Examining cancer screening disparities by race/ethnicity and insurance groups: A comparison of 2008 and 2018 National Health Interview Survey (NHIS) data in the United States.

BACKGROUND: Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data. METHODS: A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders. RESULTS: Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32-0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42-0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47-2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02-1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018. CONCLUSION: Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions.

Efficiency and equity of bed utilization in China's health institutions: based on the rank-sum ratio method.

OBJECTIVE: The study aimed to analyze the efficiency and equity of bed utilization in Please check if the section headings are assigned to appropriate levels.China's healthcare institutions and to compare and analyze the overall health resource utilization efficiency in recent years and some specific utilization conditions in 2021, to provide empirical experience for the allocation of health care resources in epidemic China. METHODS: To compare and analyze the overall health resource utilization efficiency of the whole country with that of the East, middle, and West in 2021, and to analyze the bed utilization efficiency of different types of healthcare institutions in China and the bed utilization efficiency of various types of specialist hospitals in the country in 2021 by using the rank-sum ratio method. RESULTS: In 2021, the bed utilization rate of China's health institutions was 69.82%, and the number of bed turnover times was 27.65 times; the bed utilization rate of hospitals was 74.6%, and the number of bed turnover times was 26.08 times. The number of hospital bed turnovers was highest in the western region, lowest in the central region, and close to the national average in the eastern region. The average length of stay for discharged patients was the highest in the central region, the lowest in the eastern region, and the same as the national average in the western region. The analysis of rank-sum ratio method shows that among different types of health institutions' bed utilization efficiency (r = 0.935, P = 0.000), general hospitals and traditional Chinese medicine hospitals have the best bed utilization rate, and the bed utilization rate of community health service centers (stations) needs to be improved; while among various types of specialized hospitals' bed utilization efficiency (r = 0.959, P = 0.000), oncology hospitals, thoracic hospitals, and hematology hospitals, children's hospitals have high bed utilization efficiency; leprosy hospitals, cosmetic hospitals, and stomatology hospitals have low bed utilization efficiency. Health technicians per 1,000 population are highest in the western region, lowest in the central region, and lower in the eastern region than in the western region but slightly higher than the national average. The number of beds in health institutions per 1,000 population is the highest in the central region, the lowest in the eastern region, and slightly lower in the northwest than in the central region but higher than the national average. CONCLUSION: China's investment in health funding in the field of health care has been on the rise in recent years. However, there still exists the situation of uneven investment in health expenses and inconsistent medical efficiency among regions. And change such a status quo can be further improved in terms of government, capital, human resources, technology, information system, and so on.

Allium vegetable intake associated with the risk of incident gastric cancer: a continuous follow-up study of a randomized intervention trial.

BACKGROUND: Allium vegetable components have antibacterial, antioxidative, and immune modulation properties, thus potentially exhibiting antitumor effects. Despite evidence from case-control studies, prospective studies linking allium vegetables with gastric cancer (GC) have been sparse. OBJECTIVE: In a prospective study, we examined whether allium vegetable intake would change the risk of GC occurrence and whether the associations would be modified by vitamin supplementation, garlic supplementation, and Helicobacter pylori (H. pylori) treatment. METHODS: The study was conducted on the basis of the Shandong Intervention Trial, a randomized, placebo-controlled, factorial-designed trial (1995-2003) in a well-recognized high-risk area for GC in China. Participants were continuously followed up to December 2017 for 22.3 y (1995-2017). A total of 3229 subjects were included, with information on the intake of allium vegetables (garlic vegetables and scallions), collected by structured questionnaires in 1994. The associations of total and individual allium vegetable intake with the risk of GC were examined, respectively. RESULTS: During the follow-up, 144 incident cases of GC were identified. Garlic vegetable intake was associated with a decreased risk of incident GC (P-trend = 0.02; OR: 0.83; 95% CI: 0.70, 0.98, per 1 kg/y increment), whereas scallion intake showed no association (P-trend = 0.80). An inverse association of the risk of GC with total allium vegetable and garlic vegetable intake was particularly stronger among those receiving the placebo for vitamin supplementation or garlic supplementation, indicating potential effect modifications by nutritional supplementation on allium vegetable intake and the risk of developing GC. Similar findings were found for analyses of the combined prevalence of dysplasia or GC. CONCLUSIONS: We found a significant reduction in the risk of developing GC with increasing dietary intake of allium vegetables, particularly garlic vegetables. The findings add to the literature on the potential inverse association of garlic vegetable intake with the risk of GC, therefore holding public health implications for dietary recommendations. This trial was registered at clinicaltrials.gov as NCT00339768.

Associations of Annual Hospital and Surgeon Volume with Patient Outcomes After Gastrectomy: A Systematic Review and Meta-analysis.

BACKGROUND: Procedural volume is an important determinant of outcomes in cancer surgery. There is a lack of a comprehensive and updated assessment of hospital and surgeon volumes in relation to short- and long-term outcomes after gastrectomy for cancer. METHODS: The PubMed and Embase databases were searched on January 2021. We conducted meta-analyses and meta-regressions assuming a random effects model to assess the associations of procedural volumes with outcomes after gastrectomy. Effect sizes included hazard ratios (HRs), odds ratios (ORs), and standardized mean differences (SMDs). Heterogeneity was evaluated with the I2 statistic and explored by subgroup analyses. The risk of publication bias, risk of bias, and certainty of evidence were also assessed. RESULTS: We identified 53 primary publications on the effect of hospital (n = 48) or surgeon (n = 11) volume on 11 gastrectomy outcomes. Patients operated on in high-volume centers had better overall survival (HR 0.82, 95% confidence interval [CI] 0.75-0.90), lower short-term mortality (OR 0.66, 95% CI 0.58-0.75), more adequate lymphadenectomy (OR 2.14, 95% CI 1.76-2.59), and shorter length of stay (SMD - 0.08, 95% CI - 0.12 to - 0.04). The meta-analysis showed no significant associations of hospital volume with surgical complications, R0 or negative margin resection, or disease-free survival (all p > 0.05). A higher surgeon volume was associated with lower 30-day mortality (OR 0.94, 95% CI 0.90-0.97). CONCLUSIONS: The current study suggested with high confidence that gastric cancer patients operated on in high-volume centers had better overall survival. Centralization of gastrectomy in high-volume centers might lead to an overall improvement in other outcomes, but more studies, especially on surgeon volume, are needed.

The Risk of Developing Osteoporosis in Hemolytic Anemia-What Aggravates the Bone Loss?

Hemolytic anemia (HA) renders erythropoietic stress on the bone marrow and has been linked to osteoporosis. In this nationwide retrospective cohort study, we examined this correlation by utilizing the Taiwan National Health Insurance Research Database (NHIRD). We identified two cohorts, matching population with and without HA in a 1:4 ratio. A total of 2242 HA patients and 8968 non-HA patients were enrolled. Patients with HA had a significantly higher cumulative incidence (log-rank test p = 0.0073), higher incidence density (5.11 vs. 3.76 per 1000 persons-years), and a 1.31-fold risk of developing osteoporosis than non-HA patients (aHR = 1.31, 95% C.I. 1.04-1.63, p = 0.01). After adjusting for age, sex, and comorbidities, patients with factors including female (aHR = 2.57, 95% C.I. 2.05-3.22, p < 0.001), age > 65 (aHR = 9.25, 95% C.I. 7.46-11.50, p < 0.001), diagnosis of cholelithiasis (aHR = 1.76, 95% C.I. 1.20-2.58, p = 0.003) and peptic ulcer disease (aHR = 1.87, 95% C.I. 1.52-2.29, p < 0.001) had significantly higher risk of osteoporosis. We propose that this correlation may be related to increased hematopoietic stress, increased consumption of nitric oxide (NO) by hemolysis, and the inhibitory effects of iron supplements on osteogenesis through the receptor activator of nuclear factor κB ligand (RANKL)/Osteoprotegerin pathway and the Runt-related transcription factor 2 (RUNX2) factor. Our findings suggest that patients with hemolytic anemia are at a higher risk of developing osteoporosis, and it would be in the patient's best interest for physicians to be aware of this potential complication and offer preventative measures.

How peptic ulcer disease could potentially lead to the lifelong, debilitating effects of chronic fatigue syndrome: an insight.

Chronic Fatigue Syndrome (CFS) has been defined as unexplained relapsing or persistent fatigue for at least 6 consecutive months. Immuno-inflammatory pathway, bacterial infection, and other causes play essential roles in CFS. Helicobacter pylori infection is one of the most common causes of foregut inflammation, leading to peptic ulcer disease (PUD). This study aimed to analyze the risk of CFS development between patients with and without PUD. Other related factors were also analyzed. We performed a retrospective, nationwide cohort study identifying patients with or without PUD respectively by analyzing the Longitudinal Health Insurance Database 2000 (LHID2000), Taiwan. The overall incidence of CFS was higher in the PUD cohort than in the non- PUD cohort (HR = 2.01, 95% CI = 1.75-2.30), with the same adjusted HR (aHR) when adjusting for age, sex, and comorbidities. The sex-specific PUD cohort to the non-PUD cohort relative risk of CFS was significant in both genders. The age-specific incidence of CFS showed incidence density increasing with age in both cohorts. There is an increased risk of developing CFS following PUD, especially in females and the aging population. Hopefully, these findings can prevent common infections from progressing to debilitating, chronic conditions such as CFS.

Associations of centralization with health care quality for gastric cancer patients receiving gastrectomy in China.

OBJECTIVE: Limited evidence is available regarding the associations of centralization with gastric cancer patients' quality of care in high surgical volume settings. The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index (HHI) on in-hospital mortality, total cost, and length of stay for Chinese gastrectomy patients in a nationwide database. METHODS: We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018. Hospital volume was divided into 4 quartiles: low (1-83 cases per year), medium (84-238 cases), high (239-579 cases), and very high (580-1,193 cases). The HHI was divided into 3 categories: highly concentrated (>2,500), moderately concentrated (1,500-2,500), and unconcentrated (<1,500). We used mixed-effects models to analyze the data while accounting for data clustering. RESULTS: We analyzed 125,683 patients in 515 institutions. In the multivariable analyses, hospital volume was significantly associated with in-hospital mortality [medium vs. low: odds ratio (OR)=0.61, 95% confidence interval (95% CI)=0.43-0.84, P=0.003; high: OR=0.57, 95% CI=0.38-0.87, P=0.009; and very high: OR=0.33, 95% CI=0.18-0.61, P<0.001) and length of stay (highvs. low: ß=-0.036, 95% CI=-0.071--0.002, P=0.039) but not with total cost. Hospitals located in unconcentrated provinces had higher in-hospital mortality (OR=1.52, 95% CI=1.03-2.26, P=0.036) and longer lengths of stay (ß=0.024, 95% CI=0.001-0.047, P=0.041) than hospitals located in highly concentrated provinces. CONCLUSIONS: Centralization of gastrectomy, measured by hospital volume and the HHI, was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost. These results support the strategy of centralizing gastrectomy in high-volume settings.

Data mining-based model and risk prediction of colorectal cancer by using secondary health data: A systematic review.

OBJECTIVE: Prevention and early detection of colorectal cancer (CRC) can increase the chances of successful treatment and reduce burden. Various data mining technologies have been utilized to strengthen the early detection of CRC in primary care. Evidence synthesis on the model's effectiveness is scant. This systematic review synthesizes studies that examine the effect of data mining on improving risk prediction of CRC. METHODS: The PRISMA framework guided the conduct of this study. We obtained papers via PubMed, Cochrane Library, EMBASE and Google Scholar. Quality appraisal was performed using Downs and Black's quality checklist. To evaluate the performance of included models, the values of specificity and sensitivity were comparted, the values of area under the curve (AUC) were plotted, and the median of overall AUC of included studies was computed. RESULTS: A total of 316 studies were reviewed for full text. Seven articles were included. Included studies implement techniques including artificial neural networks, Bayesian networks and decision trees. Six articles reported the overall model accuracy. Overall, the median AUC is 0.8243 [interquartile range (IQR): 0.8050-0.8886]. In the two articles that reported comparison results with traditional models, the data mining method performed better than the traditional models, with the best AUC improvement of 10.7%. CONCLUSIONS: The adoption of data mining technologies for CRC detection is at an early stage. Limited numbers of included articles and heterogeneity of those studies implied that more rigorous research is expected to further investigate the techniques' effects.

Cancer screening among racial/ethnic groups in health centers.

BACKGROUND: Underserved and low-income population are placed at a disadvantage for receiving necessary cancer screenings. This study aims to measure the rates of receiving three types of cancer screening services, Pap test, mammogram and colorectal cancer screening, among patients seen at U.S. health centers (HCs) to investigate if cancer screening among patients varies by race/ethnicity. METHODS: We analyzed data from the 2014 U.S. Health Center Patient Survey, and included samples age 21 and above. We examined three cancer screening indicators as our dependent variables including cervical, breast, and colorectal cancer screening. Logistic regressions were used to assess the racial/ethnic disparities on cancer screening, while controlling for potentially confounding factors. RESULTS: The rates of receiving three types of cancer screening were comparable and even higher among HC patients than those for the U.S. general population. Both bivariate and multivariate results showed there were racial/ethnic differences in the likelihood of receiving cancer screening services. However, the differences did not favor non-Hispanic Whites. African Americans had higher odds than Whites (OR: 1.92, 95% CI: 1.44-2.55, p < 0.001) of receiving Pap tests. Similar results were also found in measures of the receipt of mammogram (OR = 1.96, 95% CI: 1.46-2.64, P < 0.001) and colorectal cancer screening (OR = 1.28, 95% CI: 1.02-1.60, p < 0.05). CONCLUSION: The current study presents U.S. nationally representative estimates and imply that HCs are helping fulfill an important role as a health care safety-net in reducing racial/ethnic disparities in the delivery of cancer screening services.

Increased risk of chronic fatigue syndrome following burn injuries.

BACKGROUND: The overlapping symptoms and pathophysiological similarities between burn injury and chronic fatigue syndrome (CFS) are noteworthy. Thus, this study explores the possible association between burn injury and the subsequent risk of CFS. METHOD: We used data from the Taiwan National Health Insurance system to address the research topic. The exposure cohort comprised of 17,204 patients with new diagnoses of burn injury. Each patient was frequency matched according to age, sex, index year, and comorbidities with four participants from the general population who did not have a history of CFS (control cohort). Cox proportional hazards regression analysis was conducted to estimate the relationship between burn injury and the risk of subsequent CFS. RESULT: The incidence of CFS in the exposure and control cohorts was 1.61 and 0.86 per 1000 person-years, respectively. The exposure cohort had a significantly higher overall risk of subsequent CFS than did the control cohort (adjusted hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.41-1.56). The risk of CFS in patients with burn injury in whichever stratification (including sex, age, and comorbidity) was also higher than that of the control cohort. CONCLUSION: The findings from this population-based retrospective cohort study suggest that thermal injury is associated with an increased risk of subsequent CFS and provided a point of view suggesting burn injuries in sun- exposed areas such as the face and limbs had greater impact on subsequent development of CFS compared with trunk areas. In addition, extensively burned areas and visible scars were predictors of greater physiological and psychosocial that are needed to follow-up in the long run.

Educational video-assisted versus conventional informed consent for trauma-related debridement surgery: a parallel group randomized controlled trial.

BACKGROUND: We investigated whether, in the emergency department (ED), educational video-assisted informed consent is superior to the conventional consent process, to inform trauma patients undergoing surgery about the procedure, benefits, risks, alternatives, and postoperative care. METHODS: We conducted a prospective randomized controlled trial, with superiority study design. All trauma patients scheduled to receive trauma-related debridement surgery in the ED of Kaohsiung Medical University Hospital were included. Patients were assigned to one of two education protocols. Participants in the intervention group watched an educational video illustrating informed consent information, whereas those in the control group read an informed consent document. The primary outcome was knowledge scores and the secondary outcome was assessment of patient satisfaction. A multivariable regression model, with predefined covariates, was used to analyze differences in knowledge scores and patient satisfaction levels between the groups. RESULTS: A total of 142 patients were enrolled, with 70 and 72 assigned to the intervention and control groups, respectively. Mean knowledge scores were higher in the intervention (72.57 ± 16.21 (SD)) than in the control (61.67 ± 18.39) group. By multivariate analysis, the intervention group had significantly greater differences in knowledge scores (coefficient: 7.646, 95% CI: 3.381-11.911). Age, injury severity score, and baseline knowledge score significantly affected the differences in knowledge scores. Significant improvements were observed in patients' perception of statements addressing comprehension of the information provided, helpfulness of the supplied information for decision making, and satisfaction with the informed consent process. Multivariate analysis showed significant correlations between video education and patient satisfaction. CONCLUSIONS: Both the educational approach and severity of injury may have an impact on patient understanding during the informed consent process in an emergency environment. Video-assisted informed consent may improve the understanding of surgery and satisfaction with the informed consent process for trauma patients in the ED. Institutions should develop structured methods and other strategies to better inform trauma patients, facilitate treatment decisions, and improve patient satisfaction. TRIAL REGISTRATION: The ClinicalTrials.gov Identifier is NCT01338480 . The date of registration was April 18, 2011 (retrospectively registered).

Development and pilot testing of an informed consent video for patients with limb trauma prior to debridement surgery using a modified Delphi technique.

BACKGROUND: Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients' knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. METHODS: A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. RESULTS: The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department (ED) were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. CONCLUSIONS: Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts' opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. TRIAL REGISTRATION: The ClinicalTrials.gov Identifier is NCT01338480 . The date of registration was April 18, 2011 (retrospectively registered).

Aspirin as a potential modality for the chemoprevention of breast cancer: A dose-response meta-analysis of cohort studies from 857,831 participants.

BACKGROUND: Previous meta-analyses on the relationship between aspirin use and breast cancer risk have drawn inconsistent results. In addition, the threshold effect of different doses, frequencies and durations of aspirin use in preventing breast cancer have yet to be established. RESULTS: The search yielded 13 prospective cohort studies (N=857,831 participants) that reported an average of 7.6 cases/1,000 person-years of breast cancer during a follow-up period of from 4.4 to 14 years. With a random effects model, a borderline significant inverse association was observed between overall aspirin use and breast cancer risk, with a summarized RR = 0.94 (P = 0.051, 95% CI 0.87-1.01). The linear regression model was a better fit for the dose-response relationship, which displayed a potential relationship between the frequency of aspirin use and breast cancer risk (RR = 0.97, 0.95 and 0.90 for 5, 10 and 20 times/week aspirin use, respectively). It was also a better fit for the duration of aspirin use and breast cancer risk (RR = 0.86, 0.73 and 0.54 for 5, 10 and 20 years of aspirin use). METHODS: We searched MEDLINE, EMBASE and CENTRAL databases through early October 2016 for relevant prospective cohort studies of aspirin use and breast cancer risk. Meta-analysis of relative risks (RR) estimates associated with aspirin intake were presented by fixed or random effects models. The dose-response meta-analysis was performed by linear trend regression and restricted cubic spline regression. CONCLUSION: Our study confirmed a dose-response relationship between aspirin use and breast cancer risk. For clinical prevention, long term (>5 years) consistent use (2-7 times/week) of aspirin appears to be more effective in achieving a protective effect against breast cancer.

Patient-Centered Medical Home Recognition and Clinical Performance in U.S. Community Health Centers.

INTRODUCTION: America's community health centers (HCs) are uniquely poised to implement the patient-centered medical home (PCMH) model, as they are effective in providing comprehensive, accessible, and continuous primary care. This study aims to evaluate the relationship between PCMH recognition in HCs and clinical performance. METHODS: Data for this study came from the 2012 Uniform Data System (UDS) as well as a survey of HCs' PCMH recognition achievement. The dependent variables included all 16 measures of clinical performance collected through UDS. Control measures included HC patient, provider, and practice characteristics. Bivariate analyses and multiple logistic regressions were conducted to compare clinical performance between HCs with and without PCMH recognition. FINDINGS: Health centers that receive PCMH recognition generally performed better on clinical measures than HCs without PCMH recognition. After controlling for HC patient, provider, and practice characteristics, HCs with PCMH recognition reported significantly better performance on asthma-related pharmacologic therapy, diabetes control, pap testing, prenatal care, and tobacco cessation intervention. CONCLUSION: This study establishes a positive association between PCMH recognition and clinical performance in HCs. If borne out in future longitudinal studies, policy makers and practices should advance the PCMH model as a strategy to further enhance the quality of primary care.

Preventive Counseling Services during Primary Care Visits: A Comparison of Health Centers versus Other Physician Offices.

We compared preventive counseling services provided by health centers versus other physician offices. Cross-sectional data came from the 2008 National Ambulatory Medical Care Survey, including 25,177 patient visits in physician offices and 3,345 patient visits in health centers. Despite serving disproportionately more vulnerable patients, health centers provided comparable rates of preventive counseling services, compared with other physician offices: health education (39% vs. 36%), disease management (34% vs. 41%), asthma education (21% vs. 13%), tobacco education (19% for both), and weight reduction education (6% vs. 9%) (p>.05 for all). Adjusted analyses showed no association between health care setting and preventive counseling.

Patient-centered Medical Home capability and clinical performance in HRSA-supported health centers.

OBJECTIVES: To evaluate the relationship between Patient-centered Medical Home (PCMH) model adoption in health centers (HCs) and clinical performance measures and to determine if adoption of PCMH characteristics is associated with better clinical performance. RESEARCH DESIGN: Data came from the Health Resources and Services Administration's 2009 Uniform Data System and the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers. Clinical performance measures included 2 process measures (childhood immunization and cervical cancer screening) and 2 outcome measures (hypertension control and diabetes control). Total and subscale PCMH scores were regressed on the clinical performance measures, adjusting for patient, provider, financial, and institutional characteristics. RESULTS: The findings showed different directional relationships, with some PCMH domains (care management, test/referral tracking, quality improvement, and external coordination) showing little or no effect on outcome measures of interest, 1 domain (access/communication) associated with improved outcomes, and 1 domain (patient tracking/registry) associated with worse outcomes. CONCLUSIONS: This study is among the first to examine the association between PCMH transformation and clinical performance in HCs, providing an understanding of the impact of PCMH adoption within safety-net settings. The mixed results highlight the importance of examining relationships between specific PCMH domains and specific clinical quality measures, in addition to analyzing overall PCMH scores which could yield distorted findings.

Report from China: health insurance in China--evolution, current status, and challenges.

The authors review the evolution of health insurance in China and analyze how it has been shaped to its current form by political and economic dynamics. They summarize the current status of health insurance in terms of population coverage, benefit design, scope of service, and its interaction with providers; address challenges regarding future health insurance reform; and propose policy recommendations. Although the recent health insurance reform has made major breakthroughs in population coverage, it is still too early to judge whether the political willingness to appease social unrest can be translated into concrete health care protections for the population.

Clinical quality performance in U.S. health centers.

OBJECTIVE: To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. DATA SOURCES: National data from the 2009 Uniform Data System. DATA COLLECTION/EXTRACTION METHODS: Health centers reviewed patient records and reported aggregate data to the Uniform Data System. STUDY DESIGN: Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. PRINCIPAL FINDINGS: Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. CONCLUSIONS: Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.

Cancer screening among racial/ethnic and insurance groups in the United States: a comparison of disparities in 2000 and 2008.

Using the National Health Interview Survey, we examined associations among race/ ethnicity, insurance coverage, and cancer screening, and assessed changes in the magnitude of disparities over the past decade. Outcomes included recent cervical, breast, and colorectal cancer screening. Rates of colorectal screening increased for all racial/ethnic groups and some insurance groups from 2000 to 2008. However, rates of Pap tests and mammograms remained stagnant, and even decreased for certain groups. Some Hispanic-White and Asian-White disparities in cancer screening were reduced or eliminated over this time period. However, in 2008 Asians continued to have lower odds of Pap tests and Hispanics lower odds of colorectal cancer screening, even after accounting for potential confounders. There were no significant changes in Black-White disparities. The uninsured continued to be at a disadvantage for all three types of cancer screening, relative to the privately insured, as were publicly insured individuals with respect to colorectal cancer screening.

Nativity status and access to care in Canada and the U.S.: factoring in the roles of race/ethnicity and socioeconomic status.

We conducted cross-country comparisons of Canada and the U.S., and assessed the extent to which access to care varies by nativity status overall, as well as in conjunction with race/ethnicity and socioeconomic status. Data came from the Joint Canada-U.S. Survey of Health (n=6,620 non-elderly adults). Access measures included having a regular medical doctor, consultation with a health professional in the past year, dentist visit in the past year, Pap test in the past three years, and any unmet health care needs in the past year. Logistic regression was employed to estimate the relative odds of access to care, adjusting for potential confounders. Disparities in access to care based on nativity status overall, as well as nativity-by-race joint effects, were found in both countries. There was also a dose-response effect of education on access to care among the native-born but not among the foreign-born; there were few nativity-by-income joint effects.