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Niedzwiecki MJ, Forrow LV, Gellar J, Pohl RV, Chen A, Miescier L, Kranker K. The Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illness. Health Serv Res 2024; 59:e14289. [PMID: 38419507 DOI: 10.1111/1475-6773.14289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To assess the effects of the Medicare Care Choices Model (MCCM) on disparities in hospice use and quality of end-of-life care for Medicare beneficiaries from underserved groups-those from racial and ethnic minority groups, dually eligible for Medicare and Medicaid, or living in rural areas. DATA SOURCES AND STUDY SETTING Medicare enrollment and claims data from 2013 to 2021 for terminally ill Medicare fee-for-service beneficiaries nationwide. STUDY DESIGN Through MCCM, terminally ill enrolled Medicare beneficiaries received supportive and palliative care services from hospice providers concurrently with curative treatments. Using a matched comparison group, we estimated subgroup-specific effects on hospice use, days at home, and aggressive treatment and multiple emergency department visits in the last 30 days of life. DATA COLLECTION/EXTRACTION METHODS The sample included decedent Medicare beneficiaries enrolled in MCCM and a matched comparison group from the same geographic areas who met model eligibility criteria at time of enrollment: having a diagnosis of cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS; living in the community; not enrolled in the Medicare hospice benefit in the previous 30 days; and having at least one hospital stay and three office visits in the previous 12 months. PRINCIPAL FINDINGS Eligible beneficiaries from underserved groups were underrepresented in MCCM. MCCM increased enrollees' hospice use and the number of days at home and reduced aggressive treatment among all subgroups analyzed. MCCM also reduced disparities in hospice use by race and ethnicity and dual eligibility by 4.1 (90% credible interval [CI]: 1.3-6.1) and 2.4 (90% CI: 0.6-4.4) percentage points, respectively. It also reduced disparities in having multiple emergency department visits for rural enrollees by 1.3 (90% CI: 0.1-2.7) percentage points. CONCLUSIONS MCCM increased hospice use and quality of end-of-life care for model enrollees from underserved groups and reduced disparities in hospice use and having multiple emergency department visits.
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Affiliation(s)
| | | | | | | | | | - Lynn Miescier
- Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
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Shukla M, Amberson T, Heagele T, McNeill C, Adams L, Ndayishimiye K, Castner J. Tailoring Household Disaster Preparedness Interventions to Reduce Health Disparities: Nursing Implications from Machine Learning Importance Features from the 2018-2020 FEMA National Household Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:521. [PMID: 38791736 PMCID: PMC11121406 DOI: 10.3390/ijerph21050521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/26/2024]
Abstract
Tailored disaster preparedness interventions may be more effective and equitable, yet little is known about specific factors associated with disaster household preparedness for older adults and/or those with African American/Black identities. This study aims to ascertain differences in the importance features of machine learning models of household disaster preparedness for four groups to inform culturally tailored intervention recommendations for nursing practice. A machine learning model was developed and tested by combining data from the 2018, 2019, and 2020 Federal Emergency Management Agency National Household Survey. The primary outcome variable was a composite readiness score. A total of 252 variables from 15,048 participants were included. Over 10% of the sample self-identified as African American/Black and 30.3% reported being 65 years of age or older. Importance features varied regarding financial and insurance preparedness, information seeking and transportation between groups. These results reiterate the need for targeted interventions to support financial resilience and equitable resource access. Notably, older adults with Black racial identities were the only group where TV, TV news, and the Weather Channel was a priority feature for household disaster preparedness. Additionally, reliance on public transportation was most important among older adults with Black racial identities, highlighting priority needs for equity in disaster preparedness and policy.
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Affiliation(s)
- Meghna Shukla
- College of Nursing, Wayne State University, 5557 Cass Ave, Detroit, MI 48202, USA;
| | - Taryn Amberson
- Castner Incorporated, 1879 Whitehaven Road #150, Grand Island, NY 14072, USA (J.C.)
- Health Systems and Population Health School of Public Health, Department of Health Services Research, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
- Administration for Strategic Preparedness and Response, National Disaster Medical System, 200 Independence Ave., Washington, DC 20201, USA
| | - Tara Heagele
- Hunter-Bellevue School of Nursing, Hunter College, The City University of New York, 425 East 25th Street, Office 427W, New York, NY 10010, USA;
| | - Charleen McNeill
- College of Nursing, University of Tennessee Health Science Center’s, Suite 140C, 874 Union Ave., Memphis, TN 38163, USA;
| | - Lavonne Adams
- Harris College of Nursing & Health Sciences, Texas Christian University, TCU Box 298620, Fort Worth, TX 76129, USA;
| | - Kevin Ndayishimiye
- Castner Incorporated, 1879 Whitehaven Road #150, Grand Island, NY 14072, USA (J.C.)
| | - Jessica Castner
- Castner Incorporated, 1879 Whitehaven Road #150, Grand Island, NY 14072, USA (J.C.)
- Health Policy, Management and Behavior, School of Public Health, University at Albany, 1400 Washington Avenue, Albany, NY 14222, USA
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Thoumi A, Plasencia G, Madanay F, Ho ESA, Palmer C, Kaalund K, Chaudhry N, Labrador A, Rigsby K, Onunkwo A, Almonte I, Gonzalez-Guarda R, Martinez-Bianchi V, Cholera R. Promoting Latinx health equity through community-engaged policy and practice reforms in North Carolina. Front Public Health 2023; 11:1227853. [PMID: 38074704 PMCID: PMC10701733 DOI: 10.3389/fpubh.2023.1227853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction The Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19) is a unique multi-sector coalition formed early in the COVID-19 pandemic to address the multi-level health inequities faced by Latinx communities in North Carolina. Methods We utilized the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to conduct a directed content analysis of 58 LATIN-19 meeting minutes from April 2020 through October 2021. Application of the NIMHD Research Framework facilitated a comprehensive assessment of complex and multidimensional barriers and interventions contributing to Latinx health while centering on community voices and perspectives. Results Community interventions focused on reducing language barriers and increasing community-level access to social supports while policy interventions focused on increasing services to slow the spread of COVID-19. Discussion Our study adds to the literature by identifying community-based strategies to ensure the power of communities is accounted for in policy reforms that affect Latinx health outcomes across the U.S. Multisector coalitions, such as LATIN-19, can enable the improved understanding of underlying barriers and embed community priorities into policy solutions to address health inequities.
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Affiliation(s)
- Andrea Thoumi
- Margolis Center for Health Policy, Duke University, Washington, NC, United States
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States
- LATIN-19, Durham, NC, United States
| | - Gabriela Plasencia
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States
- LATIN-19, Durham, NC, United States
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Farrah Madanay
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Sanford School of Public Policy, Duke University, Durham, NC, United States
| | - Ethan Shih-An Ho
- Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Caroline Palmer
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Kamaria Kaalund
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Nikhil Chaudhry
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Amy Labrador
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Kristen Rigsby
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Adaobi Onunkwo
- Fuqua School of Business, Duke University, Durham, NC, United States
| | | | - Rosa Gonzalez-Guarda
- LATIN-19, Durham, NC, United States
- School of Nursing, Duke University, Durham, NC, United States
| | - Viviana Martinez-Bianchi
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States
- LATIN-19, Durham, NC, United States
| | - Rushina Cholera
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, United States
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Collons D, Florez N, Petrillo L, Dhawan N, Gray TF. Palliative Care for All? An Assessment of Racial and Ethnic Disparities Research With Solutions. J Pain Symptom Manage 2023; 66:e521-e523. [PMID: 37364736 DOI: 10.1016/j.jpainsymman.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Danielle Collons
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA.
| | - Narjust Florez
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA
| | - Laura Petrillo
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA
| | - Natasha Dhawan
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA
| | - Tamryn F Gray
- Dana-Farber Cancer Institute (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Brigham and Women's Hospital (D.C., N.F., T.F.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (L.P.), Boston, Massachusetts, USA; Dartmouth-Hitchcock Medical Center (N.D.), Lebanon, New Hampshire, USA; Dartmouth Cancer Center (N.D.), Lebanon, New Hampshire, USA
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Kutney-Lee A, Rodriguez KL, Ersek M, Carthon JMB. "They Did Not Know How to Talk to Us and It Seems That They Didn't Care:" Narratives from Bereaved Family Members of Black Veterans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01790-4. [PMID: 37733285 DOI: 10.1007/s40615-023-01790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
Racial disparities in the quality of health care services, including end of life (EOL) care, are well-documented. While several explanations for these inequities have been proposed, few studies have examined the underlying mechanisms. This paper presents the results of the qualitative phase of a concurrent mixed-methods study (QUANT + QUAL) that sought to identify explanations for observed racial differences in quality of EOL care ratings using the Department of Veterans Affairs Bereaved Family Survey (BFS). The objective of the qualitative phase of the study was to understand the specific experiences that contributed to an unfavorable overall EOL quality rating on the BFS among family members of Black Veterans. We used inductive thematic analysis to code BFS open-ended items associated with 165 Black Veterans whose family member rated the overall quality of care received by the Veteran in the last month of life as "poor" or "fair." Four major themes emerged from the BFS narratives, including (1) Positive Aspects of Care, (2) Unmet Care Needs, (3) Lack of Empathy, Dignity, and Respect, and (4) Poor Communication. Additionally, some family members offered recommendations for care improvements. Our discussion includes integrated results from both our qualitative and previously reported quantitative findings that may serve as a foundation for future evidence-based interventions to improve the equitable delivery of high-quality EOL care.
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Affiliation(s)
- Ann Kutney-Lee
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - J Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Homme P, Truong R, Gong J, Ziegler C, Freitas C, Yeung A, Tan DH, Burchell AN. Sexual health promotion for sexual and gender minorities in primary care: a scoping review protocol. BMJ Open 2023; 13:e066704. [PMID: 36868597 PMCID: PMC9990650 DOI: 10.1136/bmjopen-2022-066704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION Sexual and gender minorities (SGMs) face health disparities related to systemic discrimination and barriers to sexual health. Sexual health promotion encompasses strategies that enable individuals, groups and communities to make informed decisions regarding their sexual well-being. Our objective is to describe the existing sexual health promotion interventions tailored for SGMs within the primary care context. METHODS AND ANALYSIS We will conduct a scoping review and search for articles in 12 medical and social science academic databases on interventions that are targeted towards SGMs in the primary care context in industrialised countries. Searches were conducted on 7 July 2020 and 31 May 2022. We defined sexual health interventions in the inclusion framework as: (1) promote positive sexual health, or sex and relationship education; (2) reduce the incidence of sexually transmitted infections; (3) reduce unintended pregnancies; or (4) change prejudice, stigma and discrimination around sexual health, or increase awareness surrounding positive sex. Two independent reviewers will select articles meeting inclusion criteria and extract data. Participant and study characteristics will be summarised using frequencies and proportions. Our primary analysis will include a descriptive summary of key interventional themes from content and thematic analysis. Gender-based Analysis Plus will be used to stratify themes based on gender, race, sexuality and other identities. The secondary analysis will include the use of the Sexual and Gender Minority Disparities Research Framework to analyse the interventions from a socioecological perspective. ETHICS AND DISSEMINATION No ethical approval is required for a scoping review. The protocol was registered on the Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/X5R47). The intended audiences are primary care providers, public health, researchers and community-based organisations. Results will be communicated through peer-reviewed publication, conferences, rounds and other opportunities to reach primary care providers. Community-based engagement will occur through presentations, guest speakers, community forums and research summary handouts.
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Affiliation(s)
- Paige Homme
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robinson Truong
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Gong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cassandra Freitas
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna Yeung
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Darrell Hs Tan
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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