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Dear John,
The February issue of Health Affairs covers behavioral health, including
mental health and substance use; the nursing home workforce; and health
equity issues such as racial and ethnic disparities in ambulance
transportation destinations and adverse birth outcomes.
Read The Issue
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Behavioral Health
In the midst of a mental health provider shortage, Lisa Rotenstein and
coauthors find an almost 50 percent increase in the share of primary
care physician visits
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that address a mental health concern, with growth from 10.7 percent of
visits in 2006-07 to 15.9 percent in 2016 and 2018.
Black patients and Hispanic patients are 40 percent less likely than
White patients and non-Hispanic patients, respectively, to have a mental
health concern addressed during a primary care visit.
K. John McConnell and colleagues use newly available national Medicaid
claims data from 2018
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to examine emergency department (ED) visits for mental health conditions
among Medicaid beneficiaries.
They report substantial state-to-state variation "both in ED visits
for mental health conditions and in outpatient mental health visits,
with these measures positively correlated."
Lori Uscher-Pines and coauthors explore recent trends in the use of
telemedicine
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to address opioid use disorder (OUD).
More than three-quarters of clinicians treating OUD report the use of
one or more digital equity strategies designed to address barriers
patients may have to using telemedicine, with about one-third offering
real-time technical assistance and more than 15 percent supplying
patients with electronic devices if they do not have them.
Brendan Saloner and coauthors investigate smoking rates among people
involved in the criminal legal system
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group of people with relatively high rates of smoking and substance use
disorder (SUD).
Using data from the period 2010-19, the authors find that "overall
smoking rates among people with SUD decreased by 9.4 percentage
points...during the study period, but they remained effectively
unchanged in the subgroup of people with SUD who had criminal legal
involvement."
Read More
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Nursing Home Workforce
Using a novel database of real estate investment trust (REIT)
investments in US nursing homes and Medicare cost data from the period
2013-19, Robert Tyler Braun and coauthors determine that REIT
investment in a nursing home
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increased licensed practical nurse and certified nursing assistant
staffing hours per resident day by 2.15 percent and 1.55 percent,
respectively, while decreasing registered nurse staffing in years 2 and
3 after investment.
Elizabeth White and coauthors explore the relationship between nursing
home staff shift times
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and COVID-19 testing and vaccination status. They find that day-shift
staff had the highest testing rates and odds of vaccination, whereas
night-shift staff had the lowest.
Adequate staffing is central to ensuring high nursing home quality. To
help illuminate the implications of various policy recommendations, John
Bowblis and coauthors analyze nursing home staff expenditures
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and determine that "any specific threshold for nursing staff
expenditures...would have a varying degree of effectiveness in ensuring
that any given nursing home was adequately staffed."
Ultimately, the authors argue, increased expenditures on staff do not
necessarily translate to an increase in staffing levels.
Read More
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Equity
Christine Pack and coauthors investigate ambulance destinations for
patients transported in 2020
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from the same ZIP code and find meaningful differences by race and
ethnicity.
"In half of the studied ZIP codes, at least 8 percent of White
patients would have had to be transported to different hospitals to
achieve evenness in the transport destinations of White and non-White
patients," the authors report.
Clare Brown and coauthors examine disparities in rates of preterm birth
and low birthweight
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across racial and ethnic subcategories.
They find sizable variation in adverse birth outcomes within racial and
ethnic groups, demonstrating that broad racial and ethnic
categorizations can conceal important intragroup differences.
Eunhae Grace Oh and coauthors analyze dialysis facility networks for
Medicare Advantage (MA) plans
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in 2020, one year before changes that significantly increased MA
enrollment among patients with end-stage renal disease (ESRD).
Nearly one-quarter of dialysis networks were narrow, which the authors
define as including 25 percent or less of the dialysis facilities within
the plan's service area.
Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native
beneficiaries with ESRD were more likely than White beneficiaries to be
enrolled in narrow-network MA plans.
Examining COVID-19 booster rates
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the end of the first Omicron wave in 462 Massachusetts communities, Adam
Gaffney and coauthors find lower rates in communities with higher
uninsurance rates and lower prevalence of medical checkups, after
controlling for demographic factors.
They call for "innovative vaccination outreach efforts to communities
with a high prevalence of chronic illness...to mitigate the inequitable
burden of COVID-19."
Read More
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Order The Issue
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Join Health Affairs Unlimited to access our current and past issues
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Our events in February will cover topics including health spending and
financing of nursing homes, plus a fun Happy Hour for Insider members to
meet Health Affairs leaders and each other.
* Lunch and Learn: How to Make the Editor's Top Ten List
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on February 8
* Journal Club: "The Role Of Real Estate Investment Trusts In Staffing
US Nursing Homes
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on February 16
* Virtual Happy Hour
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on February 28
View Full Event Schedule
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Sponsored By UnitedHealthcare
Community & State <[link removed]> is the business
segment of UnitedHealthcare that provides health care coverage for the
economically disadvantaged, the medically underserved and those without
the benefit of employer-funded health plans. These state-based health
plans meet local needs, while leveraging the national resources of
UnitedHealthcare.
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Listen To These Podcasts
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This month, we'll host featured authors in the February issue to discuss
topics like behavioral health, nursing home workforce, and more.
Recently, we wrapped up the newest season of Pathways
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where NYC Health + Hospitals' Michael Shen, a primary care doctor,
explores safety-net hospitals and how we pay for them.
Check out our podcasts, and subscribe on Spotify
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or wherever you prefer to listen.
Listen
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About Health Affairs
Health Affairs is the leading peer-reviewed journal
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health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org <healthaffairs.org>, Health Affairs Today
<[link removed]>, and Health Affairs Sunday
Update <[link removed]>. Â
Project HOPE <[link removed]> is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.
Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States
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