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Vitamin D deficiency has long been associated with reduced immune function that can lead to viral infection. Several studies have shown that Vitamin D deficiency is associated with increases the risk of infection with COVID-19. However, it is unknown if treatment with Vitamin D can reduce the associated risk of COVID-19 infection, which is the focus of this study. In the population of US veterans, we show that Vitamin D 2 and D 3 fills were associated with reductions in COVID-19 infection of 28% and 20%, respectively [(D 3 Hazard Ratio (HR) = 0.80, [95% CI 0.77, 0.83]), D 2 HR = 0.72, [95% CI 0.65, 0.79]]. Mortality within 30-days of COVID-19 infection was similarly 33% lower with Vitamin D 3 and 25% lower with D 2 (D 3 HR = 0.67, [95% CI 0.59, 0.75]; D 2 HR = 0.75, [95% CI 0.55, 1.04]). We also find that after controlling for vitamin D blood levels, veterans receiving higher dosages of Vitamin D obtained greater benefits from supplementation than veterans receiving lower dosages. Veterans with Vitamin D blood levels between 0 and 19 ng/ml exhibited the largest decrease in COVID-19 infection following supplementation. Black veterans received greater associated COVID-19 risk reductions with supplementation than White veterans. As a safe, widely available, and affordable treatment, Vitamin D may help to reduce the severity of the COVID-19 pandemic.

Health information technology (IT) has been championed as a tool that can transform health care delivery. We estimate the parameters of a value-added hospital production function correcting for endogenous input choices to assess the private returns hospitals earn from health IT. Despite high marginal products, the total benefits from expanded IT adoption are modest. Over the span of our data, health IT inputs increased by more than 210% and contributed about 6% to the increase in value-added. Not-for-profits invested more heavily and differently in IT. Finally, we find no compelling evidence of labor complementarities or network externalities from competitors' IT investment.

The potential of health information technology (IT) to transform health care delivery has spurred health IT adoption and will likely contribute to increased investments in coming years. Although an extensive literature shows the value of health IT at leading academic institutions, its broader value remains unknown. We sought to estimate IT's effect on key patient safety measures in a national sample. Using four years of Medicare inpatient data, we found that electronic medical records have a small, positive effect on patient safety. Although these results are encouraging, we suggest that investment in health IT should be accompanied by investment in the evidence base needed to evaluate it. [PUBLICATION ABSTRACT]

Americans increasingly post and consult online physician rankings, yet we know little about this new phenomenon of public physician quality reporting. Physicians worry these rankings will become an outlet for disgruntled patients. To describe trends in patients' online ratings over time, across specialties, to identify what physician characteristics influence online ratings, and to examine how the value of ratings reflects physician quality. We used data from RateMDs.com, which included over 386,000 national ratings from 2005 to 2010 and provided insight into the evolution of patients' online ratings. We obtained physician demographic data from the US Department of Health and Human Services' Area Resource File. Finally, we matched patients' ratings with physician-level data from the Virginia Medical Board and examined the probability of being rated and resultant rating levels. We estimate that 1 in 6 practicing US physicians received an online review by January 2010. Obstetrician/gynecologists were twice as likely to be rated (P < .001) as other physicians. Online reviews were generally quite positive (mean 3.93 on a scale of 1 to 5). Based on the Virginia physician population, long-time graduates were more likely to be rated, while physicians who graduated in recent years received higher average ratings (P < .001). Patients gave slightly higher ratings to board-certified physicians (P = .04), those who graduated from highly rated medical schools (P = .002), and those without malpractice claims (P = .1). Online physician rating is rapidly growing in popularity and becoming commonplace with no evidence that they are dominated by disgruntled patients. There exist statistically significant correlations between the value of ratings and physician experience, board certification, education, and malpractice claims, suggesting a positive correlation between online ratings and physician quality. However, the magnitude is small. The average number of ratings per physician is still low, and most rating variation reflects evaluations of punctuality and staff. Understanding whether they truly reflect better care and how they are used will be critically important.

Health information technology (IT) adoption, it is argued, will dramatically improve patient care. We study the impact of hospital IT adoption on patient outcomes focusing on the role of patient and organizational heterogeneity. We link detailed hospital discharge data on all Medicare feefor-service admissions from 2002-2007 to detailed hospital-level IT adoption information. For all IT-sensitive conditions, we find that health IT adoption reduces mortality for the most complex patients but does not affect outcomes for the median patient. Benefits from health IT are primarily experienced by patients whose diagnoses require cross-specialty care coordination and extensive clinical information management.

Health information technology (IT), such as computerized physician order entry and electronic health records, has potential to improve the quality of health care. But the returns from widespread adoption of such technologies remain uncertain. We measured changes in the quality of care following adoption of electronic health records among a national sample of U.S. hospitals from 2004 to 2007. The use of computerized physician order entry and electronic health records resulted in significant improvements in two quality measures, with larger effects in academic than nonacademic hospitals. We conclude that achieving substantive benefits from national implementation of health IT may be a lengthy process. Policies to improve health IT's efficacy in nonacademic hospitals might be more beneficial than adoption subsidies. [PUBLICATION ABSTRACT]

Alcohol consumption is associated with a wide range of adverse health consequences and a leading cause of preventable deaths. Ride-hailing services such as Uber have been found to prevent alcohol-related motor vehicle fatalities. These services may, however, facilitate alcohol consumption generally and binge drinking in particular. The goal of the research is to measure the impact of ride-hailing services on the extent and intensity of alcohol consumption. We allow these associations to depend on population density as the use of ride-hailing services varies across markets. We exploit the phased rollout of the ride-hailing platform Uber using a difference-in-differences approach. We use this variation to measure changes in alcohol consumption among a local population following Uber's entry. Data are drawn from Uber press releases to capture platform entry and the Behavioral Risk Factor Surveillance Systems (BRFSS) Annual Survey to measure alcohol consumption in 113 metropolitan areas. Models are estimated using fixed-effects Poisson regression. Pre- and postentry trends are used to validate this approach. Ride-hailing has no association with the extent of alcohol consumption in high (0.61 [95% CI -0.05% to 1.28%]) or low (0.61 [95% CI -0.05% to 1.28%]) density markets, but is associated with increases in the binge drinking rate in high-density markets (0.71 [95% CI 0.13% to 1.29%]). This corresponds to a 4% increase in binge drinking within a Metropolitan Statistical Area. Ride-hailing services are associated with an increase in binge drinking, which has been associated with a wide array of adverse health outcomes. Drunk driving rates have fallen for more than a decade, while binge drinking continues to climb. Both trends may be accelerated by ride-hailing services. This suggests that health information messaging should increase emphasis on the direct dangers of alcohol consumption and binge drinking.

The continuous Medicaid enrollment provision adopted during the COVID-19 pandemic ended in March 2023, after which 24 million US residents were disenrolled. Prior studies suggest this \"unwinding\" was associated with increased discontinuation of buprenorphine, an effective treatment for opioid use disorder. On December 1, 2023, North Carolina expanded Medicaid to low-income adults under the Patient Protection and Affordable Care Act (ACA). To evaluate changes in buprenorphine dispensing following North Carolina's Medicaid expansion. This cross-sectional study used a difference-in-differences analysis of the IQVIA Longitudinal Prescription Database, which captures 92% of US prescriptions. The analysis was limited to North Carolina and South Carolina, which has not expanded Medicaid under the ACA. The sample included adults with Medicaid-paid buprenorphine prescriptions from March to May 2023, 3 months before unwinding began in these states. The preintervention period was June 1 to November 30, 2023, and the postintervention period was December 1, 2023 to December 31, 2024. North Carolina's Medicaid expansion. Monthly proportion of patients with at least 1 active buprenorphine prescription; monthly proportion of patients with at least 1 active prescription paid by Medicaid, private insurance, or cash. Linear probability models estimated differential changes in outcomes over time in North Carolina vs South Carolina. Analyses included 286 216 person-months of data from 15 064 patients (mean [SD] age, 39.8 [9.2] years; 210 881 person-months [73.7%] contributed by women). The monthly proportion of patients with at least 1 active buprenorphine prescription declined by 11.3 and 11.2 percentage points in North Carolina and South Carolina, respectively, between June and November 2023. North Carolina's Medicaid expansion was associated with a 1.6 (95% CI, 0.9-2.3) percentage point differential increase in this proportion, a 7.4 (95% CI, 5.7-9.1) percentage point differential increase in the probability of having at least 1 Medicaid-paid prescription, a -4.1 (95% CI, -5.2 to -3.0) percentage point differential change in the probability of having at least 1 private-pay prescription, and a -1.4 (95% CI, -2.6 to -0.3) percentage point differential change in the probability of having at least 1 cash-pay prescription. In this cross-sectional study of prescription dispensing data, North Carolina's Medicaid expansion was associated with a slowing of the decline in buprenorphine dispensing that occurred after unwinding of Medicaid continuous coverage requirement began. Medicaid expansion may have partially mitigated the adverse changes in buprenorphine dispensing associated with unwinding.

During the COVID-19 pandemic, many primary care practices adopted telehealth in place of in-person care to preserve access to care for patients with acute and chronic conditions. The extent to which this change was associated with their rates of acute care visits (ie, emergency department visits and hospitalizations) for these conditions is unknown. To examine whether a primary care practice's level of telehealth use is associated with a change in their rate of acute care visits for ambulatory care-sensitive conditions (ACSC visits). This retrospective cohort analysis used a difference-in-differences study design to analyze insurance claims data from 4038 Michigan primary care practices from January 1, 2019, to September 30, 2020. Low, medium, or high tertile of practice-level telehealth use based on the rate of telehealth visits from March 1 to August 31, 2020, compared with prepandemic visit volumes. Risk-adjusted ACSC visit rates before (June to September 2019) and after (June to September 2020) the start of the COVID-19 pandemic, reported as an annualized average marginal effect. The study examined overall, acute, and chronic ACSC visits separately and controlled for practice size, in-person visit volume, zip code-level attributes, and patient characteristics. A total of nearly 1.5 million beneficiaries (53% female; mean [SD] age, 40 [22] years) were attributed to 4038 primary care practices. Compared with 2019 visit volumes, median telehealth use was 0.4% for the low telehealth tertile, 14.7% for the medium telehealth tertile, and 39.0% for the high telehealth tertile. The number of ACSC visits decreased in all tertiles, with adjusted rates changing from 24.3 to 14.9 per 1000 patients per year (low), 23.9 to 15.3 per 1000 patients per year (medium), and 27.5 to 20.2 per 1000 patients per year (high). In difference-in-differences analysis, high telehealth use was associated with a higher ACSC visit rate (2.10 more visits per 1000 patients per year; 95% CI, 0.22-3.97) compared with low telehealth practices; practices in the middle tertile did not differ significantly from the low tertile. No difference was found in ACSC visits across tertiles when acute and chronic ACSC visits were examined separately. In this cohort study that used a difference-in-differences analysis, the association between practice-level telehealth use and ACSC visits was mixed. High telehealth use was associated with a slightly higher overall ACSC visit rate than low telehealth practices. The association of telehealth with downstream care use should be closely monitored going forward.

•Pneumococcal vaccination rates are low, but rising in non-elderly, commercially-insured individuals.•Individuals with diabetes were more likely to be vaccinated.•Pneumococcal vaccination has a modest impact reducing costs of pneumococcal disease in this population. The 23-valent pneumococcal polysaccharide vaccine is routinely recommended for adults with diabetes, but little is known about adherence to this recommendation and how vaccination of these adults affects costs related to pneumococcal disease. We used data from a commercial insurance claims dataset to examine a cohort of non-elderly adults with a new diagnosis of diabetes and adults with no diagnosis of diabetes from 2005 to 2014. We examined rates of pneumococcal polysaccharide vaccination and the relationship between vaccination and pneumococcal disease costs, comparing results for persons with a diagnosis of diabetes and those with no diagnosis of diabetes. Overall rates of pneumococcal polysaccharide vaccination among adults 30–60 years old were <1%/year. Rates of pneumococcal polysaccharide vaccination were higher for adults with diabetes. Pneumococcal polysaccharide vaccination rates more than doubled from 2.9% per year in 2005 to 6.0% per year in 2014 for adults vaccinated during the same year as their diabetes diagnosis. Using a two-part differences-in-differences model on a propensity-score matched dataset, pneumococcal polysaccharide vaccination may reduce average annual per-person pneumococcal disease costs by $90.54 [95% CI: $183.59, -$2.49, (p = 0.056)] in persons with diabetes from two years before to two years after vaccination. Non-elderly adults with diabetes have low but rising rates of pneumococcal polysaccharide vaccination. Pneumococcal polysaccharide vaccination has a modest impact reducing overall costs of pneumococcal disease in this population.