Population Health Management
ISSN / EISSN: 19427891 / 19427905
Published by: Mary Ann Liebert Inc
Total articles ≅ 1,121
Latest articles in this journal
Population Health Management; https://doi.org/10.1089/pop.2022.0258
The objective of this study was to assess the impact of local health department (LHD) expenditures on population health measures using counties as the unit of analysis. An observational research design is used to examine whether public health benefits are associated with higher levels of public health funding. Linear probability multivariate regression models with the use of local level cross-sectional and panel data are employed. A 1-year and a 2-year lag structure are also used to quantify the longer term public health effects of changes in LHD expenditures. Analyses were performed at the county level using local data representing 2120 LHDs, covering 48 US states. Expenditure data from the National Association of County and City Health Officials Profile Surveys and public health measures from County Health Rankings Annual Reports are used. Four public health measures are examined—obesity prevalence, sexually transmitted diseases, diabetes prevalence, and human immunodeficiency virus prevalence. Results from cross-sectional, pooled ordinary least squares, and panel data with fixed effects reveal that increased LHD expenditures per capita were not associated with any of the population health outcomes studied. Multivariate linear regression results using a 1- and 2-year lag structure reveal similar results: funding was not significantly predictive of better public health outcomes. The study design did not control for the potential endogeneity of public health funding. More detailed data and robust research approaches are needed to disentangle the effect and effectively answer whether increased public funding translates to improved population health.
Population Health Management; https://doi.org/10.1089/pop.2022.0227
This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010–2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort (N = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort (N = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%–10%, 10%–15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.
Population Health Management; https://doi.org/10.1089/pop.2022.0244
Population Health Management; https://doi.org/10.1089/pop.2023.29007.rtd
Population Health Management; https://doi.org/10.1089/pop.2022.0183
Maternal mortality and morbidity in the United States are high compared with those in similar countries, and racial/ethnic disparities exist, with many of these events occurring in the later postpartum period. Proposed federal and recently enacted state policy interventions extend pregnancy Medicaid from covering 60 days to a full year postpartum. This study estimates the association between maintaining Medicaid eligibility in the later postpartum period (relative to only having pregnancy Medicaid eligibility) with postpartum checkup attendance and depressive symptoms using regression analysis, overall and stratified by race/ethnicity. People with postpartum Medicaid eligibility were 1.0%–1.4% more likely to attend a postpartum checkup relative to those with only pregnancy Medicaid eligibility overall, primarily driven by a 3.8%–4.0% higher likelihood among Hispanic postpartum people. Conversely, postpartum Medicaid is associated with a 2.2%–2.3% lower likelihood of postpartum checkup attendance for Black postpartum people. Postpartum eligibility is also associated with a 9.7%–11.6% lower likelihood of self-reported depressive symptoms compared with only pregnancy Medicaid eligibility for White postpartum people only. Postpartum Medicaid eligibility is associated with some improvements in maternal health care utilization and mental health, but differences by race and ethnicity imply that inequitable systems and structures that cannot be overcome by insurance alone may also play an important role in postpartum health.
Population Health Management; https://doi.org/10.1089/pop.2022.0143
Differences in preference-weighted health-related quality of life (HRQOL) scores by race/ethnicity may be due to social factors. Here, Short-Form Six-Dimension (SF-6D) scores are analyzed among men in a prostate cancer prevention trial to explore such differences. Selenium and vitamin E cancer prevention trial participants who completed the SF-6D at baseline, and in at least 1 of follow-up years 1, 3, and 5 were included. This study compared mean SF-6D scores across race/ethnicity at each point using a linear mixed model controlling for demographic and clinical characteristics. At baseline, 9691 men were eligible for analysis, of whom 7556 (78%) were non-Hispanic White, 1592 (16.4%) were non-Hispanic Black, and 543 (5.6%) were Hispanic. Hispanic and White participants had higher unadjusted mean SF-6D scores than Black participants at every time point (P < 0.05), while white participants had lower mean scores than Hispanic participants at every time point after baseline (P < 0.05). After adjusting for covariates, statistically significant differences in HRQOL among the 3 groups persisted. Hispanic participants had higher preference scores than White participants by 0.073 (P < 0.001), 0.075 (P < 0.001), and 0.040 (P < 0.001) in follow-up years 1, 3, and 5, respectively. Black participants had lower scores than White participants by 0.009 (P = 0.004) and 0.008 (P = 0.02) in follow-up years 1 and 3, respectively. The results suggest there is a preference-weighted HRQOL difference by race/ethnicity that cannot be explained by social and clinical variables alone. Understanding how individuals belonging to different racial/ethnic categories view their own HRQOL is necessary for culturally competent care and cost-effectiveness analyses.
Population Health Management; https://doi.org/10.1089/pop.2022.0209
There is increased acceptance that social and behavioral determinants of health (SBDH) impact health outcomes, but electronic health records (EHRs) are not always set up to capture the full range of SBDH variables in a systematic manner. The purpose of this study was to explore rates and trends of social history (SH) data collection—1 element of SBDH—in a structured portion of an EHR within a large academic integrated delivery system. EHR data for individuals with at least 1 visit in 2017 were included in this study. Completeness rates were calculated for how often SBDH variable was assessed and documented. Logistic regressions identified factors associated with assessment rates for each variable. A total of 44,166 study patients had at least 1 SH variable present. Tobacco use and alcohol use were the most frequently captured SH variables. Black individuals were more likely to have their alcohol use assessed (odds ratio [OR] 1.21) compared with White individuals, whereas White individuals were more likely to have their “smokeless tobacco use” assessed (OR 0.92). There were also differences between insurance types. Drug use was more likely to be assessed in the Medicaid population for individuals who were single (OR 0.95) compared with the commercial population (OR 1.05). SH variable assessment is inconsistent, which makes use of EHR data difficult to gain better understanding of the impact of SBDH on health outcomes. Standards and guidelines on how and why to collect SBDH information within the EHR are needed.
Population Health Management, Volume 25, pp 721-728; https://doi.org/10.1089/pop.2022.0160
Behavioral health integration (BHI) within primary care settings is shown to improve outcomes. However, achieving BHI requires identifying best practices and a reliable tool that can be used to measure existing levels and progress toward BHI. The objective of this study was to develop and apply a conceptual framework to measure BHI, test the approach, and examine challenges to achieving BHI. Surveys and interviews were conducted with key informants within 17 designated public hospitals in California at the midpoint of participating in a 5-year project to establish BHI. A framework and coding methodology were developed to assess BHI best practices at each hospital. BHI status was assessed in the domains of infrastructure and process. Each domain included 5 themes such as electronic health record integration and functionality (infrastructure) and interprovider communication (process). Themes were assessed using a 6-point scale for various activities under a theme and associated weights. Theme-specific values were standardized from 0% to 100% to compare BHI scores between hospitals. Overall progress toward BHI ranged from scores of 52% to 83% (mean 63%) and indicated greater contribution of infrastructure versus process implementation. Within the infrastructure domain, scores were higher for having institutional and provider support, but lagged in establishing provider proximity. Within the process domain, scores were highest for implementation of behavioral health screening, but were frequently lower for other themes such as use of care coordination and referral processes. Further research is needed to test the robustness of this approach in other settings.
Population Health Management, Volume 25, pp 814-821; https://doi.org/10.1089/pop.2022.0166
The COVID-19 pandemic has underscored the urgency to focus on the essential value of public health systems (PHSs) in fostering health equity across the US health care delivery system. PHS integration and care coordination can be successfully achieved through health information technology systems. The objective of the study was to examine the association between PHS partnerships (PHSPs), telehealth postdischarge, and racial and ethnic disparities in health care. The analysis used 2017 Centers for Medicare and Medicaid Services Medicare 100% inpatient claims data, the Medicare Beneficiary Summary File, the American Hospital Association Annual Survey, and the American Community Survey. Results showed that compared with those treated in hospitals with neither PHSP nor telehealth postdischarge services, beneficiaries treated in hospitals with PHSP encountered significantly lower Medicare payment and inpatient and readmission rates. Black patients experienced significantly lower cost, inpatient visits, and readmission rates when treated in hospitals with PHSP and telehealth postdischarge services (coefficient = −0.051, P < 0.001; incidence rate ratio [IRR] = 0.982, P = 0.007; IRR = 0.891, P = 0.003). The results of the study demonstrated the importance of combining PHSP and telehealth postdischarge services to improve the efficiency of the health care delivery system and health equity. It is urgent to ensure that PHSs have adequate funding and telehealth infrastructure to support population health.
Population Health Management, Volume 25, pp 807-813; https://doi.org/10.1089/pop.2022.0144
The United States has one of the highest cumulative mortalities of coronavirus disease 2019 (COVID-19) and has reached 1 million deaths as of May 19th, 2022. Understanding which community and hospital factors contributed to disparities in COVID-19 mortality is important to inform public health strategies. This study aimed to explore the potential relationship between hospital service area (1) community (ie, health professional shortage areas, market competition, and uninsured percentage) and (2) hospital (ie, teaching, system, and ownership status) characteristics (2013–2018) on publicly available COVD-19 (February to October 2020) mortality data. The study included 2514 health service areas and used multilevel mixed-effects linear model to account for the multilevel data structure. The outcome measure was the number of COVID-19 deaths. This study found that public health, as opposed to acute care provision, was associated with community health and, ultimately, COVID-19 mortality. The study found that population characteristics including more uninsured greater proportion of those over 65 years, more diverse populations, and larger populations were all associated with a higher rate of death. In addition, communities with fewer hospitals were associated with a lower rate of death. When considering region in the United States, the west region showed a higher rate of death than all other regions. The association between some community characteristics and higher COVID-19 deaths demonstrated that access to health care, either for COVID-19 infection or worse health from higher disease burden, is strongly associated with COVID-19 deaths. Thus, to be better prepared for potential future pandemics, a greater emphasis on public health infrastructure is needed.