Browsing by Author "Carton, Thomas"

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    Dance of Dollars: State Funding Effects on Local Health Department Expenditures
    (Wolters Kluwer, 2022) Viall, Abigail H.; Bekemeier, Betty; Yeager, Valerie; Carton, Thomas; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: We examined changes in total local health department (LHD) expenditures in the state of Washington following introduction of a new state funding program to support core public health services and infrastructure. Methods: We used a pre/posttest design regression model to evaluate changes in LHD expenditures 1, 2, and 6 years into the new state program. To address potential endogeneity in the model, we repeated all 3 analyses using 2-stage least squares regression. Results: In the base case, overall spending among LHDs significantly increased with receipt of the new state funds in the first years of the program (2008 and 2009). However, those increases were not sustained over the longer term (2013). In subpopulation analyses, total LHD spending increased more among larger LHDs. Conclusions: Between 2006 and 2013, new state investments in core public health functions increased Washington State LHD expenditures in the short term, but those increases did not persist over time. For public health financial modernization efforts to translate into public health infrastructure modernization successes, the way new investments are structured may be as important as the amount of funding added.
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    Establishing a framework for privacy-preserving record linkage among electronic health record and administrative claims databases within PCORnet®, the National Patient-Centered Clinical Research Network
    (BMC, 2022-10-31) Kiernan, Daniel; Carton, Thomas; Toh, Sengwee; Phua, Jasmin; Zirkle, Maryan; Louzao, Darcy; Haynes, Kevin; Weiner, Mark; Angulo, Francisco; Bailey, Charles; Bian, Jiang; Fort, Daniel; Grannis, Shaun; Krishnamurthy, Ashok Kumar; Nair, Vinit; Rivera, Pedro; Silverstein, Jonathan; Marsolo, Keith; Medicine, School of Medicine
    Objective: The aim of this study was to determine whether a secure, privacy-preserving record linkage (PPRL) methodology can be implemented in a scalable manner for use in a large national clinical research network. Results: We established the governance and technical capacity to support the use of PPRL across the National Patient-Centered Clinical Research Network (PCORnet®). As a pilot, four sites used the Datavant software to transform patient personally identifiable information (PII) into de-identified tokens. We queried the sites for patients with a clinical encounter in 2018 or 2019 and matched their tokens to determine whether overlap existed. We described patient overlap among the sites and generated a "deduplicated" table of patient demographic characteristics. Overlapping patients were found in 3 of the 6 site-pairs. Following deduplication, the total patient count was 3,108,515 (0.11% reduction), with the largest reduction in count for patients with an "Other/Missing" value for Sex; from 198 to 163 (17.6% reduction). The PPRL solution successfully links patients across data sources using distributed queries without directly accessing patient PII. The overlap queries and analysis performed in this pilot is being replicated across the full network to provide additional insight into patient linkages among a distributed research network.