Association of Pay-for-Performance Reimbursement With Clinical Quality for Minnesota Nursing Homes Residents.

In 2016, Minnesota implemented a new pay-for-performance reimbursement scheme for Medicaid residents in nursing homes, known as Value-Based Reimbursement (VBR). This study seeks to understand whether there is an association between VBR and quality improvement. We use data from 2013 to 2019 including Centers for Medicare and Medicaid Services, Nursing Home Compare, and Long-term care Facts in the US. Using multivariate regression with commuting zone fixed effects, we compare five long-stay and two short-stay clinical quality metrics in Minnesota nursing homes to nursing homes bordering states, before and after VBR was implemented. We find minimal significant changes in quality in Minnesota nursing homes after VBR. Minnesota should reconsider its pay-for-performance efforts.

Did States With More Social Capital Pre-pandemic Offer Mental Health Protection During the COVID-19 Pandemic? A Cross-Sectional View.

Background: Social capital is a well-known health determinant with both relational and geographic aspects. It can help mitigate adverse events and has been shown to impact behaviors and responses during the COVID-19 pandemic. Mental health has declined during the COVID-19 pandemic, and social capital, may serve to buffer those declines. Methods: Building from this, we assessed whether pre-pandemic social capital and contemporaneous social policy, which included indicators of social trust, civic participation, and presence of mask mandates, affected pandemic mental health, measured as the percent of the population experiencing symptoms of depression and anxiety at the state level. Results: Generalized social trust and state mask mandates were significantly associated with lower levels of depression and anxiety. Conversely, states with greater civic engagement prior to the pandemic experienced more anxiety and depression. Conclusions: Findings suggest that existing social capital, particularly social trust, may protect against anxiety and depression and contribute to community resilience during times of adversity. States should invest in policies and programs that increase social trust.

A qualitative assessment of barriers and facilitators associated with addressing social determinants of health among members of a health collaborative in the rural Midwest.

PURPOSE: Rural communities have unique economic and social structures, different disease burdens, and a more patchworked healthcare delivery system compared to urban counterparts. Yet research into addressing social determinants of health has focused on larger, urban, integrated health systems. Our study sought to understand capacities, facilitators, and barriers related to addressing social health needs across a collaborative of independent provider organizations in rural Northeastern Minnesota and Northwestern Wisconsin. METHODS: We conducted qualitative, semi-structured interviews with a purposive sample of 37 key informants from collaborative members including 4 stand-alone critical access hospitals, 3 critical access hospitals affiliated with primary care, 1 multi-clinic system, and 1 integrated regional health system. FINDINGS: Barriers were abundant and occurred at the organizational, community and policy levels. Rural providers described a lack of financial, labor, Internet, and community-based social services resources, a limited capacity to partner with other organizations, and workflows that were less than optimal for addressing SDOH. State Medicaid and other payer policies posed challenges that made it more difficult to use available resources, as did misaligned incentives between partners. While specific payer programs and organizational innovations helped facilitate their work, nothing was systemic. Relationships within the collaborative that allowed sharing of innovations and information were helpful, as was the role leadership played in promoting value-based care. CONCLUSIONS: Policy change is needed to support rural providers in this work. Collaboration among rural health systems should be fostered to develop common protocols, promote value-based care, and offer economies of scale to leverage value-based payment. States can help align incentives and performance metrics across rural health care entities, engage payers in promoting value-based care, and bolster social service capacity.

Summary of adverse drug events for hydroxychloroquine, azithromycin, and chloroquine during the COVID-19 pandemic.

OBJECTIVE: Given the increased use of hydroxychloroquine (HCQ), chloroquine (CQ), and azithromycin (AZM) during the early months of the coronavirus disease 2019 (COVID-19) pandemic, there is a need to evaluate the associated safety concerns. The objective of this study was to summarize the adverse drug events (ADEs) associated with HCQ, CQ, and AZM use during the national COVID-19 emergency and compare the results with known adverse reactions listed in the drugs' package inserts. METHODS: A cross-sectional study design was used. The publicly available Food and Drug Administration Adverse Event Reporting System quarterly data extract files from January 1, 2020 to June 30, 2020 were downloaded. A disproportionality analysis was conducted using the proportional reporting ratio to identify possible ADE signals. A Poisson regression was used to assess if the number of ADE reports for the 3 drugs increased over time. RESULTS: There was a statistically significant increasing trend in the reported ADEs for both HCQ (P < 0.001) and AZM (P < 0.001). Before the declaration of the national emergency, there were 592 reported drug-ADE pairs for the 3 drugs compared with 2492 drug-ADE pairs reported after March 13, 2020. These 2492 drug-ADE pairs represented 848 ADEs across the 3 drugs, of which 114 (13.4%) were identified as potential signals including 55 (48.2%) that were not listed in the prescribing information. CONCLUSIONS: Our results showed that the reported ADEs for HCQ and AZM have increased during the COVID-19 pandemic. Differences were observed in both the type of and frequency of the highest reported ADEs for the 3 selected drugs before and after the national emergency declaration. Although causation cannot be determined from ADE reports, further investigation of some reports may be warranted. Our results highlight the need for pharmacovigilance and education of health care professionals on the safety of these drugs when being used for COVID-19 prophylaxis or treatment.

FDA's Unimproved Enforcement of Postmarketing Requirements and Commitments: Implications for Providers and Patients.

BACKGROUND: The 2007 reauthorization of the Prescription Drug User Fee Act empowered the Food and Drug Administration (FDA) to require and enforce postmarketing studies to monitor the safety of prescription drugs, an increasing number of which are approved under expedited development or review programs. However, compliance rates for postmarketing requirements are low, and the FDA has not exercised its enforcement authority, allowing the very safety concerns that prompted the expansion of its power to continue. Prior evaluations have found that the FDA lacks reliable, timely, and readily accessible data for tracking postmarket safety issues, and that it has failed to enforce the postmarket surveillance measures it requires of the pharmaceutical industry. OBJECTIVE: This study provides an updated evaluation of FDA oversight of postmarketing requirements and commitments and assesses whether there have been improvements since 2010. METHODS: This study utilized data from the FDA's annual Report on the Performance of Drug and Biologics Firms in Conducting Postmarketing Requirements and Commitments. It evaluated studies opened in FY 2011-2014 and tracked their status through the FDA's FY 2018 report (data as of September 30, 2018), thereby allowing the pharmaceutical industry 4-7 years to complete a given PMR/PMC. Descriptive statistics were calculated, and differences in the status of postmarketing requirements and postmarketing commitments between FYs 2011-2014 and FY 2009-2010 were evaluated. RESULTS: During fiscal years 2011-2014, there was little difference in the FDA's oversight of postmarketing studies compared to fiscal years 2009-2010. While there were some year-to-year significant differences, the overall trend indicated no change. CONCLUSIONS: The FDA's oversight of postmarketing studies has not improved since 2010. This paper discusses implications for providers and patients who unduly assume the responsibility of postmarketing surveillance due to the lack of FDA oversight.

A retrospective assessment of metropolitan religious adherence rate, individual and neighborhood social capital and their impact on women's health.

BACKGROUND: Social capital is a multilevel construct impacting health. Community level social capital, beyond the neighborhood, has received relatively less attention. Moreover, the measurement of community level social capital has tended to make use of aggregated individual data, rather than observable community characteristics. METHODS: Herein, metropolitan religious adherence, as an observable community-level measure of social capital, is used. We match it to city of residence for 2826 women in the Fragile Families Childhood Wellbeing Study (a cohort study) who have lived continuously in that city during a nine-year period. Using ordered logistic regression with clustered standard errors to account for area effects, we look at the relationship between metropolitan religious adherence and self-rated health, while controlling for lagged individual, neighborhood, and socioeconomic factors, as well as individual level religious attendance. RESULTS: Religious adherence at the community level is positive and statistically significant; every 1% increase in area religiosity corresponds to a 1.2% increase in the odds of good health. CONCLUSIONS: These findings shed light on a possible pathway by which social capital may improve health, perhaps acting as a stress buffer or through spillover effects of reciprocity generated by exposure to religion.

Examination of the influence of social capital on depression in fragile families.

BACKGROUND: While it appears that social capital has a positive effect on mental health, most studies have been cross-sectional in nature and/or employ weak measures of social capital or mental health. Even less attention has been paid to vulnerable populations, such as low-income women with children. Thus, our objective was to explore how different dimensions of social capital impact depression in this population. METHODS: We used data from the Fragile Families and Child Wellbeing Study, which has followed a cohort of children born in large US cities to mostly minority, unmarried parents for over 9 years. These families tend to be at greater risk for falling into poverty. Four separate measures of social capital were constructed, using measures that are reliable and that offer evidence of validity including social support and trust, social participation, perceptions of neighbourhood social cohesion and perceptions of neighbourhood social control. The temporal effect of social capital on mental health, as measured by a standardised screening for depression was investigated using logistic regression. RESULTS: After controlling for relevant socioeconomic and demographic factors, prior depression, and prior self-rated health, the social capital dimensions of social support and trust and perceived neighbourhood social cohesion are significant predictors of depression. CONCLUSIONS: These results suggest that social and neighbourhood environments play an important role in mental health status. Intervention and policy initiatives that increase social capital may be viable for improving mental health among low-income urban, minority women.

Go!: results from a quasi-experimental obesity prevention trial with hospital employees.

BACKGROUND: Worksite obesity prevention interventions using an ecological approach may hold promise for reducing typical weight gain. The purpose of this study was to examine the effectiveness of Go!, an innovative 12-month multi-component worksite obesity prevention intervention. METHODS: A quasi-experimental non-equivalent control group design was utilized; 407 eligible hospital employees (intervention arm) and 93 eligible clinic employees (comparison arm) participated. The intervention involved pedometer distribution, labeling of all foods in the worksite cafeteria and vending machines (with calories, step equivalent, and a traffic light based on energy density signaling recommended portion), persuasive messaging throughout the hospital, and the integration of influential employees to reinforce healthy social norms. Changes in weight, BMI, waist circumference, physical activity, and dietary behavior after 6 months and 1 year were primary outcomes. Secondary outcomes included knowledge, perceptions of employer commitment to employee health, availability of information about diet, exercise, and weight loss, perceptions of coworker support and frequency of health discussions with coworkers. A process evaluation was conducted as part of the study. RESULTS: Repeated measures ANCOVA indicated that neither group showed significant increases in weight, BMI, or waist circumference over 12 months. The intervention group showed a modest increase in physical activity in the form of walking, but decreases in fruit and vegetable servings and fiber intake. They also reported significant increases in knowledge, information, perceptions of employer commitment, and health discussions with peers. Employees expressed positive attitudes towards all components of the Go! CONCLUSIONS: This low-intensity intervention was well-received by employees but had little effect on their weight over the course of 12 months. Such results are consistent with other worksite obesity prevention studies using ecological approaches. Implementing low-impact physical activity (e.g., walking, stair use) may be more readily incorporated into the worksite setting than more challenging behaviors of altering dietary habits and increasing more vigorous forms of physical activity. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov (NCT01585480) on April 24, 2012.

Psychosocial and environmental determinants of eating behaviors, physical activity, and weight change among college students: a qualitative analysis.

OBJECTIVE: The goal of this study was to identify factors that college students perceived as contributing to healthy and unhealthy eating patterns, physical activity (PA) levels, and weight change. PARTICIPANTS: Forty-nine 18- to 22-year-old students at a midwestern university participated. METHODS: Six focus groups (3 with each gender) were conducted, and data were analyzed using qualitative software to code and categorize themes and then reduce these to clusters according to commonly practiced methods of qualitative analysis. RESULTS: Eating and PA behaviors appear to be determined by a complex interplay between motivations and self-regulatory skills as well as the unique social and physical environment comprising college life. Moreover, there appear to be gender differences in how these determinants impact behavior. CONCLUSIONS: Future research should examine these interactions in the college context in order to further our understanding of potential interventions or environmental modifications that support healthy eating and PA.

Evaluating leadership training in African American HIV prevention organizations.

This article aimed to examine changes in the HIV prevention capacity of HIV prevention program managers who completed the Institute for HIV Prevention Leadership ("Institute") between 2002 and 2004, and who worked in community-based organizations that primarily served African Americans. Participants completed a survey at three points in time, in which they rated the frequency with which they conducted activities related to HIV prevention practice. Participants also rated their confidence in performing activities. Repeated measures ANOVA was conducted to detect differences at three time points (baseline, immediate posttest, and 6 months posttest). A significant overall positive trend was found in the frequency and confidence of participants to perform specific HIV prevention practices and an overall positive trend in the frequency of processes that support HIV prevention practice. Investment in long-term, intensive, capacity-building programs like the Institute is critical to address the increasing incidence of HIV in many African American communities.

Cost savings threshold analysis of a capacity-building program for HIV prevention organizations.

Although the incidence of HIV each year remains steady, prevention funding is increasingly competitive. Programs need to justify costs in terms of evaluation outcomes, including economic ones. Threshold analyses set performance standards to determine program effectiveness relative to that threshold. This method was used to evaluate the potential cost savings of a national capacity-building program for HIV prevention organizations. Program costs were compared with the lifetime treatment costs of HIV, yielding an estimate of the HIV infections that would have to be prevented for the program to be cost saving. The 136 persons who completed the capacity-building program between 2000 and 2003 would have to avert 41 cases of HIV for the program to be considered cost saving. These figures represent less than one tenth of 1% of the 40,000 new HIV infections that occur in the United States annually and suggest a reasonable performance standard. These data underscore the resources needed to prevent HIV.

Evaluation results of the CDC/ASPH Institute for HIV Prevention Leadership: a capacity-building educational program for HIV prevention program managers.

OBJECTIVE: The goal of this research was to evaluate changes over time in the capacity of participants of the CDC/ASPH Institute for HIV Prevention Leadership (Institute), a capacity-building program for HIV prevention program managers in minority-based, community-based organizations. Capacity was defined as the application of new skills and knowledge to participants' jobs and confidence in using those new skills and knowledge to strategically manage and apply "best practices" to their HIV prevention activities. METHODS: This is a longitudinal study involving measuring scholar capacity at three points in time: pre-Institute, post-Institute, and 6 months' post-Institute. Only responses from participants who completed all three surveys are included in this final analysis of the data (N = 94). RESULTS: Results indicate that participants from 3 years of the Institute (2002-2004) increased their capacity in HIV prevention programming and strategic planning and management. Significant changes were seen in the frequency and self-efficacy with which participants conduct several HIV prevention programming activities. Participants also reported conducting strategic planning activities at more appropriate intervals and were significantly more confident in conducting these activities. CONCLUSION: The Institute has positively and significantly increased the capacity of participants to conduct more effective HIV prevention programs on a national level.

Development of a curriculum to enhance community-based organizations' capacity for effective HIV prevention programming and management.

Community-based organizations (CBOs), particularly minority-based CBOs, are instrumental in the delivery of HIV/AIDS prevention programs and services. Despite a tremendous need, many CBOs lack the capacity to plan, implement, and evaluate targeted prevention interventions to serve culturally diverse populations. This article describes a comprehensive, innovative curriculum for building capacity within CBOs providing HIV prevention programming. An overview of the process through which the Centers for Disease Control and Prevention/Association of Schools of Public Health Institute for HIV Prevention Leadership evolved is discussed. The development of the curriculum occurred in four phases: needs assessment, curricular design, implementation, and evaluation. A description of the Institute's evaluation strategies and procedures are described. Selected preliminary evaluation results from two cohorts of participants indicate significant knowledge gains and high levels of satisfaction with the Institute sessions, assignments, and faculty. The Institute's model shows promise for the provision of capacity building education at the individual and organizational level for community-based professionals implementing HIV prevention programs.