeks. Many primary care patients no-showed to appointments and did not receive care. We implemented a telephone outreach program using medical students to call primary care patients who no-showed to appointments and did not receive care.

How Workers Fared under the ACA.

Many politicians, policy makers, and analysts have debated whether the Affordable Care Act (ACA) would have negative effects on the labor market, such as reducing employment, earnings, or hours worked. Building on the existing literature, we investigated how workers' coverage changed under the ACA and whether coverage gains were associated with changes in labor market outcomes across occupations through 2017. We also examined whether occupations experiencing increased coverage through nonemployment sources (i.

Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of 'Strong Start For Mothers And Newborns'.

The federal Strong Start for Mothers and Newborns initiative supported alternative approaches to prenatal care, enhancing service delivery through the use of birth centers, group prenatal care, and maternity care homes. Using propensity score reweighting to control for medical and social risks, we evaluated the impacts of Strong Start's models on birth outcomes and costs by comparing the experiences of Strong Start enrollees to those of Medicaid-covered women who received typical prenatal care. We found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rates of cesarean section, and higher rates of vaginal birth after cesarean than did the women in the comparison groups.

Palliative Care Consultation Reduces Heart Failure Transitions: A Matched Analysis.

Background Palliative care supports quality of life, symptom control, and goal setting in heart failure (HF) patients. Unlike hospice, palliative care does not restrict life-prolonging therapy. This study examined the association between palliative care during hospitalization for HF on the subsequent transitions and procedures.

Do young female dancers improve symptoms and return to dancing after periacetabular osteotomy for the treatment of symptomatic hip dysplasia?

Although preservation of high activity level has been reported in active young patients after periacetabular osteotomy (PAO) for the treatment of symptomatic hip dysplasia, there is limited evidence whether a dancer may be able to resume dancing after PAO. We asked whether female dancers experience improvement in pain and sports-related activities and return to dance following PAO. Between 1997 and 2014 we performed a total of 44 PAOs in 33 female dancers with symptomatic hip dysplasia.

A Multivariable Prediction Model for Mortality in Individuals Admitted for Heart Failure.

Objectives: To derive and validate a 30-day mortality clinical prediction rule for heart failure based on admission data and prior healthcare usage. A secondary objective was to determine the discriminatory function for mortality at 1 and 2 years.

Design: Observational cohort.

New Risk-Adjustment Policies Reduce But Do Not Eliminate Special Enrollment Period Underpayment.

Millions of uninsured Americans do not sign up for available coverage despite job loss or other factors that would make them eligible for special enrollment periods (SEPs). Such periods let people enroll in nongroup insurance outside the usual open enrollment period for Marketplace coverage. Concerned that risk adjustment results in underpayment for the health risks associated with SEP enrollees, carriers rarely market their products to consumers eligible for SEPs, and many do not pay agents and brokers to enroll such consumers.

Body Mass Index Affects Proximal Femoral but Not Acetabular Morphology in Adolescents Without Hip Pathology.

Background: Increased mechanical load secondary to a large body mass index (BMI) may influence bone remodeling. The purpose of this study was to investigate whether BMI is associated with the morphology of the proximal part of the femur and the acetabulum in a cohort of adolescents without a history of hip disorders.

Methods: We evaluated pelvic computed tomographic (CT) images in 128 adolescents with abdominal pain without a history of hip pathology.

Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply.

We examined the effect of the expansion of Medicaid eligibility under the Affordable Care Act on health insurance coverage and labor supply of low-educated and low-income adults. We found that the Medicaid expansions were associated with large increases in Medicaid coverage, for example, 50 percent among childless adults, and corresponding decreases in the proportion uninsured. There was relatively little change in private insurance coverage, although the expansions tended to decrease such coverage slightly.

Acetabular Retroversion, but Not Increased Acetabular Depth or Coverage, in Slipped Capital Femoral Epiphysis: A Matched-Cohort Study.

Background: Femoral head overcoverage by a deep and retroverted acetabulum has been postulated as a mechanical factor in slipped capital femoral epiphysis (SCFE). We assessed acetabular depth, coverage, and version in the hips of patients with unilateral SCFE; in the contralateral, uninvolved hips; and in healthy control hips.

Methods: Thirty-six patients affected by unilateral SCFE were matched to 36 controls on the basis of sex and age.

Predictors and trajectories of chronic postoperative pain following hip preservation surgery.

Factors contributing to chronic postoperative pain (CPOP) are poorly defined in young people and developmental considerations are poorly understood. With over 5 million children undergoing surgery yearly and 25% of adults referred to chronic pain clinics identifying surgery as the antecedent, there is a need to elucidate factors that contribute to CPOP in surgical patients. The present study includes patients undergoing hip preservation surgery at a children's hospital.

Both 3-T dGEMRIC and Acetabular-Femoral T2 Difference May Detect Cartilage Damage at the Chondrolabral Junction.

Background: In addition to case reports of gadolinium-related toxicities, there are increasing theoretical concerns about the use of gadolinium for MR imaging. As a result, there is increasing interest in noncontrast imaging techniques for biochemical cartilage assessment. Among them, T2 mapping holds promise because of its simplicity, but its biophysical interpretation has been controversial.

Estimating the Counterfactual: How Many Uninsured Adults Would There Be Today Without the ACA?

Time lags in receiving data from long-standing, large federal surveys complicate real-time estimation of the coverage effects of full Affordable Care Act (ACA) implementation. Fast-turnaround household surveys fill some of the void in data on recent changes to insurance coverage, but they lack the historical data that allow analysts to account for trends that predate the ACA, economic fluctuations, and earlier public program expansions when predicting how many people would be uninsured without comprehensive health care reform. Using data from the Current Population Survey (CPS) from 2000 to 2012 and the Health Reform Monitoring Survey (HRMS) data for 2013 and 2015, this article develops an approach to estimate the number of people who would be uninsured in the absence of the ACA and isolates the change in coverage as of March 2015 that can be attributed to the ACA.

A phase Ib multiple ascending dose study of the safety, tolerability, and central nervous system availability of AZD0530 (saracatinib) in Alzheimer's disease.

Introduction: Despite significant progress, a disease-modifying therapy for Alzheimer's disease (AD) has not yet been developed. Recent findings implicate soluble oligomeric amyloid beta as the most relevant protein conformation in AD pathogenesis. We recently described a signaling cascade whereby oligomeric amyloid beta binds to cellular prion protein on the neuronal cell surface, activating intracellular Fyn kinase to mediate synaptotoxicity.

Potential Medicaid cost savings from maternity care based at a freestanding birth center.

Objectives: Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This study draws on information from a previous study of the outcomes of birth center care to determine whether such care reduces Medicaid costs for low income women.

Midwifery care at a freestanding birth center: a safe and effective alternative to conventional maternity care.

Objective: To estimate the effect of a midwifery model of care delivered in a freestanding birth center on maternal and infant outcomes when compared with conventional care.

Data Sources/study Setting: Birth certificate data for women who gave birth in Washington D.C.

Reforming Medicare payments to skilled nursing facilities to cut incentives for unneeded care and avoiding high-cost patients.

Despite many changes made in 2010 and 2011 to Medicare's payment system for short-term stays in skilled nursing facilities, a flawed payment structure continues to underpay facilities for certain types of patients and overpay for others. The flaws in the payment structure create incentives to selectively admit or refuse patients based on the type and complexity of their conditions, while payments that vary with level of use encourage providers to furnish therapy services, such as rehabilitation care, that some patients might not need. We propose an alternative payment design and demonstrate that it would dampen such incentives by making payments that are more closely matched to costs and based on characteristics of the patients treated.

Health insurance and labor markets: concepts, open questions, and data needs.

This paper reviews the recent economic research on the relationship between health insurance and labor markets in the United States, with an emphasis on research that has emerged since existing major reviews and the aim of identifying the types of data that are needed for this research to progress. We focus on the conceptual and empirical challenges that researchers face in studying these relationships, the data that have allowed this research to proceed, policy-relevant questions that need further study, and the types of data that would help in obtaining better answers to these questions.

Does Medicaid managed care affect access to care for the uninsured?

This study investigates whether the implementation of Medicaid managed care from 1994 to 2001 was associated with changes in access to care for the uninsured. We used regression analysis to examine relationships between changes in county-level Medicaid managed care activity over time and changes in four measures of perceived access to care. After we controlled for sex, race, ethnicity, poverty, age, health, and education and included county fixed effects to account for unobserved county characteristics that are potentially associated with the implementation of Medicaid managed care and outcome measures, we found that Medicaid managed care has had no consistent effect on access.

National estimates of the effects of mandatory Medicaid managed care programs on health care access and use, 1997-1999.

Objective: We sought to explore how mandatory Medicaid managed care programs affect access to care and use among full-year Medicaid beneficiaries not receiving SSI or Medicare.

Research Design: We used data from the 1997 and 1999 National Survey of America's Families. To establish what Medicaid beneficiaries' access and use would have been in the absence of Medicaid managed care (MMC) and to control for unobserved county differences, we estimated difference-in-difference models using a comparison group of privately insured individuals who we would not expect to be affected by MMC.

Effects of Medicaid managed care programs on health services access and use.

Objective: To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees' access to and use of health care services at the national level.

Data Sources/study Setting: 1991-1995 National Health Interview Surveys (NHIS) and a 1998 Urban Institute survey on state Medicaid managed care programs.

Study Design: Using multivariate regression models, we estimated the effect of living in a county with an MMC program on several access and use measures for nonelderly women who receive Medicaid through AFDC and child Medicaid recipients.

Health insurance expansions for working families: a comparison of targeting strategies.

We compare three eligibility criteria for targeting health insurance expansions in working families: poverty, hourly wages, and employment in a small firm. Making pairwise comparisons among these, we find that targeting by poverty is the most effective and efficient. A poverty-based method is also the most effective way to target those lacking access to employer-sponsored insurance and those with low take-up of such coverage.