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Background: Firearm injuries are a long-running yet preventable public health concern in the USA. We analyzed national inpatient data to determine the burden of firearm injuries on the USA hospital system. For each year from 2000–2014 and 2016–2020, we calculated the annual frequency of firearm hospitalization in the USA overall and by the intent of the shooter. We also calculated the rate of firearm hospitalizations per 100,000 inpatient encounters. For each outcome, we used regression analysis to estimate the average year-over-year change. Finally, we explored the types of firearms responsible for firearm hospitalizations. Findings: Each year during 2000–2020 (excluding 2015), there were an average of 30,428 firearm hospitalizations in the USA. On average, firearm hospitalizations represented 84 out of every 100,000 inpatient encounters each year. There was not a statistically significant year-over-year increase in firearm hospitalizations for either the periods 2000–2014 or 2016–2020. However, firearm hospitalizations were noticeably higher in 2020 than in other years. Until 2019, the most frequent intent among firearm hospitalizations was assault. Beginning in 2019, assaults were outnumbered by unintentional firearm hospitalizations. According to diagnosis codes, handguns were used more often than rifles/shotguns/larger firearms in firearm injuries that resulted in hospitalization for the intents assault (27.93% handguns; 5.87% rifles/shotguns/larger firearms), unintentional (23.94% handguns; 10.48% rifles/shotguns/larger firearms), self-harm (46.63% handguns; 14.35% rifles/shotguns/larger firearms) and undetermined (17.82% handguns; 6.21% rifles/shotguns/larger firearms). Frequently, the type of firearm responsible for the hospitalization was not recorded in the patient’s diagnosis code. Conclusion: Firearm injuries inflict a significant burden on the hospital system in the USA. While firearm hospitalizations were unusually high in 2020, there is not strong evidence that the burden of firearm injuries on the hospital system is changing over time. The frequent non-identification of the type of firearm responsible for the injury in hospital patients’ diagnosis code complicates injury surveillance efforts. [ABSTRACT FROM AUTHOR]

This study measures the effect of Medicaid expansion on emergency department (ED) utilization. It also explores the mechanism through which treatment effects operate. Identification relies on a county‐level Medicaid expansion rollout within California from 2011 to 2013. The results suggest that Medicaid expansion increased ED utilization in California. Every time one individual transferred into the Medicaid program, there emerged one additional ED visit per year. Furthermore, the effect appears to be driven by difficulty accessing primary care. These findings suggest Medicaid expansion may have different effects in different environments, depending on how easily enrollees can schedule appointments. [ABSTRACT FROM AUTHOR]

Purpose: We undertook a study to evaluate variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California, and its relationship to emergency department (ED) use after Medicaid expansion.Methods: We placed simulated calls by purported Medi-Cal enrollees to 581 primary care clinicians (PCCs) listed as accepting new patients in online directories of Medi-Cal managed care plans. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used in analyses. We developed multilevel, mixed-effect models to evaluate variation in appointment access. Multiple linear regression was used to examine the relationship between primary care access and ED use by county.Results: Availability of PCC new patient appointments to Medi-Cal enrollees lacking a PCC varied significantly across counties in the multilevel model, ranging from 77 enrollees (95% CI, 70-81) to 472 enrollees (95% CI, 378-628) per each available new patient appointment. Just 19% of PCCs had available appointments within the state-mandated 10 business days. Clinicians at Federally Qualified Health Centers had higher availability of new patient appointments (rate ratio = 1.56; 95% CI, 1.24-1.97). Counties with poorer PCC access had higher ED use by Medi-Cal enrollees.Conclusions: In contrast to findings from other states, access to primary care in Northern California was limited for new patient Medi-Cal enrollees and varied across counties, despite standard statewide reimbursement rates. Counties with more limited access to primary care new patient appointments had higher ED use by Medi-Cal enrollees. [ABSTRACT FROM AUTHOR]

Wait times are rising in U.S. emergency departments (EDs). The longer a patient waits to be seen, the more their condition may worsen. Notably, patients in worse condition can cost more to care for. This study estimates the effect of ED wait time on the cost of care by exploiting the quasi‐random assignment of patients to triage nurses in an instrumental variables framework. The results suggest that prolonging the wait of a patient who arrives with a serious condition by 10 minutes will increase the hospital's cost to care for the patient by an average of 6%. The magnitude of this effect dissipates (fading to zero) among patients who arrive with less serious conditions.(JEL D24, H41, I10) [ABSTRACT FROM AUTHOR]

We examine the impact of providing voters with additional information related to candidates' views on particular issues on voters' tendencies to cross the party line. When we randomize the provision of this information in an experimental setting where participants are undergraduate students at a large public university, we find that "treatment" increases the likelihood that a voter will cross the party line by an average of 4 percentage points. This corresponds to an approximately 20% decrease in partisan voting. Surprisingly, treatment effects are not more pronounced among voters whose opposing party's candidate is the relatively moderate candidate in the election. They are, however, more pronounced among Democrat voters. These findings suggest that transparency, with respect to candidates' views on particular issues, has a corroding effect on partisanship among a subset of voters. [ABSTRACT FROM AUTHOR]

The competing theories of proximity and directional voting have long been used to model voting behavior. Empirically evaluating these theories, however, requires knowledge of voters' utilities, which are inherently unobserved. Empiricists have generally dealt with this by using self-reports of utility. Yet, self-reports are likely biased, leaving experimental predictions at odds with real-world election outcomes. We improve upon this method by constructing a discrete choice model which is able to measure the likelihood of any one voter exhibiting proximity voting behavior as opposed to directional voting behavior, without needing to know voters' utilities. We subsequently conduct a voting experiment with over 1,800 participants to estimate the parameters of the model. Our results suggest that, among voters whose expected behavior differs across the two theories, there is an approximately even split between voting behaviors, and the probability of exhibiting proximity voting behavior decreases by roughly 10 percentage points for each step away from the midpoint of a (−10 to +10) political spectrum. Our results are robust across two measures of preferences and four candidate pairings. The outcomes of our experiment are also consistent with the results of the 2012 Presidential Election, which took place the day after our experiment closed. [ABSTRACT FROM AUTHOR]

States are increasingly adopting Medicaid managed care in efforts to address budgetary concerns. The intent is that by releasing Medicaid oversight to private organizations, competition will drive down healthcare expenditures so that savings may be passed to the state. Yet there are concerns that this competitive solution to cost savings might compromise safety-net hospitals. Managed care organizations cut costs by restricting the providers that enrollees are allowed to see. If movement in Medicaid patients disrupts safety-net hospitals' casemix, this could affect their ability to cross-subsidize care. This study estimates the impact of Medicaid managed care on safety-net hospitals by exploiting a Florida pilot program that required Medicaid recipients in five counties to enroll in managed care. The results suggest this mandate led to a small reduction in safety-net hospitals' average ratio of payment-to-cost. There is also some evidence that the effect on safety-net hospitals was disproportionate. This disproportionality was such that hospitals nearest the margin were pushed the furthest towards the edge. [ABSTRACT FROM AUTHOR]

Background: Pneumothorax is an under-recognized complication of apnea testing performed as part of the neurological determination of death. It may result in hemodynamic instability or even cardiac arrest, compromising ability to declare brain death (BD) and viability of organs for transplantation. We report three cases of pneumothorax with apnea testing (PAT) and review the available literature of this phenomenon.Methods: Series of three cases supplemented with a systematic review of literature (including discussion of apnea testing in major brain death guidelines).Results: Two patients were diagnosed with PAT due to immediate hemodynamic compromise, while the third was diagnosed many hours after BD. An additional nine cases of PAT were found in the literature. Information regarding oxygen cannula diameter was available for nine patients (range 2.3-5.3 mm), and flow rate was available for ten patients (mean 11 L/min). Pneumothorax was treated to resolution in the majority of patients (n = 8), although only six completed apnea testing following diagnosis/treatment of pneumothorax and only three patients became organ donors afterward. Review of major BD guidelines showed that although use of low oxygen flow rate (usually ≤ 6 L/min) during apnea testing is suggested, the risk of PAT was explicitly mentioned in just one.Conclusion: Development of PAT may adversely affect the process of BD determination and could limit the opportunity for organ donation. Each institution should have preventive measures in place. [ABSTRACT FROM AUTHOR]

Caring for children with mental and behavioral health conditions can lead to family strain. Research indicates that Latino children are less likely to adhere to recommended treatment for their mental health diagnoses, increasing the potential for family strain. Little research has focused on understanding the different predictors of family strain among white and Latino families of children with mental health or behavioral health diagnoses. This paper uses a model of family strain to understand how stressors, resources, and perceptions predict family strain for white and Latino parents of children with a mental or behavioral health condition. Data from a telephone survey of 268 parents of children with a mental or behavioral health condition were analyzed to understand predictors of strain using the Family Strain Index scale. Findings indicate that family strain does differ between white and Latino families. Latino families' strain was predicted by age of parent (β = −0.381, P < 0.001), perceptions of treatment quality (β = 0.306, P < 0.001), and child's current symptom burden (β = −0.390, P < 0.001). White family strain was related to their child's health status (β = −0.240, P < 0.001), symptom burden (β = −0.339, P < 0.001), and parent's level of education (β = −0.315, P < 0.001). [ABSTRACT FROM AUTHOR]

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that Medicare-participating hospitals screen and stabilize all individuals appearing in their emergency departments, regardless of expected compensation. To counter the incentive to prioritize revenue-generating patients, the law also prohibits facilities from delaying care to under-insured individuals. I estimate whether timeliness of emergency care is, in fact, unaffected by payer source as mandated. Using the National Hospital Ambulatory Medical Care Survey, I first examine the direct effect of under-insurance and find that under-insurance is associated with an approximately 6-10 % increase in emergency department wait time. Because of concerns that the effects of under-insurance may be mediated by triage assignment, I subsequently estimate the relationship between under-insurance and triage assignment, using the office hours of general practitioners as an exogenous source of variation in payer source. Instrumental variable results suggest that under-insured patients are inexplicably assigned higher triage scores which are known to lengthen waits. Contrary to the stipulations of EMTALA, discrepancies in timeliness of care do exist. Yet, this noncompliance is not readily apparent; roughly 80 % of the increase in under-insured individuals' wait times are masked by adjustments to triage scores. [ABSTRACT FROM AUTHOR]

At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities. [ABSTRACT FROM AUTHOR]

This study looks at the educational outcomes of adopted children as perceived by their parents. Descriptive and multivariate analyses were performed using data from the 2007–2008 National Survey of Adoptive Parents. Our findings suggest that adoptive parents believe math and reading performance to be affected by special health care needs and household income. The odds of truancy and suspension are also believed to be affected by special heath care needs and gender. Though educational disruptions are infrequent, few adopted children perform at or above average in reading or math. These findings can be used to inform policy makers about post-adoption services. [ABSTRACT FROM PUBLISHER]