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Background: Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts. Methods: The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non‐clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst. Results: We included 14 papers reporting on six studies. All services were US‐based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well‐being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages. Conclusions: DCN services have the potential to effectively provide non‐clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required. Key points: Evidence on the impact of Dementia Care Navigators (DCNs) is limited but shows promising benefits for people living with dementia and their carers.More research needs to be conducted in countries other than the US, where all evidence was reported, and with similar outcome measures to allow comparison.DCNs are a highly useful professional group without medical training, who can navigate people living with dementia and their carers to support and provide support themselves. [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider–patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be 'deployed' outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future‐ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care. [ABSTRACT FROM AUTHOR]

This paper begins with the lived accounts of emergency and critical care medical interventions in which an unhoused person is brought to the emergency department in cardiac arrest. The case is a dramatised representation of the extent to which biopolitical forces via reduction to bare life through biopolitical and necropolitical operations are prominent influences in nursing and medical care. This paper draws on the scholarship of Michel Foucault, Giorgio Agamben, and Achille Mbembe to offer a theoretical analysis of the power dynamics that influence the health care and death care of patients who are caught in the auspices of a neoliberal capitalist healthcare apparatus. This paper offers analysis of the overt displays of biopower over those individuals cast aside as generally unworthy of access to healthcare in a postcolonial capitalist system, in addition to the ways in which humans are reduced to 'bare life' in their dying days. We analyse this case study through Agamben's description of thanatopolitics, a 'regime of death', and the technologies that accompany the dying process, particularly in that of the homo sacer. Additionally, this paper illustrates the ways in which necropolitics and biopower are integral to understanding how the most advanced and expensive medical interventions make visible the political values of the healthcare system and how nurses and healthcare functions in these deathworlds. The purpose of this paper is to develop a greater understanding of biopolitical and necropolitical operations in acute and critical care environments, and to offer guidance to nurses in these spaces as they work to uphold ethical duties in a system that increasingly dehumanises. [ABSTRACT FROM AUTHOR]

Background: More than 20 million children in the United States lack access to primary health care. Practice Learning: Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. Implication For School Health Policy, Practice, And Equity: School‐based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full‐range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non‐insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. Conclusions: This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid‐Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district. [ABSTRACT FROM AUTHOR]

Papers in the Special Section on Racial Disparities in Health Care stemmed from. the 60th Anniversary of Family Process Conference, The Heart of the Matter: Systemic Imperatives to Address Health Disparities and Racism in the Time of COVID, which took place in Washington, DC in September 2021. Of the 12 presenters at the conference, these four were asked to recreate their talks into articles. They address key issues that help to explain health disparities in people of color, particularly African Americans, in the United States, as well as suggest innovations to clinical interventions and health care delivery systems to better serve people who have suffered adversity from the racial inequities in the American system. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has reinforced awareness that the health of populations is inextricably linked around the globe. Nurses require increased knowledge and preparation in global health. Nursing educators need examples of how to improve content in the curriculum. Aims: The purpose of this paper is to describe reconceptualization of a master’s level nursing course entitled “Population Health in a Global Society” to include global health competencies. Methods: We identified four global health competencies within the following three domains: globalization of health and healthcare; collaboration, partnering, and communication; and sociocultural and political awareness. Implementation: We utilized guest lectures, a panel discussion, discussion forums and an independent research assignment. The methods used were well received by students, and the content delivered improved their perceived knowledge in global population health. Discussion: The global health domains and competencies provided a roadmap for improving our course to focus on population health from a global perspective. Conclusion: In order to prepare nurses to contribute to global population health, population health courses should integrate global health competencies. The content of the revised course will better prepare nurses who will practice in a wide variety of settings and is designed for interdisciplinary education. [ABSTRACT FROM AUTHOR]

This paper describes the nature of today's corporatized health care system in the United States, offering examples of the psychological toll it takes on clinicians at all levels. It details corporate practices that disenfranchise practitioners from exercising their clinical judgment and from offering input to system administrators about problematic patient care experiences. It discusses the sense of frustration, resignation and moral injury that can permeate their work lives and disrupt their sense of effectiveness and well‐being in this context. Following this background is a psychoanalytic analysis of narratives from two physicians about their corporate health care experiences. Two case studies follow, in which a nurse and a physician entered psychoanalytic psychotherapy to process the destructive psychological impact of their work environments. A third case illustrates the negative impact of automatized insurance practices on one psychologist and her patient. [ABSTRACT FROM AUTHOR]

This paper is a statement of the American Geriatrics Society's (AGS) core policy priorities and the Society's positions on federal programs and policies that support older Americans as articulated to the new administration. Among the AGS priorities discussed in this paper are health reform, Medicare, and Medicaid. The AGS is committed to leveraging its expertise to inform regulatory and legislative policy proposals. [ABSTRACT FROM AUTHOR]

A majority of married couples in the USA take advantage of the fact that employers often provide health insurance coverage to spouses. When older spouses become eligible for Medicare, however, many of them can no longer provide their younger spouses with coverage. In this paper, we study how spousal eligibility for Medicare affects the health insurance and health care access of younger spouses. We find that spousal eligibility for Medicare results in younger spouses no longer having employers pay for their insurance and being less likely to have employer-sponsored coverage. Instead, younger spouses switch to privately purchased coverage, which tends to be worse than what they had before their spouses became eligible for Medicare. We also find suggestive evidence that younger spouses are less likely to use health care services after their older spouses become eligible for Medicare. [ABSTRACT FROM AUTHOR]

Local governments across the United States have had a prominent role in financing the pandemic response during the ongoing COVID‐19 outbreak and economic recession. Yet, such governments are increasingly facing budgetary strain as sources of tax revenue evaporate. If the financial burden on such governments can be eased, they may better address those aspects of pandemic response to which they are uniquely suited, such as coordinating resources and re‐allocating space within their communities. This paper investigates the role of Medicaid, traditionally the default insurer of the unemployed, as a stabilizing force on local government budgets. Using panel data from county governments during the Great Recession (2006–2012), we estimate the effect of state Medicaid generosity on public finances. We find that Medicaid mitigates the effect of unemployment shocks on county government expenditures, specifically safety‐net programs and debt. We apply these point estimates to extrapolate predictions based on contemporary state Medicaid generosity and local unemployment rates. In this way, we show that Medicaid continues to mitigate the financial strain on local government during the COVID‐19 pandemic. Applications For Practice•Local governments contribute heavily to hospital, health, and welfare services in the United States, and are an important implementor of pandemic policies.•As the pandemic spreads, local governments incur additional expenditures in a time of depressed revenue.•Often, the debate around Medicaid financing is framed around federal and state government budgets. However, local governments support the safety‐net for indigent residents by assuming a substantial role in the finance and delivery of health care and will likely benefit from this relief.•Our findings indicate higher Medicaid generosity reduces the downstream economic strain on local governments emanating from labor market shocks.•State and federal policy may establish grants to aid local governments during the pandemic, such as in the CARES Act of 2020. However, we establish that the Medicaid program is itself a channel by which state and federal governments can support local governments. [ABSTRACT FROM AUTHOR]

Abstract: This paper analyzes the effect of a change in the status of housing equity as a protected asset for Medicaid long‐term care payment eligibility. A difference‐in‐difference‐in‐differences strategy is employed to estimate the effect of the policy on the housing equity holdings of potentially treated individuals. Using a panel of unmarried homeowners, the policy induced treated individuals who were likely to require long‐term care to hold less housing equity by values of $82,000 to $193,000 relative to control individuals. This equates to relative reductions of 12 to 29 percent for treated individuals after the policy change. Similar effects are not observed when considering health measures less predictive of long‐term care services and for a sample of married households who were unlikely affected by the policy. These estimates confirm the importance of the housing asset as a shelter for Medicaid eligibility. [ABSTRACT FROM AUTHOR]

Context Few qualitative findings have been published that explore and identify the challenges experienced by independent abortion providers during the COVID‐19 pandemic in the United States (US). In this paper, we explore these themes while expanding the concept of "abortion exceptionalism" beyond its original legal meaning to address the impact of abortion stigma. Methods: Twenty abortion providers from independent abortion clinics throughout the US South and Midwest participated in semi‐structured interviews in June and July 2020. Interviews explored the challenges of providing abortion care in the wake of the COVID‐19 pandemic and sought to identify how clinics strategized and amended their clinical practices to continue providing abortion care during this time. Results: All providers we spoke to noted significant challenges to providing abortion care in the early days of COVID‐19. In addition to experiencing the same concerns as other health care institutions, abortion clinics also faced additional, unique burdens that can only be attributed to the politics of abortion exceptionalism. Examples of this abortion exceptionalism include abrupt orders to close clinics, the need to rely on traveling physicians, legislature‐imposed limits on telemedicine, heightened activities of protesters, and non‐evidence‐based regulation of medication abortion. Conclusion: Despite major challenges and differential treatment, independent abortion clinics in the US persevered to continue to provide abortion care throughout the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

This paper examines the presence of contagion in health care fraud across jurisdictional boundaries. Using state‐level data for the United States, we find evidence of contagion in medical fraud. There are also spillovers from border corruption on medical fraud, but no evidence of spillovers from international borders. In other findings, greater urbanization, greater elderly population, and higher hospital occupancy positively contribute to medical fraud, while nursing employment has a mitigating effect. Further, it is economic inequality rather than economic prosperity that seems relevant. The main findings are robust to consideration of simultaneity, but dependent upon the prevalence of fraud across states. [ABSTRACT FROM AUTHOR]

The origins of pharmacy specialization has its beginning in the efforts of Harvey A. K. Whitney, Sr. through his leadership in establishing progressive hospital pharmacy services and hospital‐focused programs and policies within the nation's professional pharmacy organizations. Later, Donald Francke spoke of specialization in the hospital pharmacy setting as a natural outgrowth of practice activities that required more time and specialized expertise. A broader national discussion and eventual codification of specialty recognition and attendant certification within pharmacy began in 1971 with a policy statement approved by the APhA House of Delegates that led to the creation of a Task Force on Specialties in Pharmacy followed by the creation of the Board of Pharmaceutical Specialties (BPS). Given that specialization in any health profession is primarily a function of the reality of ever‐increasing scientific and technological developments, debate regarding the need, types, and value of specialization in pharmacy seem destined to be driven not by intra‐ or inter‐professional debates within pharmacy, but by the needs, expectations, and values of patients and health care systems. [ABSTRACT FROM AUTHOR]

Objectives To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions ( MCCs). Design Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. Setting Survey conducted through the Health Care Systems Research Network ( HCSRN) and Claude D. Pepper Older Americans Independence Centers ( OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. Participants Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. Measurements A 'top box' methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. Results The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. Conclusion Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this 'high-need, high-cost' population and the healthcare delivery systems responsible for serving it. [ABSTRACT FROM AUTHOR]

Objectives: The United States health system is challenged to improve patient and population health, enhance patients' experience of care, and reduce health care costs. Value-based health care (VBHC) models are proposed to address these issues. Medical health systems are making strides toward VBHC, whereas dental care systems lag behind. The aims of this paper are to a) present study findings of an interprofessional practice model integrating oral health and primary care in a dental practice setting, and b) discuss practice and research implications for advancing VBHC approaches in oral health.Methods: A nonexperimental research method was employed to evaluate the Nurse Practitioner-Dentist Model for Primary Care (NPD Model) at the Harvard Dental Center. Pretest/post-test design was used to assess clinical patient outcomes for a convenience cohort of Medicare beneficiaries (n = 31) with a reported diagnosis of hypertension and/or type 2 diabetes. Clinical outcome measures included: blood pressure, weight, body mass index (BMI), and Hemoglobin A1c.Results: Positive and significant improvements in biometrics (blood pressure, body weight, BMI, HbA1c) were found.Conclusions: The NPD Model is an early prototype for interprofessional VBHC in oral health and holds promise for improving patient and population health outcomes. Integration of interprofessional VBHC in oral health is an imperative for achieving the Triple Aim to improve the overall health of our nation. [ABSTRACT FROM AUTHOR]

Tax-preferred health savings devices such as Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) offer employees potentially valuable financial instruments for directing pre-tax earnings to eligible medical expenses. Despite their increasing popularity as an employee benefit, however, there is little causal evidence around individual demand for these accounts. This paper seeks to address this gap in the literature, reporting on a randomized controlled field experiment conducted with over 11,000 U. S federal employees in 2017 in order to evaluate the effectiveness of targeted messages designed to increase FSA contributions. Our results suggest that the provision of basic information about FSAs delivered via an emailed employee newsletter did not affect the likelihood of contribution or the contribution level. The addition of statements about the absolute returns or relative returns offered by the accounts similarly had no significant effects, and these null effects are observed despite relatively high email open rates. We discuss explanations for the null results and the policy implications of findings from what appears to be the first health economics experiment analyzing tax incentives around health care savings. [ABSTRACT FROM AUTHOR]

An introduction to various papers within the issue which provide an overview of the current state of the research literature around improving the value of the health care system in the U.S. such as payment incentives and the theory and practice of fee-for-service is presented.

In order to reduce the numbers of medication errors (MEs) that cause adverse reactions (ARs) many authors have tried to identify patient-related risk factors. However, the evidence remains controversial. The aim was to review systematically the evidence on the relationship between patient-related risk factors and the risk of serious ARs. A systematic search in Pubmed, Embase, Cochrane Systematic Reviews, Psychinfo and SweMed+ was performed. Included full text articles were hand searched for further references. Peer reviewed papers including adults from primary and secondary healthcare were included if they clearly defined seriousness of the ARs and described correlations to risk factors by statistical analysis. A total of 28 studies were identified including 85 212 patients with 3385 serious ARs, resulting in an overall frequency of serious ARs in 4% of patients. Age, gender and number of drugs were by far the most frequently investigated risk factors. The total number of drugs was the most consistent correlated risk factor found in both univariate and multivariate analyses. The number of drugs is the most frequently documented independent patient-related risk factor for serious ARs in both the general adult population as well as in the elderly. The existing evidence is however conflicting due to heterogeneity of populations and study methods. The knowledge of patient-related risk factors for experiencing ARs could be used for electronic risk stratification of patients and thereby allocation of healthcare resources to high risk patients. [ABSTRACT FROM AUTHOR]

The article presents author's comments on the Health Services Research exploiting the membership on a committee that advises Medicare on administered pricing system for physician services in Medicare Part B. It mentions that the traditional fee-for-service Medicare program depends on administered prices. It focuses on the Specialty Society Relative Value Scale Update Committee (RUC) and the U.S. Centers for Medicare & Medicaid Services (CMS).

This paper presents longitudinal data representing federal funding for health services research and discusses the observed trends in the larger context of overall funding for research and development in the United States. By putting into context public and private funding trends, the authors examine how these trends effect the supply and demand of the health services research workforce. [ABSTRACT FROM AUTHOR]

Objectives: To explore (1) differences in validity and feasibility ratings for geriatric surgical standards across a diverse stakeholder group (surgeons vs. nonsurgeons, health care providers vs. nonproviders, including patient-family, advocacy, and regulatory agencies); (2) whether three multidisciplinary discussion subgroups would reach similar conclusions.Data Source/study Setting: Primary data (ratings) were reported from 58 stakeholder organizations.Study Design: An adaptation of the RAND-UCLA Appropriateness Methodology (RAM) process was conducted in May 2016.Data Collection/extraction Methods: Stakeholders self-administered ratings on paper, returned via mail (Round 1) and in-person (Round 2).Principal Findings: In Round 1, surgeons rated standards more critically (91.2 percent valid; 64.9 percent feasible) than nonsurgeons (100 percent valid; 87.0 percent feasible) but increased ratings in Round 2 (98.7 percent valid; 90.6 percent feasible), aligning with nonsurgeons (99.7 percent valid; 96.1 percent feasible). Three parallel subgroups rated validity at 96.8 percent (group 1), 100 percent (group 2), and 97.4 percent (group 3). Feasibility ratings were 76.9 percent (group 1), 96.1 percent (group 2), and 92.2 percent (group 3).Conclusions: There are differences in validity and feasibility ratings by health professions, with surgeons rating standards more critically than nonsurgeons. However, three separate discussion subgroups rated a high proportion (96-100 percent) of standards as valid, indicating the RAM can be successfully applied to a large stakeholder group. [ABSTRACT FROM AUTHOR]

The first baby has successfully been born by uterus transplantation (UTx) in the United States and the procedure is swiftly becoming a viable clinical option for patients with uterine factor infertility (UFI). This raises a practical ethical question: should health insurers finance UTx and what issues should they consider in coming to this decision? The article lays forth some of the factors that shape the decision over whether to finance UTx in the United States, including what procedures must be covered, whether UTx is more like organ transplantation or infertility treatment (which are treated differently in the United States), and the benefits and alternatives of the procedure. Then, the article explores arguments around why UTx should be financed, or at least considered along with other important medical needs. The paper argues that UTx ought to be considered along with other competing claims for healthcare services. In countries that generously cover other infertility services, it may logically follow that medical services that enable gestation should be insured when the healthcare system covers services to conceive. In the United States, however, many groups have long suffered inadequate access to medical care, in the context of infertility and more broadly. U.S. healthcare may need to be made more widely equitable, before covering UTx is seen as financially or politically possible. [ABSTRACT FROM AUTHOR]

In the United States, the past decade has seen rapid growth in treatment centers providing specialty care to patients with eating disorders. Much of this growth has been in higher levels of care, including hospital‐based and residential treatment. Despite this expansion, there remains lack of agreement regarding the most important components of care, such as staff training or specifics of treatment delivery. Additionally there is no consensus on how best to assess outcome and compare performance across programs. This leaves patients, families, public and private insurance programs, and policy makers with limited information to help facilitate treatment decisions. The present paper considers implications of these changes in the eating disorder treatment landscape and examines two ideas that, if implemented, may enhance the quality of eating disorder care. First, we explore the proposal to develop a network of centers of excellence in eating disorder treatment and the value this may have for improving overall treatment quality. This idea was discussed at an expert meeting held at SAMSHA in 2017 regarding issues important to the field following passage of the 21st Century Cures Act. Second, we consider the potential utility of a study using the Delphi method to promote expert consensus regarding clinical outcome assessments. [ABSTRACT FROM AUTHOR]

Objectives: To examine: (1) what elements of patient-centered medical homes (PCMHs) are typically provided to low-income populations, (2) whether PCMHs improve health behaviors, experiences, and outcomes for low-income groups.Data Sources/study Setting: Existing literature on PCMH utilization among health care organizations serving low-income populations.Study Design: Systematic review and meta-analysis.Data Collection/extraction Methods: We obtained papers through existing systematic and literature reviews and via PubMed, Web of Science, and the TRIP databases, which examined PCMHs serving low-income populations. A total of 434 studies were reviewed. Thirty-three articles met eligibility criteria.Principal Findings: Patient-centered medical home interventions usually were composed of five of the six recommended components. Overall positive effect of PCMH interventions was d = 0.247 (range -0.965 to 1.42). PCMH patients had better clinical outcomes (d = 0.395), higher adherence (0.392), and lower utilization of emergency rooms (d = -0.248), but there were apparent limitations in study quality.Conclusions: Evidence shows that the PCMH model can increase health outcomes among low-income populations. However, limitations to quality include no assessment for confounding variables. Implications are discussed. [ABSTRACT FROM AUTHOR]

Background: This paper aims to contribute to the discussion about patient‐centred care in surgery. It is contended here that the paradigm shift towards patient‐centred decision‐making in health care does not mean that patient values alone (or those of their proxies) should, uncritically, be the lead decision makers in determining surgical care. Methods: In support of that contention, three clarifications to our conception of autonomy will be offered. Results: First, autonomy may not be best positioned as the lead principle guiding healthcare decision‐making. Second, arguably, our traditional understanding of autonomy, as it might be applied to health care, is incomplete. Third, where autonomy is vested is contentious, and proxy decision makers can further complicate the decision‐making process. Conclusion: It will be argued that an approach of inclusive, non‐coercive and reflective dialogue seeking a consensual decision amongst all those affected is more appropriate for moral decision‐making in surgery. This dialogue is set in the actual reality of the patient's illness. During the discourse, each participant has equal rights to contribute and to be heard, equal duties not to coerce and equal co‐responsibilities to share the perspectives of others in the discourse, with an aim to reach consensus. [ABSTRACT FROM AUTHOR]

Suboptimal maternal nutrition and excessive gestational weight gain (GWG) establish in mothers and their offspring a weight gain trajectory towards overweight and obesity. Therefore, pregnancy may be the best opportunity to disrupt the generational cycle of obesity. More than half of women in the UK now enter pregnancy overweight or obese, highlighting that if interventions are not targeted towards women in higher weight categories before conception they are likely to 'miss the mark'. To address issues of suboptimal maternal nutrition and excessive GWG in antenatal care, health professionals need to consider how women's requirements and expectations may have changed in recent years and the impact of weight stigma on the care of women who are obese. This paper aims to drive changes in clinical practice guidelines, medical curricula, the language used by health professionals, and ultimately promote maternal nutrition and weight management in pregnancy as key priorities during antenatal care. Evidence indicates that women want non-judgemental, simple and encouraging guidance in these areas. Small changes to health professionals' practice can improve how advice regarding nutrition and weight management in pregnancy is delivered, and has the potential to reduce overweight and obesity prevalence in women and their children in the years to come. Surely that goal is worth pursuing. [ABSTRACT FROM AUTHOR]

Abstract: This article explores the complicated and often‐contradictory notions of choice at play in complex care management (CCM) programmes in the US healthcare safety net. Drawing from longitudinal data collected over two years of ethnographic fieldwork at urban safety‐net clinics, our study examines the CCM goal of transforming frequent emergency department (ED) utilisers into ‘active’ patients who will reduce their service utilisation and thereby contribute to a more rational, cost‐effective healthcare system. By considering our data alongside philosopher Annemarie Mol's (2008) conceptualisation of the competing logics of choice and care, we argue that these premises often undermine CCM teams' efforts to support patients and provide the care they need – not only to prevent medical crises, but to overcome socio‐economic barriers as well. We assert that while safety‐net CCM programmes are held accountable for the degree to which their patients successfully transform into self‐managing, cost‐effective actors, much of the care CCM staff provide in fact involves attempts to intervene on structural obstacles that impinge on patient choice. CCM programmes thus struggle between an economic imperative to get patients to make better health choices and a moral imperative to provide care in the face of systemic societal neglect. (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA). [ABSTRACT FROM AUTHOR]

Home hemodialysis (HD) was first introduced in the 1960s with a rapid increase in its use due to inability of dialysis units to accommodate patient demand. A sharp decline was subsequently seen with expanding outpatient dialysis facilities and changes in reimbursement policies. In the last decade, with emerging reports of benefits with home HD and more user-friendly equipment, there has been resurgence in home HD. However, home HD remains underutilized with considerable variations between and within countries. This paper will review the history of home HD, elaborate on its established benefits, identify some of the barriers in uptake of this modality and expand on potential strategies to overcome these barriers. [ABSTRACT FROM AUTHOR]

According to the National Transgender Discrimination Survey, 28% of trans respondents reported postponing medical care due to discrimination, and 28% reported being harassed by providers when they did seek out care. Scholars have proposed that what is taught (or not) in medical schools might play a role in the unequal health care experienced by many trans people. As medical education becomes a site of intervention for reducing transgender health disparities, it presents opportunities for sociologists to study and explain the processes by which medical training creates, reinforces, and potentially challenges stigma-related health disparities. In this paper, we propose three areas of inquiry that might help explain this situation: the hidden curriculum, patient health movements and consumerism, and medical competency. By employing these concepts, we argue that sociologists can develop more comprehensive explanations for the relationship between medical education and transgender health inequalities and offer solutions to address this disparity. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the Massachusetts Health Reform Survey, self-reported health measures in predicting individuals with high future health care needs, and the American Community Survey and the Survey of Income Program Participation.

What were the impacts of the Covid‐19 pandemic on trust in public health information, and what can be done to rebuild trust in public health authorities? This essay synthesizes insights from science and technology studies, information studies, and bioethics to explore sociotechnical factors that may have contributed to the breakdown of trust in public health information during the Covid‐19 pandemic. The field of science and technology studies lays out the dynamic nature of facts, helping to explain rapid shifts in public health messaging during Covid‐19 and reasons they produced a lack of trust in public health authorities. The information field looks at how facts are sociotechnically constructed through systems of classification, illustrating how extrascientific factors influence public health authorities. Putting these perspectives alongside bioethics principles raises additional factors to consider. The goal of this essay is to learn from past failures to point toward a brighter future where trust in public health authorities can be rebuilt, not on faith, but rather through striving for calibrated trust within which, through a virtuous circle, trust is validated. [ABSTRACT FROM AUTHOR]

Context: The Person‐Centered Contraceptive Care measure (PCCC) evaluates patient experience of contraceptive counseling, a construct not represented within United States surveillance metrics of contraceptive care. We explore use of PCCC in a national probability sample and examine predictors of person‐centered contraceptive care. Methods: Among 2228 women from the 2017–2019 National Survey of Family Growth who reported receiving contraceptive care in the last year, we conducted univariate and multivariable linear regression to identify associations between individual characteristics and PCCC scores. Results: PCCC scores were high (x¯: 17.84, CI: 17.59–18.08 on a 4–20 scale), yet varied across characteristics. In adjusted analyses, Hispanic identity with Spanish language primacy and non‐Hispanic other or multiple racial identities were significantly associated with lower average PCCC scores compared to those of non‐Hispanic white identity (B = −1.232 [−1.970, −0.493]; B = −0.792 [−1.411, −0.173]). Gay, lesbian, or bisexual identity was associated with lower average PCCC scores compared to heterosexual (B = −0.673 [−1.243, −0.103]). PCCC scores had a positive association with incomes of 150%–299% and ≥300% of the federal poverty level compared to those of income <150% (150%–299%: B = 0.669 [0.198, 1.141]; ≥300%: B = 0.892 [0.412, 1.372]). Cannabis use in the past year was associated with lower PCCC scores (B = −0.542 [−0.971, −0.113]). Conclusions: The PCCC can capture differential experiences of contraceptive care to monitor patient experience and to motivate and track care quality over time. Differences in reported quality of care have implications for informing national priorities for contraceptive care improvements. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess differences in reported information about treatment, integration into care, and respect by self‐identified Black and White individuals with advanced prostate cancer in the United States. Patients and Methods: This is a prospective cohort study of 701 participants (20% identifying as Black) enrolled in the International Registry for Men with Advanced Prostate Cancer at 37 US sites from 2017 to 2022. Participants were asked six questions from the Cancer Australia National Cancer Control Indicators about their experience with care at study enrollment. Prevalence differences by self‐reported race were estimated using marginal standardization of logistic‐normal mixed effects models (adjusted for age at enrollment and disease state at enrollment), and 95% CIs were estimated using parametric bootstrapping. Results: Most participants reported a high quality of care for each question. Black participants generally reported higher care quality compared with White participants. Black participants reported more frequently that they were offered a written assessment and care plan (71%) compared with White participants (58%; adjusted difference, 13 percentage points; 95% CI, 4–23). Black participants also reported more frequently being given the name of nonphysician personnel who would support them (64%) than White participants (52%; adjusted difference, 10; 95% CI, 1–20). Prevalence differences did not differ by disease state at enrollment. Conclusions: Black participants generally reported a higher quality of care compared with White participants. This study calls attention to the need to study potential mediating factors and interpersonal aspects of care in this population to improve survivorship. Patients with advanced prostate cancer in the United States reported a high quality of care. Black participants tended to report higher quality of care compared with White participants regarding information about treatment, integration into care, and respect for patient preference. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to describe and explore the lived experience of Chinese medical tourists receiving cancer care in clinical settings in the United States. Design: A qualitative phenomenological design. Methods: In this study, Hermeneutic phenomenology was used to interview 11 participants on WeChat, a popular social media platform of China. Hermeneutic phenomenology methods and hermeneutic circles were used to analyse data. Results: Five themes identified were: the application process involves various challenges; overcoming transportation and language barriers; feeling content with healthcare received in the United States; nearly perfect experience, except for long waiting times; and high cost of being a medical tourist. Conclusion: Despite the cost and complexity of cancer treatment, Chinese medical tourists valued their experience in US clinical settings. Although, they experienced real challenges, they overcame obstacles with self‐determination and varied resources. Therefore, culturally appropriate healthcare is highly recommended. Relevance to clinical practice: The findings of this study are relevant for clinical practice, particularly cancer care to medical tourists in the United States. To better support the Chinese medical tourists with cancer, various strategies and techniques, as reported in this study, could be helpful. It is highly recommended to provide healthcare providers to enable them to understand and respect the diversity norms of other cultures. [ABSTRACT FROM AUTHOR]

Objective: To test how Certificate of Need laws affect all‐cause mortality in the United States. Data Sources: The data of 1992–2011 all‐cause mortality are from the Center for Disease Control's Compressed Mortality File; control variables are from the Current Population Survey, Behavioral Risk Factor Surveillance System, and Area Health Resources File; and data on Certificate of Need laws are from Stratmann and Russ ( ). Study design: Using fixed‐ and random‐effects regressions, I test how the scope of state Certificate of Need laws affects all‐cause mortality within US counties. Principal Findings: Certificate of Need laws have no statistically significant effect on all‐cause mortality. Point estimates indicate that if they have any effect, they are more likely to increase mortality than decrease it. Conclusions: Proponents of Certificate of Need laws have claimed that they reduce mortality by concentrating more care into fewer, larger facilities that engage in learning‐by‐doing. However, I find no evidence that these laws reduce all‐cause mortality. [ABSTRACT FROM AUTHOR]

The authors analyze the relationship between acute and postacute medical care in the U.S. The authors discuss the problems associated with patient transition between acute and postacute care settings and the medical policies that have been implemented to reduce fragmentation between the two patient care settings. They recommend their own solutions to reducing fragmentation, including integrating acute and postacute care into a single financial entity.

Objectives: The COVID‐19 pandemic has tremendously impacted the U.S. healthcare system, but no study has examined the impact of the pandemic on utilization of dental care among U.S. children. Changes in past‐year dental versus medical visits and perceived unmet health needs between 2019 and 2020 among U.S. children aged 1–17 years were examined. Methods: National and state representative, cross‐sectional data from the National Survey of Children's Health conducted during June 2019–January 2020 (i.e. pre‐pandemic, n = 28 500) and July 2020–January 2021 (i.e. intra‐pandemic, n = 41 380) were analysed. Any past‐year visit and perceived unmet needs (i.e. delay or inability to receive needed care) were reported by the parent proxy. Weighted prevalence estimates were compared using two‐tailed chi‐squared tests at p <.05. Poisson regression analyses were used to explore the relationship between having dental and/or medical unmet needs during the pandemic and indicators of poor health and social wellbeing. Results: Between 2019 and 2020, a significantly reduced prevalence of past‐year medical (87.2%–81.3%) and dental visits (82.6%–78.2%) among U.S. children aged 1–17 years (all p <.05) were observed. Correspondingly, perceived unmet needs increased by half for dental care (from 2.9% in 2019 to 4.4% in 2020) and almost one‐third for medical care (from 3.2% to 4.2% in 2020). Subgroups with the highest prevalence of unmet dental need included those with low socio‐economic status, living with their grandparents, uninsured and living with a smoker. Conclusions: Unmet health needs increased in general but increased more for dental than for medical care among U.S. children aged 1–17 years. Enhanced and sustained efforts will be needed to deliver targeted services towards disadvantaged segments of the population to narrow existing disparities. [ABSTRACT FROM AUTHOR]

Policy PointsHospitals address population health needs and patients' social determinants of health by offering social care services. Tax‐exempt hospitals are required to invest in community benefits, including social care services programs, though most community benefits spending is toward unreimbursed health care services.Tax‐exempt hospitals offer about 36% more social care services than for‐profit hospitals. Among tax‐exempt hospitals, those that allocate more resources to community benefits spending offer more types of social care services, but those in states with minimum community benefits spending requirements offer fewer social care services.Policymakers may consider specifically incentivizing community benefits expenditures toward particular social care services, including linking tax exemptions to implementation, utilization, and outcome targets, to more directly help patients. Context: Despite growing interest in identifying patients' social needs, little is known about hospitals' provision of services to address them. We identify social care services offered by US hospitals and determine whether hospital spending or state policies toward community benefits are associated with the provision of these services by tax‐exempt hospitals. Methods: National secondary data about hospitals were collected from the American Hospital Association Annual Survey, with additional Internal Revenue Service (IRS) Form 990 data on community benefits spending from CommunityBenefitInsight.org and state‐level community benefits policies from HilltopInstitute.org. Descriptive statistics for types of social care services and hospital characteristics were calculated, with bivariate chi‐square and t‐tests comparing for‐profit and tax‐exempt hospitals. Multivariable Poisson regression was used to estimate associations between hospital characteristics and types of services offered and among tax‐exempt hospitals to estimate associations between social care services and community benefits spending and policies. Multivariable logistic regressions modeled associations between community benefits spending/policies and each type of social care services. Findings: Private US hospitals offered an average of 5.7 types of social care services in 2018. Tax‐exempt hospitals offered about 36% more social care services than for‐profit hospitals. Larger number of beds, health system affiliation, and having community partnerships are associated with more social care services, whereas rural hospitals and those managed under contract offered fewer social care services. Among tax‐exempt hospitals, greater community benefits spending is associated with offering more total (incidence rate ratio [IRR] = 1.10, p < 0.01) and patient‐focused social care services (IRR = 1.16, p < 0.01). Hospitals in states with minimum community benefits spending requirements offered significantly fewer social care services. Conclusions: Although tax‐exempt status and increased community benefits spending were associated with increased social care services provision, the observation that certain hospital characteristics and state minimum community benefits spending requirements were associated with fewer social care services suggests opportunities for policy reform to increase social care services implementation. [ABSTRACT FROM AUTHOR]

Background: Older adults are underrepresented in most clinical trials. As the United States observes growth in the number of older adults over time, it will be critical to include them in clinical trials to improve the generalizability of results across age groups. Although clinical trial participation requires clinical trial knowledge, no study has assessed clinical trial knowledge among older adults. Using a national survey, this study aims to identify the prevalence and determinants of clinical trial knowledge among older adults. Methods: We used the 2020 Health Information National Trends Survey for secondary data analysis. We restricted the sample to older adults (aged 65 years and up). Our outcome variable was whether respondents reported having any clinical trial knowledge. We controlled for demographics, social determinants of health, healthcare utilization, and comorbidities through multivariable logistic regression models. Results: Using a weighted sample of 27,574,958 adults, we estimated that 61.1% of older adults reported having at least some knowledge of clinical trials. After controlling for other factors, those with one to two (OR = 1.80, 95% CI:1.14–2.84) or three to five (OR = 2.93, 95% CI:1.74–4.95) portal visits compared with no portal visits, those with cancer (OR = 1.92, 95% CI:1.22–3.02), and those with depression (OR = 2.27, 95% CI:1.23–4.20) had greater odds of having clinical trial knowledge. Inversely, those with hypertension (OR = 0.62, 95% CI:0.42–0.92) had lower odds of clinical trial knowledge. Conclusions: Patient portal recruitment may be a supplemental intervention to improve clinical trial knowledge among older adults. Further research on additional interventions for identifying eligible participants is needed to minimize the burden among clinicians amidst other competing demands during clinic visits. [ABSTRACT FROM AUTHOR]

Medication synchronization (med‐sync) or appointment‐based medication synchronization (ABMS) programs allow patients to have their chronic medication refills aligned to one pickup day. For patients on multiple chronic medications, it provides a more manageable way of picking up those medications. The objective of the study was to systematically characterize literature describing economic and healthcare utilization, clinical, and humanistic outcomes for patients enrolled in med‐sync. A literature search was conducted on PubMed, International Pharmaceutical Abstracts (Ovid), CINAHL (EBSCO), EMBASE (Elsevier), and Cochrane Library. Studies were included if they were conducted at a pharmacy in the United States, between January 2008 and October 2022, and evaluated the impact of med‐sync on at least one of the four outcomes of interest (utilization, economic, clinical, and humanistic). The title and abstracts were screened, followed by a full‐text review and final data extraction by two researchers. A data extraction template and Cochrane risk of bias tool were used for data collection and quality assessments, respectively. The search resulted in 1617 studies and finally, 27 studies were included in the systematic review. All studies included patients enrolled in either ABMS, med‐sync, or in conjunction with other pharmacy services. Across all studies evaluating medication adherence, proportion of days covered (PDC) increased. All studies that administered patient surveys showed a majority of patients were satisfied with their med‐sync program. One study showed a reduction in healthcare utilization and costs, while another study indicated no change. Med‐sync programs have shown clinical outcomes, specifically to improve adherence in patients taking chronic medications. In terms of humanistic outcomes, patient surveys have shown high rates of satisfaction with med‐sync programs. Additional studies are needed to determine if med‐sync can lead to improvements in healthcare utilization and cost outcomes. [ABSTRACT FROM AUTHOR]

Background: The Institute for Healthcare Improvement's 4‐Ms framework of care for older adults recommends a multidisciplinary assessment of a patient's Medications, Mentation, Mobility, and What Matters Most. Electronic health record (EHR) systems were developed prior to this emphasis on the 4‐Ms. We sought to understand how healthcare providers across the healthcare system perceive their EHRs and to identify any current best practices and ideas for improvement regarding integration of the 4‐Ms. Methods: Anonymous survey of healthcare providers who care for older adults. The survey aimed to evaluate efficiency, error tolerance, and satisfaction (usefulness and likeability). The survey was distributed through organizational list serves that focus on the care of older adults and through social media. Results: Sixty‐six respondents from all geographic segments of the U.S. (n = 62) and non‐U.S. practices (n = 4) responded. Most (82%) were physicians. Respondents used a range of EHRs and 82% had >5 years of experience with their current EHR. Over half of respondents agreed that their EHR had easy to find contact information (56%) and advance directives. Finding a patient's prior cognitive status (26% agreement), goals of care (24%), functional status (14%), and multidisciplinary geriatric assessments (27%) was more difficult. Only 3% were satisfied with how their EHR handles geriatric syndromes. In free text responses, respondents (79%) described three areas that the EHR assists in the care of older adults: screening tied to actions or orders; advance care planning, and medication alerts or review. Common suggestions on how to improve the EHR included incorporating geriatric assessments in notes, establishing a unified place to review the 4‐Ms, and creating age‐specific best practice alerts. Conclusions: The majority of healthcare providers were not satisfied with how their EHR handles multidisciplinary geriatric assessment and geriatric care. EHR modifications would aide in reporting, communicating, and tracking the 4‐Ms in EHRs. [ABSTRACT FROM AUTHOR]

Policy PointsThe predominantly fee‐for‐service reimbursement architecture of the US health care system contributes to waste and excess spending.While the past decade of payment reforms has galvanized the adoption of alternative payment models and generated moderate savings, uptake of truly population‐based payment systems continues to lag, and interventions to date have had limited impact on care quality, outcomes, and health equity.To realize the promise of payment reforms as instruments for delivery system transformation, future policies for health care financing must focus on accelerating the diffusion of value‐based payment, leveraging payments to redress inequities, and incentivizing partnerships with cross‐sector entities to invest in the upstream drivers of health. [ABSTRACT FROM AUTHOR]

Objective: To provide guidelines to researchers measuring health expenditures by disease and compare these methodologies' implied inflation estimates.Data Source: A convenience sample of commercially insured individuals over the 2003 to 2007 period from Truven Health. Population weights are applied, based on age, sex, and region, to make the sample of over 4 million enrollees representative of the entire commercially insured population.Study Design: Different methods are used to allocate medical-care expenditures to distinct condition categories. We compare the estimates of disease-price inflation by method.Principal Findings: Across a variety of methods, the compound annual growth rate stays within the range 3.1 to 3.9 percentage points. Disease-specific inflation measures are more sensitive to the selected methodology.Conclusion: The selected allocation method impacts aggregate inflation rates, but considering the variety of methods applied, the differences appear small. Future research is necessary to better understand these differences in other population samples and to connect disease expenditures to measures of quality. [ABSTRACT FROM AUTHOR]

The onset of the 2020 COVID‐19 pandemic necessitated a rapid transition of mental health services from in‐person to telehealth counselling. Despite the far‐reaching impact of this transition, we know little about the impact of this transition on outcomes for clients working with counsellor trainees. The present study utilised longitudinal data collected from a counselling training centre at a major U.S. university to compare client ratings of depression, anxiety and working alliance across 1) in‐person services delivered (i.e. pre‐pandemic) and 2) telehealth services delivered after the pandemic began (i.e. intra‐pandemic) among the same group of clients. Results support our hypothesis that changes in clients' self‐reports would be generally equivalent across in‐person and telehealth services. Depression and anxiety symptoms decreased, and working alliance tended to increase during both in‐person and telehealth care; however, these trends were only statistically significant during telehealth services. Limitations related to sample size (N = 15 clients; up to 17 sessions per client) and low statistical power are discussed. Nonetheless, this study supports the growing body of literature supporting the efficacy of telehealth counselling services. We provide suggestions for future telehealth research and discuss implications for counsellor training. [ABSTRACT FROM AUTHOR]

The article discusses issues and recommendations from the National Academies of Sciences, Engineering, and Medicine (NASEM) report as of 2023. Topics covered include care delivery, quality measurement, and quality improvement in nursing homes, and the goals of person-centered care, testing existing and emergent models of care, and expanding quality measurement. Also noted is using quality improvement methods to facilitate the adoption of evidence-based practices.

Purpose: To investigate telehealth use for contraceptive service provision among rural and urban federally qualified health centers (FQHCs) in Alabama (AL) and South Carolina (SC) during the initial months of the COVID‐19 pandemic. Methods: This is a mixed‐methods study using data from the FQHC Contraceptive Care Survey and key informant interviews with FQHC staff in AL and SC conducted in 2020. Differences between rural and urban clinics in telehealth use for contraceptive service provision were assessed with a chi‐square test of independence. Interviews were audio recorded, transcribed, and coded to identify facilitators and barriers to telehealth. Findings: Telehealth for contraceptive care increased during the early months of the pandemic relative to prepandemic. Fewer rural clinics than urban clinics provided telehealth for contraceptive counseling (16.3% vs 50.6%) (P =.0002), emergency contraception (0.0% vs 16.1%) (P =.004), and sexually transmitted infection care (16.3% vs 34.6%) (P =.031). Key facilitators of telehealth were reimbursement policy, electronic infrastructure and technology, and funding for technology. Barriers included challenges with funding for telehealth, limited electronic infrastructure, and reduced staffing capacity. Conclusions: Differences in telehealth service provision for contraceptive care between rural and urban FQHCs highlight the need for supportive strategies to increase access to care for low‐income rural populations, particularly in AL and SC. It is essential for public and private entities to support the implementation and continuation of telehealth among rural clinics, particularly, investing in widespread and clinic‐level electronic infrastructure and technology for telehealth, such as broadband and electronic health record systems compatible with telehealth technology. [ABSTRACT FROM AUTHOR]