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Cameron J. Gettel MD MHS Peter T. Serina MD MPH Ivie Uzamere BA Kizzy Hernandez-Bigos BA Arjun K. Venkatesh MD MBA MHS Kristin L. Rising MD MSHP Elizabeth M. Goldberg MD ScM Shelli L. Feder PhD APRN Andrew B. Cohen MD DPhil Ula Hwang MD MPH 《Journal of the American Geriatrics Society》2022,70(11):3152-3162
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Skilled nursing facilities (SNF) represent a common postdischarge destination for hospitalized older adults. The goals of SNF care include the completion of extended skilled nursing care and physical rehabilitation to enable patients to safely return home. However, nearly one in four older adults discharged to SNF are rehospitalized and one in five seek care in the emergency department (ED) but are discharged back to SNF. Our aim was to measure the national prevalence and costs to Medicare of ED visits by SNF patients. Of the 1,551,703 Medicare beneficiaries discharged to SNF in 2019, 16.3% had an ED visit within 14 days (n = 253,104). Of those ED visits, 25.5% resulted in a same-day discharge back to SNF (n = 64,472), costing Medicare $24.6 million. Novel care models that can leverage SNF staff and resources while providing rapid diagnostic services are urgently needed. 相似文献
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Jenny Ruiz MD MSCE Yimei Li PhD Lusha Cao PhD Yuan-Shung V. Huang MS Vicky Tam MA Heather M. Griffis PhD Lena E. Winestone MD MSHP Brian T. Fisher DO MSCE Todd A. Alonzo PhD Yi-Cheng J. Wang MS Alice T. Dang MPH E. Anders Kolb MD Karen Glanz PhD MPH Kelly D. Getz PhD Richard Aplenc MD MSCE PhD Alix E. Seif MD MPH 《Cancer》2024,130(6):962-972
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Monique Jindal MD MPH Krisda H. Chaiyachati MD MPH MSHP Vicki Fung PhD Spero M. Manson PhD Karoline Mortensen PhD 《Health services research》2023,58(Z3):300-310
Objective
To provide a research agenda and recommendations to address inequities in access to health care.Data Sources and Study Setting
The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government.Study Design
Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations.Data Collection/Extraction Methods
Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased.Principal Findings
The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access.Conclusions
AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations. 相似文献39.