CSDE Affiliates Tracy M. Mroz (Rehabilitation Medicine), Rachel Prusynski (Physical Therapy), and co-authors published two articles that examine patient outcomes in the context of skilled nursing facilities (SNFs). The first article “Current Evidence on the Impact of Medicare Payment Policy on Stroke Rehabilitation in Skilled Nursing Facilities” is published in Current Physical Medicine and Rehabilitation Reports, where the authors focus on patients recovering from stroke. Patients recovering from stroke benefit from frequent, multi-disciplinary therapies in skilled nursing facilities (SNFs). As a major driver of spending, rehabilitation in SNFs is vulnerable to scrutiny from payers including Medicare. This review explored impacts of current payment programs (Patient Driven Payment Model, Bundled Payments for Care Improvement Advanced, Accountable Care Organizations, and Medicare Advantage) on access and outcomes of rehabilitation in SNFs after stroke. The authors’ second article “Skilled Nursing Facility Changes in Ownership and Short-Stay Medicare Patient Outcomes” is published in JAMA Network Open. In this study, the authors examine what types of skilled nursing facilities (SNF) change ownership, and are SNF sales associated with short-stay patient outcomes? In this cohort study of 11 004 SNFs, urban, for-profit, and chain SNFs with lower staffing ratings and more Medicaid patients were more likely to change ownership. Ownership change was associated with short-term increases in emergency department visits but was not associated with hospital readmissions or community discharge rates. These findings suggest that SNF ownership changes may be a symptom, rather than a cause, of lower quality care for short-stay patients.

CSDE Affiliate Kenneth Sherr (Global Health) and co-authors recently published their research in The Lancet HIV, titled “Impact of differentiated service delivery models on 12-month retention in HIV treatment in Mozambique: an interrupted time-series analysis“. HIV treatment has been available in Mozambique since 2004, but coverage of, and retention in, antiretroviral therapy (ART) remain suboptimal. Therefore, to increase health system efficiency and reduce HIV-associated mortality, in November, 2018, the Ministry of Health launched national guidelines on implementing eight differentiated service delivery models (DSDMs) for HIV treatment. The authors assessed the effect of this implementation on retention in ART 12 months after initiation, and explored the associated effects of COVID-19. They find that the implementation of eight DSDMs for HIV treatment had a positive impact on 12-month retention in ART. COVID-19 negatively influenced this outcome.

Kyle Crowder, CSDE Affiliate (Sociology) and co-authors published their research, “Real Estate Platforms, the Housing Search Process, and Racial Residential Stratification” in the journal Race and Social Problems. Recent theoretical arguments suggest that, in addition to ongoing, overt racial housing discrimination and unequal access to resources, multiple subtle housing search processes are racially stratified and contribute to persistent racial segregation. Yet, little prior research has examined these processes. The present paper helps to fill this gap by investigating the racialized differences in the subtle ways that individuals use online housing search tools and identify real estate agents to assist them through the housing search process. To do so, we rely on novel survey data collected by Redfin from 2647 housing consumers using multiple online platforms to search for housing in markets across the United States and examine racialized differences in the likelihood of homebuyers attempting various types of activities using online housing search tools, successfully using the online search tools, and methods of identifying real estate agents with whom to work. While the nature of the data preclude definitive conclusions, our findings point to significant racialized differences in attempting, and successfully completing, online activities across three different ‘types’ of online tool engagement—early search, neighborhood search, and housing unit—as well as in identifying real estate agents. After reviewing our results, we discuss the implications of these findings for persistent racial residential stratification, and directions for future research.

CSDE Affiliate Roberto Orellana (Social Work) and co-authors recently published research in the JAIDS Journal of Acquired Immune Deficiency Syndromes, titled “Impact of a Multi-Institutional Initiative to Engage Students and Early-Stage Scholars From Underrepresented Racial and Ethnic Minority Groups in HIV Research: The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative“. The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI) aims to establish programs to develop pathways for successful careers in HIV science among scholars from underrepresented racial and ethnic populations. This article describes cross-site evaluation outcomes during the first 18 months (July 2021-December 2022) across 15 programs. The aims of the evaluation were to characterize participants, describe feasibility, challenges, and successes of the programs and provide a basis for the generalizability of best practices to Diversity, Equity, and Inclusion (DEI) programs in the United States. Two primary data collection methods were used: a quarterly programmatic monitoring process and a centrally managed, individual-level, participant quantitative and qualitative survey. These data provide evidence to support the feasibility and impact of novel DEI programs in HIV research to engage and encourage racially and ethnically diverse scholars to pursue careers in HIV science.

CSDE Affiliate Stipica Mudrazija (Health Systems and Population Health) and co-authors recently published their chapter “Health status of older Europeans living alone: The role of living arrangements,healthcare, and social supports in the COVID-19 pandemic” in an edited collection about the well-being of older Europeans during the pandemic. The authors’ chapter explores systemic differences in the health status of older adults depending on their living arrangements and investigate how their socio-demographic and health-related characteristics may moderate the link between their living arrangements and their health. Furthermore, they focus on variables indicating that these older adults had unmet healthcare needs and the importance of these variables in shaping their health status. Another goal of this chapter is to examine whether different institutional contexts–i.e., differences between welfare regimes more broadly and the characteristics of health systems more specifically–can be related to the health status of older Europeans who were living alone during the COVID-19 crisis. Finally, they discuss the findings on the health of older Europeans living alone during the COVID-19 pandemic in the context of public healthcare policies designed to address their needs.

CSDE Affiliate Katarina Guttmannova (Psychiatry and Behavioral Sciences) and co-authors recently published their research in the American Journal of Preventative Medicine, titled “Changes in cannabis use from 2014–2019 among young adults in Washington State“. Understanding changes in cannabis use in the legalized nonmedical cannabis context is critical. Washington State (WA), one the earliest states to implement legalization, presents a unique opportunity to examine how cannabis use and its consequences changed after implementation of legalization for adults. With a focus on WA young adults, this study conducted in 2022/2023 examined changes in (1) cannabis use by sex and age, (2) preferred mode of use, and (3) cannabis use disorder (CUD) symptoms. During the five-year period following implementation of legalization, patterns of young adult cannabis use shifted, including particularly sharp increases among females and increases in CUD symptoms. Future studies should investigate underlying causes for these important changes.