Telehealth Infrastructure, Accountable Care Organization, and Medicare Payment for Patients with Alzheimer's Disease and Related Dementia Living in Socially Vulnerable Areas.

Background: Structural social determinants of health have an accumulated negative impact on physical and mental health. Evidence is needed to understand whether emerging health information technology and innovative payment models can help address such structural social determinants for patients with complex health needs, such as Alzheimer's disease and related dementias (ADRD). Objective: This study aimed to test whether telehealth for care coordination and Accountable Care Organization (ACO) enrollment for residents in the most disadvantaged areas, particularly those with ADRD, was associated with reduced Medicare payment. Methods: The study used the merged data set of 2020 Centers for Medicare and Medicaid Services Medicare inpatient claims data, the Medicare Beneficiary Summary File, the Medicare Shared Savings Program ACO, the Center for Medicare and Medicaid Service's Social Vulnerability Index (SVI), and the American Hospital Annual Survey. Our study focused on community-dwelling Medicare fee-for-service beneficiaries aged 65 years and up. Cross-sectional analyses and generalized linear models (GLM) were implemented. Analyses were implemented from November 2023 to February 2024. Results: Medicare fee-for-service beneficiaries residing in SVI Q4 (i.e., the most vulnerable areas) reported significantly higher total Medicare costs and were least likely to be treated in hospitals that provided telehealth post-discharge services or have ACO affiliation. Meanwhile, the proportion of the population with ADRD was the highest in SVI Q4 compared with other SVI levels. The GLM regression results showed that hospital telehealth post-discharge infrastructure, patient ACO affiliation, SVI Q4, and ADRD were significantly associated with higher Medicare payments. However, coefficients of interaction terms among these factors were significantly negative. For example, the average interaction effect of telehealth post-discharge and ACO, SVI Q4, and ADRD on Medicare payment was -$1,766.2 (95% confidence interval: -$2,576.4 to -$976). Conclusions: Our results suggested that the combination of telehealth post-discharge and ACO financial incentives that promote care coordination is promising to reduce the Medicare cost burden among patients with ADRD living in socially vulnerable areas.

Oral Health Literacy and Dental Care among Low-Income Pregnant Women.

Objectives: In this study, we sought to determine the impact of oral health literacy (OHL) on use of prenatal dental care and knowledge, understanding, and practices related to preventing dental caries (tooth decay) among low-income pregnant women in Maryland. Methods: We conducted a mixed methods study using a survey and a structured guide for one-on-one interviews or focus groups. The study included 117 pregnant women and was conducted between July 2016 and April 2018 in Maryland. Results: Respondents had a low level of OHL. Maryland Medicaid covers prenatal dental care, but only 53% of participants reported seeing a dentist during their pregnancy. Most women were unaware of the Medicaid dental program for pregnant women and the importance of prenatal dental care. They could not afford care if there was an associated cost and had difficulty finding a Medicaid dental provider. Importantly, they lacked understanding of how to prevent caries and did not practice behaviors to prevent this disease. Conclusions: To decrease caries rates, policies and programs must be implemented to increase the OHL of low-income pregnant women because the OHL of caregivers is associated with their children's oral health status.

Exposures Associated with Minority High Schoolers' Predisposition for Health Science.

OBJECTIVE: We examined modifiable facilitation strategies (exposures) during high school that are associated with motiva- tion for minority youth pursuit of health science. METHODS: A sample (N = 116) of minority (73% African-American/Black, 21% Hispanic/Latino) 12th graders from 6 high schools in a lower socioeconomic area bordering Washington, DC completed a self-administered survey. Path modeling was used to examine whether: (1) exposures: high school science courses, extra-curricular science activities, personal health experiences, and adult encouragement predict Theory of Planned Behavior (TPB) constructs including attitude, subjective norm, and perceived behavioral control, and (2) TPB constructs predict the outcome of intent to pursue college health science. RESULTS: The path model indicated that adult encouragement was associated with attitude (p < .01), subjective norm (p < .01), and perceived behavioral control (p < .01); and personal health experiences were associated with attitude (p < .01). Attitude and subjective norm were associated with intent (p < .01). CONCLUSION: Motivating minority high schoolers from low socioeconomic areas through adult encouragement and personal health experiences to value health scientists and to perceive that others support their pursuit of health science may be pathways for facilitating their intention to pursue college health science.