Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24.487
Filtrar
1.
N C Med J ; 81(6): 389-393, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139472

RESUMO

The Patient Protection and Affordable Care Act has resulted in benefits for North Carolina hospitals and the patients they serve. The impact of the ACA is not as great as it might have been due to lack of Medicaid expansion and exigent challenges at the state and local level.


Assuntos
Hospitais , Patient Protection and Affordable Care Act , Humanos , Governo Local , Medicaid/organização & administração , North Carolina , Governo Estadual , Estados Unidos
2.
Pediatr Dent ; 42(5): 380-386, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-33087223

RESUMO

Purpose: To evaluate dentists' perspectives on the Medicaid program and explore hypothetical changes that could lead to increased participation. Methods: A 26-item questionnaire assessing demographics, practice profile, attitudes towards the Medicaid program and hypothetical scenarios to increase participation was administered to general and pediatric dentists. Results: A total of 165 surveys were completed; 50.6 percent of respondents indicated they were not Medicaid participating providers. Pediatric dentists were more likely than general dentists to be participating in Medicaid and willing to participate in the future, 35.5 percent vs. 23.2 percent respectively. A 68 percent increase in fees would yield the highest level of participation with 58.4 percent of participants responding they would treat at least 16 additional children per week. Pediatric versus general dentists would be more likely to participate in Medicaid with more modest raises, i.e. 30-44 percent range. Low compensation by Medicaid (weighted average of 4.77) was the greatest barrier indicated by all participants. Hispanic dentists had greater odds of participating in Medicaid than non-Hispanic dentists. Dentists who were 'employees' had a greater odds of participating in Medicaid than a 'solo owner of a practice'. Conclusion: Increased participation in Medicaid would require a combination of meaningful increases in reimbursement rates, loan forgiveness programs and tax credits.


Assuntos
Odontólogos , Medicaid , Criança , Honorários e Preços , Florida , Humanos , Inquéritos e Questionários , Estados Unidos
4.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33000953

RESUMO

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Assuntos
Tomada de Decisão Compartilhada , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Neoplasias Pulmonares/diagnóstico , Fumar/etnologia , Definição da Elegibilidade , Grupos Étnicos/estatística & dados numéricos , Custos de Cuidados de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Cobertura do Seguro , Marketing de Serviços de Saúde/métodos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Sexuais , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Classe Social , Estados Unidos
5.
PLoS One ; 15(10): e0240080, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33022013

RESUMO

The global COVID-19 pandemic is causing unprecedented job loss and financial strain. It is unclear how those most directly experiencing economic impacts may seek assistance from disparate safety net programs. To identify self-reported economic hardship and enrollment in major safety net programs before and early in the COVID-19 pandemic, we compared individuals with COVID-19 related employment or earnings reduction with other individuals. We created a set of questions related to COVID-19 economic impact that was added to a cross-sectional, nationally representative online survey of American adults (age ≥18, English-speaking) in the AmeriSpeak panel fielded from April 23-27, 2020. All analyses were weighted to account for survey non-response and known oversampling probabilities. We calculated unadjusted bivariate differences, comparing people with and without COVID-19 employment and earnings reductions with other individuals. Our study looked primarily at awareness and enrollment in seven major safety net programs before and since the pandemic (Medicaid, health insurance marketplaces/exchanges, unemployment insurance, food pantries/free meals, housing/renters assistance, SNAP, and TANF). Overall, 28.1% of all individuals experienced an employment reduction (job loss or reduced earnings). Prior to the pandemic, 39.0% of the sample was enrolled in ≥1 safety net program, and 50.0% of individuals who subsequently experienced COVID-19 employment reduction were enrolled in at least one safety net program. Those who experienced COVID-19 employment reduction versus those who did not were significantly more likely to have applied or enrolled in ≥1 program (45.9% versus 11.7%, p<0.001) and also significantly more likely to specifically have enrolled in unemployment insurance (29.4% versus 5.4%, p < .001) and SNAP (16.8% versus 2.8%, p = 0.028). The economic devastation from COVID-19 increases the importance of a robust safety net.


Assuntos
Betacoronavirus , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Trocas de Seguro de Saúde , Acesso aos Serviços de Saúde , Medicaid , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Provedores de Redes de Segurança , Adolescente , Adulto , Infecções por Coronavirus/virologia , Estudos Transversais , Características da Família , Feminino , Assistência Alimentar , Habitação/economia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Inquéritos e Questionários , Desemprego , Estados Unidos/epidemiologia , Adulto Jovem
6.
Health Aff (Millwood) ; 39(10): 1743-1751, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33017236

RESUMO

Expansion of Medicaid and establishment of the Children's Health Insurance Program (CHIP) represent a significant success story in the national effort to guarantee health insurance for children. That success is reflected in the high rates of coverage and health care access achieved for children, including those in low-income families. But significant coverage gaps remain-gaps that have been increasing since 2016 and are likely to accelerate with the coronavirus disease 2019 (COVID-19) pandemic and the associated recession. Using National Health Interview Survey data, we found that the proportion of uninsured children was 5.5 percent in 2018. Children continue to face coverage interruptions, and Latino, adolescent, and noncitizen children continue to face elevated risks of being uninsured. Although we note the benefits of a universal, federally financed, single-payer approach to coverage, we also offer two possible reform pathways that can take place within the current multipayer system, aimed at ensuring coverage, access, continuity, and comprehensiveness to move the nation closer to the goal of providing the health care that children need to reach their full potential and to reduce racial and economic inequalities.


Assuntos
Serviços de Saúde da Criança/economia , Saúde da Criança , Children's Health Insurance Program/economia , Disparidades em Assistência à Saúde/economia , Cobertura do Seguro/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Medicaid/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/economia , Pandemias/estatística & dados numéricos , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pobreza , Fatores Socioeconômicos , Estados Unidos
7.
Health Aff (Millwood) ; 39(10): 1752-1761, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33017237

RESUMO

Safety-net programs improve health for low-income children over the short and long term. In September 2018 the Trump administration announced its intention to change the guidance on how to identify a potential "public charge," defined as a noncitizen primarily dependent on the government for subsistence. After this change, immigrants' applications for permanent residence could be denied for using a broader range of safety-net programs. We investigated whether the announced public charge rule affected the share of children enrolled in Medicaid, the Supplemental Nutrition Assistance Program, and the Special Supplemental Nutrition Program for Women, Infants, and Children, using county-level data. Results show that a 1-percentage-point increase in a county's noncitizen share was associated with a 0.1-percentage-point reduction in child Medicaid use. Applied nationwide, this implies a decline in coverage of 260,000 children. The public charge rule was adopted in February 2020, just before the coronavirus disease 2019 (COVID-19) pandemic began in the US. These results suggest that the Trump administration's public charge announcement could have led to many thousands of eligible, low-income children failing to receive safety-net support during a severe health and economic crisis.


Assuntos
Serviços de Saúde da Criança/organização & administração , Infecções por Coronavirus/prevenção & controle , Assistência Alimentar/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Medicaid/economia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pobreza/estatística & dados numéricos , Adolescente , Criança , Saúde da Criança , Pré-Escolar , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais , Medo , Feminino , Política de Saúde/legislação & jurisprudência , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Inovação Organizacional , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Formulação de Políticas , Estudos Retrospectivos , Provedores de Redes de Segurança/organização & administração , Estados Unidos
8.
JAMA Netw Open ; 3(9): e2015470, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32876682

RESUMO

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Design, Setting, and Participants: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Exposures: Hospital referral to home health care. Main Outcomes and Measures: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Results: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Conclusions and Relevance: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Encaminhamento e Consulta , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare , Medicare Part C , Alta do Paciente , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Estados Unidos
9.
10.
Sr Care Pharm ; 35(10): 408-412, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32972490

RESUMO

As America works towards more inclusive practices in aged care, we are learning more about how racial and ethnic disparities affect this sector. Furthermore, research has allowed for a more complete understanding of how wealth disparities along racial lines re-enforce gaps in access to care. A 2017 report from the Board of Governors of the Federal Reserve System illustrates this clearly. It finds that the mean net worth of White Americans was $933,700, compared to the $138,200 mean net worth of Black Americans. These numbers include adults over age 65 and the families that may assist them in covering their health expenses. Thus, these wealth disparities have profound implications in access to long-term care.


Assuntos
Medicaid , Grupos de Populações Continentais , Grupo com Ancestrais do Continente Europeu , Hispano-Americanos , Humanos , Assistência de Longa Duração , Estados Unidos
11.
Ann Surg ; 272(4): 548-553, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32932304

RESUMO

OBJECTIVE: Patients may call urgent care centers (UCCs) with urgent surgical conditions but may not be properly referred to a higher level of care. This study aims to characterize how UCCs manage Medicaid and privately insured patients who present with an emergent condition. METHODS: Using a standardized script, we called 1245 randomly selected UCCs in 50 states on 2 occasions. Investigators posed as either a Medicaid or a privately-insured patient with symptoms of an incarcerated inguinal hernia. Rates of direct emergency department (ED) referral were compared between insurance types. RESULTS: A total of 1223 (98.2%) UCCs accepted private insurance and 981 (78.8%) accepted Medicaid. At the 971 (78.0%) UCCs that accepted both insurance types, direct-to-ED referral rates for private and Medicaid patients were 27.9% and 33.8%, respectively. Medicaid patients were significantly more likely than private patients to be referred to the ED [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.09-1.60]. Private patients who were triaged by a clinician compared to nonclinician staff were over 6 times more likely to be referred to the ED (OR 6.46, 95% CI 4.63-9.01). Medicaid patients were nearly 9 times more likely to have an ED referral when triaged by a clinician (OR 8.72, 95% CI 6.19-12.29). CONCLUSIONS: Only one-third of UCCs across the United States referred an apparent emergent surgical case to the ED, potentially delaying care. Medicaid patients were more likely to be referred directly to the ED versus privately insured patients. All patients triaged by clinicians were significantly more likely to be referred to the ED; however, the disparity between private and Medicaid patients remained.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Cobertura do Seguro , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Humanos , Medicaid , Estados Unidos
12.
Ann Surg ; 272(4): 612-619, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32932318

RESUMO

OBJECTIVE: To evaluate the impact of the Affordable Care Act's Medicaid expansion on patient safety metrics at the hospital level by expansion status, across varying levels of safety-net burden, and over time. SUMMARY BACKGROUND DATA: Medicaid expansion has raised concerns over the influx of additional medically and socially complex populations on hospital systems. Whether increases in Medicaid and uninsured payor mix impact hospital performance metrics remains largely unknown. We sought to evaluate the effects of expansion on Centers for Medicare and Medicaid Services-endorsed Patient Safety Indicators (PSI-90). METHODS: Three hundred fifty-eight hospitals were identified using State Inpatient Databases (2012-2015) from 3 expansions (KY, MD, NJ) and 2 nonexpansion (FL, NC) states. PSI-90 scores were calculated using Agency for Healthcare Research and Quality modules. Hospital Medicaid and uninsured patients were categorized into safety-net burden (SNB) quartiles. Hospital-level, multivariate linear regression was performed to measure the effects of expansion and change in SNB on PSI-90. RESULTS: PSI-90 decreased (safety improved) over time across all hospitals (-5.2%), with comparable reductions in expansion versus nonexpansion states (-5.9% vs -4.7%, respectively; P = 0.441) and across high SNB hospitals within expansion versus nonexpansion states (-3.9% vs -5.2%, P = 0.639). Pre-ACA SNB quartile did not predict changes in PSI-90 post-ACA. However, when hospitals increased their SNB by 5%, they incurred significantly more safety events in expansion relative to nonexpansion states (+1.87% vs -14.0%, P = 0.013). CONCLUSIONS: Despite overall improvement in patient safety, increased SNB was associated with increased safety events in expansion states. Accordingly, Centers for Medicare and Medicaid Services measures may unintentionally penalize hospitals with increased SNB following Medicaid expansion.


Assuntos
Economia Hospitalar , Reforma dos Serviços de Saúde , Patient Protection and Affordable Care Act , Segurança do Paciente , Humanos , Medicaid/organização & administração , Pessoas sem Cobertura de Seguro de Saúde , Medicare/organização & administração , Provedores de Redes de Segurança/economia , Estados Unidos
14.
Medicine (Baltimore) ; 99(38): e22245, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957371

RESUMO

BACKGROUND: CMS recently decided to produce private "healthcare disparities reports" that include dual eligibility (DE) as the sole stratifying variable used to assess pneumonia readmission disparities. RESEARCH DESIGN: We measure the relationship between DE status and readmissions, both with and without conceptually relevant social risk factors, including air pollution, severe housing problems, and food insecurity, using data from county- and hospital-level readmission rates, DE status, and social risk factors. RESULTS: At the county level, the relationship between DE status and readmissions is partially confounded by at least three social risk factors. DE populations vary widely across hospitals, creating unequal between-hospital comparisons. CONCLUSIONS: Because of differences in the DE population, between-hospital comparisons could be misleading using a methodology that stratifies by DE only. We suggest viable alternatives to sole-factor stratification to properly account for social risk factors and better isolate quality differences that might yield readmission rate inequities. IMPLICATIONS: CMS's healthcare disparities reports provided to hospitals are limited by relying exclusively on DE proportion as the measure of social risk, undercutting the power of quality measurement and its related incentives to close or minimize healthcare inequities.


Assuntos
Definição da Elegibilidade , Disparidades em Assistência à Saúde , Medicaid/organização & administração , Medicare/organização & administração , Determinantes Sociais da Saúde , Poluição do Ar/efeitos adversos , Abastecimento de Alimentos , Habitação , Humanos , Readmissão do Paciente , Pneumonia/terapia , Fatores de Risco , Estados Unidos
15.
JAMA ; 324(10): 975-983, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32897345

RESUMO

Importance: The US Merit-based Incentive Payment System (MIPS) is a major Medicare value-based payment program aimed at improving quality and reducing costs. Little is known about how physicians' performance varies by social risk of their patients. Objective: To determine the relationship between patient social risk and physicians' scores in the first year of MIPS. Design, Setting, and Participants: Cross-sectional study of physicians participating in MIPS in 2017. Exposures: Physicians in the highest quintile of proportion of dually eligible patients served; physicians in the 3 middle quintiles; and physicians in the lowest quintile. Main Outcomes and Measures: The primary outcome was the 2017 composite MIPS score (range, 0-100; higher scores indicate better performance). Payment rates were adjusted -4% to 4% based on scores. Results: The final sample included 284 544 physicians (76.1% men, 60.1% with ≥20 years in practice, 11.9% in rural location, 26.8% hospital-based, and 24.6% in primary care). The mean composite MIPS score was 73.3. Physicians in the highest risk quintile cared for 52.0% of dually eligible patients; those in the 3 middle risk quintiles, 21.8%; and those in the lowest risk quintile, 6.6%. After adjusting for medical complexity, the mean MIPS score for physicians in the highest risk quintile (64.7) was lower relative to scores for physicians in the middle 3 (75.4) and lowest (75.9) risk quintiles (difference for highest vs middle 3, -10.7 [95% CI, -11.0 to -10.4]; highest vs lowest, -11.2 [95% CI, -11.6 to -10.8]; P < .001). This relationship was found across specialties except psychiatry. Compared with physicians in the lowest risk quintile, physicians in the highest risk quintile were more likely to work in rural areas (12.7% vs 6.4%; difference, 6.3 percentage points [95% CI, 6.0 to 6.7]; P < .001) but less likely to care for more than 1000 Medicare beneficiaries (9.4% vs 17.8%; difference, -8.3 percentage points [95% CI, -8.7 to -8.0]; P < .001) or to have more than 20 years in practice (56.7% vs 70.6%; difference, -13.9 percentage points [95% CI, -14.4 to -13.3]; P < .001). For physicians in the highest risk quintile, several characteristics were associated with higher MIPS scores, including practicing in a larger group (mean score, 82.4 for more than 50 physicians vs 46.1 for 1-5 physicians; difference, 36.2 [95% CI, 35.3 to 37.2]; P < .001) and reporting through an alternative payment model (mean score, 79.5 for alternative payment model vs 59.9 for reporting as individual; difference, 19.7 [95% CI, 18.9 to 20.4]; P < .001). Conclusions and Relevance: In this cross-sectional analysis of physicians who participated in the first year of the Medicare MIPS program, physicians with the highest proportion of patients dually eligible for Medicare and Medicaid had significantly lower MIPS scores compared with other physicians. Further research is needed to understand the reasons underlying the differences in physician MIPS scores by levels of patient social risk.


Assuntos
Avaliação de Desempenho Profissional , Medicare/economia , Médicos , Reembolso de Incentivo , Fatores Socioeconômicos , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Medicaid , Planos de Incentivos Médicos , Indicadores de Qualidade em Assistência à Saúde , Estados Unidos
16.
N C Med J ; 81(5): 293-299, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32900887

RESUMO

BACKGROUND Mailed at-home stool testing offers a promising strategy for overcoming barriers to colorectal cancer (CRC) screening in vulnerable populations. This paper evaluates the facilitators and barriers of successful implementation of a mailed fecal testing program among Medicaid populations within a health department setting.METHOD Interviews were conducted with key informants involved in intervention start-up and implementation tasks. The Consolidated Framework for Implementation Research (CFIR) was used to design the interview guide and structure the analysis. Axial coding was used to connect the themes to each other under the major categories of facilitators and barriers.RESULTS Overall, the process evaluation suggests that with strong partnerships, effective champions, and existing infrastructure, a large county health department can successfully implement a mailed fecal testing program targeted at Medicaid beneficiaries. The identified facilitators and challenges to implementation provide important information for similar emerging programs.LIMITATIONS The sample size of this evaluation is small. Additionally, we are unable to discern whether participating stakeholders' responses represent the feelings of non-interviewed staff, program implementers, or participants. We were not able to collect data on patient perspectives of the intervention. The nursing staff and interns were not able to be included in the process evaluation. Lastly, the information taken from this process evaluation may not be applicable to organizations and systems with different attributes.CONCLUSION The process evaluation suggests strong partnerships, effective champions, and elegant program designs were key contributors to successful implementation of a CRC screening program targeted at Medicaid beneficiaries in a large county health department.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Acesso aos Serviços de Saúde , Fezes , Humanos , Medicaid , Serviços Postais , Avaliação de Programas e Projetos de Saúde , Estados Unidos
17.
Tex Med ; 116(8): 12-13, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32866274

RESUMO

Stephanie Stephens received a not-so-welcome gift entering her new job running Medicaid operations for the nation's second-largest state: A global pandemic. In that sense, the universe wasn't easy on Ms. Stephens, the new director of Medicaid and CHIP for the Texas Health and Human Services Commission (HHSC).


Assuntos
Acesso aos Serviços de Saúde , Administração de Serviços de Saúde , Liderança , Medicaid/organização & administração , Infecções por Coronavirus/epidemiologia , Feminino , Saúde Global , História do Século XXI , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Texas , Estados Unidos
18.
PLoS One ; 15(9): e0238813, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936794

RESUMO

INTRODUCTION: We sought to assess the impact of Affordable Care Act Dependent Care Expansion (ACA-DCE), which allowed dependent coverage for adults aged 19-25, and Medicaid expansion on outcomes for men with testicular cancer. METHODS: Using a US-based cancer registry, we performed adjusted difference-in-difference (DID) analyses comparing outcomes between men aged 19-25 (n = 8,026) and 26-64 (n = 33,303) pre- (2007-2009) and post-ACA-DCE (2011-2016) and between men in states that expanded Medicaid (n = 2,296) to men in those that did not (n = 2,265)pre- (2011-2013) and post-Medicaid expansion (2015-2016). RESULTS: In ACA-DCE analysis, rates of uninsurance decreased (DID -5.64, 95% confidence interval [CI] -7.23 to -4.04%, p<0.001) among patients aged 19-25 relative to older patients aged 26-64. There was no significant DID in advanced stage at diagnosis (stage≥II; p = 0.6) or orchiectomy more than 14 days after diagnosis (p = 0.6). For patients who received chemotherapy or radiotherapy as their first course of treatment, treatment greater than 60 days after diagnosis decreased (DID -4.84%, 95% CI -8.22 to -1.45%, p = 0.005) among patients aged 19-25 relative to patients aged 26-64. In Medicaid expansion states, rates of uninsurance decreased (DID -4.20%, 95% CI -7.67 to -0.73%, p = 0.018) while patients receiving chemotherapy or radiotherapy greater than 60 days after diagnosis decreased (DID -8.76, 95% CI -17.13 to -0.38%, p = 0.040) compared to rates in non-expansion states. No significant DIDs were seen for stage (p = 0.8) or time to orchiectomy (p = 0.1). CONCLUSIONS: Men with testicular cancer had lower uninsurance rates and decreased time to delivery of chemotherapy or radiotherapy following ACA-DCE and Medicaid expansions. Time to orchiectomy and stage at diagnosis did not change following either insurance expansion.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Neoplasias Testiculares , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/estatística & dados numéricos , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/terapia , Tempo para o Tratamento/estatística & dados numéricos , Estados Unidos , Adulto Jovem
19.
Ann Hematol ; 99(11): 2497-2505, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32869184

RESUMO

To add to the limited existing evidence on clinical outcomes and healthcare use in sickle cell disease (SCD) among beneficiaries of the US Medicaid program, we conducted a cohort study using nationwide Medicaid claims data (2000-2013). Patients were included based on HbSS SCD diagnosis and followed until Medicaid disenrollment, death, bone marrow transplant, or end of data availability to assess vasoocclusive crises (VOC), emergency room (ER) visits, hospitalizations, outpatient visits, and blood transfusions. Annualized event rates (with 95% confidence intervals [CI]) were reported. The impact of VOCs on the risk of mortality was analyzed using a multivariable Cox model with VOC modeled as time-varying and updated annually. In a total of 44,033 SCD patients included with a mean (SD) age of 15.7 (13.6) years, the VOC rate (95% CI) was 3.71 (3.70-3.72) per person-year, with highest rate among patients 19-35 years who had ≥ 5 VOCs at baseline (13.20 [13.15-13.26]). Event rates (95% CI) per person per year for other outcomes were 2.97 (2.97-2.98) ER visits, 2.39 (2.38-2.40) hospitalizations, 5.80 (5.79-5.81) outpatient visits, and 0.91 (0.90-0.91) blood transfusions. A higher VOC burden in the preceding year was associated with an increased risk of mortality, with a hazard ratio (95% CI) of 1.26 (1.14-1.40) for 2-4 VOC vs. < 2 and 1.57 (1.41-1.74) for ≥ 5 VOC vs < 2. In conclusion, we documented a substantial burden of SCD in US Medicaid enrollees, especially during early adulthood and noted that ongoing burden of VOC is associated with mortality in these patients.


Assuntos
Anemia Falciforme/mortalidade , Anemia Falciforme/terapia , Medicaid , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mortalidade , Fatores de Risco , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA