With health equity growing as a priority within health care, health systems must transform that calling into action within their social, economic, and political environments. The current literature has not compared how different organizations manage the same health disparities intervention. This qualitative study aims to illustrate how different organizations navigated the implementation and sustainability of a hypertension disparities intervention by comparing experiences across Federally Qualified Health Centers (FQHCs), a private health system, and other non-clinical partnering organizations. As a study within a randomized controlled trial designed to reduce disparities in hypertension care, we conducted interviews with health care leaders before and after participation in the trial\'s multi-level intervention. Before participation, we interviewed five health care leaders representing five health systems. Following the intervention, we interviewed 14 leaders representing the five health systems and two partnering organizations. Discussions focused on intervention implementation and plans for sustainability. The primary considerations in implementation were appropriate staffing and multi-level organizational buy-in. When discussing long-term planning, health systems prioritized the structure of a stepped-care protocol incorporating community health workers (CHWs) and case managers. The sustainability of the CHW intervention at FQHCs was dependent on funding, whereas a private, non-FQHC physician practice network focused on expanding current resources for more patients. These findings serve as anticipatory guidance for organizations aiming to reduce hypertension disparities and provide support for policies that financially assist these interventions. Further investigation is warranted on the organizational factors that may influence the degree of success in eliminating health care disparities.

BACKGROUND: Recent research highlighting a shortage of pediatric subspecialists in the United States has shown wide variations in the distance from children to the nearest subspecialists but has not accounted for subspecialty outreach clinics, in which specialists may improve access in rural areas by periodically staffing clinics there. This study aimed to determine the impact of pediatric subspecialty outreach clinics on the driving times to the nearest pediatric subspecialists for children in Maine.
METHODS: This cross-sectional study utilized administrative data on the schedule and location of pediatric subspecialty clinics in Maine in 2022 to estimate the driving time from each ZIP-code tabulation area to the nearest subspecialist, with and without the inclusion of outreach clinics. Using 2020 census data, we calculated the median and interquartile ranges of driving times for the state\'s overall child population, as well as for children living in urban and rural areas.
RESULTS: Of 207,409 individuals under 20 years old in Maine, 68% were located closer to an outreach location than to a clinical hub. Across the seven subspecialties offering outreach clinics, outreach clinics decreased median driving times to the nearest pediatric subspecialist by 5 to 26 minutes among all children, and by 16 to 46 minutes among rural children.
CONCLUSIONS: Pediatric subspecialty outreach clinics can substantially reduce the driving time to the nearest pediatric subspecialist , especially for children living in rural areas. The use of outreach clinics should be accounted for in research describing the geographic access or barriers to care. Expanding the number of outreach clinics should be considered by policymakers hoping to improve access.

BACKGROUND: Most of the 11 million undocumented immigrants living in the United States are excluded from government healthcare programs. Yet, healthcare inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government healthcare programs.
METHODS: The first survey experiment explores whether work ethic can affect perceptions of undocumented immigrants as deserving of government healthcare programs. The second survey experiment tests to what extent appeals to fairness and self-interest, during a pandemic, shape healthcare deservingness attitudes.
RESULTS: The results show that respondents view undocumented immigrants as less deserving of healthcare than citizens, even when undocumented immigrants have a solid work history. The second survey experiment, however, shows that appeals to fairness and self-interest trigger substantial increases in support for undocumented immigrants, both among Republicans and Democrats.
CONCLUSIONS: The results suggest that while undocumented immigrants are seen as less deserving of access, appeals to fairness and self-interest can trigger increased support.

UNASSIGNED: Randomized studies assessing the effect of PSA screening on mortality in non-Hispanic Black (NHB) men are lacking. We aimed to assess the association between PSA screening and survival among NHB men in comparison to non-Hispanic White (NHW) men in a racially diverse real-world North American population.
UNASSIGNED: The study cohort included 6378 men who self-identified as NHB or NHW and were diagnosed with prostate cancer (PCa). Patients received PSA screening and subsequent PCa treatment and follow-up at our institution. Patients were sorted based on PSA testing intensity for the 5 years prior to diagnosis, as follows: never, some (<1 test/y), and annual testing (1 test/y). The primary outcome was risk of prostate cancer-specific mortality (PCSM). Competing risk cumulative incidence curves estimated PCSM rates. Competing risk regression analyses examined the impact of PSA testing on PCSM. An interaction term was incorporated to assess the impact of race on the outcome.
UNASSIGNED: Median (IQR) age and PSA at diagnosis were 67 (60-73) years and 5.8 (4.4-9.6) ng/mL, respectively, and 2929 (46%) men were NHB (Kruskal-Wallis P values < .001). Annual PSA testing was more frequent in NHW (5%) than in NHB (3%) men (χ2 P value < .001). On cumulative incidence analysis, in the never, some, and annual PSA testing groups, the 10-year PCSM was respectively 12.3%, 5.8%, and 4.6% in NHW and 18.5%, 7%, and 1.2% in NHB patients (Gray\'s test P values < .001). At CCR, PSA screening rate was associated with more favorable PCSM rates (HR: 0.47; 95% CI 0.33-0.68; P < .001). The interaction term for race did not show statistical significance (P = .2).
UNASSIGNED: PSA testing was associated with a reduced risk of PCSM in both NHB and NHW men diagnosed with PCa. Additionally, the positive impact of the screening rate seemed to be independent of race.

OBJECTIVE: To estimate the association of Medicaid coverage of abortion care with cumulative lifetime abortion incidence among women insured by Medicaid.
METHODS: We use 2016-2019 (Pre-Dobbs) data from the Survey of Women studies that represent women aged 18-44 living in six U.S. states. One state, Maryland, has a Medicaid program that has long covered the cost of abortion care. The other five states, Alabama, Delaware, Iowa, Ohio, and South Carolina, have Medicaid programs that do not cover the cost of abortion care. Our sample includes 8972 women residing in the study states.
METHODS: Our outcome, cumulative lifetime abortion incidence, is identified using an indirect survey method, the double list experiment. We use a multivariate regression of cumulative lifetime abortion on variables including whether women were Medicaid-insured and whether they were residing in Maryland versus in one of the other five states.
METHODS: This study used secondary survey data.
RESULTS: We estimate that Medicaid coverage of abortion care in Maryland is associated with a 37.0 percentage-point (95% CI: 12.3-61.4) higher cumulative lifetime abortion incidence among Medicaid-insured women relative to women not insured by Medicaid compared with those differences by insurance status in states whose Medicaid programs do not cover the cost of abortion care.
CONCLUSIONS: We found that Medicaid coverage of abortion care is associated with a much higher lifetime incidence of abortion among individuals insured by Medicaid. We infer that Medicaid coverage of abortion care costs may have a very large impact on the accessibility of abortion care for low-income women.

General pediatricians and those specialized in developmental-behavioral and neurodevelopmental disabilities support children with neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). We identified substantial geographic disparities in pediatrician availability (eg, urban > rural areas), as well as regions with low pediatrician access but high ASD/ADHD prevalence estimates (eg, the US Southeast).

OBJECTIVE: To explore the perspectives of cerebral palsy (CP) experts on access to healthcare and an analysis of socioeconomic and environmental determinants impacting young individuals with CP in Europe.
METHODS: Cross-sectional survey designed by a convenience multi-disciplinary panel of invited experts and completed by clinicians, researchers and opinions leaders in the field of CP.
RESULTS: Fifty-eight experts (response rate 85 %) from 39 regions in 26 European countries completed the survey. All countries provide care and financing through public systems. Long waiting lists were reported (mean 3 mo, range 1-12 mo), depending on type of specialist care and place of residence. Although diagnostic and therapeutic services were available, access within countries/regions were unevenly distributed, with children receiving better care than adults. Most experts reported a lack of transition services, although improvement is expected (62 % of responses). Hip and malnutrition surveillance, as well as educational and recreational activities were variably available. Public transportation, accessible roads and pavements, and urban green spaces for persons with disabilities were more available in larger cities. Overall, only 57 % of responders felt that most patients had adequate access to healthcare.
CONCLUSIONS: The survey of CP experts\' perspectives from the majority of European countries indicates discrepancies in the availability and accessibility of healthcare needed by people with CP and nonuniform implementation of policies across Europe.

OBJECTIVE: Studies evaluating the role of baseline midlife prostate-specific antigen (PSA) as a predictor of development and progression of prostate cancer relied predominately on cohorts from the pre-PSA screening introduction era. The aim of our study was to examine the role of baseline PSA prior to the age of 60 yr as a predictor of developing lethal prostate cancer using a contemporary North American cohort.
METHODS: Our cohort included all men aged 40-59 yr who received their first PSA through our health system between the years 1995 and 2019. Patients were divided into four categories based on age: 40-44, 45-49, 50-54, and 55-59 yr. Baseline PSA was the predictor of interest. Lethal disease was defined as death from prostate cancer or development of metastatic disease either at diagnosis or during follow-up. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry. Competing-risk regression was used to evaluate the association between PSA and lethal prostate cancer.
UNASSIGNED: A total of 129067 men met the inclusion criteria during the study period. The median follow-up for patients free from cancer was 7.4 yr. For men aged 40-44, 45-49, 50-54, and 55-59 yr, the estimated rates of lethal prostate cancer at 20 yr were 0.02%, 0.14%, 0.33%, and 0.51% in men with PSA CONCLUSIONS: Baseline PSA is a very strong predictor of the subsequent risk of developing lethal prostate cancer in a large contemporary diverse North American cohort, which was exposed to opportunistic PSA screening. The association was far larger than that found for polygenic risk scores, confirming that baseline PSA prior to the age of 60 yr is the most effective tool for adjusting subsequent screening. Compared with studies of unscreened cohorts, there was a smaller difference in discrimination between incident and lethal disease, reflecting the influence of screening.
RESULTS: In this study, we found that a single baseline prostate-specific antigen (PSA) value is strongly predictive of the subsequent risk of developing metastatic prostate cancer, as well as the risk of dying from prostate cancer. The initial PSA level can therefore be used to adjust the frequency of subsequent PSA testing.

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UNASSIGNED: The purpose of the study was to investigate the relationship between community-level variables and emergency department (ED) visit rates before and during COVID-19. The focus was on opioid-related ED visits. Despite large declines in overall ED visits during COVID-19, opioid-related visits increased. While visits for avoidable conditions decreased, the opposite was true for opioid-related visits.
UNASSIGNED: We combined data from Florida EDs with community-level variables from the 2020 American Community Survey. The outcome measures of the study were quarterly ZIP code tabulation-area-level ED visit rates for opioid-related ED visits as well as visit rates for all other causes. Associations with opioid-related visit rates were estimated before and during COVID-19.
UNASSIGNED: The associations between community-level variables and opioid-related visit rates did not match those found when analyzing overall ED visit rates. The increase in opioid-related visits during COVID-19 was not unique to or more prevalent in areas with a larger percentage of racial/ethnic minority populations. However, socioeconomic status was important, as areas with higher unemployment, lower income, lower home ownership, and higher uninsured had higher overall ED visit rates and opioid visit rates during the pandemic. In addition, the negative association with income increased during the pandemic.
UNASSIGNED: These results suggest socioeconomic status should be the focus of prevention and treatment efforts to reduce opioid-related visits in future pandemics. Healthcare organizations can use these results to target their prevention and treatment efforts during future pandemics.