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Objective: This retrospective study using claims data compared demographics, clinical characteristics, treatment patterns, healthcare resource utilization, and clinical outcomes in Black and White patients with pulmonary arterial hypertension (PAH) in the United States. Methods: Patients (aged ≥18 years) had ≥1 pharmacy claim for PAH medication, ≥6 months' continuous healthcare plan enrollment, ≥1 inpatient/outpatient medical claim with a pulmonary hypertension diagnosis ≤6 months before first PAH medication, and race recorded. Results: This analysis included 836 Black and 2896 White patients. Black patients were younger, with lower levels of education and annual household income, and higher comorbidity scores versus White patients. Only ∼14% of Black and White patients received index combination therapy. Lower adherence to index treatment was observed in Black patients. Although adjusted regression analysis in the overall population showed no differences in outcomes between groups, Black patients <65 years were 36% less likely to receive index combination therapy (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.41–0.99), and 46% less likely to adhere to index treatment (OR 0.54; 95% CI 0.33–0.90). Other disparities included 24% higher all-cause health care resource utilization, 75% higher all-cause costs, and higher risk of clinical composite outcome. Social determinants of health (education, income, health insurance plan) partially mediated these race effects. Conclusions: Differences in demographics, clinical characteristics, and treatment patterns between Black and White patients with PAH were observed. Disparities between Black and White patients <65 years were only partially mediated through social determinants of health variables, suggesting other factors may be involved. [ABSTRACT FROM AUTHOR]

Regular expert follow‐up, risk assessment, and early therapeutic intervention minimize worsening of pulmonary arterial hypertension (PAH). COVID‐19 lockdown measures were challenging for chronic disease management. This retrospective, longitudinal analysis used US claims data (January 12, 2016 to September 11, 2021) for patients treated with PAH‐specific medication to compare in‐person outpatient and specialist visits, telemedicine visits, and PAH‐related tests during 6‐month assessment periods pre‐ and immediately post‐COVID‐19. Hospitalizations, costs, and outcomes were compared in patients with and without care disruptions (no in‐person or telemedicine outpatient visits in immediate post‐COVID‐19 period). Patients in the immediate post‐COVID‐19 (N = 599) versus the pre‐COVID‐19 period (N = 598) had fewer in‐person outpatient visits (mean 1.27 vs. 2.12) and in‐person specialist visits (pulmonologist, 22.9% vs. 37.0% of patients; cardiologist, 27.5% vs. 33.8%); and more telemedicine visits (mean 0.45 vs. 0.02). In the immediate post‐COVID‐19 period, patients were less likely to have a PAH‐related test versus the pre‐COVID‐19 period (incidence rate ratio: 0.700; 95% confidence interval: 0.615−0.797), including electrocardiograms (41.7% vs. 54.2%) and 6‐minute walk distance tests (16.2% vs. 24.9%). In the immediate post‐COVID‐19 period, 48 patients had care disruptions and, in the following year, required more hospital days than those without care disruptions (N = 240) (median 10 vs. 5 days in total) and had higher overall hospitalization costs (median US$34,755 vs. US$20,090). Our findings support the need for minimizing care disruptions to potentially avoid incremental post‐disruption healthcare utilization and costs among patients with serious chronic diseases such as PAH. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is commonly associated with connective tissue disorders (CTDs). This study provides a contemporary assessment of the economic burden of CTD + PAH and PAH in the United States. Eligible adult patients identified from Optum's deidentified Clinformatics ® Data Mart Database (10/01/2015-09/30/2021) were classified into mutually exclusive cohorts based on recorded diagnoses: (1) CTD + PAH, (2) PAH, (3) CTD, (4) control without CTD/PAH. The index date was a randomly selected diagnosis date for PAH (CTD + PAH, PAH cohorts) or CTD (CTD cohort), or a random date (control cohort). Entropy balancing was used to balance characteristics across cohorts. Healthcare costs and healthcare resource utilization (HRU) per patient per month (PPPM) were assessed for =12 months postindex and compared among balanced cohorts. A total of 552,900 patients were included (CTD + PAH: n = 1876; PAH: n = 8177; CTD: n = 209,156; control: n = 333,691). Average total all-cause costs were higher for CTD + PAH than PAH cohort ($16,854 vs. $15,686 PPPM; p = 0.02); both cohorts incurred higher costs than CTD and control cohorts ($4476 and $2170 PPPM; all p < 0.001). Average HRU PPPM was similar between CTD + PAH and PAH cohorts (inpatient stay: 0.15 vs. 0.15, outpatient visits: 4.23 vs. 4.11; all p > 0.05), while CTD and control cohorts incurred less HRU (inpatient stay: 0.07 and 0.03, outpatient visits: 2.67 and 1.69; all p < 0.001). CTD + PAH and PAH are associated with a substantial economic burden. The incremental burden attributable to PAH versus the general population and patients with CTD without PAH highlights significant unmet needs among PAH patients. [ABSTRACT FROM AUTHOR]

As nurse practitioners (NPs) are increasingly relied on to deliver primary care in rural communities, it is critical to understand the contexts in which they work and whether they are characterized by work environments and infrastructures that facilitate the provision of high-quality patient care. This study compares urban and rural NPs using data from a survey of 1,244 primary care NPs in Arizona, California, New Jersey, Pennsylvania, Texas, and Washington. While rural and urban NPs have a number of similarities in terms of demographic characteristics, practice patterns, and job outcomes, they also have noteworthy differences. Rural NPs report higher levels of independent practice, fewer structural capabilities that facilitate quality care, and poorer relationships with physicians. Health care organizations in rural communities may need to invest in work environments and infrastructures that facilitate high-quality care and autonomous practice for NPs. [ABSTRACT FROM AUTHOR]

The Centers for Medicare and Medicaid Services' Pay-for-Performance (P4P) programs aim to improve hospital care through financial incentives for care quality and patient outcomes. Magnet® recognition—a potential pathway for improving nurse work environments—is associated with better patient outcomes and P4P program scores, but whether these indicators of higher quality are substantial enough to avoid penalties and thereby impact hospital reimbursements is unknown. This cross-sectional study used a national sample of 2,860 hospitals to examine the relationship between hospital Magnet® status and P4P penalties under P4P programs: Hospital Readmission Reduction Program, Hospital-Acquired Conditions (HAC) Reduction Program, Hospital Value-Based Purchasing (VBP) Program. Magnet® hospitals were matched 1:1 with non-Magnet hospitals accounting for 13 organizational characteristics including hospital size and location. Post-match logistic regression models were used to compute a hospital's odds of penalties. In a national sample of hospitals, 77% of hospitals experienced P4P penalties. Magnet® hospitals were less likely to be penalized in the VBP program compared to their matched non-Magnet counterparts (40% vs. 48%). Magnet® status was associated with 30% lower odds of VBP penalties relative to non-Magnet hospitals. Lower P4P program penalties is one benefit associated with achieving Magnet® status or otherwise maintaining high-quality nurse work environments. [ABSTRACT FROM AUTHOR]

In October 2018, President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. This piece of legislation addresses treatment, prevention, recovery, and enforcement with particular attention to access in rural areas. It contains numerous provisions to improve needed access to treat substance use disorders and especially opioid use disorder (OUD), including mandatory coverage of medications for OUD, partial elimination of Medicaid payment for inpatient mental health treatment, and state planning grants to increase provider capacity. Many of these provisions would be significantly enhanced by removing barriers to prescriptive authority for Advanced Practice Registered Nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and other state-specific titles for nurses whose scope allows the prescription of controlled substances. This policy brief includes a history of the role of APRNs in the delivery of medications for OUD, scope of practice restrictions related to prescriptive authority as a barrier in their ability to deliver care for this vulnerable population, and actionable strategies that APRNs can take to advocate for an increased role in providing care. [ABSTRACT FROM AUTHOR]

Abstract: To identify the impact of postdischarge psychiatric medication changes on general medical readmissions among patients with serious mental illness (SMI; bipolar disorder, major depressive disorder, and schizophrenia), claims from a 5% national sample of Medicare fee-for-service (FFS) beneficiaries hospitalized between 2013 and 2016 were studied. A total of 165,490 Medicare FFS beneficiaries with SMI 18 years or older with at least 1 year of continuous Medicare enrollment were identified. Within 30 days of discharge from index admission, 47.4% experienced a psychiatric medication change-including 75,892 beneficiaries experiencing a deletion and 55,713 experiencing an addition. After adjusting for potential confounders, those with a medication change experienced an 10% increase in the odds of 30-day readmission (odds ratio, 1.10; SE, 0.019; p < 0.001). Comorbid drug use disorder was also associated with an increased odds of readmission after controlling for other covariates. These findings suggest important factors that clinicians should be aware of when discharging patients with SMI. [ABSTRACT FROM AUTHOR]

Nurse practitioners (NPs) represent the fastest growing segment of the U.S. primary care workforce. Surveys of primary care NPs can help to better understand the care NPs deliver across different health care settings, the factors that impact NP job satisfaction and burnout, and the structural capabilities required to support their practice. The purpose of this article is to provide an overview of national sampling frames that can be used by researchers interested in surveying or studying the U.S. primary care NP workforce. We conducted an environmental scan and review of published literature on the NP workforce to identify data sources that can be used to sample primary care NPs. In this article, we (a) identify the data elements needed to develop an NP sampling frame and (b) describe national data sets that can be used to sample primary care NPs, including the strengths and weaknesses of each. This information is intended to facilitate research on the primary care NP workforce to inform practice and policy. [ABSTRACT FROM AUTHOR]

It is well-established that hospitals recognized for good nursing care -- Magnet hospitals -- are associated with better patient outcomes. Less is known about how Magnet hospitals compare to non-Magnets on quality measures linked to Medicare reimbursement. The purpose of this study was to determine how Magnet hospitals perform compared to matched non- Magnet hospitals on Hospital Value Based Purchasing (VBP) measures. A cross-sectional analysis of three linked data sources was performed. The sample included 3,021 non-federal acute care hospitals participating in the VBP program (323 Magnets; 2,698 non-Magnets). Propensity score matching was used to match Magnet and non-Magnet hospitals with similar hospital characteristics. After matching, linear and logistic regression models were used to examine the relationship between Magnet status and VBP performance. After matching and adjusting for hospital characteristics. Magnet recognition predicted higher scores on Total Performance (Regression Coefficient [RC] = 1.66, p< 0.05), Clinical Processes (RC = 3.85; p <0.01), and Patient Experience (RC = 6.33; p < 0.001). The relationships between Magnet recognition and the Outcome and Efficiency domains were not statistically significant. Magnet hospitals known for nursing excellence perform better on Hospital VBP measures. As healthcare systems adapt to evolving incentives that reward value, attention to nurses at the frontlines may be central to ensuring high-value care for patients. [ABSTRACT FROM AUTHOR]