Understanding Physician Variation in High Risk Medication Prescribing Among Hospitalized Older Adults
Overuse is the provision of care where the potential for harm exceeds the potential for benefit and has been identified as a significant contributor to the high cost of health care. High risk medications are a significant overuse issue in elderly patients. Inappropriate medication prescribing in older adults is a major public health concern due to its high prevalence, associated negative outcomes, morbidity, hospitalization, health services use, and increased costs. Excessive variation in physician practice represents an important, but poorly understood, source of PIM prescribing.
Prevalence of opioid use disorder (OUD) is rising among older adults. Older adults increasingly utilize postacute care (PAC) following a hospitalization. Veterans receive PAC services with home health care or in skilled nursing facilities within and outside the Veterans Administration. Several factors, including stigma and need for medication assisted therapy for OUD, create barriers to PAC access and delivery for veterans with OUD.
Pilot Mixed Methods Evaluation of the Barriers and Facilitators to Suicide Prevention in Juvenile Detention
Death by suicide is a major public health concern, particularly among 10-25-year-olds. Vulnerable youth who enter the juvenile justice (JJ) system are four times more likely to engage in suicidal behaviors than their peers. The Zero Suicide model and suicide prevention guidelines for JJ recommend suicide prevention in juvenile detention include ongoing evidence-based suicide risk screening and triaging to appropriate pathways of care.
Pediatric Caregiver Perspectives Regarding Use of an Electronic Resource Map to Address Unmet Social Needs
Poverty and associated social determinants of health adversely impact children’s health and development and can exacerbate existing disparities in health outcomes and access to care for vulnerable children and families. The American Academy of Pediatrics therefore recommends that pediatricians incorporate routine social needs screening into their clinical practice.
Early childhood is a sensitive period in which young children develop language and socio-emotional skills foundational for school readiness. Unfortunately, poor vulnerable children experience disparities in these critical areas of development. Parent-child shared reading can help ameliorate these disparities, yet low-income parents do not consistently engage in this activity. Behavioral economics approaches utilizing automated hovering (AH) have the potential to increase parent-child shared reading through text messages and financial inducements.
An important concern in the ongoing policy debate over providing universal single payer health coverage ("Medicare for all") is the potential detrimental impact on health care provider finances. A key input into policy design is to know the marginal value of taxpayer dollars i.e. what would hospitals and other providers do when they lose a dollar of revenue. To shed light on this question, we propose to learn from a related setting -- the recent public insurance expansions authorized by the Affordable Care Act (ACA).
Significance: Infants with neonatal abstinence syndrome (NAS) and prenatal opioid exposure (OE) have complex care needs. Potential racial and geographic outcome disparities among NAS/OE infants are uncertain. Due to their complex care needs, these infants may be especially sensitive to variation in hospital nursing resources.
Impact of Community Health Workers in High Risk Pediatric Patients with Newly Diagnosed Type 1 Diabetes
Lower socioeconomic status (SES) is associated with adverse outcomes in children with type 1 diabetes. (T1D)1. These children have poorer glycemic control, lower quality of life, and increased healthcare utilization. Previous efforts to improve outcomes in this patient population have focused on high-cost, high-intensity educational interventions. These efforts have been ineffective in improving clinical outcomes in patients with low SES2.
Behavior change interventions commonly use incentives, which can be either financial or social. These two types of incentives are fundamentally different and may not be interchangeable but we currently lack a strong rationale for choosing one or the other. In response, this pilot study begins a new line of research investigating when financial incentives are most likely to succeed. This line of research will also identify the circumstances under which social incentives are ideal means of changing behavior.
The Get To Sleep Study: Assessing the Feasibility of Using Mobile Methods to Assess Neighborhood Context and Sleep among Urban Adolescents
Insufficient sleep is highly prevalent among adolescents and increases disease risk. Adolescents from low income communities are a vulnerable population at particular risk for insufficient sleep. Although a growing evidence base suggests that neighborhood-level stressors including crime and physical disorder adversely influence adolescent sleep, key methodological issues limit understanding of the environmental determinants of adolescent sleep.
Predicting Prescription Drug Adherence and Treatment Gaps for Medicare Beneficiaries with Chronic Conditions: A Comparison between Traditional Models and Machine Learning Algorithms
Over the past few decades, new pharmaceutical treatments including specialty drugs have offered new possibilities for patients with serious, chronic, or life-threatening diseases for whom prior treatments were ineffective, highly toxic, or previously unavailable. However, real-world studies have shown that patients are poorly adherent to these innovative drugs, particularly in the Medicare population.
As U.S. healthcare shifts toward value-based payment, health systems and policy makers are starting to consider housing affordability as an important social determinant of health. However, whether housing affordability is associated with health outcomes is unknown. Several pathways may link housing affordability to health consequences among older adults. First, housing affordability represents a competing demand that may divert resources from one’s health and self-care, eventually resulting in higher healthcare utilization.
Information Gains versus Hassle Costs: How Do Prescription Drug Monitoring Programs Reduce Opioid Prescribing?
Abstract: In the U.S., opioid overdoses, abuse and diversion have increased dramatically over the last two decades creating an unprecedented public health crisis. Interventions targeted at physician prescribing may play an important role in reducing opioid abuse. In this project, we will study the consequences of one of the most widely adopted physician interventions– Prescription Drug Monitoring Programs (PDMPs).
Housing Affordability and Health Outcomes: a Longitudinal Study of Community Dwelling Older Adults in the U.S. from 2006-2016
Abstract: As U.S. healthcare shifts toward value-based payment, health systems and policy makers are starting to consider housing affordability as an important social determinant of health. However, little is known about the association of housing affordability with health outcomes among older adults. Several pathways may link housing affordability to health consequences among older people. First, housing affordability may act as a competing demand that diverts resources from one’s health and self-care, leading to higher healthcare utilization.
Does access to gynecologic oncologists or medical oncologists affect outcomes for advanced gynecologic cancers? Impact of provider specialty on survival outcomes, health care utilization, and spending.
Abstract: The aim of the proposed pilot study is to examine the impact of provider specialty on health care utilization and spending for women with advanced gynecologic cancers. Currently, women with advanced gynecologic cancer may receive chemotherapy from one of two specialty providers, gynecologic oncologists or medical oncologists, due to geographic-based availability of providers, health insurer network coverage, or other patient, provider, and systems factors.