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Singer PM, Skinner D, Wright B. What the Evolution of 1332 Waivers Tells Us about Their Innovative Potential. J Health Polit Policy Law 2024; 49:269-288. [PMID: 37801019 DOI: 10.1215/03616878-10989687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Section 1332 of the Affordable Care Act (ACA) provides states unprecedented flexibility to alter federal health policy. The authors analyze state waiver activity from 2019 to 2023, applying a comparative approach to understand waivers proposed by Georgia, Colorado, Washington, Oregon, and Nevada. Much of the waiver activity during this period focused on reinsurance programs. During the Trump administration, the most innovative waiver application was from Georgia, which sought to restructure and decentralize its individual market, moving away from the framework established by the ACA. While the Biden administration suspended Georgia's efforts, Democratic-led states have focused implementing waiver programs supporting and expanding on the ACA. This has included adopting public-option insurance plans offered by private insurers and expanding eligibility for qualified health plans for previously ineligible groups. The authors' analysis offers insights into contemporary health politics, policy durability, and the role of the administrative presidency.
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Giannouchos TV, Ukert B, Pirrallo RG, Smith J, Kum HC, Wright B, Dietrich A. Determinants of Persistent, Multi-Year, Frequent Emergency Department Use Among Children and Young Adults in Three US States. Acad Pediatr 2024; 24:442-450. [PMID: 37673206 DOI: 10.1016/j.acap.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE This study examines the factors associated with persistent, multi-year, and frequent emergency department (ED) use among children and young adults. METHODS We conducted a retrospective secondary analysis using the 2012-2017 Healthcare Cost and Utilization Project State Emergency Department Databases for children and young adults aged 0-19 who visited any ED in Florida, Massachusetts, and New York. We estimated the association between persistent frequent ED use and individuals' characteristics using multivariable logistic regression models. RESULTS Among 1.3 million patients with 1.8 million ED visits in 2012, 2.9% (37,558) exhibited frequent ED use (≥4 visits in 2012) and accounted for 10.2% (181,138) of all ED visits. Longitudinal follow-up of frequent ED users indicated that 15.4% (5770) remained frequent users periodically over the next 1 or 2 years, while 2.2% (831) exhibited persistent frequent use over the next 3-5 years. Over the 6-year study period, persistent frequent users had 31,551 ED visits at an average of 38.0 (standard deviation = 16.2) visits. Persistent frequent ED use was associated with higher intensity of ED use in 2012, public health insurance coverage, inconsistent health insurance coverage over time, residence in non-metropolitan and lower-income areas, multimorbidity, and more ED visits for less medically urgent conditions. CONCLUSIONS Clinicians and policymakers should consider the diverse characteristics and needs of pediatric persistent frequent ED users compared to broader definitions of frequent users when designing and implementing interventions to improve health outcomes and contain ED visit costs.
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Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Policy & Organization (TV Giannouchos), School of Public Health, The University of Alabama at Birmingham, Birmingham, Ala.
| | - Benjamin Ukert
- Department of Health Policy and Management (B Ukert, H-C Kum), School of Public Health, Texas A and M University, College Station, Tex
| | - Ronald G Pirrallo
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| | - Jeremiah Smith
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| | - Hye-Chung Kum
- Department of Health Policy and Management (B Ukert, H-C Kum), School of Public Health, Texas A and M University, College Station, Tex
| | - Brad Wright
- Department of Health Services Policy and Management (B Wright), Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ann Dietrich
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
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Brainard J, Crawford A, Wright B, Lim M, Everden P. Retaining dermatology patients in primary care through dialogue with secondary care providers: A service evaluation. Ann Dermatol Venereol 2024; 151:103248. [PMID: 38513422 DOI: 10.1016/j.annder.2024.103248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/28/2023] [Accepted: 11/07/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND There are long patient waiting lists for specialist care. A dermatology dialogue service between primary and secondary care (DDPS) was developed in eastern England. Primary care referrers uploaded patient images of skin conditions for review by and dialogue with consultant dermatologists in an attempt to retain patients in primary care rather than refer them to secondary care. METHODS Evaluation of service performance against specific targets, including reduction in secondary care waiting list growth over the period April 2021-March 2022 inclusive. Service activity was summarized in terms of speed of resolution, case numbers, and dispositions. Clinician and patient satisfaction were assessed using structured questionnaires. Actual numbers of new referrals were compared to projections based on historical data. Waiting list growth was compared to other specialties and other commissioning areas. Waiting times to initial treatment were monitored. RESULTS Over 3300 patients were enrolled and > 90% of dialogues were resolved within 36 hours. Clinician and patient satisfaction were high. Frequently asked questions and conditions were highlighted by dermatologists to design and deliver an educational event for primary care clinicians that was well received. Waiting list growth for dermatology patients in the commissioning area was smaller than for other major specialties, and generally smaller than growth for dermatology waiting lists commissioned by other NHS commissioners. There was no negative impact on the urgent priority (cancer pathway) waiting list. CONCLUSION The DDPS was satisfactory for clinicians and patients and coincided with lower growth in dermatology waiting lists than might otherwise have been expected.
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Affiliation(s)
- J Brainard
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - A Crawford
- North Norfolk Primary Care, 4 Alkmaar Way, Norwich NR6 6BF, United Kingdom
| | - B Wright
- North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, United Kingdom
| | - M Lim
- Norfolk and Waveney Integrated Care Board, County Hall, Martineau Lane, Norwich NR1 2DL, United Kingdom
| | - P Everden
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom; North Norfolk Primary Care, 4 Alkmaar Way, Norwich NR6 6BF, United Kingdom
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Giannouchos TV, Ukert B, Wright B. Concordance in Medical Urgency Classification of Discharge Diagnoses and Reasons for Visit. JAMA Netw Open 2024; 7:e2350522. [PMID: 38198140 PMCID: PMC10782231 DOI: 10.1001/jamanetworkopen.2023.50522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/09/2023] [Indexed: 01/11/2024] Open
Abstract
Importance Current policies to divert emergency department (ED) visits for less medically urgent conditions to more cost-effective settings rely on retrospective adjudication of discharge diagnoses. However, patients present to the ED with concerns, making it challenging for clinicians. Objective To characterize ED visits based on the medical urgency of the presenting reasons for visit and to explore the concordance between discharge diagnoses and reasons for visit. Design, Setting, and Participants In this retrospective, cross-sectional study, a nationwide sample of ED visits by adults (aged ≥18 years) in the US from the 2018 and 2019 calendar years' ED data of the National Hospital Ambulatory Medical Care Survey was used. An algorithm to probabilistically assign ED visits into medical urgency categories based on the presenting reason for visit was developed. A 3-step, look-back method was applied using an updated version of the New York University ED algorithm, and a map of all possible discharge diagnoses to the same reasons for visit was developed. Analyses were conducted in July and August 2023. Main Outcomes and Measures The main outcome was probabilistic medical urgency classification of reasons for visits and discharge diagnoses and their concordance. Results We analyzed 27 068 ED visits (mean age, 48.2% years [95% CI, 47.5%-48.9% years]) representing 190.7 million visits nationwide. Women (mean, 57.0% [95% CI, 55.9%-58.1%]) and patients with public health insurance coverage, including Medicare (mean, 24.9% [95% CI, 21.9%-28.0%]) and Medicaid (mean, 25.1% [95% CI, 21.0%-29.2%]), accounted for the largest share of ED visits, and a mean of 13.2% (95% CI, 11.4%-15.0%) of all visits resulted in a hospital admission. Overall, about 38.5% and 53.9% of all ED visits were classified with 100% and 75% probabilities, respectively, as injury related, emergency care needed, emergent but primary care treatable, nonemergent, or mental health or substance use disorders related based on discharge diagnosis compared with 0.4% and 12.4%, respectively, of all encounters based on patients' reason for visit. Among discharge diagnoses assigned with high certainty to only 1 urgency category using the New York University ED algorithm, between 38.0% (95% CI, 36.3%-39.6%) and 57.4% (95% CI, 56.0%-58.8%) aligned with the probabilistic categorical assignments of their corresponding reasons for visit. Conclusions and Relevance In this cross-sectional study of 190.7 million ED visits among adults aged 18 years or older, a smaller percentage of reasons for visit could be prospectively categorized with high accuracy to a specific medical urgency category compared with all visits based on discharge diagnoses, and a limited concordance between reasons for visit and discharge diagnoses was found. Alternative methods are needed to identify the medical necessity of ED encounters more accurately.
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Affiliation(s)
- Theodoros V. Giannouchos
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham
| | - Benjamin Ukert
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
| | - Brad Wright
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia
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Sabbatini AK, Parrish C, Liao JM, Wright B, Basu A, Kreuter W, Joynt-Maddox KE. Hospital Performance Under Alternative Readmission Measures Incorporating Observation Stays. Med Care 2023; 61:779-786. [PMID: 37712715 PMCID: PMC10592134 DOI: 10.1097/mlr.0000000000001920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To determine the extent to which counting observation stays changes hospital performance on 30-day readmission measures. METHODS This was a retrospective study of inpatient admissions and observation stays among fee-for-service Medicare enrollees in 2017. We generated 3 specifications of 30-day risk-standardized readmissions measures: the hospital-wide readmission (HWR) measure utilized by the Centers for Medicare and Medicaid Services, which captures inpatient readmissions within 30 days of inpatient discharge; an expanded HWR measure, which captures any unplanned hospitalization (inpatient admission or observation stay) within 30 days of inpatient discharge; an all-hospitalization readmission (AHR) measure, which captures any unplanned hospitalization following any hospital discharge (observation stays are included in both the numerator and denominator of the measure). Estimated excess readmissions for hospitals were compared across the 3 measures. High performers were defined as those with a lower-than-expected number of readmissions whereas low performers had higher-than-expected or excess readmissions. Multivariable logistic regression identified hospital characteristics associated with worse performance under the measures that included observation stays. RESULTS Our sample had 2586 hospitals with 5,749,779 hospitalizations. Observation stays ranged from 0% to 41.7% of total hospitalizations. Mean (SD) readmission rates were 16.6% (5.4) for the HWR, 18.5% (5.7) for the expanded HWR, and 17.9% (5.7) in the all-hospitalization readmission measure. Approximately 1 in 7 hospitals (14.9%) would switch from being classified as a high performer to a low performer or vice-versa if observation stays were fully included in the calculation of readmission rates. Safety-net hospitals and those with a higher propensity to use observation would perform significantly worse. CONCLUSIONS Fully incorporating observation stays in readmission measures would substantially change performance in value-based programs for safety-net hospitals and hospitals with high rates of observation stays.
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Affiliation(s)
- Amber K. Sabbatini
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, School of Public Health
| | - Canada Parrish
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, School of Public Health
| | - Joshua M. Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- Value System Science Lab, Department of Medicine, University of Washington, Seattle, WA
| | - Brad Wright
- Department of Health Services, Policy and Management University of South Carolina School of Public Health, Columbia, SC
| | - Anirban Basu
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, WA
| | - William Kreuter
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, WA
| | - Karen E. Joynt-Maddox
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
- Center for Health Economics and Policy, Institute for Public Health, Washington University in St Louis, St Louis, Missouri
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Giannouchos TV, Reynolds J, Damiano P, Wright B. Correction: Association of Medicaid expansion with dental emergency department visits overall and by states' Medicaid dental benefits provision. BMC Health Serv Res 2023; 23:694. [PMID: 37370131 DOI: 10.1186/s12913-023-09709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA.
| | - Julie Reynolds
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Peter Damiano
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Brad Wright
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA
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Giannouchos TV, Reynolds J, Damiano P, Wright B. Association of Medicaid expansion with dental emergency department visits overall and by states' Medicaid dental benefits provision. BMC Health Serv Res 2023; 23:625. [PMID: 37312114 DOI: 10.1186/s12913-023-09488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/02/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Evidence on the association of Medicaid expansion with dental emergency department (ED) utilization is limited, while even less is known on policy-related changes in dental ED visits by Medicaid programs' dental benefits generosity. The objective of this study was to estimate the association of Medicaid expansion with changes in dental ED visits overall and by states' benefits generosity. METHODS We used the Healthcare Cost and Utilization Project's Fast Stats Database from 2010 to 2015 for non-elderly adults (19 to 64 years of age) across 23 States, 11 of which expanded Medicaid in January 2014 while 12 did not. Difference-in-differences regression models were used to estimate changes in dental-related ED visits overall and further stratified by states' dental benefit coverage in Medicaid between expansion and non-expansion States. RESULTS After 2014, dental ED visits declined by 10.9 [95% confidence intervals (CI): -18.5 to -3.4] visits per 100,000 population quarterly in states that expanded Medicaid compared to non-expansion states. However, the overall decline was concentrated in Medicaid expansion states with dental benefits. In particular, among expansion states, dental ED visits per 100,000 population declined by 11.4 visits (95% CI: -17.9 to -4.9) quarterly in states with dental benefits in Medicaid compared to states with emergency-only or no dental benefits. Significant differences between non-expansion states by Medicaid's dental benefits generosity were not observed [6.3 visits (95% CI: -22.3 to 34.9)]. CONCLUSIONS Our findings suggest the need to strengthen public health insurance programs with more generous dental benefits to curtail costly dental ED visits.
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Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, 29208, Columbia, SC, USA.
| | - Julie Reynolds
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Peter Damiano
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Brad Wright
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, 29208, Columbia, SC, USA
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Skinner D, Wright B. The Paradoxical Politics of Community Health Centers from the Great Society to the COVID-19 Pandemic. J Health Polit Policy Law 2023; 48:379-404. [PMID: 36441636 DOI: 10.1215/03616878-10358724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
CONTEXT Although community health centers (CHCs) arose in the 1960s as part of a Democratic policy push committed to social justice, subsequent support has been shaped by paradoxical politics wherein Republican and Democratic support for CHCs continually morphed in response to changes in the health policy landscape. METHODS Drawing on the CHC literature and empirical examples from firsthand accounts and reporting, this article explains CHCs' curious historical development from 1965 to the present. FINDINGS Both Republicans and Democrats have calibrated their support for CHCs in response to a broader set of political considerations, from antiwelfare policy commitments to aspirations of establishing a national health care plan. CONCLUSIONS CHCs have proven to be a politically malleable policy tool within the broader context of American health care policy. The COVID-19 pandemic raised new questions about CHCs' sustainability and future, but CHCs will continue to play a critical role in providing health care access to underserved populations. They also will continue to be an attractive bipartisan policy option within the larger framework of US health policy.
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Cole MB, Lee EK, Frogner BK, Wright B. Changes in Performance Measures and Service Volume at US Federally Qualified Health Centers During the COVID-19 Pandemic. JAMA Health Forum 2023; 4:e230351. [PMID: 37027165 PMCID: PMC10082403 DOI: 10.1001/jamahealthforum.2023.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Importance Stay-at-home orders, site closures, staffing shortages, and competing COVID-19 testing and treatment needs all potentially decreased primary care access and quality during the COVID-19 pandemic. These challenges may have especially affected federally qualified health centers (FQHCs), which serve patients with low income nationwide. Objective To examine changes in FQHCs' quality-of-care measures and visit volumes in 2020 to 2021 vs prepandemic. Design, Setting, and Participants This cohort study used a census of US FQHCs to calculate changes in outcomes between 2016 and 2021 using generalized estimating equations. Main Outcomes and Measures Twelve quality-of-care measures and 41 visit types based on diagnoses and services rendered, measured at the FQHC-year level. Results A total of 1037 FQHCs were included, representing 26.6 million patients (63% 18-64 years old; 56% female) in 2021. Despite upward trajectories for most measures prepandemic, the percentage of patients served by FQHCs receiving recommended care or achieving recommended clinical thresholds showed a statistically significant decrease between 2019 and 2020 for 10 of 12 quality measures. For example, declines were observed for cervical cancer screening (-3.8 percentage points [pp]; 95% CI, -4.3 to -3.2 pp), depression screening (-7.0 pp; 95% CI, -8.0 to -5.9 pp), and blood pressure control in patients with hypertension (-6.5 pp; 95% CI, -7.0 to -6.0 pp). By 2021, only 1 of these 10 measures returned to 2019 levels. From 2019 to 2020, 28 of 41 visit types showed a statistically significant decrease, including immunizations (incidence rate ratio [IRR], 0.76; 95% CI, 0.73-0.78), oral examinations (IRR, 0.61; 95% CI, 0.59-0.63), and supervision of infant or child health (IRR, 0.87; 95% CI, 0.85-0.89); 11 of these 28 visits approximated or exceeded prepandemic rates by 2021, while 17 remained below prepandemic rates. Five visit types increased in 2020, including substance use disorder (IRR, 1.07; 95% CI, 1.02-1.11), depression (IRR, 1.06; 95% CI, 1.03-1.09), and anxiety (IRR, 1.16; 95% CI, 1.14-1.19); all 5 continued to increase in 2021. Conclusions and Relevance In this cohort study of US FQHCs, nearly all quality measures declined during the first year of the COVID-19 pandemic, with most declines persisting through 2021. Similarly, most visit types declined in 2020; 60% of these remained below prepandemic levels in 2021. By contrast, mental health and substance use visits increased in both years. The pandemic led to forgone care and likely exacerbated behavioral health needs. As such, FQHCs need sustained federal funding to expand service capacity, staffing, and patient outreach. Quality reporting and value-based care models must also adapt to the pandemic's influence on quality measures.
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Affiliation(s)
- Megan B Cole
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Eun Kyung Lee
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington School of Medicine, Seattle
| | - Brad Wright
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia
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Potter AJ, Wright B, Akiyama J, Stehlin GG, Trivedi AN, Wolinsky FD. Primary care patterns among dual eligibles with Alzheimer's disease and related dementias. J Am Geriatr Soc 2023; 71:1259-1266. [PMID: 36585893 PMCID: PMC10089966 DOI: 10.1111/jgs.18166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/20/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Primary care is essential for persons with Alzheimer's disease and related dementias (ADRD). Prior research suggests that the propensity to provide high-quality, continuous primary care varies by provider setting, but the settings used by Medicare-Medicaid dual-eligibles with ADRD have not been described at the population level. METHODS Using 2012-2018 Medicare data, we identified dual-eligibles with ADRD. For each person-year, we identified primary care visits occurring in six settings. We calculated descriptive statistics for beneficiaries with a majority of visits in each setting, and conducted a k-means cluster analysis to determine utilization patterns, using the standardized count of primary care visits in each setting. RESULTS Each year from 2012 to 2018, at least 45.6% of dual-eligibles with ADRD received a majority of their primary care in nursing facilities, while at least 25.2% did so in physician offices. Over time, the share relying on nursing facilities for primary care decreased by 5.2 percentage points, offset by growth in Federally Qualified Health Centers (FQHCs) and miscellaneous settings (2.3 percentage points each). Dual-eligibles relying on nursing facilities had more annual primary care visits (16.1) than those relying on other settings (range: 6.8-10.7 visits). Interpersonal care continuity was also higher in nursing facilities (97.0%) and physician offices (87.9%) than in FQHCs (54.2%), rural health clinics (RHCs, 46.6%), or hospital-based clinics (56.8%). Among dual-eligibles without care continuity, 82.7% were assigned to a cluster with few primary care visits. CONCLUSIONS A trend toward care in different settings likely reflects improved access to patient-centered primary care. Low rates of interpersonal care continuity in FQHCs, RHCs, and physician offices may warrant concern, unless providers in these settings function as a care team. Nonetheless, every healthcare system encounter presents an opportunity to designate a primary care provider for dual-eligibles with ADRD who use little or no primary care.
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Affiliation(s)
- Andrew J. Potter
- Department of Political Science & Criminal Justice, California State University, Chico
| | - Brad Wright
- Department of Family Medicine, UNC-Chapel Hill School of Medicine, Chapel Hill, NC
- Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, NC
| | - Jill Akiyama
- Department of Health Policy and Management, Gillings School of Public Health, UNC-Chapel Hill
| | - Grace G. Stehlin
- Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, NC
| | - Amal N. Trivedi
- Department of Health Services, Policy and Practice, School of Public Health, Brown University
| | - Fredric D. Wolinsky
- Department of Health Management and Policy, College of Public Health, University of Iowa
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Wright B, Parrish C, Basu A, Joynt Maddox KE, Liao JM, Sabbatini AK. Medicare's hospital readmissions reduction program and the rise in observation stays. Health Serv Res 2023; 58:554-559. [PMID: 36755372 PMCID: PMC10154161 DOI: 10.1111/1475-6773.14142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE To evaluate whether Medicare's Hospital Readmissions Reduction Program (HRRP) is associated with increased observation stay use. DATA SOURCES AND STUDY SETTING A nationally representative sample of fee-for-service Medicare claims, January 2009-September 2016. STUDY DESIGN Using a difference-in-difference (DID) design, we modeled changes in observation stays as a proportion of total hospitalizations, separately comparing the initial (acute myocardial infarction, pneumonia, heart failure) and subsequent (chronic obstructive pulmonary disease) target conditions with a control group of nontarget conditions. Each model used 3 time periods: baseline (15 months before program announcement), an intervening period between announcement and implementation, and a 2-year post-implementation period, with specific dates defined by HRRP policies. DATA COLLECTION/EXTRACTION METHODS We derived a 20% random sample of all hospitalizations for beneficiaries continuously enrolled for 12 months before hospitalization (N = 7,162,189). PRINCIPAL FINDINGS Observation stays increased similarly for the initial HRRP target and nontarget conditions in the intervening period (0.01% points per month [95% CI -0.01, 0.3]). Post-implementation, observation stays increased significantly more for target versus nontarget conditions, but the difference is quite small (0.02% points per month [95% CI 0.002, 0.04]). Results for the COPD analysis were statistically insignificant in both policy periods. CONCLUSIONS The increase in observation stays is likely due to other factors, including audit activity and clinical advances.
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Affiliation(s)
- Brad Wright
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Canada Parrish
- Department of Health Systems and Population Health, University of Washington School of Public Health and Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anirban Basu
- Department of Pharmacy and The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, Washington, USA.,Department of Medicine, Washington University School of Medicine in St. Louis and Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Karen E Joynt Maddox
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Joshua M Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Amber K Sabbatini
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Davies R, Wilson E, Richfield E, Mundy C, Wright B, Stratton E. 1230 PALLIATIVE CARE MOVEMENT DISORDERS MULTIDISCIPLINARY MEETING. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
It is well recognised that patients with Parkinson’s disease (PD) have significant symptom burden in advanced stages of their disease. Integration of movement disorder and palliative care services has been limited by concerns about resource and sustainability. We present our experience of establishing a movement disorders palliative care multidisciplinary meeting.
Method
In 2019 we established a multidisciplinary virtual bimonthly meeting between movement disorders and palliative care specialists. Referrals were accepted from movement disorder specialists, community Parkinson’s practitioners and palliative care specialists. Referring clinicians all actively applied primary palliative care approaches within their existing services. Aims of the meeting were to facilitate holistic management of complex needs, support advance care planning (ACP) and consider referral to specialist palliative care services.
Result
37 patients in total were discussed over a 2-year period (although the service was limited for a time due to COVID pressures). On average 3 new patients were discussed per meeting. Reasons for referral included motor and non-motor symptoms, support with ACP, medication advice, caregiver concerns and emotional distress. Meeting outcomes included medication adjustments, expediting reviews, hospice support, carer support, and referral to other services. Since the meetings started 23 (62%) patients have died. Of these, 30% died in hospital compared with the national average of 43.4%. The average between discussion at the meeting and death was 139 days. The meeting has generated education opportunities, triggered joint assessments and a professionals’ framework for the palliative management of patients with a movement disorder.
Conclusions
We present the experience of an MDT embedded within an early integrated palliative care service for movement disorders. The MDT has strengthened partnership working and findings suggest that alongside active primary palliative care, specialist palliative care for PD can be sustainable and resource efficient in a UK setting.
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Affiliation(s)
- R Davies
- University Hospitals Bristol and Weston NHS Trust Dept of Elderly Care
| | - E Wilson
- Yeovil District Hospital Dept of Stroke Medicine
| | - E Richfield
- North Bristol NHS Trust Dept of Elderly Care
| | | | | | - E Stratton
- University Hospitals Bristol and Weston NHS Trust Dept of Elderly Care
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13
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Wright B, Akiyama J, Potter AJ, Sabik LM, Stehlin GG, Trivedi AN, Wolinsky FD. Racial and Ethnic Disparities in Hospital-Based Care Among Dual Eligibles Who Use Health Centers. Health Equity 2023; 7:9-18. [PMID: 36744239 PMCID: PMC9892926 DOI: 10.1089/heq.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction Health center use may reduce hospital-based care among Medicare-Medicaid dual eligibles, but racial and ethnic disparities in this population have not been widely studied. We examined the extent of racial and ethnic disparities in hospital-based care among duals using health centers and the degree to which disparities occur within or between health centers. Methods We used 2012-2018 Medicare claims and health center data to model emergency department (ED) visits, observation stays, hospitalizations, and 30-day unplanned returns as a function of race and ethnicity among dual eligibles using health centers. Results In rural and urban counties, age-eligible Black individuals had more ED visits (7.9 [4.0, 11.7] and 13.7 [10.0, 17.4] per 100 person-years) and were more likely to experience an unplanned return (1.4 [0.4, 2.4] and 1 [0.4, 1.6] percentage points [pp]) than White individuals, but were less likely to be hospitalized (-3.3 [-3.9, -2.8] and -1.2 [-1.6, -0.9] pp). In urban counties, age-eligible Black individuals were 1.2 [0.9, 1.5] pp more likely than White individuals to have observation stays. Other racial and ethnic groups used the same or less hospital-based care than White individuals. Including state and health center fixed effects eliminated Black versus White disparities in all outcomes, except hospitalization. Results were similar among disability-eligible duals. Conclusion Racial and ethnic disparities in hospital-based care among dual eligibles are less common within than between health centers. If health centers are to play a more central role in eliminating racial and ethnic health disparities, these differences across health centers must be understood and addressed.
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Affiliation(s)
- Brad Wright
- Department of Family Medicine, UNC-Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.,Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, North Carolina, USA.,*Address correspondence to: Brad Wright, PhD, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 355, Columbia, SC 29208, USA,
| | - Jill Akiyama
- Department of Health Policy and Management, Gillings School of Public Health, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew J. Potter
- Department of Political Science and Criminal Justice, California State University, Chico, California, USA
| | - Lindsay M. Sabik
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Grace G. Stehlin
- Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amal N. Trivedi
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Fredric D. Wolinsky
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
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14
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Wright B, Akiyama J, Potter AJ, Sabik LM, Stehlin GG, Trivedi AN, Wolinsky FD. Characterizing the Uptake of Newly Opened Health Centers by Individuals Dually Enrolled in Medicare and Medicaid. J Ambul Care Manage 2023; 46:2-11. [PMID: 36150035 PMCID: PMC9691473 DOI: 10.1097/jac.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Federally qualified health centers (FQHCs) increasingly provide high-quality, cost-effective primary care to individuals dually enrolled in Medicare and Medicaid. However, not everyone can access an FQHC. We used 2012 to 2018 Medicare claims and federally collected FQHC data to examine communities where an FQHC first opened and determine which dual eligibles used it. Overall uptake was 10%, ranging from 6.6% among age-eligible urban residents to 14.8% among disability-eligible rural residents. Community-level uptake ranged from 0% to 76.4% (median = 5.5%; interquartile range = 2.8%-11.3%). Certain subpopulations of dual eligibles are significantly more likely to use FQHCs. Our findings should inform the targeting of future FQHC expansions.
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Affiliation(s)
- Brad Wright
- Department of Health Services Policy and Management, University of South Carolina, Columbia (Dr Wright); Department of Health Policy and Management, Gillings School of Public Health, UNC-Chapel Hill, Chapel Hill, North Carolina (Ms Akiyama); Department of Political Science & Criminal Justice, The California State University, Chico (Dr Potter); Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Sabik); The Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, North Carolina (Ms Stehlin); Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island (Dr Trivedi); and Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City (Dr Wolinsky)
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15
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Sabbatini AK, Joynt-Maddox KE, Liao J, Basu A, Parrish C, Kreuter W, Wright B. Accounting for the Growth of Observation Stays in the Assessment of Medicare's Hospital Readmissions Reduction Program. JAMA Netw Open 2022; 5:e2242587. [PMID: 36394872 PMCID: PMC9672971 DOI: 10.1001/jamanetworkopen.2022.42587] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Decreases in 30-day readmissions following the implementation of the Medicare Hospital Readmissions Reduction Program (HRRP) have occurred against the backdrop of increasing hospital observation stay use, yet observation stays are not captured in readmission measures. OBJECTIVE To examine whether the HRRP was associated with decreases in 30-day readmissions after accounting for observation stays. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included a 20% sample of inpatient admissions and observation stays among Medicare fee-for-service beneficiaries from January 1, 2009, to December 31, 2015. Data analysis was performed from November 2021 to June 2022. A differences-in-differences analysis assessed changes in 30-day readmissions after the announcement of the HRRP and implementation of penalties for target conditions (heart failure, acute myocardial infarction, and pneumonia) vs nontarget conditions under scenarios that excluded and included observation stays. MAIN OUTCOMES AND MEASURES Thirty-day inpatient admissions and observation stays. RESULTS The study included 8 944 295 hospitalizations (mean [SD] age, 78.7 [8.2] years; 58.6% were female; 1.3% Asian; 10.0% Black; 2.0% Hispanic; 0.5% North American Native; 85.0% White; and 1.2% other or unknown). Observation stays increased from 2.3% to 4.4% (91.3% relative increase) of index hospitalizations among target conditions and 14.1% to 21.3% (51.1% relative increase) of index hospitalizations for nontarget conditions. Readmission rates decreased significantly after the announcement of the HRRP and returned to baseline by the time penalties were implemented for both target and nontarget conditions regardless of whether observation stays were included. When only inpatient hospitalizations were counted, decreasing readmissions accrued into a -1.48 percentage point (95% CI, -1.65 to -1.31 percentage points) absolute reduction in readmission rates by the postpenalty period for target conditions and -1.13 percentage point (95% CI, -1.30 to -0.96 percentage points) absolute reduction in readmission rates by the postpenalty period for nontarget conditions. This reduction corresponded to a statistically significant differential change of -0.35 percentage points (95% CI, -0.59 to -0.11 percentage points). Accounting for observation stays more than halved the absolute decrease in readmission rates for target conditions (-0.66 percentage points; 95% CI, -0.83 to -0.49 percentage points). Nontarget conditions showed an overall greater decrease during the same period (-0.76 percentage points; 95% CI, -0.92 to -0.59 percentage points), corresponding to a differential change in readmission rates of 0.10 percentage points (95% CI, -0.14 to 0.33 percentage points) that was not statistically significant. CONCLUSIONS AND RELEVANCE The findings of this study suggest that the reduction of readmissions associated with the implementation of the HRRP was smaller than originally reported. More than half of the decrease in readmissions for target conditions appears to be attributable to the reclassification of inpatient admission to observation stays.
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Affiliation(s)
- Amber K. Sabbatini
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Karen E. Joynt-Maddox
- Center for Health Economics and Policy, Institute for Public Health, Washington University in St Louis, St Louis, Missouri
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
| | - Josh Liao
- Department of Medicine, University of Washington School of Medicine, Seattle
- Value System Science Lab, Department of Medicine, University of Washington, Seattle
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington School of Pharmacy, Seattle
| | - Canada Parrish
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - William Kreuter
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington School of Pharmacy, Seattle
| | - Brad Wright
- Department of Health Services, Policy and Management University of South Carolina School of Public Health, Columbia
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16
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Monteiro BP, Lascelles BDX, Murrell J, Robertson S, Steagall PVM, Wright B. 2022
WSAVA
guidelines for the recognition, assessment and treatment of pain. J Small Anim Pract 2022. [DOI: 10.1111/jsap.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. P. Monteiro
- Department of Clinical Sciences, Faculty of Veterinary Medicine Université de Montréal 3200 rue Sicotte, Saint‐Hyacinthe Quebec Canada
| | - B. D. X. Lascelles
- Comparative Pain Research Laboratory and Surgery Section North Carolina State University 4700 Hillsborough Street Raleigh NC USA
| | - J. Murrell
- Highcroft Veterinary Referrals 615 Wells Rd, Whitchurch Bristol BS149BE UK
| | - S. Robertson
- Senior Medical Director Lap of Love Veterinary Hospice 17804 N US Highway 41 Lutz FL 33549 USA
| | - P. V. M. Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine Université de Montréal 3200 rue Sicotte, Saint‐Hyacinthe Quebec Canada
| | - B. Wright
- Mistral Vet 4450 Thompson Pkwy Fort Collins CO 80534 USA
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17
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Wright B, Akiyama J, Potter AJ, Sabik LM, Stehlin GG, Trivedi AN, Wolinsky FD. Health center use and hospital-based care among individuals dually enrolled in Medicare and Medicaid, 2012-2018. Health Serv Res 2022; 57:1045-1057. [PMID: 35124817 PMCID: PMC9441286 DOI: 10.1111/1475-6773.13946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/19/2021] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine the relationship between federally qualified health center (FQHC) use and hospital-based care among individuals dually enrolled in Medicare and Medicaid. DATA SOURCES Data were obtained from 2012 to 2018 Medicare claims. STUDY DESIGN We modeled hospital-based care as a function of FQHC use, person-level factors, a Medicare prospective payment system (PPS) indicator, and ZIP code fixed effects. Outcomes included emergency department (ED) visits (overall and nonemergent), observation stays, hospitalizations (overall and for ambulatory care sensitive conditions), and 30-day unplanned returns. We stratified all models on the basis of eligibility and rurality. DATA EXTRACTION METHODS Our sample included individuals dually enrolled in Medicare and Medicaid for at least two full consecutive years, residing in a primary care service area with an FQHC. We excluded individuals without primary care visits, who died, or had end-stage renal disease. PRINCIPAL FINDINGS After the Medicare PPS was introduced, FQHC use in rural counties was associated with fewer ED and nonemergent ED visits per 100 person-years among both age-eligible (-14.8 [-17.5, -12.1]; -6.6 [-7.5, -5.6]) and disability-eligible duals (-11.3 [-14.4, -8.3]; -6 [-7.4, -4.6]) as well as a lower probability of observation stays (-0.8 pp age-eligible; -0.4 pp disability-eligible) and unplanned returns (-2.1 pp age-eligible; -1.9 pp disability-eligible). In urban counties, FQHC use was associated with more ED and nonemergent ED visits per 100 person-years (10.6 [8.4, 12.8]; 4.0 [2.6, 5.4]) among disability-eligible duals (a decrease of more than 60% compared with the pre-PPS period) and increases in the probability of hospitalization (1.1 pp age-eligible; 0.8 pp disability-eligible) and ACS hospitalization (0.5 pp age-eligible; 0.3 pp disability-eligible) (a decrease of roughly 50% compared with the pre-PPS period). CONCLUSIONS FQHC use is associated with reductions in hospital-based care among dual enrollees after introduction of the Medicare PPS. Further research is needed to understand how FQHCs can tailor care to best serve this complex population.
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Affiliation(s)
- Brad Wright
- Department of Family MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Jill Akiyama
- Department of Health Policy and ManagementUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Andrew J. Potter
- Department of Political Science and Criminal JusticeCalifornia State UniversityChicoCaliforniaUSA
| | - Lindsay M. Sabik
- Department of Health Policy and ManagementUniversity of Pittsburgh School of Public HealthPittsburghPennsylvaniaUSA
| | - Grace G. Stehlin
- Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Amal N. Trivedi
- Department of Health Services Policy and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Fredric D. Wolinsky
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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18
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Tan CH, Wright B, Black M, Devlin B. 630 Hailey-Hailey Disease: A Rare Presentation in the Hypopharnyx. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Hailey-Hailey disease or familial benign pemphigus is a rare genetic blistering skin disease due to mutation of the ATP2C1 gene inherited in autosomal dominant fashion. Prevalence is around 1 in 50,000 and positive family history is observed in 75% of cases. Patients typically present with well-demarcated painful erosive and yellow-crusted rash in the skin folds, following a relapsing-remitting pattern. There are very limited known cases of extra-dermatological presentation of this disease.
Case
64-year-old gentleman presented with dysphagia, hoarseness, sore throat, dry cough, and intermittent haemoptysis. Initial flexible nasendoscopy showed mild erythema of epiglottis and false cords, post-cricoid oedema and very mild Reinke's oedema. He was treated as acid reflux with omeprazole but to little effect. Endoscopy 4 months later showed similar findings hence biopsy of the hypopharynx was taken. The sample demonstrated intraepithelial clefting, suspicious of intraepithelial vesiculobullous disorder particularly pemphigus vulgaris.
Looking into this gentleman's medical history, it was found that he is under the care of dermatology for Hailey-Hailey disease, which he was diagnosed 30 years ago. He also has a strong family history of this condition. Based on the biopsy findings and patient profile, it was concluded that this gentleman has a hypopharyngeal manifestation of Hailey-Hailey disease.
Discussion
Hailey-Hailey disease is traditionally described as a dermatological condition. This gentleman is one of the rare few cases of non-dermatological manifestation of this disease.
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Affiliation(s)
- CH Tan
- Royal Victoria Hospital , Belfast , United Kingdom
| | - B Wright
- Royal Victoria Hospital , Belfast , United Kingdom
| | - M Black
- Royal Victoria Hospital , Belfast , United Kingdom
| | - B Devlin
- Royal Victoria Hospital , Belfast , United Kingdom
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19
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Oh NL, Potter AJ, Sabik LM, Trivedi AN, Wolinsky F, Wright B. The association between primary care use and potentially-preventable hospitalization among dual eligibles age 65 and over. BMC Health Serv Res 2022; 22:927. [PMID: 35854303 PMCID: PMC9295296 DOI: 10.1186/s12913-022-08326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Individuals dually-enrolled in Medicare and Medicaid (dual eligibles) are disproportionately sicker, have higher health care costs, and are hospitalized more often for ambulatory care sensitive conditions (ACSCs) than other Medicare beneficiaries. Primary care may reduce ACSC hospitalizations, but this has not been well studied among dual eligibles. We examined the relationship between primary care and ACSC hospitalization among dual eligibles age 65 and older. Methods In this observational study, we used 100% Medicare claims data for dual eligibles ages 65 and over from 2012 to 2018 to estimate the likelihood of ACSC hospitalization as a function of primary care visits and other factors. We used linear probability models stratified by rurality, with subgroup analyses for dual eligibles with diabetes or congestive heart failure. Results Each additional primary care visit was associated with an 0.05 and 0.09 percentage point decrease in the probability of ACSC hospitalization among urban (95% CI: − 0.059, − 0.044) and rural (95% CI: − 0.10, − 0.08) dual eligibles, respectively. Among dual eligibles with CHF, the relationship was even stronger with decreases of 0.09 percentage points (95% CI: − 0.10, − 0.08) and 0.15 percentage points (95% CI: − 0.17, − 0.13) among urban and rural residents, respectively. Conclusions Increased primary care use is associated with lower rates of preventable hospitalizations for dual eligibles age 65 and older, especially for dual eligibles with diabetes and congestive heart failure. In turn, efforts to reduce preventable hospitalizations for this dual-eligible population should consider how to increase access to and use of primary care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08326-2.
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Affiliation(s)
- N Loren Oh
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.,Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Andrew J Potter
- Department of Political Science & Criminal Justice, California State University, Chico, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Amal N Trivedi
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, USA
| | - Fredric Wolinsky
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, USA
| | - Brad Wright
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA. .,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 590 Manning Dr. CB 7595, Chapel Hill, NC, 27599, USA.
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20
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Wright B, Anderson D, Whitaker R, Shrader P, Bettger JP, Wong C, Shafer P. Comparing health care use and costs among new Medicaid enrollees before and during the COVID-19 pandemic. BMC Health Serv Res 2021; 21:1152. [PMID: 34696801 PMCID: PMC8544632 DOI: 10.1186/s12913-021-07027-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background and Objective To characterize health care use and costs among new Medicaid enrollees before and during the COVID pandemic. Results can help Medicaid non-expansion states understand health care use and costs of new enrollees in a period of enrollment growth. Research Design Retrospective cross-sectional analysis of North Carolina Medicaid claims data (January 1, 2018 - August 31, 2020). We used modified Poisson and ordinary least squares regression analysis to estimate health care use and costs as a function of personal characteristics and enrollment during COVID. Using data on existing enrollees before and during COVID, we projected the extent to which changes in outcomes among new enrollees during COVID were pandemic-related. Subjects 340,782 new enrollees pre-COVID (January 2018 – December 2019) and 56,428 new enrollees during COVID (March 2020 – June 2020). Measures We observed new enrollees for 60-days after enrollment to identify emergency department (ED) visits, nonemergent ED visits, primary care visits, potentially-avoidable hospitalizations, dental visits, and health care costs. Results New Medicaid enrollees during COVID were less likely to have an ED visit (-46 % [95 % CI: -48 %, -43 %]), nonemergent ED visit (-52 % [95 % CI: -56 %, -48 %]), potentially-avoidable hospitalization (-52 % [95 % CI: -60 %, -43 %]), primary care visit (-34 % [95 % CI: -36 %, -33 %]), or dental visit (-36 % [95 % CI: -41 %, -30 %]). They were also less likely to incur any health care costs (-29 % [95 % CI: -30 %, -28 %]), and their total costs were 8 % lower [95 % CI: -12 %, -4 %]. Depending on the outcome, COVID explained between 34 % and 100 % of these reductions. Conclusions New Medicaid enrollees during COVID used significantly less care than new enrollees pre-COVID. Most of the reduction stems from pandemic-related changes in supply and demand, but the profile of new enrollees before versus during COVID also differed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07027-6.
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Affiliation(s)
- Brad Wright
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr, NC, CB 7595, Chapel Hill, United States. .,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | | | | | | | - Janet Prvu Bettger
- Duke-Margolis Center for Health Policy, Washington, USA.,Department of Orthopaedic Surgery, Duke University, Durham, USA
| | - Charlene Wong
- Duke-Margolis Center for Health Policy, Washington, USA.,Department of Pediatrics, Duke University, Durham, USA
| | - Paul Shafer
- Department of Health Law, Policy, and Management, Boston University, Boston, USA
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21
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Wright B, Hargate R, Garside M, Carr G, Wakefield T, Swanwick R, Noon I, Simpson P. A systematic scoping review of early interventions for parents of deaf infants. BMC Pediatr 2021; 21:467. [PMID: 34686176 PMCID: PMC8532316 DOI: 10.1186/s12887-021-02893-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/03/2021] [Indexed: 02/14/2023] Open
Abstract
Background Over 90% of the 50,000 deaf children in the UK have hearing parents, many of whom were not expecting a deaf child and may require specialist support. Deaf children can experience poorer long-term outcomes than hearing children across a range of domains. After early detection by the Universal Newborn Hearing Screening Programme, parents in the UK receive support from Qualified Teachers of the Deaf and audiologists but resources are tight and intervention support can vary by locality. There are challenges faced due to a lack of clarity around what specific parenting support interventions are most helpful. Methods The aim of this research was to complete a systematic scoping review of the evidence to identify early support interventions for parents of deaf infants. From 5577 identified records, 54 met inclusion criteria. Two reviewers screened papers through three rounds before completing data extraction and quality assessment. Results Identified parent support interventions included both group and individual sessions in various settings (including online). They were led by a range of professionals and targeted various outcomes. Internationally there were only five randomised controlled trials. Other designs included non-randomised comparison groups, pre / post and other designs e.g. longitudinal, qualitative and case studies. Quality assessment showed few high quality studies with most having some concerns over risk of bias. Conclusion Interventions commonly focused on infant language and communication followed by parental knowledge and skills; parent wellbeing and empowerment; and parent/child relationship. There were no interventions that focused specifically on parent support to understand or nurture child socio-emotional development despite this being a well-established area of poor outcome for deaf children. There were few UK studies and research generally was not of high quality. Many studies were not recent and so not in the context of recent healthcare advances. Further research in this area is urgently needed to help develop evidence based early interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02893-9.
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Affiliation(s)
- B Wright
- Leeds and York Partnership NHS Foundation Trust, COMIC Research, IT Centre, Science Park, University of York, Innovation Way, Heslington, York, YO10 5NP, UK
| | - R Hargate
- Leeds and York Partnership NHS Foundation Trust, COMIC Research, IT Centre, Science Park, University of York, Innovation Way, Heslington, York, YO10 5NP, UK
| | - M Garside
- Leeds and York Partnership NHS Foundation Trust, COMIC Research, IT Centre, Science Park, University of York, Innovation Way, Heslington, York, YO10 5NP, UK.
| | - G Carr
- The University College London Ear Institute, 332 Grays Inn Rd, London, WC1X 8EE, UK
| | - T Wakefield
- National Deaf Children's Society and NatSIP, Ground Floor South, Castle House 37-45 Paul Street, London, EC2A 4LS, UK
| | - R Swanwick
- University of Leeds, School of Education, Hillary Place, Woodhouse, Leeds, LS2 9JT, UK
| | - I Noon
- National Deaf Children's Society and NatSIP, Ground Floor South, Castle House 37-45 Paul Street, London, EC2A 4LS, UK
| | - P Simpson
- British Association of Teachers of the Deaf, 21, Keating Close, Rochester, ME1 1EQ, UK
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22
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Zuccarelli A, Wright B, Trimble K. 1068 Cranial Fasciitis of the Temporal Bone. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We present the case of a child with a rare benign tumour of the temporal bone.
A nine-month-old girl was referred to her local paediatric hospital with a painless right-sided, post-auricular swelling increasing in size in the preceding two months. On examination there was a 2x2cm mass overlying the temporal bone posterior to the right ear. The mass was firm, immobile, non-tender and well circumscribed. Ultrasound demonstrated a 1.9cm subcuticular mass with evidence of intracranial extension through the suture. Vascular flow and hyperechoic foci were demonstrated within the lesion. The local paediatric team requested magnetic resonance imaging (MRI) and computed tomography (CT) of temporal bone prior to referral to tertiary care centre. Imaging displayed a 2cm expansile lesion of the temporal bone with cortical loss and effacement of underlying dural venous sinus. The patient proceeded to incisional biopsy for tissue diagnosis which was suggestive of cranial fasciitis. Following discussion at the regional multidisciplinary meeting, she underwent surgical excision of the tumour in a joint Neurosurgery/Otology case. The tumour was fully resected macroscopically, with the normal surrounding bone and mastoid air cells preserved. Final histopathology showed a highly cellular lesion composed of spindle cells arranged in fascicles, with areas of myxoid background and confirmed the tumour to be cranial fasciitis. The child has made a good recovery and will be kept under close clinical follow-up. This case demonstrates a rare benign tumour of the temporal bone that may present to an otolaryngologist and the importance of tissue diagnosis, imaging and multidisciplinary management.
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Affiliation(s)
- A Zuccarelli
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - B Wright
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - K Trimble
- Belfast Health and Social Care Trust, Belfast, United Kingdom
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Shafer PR, Anderson DM, Whitaker R, Wong CA, Wright B. Association Of Unemployment With Medicaid Enrollment By Social Vulnerability In North Carolina During COVID-19. Health Aff (Millwood) 2021; 40:1491-1500. [PMID: 34495714 DOI: 10.1377/hlthaff.2021.00377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The COVID-19 pandemic precipitated an unemployment crisis in the US that surpassed the Great Recession of 2007-09 within the first three months of the pandemic. This article builds on the limited early evidence of the relationship between the pandemic and health insurance coverage, using county-level unemployment and Medicaid enrollment data from North Carolina, a large state that did not expand Medicaid. We used linear and county fixed effects models to assess this relationship, accounting for county-level social vulnerability, physical and virtual access to Medicaid enrollment, and COVID-19 case burden. Using data from January 2018 through August 2020, we estimated that the passthrough rate-the share of unemployed people who gained Medicaid coverage-was approximately 15 percent statewide but higher in more socially vulnerable counties. This low passthrough rate during a period of increased unemployment resulting from the COVID-19 pandemic means that Medicaid was unable to completely fulfill its countercyclical role, in which it grows to meet greater need during periods of widespread economic hardship, because of North Carolina's stringent Medicaid eligibility criteria. Working toward greater adoption of Medicaid expansion may help ensure that the US is better prepared for the next crisis by ensuring access to health insurance coverage.
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Affiliation(s)
- Paul R Shafer
- Paul R. Shafer is an assistant professor in the Department of Health Law, Policy, and Management at the Boston University School of Public Health, in Boston, Massachusetts
| | - David M Anderson
- David M. Anderson is a research associate at the Duke-Margolis Center for Health Policy, Duke University, in Durham, North Carolina
| | - Rebecca Whitaker
- Rebecca Whitaker is a managing associate at the Duke-Margolis Center for Health Policy, Duke University
| | - Charlene A Wong
- Charlene A. Wong is an associate professor of pediatrics and public policy at Duke University, the Children's Health and Discovery Initiative, and the Duke-Margolis Center for Health Policy
| | - Brad Wright
- Brad Wright is an associate professor in the Department of Family Medicine and codirector of the Health Care Economics and Finance Program, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina
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Moore RA, Fried MW, Wright B. Primary Care Providers in Federally Qualified Health Centers Can Treat Hepatitis C Effectively Without Ongoing Consultative Support From Specialists. Med Care 2021; 59:699-703. [PMID: 34081677 DOI: 10.1097/mlr.0000000000001582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection remains underdiagnosed and undertreated, but treatment advances may allow primary care providers to address gaps in care by delivering HCV treatment themselves. OBJECTIVE The objective of this study was to evaluate results of an HCV treatment program at a federally qualified health center (FQHC) in rural North Carolina and assess the extent to which program success depends upon ongoing consultative support from specialists. METHODS In this retrospective cohort study, we used data on 381 FQHC patients internally referred for HCV care from January 2015 to December 2018, with follow-up through December 2019. Using modified Poisson regression analyses we compared outcomes during periods with (2015-2016) and without (2017-2018) consultative support. Outcomes included treatment initiation, completion, and cure. We also modeled the likelihood of keeping the first appointment, but because multiple referral attempts were made among nonresponsive patients throughout the study period, we could not compare this outcome in periods with and without consultative support. RESULTS Of all patients referred for evaluation, 91.3% kept at least 1 appointment, 74.1% initiated treatment, 72% completed treatment, and 68.1% were cured. When comparing periods with and without consultative support, there were no significant differences in treatment initiation ([relative risk (RR): 0.975, 95% confidence interval (CI): 0.871, 1.092], treatment completion (RR: 0.989, 95% CI: 0.953, 1.027), or cure (RR: 0.977, 95% CI: 0.926, 1.031). CONCLUSIONS After 2 years of consultative support from specialists, primary care providers at FQHCs can deliver HCV treatment effectively without ongoing support. However, more research is needed to determine whether our findings are generalizable across primary care settings.
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Affiliation(s)
| | - Michael W Fried
- Department of Medicine, Division of Gastroenterology and Hepatology
| | - Brad Wright
- Department of Family Medicine
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Wright B, McKenna C, Reddy C. The effect of the COVID-19 pandemic on non-elective otolaryngology admissions and a positive change in clinical practice. Ann R Coll Surg Engl 2021; 103:496-498. [PMID: 34192485 DOI: 10.1308/rcsann.2021.0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As the COVID-19 pandemic progressed across the UK and Northern Ireland in March 2020, our otolaryngology department began to make preparations and changes in practice to accommodate for potentially large numbers of patients with COVID-19 related respiratory illness in the hospital. We retrospectively reviewed the number of non-elective admissions to our department between the months of January and May in 2019 and 2020. A significant reduction in admissions of up to 94% during the months of the pandemic was observed. Our practice shifted to manage patients with epistaxis and peritonsillar abscess on an outpatient basis, and while prospectively collecting data on this, we did not observe any significant adverse events. We view this as a positive learning point and change in our practice as a result of the COVID-19 pandemic.
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Brady PJ, Askelson NM, Wright B, Daly E, Momany E, McInroy B, Damiano P. Food Insecurity Is Prevalent in Iowa's Medicaid Expansion Population. J Acad Nutr Diet 2021; 122:394-402. [PMID: 33994143 DOI: 10.1016/j.jand.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Food insecurity has been identified as an important social determinant of health and is associated with many health issues prevalent in Medicaid members. Despite this, little research has been done around food insecurity within Medicaid populations. OBJECTIVE Our objective was to estimate the prevalence of household food insecurity and identify factors associated with experiencing food insecurity in Iowa's Medicaid expansion population. DESIGN We conducted a cross-sectional telephone survey between March and May of 2019. PARTICIPANTS Our sample was drawn from Medicaid members enrolled in Iowa's expansion program at least 14 months, stratified by Federal Poverty Level (FPL) category. Members who did not have valid contact information were excluded. We selected one individual per household to reduce the interrelatedness of responses. We sampled 6,000 individuals and had 1,349 respondents in the analytic sample. MAIN OUTCOME MEASURE Our main outcome was whether a respondent's household experienced food insecurity in the previous year, using the Hunger Vital Sign screening tool. STATISTICAL ANALYSES PERFORMED We weighted responses to account for the sampling design and differential nonresponse between strata. We estimated the prevalence of food insecurity and used logistic regression to model food insecurity as a function of demographic (age, FPL category, gender, employment, education, race, rurality, and Supplemental Nutrition Assistance Program [SNAP] participation) and health-related (self-rated health, self-rated oral health, health literacy) factors. RESULTS The estimated prevalence of experiencing food insecurity was 51.3%. Race, gender, education, employment, health literacy, and self-rated health were all significantly associated with food insecurity. CONCLUSIONS Our findings show that food insecurity is prevalent in Iowa's Medicaid expansion population. Food insecurity should be more widely measured as a critical social determinant of health in Medicaid populations. Policymakers and clinicians should consider interventions that connect households experiencing food insecurity to food resources (eg, produce prescriptions and food pantry referrals) and policies that increase food access. ABBREVIATIONS Iowa Wellness Plan (IWP); Federal Poverty Level (FPL); Healthy Behavior Program (HBP); Supplemental Nutrition Assistance Program (SNAP).
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Wright B, Johnson B, Saidian A, Rais-Bahrami S, Vassar M, Gunn A. Abstract No. 110 Trans-arterial embolization of renal cell carcinoma: a systematic review and meta-analysis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Treleaven J, Dillon M, Fitzgerald C, Smith C, Wright B, Sarig-Bahat H. Change in a clinical measure of cervical movement sense following four weeks of kinematic training. Musculoskelet Sci Pract 2021; 51:102312. [PMID: 33272876 DOI: 10.1016/j.msksp.2020.102312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Training targeted towards improving cervical movement accuracy is an effective strategy in the management of neck pain. Relatively complex measures have been validated to measure this in research although a simple clinical measure using a head mounted laser tracing a standardised pattern has been shown to be reliable. It is not known if this method demonstrate clinically meaningful change to training. OBJECTIVE To assess change responsiveness of the clinical cervical movement sense (CCMS) test following home kinematic training (KT). STUDY DESIGN Pre-post treatment observational study. METHODS The CCMS measure was assessed in 56 patients with chronic neck pain (41 intervention, 15 control) at baseline and 4 weeks post intervention by blinded assessors. Task completion time and error number were assessed reviewing video of the performances. Change pre-post intervention was compared between groups. RESULTS There was a significantly greater mean improvement in the intervention (-9.2 ± 9.3) seconds) for completion time and combined time and error (-13.3 ± 16) compared to the control group for time (-2.0 ± 9.8) and combined time and error (-1.8 ± 14) with moderate to high effect sizes (Cohen's d 0.76). There was a non-significant trend for decreased number of errors in the intervention (-4.1 ± 9.0) compared to control group (0.2 ± 8.3). CONCLUSION Completion time of the CCMS test appears to be able to demonstrate meaningful change following four weeks of KT. This further supports its clinical utility as a measure of cervical movement accuracy and provides direction for future clinical use.
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Affiliation(s)
- J Treleaven
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia.
| | - M Dillon
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
| | - C Fitzgerald
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
| | - C Smith
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
| | - B Wright
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
| | - H Sarig-Bahat
- Neck Pain and Whiplash Research Unit, SHRS, University of QLD, Brisbane, Australia
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Rahman M, Meyers DJ, Wright B. Unintended Consequences of Observation Stay Use May Disproportionately Burden Medicare Beneficiaries in Disadvantaged Neighborhoods. Mayo Clin Proc 2020; 95:2589-2591. [PMID: 33276830 DOI: 10.1016/j.mayocp.2020.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Momotazur Rahman
- Department of Health Services, Policy, and PracticeBrown University.
| | - David J Meyers
- Department of Health Services, Policy, and PracticeBrown University
| | - Brad Wright
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Freeman C, Bauer C, Miller H, Wright B, Rukasin C, Badia P. M278 XMEN DISEASE: AN UNEXPECTED PRESENTATION WITH AN UNEXAMPLED MUTATION. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grueber CE, Peel E, Wright B, Hogg CJ, Belov K. A Tasmanian devil breeding program to support wild recovery. Reprod Fertil Dev 2020; 31:1296-1304. [PMID: 32172782 DOI: 10.1071/rd18152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/01/2018] [Indexed: 01/03/2023] Open
Abstract
Tasmanian devils are threatened in the wild by devil facial tumour disease: a transmissible cancer with a high fatality rate. In response, the Save the Tasmanian Devil Program (STDP) established an 'insurance population' to enable the preservation of genetic diversity and natural behaviours of devils. This breeding program includes a range of institutions and facilities, from zoo-based intensive enclosures to larger, more natural environments, and a strategic approach has been required to capture and maintain genetic diversity, natural behaviours and to ensure reproductive success. Laboratory-based research, particularly genetics, in tandem with adaptive management has helped the STDP reach its goals, and has directly contributed to the conservation of the species in the wild. Here we review this work and show that the Tasmanian devil breeding program is a powerful example of how genetic research can be used to understand and improve reproductive success in a threatened species.
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Affiliation(s)
- C E Grueber
- The University of Sydney, School of Life and Environmental Sciences, Faculty of Science, Sydney, NSW 2006, Australia
| | - E Peel
- The University of Sydney, School of Life and Environmental Sciences, Faculty of Science, Sydney, NSW 2006, Australia
| | - B Wright
- The University of Sydney, School of Life and Environmental Sciences, Faculty of Science, Sydney, NSW 2006, Australia
| | - C J Hogg
- The University of Sydney, School of Life and Environmental Sciences, Faculty of Science, Sydney, NSW 2006, Australia
| | - K Belov
- The University of Sydney, School of Life and Environmental Sciences, Faculty of Science, Sydney, NSW 2006, Australia
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32
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Lovegrove C, Musbahi O, Ranasinha N, Omer A, Campbell A, Bryant R, Leslie T, Bell R, Brewster S, Hamdy F, Wright B, Lamb A. Implications of celebrity endorsement of prostate cancer awareness in a tertiary referral unit: The “Fry-Turnbull” effect. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wright B, Teige C, Watson J, Hodkinson R, Marshall D, Varley D, Allgar V, Mandefield L, Parrott S, Kingsley E, Hargate R, Mitchell N, Ali S, McMillan D, Wang H, Hewitt C. Autism Spectrum Social Stories In Schools Trial 2 (ASSSIST2): study protocol for a randomised controlled trial analysing clinical and cost-effectiveness of Social Stories™ in primary schools. BMC Psychol 2020; 8:60. [PMID: 32532354 PMCID: PMC7291714 DOI: 10.1186/s40359-020-00427-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/05/2020] [Indexed: 11/14/2022] Open
Abstract
Background Interventions designed to support children with a diagnosis of Autism Spectrum Conditions (ASC) can be time consuming, needing involvement of outside experts. Social Stories™ are a highly personalised intervention aiming to give children with ASC social information or describing an otherwise difficult situation or skill. This can be delivered daily by staff in education settings. Studies examining Social Story™ use have yielded mostly positive results but have largely been single case studies with a lack of randomised controlled trials (RCTs). Despite this numerous schools are utilising Social Stories™, and a fully powered RCT is timely. Methods A multi-site pragmatic cluster RCT comparing care as usual with Social Stories™ and care as usual. This study will recruit 278 participants (aged 4–11) with a clinical diagnosis of ASC, currently attending primary school in the North of England. Approximately 278 school based staff will be recruited to provide school based information about participating children with approximately 140 recruited to deliver the intervention. The study will be cluster randomised by school. Potential participants will be screened for eligibility prior to giving informed consent. Follow up data will be collected at 6 weeks and 6 months post randomisation and will assess changes in participants’ social responsiveness, goal based outcomes, social and emotional health. The primary outcome measure is the Social Responsiveness Scale Second Edition (SRS-2) completed by school based staff at 6 months. Approvals have been obtained from the University of York’s Research Governance Committee, Research Ethics Committee and the Health Research Authority. Study results will be submitted for publication in peer-reviewed journals and disseminated to participating families, educational staff, local authority representatives, community groups and Patient and Participant Involvement representatives. Suggestions will be made to NICE about treatment evidence dependent on findings. Discussion This study addresses a much used but currently under researched intervention and results will inform school based support for primary school children with a diagnosis of ASC. Trial registration The trial is registered on the ISRCTN registry (registration number: ISRCTN11634810). The trial was retrospectively registered on 23rd April 2019.
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Affiliation(s)
- B Wright
- Child Oriented Mental Health Intervention Centre, Leeds and York Partnership NHS Foundation Trust, York, UK. .,Hull York Medical School, University of York, York, UK. .,COMIC, IT Centre, Innovation Way, Heslington, York, YO10 5NP, UK.
| | - C Teige
- Child Oriented Mental Health Intervention Centre, Leeds and York Partnership NHS Foundation Trust, York, UK
| | - J Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - R Hodkinson
- Child Oriented Mental Health Intervention Centre, Leeds and York Partnership NHS Foundation Trust, York, UK
| | - D Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - D Varley
- Department of Health Sciences, University of York, York, UK
| | - V Allgar
- Department of Health Sciences, University of York, York, UK
| | - L Mandefield
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - S Parrott
- Department of Health Sciences, University of York, York, UK
| | - E Kingsley
- Child Oriented Mental Health Intervention Centre, Leeds and York Partnership NHS Foundation Trust, York, UK
| | - R Hargate
- Child Oriented Mental Health Intervention Centre, Leeds and York Partnership NHS Foundation Trust, York, UK
| | - N Mitchell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - S Ali
- Department of Health Sciences, University of York, York, UK.,Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - D McMillan
- Department of Health Sciences, University of York, York, UK
| | - H Wang
- Department of Health Sciences, University of York, York, UK
| | - C Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Affiliation(s)
- Brad Wright
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin Fraher
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Jill Akiyama
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian Toomey
- Piedmont Health Services, Inc., Chapel Hill, North Carolina
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Wright B, Jung YS, Askelson NM, Momany ET, Damiano P. Iowa's Medicaid Healthy Behaviors Program Associated With Reduced Hospital-Based Care But Higher Spending, 2012-17. Health Aff (Millwood) 2020; 39:876-883. [PMID: 32364851 DOI: 10.1377/hlthaff.2019.01145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health behavior incentive programs are increasingly common in Medicaid programs nationwide. Iowa's Healthy Behaviors Program (HBP) requires Medicaid expansion enrollees to complete an annual wellness exam and health risk assessment or pay monthly premiums to avoid disenrollment. The extent to which the program reduces the use of hospital-based care and lowers health care spending is unknown. Using data for 2012-17 from Medicaid and for 2014-17 from HBP, we evaluated changes in use and spending associated with HBP participation. Compared to nonparticipants, HBP participants were less likely to have an emergency department visit or be hospitalized (by 9.6 percentage points and 2.8 percentage points, respectively) but had higher total health care spending ($1,594). Meanwhile, Iowa's Medicaid expansion was associated with increased use and spending independent of HBP participation-that is, applying to both participants and nonparticipants. Overall, our findings suggest that the HBP was associated with substantial reductions in hospital-based care but increased health care spending.
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Affiliation(s)
- Brad Wright
- Brad Wright ( brad_wright@med. unc. edu ) is an associate professor in the Department of Family Medicine and codirector of the Health Care Economics and Finance Program at the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Youn Soo Jung
- Youn Soo Jung is a research associate at the Public Policy Center, University of Iowa, in Iowa City
| | - Natoshia M Askelson
- Natoshia M. Askelson is an assistant professor in the Department of Community and Behavioral Health and a research fellow at the Public Policy Center, University of Iowa
| | - Elizabeth T Momany
- Elizabeth T. Momany is a senior research scientist at the Public Policy Center, University of Iowa
| | - Peter Damiano
- Peter Damiano is a professor in the Department of Preventive and Community Dentistry, College of Dentistry, and director of the Public Policy Center, University of Iowa
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Askelson NM, Wright B, Brady PJ, Jung YS, Momany ET, McInroy B, Damiano P. Implementation Matters: Lessons From Iowa Medicaid’s Healthy Behaviors Program. Health Aff (Millwood) 2020; 39:884-891. [DOI: 10.1377/hlthaff.2019.01302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Natoshia M. Askelson
- Natoshia M. Askelson is an assistant professor in the Department of Community and Behavioral Health and a research fellow at the Public Policy Center, University of Iowa, in Iowa City
| | - Brad Wright
- Brad Wright is an associate professor in the Department of Family Medicine and codirector of the Health Care Economics and Finance Program at the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Patrick J. Brady
- Patrick J. Brady is a graduate research assistant in the Department of Community and Behavioral Health, University of Iowa
| | - Youn Soo Jung
- Youn Soo Jung is a research associate at the Public Policy Center, University of Iowa
| | - Elizabeth T. Momany
- Elizabeth T. Momany is a senior research scientist at the Public Policy Center, University of Iowa
| | - Brooke McInroy
- Brooke McInroy is a research associate at the Public Policy Center, University of Iowa
| | - Peter Damiano
- Peter Damiano is a professor in the Department of Preventive and Community Dentistry, College of Dentistry, and director of the Public Policy Center, University of Iowa
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Wright B, Kronen PW, Lascelles D, Monteiro B, Murrell JC, Robertson S, Steagall PVM, Yamashita K. Ice therapy: cool, current and complicated. J Small Anim Pract 2020; 61:267-271. [PMID: 32201945 DOI: 10.1111/jsap.13130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/13/2020] [Accepted: 02/16/2020] [Indexed: 12/01/2022]
Abstract
This is the fourth Capsule review article provided by the WSAVA Global Pain Council and which discusses the use of ice or cold therapy as a non-pharmacologic modality for pain control in small animal practice. The physiological effects of cold therapy on tissues, receptors and ion channels are discussed; as well as indications, recommendations for, and limitations of use.
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Affiliation(s)
- B Wright
- Mistralvet, 4450 Thompson Parkway, Johnstown, CO, 80534, USA
| | - P W Kronen
- Veterinary Anaesthesia Service - International Zuercherstrasse 39, Winterthur 8400, Switzerland.,Center for Applied Biotechnologyand Molecular Medicine - Winterthurer Strasse 190, Zürich, 8057, Switzerland
| | - D Lascelles
- North Carolina State University - Comparative Pain Research Laboratory and Surgery Section 4700 Hillsborough Street Raleigh, Raleigh, NC, 27606, USA
| | - B Monteiro
- University of Montreal - Biomedical Sciences 3200 rueSicote, Saint-Hyacinthe, Quebec J2S 2M2, Canada
| | - J C Murrell
- University of Bristol - Clinical Veterinary Science Langford House Langford, Bristol BS40 5DU, United Kingdom of Great Britain and Northern Ireland
| | | | | | - K Yamashita
- Rakuno Gakuen University - Small Animal Clinical Sciences 582 Bunkyodai-Midorimachi, Ebetsu, Hokkaodo, 069-8501, Japan
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Lines KE, Filippakopoulos P, Stevenson M, Müller S, Lockstone HE, Wright B, Knapp S, Buck D, Bountra C, Thakker RV. Effects of epigenetic pathway inhibitors on corticotroph tumour AtT20 cells. Endocr Relat Cancer 2020; 27:163-174. [PMID: 31935194 PMCID: PMC7040567 DOI: 10.1530/erc-19-0448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
Medical treatments for corticotrophinomas are limited, and we therefore investigated the effects of epigenetic modulators, a new class of anti-tumour drugs, on the murine adrenocorticotropic hormone (ACTH)-secreting corticotrophinoma cell line AtT20. We found that AtT20 cells express members of the bromo and extra-terminal (BET) protein family, which bind acetylated histones, and therefore, studied the anti-proliferative and pro-apoptotic effects of two BET inhibitors, referred to as (+)-JQ1 (JQ1) and PFI-1, using CellTiter Blue and Caspase Glo assays, respectively. JQ1 and PFI-1 significantly decreased proliferation by 95% (P < 0.0005) and 43% (P < 0.0005), respectively, but only JQ1 significantly increased apoptosis by >50-fold (P < 0.0005), when compared to untreated control cells. The anti-proliferative effects of JQ1 and PFI-1 remained for 96 h after removal of the respective compound. JQ1, but not PFI-1, affected the cell cycle, as assessed by propidium iodide staining and flow cytometry, and resulted in a higher number of AtT20 cells in the sub G1 phase. RNA-sequence analysis, which was confirmed by qRT-PCR and Western blot analyses, revealed that JQ1 treatment significantly altered expression of genes involved in apoptosis, such as NFκB, and the somatostatin receptor 2 (SSTR2) anti-proliferative signalling pathway, including SSTR2. JQ1 treatment also significantly reduced transcription and protein expression of the ACTH precursor pro-opiomelanocortin (POMC) and ACTH secretion by AtT20 cells. Thus, JQ1 treatment has anti-proliferative and pro-apoptotic effects on AtT20 cells and reduces ACTH secretion, thereby indicating that BET inhibition may provide a novel approach for treatment of corticotrophinomas.
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Affiliation(s)
- K E Lines
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | | | - M Stevenson
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - S Müller
- Structural Genomics Consortium, Buchmann Institute for Life Sciences, Goethe-University Frankfurt, Frankfurt, Germany
| | - H E Lockstone
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - B Wright
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - S Knapp
- Structural Genomics Consortium, Buchmann Institute for Life Sciences, Goethe-University Frankfurt, Frankfurt, Germany
- Institute of Pharmaceutical Chemistry, Goethe-University Frankfurt, Frankfurt, Germany
| | - D Buck
- Oxford Genomics Centre, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - C Bountra
- Structural Genomics Consortium, University of Oxford, Oxford, UK
| | - R V Thakker
- OCDEM, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Correspondence should be addressed to R V Thakker:
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Abstract
Purpose: To describe the impact of disenrollment from Medicaid because of failure to pay premiums as part of Iowa's Medicaid program's personal responsibility component. Methods: We conducted a mixed method study consisting of in-depth interviews with disenrolled members in 2016 and 2017 (n=72) and a survey of disenrolled members in 2017 (n=225). Results: Many disenrollees did not know why they were disenrolled, were unaware of the personal responsibility component or premium requirement, and were confused by the disenrollment process. Disenrollment had negative effects including stress, financial burden, and engaging in behaviors such as skipping medication and postponing medical or dental care. Furthermore, disenrollees were often unable to enroll in health insurance, and for those who did, many reported it was a difficult process. Conclusions: Disenrollment had numerous, negative impacts on members who failed to pay their premiums. There was confusion about program requirements, which might indicate challenges communicating about a complicated program. Policymakers need to consider how to design and implement personal responsibility programs to achieve their desired outcome and reduce confusion and negative consequences.
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Affiliation(s)
- Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa.,Public Policy Center, University of Iowa, Iowa City, Iowa
| | - Patrick Brady
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa.,Public Policy Center, University of Iowa, Iowa City, Iowa
| | - Brad Wright
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | - Peter Damiano
- Public Policy Center, University of Iowa, Iowa City, Iowa
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Steagall PVM, Benito J, Monteiro B, Lascelles D, Kronen PW, Murrell JC, Robertson S, Wright B, Yamashita K. Intraperitoneal and incisional analgesia in small animals: simple, cost-effective techniques. J Small Anim Pract 2019; 61:19-23. [PMID: 31737915 DOI: 10.1111/jsap.13084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 08/26/2019] [Accepted: 09/30/2019] [Indexed: 11/27/2022]
Abstract
The World Small Animal Veterinary Association Global Pain Council (WSAVA-GPC) has recently published its first "capsule review" by Monteiro et al. These are short articles that present a brief assessment of the scientific evidence and practical recommendations on important, and sometimes controversial, subjects in pain management. The capsules will be published regularly in the Journal of Small Animal Practice, the official journal of the WSAVA. This second article discusses the use of intraperitoneal and incisional analgesia in small animal practice, including their limitations and recommendations by the authors.
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Affiliation(s)
- P V M Steagall
- Department of Clinical Sciences, Université de Montréal, Montreal, Quebec, J2S 2M2, Canada
| | - J Benito
- Department of Clinical Sciences, Université de Montréal, Montreal, Quebec, J2S 2M2, Canada
| | - B Monteiro
- Department of Clinical Sciences, Université de Montréal, Montreal, Quebec, J2S 2M2, Canada
| | - D Lascelles
- Translational Research in Pain Program, Comparative Pain Research and Education Center, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, 27606, USA
| | - P W Kronen
- Veterinary Anaesthesia Service - International, Winterthur, 8400, Switzerland
| | - J C Murrell
- Highcroft Veterinary Referrals, Whitchurch, Bristol, BS14 9BE, UK
| | - S Robertson
- Lap of Love Veterinary Hospice, Lutz, Florida, 33549, USA
| | - B Wright
- Mistral Vet, Fort Collins, Colorado, 80534, USA
| | - K Yamashita
- Small Animal Clinical Sciences, Rakuno Gakuen University, Ebetsu, Hokkaido, 069-8501, Japan
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41
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Missikpode C, Peek‐Asa C, Wright B, Ramirez M. Characteristics of agricultural and occupational injuries by workers' compensation and other payer sources. Am J Ind Med 2019; 62:969-977. [PMID: 31436863 DOI: 10.1002/ajim.23040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Workers' compensation claims data are routinely used to identify and describe work-related injury for public health surveillance and research, yet the proportion of work-related injuries covered by workers' compensation, especially in the agricultural industry, is unknown. METHODS Using data from the Iowa Trauma Registry, we determined the sensitivity and specificity of the use of workers' compensation as a payer source to ascertain work-related injuries requiring acute care comparing agriculture with other rural industries. RESULTS The sensitivity of workers' compensation as a payer source to identify work-related agricultural injuries was 18.5%, suggesting that the large majority of occupational agricultural injuries would not be accurately identified through workers' compensation records. For rural nonagricultural, rural occupational injuries, the sensitivity was higher (64.2%). Work-related agricultural injuries were most frequently covered by private insurance (39.6%) and public insurance (21.4%), while rural nonagricultural injuries were most frequently covered by workers' compensation (65.2%). CONCLUSIONS Workers' compensation claims data will not include the majority of work-related agricultural injuries.
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Affiliation(s)
- Celestin Missikpode
- Department of Epidemiology, College of Public HealthUniversity of Iowa Iowa City Iowa
| | - Corinne Peek‐Asa
- Department of Occupational and Environmental Health, College of Public HealthUniversity of Iowa Iowa City Iowa
| | - Brad Wright
- Department of Health Management and Policy, College of Public HealthUniversity of Iowa Iowa City Iowa
| | - Marizen Ramirez
- Department of Occupational and Environmental Health, College of Public HealthUniversity of Iowa Iowa City Iowa
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Hindman J, Bowren MD, Bruss J, Wright B, Geerling JC, Boes AD. Thalamic strokes that severely impair arousal extend into the brainstem. Ann Neurol 2019; 84:926-930. [PMID: 30421457 DOI: 10.1002/ana.25377] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022]
Abstract
In this study, we evaluate the role of the thalamus in the neural circuitry of arousal. Level of consciousness within the first 12 hours of a thalamic stroke is assessed with lesion symptom mapping. Impaired arousal correlates with lesions in the paramedian posterior thalamus near the centromedian and parafascicular nuclei, posterior hypothalamus, and midbrain tegmentum. All patients with severely impaired arousal (coma, stupor) had lesion extension into the midbrain and/or pontine tegmentum, whereas purely thalamic lesions did not severely impair arousal. These results are consistent with growing evidence that pathways most critical for human arousal lie outside the thalamus. Ann Neurol 2018;84:926-930.
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Affiliation(s)
- Joseph Hindman
- University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Mark D Bowren
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA
| | - Joel Bruss
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brad Wright
- Department of Radiology, University of Utah Health, Iowa City, IA
| | - Joel C Geerling
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA.,Iowa Neuroscience Institute, University of Iowa, Iowa City, IA
| | - Aaron D Boes
- Departments of Pediatrics, Neurology, and Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA.,Iowa Neuroscience Institute, University of Iowa, Iowa City, IA
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43
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Court R, Chirehwa MT, Wiesner L, Wright B, Smythe W, Kramer N, McIlleron H. Quality assurance of rifampicin-containing fixed-drug combinations in South Africa: dosing implications. Int J Tuberc Lung Dis 2019; 22:537-543. [PMID: 29663959 PMCID: PMC5905389 DOI: 10.5588/ijtld.17.0697] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Rifampicin (RMP) drives treatment response in drug-susceptible tuberculosis. Low RMP concentrations increase the risk of poor outcomes, and drug quality needs to be excluded as a contributor to low RMP exposure. OBJECTIVES AND DESIGN: We performed an open-label, three-way cross-over study of three licensed RMP-containing formulations widely used in South Africa to evaluate the bioavailability of RMP in a two-drug fixed-dose combination tablet (2FDC) and a four-drug FDC (4FDC) against a single-drug reference. RMP dosed at 600 mg was administered 2 weeks apart in random sequence. Plasma RMP concentrations were measured pre-dose and 1, 2, 3, 4, 6, 8 and 12 h post-dose. The area under the concentration-time curve (AUC0–12) of the FDCs was compared to the single drug reference. Simulations were used to predict the impact of our findings. RESULTS: Twenty healthy volunteers (median age 22.8 years, body mass index 24.2 kg/m2) completed the study. The AUC0–12 of the 4FDC/reference (geometric mean ratio [GMR] 78%, 90%CI 69–89) indicated an average 20% reduction in RMP bioavailability in the 4FDC. The 2FDC/reference (GMR 104%, 90%CI 97–111) was bioequivalent. Simulations suggested dose adjustments to compensate for the poor bioavailability of RMP with the 4FDC, and revised weight-band doses to prevent systematic underdosing of low-weight patients. CONCLUSION: Post-marketing surveillance of in vivo bioavailability of RMP and improved weight band-based dosing are recommended.
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Affiliation(s)
- R Court
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - M T Chirehwa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - L Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - B Wright
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, South Africa
| | - W Smythe
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, South Africa
| | - N Kramer
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, South Africa
| | - H McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Monteiro B, Steagall PVM, Lascelles BDX, Robertson S, Murrell JC, Kronen PW, Wright B, Yamashita K. Long-term use of non-steroidal anti-inflammatory drugs in cats with chronic kidney disease: from controversy to optimism. J Small Anim Pract 2019; 60:459-462. [PMID: 31081136 DOI: 10.1111/jsap.13012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/16/2019] [Accepted: 03/28/2019] [Indexed: 11/29/2022]
Abstract
This is the first of a series of capsule reviews published by the World Small Animal Veterinary Association - Global Pain Council (WSAVA-GPC). Each of these short articles provides a brisk assessment of the scientific evidence in specific aspects of pain management, including analgesic techniques, recommendations and controversies surrounding their use. In this first capsule review, the scientific evidence available on the long-term use of non-steroidal anti-inflammatory drugs in cats with concomitant chronic pain and chronic kidney disease is discussed.
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Affiliation(s)
- B Monteiro
- Clinical Sciences, University of Montreal, Montreal, Quebec, J2S 2M2, Canada
| | - P V M Steagall
- Clinical Sciences, University of Montreal, Montreal, Quebec, J2S 2M2, Canada
| | - B D X Lascelles
- Translational Research in Pain Program, Comparative Pain Research and Education Center, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, 27606, USA
| | - S Robertson
- Lap of Love Veterinary Hospice, 1780 N US Highway 41, Lutz, FL 33549, USA
| | - J C Murrell
- Highcroft Veterinary Referrals, Whitchurch, Bristol, BS14 9BE, UK
| | - P W Kronen
- Veterinary Anaesthesia Service - International, Winterthur 8400, Switzerland
| | - B Wright
- Mistral Vet, Fort Collins, Colorado 80534, USA
| | - K Yamashita
- Small Animal Clinical Sciences, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan
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45
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Abstract
BACKGROUND The effort-reward imbalance model suggests that, when the efforts required within the workplace are disproportionately large in comparison to the rewards resulting from those efforts, there is an increased risk of stress-related health issues. The model posits that higher levels of "overcommitment," in addition to a high effort-reward imbalance ratio, magnifies this risk of ill-health. While work has been conducted to assess the validity of this model within the school setting, research in the higher education sector is limited. OBJECTIVES This study explored the validity of the effort-reward imbalance model for explaining burnout, poor health, and academic productivity among university students. DESIGN AND METHODS This study utilized a cross-sectional survey of Australian university students (n = 395) from a range of universities. RESULTS An imbalance of effort and reward was associated with poorer physical health, increased burnout, and reduced productivity. Effort-reward imbalance mediated a relationship between overcommitment and burnout; those high in overcommitment were more likely to experience an imbalance of effort and reward at university. CONCLUSION The relationships between effort-reward imbalance, health, burnout, and academic productivity support the generalizability of this model to the university setting. In addition, the personal characteristic of overcommitment also appears to have an important relationship with burnout.
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Affiliation(s)
- Brad Hodge
- School of Psychological Science & Public Health, La Trobe University, Bundoora, Australia
| | - Brad Wright
- School of Psychological Science & Public Health, La Trobe University, Bundoora, Australia
| | - Pauleen Bennett
- School of Psychological Science & Public Health, La Trobe University, Bundoora, Australia
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46
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Cole MB, Wright B, Wilson IB, Galárraga O, Trivedi AN. Medicaid Expansion And Community Health Centers: Care Quality And Service Use Increased For Rural Patients. Health Aff (Millwood) 2019; 37:900-907. [PMID: 29863920 DOI: 10.1377/hlthaff.2017.1542] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medicaid expansion had great potential to affect community health centers (CHCs), particularly in rural areas, because their patients are predominantly low income and disproportionately uninsured. Using data for 2011-15 on all CHCs, we found that after two years Medicaid expansion was associated with an 11.44-percentage-point decline in the share of CHC patients who were uninsured and a 13.15-percentage-point increase in the share with Medicaid. Changes in quality and volume were consistently observed in rural CHCs in expansion states, which had relative improvements in asthma treatment, body mass index screening and follow-up, and hypertension control, along with substantial increases in volumes for eighteen of twenty-one types of visits-particularly those for mammograms, abnormal breast findings, alcohol-related disorder, and other substance abuse disorder. Similar relative gains were not observed in urban CHCs in expansion states. Repealing or phasing out Medicaid expansion could reverse observed gains in quality and service use and could be particularly detrimental to low-income rural populations.
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Affiliation(s)
- Megan B Cole
- Megan B. Cole ( ) is an assistant professor in the Department of Health Law, Policy, and Management at the Boston University School of Public Health, in Massachusetts
| | - Brad Wright
- Brad Wright is an associate professor in the Department of Health Management and Policy at the University of Iowa College of Public Health, in Iowa City
| | - Ira B Wilson
- Ira B. Wilson is a professor in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health, in Providence, Rhode Island
| | - Omar Galárraga
- Omar Galárraga is an associate professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health
| | - Amal N Trivedi
- Amal N. Trivedi is an associate professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health
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Hogg CJ, Wright B, Morris KM, Lee AV, Ivy JA, Grueber CE, Belov K. Founder relationships and conservation management: empirical kinships reveal the effect on breeding programmes when founders are assumed to be unrelated. Anim Conserv 2018. [DOI: 10.1111/acv.12463] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- C. J. Hogg
- School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
- Zoo and Aquarium Association Australasia Mosman NSW Australia
| | - B. Wright
- School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
| | - K. M. Morris
- School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
| | - A. V. Lee
- Save the Tasmanian Devil Program DPIPWE Hobart TAS Australia
| | - J. A. Ivy
- San Diego Zoo Global San Diego CA USA
| | - C. E. Grueber
- School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
- San Diego Zoo Global San Diego CA USA
| | - K. Belov
- School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
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48
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Sabbatini AK, Wright B, Kocher K, Hall MK, Basu A. Postdischarge Unplanned Care Events Among Commercially Insured Patients With an Observation Stay Versus Short Inpatient Admission. Ann Emerg Med 2018; 74:334-344. [PMID: 30470517 DOI: 10.1016/j.annemergmed.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/22/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE Observation stays are composing an increasing proportion of unscheduled hospitalizations in the United States, with unclear consequences for the quality of care. This study used a nationally representative data set of commercially insured patients hospitalized from the emergency department (ED) to compare 30-day postdischarge unplanned care events after an observation stay versus a short inpatient admission. METHODS This was a retrospective analysis of ED hospitalizations using the 2015 Truven MarketScan Commercial Claims and Encounters data set. Adult observation stays and short inpatient hospitalizations of 2 days or less were identified and followed for 30 days from hospital discharge to identify unplanned care events, defined as a subsequent inpatient admission, observation stay, or return ED visit. A propensity score analysis was used to compare rates of unplanned events after each type of index hospitalization. RESULTS Among the propensity-weighted cohorts, patients with an index observation stay were 28% more likely to experience any unplanned care event within 30 days of discharge compared with those with a short inpatient admission (20.4% versus 15.9%; risk ratio 1.28; 95% confidence interval [CI] 1.21 to 1.34). Specifically, patients in the observation stay group had substantially higher rates of postdischarge observation stays (4.8% versus 1.9%; odds ratio 2.60; 95% CI 2.15 to 3.16) and ED revisits with discharge (11.1% versus 8.8%; odds ratio 1.26; 95% CI 1.21 to 1.44) compared with those in the inpatient group, but were less likely to be readmitted as inpatients (6.4% versus 7.2%; odds ratio 0.90; 95% CI 0.83 to 0.96). CONCLUSION Commercially insured patients with an observation stay from the ED have a higher risk of postdischarge acute care events compared with similar patients with a short inpatient admission. Additional research is necessary to determine the extent to which quality of care, including care transitions, may differ between these 2 groups.
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Affiliation(s)
- Amber K Sabbatini
- Department of Emergency Medicine, University of Washington, Seattle, WA.
| | - Brad Wright
- Department of Health Management and Policy, University of Iowa, Iowa City, IA
| | - Keith Kocher
- Department of Emergency Medicine and Institute for Health Policy and Innovation, University of Michigan
| | - M Kennedy Hall
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Anirban Basu
- Departments of Health Services and Center for Comparative Health Outcomes, Policy, and Economics, University of Washington, Seattle, WA
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49
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Wright B, Martin GP, Ahmed A, Banerjee J, Mason S, Roland D. In reply. Ann Emerg Med 2018; 72:625-626. [PMID: 30342739 DOI: 10.1016/j.annemergmed.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Brad Wright
- Department of Health Management and Policy, University of Iowa, Iowa City, IA
| | - Graham P Martin
- SAPPHIRE Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Azeemuddin Ahmed
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Jay Banerjee
- University Hospitals of Leicester NHS Trust, Emergency Department, Leicester, UK
| | - Suzanne Mason
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Damian Roland
- University Hospitals of Leicester NHS Trust, Pediatric Emergency Medicine Academic Group, Leicester, UK
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50
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Wright B, Dusetzina SB, Upchurch G. Medicare's Variation in Out‐of‐Pocket Costs for Prescriptions: The Irrational Examples of In‐Hospital Observation and Home Infusion. J Am Geriatr Soc 2018; 66:2249-2253. [DOI: 10.1111/jgs.15576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Brad Wright
- Department of Health Management and Policy, College of Public HealthUniversity of Iowa Iowa City Iowa
- Public Policy CenterUniversity of Iowa Iowa City Iowa
| | - Stacie B. Dusetzina
- Department of Health PolicyVanderbilt University School of Medicine Nashville Tennessee
- Vanderbilt‐Ingram Cancer Center Nashville Tennessee
| | - Gina Upchurch
- Senior PharmAssist Durham North Carolina
- Geriatric Workforce Enhancement ProgramDuke University Durham North Carolina
- Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
- Eshelman School of PharmacyUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
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