Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013

February 17, 2017

Questions for Esther Hing, Survey Statistician and Lead Author on “Characteristics of Primary Care Physicians in Patient-Centered Medical Home Practices: United States, 2013

Q: Can you define what a patient-centered medical home (PCMH) practice is?

EH: One of several PCMH definitions is that PCMHs provide care that is: comprehensive care provided by a team of providers, patient-centered care, coordinated care, has accessible services, and care focused on quality and safety.


Q: Why did you decide to do a report on PCMH practices?

EH: Although the PCMH has been advocated by the “primary care community” for more than a decade, there are no national estimates that describe characteristics of this model of care delivery. “Primary care community” includes primary care physicians as well as other primary care providers and associated professional societies. The report, based on questions funded by the Assistant Secretary for Planning and Evaluation (ASPE), will inform policy makers of the prevalence of certified PCMH practices in the United States, as well as care attributes of these practices (compared with non-PCMH practices).

Estimates not only serve as benchmark estimates for this model of primary care, but adds to the knowledge base about this type of practice. Payers and the federal government have increasingly funded PCMH demonstrations, and certain payers and states have also increased funding to practitioners in PCMH practices.


Q: Is the first time NCHS has published a report on this topic?

EH: Yes, this is the first year that the PCMH questions have been reported.


Q: What did your report find on primary care physicians in PCMH practices?

EH: The report found that primary care physicians in PCMH practices tended to be in larger practices, and located in urban areas. These findings may be attributed to infrastructure requirements needed for PCMH care delivery. It may also reflect that in 2013, the Centers for Medicare and Medicaid Service (CMS) demonstrations and payment policy supporting chronic care was not yet implemented or was in early stages of development.


Q: Were there any findings that surprised you?

EH: The finding that a substantial percentage of non-PCMH practices have non- physician clinicians and Electronic Health Records suggests that there is untapped potential for a greater number of primary care practices to become PCMHs.

However, the relatively lower participation by solo and small practices as PCMHs suggests the need for assistance or coaching to make this transformation. The ongoing implementation of payment incentives from CMS and elsewhere has encouraged growth of PCMHs. This is a trend that the National Ambulatory Medical Care Survey (NAMCS) can be used to examine for the next few years and beyond.


U.S. Heart Attack Deaths from 2010-2015

February 15, 2017
Year
Deaths
2010
122,071
2011
119,905
2012
117,944
2013
116,793
2014
114,019
2015
114,023
TOTAL
704,755

 Source: http://wonder.cdc.gov

ICD-10: Acute myocardial infarction (I21-I22)

 


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-September 2016

February 14, 2017
Michael Martinez, M.P.H., M.H.S.A., Epidemiologist and Health Statistician

Michael Martinez, M.P.H., M.H.S.A., Epidemiologist and Health Statistician

Questions for Michael Martinez, M.P.H., M.H.S.A., Epidemiologist, Health Statistician and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-September 2016

Q: What do you think is the most significant finding in your new study?

MM: I think the most significant finding in this study is the snapshot view of varied health insurance types. While from January through September 2016, among adults aged 18 to 64, 12.3% were uninsured at the time of interview, 20.3% had public coverage, and 69.0% had private health insurance coverage. Among the 136.0 million adults in this age group with private coverage, 9.3 million–or 4.7%–were covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges during the first 9 months of 2016.


Q: How did health insurance coverage in the United States compare in the first 9 months of 2016 to 2015 and 2010?

MM: We’ve observed a number of changes in health insurance coverage between 2010 and 2015 compared to the first 9 months of 2016. Between 2010 and the first 9 months of 2016, 20.4 million persons of all ages gained coverage. In the first 9 months of 2016, 28.2 million (8.8%) persons of all ages were uninsured at the time of interview, compared with 48.6 million (16.0%) persons in 2010 and 28.6 million (9.1%) persons in 2015. The difference in uninsured estimates between 2015 and the first 9 months of 2016 was not significant.


Q: Where do high-deductible plans through private health insurance fit into 2016 estimates compared to earlier years?

MM: Among private health insurance plans, enrollment in high-deductible health plans has been increasing in recent years. 39.1% of persons under age 65 with private health insurance were enrolled in high-deductible health plans in the first 9 months of 2016. This percentage has increased significantly, from 25.3% in 2010 and from 36.7% in 2015.


Q: What are the trends among race and ethnicity groups in health insurance coverage this year and compared over time?

MM: There’s been quite a bit of change in health insurance coverage among race and ethnicity groups over the years. For example, in the first 9 months of 2016, 24.7% of Hispanic, 15.1% of non-Hispanic black, 8.5% of non-Hispanic white, and 7.8% of non-Hispanic Asian adults aged 18–64 lacked health insurance coverage at the time of interview. Significant decreases in the percentage of uninsured adults were observed between 2013 and the first 9 months of 2016 for Hispanic, non-Hispanic black, non-Hispanic white, and non-Hispanic Asian adults. Hispanic adults had the greatest percentage point decrease in the uninsured rate between 2013 (40.6%) and the first 9 months of 2016 (24.7%).


Q: How is health insurance coverage looking this year for our youngest population – children under 18 years of age?

MM: From January through September 2016, among children under 18 years of age, 5.0% were uninsured at the time of interview, 43.4% had public coverage, and 53.5% had private health insurance coverage. Among the 39.3 million children under 18 years of age with private coverage, 1.7 million or 2.3% were covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges during the first 9 months of 2016.


QuickStats: Prevalence of Edentualism in Adults Aged 65 Years or Older, by Age Group and Race/Hispanic Origin

January 31, 2017

During 2011–2014, 17.6% of adults aged 65 years or older were edentulous or had lost all their natural, permanent teeth.

Adults aged 75 years or older (23%) were more likely to be edentulous compared with adults aged 65–74 years (13.9%).

Non-Hispanic black adults aged 65 years or older were more likely to be edentulous (27%) compared with non-Hispanic white (16.2%), non-Hispanic Asian (18.0%), and Hispanic adults (16.4%) aged 65 years or older.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6603a12.htm


FACT OR FICTION: Do most boys and girls drink sugar-sweetened beverages each day?

January 26, 2017

Source: National Health and Nutrition Examination Survey

https://www.cdc.gov/nchs/data/databriefs/db271.pdf


Sugar-Sweetened Beverage Consumption in U.S.

January 26, 2017
Asher Rosinger, Epidemic Intelligence Service Officer

Asher Rosinger, Epidemic Intelligence Service Officer

Questions for Asher Rosinger, Epidemic Intelligence Service Officer and Lead Author of “Sugar-Sweetened Beverage Consumption Among U.S. Adults, 2011–2014” and “Sugar-Sweetened Beverage Consumption Among U.S. Youth, 2011–2014

Q: Why did you decide to do a report on sugar-sweetened beverage consumption?

AR: Sugar-sweetened beverage consumption has been linked to a myriad of negative health conditions, such as weight gain, dental caries, and type 2 diabetes.

In these reports we wanted to provide the most recent estimates of the calories adults and youth are consuming from sugar-sweetened beverages, what percentage of their daily caloric intake sugar-sweetened beverages represented, and how these patterns differed by sex, age, and race and Hispanic origin.


Q: How do you define a sugar-sweetened beverage?

AR: We defined sugar-sweetened beverages to include regular soda, fruit drinks (including sweetened bottled waters and fruit juices and nectars with added sugars), sports and energy drinks, sweetened coffees and teas, and other pre-sweetened beverages. Sugar-sweetened beverages do not include diet drinks, defined as less than 40 kilocalories (kcal) per 240 mL of the beverage; 100% fruit juice; beverages sweetened by the participant, including coffee and teas; alcohol; or flavored milks. This definition is consistent with previous reports.


Q: Is this the first time NHANES has released a report on this topic? If not, where is trend data available?

AR: NHANES has reported on sugar-sweetened beverage consumption in a previous report and most recently in a journal article in the American Journal of Clinical Nutrition by Kit et al, which specifically looked at trends from 1999–2010 among youth and adults. We used the same definition as Kit et al. so that our results are comparable. The mean calorie consumption and percentage of total daily calories consumed from sugar-sweetened beverages among U.S. adults declined from 196 kcal and 8.7% in 1999–2000 to 151 kcal and 6.9% per day in 2009–2010. For youth the drop has been more dramatic. The mean calorie consumption and the percentage of calories consumed from sugar-sweetened beverages among U.S. youth declined from 223 kcal and 10.9% in 1999–2000 to 155 kcal and 8.0% per day in 2009–2010. Our reports found that in 2011–2014 U.S. adults consumed 145 kcal and 6.5% of their daily caloric intake from sugar-sweetened beverages, while U.S. youth consumed 143 kcal and 7.3%.

Kit BK, Fakhouri TH, Park S, Nielsen SJ, Ogden CL. Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999–2010. Am J Clin Nutr 98(1):180–8. 2013.


Q: How many U.S. adults and children are consuming at least one sugar-sweetened beverage a day?

AR: Nearly half or 49.3% of U.S. adults and almost two-thirds or 62.9% of children are consuming at least one sugar-sweetened beverage a day. Using the 2011-2012 and 2013-2014 Alternative Population Control totals these percentages translate to more than 111 million U.S. adults and 47 million children who drank at least one sugar-sweetened beverage on a given day.


Q: Were there any findings that surprised you?

AR: We were surprised by the finding that non-Hispanic Asian adults and youth consumed fewer calories from sugar-sweetened beverages than any other race and Hispanic origin group. In fact, consumption in this group was nearly half the amount of calories and percent of total daily caloric intake than the other groups. For example, on average non-Hispanic Asian boys consumed 73 kilocalories from sugar-sweetened beverages representing 3.5% of their total daily caloric intake, whereas every other group consumed more than 150 kcals and more than 7% of their total caloric intake from sugar-sweetened beverages.


Physician Office Visits for ADHD in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

January 25, 2017

Questions for Michael Albert, Medical Officer and Lead Author on “Physician Office Visits for Attention-deficit/Hyperactivity Disorder in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

Q: Did we learn anything new from this new report about the problem of Attention-deficit/Hyperactivity Disorder (ADHD) among children?

MA: Yes, this report provides a snapshot of health care utilization related to ADHD among children aged 4-17 years. Specifically, it looks at visits to physician offices and uses nationally representative data from the 2012-13 National Ambulatory Medical Care Survey.  Based on a sample of 946 visits by children aged 4-17 years with a primary diagnosis of ADHD, an estimated annual average of 6.1 million physician office visits were made by this age group during 2012-13, corresponding to a visit rate of 105 visits per 1,000 children.


Q:  Does your research back up the notion that boys are more commonly afflicted with ADHD than girls?

MA: Our analysis did find that among children aged 4-17 years with a primary diagnosis of ADHD, the visit rate was more than twice as high for boys as girls.


Q: Is it true that medication is very often involved in the treatment of ADHD?

MA: Central nervous system stimulant medications were provided, prescribed, or continued at approximately 80% of these ADHD visits.  A total of 29% of ADHD visits included a diagnostic code for an additional mental health disorder.  In terms of what specialty of physician provided care at these visits, it was a pediatrician at 48%, psychiatrist at 36%, and general and family medicine physician at 12%.


Q: Was it surprising that 80% of office visits for ADHD involve medication?

MA: It is important to interpret this finding carefully.  Because the National Ambulatory Medical Care Survey is a visit-based survey, as opposed to population based, estimates of persons cannot be made.  Thus, the finding should not be interpreted as indicating that 80% of children aged 4-17 years with ADHD are taking CNS stimulant medications. It is possible that patients taking CNS stimulant medications tend to make more physician office visits than those not taking these medications.  This might be in order to monitor the medication, or for other reasons such as differences in the severity of disease between those who take medication and those who do not.  Although the use of medication in children with ADHD in our survey cannot be directly compared with population-based surveys, there is evidence from the latter that medication is frequently used.  An analysis of parent-reported data from the National Survey of Children’s Health found that among children aged 4-17 years, 69% of children with current ADHD were taking medication for their ADHD (the specific medication was not identified).


Q: Anything else you’d like to address about the report?

MA: Again, we think the significance of this report lies in providing a snapshot of health care utilization related to ADHD in children that is nationally representative.  We chose to investigate several variables to in our analysis that are of interest and provide important information.