Health Policy & Management Research Works

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‘Strategy-as-Practice’ by Personnel in Hospitals: A Scoping Review
(2024-08-23) Jones, Brendan; Millwee, Elizabeth; Mulhall, Gabriela Irene; Ajayi, Damilola; Amon-Kotei, Nii Amon; Adeoti, Moboluwape; Din, Abdu Wakil Cyeef; Griffin, Lyndsey; Hashmi, Maryam Aslam; Schwartz, Brad E.; Fouladi, Negin; Tchangalova, Nedelina; Frazer, Kate; Kroll, Thilo; Donohoe, Carolyn
BACKGROUND Globally, hospitals face growing demands with increasing patient acuity compounded by workforce challenges, balancing finite resources, and responding to strategic developments. Strategizing in organizations is an active process of sensing, planning, implementing, and evaluating strategy. It is recognized that there is a disconnection between strategic planning and implementation; however, little is known about how organizational context influences the strategic process or how hospital personnel engage in strategic activities. STUDY AIMS This review aimed to map the extent and breadth of strategy-as-practice peer-reviewed literature relating to hospital personnel and establish how strategizing or ‘strategy-as-practice’ is described in hospital settings, how it is used, and what gaps exist. METHODS Four databases (Business Source Complete, CINAHL, PsycINFO through EBSCOhost, PubMed) were searched from January 1st, 2018, to June 27th, 2023. All study designs were included, and language was restricted to publications in English. Records were independently screened for eligibility, followed by full-text review. Reporting follows PRISMA-ScR guidelines. RESULTS 4,719 unique records were identified, and 45 full-text papers were included. Preliminary evidence from 17 countries is reported: 27.8% of studies (12/45) report evidence from the USA. All study designs are reported. Few studies (n=4) provided a specific definition of strategizing. 53.3% (24/45 studies) report multidisciplinary team perspectives, with only three studies including patients' perspectives. Flexible approaches are critical to adopting. IMPLICATIONS Current evidence shows that when hospital personnel strategize in practice, they use a combination of planning processes, varying quality improvement tools, and methodological approaches. CONCLUSION Understanding and operationalizing strategy in a hospital setting is critical to maintaining organizational adaptability and improving performance and quality of care. Future research should focus on robust studies with longitudinal follow-up to understand the sustainability of strategizing in hospital settings and how it continues to meet the growing demands for services and activities.
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.
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.
Residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling by adults with lower incomes: Is increased access to primary care enough?
(Wiley, 2023-07-08) Phillips, Aryn Z.; Karriker-Jaffe, Katherine J.; Bensley, Kara M. K.; Subbaraman, Meenakshi S.; Delk, Joanne; Mulia, Nina
Background We investigate whether living in a state that expanded Medicaid eligibility is associated with receiving alcohol screening and brief counseling among nonelderly, low-income adults and a subgroup with chronic health conditions caused or exacerbated by alcohol use. Method Data are from the 2017 and 2019 Behavioral Risk Factor Surveillance System (N = 15,743 low-income adults; n = 7062 with a chronic condition). We used propensity score-weighted, covariate-adjusted, modified Poisson regression to estimate associations between residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling. Models estimated associations in the overall sample and chronic conditions subsample, as well as differential associations across sex, race, and ethnicity using interaction terms. Results Living in a state that expanded Medicaid eligibility was associated with being asked whether one drank (prevalence ratio (PR) = 1.15, 95% confidence interval (CI) = 1.08, 1.22), but not with further alcohol screening, guidance about harmful drinking, or advice to reduce drinking. Among individuals with alcohol-related chronic conditions, expansion state residence was associated with being asked about drinking (PR = 1.13, 95% CI = 1.05, 1.20) and, among past 30-day drinkers with chronic conditions, being asked how much one drank (PR = 1.28, 95% CI = 1.04, 1.59) and about binge drinking (PR = 1.43, 95% CI = 1.03, 1.99). Interaction terms suggest that some associations differ by race and ethnicity. Conclusions Living in a state that expanded Medicaid is associated with a higher prevalence of receiving some alcohol screening at a check-up in the past 2 years among low-income residents, particularly among individuals with alcohol-related chronic conditions, but not with the receipt of high-quality screening and brief counseling. Policies may have to address provider barriers to delivery of these services in addition to access to care.
Changes in prenatal care and birth outcomes after federally qualified health center expansion
(Wiley, 2022-11-07) Gourevitch, Rebecca A.; Hatfield, Laura A.
Objective To evaluate whether the expansion of Federally Qualified Health Centers (FQHCs) improved late prenatal care initiation, low birth weight, and preterm birth among Medicaid-covered or uninsured individuals. Data Sources and Study Setting We identified all FQHCs in California using the Health Resources and Services Administration's Uniform Data System from 2000 to 2019. We used data from the U.S. Census American Community Survey to describe area characteristics. We measured outcomes in California birth certificate data from 2007 to 2019. Study Design We compared areas that received their first FQHC between 2011 and 2016 to areas that received it later or that had never had an FQHC. Specifically, we used a synthetic control with a staggered adoption approach to calculate non-parametric estimates of the average treatment effects on the treated areas. The key outcome variables were the rate of Medicaid or uninsured births with late prenatal care initiation (>3 months' gestation), with low birth weight (<2500 grams), or with preterm birth (<37 weeks' gestation). Data Collection/Extraction Methods The analysis was limited to births covered by Medicaid or that were uninsured, as indicated on the birth certificate. Principal Findings The 55 areas in California that received their first FQHC in 2011–2016 were more populous; their residents were more likely to be covered by Medicaid, to be low-income, or to be Hispanic than residents of the 48 areas that did not have an FQHC by the end of the study period. We found no statistically significant impact of the first FQHC on rates of late prenatal care initiation (ATT: −10.4 [95% CI −38.1, 15.0]), low birth weight (ATT: 0.2 [95% CI −7.1, 5.4]), or preterm birth (ATT: −7.0 [95% CI −15.5, 2.3]). Conclusions Our results from California suggest that access to primary and prenatal care may not be enough to improve these outcomes. Future work should evaluate the impact of ongoing initiatives to increase access to maternal health care at FQHCs through targeted workforce investments.
Differential associations of homelessness with emergencydepartment visits and hospitalizations by race, ethnicity, andgender
(Wiley, 2022-05-20) Yue, Dahai; Pourat, Nadereh; Essien, Elsie A.; Chen, Xiao; Zhou, Weihao; O'Masta, Brenna
Objective To investigate the differential associations of homelessness with emergency department (ED) visits and hospitalizations by race, ethnicity, and gender. Data Sources California Medicaid enrollment and claims. Study Design We identified beneficiaries experiencing homelessness (BEH) and those who did not (NBEH) using diagnosis and place of service codes and residential addresses. Outcomes include four ED visit measures and four hospitalization measures. We compared the use of these services by BEH to NBEH overall and by race, ethnicity, and gender groups in regression models controlling for covariates. Data Collection We used a sample of Medicaid beneficiaries who met eligibility criteria for a California Medicaid demonstration program in 2017 and 2018 but were not enrolled in the program. We identified 473,069 BEH, and the rest (1,948,422) were considered NBEH. We used the 2018 data for utilization analyses and most covariates. We constructed lagged measures of health conditions using 2017 data. Principal Findings We found that homelessness was significantly associated with 0.34 more ED visits (p < 0.01) and a higher likelihood of frequent ED visits (2.77 percentage points [pp], p < 0.01), any ED visits due to mental health conditions (0.79 pp, p < 0.01), and any ED visits due to substance use disorders (1.47 pp, p < 0.01). Experiencing homelessness was also significantly associated with 0.03 more hospitalizations (p < 0.01), a higher likelihood of frequent hospitalizations (0.68 pp, p < 0.01) and high frequent hospitalizations (0.28 pp, p < 0.01), and a longer length of stay (0.53 days, p < 0.01). We found a larger association for American Indian and Alaska Native, Black, Native Hawaii or Pacific Islander, and White populations than that for Asian and Hispanic populations. The associations are larger for males than females. Conclusions Our findings identified distinct utilization patterns by race, ethnicity, and gender. They indicated the need for developing race, ethnicity, and gender-specific strategies to reduce ED visits and hospitalizations of BEH.
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.
Umbrella Review: COVID-19 Public Health Measures and Patient and Public Involvement in Health and Social Care Research
(2023-08-10) Fouladi, Negin; Tchangalova, Nedelina; Ajayi, Damilola; Millwee, Elizabeth; Lovett, Corinne; Del Sordi, Alana; Liggett, Samantha; De Silva, Malki; Bonilla, Laura; Nkwonta, Angel; Ramnarine, Leah; Munoz, Allyssa; Frazer, Kate; Kroll, Thilo
Background: - Patient and public involvement (PPI) in health research refers to patients and other members of the public with relevant experience contributing to design, implementation, and dissemination of research. PPI entails research being carried out ‘with’ or ‘by’ members of the public, rather than ‘to’, ‘about’ or ‘for’ them. - Over the past decade, there has been an increased emphasis on the importance of PPI in health and social research as it provides alternative views and insights into the needs of healthcare users to improve the quality and relevance of research. - PPI enhances the efficiency, design, and quality of healthcare initiatives and facilitates decision-making regarding resource allocations and the usability of services by including information about the capabilities, needs, and priorities of local people. - The rapid response to the COVID-19 pandemic resulted in PPI being viewed as non-essential, leading to its minimal inclusion in research and, thereby, minimizing the contribution of patients, the public, and, particularly, minority groups in helping find solutions to the pandemic crisis. - Public health measures (PHM) aim to reduce the transmission, severity of illness, and death and are critical strategies to address pandemic outbreaks, therefore, PPI is crucial in building trust and acceptance in research, greater benefits for the community, new and improved services, valuable changes in practice/partnership leading to positive changes and outcomes.
COVID-19 public health measures and patient and public involvement in health and social care research: An umbrella review
(International Journal of Environmental Research and Public Health, 2023-03-10) Fouladi, Negin; Tchangalova, Nedelina; Ajayi, Damilola; Millwee, Elizabeth; Lovett, Corinne; Del Sordi, Alana; Liggett, Samantha; De Silva, Malki; Bonilla, Laura; Nkwonta, Angel; Ramnarine, Leah; Munoz, Allyssa; Frazer, Kate; Kroll, Thillo
An umbrella review of previously published systematic reviews was conducted to determine the nature and extent of the patient and public involvement (PPI) in COVID-19 health and social care research and identify how PPI has been used to develop public health measures (PHM). In recent years, there has been a growing emphasis on PPI in research as it offers alternative perspectives and insight into the needs of healthcare users to improve the quality and relevance of research. In January 2022, nine databases were searched from 2020–2022, and records were filtered to identify peer-reviewed articles published in English. From a total of 1437 unique records, 54 full-text articles were initially evaluated, and six articles met the inclusion criteria. The included studies suggest that PHM should be attuned to communities within a sociocultural context. Based on the evidence included, it is evident that PPI in COVID-19-related research is varied. The existing evidence includes written feedback, conversations with stakeholders, and working groups/task forces. An inconsistent evidence base exists in the application and use of PPI in PHM. Successful mitigation efforts must be community specific while making PPI an integral component of shared decision-making.
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.
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.
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.
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.
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.
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.
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.
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.

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