Research Roundup: Parental Engagement And Gun Violence; Medically Tailored Meals; And Incentive Payments For Providers

Pediatrics: Parental Disengagement In Childhood And Adolescent Male Gun Carrying
Boys exposed to poorer parental engagement during childhood are more likely to affiliate with delinquent peers and exhibit externalizing problems during early adolescence, which (in turn) increases their risk of carrying a firearm in later adolescence. This suggests that gun violence prevention efforts with children should work to enhance aspects of parental engagement. (Beardslee et al, 4/1)

JAMA Internal Medicine: Association Between Receipt Of A Medically Tailored Meal Program And Health Care Use.
A retrospective cohort study was conducted using near/far matching instrumental variable analysis. Data from the 2011-2015 Massachusetts All-Payer Claims database and Community Servings, a not-for-profit organization delivering medically tailored meals (MTMs), were linked. The study was conducted from December 15, 2016, to January 16, 2019. Recipients of MTMs who had at least 360 days of preintervention claims data were matched to nonrecipients on the basis of demographic, clinical, and neighborhood characteristics. (Berkowitz et al, 4/22)

Health Affairs: Do Incentive Payments Reward The Wrong Providers? A Study Of Primary Care Reform In Ontario, Canada
Primary care payment reform in the US and elsewhere usually involves capitation, often combined with bonuses and incentives. In capitation systems, providing care within the practice group is needed to contain costs and ensure continuity of care, yet this is challenging in settings that allow patient choice in access to services. We used linked population-based administrative databases in Ontario, Canada, to examine a substantial payment called the “access bonus” designed to incentivize primary care access and to minimize primary care visits outside of capitation practices. We found that the access bonus flowed disproportionately to physicians outside large cities and to those whose patients made fewer primary care visits, received less after-hours care, made more emergency department visits, and had higher adjusted ambulatory costs. Our findings indicate a lack of alignment between these payments and their intended purpose. Financial incentives should be prospectively evaluated and frequently revisited to ensure relevance, alignment with system goals, efficiency, and equity. (Glazier et al, 4/1)

JAMA Internal Medicine: Findings From The Behavioral Risk Factor Surveillance System On Health-Related Quality Of Life Among US Transgender Adults, 2014-2017.
The National Institutes of Health has prioritized research into disparities affecting the transgender population. An important domain in disparities research is health-related quality of life (HRQOL), which reflects the burden of chronic and acute physical and mental health conditions as well as unmet health care needs.1 Historically, a lack of routine, standardized data collection has hindered explorations of transgender population health and HRQOL. In 2014, however, the Centers for Disease Control and Prevention (CDC) introduced an optional Sexual Orientation and Gender Identity module for the Behavioral Risk Factor Surveillance System (BRFSS). In 2014 through 2017, 36 states and territories representing almost 75% of the US population used the module at least once. This study compared HRQOL between transgender and cisgender adults in this rare probability sample of the transgender population. (Baker, 4/22)

Health Affairs: Knowledge Of Practicing Physicians About Their Legal Obligations When Caring For Patients With Disability
Disability civil rights laws require equitable treatment of the approximately sixty-one million Americans with disability. However, federal reports and numerous research studies indicate that this diverse and growing population often experiences health care disparities. To examine one possible contributing factor, we interviewed practicing physicians to explore their knowledge of their obligations to accommodate patients with disability under federal civil rights law. Interviewees reported having had little formal training about, and demonstrated superficial or incorrect understanding of, their obligations in three potentially problematic areas: deciding which accommodations their practices should implement, refusing patients with disability, and holding patients accountable for costs of accommodations. The fact that practicing physicians might not fully understand their legal responsibilities when caring for people with disability may contribute to persisting inequity in their care, and it suggests that further education in the Americans with Disabilities Act and other disability civil rights laws may be warranted. (Agaronnik et al, 4/1)