Supermarket Opening in an Urban, Low-Income Community Was Not Found to Be Associated With Improvements in Dietary Outcomes for Most Residents in the First Year.

Background: Limited access to healthy foods in low-income, racial and ethnic minority communities has been proposed as a critical factor contributing to health disparities. One policy option for improving access is to introduce supermarkets in low-income communities, but evidence increasingly points to null effects.

Objective: The aim of this study was to examine whether the introduction of a new supermarket in a public housing community, and proximity to it, were associated with improvements in residents' dietary outcomes.

A Cluster Randomized Trial: Mixed Methods Comparison of 2 Approaches to Promote Nonpharmacologic, Resident-Centered Dementia Care in Nursing Homes.

Objectives: Nursing home dementia care initiatives have prioritized nonpharmacologic approaches to manage behavioral symptoms. This study compares the effectiveness of 2 nonpharmacologic approaches on resident outcomes.

Design And Intervention: Cluster randomized controlled trial using a convergent mixed methods design to compare the team-based and problem-based approaches to dementia care.

Comparison of Team-Based and Problem-Based Approaches to Dementia Care in Nursing Homes and Their Effects on Resident Outcomes During the COVID-19 Pandemic: A Mixed-Methods Study.

Objectives: Compare the effectiveness of 2 nonpharmacologic approaches to dementia care in nursing homes on 12- and 18-month resident outcomes, which was after the emergence of COVID-19.

Design And Intervention: A cluster randomized pragmatic trial, which included an embedded convergent mixed-methods design. Nursing homes were randomized to a team-based (TB) or problem-based (PB) intervention arm.

A natural experiment: The opening of a supermarket in a public housing community and impacts on children's dietary patterns.

Objective: The aim of the present study is to utilize a natural experiment and examine changes in dietary patterns of predominantly low-income, racial and ethnic minority children who live in a public housing community following the opening of a new supermarket.

Methods: Data comes from the Watts Neighborhood Health Study (WNHS), an ongoing study in South Los Angeles, United States, that follows residents of Jordan Downs, a public housing community undergoing redevelopment. Surveys were administered to children aged 9-17 years (n = 297), as well as an adult in the household.

Heterogeneity in COVID-19 vaccine uptake within low-income minority communities: evidence from the watts neighborhood health study.

Background: The literature on disparities in COVID-19 vaccine uptake focuses primarily on the differences between White versus non-White individuals or differences by socioeconomic status. Much less is known about disparities in vaccine uptake within low-income, minority communities and its correlates.

Methods: This study investigates disparities in COVID-19 vaccination uptake within racial and ethnic minoritized communities with similar socioeconomic backgrounds and built environments, specifically focusing on Black-Hispanic disparities and disparities within the Hispanic community by country of origin.

Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage.

Importance: Medicare Advantage (MA) plans receive capitated per enrollee payments that create financial incentives to provide care more efficiently than traditional Medicare (TM); however, incentives could be associated with MA plans reducing use of beneficial services. Postacute care can improve functional status, but it is costly, and thus may be provided differently to Medicare beneficiaries by MA plans compared with TM.

Objective: To estimate the association of MA compared with TM enrollment with postacute care use and postdischarge outcomes.

The Impact of State Dementia Training Requirements for Nursing Homes on Antipsychotic Medication Use.

Objectives: Nursing home (NH) staff often report not having adequate dementia-specific knowledge to effectively care for these residents. Between 2011 and 2019, 9 states in the United States implemented dementia training requirements for NH staff. This study evaluated whether the state-mandated dementia training for NH staff was associated with improving resident outcomes.

Evaluating non-pharmacological approaches to nursing home dementia care: A protocol.

Background: The COVID-19 pandemic has underscored the daily challenges nursing home (NH) staff face caring for the residents living with Alzheimer's Disease and Related Dementias (). Non-pharmacological approaches are prioritized over off-label medication to manage the behavioral and psychological symptoms of ADRD. Yet, it is not clear how to best equip NH staff and families with the knowledge and strategies needed to provide non-pharmacological approaches to these residents.

Potentially Inappropriate Medication Use in Community-Dwelling Older Adults Living with Dementia.

Background: The Beers Criteria identifies potentially inappropriate medications (PIMs) that should be avoided in older adults living with dementia.

Objective: The aim of this study was to provide estimates of the prevalence and persistence of PIM use among community-dwelling older adults living with dementia in 2011-2017.

Methods: Medicare claims data were used to create an analytic dataset spanning from 2011 to 2017.

Understanding drivers of micro-level disparities in childhood body mass index, overweight, and obesity within low-income, minority communities.

The focus of childhood obesity disparities has been mainly on macro-level disparities, such as, between lower versus higher socioeconomic groups. But, less is known about -level disparities, that is disparities minority and low-income populations. The present study examines individual and family level predictors of micro-level obesity disparities.

Heterogeneity in grocery shopping patterns among low-income minority women in public housing.

Background: Public housing residents, who tend to be predominantly female and racial/ethnic minorities, are at a particularly high risk for chronic health conditions. Prior studies have suggested that a lack of access to healthy and affordable food may be an important barrier in public housing communities, but evidence is mixed on the association between the neighborhood food environment and dietary quality, suggesting the need to examine food access patterns in low-income, minority communities more deeply. The purpose of this study was to examine the variability in grocery shopping patterns, and the factors that predict them, among low-income minority women in public housing.

Developing standardized patient assessment data elements for Medicare post-acute care assessments.

Background: To support interoperability and care planning across provider types, the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the submission of standardized patient assessment data using the assessment instruments provided by the Centers for Medicare & Medicaid Services (CMS). CMS was tasked with developing standardized assessment data elements (SADEs) within clinical categories named in the IMPACT Act.

Method: We used environmental scans, subject matter expert, and stakeholder input to identify candidate SADEs; tested candidate data elements in alpha testing; revised SADEs and training protocols based on alpha analyses and stakeholder feedback; tested SADEs across post-acute care (PAC) settings in a national field test that included 3121 patients across 143 home health agencies, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities in 14 markets across the United States; and analyzed data and stakeholder input from national testing.

Standardized assessment of cognitive function, mood, and pain among patients who are unable to communicate.

Background: Assessments of patients have sought to increase the patient voice through direct patient interviews and performance-based testing. However, some patients in post-acute care (PAC) are unable to communicate and cannot participate in interviews or structured cognitive tests. Therefore, we tested the feasibility and reliability of observational assessments of cognitive function, mood, and pain for patients who are unable to communicate in PAC settings.

Standardized assessment of cognitive function of post-acute care patients.

Background: The assessment of cognitive function in post-acute care (PAC) settings is important for understanding an individual's condition and care needs, developing better person-directed care plans, predicting resource needs and understanding case mix. Therefore, we tested the feasibility and reliability of cognitive function assessments, including the Brief Interview for Mental Status (BIMS), Confusion Assessment Method (CAM©), Expression and Understanding, and Behavioral Signs and Symptoms for patients in PAC under the intent of the IMPACT Act of 2014.

Methods: We conducted a national test of assessments of four standardized cognitive function data elements among patients in PAC.

Predictive Utility of Alternate Measures of Physical Activity and Diet for Overweight and Obesity in Low-Income Minority Women.

Purpose: The purpose is to compare the predictive utility of alternate measures of diet and physical activity for overweight and obesity among low-income minority women.

Design: Cross-sectional analysis of baseline data from a cohort study.

Setting: Three public housing developments in South Los Angeles.

Assessing impacts of redeveloping public housing communities on obesity in low-income minority residents: Rationale, study design, and baseline data from the Watts Neighborhood Health Study.

Introduction: Obesogenic built- and social-environments in low-income and minority communities are often blamed for the higher rates of obesity in this population, but existing evidence is based largely on observational studies. This study leverages a natural experiment created by the redevelopment of a public housing community to examine the impact of major improvements to the housing, built, and social environments on obesity among residents.

Methods/design: The study design is a natural experiment where residents from the redeveloped community (treatment group) will be compared to those from a similar community (control group) in terms of their pre/post changes in primary outcomes using annual longitudinal data on a cohort of residents.

The effects of vertically integrated care on health care use and outcomes in inpatient rehabilitation facilities.

Objective: To understand the effects of receiving vertically integrated care in inpatient rehabilitation facilities (IRFs) on health care use and outcomes.

Data Sources: Medicare enrollment, claims, and IRF patient assessment data from 2012 to 2014.

Study Design: We estimated within-IRF differences in health care use and outcomes between IRF patients admitted from hospitals vertically integrated with the IRF (parent hospital) vs patients admitted from other hospitals.

The Impact of Comprehensive Care for Joint Replacement Bundled Payment Program on Care Delivery.

Background: Comprehensive Care for Joint Replacement (CJR) is a Medicare initiative to test the impact of holding a hospital accountable for services provided during an episode of care for a lower extremity joint arthroplasty on costs and quality. This study examines whether hospital participation in CJR is associated with having programs focused on improving posthospitalization care or reducing costs using a survey of orthopedic surgeons.

Methods: Seventy-three (of 104) orthopedic surgeon members of the Hip Society, a national professional organization of hip surgeons, completed the survey.

Development and Maintenance of Standardized Cross Setting Patient Assessment Data for Post-Acute Care: Summary Report of Findings from Alpha 1 Pilot Testing.

The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to identify and/or develop standardized items to include in the post-acute care patient assessment instruments. RAND was tasked by CMS with developing and testing items to measure seven areas of health status for Medicare beneficiaries: (1) vision and hearing; (2) cognitive status; (3) depressed mood; (4) pain; (5) care preferences; (6) medication reconciliation; and (7) bladder and bowel continence. This article presents results of the first Alpha 1 feasibility test of a proposed set of items for measuring each of these health status areas.

Parental Deployment, Adolescent Academic and Social-Behavioral Maladjustment, and Parental Psychological Well-being in Military Families.

Objective: Increases in the frequency and length of military deployments have raised concerns about the well-being of military families. We examined the relationship between a military parent's deployment and (1) adolescent academic and social-behavioral maladjustment and (2) parental psychological well-being.

Methods: We collected data from April 2013 through January 2014 from 1021 families of enlisted US Army personnel with children aged 12 or 13 during the Military Teenagers' Environments, Exercise, and Nutrition Study.

Implementing exercise programs to prevent falls: systematic descriptive review.

Background: The United States Preventive Services Task Force recommends exercise to prevent falls in community-dwelling adults aged ≥ 65 years at increased fall risk. However, little is known about how best to implement exercise programs in routine care when a patient's need for exercise is identified within the healthcare system.

Methods: Using a qualitative approach, we reviewed the literature to determine how exercise programs to prevent falls are implemented from the vantage point of a health care setting.

The Role of School Environments in Explaining Racial-Ethnic Disparities in Body Mass Index Among U.S. Adolescents.

Purpose: Policymakers have focused substantial efforts on how school environments can be used to combat obesity. Given this intense focus, this article examined whether disparities in body mass index (BMI) noted among black and Hispanic adolescents relative to whites were explained by the well-documented differences in the school socioeconomic characteristics, and food and physical activity environment.

Methods: Data from the fifth- and eighth-grade waves of the Early Childhood Longitudinal Study-Kindergarten Class were analyzed.

Neighborhood and home food environment and children's diet and obesity: Evidence from military personnel's installation assignment.

Research and policy initiatives are increasingly focused on the role of neighborhood food environment in children's diet and obesity. However, existing evidence relies on observational data that is limited by neighborhood selection bias. The Military Teenagers' Environments, Exercise, and Nutrition Study (M-TEENS) leverages the quasi-random variation in neighborhood environment generated by military personnel's assignment to installations to examine whether neighborhood food environments are associated with children's dietary behaviors and BMI.

How will provider-focused payment reform impact geographic variation in Medicare spending?

Objectives: The Institute of Medicine has recently argued against a value index as a mechanism to address geographic variation in spending and instead promoted payment reform targeted at individual providers. It is unknown whether such provider-focused payment reform reduces geographic variation in spending.

Study Design: We estimated the potential impact of 3 Medicare provider-focused payment policies-pay-for-performance, bundled payment, and accountable care organizations-on geographic variation in Medicare spending across Hospital Referral Regions (HRRs).

Neighborhood environment and children's physical activity and body mass index: evidence from military personnel installation assignments.

Background: The majority of existing studies use observed, rather than experimental or quasi-experimental, variation in individuals' neighborhood environments to study their influence on body weight and related behaviors.

Purpose: This study leverages the periodic relocation of military personnel to examine the relationship between neighborhood environment and children's physical activity (PA) and BMI in military families.

Methods: This study utilizes data on 12- and 13-year-old children from the Military Teenagers Environments, Exercise, and Nutrition Study (N=903).