New research on home care cooperatives identifies novel approaches for improving home care quality

University of California - Los Angeles Health Sciences

Facebook

XLinkedIn
MessageWhatsAppEmail

New research on home care cooperatives – agencies co-owned and managed by home care workers – has identified key factors that appear to significantly improve the quality of care for patients.

The researchers identified four main drivers of improved care quality at cooperatives, all centered on empowering workers as stakeholders: incorporation of worker input into care planning; a boost in motivation derived from being co-owners; selective hiring of high-performing workers; and access to high-quality, hands-on training.

“This study identifies specific factors that may improve the quality of home care, a relatively understudied area but one that has major consequences for care recipients and the broader health care system,” said Dr. Geoffrey Gusoff, assistant professor of family medicine at the David Geffen School of Medicine at UCLA and the study’s lead author. “The care-enhancing practices identified by participants represent testable interventions that have the potential to significantly improve care quality across the home care sector.”

The study will be published in the peer-reviewed journal Health Affairs Scholar.

Millions of older Americans rely on home care provided by paid caregivers. But those traditional services are plagued by high turnover, limited training and difficulty communicating with other team members, Gusoff said.

“Quality home care is essential for improving the quality of life of care recipients and reducing unnecessary medical costs, but our current system, which often treats home care workers as low-skilled and easily replaceable, undermines home care quality,” he said.

Cooperatives can represent a new approach toward providing quality home care. “Expanding the home care cooperative model and the adoption of cooperatives' practices by traditional agencies could contribute to significantly improved home care quality, benefiting both care recipients and the broader healthcare system,” he said.  

Home care cooperatives provide the same daily living assistance to the elderly such as bathing, medication management and meal preparation as do traditional home care services. Unlike traditional home care services, cooperatives are owned and operated by the workers that deliver these services, leading to a more collaborative experience and sense of ownership for the participants.

In previous research, the team focused on how cooperatives can reduce employee turnover through practices such as better compensation, a sense of community, and control. For this study, the researchers examined which cooperative practices appear to improve the quality of care.

The researchers conducted 32 semi-structured interviews with home care workers and other staff at five cooperatives to identify drivers of care quality.

The researchers acknowledged several limitations of the study, including a lack of input from care recipients and non-English speaking workers, who may provide additional insight into care quality drivers. They also noted the possibility of selection or recall bias in participant responses and that additional research is needed to test the true impacts of the perceived drivers of care quality identified.

The next step in the research is to conduct quantitative studies to assess how the identified factors impact safety, patient experience and health outcomes, Gusoff said.

Additional study authors are Miguel Cuevas and Dr.  Catherine Sarkisian of UCLA, Dr. Madeline Sterling of Weill Cornell Medicine, Ariel Avgar of Cornell University, and Gery Ryan of Kaiser Permanente Bernard J. Tyson School of Medicine.

The study was funded by the National Institute on Aging (K01AG088782, 1K24AG047899-07), University of California, Los Angeles Clinical and Translational Science Institute (TL1TR001883, UL1TR001881), the Cornell University Center for Applied Research on Work, the Rutgers University Institute for the Study of Employee Ownership and Profit Sharing, the National Heart Lung and Blood Institute (K23HL150160) and the Doris Duke Charitable Foundation (DDCF 2022053).

---

Journal

Health Affairs Scholar

Method of Research

Survey

Subject of Research

People

Article Title

The Cooperative Difference: Perceived Drivers of Higher Care Quality at Home Care Cooperatives

Article Publication Date

26-Jun-2025

 

A good soak in a hot tub might beat a sauna for health benefits

A UO study showed hot-water immersion helped lower blood pressure and boost the immune system

University of Oregon

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

A study participant soaking in a hot tub in the lab. Photo courtesy of the Minson Lab.

view more 

Credit: Minson Lab, University of Oregon

Hot tubs and saunas can both soothe aching muscles and provide welcome warmth, but hot tubs might offer greater health benefits.

That’s the takeaway from a new study done by researchers in the Bowerman Sports Science Center at the University of Oregon, which compared the physiological effects of soaking in a hot tub to sitting in a traditional dry heat sauna or a more modern far-infrared sauna.

By raising core body temperatures, soaking in hot water can help lower blood pressure, stimulate the immune system and, over time, improve the body’s response to heat stress. Moreover, those effects can last beyond the minutes spent directly in heat treatment.

“We compared the most commonly utilized modalities of passive heating as they’re used in everyday life and studied in scientific research,” said study lead author Jessica Atencio, a doctoral student in the lab of Christopher Minson. “No studies have compared the acute responses between the three.”

The results were published in June in the American Journal of Physiology.

Under the guidance of Minson, the Kenneth M. and Kenda H. Singer Endowed Professor of Human Physiology and director of the Bowerman Center, researchers monitored body temperature, blood pressure, heart rate, cardiac output (the amount of blood the heart pumps per minute) and immune cell populations and blood biomarkers of inflammation. Data were collected before, during and after subjects soaked in a hot tub and sat in traditional dry heat and far-infrared saunas.

The study looked at 10 men and 10 women who exercised regularly and ranged in age from 20 to 28 years old. The goal was to isolate the physiological responses to each heating method in a young, healthy population.

“We saw that hot water immersion was the most impactful in increasing core body temperature, which is the main stimulus for these subsequent responses,” Atencio said. “Increasing body temperature causes an increase in blood flow, and just the force of blood moving across your vessels is beneficial for your vascular health.”

While the research team took blood samples from subjects after each kind of heat therapy, only hot-water immersion produced an inflammatory response as measured by the levels of inflammatory cytokines, a kind of immune signaling molecule, and immune cell populations.

Atencio and her team were not surprised by those results.

“Hot water immersion gives you the most robust changes in core temperature because you can’t effectively dissipate heat as you can if you have contact with the air and you’re sweating to cool the body,” she said. “When you’re submerged in water, the sweat mechanisms aren’t efficient.”

Minson has studied heat therapies for more than two decades. He has focused on how heat interacts with factors such as age, exercise and illness in men and women.

“There's no doubt in my mind that if people are willing to do some heat therapy, it’s going to align with improved health, as long as it’s done in moderation,” Minson said. “If you repeat these stresses over time, our lab and many others have shown that they are consistent with improved health.”

Regular exercise can provide benefits similar to and even better in some respects than those from heat therapy, he added, but individuals who are unable or unwilling to exercise may find that heat therapy provides an attractive option.

“It can be a very peaceful, sometimes religious, sometimes cultural and sometimes social experience,” Minson said. “And I think those aspects contribute to the health benefits and are critically important.”

“We want people to be smart and safe about it,” he added. “We need to make sure that they are cleared by their physicians or others for heat therapy or for exercise, whether it’s mild to moderate walking or jogging or strength training. Then they’ll be fine to do heat therapy.”

As a runner herself, Atencio knows people who like to combine heat therapy with exercise.

“We always say that exercise is the primary nonpharmacological treatment that people should be doing to promote health, but some people can’t or just won’t exercise,” she said. “Heat therapy is good supplementation.”

---

DOI

10.1152/ajpregu.00012.2025 

Article Title

Comparison of thermoregulatory, cardiovascular, and immune responses to different passive heat therapy modalities

MERIT PAY FAIL

GP performance pay fails to drive lasting changes in quality of care

Financial incentives alone are no magic bullet to improve quality, say researchers

BMJ Group

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

Introducing performance related pay for UK general practices initially improved quality of care, but did not seem to provide lasting improvements beyond that expected by previous trends, finds a study published by The BMJ today.

And initial gains in quality seemed to reverse when financial incentives were withdrawn, say the researchers.

The UK Quality and Outcomes Framework (QOF) pay-for-performance programme was introduced across the NHS in 2004 to reward general practices for providing high quality care across a range of disease indicators such as cancer, diabetes, heart disease, mental health, and obesity.

In 2014, a large number of QOF indicators were withdrawn, and in 2016 Scotland abolished the scheme, giving researchers an opportunity to examine its short and medium term impact.

To do this, they reviewed 11 studies of the impact of introducing QOF incentives for 83 indicators and withdrawing incentives for 31 indicators at a minimum of three time points before and after QOF began.

Although the design and quality of the studies differed, their risk of bias was low.

Compared with predicted levels of quality based on prior trends, QOF incentives were associated with improvements in recorded quality of care across all indicators at one year (average increase 6.1% beyond that expected), but improvement in quality was less consistent at three years (average increase 0.7%).

In contrast, incentive withdrawal led to a decline in recorded quality of care at both one and three years (average decreases of 10.7% and 12.8%, respectively), suggesting that the effects of pay-for-performance programmes are often not sustained without continued financial motivation.

Complex process indicators, such as foot screening in patients with diabetes, had larger declines than simple process indicators (for example, blood pressure measurement), intermediate outcomes (for example, blood pressure control), and treatment indicators (for example, anti-clotting therapy).

At three years, small declines in the quality of non-incentivised care was also found, suggesting that the focus on incentivised conditions may have come at the expense of important but non-incentivised aspects of healthcare.

These are observational findings, so no firm conclusions can be drawn about cause and effect, and the authors acknowledge that they could not distinguish changes in data recording from changes in the care actually provided to patients, and that some indicators were already near maximum before incentivisation, limiting likely benefit.

Whether or how best to deploy financial incentives in primary care remains uncertain, although financial incentives may have a role for engaging practices in broader quality improvement initiatives, the study authors conclude.

These findings raise important questions about the value of pay-for-performance programmes for patients, clinicians, and policy makers, say researchers in a linked editorial.

They point out that, as health systems globally continue to grapple with the challenge of improving quality of care in an era of financial restrictions, the lessons from the QOF programme in the UK can help in developing more effective and sustainable approaches to incentivising high quality primary care.

An effective QOF programme that focuses on key clinical areas and that makes best use of developments in information technology remains essential for the NHS if we are to reduce health inequalities, increase healthcare efficiency, and improve health outcomes, they conclude.

---

Journal

The BMJ

DOI

10.1136/bmj-2024-083424 

Method of Research

Systematic review

Article Title

Effect of UK Quality and Outcomes Framework pay-for-performance programme on quality of primary care: systematic review with quantitative synthesis

Article Publication Date

25-Jun-2025

COI Statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Economic and Social Research Council and Legal and General Group; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Can targeted payment adjustments help solve the infectious disease physician shortage?

A new analysis examines the first specialty-specific add-on code for Medicare infectious disease services

Harvard Pilgrim Health Care Institute

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

Key Points:

• Infectious disease (ID) physicians are among the lowest paid of all medical specialties, leading to declining interest among medical students and a national shortage.
• To address this, the Centers for Medicare and Medicaid Services (CMS) introduced a new add-on code increasing payments by ~20%  in 2025, the first specialty-specific workforce incentive in the Medicare fee schedule.
• This new analysis offers three recommendations for CMS to guide implementation and evaluation of this new payment model.

Boston, MA – A new analysis by researchers from the Harvard Pilgrim Health Care Institute examines the first Centers for Medicare and Medicaid Services (CMS) add-on code targeting a single physician specialty: infectious disease (ID). The measure is a significant departure from the agency’s past strategies, with the potential to combat the growing shortage of ID physicians and broader implications for physician reimbursement and healthcare delivery, according to the authors.

The Viewpoint, “Raising Reimbursement Rates to Combat Specialty Physician Shortages: A New Federal Initiative” was published on June 25 in JAMA.

Despite the vital role ID doctors play in critical public health functions such as pandemic preparedness and antimicrobial stewardship, they are among the lowest paid of all medical specialists. This imbalance between expertise and pay has contributed to a declining interest in the field, leaving half of ID fellowship positions unfilled in 2024. As a result, the U.S. faces a growing shortage of ID physicians, with an uneven distribution that disproportionately affects vulnerable and rural populations.

In response to ID physician discontent, the 2025 Medicare Physician Payment Final Rule included a new add-on code (G0545) for inpatient ID consultations, increasing reimbursement by $28.80 per inpatient ID consultation, an increase of approximately 20% on average over prior compensation levels. The services eligible for the add-on code include disease transmission risk mitigation, public health investigation, analysis and testing, and complex antimicrobial counseling and treatment.

“Infectious disease physicians are at the frontlines managing COVID-19 as well as future pandemics, yet their compensation is within the lowest quartile of all physician compensation,” said lead author Hao Yu, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute. “The add-on code is a meaningful recognition that ID physicians are under-compensated relative to the complexity and intensity of their work, but it remains to be seen whether it will improve ID physician salaries and workforce.”

The authors emphasize that, compared to other physician-shortage incentive payment programs, the new ID add-on code does not have a time limit, offers a higher reimbursement increase, and is specialty-specific. They note that while this novel strategy put forth by CMS appears promising, additional steps should be considered while implementing and evaluating the new code. They make three recommendations:

1. Ensure the payments translate to increases in physician salary: Efforts are needed to support the complexity of their services rather than the add-on payments being billed by the hospital but not translating to physician salary. For example, CMS could tie payment of the add-on code with transparent reporting from hospitals about ID specialist compensation in their annual cost reports, which are audited by Medicare. This policy lever would be similar to the New Technology Add-on Payment that requires hospital attestation with compliance via Medicare auditing.
2. Add location-based incentives: To help alleviate the critical shortage of ID specialists in rural and underserved areas, the add-on code should be extended with a higher reimbursement rate specifically for these areas.
3. Treat the ID add-on code as a pilot test: Carefully monitor and evaluate the effectiveness of the add-on code to determine whether it is a viable solution to combat shortfalls in ID specialties before implementing similar measures for other specialties.

The authors note that Medicare’s outsized influence on commercial payer fee setting means that the new add-on code has the potential to reset national benchmarks for ID compensation if done effectively. “Medicare is sending a strong signal that Infectious Disease expertise is worth more than our current payment system recognizes,” noted Tarun Ramesh, senior author of the study and research fellow at the Harvard Pilgrim Health Care Institute. He adds, “But if hospitals do not pass the bonus through to physicians, shortages in this specialty will continue to adversely affect patient care access and health outcomes.” 
 

---

About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky, X, and LinkedIn.

---

Journal

JAMA

Article Title

Raising Reimbursement Rates to Combat Specialty Physician Shortages A New Federal Initiative

Article Publication Date

25-Jun-2025

 

In sub-Saharan Africa, 1 in 6 cancer medications found to be defective

University of Notre Dame

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

Notre Dame Professor Marya Lieberman works in her research lab. 

view more 

Credit: Photo by Barbara Johnston/University of Notre Dame

Serious quality defects were found in a significant number of cancer medications from sub-Saharan Africa, according to new research from the University of Notre Dame.

For the study published in The Lancet Global Health, researchers collected different cancer medications from Cameroon, Ethiopia, Kenya and Malawi and evaluated whether each drug met regulatory standards. Researchers considered a variety of factors, including appearance, packaging, labeling and, most importantly, the assay value.

The assay value is the quantity of active pharmaceutical ingredient (API) found in each drug. To meet safety standards, most products should be within a range of 90 to 110 percent of the right amount of API. Researchers measured the API content of each product and compared that number to what was designated on the medication packaging.

“It is important that cancer medications contain the right amount of the active ingredients so the patient gets the correct dose,” said Marya Lieberman, professor of chemistry and biochemistry at Notre Dame and lead author of the study. “If the patient’s dose is too small, the cancer can survive and spread to other locations. If the patient’s dose is too high, they can be harmed by toxic side effects from the medicine.”

One in six cancer medications tested was found to contain the incorrect quantity of API, with tested medications having APIs ranging from 28 to 120 percent. The study evaluated 251 samples of cancer medications collected from major hospitals and private markets in all four countries.

The study, funded by the National Cancer Institute of the National Institutes of Health, is among the first to evaluate cancer drug quality in sub-Saharan Africa. Currently, sub-Saharan Africa has no pharmaceutical regulatory laboratories carrying out chemical analyses for cancer drugs according to the standards required for regulatory purposes.

Yet, the need for cancer drugs is growing.

“We found bad-quality cancer medications in all of the countries, in all of the hospital pharmacies and in the private markets,” said Lieberman, an affiliate of Notre Dame’s Eck Institute for Global Health and Harper Cancer Research Institute. “We learned that visual inspection, which is the main method for detecting bad-quality cancer drugs in sub-Saharan Africa today, only found one in 10 of the bad products.”

In their study, the researchers explained how a combination of high demand for cancer medications, lack of regulatory capacity, and poor manufacturing, distribution and storage practices likely created a problematic environment throughout sub-Saharan Africa. They also argue that given these factors and the global supply chain for pharmaceuticals, substandard cancer medications are likely present in other low and middle-income countries as well.

Lieberman and her team identified several strategies that could help the global community address poor-quality cancer medications:

• Provide inexpensive technologies at the point of care to screen for bad-quality cancer medicines and create policies for how to respond to products that fail screening tests.
• Help regulatory agencies in low and middle-income countries get safety equipment and training so they can analyze the quality of cancer medicines in their markets, conduct root-cause investigations when products fail testing, take quick regulatory actions enabled by lab data and share data about bad-quality products.
• Perform cost-benefit analyses of interventions that tackle common problems (such as medications being out of stock, unsafe shipping, storage or dispensing practices, and lack of availability or affordability of medications) to help policymakers and funders get the most impact on patient outcomes from their available resources.
• Work with care providers to develop site-specific response policies and messaging for patients and engage regulators, donors and other resources.

Lieberman and her lab are developing a user-friendly technology called the chemoPAD for screening cancer medications. This low-cost paper device could potentially help hospitals, pharmacies and health care professionals in low and middle-income countries monitor drug quality without restricting a patient’s access to the medication.

“This is all part of a bigger project aimed at developing the ChemoPAD as a point-of-care testing device that we can use, something that’s more accurate in detecting poor-quality products than just visual inspection,” Lieberman said.

“There are lots of medicines where the regulators don’t have enough resources to verify the quality, and some manufacturers take advantage of that to cut corners. There are also problems with distribution systems, so even if a product is good quality when it leaves the manufacturer, it may be degraded during shipping or storage. These products flow into low and middle-income countries, and they get used on patients. I want to change that.”

In addition to Lieberman, co-authors include Maximilian J. Wilfinger, Jack Doohan and Ekezie Okorigwe from Notre Dame; Ayenew Ashenef and Atalay Mulu Fentie from Addis Ababa University; Ibrahim Chikowe from Kamuzu University of Health Sciences; Hanna S. Kumwenda from the University of North Carolina Project Malawi; Paul Ndom from University of Yaoundé; Yauba Saidu from the Clinton Health Access Initiative; Jesse Opakas from the Moi Teaching and Referral Hospital; Phelix Makoto Were from AMPATH - Moi Teaching and Referral Hospital; and Sachiko Ozawa and Benyam Muluneh from the University of North Carolina.

This study was funded by the National Cancer Institute as part of the National Institutes of Health.

Contact: Brandi Wampler, associate director of media relations, 574-631-2632, brandiwampler@nd.edu

Maximilian J. Wilfinger, study co-author and Notre Dame graduate student, tests chemotherapy drugs in Marya Lieberman's lab.

Credit

Photo by Matt Cashore/University of Notre Dame

Journal

The Lancet Global Health

Article Title

Substandard anticancer medications in clinical care settings and private pharmacies in sub-Saharan Africa: a systematic pharmaceutical investigation

Article Publication Date

25-Jun-2025