Bis[2,6-bis-(benzimidazol-2-yl)pyridine-κ3N,N',N'']nickel(II) bis-(tri-fluoro-methane-sulfonate) diethyl ether monosolvate.

In the title complex, [Ni(C19H13N5)2](CF3SO3)2·(CH3CH2)2O, the central NiII atom is sixfold coordinated by three nitro-gen atoms of each 2,6-bis-(2-benzimidazol-yl)pyridine ligand in a distorted octa-hedral geometry with two tri-fluoro-methane-sulfonate ions and a mol-ecule of diethyl ether completing the outer coordination sphere of the complex. Hydrogen bonding contributes to the organization of the asymmetric units in columns along the a axis generating a porous supra-molecular structure. The structure was refined as a two-component twin with a refined BASF value of 0.4104 (13).

Discretizing continuous variables in nutrition and obesity research: a practice that needs to be cut short.

BACKGROUND/OBJECTIVES: Nutrition and obesity researchers often dichotomize or discretize continuous independent variables to conduct an analysis of variance to examine group differences. We describe consequences associated with dichotomizing and discretizing continuous variables using two cross-sectional studies related to nutrition. SUBJECTS/METHODS: Study 1 investigated the effects of health literacy and nutrition knowledge on nutrition label accuracy (n = 612). Study 2 investigated the effects of cognitive restraint and BMI on fruit and vegetable (F/V) intake (n = 586). We compare analytic approaches where continuous independent variables were either discretized/dichotomized or analyzed as continuous variables. RESULTS: In Study 1, dichotomization of health literacy and nutrition knowledge for 2 × 2 ANOVA revealed health literacy had an effect on nutrition label accuracy. Nutrition knowledge has an effect on nutrition label accuracy, but the health literacy by nutrition knowledge interaction was not significant. When analyzed using regression, the nutrition knowledge effect was significant. The simple effect of health literacy was also significant when health literacy equals zero. Finally, the quadratic effect of health literacy was negative and significant. In Study 2, dichotomization and discretization of cognitive restraint and BMI were used for three ANOVAs, which discretized BMI in three ways. For all ANOVAs, the BMI main effect for predicting fruit and vegetable intake was significant, the interaction between BMI and cognitive restraint was non-significant, and cognitive restraint was only significant when both variables were dichotomized. When analyzed using regression, the continuous mean-centered variables, and their interaction each significantly predicted F/V intake. CONCLUSIONS: Dichotomizing continuous independent variables resulted in distortions of effect sizes across studies, an inability to assess the quadratic effect of health literacy, and an inability to detect the moderating effect of BMI. We discourage researchers from dichotomizing and discretizing continuous independent variables and instead use multiple regression to examine relationships between continuous independent and dependent variables.

The Massachusetts Department of Public Health Post Overdose Support Team Initiative: A Public Health-Centered Co-Response Model for Post-Overdose Outreach.

CONTEXT: Post-overdose outreach programs have emerged in response to surging overdose deaths amid fentanyl contamination of the illicit opioid supply. Predominantly centered in police departments in collaboration with public health providers, these programs conduct home-based outreach with survivors and their social networks following an overdose. APPROACH: We describe implementation of the Post Overdose Support Team (POST) initiative, an ongoing public health funded and centered approach. Post Overdose Support Team is a person-centered model led by harm reductionists in health and human services agencies in collaboration with municipal first responders. The goal of POST is to engage overdose survivors and their social network to improve general health, connect people to services (including access to treatment, if desired), and reduce risk of subsequent overdose. IMPLEMENTATION: Nine agencies in Massachusetts that are part of the state's overdose education and naloxone distribution network implemented POST programs, covering 28 municipalities. The POST teams conduct home-based outreach with individuals who experienced an opioid-related overdose to provide a menu of services, including naloxone rescue kits, overdose response and risk reduction planning, referral to treatment for substance use disorders, including medication for opioid use disorder, and referral to recovery and family supports. EVALUATION: From October 2017 to October 2021, the POST teams attempted to reach 5634 overdose survivors via 10 536 outreach visits. Teams successfully engaged 3014 survivors, either directly or through contact with their social network (53.5% success rate). Using data from a real-time encounter-level database, monthly peer-sharing calls with program sites, and annual site visits, we describe the implementation of the POST initiative and provide practice-based recommendations and lessons learned. DISCUSSION: Early evidence suggests that the POST initiative is meeting its goal to engage overdose survivors, improve general health, and reduce subsequent overdose risk. Future evaluations should examine long-term outcomes among participants, including service linkages and incremental behavior change.

Implementation and Uptake of the Massachusetts Drug Supply Data Stream: A Statewide Public Health-Public Safety Partnership Drug Checking Program.

CONTEXT: The illicit drug supply is rapidly evolving. Equally important to gathering drug supply data for monitoring is timely sharing of information with people who use drugs, the providers who care for them, law enforcement partners, and public health stakeholders so that efforts to avoid harmful substances, take preventive actions, and better target interventions can occur. PROGRAM: The Massachusetts Drug Supply Data Stream (MADDS) is the country's first statewide community drug checking program. Founded on public health-public safety partnerships, MADDS collects remnant drug packaging and paraphernalia with residue from people who use drugs and noncriminal samples from partnering police departments. MADDS tests samples using simultaneous immunoassay fentanyl test strips, Fourier-transform infrared spectrometry (FTIR), and off-site laboratory testing by gas chromatography-mass spectrometry (GC/MS). Results are accessible to community programs and municipalities, while trend analyses inform public health for cross-site alerts and informational bulletins. IMPLEMENTATION: MADDS was launched statewide in 2020 and rapidly expanded to a multisite program. Program staff approached communities and met with municipal police and community partners to secure written agreements to host drug checking. Community partners designed sample collection consistent with their pandemic era workflows. Consultations with stakeholders gathered feedback on design and deliverables. EVALUATION: The program tests sample donations on-site from community agencies and police departments, incorporates review by a medical toxicologist for health and safety concerns, crafts stakeholder-specific communications, and disseminates English, Spanish, and Portuguese language materials. For 2020, a total of 427 samples were tested, of which 47.1% were positive for fentanyl. By early 2021, MADDS detected shifts in cocaine purity, alerted communities of a new toxic fentanyl analogue and a synthetic cannabinoid contaminant, and confirmed the increase of xylazine (a veterinary sedative) in Massachusetts. DISCUSSION: Community drug checking programs can be collaboratively designed with public health and public safety to generate critical health and safety information for people who use drugs and the communities where they live.

Monitoring Cognitive Health Status in Homebound Older Adults: Insights from a Nationwide Request for Information.

The COVID-19 pandemic has fueled growing concerns about the long-term impacts on outcomes in older adults including social isolation and declines in cognitive health. Prior to the pandemic, the Administration for Community Living (ACL) released a nationwide request for information to understand how community-based organizations monitor changes in cognitive status for homebound older adults. This Perspective describes strategies reported by community-based organizations to monitor cognitive status in homebound older adults and notes the potential for technology to mitigate the risk of social isolation and delays in observing cognitive decline, considerations that are especially relevant during COVID-19 amid social distancing requirements.

Eat Well El Paso!: Lessons Learned From a Community-Level Restaurant Initiative to Increase Availability of Healthy Options While Celebrating Local Cuisine.

PURPOSE: Restaurants have the potential to improve nutrition and positively shape social norms. We describe lessons learned and recommended strategies from Eat Well El Paso! (EWEP), a local restaurant initiative. DESIGN: Descriptive case study. SETTING: EWEP partnered with local restaurants from 2012-2017 in El Paso, Texas, along the US/Mexico border. SAMPLE: Our sampling frame included EWEP staff and managers/owners at participating restaurants, of which the majority participated (80% and 85%, respectively). INTERVENTION: EWEP was a local restaurant initiative led by the city public health department. EWEP contracted registered dietitians to assist locally-owned restaurants to increase availability of healthy menu options. MEASURES: Observation, key informant interviews, and document review assessed participation, barriers, and facilitators to restaurant participation and program sustainability. ANALYSIS: Thematic and descriptive analyses. RESULTS: 57% of restaurants completed the full on-boarding process, but long-term retention was low (24% of completers). Restaurant managers/owners perceived value in marketing, nutritional analysis, and menu design. Barriers included scheduling, complexity of restaurant culture, fear of food inspections, restaurant turnover, competing responsibilities, and lack of dedicated funding. CONCLUSION: Although local context and sample size may limit generalizability, lessons learned and recommended strategies are relevant and informative for communities working to increase restaurants' healthy menu options.

Emotion socialization in mothers with mood disorders: Affective modeling and recollected responses to childhood emotion.

Growing evidence suggests that emotion socialization may be disrupted by maternal depression. However, little is known about emotion-related parenting by mothers with bipolar disorder or whether affective modeling in early childhood is linked to young adults' recollections of emotion socialization practices. The current study investigates emotion socialization by mothers with histories of major depression, bipolar disorder, or no mood disorder. Affective modeling was coded from parent-child interactions in early childhood and maternal responses to negative emotions were recollected by young adult offspring (n = 131, 59.5% female, M age = 22.16, SD = 2.58). Multilevel models revealed that maternal bipolar disorder was associated with more neglecting, punishing, and magnifying responses to children's emotions, whereas maternal major depression was associated with more magnifying responses; links between maternal diagnosis and magnifying responses were robust to covariates. Young adult recollections of maternal responses to emotion were predicted by affective modeling in early childhood, providing preliminary validity evidence for the Emotions as a Child Scale. Findings provide novel evidence that major depression and bipolar disorder are associated with altered emotion socialization and that maternal affective modeling in early childhood prospectively predicts young adults' recollections of emotion socialization in families with and without mood disorder.

Children's secure base script knowledge as a mediator between early life stress and later behavior problems.

Attachment theory posits that children's interactions with caregivers contribute to internalized representations that reflects the common and recurring elements of sensitive caregiving interactions (i.e. the secure base script). These internalized representations are theorized to influence later adaptation, including the development of psychopathology. Given prior research suggesting that stress exposure may undermine secure base script knowledge (SBSK), this study evaluated SBSK development in early childhood as a mechanism by which childhood stress exposure may influence later adaptation. We hypothesized that children's (N = 230; Mage = 73.30 months, SD = 2.51, 50% girls; 45.7% Latinx) stress exposure would be associated with lower levels of SBSK at age 6, which, in turn, would contribute to increased internalizing and externalizing symptoms at age 8. SBSK emerged as a significant mechanism by which early life stress may contribute to later externalizing, but not internalizing, child behavior problems. These findings highlight the role of SBSK as a profitable focus for both risk identification and intervention efforts aimed at reducing behavioral maladaptation among stress-exposed children.

Health characteristics and outcomes of caregivers in the United States: An Analysis of the 2017 Health Information National Trends Survey (HINTS).

BACKGROUND: Caregivers are essential for assisting people with disabilities to fully participate in their communities. Past research has primarily focused on family caregivers in the U.S. providing care to older adults rather than children and adults with disabilities. OBJECTIVE: This paper examines the demographic and health characteristics of caregivers of children and adults with disabilities across the lifespan using data from the 2017 Health Information National Trends Survey (HINTS). METHODS: Chi square, t-test, linear and logistic regression analyses show differences between caregivers and non-caregivers related to gender, age, employment, and specific health outcomes. RESULTS: Of 3285 respondents, 18% self-identified as caregivers of children or adults with disabilities (n = 546). Almost one-third of all caregivers reported being diagnosed with depression or an anxiety disorder as compared to one-fifth of non-caregivers. Psychological distress was associated with an increased risk for a diagnosis of depression/anxiety. We also found that distress decreased with age when controlling for other factors. CONCLUSION: This paper increases knowledge of a growing segment of family caregivers providing care for members with disabilities across the lifespan. Research and policy needs are discussed.

Factors associated with help seeking by community responders trained in overdose prevention and naloxone administration in Massachusetts.

BACKGROUND: Community overdose responders do not always seek help from emergency services when administering naloxone. We aimed to identify responder, overdose event, and community characteristics associated with help seeking from emergency services during overdoses reported by Massachusetts Overdose Education and Naloxone Distribution (OEND) enrollees, and to assess trends in help seeking over time. METHODS: We analyzed overdose reports submitted between 2007 and 2017 to the Massachusetts Department of Public Health. We used logistic regression, stratified by responder drug use status, to assess associations of characteristics with help seeking during an overdose. RESULTS: From January 2007 through December 2017, there were 69,870 OEND enrollees. 5,588 enrollees reported 10,246 overdoses. Help seeking was more likely among responders who did not use drugs. Among responders who did not use drugs, help seeking was more likely when: the responder was older or female, the victim was a stranger or client, and when naloxone did not work. Among responders who used drugs, help seeking was more likely when: the responder was female or had not previously reported responding to an overdose, the victim was a stranger or client or did not use fentanyl, naloxone took a longer time to work, and when the overdose was public or occurred more recently. The percentage of overdoses where help seeking occurred reached a maximum in 2016 at 50%. CONCLUSIONS: Help seeking by OEND enrollees was significantly associated with several responder, victim, and event characteristics. Targeted interventions to promote help seeking are warranted, particularly as the lethality of opioid supplies rises.

The Role of Lysosomes in a Broad Disease-Modifying Approach Evaluated across Transgenic Mouse Models of Alzheimer's Disease and Parkinson's Disease and Models of Mild Cognitive Impairment.

Many neurodegenerative disorders have lysosomal impediments, and the list of proposed treatments targeting lysosomes is growing. We investigated the role of lysosomes in Alzheimer's disease (AD) and other age-related disorders, as well as in a strategy to compensate for lysosomal disturbances. Comprehensive immunostaining was used to analyze brains from wild-type mice vs. amyloid precursor protein/presenilin-1 (APP/PS1) mice that express mutant proteins linked to familial AD. Also, lysosomal modulation was evaluated for inducing synaptic and behavioral improvements in transgenic models of AD and Parkinson's disease, and in models of mild cognitive impairment (MCI). Amyloid plaques were surrounded by swollen organelles positive for the lysosome-associated membrane protein 1 (LAMP1) in the APP/PS1 cortex and hippocampus, regions with robust synaptic deterioration. Within neurons, lysosomes contain the amyloid ß 42 (Aß42) degradation product Aß38, and this indicator of Aß42 detoxification was augmented by Z-Phe-Ala-diazomethylketone (PADK; also known as ZFAD) as it enhanced the lysosomal hydrolase cathepsin B (CatB). PADK promoted Aß42 colocalization with CatB in lysosomes that formed clusters in neurons, while reducing Aß deposits as well. PADK also reduced amyloidogenic peptides and α-synuclein in correspondence with restored synaptic markers, and both synaptic and cognitive measures were improved in the APP/PS1 and MCI models. These findings indicate that lysosomal perturbation contributes to synaptic and cognitive decay, whereas safely enhancing protein clearance through modulated CatB ameliorates the compromised synapses and cognition, thus supporting early CatB upregulation as a disease-modifying therapy that may also slow the MCI to dementia continuum.

Adolescent suicide attempts and ideation are linked to brain function during peer interactions.

Understanding the neural correlates of social interaction among depressed adolescents with suicidal tendencies might help personalize treatment. We tested whether brain function during social interaction is disrupted for depressed adolescents with (1) high suicide ideation and (2) recent attempts. Depressed adolescents with high suicide ideation, including attempters (n = 45;HS) or low suicide ideation (n = 42;LS), and healthy adolescents (n = 39;HC), completed a version of the Cyberball peer interaction task during an fMRI scan. Groups were compared on brain activity during peer exclusion and inclusion versus a non-social condition. During peer exclusion and inclusion, HS youth showed significantly lower activity in precentral and postcentral gyrus, superior temporal gyrus, medial frontal gyrus, insula, and putamen compared to LS youth; and significantly reduced activity in caudate and anterior cingulate cortex compared to HC youth. In a second analysis, suicide attempters (n = 26;SA) were compared to other groups. SA adolescents showed significantly higher activity in ACC and superior and middle frontal gyrus than all other groups. Brain activity was significantly correlated with negative emotionality, social functioning, and cognitive control. Conclusions: Adolescent suicide ideation and attempts were linked to altered neural function during positive and negative peer interactions. We discuss the implications of these findings for suicide prevention efforts.

Practical Strategies to Improve Your Writing: Lessons Learned From Public Health Practitioners Participating in a Writing Group.

Many public health professionals (researchers and practitioners) do not regularly spend time writing. We often receive no formal training in the practices that lead one to become a productive writer. In addition, many internal (mental/emotional) and external (schedules/distractions) barriers make writing consistently even less appealing and may lead to a cycle of avoidance followed by binge writing. This commentary demonstrates how one writing group became an effective means of providing career and professional development. Each week for 9 months we held a 1-hour writing group meeting designed around a commitment to ground rules, accountability, training opportunities, and feedback. Our experiences suggest that engaging in a writing group can help us develop as writers by allowing us to learn new practices and skills. Adopting new practices like writing regularly for short blocks of time, in turn, led to benefits like reduced anxiety and increased productivity. In the process, we became better writers, reviewers, and mentors. We provide recommendations and resources for groups and individuals who are interested in improving their writing as an essential component of their continuing education and professional development. Whatever your professional role, using a writing group to become a more powerful and productive writer will make you more effective.

A Framework for Rigorous Qualitative Research as a Component of Mixed Method Rapid-Cycle Evaluation.

As federal, state, and local governments continue to test innovative approaches to health care delivery, the ability to produce timely and reliable evidence of what works and why it works is crucial. There is limited literature on methodological approaches to rapid-cycle qualitative research. The purpose of this article is to describe the advantages and limitations of a broadly applicable framework for in-depth qualitative analysis placed within a larger rapid-cycle, multisite, mixed-method evaluation. This evaluation included multiple cycles of primary qualitative data collection and quarterly and annual reporting. Several strategies allowed us to be adaptable while remaining rigorous; these included planning for multiple waves of qualitative coding, a hybrid inductive/deductive approach informed by a cross-program evaluation framework, and use of a large team with specific program expertise. Lessons from this evaluation can inform researchers and evaluators functioning in rapid assessment or rapid-cycle evaluation contexts.

Adult attachment representations and the quality of romantic and parent-child relationships: An examination of the contributions of coherence of discourse and secure base script knowledge.

Attachment theory suggests that early experiences with caregivers are carried forward across development in the form of mental representations of attachment experiences. Researchers have investigated at least two representation-based constructs when studying attachment and successful adaptation in adulthood: (a) coherence of autobiographical discourse/memories and (b) knowledge of the secure base script. Here, we present data examining the unique contributions of coherent discourse regarding childhood caregiving experience and secure base script knowledge in a prospective high-risk longitudinal study, the Minnesota Longitudinal Study of Risk and Adaptation. The current study included three indicators of the quality of romantic relationships: (a) observed quality of interaction with romantic partners, (b) self-reported relationship satisfaction, and (c) interview-rated effectiveness of romantic engagement. Parent-child relationship quality was also assessed across three key outcomes: (a) infant attachment security, (b) observations of supportive parenting, and (c) interview-rated supportive parenting. When examining both attachment representations simultaneously, each representation-based construct was uniquely associated with different relationship quality indices. Specifically, secure base script knowledge was uniquely associated with infant attachment security in the next generation, and coherence of discourse was uniquely associated with observations of romantic relationships quality and interview-rated supportive parenting. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Young adult's attachment style as a partial mediator between maternal functioning and young adult offsprings' functioning.

BACKGROUND: The quality of our early attachment relationships with primary caregivers is carried forward to new developmental domains, including interpersonal contexts in adulthood. One of the factors that can disrupt early attachment is maternal depression, which may be associated with less responsive care and may impede the development of a secure attachment. Moreover, this disruption in secure attachment may act as a mechanism by which offspring of depressed mothers are more likely to experience their own psychopathology. In this study we predicted that attachment anxiety and avoidance would mediate the relationship between maternal depression diagnosis and functional impairment predicting young adult offspring's functional impairment. METHODS: This study utilized longitudinal data from 98 families with clinically diagnosed depressed and well mothers, and two of their young adult children, an older and younger sibling (N = 123, Female = 75, Mage = 22.09, SD = 2.57). Mother's and young adult children's functioning was based on clinical ratings on the Global Assessment Scale. Attachment was based on the young adult's self-report on the Experiences in Close Relationships. RESULTS: Results indicate that maternal diagnosis and functional impairment predicted offspring's functional impairment. This relationship was partially mediated through offspring's attachment anxiety, but not attachment avoidance. LIMITATIONS: The mediator and outcome variable were measured concurrently, thus causal implications are limited. CONCLUSIONS: Our study provides critical evidence that early experiences with depressed mothers may have influence into young adulthood in typical and atypical domains of development. This work extends our understanding of the impact of early experiences in long-term development, and may have treatment implications for intervening on both maternal and romantic relationships to improve attachment.

Post opioid overdose outreach by public health and public safety agencies: Exploration of emerging programs in Massachusetts.

BACKGROUND: Opioid overdose is a significant public health problem. Collaborative programs between local public health and public safety agencies have emerged to connect overdose survivors and their personal networks with harm reduction and addiction treatment services following a non-fatal overdose event. This study explored the prevalence of these programs in Massachusetts and the different ways they have been structured and function. METHODS: We sent an online screening questionnaire to police and fire departments in all 351 communities in Massachusetts to find instances in which they collaborated with a community-based public health agency to implement a post-overdose outreach and support program. We conducted telephone interviews with communities that implemented this type of program and categorized programs based on their structure, outreach approach, and other key characteristics. RESULTS: Police and fire personnel from 110 of the 351 communities in Massachusetts (31% response rate) completed the screening survey. Among respondents, 21% (23/110) had implemented a collaborative, community-based, post-overdose program with a well-defined process to connect overdose survivors and their personal networks with support services or addiction treatment services. Using data from the interviews, we identified four types of programs: (1) Multi-Disciplinary Team Visit, (2) Police Visit with Referrals, (3) Clinician Outreach, and (4) Location-Based Outreach. CONCLUSIONS: This study represents the first attempt to systematically document an emerging approach intended to connect opioid overdose survivors and their personal networks with harm reduction and addiction treatment services soon after a non-fatal overdose event. These programs have the potential to increase engagement with the social service and addiction treatment systems by those who are at elevated risk for experiencing a fatal opioid overdose.

Expanding access to naloxone for family members: The Massachusetts experience.

INTRODUCTION AND AIMS: The Massachusetts Department of Public Health Overdose Education and Naloxone Distribution Program provides overdose education and naloxone rescue kits to people at risk for overdose and bystanders, including family members. Using Massachusetts Department of Public Health data, the aims are to: (i) describe characteristics of family members who receive naloxone; (ii) identify where family members obtain naloxone; and (iii) describe characteristics of rescues by family members. DESIGN AND METHODS: We conducted a retrospective review using program enrollee information collected on a standardised form between 2008 and 2015. We calculated descriptive statistics, including demographics, current substance use, enrolment location, history of witnessed overdoses and rescue attempt characteristics. We conducted a stratified analysis comparing family members who used drugs with those who did not. RESULTS: Family members were 27% of total program enrollees (n = 10 883/40 801). Family members who reported substance use (n = 4679) were 35.6 years (mean), 50.6% female, 76.3% non-Hispanic white, 75.6% had witnessed an overdose, and they obtained naloxone most frequently at HIV prevention programs. Family members who did not report substance use (n = 6148) were 49.2 years (mean), 73.8% female, 87.9% non-Hispanic white, 35.3% had witnessed an overdose, and they obtained naloxone most frequently at community meetings. Family members were responsible for 20% (n = 860/4373) of the total rescue attempts. DISCUSSION AND CONCLUSIONS: The Massachusetts experience demonstrates that family members can be active participants in responding to the overdose epidemic by rescuing family members and others. Targeted intervention strategies for families should be included in efforts to expand overdose education and naloxone in Massachusetts.

Multiple Dimensions of Childhood Abuse and Neglect Prospectively Predict Poorer Adult Romantic Functioning.

The present study used data from the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) to investigate how multiple dimensions of childhood abuse and neglect predict romantic relationship functioning in adulthood. Several dimensions of abuse and neglect (any experience, type, chronicity, co-occurrence, and perpetrator) were rated prospectively from birth through age 17.5 years. Multimethod assessments of relational competence and violence in romantic relationships were conducted repeatedly from ages 20 to 32 years. As expected, experiencing childhood abuse and neglect was associated with lower romantic competence and more relational violence in adulthood. Follow-up analyses indicated that lower romantic competence was specifically associated with physical abuse, maternal perpetration, chronicity, and co-occurrence, whereas more relational violence was uniquely associated with nonparental perpetration. We discuss these novel prospective findings in the context of theory and research on antecedents of romantic relationship functioning.

Two Innovative Cancer Care Programs Have Potential to Reduce Utilization and Spending.

BACKGROUND: Cancer patients often present to the emergency department (ED) and hospital for symptom management, but many of these visits are avoidable and costly. OBJECTIVE: We assessed the impact of 2 Health Care Innovation Awards that used an oncology medical home model [Community Oncology Medical Home (COME HOME)] or patient navigation model [Patient Care Connect Program (PCCP)] on utilization and spending. METHODS: Participants in COME HOME and PCCP models were matched to similar comparators using propensity scores. We analyzed utilization and spending outcomes using Medicare fee-for-service claims with unadjusted and adjusted difference-in-differences models. RESULTS: In the adjusted models, both COME HOME and PCCP were associated with fewer ED visits than a comparison group (15 and 22 per 1000 patients/quarter, respectively; P<0.01). In addition, COME HOME had lower spending ($675 per patient/quarter; P<0.01), and PCCP had fewer hospitalizations (11 per 1000 patients/quarter; P<0.05), relative to the comparison group. Among patients undergoing chemotherapy, fewer COME HOME and PCCP patients had ED visits (18 and 28 per 1000 patients/quarter, respectively; P<0.01) and fewer PCCP patients had hospitalizations (13 per 1000 patients/quarter; P<0.05), than comparison patients. CONCLUSIONS: The oncology medical home and patient navigator programs both showed reductions in spending or utilization. Adoption of such programs holds promise for improving cancer care.