JAMA network open
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The Smart Snacks in School standards (hereafter, Smart Snacks) were issued in 2013 with the aim of improving students' dietary intake behaviors. Goals of Smart Snacks included reducing total energy intake, consumption of solid fats and added sugars, and sodium intake. Smart Snacks standards were required to be implemented by the start of the 2014 to 2015 school year at all US schools participating in federal child nutrition programs. ⋯ These findings suggest that students in states with laws requiring schools to implement Smart Snacks had better dietary intake than students in states without laws, consuming a mean of 53.9 fewer kilocalories from solid fats and added sugars per day, after adjusting for covariates. State-level policy mechanisms may support schools' implementation of federal standards in ways that are associated with healthier diets among children and adolescents.
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Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States. ⋯ In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.
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Comparative Study
Assessment of Rural-Urban Differences in Postacute Care Utilization and Outcomes Among Older US Adults.
Although people living in rural areas of the United States are disproportionately older and more likely to die of conditions that require postacute care than those living in urban areas, rural-urban differences in postacute care utilization and outcomes have been understudied. ⋯ These findings suggest that rates of discharge to the community and postacute care settings were similar among patients from rural and urban counties. Rural-urban differences in mortality following discharge were much larger for patients receiving postacute care compared with patients discharged to the community setting. Improving postacute care in rural areas may reduce rural-urban disparities in patient outcomes.
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In 2016, the Centers for Medicare & Medicaid Services introduced mandatory bundled payments for knee and hip replacement surgical procedures among traditional Medicare (TM) patients in randomly selected areas. The association of bundled payments with outcomes among patients enrolled in Medicare Advantage (MA) is not known. ⋯ In this study, the first 18 months of the Centers for Medicare & Medicaid Services bundled payment program for joint replacement surgery were associated with reductions in the use of institutional PAC among MA patients. Past evaluations of bundled payments that focused on TM patients may not have measured the full consequences of this alternative payment model.