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Objectives This study examined the association between hospital participation in Bundled Payments for Care Improvement (BPCI) or Comprehensive Care for Joint Replacement (CJR) and the timely initiation of home health rehabilitation services for lower extremity joint replacements. Furthermore, this study examined the association between the timely initiation of home health rehabilitation services with improvement in self-care, mobility, and 90-day hospital readmission. Method This retrospective cohort study used Medicare inpatient claims and home health assessment data from 2016 to 2017 for older adults discharged to home with home health following hospitalization after joint replacement. Multilevel multivariate logistic regression was used to examine the association between hospital participation in BPCI or CJR programs and timely initiation of home health rehabilitation service. A 2-staged generalized boosted model was used to examine the association between delay in home health initiation and improvement in self-care, mobility, and 90-day risk-adjusted hospital readmission. Results Compared with patients discharged from hospitals that did not have BPCI or CJR, patients discharged from hospitals with these programs had a lower likelihood of delayed initiation of home health rehabilitation services for both knees and hip replacement. Using propensity scores as the inverse probability of treatment weights, delay in the initiation of home health rehabilitation services was associated with lower improvement in self-care (odds ratio [OR] = 1.23; 95% CI = 1.20–1.26), mobility (OR = 1.15; 95% CI = 1.13–1.18), and higher rate of 90-day hospital readmission (OR = 1.19; 95% CI = 1.15–1.24) for knee replacement. Likewise, delayed initiation of home health rehabilitation services was associated with lower improvement in self-care (OR = 1.16; 95% CI = 1.13–1.20) and mobility (OR = 1.26; 95% CI = 1.22–1.30) for hip replacement. Conclusion Hospital participation in BPCI or comprehensive CJR was associated with early home health rehabilitation care initiation, which was further associated with significant increases in functional recovery and lower risks of hospital readmission. Impact Policy makers may consider incentivizing health care providers to initiate early home health services and care coordination in value-based payment models. [ABSTRACT FROM AUTHOR]

Timely access and continuum of care in older adults with Alzheimer's Disease and Related Dementia (ADRD) is critical. This is a retrospective study on Medicare fee-for-service beneficiaries with ADRD diagnosis discharged to home with home health care following an episode of acute hospitalization. Our sample included 262,525 patients. White patients in rural areas have significantly higher odds of delay (odds ratio [OR], 1.03; 95% CI, 1.01–1.06). Black patients in urban areas (OR, 1.15; 95% CI, 1.12–1.19) and Hispanic patients in urban areas also were more likely to have a delay (OR, 1.07; 95% CI, 1.03–1.11). Black and Hispanic patients residing in urban areas had a higher likelihood of delay in home healthcare initiation following hospitalization compared to Whites residing in urban areas. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We examined differences in the timeliness of the initiation of home health care by race and the quality of home health agencies (HHA) among patients with Alzheimer's disease and related dementias (ADRD). METHODS: Medicare claims and home health assessment data were used for the study cohort: individuals aged ≥65 years with ADRD, and discharged from the hospital. Home health latency was defined as patients receiving home health care after 2 days following hospital discharge. RESULTS: Of 251,887 patients with ADRD, 57% received home health within 2 days following hospital discharge. Black patients were significantly more likely to experience home health latency (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.11–1.19) compared to White patients. Home health latency was significantly higher for Black patients in low‐rating HHA (OR = 1.29, 95% CI = 1.22–1.37) compared to White patients in high‐rating HHA. DISCUSSION: Black patients are more likely to experience a delay in home health care initiation than White patients. [ABSTRACT FROM AUTHOR]

Objectives: To examine the role COVID‐19 had on access to dental services among children in Arizona by comparing paid pediatric dental claims made before and during the pandemic. Methods: In a retrospective descriptive study, we examined Medicaid paid claims for dental services among pediatric patients from March through December 2019 and during the outbreak in 2020. Using dental claims data obtained from the Centers for Health Information and Research at Arizona State University (ASU), we analyzed Medicaid (Arizona Health Care Cost Containment System [AHCCCS]) reimbursed dental services. Results: During the COVID‐19 pandemic, paid preventive dental claims for children aged birth to 21 years decreased in 2020 compared to the same time period in 2019. Pediatric patients in Arizona utilized fewer dental services and had less access to credentialed Medicaid dental providers during the pandemic. Further, rural counties had statistically significant fewer preventive, minor restorative, major restorative, and endodontic claims compared to urban counties. Arizona rural counties also had fewer providers who were paid $10,000 or more per year during 2020 than in 2019. Conclusions: COVID‐19 has had a detrimental impact on pediatric dental service utilization. While dental services were provided during the COVID‐19 pandemic, preventive and restorative dental claims dropped for rural Arizona children aged birth to 21 years. This reveals potential negative impacts on oral health. Further research should examine the direct and indirect impact the COVID‐19 pandemic has had on dental service utilization and oral health for the general pediatric population. [ABSTRACT FROM AUTHOR]

Objective Provision of early rehabilitation services during acute hospitalization after a hip fracture is vital for improving patient outcomes. The purpose of this study was to examine the association between the amount of rehabilitation services received during the acute care stay and hospital readmission in older patients after a hip fracture. Methods Medicare claims data (2016–2017) for older adults admitted to acute hospitals for a hip fracture (n = 131,127) were used. Hospital-based rehabilitation (physical therapy, occupational therapy, or both) was categorized into tertiles by minutes per day as low (median = 17.5), middle (median = 30.0), and high (median = 48.8). The study outcome was risk-adjusted 7-day and 30-day all-cause hospital readmission. Results The median hospital stay was 5 days (interquartile range [IQR] = 4–6 days). The median rehabilitation minutes per day was 30 (IQR = 21–42.5 minutes), with 17 (IQR = 12.6–20.6 minutes) in the low tertile, 30 (IQR = 12.6–20.6 minutes) in the middle tertile, and 48.8 (IQR = 42.8–60.0 minutes) in the high tertile. Compared with high therapy minutes groups, those in the low and middle tertiles had higher odds of a 30-day readmission (low tertile: odds ratio [OR] = 1.11, 95% CI = 1.06–1.17; middle tertile: OR = 1.07, 95% CI = 1.02–1.12). In addition, patients who received low rehabilitation volume had higher odds of a 7-day readmission (OR = 1.20; 95% CI = 1.10–1.30) compared with high volume. Conclusion Elderly patients with hip fractures who received less rehabilitation were at higher risk of readmission within 7 and 30 days. Impact These findings confirm the need to update clinical guidelines in the provision of early rehabilitation services to improve patient outcomes during acute hospital stays for individuals with hip fracture. Lay summary There is significant individual- and hospital-level variation in the amount of hospital-based rehabilitation delivered to older adults during hip fracture hospitalization. Higher intensity of hospital-based rehabilitation care was associated with a lower risk of hospital readmission within 7 and 30 days. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate the potential geospatial relationship between agricultural pesticide use and two cancer metrics (pediatric cancer incidence and total cancer incidence) across each of the 11 contiguous states in the Western United States at state and county resolution. The pesticide usage data were collected from the U.S. Geological Survey Pesticide National Synthesis Project database, while cancer data for each state were compiled from the National Cancer Institute State Cancer Profiles. At the state spatial scale, this study identified a significant positive association between the total mass of fumigants and pediatric cancer incidence, and also between the mass of one fumigant in particular, metam, and total cancer incidence (P‐value < 0.05). At the county scale, the relationship of all cancer incidence to pesticide usage was evaluated using a multilevel model including pesticide mass and pesticide mass tertiles. Low pediatric cancer rates in many counties precluded this type of evaluation in association with pesticide usage. At the county scale, the multilevel model using fumigant mass, fumigant mass tertiles, county, and state predicted the total cancer incidence (R‐squared = 0.95, NSE = 0.91, and Sum of square of residuals [SSR] = 8.22). Moreover, this study identified significant associations between total fumigant mass, high and medium tertiles of fumigant mass, total pesticide mass, and high tertiles of pesticide mass relative to total cancer incidence across counties. Fumigant application rate was shown to be important relative to the incidence of total cancer and pediatric cancer, at both state and county scales. Plain Language Summary: The objective of the study was to evaluate the associations between agricultural pesticide usage and cancer incidence among adults and children. The analysis was conducted in the 11 neighboring states in the western U.S. We collected the information on agricultural pesticide usage from the U.S. Geological Survey Pesticide National Synthesis Project database. The data on cancer incidence among adults and children were collected from the National Cancer Institute State Cancer Profiles. We find that the agricultural pesticide type, namely fumigants, are associated with the cancer incidence among adults and children in the western U.S. The most predominant fumigant, metam was also found to be associated with cancer incidence among adults. A model was developed in this study to predict cancer incidence among adults using pesticide usage information. The study infers that the agricultural pesticide type, fumigants are important relative to cancer incidence among adults and children. Key Points: This study analyzed the geospatial relationship between cancer metrics and pesticide usage in the 11 western states of the United StatesA multilevel model was employed, which accurately estimated the cancer incidence at county spatial resolutionFumigants were found to be statistically significantly associated with cancer incidence at both state and county spatial scales [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to examine the impact of hospital-based rehabilitation services on community discharge rates after hip and knee replacement surgery according to hospital participation in value-based care models: bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR). The secondary objective was to determine whether community discharge rates after hip and knee replacement surgery differed by participation in these models. Methods. A secondary analysis of Medicare fee-for-service claims was conducted for beneficiaries 65 years of age or older who underwent hip and knee replacement surgery from 2016 to 2017. Independent variables were hospital participation in value-based programs categorized as: (1) BPCI, (2) CJR, and (3) non-BPCI/CJR; and total minutes per day of hospital-based rehabilitation services categorized into tertiles. The primary outcome variable was discharged to the community versus discharged to institutional post-acute care settings. The association between rehabilitation amount and community discharge among BPCI, CJR, and non-BPCI/CJR hospitals was adjusted for patient-level clinical and hospital characteristics. Results. Participation in BPCI or CJR was not associated with community discharge. This analysis found a dose--response relationship between the amount of rehabilitation services and odds of community discharge. Among those who received a hip replacement, this relationship was most pronounced in the BPCI group; compared with the low rehabilitation category, the medium category had odds ratio (OR)=1.28 (95% CI=1.17 to 1.41), and the high category had OR=1.90 (95% CI=1.71 to 2.11). For those who received a knee replacement, there was a dose--response relationship in the CJR group only; compared with the low rehabilitation category, the medium category had OR=1.21 (95% CI=1.15 to 1.28), and the high category had OR=1.56 (95% CI=1.46 to 1.66). Conclusion. Regardless of hospital participation in BPCI or CJR models, higher amounts of rehabilitation services delivered during acute hospitalization is associated with a higher likelihood of discharge to community following hip and knee replacement surgery. Impact. In the era of value-based care, frontloading of rehabilitation care is vital for improving patient-centered health outcomes in acute phases of lower extremity joint replacement. [ABSTRACT FROM AUTHOR]

Objectives: This article assessed whether disparities among ADRD Medicare beneficiaries existed in five different long-stay quality measures. Methods: We linked individual-level data and facility-level characteristics. The main quality outcomes included whether residents: 1) were assessed/appropriately given the seasonal influenza vaccine; 2) received an antipsychotic medication; 3) experienced one/more falls with major injury; 4) were physically restrained; and 5) lost too much weight. Results: In 2016, there were 1,005,781 Medicare Advantage and fee-for-service long-term residents. About 78% were White, 13% Black, 2% Asian/Pacific Islander (Asian/PI), 6% Hispanic, and 0.4% American Indian/Alaska Native (AI/AN). Whites reported higher use of antipsychotic medications along with Hispanics and AI/AN (28%, 28%, and 27%, respectively). Similarly, Whites and AIs/ANs reported having one/more falls compared to the other groups (9% and 8%, respectively). Discussion: Efforts to understand disparities in access and quality of care among American Indians/Alaska Natives are needed, especially post-pandemic. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has disproportionately affected racial and ethnic minorities in the United States and has been devastating for residents of nursing homes (NHs). However, evidence on racial and ethnic disparities in COVID-19–related mortality rates within NHs and how that has changed over time has been limited. This study examines the impact of a high proportion of minority residents in NHs on COVID-19–related mortality rates over a 30-week period. Longitudinal study. Centers for Medicare & Medicaid Services Nursing Home COVID-19 Public Use File data from 50 states from June 1, 2020, to December 27, 2020. We linked data from 11,718 NHs to (1) Nursing Home Compare data, (2) the Long-Term Care: Facts on Care in the U.S., and (3) US county-level data on COVID cases and deaths. Our primary independent variable was proportion of minority residents (blacks and Hispanics) in NHs and its association with mortality rate over time. During the first 6 weeks from June 1, 2020, NHs with a higher proportion of black residents reported more COVID-19 deaths per 1000 followed by NHs with a higher proportion of Hispanic residents. Between 7 and 12 weeks, NHs with a higher proportion of Hispanic residents reported more deaths per 1000, followed by NHs with a higher proportion of black residents. However, after 23 weeks (mid-November 2020), NHs serving a higher proportion of white residents reported more deaths per 1000 than NHs serving a high proportion of black and Hispanic residents. The disparities in COVID-19–related mortality for nursing homes serving minority residents is evident for the first 12 weeks of our study period. Policy interventions and the equitable distribution of vaccine are required to mitigate the impact of systemic racial injustice on health outcomes of people of color residing in NHs. [ABSTRACT FROM AUTHOR]