Most of the July issue of Health Affairs is dedicated to articles about how we can provide preventive care and positive outcomes for type 2 diabetes. There are also studies looking at the frequency of inaccurate Medicaid mental health provider directories, recent changes in disease burden expenditures and the correlation between a community’s hospital readmission rates and patient care options once a patient is discharged.
Featured articles highlighted and described below:
Diet, work and hospitalizations in adults with type 2 diabetes.
The Department of Agriculture estimates that in 2020, 10.5% of U.S. households experienced food insecurity, defined as “the limited or uncertain availability of nutritionally adequate or safe food.” Research has shown that food insecurity is more common in people with type 2 diabetes. However, few studies have investigated the relationship between food insecurity in working-age adults living with the disease. To fill this void, Joshua Weinstein and his co-authors at the University of North Carolina at Chapel Hill assessed data from a 2011 to 2018 government survey of American adults aged sixty-five and under with the disease. diabetes and found that food insecure survey participants had an average of 13.32 days missed from health-related work over the past twelve months, compared to 6.02 days missed among those with diabetes. Food Safety. For those who reported hospitalizations in the past twelve months, food-insecure adults spent an average of 2.77 nights in hospital, compared to 1.41 nights among their food-secure counterparts. The authors hypothesize that food insecurity can lead to a vicious circle – it worsens health, potentially reduces income and increases the extent of food insecurity – and recommend that policy makers consider the potential benefits of productivity in addition to implications for health care utilization.
- Also in the July issue: six studies, published June 27, discuss how to provide preventive care and improve outcomes for type 2 diabetes.
Oregon Medicaid mental health provider directories frequently include “ghost” participants.
Health insurance plans are required to provide their customers with a list of providers in their networks. These databases are a crucial tool that patients can use to select health plans or locate providers in the network, especially for mental health services, which a 2019 Health Affairs study showed that they were up to six times more likely than general medical services to be provided out-of-network. Previous studies have revealed widespread inaccuracies in these directories, with growing concerns about so-called “ghost networks”. In what is among the first studies of provider data (as opposed to studies using “secret shoppers”), Jane Zhu of Oregon Health and Science University and her co-authors examined lists of providers in network directories compared to provider networks empirically constructed from administrative claims among Oregon Medicaid managed care organizations in 2018. They found that 58.2% of providers listed in the network saw four or fewer Medicaid patients in that year, including 67.4% of mental health prescribers, 59.0% of mental health non-prescribers, and 54.0% of primary care providers. They conclude that these discrepancies suggest that federal and state efforts to monitor and enforce network adequacy standards may not be accurate if they rely on current network directories.
Hospital readmission rates related to patient care options after discharge.
Hospital readmissions are increasingly seen as an indicator of quality of care. The Centers for Medicare and Medicaid Services (CMS) calculates annual readmission rates and financially penalizes hospitals whose readmission rates exceed national averages. However, it is unknown whether a patient’s risk of readmission is influenced by the local availability of follow-up care after discharge. To better understand this relationship, Kevin Griffith of Vanderbilt University Medical Center and his co-authors linked county-level data on healthcare workforce and infrastructure to hospital 30-day readmission rates for heart attack, heart failure and pneumonia between 2013 and 2019. Their results showed lower thirty-day readmission rates in hospitals that operated a palliative care service or had a greater local supply of primary care physicians, skilled nursing facility beds and licensed nursing home beds. In contrast, hospitals with more local home care agencies or nurse practitioners were associated with increased readmissions. The authors conclude that CMS can penalize or reward hospitals in part based on the communities they serve versus the quality of care they provide. The findings also suggest that hospitals could benefit from work to improve local access to care or from hospital-community partnerships to improve continuity of care after a patient is discharged.
Non-pharmaceutical responses to COVID-19 in Brazil.
When the first cases of COVID-19 appeared in Brazil at the end of February 2020, the twenty-seven Brazilian states responded by implementing a variety of non-pharmaceutical interventions: restrictions on public events, schools and non-essential commerce , and a bit later, masking orders. In this study, Louise Russell of the University of Pennsylvania and her co-authors estimated the independent effects of seven of these interventions on COVID-19 cases and deaths in twelve Brazilian states, using daily data from March to December 2020. They found that two interventions — restrictions on public events and masking mandates — significantly reduced the spread of the disease. Complete restrictions on public events reduced the growth rate of COVID-19 cases by 0.227, which averaged 1.30 before any intervention was introduced. Partial restrictions on public events have been equally effective, suggesting some easing was possible without increasing cases. Full Hide Mandates were also effective, with a growth rate reduction of 0.060. The authors note that the combined effect of suspending public events and imposing full blackout warrants reduced the growth rate to nearly 1, the point at which cases are no longer increasing. Selective use of non-pharmaceutical interventions is important in all countries to minimize the economic and social burdens of controlling COVID-19, but may be particularly important in low- and middle-income countries like Brazil, which have more workers in informal jobs that lack security. net services, poor infrastructure for distance education and less ability to stimulate their economies. The authors conclude that their findings can help policy makers choose the most effective measures to adopt when community transmission and incidence of COVID-19 increase.
Also interesting in the July issue: