Role of Social Support in Screening Colonoscopy/Sigmoidoscopy Uptake among U.S. Adults.

Colorectal cancer (CRC) is a major clinical and public health burden. Screening has been shown to be effective in preventing CRC. In 2021, less than 72% of adult Americans had received CRC screening based on the most recent guidelines. This study examined the relationship between social support and screening colonoscopy or sigmoidoscopy uptake among U.S. adults and the socioeconomic factors that impact the relationship. We conducted a cross-sectional study using the 2021 National Health Interview Survey (NHIS) data for 20,008 U.S. adults to assess the weighted rates of screening colonoscopy or sigmoidoscopy among individuals with strong, some, and weak social support. Adjusted binary logistic regression models were utilized to obtain the weighted odds of receiving a screening colonoscopy or sigmoidoscopy among adults with different levels of social support and socioeconomic status. About 58.0% of adults who reported having colonoscopy or sigmoidoscopy had strong social support, compared to 52.0% who had some or weak social support. In addition, compared to adults with weak social support, the weighted adjusted odds of having colonoscopy or sigmoidoscopy were 1.0 (95% C.I. = 0.994, 0.997; p < 0.001) and 1.3 (95% C.I. = 1.260, 1.263; p < 0.001) for adults with some and strong social support, respectively. Socioeconomic differences were observed in the odds of colonoscopy or sigmoidoscopy uptake based on having strong social support. Having strong social support is an important factor in increasing colonoscopy or sigmoidoscopy screening uptake. Policies and interventions that enhance social support among adults for screening colonoscopy or sigmoidoscopy are warranted.

Child Marriage and Cardiovascular Risk: An Application of the Non-laboratory Framingham Risk Score.

INTRODUCTION: Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health. AIM: This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults. METHODS: Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30-49 years and 49,617 men aged 30-54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator. RESULTS: We found that women who were married in childhood had 1.06 (95% CI 1.01-1.10) and 1.22 (95% CI 1.16-1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups. CONCLUSIONS: These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing.

Patient perspectives of an individualized diabetes care management plan.

PURPOSE: This cross sectional study examines patients' knowledge, attitudes and beliefs about a diabetic care management plan (DCMP) that was developed to provide patient education on diabetes guidelines and display individual diabetic core measures. Secondary objectives included a comparison of diabetic core measures [hemoglobin A1C (HbA1C), systolic and diastolic blood pressure (SBP, DBP), low-density lipoprotein (LDL) and urine microalbumin (Um)] before and after DCMP implementation. We hypothesize this tool will contribute to patients' awareness of current disease status, diabetes knowledge and diabetic core value improvement over time. METHODS: A consecutive sample of 102 adult patients with diabetes mellitus type 2 in a primary care setting participated. Patients' perspectives on the care plan and knowledge about diabetes was collected via survey after care plan implementation. A comparison of selected diabetic core measures was conducted at baseline and post-DCMP. Descriptive statistics summarized survey response and diabetic core measures. A repeated measures ANOVA was used to assess change in diabetic core measures over time. RESULTS: Participants understood the DCMP (96%), found it important because it explained their laboratory results and medications (89%) and believed it would help them to have better diabetic control (99%). There was a significant interaction between time and being at goal pre-DCMP for HbA1c, SBP and LDL. Patients not at goal pre-DCMP for the above measures decreased significantly over time (P = <0.01 for HbA1c, SBP and LDL). Participants at goal for all diabetic core measures increased pre- to post-DCMP from 13% to 20% (P = 0.28). CONCLUSION: Patients perceived the diabetic care management plan favorably and their diabetic core measurements improved over time. This simple and reproducible self-management intervention can enhance self-management in a patient population with diabetes mellitus type 2.

Advanced Alternative Payment Models. Part I: Understanding the Medicare Shared Savings Program.

With CMS establishing preliminary definitions for fully qualifying Advanced Alternative Payment Models (APMs) in May 2016, it has become of interest to many care providers accepting Medicare and Medicaid payments to understand the nature of these entities if they wish to eventually participate in one of the current or future payment models. Changes under the Medicare Access and CHIP Reauthorization Act of 2015 specifically identify subsets of APMs that allow providers to avoid possible negative adjustments for poor relative performance compared with their respective peer groups through the Merit-Based Incentive Payment System beginning in 2017. This article reviews the nature of one of the fully qualifying Advanced APMs, the Medicare Shared Savings Program, and its risk/benefit sharing principles. Due to the lack of specialty-specific elements, this program acts as a very broad APM for practices and organizations seeking participation in either a simple or Advanced APM for the 2018 reporting period and beyond.

Advanced Alternative Payment Models Part II: Understanding the Next Generation Accountable Care Organization Model.

With CMS establishing preliminary definitions for fully qualifying Advanced Alternative Payment Models (APMs) in May of 2016, it has become crucial to many care providers accepting Medicare and Medicaid payments to understand the nature of these entities if they wish to eventually participate in one of the current or future payment models. Changes under the Medicare Access and CHIP Reauthorization Act of 2015 specifically identify subsets of APMs that allow providers to avoid possible negative adjustments for poor relative performance compared with their respective peer groups through the Merit-Based Incentive Payment System beginning in 2017. This article reviews the nature of one of the fully qualifying Advanced APMs, the Next Generation Accountable Care Organization (ACO) Model, and its risk-benefit sharing principles based on prior experience with the Medicare Shared Savings Program and other previous ACO models. This model represents a more sophisticated option for organizations with significant ACO experience seeking an Advanced APM for the 2018 reporting reriod and beyond.

Vision Loss in Older Adults.

Vision loss affects 37 million Americans older than 50 years and one in four who are older than 80 years. The U.S. Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in adults older than 65 years. However, family physicians play a critical role in identifying persons who are at risk of vision loss, counseling patients, and referring patients for disease-specific treatment. The conditions that cause most cases of vision loss in older patients are age-related macular degeneration, glaucoma, ocular complications of diabetes mellitus, and age-related cataracts. Vitamin supplements can delay the progression of age-related macular degeneration. Intravitreal injection of a vascular endothelial growth factor inhibitor can preserve vision in the neovascular form of macular degeneration. Medicated eye drops reduce intraocular pressure and can delay the progression of vision loss in patients with glaucoma, but adherence to treatment is poor. Laser trabeculoplasty also lowers intraocular pressure and preserves vision in patients with primary open-angle glaucoma, but long-term studies are needed to identify who is most likely to benefit from surgery. Tight glycemic control in adults with diabetes slows the progression of diabetic retinopathy, but must be balanced against the risks of hypoglycemia and death in older adults. Fenofibrate also slows progression of diabetic retinopathy. Panretinal photocoagulation is the mainstay of treatment for diabetic retinopathy, whereas vascular endothelial growth factor inhibitors slow vision loss resulting from diabetic macular edema. Preoperative testing before cataract surgery does not improve outcomes and is not recommended.

Modified Stage 2 and Stage 3 Meaningful Use for Eligible Providers: Performance Metrics, Reporting Period Lengths, and Hardship Exemptions.

In October 2015, the Centers for Medicare & Medicaid Services released its final rule on the new guidelines for alterations to the long-standing EHR Incentive Program. These Modified Stage 2 and upcoming Stage 3 Meaningful Use Rules were developed in response to provider and organizational feedback during the last few years. This article provides a comprehensive overview for the new rules as they relate to Medicare and Medicaid Eligible Providers. Reporting deadlines for previous calendar year compliance and the basic criteria for automatic provider hardship exemptions to avoid reimbursement penalties also are discussed.

Creating Loose Alternative Payment Model Guiding Principles: A Brief Overview.

Alternative payment models (APMs) represent an unprecedented opportunity. for providers to have direct input into the terms of their own reimbursements for services provided. Understanding the rough boundaries of what comprises an APM is critical for those wishing to pursue possible involvement in APM devel- opment. This article attempts to provide structure to the plethora of CMS and other sources describing the principles guiding APM creation. Most importantly, as it is becoming increasingly apparent that APMs are a preferred method for. CMS to pay providers, organizations capable of leveraging stakeholder input and identifying methods to help meet the CMS Triple Aim via novel APMs will undoubtedly find themselves in much more powerful bargaining positions than those who simply adopt cookie-cutter approaches or, worse, fail to meet CMS goals and receive negative reimbursement adjustments through the Merit-based Incentive Payment System (MIPS) in 2019.

A Sampling of Alternative Payment Models.

Understanding the current selection of CMS-approved alternative payment models is critical for providers in the current healthcare policy climate who wish to pursue alternatives to traditional reimbursement schemes. This has become a topic of increasing interest with the recent passage of the Medicare Access and CHIP Reauthorization Act of 2015, as traditional fee-for-service payments will be altered-either positively or negatively-by criteria defined under the Merit-Based Incentive Payment System (MIPS). This article offers a framework for current and proposed models being implemented or investigated by the CMS. Further exploration of the topic can be carried out through supplementary or primary sources to determine best fits for specific practice environments.

The Components of the Merit-Based Incentive Payment System.

The passage of the Medicare Access and CHIP Reauthorization Act in Apri 2015 set the stage for the Part B reimbursement changes set to take place in 2019 based on the 2017 reporting period in relation to performance within core Medicare initiatives through the Merit-Based Incentive Payment System (MIPS) These changes will reflect the new "fee-for-performance" approach to reimbursements through individualized changes to an individual or practice group's conversion factor used in the RVU reimbursement calculation. The metrics being used as a basis for eligible provider competitive ranking for either positive or negative reimbursement changes are in proportion to performance on chosen Physician Quality Reporting System measures, value-based payment modifier calculations, compliance with Modified Stage 2 or Stage 3 Meaningful Use as part of the Electronic Health Record Incentive Program, and ongoing participation in clinical practice improvement activities. This article describes the core elements that make up MIPS and discusses the likely criteria that will be used as the core elements necessary for competitive reimbursement rankinq.

Specialty Recertification.

The recognition of specialty boards started with the National Board of Medical Examiners and eventually gave rise to the Liaison Committee for Specialty Boards. The most appealing feature of any organization is its ability to provide quality of care. Because the timeframe for recertification may vary greatly among specialties, an approach that encourages physicians to participate in ongoing education between the 6- to 10-year certification deadlines is encouraged. Recertification demonstrates the physician's knowledge of new, innovative practices true competency, however, should encompass a physician's overall knowledge and ability to provide care that is both appropriate and effective. The standardization of healthcare is more evident now with healthcare reform underway, and with changes in the system. A physician's services need to be acceptable, and certification is a step in assuring that a standard of care is being met.

Undocumented and uninsured: aftereffects of the Patient Protection and Affordable Care Act.

Although with the implementation of the Patient Protection and Affordable Care Act millions of previously uninsured American residents will gain access to healthcare coverage, millions more will remain uninsured due to the lack of mandatory state Medicaid expansion as well as mandates that forbid undocumented immigrants and legal residents of less than five years from purchasing insurance through the newly available market exchange. With limited options for healthcare coverage due to employment and lack of citizen status, undocumented immigrants rely heavily on funds provided by both Emergency Medicaid and Disproportionate Share Hospital programs. Through reevaluation of current funding, mandates forbidding access to market exchanges, and plans to further enable access to affordable health coverage, states have the unique opportunity to both aid their residents and relieve the financial burden on healthcare facilities and Emergency Medicaid funds.

The Patient-Centered Medical Home and Meaningful Use: a challenge for better care.

This article discusses and illustrates the alignment between the National Committee for Quality Assurance's Patient-Centered Medical Home and Meaningful Use. In addition to the various overlaps, there is also significant discussion about Patient-Centered Medical Home and Meaningful Use as well as their distinct requirements. With impending deadlines for Meaningful Use and potential penalties being imposed, this article provides a layout of dates, stages, and incentive payments and penalties for Meaningful Use, and discusses how obtaining Patient-Centered Medical Home recognition could be beneficial to achieving Meaningful Use.

The new era of healthcare: incorporating patients' rights and responsibilities in diabetes management.

As the healthcare landscape changes and federal regulatory guidelines come into effect, it is up to providers and patients to work together to effectively coordinate care so that optimal healthcare can be provided. Most patients know that they have medical rights but most do not know that there are medical responsibilities that they too must comply with to facilitate their care with the help of providers' judgment and medical knowledge. Optimizing patient education can enable better communication, comprehension, and compliance among patients. Physicians can successfully implement these types of changes, as well as ensure that federal guidelines are instituted, thus improving overall patient outcomes.