Introduction and contextIn response to rising and disproportionate overdose deaths, a Massachusetts agency developed a program model (CARE) that incorporated evidence-based and evidence-informed practices to support recovery and overdose prevention for Black and Latino men returning to their communities from incarceration. Recruitment of Black and Latino men at risk of overdose was intended to begin in local jails prior to release. Key program components included culturally-responsive care, person-centered care, support for social determinants of health (SDoH), community building and social support, and facilitating access to evidence-based substance use disorder (SUD) treatment and harm reduction services. The evaluation used the RE-AIM framework to examine the program’s reach, adoption, and implementation among five community-based providers with varied sizes, populations of focus, prior experience with similar services, and institutional capacities.Evaluation methodsThe evaluation used a participatory process to develop a theory of change for CARE and corresponding mixed-methods data collection procedures. Qualitative data were collected from semi-structured interviews and focus groups with 35 staff members, and interviews with 41 clients. Quantitative data sources included administrative program data on client characteristics, contacts, and service planning.ResultsThe evaluation found considerable inter-provider variation in recruitment of the focus population, with underrepresentation of Black men, and people with substance use histories that indicate highest overdose risk. All providers experienced challenges with recruitment and retention of staff. A minority of funded organizations established dedicated program space in alignment with the program design. Most providers experienced challenges with client recruitment in local jails. Providers successfully implemented culturally-responsive care and supporting SDoH needs. Implementation success was more mixed around community-building, the provision of person-centered care, and facilitating access to evidence-based substance use disorder treatment and harm reduction services.DiscussionThe evaluation demonstrates that while the CARE program model is generally feasible, successful implementation of the core program elements was correlated with organizational size, longevity, experience with grant-funded program implementation and SUD service delivery, and physical infrastructure. Evaluation findings highlight lessons that can be used by funders and programs to effectively engage and serve populations at high risk of overdose, as well as future directions for further evaluation.
ABSTRACT Objectives To characterize demographic factors associated with dental care utilization in the past year among patients receiving primary care at a Massachusetts Accountable Care Organization ‐participating health system. Methods Electronic medical record data were obtained for unique primary care patients who completed oral health screening at a single Massachusetts ACO‐participating health system between July 1, 2023, and March 1, 2024. Dental care utilization was assessed using patients' self‐reported receipt of dental care in the previous 12 months. Bivariate and multivariable logistic regression models assessed associations between patient demographics and non‐utilization of dental care. Results Overall, 38% of patients had not utilized dental care in the past year. Compared with reference groups in their respective categories, higher odds of non‐utilization were observed among males (OR 1.21; 95% CI: 1.16–1.26), children aged 0–5 (OR 3.97; 95% CI: 3.51–4.48), adults aged ≥ 60 (OR 4.03; 95% CI: 3.61–4.49), Haitian Creole speakers (OR 1.78; 95% CI: 1.59–2.00), Asian patients (OR 1.27; 95% CI: 1.16–1.38) and publicly insured patients (OR 2.34; 95% CI: 2.19–2.49). Conclusions Disparities in self‐reported dental care utilization were observed across sex, age, language, race, and insurance status within a single Massachusetts Accountable Care Organization ‐participating health system.
This study explores the potential for health care staffing shortages in the US by estimating the number of immigrants employed in health care who could be affected by deportation or immigration restrictions.
Background: The term preserved ratio impaired spirometry (PRISm) is defined as post-bronchodilator forced expiratory volume in 1 s (FEV1) <80% predicted and FEV1/forced vital capacity (FVC) ratio ≥0.7 or ≥lower limit of normal (LLN). The population prevalence is estimated to be between 3% and 20%. PRISm does not indicate a specific lung disease but is associated with functional limitations, respiratory symptoms, comorbidities, and mortality. The aim of this study is to analyze the PRISm prevalence in an excellently characterized epidemiological study, to obtain better insight into the influence of comorbidities on PRISm development and its impact on overall mortality. Methods: We included 3403 healthy subjects from the Study of Health in Pomerania (SHIP) and 507 individuals with PRISm. Data from lung function testing, cardiopulmonary exercise testing (CPET), and echocardiography were compared in both groups. Comorbidities, as well as cardiovascular and all-cause mortality data, were analyzed. Results: Individuals in the PRISm group reported more often a history of myocardial infarction, hypertension, type 2 diabetes, dyspnea, and lung disease, and had more unfavorable median values for most of the lung function, CPET, and echocardiographic parameters compared to the non-PRISm group. Furthermore, they were older, more often current smokers, and had higher body fat marker values. Likewise, all-cause and cardiovascular death were more frequently observed in the PRISm group. Conclusions: Future studies are warranted to identify the underlying mechanisms and longitudinal progression of PRISm. However, our findings reveal that PRISm is not only associated with cardiovascular comorbidities but also with increased dyspnea, an impaired exercise capacity, and mortality.
Purpose Medical-dental integration models in primary care settings offer opportunities to increase access to oral health care, particularly for vulnerable populations. The purpose of this study was to assess dental care utilization and measure patient interest in accessing integrated dental services within the primary care setting, among patients attending a primary care practice participating in MassHealth's Accountable Care Organization program.Methods Convenience sampling was used to recruit participants from a safety-net health care system serving the greater Boston area. A 10-item survey was used to collect data on dental care utilization and measure interest in accessing integrated dental services at one primary care practice. Descriptive statistics, in addition to bivariate and multivariate logistic regression models were used to characterize the sample and explore dental care utilization associations.Results A total of 149 individuals participated, with over half (52%) reporting dental care utilization in the past year. Participants with public insurance were less likely to have seen a dental provider compared to those with private insurance (OR=0.35, 95% CI [0.12, 0.99]). Most patients (77.2%) expressed interest in accessing both in-person appointments with dental hygienists and teledentistry appointments with dentists (63.8%). When asked to choose between the two services, integrated dental hygienist appointments emerged as the more popular option for a majority of respondents (83.9%) Interest in accessing teledentistry appointments was higher among non-English speakers (OR=2.76, 95% CI [1.19, 6.40]).Conclusion Patients with low dental care utilization showed high interest in accessing integrated dental services at a primary care practice that participates in MassHealth's Accountable Care Organization program, supporting moving forward with pilot initiatives to evaluate implementation strategies.
