Population Health Management

Health systems are integrating interventions to assist patients with food insecurity; however, people need varying levels of support. Rather than using a single intervention, adaptively providing interventions may be a more effective approach. The authors conducted a pilot, sequential, multiple-assignment randomized trial to determine the feasibility of an adaptive food insecurity intervention. Adults with uncontrolled hypertension who reported food insecurity were randomized to one of two interventions for 3 months in Stage 1: information about community resources or community health worker (CHW) support. Participants who did not have ≥10 mmHg improvement in systolic blood pressure at 3 months were re-randomized to CHW support or the delivery of medically tailored meals (MTM) in Stage 2 for an additional 3 months. We evaluated the proportion who enrolled, completed follow-up, and had an improvement in blood pressure. Sixty of 61 (98.3%) eligible patients enrolled. Four withdrew, 46 of 56 (82.1%) completed the 3-month follow-up, and 40 of 56 (71.4%) completed the 6-month follow-up. Of 27 randomized to resource information, 15 (55.6%) did not have ≥10 mmHg improvement and were re-randomized. Of 29 randomized to CHW support, 14 (48.3%) were re-randomized. The adaptive intervention that provided CHW support in Stage 1 and additional CHW support in Stage 2 resulted in 46.7% of participants with ≥10 mmHg improvement in systolic blood pressure at 6 months. The adaptive intervention that provided CHW support in Stage 1 and MTM in Stage 2 resulted in 66.7% of participants with ≥10 mmHg improvement. This study found that an adaptive food insecurity intervention was feasible to utilize.

Arthritis is a major health concern in middle-aged and older people. In females, estrogen decline after midlife may exacerbate abnormal adiposity and thereby heighten arthritis risk. Given China’s large population, clarifying the relationship between fat mass and arthritis in middle-aged and older Chinese females is of great public-health importance. To explore the relationship between relative fat mass (RFM) and incident arthritis in middle-aged and older Chinese females. This population-based longitudinal study included 3874 females from the China Health and Retirement Longitudinal Study. Logistic regression and restricted cubic splines (RCS) evaluated the relationship between RFM and arthritis. Subgroup and interaction analyses explored potential heterogeneity across age groups and subgroups defined by chronic disease status. After full adjustment, females in the third (Q3 OR = 1.70, 95% CI: 1.24–2.33, P < 0.001) and fourth (Q4 OR = 1.67, 95% CI: 1.13–2.47, P = 0.010) RFM quartiles exhibited significantly higher odds of incident arthritis compared with those in the lowest quartile (Q1). Across the full study population and within the stratum of women below 60 years, RCS disclosed a statistically significant association between arthritis risk and RFM (P_overall < 0.05), with no indication of nonlinearity (P_nonlinear > 0.05). Subgroup analyses revealed no evidence of effect modification (P_interaction > 0.05). Higher levels of RFM are associated with increased risk of new-onset arthritis in middle-aged and older Chinese females, providing a crucial indicator for the early screening of female arthritis and indicating a potential for controlling arthritis incidence by targeted body fat management.

Colorectal cancer (CRC) incidence and death rates are increasing among people under age 50 in the United States. In addition to promoting on-time screening for average-risk adults starting at age 45, CRC signs and symptoms may need timely assessment by a health care provider to rule out other conditions and identify a diagnosis. The objective of this study was to examine primary care providers’ (PCPs’) awareness of CRC-related symptoms and their diagnostic approaches for patients under age 50 using the 2023 DocStyles panel survey. This survey included 1490 PCPs practicing in the United States. A descriptive analysis was conducted to examine symptom awareness and referral practices. Log binomial regression was used to examine predictors of greater symptom awareness. Symptom awareness of early-onset CRC was highest for changes in bowel habits (79%) and lowest for abdominal pain (43%). Fewer obstetricians/gynecologists and physician assistants were aware of CRC signs and symptoms. Most PCPs would complete a workup and assess patients for family history of cancer for patients presenting with rectal bleeding/bloody stools, iron deficiency anemia, or changes in bowel habits. Around 45% of PCPs would refer patients with rectal bleeding/bloody stools to diagnostic colonoscopy or offer a stool-based screening test. Some PCPs may benefit from additional training on signs and symptoms of early-onset CRC and evidence-based guidelines for symptom assessment. These findings indicate that many PCPs prefer to complete a medical workup and assess for family history of cancer as first steps, and most would not immediately refer patients to diagnostic colonoscopy.

Preventable readmissions represent a significant opportunity to improve quality and reduce healthcare costs, with approximately 26% of Medicare medicine readmissions considered preventable. However, evidence on the effectiveness of post-discharge interventions at scale remains mixed, and implementing evidence-based practices consistently across large, diverse health systems is a challenge. To address these concerns, the Mass General Brigham Population Health Services Organization (MGB PHSO) developed and implemented a novel, multidisciplinary, system-wide post-discharge intervention aimed at reducing 30-day readmissions within its Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO). It was hypothesized that standardizing delivery through a high-fidelity workflow would reduce readmissions. A standardized, multidisciplinary program was created involving: (1) a coordinator conducting chart review and obtaining records; (2) a pharmacist performing medication reconciliation; and (3) a registered nurse completing a post-discharge assessment. A prospective cohort study was conducted comparing the outcomes of patients at pilot intervention sites with those of a propensity-matched control group. The intervention cohort showed a directional reduction in 30-day readmission rates compared to the matched controls (13.5% vs. 16.3%, P = 0.07) but no significant difference in 30-day emergency department presentations. The intervention group also had a significantly higher rate of 14-day follow-up appointments (70.0% vs. 65.3%, P = 0.025). These findings support the effectiveness of a centralized, standardized post-discharge strategy for reducing readmissions within an ACO setting. This study demonstrates that structured, system-level interventions can improve care transitions and outcomes in value-based care models.

Health systems worldwide are challenged by the need to prioritize and fund rapidly evolving health technologies. The methodology of health technology assessment (HTA) incorporates benefits, costs, and social implications, supporting prioritization of public coverage regarding national health policy. The aim of this study is to identify, analyze, and compare key considerations in the adoption of medical technologies reflecting the national health policies in Israel and England. All Israeli pharmaceuticals approved for public funding during 2020–2022 (287) were analyzed and compared with England recommendations concerned clinical effectiveness, economic considerations, and social values. Both health systems demonstrated 49% agreement regarding approval of funding recommendations policy, while in oncology, diabetes, and hematology, this reached 60%–65%. In both health systems, adoption was determined by clinical impact considering the disease burden and regarding the added value of the innovative technology compared with existing treatments, followed by social considerations. Budget considerations prevail in England. This relatively high resemblance in adoption decisions between England and Israel may emerge from similar principles of accountability for public coverage of medical care. In addition, it may also be driven by the forefront of innovative technological research worldwide and global interest. Nevertheless, economic considerations differ between the 2 health systems, introducing policy discrepancies or tactical diversity.

Geographic and socioeconomic disparities in access to mental health care contribute to overall health inequity. Identifying scalable interventions that expand access to affordable and effective care remains a critical priority. This retrospective cohort study analyzed medical claims and census-level socioeconomic data from 742,658 individuals representing 90.9% of all US counties who were eligible for an employer-sponsored mental health benefit. Mental health service utilization was compared between individuals who accessed care through the benefit program and those who used the traditional health plan, across levels of socioeconomic disadvantage as measured by the area deprivation index. Program implementation was associated with a 36% relative increase in mental health care use overall compared to health plan utilization in the prior year. Following program implementation, care initiation increased equitably among program users, while disparities by area deprivation persisted among health plan users. Program users also had more equitable care retention and therapy duration across deprivation levels, whereas disparities increased among health plan users. Program initiation was positively associated with the number of employer-sponsored sessions, with a stronger association observed among individuals in high-deprivation areas. Lastly, program use was associated with significant reductions in anxiety and depression symptoms, with comparable treatment effects across deprivation levels. The benefit program was associated with more equitable care initiation and reduced socioeconomic disparities in engagement relative to traditional plans. Program users also experienced significant clinical improvements across deprivation levels. These findings highlight opportunities to reduce systemic barriers and promote equitable access to mental health care through scalable, real-world interventions.

Unpaid caregiving is associated with significant burdens, including financial strain, time constraints, diminished quality of life, and elevated stress levels. Despite these challenges, existing literature on disease burdens devotes limited attention to caregiver experiences. The aim of this scoping literature review was to identify instruments used to measure caregiver burden to better inform future studies of caregiver costs. This study included articles that estimated the costs or burdens associated with unpaid caregiving to patients in the United States and used a survey or cohort study design to conduct primary or secondary quantitative data analysis. Across the 46 articles abstracted, 27 unique survey instruments were identified; 23 (89%) instruments were validated, 12 (46%) were publicly available, and 14 (54%) were designed for or validated among caregivers. Among studies included in this review, 18 (39%) studies designed their own questionnaires to assess caregiver burden. This review additionally identified six nonsurvey data sources, such as medical claims data, used to estimate caregiver costs. The heterogeneity across measurement tools limits comparability across studies. Standardized, validated, and accessible instruments are essential for understanding caregiver burdens and advancing research to improve outcomes for patients and their caregivers.