Research Roundup: Medicaid Work Requirements; Veterans’ Care; And Traffic Accidents For Drivers With ADHD
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Urban Institute:
Many Adults Targeted By Medicaid Work Requirements Face Barriers To Sustained Employment
A growing number of states seek to establish work requirements in their Medicaid programs. Using pooled data from the September 2018 and March 2019 rounds of the Health Reform Monitoring Survey, this study assesses potential barriers facing Medicaid enrollees in meeting these requirements through employment on a sustained basis. Compared with privately insured adults, Medicaid enrollees who would potentially be subject to work requirements are more likely to face employment barriers, including low educational attainment, health problems, limited transportation and internet access, criminal records, and residence in high-unemployment or high-poverty neighborhoods. (Karpman, 5/30)
Health Affairs:
Including Family Caregivers In Seriously Ill Veterans’ Care: A Mixed-Methods Study
Family caregivers often serve as unpaid members of the home and community-based care workforce for people with serious illness; as key partners in the home-clinic continuum, they should be included in health care teams. The Campaign for Inclusive Care is an initiative within the Veterans Affairs health care system to improve provider practices for including caregivers of military members in treatment planning and decisions. We defined inclusive care using a literature review, provider interviews, and a caregiver survey. We found that inclusive care involves clear definition of the caregiver role, system policies for inclusion, assessment of caregivers’ capacity, explicit involvement of caregivers, and mutuality in caregiver-provider communication. We recommend solutions based on this definition that can inform development of a national caregiver strategy, required of the Department of Health and Human Services by the Recognize, Assist, Include, Support, and Engage Family Caregivers Act of 2018. (Sperber, 6/3)
Pediatrics:
Traffic Crashes, Violations, And Suspensions Among Young Drivers With ADHD
Crash rates were higher for drivers with ADHD regardless of licensing age and, in particular, during the first month of licensure (adjusted rate ratio: 1.62 [95% confidence interval: 1.18−2.23]). They also experienced higher rates of specific crash types: their 4-year rate of alcohol-related crashes was 2.1 times that of drivers without ADHD. Finally, drivers with ADHD had higher rates of moving violations (for speeding, seat belt nonuse, and electronic equipment use) and suspensions. In the first year of driving, the rate of alcohol and/or drug violations was 3.6 times higher for adolescents with ADHD. (Curry et al, 6/3)
JAMA Internal Medicine:
An Implementation Guide To Promote Sleep And Reduce Sedative-Hypnotic Initiation For Noncritically Ill Inpatients
Sedative-hypnotic medications are frequently prescribed for hospitalized patients with insomnia, but they can result in preventable harm such as delirium, falls, hip fractures, and increased morbidity. Furthermore, sedative-hypnotic initiation while in the hospital carries a risk of chronic use after discharge. Disrupted sleep is a major contributor to sedative-hypnotic use among patients in the hospital and other institutional settings. Numerous multicomponent studies on improving sleep quality in these settings have been described, some demonstrating an associated reduction of sedative-hypnotic prescriptions. This selected review summarizes effective interventions aimed at promoting sleep and reducing inappropriate sedative-hypnotic initiation and proposes an implementation strategy to guide quality improvement teams. (Soong et al, 6/3)
Health Affairs:
Care For America’s Elderly And Disabled People Relies On Immigrant Labor
As the US wrestles with immigration policy and caring for an aging population, data on immigrants’ role as health care and long-term care workers can inform both debates. Previous studies have examined immigrants’ role as health care and direct care workers (nursing, home health, and personal care aides) but not that of immigrants hired by private households or nonmedical facilities such as senior housing to assist elderly and disabled people or unauthorized immigrants’ role in providing these services. Using nationally representative data, we found that in 2017 immigrants accounted for 18.2 percent of health care workers and 23.5 percent of formal and nonformal long-term care sector workers. More than one-quarter (27.5 percent) of direct care workers and 30.3 percent of nursing home housekeeping and maintenance workers were immigrants. (Zallman et al, 6/3)
Pediatrics:
Poverty And Early Childhood Outcomes
Children born into poverty had greater odds of not being ready for school than children not born into poverty (adjusted odds ratio = 1.54, 1.59, 1.26 for children born in household and neighborhood poverty, household poverty only, and neighborhood poverty only, respectively; all significant at P < .05). Similar patterns were seen across outcomes. For those born into neighborhood poverty, the odds of school readiness were higher only if children moved before age 2. (Roos, Wall-Wieler and Lee, 6/3)
