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Jopson AD, Fabius CD, Shen K, Ornstein KA, Wolff JL. Profile of Older Dual-Enrollees Living in Areas with Managed Long-Term Services and Supports. J Am Med Dir Assoc 2024; 25:722-728. [PMID: 38103571 PMCID: PMC10990790 DOI: 10.1016/j.jamda.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Nearly half of all state Medicaid agencies in the United States have implemented managed long-term services and supports (MLTSS). Data gaps have inhibited our understanding of MLTSS experiences to date. We draw on a national survey with novel data linkages to develop a profile of older dual-enrollees with significant LTSS needs by MLTSS program presence. DESIGN Cross-sectional observational study using the 2015 round of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING AND PARTICIPANTS The sample comprised 275 participants who self-reported Medicaid enrollment and met our definition of significant LTSS need as defined by receiving help with 2 or more self-care or mobility activities (eating, bathing, toileting, dressing, bed transfer, indoor mobility). METHODS Bivariate analyses were used to comparatively examine differences in demographic, health, and care circumstances by MLTSS, as defined by living in a county with MLTSS program presence. RESULTS Among approximately 1 million (weighted sample) older dual-enrollees with significant LTSS needs, 56.2% (weighted percentage) lived in counties with MLTSS and 43.7% lived in counties with mandatory MLTSS enrollment in 2015. Those living in areas with MLTSS were much more likely to be of Hispanic or other race and ethnicity (50.5% vs 15.1%, P < .001) yet less likely to live in a rural location (8.7% vs 31.4%, P < .05) or in a residential care facility or nursing home (18.4% vs 34.7%, P < .05). The majority (78.5%) received assistance from 2 or more helpers and received more than 70 hours of care per week. CONCLUSIONS AND IMPLICATIONS Our findings reinforce the growing reach of MLTSS programs and importance of filling evidence gaps about who these programs are serving.
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Affiliation(s)
- Andrew D Jopson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Chanee D Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Shen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine A Ornstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Larson EH, Oster NV, Jopson AD, Andrilla CHA, Pollack SW, Patterson DG. Routes to Rural Readiness: Enhancing Clinical Training Experiences for Physician Assistants. J Physician Assist Educ 2023; 34:178-187. [PMID: 37467205 DOI: 10.1097/jpa.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE The purpose of this study was to describe practices and experiences of rurally oriented physician assistant (PA) training programs in providing rural clinical training to PA students. METHODS A survey of PA program directors (PDs) included questions about program characteristics, student and clinical preceptor (CP) recruitment in rural areas, and barriers to, and facilitators of, rural clinical training. Programs that considered rural training "very important" to their goals were identified. We interviewed PDs from rurally oriented programs about their rural clinical training and rural CPs about their experiences training PA students for rural practice. We identified key themes through content analysis. RESULTS Of 178 programs surveyed, 113 (63.5%) responded, 61 (54.0%) of which were rurally oriented and more likely than other programs to recruit rural students or those with rural practice interests and to address rural issues in didactic curriculum. The 13 PDs interviewed linked successful rural training to finding and supporting rural preceptors who enjoy teaching and helping students understand rural communities. The 13 rural CPs identified enthusiastic and rurally interested students as key elements to successful rural training. Interviewees identified systemic barriers to rural training, including student housing, decreased productivity, competition for training slots, and administrative burden. CONCLUSIONS Physician assistant students can be coached to capitalize on their rural clinical experiences. Knowing how to "jump in" to rotations and having genuine interest in the community are particularly important. Student housing, competition for training slots, and lack of financial incentives are major system-level challenges for sustaining and increasing the availability of PA rural clinical training.
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Affiliation(s)
- Eric H Larson
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - Natalia V Oster
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - Andrew D Jopson
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - C Holly A Andrilla
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - Samantha W Pollack
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - Davis G Patterson
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
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Van Eijk MS, Guenther GA, Kett PM, Jopson AD, Frogner BK, Skillman SM. Addressing Systemic Racism in Birth Doula Services to Reduce Health Inequities in the United States. Health Equity 2022; 6:98-105. [PMID: 35261936 PMCID: PMC8896213 DOI: 10.1089/heq.2021.0033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: Birth doulas support pregnant people during the perinatal period. Evidence of doulas' positive impacts on pregnancy and birth outcomes, particularly among underserved populations, supports expanding access. However, health workforce-related barriers challenge the development of robust doula services in the United States. This study examined the various approaches organizations have taken to train, recruit, and employ doulas as well as their perspectives on what system-level changes are needed to redress health inequities in underserved communities and expand access to birth doula services. Methods: In addition to literature and policy reviews, we conducted 16 semistructured interviews from March to August 2020 with key informants from organizations involved in training, certifying, advocating for, and employing doulas, and informants involved in state policy making. We analyzed data using qualitative analysis software to identify cross-cutting themes. Results: The landscape of organizations involved in doula training and certification is diverse. In discussing their training and curriculum, interviewees from large organizations and community-based organizations (CBOs) stressed the importance of incorporating a focus on structural racism in maternal health into training curricula. CBOs specifically offered three areas of systems-level change that can help equitably grow doula services: the importance of addressing structural racism, changing the balance of power in decision making and policy making, and a cautious approach to Medicaid reimbursement. Conclusion: This study provides evidence of how doula organizations move the field toward better serving the specific needs of underserved populations. It recognizes the expertise of CBOs in developing policy to expand doula services to communities in need. The information from this study highlights the complexities of facilitating consistency across doula training and certification requirements and implementing a sustainable funding mechanism while also meeting communities' unique needs.
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Affiliation(s)
- Marieke S. Van Eijk
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Grace A. Guenther
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Paula M. Kett
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew D. Jopson
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Bianca K. Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Susan M. Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Evans DV, Jopson AD, Andrilla CHA, Longenecker RL, Patterson DG. Targeted Medical School Admissions: A Strategic Process for Meeting Our Social Mission. Fam Med 2020; 52:474-482. [PMID: 32640469 DOI: 10.22454/fammed.2020.470334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Increased medical school class sizes and new medical schools have not addressed the workforce inadequacies in primary care or underserved settings. While there is substantial evidence that student attributes predict practice specialty and location, little is known about how schools use these factors in admissions processes. We sought to describe admissions strategies to recruit students likely to practice in primary care or underserved settings. METHODS We surveyed admissions personnel at US allopathic and osteopathic medical schools in 2018 about targeted admissions strategies aimed at recruitment and selection of students likely to practice rurally, in urban underserved areas, or in primary care Results: One hundred thirty-three of 185 (71.8%) US medical schools responded. Respondents reported targeted admissions strategies as follows: rural, 69.2%; urban underserved, 67.4%; and primary care, 45.3%. Nearly 90% reported some type of recruitment outreach to 4-year universities, but much less to community colleges. Student characteristics used to identify those likely to practice in targeted areas were largely evidence-based. Strategies to select students varied widely. CONCLUSIONS Most responding US medical schools reported a targeted process to recruit and select students likely to practice in rural, urban underserved, or primary care settings, indicating widespread awareness of workforce challenges. This study also demonstrates varying approaches to and allocation of resources toward admissions targeting, especially the application and interviewing processes. Understanding how schools identify and admit students likely to practice in these fields is a first step in identifying best practices for selective admissions focused on addressing workforce gaps.
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Affiliation(s)
- David V Evans
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | - Andrew D Jopson
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | - C Holly A Andrilla
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Davis G Patterson
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
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