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Nir Menachemi
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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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Item 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 NursingThis 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.Item Assessing the capacity of social determinants of health data to augment predictive models identifying patients in need of wraparound social services(Oxford Press, 2018-01) Kasthurirathne, Suranga N.; Vest, Joshua R.; Menachemi, Nir; Halverson, Paul K.; Grannis, Shaun J.; Health Policy and Management, School of Public HealthIntroduction A growing variety of diverse data sources is emerging to better inform health care delivery and health outcomes. We sought to evaluate the capacity for clinical, socioeconomic, and public health data sources to predict the need for various social service referrals among patients at a safety-net hospital. Materials and Methods We integrated patient clinical data and community-level data representing patients’ social determinants of health (SDH) obtained from multiple sources to build random forest decision models to predict the need for any, mental health, dietitian, social work, or other SDH service referrals. To assess the impact of SDH on improving performance, we built separate decision models using clinical and SDH determinants and clinical data only. Results Decision models predicting the need for any, mental health, and dietitian referrals yielded sensitivity, specificity, and accuracy measures ranging between 60% and 75%. Specificity and accuracy scores for social work and other SDH services ranged between 67% and 77%, while sensitivity scores were between 50% and 63%. Area under the receiver operating characteristic curve values for the decision models ranged between 70% and 78%. Models for predicting the need for any services reported positive predictive values between 65% and 73%. Positive predictive values for predicting individual outcomes were below 40%. Discussion The need for various social service referrals can be predicted with considerable accuracy using a wide range of readily available clinical and community data that measure socioeconomic and public health conditions. While the use of SDH did not result in significant performance improvements, our approach represents a novel and important application of risk predictive modeling.Item Assessing the Quality Measure for Follow-up Care After Children’s Psychiatric Hospitalizations(AAP, 2019-11) Blackburn, Justin; Sharma, Pradeep; Corvey, Kathryn; Morrisey, Michael A.; Menachemi, Nir; Sen, Bisakha; Caldwell, Cathy; Becker, David; Health Policy and Management, School of Public HealthOBJECTIVES: Medicaid and Children’s Health Insurance Program plans publicly report quality measures, including follow-up care after psychiatric hospitalization. We aimed to understand failure to meet this measure, including measurement definitions and enrollee characteristics, while investigating how follow-up affects subsequent psychiatric hospitalizations and emergency department (ED) visits. METHODS: Administrative data representing Alabama’s Children’s Health Insurance Program from 2013 to 2016 were used to identify qualifying psychiatric hospitalizations and follow-up care with a mental health provider within 7 to 30 days of discharge. Using relaxed measure definitions, follow-up care was extended to include visits at 45 to 60 days and visits to a primary care provider. Logit regressions estimated enrollee characteristics associated with follow-up care and, separately, the likelihood of subsequent psychiatric hospitalizations and/or ED visits within 30, 60, and 120 days. RESULTS: We observed 1072 psychiatric hospitalizations during the study period. Of these, 356 (33.2%) received follow-up within 7 days and 566 (52.8%) received it within 30 days. Relaxed measure definitions captured minimal additional follow-up visits. The likelihood of follow-up was lower for both 7 days (−18 percentage points; 95% confidence interval [CI] −26 to −10 percentage points) and 30 days (−26 percentage points; 95% CI −35 to −17 percentage points) regarding hospitalization stays of ≥8 days. Meeting the measure reduced the likelihood of subsequent psychiatric hospitalizations within 60 days by 3 percentage points (95% CI −6 to −1 percentage point). CONCLUSIONS: Among children, receipt of timely follow-up care after a psychiatric hospitalization is low and not sensitive to measurement definitions. Follow-up care may reduce the need for future psychiatric hospitalizations and/or ED visits.Item Association of Health Status and Nicotine Consumption with SARS-CoV-2 positivity rates(BMC, 2021-10) Duszynski, Thomas J.; Fadel, William; Wools-Kaloustian, Kara K.; Dixon, Brian E.; Yiannoutsos, Constantin; Halverson, Paul K.; Menachemi, Nir; Epidemiology, School of Public HealthBACKGROUND: Much of what is known about COVID-19 risk factors comes from patients with serious symptoms who test positive. While risk factors for hospitalization or death include chronic conditions and smoking; less is known about how health status or nicotine consumption is associated with risk of SARS-CoV-2 infection among individuals who do not present clinically. METHODS: Two community-based population samples (including individuals randomly and nonrandomly selected for statewide testing, n = 8214) underwent SARS-CoV-2 testing in nonclinical settings. Each participant was tested for current (viral PCR) and past (antibody) infection in either April or June of 2020. Before testing, participants provided demographic information and self-reported health status and nicotine and tobacco behaviors (smoking, chewing, vaping/e-cigarettes). Using descriptive statistics and a bivariate logistic regression model, we examined the association between health status and use of tobacco or nicotine with SARS-CoV-2 positivity on either PCR or antibody tests. RESULTS: Compared to people with self-identified "excellent" or very good health status, those reporting "good" or "fair" health status had a higher risk of past or current infections. Positive smoking status was inversely associated with SARS-CoV-2 infection. Chewing tobacco was associated with infection and the use of vaping/e-cigarettes was not associated with infection. CONCLUSIONS: In a statewide, community-based population drawn for SARS-CoV-2 testing, we find that overall health status was associated with infection rates. Unlike in studies of COVID-19 patients, smoking status was inversely associated with SARS-CoV-2 positivity. More research is needed to further understand the nature of this relationship.Item Bayesian estimation of SARS-CoV-2 prevalence in Indiana by random testing(NAS, 2021-02) Yiannoutsos, Constantin T.; Halverson, Paul K.; Menachemi, Nir; Biostatistics, School of Public HealthFrom 25 to 29 April 2020, the state of Indiana undertook testing of 3,658 randomly chosen state residents for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, the agent causing COVID-19 disease. This was the first statewide randomized study of COVID-19 testing in the United States. Both PCR and serological tests were administered to all study participants. This paper describes statistical methods used to address nonresponse among various demographic groups and to adjust for testing errors to reduce bias in the estimates of the overall disease prevalence in Indiana. These adjustments were implemented through Bayesian methods, which incorporated all available information on disease prevalence and test performance, along with external data obtained from census of the Indiana statewide population. Both adjustments appeared to have significant impact on the unadjusted estimates, mainly due to upweighting data in study participants of non-White races and Hispanic ethnicity and anticipated false-positive and false-negative test results among both the PCR and antibody tests utilized in the study.Item The benefits of health information exchange: an updated systematic review(Oxford Academic, 2018-09) Menachemi, Nir; Rahurkar, Saurabh; Harle, Christopher A.; Vest, Joshua R.; Health Policy and Management, School of Public HealthObjective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.Item Characterizing variability in state-level regulations governing opioid treatment programs(Journal of Substance Abuse Treatment, 2020-04-24) Jackson, Joanna R.; Harle, Christopher A.; Silverman, Ross D.; Simon, Kosali; Menachemi, NirAbstract Introduction: The opioid use crisis has left nearly 1 million people in need of treatment. States have focused primarily on policies aimed at decreasing the prevalence of opioid use disorder. However, opioid treatment programs (OTPs), an evidence-based modality which can prevent and decrease opioid-related mortality and morbidity, remain highly complex with variation in treatment by state. A focus on evidence-based state-level regulation of OTPs may help improve the unmet need for treatment. This study characterized the variability in state laws that regulate OTPs and examines how this variability is associated with state characteristics. These data provides an opportunity for policymakers to consider regulations that increase access to care and retention in OTPs, which could improve population health. Materials and Methods: Utilizing legal mapping techniques, we identified all regulations governing OTPs in effect on January 1, 2017 and determined whether the most common regulations were consistent with best practices. We then examined how the number and type of regulations were associated with state characteristics. All legal mapping research was conducted between November 2017 and March 2019. Results: We identified 89 different regulations, the most common of which exists in fewer than half of all states; and most exist in less than 25% of states. Eighteen of the 30 most common regulations were inconsistent with best practice recommendations. Overall, variability in the number and type of OTP regulations was related to geographic location as opposed to state size or political leanings. Conclusions: Wide-ranging variability in the regulations of OTPs exists across the U.S. The majority of state OTP regulations are not congruent with best practices.Item Community COVID-19 activity level and nursing home staff testing for active SARS-CoV-2 infection in Indiana(Elsevier, 2020) Blackburn, Justin; Weaver, Lindsay; Cohen, Liza; Menachemi, Nir; Rusyniak, Dan; Unroe, Kathleen T.; Health Policy and Management, School of Public HealthObjectives: To assess whether using coronavirus disease 2019 (COVID-19) community activity level can accurately inform strategies for routine testing of facility staff for active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design: Cross-sectional study. Setting and Participants: In total, 59,930 nursing home staff tested for active SARS-CoV-2 infection in Indiana. Measures: Receiver operator characteristic curves and the area under the curve to compare the sensitivity and specificity of identifying positive cases of staff within facilities based on community COVID-19 activity level including county positivity rate and county cases per 10,000. Results: The detection of any infected staff within a facility using county cases per 10,000 population or county positivity rate resulted in an area under the curve of 0.648 (95% confidence interval 0.601‒0.696) and 0.649 (95% confidence interval 0.601‒0.696), respectively. Of staff tested, 28.0% were certified nursing assistants, yet accounted for 36.9% of all staff testing positive. Similarly, licensed practical nurses were 1.4% of staff, but 4.7% of positive cases. Conclusions and Implications: We failed to observe a meaningful threshold of community COVID-19 activity for the purpose of predicting nursing homes with any positive staff. Guidance issued by the Centers for Medicare and Medicaid Services in August 2020 sets the minimum frequency of routine testing for nursing home staff based on county positivity rates. Using the recommended 5% county positivity rate to require weekly testing may miss asymptomatic infections among nursing home staff. Further data on results of all-staff testing efforts, particularly with the implementation of new widespread strategies such as point-of-care testing, is needed to guide policy to protect high-risk nursing home residents and staff. If the goal is to identify all asymptomatic SARS-Cov-2 infected nursing home staff, comprehensive repeat testing may be needed regardless of community level activity.Item A critical appraisal of guidelines for electronic communication between patients and clinicians: the need to modernize current recommendations(Oxford, 2018-04) Lee, Joy L.; Matthias, Marianne S.; Menachemi, Nir; Frankel, Richard M.; Weiner, Michael; Medicine, School of MedicineBackground Patient-provider electronic communication has proliferated in recent years, yet there is a dearth of published research either leading to, or including, recommendations that improve clinical care and prevent unintended negative consequences. We critically appraise published guidelines and suggest an agenda for future work in this area. Objective To understand how existing guidelines align with current practice, evidence, and technology. Methods We performed a narrative review of provider-targeted guidelines for electronic communication between patients and providers, searching Ovid MEDLINE, Embase, and PubMed databases using relevant terms. We limited the search to articles published in English, and manually searched the citations of relevant articles. For each article, we identified and evaluated the suggested practices. Results Across 11 identified guidelines, the primary focus was on technical and administrative concerns, rather than on relational communication. Some of the security practices recommended by the guidelines are no longer needed because of shifts in technology. It is unclear the extent to which the recommendations that are still relevant are being followed. Moreover, there is no guideline-cited evidence of the effectiveness of the practices that have been proposed. Conclusion Our analysis revealed major weaknesses in current guidelines for electronic communication between patients and providers: the guidelines appear to be based on minimal evidence and offer little guidance on how best to use electronic tools to communicate effectively. Further work is needed to systematically evaluate and identify effective practices, create a framework to evaluate quality of communication, and assess the relationship between electronic communication and quality of care.Item Does preventive dental care reduce non-preventive dental visits and expenditures among Medicaid-enrolled adults?(Wiley, 2022) Taylor, Heather L.; Sen, Bisakha; Holmes, Ann M.; Schleyer, Titus; Menachemi, Nir; Blackburn, Justin; Health Policy and Management, School of Public HealthObjective To determine whether preventive dental visits are associated with fewer subsequent non-preventive dental visits and lower dental expenditures. Data Sources Indiana Medicaid enrollment and claims data (2015–2018) and the Area Health Resource File. Study design A repeated measures design with individual and year fixed effects examining the relationship between preventive dental visits (PDVs) and non-preventive dental visits (NPVs) and dental expenditures. Data Collection/Extraction Methods Not applicable. Principal findings Of 28,152 adults (108,349 observation-years) meeting inclusion criteria, 36.0% had any dental visit, 27.8% a PDV, and 22.1% a NPV. Compared to no PDV in the prior year, at least one was associated with fewer NPVs (β = −0.13; 95% CI -0.12, −0.11), lower NPV expenditures (β = −$29.12.53; 95% CI -28.07, −21.05), and lower total dental expenditures (−$70.12; 95% -74.92, −65.31), as well as fewer PDVs (β = −0.24; 95% CI -0.26, −0.23). Conclusions Our findings suggest that prior year PDVs are associated with fewer subsequent NPVs and lower dental expenditures among Medicaid-enrolled adults. Thus, from a public insurance program standpoint, supporting preventive dental care use may translate into improved population oral health outcomes and lower dental costs among certain low-income adult populations, but barriers to consistent utilization of PDV prohibit definitive findings.