Background: Advance care planning (ACP), or the consideration and communication of care preferences for the end-of-life (EOL), is a critical process for improving quality of care for patients with advanced cancer. The incorporation of billed service codes for ACP allows for new inquiries on the association between systematic ACP and improved EOL outcomes. Objective: Using the IBM MarketScan® Database, we conducted a retrospective medical claims analysis for patients with an advanced cancer diagnosis and referral to hospice between January 2016 and December 2017. We evaluated the association between billed ACP services and EOL hospital admissions in the final 30 days of life. Design: This is a cross-sectional retrospective cohort study. Participants: A total of 3,705 patients met the study criteria. Main Measures: ACP was measured via the presence of a billed ACP encounter (codes 99497 and 99498) prior to the last 30 days of life; hospital admissions included a dichotomous indicator for inpatient admission in the final 30 days of life. Key Results: Controlling for key covariates, patients who received billed ACP were less likely to experience inpatient hospital admissions in the final 30 days of life compared to those not receiving billed ACP (OR: 0.34; p < 0.001). Conclusion: The receipt of a billed ACP encounter is associated with reduced EOL hospital admissions in a population of patients with advanced cancer on hospice care. Strategies for consistent, anticipatory delivery of billable ACP services prior to hospice referral may prevent potentially undesired late-life hospital admissions.

Background: The coronavirus disease 2019 (COVID-19) pandemic has created exceptional health and economic uncertainty for Ohioans in 2020. In the spring of 2020, the state commissioned the Ohio COVID-19 Survey (OCS) to ask residential Ohio adults about how the pandemic was affecting them. The purpose of this research is to provide state leadership with real-time information about the effects of the pandemic and concurrent recession on Ohio households.Methods: The OCS is a special supplement to the Ohio Medicaid Assessment Survey (OMAS), a stratified random digit dial, cell phone and landline telephone survey. This study includes data collected weekly between April 20, 2020, and August 24, 2020. We conducted descriptive time-series analysis of the survey data and provided updates to the state's COVID-19 Response Team throughout the survey period.Results: Preliminary findings from the OCS reflect 3 themes among respondents: 1) elevated levels of concern over health and household economics; 2) disproportionate effects that exacerbate existing inequities; and 3) majority adjustment to "new normal" and acceptance of public health guidelines .Conclusion: Preliminary findings indicate that groups that were struggling before the pandemic have faced the biggest challenges with regard to health and household economics since it began. Data from the OCS enabled us to provide real-time analysis to state leadership regarding Ohioans' experience during the first 6 months of the COVID-19 pandemic. Further analysis and integration of additional data will allow us to provide deeper insights as Ohio seeks to move into recovery.

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The processes of status separation that assure rapid and legitimized stratification in modern American society are no secret. It is often forgotten that these same social forces exist even within highly prestigious occupational groups like physicians.As a student of health policy who finds himself increasingly drawn to the field of medical sociology, I was excited at the prospect of reading and reviewing Tania Jenkins' Doctors' Orders: The Making of Status Hierarchies in an Elite Profession. Noting a stark trend-the segregation of residency programs based on medical pedigree despite the lack of any formal rules or regulations dictating such separation-Jenkins, who is Assistant Professor of Sociology at the University of North Carolina-Chapel Hill, conducts a thorough and fascinating ethnography of two contrasting internal medicine programs.At Stonewood Hospital (a pseudonym for one of her study sites, both of which are located in the Northeastern U.S.), residents are overwhelmingly U.S. graduates of allopathic medical schools (hereafter USMDs), train with highly complex patients, and find themselves supported from start to finish. At Legacy Hospital (also a pseudonym), comprised mostly of graduates from osteopathic and international schools (hereafter non-USMDs), Jenkins finds an entirely different training environment which largely deprives residents of the experiences they need to find success within the profession. Unsurprisingly, those from Stonewood have more success at matching into subspecialties of their choice. The sorting of USMDs and non-USMDs into programs of disparate educational quality and the subsequent disparate outcomes could ostensibly be explained by a narrative where USMDs are objectively better doctors, thus deserving of the best opportunities within the profession. Jenkins' powerful qualitative data, however, suggest that this justification is wielded disingenuously by the professional establishment, masking the structural factors that stymie success for non-USMDs while all but guaranteeing elite ascension for USMDs.At the core of Jenkins' findings is what she refers to as a "self-fulfilling prophecy" (p. 173). First, non-USMDs are regarded as lower-quality candidates for the field of medicine, a stigmatization process undergirded by both classist and nativist sentiments. Admission to an allopathic medical school is highly dependent on a stable and supportive upbringing so that one is set up for "playing the game" (p. 39). Despite these underlying structural barriers for those without early access to resources, individuals attending nonallopathic schools were assumed to be intellectually inferior. However, prosperous upbringing is not the only important driver: many international medical graduates also had positive early life experiences. These candidates experienced stigmatization not from a lack of early social support to grant them advantages, but rather from powerful societal status beliefs dictating that foreign people, even those intending to work in a highly prestigious occupation, a...