Nir Menachemi

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https://hdl.handle.net/1805/26679

What is motivating parents' COVID-19 vaccination decisions? A Statewide Survey of Indiana Parents

The COVID-19 vaccine is already available to children over 12 years old, and it will soon be available for children 5- 11 years old. Professor Nir Menachemi and his research partner, Professor Katharine Head, wanted to understand Hoosier parents’ perceptions of the COVID-19 vaccine and assess their intentions to get their children vaccinated. This sort of information can assist state and local governments, public health agencies, and community organizations in crafting targeted educational campaigns and other strategies that will assure high uptake of the vaccine among children.

They worked with the Indiana Department of Health and the Indiana Department of Education to recruit parents and caregivers across Indiana to fill out a web-based survey that assessed their perceptions about the COVID-19 vaccination. Over 10,000 parents filled out the anonymous survey! Some of the key findings include that only about 45% of parents have or intend to vaccinate their children, while about 42% do not intend to vaccinate. About 13% of parents who said they would “wait and see.” Of those wait and see parents, the researchers found some interesting perceptions about the vaccine that may suggest ways they can develop targeted educational messages to hopefully encourage them to get vaccinated, such as their perceptions of safety, perceptions of what other parents are doing, and perceptions about what their healthcare provider would want them to do. Based on these findings, they have developed a set of evidence-based suggestions for designing parent and family focused COVID-19 vaccination interventions that can be implemented in communities across Indiana.

Professor Menachemi's translation of research into strategies to increase the number of vaccinated children in the fight against COVID-19 is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Adverse Selection in the Children’s Health Insurance Program
(Sage, 2015-01) Morrisey, Michael A.; Blackburn, Justin; Becker, David J.; Sen, Bisakha; Kilgore, Meredith L.; Caldwell, Cathy; Menachemi, Nir; Department of Nursing, IU School of Nursing
This study investigates whether new enrollees in the Alabama Children’s Health Insurance Program have different claims experience from renewing enrollees who do not have a lapse in coverage and from continuing enrollees. The analysis compared health services utilization in the first month of enrollment for new enrollees (who had not been in the program for at least 12 months) with utilization among continuing enrollees. A second analysis compared first-month utilization of those who renew immediately with those who waited at least 2 months to renew. A 2-part model estimated the probability of usage and then the extent of usage conditional on any utilization. Claims data for 826 866 child-years over the period from 1999 to 2012 were used. New enrollees annually constituted a stable 40% share of participants. Among those enrolled in the program, 13.5% renewed on time and 86.5% of enrollees were late to renew their enrollment. In the multivariate 2-part models, controlling for age, gender, race, income eligibility category, and year, new enrollees had overall first-month claims experience that was nearly $29 less than continuing enrollees. This was driven by lower ambulatory use. Late renewals had overall first-month claims experience that was $10 less than immediate renewals. However, controlling for the presence of chronic health conditions, there was no statistically meaningful difference in the first-month claims experience of late and early renewals. Thus, differences in claims experience between new and continuing enrollees and between early and late renewals are small, with greater spending found among continuing and early renewing participants. Higher claims experience by early renewals is attributable to having chronic health conditions.
The Relationship between External Environment and Physician E-mail Communication: The Mediating Role of Health Information Technology (HIT) Availability
(Lippincott Williams & Wilkins, 2015-11) Mazurenko, Olena; Hearld, Larry R.; Menachemi, Nir; Department of Health Policy and Management, School of Public Health
Background: Physician e-mail communication, with patients and other providers, is one of the cornerstones of effective care coordination but varies significantly across physicians. A physician's external environment may contribute to such variations by enabling or constraining a physician's ability to adopt innovations such as health information technology (HIT) that can be used to support e-mail communication. Purpose: The aim of the study was to examine whether the relationship of the external environment and physician e-mail communication with patients and other providers is mediated by the practice's HIT availability. Methodology: The data were obtained from the Health Tracking Physician Survey (2008) and the Area Resource File (2008). Cross-sectional multivariable subgroup path analysis was used to investigate the mediating role of HIT availability across 2,850 U.S. physicians. Findings: Solo physicians' perceptions about malpractice were associated with 0.97 lower odds (p < .05) of e-mail communication with patients and other providers, as compared to group and hospital practices, even when mediated by HIT availability. Subgroup analyses indicated that different types of practices are responsive to the different dimensions of the external environment. Specifically, solo practitioners were more responsive to the availability of resources in their environment, with per capita income associated with lower likelihood of physician e-mail communication (OR = 0.99, p < .01). In contrast, physicians working in the group practices were more responsive to the complexity of their environment, with a physician's perception of practicing in environments with higher malpractice risks associated with greater information technology availability, which in turn was associated with a greater likelihood of communicating via e-mail with patients (OR = 1.02, p < .05) and other physicians (OR = 1.03, p < .001). Practical Applications: The association between physician e-mail communication and the external environment is mediated by the practice's HIT availability. Efforts to improve physician e-mail communication and HIT adoption may need to reflect the varied perceptions of different types of practices.
Health Expenditure Concentration and Characteristics of High-Cost Enrollees in CHIP
(Sage, 2016) Sen, Bisakha; Blackburn, Justin; Aswani, Monica S.; Morrisey, Michael A.; Becker, David J.; Kilgore, Meredith L.; Caldwell, Cathy; Sellers, Chris; Menachemi, Nir; Department of Nursing, School of Nursing
Devising effective cost-containment strategies in public insurance programs requires understanding the distribution of health care spending and characteristics of high-cost enrollees. The aim was to characterize high-cost enrollees in a state’s public insurance program and determine whether expenditure inequality changes over time, or with changes in cost-sharing policies or program eligibility. We use 1999-2011 claims and enrollment data from the Alabama Children’s Health Insurance Program, ALL Kids. All children enrolled in ALL Kids were included in our study, including multiple years of enrollment (N = 1,031,600 enrollee-months). We examine the distribution of costs over time, whether this distribution changes after increases in cost sharing and expanded eligibility, patient characteristics that predict high-cost status, and examine health services used by high-cost children to identify what is preventable. The top 10% (1%) of enrollees account for about 65.5% (24.7%) of total program costs. Inpatient and outpatient costs are the largest components of costs incurred by high-cost utilizers. Non-urgent emergency department costs are a relatively small portion. Average expenditure increases over time, particularly after expanded eligibility, and the share of costs incurred by the top 10% and 1% increases slightly. Multivariable logistic regression results indicate that infants and older teens, Caucasian children, and those with chronic conditions are more likely to be high-cost utilizers. Increased cost sharing does not reduce cost concentration or average expenditure among high-cost utilizers. These findings suggest that identifying and targeting potentially preventable costs among high-cost utilizers are called for to help reduce costs in public insurance programs.
Not only teachers: What do health administration faculty members do?
(2016) Harle, Christopher A.; Mullen, Cody; Vest, Joshua R.; Menachemi, Nir; Health Policy and Management, School of Public Health
Researchers have long been interested in how university faculty allocate their time between professional tasks. This study uses multiple years of Health Administration (HA) faculty survey data to examine how work activity has changed over time, and how work activity relates to faculty rank and the type of school in which a faculty member is employed. We report on faculty time allocation to research, teaching, and administration by survey year, faculty rank, and type of school. We also examine factors related to faculty's status as a principal investigator, teaching load, and research funding. On average, HA faculty spent 43% of their time teaching, 31% doing research, 20% in administrative activities, and 5% in other activities. Full professors spent significantly less time teaching, had lighter teaching loads, and spent more time on administration than other faculty. Faculty in schools of health professions, business, and other schools spent more time in teaching and had lower research funding expectations than faculty in schools of public health and medicine. These findings may help faculty identify jobs that best align with their interests and benchmark their work against industry norms. These findings may also help administrators in HA programs set appropriate expectations for their faculty.
Using Bibliometric Big Data to Analyze Faculty Research Productivity in Health Policy and Management
(2016-03) Harle, Christopher A.; Vest, Joshua R.; Menachemi, Nir; Health Policy and Management, School of Public Health
Bibliometric big data and social media tools provide new opportunities to aggregate and analyze researchers' scholarly impact. The purpose of the current paper is to describe the process and results we obtained after aggregating a list of public Google Scholar profiles representing researchers in Health Policy and Management or closely-related disciplines. We extracted publication and citation data on 191 researchers affiliated with health administration programs in the U.S. With these data, we created a publicly available listing of faculty that includes each person's name, affiliation, year of first citation, total citations, h-index, and i-10 index. The median of total citations per individual faculty member was 700, while the maximum was 46,363. The median h-index was 13, while the maximum was 91. We plan to update these statistics and add new faculty to our public listing as new Google Scholar profiles are created by faculty members in the field. This listing provides a resource for students and faculty in our discipline to easily compare productivity and publication records of faculty members in their own and other departments. Similarly, this listing provides a resource for faculty, including department chairs and deans, who desire discipline-specific context for promotion and tenure processes.
Urban Park Development and Pediatric Obesity Rates: A Quasi-Experiment Using Electronic Health Record Data
(MDPI, 2016-04-08) Goldsby, TaShauna U.; George, Brandon J.; Yeager, Valerie A.; Sen, Bisakha P.; Ferdinand, Alva; Sims, Devon M. T.; Manzella, Bryn; Cockrell Skinner, Ashley; Allison, David B.; Menachemi, Nir; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
INTRODUCTION: Childhood obesity affects ~20% of children in the United States. Environmental influences, such as parks, are linked with increased physical activity (PA). OBJECTIVE: To examine whether changes in Body Mass Index (BMI) z-score were associated with construction of a new park. METHODS: A quasi-experimental design was used to determine whether living in proximity of a park was associated with a reduction in BMI z-score. Children were selected from health clinics within an 11 mile radius of the park. A repeated-measure ANOVA was employed for analysis of the relationship between exposure (new park) and BMI z-score. RESULTS: Participants were 1443 (median age 10.3 range (2-17.9 years), BMI: z-score 0.84 ± 1.09) African American (77.4%) adolescents. Change in BMI z-score was not statistically different for children living at different distances from the park after controlling for age, gender, race, ethnicity, or payer type (p = 0.4482). We did observe a small 0.03 increase in BMI z-score from pre- to post-park (p = 0.0007). There was a significant positive association between child's baseline age and BMI z-score (p < 0.001). CONCLUSIONS: This study found proximity to a park was not associated with reductions in BMI z-score. Additional efforts to understand the complex relationship between park proximity, access, and PA are warranted.
Using Web-Based Search Data to Study the Public’s Reactions to Societal Events: The Case of the Sandy Hook Shooting
(JMIR Publications, 2017) Menachemi, Nir; Rahurkar, Saurabh; Rahurkar, Mandar; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
Background: Internet search is the most common activity on the World Wide Web and generates a vast amount of user-reported data regarding their information-seeking preferences and behavior. Although this data has been successfully used to examine outbreaks, health care utilization, and outcomes related to quality of care, its value in informing public health policy remains unclear. Objective: The aim of this study was to evaluate the role of Internet search query data in health policy development. To do so, we studied the public’s reaction to a major societal event in the context of the 2012 Sandy Hook School shooting incident. Methods: Query data from the Yahoo! search engine regarding firearm-related searches was analyzed to examine changes in user-selected search terms and subsequent websites visited for a period of 14 days before and after the shooting incident. Results: A total of 5,653,588 firearm-related search queries were analyzed. In the after period, queries increased for search terms related to “guns” (+50.06%), “shooting incident” (+333.71%), “ammunition” (+155.14%), and “gun-related laws” (+535.47%). The highest increase (+1054.37%) in Web traffic was seen by news websites following “shooting incident” queries whereas searches for “guns” (+61.02%) and “ammunition” (+173.15%) resulted in notable increases in visits to retail websites. Firearm-related queries generally returned to baseline levels after approximately 10 days. Conclusions: Search engine queries present a viable infodemiology metric on public reactions and subsequent behaviors to major societal events and could be used by policymakers to inform policy development. [JMIR Public Health Surveill 2017;3(1):e12]
A population ecology perspective on the functioning and future of health information organizations
(Wolters Kluwer, 2017) Vest, Joshua R.; Menachemi, Nir; Health Policy and Management, School of Public Health
Background: Increasingly, health care providers need to exchange information to meet policy expectations and business needs. A variety of health information organizations (HIOs) provide services to facilitate health information exchange (HIE). However, the future of these organizations is unclear. Purpose: The aim of this study was to explore the environmental context, potential futures, and survivability of community HIOs, enterprise HIEs, and electronic health record vendor-mediated exchange using the population ecology theory. Approach: Qualitative interviews with 33 key informants representing each type of HIE organization were analyzed using template analysis. Results: Community HIOs, enterprise HIEs, and electronic health record vendors exhibited a high degree of competition for resources, especially in the area of exchange infrastructure services. Competition resulted in closures in some areas. In response to environmental pressures, each organizational type was endeavoring to differentiate its services and unique use case, as well as pursing symbiotic relationships or attempting resource partitioning. Conclusion: HIOs compete for similar resources and are reacting to environmental pressures to better position themselves for continued survival and success. Our ecological research perspective helps move the discourse away from situation of a single exchange organization type toward a view of the broader dynamics and relationships of all organizations involved in facilitating HIE activities.
Using structured and unstructured data to identify patients’ need for services that address the social determinants of health
(Elsevier, 2017-10) Vest, Joshua R.; Grannis, Shaun J.; Haut, Dawn P.; Halverson, Paul; Menachemi, Nir; Health Policy and Management, School of Public Health
Introduction Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. Methods A cross-sectional study described patients in need of SDH services offered by a safety-net hospital’s federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. Results More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. Discussion The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data.
Impact of Mental Health Parity & Addiction Equity Act on Costs & Utilization in Alabama's Children's Health Insurance Program
(Elsevier, 2018) Sen, Bisakha; Blackburn, Justin; Morrisey, Michael A.; Kilgore, Meredith; Menachemi, Nir; Caldwell, Cathy; Becker, David; Health Policy and Management, School of Public Health
Objective: The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 mandates equivalent insurance coverage for mental-health (MH) and substance-use disorders (SUD) to other medical and surgical services covered by group insurance plans, Medicaid and Children's Health Insurance Programs (CHIP). We explored the impact of MHPAEA on enrollees in ALL Kids, the Alabama CHIP. Methods: We use All Kids claims data for October 2008-December 2014. October 2008 through September 2009 marks the period prior to MHPAEA implementation. We evaluated changes in MH/SUD related utilization and program costs, and changes in racial/ethnic disparities in the use of MH/SUD services for ALL Kids enrollees, using two-part models. This allowed analyses of changes from no use to any use, as well as in intensity of use. Results: No significant effect is found on overall MH service-use. There are statistically significant increases in for inpatient visits and length of stay, and some increase in overall MH costs. These increases may not be clinically important, and are concentrated in 2009-2011. Disparities in utilization between African-American and non-Hispanic white enrollees are somewhat exacerbated, while disparities between other minorities and non-Hispanic whites are reduced. Conclusions: Findings indicate that MHPAEA led to a 14.3% increase in inpatient visits, a 12.5% increase in length of inpatient stay, and a 7.8% increase in MH costs. The increases appear limited to 2009-2011, suggesting existing pent-up ‘needs’ among enrollees for added MH/SUD services that resulted in a temporary spike in service use and cost immediately after MHPAEA, and which subsequently subsided.

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