Health Services Research Commons^™

Increasing Covid-19 Vaccination Coverage For Newcomer Communities: The Importance Of Disaggregation By Language, Abigail Steiner, Kristine Knuti Rodrigues, Nadège Mudenge, Janine Young, Rasulo Rasulo, Colleen Payton, Malini Desilva, Jeremy Michel, Mary Fabio, Katherine Yun

College of Population Health Faculty Papers

The COVID-19 pandemic has disproportionately affected refugee, immigrant, and migrant populations. Vaccines are essential for decreasing transmission and severity of COVID-19 infection. Understanding differences in vaccination coverage based on preferred language is crucial for focusing efforts to decrease COVID-19-related disparities. Four sites in the Minnesota Center of Excellence in Newcomer Health collaboratively evaluated completion of primary COVID-19 vaccination series on or before December 31, 2021, for patients who were 12 years or older on June 30, 2021, by preferred language. The non-English/non-Spanish speaking population included 46,714 patients who spoke 174 languages; COVID-19 vaccination coverage by language ranged from 26.2% to …

Cancer Patient And Provider Responses To Companion Scales Assessing Experiences With Lgbtqi-Affirming Healthcare, Mandi L. Pratt-Chapman, Yan Wang, Gwendolyn P. Quinn, Sylvia Shirima, Sarah Adler, Ruta Brazinskaite, Asa Radix, Barbara Warren, Kristen Eckstrand, Ana Maria Lopez

Department of Medical Oncology Faculty Papers

Background: Sexual and gender minority (SGM) persons are at a higher risk for some cancers and may have poorer health outcomes as a result of ongoing minority stress, social stigma, and cisnormative, heteronormative healthcare environments. This study compared patient and provider experiences of affirming environmental and behavioral cues and also examined provider-reported knowledge, attitudes, behaviors, and clinical preparedness in caring for SGM patients among a convenience sample.

Methods: National convenience samples of oncology providers (n = 107) and patients (n = 88) were recruited separately via snowball sampling. No incentives were provided. After reverse coding of appropriate items for unidirectional …

Telehealth In Medicine: Predictions 2023–2024, Jiang Li, Ingrid Vasiliu-Feltes, Kathleen Mcgrow, Brendan F. Smith, Paul Barach, Sweta Sneha, Francis X. Campion

College of Population Health Faculty Papers

Each year, Telehealth and Medicine Today asks experts in the field to share their insights into the future and predict how telehealth will influence uptake and healthcare in the new year.

Using A Human-Centered, Mixed Methods Approach To Understand The Patient Waiting Experience And Its Impact On Medically Underserved Populations, Elizabeth N. Liao, Lara Z. Chehab, Kathryn Neville, Jennifer Liao, Devika Patel, Amanda Sammann

Department of Emergency Medicine Faculty Papers

Purpose: To use a mixed methods approach to investigate the patient waiting experience for a medically underserved population at an outpatient surgical clinic.

Methods: We used lean methodology to perform 96 time-tracked observations of the patient journey in clinic, documenting the duration of activities from arrival to departure. We also used human-centered design (HCD) to perform and analyze 43 semi-structured interviews to understand patients’ unmet needs.

Results: Patients spent an average of 68.5% of their total clinic visit waiting to be seen. While the average visit was 95.8minutes, over a quarter of visits (27%) were over 2hours. Patients waited an …

Increased Incidence Of Suspected Smoke Inhalation During The Coronavirus Disease 2019 Pandemic: A National Database Study, Theodore E Habarth-Morales, Arturo J. Rios Diaz, Emily Isch, Shreyas Chandragiri, Lucy Qi, Rose Ni, Edward J. Caterson

Student Papers, Posters & Projects

The COVID-19 pandemic has forced many Americans to adapt their daily routines. In 2020, there was a significant increase in house fires according to the National Fire Prevention Association (NFPA). The objective of this study was to characterize the changes in suspected smoke inhalations (SSIs) during the first year of the pandemic in the National Emergency Medical Services Information System (NEMSIS). The NEMSIS database was queried for all EMS transports captured between 2017 and 2020. Differences in the incidences of SSIs and fire dispatches in 2020 were estimated using Poisson regression models. There was a 13.4% increase in the incidence …

Emerging Lessons From The Covid-19 Pandemic About The Decisive Competencies Needed For The Public Health Workforce: A Qualitative Study, Osnat Bashkin, Robert Otok, Lore Leighton, Kasia Czabanowska, Paul Barach, Nadav Davidovitch, Keren Dopelt, Mariusz Duplaga, Leah Okenwa Emegwa, Fiona Macleod, Yehuda Neumark, Maya Peled Raz, Theodore Tulchinsky, Zohar Mor

College of Population Health Faculty Papers

The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between …

Credible Practice Of Modeling And Simulation In Healthcare: Ten Rules From A Multidisciplinary Perspective, Ahmet Erdemir, Lealem Mulugeta, Joy P Ku, Andrew Drach, Marc Horner, Tina M Morrison, Grace C Y Peng, Rajanikanth Vadigepalli, William W Lytton, Jerry G Myers

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

The complexities of modern biomedicine are rapidly increasing. Thus, modeling and simulation have become increasingly important as a strategy to understand and predict the trajectory of pathophysiology, disease genesis, and disease spread in support of clinical and policy decisions. In such cases, inappropriate or ill-placed trust in the model and simulation outcomes may result in negative outcomes, and hence illustrate the need to formalize the execution and communication of modeling and simulation practices. Although verification and validation have been generally accepted as significant components of a model's credibility, they cannot be assumed to equate to a holistic credible practice, which …

Literature Review On Hospital Costs For Patients Undergoing Colectomy, Brian P.H. Chen, Scm, Hang Cheng, Martha Romney, Rn, Ms, Jd, Mph, Carine Chia-Wen Hsiao

College of Population Health Posters

Objective:

This study aims to identify the range of direct hospital costs associated with a minimally invasive or open colectomy procedure across different countries.

Poster presented at 2016 ISPOR conference in Washington DC.

Literature Review On Hospital Costs For Patients Undergoing Hysterectomy, Brian P.H. Chen, Scm, Pharmd, Hang Cheng, Martha Romney, Rn, Ms, Jd, Mph, Carine Chia-Wen Hsiao

College of Population Health Posters

Objective:

This study aims to identify the range of direct hospital costs associated with a minimally invasive or abdonimal hysterectomy procedure across different countries.

Poster presented at 2016 ISPOR conference in Washington DC.

Erosion Of Empathy In Primary Care Trainees, Jacquelyn Mcrae, Pharmd, G. Calusi, Mengdan Liu, V. Scognamiglio, E. Messina, L. Polenzani, Vittorio Maio, Pharmd, Msph

College of Population Health Posters

Objective:

To evaluate if empathy among physician residents (trainees) differs dependent on training year and to assess trainees' characteristics associated with higher empathy scores.

Poster presented at 2016 ISPOR conference in Washington DC.

A Review Of Current Quality Metrics For Evaluating Patient-Centered Medical Homes, Stefan Varga, M. Lombardi, Vittorio Maio, Pharmd, Msph

College of Population Health Posters

Objectives:

This review sought to explore the quality metrics that are currently utilized to assess PCMHs

Poster presented at 2016 ISPOR conference in Washington DC.

Treatment Plan Adherence To Guidelines In Senior Adult Oncology Patients, Amy R. Mackenzie, Md, Andrea M. Barsevick, Phd, Ronald Myers, Phd, Ludmila De Oliveira Koch, Md, Scott W. Keith, Phd, Thomas Wolf, Ma, James Cocroft, Ma, Joshua Schoppe, Mph, Ulysses Williams Iii, Andrew Chapman, Do

Department of Medical Oncology Faculty Papers

Materials & Methods:

• Review of 287 records
• Patients ≥ 65 years old with new diagnosis of cancer
• Seen by 6, dual-boarded hematologists/ oncologists practicing in an urban academic cancer center
• Treatment plans compared to national guidelines to determine plan adherence status
• Patients were recommended:

Adherent plan (AP) or Non-adherent plan (N-AP)

Innovating At Jefferson: Developing The Patient-Centered Medical Home (Pcmh) Cost Tool, Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented at Jefferson School of Population Health Faculty Research Seminar.

Objectives:

Describe the cost-collection tool we created for the PCMH Model

Propose improvements to our tool in order to enhance the response rate

Determine our next steps in terms of research and innovation for PCMH at Jefferson

21 slides

The Future Of Population-Based Reimbursement, David Chin, Md, Mba

College of Population Health Forum

David C. Chin, MD, MBA is a Distinguished Scholar at the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Medicine, where he focuses on novel industry/academic research partnerships and preparing health systems and academic medical centers for success under accountable care.

Dr. Chin will describe the Maryland-All payer system as a model of innovative population-based reimbursement. He will discuss early adaptive strategies, including ways in which health care systems will need to change. Dr. Chin will also provide a comparison of the new incentives in the model vs. fee-for-service.

Prior to joining Hopkins Dr. Chin has …

Models For Identifying Patients At Risk Of Hospitalization: Use In Medical Homes In Emilia-Romagna Region, Italy, Vittorio Maio Pharmd, Ms, Msph, Guiseppina Rossi Md, Stefano Del Canale Md, Phd, Massimo Fabi Md, Ettore Brianti Md, Stefano Sforza Ms, Mary Robeson Ms, Scott Keith Phd, Joseph S. Gonnella Md, Daniel Z. Louis Ms

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Modeling To Assess Value: Is It Ready For Prime Time?, Jaime J. Caro, Mdcm, Frcpc, Facp

Jefferson School of Population Health Fellows’ Day

Jaime Caro is Senior Vice President, Research, at a consulting firm, where he leads development and application of novel techniques in health economics, multi-criteria decision analysis, benefit-risk analysis, comparative effectiveness, and epidemiology. He led the Caro Research Institute for more than a decade, until CRI was acquired in 2007. Dr. Caro trained at McGill University, where he practiced internal medicine and continues as adjunct Professor of Medicine, as well as of Epidemiology and Biostatistics. He is also adjunct professor at the Massachusetts College of Pharmacy and Health Sciences and lecturer at Thomas Jefferson University School of Population Health.

Out-Of-Pocket Costs And Prescription Reversals: The Case Of Oral Linezolid, Margaret K. Pasquale, Anthony M. Louder, Michael C. Deminski, Richard B. Chambers, Seema Haider

Jefferson School of Population Health Fellows’ Day

Kim A. Caldwell, RPh

Employed by Humana Inc., Kim is the Director of Pharmacy Professional Affairs for Humana Pharmacy Solutions. In this role, he and his team serve to liaison between HPS business owners, Humana Public Affairs, and key professional and trade partners. They serve as the pharmacy subject matter experts aligned with key business and regulatory issues, including visits with members of federal and state legislatures as well as the interface with state boards of pharmacy and key trade organizations. Previously, he started and directed Competitive Health Analytics, Inc. (CHA) a business unit within Humana Inc. for the first …

Analyzing The Health Care Cost Curve: A Case Study, Robert Lieberthal

College of Population Health Faculty Papers

This case study uses data from a self-insured employer plan to perform an analysis into the properties of the health care cost curve. The analysis shows that one statistical property of the health care cost curve is that costs rise continuously, not on an annual or monthly basis. Graphical analysis indicates that managed care techniques used to restrain costs can also smooth utilization, producing the continuously growing cost curve observed. The analysis further illustrates that there is no one ‘‘cost curve’’—analysis must be segmented by population. Finally, the power of predictive models to fit the cost curve varies by population. …

College Within The College: Population Health, James D. Plumb, Md, Mph, Rickie Brawer, Mph, Phd, Mches, Abbie Santana, Msph, Rob Simmons, Drph, Mph, Mches, Cph, Nancy L. Chernett, Ma, Mph

College of Population Health Lectures, Presentations, Workshops

College within the College (CwiC) – Population Health Skills for Physicians

• Incorporate culturally relevant information into a treatment plan for a patient

• Counsel individuals about healthy lifestyles

• Identify community support and resources to serve patients

• Coordinate health care services as a member of multidisciplinary teams

• Promote primary and secondary prevention

• Advocate for the needs of patients and the community

• Conduct population health research/evaluation

• Promote healthy lifestyles in communities

• Work in partnership with community based agencies and organizations

An Economic Model To Value Companion Diagnostics In Non-Small-Cell Lung Cancer, Robert D. Lieberthal, Kellie Dudash, Rita S. Axelrod, Neil I. Goldfarb

College of Population Health Faculty Papers

Aim: An economic model was used to evaluate the potential economic impact and cost–effectiveness of companion diagnostic testing for patients with non-small-cell lung cancer (NSCLC). Materials & methods: A decision analysis model examined alternative patient management strategies for patients with advanced NSCLC who were not amenable to surgical treatment. A review of the literature provided the variables used to develop a timely base case and sensitivity analysis. A potential future scenario was also modeled. The model includes three options: conventional treatment (CT), new treatment (NT) and companion diagnostic (CD) strategy. Results: In the base case analysis based upon current data, …

The Use Of Interpreters To Improve The Quality And Safety Of Healthcare Through Better Communication In Obstetric Patients: Effect On Primary Cesarean Delivery Rate, Stephen A. Pearlman, Md

Master of Science in Healthcare Quality and Safety Capstone Presentations

Patients with limited English proficiency have poorer healthcare outcomes. An assessment of the cultural and linguistic competency of Christiana Care Health Systems revealed that our language services were not sufficiently robust and this was affecting care. Therefore, the purpose of this quality improvement study was to improve healthcare outcomes, specifically the rate of primary cesarean delivery, through improved language assistance, to patients with limited English proficiency presenting to labor and delivery. The methods employed included use of the TeamSTEPPS program to educate the staff on how to improve safety for patients with limited English proficiency, adding a live Spanish interpreter …

Stubborn, Persistent, Dangerous C.Difficile Infections. Is Improvement Possible?, Sara Townsend

Master of Science in Healthcare Quality and Safety Capstone Presentations

C.difficile also known as C.diff or CDI has developed into a dangerous infection for the United States’ health care system. While much work has been done to improve C.diff rates, health care teams have not been successful in reducing C.difficile infections. Many studies have focused on the mode of transmission of C.difficle, yet there still is not consensus on understanding how this infection is spread. Bryn Mawr Hospital, a community hospital in the suburbs of Philadelphia, Pa, has struggled to improve their C.diff rates like their peers throughout the country. While their infection rates for C.diff are …

Insights From "Creating The Healthcare Workforce For The 21(St) Century" Conference., Amanda R Solis

College of Population Health Faculty Papers

No abstract provided.

Improved Cardiac Management With A Disease Management Program Incorporating Comprehensive Lipid Profiling., John F Mcana, Neil I Goldfarb, Joseph Couto, Michelle A Henry, Gary Piefer, George M Rapier

College of Population Health Faculty Papers

Abstract The objective of this study was to evaluate the improved effectiveness of a disease management treatment protocol incorporating comprehensive lipid profiling and targeted lipid care based on lipid profile findings in patients with ischemic heart disease (IHD) or congestive heart failure (CHF) enrolled in a managed care plan. This retrospective cohort study, conducted over a 2-year period, compared outcomes between patients with a standard lipid profile to those evaluated with a comprehensive lipid profile. All adult members of the WellMed Medical Management, Inc. managed care health plan diagnosed with IHD or CHF, and continuously enrolled between July 1, 2006 …

Improved Cardiac Management With A Disease Management Program Incorporating Comprehensive Lipid Profiling., John F Mcana, Neil I Goldfarb, Joseph Couto, Michelle A Henry, Gary Piefer, George M Rapier

College of Population Health Faculty Papers

The objective of this study was to evaluate the improved effectiveness of a disease management treatment protocol incorporating comprehensive lipid profiling and targeted lipid care based on lipid profile findings in patients with ischemic heart disease (IHD) or congestive heart failure (CHF) enrolled in a managed care plan. This retrospective cohort study, conducted over a 2-year period, compared outcomes between patients with a standard lipid profile to those evaluated with a comprehensive lipid profile. All adult members of the WellMed Medical Management, Inc. managed care health plan diagnosed with IHD or CHF, and continuously enrolled between July 1, 2006 and …

Prevalence And Risk Of Polypharmacy Among The Elderly In An Outpatient Setting: A Retrospective Cohort Study In The Emilia-Romagna Region, Italy, S. Lane Slabaugh, Vittorio Maio, Megan Templin, Safiya Abouzaid

College of Population Health Faculty Papers

Background: Polypharmacy, the simultaneous taking of many medications, has been well documented and is a topic of much concern for those looking to improve the quality of care for the elderly. Elderly patients often develop complicated and multi-factorial health states that require extensive pharmacotherapy, leaving this population at risk for exposure to drug-drug interactions and other adverse events. Previous literature supports an association between an increase in the rate of adverse events as the number of drugs taken by a patient increases.

Objective: We sought to evaluate the prevalence of polypharmacy, and to determine patient characteristics that are predictive of …

Current And Future Directions In Frailty Research., Anita Mohandas, Joanne Reifsnyder, Mimi Jacobs, Tim Fox

College of Population Health Faculty Papers

The concept of frailty has been evolving dramatically for the past 30 years. Through its evolution, a variety of single and multidimensional models have been used to describe frailty. This article reviews the current literature related to the defining dimensions of frailty and identifies the gaps in the literature requiring additional research. A detailed literature review was performed to identify key dimensions and models currently being used to define frailty, classify interventions that have been developed to reverse frailty, and identify potential areas for future research within this field. Despite the large body of research defining the dimensions of frailty, …

Appropriate Medication Prescribing In Elderly Patients: How Knowledgeable Are Primary Care Physicians? A Survey Study In Parma, Italy., Vittorio Maio, Pharmd, Ms, Mph, Eric Jutkowitz, Ba, Karina Herrera Ba, Ms, Safiya Abouzaid Pharmd, Giavanna Negri, Pharmd, Stefano Del Canale, Md, Phd

College of Population Health Faculty Papers

What is known and Objective:  Increasing attention is being paid to inappropriate medication prescribing for the elderly. A growing body of studies have detected a prevalence of inappropriate prescribing ranging from 12% to 40% worldwide, including Regione Emilia-Romagna, Italy. To improve quality of prescribing, a multi-phase pilot project in the Local Health Unit (LHU) of Parma, Regione Emilia-Romagna, was established. This phase aimed to assess primary care physicians' knowledge of appropriate prescribing in elderly patients. Methods:  In total, 155 primary care physicians (51% of the total), convened by the LHU of Parma for an educational session, were asked to complete …

International Evidence On Medical Spending, Robert D. Lieberthal

College of Population Health Faculty Papers

Abstract
U.S. medical spending is high by measures including the level of spending, level of spending per capita, and level of spending as a share of GDP. U.S. medical spending growth is average by measures including the annual growth rate, annual growth rate per capita, and annual growth in spending as a percent of GDP. The volatility of U.S. medical spending growth is low by measures including the standard deviation, skew, and excess kurtosis.

Foreign healthcare systems, with a much larger government involvement, have not been able to control medical spending growth better than the U.S. with its mixed system. …

Beta-Blocker Initiation And Adherence After Hospitalization For Acute Myocardial Infarction., Vittorio Maio, Pharmd, Ms, Msph, Massimiliano Marino, Phd, Mary Robeson, Md, Joshua J Gagne, Pharmd, Ms

College of Population Health Faculty Papers

Aims: We sought to: (1) estimate the proportion of patients who initiated beta-blocker therapy after acute myocardial infarction (AMI) in Regione Emilia-Romagna (RER); (2) examine predictors of post-AMI beta-blocker initiation; and (3) assess adherence to such therapy.

Methods and Results: Using healthcare claims data covering all of RER, we identified a cohort of 24,367 patients with a hospitalization for AMI between 2004 and 2007, who were discharged from the hospital alive and without contraindications to beta-blocker therapy. We estimated the proportion of eligible patients with at least one prescription for a beta-blocker following discharge and performed a multivariable logistic regression …