Author: Anonymous

Extra Credit Question (worth 2 points; no word limit) What 1 or 2 topics do you think the most important (or interesting) in this course? And what 1 or 2 topics (related to HSR) would you like to be covered in the rest of the semester? 

What is a measure of the ‘access to care’ in a population?

Which of the following does not accurately describe an aspect of the transition toward value-based care?

Read the abstract provided below and determine the type of review: Abstract Issue: The Affordable Care Act’s (ACA’s) health insurance marketplaces provide a critical source of coverage and financial assistance. States operating their own marketplaces cover a significant number of consumers without access to employment-based health insurance or public programs. Federal actions under the Trump administration have undermined the marketplaces, but the new administration has opportunities to implement and advocate for policies that strengthen state-based marketplaces (SBMs) to ensure they continue to serve as a coverage safety net. Goal: Identify federal policies to support SBMs and the consumers they serve. Methods: Structured interviews with directors and officials from 17 SBMs and analysis of recent federal policies impacting SBMs. Key Findings and Conclusions: The Trump administration has hindered SBMs by establishing onerous requirements and creating consumer confusion. Affordability remains a primary barrier to marketplace coverage, and federal initiatives could help reduce premiums and cost sharing. SBMs are an important resource for people who do not have access to affordable insurance through their jobs, but federal policy changes are needed to clear an easier pathway to coverage. In addition, the federal government should reinvest in advertising and outreach for the federally facilitated marketplace.

The expansion of health insurance coverage across the entire population is the central aim of the population health movement.

Which type of research is usually conducted when relatively little is known about the phenomenon under study?

A/an ________________ occurs when a patient has been discharged from a healthcare facility but later has to be admitted again for the same condition.

Using PICOT framework, analyze the abstract provided below and formulate the research question.  *Note: ‘T’ is optional; but ‘PICO’ parts are necessary.    **This is an example of an answer for this type of question: Population: Bariatric adolescents considering or undergoing gastric bypass surgery. Intervention: The nurse’s role as a primary member of the multidisciplinary team regarding perioperative care of the bariatric adolescent patient. Comparison: The nurse’s role as a secondary member of the multidisciplinary team without any specialized training and is only involved in perioperative care of the bariatric adolescent patient. Outcome: When the nurse is involved as one of the primary members in the multidisciplinary team approach, the bariatric adolescent patient has better continuity of care. Time: perioperative including the 6 weeks post-recovery. PICOT Question: Does the bariatric adolescent patient undergoing gastric bypass have better continuity of care perioperatively and postoperatively when the nurse is a primary member of the multidisciplinary team versus when the nurse is a secondary member whose only role is in providing perioperative care during 6 weeks post-recovery?   ——————————————————– AbstractImportance:  State decisions not to expand Medicaid under the Patient Protection and Affordable Care Act could reduce emergency access to acute care hospitals. Objective:  To determine the relationship between state Medicaid expansion and emergency access to acute care hospitals in the United States. Design, Setting, and Participants:  This cross-sectional study linked hospital-level data from the Centers for Medicare & Medicaid Services from 2007 to 2017 to US Census data for all 50 US states and the District of Columbia. Geospatial analyses and difference-in-differences regression models were used to compare temporal changes in the size of the population without 30-minute access to acute care hospitals between 32 states that expanded Medicaid with the population without access in 19 that did not, before and after expansion. Analyses focused on the total population and those with low incomes; secondary analyses examined emergency access to safety-net hospitals. Exposures:  State-level Medicaid expansion. Main Outcomes and Measures:  Population without emergency access to an acute care hospital, defined as living outside a 30-minute drive of any hospital. Results:  States that did not expand Medicaid experienced an increase in the population without access to hospitals overall (without expansion: 6.76% to 6.79% [0.03%]; vs with expansion: 5.65% to 5.35% [–0.30%]; difference-in-differences, 0.33%; 95% CI, 0.33%-0.34%; P 

Read the abstract provided below and determine the type of review: Abstract The Behavioral Model of Health Services Use by Ronald M. Andersen and colleagues is the most widely adopted theoretical framework for analyzing and predicting health care utilization. Among other things, it is employed in the German Federal Health Reporting since 2001. It differentiates need factors, predisposing factors and enabling factors both on the contextual level and the individual level as determinants of individual health services use. From the viewpoint of social epidemiology, one of the key strengths of the Behavioral Model is its capability to systematize and empiricize equity and inequity in the access to health services by specifying need vs. predisposing and enabling factors. This strength could be even promoted by including direct effects on utilization of psychological factors (besides social factors) as contributing to inequity. Another strength of the Behavioral Model since its fifth version is that it conceptualizes need factors, predisposing factors and enabling factors both on the contextual level and the individual level in a structurally equivalent manner. Thus, not only are theoretically consistent multilevel models possible on the predictor side, but general theories of action and behavior from sociology and psychology are more easily applied on the behavior of professionals working in health policy and services. On the side of health-related behaviors (as mediating factors) and the outcomes of the model (including, since its sixth version, quality of life), the question is why these are represented as individual entities only, thus excluding relevant prevalences and incidences only from the scope of the model. Here, the Behavioral Model could be further developed by integrating assumptions of the Basic Behavioral Epidemology Model by Thomas von Lengerke and colleagues which – following the micro-micro-model of sociological explanation – allows the description and explanation of collective outcomes. Finally, regarding the empirical and statistical application of the Behavioral Model, improvements are possible by use of the methodological differentiation between mediation and moderation. For instance, it should be clarified whether only enabling factors, which according to classical social ecology tend to moderate associations between other variables (in the present case need factors and utilization), may be conceptualized and modelled as effect modifiers, or predisposing factors as well. In the context of data analyses oriented by the Behavioral Model, this would have direct implications for specifying hierarchical models and relevant interaction terms.

The goal of increasing value in healthcare cannot be achieved simply by decreasing unit prices for services, because providers could simply increase the volume of services to make up for the lower unit prices. Thus, the movement toward value-based healthcare must include payment reform that rewards efficiency of resource utilization and care delivery.