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OBJECTIVES: To quantify geographic variation in home health expenditures per Medicare home health beneficiary and investigate factors associated with this variation. STUDY DESIGN: Retrospective study design analyzing US counties in which at least 1 home health agency served 11 or more beneficiaries in 2016. Several sources of 2016 national public data were used. METHODS: The key variable is county-level Medicare home health expenditures per home health beneficiary. Counties were grouped into quintiles based on per-beneficiary expenditures. Analyses included calculation of coefficients of variation, computation of the ratio of 90th percentile to 10th percentile in expenditures, and linear regression predicting expenditure. The control variables included characteristics of patients, agencies, and communities. RESULTS: Significant variation in home health expenditures was identified across county quintiles, with a 90th-to- 10th-percentile expenditure ratio of 2.5. The percentage of for-profit agencies in the lowest quintile was 15.7 compared with 81.7 in the highest quintile of spending. Unadjusted spending differed by $3864 (95% CI, $3793-$3936), compared with $3611 (95% CI, $3514-$3708) in the adjusted model, between counties in spending quintiles 1 and 5. Although state fixed effects explained nearly 20% of the variation in home health expenditures, 42% of the variation remained unexplained. CONCLUSIONS: Home health care exhibits considerable unwarranted variation in per-patient expenditures across counties, signifying inefficiency and waste. Given the expected growth in home health demand, strategies to reduce unwarranted geographic variation are needed. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolemia (FH) is an inherited disease which causes premature atherosclerotic cardiovascular disease. However, less than 10% of individuals with FH have been identified. Objective: To assess parental perspectives for inclusion of FH on routine newborn screening (NBS) and to highlight potential benefits, harms, and ethical concerns. Methods: Telephone interviews of two groups were conducted: 1) parents of children diagnosed with FH, and 2) parents of children diagnosed with a genetic condition through NBS. Stratified purposive sampling was used to ensure adequate representation. The 11 telephone interviews were conducted in 30-min sessions guided by a semi-structured interview script. At the beginning of the interview, participants were educated on the NBS process and FH. The interviews were transcribed verbatim, and a thematic analysis was performed in multiple steps. Results: All interviewees indicated that they would be interested in having their child be screened for FH on the newborn screen. Reasons supporting screening during the newborn period included knowing their child's diagnosis, the ability to screen family members for FH, incorporation of lifestyle changes, and access to preventive care. Negatives surrounding screening during the newborn period included increased stress or anxiety, knowledge, stigma, and the delay from diagnosis to initiation of pharmacotherapy for FH. Conclusion: While these interviewees were in favor of NBS for FH, further education of parents and clinicians is needed to ensure proper implementation. The results of this study may be useful to formulate family notification and care protocols for newborns diagnosed with FH and other diseases. Significance: What is already known on this subject? Familial hypercholesterolemia is a common inherited disorder that predisposes to early cardiovascular disease, but most affected individuals are not diagnosed. Childhood cholesterol screening is an effective but underutilized diagnostic tool. Previous studies report parents find childhood cholesterol screening acceptable, but it is not known if screening newborns would also be acceptable. What does this study add? Interviewees found screening newborns for familial hypercholesterolemia acceptable and would agree to screen their own newborn. The ability to screen other family members and access to early treatment were important factors in their decision to screen. Education of clinicians about familial hypercholesterolemia was an important concern raised by interviewees. [ABSTRACT FROM AUTHOR]

• Latino US-born, Latino immigrant, and Asian immigrant parents reported significantly low functional health literacy levels. • Higher parental functional health literacy was a significant correlate of positive child health outcome. • Customized health literacy educational messages and intervention strategies should be developed to raise parental functional health literacy. Low health literacy has been identified as an important factor linked to negative health outcomes. However, little research has analyzed the relationship between parental health literacy and children's health outcomes. This is particularly true regarding subgroups of immigrant families, which often face a greater risk of low health literacy and high health disparities. The present study aimed to address this gap by investigating the functional health literacy levels of immigrant and US-born parents and the relation of these functional health literacy levels to child health status. The 2007 California Health Interview Survey (CHIS) was used to identify 5877 parents and their children aged 4–10 years. Parental functional health literacy level was assessed using two proxy items. Children's health outcomes were measured by parents' self-report. Weighted univariate, bivariate, and multivariate analyses were conducted using STATA 12.0. Latino US-born, Latino immigrant, and Asian immigrant parents reported significantly lower health literacy levels than their Asian US-born and non-Latino white US-born peers, who reported the highest health literacy levels. Higher parental functional health literacy was a significant correlate of positive child health outcomes only for children of Latino US-born, Latino immigrant, and Asian immigrant parents. Parental functional health literacy levels varied significantly between groups. However, parental health literacy was significantly related to child health only for the groups that reported lower parental health literacy levels. Customized health literacy educational messages and intervention strategies should be developed to raise parental health literacy regarding their children in Latino US-born, Latino immigrant, and Asian immigrant parents. [ABSTRACT FROM AUTHOR]