Office of the Assistant Secretary for Health

In recent years, policy makers, payers, and providers have increasingly focused on resolving health-related social needs (HRSNs). The authors evaluated a private payer–led program, Community Connected Care (CCC), which integrates screening and addressing of social needs to enhance members’ overall health, and assessed the impact on health care costs among referred Medicaid beneficiaries with high clinical risks. The authors used adjusted difference-in-differences analyses with generalized estimating equation regression models to estimate the average effect of the CCC program intervention on per-member per-month (PMPM) total allowed health care costs among referred high clinical risk Medicaid beneficiaries from January 1, 2022 to December 31, 2022. Differences in average PMPM cost outcomes between an intervention group (referred members who were successfully reached and assessed by program staff) and a control group (referred members who could not be reached) across pre- and postintervention periods (6 months before to 6 months after the index referral date) were compared after baseline covariate adjustment. Additional stratified subgroup analyses were conducted based on additional presence or absence of high social risk. There was a statistically significant decline in PMPM total allowed costs across all high clinical risk Medicaid beneficiaries referred to the CCC model (−US$85 [95% confidence interval (CI), −US$167 to −US$3], P=0.0421). In subgroup analysis, there was a larger and statistically significant decline in total allowed costs (PMPM reduction of −US$181 [95% CI, −US$329 to –US$33], P=0.0163) among the subset of high clinical risk Medicaid beneficiaries with known high social risk at the time of referral. In addition, there were statistically significant reductions in emergency department allowed costs and increases in primary care costs for this high clinical and high social risk Medicaid cohort after referral. By contrast, there was no statistically significant impact on PMPM total allowed costs for Medicaid members who only had high clinical risks without having additional high social risk (−US$40 [95% CI, −US$139 to US$59], P=0.4284). This study suggests that addressing HRSNs among Medicaid members with high clinical needs can lead to lower health care allowed costs. However, the health care industry should adopt a broader framework beyond medical cost reduction when evaluating the returns on addressing HRSNs. Metrics should also reflect nonmonetary values such as improved patient experience, enhanced quality of life, and the potential to reduce health disparities.

Background: Ambient particulate air pollution is a major environmental determinant of acute respiratory morbidity, particularly in rapidly urbanizing regions such as Punjab, Pakistan, where recurrent smog episodes coincide with increased healthcare demand. However, locally derived, hospital-based estimates quantifying short-term pollution-related emergency respiratory burden remain limited. Objective: To evaluate the association between short-term ambient air pollutant exposure, particularly PM₂.₅, and daily emergency department (ED) respiratory visits in an urban tertiary-care setting. Methods: A hospital-based ecological time-series study was conducted from 1 January to 31 December 2023. All ED visits with a primary respiratory diagnosis were included. Daily ambient pollutant concentrations (PM₂.₅, PM₁₀, NO₂, SO₂, O₃, CO) were obtained from official monitoring stations and linked to daily respiratory visit counts. Associations were estimated using negative binomial regression models adjusted for temperature, humidity, day of week, and seasonal trends, with evaluation of lag structures (0–3 days) and short moving averages. Results: A total of 1,680 respiratory ED visits were recorded (mean 26.5/day). Each 10 µg/m³ increase in same-day PM₂.₅ was associated with a 3.2% increase in daily respiratory visits (IRR 1.032; 95% CI 1.018–1.046; p < 0.001), with stronger effects observed for the 3-day moving average (IRR 1.041; 95% CI 1.022–1.061). Associations were more pronounced for asthma (IRR 1.048) and COPD exacerbations (IRR 1.039) than for pneumonia/LRTI. Conclusion: Short-term increases in ambient PM₂.₅ are significantly associated with heightened emergency respiratory demand, supporting integration of air-quality surveillance into hospital preparedness and urban pollution-control strategies.

Primary care provides a broad service range, including preventive screenings and chronic disease care. Busy clinicians frequently select which health care processes to address per visit based on time or perceived disease impact, especially for patients with multimorbidity. Little evidence exists for how to prioritize processes by patient-centered health goals. To identify criteria for prioritizing health care processes for patients with multimorbidity and using these criteria, develop recommended priority rankings of health care processes aligned with patient-centered health goals. This consensus statement was developed using multicriteria decision analysis, a group consensus method. Using purposeful sampling, 21 national subject matter experts were recruited across 10 sites, with input from patient and health system partners. Experts completed 2 electronic survey rounds. The first round was conducted February 26 to April 2, 2024, with experts weighting 12 criteria for health care processes by importance (0-100 scale, with higher score indicating more importance) for addressing 3 common domains of patient-centered health goals (mortality, symptom relief, physical function) for hypothetical patients with multimorbidity. The second round was conducted June 3 to July 26, 2024, with experts scoring 53 health care processes by criteria (1-9 scale, with higher scores indicating greater priority). Experts received an evidence summary (publications through January 19, 2023) underlying health care processes. Weights and scores were combined as weighted sums, converted to process rankings per goal. Monte Carlo simulation (5000 randomizations) was used to evaluate confidence in findings (described as percentage of iterations at rank). A total of 20 experts participated (95% response rate). Survey 1 determined attributes important for decision-making. Seven criteria were selected: actionability, safety impact, completion ease, impact on high-prevalence health issues, evidence quality, long-term health outcome impact, and validity. The second survey used these criteria to rank health care processes by patient goals. Tobacco use screening was the highest priority health care process for all goals (function: total score, 6.9 [49% of iterations ranked as No. 1]; mortality: total score, 7.4 [27% of iterations ranked as No. 1]; symptoms: total score, 7.1 [44% of participants ranked as No. 1]). Rankings for remaining health care processes varied by goal. In this consensus statement, consideration of patient-centered health goals led to varied recommended decision-making criteria and prioritization of health care processes by subject matter experts. For patients with multimorbidity, these findings could inform systems evaluating health care process applications (eg, selection of screenings for patient-centered quality initiatives) or clinicians personalizing care delivery for patients (eg, catalyzing conversation about goals or efficiently addressing processes if goals are known).

Purpose The impact of digital transformation on banks' systemic risk merits thorough investigation. Design/methodology/approach This study examines the influence of digital transformation on banks' systemic risk based on the fixed effect model with quarterly unbalanced panel data on 36 listed commercial banks in China from 2011 to 2020. Findings Results show that digital transformation has a negative impact on banks' systemic risk by reducing both bank-specific tail risk and systemic linkage to extreme market shocks. Heterogeneity analysis suggests that digital transformation can significantly reduce systemic risk in national commercial banks relative to regional commercial banks, mediated through lowered management costs. Finally, this study finds an asymmetric relationship between digital transformation and banks' systemic risk. Particularly, a desirable level of digital transformation can reduce systemic risk, while excessive digital transformation may exacerbate it. Originality/value These findings provide valuable guidance for promoting digital transformation for banks and mitigating systemic risk from digitalization.

During bar code medication administration (BCMA), clinicians use scanning technology to match patients to ordered medication and review messages that provide information about potential safety concerns. We used an iterative human centered design (HCD) approach with clinicians representing multiple areas within the health care system to evaluate and revise BCMA messages for patient safety and usability. A usability inspection helped to identify, classify, and explain usability concerns with the alert message language. Next, a workgroup consisting of nurses, pharmacists, and human factors engineers convened to redesign the messages. The process included identification of alert messages, discussion of revised language, and evaluation of mockups of alternative messages. A usability assessment with representative end users was conducted on messages identified as most critical and/or confusing. The revised alert messages should support clinicians in understanding the system and promote patient safety.

Background: Cardiovascular disease (CVD) is leading cause of mortality in Asian country and it is very essential to understand the current epidemiological characteristics of disease in developing countries like Nepal. Objective: The objective of the study was to assess the level of knowledge, attitude, and preventive practices regarding cardiovascular diseases among community members. Method: A descriptive cross-sectional study was conducted among 407 adults selected from the community of Gorkha using probability and multi-stage cluster random sampling techniques from May to June 2024. Data collection was conducted using the standard tool CVD-KAP29. Frequency, percentage, mean, standard deviation and chi-square was used for data analysis. Result: Majority of the respondents (77.15%) had good knowledge related to cardiovascular diseases (CVDs), and more than half (65.8%) had positive attitudes towards CVDs, 81.3% of the respondents demonstrated good practices towards CVDs. The level of knowledge was significantly associated with gender, level of education, income, and family history of CVDs. Gender, age, residence, education level, and family history of CVDs were significantly associated with attitudes. The level of practice was significantly associated with age, residence, level of education, and income. Conclusion: The study concludes that majority of the respondents had good knowledge, more than half had good attitude and majority had good preventive practices towards CVDs. While most respondents showed good knowledge and preventive practices regarding CVDs, the relatively lower proportion with a good attitude highlights the need for targeted interventions. It is recommended to strengthen health education programs to promote positive attitudes, conduct regular community-based awareness and counseling sessions, reinforce preventive practices through follow-up and support activities.

Deployment to Afghanistan and Southwest Asia has been associated with adverse respiratory health outcomes. However, the impact of inhalational exposures (eg, vapor, dust, gas, fumes), which are known correlates of reduced lung function and future chronic lung disease, during military service time outside this deployment period has not been assessed. To assess military inhalational exposures during nonwartime routine activities and their associations with chronic respiratory symptoms. This cross-sectional study used data from the US Department of Veterans Affairs Service and Health Among Deployed Veterans study. US veterans who served between October 7, 2001, and February 28, 2017; deployed to Afghanistan or Southwest Asia; and living near 6 Veterans Affairs sites were randomly selected from Defense Manpower Data Center records. Participants completed interviewer-administered multi-item questionnaires about 29 exposures related to active duty military service time when not deployed. Onsite visits occurred between April 27, 2018, and March 13, 2020, and analyses were performed between April 1, 2023, and February 10, 2025. Inhalation exposures during active duty military service time. The main outcomes were chronic respiratory symptoms of dyspnea, wheeze in the previous 12 months, and chronic bronchitis. Using factor analysis, the 29 exposures were reduced to 20 items and categorized into 5 factors. Responses were scored ordinally (0, 1, 2) according to exposure prevalence and duration. Generalized linear modeling was used to explore associations between exposures and chronic respiratory symptoms. The sample included 1712 veterans (median [IQR] age, 37 [33-45] years; 1522 male [88.9%]) who had military service other than during their deployment to Afghanistan or Southwest Asia. The median (IQR) total active duty military service duration was 77 (57-128) months, with 82.8% of their service time spent outside the theater of conflict. The prevalence of dyspnea, chronic bronchitis, and wheeze was 7.0% (117 participants), 7.1% (121 participants), and 15.2% (260 participants), respectively. The most commonly reported exposure categories were combustion and ground dust (1014 participants [59.2%]), aircraft maintenance (812 participants [47.4%]), and heavy equipment maintenance (783 participants [45.7%]). Adjusted multivariable analyses identified significant associations between heavy equipment maintenance exposures and dyspnea (odds ratio [OR], 1.33; 95% CI, 1.06-1.68) and wheeze (OR, 1.29; 95% CI, 1.10-1.52). Aircraft maintenance exposures were significantly associated with wheeze (OR, 1.22; 95% CI, 1.01-1.47). No statistically significant associations were found between these exposures and chronic bronchitis. This cross-sectional study shows significant associations between heavy equipment maintenance and aircraft maintenance inhalation exposures outside of deployment with chronic respiratory symptoms among US veterans. These findings suggest that certain military inhalational exposures may contribute to the development of chronic lung disease and that policy interventions to reduce such exposures may protect the long-term respiratory health of military personnel.

Abstract One Health, Planetary Health, and EcoHealth – there are myriad conceptual frameworks for expanding discussions to move beyond human, animal and plant health, to be inclusive for the health of ecosystems. At present, however, despite its crucial role in the survival of our world, the ocean receives insufficient consideration within these frameworks. Therefore, greater emphasis should be placed on what can be coined One Ocean Health . To this end, we relate the health of the ocean to currently dominant connotations of the concept of health and acknowledge the ocean’s nature as one gigantic, interconnected ecosystem; a common, irreplaceable ocean on which all living things depend, human and non-human, terrestrial and aquatic alike. Recognizing the interconnectedness of ocean and society, and drawing on concepts from medical theory, we advocate for a holistic, co-developed approach to ocean health that integrates not only scientific and policy perspectives but also acknowledges the cultural diversity in the ways in which people relate to the ocean and engage with it. To achieve this, objective and subjective perspectives of what constitutes “diseases” in marine ecosystems need to be considered, while also defining means and normative goals of a “healthy ocean” – always bearing in mind the fact that this is not an end in itself, but remains crucial for the preservation of the planet that we as humans. One Health impact statement This research represents an interdisciplinary reflection on the neglected role of ocean health within the One Health framework. Despite its critical importance, the ocean is often rather absent from discussions from One Health deliberations. We examine how different conceptualizations of what constitutes a “healthy” or “diseased” system influence these debates, and explore the challenges and opportunities for integrating holistic, transdisciplinary views into ocean health via the proposed One Ocean Health perspective. We argue that this perspective further emphasizes the deep interconnectedness of ocean, human and non-human organisms, advocating for enhanced inter- and transdisciplinary collaboration and knowledge exchange. Recognizing the ocean as a fundamental component of global health is essential to addressing complex environmental and societal challenges, ultimately ensuring a more resilient and sustainable future.