Health Services Administration Commons^™

Single-Level Anterior Cervical Discectomy And Fusion Is Associated With Higher Nonroutine Discharge Rates Compared To Cervical Disc Arthroplasty In Obese Patients, Paul G. Mastrokostas, Luke B. Schwartz, Eli Berglas, Aaron B. Lavi, Leonidas E. Mastrokostas, Jonathan Dalton, Christopher K. Kepler, Arya Varthi, Jad Bou Monsef, Afshin E. Razi, Mitchell K. Ng

Rothman Institute Papers

CONTEXT: Obesity is a recognized risk factor for adverse outcomes in cervical spine surgery. While cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF), comparative outcomes among obese patients remain underexplored.

AIMS: The aim of this study is to compare nonroutine discharge rates and other postoperative outcomes between obese patients undergoing single-level ACDF and CDA.

SETTINGS AND DESIGN: Retrospective cohort study using a national database.

SUBJECTS AND METHODS: The National Inpatient Sample was queried to identify obese patients who underwent single-level ACDF or CDA between 2016 and 2020. Inclusion and exclusion criteria were …

Medicaid Managed Care Organization Service Coverage And Diagnosis And Treatment Of Opioid Use Disorder: Evidence From Quasi-Random Auto-Assignment In Kentucky, Shelby R. Steuart, Miguel Antonio G Estrada, Christina Andrews Ph.D., Colleen M. Grogan, Olivia M. Hinds, Emily C. Lawler, Lauren A. Peterson, Felipe Lozano-Rojas, Emily C. Lawler, Lauren A. Peterson, Felipe Lozano-Rojas, Melissa A. Westlake, Coady Wing, Amanda J. Abraham

Faculty Publications

Introduction

Opioid-related mortality continues to claim tens of thousands of American lives annually. Medicaid plays an outsized role in financing opioid use disorder (OUD) treatment, paying for almost 40% of all Americans who received OUD treatment in 2017. Methods

Using Medicaid T-MSIS Analytic Files data and a novel data set of Medicaid managed care organization (MCO) plan coverage, we examined the relationship between comprehensiveness of benefits for OUD treatment provided by Medicaid MCO plans and the likelihood of OUD diagnosis and medications for OUD (MOUD) receipt among newly enrolled Medicaid beneficiaries in Kentucky. We use two stage least squares to …

The Case For Compulsory Dna Testing At Birth To Confirm Paternity: Ethical, Legal, And Social Considerations, Michael Mncedisi Willie

Journal of Indonesian Health Policy and Administration

Compulsory paternity testing at birth has sparked significant legal, ethical, and social debate due to its potential impact on family dynamics, child well-being, and parental responsibility. This review explores the ethical, legal, and societal implications of such testing, using Bioecological Systems Theory and Rawls' Theory of Justice to frame the discussion. This review evaluates the benefits and challenges of mandatory DNA testing at birth, particularly in reducing paternity fraud, ensuring fairness in child support allocation, and enhancing socio-economic outcomes, especially in low-income households. This qualitative review draws on multidisciplinary literature from family law, genetic counseling, social policy, and fathers' rights …

Respectful Patient-Provider Communication And Patient Portal Usage In Pregnant People Of Color, Amy H. Goh, Christopher Lee, Chisolum Nkenke, Joyce K. Edmonds

College of Health Professions Faculty Papers

BACKGROUND: Patient-provider communication (PPC) increasingly occurs in online patient portals. Variations in portal usage might worsen communication inequities for pregnant people of color (POC), widening the digital divide. The objective of this study was to examine the relationships between respectful PPC, patient portal usage, and digital health literacy (DHL) in pregnant POC.

METHODS: A multimethod cross-sectional survey design was used. Ordered logistic regression was performed to determine the relationship between PPC and portal use, controlling for trimester prenatal care was initiated, insurance type, age, gestational age, and parity. The moderating effect of Digital Health Literacy Instrument (DHLI) was tested on …

“Are You Worried About Going Into Withdrawal Today?” Retrospective Analysis Of Single-Question, Patient-Centered Screen For Substance Use And Care Linkage, Kory S. London, Beth Hurwitz, Jennifer Davis, Tareva Warrick-Stone, Alan Cherney, Frederick Randolph, Bernice Bradley-O'Toole, Kate Deis, Karen Alexander

Department of Emergency Medicine Faculty Papers

BACKGROUND: Emergency Department (ED) screening for substance use disorder (SUD) is limited by a lack of standardization and challenging clinical environments. Existing tools may be focused on informing clinicians rather than supporting patients. This study assessed a novel single-question screening tool to identify patients at risk of withdrawal and link those with opioid use disorder (OUD) to standardized treatment.

METHODS: A cross-sectional, retrospective study was conducted at two urban EDs in Philadelphia, PA, using electronic health record data between November 8, 2022, and February 28, 2025. Patients were included in the study if they arrived ambulatory to the emergency department, …

One Health Integration To Control And Prevent Zoonoses: Application Of Organizational Theory Literature, Lisset M. Dumet Poma, Sherril Gelmon, Julia M. Goodman, Seth E. O’Neal

Hatfield Graduate Journal of Public Affairs

Zoonoses are infectious diseases transmitted between animals and people that disproportionately affect low- and middle-income countries (LMICs). The One Health (OH) approach aims to integrate systems, incentivizing collaboration among animal, human, and environmental systems to address zoonoses and improve health. Innovative solutions for effectively and sustainably achieving systems integration are needed. Organizational theories can facilitate the study of the context of OH implementation, applying comprehensive approaches that recognize the interconnections among organisms, the environment, and social systems, including the diverse entities needing integration (e.g., policy, community, public organizations). This narrative review examines organization and systems literature to provide recommendations for …

Community Perspectives On Cancer And Cancer Research: Findings From Listening Sessions With Diverse Groups In Philadelphia, Karen Glanz, Emma A. Soliva, Krista Scheffey, Yawei Song, Charnita Zeigler-Johnson, Evelyn T. González, Thierry Fortune, Nilsa Graciani, Amy E. Leader

Kimmel Cancer Center Faculty Papers

BACKGROUND: Listening sessions are useful for understanding community perspectives on cancer disparities. The Philadelphia Communities Conquering Cancer (PC3) coalition conducted listening sessions to identify community priorities for cancer prevention and control research among diverse communities in Philadelphia.

METHODS: Guided by a Stakeholder Advisory Committee, PC3 partnered with community-based organizations to conduct 8 listening sessions with diverse communities (including Black, Hispanic, Asian, Russian, LGBTQ + , and veterans) to learn about perceptions of cancer, research priorities, and training and communication preferences. Sessions were facilitated by community members or PC3 members in the primary language of participants. Sessions were audio recorded, transcribed, …

Forecasting Influenza Rates Using Machine Learning: A Study Of Chatgpt's Predictive Accuracy, Sara Saleh

University Honors Theses

This study evaluates ChatGPT's ability to forecast influenza rates, such as the number of flu cases, hospitalizations, and death during peak season periods using CDC data, and comparing forecasts against actual results to calculate statistical accuracy and consistency. Influenza forecasting is essential for public health planning, but traditional methods may not always provide timely or accurate predictions. In this research study, ChatGPT was utilized to predict the influenza rates for the following week based on the previous week's data obtained from the FluView surveillance system. The predicted rates were compared to the actual influenza rates to assess the model's overall …

Telehealth And In-Person Hiv Care During The Covid-19 Pandemic At A Large Academic Medical Center In North Carolina, Valerie Yelverton, Jan Ostermann Ph.D., Michael E. Yarrington, Andrew K. Weinhold, Nabil Natafgi, Bankole Olatosi, Sharon Weissman, Nathan M. Thielman

Faculty Publications

Background

To maintain HIV care during the COVID-19 pandemic, many HIV clinics across the United States adopted telehealth. However, not everyone participated in telehealth equally. This study assessed the use and disparities in telehealth and in-person HIV care at a large academic medical center in North Carolina (NC) relative to the COVID-19 pandemic.

Methods

Data from the Duke University Infectious Disease clinic in NC were extracted from electronic health records (EHR), aggregated across persons with HIV (PWH) by calendar month, visit type (in-person vs. telehealth HIV care), and by key sociodemographic and clinical characteristics. Variation in HIV care over time …

Comparison Between Pipeline Embolization Device (Ped) Versus Flow Redirection Endoluminal Device (Fred) For Intracranial Aneurysms: A Comprehensive Systematic Review And Meta-Analysis, Seyed Maroufi, Mohammad Fallahi, Muhammad Waqas, Othman Bin-Alamer, Manisha Koneru, Joanna Roy, Jane Khalife, Hamza Shaikh, Daniel Tonetti

Department of Neurosurgery Faculty Papers

OBJECTIVES: The performance of the Pipeline Embolization Device (PED) and relatively newer double-layered Flow Re-Direction Endoluminal Device (FRED) have been studied for the treatment of intracranial aneurysms, but direct comparisons between PED and FRED are limited. The current systematic review aims at comparing the efficacy and safety of PED and FRED.

METHODS: A systematic review of the literature was conducted according to the PRISMA guideline. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched, and related records were identified. A meta-analysis of double-arm studies comparing PED and FRED was conducted on angiographic and clinical outcomes, retreatment rates, and …

Blueprint For A Youth Violence Intervention Program In East Baton Rouge Parish: Adapting Hospital-Based Strategies, Kristina G. Little, Elizabeth Winchester, Judith L F Rhodes

Reports

Youth violence in East Baton Rouge Parish remains a persistent public safety and public health challenge. This report proposes an adapted, evidence-informed model for East Baton Rouge Parish that retains the core components of traditional HVIPs while leveraging existing legal, hospital, and social service resources. The model is grounded in a public health framework and emphasizes trauma-informed, bedside intervention at the “teachable moment” when youth are most receptive to change, and long-term wraparound case management. The report concludes with recommendations for implementing this adapted approach, including identifying a health system champion, building referral protocols, embedding training, and developing a long-term …

Protecting The Future Of Medical Innovation: Balancing Fiscal Responsibility With The Need For National Institutes Of Health And Federal Health Funding, Irina Petrache, Raed A. Dweik, Michelle Ng Gong, Jesse Roman, M. Patricia Rivera, Karen J. Collishaw

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Transforming The Future Of Health: Building Learning Health Systems Across The Globe, Sandra Yankah, Robert Saunders, Mark L. Tykocinski, Claudia Salzberg, Jonathan Gonzalez-Smith, Rachel Bonesteel, Cameron Joyce, Charles Kahn, Mark Mcclellan, Eyal Zimlichman

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Health care has faced disruptions over the past 5 years, including a global pandemic, supply chain interruptions, workforce shifts, and the introduction of new artificial intelligence (AI) tools. Health care organizations continue to leverage the learning health system (LHS) concept to adapt to these challenges through iterative feedback loops. The Future of Health (FOH), an international community of over 50 senior health leaders that focuses on shared challenges across international health systems, collaborated with the Duke-Margolis Institute for Health Policy in a consensus-building process with FOH members to identify opportunities for action in an LHS. Key areas for action identified …

High Prevalence Of Diabetes Mellitus Among Patients With Fabry Disease In Taiwan: A Cross-Sectional Study, Shih Han Hung, Sudha Xirasagar Mbbs., Ph.D, Yen Fu Cheng, Herng Ching Lin, Chin Shyan Chen

Publications

Objectives This study aimed to investigate the prevalence of diabetes mellitus in patients with Fabry disease using a nationwide population-based dataset. We hypothesised that patients with Fabry disease would have a higher prevalence of diabetes mellitus compared with the general population. Design A cross-sectional study. Setting Taiwan. Participants We identified a study sample from Taiwan's LHID2010 Database. There were 9408 sampled patients in this study, 2352 study patients with Fabry disease and 7056 propensity-score-matched comparison patients. Primary outcome measures Multiple logistic regression analyses were conducted to explore the association between diabetes mellitus and Fabry disease after taking the variables of …

Job Satisfaction Among Health Workers At Primary Health Care In Palembang City, Indonesia, Asmaripa Ainy, Merri Nurmala Sarri, Poppy Fujiyanti, Hartati Inaku, Tannia Tembo

Kesmas

Health workers at primary health care are the frontline providers of community health services. This study aimed to investigate the level of job satisfaction of health workers at primary health care in Palembang City, South Sumatra Province, Indonesia, and its influencing factors. Using a questionnaire developed by the authors' team, the study involved 257 samples. A total of 66.15% of respondents indicated high satisfaction, 21.79% reported moderate satisfaction, and 12.06% expressed dissatisfaction. A statistically significant correlation was found between knowledge, skills, income, promotion opportunities, work supervision, and relationships with colleagues and job satisfaction (p-value <0.001). The correlations were strong, with Spearman's rho of 0.822, 0.869, 0.912, 0.895, and 0.821, respectively. Statistical analysis of the Wilcoxon rank-sum and Kruskal-Wallis tests showed no significant differences in median satisfaction scores between sociodemographic groups (p-value 0.072 to 0.552>0.05). These findings showed that job …

Association Between ‘Emergency Obstetric & Newborn Care Readiness’ And Delivery Service Utilization In Bangladesh: Evidence From National Health Facility Assessment Surveys, Kaji Keya-Korotki, Nabil Natafgi Ph.D., Mph, Cph, Mark Macauda, Syed Abdul Hamid, M. Mahmud Khan

Faculty Publications

Background

Bangladesh faces one of the highest global burdens of maternal and newborn deaths, primarily caused by hemorrhage and eclampsia/preeclampsia. Despite reducing maternal mortality by 40%, comprehensive medical interventions remain insufficient in health facilities.

Objectives

This study assessed the readiness of sub-district hospitals in Bangladesh to provide Emergency Obstetric and Newborn Care (EmONC) and analyzed the association between facility readiness and delivery rates.

Methods

Using Health Facility Assessment Survey data from 140 hospitals in 2014 and 141 in 2017, facility readiness was measured based on nine signal functions: administering antibiotics, oxytocin, and anticonvulsants; providing blood transfusions; performing cesarean and assisted …

Association Between ‘Emergency Obstetric & Newborn Care Readiness’ And Delivery Service Utilization In Bangladesh: Evidence From National Health Facility Assessment Surveys, Kaji Keya-Korotki, Nabil Natafgi Ph.D., Mph, Cph, Mark Macauda, Syed Abdul Hamid, M. Mahmud Khan

Faculty Publications

Background

Bangladesh faces one of the highest global burdens of maternal and newborn deaths, primarily caused by hemorrhage and eclampsia/preeclampsia. Despite reducing maternal mortality by 40%, comprehensive medical interventions remain insufficient in health facilities.

Objectives

This study assessed the readiness of sub-district hospitals in Bangladesh to provide Emergency Obstetric and Newborn Care (EmONC) and analyzed the association between facility readiness and delivery rates.

Methods

Using Health Facility Assessment Survey data from 140 hospitals in 2014 and 141 in 2017, facility readiness was measured based on nine signal functions: administering antibiotics, oxytocin, and anticonvulsants; providing blood transfusions; performing cesarean and assisted …

The Risk Of Interstitial Lung Disease In Psoriatic Arthritis Versus Psoriasis: A Retrospective Nationwide Database Analysis (2014-24), Andrew Engel, Christopher Xie, Ross Summer, Giorgos Loizidis

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

OBJECTIVES: Psoriasis (PsO) is a systemic autoimmune disease primarily characterized by erythematous plaques on the skin. While extra-dermal manifestations like psoriatic arthritis (PsA) are well recognized, data linking PsO to interstitial lung disease (ILD) remain limited. This study aimed to evaluate whether patients with PsA have a higher risk of developing ILD compared with patients with PsO.

METHODS: A retrospective analysis of the TriNetX US database (2014-24) was performed. Adult patients with PsO or PsA treated with systemic immunosuppressive medications were included, excluding those with other autoimmune diseases. ILD risk in PsO and PsA cohorts was compared with a reference …

The Influence Of Compensation From Wages And Benefits On Healthcare Workers' Performance In Healthcare Services, Jiddan Azizan Hakim, Ghania Danisha Maharani, Riswandy Wasir, Alif Indah Melani, Cahya Arbitera

Journal of Indonesian Health Policy and Administration

This study aims to evaluate the influence of compensation, including wages, incentives, and benefits, on the performance of health workers in primary health centers and hospitals. A literature review was conducted using Google Scholar and PubMed, focusing on articles published in the last 5–10 years. From an initial search yielding 1,021 articles, nine were selected based on inclusion criteria. The results show that direct compensation (salary) and indirect compensation (benefits) have a positive impact on health worker performance. However, the effect of incentives varies depending on implementation. Motivation and job satisfaction were mediating factors that strengthened the relationship between compensation …

Strengthening Occupational Health And Safety (Ohs) In Schools To Minimize Risks For Students, Teachers, And Visitors: Policy Recommendation, Wiwik Eko Pertiwi, Hanifa Maher Denny, Yuliani Setyaningsih, Agung Dwi Laksono

Journal of Indonesian Health Policy and Administration

Vocational schools equip students with practical skills and expose them to industry-related hazards, making Occupational Health and Safety (OHS) a crucial aspect of the school environment. This study aims to identify key factors behind the weak implementation of OHS in vocational schools. A literature review used articles published between 2017–2024 from national and international journals. The review found poor OHS implementation stems from lack of awareness, inadequate policies, insufficient infrastructure, weak safety culture, and negligence in accident prevention. To address these issues, the study recommends OHS education and training, improvement of school infrastructure, curriculum integration, formation of safety teams, and …