Individual-level Outcomes Research Articles

Evaluation of Healthy South Texas Asthma Program on improving health outcomes and reducing health disparities among the underserved Hispanic population: using the RE-AIM model

BackgroundIn the United States, childhood asthma prevalence is higher among low-income communities and Hispanic populations. Previous studies found that asthma education could improve health and quality of life, especially in vulnerable populations lacking healthcare access. This study aims to describe Healthy South Texas Asthma Program (HSTAP), an evidence-based asthma education and environmental modification program in South Texas, and evaluate its associations with health-related outcomes among Hispanic children with asthma and their families.MethodsThe RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework was used as an overarching tool to evaluate the impact of the HSTAP. This educational program included 451 children with asthma and their families living in South Texas, an impoverished area at the Texas-Mexico border. The program consisted of (a) the asthma education (2-h) for children with asthma provided by Respiratory Therapy students at the children’s schools and (b) the home visit Asthma and Healthy Homes education and walk-through sessions (at baseline and 3 months) for parents and two follow-up visits (6 and 9–12 months later) led by community health workers. The education was provided in either English or Spanish between September 2015 and August 2020 as part of the Healthy South Texas Initiative. A pre-and post-test design was implemented to assess the differences in health outcomes, knowledge, and behaviors using standardized self-reported surveys as reported by parents. Analyses included primary descriptive analyses, generalized estimating equation models, the Wilcoxon signed-rank test, and the McNemar test.ResultsThe HSTAP was significantly associated with improved individual-level outcomes on the frequency of asthma-related respiratory symptoms, including shortness of breath, chest tightness, coughing, and sleep difficulty, among children with asthma, as well as an enhanced asthma knowledge in their family. This study also showed significant associations with children’s school attendance and participation in physical activities and family social events and decreased families’ worry about their asthma management.ConclusionsThe RE-AIM model was a helpful framework to assess the HSTAP on all its components. The results suggest that participation in an asthma education and environmental modification program was associated with improved individual-level health conditions and reduced health disparities among children with asthma in low-income communities.

Team Coping: Cross-Level Influence of Team Member Coping Activities on Individual Burnout.

Coping with stress has been primarily investigated as an individual-level phenomenon. In work settings, however, an individual’s exposure to demands is often shared with co-workers, and the process of dealing with these demands takes place in the interaction with them. Coping, therefore, may be conceptualized as a multilevel construct. This paper introduces the team coping concept and shows that including coping as a higher-level team property may help explain individual-level outcomes. Specifically, we investigated the effects of exposure to danger during deployment on burnout symptoms in military service members and examined to what extent this relationship was moderated by individual-level and team-level functional coping. We hypothesized that the relationship between individuals’ exposure to danger and burnout is contingent on both. In line with our predictions, we found that service members who were highly exposed to danger, and did not engage in much functional coping, suffered most from burnout symptoms, but only when their teammates did not engage in much functional coping either. When their teammates did engage in much functional coping, the effect of exposure to danger on burnout was buffered. Hence, team members’ coping efforts functioned as a resilience resource for these service members.

A perspective on embracing emerging technologies research for organizational behavior

Purpose Emerging technologies are capable of enhancing organizational- and individual-level outcomes. The organizational behavior (OB) field is beginning to pursue opportunities for researching emerging technologies. This study aims to describe a framework consisting of white, black and grey boxes to demonstrate the tight coupling of phenomena and paradigms in the field and discusses deconstructing OB’s white box to encourage data-driven phenomena to coexist in the spatial framework. Design/methodology/approach A scoping literature review was conducted to offer a preliminary assessment of technology-oriented research currently occurring in OB. Findings The literature search revealed two findings. First, the number of published papers on emerging technologies in top management journals has been increasing at a steady pace. Second, various theoretical perspectives at the micro- and macro- organizational level have been used so far for conducting technology-oriented research. Originality/value By conducting a scoping review of emerging technologies research in OB literature, this paper reveals a conceptual black box relating to technology-oriented research. The essay advocates for loosening OB’s tightly coupled white box to incorporate emerging technologies both as a phenomenon and as data analytical techniques.

The heterogeneous effects of COVID-19 on labor markets: People’s movement and non-pharmaceutical interventions

The paper investigates the heterogeneous effect of a policy-induced decline in people’s mobility on the Japanese labor market outcome during the early COVID-19 period. Regressing individual-level labor market outcomes on prefecture-level mobility changes using policy stringency index as an instrument, our two-stage least squares estimator presents the following findings. First, the number of people absent from work increased for all groups of individuals, but the magnitude was greater for workers with non-regular employment status, low-educated people, females especially with children, and those aged 31 to 45 years. Second, while work hours decreased for most groups, the magnitude was especially greater for business owners without employees and those aged 31 to 45. Third, the negative effect on unemployment was statistically significant for older males who worked as regular workers in the previous year. The impact was particularly considerable for those aged 60 and 65, thus suggesting that they lost their re-employment opportunity due to COVID-19. Fourth, all these adverse effects were greater for people working in service and sales occupations. Fifth, a counterfactual experiment of more stringent policies indicates that while an average worker would lose JPY 3857 in weekly earnings by shortening their work hours, the weekly loss for those aged 31 to 45 years and working in service and sales occupations would be about JPY 13,842.

Clinical Characteristics and Outcomes in Immune Checkpoint Inhibitor Therapy-Associated Myocarditis.

Immune checkpoint inhibitor (ICI) therapy has played an important role in the treatment of several groups of cancers. Although a life prolonging treatment, many side effects have been shown with ICI therapy. This study looked at individual level clinical characteristics and outcomes with ICI therapy in patients who developed ICI-related myocarditis. A comprehensive review of the National Library of Medicine PubMed database was performed. Inclusion criteria were all studies that were composed of case reports and case series of individual patients undergoing ICI therapy that developed myocarditis. To appreciate individual patient level data, observational studies, clinical trials, systematic reviews, and meta-analyses were excluded. Our search yielded 333 results with 71 cases reviewed of ICI therapy-related myocarditis. The findings included an average age of 68 years, higher incidence in men, and pretreatment cardiac history of hypertension. Melanoma was the most prevalent malignancy with nivolumab being the most used ICI therapy. Heart failure was the most prevalent adverse event that was co-prevalent with myocarditis. Corticosteroid therapy alone was the most utilized therapy to treat ICI-related myocarditis. Mortality was seen in nearly half of the patient population. Our study reviewed the preexisting literature of prior reported myocarditis secondary to ICI therapy. Periodic surveillance should be performed by the cardio-oncologist and internist. Due to the expanding role of ICI therapy in treating a variety of cancer patients, appreciation of its impact on the development of myocarditis is needed.

Towards an agricultural entrepreneurship development model: an empirical investigation in Namibia’s agricultural communities

PurposeEntrepreneurship is increasingly being recognised as a vehicle for bringing about the development of different economic sectors in various geographical regions, and it is believed to result in greater productivity and entrepreneurial performance in agriculture. To date, there are no empirically verified holistic models focussing on the development of agricultural entrepreneurship in an African context. This study aims to fill this gap by developing an agricultural entrepreneurial development model (AEDM) that provides a basis for enhancing entrepreneurial performance in the agriculture sector.Design/methodology/approachFirst, a holistic conceptual AEDM was built from the extant literature with a focus on the African context and encompassing dimension of the enabling environment, entrepreneurial performance and its outcomes. Then, the model was tested empirically by conducting a survey with 477 farmers in Namibia who benefit from Namibia’s National Resettlement Programme and the Affirmative Action Loan Scheme. The model was tested statistically using partial least square-structural equation modelling.FindingsThe results reveal that a supportive environment, entrepreneurial orientation and agricultural sustainability exert a positive impact on entrepreneurial performance in agriculture, which, in turn, leads to greater agricultural productivity and increased income for farmers.Originality/valueThe study theoretically develops and empirically tests a holistic model of agricultural entrepreneurship development. The value of the model lies in its consideration of a plethora of enabling-environment antecedents of entrepreneurial performance in agriculture, as well as some specific organisational- and individual-level outcomes thereof. Therefore, it offers policymakers and practitioners a blueprint for developing agricultural entrepreneurship in an African context.

Near-roadway air pollution associated with COVID-19 severity and mortality - Multiethnic cohort study in Southern California.

BackgroundAir pollution exposure has been associated with increased risk of COVID-19 incidence and mortality by ecological analyses. Few studies have investigated the specific effect of traffic-related air pollution on COVID-19 severity.ObjectiveTo investigate the associations of near-roadway air pollution (NRAP) exposure with COVID-19 severity and mortality using individual-level exposure and outcome data.MethodsThe retrospective cohort includes 75,010 individuals (mean age 42.5 years, 54% female, 66% Hispanic) diagnosed with COVID-19 at Kaiser Permanente Southern California between 3/1/2020–8/31/2020. NRAP exposures from both freeways and non-freeways during 1-year prior to the COVID-19 diagnosis date were estimated based on residential address history using the CALINE4 line source dispersion model. Primary outcomes include COVID-19 severity defined as COVID-19-related hospitalizations, intensive respiratory support (IRS), intensive care unit (ICU) admissions within 30 days, and mortality within 60 days after COVID-19 diagnosis. Covariates including socio-characteristics and comorbidities were adjusted for in the analysis.ResultOne standard deviation (SD) increase in 1-year-averaged non-freeway NRAP (0.5 ppb NOx) was associated with increased odds of COVID-19-related IRS and ICU admission [OR (95% CI): 1.07 (1.01, 1.13) and 1.11 (1.04, 1.19) respectively] and increased risk of mortality (HR = 1.10, 95% CI = 1.03, 1.18). The associations of non-freeway NRAP with COVID-19 outcomes were largely independent of the effect of regional fine particulate matter and nitrogen dioxide exposures. These associations were generally consistent across age, sex, and race/ethnicity subgroups. The associations of freeway and total NRAP with COVID-19 severity and mortality were not statistically significant.ConclusionsData from this multiethnic cohort suggested that NRAP, particularly non-freeway exposure in Southern California, may be associated with increased risk of COVID-19 severity and mortality among COVID-19 infected patients. Future studies are needed to assess the impact of emerging COVID-19 variants and chemical components from freeway and non-freeway NRAP.

National Early Warning Scores and COVID-19 deaths in care homes: an ecological time-series study

ObjectivesTo investigate whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes.Setting460 care home units using the same software package to collect data on residents, from...

1369Probabilistic data linkage of health facility and individual data using PMA2020 surveys

Abstract Background Most studies rely on clustered analyses to study how the characteristics of health facilities influence individual outcomes. Our aim was to perform a probabilistic linkage between individual and health facility data to enable individual-level analyses. Methods We linked data from the most recent female questionnaire from 11 countries monitored by the Performance Monitoring for Action 2020 to a master health facility dataset (appending all rounds of surveys). Only women that reported which type of facility they visited were considered in the analysis. A probabilistic linkage was performed using 13 blocking variables (e.g., facility type and cluster of residence/location of the woman/facility) and 11 matching variables (e.g., types of contraceptive methods used/offered by the women/facility). Each concordant matching variable received a + 1 score, or a 0 score otherwise. We assessed linkage quality by pooled odds ratio of non-matches according to wealth tertiles (richest vs. poorest) and area of residence (urban vs. rural) using a meta-analytical approach. Results A total of 21,102 women and 7,056 facilities were considered in the linkage process. The average match rate was 57.9%, ranging from 42.5% in Indonesia to 69.1% in Burkina Faso. The pooled odds of non-match were 74% higher for the richest women compared to the poorest, and 67% higher for women living in urban areas compared to rural areas. Conclusions High match rates were achieved in countries with sufficient information on public and private facilities. The lack of information about private facilities contributed to the higher odds of non-match among the better off. Key messages We performed a probabilistic linkage approach to link individual and health facility data, making it possible to understand how the characteristics of health facilities can influence individual-level outcomes. Our findings also bring light to the importance of sampling both public and private facilities, aiming to maximise match rates and reduce differences on match rates according to socio demographic characteristics of the sample.

Health of aging families: Comparing compound and noncompound caregivers

ABSTRACT Providing care to a family member with disabilities takes a toll on the health of the caregiver and the family. Among aging caregivers, compound caregiving (i.e., caring for two or more family members) has become an increasingly common scenario. However, few research studies have focused on compound caregivers. Extant literature describes individual-level outcomes, with sparse knowledge on family-level outcomes. The family quality of life framework was used in this study to examine differences in the individual and family health of aging compound and noncompound caregivers. Web-based cross-sectional data collected from 112 aging caregivers (age 50 and older) were analyzed using chi-square and independent sample t-tests to examine differences between caregivers. Compound caregivers had poorer perceptions of personal health than noncompound caregivers. In terms of family health, although all caregivers shared similar perceptions on the importance, opportunities, initiative, and stability, compound caregivers had lower attainment and satisfaction than noncompound caregivers. Multivariate regression analyses indicated that compound caregiving was associated with poorer family health. Personal health was positively associated with family health. Study findings have practice implications for identifying caregivers’ multiple responsibilities. It is necessary to develop individual and family level programs focused on health promotion and caregiver training.

Individual-level and country-level socio-economic factors and health outcomes in spondyloarthritis: analysis of the ASAS-perSpA study.

The aim of this study was to investigate the association between individual-level and country-level socio-economic (SE) factors and health outcomes across SpA phenotypes. Patients with axial SpA (axSpA), peripheral SpA (pSpA) or PsA from the ASAS-perSpA study (in 23 countries) were included. The effect of individual-level (age, gender, education and marital status) and country-level [e.g. Gross Domestic Product (GDP)] SE factors on health outcomes [Ankylosing Spondylitis Disease Activity Score (ASDAS) ≥ 2.1, ASDAS, BASFI, fatigue and the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI)] was assessed in mixed-effects models adjusted for potential confounders. Interactions between SE factors and disease phenotype were tested. A mediation analysis was conducted to explore whether the impact of country-level SE factors on ASDAS was mediated through biologic/targeted synthetic (b/ts) DMARD uptake. In total, 4185 patients (61% males, mean age 45) were included (65% axSpA, 25% PsA, 10% pSpA). Female gender [β= 0.14 (95% CI: 0.06, 0.23)], lower educational level [β = 0.35 (0.25, 0.45)) and single marital status [β = 0.09 (0.01, 0.17)] were associated with higher ASDAS. Living in lower GDP countries was also associated with higher ASDAS [β = 0.39 (0.16, 0.63)], and 7% of this association was mediated by b/tsDMARD uptake. Higher BASFI was similarly associated with female gender, lower education and living alone, without the effect of country-level SE factors. Female gender and lower educational level were associated with worse ASAS-HI, while more fatigue was associated with female gender and higher country-level SE factors [lower GDP, β = -0.46 (-0.89 to -0.04)]. No differences across disease phenotypes were found. Our study shows country-driven variations in health outcomes in SpA, independently influenced by individual-level and country-level SE factors and without differences across disease phenotypes.

Evaluating Ideas When Innovators Are Diverse

We propose to examine how ideas are evaluated when innovators are diverse and the implications on organizational and individual-level outcomes. This question is timely because managers from more organizations are beginning to evaluate novel ideas and innovators. Organizations finance early stage ventures (e.g. Duschnitsky, 2012; Cohen, Fehder, Hochberg, & Murray, 2019; Lerner & Nanda, 2020), access new ideas via broadcast search (e.g. Jeppesen & Lakhani, 2010; Lifschitz-Assaf, 2018), or directly employ intrapreneurs (Nielson, Peters, & Hisrich, 1985). Managers are increasingly conscious about the diversity of innovators in their networks in part due to growing political and social interest (Dobbin, Kalev, & Kim, 2011; Luo & Zhang, 2020). We propose to bring together five papers presented by a panel of Aleksanda Kacperczyk (London Business School), Rembrand Koning (Harvard Business School), Amisha Miller (Boston University), Dan Wang (Columbia Business School), Nataliya Langburd Wright (Harvard Business School), and Peter Younkin (University of Oregon), which examine the evaluation of ideas from diverse innovators. We will identify novel organizational mechanisms that could affect the diversity of innovators, as well as the implications of evaluation processes on organizations, innovators’ careers, and the direction of innovation. Do Richer Foreign Work Experiences Lead to Intrapreneurial Success? Presenter: Dan Jun Wang; Columbia Business School Judging Foreign Startups Presenter: Nataliya Wright; Harvard Business School Presenter: Rembrand Michael Koning; Harvard Business School Presenter: Tarun Khanna; Harvard U. Changing the System, Not the Seeker: Evaluating Startups Led by Female Founders Presenter: Amisha Miller; Boston U. Questrom School of Business Clearing Hurdles but Digging Holes: An Exit, Not an Entrance: The Employment Opportunities for Black Presenter: Aleksandra Joanna Kacperczyk; - Presenter: Peter Younkin; U. of Oregon Biased Sampling of Early Users and the Direction of Startup Innovation Presenter: Ruiqing Cao; - Presenter: Rembrand Michael Koning; Harvard Business School Presenter: Ramana Nanda; Imperial College London

The impact of international experience on individual-level outcomes: A meta-analysis

This meta-analysis aggregates the insights of 202 studies on the relationships between international experience (IE) and a range of individual-level outcomes including cultural intelligence, cross-cultural adjustment, and work-related satisfaction, performance, and turnover intentions. We provide a conceptual framework to organize the literature, review and integrate existing research on IE-outcome links, explore the impact that different types of IE operationalization and measurement have on the direction and magnitude of effects, and establish the incremental predictive validity of IE beyond commonly used predictors, such as personality traits, general mental ability, and language proficiency. We find that effect sizes are generally small; however, subgroup analyses of different types of IE operationalization and measurement yield substantially larger effect sizes. Additionally, we show incremental predictive validity of IE for more proximal outcomes beyond a set of established predictors. We discuss the implications of our findings for theory development and measurement of IE and offer avenues for future research.

A systematic review exploring the impact of focal leader behaviours on health care team performance.

The aim of this study is to understand how the behaviour of focal leaders impacts health care team performance and effectiveness. Despite recent shifts towards more collectivistic leadership approaches, hierarchical structures that emphasize the role of an individual focal leader (i.e., the formal appointed leader) are still the norm in health care. Our understanding of the effect of focal leader behaviours on health care team performance remains unclear. A systematic review was conducted. Five electronic databases were searched using key terms. One thousand forty-seven records were retrieved. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifty papers met the criteria for inclusion, were reviewed and synthesized under the following categories: task-focused leadership, directive leadership, empowering leadership and relational focused leadership. Categories are discussed in relation to team performance outcomes, safety specific outcomes, individual-level outcomes and outcomes related to interpersonal dynamics. Emerging themes are explored to examine and reflect on how leadership is enacted in health care, to catalogue best practices and to cascade these leadership practices broadly. Empowering and relational leadership styles were associated with positive outcomes for nursing team performance. This underscores the importance of training and encouraging nursing leaders to engage in more collaborative leadership behaviours.

A Nudge to Quit? The Effect of a Change in Pension Information on Annuitisation, Labour Supply and Retirement Choices Among Older Workers

Abstract We study the effects of two exogenous modifications in the Swedish pension system application form nudging individuals towards a fixed-term payout. Meanwhile, the set of available options and the default option—life annuity—were unchanged during the period under study. We examine the effects on individuals’ payout decisions and the spillover effects on labour supply and other pensions using a difference-in-difference framework and detailed administrative data on actual payout decisions and a wide range of individual-level outcomes. Each modification increased the demand for the nudged payout by around 30 percentage points. The first modification also induced individuals to work less.

The Complexity of Heavy Work Investment (HWI): A Conceptual Integration and Review of Antecedents, Dimensions, and Outcomes

The purpose of this paper is to bring conceptual clarity to the heavy work investment (HWI) construct while building a model based on a review of extant empirical and theoretical research and to encourage further discussion and investigations regarding the nature of HWI, specifically its individual level antecedents, dimensions, and outcomes for both the employee and the organization. The proposed theoretical framework builds upon the Job Demands–Resources model and conceptualizes HWI on a continuum of workaholism and work engagement. Specific propositions for the antecedents and outcomes of the HWI continuum are developed. The paper ends with a discussion of future research directions.

Measuring for Success: Evaluating Leadership Training Programs for Sustainable Impact.

Background:In an era of global health security challenges such as the COVID-19 pandemic, there is greater need for strong leadership. Over the past decades, significant investments have been made in global health leadership development programs by governments and philanthropic organizations to address this need. Evaluating the societal impact of these programs remains challenging, despite consensus on the importance of public health leadership.Objective:This article identifies the gaps and highlights the critical role of monitoring and evaluation approaches in assessing the impact of global health leadership programs. Importantly, we also propose the theory of change (TOC) as a common framework and identify a set of tools and indicators that leadership programs can adapt and use.Methods:We carried out an informal review of major global health leadership programs, including a literature review on leadership program evaluation approaches. Current practices in assessing the short- to long-term outcomes of leadership training programs were explored and synthesized. We also examined use of program theory frameworks, such as theory of change to guide the evaluation strategy. We find the TOC approach can be enhanced by integrating evaluation-specific frameworks and establishing broad stakeholder buy-in. We highlight measurement challenges, proposed outcome indicators and evaluation methodologies, and outline the future direction for such efforts.Findings:Most evaluation of current leadership programs is focused on short-term individual-level outcomes, while reports on long-term societal impact were limited. Reciprocal impacts on and benefits for the “host” organizations were not included in evaluation metrics. Most programs had program logic or result chains, but with no well-articulated program theories.Conclusion:Key stakeholders involved in leadership training programs benefit from the evidence of rigorous program evaluations to inform decisions that address barriers in fostering global health leadership and improving population health outcomes. Insight into reciprocal change in host organizations is important. Evaluation of global health leadership training must go beyond the individual trainee and encompass organizational and community-level impacts. Documentation of long-lasting organizational and societal impacts is essential for donors to appreciate the return on their investment.Key TakeawaysEvaluation plays an important role in understanding how leadership development takes place and how it contributes to improving public health outcomes.Making the case for investments in leadership development programs requires robust evidence from monitoring and evaluation strategies that link investments beyond the individual-level to longer-term societal impacts.The first critical step towards a strategy for success is for leadership programs to clearly build, articulate, share, and use their program theories or theories of change.Theories of change help identify the pathways (and potential tensions) through which leadership development programs effect change at the individual, organizational and community levels.Evaluation methods that examine outcomes of leadership programs should be multi-method, multi-level, and where possible include counterfactual outcomes.Allocation of funds to evaluate on-going and long-lasting societal impact of leadership programs should be a routine practice.

Motivational antecedents, employee engagement and knowledge management performance

PurposeThis paper aims to investigate the causal relationships between organisational practices, employee knowledge management (KM) engagement and organisational KM performance.Design/methodology/approachFollowing a quantitative research approach, an online survey of 536 knowledge workers from multinational knowledge-based organisations located in Sri Lanka was carried out. The data were analysed with structural equation modelling.FindingsTeamwork, reward structure, learning, performance management and employee empowerment are found to be motivational antecedents of KM engagement while, subsequently, organisational KM performance is affected by employee KM engagement.Research limitations/implicationsThe findings of this study are based on the use of five key organisational practices derived from the literature. Further research is needed to establish whether the findings extend to other organisational practices such as resourcing strategy, organisational culture and communication. Further, the sample for this research comprised knowledge workers in Sri Lankan organisations which limit the generalisability of the findings.Practical implicationsTeamwork, rewards structure, learning, performance management and employee empowerment are organisational practices that foster employee KM engagement. Organisational practices and employee KM engagement are imperative for the organisational success of KM initiatives.Originality/valueThis research introduces the term KM engagement as the indicator of individual-level KM success and integrates the sequential linkage between individual-level KM outcomes (i.e. KM engagement) and organisational KM outcomes (KM performance) which has not yet been investigated.

Healthcare provider characteristics that influence the implementation of individual-level patient-centered outcome measure (PROM) and patient-reported experience measure (PREM) data across practice settings: a protocol for a mixed methods systematic review with a narrative synthesis

BackgroundSubstantial literature has highlighted the importance of patient-reported outcome and experience measures (PROMs and PREMs, respectively) to collect clinically relevant information to better understand and address what matters to patients. The purpose of this systematic review is to synthesize the evidence about how healthcare providers implement individual-level PROMs and PREMs data into daily practice.MethodsThis mixed methods systematic review protocol describes the design of our synthesis of the peer-reviewed research evidence (i.e., qualitative, quantitative, and mixed methods), systematic reviews, organizational implementation projects, expert opinion, and grey literature. Keyword synonyms for “PROMs,” PREMs,” and “implementation” will be used to search eight databases (i.e., MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, SPORTDiscus, Evidence-based Medicine Reviews, and ProQuest (Dissertation and Theses)) with limiters of English from 2009 onwards. Study selection criteria include implementation at the point-of-care by healthcare providers in any practice setting. Eligible studies will be critically appraised using validated tools (e.g., Joanna Briggs Institute). Guided by the review questions, data extraction and synthesis will occur simultaneously to identify biographical information and methodological characteristics as well as classify study findings related to implementation processes and strategies. As part of the narrative synthesis approach, two frameworks will be utilized: (a) Consolidated Framework for Implementation Research (CFIR) to identify influential factors of PROMs and PREMs implementation and (b) Expert Recommendations for Implementing Change (ERIC) to illicit strategies. Data management will be undertaken using NVivo 12TM.DiscussionData from PROMs and PREMs are critical to adopt a person-centered approach to healthcare. Findings from this review will guide subsequent phases of a larger project that includes interviews and a consensus-building forum with end users to create guidelines for implementing PROMs and PREMs at the point of care.Systematic review registrationPROSPERO CRD42020182904.

Impact of Neighborhood Social and Environmental Resources on Medicaid Spending

In an era of COVID-19, Black Lives Matter, and unsustainable healthcare spending, efforts to address the root causes of health are urgently needed. Research linking medical spending to variation in neighborhood resources is critical to building the case for increased funding for social conditions. However, few studies link neighborhood factors to medical spending. This study assesses the relationship between neighborhood social and environmental resources and medical spending across the spending distribution. Individual-level health outcomes were drawn from a sample of Medicaid enrollees living in Baltimore, Maryland during 2016. A multidimensional index of neighborhood social and environmental resources was created and stratified by tertile (high, medium, and low). Differences were examined in individual-level medical spending associated with living in high-, medium-, or low-resource neighborhoods in unadjusted and adjusted 2-part models and quantile regression models. Analyses were conducted in 2019. Enrollees who live in neighborhoods with low social and environmental resources incur significantly higher spending at the mean and across the distribution of medical spending even after controlling for age, race, sex, and morbidity than those who live in neighborhoods with high social and environmental resources. On average, this spending difference between individuals in low- and those in high-resource neighborhoods is estimated to be $523.60 per person per year. Living in neighborhoods with low (versus those with high) resources is associated with higher individual-level medical spending across the distribution of medical spending. Findings suggest potential benefits from efforts to address the social and environmental context of neighborhoods in addition to the traditional orientation to addressing individual behavior and risk.