Association Between the ACA Medicaid Expansions and Primary Care and Emergency Department Use During the First 3 Years.

Background: Evidence is limited and mixed as to how the Patient Protection and Affordable Care Act (ACA) Medicaid expansions affected the utilization of primary care physicians (PCPs) and emergency departments (EDs) at the national level.

Objective: To examine the association between the ACA Medicaid expansions and changes in the utilization of PCP and ED visits at the national level during the first 3 years (2014-2016) of the implementation.

Design: A difference-in-differences analysis to compare outcomes between individuals in 32 states that expanded Medicaid versus individuals in 19 non-expansion states.

HRSA-funded Health Centers Are an Important Source of Care and Reduce Unmet Needs in Primary Care Services.

Background: Evidence indicates the unmet need for primary care services including medical, mental health, and dental care is greater among uninsured and Medicaid beneficiaries than privately insured individuals, many of whom use Health Resources and Services Administration-funded health centers (HRSA HCs).

Objective: We examined differences in rates of unmet need between low-income uninsured and Medicaid patients of HRSA HCs and safety-net clinics in general or private physicians.

Research Design: We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians.

Worse Mental Health Among More-Acculturated and Younger Immigrants Experiencing Discrimination: California Health Interview Survey, 2015-2016.

Background: Experiences of discrimination harm mental and physical health, with the strongest penalty on mental health. Among immigrants, it remains unclear how acculturation-the process by which immigrants acquire the beliefs and practices of a host culture-influences the mental health burden of navigating discrimination. On the one hand, acculturation can be associated with upward social mobility.

Association between homelessness and opioid overdose and opioid-related hospital admissions/emergency department visits.

Background: Although homelessness and opioid overdose are major public health issues in the U.S., evidence is limited as to whether homelessness is associated with an increased risk of opioid overdose.

Place of Residence, Working Conditions and the Burden of Back Pain among Hired Farmworkers in the United States.

: Back pain is the leading occupational health problem among agricultural workers. Current study aimed to assess the burden of farm work-related back pain and to investigate its associations with living residence location and work conditions among farmworkers. : We used the National Agricultural Workers Survey (NAWS) data from 1999 to 2004, 2008-2010, and 2014.

Enabling Services Improve Access To Care, Preventive Services, And Satisfaction Among Health Center Patients.

Enabling services address a combination of social determinants of health and barriers to access to primary care and are intended to reduce health disparities. They include care coordination; health education; transportation; and assistance with obtaining food, shelter, and benefits. Empirical evidence of enabling services' potential contribution to health outcomes is limited, which impedes their widespread dissemination.

Variation in Intraoperative and Postoperative Utilization for 3 Common General Surgery Procedures.

Objective: The aim of this study was to understand variation in intraoperative and postoperative utilization for common general surgery procedures.

Summary Background Data: Reducing surgical costs is paramount to the viability of hospitals.

Methods: Retrospective analysis of electronic health record data for 7762 operations from 2 health systems.

Gerontology competencies: Construction, consensus and contribution.

The Academy for Gerontology in Higher Education (AGHE) in 2014 approved the first integrative "Gerontology Competencies for Undergraduate and Graduate Education"©. This article describes the background, thought development, guiding framework and consensus process for its construction. A modified Delphi method utilizing seven review rounds within three developmental cycles, with gerontology educators from 30 institutions, achieved input and consensus.

An Assessment of Pay for Performance Under California's Delivery System Reform Incentive Payment Program.

California was the first state to implement the Delivery System Payment Reform Incentive Payment (DSRIP) program, which focused on improving health care delivery for Medicaid beneficiaries in specific public hospitals. With an overall $6.7 billion investment, California provided financial incentives toward transforming infrastructure and care delivery, and toward achieving better outcomes.

Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California.

To improve the coordination of long-term services and supports for dual-eligibles (those with both Medicare and Medicaid), California created Cal MediConnect (CMC), an Affordable Care Act-authorized managed care demonstration program. Beneficiaries were "passively enrolled" into CMC, meaning they were automatically enrolled unless they actively opted out. The aim of this study was to examine differences in factors influencing the enrollment decisions of U.

Included, but Deportable: A New Public Health Approach to Policies That Criminalize and Integrate Immigrants.

There has been a burst of research on immigrant health in the United States and an increasing attention to the broad range of state and local policies that are social determinants of immigrant health. Many of these policies criminalize immigrants by regulating the "legality" of their day-to-day lives while others function to integrate immigrants through expanded rights and eligibility for health care, social services, and other resources.Research on the health impact of policies has primarily focused on the extremes of either criminalization or integration.

Improving Outcomes of Care for HRSA-Funded Health Center Patients Who Have Mental Health Conditions and Substance Use Disorders.

The rising prevalence of mental health conditions and substance use disorders (MH/SUD) underscores the important role of health centers (HCs) in caring for low-income and uninsured MH/SUD patients. This study used the 2014 Health Center Patient Survey and 2014 Uniform Data System to determine the independent association between delivery of MH/SUD integration and related interventions to patients that reported a MH/SUD condition (n=2714) with the number of HC visits, emergency department (ED) visits, and hospitalizations last year. Results showed that health education was associated with fewer predicted ED visits (1.

Factors affecting the dose of intervention received and the participant satisfaction in a school-based obesity prevention intervention.

This study assessed factors associated with the perceived dose of intervention received and with the participant satisfaction in a school-based obesity prevention intervention. It also explored the variance in the dose of intervention received that was at the school level. Process evaluation data from a school-based intervention study conducted in Oslo in 2007-2009 were used.

Expansion of Dental Care for Low-Income Children Through a Mobile Services Program.

Background: Although access to dental care has improved over time, many children still face difficulty in obtaining services. One strategy to increase access is through mobile dental services, often in collaboration with schools, Head Start programs, and school-based health centers. This study evaluates a large mobile dental care program based in Minnesota.

Multisectoral Collaborations to Increase the Use of Recommended Cancer Screening and Other Clinical Preventive Services by Older Adults.

The Healthy Aging Partnerships in Prevention Initiative (HAPPI) is a multisectoral collaboration that aims to increase use of recommended cancer screening and other clinical preventive services (CPS) among underserved African American and Latino adults aged 50 and older in South Los Angeles. HAPPI uses the principles of the evidence-based model Sickness Prevention Achieved through Regional Collaboration to increase capacity for the delivery of breast, cervical, and colorectal cancer screening, as well as influenza and pneumococcal immunizations, and cholesterol screening. This article describes HAPPI's collaborative efforts to enhance local capacity by training personnel from community health centers (CHCs) and community-based organizations (CBOs), implementing a small grants program, and forming a community advisory council.

Gender-specific mediators of the association between parental education and adiposity among adolescents: the HEIA study.

Identifying the mechanisms behind socioeconomic inequalities in adiposity among youth is vital for efforts aimed at combating these inequalities. The study explored whether a broad range of behavioral and familial factors mediated the associations between parental education and indicators of adiposity among adolescents. Baseline data from a school-based intervention study conducted in 2007 among 11-year-old adolescents were used.

A Comparison of Payments to a For-profit Dialysis Firm From Government and Commercial Insurers.

This study assesses differences in payments from government and commercial insurers to dialysis clinics using data from a single for-profit organization.

Economic evaluation of California prenatal participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) to prevent preterm birth.

There is growing evidence that prenatal participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) reduces the risk of adverse birth outcomes. With recent changes in health care, rising health care costs, and increasing rates of prematurity in the U.S.

Selection of a Child Clinical Outcome Measure for Statewide Use in Publicly Funded Outpatient Mental Health Programs.

Objective: This study describes the process of choosing a clinical outcome measure for a statewide performance outcome system for children receiving publicly funded mental health services in California.

Methods: The recommendation is based on a five-phase approach, including an environmental scan of measures used by state mental health agencies; a statewide provider survey; a scientific literature review; a modified Delphi panel; and final rating of candidate measures by using nine minimum criteria informed by stakeholder priorities, scientific evidence, and state statute.

Results: Only 10 states reported use of at least one standardized measure for outcome measurement.

California's Behavioral Health Services Workforce is Inadequate for Older Adults.

The Workforce Education and Training component of California's Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California.

The Current State Of Telehealth Evidence: A Rapid Review.

Policy makers and practitioners show a continued interest in telehealth's potential to increase efficiency and reach patients facing access barriers. However, telehealth encompasses many applications for varied conditions and populations. It is therefore difficult to draw broad conclusions about telehealth's efficacy.

Assessing the Impact of Patient-Centered Medical Home Principles on Hypertension Outcomes Among Patients of HRSA-Funded Health Centers.

Background: Millions of Americans have uncontrolled hypertension and are low-income or uninsured populations. Health Resources and Services Administration-funded health centers (HCs) are primary providers of care to these patients and a majority have adopted the patient-centered medical home (PCMH). PCMH includes principles of care coordination or integration and care management-support important to the treatment of hypertension.

A social determinants framework identifying state-level immigrant policies and their influence on health.

Background: Many conceptual frameworks that touch on immigration and health have been published over the past several years. Most discuss broad social trends or specific immigrant policies, but few address how the policy environment affects the context of settlement and incorporation. Research on the social determinants of health shows how policies across multiple sectors have an impact on health status and health services, but has not yet identified the policies most important for immigrants.

The impact of integrating medical assistants and community health workers on diabetes care management in community health centers.

Objective: To compare the impact of implementing team-based diabetes care management involving community health workers (CHWs) vs. medical assistants (MA) in community health centers (CHCs) on diabetes care processes, intermediate outcomes, and patients' experiences of chronic care.

Data Sources: Clinical and administrative data (n = 6111) and patient surveys (n = 698) pre-intervention and post-intervention.