National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (5)
- Behavioral Health (1)
- Children/Adolescents (4)
- Chronic Conditions (4)
- Clinician-Patient Communication (1)
- COVID-19 (2)
- Diabetes (4)
- Elderly (1)
- Emergency Department (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- Healthcare Utilization (2)
- Health Insurance (4)
- Home Healthcare (1)
- Hospitals (2)
- Kidney Disease and Health (1)
- Long-Term Care (1)
- Maternal Care (1)
- Medicaid (4)
- Medication (3)
- Mortality (1)
- Opioids (5)
- Palliative Care (1)
- (-) Policy (21)
- Prevention (4)
- Primary Care (1)
- Public Health (1)
- Quality Improvement (1)
- Quality of Care (1)
- Quality of Life (1)
- Rural/Inner-City Residents (1)
- Rural Health (1)
- Substance Abuse (2)
- Transitions of Care (1)
- Uninsured (1)
- Urban Health (1)
- Vaccination (1)
- Vulnerable Populations (1)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 21 of 21 Research Studies DisplayedHughes PM, Ostrach B, Tak CR
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
This study used State-level secondary data to examine the impact of North Carolina's 2017 STOP Act on opioid overdose deaths by race. The results showed that the opioid overdose death rate among the White population decreased following the STOP Act, but found no significant change among the Black/African American population. The authors concluded that these findings have implications for health equity and may inform the development of future substance use policies.
AHRQ-funded; HS000032.
Citation: Hughes PM, Ostrach B, Tak CR .
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
J Subst Use Addict Treat 2023 Dec; 155:209171. doi: 10.1016/j.josat.2023.209171..
Keywords: Opioids, Mortality, Substance Abuse, Policy
Watnick S, Blake PG, Mehrotra R
System-level strategies to improve home dialysis: policy levers and quality initiatives.
This article discusses trends in home dialysis use, reviews the evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discusses policy and advocacy efforts that continue to shape the care of US patients, and compares with experiences in other countries. The authors conclude by discussing future directions for quality and advocacy efforts.
AHRQ-funded; HS028684.
Citation: Watnick S, Blake PG, Mehrotra R .
System-level strategies to improve home dialysis: policy levers and quality initiatives.
Clin J Am Soc Nephrol 2023 Dec; 18(12):1616-25. doi: 10.2215/cjn.0000000000000299..
Keywords: Home Healthcare, Kidney Disease and Health, Policy, Quality Improvement, Quality of Care
Vest JR, Hinrichs RJ, Hosler H
How legal problems are conceptualized and measured in healthcare settings: a systematic review.
The purpose of this study was to answer the question, “How has the concept of patients' "legal problems" been operationalized in healthcare settings?” via a systematic review of the peer-reviewed English-language health literature following the PRISMA guidelines. The researchers reviewed 58 studies reporting a total of 82 different measurements of legal problems. The study found that 56.8% of measures included a single concept (e.g., incarcerated only). The remainder of the measures included two or more concepts within a single reported measure (e.g., incarcerations and arrests). The concept of incarceration or being imprisoned was the most frequently appearing concept. The average of the reported legal problems was 26%. The researchers concluded from the literature that legal concepts are operationalize differently and are quite common among patients.
AHRQ-funded; HS028636.
Citation: Vest JR, Hinrichs RJ, Hosler H .
How legal problems are conceptualized and measured in healthcare settings: a systematic review.
Health Justice 2023 Nov 18; 11(1):48. doi: 10.1186/s40352-023-00246-5..
Keywords: Policy
Armstrong M, Groner JI, Samora J
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
This retrospective chart review study’s goal was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. The cohort included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. In addition, legal guardians prospectively completed a survey for a convenience sample of 50 patients. From pre-law to post-law, there was a significant decrease within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total morphine milligram equivalents (MMEs) prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). Results from the prospective survey showed that more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee).
AHRQ-funded; HS029183.
Citation: Armstrong M, Groner JI, Samora J .
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
PLoS One 2023 Nov 16; 18(11):e0294279. doi: 10.1371/journal.pone.0294279..
Keywords: Children/Adolescents, Opioids, Policy, Medication
MacMartin M, Zeng A, Chelen J
'The burden of wanting to make it right': thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA.
The objective of this study was to examine the experience of healthcare professionals who created policies for crisis standards of care. Researchers conducted semistructured interviews with healthcare professionals involved in institutional planning for resource shortages in the setting of the COVID-19 pandemic, specifically regarding the allocation of ventilators in the event of a shortage. One overarching theme developed: planning for resource shortages imposed a psychological burden on many planners. Four subthemes that influenced that burden were also identified. The researchers concluded that improved leadership strategies and cross-institutional collaboration can reduce the psychological burden of planning and can facilitate the update of plans in anticipation of future shortages.
AHRQ-funded; HS024075.
Citation: MacMartin M, Zeng A, Chelen J .
'The burden of wanting to make it right': thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA.
BMJ Open 2023 Nov 9; 13(11):e076674. doi: 10.1136/bmjopen-2023-076674..
Keywords: COVID-19, Public Health, Policy
Kelm JD, Aubry ST, Cain-Nielsen AH
Impact of state opioid laws on prescribing in trauma patients.
In this cross-sectional study, researchers compared oral morphine equivalents prescribed at discharge before and after the implementation of Michigan's Public Act 251, which established a state-wide policy that limited opioid prescriptions for acute pain to a 7-day supply. Subjects were adult patients who received oral opioids at discharge from a Level 1 trauma center. The findings indicated that prescription amounts for opioids in trauma patients decreased by approximately one-half following the implementation of Public Act 251; there was no compensatory increase in subsequent refill prescriptions. The researchers concluded that further work is needed to evaluate the effect of such policies on pain management and functional recovery after injury.
AHRQ-funded; HS028672; HS027788.
Citation: Kelm JD, Aubry ST, Cain-Nielsen AH .
Impact of state opioid laws on prescribing in trauma patients.
Surgery 2023 Nov; 174(5):1255-62. doi: 10.1016/j.surg.2023.08.006..
Keywords: Opioids, Policy, Medication
Steitz BD, Padi-Adjirackor NA, Griffith KN
Impact of notification policy on patient-before-clinician review of immediately released test results.
The 21st Century Cures Act requires that test results be made available immediately upon request. Not all organizations send notifications when those results become available. The purpose of this study was to measure the effect of notification policies on rates of patient-before-clinician result review and patient-initiated messaging. The researchers implemented 2 policies, immediate notifications for all results, and notifications only to patients who opted in to the system. In the group with immediate notification of test results, the ratio of patient-before-clinician review rose 4-fold and the ratio of patients who sent messages increased 3%. After transition to opt-in notifications, patient-before-clinician review decreased 2.4% and patient-initiated messaging decreased 0.4%.
AHRQ-funded; HS026395.
Citation: Steitz BD, Padi-Adjirackor NA, Griffith KN .
Impact of notification policy on patient-before-clinician review of immediately released test results.
J Am Med Inform Assoc 2023 Sep 25; 30(10):1707-10. doi: 10.1093/jamia/ocad126..
Keywords: Policy, Clinician-Patient Communication
Weaver MS, Ulrich CM, Moon MR
Adherence to the AAP's institutional ethics committee policy recommendations.
The aim of this study was to determine the level at which pediatric institutional ethics committees (IECs) comply with to the American Academy of Pediatrics (AAP) IEC Policy Statement recommendations. The researchers utilized a convenience sample taken from the Children's Hospital Association membership who were invited to complete an electronic survey in spring 2022. A total of 117 out of 181 surveys were completed (65%). The study found that stark gaps in IEC practice included: lack of membership diversity, needs for training to maintain members' competencies, organizational quality improvement, and scope of ethics service. Results indicated that 25% of IECs did not have a systematic method for informing hospital staff about ethics consultancy services and how to place an ethics consult. Further, 19% of responding IEC services did not inform patients or families about the availability of ethics consult services. 33% of the responding children's hospitals did not provide resources for the IECs to provide ethics education at their facility.
AHRQ-funded; HS028427.
Citation: Weaver MS, Ulrich CM, Moon MR .
Adherence to the AAP's institutional ethics committee policy recommendations.
Hosp Pediatr 2023 Sep; 13(9):e246-e50. doi: 10.1542/hpeds.2023-007124..
Keywords: Children/Adolescents, Policy, Hospitals
Decker S, Dworsky M, Gibson TB
AHRQ Author: Decker S
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
The authors leveraged ACA coverage expansions, including Medicaid expansion and Marketplaces, to study the impact of health insurance on opioid-related emergency department (ED) visits. They used ZIP-code–level ED utilization data from HCUP’s State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for 29 states. They found evidence of a dose-response relationship between pre-ACA uninsured and changes in ED visit rates in both expansion and non-expansion states: areas with higher uninsured rates prior to ACA saw larger reductions in opioid-related ED visits after the ACA took effect. The authors concluded that these findings suggest that increased insurance coverage may to help mitigate the opioid crisis.
AHRQ-authored.
Citation: Decker S, Dworsky M, Gibson TB .
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
American Journal of Health Economics 2023 Sum; 9(3):405–34..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Policy, Health Insurance, Emergency Department, Access to Care, Medicaid, Healthcare Utilization
Borah L, Zebib L, Sanders HM
State restrictions and geographic access to gender-affirming care for transgender youth.
This research letter described a study that estimated changes in geographic access and drive times to gender clinics after 20 states enacted legislation to restrict puberty-suppressing medications and hormones for those under the age of 18. Access to appropriate medical and social services for transgender youths was associated with mental health benefits and decreased levels of suicidality.
AHRQ-funded; HS028748.
Citation: Borah L, Zebib L, Sanders HM .
State restrictions and geographic access to gender-affirming care for transgender youth.
JAMA 2023 Jul 25; 330(4):375-78. doi: 10.1001/jama.2023.11299..
Keywords: Children/Adolescents, Vulnerable Populations, Access to Care, Policy
Hatch BA, Kenzie E, Ramalingam N
Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making.
The purpose of this cross-sectional study was to determine how vaccine mandates affect the healthcare workforce. Between October 28, 2021- November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel, the researchers conducted a survey of Oregon primary care clinic staff. The survey included 19 questions that assessed the clinic-level effects of the vaccination mandate. Study outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. The study found that clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) used medical and/or religious vaccination waivers (71% vs 33%) and reported significant impact on clinic staffing (45% vs 21%). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%). Qualitative analysis revealed a decrease in clinic morale and mixed opinions of the vaccination mandate.
AHRQ-funded; HS027080.
Citation: Hatch BA, Kenzie E, Ramalingam N .
Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making.
PLoS One 2023 Jun 27; 18(6):e0287553. doi: 10.1371/journal.pone.0287553..
Keywords: COVID-19, Vaccination, Primary Care, Policy, Rural Health, Urban Health, Rural/Inner-City Residents
Vasan A, Kenyon CC, Fiks AG
Continuous eligibility and coverage policies expanded children's Medicaid enrollment.
Researchers examined children's participation in Medicaid during 2019-21. Their findings found that states that had adopted continuous Medicaid coverage for children during the COVID-19 pandemic experienced a 4.62 percent relative increase in children's Medicaid participation when compared with states with existing continuous eligibility policies.
AHRQ-funded; HS028555.
Citation: Vasan A, Kenyon CC, Fiks AG .
Continuous eligibility and coverage policies expanded children's Medicaid enrollment.
Health Aff 2023 Jun; 42(6):753-58. doi: 10.1377/hlthaff.2022.01465..
Keywords: Children/Adolescents, Medicaid, Policy, Health Insurance, Access to Care
Guo W, Cai S, Caprio T
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
This study’s objective was to examine the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. This cohort study included Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). The authors found end-of-life care transitions were observed among 34.89% of our study sample in the last 30 days before death, and among 17.25% in the last 7 days. Higher frequency of care transitions in the last 7 days of life was associated with higher regulatory specificity of licensed [incidence risk ratio (IRR) = 1.08] and direct care worker staffing (IRR = 1.22). Greater regulatory specificity of direct care worker training (IRR = 0.75) was associated with fewer transitions. Similar associations were found for direct care worker staffing (IRR = 1.15) and training (IRR = 0.79) and transitions within 30 days of death. There were significant variations in the number of care transitions in different states.
AHRQ-funded; HS026893.
Citation: Guo W, Cai S, Caprio T .
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
J Am Med Dir Assoc 2023 Jun; 24(6):827-32.e3. doi: 10.1016/j.jamda.2023.02.002..
Keywords: Transitions of Care, Long-Term Care, Policy, Palliative Care, Elderly
Quinlan TAG, Lindrooth RC, Guiahi M
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
In addition to providing a global payment for maternity care, an increasing number of state Medicaid programs pay for immediate postpartum long-acting reversible contraception (LARC). The purpose of this study was to examine postpartum LARC utilization by race and ethnicity and overall among respondents with Medicaid-paid births during 2012-2018 in eight states that implemented immediate postpartum LARC payment and eight states without immediate postpartum LARC payment. The study found that the policy resulted in a 2.1-percentage-point increase in postpartum LARC use overall. Further analysis found no significant change among White mothers and a 3.7-percentage-point increase in use among Black mothers compared with White mothers. The researchers concluded that additional research is required to determine whether the increase was related with patients' preferences and whether hospitals' immediate postpartum LARC policies and practices utilize a patient-centered approach that reinforces reproductive autonomy and equity.
AHRQ-funded; HS028762.
Citation: Quinlan TAG, Lindrooth RC, Guiahi M .
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
Health Aff 2023 May; 42(5):665-73. doi: 10.1377/hlthaff.2022.01178..
Keywords: Medicaid, Maternal Care, Women, Access to Care, Policy
Meille G, Post B
AHRQ Author: Meille G
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
AHRQ-authored.
Citation: Meille G, Post B .
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Treasure G, Anderson DM, Hatcher L
Plan selection, enrollee risk, and health spending on the Patient Protection and Affordable Care Act individual marketplaces, 2019.
This study’s goal was to describe individual Patient Protection and Affordable Care Act (ACA) marketplace enrollees’ metal tier selections by risk score and assess enrollees’ health spending by metal tier, risk score, and spending type. This retrospective, cross-sectional study analyzed claims data from the Wakely Consulting Group ACA database including enrollees with continuous, full-year enrollment in on-exchange or off-exchange ACA-qualified health plans during the 2019 contract year. Enrollment totals, total spending, and out-of-pocket cost were calculated, stratified by metal tier and the Department of Health and Human Services (HHS) Hierarchical Condition Category (HCC) risk score for 2019. Enrollment and claims data were obtained for 1,317,707 enrollees (53.5% female; mean age, 46.35 years) across all census areas, age groups, and sexes. Of this cohort, 34.6% were on plans with cost-sharing reductions (CSRs), 75.5% did not have an assigned HCC, and 84.0% submitted at least 1 claim. Enrollees were more likely to be classified in the top HHS-HCC risk quartile if they selected platinum (42.0%), gold (34.4%), or silver (29.7%) plans compared with enrollees in bronze plans (17.2%). Median total spending was lower among bronze plan enrollees ($593; interquartile range (IQR), $28-$2100) vs platinum ($4111; IQR, $992-$15,821) or gold ($2675; IQR, $728-$9070).
AHRQ-funded; HS026395.
Citation: Treasure G, Anderson DM, Hatcher L .
Plan selection, enrollee risk, and health spending on the Patient Protection and Affordable Care Act individual marketplaces, 2019.
JAMA Netw Open 2023 Mar; 6(3):e234529. doi: 10.1001/jamanetworkopen.2023.4529..
Keywords: Health Insurance, Healthcare Costs, Policy
Ali MM, McClellan C, Mutter R
AHRQ Author: McClellan C
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Using micro data from the National Survey on Drug Use and Health, researchers examined the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. They found that RML adoption reduced the likelihood of misusing prescription opioids; however, this initial effect appeared to dissipate 2 or 3 years after RML adoption, when the relationship to the likelihood of misusing prescription opioids became positive.
AHRQ-authored.
Citation: Ali MM, McClellan C, Mutter R .
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Health Econ 2023 Feb; 32(2):277-301. doi: 10.1002/hec.4620..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Policy
Schillinger D, Bullock A, Powell C
The National Clinical Care Commission report to Congress: leveraging federal policies and programs for population-level diabetes prevention and control: recommendations from the National Clinical Care Commission.
The purpose of this article was to explore and consider the National Clinical Care Commission’s (NCCC) population-wide recommendations focusing on food systems; consumption of water over beverages sweetened with sugar; labeling of food and beverages; marketing and advertising; workplace, ambient, and built environments; and research to address the myriad of complex factors contributing to Type 1 and 2 diabetes. The authors’ recommendations are directed toward federal policies, agencies, departments and programs, including the Environmental Protection Agency, the Food and Drug Administration, the Department of Housing and Urban Development, and others.
AHRQ-funded.
Citation: Schillinger D, Bullock A, Powell C .
The National Clinical Care Commission report to Congress: leveraging federal policies and programs for population-level diabetes prevention and control: recommendations from the National Clinical Care Commission.
Diabetes Care 2023 Feb; 46(2):e24-e38. doi: 10.2337/dc22-0619..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention
Greenlee MC, Bolen S, Chong W
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to improve diabetes treatment and reduce complications.
This paper is the fourth in a series of five articles describing the recommendations of the National Clinician Care Commission (NCCC) on diabetes care. This paper focused on the recommendations of the Treatment and Complications subcommittee of the National Clinical Care Commission. The Commission made recommendations at all levels: patient, practice, health system, and health policy. They also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health.
AHRQ-funded.
Citation: Greenlee MC, Bolen S, Chong W .
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to improve diabetes treatment and reduce complications.
Diabetes Care 2023 Feb; 46(2):e51-e59. doi: 10.2337/dc22-0621..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention, Quality of Life
Herman WH, Schillinger D, Bolen S
AHRQ Author: Tracer H
The National Clinical Care Commission report to Congress: recommendations to better leverage federal policies and programs to prevent and control diabetes.
This AHRQ-authored article is an overview paper of the recommendations of the National Clinical Care Commission (NCCC) Report to Congress to better leverage federal policies and programs to prevent and control diabetes. The NCCC surveyed federal agencies and conducted follow-up meetings with representatives from 10 health-related and 11 non-health-related federal agencies. They held 12 public meetings, solicited comments, met with numerous interested parties and key informants, and performed comprehensive literature reviews. The final report was transmitted to Congress in January 2022 and contained 39 specific recommendations, including 3 foundational recommendations that addressed the necessity of an all-of-government approach to diabetes, health equity, and access to health care. Recommendations were made at the general population level and the individual level to strengthen federal policies and programs to increase awareness of prediabetes and remove barriers to proven effective treatments for diabetes and its complications.
AHRQ-authored; AHRQ-funded.
Citation: Herman WH, Schillinger D, Bolen S .
The National Clinical Care Commission report to Congress: recommendations to better leverage federal policies and programs to prevent and control diabetes.
Diabetes Care 2023 Feb; 46(2):255-61. doi: 10.2337/dc22-1587..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention
Conlin PR, Boltri JM, Bullock A
The National Clinical Care Commission report to Congress: summary and next steps.
This article summarized recommendations of the National Clinical Care Commission (NCCC) to prevent and control diabetes and its complications more effectively. The NCCC has determined that diabetes should not be considered solely as a medical problem but must also as a societal problem. Its recommendations cover policies and programs of both non-health-related and health-related federal agencies, including three recommendations that: non-health-related and health-related federal agencies coordinate their activities to better address diabetes; all federal agencies and departments ensure health equity as a guiding principle for their policies and programs that impact diabetes; all Americans have access to comprehensive and affordable health care. The NCCC also recommends that a coordinating Office of National Diabetes Policy be established.
AHRQ-authored; AHRQ-funded.
Citation: Conlin PR, Boltri JM, Bullock A .
The National Clinical Care Commission report to Congress: summary and next steps.
Diabetes Care 2023 Feb; 46(2):e60-e63. doi: 10.2337/dc22-0622..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention