Trends in Contracting and Common Ownership Between Hospice Agencies and Nursing Homes.

BACKGROUND: In recent years, policymakers have paid particular attention to the emergence of a robust for-profit hospice sector and increased hospice use by nursing home residents. Previous research has explored financial incentives for nursing home-hospice use, but there has been limited research on nursing home-hospice partnerships and none on the extent of nursing home-hospice common ownership. OBJECTIVE: To describe trends in nursing home-hospice contracting and common ownership and to identify potential tradeoffs in care provided by nursing homes and hospice agencies that share common ownership. RESEARCH DESIGN: Retrospective cohort study of nursing home-hospice patients between 2005 and 2015. RESULTS: Between 2005 and 2015, the number of hospice agencies and nursing homes with common ownership grew substantially, now representing almost 1-in-5 providers in each sector. Relative to individuals using hospice in nursing homes without common ownership, adjusted analyses found that individuals receiving hospice from a commonly owned agency had a greater likelihood of having stays of 90 days or more [odds ratio (OR)=1.06; 95% confidence interval (CI), 1.02-1.10], having a stay resulting in a live discharge (OR=1.06; 95% CI, 1.02-1.11), and having at least 1 registered nurse/licensed practical nurse visit during the last 3 days of life (OR=1.17; 95% CI, 1.05-1.29); these individuals also had a lower mean visit hours per day (-0.07; P=0.003). CONCLUSIONS: Common ownership between hospice agencies and nursing homes is an emerging trend that reflects a broader push toward consolidation in the health care sector. Our analyses highlight potential concerns relevant to Medicare payment policy and are a first step toward improving our understanding of these trends and their implications.

Strategies for the Successful Implementation of a Novel iPhone Loaner System (iShare) in mHealth Interventions: Prospective Study.

BACKGROUND: As smartphone ownership continues to rise, health care systems and technology companies are driven to develop mobile health (mHealth) interventions as both diagnostic and therapeutic tools. An important consideration during mHealth intervention development is how to achieve health equity despite demographic differences in smartphone ownership. One solution is through the recirculation of loaner smartphones; however, best practices for implementing such programs to optimize security, privacy, scalability, and convenience for participants are not well defined. OBJECTIVE: In this tutorial, we describe how we implemented our novel Corrie iShare program, a 30-day loaner iPhone and smartwatch recirculation program, as part of a multi-center mHealth intervention to improve recovery and access to guideline-directed therapy following acute myocardial infarction. METHODS: We conducted a prospective study utilizing a smartphone app and leveraged iOS enterprise features as well as cellular data service to automate recirculation. RESULTS: Our configuration protocol was shortened from 1 hour to 10 minutes. Of 200 participants, 92 (46.0%) did not own an iPhone and would have been excluded from the study without iShare. Among iShare participants, 72% (66/92) returned their loaned smartphones. CONCLUSIONS: The Corrie iShare program demonstrates the potential for a sustainable and scalable mHealth loaner program, enabling broader population reach while optimizing user experience. Implementation may face institutional constraints and software limitations. Consideration should be given to optimizing loaner returns.

Trends In Public Opinion On US Gun Laws: Majorities Of Gun Owners And Non-Gun Owners Support A Range Of Measures.

Gun policy is a prominent topic of debate in the 2020 US election cycle. Tracking evolving public attitudes about gun policy is critical in this context. Using data from the National Survey of Gun Policy fielded in 2013, 2015, 2017, and 2019 by the Johns Hopkins Center for Gun Policy and Research, we examined trends in support for more than two dozen gun policies over time by gun ownership status and political party affiliation, and across states. Most policies that we considered had majority support across the study period. We identified increases in public support over time for licensing and universal background checks of handgun purchasers, stronger regulation of gun dealers, and extreme risk protection orders. Gun owners and non-gun owners were highly supportive of requiring tests to demonstrate safe handling before carrying a concealed weapon, but there were large differences in support for other concealed carry policies by gun ownership status. A new item included in the 2019 survey showed that 84 percent of Americans supported requiring first-time gun purchasers to take a safety course. While gun policy continues to be characterized as highly polemical, large majorities of both gun owners and non-gun owners strongly support a range of measures to strengthen US gun laws.

Family Firearm Ownership and Firearm-Related Mortality Among Young Children: 1976-2016.

: media-1vid110.1542/5972298231001PEDS-VA_2018-1171Video Abstract BACKGROUND: Firearm-related fatalities are a top 3 cause of death among children in the United States. Despite historical declines in firearm ownership, the firearm-related mortality rate among young children has risen over the past decade. In this study, we examined changes in firearm ownership among families with young children from 1976 to 2016, exploring how such changes relate to recent increases in firearm-related mortality among 1- to 5-year-olds. METHODS: Individual-level data from the National Vital Statistics System were merged with household-level data from the General Social Survey to create national-level estimates of firearm-related child mortality and family firearm ownership from 1976 to 2016 (n = 41 years). Vector autoregression models were used to examine the association between firearm ownership and child mortality. RESULTS: The proportion of non-Hispanic white families with young children who owned firearms declined from 50% in 1976 to 45% in 2016 and from 38% to 6% among non-Hispanic African American families. The proportion of white families with young children who owned handguns, however, increased from 25% to 32%; 72% of firearm-owning families with young children now own a handgun. Increases in handgun ownership partially explained the recent rise in firearm-related white child mortality (B = 0.426), net of economic conditions, and sociodemographic characteristics of firearm-owning families. CONCLUSIONS: Changes in the types of firearms in the homes of US families may partially explain recently rising firearm-related mortality among young white children. These findings hold relevance for pediatricians and policy makers aiming to reduce firearm-related mortality and promote firearm safety in children's homes.

Alienation from the Objectives of the Patent System: How to Remedy the Situation of Biotechnology Patent.

Some fundamental biotechnologies hold unprecedented potential to eradicate many incurable diseases. However, in absence of regulations, the power of patent makes the future use of some important biotechnology in few institution's hands. The excessive patents restrict researcher access to the fundamental technologies. It generates concerns and complaints of deteriorating the public health and social welfare. Furthermore, intellectual curiosities, funding, respect among colleagues etc., rather than patents, are the real motivations driving a major ground-breaking discoveries in biotechnology. These phenomena reveal that some biotechnology patents are alienated from the purpose of patent system. Therefore, it is necessary to take some approaches to stop over-patenting these fundamental biotechnology inventions. This article proposes a model regulatory framework for controlling biotechnology patent alienating from the purpose of patent system.

Not one Brexit: How local context and social processes influence policy analysis.

This paper develops an empirical agent-based model to assess the impacts of Brexit on Scottish cattle farms. We first identify several trends and processes among Scottish cattle farms that were ongoing before Brexit: the lack of succession, the rise of leisure farming, the trend to diversify and industrialise, and, finally, the phenomenon of the "disappearing middle", characterised by the decline of medium-sized farms and the polarization of farm sizes. We then study the potential impact of Brexit amid the local context and those ongoing social processes. We find that the impact of Brexit is indeed subject to pre-Brexit conditions. For example, whether industrialization is present locally can significantly alter the impact of Brexit. The impact of Brexit also varies by location: we find a clear divide between constituencies in the north (highland and islands), the middle (the central belt) and the south. Finally, we argue that policy analysis of Brexit should consider the heterogeneous social context and the complex social processes under which Brexit occurs. Rather than fitting the world into simple system models and ignoring the evidence when it does not fit, we need to develop policy analysis frameworks that can incorporate real world complexities, so that we can assess the impacts of major events and policy changes in a more meaningful way.

Detail-oriented visual processing style: Its role in the relationships between early life adversity and hoarding-related dysfunctions.

Early life adversity, ranging from material deprivation and parental dysfunction to abusive and life-threatening events, has been associated with hoarding symptom severity. Moreover, both victims of early life adversity and individuals with hoarding disorder have been found to have a higher tendency toward detail-oriented visual processing. This study aimed to investigate the role of detail-oriented visual processing in the relationship between early life adversity and hoarding-related dysfunction. Childhood exposure to life adversity, hoarding symptom severity, and emotional attachment to possessions, a hoarding-related dysfunction thought to be most closely related to adversity exposure, were assessed. Detail-oriented visual processing was evaluated using the Central Coherence Index, which was calculated based on the drawing process during the Rey-Osterrieth Complex Figure Test. It was found that detail-oriented visual processing was not significantly associated with hoarding symptom severity, emotional attachment to possessions, or the relationship between early life adversity and hoarding symptom severity. It did, however, act as a significant moderator in the relationship between early life adversity and emotional attachment to possessions. These findings add to the literature by identifying the role of a specific neurocognitive processing style in the mechanism through which early life adversity affects the development of a key hoarding-related dysfunction, elevated emotional attachment to possessions.

State Firearm Laws and Interstate Transfer of Guns in the USA, 2006-2016.

In a cross-sectional, panel study, we examined the relationship between state firearm laws and the extent of interstate transfer of guns, as measured by the percentage of crime guns recovered in a state and traced to an in-state source (as opposed to guns recovered in a state and traced to an out-of-state source). We used 2006-2016 data on state firearm laws obtained from a search of selected state statutes and 2006-2016 crime gun trace data from the Bureau of Alcohol, Tobacco, Firearms, and Explosives. We examined the relationship between state firearm laws and interstate transfer of guns using annual data from all 50 states during the period 2006-2016 and employing a two-way fixed effects model. The primary outcome variable was the percentage of crime guns recovered in a state that could be traced to an original point of purchase within that state as opposed to another state. The main exposure variables were eight specific state firearm laws pertaining to dealer licensing, sales restrictions, background checks, registration, prohibitors for firearm purchase, and straw purchase of guns. Four laws were independently associated with a significantly lower percentage of in-state guns: a waiting period for handgun purchase, permits required for firearm purchase, prohibition of firearm possession by people convicted of a violent misdemeanor, and a requirement for relinquishment of firearms when a person becomes disqualified from owning them. States with a higher number of gun laws had a lower percentage of traced guns to in-state dealers, with each increase of one in the total number of laws associated with a decrease of 1.6 percentage points in the proportion of recovered guns that were traced to an in-state as opposed to an out-of-state source. Based on an examination of the movement patterns of guns across states, the overall observed pattern of gun flow was out of states with weak gun laws and into states with strong gun laws. These findings indicate that certain state firearm laws are associated with a lower percentage of recovered crime guns being traced to an in-state source, suggesting reduced access to guns in states with those laws.

Loaded: Gun involvement among opioid users.

INTRODUCTION: Despite ample research examining how alcohol use relates to gun involvement, little is known about the relationship between opioids and gun involvement. In the current study, we examined correlates of gun possession, accessibility, and related behaviors in an opioid dependent sample. METHODS: Between October 2016 and April 2017, we surveyed persons entering a brief, inpatient opioid detoxification (n = 386) and 51 contemporaneous persons seeking alcohol detoxification at the same facility in Massachusetts and recorded their lifetime experiences with gun involvement. RESULTS: Participants averaged 33 years of age, 74% were male, 83% were White, and 64% had a history of incarceration. Opioid users had significantly higher rates of gun involvement than persons in alcohol detoxification; for example, 31.3% (vs. 3.9%) had carried a gun for protection, 45.1% (vs. 25.5%) had been threatened with a gun, and 13.8% (vs. 2.0%) had shot at another person. Among persons misusing opioids, male and non-White respondents, and those with a history of incarceration or poorer self-control reported greater gun involvement. CONCLUSIONS: Opioid users, both men and women, lead gun-involved lives.

The Hidden Roles That Management Partners Play In Accountable Care Organizations.

Accountable care organizations (ACOs) are often discussed and promoted as driven by physicians, hospitals, and other health care providers. However, because of the flexible nature of ACO contracts, management organizations may also become partners in ACOs. We used data from 2013-15 on 276 ACOs from the National Survey of Accountable Care Organizations to understand the prevalence of nonprovider management partners' involvement in ACOs, the services these partners provide, and the structure of ACOs that have such partners. We found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards. Among ACOs with partners, 94 percent had data services provided by the partner, 87 percent received administrative services, 68 percent received educational services, and 66 percent received care coordination services. Half received all four of these services from their partner. ACOs with partners were more heavily primary care than other ACOs. ACOs with and without partners had similar performance on costs and quality in Medicare ACO programs. Our findings suggest that management partners play a central role in many ACOs, perhaps supplying smaller and physician-run ACOs with services or expertise perceived as necessary for ACO success.

[The ownership of genetic data: from data to information]. / La propriété des données génétiques - De la donnéeà l'information.

In France, genetic data are not covered by property laws. They are considered to be equivalent to a part of the human body, to be protected rather than as something of economic value. However, in this highly competitive world, France must find solutions to increase the scientific and economic values of its genetic data. One possibility would be to define genetic data as raw information with no value for use. The choice of such a value of use (clinical, scientific, economic, etc.), following various key analysis and treatment processes will thus transform genetic data into useful information. In this case, and under certain conditions, intellectual property law could consider this information to be an original creation with an economic value, whilst maintaining current levels of protection for genetic data. France thus faces a choice between changing its laws concerning the protection of genetic data, bringing them into line with the North American approach, according to which data are a form of capital that everyone has the right to increase or sell, and making the distinction between genetic data and information clearer.

Hospital Ownership of Physicians: Hospital Versus Physician Perspectives.

Although there has been significant interest from health services researchers and policy makers about recent trends in hospitals' ownership of physician practices, few studies have investigated the strengths and weaknesses of available data sources. In this article, we compare results from two national surveys that have been used to assess ownership patterns, one of hospitals (the American Hospital Association survey) and one of physicians (the SK&A survey). We find some areas of agreement, but also some disagreement, between the two surveys. We conclude that full understanding of the causes and consequences of hospital ownership of physicians requires data collected at the both the hospital and the physician level. The appropriate measure of integration depends on the research question being investigated.

2017 ACR Annual Meeting Open-Microphone Session: Navigating the Landscape of Changing Practice Models: Private Practice, Corporate Radiology, and Enterprise Systems.

Many practice groups are considering adopting new practice models, primarily to secure their practices by adapting to new payment models, government compliance and regulation, and increasing IT and infrastructure costs. As we move toward value-based care and capitation, the value equation (value = quality/cost) will lead us to also compete on cost to improve value. No matter what payment models ultimately dominate, we need to be prepared to lead in a value-based care environment. Measures of value will either be defined by radiologists or imposed by outside entities. It is critical to our continued success that practices and practice leaders continue to fully and strongly support the ACR to avoid the possibility of a decline in membership that may accompany a lack of practice engagement. Consolidation appears inevitable, but with the help of the ACR, radiologists should have a vibrant future if investments are made now in determining appropriate radiology-specific value measures that are meaningful in consolidated health care environments.

Progress in coverage of bed net ownership and use in Burkina Faso 2003-2014: evidence from population-based surveys.

BACKGROUND: Use of insecticide-treated bed nets (ITNs) is the cornerstone of malaria prevention. In 2010 and 2013, the Burkina Faso Government launched mass distribution campaigns of ITNs to increase coverage of ownership and use in the country. This study assessed the progress towards universal bed net coverage in Burkina Faso. METHODS: The authors used data from the Burkina Faso 2003 and 2010 Demographic and Health Surveys (DHS), the 2006 Multiple Indicator Cluster Surveys (MICS) and the 2014 Malaria Indicator Survey (MIS). For each survey, the authors computed key malaria prevention indicators in line with recommendations from the Survey and Indicator Task Force of the Roll Back Malaria Monitoring and Evaluation Reference Group. The trends over a decade was assessed by calculating percentage point change between 2003 and 2014. RESULTS: At national level, the proportion of households owning at least one ITN increased substantially from 5.6, 95% CI (4.7, 6.5%) in 2003 to 89.9% (88.5, 91.2%) in 2014, with low heterogeneity between regions. The proportion of households owning at least one ITN per two people increased significantly from 1.8% (1.4, 2.3%) in 2003 to 49.2% (47.3, 51.0%) in 2014. ITN use in the general population increased from 2.0% (1.6, 2.3%) in 2003, to 67.0% (65.3, 68.7%) in 2014. A similar trend was observed among children under the age of  five years, increasing from 1.9% (1.5, 2.4%) in 2003 to 75.2% (73.2, 77.3%) in 2014, and among pregnant women, increasing from 3.0% (1.9, 4.2%) in 2003 to 77.1% (72.9, 81.3%) in 2014. The intra-household ownership gap was 67.0% (61.5, 72.4%) in 2003, but decreased significantly to 45.3% (43.6, 47.1%) in 2014. The behavioural gap, which was relatively low in 2013 with only 20.0% of people who had access to an ITN but were not using it, further decreased to 5.9% in 2014. CONCLUSION: Burkina Faso made considerable progress in coverage of ITN ownership, access and use between 2003 and 2014, as a result of the two free mass distribution campaigns in 2010 and 2013. However, ITN coverage remains below the national targets of 100% for ownership and 80% for use. The results of 90% of ownership and 67% of use confirm that free mass distribution campaigns of ITNs are effective; however, there is room for improvement to reach and maintain optimal coverage of ITN ownership and use.

Firearm-Related Laws in All 50 US States, 1991-2016.

OBJECTIVES: To describe a new database containing detailed annual information on firearm-related laws in place in each of the 50 US states from 1991 to 2016 and to summarize key trends in firearm-related laws during this time period. METHODS: Using Thomson Reuters Westlaw data to access historical state statutes and session laws, we developed a database indicating the presence or absence of each of 133 provisions of firearm laws in each state over the 26-year period. These provisions covered 14 aspects of state policies, including regulation of the process by which firearm transfers take place, ammunition, firearm possession, firearm storage, firearm trafficking, and liability of firearm manufacturers. RESULTS: An examination of trends in state firearm laws via this database revealed that although the number of laws nearly doubled during the study period, there was substantial heterogeneity across states, leading to a widening disparity in the number of firearm laws. CONCLUSIONS: This database can help advance firearm policy research by providing 26 years of comprehensive policy data that will allow longitudinal panel study designs that minimize the limitations present in many previous studies.

Analysis of Factors Relating to Companion Rabbits Relinquished to Two United Kingdom Rehoming Centers.

Rabbits are a common companion animal in the United Kingdom, and some reports have suggested that large numbers are relinquished to rehoming centers each year. This study aimed to investigate the characteristics of rabbits relinquished to 2 UK rehoming centers and explore reasons given for relinquishment. The centers contributed data for all rabbits who entered their center during 2013 (n = 205). Most rabbits (59.5%) were relinquished by a guardian. Similar numbers of males and females were relinquished, and a larger number of rabbits were not neutered (72.4%) and adults (56%). Most rabbits were healthy on arrival (61.5%). The most common reasons for relinquishment were: "too many rabbits/unplanned litters" (30.3%) and "housing problems" (23.8%). Rabbit-related reasons accounted for 12.2% of rabbits relinquished. Reasons for relinquishment were associated with 1 of the recorded rabbit characteristics. Further detailed studies are needed to explore the dynamics of companion rabbit ownership and factors that affect the breakdown of rabbit-guardian relationships in the United Kingdom.

The shifting dynamics of social roles and project ownership over the lifecycle of a community-based participatory research project.

Background: . Community based participatory research (CBPR) is often initiated by academic researchers, yet relies on meaningful community engagement and ownership to have lasting impact. Little is understood about how ownership shifts from academic to community partners. Objectives: . We examined a CBPR project over its life course and asked: what does the evolution of ownership look like from project initiation by an academic (non-community) champion (T1); to maturation-when the intervention is ready to be deployed (T2); to independence-the time when the original champion steps aside (T3); and finally, to its maintenance-when the community has had an opportunity to function independently of the original academic champion (T4)? Methods: . Using sociometric (whole network) social network analysis, knowledge leadership was measured using 'in-degree centrality'. Stakeholder network structure was measured using 'centralisation' and 'core-periphery analysis'. Friedman rank sum test was used to measure change in actor roles over time from T1 to T4. Results: . Project stakeholder roles were observed to shift significantly (P < 0.005) from initiation (T1) to project maintenance (T4). Community stakeholders emerged into positions of knowledge leadership, while the roles of academic partners diminished in importance. The overall stakeholder network demonstrated a structural shift towards a core of densely interacting community stakeholders. Conclusion: . This was the first study to use Social network analysis to document a shift in ownership from academic to community partners, indicating community self-determination over the research process. Further analysis of qualitative data will determine which participatory actions or strategies were responsible for this observed change.