Service Center Research Articles

Hospital readmissions reduction program penalizes safety net hospital clinicians.

The Hospital Readmissions Reduction Program (HRRP), started under the Patient Protection and Affordable Care Act and administered by the Centers for Medicare and Medicaid Services, was created with the intention to improve healthcare quality and costs. However, research on disparities in healthcare demonstrates the HRRP's protocolized risk-adjustment calculations neglect social factors, which consequently harms disadvantaged patient populations and unfairly contributes to clinician and hospital penalties. A PRISMA literature review was conducted using PubMed and Cochrane Library to explore the inclusion of social factors such as socioeconomic status on risk-adjustment calculations, and their relation to healthcare disparities, penalties, and outcomes. Fifteen articles published in the past 10 years were reviewed. Eleven (73%) of the 15 articles in this systematic review indicated that the HRRP potentiated healthcare disparities based on risk-adjustment calculation. This review strongly suggests modifying the HRRP risk-adjustment calculations to include social risk factors has the potential to equalize reimbursement for hospitals that serve the most vulnerable patients and reduce negative unintended consequences of the HRRP. Future studies are needed to produce more conclusive, consistent evidence on the effect of social risk factors in risk-adjustment calculations and associated outcomes and to determine how HRRP's risk-adjustment calculations can be modified to reduce disparities in healthcare.

Behavioral weight loss interventions in college health centers: A qualitative analysis of barriers and facilitators to implementation.

Emerging adults are underrepresented in standard behavioral weight loss interventions (BWLIs). Offering BWLIs in college health centers may help to address obesity in emerging adulthood by reducing student barriers associated with participation; however, implementation barriers and facilitators for health centers are unknown. Health services center administrators and providers (n=14) and students eligible to participate in a BWLI (n=9, average BMI=29.8±4.2kg/m2) participated in semi-structured interviews. Interviews focused on the need for and appropriateness of BWLIs in health centers and perceived barriers and facilitators to their implementation. Participants generally believed that BWLIs delivered through a health center were appropriate and indicated that BWLIs would be a beneficial offering on-campus. Facilitators of health center implementation included availability of trained health professionals, intradepartmental relationships, supportive infrastructure and resources, and in-house planning and execution. Barriers included limited student use and knowledge of health center offerings, narrow referral/recruitment pathways related to stigma concerns, and challenges related to infrastructure, resources, and competing demands. College health centers are a feasible and appropriate setting to offer BWLIs, though barriers to implementation exist. It will be important to construct a plan for implementation to address unique barriers in health centers prior to BWLI implementation.

Sustainability in Technology and Green IT

For the modern acceleration pace of tech development, especially the sustainability of green IT, significantly relates to it. Green IT refers to the use of resources at the computer machine level in an environmentally friendly way for the minimization of energy usage and carbon emissions as well as adverse impacts on the environment caused by IT-related activities [Murugesan, 2008]. The rising digital services also contribute to increased energy consumption from data center and cloud services, thus emitting more greenhouse gases [Baliga et al., 2011]. The paper deals with renewable energy in IT systems, the recycling of e-waste, sustainable design of a data center, and how computing can be made more energy-efficient [Hanne & Falk, 2010; Khan & Qureshi, 2018]. The study identifies whether practical applications and examples of Green IT solutions show benefits and challenges in real life. Industrial case studies. The study found that despite so much scope for Green IT to reduce the negativity in most developments, Environmental Impact of the IT sector: All these issues, such as high cost, scalability and regulatory, should be reduced [Murugesan, 2008; Berkhout, 2014]. In order to promote sustainability across IT industries, further technological developments and global policy reforms will be essential [Murugesan, 2008; Hanne & Falk, 2010; Khan & Qureshi, 2018].

Prescription Fills Among Patients With Type 2 Diabetes After Hospitalization for Acute Coronary Syndrome

Individuals with type 2 diabetes (T2D) have high rates of mortality following myocardial infarction (MI). Hospitalization is an opportunity to initiate or continue evidence-based treatment to reduce risk in individuals with T2D and acute coronary syndrome (ACS). To determine patterns of evidence-based medication use during the period of transition from admission to discharge after hospitalization for MI or coronary revascularization among individuals with T2D and ACS. This retrospective cohort study used data from the Centers for Medicare & Medicaid Services (CMS) for January 1, 2018, to June 30, 2020. Medicare beneficiaries older than 18 years with T2D with a qualifying hospitalization were included. Individuals were followed before admission (90 days prior), at discharge (≤90 days), and after discharge (91-180 days after) from a hospitalization for MI or coronary revascularization. Data analysis was performed in June 2023. Demographic data (race, sex, rural vs urban location of care, and comorbidities) were abstracted from CMS data using Master Beneficiary and Summary Files and International Statistical Classification of Diseases, Tenth Revision codes. Medicare Part D prescription fill records were examined for the following agents: (1) angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNIs); (2) β-blockers; (3) platelet adenosine diphosphate receptor inhibitors (P2Y12Is); (4) statins or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9Is); and (5) glucagon-like peptide 1 receptor agonists (GLP-1RAs) or sodium glucose cotransporter 2 inhibitors (SGLT2Is). Logistic regression analysis was used to examine the association between covariates and lack of prescription fills in the postdischarge period. A total of 188 651 eligible Medicare beneficiaries with T2D and hospitalization for MI or coronary revascularization were identified. Their median age was 73.0 (IQR, 67.0-79.0) years, and more than half (111 982 [59.4%]) were men; 18 383 (9.7%) were Black and 153 461 (81.3%) were White. Not filling a cardiovascular medication after hospitalization was associated with not filling that medication at the time of discharge (adjusted risk ratio, 0.27 [95% CI, 0.27-0.28] for ACEIs, ARBs, or ARNIs; 0.24 [0.24-0.25] for β-blockers; 0.20 [0.19-0.20] for P2Y12Is; 0.31 [0.31-0.32] for statins or PCSK9Is; and 0.27 [0.26-0.28] for SGLT2Is or GLP-1RAs). In this cohort study of Medicare beneficiaries with T2D, longer-term medication use following hospitalization for MI was associated with medication use at the time of discharge. These findings highlight the critical importance of this period to optimize preventive care for these high-risk individuals. Further implementation science research is needed to develop strategies to improve use of these evidence-based medications.

Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment.

This study evaluates the financial impact on healthcare payers when chronic pain patients initiate peripheral nerve stimulation (PNS) with a 60-day percutaneous PNS (60-Day PNS) treatment versus a conventional brief PNS trial (PNS-BT) with possible follow-on of a permanently implanted PNS system (PNS-PI). Centers for Medicare & Medicaid Services (CMS) fee-for-service (FFS) data were analyzed to identify patients with at least 12months of follow-up (median 26.4months) who initiated PNS treatment with: (1) 60-Day PNS or (2) PNS-BT. An economic decision tree model assessed the cost to payers in each cohort. Clinical response to 60-Day PNS was estimated by retrospectively reviewing anonymized outcomes from a national real-world database, focusing on patients≥65years of age who were implanted with a 60-day percutaneous PNS system. For the economic model, a Monte Carlo simulation with 10,000 iterations was used to generate 95% confidence intervals, considering variability in treatment outcome probability and costs. Based on CMS data, among 60-Day PNS patients, 18% (229/1265) proceeded to a permanently implanted PNS system with a 4% explant rate (10/229). Among PNS-BT patients, 41% (1140/2811) received a permanent implant with a 7% rate of explant (77/1140). Estimated PNS-related weighted average costs for the 60-Day PNS cohort [US$17,344; 95% confidence interval (CI): $16,168-$18,527] were lower than the PNS-BT cohort ($24,392; 95% CI $22,865-$25,941) when considering the percent of patients who advanced to a permanently implanted PNS system. The total cost per successful outcome also favored 60-Day PNS ($25,228 per success for the 60-Day PNS cohort vs. $64,502 per success for the PNS-BT cohort) as a first-line approach in PNS treatment. The findings suggest that, when PNS for chronic pain is warranted, initiating PNS with a 60-day treatment is more cost-effective than utilizing a brief conventional trial.

Deepening Psychedelic Integration: Exploring Complex Settings, Understanding User's Struggles, and Implementing Safe Interventions.

This chapter adopts a transdisciplinary approach to explore the concept of psychedelic integration, considering its various contexts ranging from clinical trials to Neo-shamanic, traditional, and recreational settings. It aims to provide a comprehensive understanding and description of integration, distinguishing between the needs of maximising potential benefits and addressing adverse reactions. Psychedelic Integration is a widely used term that refers to a variety of practices commonly employed after psychedelic experiences to help ground the benefits or address the challenges that arise from them. Although the term is broadly accepted, it lacks a precise definition, and a wide range of practices and techniques, often quite different from one another, are included under this category. Drawing on the experiences at the ICEERS (International Center for Ethnobotanical Education Research and Services) Integration and Support Service since 2012, the chapter highlights the practical aspects of clinical intervention.The chapter delves into the profiles of individuals seeking integration support, focusing on the primary challenges they encounter. These profiles include lack of preparation, unresolved experiences, difficulties with facilitators, traumatic psychedelic episodes, the exacerbation of pre-existing mental disorders, the emergence of previously unknown traumatic events, repeated psychedelic use without proper integration, and perceptions of being attacked or possessed by entities.Moreover, an overview of a method of clinical intervention that underscores the fundamental values inherent in psychedelic work is presented. This approach aims to integrate these values into the intervention process, employing a brief and focused methodology. By tailoring the intervention to the individual's specific needs, this method facilitates effective integration and support.

PRIORITY DIRECTIONS OF CREATING A BARRIER-FREE ENVIRONMENT IN PENAL INSTITUTIONS AND DETENTION CENTERS IN THE ASSESSMENT OF EMPLOYEES OF THE STATE CRIMINAL-EXECUTIVE SERVICE OF UKRAINE

The study is dedicated to finding out the vision of employees of penal institutions and pretrial detention centers of the State Criminal-Executive Service of Ukraine, whose duties are related to working with people with disabilities, priority directions for creating a barrier-free environment in penal institutions and pretrial detention centers. Eighty-eight research participants were united into four focus groups; the task of each was, based on their own work experience, assessments the relevance of problems related to the maintenance of persons with disabilities in the penal institutions, as well as the available capabilities of the institutions, to form a list the most priority directions and methods of barrier-free environment creation. The content analysis and generalization of the obtained data showed that additional socio-psychological support, removal of physical barriers on the territory and in the buildings of institutions, and ensuring the availability of physical support services by specially trained personnel and other convicts turned out to be the most priority areas of barrier-free implementation in the participants’ evaluations. At the same time, several important directions, such as the elimination of informational, economic, and educational barriers, were not included in the lists of most groups, which, according to the authors, may indicate both an underestimation of these components of barrier-freeness by the study participants and lack of opportunities for their implementation. Development of psychological and pedagogical programs and formation of the readiness of the State Criminal-Executive Service staff and selected convicts to provide physical support services to persons with disabilities, including barrier-free communication skills, monitoring the special needs of convicts and prisoners with disabilities, according to the authors, along with other measures, will contribute to the purposeful implementation of the Strategy for the introduction of barrier-free access in places of deprivation of liberty. Key words: barrier-free environment, prisoners and convicts, penal institutions and pretrial detention centers, staff of the State Criminal-Executive Service of Ukraine.

Production economics of jute farming in Sunsari district, Nepal

Jute cultivation has shown decreasing trend in recent years globally despite the prospective demand. Being labor-intensive, with labor making up over 70% of the entire cost and technological advancements still not evident in farmers' fields limits productivity of jute in Nepal. This study aims to analyze the economic viability of jute production, factors affecting it and constraints of jute production in Sunsari district, Nepal. Well-structured and pretested interview schedule was used to acquire required data from 120 jute cultivators of Bhokhraha Narsingh and Duhabi municipality using random and purposive sampling technique. Benefit-cost ratio analysis and multiple regression were conducted using Excel 2019 and SPSS Version 25. Jute production is found profitable as shown by positive gross margin and the average Benefit-Cost ratio of 1.52. Highest education of the family, machinery and subsidy were positively significant with Benefit-cost ratio. Number of economically active female members had shown negative influence on benefit-cost ratio of jute production. Distance to nearest extension service center showed highly significant negative relation with benefit-cost ratio implying increasing distance lowers BC ratio by a greater extent. High cost of production and labor problem were ranked as major problem in sustainable jute production. To increase the jute productivity and sustainability, this study recommends focusing on labor issues and enhancing technology interventions. The findings of this study offer policymakers a foundation to implement strategies that strengthen jute production, fostering both economic stability and environmental sustainability in Sunsari district, Nepal.

Students’ Perspectives on the Services Offered by a Writing Center to Improve English Language Writing among Students in Saudi Arabia

The study aims to encourage universities in Saudi Arabia to develop their existing writing centers or establish a new writing center through understanding the English language writing needs of Saudi pharmaceutical university students. The study is conducted by involving a group of pharmaceutical students in a survey to highlight what they do to improve their English writing without having a writing center, which English linguistics writing issues they have, what benefits they will obtain if their English writing improves, and their expectations of writing centers. The study was administered through a survey that was distributed to male students in the second semester of the academic year 2023/2024. The survey included 23 closed ended questions, distributed to 71 participants in the survey. The results of this study show that owing to the dearth of writing centers, students find it difficult to find appropriate sources to help them with their writing. The study recommends that the writing center should be the appropriate place to accommodate the challenges the students encounter in their writing, and it emphasizes the importance of involving students in deciding upon the type of writing center consultation services that they expect to receive from a trained writing tutor who understands their specific major’s requirements. The study also shows that when using a writing center services, the participants can feel more confident to continue studying their academic major and achieve their goals due to the improvement in their English writing.

Evaluating Patient-Reported Outcome Measure Collection and Attainment of Substantial Clinical Benefit in Total Joint Arthroplasty Patients

BackgroundPatient-reported outcome measures (PROMs) are important markers of post-surgical outcomes following total joint arthroplasty (TJA). Recent policies by the Centers for Medicare & Medicaid Services (CMS) will require hospitals to achieve at least 50% postoperative PROM collection rates in order to qualify for their full annual payment in fiscal year 2028. This study aimed to: 1) quantify provider PROMs collection rates for TJA patients; 2) compare mean improvements in postoperative PROMs in TJA patients; 3) identify the proportion of TJA patients achieving substantial clinical benefit (SCB); and 4) identify factors associated with TJA patient completion of matched PROMs and achievement of SCB at one year. MethodsThis retrospective cohort study included 1,493 primary total hip arthroplasty (THA) and 2,959 primary total knee arthroplasty (TKA) patients who underwent surgery at a single institution from May 2019 to December 2023. The primary outcomes were 1-year paired hip or knee PROM collection, measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS JR) and Hip Disability and Osteoarthritis Outcome Score (HOOS JR) surveys, and SCB achievement rates (22 for HOOS JR and 20 for KOOS JR). Secondary outcomes involved identifying factors associated with PROM completion and SCB achievement. Statistical analyses included descriptive statistics, t-tests, and logistic regression analysis. ResultsThere were 61.2% of THA patients and 61.1% of TKA patients who completed 1-year paired PROMs, with 72.8% of THA and 53.3% of TKA patients achieving SCB. Factors associated with higher PROMs completion included technology use (PROMs application, text reminders). For TJA patients, a lower preoperative PROM was associated with achievement of SCB at one year. For THA patients, lower BMI was associated with SCB attainment. For TKA patients, men were significantly associated with SCB attainment. ConclusionThe study indicates compliance with the 50% PROM collection requirement, but this required significant allocation of resources, including the use of a digital care platform. Substantial clinical benefit (SCB) was achieved in 72.8% of THA patients but only 53.3% of TKA patients at one year, and this was associated with certain patient demographic factors. Achieving compliance with the CMS requirement may be difficult for many providers and institutions.

Evaluating effects of meal delivery on the ability of homebound older adults to remain in the community via a pragmatic, two-arm, randomized comparative effectiveness trial: study protocol for the Deliver-EE trial

BackgroundAs food insecurity and healthcare costs are linked, healthcare entities (i.e., providers, healthcare systems, insurers) are increasingly interested in identifying and providing solutions to address food insecurity among their patients. Home-delivered meals are one long-standing solution to address food insecurity among homebound older adults. However, there is limited evidence about what mode of delivery is most effective in promoting community independence, reducing healthcare utilization, and improving quality of life as well as how these outcomes may vary as a function of people’s preferences for how meals are delivered to them.MethodsWith extensive stakeholder input, we designed and implemented a pragmatic randomized comparative effectiveness study in which we will enroll 2300 older adults on waiting lists at home-delivered meals programs across the country and randomize them to receive for 6 months, either (1) weekday lunchtime meals delivered by a local volunteer or driver who also provides socialization and wellness checks or (2) biweekly delivery of 10 frozen meals to participants’ homes. Participant data will be combined with Centers for Medicare and Medicaid Services (CMS) data to calculate post-randomization institutional vs. community days. Baseline and 3-month surveys will evaluate secondary outcomes (e.g., food insecurity, loneliness, quality of life) and exploratory outcomes (e.g., nutritional risk). To examine heterogeneity of treatment effects, we will test for interactions between the two types of meal delivery and participants’ preferred mode of meal delivery as well as participants’ living arrangements.DiscussionThis research will be the first to prospectively evaluate the comparative effectiveness of the two predominant meal delivery options. The knowledge generated from this research will be of value to healthcare providers, health systems, payers, community-based organizations, older adults, and their families, because it will identify the mode of meal delivery that best meets homebound older adults’ needs and promotes community independence. In addition, the experience of working closely with stakeholders in designing and conducting this trial will be useful to researchers seeking to engage with stakeholders in the development and evaluation of complex social service interventions while balancing regulatory, resource, and human subjects research considerations.Trial registrationClinicalTrials.gov. NCT05357261. Registered on May 02, 2022

Development and Validation of a Machine Learning-Based Early Warning Model for Lichenoid Vulvar Disease: Prediction Model Development Study.

Given the complexity and diversity of lichenoid vulvar disease (LVD) risk factors, it is crucial to actively explore these factors and construct personalized warning models using relevant clinical variables to assess disease risk in patients. Yet, to date, there has been insufficient research, both nationwide and internationally, on risk factors and warning models for LVD. In light of these gaps, this study represents the first systematic exploration of the risk factors associated with LVD. The risk factors of LVD in women were explored and a medically evidence-based warning model was constructed to provide an early alert tool for the high-risk target population. The model can be applied in the clinic to identify high-risk patients and evaluate its accuracy and practicality in predicting LVD in women. Simultaneously, it can also enhance the diagnostic and treatment proficiency of medical personnel in primary community health service centers, which is of great significance in reducing overall health care spending and disease burden. A total of 2990 patients who attended West China Second Hospital of Sichuan University from January 2013 to December 2017 were selected as the study candidates and were divided into 1218 cases in the normal vulvovagina group (group 0) and 1772 cases in the lichenoid vulvar disease group (group 1) according to the results of the case examination. We investigated and collected routine examination data from patients for intergroup comparisons, included factors with significant differences in multifactorial analysis, and constructed logistic regression, random forests, gradient boosting machine (GBM), adaboost, eXtreme Gradient Boosting, and Categorical Boosting analysis models. The predictive efficacy of these six models was evaluated using receiver operating characteristic curve and area under the curve. Univariate analysis revealed that vaginitis, urinary incontinence, humidity of the long-term residential environment, spicy dietary habits, regular intake of coffee or caffeinated beverages, daily sleep duration, diabetes mellitus, smoking history, presence of autoimmune diseases, menopausal status, and hypertension were all significant risk factors affecting female LVD. Furthermore, the area under the receiver operating characteristic curve, accuracy, sensitivity, and F1-score of the GBM warning model were notably higher than the other 5 predictive analysis models. The GBM analysis model indicated that menopausal status had the strongest impact on female LVD, showing a positive correlation, followed by the presence of autoimmune diseases, which also displayed a positive dependency. In accordance with evidence-based medicine, the construction of a predictive warning model for female LVD can be used to identify high-risk populations at an early stage, aiding in the formulation of effective preventive measures, which is of paramount importance for reducing the incidence of LVD in women.

Effects of Aligning Residency Note Templates with CMS Evaluation and Management Documentation Requirements.

Background The Centers for Medicare & Medicaid Services (CMS) introduced changes in outpatient and inpatient evaluation and management (E/M) current procedural terminology (CPT) codes in 2021 and 2023, which were intended to streamline providers' clinical documentation. Objectives To study the effects of aligning inpatient and outpatient note templates with updated CMS guidelines on character length and documentation time per note at an internal medicine residency program in the southeastern United States. Methods In April 2023, the Atrium Health Wake Forest Baptist Internal Medicine Residency Program's inpatient and outpatient note templates were updated according to the most recent CMS guidelines. A pre-post analysis of resident documentation time and length was conducted comparing notes written with the residency note templates from May 1, 2022 to August 31, 2022 (6439 notes) to notes written with the residency note templates from May 1, 2023 to August 31, 2023 (8828 notes). Interns were surveyed regarding their perceptions of the updated note templates. Results After the note template updates, when adjusted for differing percentages of note types in the pre- and post-periods and accounting for multiple notes written by each resident, notes written with the residency note templates decreased by a mean character length of -882 characters (95% CI: -953, -811, p<.0001), while time spent writing notes did not significantly decrease. 17/17 respondents had favorable perceptions of the note templates. Conclusions The internal medicine residency inpatient and outpatient note templates were updated to align with the most recent CMS E/M documentation requirement changes. These note template changes were associated with a meaningful decrease in documentation length but no overall significant reduction in mean documentation time when adjusted for differing percentages of note types in the pre- and post-periods and multiple notes written by the same author. The interns perceived the note template changes positively.

Study of the Mental Health of the Elderly and Related Factors

Background: Aging and increase in the elderly population are the most important issues in recent years in developed countries and some developing countries. Mental health is one of the crucial aspects of elderly well-being and must be addressed to improve community health. This study is conducted to examine the mental health of the elderly and the related factors in Gorgan city, 2022. Methods: The present study is descriptive-analytical and was conducted using a two-stage cluster random sampling method. First, four comprehensive health service centers were selected as a cluster from among the centers of Gorgan city, and then 263 people were randomly selected from the chosen centers, proportionate to the number of registered elderly individuals in the electronic service system. The standard depression questionnaire for the elderly was utilized for assessment. Data were then entered into SPSS software version 18 and with descriptive and analytical statistical tests, including the Mann-Whitney test, Chi-square test, and logistic regression (The significance level was less than 0.05(. Results: A total of 263 elderly people were evaluated with a mean age of 68.64 ± 7.2 . 143 (54.4%) were male and 120 (45.6%) were female. The prevalence of depression was reported to be 27.8. The occurrence of depression was significantly associated with age, marital status, and the presence of underlying disease conditions (p &lt; 0.05). However, gender, place of residence, and BMI did not show a statistically significant relationship with the occurrence of depression. Aging, underlying diseases, and not being married increase the chance of depression in the elderly. Conclusion: Although the prevalence of depression in the elderly is lower than the average of the whole country in this study, they are in a better condition. However, due to the fact that they are a special target group, as well as the various risk factors of the disease, including age, lack of marriage, and the presence of an underlying disease in this group, it is suggested that more appropriate planning be done to improve their mental health status.

Do Farm Service Centers Improve Technical Efficiency of Chickpea Growers in Karak District, Khyber Pakhtunkhwa – Pakistan

The central theme of this research endeavor was to assess the impact of Farm Service Centers (FSCs) on the technical efficiency of chickpea growers in District Karak, Khyber Pakhtunkhwa. Data were collected from chickpea growers, including both members and non-members of FSCs. Primary data were gathered from 120 chickpea growers in three villages of Karak district namely Meerzal Banda, Alam Gulkhel Banda, and Zariwaal Banda by using a multistage stratified random sampling technique. A Stochastic Frontier production function was applied to estimate technical efficiency. The results of the Stochastic Frontier Model indicated that most variables were statistically significant. The mean technical efficiency was calculated at 80%, suggesting that chickpea growers could improve their production by 17%. It is recommended that farmers may be supported with new technologies and essential inputs by the government, as these were significant contributors. Furthermore, Farm Service Centers should enhance their services and provide basic inputs at reasonable prices.

Unintended Consequences of Data Sharing Under the Meaningful Use Program.

Interoperability has been designed to improve the quality and efficiency of health care. It allows the Centers for Medicare and Medicaid Services to collect data on quality measures as a part of the Meaningful Use program. Covered providers who fail to provide data have lower rates of reimbursement. Unintended consequences also arise at each step of the data collection process: (1) providers are not reimbursed for the extra time required to generate data; (2) patients do not have control over when and how their data are provided to or used by the government; and (3) large datasets increase the chances of an accidental data breach or intentional hacker attack. After detailing the issues, we describe several solutions, including an appropriate data use review board, which is designed to oversee certain aspects of the process and ensure accountability and transparency.

Engaging Low-Wage Workers in Health and Well-Being Survey Research: Strategies From 5 Occupational Studies.

Without perspectives of low-wage workers in studies of worker health and well-being, researchers cannot comprehensively assess occupational health and health equity impacts of workplace exposures and interventions. Researchers and practitioners have noted particular challenges in engaging low-wage workers in worksite-based health survey research, yet little scholarship has described strategies for improving their engagement and response rates. To fill this gap, we present case examples from 5 occupational studies conducted between 2020 and 2024 in industries including health care, food service, and fulfillment centers. For each case, we describe how we identified barriers to worker engagement in surveys, explain specific strategies we used to address those barriers, and assess the effectiveness of these actions. Then, summarizing across case examples, we offer practical recommendations to researchers surveying low-wage populations, highlighting that high-touch recruitment, building trust with workers and managers, and obtaining manager support to take surveys during work time (for worksite-based studies) are critical for obtaining reliable, representative data. Our work contributes to broader discussions on improving survey response rates in vulnerable worker populations and aims to support future researchers undertaking similar efforts. (Am J Public Health. Published online ahead of print November 14, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307875).

Apply the information-motivation-behavioral model to explore the relationship between oral health literacy and oral health behaviors among community-dwelling older adults

ObjectiveOral health is a critical area in healthy aging. Oral health literacy (OHL) plays an important role in improving oral health behaviors and oral health status. However, few studies have investigated OHL among community-dwelling older adults and the influential mechanism of OHL on oral health behaviors has not been clarified. The aim of this study is to explore the interaction pathways through which OHL influences oral health behaviors among community-dwelling older adults.MethodsThis is a cross-sectional study. 429 community-dwelling older adults were recruited by a convenience sampling method from the activity service center in Zhenjiang, Southern China. The data were collected between September and November 2021 using the Oral Health Literacy Adult Questionnaire (OHL-AQ) and other sophisticated scale assessments. A theoretical model based on the information-motivation-behavioral skills model (IMB model) and previous research was developed and then validated using a structural equation model with AMOS v24.0.ResultsThe proposed model revealed a good fit to the data (χ2/df = 3.349, goodness of fit index = 0.957, adjusted goodness of fit index = 0.921, root mean squared error of approximation = 0.074, comparative fit index = 0.955, normed fit index = 0.938). Oral health information (β = 0.23) and motivation (β = 0.56) positively affected OHL. OHL (β = 0.20) and motivation (β = 0.25) positively affected self-efficacy; self-efficacy (β = 0.98) had a direct effect on oral health behavior. OHL had an indirect effect on oral health behaviors through self-efficacy (β = 0.19). Motivation can both directly influence oral health behavior (β = 0.18) and indirectly influence oral health behavior through OHL and self-efficacy(β = 0.35).ConclusionsThe study findings make a valuable contribution to the influential mechanism of OHL on oral health behaviors. OHL improved oral health behaviors through self-efficacy among community-dwelling older adults. Oral health information directly affected OHL. Motivation directly affected oral health behaviors as well as influence oral health behaviors by changing OHL.

Impact of farm mechanization on crop productivity and economic efficiency in central and southern Oromia, Ethiopia

IntroductionFarm mechanization has multi-dimensional impacts on agricultural production systems like economic efficiency and productivity, thereby improving the quality of life in the farming community by reducing work drudgeries. However, these impacts were not studied empirically in Ethiopia. Hence, this research was initiated to estimate the level of economic efficiency, and productivity of wheat and barley, and the impact of farm mechanization on economic efficiency and productivity of wheat and barley.MethodsThe analysis was done for 232 and 257 wheat and barley producer farmers respectively who are selected from the Arsi and West Arsi zones. The stochastic frontier model was used to estimate economic efficiency while augmented inverse probability weighted (AIPW) was used to estimate the impact.Results and discussionBased on the result, it is apparent that farm mechanization has a significant positive impact on wheat productivity while the percentage change in average treatment effect for the barley was not statistically significant. Farm mechanization also affects wheat and barley economic efficiency positively. Hence, we recommended the wider use of farm mechanization to improve economic efficiency and productivity. Therefore, policy design should focus on ways to avail farm machinery easily like establishing farm mechanization service centers and facilitating credit services for mechanization service renders.

Facility- and community-level factors associated with hospice patient experience.

Mandated by the Affordable Care Act of 2010, hospices were required to provide information regarding the Hospice Quality Reporting Program, with a reduced reimbursement tied to hospices if they fail to submit data to the Centers for Medicare and Medicaid Services. The purpose of this study was to examine the association between hospice organizational and community factors and quality of hospice care as measured by patient experience through Hospice Consumer Assessment of Healthcare Providers & Systems (CAHPS®) survey. We used secondary data from Hospice Compare, Healthcare Cost Report Information System Dataset, Rural-urban commuting area codes, and the American Community Survey to examine the relationship between hospice patient/family experience and hospice organizational-level and community-level factors for the period 2017-2020. The unit of analysis was hospice-year observations. For-profit and chain-affiliated hospices were negatively associated with CAHPS® scores. Organizational longevity and Medicare payer mix were positively associated with CAHPS® scores. Hospice community factors including competition, per capita income, and the racial/ethnic minorities' percentage were negatively associated with CAHPS® scores. Hospice organizational and community factors were related to hospice quality of care. Interventions that account for organizational and community factors may be needed to improve patient/family experience of hospice care.