The impact of COVID-19 on service delivery systems: evidence from a survey of United States refugee resettlement agencies.

BACKGROUND: Key to the US refugee resettlement effort is the role of non-governmental organizations (NGOs) who receive, place, and provide transitional programs and referrals to new and recently resettled refugees. Yet only one rapid assessment study thus far examined the impact of COVID-19 on service delivery systems of US refugee resettlement agencies. This exploratory study describes the capability and preparedness of US refugee resettlement agencies to provide services and care to clients during the COVID-19 pandemic. METHODS: Using both telephone interviews and an internet survey, we assessed the impact of COVID-19 on service delivery, agency capacity, and preparedness of 101 US refugee resettlement agencies. Descriptive statistics were used to describe the dataset, while chi-square (χ2) tests were used to examine relationships by resettlement agency size (number of employees in each agency). RESULTS: Despite a temporary pause on refugee admissions, restrictive stay-at-home orders, and refugee travel restrictions, the majority of responding US refugee resettlement agencies continued to provide specialized services and care to resettled refugees and other immigrants. Among the more important findings was that agencies that continued to provide refugee services and care onsite in their existing facilities or office rather than moving such services offsite differed by agency size [χ2 (9.494, n = 101), p < 0.05]. Almost all agencies (93.1%) strongly agreed or agreed that staff have timely access to COVID-19 information. Most of the refugee services were provided offsite (n = 72 agencies, some with multiple offices across the US). CONCLUSIONS: US refugee resettlement agencies continued to perform admirably despite a lack of funding. Future research is underway to obtain a more balanced understanding of the impact of COVID-19 on practice or operations.

Fighting mosquito bite during a crisis: capabilities of Florida mosquito control districts during the COVID-19 pandemic.

BACKGROUND: The stay-at-home orders imposed in early April 2020 due to the COVID-19 pandemic in various states complicated mosquito control activities across the United States (US), and Florida was no exception. Mosquito control programs are the first line of defense against mosquito-borne pathogens. The purpose of this study was to examine the capabilities of Florida mosquito programs to implement key mosquito measures during the COVID-19 pandemic lockdown. METHODS: Using a self-administered online survey, we examined the capabilities of all Florida mosquito control programs (both state-approved mosquito districts, N = 63; and open programs, N = 27) at a time when the state of Florida was still under heightened awareness of, stay-at-home orders and planning a phase 1 reopening over the COVID-19 pandemic (June to July 2020). The final sample included mosquito control programs structured as the Board of County Commissioners (BOCC) (n = 42), independent tax district (n = 16), municipal (n = 10), and health or emergency department (n = 5). We used descriptive statistics to summarize information about the characteristics of responding programs, their implemented mosquito control and surveillance activities.  wWe used bivariate analysis to compare the characteristics of responding programs and the self-reported mosquito measures. RESULTS: Of the recruited mosquito control programs, 73 completed the survey (81.1% response rate; 73/90). Of these, 57.5% (n = 42) were Board of County Commissioners (BOCC) mosquito control programs, 21.9% (n = 16) were independent tax district programs, 13.7% (n = 10) were municipal mosquito control programs, and only 6.8% (n = 5) were either health or emergency department mosquito control programs. Except for arbovirus surveillance, most programs either fully or partially performed larval (61.8%) and adult (78.9%) surveillance; most programs conducted species-specific control for Aedes aegypti (85.2%, n = 54), Aedes albopictus (87.3%, n = 55), Culex quinquefasciatus (92.1%, n = 58), and Culex nigripalpus (91.9%, n = 57). CONCLUSIONS: Findings underscore the importance of ongoing mosquito control activities, and suggest that Florida mosquito control programs are vigilant and have significant capability to handle potential mosquito-borne disease threats, but arbovirus surveillance systems (laboratory testing of mosquito pools and testing of human and nonhuman specimens for arboviruses) are needed during pandemics as well.

Reducing Emergency Department Visits Among Dual Eligible Patients via a Comprehensive Wellness Assessment.

The objective was to assess whether a Comprehensive Wellness Assessment (CWA) is associated with reduced emergency department (ED) visits for Special Needs Program (SNP) enrollees with diabetes. This retrospective panel study used a Medicare Advantage plan's administrative claims data for 2010-2017 and pooled member-month observations. Multivariate regression and individual fixed-effects regression models were estimated. The outcome was ED visits measured as binary and continuous outcomes. Data were derived from claims data that included at least 1 ICD-9 or 10 code between January 2010 and December 2017. Regression results indicated that SNP enrollees completing a CWA was associated with a lower probability of any monthly ED use (ß = -0.005, t-stat = -2.98) and fewer monthly visits (ß = -0.008, t-stat = -2.95). Individual fixed-effects models also demonstrated a significant decline in SNP ED use after a CWA, though the strongest effects were confined to the first 4 months after a CWA. Care models with components such as CWAs may contribute an additional benefit in the form of a reduction in ED utilization. Completing a CWA appears to be effective in reducing ED utilization among SNP members with diabetes.

The Effectiveness of a Comprehensive Wellness Assessment on Medication Adherence in a Medicare Advantage Plan Diabetic Population.

EXECUTIVE SUMMARY: The issue of medication nonadherence has generated significant interest because of its complexity from both cost and outcomes perspectives. Of the 3.2 billion prescriptions written annually in the United States, estimates indicate that half are not taken as prescribed, especially among patients with asymptomatic chronic conditions. The objective of this study was to assess whether a comprehensive wellness assessment (CWA) program helps improve medication adherence for oral diabetic medications, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARBs) in a Medicare Advantage (MA) plan diabetic population. The Centers for Medicare & Medicaid Services includes these medications among its triple-weighted measures.The researchers used a retrospective panel study employing administrative claims data and member month-level enrollment data for members who were newly diagnosed with diabetes since 2010, allowing for up to 5 years of follow-up. The treatment variable of interest was whether the enrollee had undergone a CWA in the 12 months prior to the study. Results for the full sample show that a CWA visit in the prior 12 months is significantly associated with increased adherence to statin medication (incidence rate ratio [IRR]: 1.022, t-test: 2.51) and oral diabetes medication (IRR: 1.032, t-test: 3.00), but it is not significantly associated with adherence to ACE/ARB medication (IRR: 1.009, t-test: 1.09). Results vary considerably in subsamples stratified by dual Medicare and Medicaid eligibility status, presence of certain chronic conditions, and age. CWAs are most beneficial when targeted toward dual-eligible members or members younger than 65. On the basis of these findings, improving medication adherence by targeting CWA visits to certain MA member subcategories may be more cost-effective than using CWAs for the full MA membership.

Chronic Conditions and Self-Reported Health in a Medicare Advantage Plan Population.

Self-reported changes in physical and mental health by members are an important dimension by which the quality of a Medicare Advantage (MA) plan is rated by the Centers for Medicare & Medicaid Services. To better target their interventions, MA plans need a better understanding of what observed characteristics-including clinical health conditions-predict self-reported changes in physical and mental health. This study explored how one MA plan's survey of participants' responses regarding changes in physical and mental health is associated with a set of chronic conditions as well as sociodemographic characteristics. Multinomial logistic regressions were used to examine the influence of 9 chronic conditions and age, sex, race, education, dual eligibility status (Medicare/Medicaid eligible), marital and living status, and assistance with survey completion on changes in patient-reported physical and mental health. Six conditions-dementia (P < 0.001), diabetes (P = 0.003), congestive heart failure (P = 0.002), cerebrovascular disease (P = 0.001), coronary artery disease (CAD) (P < 0.001), and rheumatoid arthritis (P < 0.001)-were associated with self-reported worsening of overall physical health. Four conditions-dementia (P < 0.002), diabetes (P = 0.047), CAD (P = 0.001), and decubitus ulcers (P = 0.033)-were associated with self-reported worsening of overall mental health. Females, married respondents, and those needing assistance with survey completion were more likely to report worsening of their mental health. Enrollees older than age 65 actually were less likely to report worsening of overall mental health. Findings provide insight into which members may be more susceptible to reporting that their physical or mental health is worsening.

Improvement in Oral Diabetes Medication Adherence after a Comprehensive Wellness Assessment in a Dual Eligible Population.

Medication adherence is often lower among disadvantaged patients. Drivers of medication adherence may include the quality of communications between patient and medical caregiver. The research objective is to assess whether an annual Comprehensive Wellness Assessment (CWA) is associated with improved medication adherence. The CWA targeted primarily dual eligible Special Needs Plan (SNP) enrollees in a Medicare Advantage plan. This retrospective panel study used administrative claims data and member-month level data for members who were newly diagnosed with diabetes in 2010, allowing for up to 5 years of follow-up. The intervention of interest is whether the member received a CWA in the past 12 months. Multivariate regression models were estimated using pooled member-month data and a difference-in-difference type approach to assess whether CWA visits improve oral diabetes medication (ODM) adherence among SNP enrollees. Twenty-six percent of pooled member-month observations are from SNP enrollees. Average monthly ODM adherence is 77.5%. Approximately 31% of SNP enrollees had a CWA in the last 12 months, compared to 5% of regular enrollees. Regression results show SNP enrollees with a CWA on average had higher monthly adherence by 3.9 percentage points (P < 0.01), and were 7% more likely to meet the threshold of at least 80% adherence (P < 0.01). Adherence is even higher for the subsample of African American SNP enrollees with CWA. CWA appears to be effective in improving ODM adherence among SNP patients. Care models with components like wellness assessments that include medication review and education may improve medication adherence as well as Medicare Advantage plan star ratings.

The Influence of Respondent Characteristics on the Validity of Self-Reported Survey Responses.

OBJECTIVE: To examine concordance between member self-reports and the organization's administrative claims data for two key health factors: number of chronic conditions, and number of prescription drugs. DATA: Medicare Advantage plan claims data and member survey data from 2011 to 2012. DESIGN: Mailed surveys to 15,000 members, enrolled minimum 6 months, drawn from a random sample of primary care physician practices with at least 200 members. METHODS: Descriptive statistics were generated for extent of concordance. Multivariable logistic regressions were used to analyze the association of selected respondent characteristics with likelihood of concordance. FINDINGS: Concordance for number of chronic conditions was 58.4 percent, with 27.3 percent under-reporting, 14.2 percent over-reporting. Concordance for number of prescription drugs was 56.6 percent with 38.9 percent under-reporting, 4.5 percent over-reporting. Number of prescriptions and assistance in survey completion were associated with higher likelihood of concordance for chronic conditions. Assistance in survey completion and number of chronic conditions were associated with higher concordance, and age and number of prescriptions were associated with lower concordance, for prescription drugs. CONCLUSIONS: Self-reported number of chronic conditions and prescription medications are not in high concordance with claims data. Health care researchers and policy makers using patient self-reported data should be aware of these potential biases.

Applying activity-based costing to the nuclear medicine unit.

Previous studies have shown the feasibility of using activity-based costing (ABC) in hospital environments. However, many of these studies discuss the general applications of ABC in health-care organizations. This research explores the potential application of ABC to the nuclear medicine unit (NMU) at a teaching hospital. The finding indicates that the current cost averages 236.11 US dollars for all procedures, which is quite different from the costs computed by using ABC. The difference is most significant with positron emission tomography scan, 463 US dollars (an increase of 96%), as well as bone scan and thyroid scan, 114 US dollars (a decrease of 52%). The result of ABC analysis demonstrates that the operational time (machine time and direct labour time) and the cost of drugs have the most influence on cost per procedure. Clearly, to reduce the cost per procedure for the NMU, the reduction in operational time and cost of drugs should be analysed. The result also indicates that ABC can be used to improve resource allocation and management. It can be an important aid in making management decisions, particularly for improving pricing practices by making costing more accurate. It also facilitates the identification of underutilized resources and related costs, leading to cost reduction. The ABC system will also help hospitals control costs, improve the quality and efficiency of the care they provide, and manage their resources better.

DRG-based cost minimization models: applications in a hospital environment.

The primary objective of this article is to investigate the feasibility of the application of cost minimization analysis in a teaching hospital environment. The investigation is concerned with the development of cost per admission and cost per patient day models. These models are further used for determining the value of the length of stay that would minimize cost per patient day (projected length of stay) and for estimating the costs. This study is based on total of 94,500 observations (1999 and 2000), obtained from a teaching hospital in South Florida. The top ten Diagnosis Related Groups (DRGs) with the highest volume are selected and classified into four insurance categories: Medicaid, Medicare, commercial, and self-pay. The cost models are fitted to the data for an average R2 value of 79%, and a MAPE value of 15%. The result demonstrates that if a hospital can control the length of stay at the projected level, on average, the cost per admission and the cost per patient day will decrease. Based on 6,367 admissions for the selected DRGs in 2000, the total cost per year and the cost per patient day decreased by approximately 11.58 and 10.35%, respectively. Overall, these results confirm that the concept of cost minimization analysis in economic theory can be applied to healthcare industries for the purpose of reducing of costs. In addition, this research offers a decision support instrument for healthcare administrators.

Decision latitude and workload demand: implications for full and partial absenteeism.

This research examined the relative importance of two components of job stress--decision latitude and workload demand--on employee absenteeism. The analysis was based on confidential self-reported data from employees at two worksites, which were collected in three independent cross-sections beginning in 1995. The negative binomial technique was used to estimate the effects of decision latitude and workload demand on employee attendance, while controlling for employee demographics and other workplace characteristics. Estimation results show that high decision latitude was negatively and significantly related to number of full days absent from work (full absenteeism) and number of days arriving late to work or leaving work early (partial absenteeism). Conversely, the coefficient estimates for low decision latitude were positive in every model and significantly related to partial absenteeism. Low workload demand was negatively and significantly related to partial absenteeism, but not full days absent. The interaction effects of decision latitude and workload demand on absenteeism were not statistically significant. Several recent studies have estimated a significant relationship between decision latitude, workload demand, and medical problems such as cardiovascular disease. The current findings suggest that decision latitude and workload demand are also related to workplace attendance. Employers and occupational hygienists should consider decision latitude and workload demand as a means to improve workplace productivity and employee health.