Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial
An educational video on the risks and benefits of total knee replacement increased the rate of surgery among black patients, in a clinical trial of an intervention that could reduce known racial disparities in treatment of osteoarthritis.
The election of Donald Trump has ushered in an uncertain future for the Affordable Care Act (ACA), from modification to total repeal. While many policy experts are concerned about people losing the coverage they gained through the ACA, other aspects of the ACA are also under threat: specifically, provisions that address the social determinants of health.
[This blog originally appeared on the PolicyLab at Children’s Hospital of Philadelphia blog.
Recurrent Violent Injury: Magnitude, Risk Factors and Opportunities For Intervention From a Statewide Analysis
Recurrent injury is a promising target for prevention, as prior injury is a strong predictor of future violent injury and death. But the incidence of recurrent violent injury, on an area-wide level, is unknown, and the risk factors contributing to it are not well understood.
Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center
In the American Journal of Public Health, Anna Morgan and colleagues, including Dave Grande, Judith Long, and Shreya Kangovi, describe the process by which Penn’s Center for Community Health Workers grew from a small grant-funded research project into a robust program serving 2,000 patients annually and funded through the health system’s operational budget. The authors describe an 8-step framework to engage both low-income patients and funders, determine outcomes, and calculate return on investment. The case illustrates a path toward sustainability for other community-based...
The projected growth, and widespread variation, in the cost of joint replacement surgeries prompted Medicare to introduce a bundled payment plan for these procedures. In a new JAMA Viewpoint, Said Ibrahim, a LDI Senior Fellow and Co-Director of the VA’s Center for Health Equity Research and Promotion, and co-authors Hyunjee Kim and K.
In the Journal of Health Care for the Poor and Underserved, Deepak Palakshappa and colleagues, including Chris Feudtner and Alexander Fiks, investigate the relationship between food insecurity and child health care utilization. They test whether differences in child health care utilization can predict household food insecurity and whether food insecurity is associated with subsequent acute health care use. This prospective cohort study involved 3,335 children screened for food insecurity at three-year well-child visits in three urban practices. The authors evaluated acute care use...
In Telemedicine and Health, Brandi Freeman and colleagues, including LDI Senior Fellow Alexander Fiks, assess the feasibility, acceptability, and utility of videos sent via mobile phones to enhance pediatric telephone triage for an underserved population with asthma. Asthma is a leading cause of childhood hospitalization, disability and healthcare-related cost. Asthma disproportionately affects Black and Hispanic children, and these populations have been shown to be more likely to use the emergency department as a routine source of sick care. Moreover, telephone triage systems...
Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities
Early evidence suggests that accountable care organizations (ACOs) - networks of doctors and hospitals whose members share responsibility for providing coordinated care to patients - improve health care quality and constrain costs. ACOs are increasingly common in the U.S., both for Medicare and commercially insured patients. However, there are concerns that ACOs may worsen existing disparities in health care quality if disadvantaged patients have less access to physicians who participate in them. Does physicians’ ACO participation relate to the sociodemographic characteristics of their patient population, and if so, why?
Geographic access to primary care providers is usually considered a problem of rural areas, rather than of more densely populated urban ones. But the supply of primary care providers may be inadequate in certain neighborhoods even if the number of providers for the population is adequate for the city as a whole.The authors conducted a spatial analysis of census tracts in Philadelphia to assess the supply of primary care providers, quantify differences in supply that might contribute to disparities, and determine population characteristics associated with variations in geographic access. They calculated the ratio of adults-per-primary-care-provider in each tract using a five-minute travel time from the center of each census tract. They wanted to know if the overall number of providers in a city obscures significant differences across neighborhoods, and if so, whether low-access neighborhoods are more likely to be found in areas with large concentrations of racial and ethnic minorities.
In Pediatrics, Jeffrey Silber and colleagues investigate whether Medicaid and non-Medicaid patients admitted to the hospital for asthma are treated differently in major children’s hospitals. Medicaid provider reimbursement levels can be significantly lower than private insurance reimbursements, making it important to analyze whether this impacts the health care received by Medicaid beneficiaries. The authors used data from 40 children’s hospitals to analyze more than 17,000 matched pairs of Medicaid to non-Medicaid children admitted for asthma in the same hospital over three years...
How should social risk factors enter into Medicare’s value-based payments to hospitals? The answer goes beyond an arcane discussion of payment policy; it has a direct impact on hospital bottom lines and the quality of care provided to underserved communities. A new report from the National Academies of Sciences, Engineering, and Medicine—the third in a series of five—lays out criteria and methods to account for social risk factors in Medicare payment.