Meals On Wheels Clients: Measurable Differences In The Likelihood Of Aging In Place Or Being Hospitalized.

Little is known about how participation in home-delivered meal programs (known as Meals on Wheels), financed in part through the Older Americans Act, relates to the use of health services and the ability to age in place for elder Medicare beneficiaries. Using 2013-20 data from the National Health and Aging Trends Study, we evaluated the relationship between Meals on Wheels use and two outcomes-likelihood of continued community residence and risk for hospitalization-in the following year for Medicare beneficiaries ages sixty-five and older, overall and by gender, race, Medicaid enrollment, and frailty. Overall, Meals on Wheels users and nonusers were equally likely to still reside in the community one year later; however, continued community residence was more likely among users than nonusers who were Black, were enrolled in Medicaid, or were frail. Program use was marginally associated with increased likelihood of hospitalization in the following year overall, but more strongly so among frail users. Our findings are consistent with the heterogeneity of Medicare-age Meals on Wheels users nationwide and suggest that program benefits differ among specific populations.

Philanthropic Strategy In The Face Of An Opioid Epidemic.

Since 2008 Interact for Health, a foundation, has worked to address the opioid epidemic in Cincinnati, Ohio, which has been particularly affected. This article shares the evolution of the foundation's ongoing work on the crisis, starting as the region's first funder to dedicate significant financial and staff resources to combating the problem. The article covers funding strategy, outcomes, lessons learned from 2008 to 2018, and future plans.

Estimating the Prevalence of Opioid use Disorder in the Cincinnati Region using Probabilistic Multiplier Methods and Model Averaging.

BACKGROUND: Opioid use disorder (OUD) and its consequences have strained the resources of health, social, and criminal justice services in the Cincinnati region. However, understanding of the potential number of people suffering from OUD is limited. Little robust and reliable information quantifies the prevalence and there is often great variation between individual estimates of prevalence. In other fields such as meteorology, finance, sports, and politics, model averaging is commonly employed to improve estimates and forecasts. The objective of this study was to apply a model averaging approach to estimate the number of individuals with OUD in the Cincinnati region. METHODS: Three individual probabilistic simulation models were developed to estimate the number of OUD individuals in the Cincinnati Core Based Statistical Area (CBSA). The models used counts of overdose deaths, non-fatal overdoses, and treatment admissions as benchmark data. A systematic literature review was performed to obtain the multiplier data for each model. The three models were averaged to generate single estimate and confidence band of the prevalence of OUD. RESULTS: This study estimated 15 067 (SE 1556) individuals with OUD in the Cincinnati CBSA (2 165 139 total population). Based on these results, we estimate the prevalence of OUD to be between 13 507 (0.62% of population) and 16 620 (0.77% of population). CONCLUSIONS: The method proposed herein has been shown in diverse fields to mitigate some of the uncertainty associated with reliance on a single model. Further, the simplicity of the method described is easily replicable by community health centers, first-responders, and social services to estimate capacity needs supported by OUD estimates for the region they serve.

Congruence of Patient Self-Rating of Health with Family Physician Ratings.

BACKGROUND: A single self-rated health (SRH) question is associated with health outcomes, but agreement between SRH and physician-rated patient health (PRPH) has been poorly studied. We studied patient and physician reasoning for health ratings and the role played by patient lifestyle and objective health measures in the congruence between SRH and PRPH. METHODS: Surveys of established family medicine patients and their physicians, and medical record review at 4 offices. Patients and physicians rated patient health on a 5-point scale and gave reasons for the rating and suggestions for improving health. Patients' and physicians' reasons for ratings and improvement suggestions were coded into taxonomies developed from the data. Bivariate relationships between the variables and the difference between SRH and PRPH were examined and all single predictors of the difference were entered into a multivariable regression model. RESULTS: Surveys were completed by 506 patients and 33 physicians. SRH and PRPH ratings matched exactly for 38% of the patient-physician dyads. Variables associated with SRH being lower than PRPH were higher patient body mass index (P = .01), seeing the physician previously (P = .04), older age, (P < .001), and a higher comorbidity score (P = .001). Only 25.7% of the dyad reasons for health status rating and 24.1% of needed improvements matched, and these matches were unrelated to SRH/PRPH agreement. Physicians focused on disease in their reasoning for most patients, whereas patients with excellent or very good SRH focused on feeling well. CONCLUSIONS: Patients' and physicians' beliefs about patient health frequently lack agreement, confirming the need for shared decision making with patients.

School-Based Health Centers: A Funder's View Of Effective Grant Making.

Health status and academic achievement have been found to be linked: When students have poor health status, they are at increased risk for poor academic outcomes. The school-based health center is a delivery model that supports improved access to health care, as well as healthy behaviors and outcomes, for students. Interact for Health is a private foundation that has provided funding to open school-based health centers in the Greater Cincinnati, Ohio, area since 1999. This article outlines grant-making strategies and effective policies that the foundation has identified as most conducive to creating sustainable school-based health centers. These include identification of the right partners, development of a business plan, and guidelines and policies that support long-term financial sustainability.

Public Opinions Regarding Advanced Dental Hygiene Practitioners in a High-Need State.

Purpose: The new Advanced Dental Hygiene Practitioner (ADHP) profession is expected to increase access to oral health care for the general population, particularly in rural and underserved areas. In order for this strategy to be successful, the public must feel comfortable with the care provided by ADHPs and seek out their services, yet consumer receptivity has been overlooked in the literature. The current study explores comfort with ADHPs for one high-need state: Kentucky.Methods: Consumer receptivity to the ADHP was assessed using a large, random sample telephone survey. As a point of comparison, respondents were first asked about their comfort with care provided by two other advanced practice clinicians already licensed in the state: advanced practice registered nurses (APRN) and physician assistants (PA).Results: After hearing a brief description of the profession, nearly 3 in 4 Kentucky adults said they would be somewhat (35.4%) or very (38.2%) comfortable seeing an ADHP for routine dental care. The total proportion of Kentucky adults who were comfortable seeking care from an ADHP (73.6%) was slightly less than the proportion indicating comfort seeing an APRN (79.7%) or PA (81.3%).Conclusion: Overall, this study demonstrates that adults are receptive to new models of care delivery and report high levels of comfort with ADHPs. Consumer concerns are unlikely to be a barrier to expanded licensure for dental hygienists in high-need areas like Kentucky.

For two regional health foundations, returns from the Kentucky Health Issues Poll are worth the investments.

With finite resources to advance their missions, regional health foundations should critically evaluate the investments they make. This article reviews the costs and associated benefits of large-scale public opinion polling--specifically, the annual Kentucky Health Issues Poll, which is sponsored by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati. In addition to the information generated by the poll, the sponsoring foundations have benefited from increased name recognition and credibility with key stakeholders, including state policy makers and the media. Furthermore, jointly funding the poll has strengthened the relationship between the sponsoring foundations and has fostered other key collaborations. We find that the benefits from this poll more than justify its modest costs ($120,000 per year) and hope that this assessment may prove informative for other funders considering similar investments.