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Objective: To determine if the release of health care report cards focused on physician practice quality measures leads to changes in consumers' awareness and use of this information.Primary Data Sources: Data from two rounds of a survey of the chronically ill adult population conducted in 14 regions across the United States, combined with longitudinal information from a public reporting tracking database. Both data were collected as part of the evaluation for Aligning Forces for Quality, a nationwide quality improvement initiative funded by the Robert Wood Johnson Foundation.Study Design: Using a longitudinal design and an individual-level fixed effects modeling approach, we estimated the impact of community public reporting efforts, measured by the availability and applicability of physician quality reports, on consumers' awareness and use of physician quality information (PQI).Principal Findings: The baseline level of awareness was 12.6 percent in our study sample, drawn from the general population of chronically ill adults. Among those who were not aware of PQI at the baseline, when PQI became available in their communities for the first time, along with quality measures that are applicable to their specific chronic conditions, the likelihood of PQI awareness increased by 3.8 percentage points. For the same group, we also find similar increases in the uses of PQI linked to newly available physician report cards, although the magnitudes are smaller, between 2 and 3 percentage points.Conclusions: Specific contents of physician report cards can be an important factor in consumers' awareness and use of PQI. Policies to improve awareness and use of PQI may consider how to customize quality report cards and target specific groups of consumers in dissemination. [ABSTRACT FROM AUTHOR]

Multi-sectoral health care alliances (MHCAs) are organizations that bring together diverse stakeholders to work collaboratively to improve health and health care in local communities. MHCA awareness is a necessary condition for cultivating and sustaining coordinated efforts among participants to improve the quality of care in a community, yet little research has examined whether MHCAs have actually fostered high levels of awareness among participants or how they go about doing so. This mixed method study used quantitative data drawn from three rounds of survey data from MHCA participants to assess the degree of MHCA awareness. It also examined whether perceptions of leadership effectiveness and management style were associated with differences in awareness at the level of the individual alliance participant, member organizations, and the community at large. Interviews with participants examined the approaches undertaken by MHCAs to foster awareness among individuals, organizations, and the community at large as well as the challenges MHCAs confront in raising awareness at each of these different levels. Findings indicate higher levels of awareness among individual participants, while awareness was perceived to be lowest at the community level. Perceptions of leadership effectiveness exhibited the most robust relationships across these three levels; it was positively associated with individual- and community-level awareness. The qualitative analysis identified variations in the strategies being used and the challenges arising at the different levels and indicated that awareness building occurred sequentially across these levels, suggesting a need for more systemic approaches to promoting awareness of these alliances and their efforts. [ABSTRACT FROM AUTHOR]

Objective The purpose of this article was to identify some common organizational features of multisector health care alliances ( MHCAs) and the analytic challenges presented by those characteristics in assessing organizational change. Data Sources Two rounds of an Internet-based survey of participants in 14 MHCAs. Study Design We highlight three analytic challenges that can arise when quantitatively studying the organizational characteristics of MHCAs-assessing change in MHCA organization, assessment of construct reliability, and aggregation of individual responses to reflect organizational characteristics. We illustrate these issues using a leadership effectiveness scale (12 items) validated in previous research and data from 14 MHCAs participating in the Robert Wood Johnson Foundation's Aligning Forces for Quality ( AF4Q) program. Findings High levels of instability and turnover in MHCA membership create challenges in using survey data to study changes in key organizational characteristics of MHCAs. We offer several recommendations to diagnose the source and extent of these problems. [ABSTRACT FROM AUTHOR]

Background: Computerized provider order entry (CPOE) can help providers deliver better quality care. We aimed to understand recent trends in use of CPOE by health system-affiliated ambulatory clinics.Methods: We analyzed longitudinal data (2014-2016) for 19,109 ambulatory clinics that participated in all 3 years of the Healthcare Information and Management Systems Society Analytics survey to assess use of CPOE and identify characteristics of clinics associated with CPOE use. We calculated descriptive statistics to examine overall trends in use, location of order entry (bedside vs. clinical station), and system-level use CPOE across all clinics. We used linear probability models to explore the association between clinic characteristics (practice size, practice type, and health system type) and two outcomes of interest: CPOE use at any point between 2014 and 2016, and CPOE use beginning in 2015 or 2016.Results: Between 2014 and 2016, use of CPOE increased more than 9 percentage points from 58 to 67%. Larger clinics and those affiliated with multi-hospital health systems were more likely to have reported use of CPOE. We found no difference in CPOE use by primary care versus specialty care clinics. When used, most clinics reported using CPOE for most or all of their orders. Health systems that used CPOE usually did so for all system-affiliated clinics.Conclusions: Small practice size or not being part of a multi-hospital system are associated with lower use of CPOE between 2014 and 2016. Less than optimal use in these environments may be harming patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: Abdominal obesity, especially visceral fat, may have negative effects on the development and progression of prostate cancer (PCa). A body shape index (ABSI) can more accurately measure visceral fat accumulation. This study aimed to investigate the association between ABSI and PCa in US adults., Methods: 11,013 participants were enrolled in the National Health and Nutrition Examination Survey from 2001 to 2018. Weighted multivariate logistic regression analyses were employed to explore the independent relationship between ABSI and PCa. Moreover, restricted cubic spline (RCS) analysis, subgroup analysis, and interaction tests were performed., Results: ABSI was positively associated with the presence of PCa. When comparing the second, third, and fourth ABSI quartile to the lowest quartile, the adjusted odds ratios (95% confidence intervals) for PCa risk were 1.34 (0.77, 2.31), 1.75 (1.03, 3.00), and 1.91 (1.12, 3.27), respectively (p for trend = 0.011). The restricted cubic spline regression analysis did not reveal a non-linear correlation between ABSI and PCa (p for non-linearity = 0.076). Subgroup analysis showed a significant interaction effect in subgroups of different BMI (p for interaction = 0.01)., Conclusions: Elevated ABSI is significantly associated with an increased risk of PCa, particularly among individuals who are under/normal weighted or obese., (© 2024. The Author(s).)

Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized tens of millions of specific predictions from more than 90 different academic, industry, and independent research groups. A multimodel ensemble forecast that combined predictions from dozens of groups every week provided the most consistently accurate probabilistic forecasts of incident deaths due to COVID-19 at the state and national level from April 2020 through October 2021. The performance of 27 individual models that submitted complete forecasts of COVID-19 deaths consistently throughout this year showed high variability in forecast skill across time, geospatial units, and forecast horizons. Two-thirds of the models evaluated showed better accuracy than a naïve baseline model. Forecast accuracy degraded as models made predictions further into the future, with probabilistic error at a 20-wk horizon three to five times larger than when predicting at a 1-wk horizon. This project underscores the role that collaboration and active coordination between governmental public-health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks.

States have the latitude to mandate coverage of diabetes self-management education (DSME) services for privately insured and Medicaid patients. The impact of these mandates on the supply of DSME resources is unknown. This study compared changes in the supply of DSME programs and program sites accredited by the American Association for Diabetes Educators (AADE) and certified diabetes educators (CDE) between states that did and did not mandate benefits for DSME. Using a unique combination of legal and programmatic data sources, the authors employed fixed effects regression models with clustered robust standard errors to compare changes in the supply of AADE-accredited DSME programs, program sites, and CDEs in states that mandated benefits with states that did not. Given the variation in state mandates, models also estimated the impact of "flexible" reimbursement provisions on the supply of resources among adopting states. The supply of DSME resources has increased over time, but results indicate that mandated benefits were not a significant driver of these changes in the supply. The impact of flexible reimbursement provisions varied. Interestingly, provisions of the Affordable Care Act were associated with an increased supply of resources. Results suggest that extending benefits to previously insured patients does not increase the supply of DSME resources, but a rapid increase in patients entering the health system does encourage growth.

Background: Despite significant investments in health information technology (IT), the technology has not yielded the intended performance effects or transformational change. We describe activities that health systems are pursuing to better leverage health IT to improve performance., Methods: We conducted semi-structured telephone interviews with C-suite executives from 24 U.S. health systems in four states during 2017-2019 and analyzed the data using a qualitative thematic approach., Results: Health systems reported two broad categories of activities: laying the foundation to improve performance with IT and using IT to improve performance. Within these categories, health systems were engaged in similar activities but varied greatly in their progress. The most substantial effort was devoted to the first category, which enabled rather than directly improved performance, and included consolidating to a single electronic health record (EHR) platform and common data across the health system, standardizing data elements, and standardizing care processes before using the EHR to implement them. Only after accomplishing such foundational activities were health systems able to focus on using the technology to improve performance through activities such as using data and analytics to monitor and provide feedback, improving uptake of evidence-based medicine, addressing variation and overuse, improving system-wide prevention and population health management, and making care more convenient., Conclusions and Implications: Leveraging IT to improve performance requires significant and sustained effort by health systems, in addition to significant investments in hardware and software. To accelerate change, better mechanisms for creating and disseminating best practices and providing advanced technical assistance are needed., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to measure the dissemination of comparative provider quality information (CPQI) and evaluate its impact on consumers' awareness and use of CPQI., Data Sources: Two-period, random-digit-dial panel survey of chronically ill consumers residing in 14 regions of the United States; summaries of CPQI dissemination activities of regional multistakeholder alliances; and the LexisNexis Academic and Access World News databases., Study Design/methods: Fixed effects regression to isolate the effect of CPQI producers' dissemination activities and the print media's CPQI coverage on chronically ill consumers' self-reported awareness and use of CPQI., Principal Findings: Direct CPQI dissemination had no overall effect on either awareness or use of CPQI. One unit increase in the media coverage of an Aligning Forces for Quality (AF4Q) multistakeholder alliance report increased consumer awareness and use of CPQI by 1.4 percentage points (P=0.049) and 1.1 percentage points (P=0.009), respectively. Similar increases for the Centers for Medicare and Medicaid Services (CMS) CPQI and for the nonalliance, non-CMS CPQI improved CPQI use by 1.6 percentage points (P<0.001) and 0.2 percentage points (P=0.041), respectively., Conclusion: Even though CPQI producers' direct dissemination efforts had little impact, the small but significant consumer impacts of CPQI's limited press coverage suggests that limited use of media in the dissemination of report cards may be a significant factor behind low consumer awareness and use.

Objectives: The adoption and use of health information technology (IT) by health systems in ambulatory care can be an important driver of care quality. We examine recent trends in health IT adoption by health system-affiliated ambulatory clinics in the context of the federal government's Meaningful Use and Promoting Interoperability programs., Study Design: We analyzed a national sample of 17,861 ambulatory clinics affiliated with 1711 health systems, using longitudinal data (2014-2016) from the HIMSS Analytics annual surveys., Methods: We used descriptive analyses and linear probability models to examine the adoption of electronic health records (EHRs), as well as 16 specific functionalities, at the clinic level and the system level. We compared the differential trends of adoption by various characteristics of health systems., Results: We find that the adoption of an EHR certified by the Office of the National Coordinator for Health IT (ONC) increased from 73% to 91%. However, in 2016, only 38% of clinics reported having all 16 health IT functionalities included in this study. Small health systems lag behind large systems in ambulatory health IT adoption. Patient-facing functionalities were less likely to be adopted than those oriented toward physicians. Health information exchange capabilities are still low among ambulatory clinics, pointing to the importance of the ONC's recent Promoting Interoperability initiative., Conclusions: The relatively low uptake of health IT functionalities important to care improvement suggests substantial opportunities for further improving adoption of ambulatory health IT even among the current EHR users.

Objective: The main purpose of this study was to estimate the tax revenue lost by state and federal governments as a result of adverse labor market outcomes attributable to opioid misuse., Methods: We pair existing, plausibly causal estimates of the effect of opioid misuse on the decline in the labor force from 2000 to 2016 with a variety of data sources to compute tax revenues lost by state and federal governments using the online TAXSIM calculator., Results: We find that between 2000 and 2016, opioid misuse cost state governments $11.8 billion, including $1.7 billion in lost sales tax revenue and $10.1 billion in lost income tax revenue. In addition, the federal government lost $26.0 billion in income tax revenue., Conclusions: By omitting lost tax revenue due to labor force exits, prior studies have missed an important component of opioid-related costs borne by state and federal governments., Policy Implications: As more states and the federal government contemplate litigation for opioid-related damages, lost tax revenue represents an important cost that could be recouped and allocated to opioid prevention and treatment programs.

Background: Collaborative forms of organizations such as multisectoral health care alliances play an increasingly prominent role in the U.S. health care system. A key feature of these organizations highlighted in previous research is leadership, yet little research has examined what happens when there is a change in leadership., Purpose: The aim of this study was to examine the relationship between leadership transitions in an alliance and member assessments of the benefits and costs of participation, indicators of the value that members derive from their involvement in the alliance., Methodology/approach: The study used quantitative data collected from three rounds of surveys of alliance members participating in the Robert Wood Johnson Foundation's Aligning Forces for Quality Program. Qualitative interview data supplemented this analysis by providing examples of why leadership transitions may affect participation benefits and costs., Findings: Quantitative analysis indicated that alliance members who experienced a change in leadership reported both higher and lower levels of participation benefits and costs, depending on the type of leadership change (i.e., alliance leader vs. programmatic leader). Qualitative analysis suggested that the scope of responsibilities of different types of leaders plays an important role in how members perceive changes. Likewise, interviews indicated that timing influences how disruptive a leadership transition is and whether it is perceived positively or negatively., Practice Implications: Leadership transitions present both challenges and opportunities; whether the effects are felt positively or negatively depends on when a transition occurs and how it is handled by incoming leaders and remaining members. Furthermore, different types of members report higher levels of participation benefits and lower levels of participation costs, suggesting that efforts to maintain a sense of alliance value during times of transitions may be able to target certain types of individuals.

Public reporting of health care provider quality is intended to spark consumer informed decision-making, yet there is concern that it might exacerbate disparities. This study explores the extent to which people with chronic conditions are aware of and using comparative quality information (CQI) on hospitals and doctors, and how awareness and use of the information differs by individuals' socio-demographic characteristics. Using a large 2011/2012 survey of adults with chronic conditions, we find low awareness of hospital and doctor CQI (26% and 16% respectively), and lower CQI use (8% and 6% respectively). Findings related to equity in awareness and use by socio-demographic subgroups was mixed. Higher education and income were related to greater CQI awareness, however Whites were less likely to be aware of and use CQI than African Americans and Latinos. The magnitudes of these differences, however, were not large; all groups had modest levels of CQI awareness and use.

Objective: The objective of this study was to examine racial-ethnic disparities in the use of antidepressants among people with private coverage and people with public insurance or no coverage., Methods: Data were from Medical Expenditure Panel Surveys (2006-2010), and logistic regression was used for the analysis., Results: Among persons with depression and private coverage, racial-ethnic minority groups were significantly less likely than non-Hispanic whites to use antidepressants (N=4,468; adjusted odds ratio [AOR]=.50, 95% confidence interval [CI]=.33-.66 for non-Hispanic blacks; AOR=.70, CI=.55-.89 for Hispanics). No significant racial-ethnic disparity in the use of antidepressants was found in Medicare (N=1,944), Medicaid (N=2,125), and uninsured populations (N=1,679). For all racial-ethnic groups, persons with no insurance coverage had much lower rates of antidepressant use than their insured counterparts., Conclusions: A wide racial-ethnic gap in the use of antidepressants existed in private coverage. As the nation continues to implement the Affordable Care Act, which will increase the number of enrollees from racial-ethnic minority groups in private plans, continuing efforts will be needed to reduce racial-ethnic disparities in the use of antidepressants.

A key component of efforts to improve the quality of care in the United States is the use of public reporting and pay-for-performance programs. Little is known, however, about the extent to which small- and medium-sized physician practices are participating in these programs. This study examined the participation of small- and medium-sized physician practices in pay-for-performance and public reporting programs and the characteristics of the participating practices. Using cross-sectional data from a national sample of 1,734 small- and medium-sized physician practices throughout the United States, we found that many practices (61.2%) were participating in at least one program, while far fewer (19.2%) were participating in multiple programs. Among practices participating in multiple programs, relatively few (21.9%) reported high levels of administrative problems due to a lack of standardization on performance measures. The study also suggests that some structural features are associated with participation and may provide leverage points for fostering participation.