Browsing by Author "Lee, Byungkyu"

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    Detecting Variation in Clinical Practice Patterns for Geriatric Trauma Care Using Social Network Analysis
    (Wolters Kluwer, 2024) Jarman, Molly P.; Ruan, Mengyuan; Tabata-Kelly, Masami; Perry, Brea L.; Lee, Byungkyu; Boustani, Malaz; Cooper, Zara; Medicine, School of Medicine
    Objective: To characterize hospital-level professional networks of physicians caring for older trauma patients as a function of trauma patient age distribution. Background: The causal factors associated with between-hospital variation in geriatric trauma outcomes are poorly understood. Variation in physician practice patterns reflected by differences in professional networks might contribute to hospital-level differences in outcomes for older trauma patients. Methods: This is a population-based, cross-sectional study of injured older adults (age 65 or above) and their physicians from January 1, 2014, to December 31, 2015, using Health Care Cost and Utilization Project inpatient data and Medicare claims from 158 hospitals in Florida. We used social network analyses to characterize the hospitals in terms of network density, cohesion, small-worldness, and heterogeneity, then used bivariate statistics to assess the relationship between network characteristics and hospital-level proportion of trauma patients who were aged 65 or above. Results: We identified 107,713 older trauma patients and 169,282 patient-physician dyads. The hospital-level proportion of trauma patients who were aged 65 or above ranged from 21.5% to 89.1%. Network density, cohesion, and small-worldness in physician networks were positively correlated with hospital geriatric trauma proportions ( R =0.29, P <0.001; R =0.16, P =0.048; and R =0.19, P <0.001, respectively). Network heterogeneity was negatively correlated with geriatric trauma proportion ( R =0.40, P <0.001). Conclusions: Characteristics of professional networks among physicians caring for injured older adults are associated with the hospital-level proportion of trauma patients who are older, indicating differences in practice patterns at hospitals with older trauma populations. Associations between interspecialty collaboration and patient outcomes should be explored as an opportunity to improve the treatment of injured older adults.
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    Substitution of Nonpharmacologic Therapy With Opioid Prescribing for Pain During the COVID-19 Pandemic
    (American Medical Association, 2021) Lee, Byungkyu; Yang, Kai-Cheng; Kaminski, Patrick; Peng, Siyun; Odabas, Meltem; Gupta, Sumedha; Green, Harold D., Jr.; Ahn, Yong-Yeol; Perry, Brea L.; Economics, School of Liberal Arts
    Importance: During the pandemic, access to medical care unrelated to COVID-19 was limited because of concerns about viral spread and corresponding policies. It is critical to assess how these conditions affected modes of pain treatment, given the addiction risks of prescription opioids. Objective: To assess the trends in opioid prescription and nonpharmacologic therapy (ie, physical therapy and complementary medicine) for pain management during the COVID-19 pandemic in 2020 compared with the patterns in 2019. Design, setting, and participants: This retrospective, cross-sectional study used weekly claims data from 24 million US patients in a nationwide commercial insurance database (Optum's deidentified Clinformatics Data Mart Database) from January 1, 2019, to September 31, 2020. Among patients with diagnoses of limb, extremity, or joint pain, back pain, and neck pain for each week, patterns of treatment use were identified and evaluated. Data analysis was performed from April 1, 2021, to September 31, 2021. Main outcomes and measures: The main outcomes of interest were weekly rates of opioid prescriptions, the strength and duration of related opioid prescriptions, and the use of nonpharmacologic therapy. Transition rates between different treatment options before the outbreak and during the early months of the pandemic were also assessed. Results: A total of 21 430 339 patients (mean [SD] age, 48.6 [24.0] years; 10 960 507 [51.1%] female; 909 061 [4.2%] Asian, 1 688 690 [7.9%] Black, 2 276 075 [10.6%] Hispanic, 11 192 789 [52.2%] White, and 5 363 724 [25.0%] unknown) were enrolled during the first 3 quarters in 2019 and 20 759 788 (mean [SD] age, 47.0 [23.8] years; 10 695 690 [51.5%] female; 798 037 [3.8%] Asian; 1 508 023 [7.3%] Black, 1 976 248 [9.5%] Hispanic, 10 059 597 [48.5%] White, and 6 417 883 [30.9%] unknown) in the first 3 quarters of 2020. During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, -15.9%; 95% CI, -16.1% to -15.8%). Patients with pain were more likely to receive opioids (mean difference, 3.5%; 95% CI, 3.3%-3.7%) and less likely to receive nonpharmacologic therapy (mean difference, -6.0%; 95% CI, -6.3% to -5.8%), and opioid prescriptions were longer and more potent during the early pandemic in 2020 relative to 2019 (mean difference, 1.07 days; 95% CI, 1.02-1.17 days; mean difference, 0.96 morphine milligram equivalents; 95% CI, 0.76-1.20). Analysis of individuals' transitions between treatment options for pain found that patients were more likely to transition out of nonpharmacologic therapy, replacing it with opioid prescriptions for pain management during the COVID-19 pandemic than in the year before. Conclusions and relevance: Nonpharmacologic therapy is a benign treatment for pain often recommended instead of opioid therapy. The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study, especially given longer days of prescription and more potent doses, may exacerbate the US opioid epidemic. These findings suggest that it is imperative to investigate the implications of limited medical access on treatment substitution, which may increase patient risk, and implement policies and guidelines to prevent those substitutions.
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    Tracking Public and Private Responses to the Covid-19 Epidemic: Evidence from State and Local Government Actions
    (University of Chicago Press, 2021) Gupta, Sumedha; Nguyen, Thuy Dieu; Lozano-Rojas, Felipe; Raman, Shyam; Lee, Byungkyu; Bento, Ana; Simon, Kosali Ilayperuma; Wing, Coady; Economics, School of Liberal Arts
    This paper examines the determinants of social distancing during the shutdown phase of the COVID-19 epidemic. We classify state and local government actions, and we study multiple proxies for social distancing based on data from smart devices. Mobility fell substantially in all states, even ones that did not adopt major distancing mandates. Most of the fall in mobility occurred prior to the most stringent sanctions against movement, such as stay-at-home laws. However, we find evidence suggesting that state and local policies did have an independent effect on mobility even after the large initial reductions occurred. Event studies show that early and information-focused actions such as first case announcements, emergency declarations, and school closures reduced mobility by 1–5 percent after five days. Between March 1 and April 14, average time spent at home grew from 9.1 hours to 13.9 hours. We find, for example, that without state emergency declarations, hours at home would have been 11.3 hours in April, suggesting that 55 percent of the growth is associated with policy and 45 percent is associated with (non-policy) trends. State and local government actions induced changes in mobility on top of a large and private response across all states to the prevailing knowledge of public health risks.