Patients who accumulate multiple emergency department visits and hospital admissions, known as super-utilizers, have become the focus of policy initiatives aimed at preventing such costly use of the health care system through less expensive community- and primary care-based interventions. We conducted cross-sectional and longitudinal analyses of 4,774 publicly insured or uninsured super-utilizers in an urban safety-net integrated delivery system for the period May 1, 2011-April 30, 2013. Our analysis found that consistently 3 percent of adult patients met super-utilizer criteria and accounted for 30 percent of adult charges. Fewer than half of super-utilizers identified as such on May 1, 2011, remained in the category seven months later, and only 28 percent remained at the end of a year. This finding has important implications for program design and for policy makers because previous studies may have obscured this instability at the individual level. Our study also identified clinically relevant subgroups amenable to different interventions, along with their per capita utilization and costs before and after being identified as super-utilizers. Future solutions include improving predictive modeling to identify individuals likely to experience sustained levels of avoidable utilization, better classifying subgroups for whom interventions are needed, and implementing stronger program evaluation designs.

Figure 1 The unadjusted correlation between the state-level Gini index and the number of COVID-19 cases (a) and deaths (b).

We found significant differences in the odds of 30-day readmissions on the basis of race, socioeconomic status, and payer. As readmissions penalties become widely adopted, payers need to be mindful of their effects on vulnerable populations.

No abstract

IMPORTANCE Inadequate access to food is a risk factor for poor health and the effectiveness of federal programs targeting food insecurity, such as the Supplemental Nutrition Assistance Program (SNAP), are well-documented. The associations between other types of interventions to provide adequate food access and food insecurity status, health outcomes, and health care utilization, however, are unclear.OBJECTIVE To review evidence on the association between food insecurity interventions and food insecurity status, clinically-relevant health outcomes, and health care utilization among adults, excluding SNAP. DATA SOURCESA systematic search for English-language literature was performed in PubMed Central and Cochrane Trials databases (inception to January 23, 2020), the Social Interventions Research and Evaluation Network database (December 10, 2019); and the gray literature using Google (February 1, 2021). STUDY SELECTION Studies of any design that assessed the association between food insecurity interventions for adult participants and food insecurity status, health outcomes, and health care utilization were screened for inclusion. Studies of interventions that described addressing participants' food needs or reporting food insecurity as an outcome were included. Interventions were categorized as home-delivered food, food offered at a secondary site, monetary assistance in the form of subsidies or income supplements, food desert interventions, and miscellaneous. DATA EXTRACTION AND SYNTHESIS Data extraction was performed independently by 3 reviewers. Study quality was assessed using the Cochrane Risk of Bias Tool, the ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) tool, and a modified version of the National Institutes of Health's Quality Assessment Tool for Before-After Studies With No Control. The certainty of evidence was based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria and supplemented with mechanistic and parallel evidence. For outcomes withinintervention categories with at least 3 studies, random effects meta-analysis was performed. MAIN OUTCOMES AND MEASURESFood insecurity (measured through surveys; eg, the 2-item Hunger Vital Sign), health outcomes (eg, hemoglobin A 1c ), and health care utilization (eg, hospitalizations, costs). RESULTS A total of 39 studies comprising 170 605 participants were included (8 randomized clinical trials and 31 observational studies). Of these, 14 studies provided high-certainty evidence of an association between offering food and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.53; 95% CI, 0.33-0.67). Ten studies provided moderate-certainty evidence of an association between offering monetary assistance and reduced food insecurity (pooled random (continued) Key Points Question Are food insecurity interventions associated with improvements in food insecurity status, health outcomes, or health care utilization? Findings In this systematic review and meta-analysis of 39 randomized and observationa...

The overall cohort had high rates of multiple chronic medical conditions, MH, substance use disorders, and homelessness. However, the patterns of these conditions were different between subgroups, providing important information for tailoring interventions.

No abstract

In the US, Filipinxs are the third largest Asian subgroup and have represented a crucial part of the country's health care workforce since the mid-20th century. Although the 2.9 million Filipinxs in the US represent about 1% of the population, approximately 1 of 4 Filipinx working adults are frontline health care workers. 1 The COVID-19 pandemic has exacted a disproportionate toll on Filipinx communities in the US and on Filipinx health care workers, specifically. The absence of disaggregated race/ethnicity data for COVID-19 has masked how the pandemic has affected Filipinxs in the US.Policy makers and researchers must recognize that these disparities are not limited to COVID-19 but are a critical example of how data aggregation under a single Asian category has hidden the health needs of the Filipinx population. Missing in the Data, Missing in Policy DiscussionsAggregate race/ethnicity data for COVID-19 cases and deaths mask the disproportionate burden on Asian subgroups, including Filipinxs in the US, leaving these disparities unrecognized and unaddressed. Asians comprise nearly 6% of the US population but only about 3% of COVID-19 cases and 4% of its deaths, suggesting that Asian Americans are not disproportionately affected by COVID-19. Yet a different picture has emerged for Filipinxs in Hawaii, the only state which publicly reports disaggregated Asian data: Filipinx residents comprise 16% of the population but 22% of COVID-19 deaths. 2 Similar analyses are not possible nationally or in any other state. While some states may collect data on Filipinxs, these data are typically restricted and only available through public information requests. For example, Filipinxs comprise 42% of COVID-19 deaths among Asian adults (18-64 years) in California 3 despite making up just 20% of the state's nonelderly Asian adult population. 1 No other Asian subgroup accounted for more than 15% of deaths (Figure ). 3 Author affiliations and article information are listed at the end of this article.