Literature Collection

PURPOSE: Advancing behavioral health and primary care integration is a priority for helping clients overcome the complex health challenges impacting healthcare deserts like those in Arizona, United States of America (USA). This study aimed to explore the perspectives of people with a substance use disorder (SUD) on accessing integrated primary care (IPC) services in a rural-serving behavioral healthcare organization in Arizona. DESIGN/METHODOLOGY/APPROACH: Clients from a behavioral health facility in Arizona (n = 10) diagnosed with SUDs who also accessed IPC participated in a 45-min semi-structured interview. FINDINGS: The authors identified six overarching themes: (1) importance of IPC for clients being treated for SUDs, (2) client low level of awareness of IPC availability at the facility, (3) strategies to increase awareness of IPC availability at the behavioral health facility, (4) cultural practices providers should consider in care integration, (5) attitudes and perceptions about the experience of accessing IPC and (6) challenges to attending IPC appointments. The authors also identified subthemes for most of the main themes. ORIGINALITY/VALUE: This is the first study in rural Arizona to identify valuable insights into the experiences of people with SUDs accessing IPC, providing a foundation for future research in the region on care integration.

OBJECTIVE: To assess the real-world frequency and characteristics associated with type 2 diabetes remission in a large and diverse cohort of U.S. adults. RESEARCH DESIGN AND METHODS: This retrospective cohort study used 2014-2023 electronic health record data from six major U.S. health care delivery systems. The cohort included 556,758 adults (≥18 years) with type 2 diabetes who had one or more HbA1c measurement in 2 years before study entry and evidence of glucose-lowering medication use. Pregnant women or adults who underwent bariatric surgery before or during the study were excluded. Type 2 diabetes remission was defined as HbA1c <6.5% persisting for ≥3 months after cessation of glucose-lowering medications. Multivariate logistic regression was used to identify characteristics associated with type 2 diabetes remission. RESULTS: Over a 3-year follow-up, 2.9% (16,016 adults) achieved type 2 diabetes remission, although 36.9% of those who experienced remission relapsed. The strongest characteristics associated with remission were not receiving glucose-lowering medications at baseline versus three or more medications (odds ratio [OR] 15.9, 95% CI 12.1-21.0), baseline HbA1c <7% vs. ≥11% (OR 3.1, 2.9-3.3) and diabetes duration <1 year versus ≥4 years (OR 2.6, 2.5-2.7). CONCLUSIONS: Type 2 diabetes remission was low among adults without bariatric surgery. The strongest associated characteristics were fewer diabetes medications, lower baseline HbA1c, and shorter diabetes duration. These findings highlight actionable factors to identify patients who may benefit most from targeted interventions. Future research should evaluate the long-term durability and health impacts of remission.

BACKGROUND: Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. PURPOSE: The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts. METHODS: We conducted semistructured interviews between July and December 2013. Our sample includes ACOs that began performance contracts in 2012, including Medicare Shared Savings Program and Pioneer participants, stratified across key factors. In total, we conducted interviews with executives from 30 ACOs. Iterative qualitative analysis identified common patterns and themes. RESULTS: ACOs in the first year of performance contracts are commonly focusing on four areas: first, transforming primary care through increased access and team-based care; second, reducing avoidable emergency department use; third, strengthening practice-based care management; and fourth, developing new boundary spanner roles and activities. ACOs were doing little around transforming specialty care, acute and postacute care, or standardizing care across practices during the first 18 months of ACO performance contracts. PRACTICE IMPLICATIONS: Results suggest that cost reductions associated with ACOs in the first years of contracts may be related to primary care. Although in the long term many hope ACOs will achieve coordination across a wide array of care settings and providers, in the short term providers under ACO contracts are focused largely on primary care-related strategies. Our work provides a template of the common areas of clinical activity in the first years of ACO contracts, which may be informative to providers considering becoming an ACO. Further research will be needed to understand how these strategies are associated with performance.