Health Policy & Management Research Works

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Trusted and Relevant Medical Knowledge: The Promise of Information Retrieval
(2006-06) Silfen, Eric
As the world of medicine becomes increasingly digitized, the Web has become a de facto resource for physicians to quickly glean pertinent clinical information to carry out diagnostic and therapeutic decisions.At present, physicians face the dual challenge of judging the relevance of the information and trusting its Web source.This paper proposes a trust-relevance framework for conceptualizing computer-accessed medical information resources, a set of criteria for evaluating these information resources, and descriptions of a sample of available online resources. It also presents a usable framework for evaluating information retrieval innovations and explains the different capabilities of representative information retrieval tools and applications. By demystifying the concepts associated with information resources, search engines, and retrieval tools, and presenting a reasonable view of current opportunities as well as future possibilities, the authors hope to provide guidance so physicians can more rapidly adopt innovative computer-assisted search tools for acquiring information that facilitate patient care decision-making.
Clinical Bioinformatics
(Philips Research, 2007-05) E. Z. Silfen
This article describes the emergence of the hybrid discipline of clinical bioinformatics. Specifically, it defines biomedical informatics as well as the four compositional domains of bioinformatics, imaging informatics, clinical informatics and public health informatics. Furthermore, it describes the relationship between bioinformatics, molecular medicine and clinical decision support, and offers a definition of clinical bioinformatics that arises from the integration of these domains. After establishing this background, the article discusses use cases for clinical bioinformatics, summarizes the field of clinical bioinformatics, and posits its potential for biomedicine research.
Family structure and multiple domains of child well-being in the United States: a cross-sectional study
(Springer Nature, 2015-02-21) Krueger, Patrick M; Jutte, Douglas P; Franzini, Luisa; Elo, Irma; Hayward, Mark D
We examine the association between family structure and children’s health care utilization, barriers to health care access, health, and schooling and cognitive outcomes and assess whether socioeconomic status (SES) accounts for those family structure differences. We advance prior research by focusing on understudied but increasingly common family structures including single father families and five different family structures that include grandparents. Our data on United States children aged birth through 17 (unweighted N = 198,864) come from the 1997–2013 waves of the National Health Interview Survey, a nationally representative, publicly available, household-based sample. We examine 17 outcomes across nine family structures, including married couple, cohabiting couple, single mother, and single father families, with and without grandparents, and skipped-generation families that include children and grandparents but not parents. The SES measures include family income, home ownership, and parents’ or grandparents’ (depending on who is in the household) employment and education. Compared to children living with married couples, children in single mother, extended single mother, and cohabiting couple families average poorer outcomes, but children in single father families sometimes average better health outcomes. The presence of grandparents in single parent, cohabiting, or married couple families does not buffer children from adverse outcomes. SES only partially explains family structure disparities in children’s well-being. All non-married couple family structures are associated with some adverse outcomes among children, but the degree of disadvantage varies across family structures. Efforts to understand and improve child well-being might be most effective if they recognize the increasing diversity in children’s living arrangements.
Gender Differences in Mental Health Outcomes before, during, and after the Great Recession
(PLOS (Public Library of Science), 2015-05-13) Dagher, Rada K.; Chen, Jie; Thomas, Stephen B.
We examined gender differences in mental health outcomes during and post-recession versus pre-recession. We utilized 2005-2006, 2008-2009, and 2010-2011 data from the Medical Expenditure Panel Survey. Females had lower odds of depression diagnoses during and post-recession and better mental health during the recession, but higher odds of anxiety diagnoses post-recession. Males had lower odds of depression diagnoses and better mental health during and post-recession and lower Kessler 6 scores post-recession. We conducted stratified analyses, which confirmed that the aforementioned findings were consistent across the four different regions of the U.S., by employment status, income and health care utilization. Importantly, we found that the higher odds of anxiety diagnoses among females after the recession were mainly prominent among specific subgroups of females: those who lived in the Northeast or the Midwest, the unemployed, and those with low household income. Gender differences in mental health in association with the economic recession highlight the importance of policymakers taking these differences into consideration when designing economic and social policies to address economic downturns. Future research should examine the reasons behind the decreased depression diagnoses among both genders, and whether they signify decreased mental healthcare utilization or increased social support and more time for exercise and leisure activities.
Residential High-Speed Internet Among Those Likely to Benefit From an Online Health Insurance Marketplace
(SAGE Publications, Inc., 2016) Boudreaux, Michel H.; Gonzales, Gilbert; Blewett, Lynn; Fried, Brett; Karaca-Mandic, Pinar
Using data from the 2013 American Community Survey, we found that 24.3 million people (about 1 in 4) who were either eligible for Medicaid/Children’s Health Inusrance Program (CHIP) or appeared likely to shop for Qualified Health Plan (QHP) lacked residential high-speed Internet. Specifically, 28.6% or 18.9 million people eligible for Medicaid/CHIP and 17.1% or 5.5 million people who appeared likely to shop for a QHP did not have high-speed Internet in the home. For both the Medicaid/CHIP eligible and those likely to shop for a QHP, the proportion of people living in households without Internet varied substantially by race, geography, and other socio-demographic characteristics.
Future expenditure risk of silent members: a statistical analysis
(Springer Nature, 2016-07-29) Krause, Trudy Millard; Donderici, Elifnur Yay; Cazaban, Cecilia Ganduglia; Franzini, Luisa
Silent-members are members of a medical health plan who submit no claims for healthcare services in a benefit year despite 12 months of continuous-enrollment. This study was conducted to evaluate the future expenditure risk of commercial-insured members who avoid all medical care despite coverage. In order to determine if the silent-members were at greater risk, we compared them to members who received care in the anchor year (2009) but had low-expenditures. The low-expenditure members were assumed to represent persons without significant medical conditions and without care-avoidance behaviors. We examined the claims experience of a cohort of silent members in the 2 years after the silent year (2009) and compared it with the corresponding claims experience for a cohort of low-expenditure members from the same anchor year (2009). Members of commercial health plans (BCBS of Texas) were selected based on continuous-enrollment in 2009. Two sub-groups were identified based on annual claims expenditure: Care avoiders were members with 12 months continuous-enrollment and no medical claims, and are thus referred to as “silent members” in the insurance industry. Low-Expenditure members were those with 12 months continuous-enrollment and total PMPY (per member per year) annual medical claims expenditure in the lowest 10th percentile of members with claims experience. “Low-expenditure” members served as a comparison group to the “silent members”, under the assumption that such claimants were using benefits for minor healthcare issues as needed. Key variables were enrollment and expenditures. Enrollment data identified demographics and continuous-enrollment. Medical claims data were used to calculate utilization and expenditures. All claims data were de-identified and no consent was required, as approved by the Institutional Review Board. No research involved human subjects. Multivariate logistic regression models were applied. Silent members who seek care in subsequent years have a greater probability of becoming high-expenditure claimants than those with low-expenditure experience. For silent members who subsequently seek treatment, the probability of becoming high-expenditure is significantly greater than low-expenditure members from the anchor year. The implications of future high costs for silent members who become claimants may support the need for additional research to address the risks of care avoidance behaviors.
A randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisits
(Springer Nature, 2018-05-03) Mi, Ranran; Hollander, Matthew M.; Jones, Courtney M. C.; DuGoff, Eva H.; Caprio, Thomas V.; Cushman, Jeremy T.; Kind, Amy J. H.; Lohmeier, Michael; Shah, Manish N.
Approximately 20% of community-dwelling older adults discharged from the emergency department (ED) return to an ED within 30 days, an occurrence partially resulting from poor care transitions. Prior published interventions to improve the ED-to-home transition have either lacked feasibility or effectiveness. The Care Transitions Intervention (CTI) has been validated to decrease rehospitalization among patients transitioning from the hospital to the home but has never been tested for patients transitioning from the ED to the home. Paramedics, traditionally involved only in emergency care, are well-positioned to deliver the CTI, but have never been previously evaluated in this role. This single-blinded randomized controlled trial tests whether the paramedic-delivered ED-to-home CTI reduces community-dwelling older adults’ ED revisits in the 30 days after an index visit. We are prospectively recruiting patients aged≥ 60 years at 3 EDs in Rochester, NY and Madison, WI to enroll 2400 patient subjects. Subjects are randomized into control and treatment groups, with the latter receiving the adapted CTI. The intervention consists of the paramedic performing one home visit and up to three follow-up phone calls. During these interactions, the paramedic follows the CTI approach by coaching patients toward their goals, with a focus on their personal health record, medication management, red flags, and primary care follow-up. We follow patient participants for 30 days. All receive a survey during the index ED visit to capture baseline demographic and health information and two telephone-based surveys to assess process objectives and outcomes. We also perform a medical record review. The primary outcome is the odds of ED revisit within 30 days after discharge from the index ED visit. This is the first study to test whether the CTI, applied to the ED-to-home transition and delivered by community paramedics, can decrease the rate at which older adults revisit an ED. Outcomes from this research will help address a major emergency care challenge by supporting older adults in the transition from the ED to home, thereby improving health outcomes for this population and reducing potentially avoidable ED visits.
Addressing refugee health through evidence-based policies: A case study
(Elsevier, 2018-06) Thiel de Bocanegra, Heike; Carter-Pokras, Olivia; Ingleby, J. David; Pottie, Kevin; Tchangalova, Nedelina; Allen, Sophia I.; Smith-Gagen, Julie; Hidalgo, Bertha
The cumulative total of persons forced to leave their country for fear of persecution or organized violence reached an unprecedented 24.5 million by the end of 2015. Providing equitable access to appropriate health services for these highly diverse newcomers poses challenges for receiving countries. In this case study, we illustrate the importance of translating epidemiology into policy to address the health needs of refugees by highlighting examples of what works as well as identifying important policy-relevant gaps in knowledge. First, we formed an international working group of epidemiologists and health services researchers to identify available literature on the intersection of epidemiology, policy, and refugee health. Second, we created a synopsis of findings to inform a recommendation for integration of policy and epidemiology to support refugee health in the United States and other high-income receiving countries. Third, we identified eight key areas to guide the involvement of epidemiologists in addressing refugee health concerns. The complexity and uniqueness of refugee health issues, and the need to develop sustainable management information systems, require epidemiologists to expand their repertoire of skills to identify health patterns among arriving refugees, monitor access to appropriately designed health services, address inequities, and communicate with policy makers and multidisciplinary teams.
The impact of integrating medical assistants and community health workers on diabetes care management in community health centers
(Springer Nature, 2018-11-20) Rodriguez, Hector P.; Friedberg, Mark W.; Vargas-Bustamante, Arturo; Chen, Xiao; Martinez, Ana E.; Roby, Dylan H.
To compare the impact of implementing team-based diabetes care management involving community health workers (CHWs) vs. medical assistants (MA) in community health centers (CHCs) on diabetes care processes, intermediate outcomes, and patients’ experiences of chronic care. Patients in the CHW intervention arm had improved annual glycated hemoglobin testing (18.5%, p < 0.001), while patients in the MA intervention arm had improved low-density lipoprotein cholesterol control (8.4%, p < 0.05) and reported better chronic care experiences over time (β=7.5, p < 0.001). Except for chronic care experiences (p < 0.05) for patients in the MA intervention group, difference-in-difference estimates were not statistically significant because control group patients also improved over time. Some diabetes care processes improved significantly more for control group patients than intervention group patients. Key informant interviews revealed that immediate patient care issues sometimes crowded out diabetes care management activities, especially for MAs. Diabetes care improved in CHCs integrating CHWs and MAs onto primary care teams, but the improvements were no different than improvements observed among matched control group patients. Greater improvement using CHW and MA team-based approaches may be possible if practice leaders minimize use of these personnel to cover shortages that often arise in busy primary care practices.
The medical home functions of primary care practices that care for adults with psychological distress: a cross-sectional study
(Springer Nature, 2019-01-09) Linman, Shawn; Benjenk, Ivy; Chen, Jie
Primary care practices are changing the way that they provide care by increasing their medical home functionality. Medical home functionality can improve access to care and increase patient-centeredness, which is essential for persons with mental health issues. This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with psychological distress. Analysis of the 2015 Medical Expenditure Panel Survey Household Component and Medical Organizations Survey. This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care. This study focused on adults aged 18 and above. As compared to adults without psychological distress, adults with psychological distress had significantly higher rates of chronic illness and poverty. Adults with psychological distress were more likely to receive care from practices that include advanced practitioners and are non-profit or hospital-based. Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with psychological distress are as likely to receive primary care from practices with medical home functionality, including case management, electronic health records, flexible scheduling, and PCMH certification, as adults without psychological distress. Practices that care for adults with mental health issues have not been left behind in the transition towards medical home models of primary care. Policy makers should continue to prioritize adults with mental health issues to receive primary care through this model of delivery due to this population’s great potential to benefit from improved access and care coordination.
Socially-assigned race and health: A scoping review with global implications for population health equity
(International Journal for Equity in Health (Springer Link), 2020-02-10) White, Kellee; Lawrence, Jourdyn A.; Tchangalova, Nedelina; Huang, Shuo J.; Cummings, Jason L.
Self-identified race/ethnicity is largely used to identify, monitor, and examine racial/ethnic inequalities. A growing body of work underscores the need to consider multiple dimensions of race – the social construction of race as a function of appearance, societal interactions, institutional dynamics, stereotypes, and social norms. One such multidimensional measure is socially-assigned race, the perception of one’s race by others, that may serve as the basis for differential or unfair treatment and subsequently lead to deleterious health outcomes. We conducted a scoping review to systematically appraise the socially-assigned race and health literature. A systematic search of the PubMed, Web of Science, 28 EBSCO databases and 24 Proquest databases up to September 2019 was conducted and supplemented by a manual search of reference lists and grey literature. Quantitative and qualitative studies that examined socially-assigned race and health or health-related outcomes were considered for inclusion. Eighteen articles were included in the narrative synthesis. Self-rated health and mental health were among the most frequent outcomes studied. The majority of studies were conducted in the United States, with fewer studies conducted in New Zealand, Canada, and Latin America. While most studies demonstrate a positive association between social assignment as a disadvantaged racial or ethnic group and poorer health, some studies did not document an association. We describe key conceptual and methodological considerations that should be prioritized in future studies examining socially-assigned race and health. Socially-assigned race can provide additional insight into observed differential health outcomes among racial/ethnic groups in racialized societies based upon their lived experiences. Studies incorporating socially-assigned race warrants further investigation and may be leveraged to examine nuanced patterns of racial health advantage and disadvantage.
Socially-assigned race and health: a scoping review with global implications for population health equity
(Springer Nature, 2020-02-10) White, Kellee; Lawrence, Jourdyn A.; Tchangalova, Nedelina; Huang, Shuo J.; Cummings, Jason L.
Self-identified race/ethnicity is largely used to identify, monitor, and examine racial/ethnic inequalities. A growing body of work underscores the need to consider multiple dimensions of race – the social construction of race as a function of appearance, societal interactions, institutional dynamics, stereotypes, and social norms. One such multidimensional measure is socially-assigned race, the perception of one’s race by others, that may serve as the basis for differential or unfair treatment and subsequently lead to deleterious health outcomes. We conducted a scoping review to systematically appraise the socially-assigned race and health literature. A systematic search of the PubMed, Web of Science, 28 EBSCO databases and 24 Proquest databases up to September 2019 was conducted and supplemented by a manual search of reference lists and grey literature. Quantitative and qualitative studies that examined socially-assigned race and health or health-related outcomes were considered for inclusion. Eighteen articles were included in the narrative synthesis. Self-rated health and mental health were among the most frequent outcomes studied. The majority of studies were conducted in the United States, with fewer studies conducted in New Zealand, Canada, and Latin America. While most studies demonstrate a positive association between social assignment as a disadvantaged racial or ethnic group and poorer health, some studies did not document an association. We describe key conceptual and methodological considerations that should be prioritized in future studies examining socially-assigned race and health. Socially-assigned race can provide additional insight into observed differential health outcomes among racial/ethnic groups in racialized societies based upon their lived experiences. Studies incorporating socially-assigned race warrants further investigation and may be leveraged to examine nuanced patterns of racial health advantage and disadvantage.
Socially-assigned race and health: a scoping review with global implications for population health equity
(Springer Nature, 2020-02-10) White, Kellee; Lawrence, Jourdyn A.; Tchangalova, Nedelina; Huang, Shuo J.; Cummings, Jason L.
Self-identified race/ethnicity is largely used to identify, monitor, and examine racial/ethnic inequalities. A growing body of work underscores the need to consider multiple dimensions of race – the social construction of race as a function of appearance, societal interactions, institutional dynamics, stereotypes, and social norms. One such multidimensional measure is socially-assigned race, the perception of one’s race by others, that may serve as the basis for differential or unfair treatment and subsequently lead to deleterious health outcomes. We conducted a scoping review to systematically appraise the socially-assigned race and health literature. A systematic search of the PubMed, Web of Science, 28 EBSCO databases and 24 Proquest databases up to September 2019 was conducted and supplemented by a manual search of reference lists and grey literature. Quantitative and qualitative studies that examined socially-assigned race and health or health-related outcomes were considered for inclusion. Eighteen articles were included in the narrative synthesis. Self-rated health and mental health were among the most frequent outcomes studied. The majority of studies were conducted in the United States, with fewer studies conducted in New Zealand, Canada, and Latin America. While most studies demonstrate a positive association between social assignment as a disadvantaged racial or ethnic group and poorer health, some studies did not document an association. We describe key conceptual and methodological considerations that should be prioritized in future studies examining socially-assigned race and health. Socially-assigned race can provide additional insight into observed differential health outcomes among racial/ethnic groups in racialized societies based upon their lived experiences. Studies incorporating socially-assigned race warrants further investigation and may be leveraged to examine nuanced patterns of racial health advantage and disadvantage.
Analyzing the Effect of Vaping Use in Teens: A Literature Review and Proposed Solutions
(Journal of Student Research, 2021-03-31) Ajayi, Damilola; Fuchs, Bruce; Reiss, Dana
Teenage vaping is a major public health issue that is emerging globally. This review article examines what influences teens to use electronic cigarettes (e-cigarettes) and vapes, including families, communities, social media, and brand marketing. Nicotine, a common component of e-cigarettes and vapes, is addictive, and teens who are using these products are starting to report negative health outcomes. After a review of the current literature, three recommendations/solutions are proposed to combat this public health issue. As teen e-cigarette use is on the rise, it is clear that the FDA and the federal government need to enforce tougher regulations on e-cigarette and vaping brands, teens need to be properly educated about these products that are on the market, and advertisements for these products need to be regulated.
The relationship between educational attainment and hospitalizations among middle-aged and older adults in the United States
(Elsevier, 2021-09-14) Yue, Dahai; Ponce, Ninez A.; Needleman, Jack; Ettner, Susan L.
There has been little research on the relationship between education and healthcare utilization, especially for racial/ethnic minorities. This study aimed to examine the association between education and hospitalizations, investigate the mechanisms, and disaggregate the relationship by gender, race/ethnicity, and age groups. A retrospective cohort analysis was conducted using data from the 1992–2016 US Health and Retirement Study. The analytic sample consists of 35,451 respondents with 215,724 person-year observations. We employed a linear probability model with standard errors clustered at the respondent level and accounted for attrition bias using an inverse probability weighting approach. On average, compared to having an education less than high school, having a college degree or above was significantly associated with an 8.37 pp (95% CI, −9.79 pp to −7.95 pp) lower probability of being hospitalized, and having education of high school or some college was related to 3.35 pp (95% CI, −4.57 pp to −2.14 pp) lower probability. The association slightly attenuated after controlling for income but dramatically reduced once holding health conditions constant. Specifically, given the same health status and childhood environment conditions, compared to those with less than high school degree, college graduates saw a 1.79 pp (95% CI, −3.16 pp to −0.42 pp) lower chance of being hospitalized, but the association for high school graduates became indistinguishable from zero. Additionally, the association was larger for females, whites, and those younger than 78. The association was statistically significantly smaller for black college graduates than their white counterparts, even when health status is held constant. Educational attainment is a strong predictor of hospitalizations for middle-aged and older US adults. Health mediates most of the education-hospitalization gradients. The heterogeneous results across age, gender, race, and ethnicity groups should inform further research on health disparities.
Who declines to respond to the reactions to race module?: findings from the South Carolina Behavioral Risk Factor Surveillance System, 2016–2017
(Springer Nature, 2021-09-19) Srivastav, Aditi; Robinson-Ector, Kaitlynn; Kipp, Colby; Strompolis, Melissa; White, Kellee
The inclusion of self-reported differential treatment by race/ethnicity in population-based public health surveillance and monitoring systems may provide an opportunity to address long-standing health inequalities. While there is a growing trend towards decreasing response rates and selective non-response in health surveys, research examining the magnitude of non-response related to self-reported discrimination warrants greater attention. This study examined the distribution of sociodemographic variables among respondents and non-respondents to the South Carolina Behavioral Risk Factor Surveillance System (SC-BRFSS) Reactions to Race module (6-question optional module capturing reports of race-based treatment). Using data from SC-BRFSS (2016, 2017), we examined patterns of non-response to the Reactions to Race module and individual items in the module. Logistic regression models were employed to examine sociodemographic factors associated with non-response and weighted to account for complex sampling design. Among 21,847 respondents, 15.3% were non-responders. Significant differences in RTRM non-response were observed by key sociodemographic variables (e.g., age, race/ethnicity, labor market participation, and health insurance status). Individuals who were younger, Hispanic, homemakers/students, unreported income, and uninsured were over-represented among non-respondents. In adjusted analyses, Hispanics and individuals with unreported income were more likely to be non-responders in RTRM and across item, while retirees were less likely to be non-responders. Heterogeneity in levels of non-responses were observed across RTRM questions, with the highest level of non-response for questions assessing differential treatment in work (54.8%) and healthcare settings (26.9%). Non-responders differed from responders according to some key sociodemographic variables, which could contribute to the underestimation of self-reported discrimination and race-related differential treatment and health outcomes. While we advocate for the use of population-based measures of self-reported racial discrimination to monitor and track state-level progress towards health equity, future efforts to estimate, assess, and address non-response variations by sociodemographic factors are warranted to improve understanding of lived experiences impacted by race-based differential treatment.
Blockchain Glossary
(2022-01-04) Silfen, Eric; None
Blockchain is classified as a General-Purpose Technology (GPT) that describes a series of decentralized distributed databases that create a tamper-proof, verifiable ledger. As with any new technology, blockchain has its own terminology. Here is a list of important terms and their meanings. N.B. Blockchain does not equal Bitcoin.
Reductions in under-5 mortality and public health improvements of the China Healthy Cities (Counties) initiative: a nationwide quasiexperimental study
(BMJ, 2022-03-09) Yue, Dahai; Chen, Xiao; Zhu, Yuhui; Macinko, James; Meng, Qingyue
Introduction The China Healthy Cities (Counties) public health initiative has been at the forefront of China’s efforts to counteract the growing challenges in the urban environment since the 1990s. It primarily focuses on improving the urban living environment. However, the nationwide health impacts of the initiative remain unexplored. Methods We constructed nationwide county-level and city-level panel data from 1996 to 2012 using data on under-5 mortality rates (U5MR), the list of China healthy cities and counties and socioeconomic factors. We used a two-step staggered difference-in-differences approach that exploits variations in the timing of achieving the title of China Healthy City/County. Subgroup analyses by region were performed. Results We included 707 cities in the China Healthy Cities study, and 1631 counties in the China Healthy Counties study. Our results indicate substantial and significant reductions in U5MR associated with the public health initiative in China. The association varies across regions with different socioeconomic statuses. China Healthy Cities were significantly associated with a reduction of 0.7/1000 (95% CI −1.2 to −0.2) in under-5 mortality 5 years after cities gained the title and a decrease of 1.4/1000 (95% CI −2.2 to −0.6) 10 years afterward. Cities from western China saw the largest statistically significant gains with 3.2/1000 and 7.2/1000 reductions in child mortality after 5 and 10 years, respectively. China Healthy Counties were also associated with significant reductions in under-5 mortality 8 years after achieving the title; it was associated with 2.6/1000 reductions in under-5 mortality nationwide and 3.8/1000 reductions in eastern China. Our results are robust to heterogeneous treatment effects across cities/counties over time and various model specifications. Conclusion Our results suggest significant reductions in under-5 mortality associated with this public health intervention focusing on living environment conditions. Future research could explore differential effects across regions and clarify the underlying causal mechanisms.
Do physicians with academic affiliation have lower burnout and higher career-related satisfaction?
(Springer Nature, 2022-04-26) Zhuang, Chu; Hu, Xiaochu; Dill, Michael J.
Physicians report increasing burnout and declining career-related satisfaction, negatively impacting physician well-being and patient care quality. For physicians with academic affiliations, these issues can directly affect future generations of physicians. Previous research on burnout and satisfaction has focused on factors like work hours, gender, race, specialty, and work setting. We seek to contribute to the literature by examining these associations while controlling for demographic, family, and work-related characteristics. Furthermore, we aim to determine any differential effects of faculty rank. We analyzed data on practicing physicians in the U.S. from the Association of American Medical College’s (AAMC) 2019 National Sample Survey of Physicians (NSSP,) which includes variables adapted from the Maslach Burnout Inventory. We used ordinal logistic regressions to explore associations between academic affiliation and burnout. We conducted a factor analysis to consolidate satisfaction measures, then examined their relationship with academic affiliation using multivariate linear regressions. All regression analyses controlled for physicians’ individual, family, and work characteristics. Among respondents (n = 6,000), 40% were affiliated with academic institutions. Physicians with academic affiliations had lower odds than their non-affiliated peers for feeling emotional exhaustion every day (Odds Ratio [OR] 0.87; 95% CI: 0.79–0.96; P < .001) and reported greater career-related satisfaction (0.10–0.14, SE, 0.03, 0.02; P < .001). The odds of feeling burnt out every day were higher for associate professors, (OR 1.57; 95% CI: 1.22–2.04; P < .001) assistant professors, (OR 1.64; 95% CI: 1.28–2.11; P < .001), and instructors (OR 1.72; 95% CI, 1.29–2.29; P < .001), relative to full professors. Our findings contribute to the literature on burnout and career satisfaction by exploring their association with academic affiliation and examining how they vary among different faculty ranks. An academic affiliation may be an essential factor in keeping physicians’ burnout levels lower and career satisfaction higher. It also suggests that policies addressing physician well-being are not “one size fits all” and should consider factors such as academic affiliation, faculty rank and career stage, gender identity, the diversity of available professional opportunities, and institutional and social supports. For instance, department chairs and administrators in medical institutions could protect physicians’ time for academic activities like teaching to help keep burnout lower and career satisfaction higher.
Relationship of neighborhood and individual socioeconomic status on mortality among older adults: Evidence from cross-level interaction analyses
(PLOS, 2022-05-19) Kim, Taehyun
The influence of community context and individual socioeconomic status on health is widely recognized. However, the dynamics of how the relationship of neighborhood context on health varies by individual socioeconomic status is less well understood. To examine the relationship between neighborhood context and mortality among older adults and examine how the influence of neighborhood context on mortality differs by individual socioeconomic status, using two measures of income-level and homeownership. A retrospective study of 362,609 Medicare Advantage respondents to the 2014–2015 Medicare Health Outcomes Survey aged 65 and older. Neighborhood context was defined using the deciles of the Area Deprivation Index. Logistic regression was used to analyze mortality with interaction terms between income/homeownership and neighborhood deciles to examine cross-level relationships, controlling for age, gender, race/ethnicity, number of chronic conditions, obese/underweight, difficulties in activities of daily living, smoking status, and survey year. Predicted mortality rates by group were calculated from the logistic model results. Low-income individuals (8.9%) and nonhomeowners (9.1%) had higher mortality rates com- pared to higher-income individuals (5.3%) and homeowners (5.3%), respectively, and the differences were significant across all neighborhoods even after adjustment. With regression adjustment, older adults residing in less disadvantaged neighborhoods showed lower predicted 2-year mortality among high-income (4.86% in the least disadvantaged neighborhood; 6.06% in the most disadvantaged neighborhood; difference p-value<0.001) or homeowning individuals (4.73% in the least disadvantaged neighborhood; 6.25% in the most disadvantaged neighborhood; difference p-value<0.001). However, this study did not observe a significant difference in predicted mortality rates among low-income individuals by neighborhood (8.7% in the least disadvantaged neighborhood; 8.61% in the most disadvantaged neighborhood; difference p-value = 0.825). Low-income or non-homeowning older adults had a higher risk of mortality regardless of neighborhood socioeconomic status. While living in a less disadvantaged neighborhood provided a protective association for higher-income or homeowning older adults, low- income older adults did not experience an observable benefit.

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