Objectives. To assess the prevalence of Adverse Childhood Experiences (ACEs) and their association with behavioral health in American Indian (AI) non-AI populations South Dakota. Methods. We included validated ACE questionnaire a statewide survey 16,001 households. examined ACEs conditions AI associations between health. Results. Compared non-AIs, AIs displayed higher including abuse, neglect, household dysfunction had total number ACEs. For having six or more significantly increased odds...

Reducing unnecessary tests and treatments is a potentially promising approach for improving the value of health care. However, relatively little known about whether insurance type or local practice patterns are associated with delivery low-value care.To compare care in Medicaid commercially insured populations, test provision type, assess care.This cross-sectional study claims data from Oregon Division Medical Assistance Programs All-Payer All-Claims database included adults aged 18 to 64...

Several state Medicaid reforms are under way, but the relative performance of different approaches is unclear.To compare Oregon's and Colorado's Accountable Care Organization (ACO) models.Oregon initiated its transformation in 2012, supported by a $1.9 billion investment from federal government, moving most enrollees into 16 Coordinated Organizations, which managed care within global budget. Colorado Collaborative 2011, creating 7 Regional Organizations that received funding to coordinate...

Little is known about changes in pain intensity that may occur after discontinuation of long-term opioid therapy (LTOT). The objective this study was to characterize over 12 months. This retrospective U.S. Department Veterans Affairs (VA) administrative data identified N = 551 patients nationally who discontinued LTOT. Data 24 months (12 before and discontinuation) were abstracted from VA records. Random-effects regression analyses examined 0 10 numeric rating scale scores time, whereas...

Abstract Purpose Research on urban/rural disparities in alcohol, drug use, and mental health (ADM) conditions is inconsistent. This study describes ADM condition prevalence access to care across diverse geographies a predominantly rural state. Methods Multimodal cross‐sectional survey South Dakota from November 2013 October 2014, with oversampling areas American Indian reservations. Measures assessed demographic characteristics, using clinical screenings participant self‐report, perceived...

<h3>Importance</h3> Medicare's Comprehensive Care for Joint Replacement (CJR) model rewards or penalizes hospitals on the basis of meeting spending benchmarks that do not account patients' preexisting social and medical complexity high expenses associated with serving disadvantaged populations such as dual-eligible patients (ie, those enrolled in both Medicare Medicaid). The CJR may have different implications a percentage (termed<i>high-dual</i>) low (termed<i>low-dual</i>)....

This cohort study was conducted from January 1 to August 31, 2021.We determined the rate of postpartum contraceptive use by state or territory categorize our findings.We excluded 6 states and territories with data assessed as "unusable" "high concern" using standardized quality assessments Center for Medicaid Services. 4Our set included all live births recipients aged 15 44 years in 2016.The institutional review board at Oregon Health & Science University, Portland, approved study.

Several factors may accelerate opioid discontinuation rates, including lack of information about the long-term effectiveness opioids for chronic pain, heightened awareness opioid-related adverse events, closer monitoring patients aberrant behaviors, and greater restrictions around prescribing. Rates be most pronounced in deemed to at "high risk." The purpose this study was compare reasons therapy (LTOT) between with without substance use disorder (SUD) diagnoses receiving care within a major...

Background: A multi-component arts initiative was instituted at a non-metropolitan, five-hospital healthcare system. This study examined whether patients’ satisfaction with the hospital arts-enhanced environment associated their likelihood to recommend hospital.Methods: survey mailed random sample of patients who had been discharged from five hospitals between 2010 and 2012. Survey items included standard HCAHPS other questions. Logistic regression used identify predictors recommend.Results:...

<h3>Importance</h3> The Comprehensive Care for Joint Replacement (CJR) model was designed to reduce the cost and improve quality of hip or knee replacement among Medicare beneficiaries. Yet whether this may exacerbate existing racial/ethnic disparities in access surgery is unclear. <h3>Objective</h3> To examine association CJR with receipt elective across White, Black, Hispanic <h3>Design, Setting, Participants</h3> Retrospective cohort study claims from 2013 through 2017 beneficiaries...

<h3>Importance</h3> There are marked racial/ethnic differences in hip and knee joint replacement care as well concerns that value-based payments may exacerbate existing disparities care. <h3>Objective</h3> To examine changes associated with Medicare's Comprehensive Care for Joint Replacement (CJR) model among White, Black, Hispanic patients. <h3>Design, Setting, Participants</h3> Retrospective cohort study of Medicare claims from 2013 through 2017 patients undergoing 67 treatment (selected...

In 2012 Oregon transformed its Medicaid program, providing coverage through sixteen coordinated care organizations (CCOs). The state identified the elimination of health disparities as a priority for CCOs, implementing multipronged approach that included strategic planning, community workers, and Regional Health Equity Coalitions. We used claims-based measures utilization, access, quality to assess baseline test changes over time. Prior CCO intervention there were significant white-black...

Medicaid is the largest payer for publicly funded contraception, serving millions of women across United States. However, relatively little known about extent to which effective contraceptive services vary geographically recipients. This study used national claims assess county-level variation in rates provision most or moderately methods contraception and long-acting reversible (LARC) forty states Washington, D.C., 2018. County-level use varied almost fourfold states, from a low 10.8...

Importance Improving access to the choice of postpartum contraceptive methods is a national public health priority, and need particularly acute within Medicaid population. One strategy ensure individuals have full range provision method prior hospital discharge following birth episode. Beginning in 2016, some states changed their billing policy, allowing separate reimbursement for intrauterine devices implants increase long-acting reversible (LARC) immediately (IPP). Objective To assess...

In 2018, Medicare made participation in the Comprehensive Care for Joint Replacement (CJR) program, which had been mandatory all hospitals 67 metropolitan statistical areas (MSAs), voluntary 33 of MSAs with lowest historical costs. CJR was designed to hold accountable cost and quality care during hip or knee replacement episodes, defined as hospitalization 90 days post-discharge care. We compared that stayed program against those withdrew. This information is important understanding effects...

Abstract Background We examined whether the Comprehensive Care for Joint Replacement (CJR) model was associated with changes in receipt of joint replacement among people Alzheimer's disease and related dementias (ADRD) as well spending, health service use, postsurgical outcomes ADRD who underwent a surgery. Methods Retrospective cohort study using 2013–2017 Medicare claims Minimum Data Set. used difference‐in‐differences analysis to compare residing CJR‐participating treatment areas versus...

Background: Despite the importance of hospital discharge destination field (“discharge code” hereafter) for research and payment reform, its accuracy is not well established. Objectives: The aim this study was to examine codes in Medicare claims. Data Sources: 2012–2015 claims knee hip replacement patients. Research Design: We identified patients’ location compared it with code. also used a mixed-effects logistic regression association patient characteristics code accuracy. Results:...

This study uses data from the Comprehensive Care for Joint Replacement program to assess level of Medicare reconciliation payments and examine these levels by hospital size teaching status understand performance.