Compared with traditional Medicare (TM), Medicare Advantage (MA) has the potential to reduce racial disparities in hospitalizations for ambulatory care sensitive conditions (ACSC). As racial disparities may be partly attributable to unequal treatment based on where people live, this suggests the need of examining geographic variations in racial disparities. The aim of this study was to examine differences in ACSC hospitalizations between White and Black beneficiaries in TM and MA and examine geographic variations in racial differences in ACSC hospitalizations in TM and MA.
Park S, Fishman P, Coe NB: Racial Disparities in Avoidable Hospitalizations in Traditional Medicare and Medicare Advantage. Medical Care 59(11): 989-966, Nov 2021.
With declining use of institutional postacute care, more patients are going directly home after hospital discharge. The consequences on the amount of help needed at home after discharge are unknown. This study is to estimate trends in the frequency and duration of receipt of help with activities of daily living (ADLs) among older adults discharged home.
Bressman E, Coe NB, Chen X, Konetzka RT, Werner RM: Trends in Receipt of Help at Home After Hospital Discharge Among Older Adults in the US. JAMA Network Open 4(11): e2135346, Nov 2021.
To estimate the impact of a new, two-sided risk model accountable care network (ACN) on Washington State employees and their families.
Coe NB, Ingraham B, Alberton E, Fishman P, Zou L, Wood S, Grembowski D, Conrad D: The One-year Impact of Accountable Care Networks among Washington State Employees. Health Services Research 56(4): 604-614, Aug 2021.
The needs of persons living with Alzheimer's disease and Alzheimer's disease-related dementia (AD/ADRD) are challenged by tremendous complexity impacting both care delivery and financing. Most persons living with dementia (PLWD) also suffer from other chronic medical or mental health conditions, which further burden quality of life and function. In addition to difficult treatment choices, optimal dementia care models likely involve people and services that are not typical pieces of the health care delivery system but are all critical partners-care partners, social workers, and community services, to name a few. More than 200 models of dementia care have demonstrated some efficacy. However, these successful interventions that might address much of the care needed by PLWD are uninsured in the United States, where insurance coverage has focused on acute care needs. This poses great difficulties for both care provision and care financing. In this article, we review these 3 key challenges: dementia care for those with chronic comorbid disease; care models that require people who are not typical providers in traditional care delivery systems; and the mandate to provide high-quality care that is currently not funded by usual health care insurance. We propose promising next steps that could substantially improve the lives of PLWD and the lives of their care partners, and highlight some of the many research questions that remain.
Coe NB, Boyd CM, Chodosh J: Chronic Care, Dementia Care Management, and Financial Considerations. Journal of the American Medical Directors Association 22(7): 1371-1376, Jul 2021.
Demographic Characteristics Driving Disparities in Receipt of Long-term Services and Supports in the Community Setting
Research suggests that growth in Black and Hispanic (minority) older adults' nursing home (NH) use may be the result of disparities in access to community-based and alternative long-term services and supports (LTSS). We aimed to determine whether minority groups receiving care in NHs versus the community had fewer differences in their functional needs compared with the differences in nonminority older adults, suggesting a disparity.
Travers JL, Naylor MD, Coe NB, Meng C, Li F, Cohen AB: Demographic Characteristics Driving Disparities in Receipt of Long-Term Services and Supports in the Community Setting. Medical Care 59(6): 537-542, Jun 2021.
Prior research and the popular press have anecdotally reported inadequate nursing home staffing levels during the COVID-19 pandemic. Maintaining adequate staffing levels is critical to ensuring high-quality nursing home care and an effective response to the pandemic. We therefore sought to examine nursing home staffing levels during the first nine months of 2020 (compared with the same period in 2019), using auditable daily payroll-based staffing data from the Centers for Medicare and Medicaid Services. We found that the total number of hours of direct care nursing declined in nursing homes during the COVID-19 pandemic, as did the average nursing home census. When we accounted for changes in census, the number of nurse staff hours per resident day remained steady or, if anything, increased slightly during the pandemic. The observed increases in staff hours per resident day were small but concentrated in nursing homes operating in counties with high COVID-19 prevalence, in nursing homes with low Medicaid census (which typically have more financial resources), and in not-for-profit nursing homes (which typically invest more in staffing). These findings raise concerns that although the number of staff hours in nursing homes did not decline, the perception of shortages has been driven by increased stresses and demands on staff time due to the pandemic, which are harder to quantify.
Werner RM, Coe NB: Nursing Home Staffing Levels Did Not Change Significantly During COVID-19. Health Affairs (Project Hope) 40(5): 795-801, May 2021.
The Washington State Innovation Models (SIM) $65 million Test Award from the Center for Medicare & Medicaid Services' Innovation Center is a statewide intervention expected to improve population health, quality of care, and cost growth through four initiatives: 1) regional accountable communities of health linking health and social services to address local needs; 2) a practice transformation support hub; 3) four value-based payment reform pilot projects mainly in state employee and Medicaid populations; and 4) data and analytic infrastructure development to support system transformation with common measures. We develop a conceptual model based on diffusion theory and apply the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to structure our evaluation. We find that in three years (2016–2018), SIM built the infrastructure for system transformation and increased Washington's readiness for health system change in the next decade. However, the initiatives have not spread statewide, which may take over 10 years.
Grembowski D, Conrad DA, Naranjo D, Wood SJ, Zhou L, Banks J, Coe NB, Kwan-Gett T, Baseman J: State-level Evaluation of Washington's State Innovation Models (SIM) Initiative. Journal of Health Care for the Poor and Underserved 32(2): 862-891, May 2021.
Difficulty with Taking Medications Is Associated with Future Diagnosis of Alzheimer's Disease and Related Dementias
Medication management requires complex cognitive functioning, and therefore, difficulty taking medications might be an early sign of cognitive impairment and could be a risk factor for Alzheimer's disease and related dementias (ADRD). Accordingly, people with difficulty taking medications may benefit from more detailed cognitive screening, potentially aiding in the diagnosis of ADRD, which is underdiagnosed. We are unaware of evidence on medication management difficulties that precede a real-world ADRD diagnosis in the USA.
Barthold D, Marcum ZA, Chen S, White L, Aliabouni N, Basu A, Coe NB, Gray SL: Difficulty with Taking Medications Is Associated with Future Diagnosis of Alzheimer's Disease and Related Dementias. Journal of General Internal Medicine 36(4): 863-868, Apr 2021.
The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020
In this systematic review, we examine the literature from 2000 to 2020 to ascertain whether we can make strong conclusions about the relative benefit of adding informal care or formal care providers to the care mix among individuals receiving care in the home, specifically focusing on care recipient outcomes. We evaluate how informal care and formal care affect (or are associated with) health care use of care recipients, health care costs of care recipients, and health outcomes of care recipients. The literature to date suggests that informal care, either alone or in concert with formal care, delivers improvements in the health and well-being of older adults receiving care. The conclusions one can draw about the effects of formal care are less clear.
Coe NB, Konetzka RT, Berkowitz M, Blecker E, Van Houtven CH: The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020. Annual Review of Public Health (42), 483-503, Apr 2021.
To assess the feasibility and effectiveness of using LHJ staff to disseminate Connect to Wellness (CtW), an effective dissemination package for increasing implementation of EBIs for chronic disease control by small worksites.
Harris JR, Hammerback K, Brown M, Ryan DE, Coe NB, Pike KJ, Santiago PM, Hannon PA: Local Health Jurisdiction Staff Deliver Health Promotion to Small Worksites, Washington. Journal of Public Health Management & Practice 27(2): 117, Mar 2021.