Medicine and Health Sciences Commons^™

The Prescription Drug Monitoring Program In A Multifactorial Approach To The Opioid Crisis: Pdmp Data, Pennsylvania, 2016–2020, Jenna R. Adalbert, Amit Syal, Karan Varshney, Brandon George, Jeffrey Hom, Asif M. Ilyas

College of Population Health Faculty Papers

Background: Prescription opioids remain an important contributor to the United States opioid crisis and to the development of opioid use disorder for opioid-naïve individuals. Recent legislative actions, such as the implementation of state prescription drug monitoring programs (PDMPs), aim to reduce opioid morbidity and mortality through enhanced tracking and reporting of prescription data. The primary objective of our study was to describe the opioid prescribing trends in the state of Pennsylvania (PA) as recorded by the PA PDMP following legislative changes in reporting guidelines, and discuss the PDMP's role in a multifactorial approach to opioid harm reduction.

Methods: State-level opioid …

Assessing The Coverage Of Us Cancer Center Primary Catchment Areas., Amy E Leader, Christopher Mcnair, Christina Yurick, Matthew Huesser, Elizabeth Schade, Emily E Stimmel, Caryn Lerman, Karen E Knudsen

Kimmel Cancer Center Faculty Papers

Background: Cancer centers are expected to engage communities and reduce the burden of cancer in their catchment areas. However, the extent to which cancer centers adequately reach the entire US population is unknown. Methods: We surveyed all members of the Association of American Cancer Institutes (N ¼ 102 cancer centers) to document and map each cancer center’s primary catchment area. Catchment area descriptions were aggregated to the county level. Catchment area coverage scores were calculated for each county and choropleths generated representing coverage across the US. Similar analyses were used to overlay US population density, cancer incidence, and cancer-related mortality …

Health Of Asylees Compared To Refugees In The United States Using Domestic Medical Examination Data, 2014-2016: A Cross-Sectional Analysis., Gayathri S Kumar, Clelia Pezzi, Colleen Payton, Blain Mamo, Kailey Urban, Kevin Scott, Jessica Montour, Nuny Cabanting, Jenny Aguirre, Rebecca Ford, Stephen E Hughes, Breanna Kawasaki, Lori Kennedy, Emily S Jentes

College of Population Health Faculty Papers

Background: Between 2008 and 2018, persons granted asylum (asylees) increased by 168% in the United States. Asylees are eligible for many of the same domestic benefits as refugees under the US Refugee Admissions Program (USRAP), including health-related benefits such as the domestic medical examination. However, little is known about the health of asylees to guide clinical practice.

Methods: We conducted a retrospective cross-sectional analysis of domestic medical examination data from 9 US sites from 2014 to 2016. We describe and compare demographics and prevalence of several infectious diseases such as latent tuberculosis infection (LTBI), hepatitis B and C virus (HBV, …

Disparities In Sars-Cov-2 Positivity Rates: Associations With Race And Ethnicity, Harvey W Kaufman, Justin K Niles, David B. Nash

College of Population Health Faculty Papers

Numerous reports indicate that African Americans and Latinos are being affected disproportionately by coronavirus disease 2019 (COVID-19). Positivity rates have not been analyzed on scale because only 4 states report race/ethnicity as part of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Previous studies also have had little ability to control for many known risk factors to better identify the effects of COVID-19 on racial and ethnic communities. Using test results from a large national reference laboratory database that included patients from all 50 states and the District of Columbia, this study compared positivity rates for SARS-CoV-2 nucleic acid amplification …

New Normal For Medical Practice Post Covid-19?, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Changes In Health Care Following Covid-19., David B. Nash, Thomas H Lee, Leana Wen, Bruce A Meyer, Judd E Hollander, Susan Skochelak

College of Population Health Faculty Papers

This conversation was held on June 17, 2020, and the resulting transcript reflects the events that were current as of the time of the original discussion. Changes to policies, events, and data may have changed between the time of the discussion and its publication.

We Know Health Is Not Elective: Impacts Of Covid-19., David B. Nash, Mark Angelo, Esther J Nash, Jonathan L Gleason, Bruce A Meyer

College of Population Health Faculty Papers

Several months into the impact of the global COVID-19 pandemic, the authors use the framework of "radical uncertainty" and specific regional health care data to understand current and future health and economic impacts. Four key areas of discussion included are: (1) How did structural health care inequality manifest itself during the closure of all elective surgeries and visits?; (2) How can we really calculate the so-called untold burden that resulted from the closure, with a special emphasis on primary care?; (3) The Pennsylvania experience - using observations from the population of one major delivery ecosystem (Jefferson Health), a major accountable …

Health Insurance Coverage Disruptions And Cancer Care And Outcomes: Systematic Review Of Published Research, K Robin Yabroff, Katherine Reeder-Hayes, Jingxuan Zhao, Michael T Halpern, Ana Maria Lopez, Leon Bernal-Mizrachi, Anderson B Collier, Joan Neuner, Jonathan Phillips, William Blackstock, Manali Patel

Kimmel Cancer Center Faculty Papers

BACKGROUND: Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival.

METHODS: We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted …

A Comparison Of Screening, Prevention, And Management For Hepatitis B Patients Between The Us And Chinese Healthcare Systems, Thomas Chen, James D. Plumb, Md

Phase 1

Introduction: Hepatitis B (HBV) is a complex disease entity with potentially serious outcomes, including developing hepatocellular carcinoma (HCC). HBV is estimated to be responsible for about 50-80% of HCC cases worldwide, and 75-95% of HCC cases in HBV endemic regions.¹ HBV and HCC are great concerns especially in East Asian countries like China. In China, HCC ranks as the 2^nd most common cancer and 2^nd in cancer mortality, both behind only lung cancer.¹ China is considered an endemic HBV region, with about 100-150 million people infected. In comparison, only an estimated 550,000-2 million people are chronically …

Use Of International Classification Of Diseases, Ninth Revision Codes For Obesity: Trends In The United States From An Electronic Health Record-Derived Database., Michelle Mocarski, Ye Tian, B. Gabriel Smolarz, John Mcana, Albert Crawford

College of Population Health Faculty Papers

Obesity is a potentially modifiable risk factor for many diseases, and a better understanding of its impact on health care utilization, costs, and medical outcomes is needed. The ability to accurately evaluate obesity outcomes depends on a correct identification of the population with obesity. The primary objective of this study was to determine the prevalence and accuracy of International Classification of Diseases, Ninth Revision (ICD-9) coding for overweight and obesity within a US primary care electronic health record (EHR) database compared against actual body mass index (BMI) values from recorded clinical patient data; characteristics of patients with obesity who did …

Differences In Work Environment For Staff As An Explanation For Variation In Central Line Bundle Compliance In Intensive Care Units., Yuna S.H. Lee, Patricia W. Stone, Monika Pogorzelska-Maziarz, Ingrid M. Nembhard

College of Nursing Faculty Papers & Presentations

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals.

PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs).

METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. …

Adverse Events In Veterans Affairs Inpatient Psychiatric Units: Staff Perspectives On Contributing And Protective Factors., Gala True, Rosemary Frasso, Sara W. Cullen, Richard C. Hermann, Steven C. Marcus

College of Population Health Faculty Papers

OBJECTIVES: This study sought to identify risk factors and protective factors in hospital-based mental health settings in the Veterans Health Administration (VHA), with the goal of informing interventions to improve care of persons with serious mental illness.

METHODS: Twenty key informants from a stratified sample of 7 VHA inpatient psychiatric units were interviewed to gain their insights on causes of patient safety events and the factors that constrain or facilitate patient safety efforts.

RESULTS: Respondents identified threats to patient safety at the system-, provider-, and patient-levels. Protective factors that, when in place, made patient safety events less likely to occur …

Anthropometric Indices For Non-Pregnant Women Of Childbearing Age Differ Widely Among Four Low-Middle Income Populations., K. Michael Hambidge, Nancy F. Krebs, Ana Garcés, Jamie E. Westcott, Lester Figueroa, Shivaprasad S. Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu, Adrien Lokangaka, Vanessa R. Thorsten, Abhik Das, Kristen Stolka, Elizabeth M. Mcclure, Rebecca L. Lander, Carl L. Bose, Richard J. Derman, Robert L. Goldenberg, Melissa Bauserman

Global Health Articles

BACKGROUND: Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).

METHODS: Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m(2)) was calculated. Z-scores were determined using WHO reference data.

RESULTS: A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = …

Human Judgment And Health Care Policy., Benjamin Djulbegovic, Jason Beckstead, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Association Between Triptanuse And Cardiac Contraindications In An Insured Migraine Population, Daisy Ng-Mak, Phd, Valerie P. Pracilio, Mph, Stephen Silberstein, Md, Joseph Couto, Pharmd, Mba, Cary Sennett, Md, Phd, Mary Hopkins, Rn, Jon Bumbaugh, Neil I. Goldfarb

College of Population Health Lectures, Presentations, Workshops

Background

Safety concerns exist when using triptansto treat patients with cardiac contraindications.

–Triptans cause vasoconstriction, a safety concern for migraineurswith cardiovascular (CV) disease or other cardiac risk factors.

–All triptans contain contraindications in their package inserts to avoid use in patients with cardiac conditions.

•Previous research indicates that clinicians are less likely to prescribe triptansin patients with CV disease or CV risk factors.

Limited research has examined the proportion of migraine patients with cardiovascular disease or those individuals who were concurrently treated with triptans.

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

The 46th Actuarial Research Conference, Poster session I, University of Connecticut, Storrs, CT. August 11, 2011.

Poster conclusions:

• U.S. spending is high.
• Long tailed medical linked insurance may be easier to write in the U.S.
• U.S. healthcare cost curve is not outrageous.
• Average spending
• Low volatility

Poster is associated with this paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section.9th International Conference on Health Policy Statistics, Cleveland, OH.

14 PowerPoint slides

Presentation associated with this paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/.

Strategies For Financing Healthcare Costs Over The Long Term., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section. 9th International Conference on Health Policy Statistics, Poster session I, Cleveland, OH.

Funding to support this work came from AHRQ grant R36 HS018835-01.

Policy Implications:

-Health insurance companies should use a broad, diversified investment portfolio as their optimal investment strategy -Insurance regulators should be focused on longer term lines of health insurance

High Frequency Evidence On Variation In Spending Growth., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section. 9th International Conference on Health Policy Statistics, Poster session I, Cleveland, OH.

Policy Implications:

• Health insurance regulation should include compensation for taking on riskier groups.
• Health programs should focus on changing needs for risk management versus health management throughout the life cycle.

Funding to support this work came from AHRQ grant R36 HS018835-01.

Got Worms?: Planning And Evaluation Of A Culturally Appropriate Health Education Pilot Program For The Control Of Soil-Transmitted Helminth Infections In Rwandan Village Children, Pier Hart

Master of Public Health Capstone Presentations

Infections with parasitic intestinal worms known as soil-transmitted helminthes (STH) are endemic in most poor countries in Africa, Asia and Latin America. In Rwanda, the prevalence of helminth infections among school-age children was found to be nearly 70%. Chronic STH infections are associated with malnutrition and anemia, which cause physical and cognitive developmental problems. These morbidities negatively affect educational attainment and vocational productivity and thereby perpetuate the cycle of poverty in affected communities. Control of STH requires both regular deworming treatments and changes in health behaviors relevant to transmission, including personal hygiene and sanitation practices. In Rwanda, a nationwide program …

Assessing Nutrition Knowledge, Skill And Attitudes In Adolescent Girls, Tatyana Jean

Master of Public Health Capstone Presentations

There is still much to be understood about the nutrition habits of adolescents who are just beginning to break away from familial habits and developing individual identities. The African American community in particular, is known to experience disproportionate amounts of overweight and obesity resulting in chronic diseases such as diabetes and hypertension. This study used quantitative and qualitative measures to assess the nutrition skills, knowledge, and attitudesof African American girls aged 14-17. After data analysis, it was found that African American adolescent girls had high body image and self esteem but poor nutrition skill and knowledge. Body image and weight …

The Need For A Sugar-Sweetened Beverage Tax In Philadelphia – Policy Analysis, J M. O'Dell

Master of Public Health Capstone Presentations

The goal of this study was to analyze sugar-sweetened beverage tax policy as one strategy to fight America’s obesity epidemic. Obesity is an enormous problem that plagues individuals worldwide. The prevalence of obesity is high in this country, exceeding 25% in 33 states. In Pennsylvania in 2009, 27.7% of adults were labeled as obese. Additionally, there are many more Philadelphians who are overweight or obese (900,000) than who are at a healthy weight (600,000). Obesity is extremely complex and has several causes. One cause of obesity and the main concern of this study is the consumption of sugar-sweetened beverages. Sugar-sweetened …

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the Casualty Actuarial Society 2011 Seminar on Reinsurance, Philadelphia, PA.

Handouts are also available at: http://www.casact.org/education/reinsure/2011/handouts/C17-Lieberthal.pdf

the audio is available at: http://www.casact.org/education/reinsure/2011/audio/C17.mp3

and it is associated with the paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

23 PowerPoint slides.

Prevalence Of Obesity, Type Ii Diabetes Mellitus, Hyperlipidemia, And Hypertension In The United States: Findings From The Ge Centricity Electronic Medical Record Database., Albert G Crawford, Christine Cote, Joseph Couto, Mehmet Daskiran, Candace Gunnarsson, Kara Haas, Sara Haas, Somesh C Nigam, Rob Schuette

College of Population Health Faculty Papers

This study analyzed GE Centricity Electronic Medical Record (EMR) data to examine the effects of body mass index (BMI) and obesity, key risk factor components of metabolic syndrome, on the prevalence of 3 chronic diseases: type II diabetes mellitus, hyperlipidemia, and hypertension. These chronic diseases occur with high prevalence and impose high disease burdens. The rationale for using Centricity EMR data is 2-fold. First, EMRs may be a good source of BMI/obesity data, which are often underreported in surveys and administrative databases. Second, EMRs provide an ideal means to track variables over time and, thus, allow longitudinal analyses of relationships …

Comparison Of Ge Centricity Electronic Medical Record Database And National Ambulatory Medical Care Survey Findings On The Prevalence Of Major Conditions In The United States., Albert G. Crawford, Christine Cote, Joseph Couto, Mehmet Daskiran, Candace Gunnarsson, Kara Haas, Sara Haas, Somesh C Nigam, Rob Schuette, Joseph Yaskin

College of Population Health Faculty Papers

The study objective was to facilitate investigations by assessing the external validity and generalizability of the Centricity Electronic Medical Record (EMR) database and analytical results to the US population using the National Ambulatory Medical Care Survey (NAMCS) data and results as an appropriate validation resource. Demographic and diagnostic data from the NAMCS were compared to similar data from the Centricity EMR database, and the impact of the different methods of data collection was analyzed. Compared to NAMCS survey data on visits, Centricity EMR data shows higher proportions of visits by younger patients and by females. Other comparisons suggest more acute …

Hand Hygiene Compliance Rates In The United States--A One-Year Multicenter Collaboration Using Product/Volume Usage Measurement And Feedback., Maryanne Mcguckin, Richard Waterman, John Govednik

College of Population Health Faculty Papers

Hand hygiene (HH) is the single most important factor in the prevention of health care-acquired infections. The 3 most frequently reported methods of measuring HH compliance are: (1) direct observation, (2) self-reporting by health care workers (HCWs), and (3) indirect calculation based on HH product usage. This article presents the results of a 12-month multicenter collaboration assessing HH compliance rates at US health care facilities by measuring product usage and providing feedback about HH compliance. Our results show that HH compliance at baseline was 26% for intensive care units (ICUs) and 36% for non-ICUs. After 12 months of measuring product …

Quality Improvement In Small Office Settings: An Examination Of Successful Practices., Daniel Wolfson, Elizabeth Bernabeo, Brian Leas, Shoshanna Sofaer, Gregory Pawlson, Donna Pillittere

College of Population Health Faculty Papers

BACKGROUND: Physicians in small to moderate primary care practices in the United States (U.S.) (<25>physicians) face unique challenges in implementing quality improvement (QI) initiatives, including limited resources, small staffs, and inadequate information technology systems 23,36. This qualitative study sought to identify and understand the characteristics and organizational cultures of physicians working in smaller practices who are actively engaged in measurement and quality improvement initiatives.

METHODS: We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39) that used performance data to drive quality improvement activities.

RESULTS: Physicians indicated that benefits to performing measurement and …

Insights From The 2007 Disease Management Colloquium., David B Nash, Tine Hansen-Turton, Tracey Moorhead, Harry Leider, Donald F Wilson

College of Population Health Faculty Papers

No abstract provided.

Quality Of Care Measures For Migraine: A Comprehensive Review, Joshua J. Gagne, Brian Leas, Jennifer H. Lofland, Neil Goldfarb, Frederick Freitag, Stephen Silberstein

College of Population Health Faculty Papers

Migraine headache is a highly prevalent, chronic, episodic disorder that is associated with high direct and indirect costs. Migraine headache impacts not only patients, but also their employers due to substantial decreases in workplace productivity. Despite the prevalence and clinical and economic burdens of migraine, no national efforts to develop and implement standardized measures of quality of care have been made. The objective of this study was to collect and report on existing quality of care measures for migraine that could be suitable for quality measurement at the health-plan level. Published literature, the Agency for Healthcare Research and Quality's National …

Chronic Care At The Crossroads: Exploring Solutions For Chronic Care Management. Report On The Us Summit., Janice L Clarke

College of Population Health Faculty Papers

Report on the US Summit