A5054427426- Healthcare Policy and Management
- Primary Care and Health Outcomes
- Global Health Care Issues
- Health disparities and outcomes
- Food Security and Health in Diverse Populations
- Geriatric Care and Nursing Homes
- Emergency and Acute Care Studies
- Chronic Disease Management Strategies
- Healthcare Systems and Technology
- Patient Satisfaction in Healthcare
- Health Systems, Economic Evaluations, Quality of Life
- Pharmaceutical Practices and Patient Outcomes
- COVID-19 and healthcare impacts
- Healthcare Systems and Reforms
- Healthcare cost, quality, practices
- Global Health Workforce Issues
- Health Promotion and Cardiovascular Prevention
- Fiscal Policy and Economic Growth
- Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Diabetes Management and Research
- Patient Safety and Medication Errors
- Homelessness and Social Issues
- Migration, Health and Trauma
- Electronic Health Records Systems
- Heart Failure Treatment and Management
Yale New Haven Health System
2014-2024
Yale University
2014-2023
National Bureau of Economic Research
2022
Hoover Institution
2022
The University of Texas at Austin
2022
Boston University
2022
Brown University
2009-2022
New York University
2018
General Department of Preventive Medicine
2010
Brigham and Women's Hospital
2008-2010
Although spending rates on health care and social services vary substantially across the states, little is known about possible association between variation in state-level outcomes allocation of state services. To estimate that association, we used repeated measures multivariable modeling for period 2000-09, with region time fixed effects adjusted total demographic economic characteristics one- two-year lags. We found states a higher ratio to (calculated as sum service public divided by...
Importance Racial and ethnic disparities in delayed medical care for reasons that are not directly associated with the cost of remain understudied. Objective To describe trends racial barriers to timely among adults during a recent 20-year period. Design, Setting, Participants This was serial cross-sectional study 590 603 noninstitutionalized US using data from National Health Interview Survey 1999 2018. Data analyses were performed December 2021 through August 2022. Exposures Self-reported...
Importance Amid efforts in the US to promote health equity, there is a need assess recent progress reducing excess deaths and years of potential life lost among Black population compared with White population. Objective To evaluate trends mortality Design, setting, participants Serial cross-sectional study using national data from Centers for Disease Control Prevention 1999 through 2020. We included non-Hispanic populations across all age groups. Exposures Race as documented death...
Background: Medication reconciliation at transitions in care is a national patient safety goal, but its effects on important outcomes require further evaluation.We sought to measure the impact of an information technology-based medication intervention discrepancies with potential for harm (potential adverse drug events [PADEs]).Methods: We performed controlled trial, randomized by medical team, general inpatient units 2 academic hospitals from May June 2006.We enrolled 322 patients admitted...
Abstract BACKGROUND: Inpatient hyperglycemia is associated with poor patient outcomes. It unknown how best to implement glycemic management strategies in the non–intensive care unit (ICU) setting. OBJECTIVE: To determine effects of a multifaceted quality improvement intervention on medical inpatients diabetes mellitus or hyperglycemia. DESIGN: Before‐after trial. SETTING: Geographically localized general service staffed by physician's assistants (PAs) and hospitalists. PATIENTS:...
States have increasingly outsourced the provision of Medicaid services to private managed care plans. To ensure that plans maintain access care, many states set network adequacy standards require contract with a minimum number physicians. In this study we used data from period 2015–17 for four assess level participation among physicians listed in provider directories each plan. We found about one-third outpatient primary and specialist contracted our sample saw fewer than ten beneficiaries...
<h3>Importance</h3> Administrative records indicate that more than half of the 80 million Medicaid enrollees identify as belonging to a racial and ethnic minority group. Despite this, disparities within program remain understudied. For example, we know no studies examining differences in spending, potential measure how equitably state resources are allocated. <h3>Objectives</h3> To examine whether what extent there health care spending utilization between Black White Medicaid. <h3>Design,...
Importance Little is known about small-area variations in health care spending and utilization across the 3 major funders of US: Medicare, Medicaid, private insurers. Objective To measure regional privately insured; to observe whether there are regions that simultaneously low for all payers; determine what factors correlated with by payer. Design, Setting, Participants Observational cross-sectional analysis US system 2016 2017 241 306 hospital referral (HRRs) 2 states. include individuals...
The objective of risk adjustment is not to predict spending accurately but support the social goals a payment system, which include equity. Setting population-based payments at accurate predictions risks entrenching levels that are insufficient mitigate impact determinants on health care use and effectiveness. Instead, advance equity, must be set above current for historically disadvantaged groups. In analyses intended guide such reallocations, we found community-dwelling Medicare population...
Background: Hospitals across the United States are pursuing strategies to reduce avoidable readmissions but evidence on how best accomplish this goal is mixed, with no specific clinical practice shown consistently. Changes hospital organizational practices, a key component of context, also may be critical improving performance readmissions, has not been studied. Objective: The aim study was understand high-performing hospitals improved risk-stratified readmission rates, and whether their...
Despite recent reductions in national unplanned readmission rates, we have relatively little understanding of which hospital strategies are most associated with changes risk-standardized rates (RSRR). We examined associations between the change 30-day RSRR for patients heart failure and uptake over 12–18 months a sample hospitals. conducted prospective study hospitals using Web-based survey at baseline (November 2010–May 2011, n = 599, 91.0 % response rate) later 2011–October 2012, 501, 83.6...
Nationally, a higher proportion of the medically underserved than general population suffer from hypertension. Poorer adherence to recommended therapies (including medication regimens, salt intake reduction, and regular visits with provider) has been linked poorer blood pressure control. To identify whether differences in are associated racial/ethnic socioeconomic characteristics, we administered survey 141 African American non-Hispanic White hypertensive patients within two hospital-based...
Since 1965, the US federal government has incentivized physicians to practice in high-need areas of country through designation Health Professional Shortage Areas (HPSAs). Despite its being place for more than half a century and directing billion dollars annually, there is limited evidence HPSA program’s effectiveness at reducing geographic disparities access care health outcomes. Using generalized difference-in-differences design with matching, we found no statistically significant changes...
Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state agencies will be required by the Center for Medicare and Services (CMS) enact time distance standards managed care organizations ensure an adequate supply specialist physicians enrollees; however, there been no published studies whether these policies significant effects on specialty care.
This study draws on qualitative interview data to examine transitions into rent-assisted housing as they relate diabetes self-management behaviors.We conducted interviews with low-income residents of New Haven, Connecticut, who had a diagnosis type 2 diabetes. To experiences transition housing, we drew those participants were living in at the baseline (n = 18) and 5) transitioned between 9-month followup. Interviews probed participants' experiences. Analysis followed an inductive grounded...
Declining job satisfaction and concurrent reductions in Medicaid participation among primary care providers have been documented, but there is limited qualitative work detailing their first-hand experiences treating patients. The objective of this study to describe the some who treat patients using in-depth analysis. We conducted interviews with 15 a Northeastern state. Participant recruitment efforts focused on including different types practicing diverse settings. Qualitative were...
<h3>Importance</h3> Medicaid enrollees typically report worse access to care than other insured populations. Expansions in through less restrictive income eligibility requirements and the resulting influx of new may further erode for those already enrolled Medicaid. <h3>Objective</h3> To assess effect previous expansions on self-reported use emergency department services by enrollees. <h3>Design, Setting, Participants</h3> Quasi-experimental difference-in-differences design among 1714 adult...
Health plans use selective physician networks to control costs while improving quality. However, narrow (limited) raise concerns about reduced access and continuity of care. In the period 2010–15, proportion Medicaid managed care in fourteen states with primary networks—that is, that employed 30 percent or less those physicians their market—declined from a peak 42 2011 27 2015. On average, experienced 12 annual turnover rate, 34 exiting within five years. Turnover was 3 percentage points...