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Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update)

September 18, 2014 Comments off

Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update)
Source: Agency for Healthcare Research and Quality

In 2009, the Tufts Evidence-based Practice Center (EPC) conducted a systematic review of the scientific literature on vitamin D and calcium intakes as related to status indicators and health outcomes. The purpose of this report was to guide the nutrition recommendations of the Institute of Medicine (IOM) Dietary Reference Intakes (DRIs).

In September 2007, the IOM held a conference to examine the lessons learned from developing DRIs, and future challenges and best practices for developing DRIs. The conference concluded that systematic reviews would enhance the transparency and rigor of DRI committee deliberations. With this framework in mind, the Agency for Healthcare Research and Quality (AHRQ) EPC program invited the Tufts EPC to perform the systematic review of vitamin D and calcium.

In May and September 2007, two conferences were held on the effect of vitamin D on health. Subsequently, a working group of scientists from the United States and Canadian Governments convened to determine whether enough new research had been published since the 1997 vitamin D DRI to justify an update. Upon reviewing the conference proceedings and results from a recent systematic review, the group concluded that sufficient new data beyond bone health had been published. Areas of possible relevance included new data on bone health for several of the life stage groups, reports on potential adverse effects, dose-response relations between intakes and circulating 25-hydroxyvitamin D (25(OH)D) concentrations and between 25(OH)D concentrations, and several health outcomes. Throughout the remainder of this summary and in the report, new text is presented in boldface type.

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Attitudes toward Health Insurance and Their Persistence over Time, Adults, 2010-2011

August 13, 2014 Comments off

Attitudes toward Health Insurance and Their Persistence over Time, Adults, 2010-2011
Source: Agency for Healthcare Research and Quality

Highlights

  • In 2011, 12.1 percent of adults agreed with the statement “I’m healthy enough that I really don’t need health insurance,” and 24.3 percent of adults agreed with the statement “Health insurance is not worth the money it costs.”
  • There were no differences in the overall national estimates when comparing the 2011 attitudes towards the cost of health insurance with those observed in 2010; however, substantial shifts in preferences were noted for the same individuals over this time period.
  • Adults ages 18-64 who were uninsured for all of 2011 were nearly twice as likely as their privately insured counterparts, and two and one-half times as likely as those with public coverage to indicate they were healthy and did not need health insurance. These uninsured adults were also more likely to agree that health insurance was not worth its cost, relative to those with coverage.
  • Adults with consistent attitudes toward health insurance in both 2010 and 2011 had coverage and utilization behaviors in accordance with their expressed preferences. Those who consistently said they were healthy and did not need coverage were more than three times as likely not to have any medical expenditures in both years, relative to those who consistently disagreed with that classification.
  • In both years, adults under age 65 who consistently indicated that health insurance was not worth the cost were nearly three times as likely to be uninsured relative to those who consistently disagreed.

State Differences in the Cost of Job-Related Health Insurance, 2013

August 5, 2014 Comments off

State Differences in the Cost of Job-Related Health Insurance, 2013
Source: Agency for Healthcare Research and Quality

This Statistical Brief presents state variations from the national average of the cost of job-related health insurance and how these costs are shared by employers and their employees. The Brief specifically examines the average premiums and employee contributions for private-sector establishments in the 10 most populous states in 2013, using the most recent data available from the Insurance Component of the Medical Expenditure Panel Survey (MEPS-IC).

Out-of-Pocket Health Care Expenses by Age and Insurance Coverage, 2011

July 29, 2014 Comments off

Out-of-Pocket Health Care Expenses by Age and Insurance Coverage, 2011
Source: Agency for Healthcare Research and Quality

Highlights

  • In 2011, an average of $703 was paid out of pocket for health care among people with some health care expenses. However, the median out-of-pocket amount was notably lower ($237).
  • Nearly one-fifth of people with some health care expenses had out-of-pocket expenses greater than $1,000 while 8.2 percent had out-of-pocket expenses greater than $2,000.
  • Average out-of-pocket expenses increased with age, ranging from $283 for children under 18 to $1,215 for people age 65 and older.
  • On average, the uninsured paid nearly two-thirds of their health care expenses out of pocket while people under age 65 covered by public insurance and people age 65 and older covered by Medicare and other public insurance paid a substantially lower percentage (only 9–11 percent).

Selection and Costs for Employer-Sponsored Health Insurance in the Private Sector, 2013 versus 2012

July 18, 2014 Comments off

Selection and Costs for Employer-Sponsored Health Insurance in the Private Sector, 2013 versus 2012
Source: Agency for Healthcare Research and Quality (Medical Expenditure Panel Survey)

Highlights

  • In 2013, 51.3 percent of private-sector employees enrolled in employer-sponsored health insurance chose single coverage, rather than employee-plus-one or family coverage. This percentage did not differ from that for 2012.
  • Average annual total premiums across all three coverage types were up in 2013 compared to 2012. Single premiums rose 3.5 percent, employee-plus-one premiums rose 3.5 percent, and family premiums rose 3.6 percent.
  • The average annual dollar amount that employees contributed toward the premium also rose for all three types of coverage in 2013 versus 2012.

Overview of Emergency Department Visits in the United States, 2011

July 4, 2014 Comments off

Overview of Emergency Department Visits in the United States, 2011
Source: Agency for Healthcare Research and Quality

Emergency departments (EDs) provide a significant source of medical care in the United States, with over 131 million total ED visits occurring in 2011. Over the past decade, the increase in ED utilization has outpaced growth of the general population, despite a national decline in the total number of ED facilities. In 2009, approximately half of all hospital inpatient admissions originated in the ED. In particular, EDs were the primary portal of entry for hospital admission for uninsured and publicly insured patients (privately insured patients were more likely to be directly admitted to the hospital from a doctor’s office or clinic).

ED utilization reflects the greater health needs of the surrounding community and may provide the only readily available care for individuals who cannot obtain care elsewhere. Many ED visits are “resource sensitive” and potentially preventable, meaning that access to high-quality, community-based health care can prevent the need for a portion of ED visits.

This HCUP Statistical Brief presents data on ED visits in the United States in 2011. Patient and hospital characteristics for two types of ED visits are provided: ED visits with admission to the same hospital and ED visits resulting in discharge, which includes patients who were stabilized in the ED and then discharged home, transferred to another hospital, or any other disposition. The most frequent conditions treated by patient age group also are presented for both types of ED visits. All differences between estimates noted in the text are statistically significant at the .0005 level or better.

Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices

July 1, 2014 Comments off

Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices
Source: Agency for Healthcare Research and Quality

Managing and treating obesity is particularly challenging for primary care practices. Although evidence suggests the potential for improving eating and physical activity behaviors by effectively linking primary care practices and community resources, establishing such linkages may be especially challenging in rural areas, where limited availability of and access to services may compound standard barriers.

In 2010 the Oregon Rural Practice-based Research Network (ORPRN) received funding from the Agency for Health Care Research and Quality for research into “Integrated Primary Care Practices and Community-based Programs to Manage Obesity.” Over a 2-year period we worked with eight primary care practices and community-based health coalitions in four rural Oregon communities to:

  1. Evaluate local clinic and community factors necessary to develop sustainable linkages between primary care and community resources for obesity management.
  2. Design, implement, and evaluate a participatory process using practice facilitation and community-health development principles to achieve these linkages.

We used the findings from this 2-year process to develop this toolkit to help other primary care clinics that want to improve linkages with community-based resources for obesity management. This process highlights strategies to build on the ties that often already exist in rural areas. Although our process is tailored to rural settings, we anticipate that many of the strategies will be beneficial for urban practices and communities to consider. This toolkit offers key steps in our process, providing tools and recommended steps that we encourage you to adapt to fit your local setting.

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