More than 17 million people have gained health insurance coverage through the Patient Protection and Affordable Care Act’s Medicaid expansion. Few studies have examined heterogeneity within the ...Medicaid expansion population. We do so based on time-varying patterns of emergency department (ED) and ambulatory care use, and characterize diagnoses associated with ED and ambulatory care visits to evaluate whether certain diagnoses predominate in individual trajectories.
We used group-based multitrajectory modeling to jointly estimate trajectories of ambulatory care and ED utilization in the first 12 months of enrollment among Pennsylvania Medicaid expansion enrollees from 2015 to 2017.
Among 601,877 expansion enrollees, we identified 6 distinct groups based on joint trajectories of ED and ambulatory care use. Mean ED use varied across groups from 3.4 to 48.7 visits per 100 enrollees in the first month and between 2.8 and 44.0 visits per 100 enrollees in month 12. Mean ambulatory visit rates varied from 0.0 to 179 visits per 100 enrollees in the first month and from 0.0 to 274 visits in month 12. Rates of ED visits did not change over time, but rates of ambulatory care visits increased by at least 50% among 4 groups during the study period. Groups varied on chronic condition diagnoses, including mental health and substance use disorders, as well as diagnoses associated with ambulatory care visits.
We found substantial variation in rates of ED and ambulatory care use across empirically defined subgroups of Medicaid expansion enrollees. We also identified heterogeneity among the diagnoses associated with these visits. This data-driven approach may be used to target resources to encourage efficient use of ED services and support engagement with ambulatory care clinicians.
Background
Prior research on the restaurant environment and obesity risk is limited by cross-sectional data and a focus on specific geographic areas.
Objective
To measure the impact of changes in ...chain restaurant calories over time on body mass index (BMI).
Design
We used a first-difference model to examine whether changes from 2012 to 2015 in chain restaurant calories per capita were associated with percent changes in BMI. We also examined differences by race and county income, restaurant type, and initial body weight categories.
Setting
USA (207 counties across 39 states).
Participants
447,873 adult patients who visited an athenahealth medical provider in 2012 and 2015 where BMI was measured.
Main Outcomes Measured
Percent change in objectively measured BMI from 2012 to 2015.
Results
Across all patients, changes in chain restaurant calories per capita were not associated with percent changes in BMI. For Black or Hispanic adults, a 10% increase in exposure to chain restaurant calories per capita was associated with a 0.16 percentage-point increase in BMI (95% CI 0.03, 0.30). This translates into a predicted weight increase of 0.89 pounds (or a 0.53% BMI increase) for an average weight woman at the 90th percentile of increases in the restaurant environment from 2012 to 2015 versus an increase 0.39 pounds (or 0.23% BMI increase) at the 10th percentile. Greater increases in exposure to chain restaurant calories also significantly increased BMI for Black or Hispanic adults receiving healthcare services in lower-income counties (0.26, 95% CI 0.04, 0.49) and with overweight/obesity (0.16, 95% CI 0.04, 0.29).
Limitations
Generalizability to non-chain restaurants is unknown and the sample of athenahealth patients is relatively homogenous.
Conclusions
Increased exposure to chain restaurant calories per capita was associated with increased weight gain among Black or Hispanic adults.
Abstract Objective The objective is to evaluate whether physician body mass index (BMI) impacts their patients' trust or perceptions of weight-related stigma. Methods We used a national ...cross-sectional survey of 600 non-pregnant overweight and obese patients conducted between April 5 and April 13, 2012. The outcome variables were patient trust (overall and by type of advice) and patient perceptions of weight-related stigma. The independent variable of interest was primary care physician (PCP) BMI. We conducted multivariate regression analyses to determine whether trust or perceived stigma differed by physician BMI, adjusting for covariates. Results Patients reported high levels of trust in their PCPs, regardless of the PCPs body weight (normal BMI = 8.6; overweight = 8.3; obese = 8.2; where 10 is the highest). Trust in diet advice was significantly higher among patients seeing overweight PCPs as compared to normal BMI PCPs (87% vs. 77%, p = 0.04). Reports of feeling judged by their PCP were significantly higher among patients seeing obese PCPs (32%; 95% confidence interval (CI): 23–41) as compared to patients seeing normal BMI PCPs (14%; 95% CI: 7–20). Conclusion Overweight and obese patients generally trust their PCP, but they more strongly trust diet advice from overweight PCPs as compared to normal BMI PCPs.
Background: The "Unborn Child" (UC) option provides state Medicaid/Children's Health Insurance Program (CHIP) programs with a new strategy to extend prenatal coverage to low-income women who would ...otherwise have difficulty enrolling in or would be ineligible for Medicaid. Objectives: To examine the association of the UC option with the probability of enrollment in Medicaid/CHIP during pregnancy and probability of receiving adequate prenatal care. Research Design: We use pooled cross-sectional data from the Pregnancy Risk Assessment Monitoring System from 32 states between 2004 and 2010 (n=81,983). Multivariable regression is employed to examine the association of the UC option with Medicaid/CHIP enrollment during pregnancy among eligible women who were uninsured preconception (n=45,082) and those who had insurance (but not Medicaid) preconception (n=36,901). Multivariable regression is also employed to assess the association between the UC option and receipt of adequate prenatal care, measured by the Adequacy of Prenatal Care Utilization Index. Results: Residing in a state with the UC option is associated with a greater probability of Medicaid enrollment during pregnancy relative to residing in a state without the policy both among women uninsured preconception (88% vs. 77%, P<0.01) and among women insured (but not in Medicaid) preconception (40% vs. 31%, P<0.01). Residing in a state with the UC option is not significantly associated with receiving adequate prenatal care, among both women with and without insurance preconception. Conclusions: The UC option provides states a key way to expand or simplify prenatal insurance coverage, but further policy efforts are needed to ensure that coverage improves access to high-quality prenatal care.
Calorie Changes in Large Chain Restaurants Bleich, Sara N., PhD; Wolfson, Julia A., MPP; Jarlenski, Marian P., PhD, MPH
American journal of preventive medicine,
2016, January 2016, 2016-01-00, Letnik:
50, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Introduction Large chain restaurants reduced the number of calories in newly introduced menu items in 2013 by about 60 calories (or 12%) relative to 2012. This paper describes trends in calories ...available in large U.S. chain restaurants to understand whether previously documented patterns persist. Methods Data (a census of items for included restaurants) were obtained from the MenuStat project. This analysis included 66 of the 100 largest U.S. restaurants that are available in all three of the data years (2012−2014; N=23,066 items). Generalized linear models were used to examine: (1) per-item calorie changes from 2012 to 2014 among items on the menu in all years; and (2) mean calories in new items in 2013 and 2014 compared with items on the menu in 2012 only. Data were analyzed in 2014. Results Overall, calories in newly introduced menu items declined by 71 (or 15%) from 2012 to 2013 ( p =0.001) and by 69 (or 14%) from 2012 to 2014 ( p =0.03). These declines were concentrated mainly in new main course items (85 fewer calories in 2013 and 55 fewer calories in 2014; p =0.01). Although average calories in newly introduced menu items are declining, they are higher than items common to the menu in all 3 years. No differences in mean calories among items on menus in 2012, 2013, or 2014 were found. Conclusions The previously observed declines in newly introduced menu items among large restaurant chains have been maintained, which suggests the beginning of a trend toward reducing calories.
The Affordable Care Act requires state Medicaid programs to cover pharmacotherapies for smoking cessation without cost sharing for pregnant women. Little is known about use of these pharmacotherapies ...among Medicaid-enrolled women.
To describe the prevalence of prescription fills for smoking-cessation pharmacotherapies during pregnancy and postpartum among Medicaid-enrolled women and to examine whether certain pregnancy complications or copayments are associated with prescription fills.
Insurance claims data for women enrolled in a Medicaid managed care plan in Maryland and who used tobacco during pregnancy from 2003 to 2010 were obtained (N=4,709) and analyzed in 2014. Descriptive statistics were used to calculate the prevalence of smoking-cessation pharmacotherapy use during pregnancy and postpartum. Generalized estimating equations were employed to examine the relationship of pregnancy complications and copayments with prescription fills of smoking-cessation pharmacotherapies during pregnancy and postpartum.
Few women filled any prescription for a smoking-cessation pharmacotherapy during pregnancy or postpartum (2.6% and 2.0%, respectively). Having any smoking-related pregnancy complication was positively associated with filling a smoking-cessation pharmacotherapy prescription during pregnancy (OR=1.69, 95% CI=1.08, 2.65) but not postpartum. Copayments were associated with significantly decreased odds of filling any prescription for smoking-cessation pharmacotherapies in the postpartum period (OR=0.38, 95% CI=0.22, 0.66).
Smoking-related pregnancy complications and substance use are predictive of filling a prescription for pharmacotherapies for smoking cessation during pregnancy. Low use of pharmacotherapies during pregnancy is consistent with clinical guidelines; however, low use postpartum suggests an unmet need for cessation aids in Medicaid populations.
Calorie Changes in Chain Restaurant Menu Items Bleich, Sara N., PhD; Wolfson, Julia A., MPP; Jarlenski, Marian P., MPH
American journal of preventive medicine,
2015, January 2015, 2015-01-00, Letnik:
48, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Background Supply-side reductions to the calories in chain restaurants are a possible benefit of upcoming menu labeling requirements. Purpose To describe trends in calories available in large U.S. ...restaurants. Methods Data were obtained from the MenuStat project, a census of menu items in 66 of the 100 largest U.S. restaurant chains, for 2012 and 2013 (N=19,417 items). Generalized linear models were used to calculate (1) the mean change in calories from 2012 to 2013, among items on the menu in both years; and (2) the difference in mean calories, comparing newly introduced items to those on the menu in 2012 only (overall and between core versus non-core items). Data were analyzed in 2014. Results Mean calories among items on menus in both 2012 and 2013 did not change. Large restaurant chains in the U.S. have recently had overall declines in calories in newly introduced menu items (–56 calories, 12% decline). These declines were concentrated mainly in new main course items (–67 calories, 10% decline). New beverage (–26 calories, 8% decline) and children’s (–46 calories, 20% decline) items also had fewer mean calories. Among chain restaurants with a specific focus (e.g., burgers), average calories in new menu items not core to the business declined more than calories in core menu items. Conclusions Large chain restaurants significantly reduced the number of calories in newly introduced menu items. Supply-side changes to the calories in chain restaurants may have a significant impact on obesity prevention.
Reply Hollander, Mara A.G.; Jarlenski, Marian P.; Krans, Elizabeth E.
American journal of obstetrics and gynecology,
10/2019, Letnik:
221, Številka:
4
Journal Article
Given the prevalence of obesity and associated chronic conditions among U.S. adults, wellness benefits are an increasingly popular approach to promoting weight loss.
The goal of the study was to ...assess overweight and obese adults' beliefs about the helpfulness of insurance coverage of weight loss-related benefits, their willingness to pay for such benefits, and whether these opinions differ by individuals' weight or health insurance type.
A national survey was fielded in 2012 among non-pregnant, overweight, and obese adults who had seen a primary care provider in the past year (n=600). Descriptive statistics summarized beliefs about which weight loss-related benefits would be helpful, willingness to pay for such benefits, and agreement about whether health insurers should be able to charge more to obese individuals. Multivariable logistic regression was employed to determine whether beliefs differed by weight category or health insurance type. Analyses were conducted in July 2012.
The majority (83%) of respondents cited a specific benefit as helpful. Those with private health insurance had a higher probability (89%, 95% CI=86%, 93%) of endorsing any benefit as helpful relative to those with other types of health insurance. Being obese relative to overweight was associated with greater support (57% vs 39%, p<0.05) for preventing health insurers from charging higher premiums to obese individuals.
In this sample of overweight adults, a large proportion endorsed the value of weight loss-related benefits offered by health plans. However, only about one third were willing to pay extra for them, and half disagreed with the notion that health plans should charge more to obese individuals. Given evidence of their effectiveness, wellness benefits should be offered to all individuals.
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