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Purpose of the studyTo develop the Caregiver Orientation Scale for Mexican-Origin Women and evaluate its psychometric properties.Design and methodsWe developed a questionnaire to measure domains of cultural orientation to the caregiver role based on formative research and on the Cultural Justifications for Caregiving Scale. We conducted a series of exploratory factor analyses (EFAs) on data collected from 163 caregivers. We estimated internal consistency reliability (Cronbach's coefficient alpha) and assessed construct validity by estimating correlations between all latent factors and self-rated health, interview language, and weekly hours of care.ResultsEFAs suggested four factors representing familism, obligation, burden, and caregiving intensity that displayed good fit (χ2 (df = 63) = 70.52, p = .24; RMSEA = .03 [90% CI: 0.00, 0.06]; comparative fit index = .99). Multi-item scales representing the four domains had coefficient alphas ranging from .68 to .86. Obligation was positively associated with burden (.46, p < .001) and intensity (.34, p < .01), which were themselves positively correlated (.63, p < .001). Familism was positively associated with obligation (.25, p < .05) yet negatively associated with burden (-.35, p < .01) and intensity (-.22, p < .05). Weekly hours of care were positively associated with burden (.26, p < .01) and intensity (.18, p < .05), whereas self-rated health and burden (-.21, p < .05) and Spanish language and intensity (-.31, p < .001) were negatively correlated.ImplicationsThe study shows that Mexican-origin caregiver orientation is multidimensional and that caregivers may have conflicting motivations for caregiving.

ObjectiveTo examine associations between physician reimbursement incentives and diabetes care processes and explore potential confounding with physician organizational model.Data sourcesPrimary data collected during 2000-2001 in 10 managed care plans.Study designMultilevel logistic regressions were used to estimate associations between reimbursement incentives and process measures, including the receipt of dilated eye exams, foot exams, influenza immunizations, advice to take aspirin, and assessments of glycemic control, proteinuria, and lipid profile. Reimbursement measures included the proportions of compensation received from salary, capitation, fee-for-service (FFS), and performance-based payment; the performance-based payment criteria used; and interactions of these criteria with the strength of the performance-based payment incentive.Data collectionPatient, provider group, and health plan surveys and medical record reviews were conducted for 6,194 patients with diabetes.Principal findingsWithout controlling for physician organizational model, care processes were better when physician compensation was based primarily on direct salary rather than FFS reimbursement (four of seven processes were better, with relative risks ranging from 1.13 to 1.23) or capitation (six were better, with relative risks from 1.06 to 1.36); and when quality/satisfaction scores influenced physician compensation (three were better, with relative risks from 1.17 to 1.26). However, these associations were substantially confounded by organizational model.ConclusionsPhysician reimbursement strategies are associated with diabetes care processes, although their independent contributions are difficult to assess, due to high correlation with physician organizational model. Regardless of causality, a group's use of quality/satisfaction scores to determine physician compensation may indicate delivery of high-quality diabetes care.

Background: The COVID-19 pandemic in the United States has disproportionately impacted communities deemed vulnerable to disease outbreaks. Our objectives were to test (1) whether infection and mortality decreased in counties in the most vulnerable (highest) tercile of the Social Vulnerability Index (SVI), and (2) whether disparities between terciles of SVI were reduced, as the length of mask mandates increased., Methods: Using the New York Times COVID-19 and the Centers for Disease Control and Prevention SVI and mask mandate datasets, we conducted negative binomial regression analyses of county-level COVID-19 cases and deaths from 1/2020-11/2021 on interactions of SVI and mask mandate durations., Results: Mask mandates were associated with decreases in mid-SVI cases (IRR: 0.79) and deaths (IRR: 0.90) and high-SVI cases (IRR: 0.89) and deaths (IRR: 0.88). Mandates were associated with the mitigation of infection disparities (Change in IRR: 0.92) and mortality disparities (Change in IRR: 0.85) between low and mid-SVI counties and mortality disparities between low and high-SVI counties (Change in IRR: 0.84)., Discussion: Mask mandates were associated with reductions in COVID-19 infection and mortality and mitigation of disparities for mid and high-vulnerability communities., Conclusions: Ongoing COVID-19 response efforts may benefit from longer-standing infection control policies, particularly in the most vulnerable communities., (Published by Elsevier Inc.)