Care Mandate Research Articles

Der Medizinische Dienst Eine sozialmedizinische Institution der Qualitätssicherung im Gesundheitssystem

As a corporation under public law, the federally established Medical Service (MD) is an organizationally and substantively independent socio-medical expert organization. It uses its expertise to support the health and nursing care insurance companies as well as their associations and other clients from the healthcare system nationwide in ensuring medical and nursing care within the social law solidarity community consisting of statutory health and social care insurance. In relation to the 12.000 employees, the specialist tasks are carried out by doctors (20.1 %), nursing staff (40.4 %) and members of other suitable professions in the healthcare sector (5.5 %). With a total of over 2.955.000 GKV assessments, 13.200 structural audits in hospitals, significantly more than 1.600 on-site quality controls in hospitals, almost 3.000.000 nursing assessments, almost 21.900 quality inspections in nursing facilities as well as committee work at state and federal level, the MD assumes a comprehensive constitutive-constitutional and quality-assuring expert care mandate. The social-medical service provided, which is committed to the general social law principles of quality, humanity and cost-effectiveness and is regulated by guidelines issued by the MD Bund and approved by the Federal Ministry of Health, is subject to standardized, nationwide quality assurance.

Low risk for post-injection syndrome after administration of olanzapine depot : Findings of real-world data evaluation at a psychiatric university hospital with a full-range care mandate

Low risk for post-injection syndrome after administration of olanzapine depot : Findings of real-world data evaluation at a psychiatric university hospital with a full-range care mandate

Responding to a nursing mandate in long-term care: A multi-modal pilot curriculum for bachelor of science in nursing students.

Responding to a nursing mandate in long-term care: A multi-modal pilot curriculum for bachelor of science in nursing students.

Advancing the Primary Health Care Mandate for Nursing.

A call to increase home visits and human function documenting by nurses.

After the Legislation Passes: How California's Palliative Care Mandate is Being Met Five Years Later

After the Legislation Passes: How California's Palliative Care Mandate is Being Met Five Years Later

The impact of COVID-19 on 2020 monthly incidence trends of primary brain and other CNS tumors.

To mitigate disease spread, restrictions implemented in the United States surrounding the COVID-19 pandemic created an environment that led to delays in cancer diagnosis. The data needed to accurately analyze the impact of the pandemic on brain and CNS tumor incidence has not been available until now. Utilizing incidence data from the Central Brain Tumor Registry of the United States (CBTRUS) we analyzed the impact of the COVID-19 pandemic on primary brain and other CNS tumor incidence for the first year of the pandemic. Monthly age-adjusted incidence rates and incidence trends for 2019 and 2020 were determined for age at diagnosis, sex, race, ethnicity, diagnostic confirmation, behavior, tumor histopathology, and county-level urbanization. Monthly incidence rate ratios comparing 2020 and 2019 were evaluated for the same factors. Overall, there was a notable decrease in incidence rates in March-May 2020 when compared to 2019. These decreases were driven by nonmalignant tumors, with a 50% incidence decrease between March 2020 and 2019. Individuals who were Black had a larger incidence decrease in early 2020 than individuals who were White. Radiographically confirmed tumors saw larger incidence decreases than histologically confirmed tumors. There were no changes in monthly incidence of glioblastoma in 2020 compared to 2019. These data provide evidence that disruptions in medical care, such as governmental and health care mandates, in response to the COVID-19 pandemic resulted in an overall decreased incidence of primary brain tumors in early 2020.

The Policy Alliance Between Hospitals and Debt Collection Agencies: Content Analysis of Public Comments on Regulations on Billing and Collections.

Significant debate persists about the obligations of nonprofit hospitals toward low-income patients. Many issues pertaining to this subject were discussed during the rulemaking process following the passage of the Affordable Care Act of 2010, which set forth rules for hospital billing and collection. In public comments, hospitals, debt collectors, and patient advocates debated what constituted "reasonable efforts" to determine whether a patient qualified for hospital financial assistance before resorting to extraordinary collection actions including lawsuits, wage garnishments, and adverse credit reporting. This study analyzes public comments to the proposed Internal Revenue Service rule on section 501(r)(6). After an initial review of the data, 5 commonly mentioned issues were identified. Respondents were organized into commenter types, and the opinion of each respondent to each issue was coded by 2 separate reviewers. Discrepancies between reviewer determinations were resolved by consensus during follow-up discussions. This analysis revealed a set of common concerns: whether reporting delinquent medical debt to credit bureaus and selling debt to third party buyers should be considered extraordinary collection actions; whether hospitals should be able to use presumptive eligibility to rule patients either eligible or ineligible for financial assistance; and whether hospitals should be held legally liable for the actions of third-party debt collectors. Hospitals and debt collection agencies were allied on most issues, particularly in their shared belief that reporting debt to credit bureaus and selling debt to third parties should not be tightly regulated. Patient advocacy organizations and hospitals had divergent opinions on most issues. The alliance of hospitals and debt collectors in advocating for fewer regulations around collections is part of a history of hospital lobbying to maintain tax-exemption with fewer charity care mandates. This alignment helps explain why third-party debt collection agencies, and aggressive collection tactics, have become commonplace in hospital billing.

Comprehensive Medical History Interview: Practical Guidance

Abstract Independent medical evaluations (IMEs), impairment assessments, and providing clinical care mandate obtaining an appropriate history. The medical interview is a crucial component for obtaining an accurate and complete medical history for IMEs, which requires interpersonal and analytical skills. The interview is a purposeful conversation aimed at understanding the patient's experiences, with a focus on verbal and nonverbal cues, to help build a comprehensive understanding of the patient's injury and current problems within the context of their overall health. The extent of history that is documented depends on the purpose of the evaluation and the nature of the injury. The process involves documenting chief complaints, injury details, pre-existing conditions, clinical course, current symptoms, and functional and past medical history.

Comprehensive program development for congenital heart disease in the United Arab Emirates and in Singapore

Background/Objective. Establishment and development of tertiary-care centres for congenital heart disease (CHD) face multiple challenges as they need to be accessible, affordable/sustainable and provide the best possible outcomes. We report our experience of foundation a new tertiary-care CHD centre in the United Arab Emirates (UAE) and program development in Singapore.
 Methods. Prevalence and incidence of CHD in the context of local sociocultural environment was reviewed. Having established program elements of team, premises and workflow, quality assurance system was established. Outcome analysis, continuous audit modified internal therapeutic policies in accordance to international databases.
 Results. Consanguinity, segregated pattern of the population, high birth rate and low prenatal screening rate increased the incidence/prevalence and complexity of CHD in the UAE. Higher complexity/redo presentation and presence of associated anomalies were prevalent in Singapore at a lower birth rate. Increasing patient-load, strict professional working environment, strong governmental financial mandate for care nominated our centre into a market-leading position in the UAE. Singapore has a highly-developed, regulated, still competitive healthcare infrastructure that represents challenges for program development. Additional surgical activity from underserviced regions could provide the adequate CHD patient-pool that is critical to achieve team-expertise and ensure the best possible patient and program outcomes.
 Conclusion. CHD has significant public health aspects, however, new and/or developing centres face different challenges depending on the sociocultural and economic environment they function in. External demographic factors, case-load, complexity, referral patterns, health-care financing structure are difficult to adjust; internal factors: program structure, quality assurance, professional working framework are subjects for improvement.

Alleviating Medical Debt in the United States.

Alleviating Medical Debt in the United States.

Profile of the multicenter cohort of the German Cancer Consortium’s Clinical Communication Platform

Treatment concepts in oncology are becoming increasingly personalized and diverse. Successively, changes in standards of care mandate continuous monitoring of patient pathways and clinical outcomes based on large, representative real-world data. The German Cancer Consortium’s (DKTK) Clinical Communication Platform (CCP) provides such opportunity. Connecting fourteen university hospital-based cancer centers, the CCP relies on a federated IT-infrastructure sourcing data from facility-based cancer registry units and biobanks. Federated analyses resulted in a cohort of 600,915 patients, out of which 232,991 were incident since 2013 and for which a comprehensive documentation is available. Next to demographic data (i.e., age at diagnosis: 2.0% 0–20 years, 8.3% 21–40 years, 30.9% 41–60 years, 50.1% 61–80 years, 8.8% 81+ years; and gender: 45.2% female, 54.7% male, 0.1% other) and diagnoses (five most frequent tumor origins: 22,523 prostate, 18,409 breast, 15,575 lung, 13,964 skin/malignant melanoma, 9005 brain), the cohort dataset contains information about therapeutic interventions and response assessments and is connected to 287,883 liquid and tissue biosamples. Focusing on diagnoses and therapy-sequences, showcase analyses of diagnosis-specific sub-cohorts (pancreas, larynx, kidney, thyroid gland) demonstrate the analytical opportunities offered by the cohort’s data. Due to its data granularity and size, the cohort is a potential catalyst for translational cancer research. It provides rapid access to comprehensive patient groups and may improve the understanding of the clinical course of various (even rare) malignancies. Therefore, the cohort may serve as a decisions-making tool for clinical trial design and contributes to the evaluation of scientific findings under real-world conditions.

The Halachic Mandate for Gender Affirming Care: Examining the Potential Efficacy of Religious Liberty Claims made by Jewish Health Care Providers

In the wake of Dobbs v. Jackson Women's Health Organization, many states enacted anti-abortion statutes which could be challenged by Jewish individuals and institutions who believe that such laws threaten their religious liberties.229 Although a valiant effort, it is necessary to take a precautionary approach to challenging such laws on grounds of religious freedom, for successfully doing so could have reeling effects on LGBTQ+, BIPOC, and other marginalized communities. This article takes a bottom-up approach to such claims and investigates whether a religious liberty argument can and should be made against anti-trans laws.

Grief Coach, a Text-Based Grief Support Intervention: Acceptability Among Hospice Family Members.

U.S. Medicare-certified hospices must provide bereavement care to family members for 13months following a patient's death. This manuscript describes Grief Coach, a text message program that delivers expert grief support and can assist hospices in meeting the bereavement care mandate. It also describes the first 350 Grief Coach subscribers from hospice and the results of a survey of active subscribers (n = 154) to learn whether and how they found the program helpful. The 13-month program retention rate was 86%. Among survey respondents (n = 100, response rate = 65%), 73% rated the program as very helpful, and 74% rated it as contributing to their sense of being supported in their grief. Grievers aged 65+ and males gave the highest ratings. Respondents' comments identify key intervention content that they found helpful. These findings suggest that Grief Coach may be a promising component of hospice grief support programming to meet the needs of grieving family members.

The Preferential Option for the Poor and Participation

Catholic health care has long been focused on the needs of the poor, yet its primary interaction with the poor is in the delivery of health care and not within leadership. The preferential option for the poor is one tool that leads to greater participation. Especially important is the hermeneutic element that Pope Francis emphasizes. While some government programs already include those who are poor in leadership, Catholic health care is only starting to grapple with the Pope’s challenge. This essay explores inclusion of the poor in governance and strategic planning, revealing a better way to engage with those who are poor and give a better witness to the Gospel mandate for Catholic health care.

Perceptions of Health Insurance Among Self-employed Korean Immigrants From South Korea in the United States.

Korean Americans in the United States are more likely than other Asian ethnic groups to lack health insurance despite their high education and economic prosperity. According to the model of health service selection, immigrants' perceptions of the health care system and health care behaviors in their host country are affected by sociocultural referents including premigration health care experience in the country of origin. This study explored Korean immigrants' perceptions of health insurance and their intentions to purchase and maintain health insurance in the United States. We conducted in-depth interviews with 24 self-employed Korean immigrants who migrated from South Korea and were living in the Greater Los Angeles area in 2015. Participants generally had negative perceptions of U.S. health insurance in terms of cost, benefits, simplicity, and accessibility. Coupled with their positive experiences with the single-payer, universal health insurance in South Korea, respondents evaluated U.S. health insurance as not worth purchasing, and indicated they would not maintain health insurance once the individual mandate of the Affordable Care Act was abolished. On the contrary, respondents who immigrated prior to the establishment of the Korean universal health insurance in South Korea were relatively satisfied with U.S. health insurance and had maintained health insurance for substantial periods of time. Korean immigrants' premigration health care experiences appeared to influence their decisions to purchase health insurance in the United States and their intention to maintain health insurance. The study findings highlight the necessity of tailored health education that takes into account sociocultural determinants of health coverage among immigrants.

Ambivalence in Child Protection Proceedings: Parents’ Views on Their Interactions with Child Protection Authorities

Child protection is a field characterized by intrinsic tensions and ambivalence, related to the state’s intervention in the family sphere and to a double mandate of care and control. This article focuses on the participation of parents in statutory child protection proceedings and the ambivalence they experience in their interactions with the Child and Adult Protection Authority in Switzerland (CAPA). The aim is to explore parents’ views on what they consider as hindering or enabling in their interactions with the CAPA in order to be able to fully participate in child protection proceedings. The article is based on a large interdisciplinary research project including multi-perspective cases collected in four cantons of Switzerland and puts the focus on in-depth interviews with ten birth parents. Results show that ambivalence is inherent to the interactions between parents and the CAPA, as the mere opening of child protection proceedings is experienced as a threat to the parents’ integrity. Establishing trust, recognizing parents’ expertise and acknowledging their needs are key to re-establishing parental integrity, which seems to be a fundamental pre-requisite for reducing ambivalence and enhancing participation in child protection proceedings.

Louisiana State Penitentiary: A Textual Analysis of Correctional Staff Views on End-of-Life Care.

As prison-based hospice programs are slowly implemented across the United States, scarce attention has been devoted to the views of correctional staff who provide essential end-of-life care to dying incarcerated individuals. These professionals must maneuver their diverse responsibilities and emotional perspectives to deliver compassionate care to a marginalized population. A textual analysis of narratives of correctional staff participating in the hospice program at Louisiana State Penitentiary was incorporated to explore the transformative experiences resulting from staff members' collaboration with incarcerated volunteers to dispense hospice-based care for critically ill incarcerated individuals. Prevalent themes focus on provider identity, role satisfaction, bonds with incarcerated individuals, and achieving care mandates. Future research should further examine end-of-life care provider narratives to effectively address the unmet needs of dying incarcerated individuals.

The impact of the repeal of the federal individual insurance mandate on uninsurance.

The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019. However, some states implemented state-level insurance mandates which essentially replaced the federal mandate. I use nationally representative survey data from the 2015–19 Annual Social and Economic Supplement to the Current Population Survey to compare the probability of becoming newly uninsured among people living in states without state-level insurance mandates versus states with a mandate, before and after the 2019 repeal. In a sample of 214,821 lower-income, nonelderly adults, the repeal of the federal mandate was associated with a 0.5% point, or 24%, increase in the year-over-year probability of becoming newly uninsured. These results suggest that people respond to financial incentives when making insurance enrollment decisions. In the absence of a federal mandate, state-level mandates may reduce transitions to uninsurance.

The impact of US policy on contraceptive access: a policy analysis

BackgroundContraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policy on contraceptive access.MethodsFederal policy changes impacting contraceptive access over the past decade were identified in grey literature. These policy changes were organized into a timeline and analyzed according to Levesque et al.'s (2013) five dimensions of healthcare access (approachability, acceptability, availability/accommodation, affordability, and appropriateness), noting the most salient healthcare dimension impacted by the policy change and analyzing whether, according to this framework, the policy created a theoretical increase or decrease in contraceptive access.ResultsOf those policy changes coded as increasing (n = 42) and decreasing (n = 28) contraceptive access, most were related to the affordability (increasing n = 13; decreasing n = 12), physical availability (increasing n = 10; decreasing n = 7), and appropriateness (increasing n = 12; decreasing n = 4) of contraceptive care. Policy changes largely followed partisan divides, with contraceptive access increasing in years with a Democratic president and decreasing when a Republican president was in office. Many policy changes were related to the Affordable Care Act (ACA) and Title X of the Public Health Services Act. The implementation of the ACA and subsequent updates to it have increased the affordability of contraception, whereas changes to Title X have decreased the availability and appropriateness of contraceptive care.ConclusionsThis study highlights recent policy changes impacting contraceptive access, organizing them according to the five dimensions of healthcare access. It outlines specific policy barriers to contraceptive access and provides suggestions for policy and practice action that will improve contraceptive access and reproductive autonomy. Opportunities to ensure contraceptive access for all Americans include promoting comprehensive sex education, extending the Community Health Center Fund, increasing contraceptive care options for people with employers who are exempted from the ACA contraceptive mandate, addressing discrimination and building trust in contraceptive care, and amplifying outreach efforts to combat misinformation and confusion created by continuous changes to key family planning policies. Continued research on the role of policy in determining reproductive autonomy is warranted, and practice and policy action is needed to improve contraceptive access.

Insurance Stability of Individuals With First-Episode Psychosis.

Insurance Stability of Individuals With First-Episode Psychosis.