Department of Health Policy and Management

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https://hdl.handle.net/1805/5091

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    A decade post-HITECH: Critical access hospitals have electronic health records but struggle to keep up with other advanced functions
    (Oxford University Press, 2021) Apathy, Nate C.; Holmgren, A. Jay; Adler-Milstein, Julia; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: Despite broad electronic health record (EHR) adoption in U.S. hospitals, there is concern that an "advanced use" digital divide exists between critical access hospitals (CAHs) and non-CAHs. We measured EHR adoption and advanced use over time to analyzed changes in the divide. Materials and methods: We used 2008 to 2018 American Hospital Association Information Technology survey data to update national EHR adoption statistics. We stratified EHR adoption by CAH status and measured advanced use for both patient engagement (PE) and clinical data analytics (CDA) domains. We used a linear probability regression for each domain with year-CAH interactions to measure temporal changes in the relationship between CAH status and advanced use. Results: In 2018, 98.3% of hospitals had adopted EHRs; there were no differences by CAH status. A total of 58.7% and 55.6% of hospitals adopted advanced PE and CDA functions, respectively. In both domains, CAHs were less likely to be advanced users: 46.6% demonstrated advanced use for PE and 32.0% for CDA. Since 2015, the advanced use divide has persisted for PE and widened for CDA. Discussion: EHR adoption among hospitals is essentially ubiquitous; however, CAHs still lag behind in advanced use functions critical to improving care quality. This may be rooted in different advanced use needs among CAH patients and lack of access to technical expertise. Conclusions: The advanced use divide prevents CAH patients from benefitting from a fully digitized healthcare system. To close the widening gap in CDA, policymakers should consider partnering with vendors to develop implementation guides and standards for functions like dashboards and high-risk patient identification algorithms to better support CAH adoption.
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    A national overview of nonprofit hospital community benefit programs to address the social determinants of health
    (Oxford University Press, 2023-12-06) Franz, Berkeley; Burns, Ashlyn; Kueffner, Kristin; Bhardwaj, Meeta; Yeager, Valerie A.; Singh, Simone; Puro, Neeraj; Cronin, Cory E.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes, yet strategies to address these upstream factors remain elusive. The aim of this study was to understand the extent to which US nonprofit hospitals invest in SDOH at either the community or individual patient level and to provide examples of programs in each area. We analyzed data from a national dataset of 613 hospital community health needs assessments and corresponding implementation strategies. Among sample hospitals, 69.3% (n = 373) identified SDOH as a top-5 health need in their community and 60.6% (n = 326) reported investments in SDOH. Of hospitals with investments in SDOH, 44% of programs addressed health-related social needs of individual patients, while the remaining 56% of programs addressed SDOH at the community level. Hospitals that were major teaching organizations, those in the Western region of the United States, and hospitals in counties with more severe housing problems had greater odds of investing in SDOH at the community level. Although many nonprofit hospitals have integrated SDOH-related activities into their community benefit work, stronger policies are necessary to encourage greater investments at the community-level that move beyond the needs of individual patients.
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    Acceptance of Automated Social Risk Scoring in the Emergency Department: Clinician, Staff, and Patient Perspectives
    (University of California, 2024) Mazurenko, Olena; Hirsh, Adam T.; Harle, Christopher A.; McNamee, Cassidy; Vest, Joshua R.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Introduction: Healthcare organizations are under increasing pressure from policymakers, payers, and advocates to screen for and address patients' health-related social needs (HRSN). The emergency department (ED) presents several challenges to HRSN screening, and patients are frequently not screened for HRSNs. Predictive modeling using machine learning and artificial intelligence, approaches may address some pragmatic HRSN screening challenges in the ED. Because predictive modeling represents a substantial change from current approaches, in this study we explored the acceptability of HRSN predictive modeling in the ED. Methods: Emergency clinicians, ED staff, and patient perspectives on the acceptability and usage of predictive modeling for HRSNs in the ED were obtained through in-depth semi-structured interviews (eight per group, total 24). All participants practiced at or had received care from an urban, Midwest, safety-net hospital system. We analyzed interview transcripts using a modified thematic analysis approach with consensus coding. Results: Emergency clinicians, ED staff, and patients agreed that HRSN predictive modeling must lead to actionable responses and positive patient outcomes. Opinions about using predictive modeling results to initiate automatic referrals to HRSN services were mixed. Emergency clinicians and staff wanted transparency on data inputs and usage, demanded high performance, and expressed concern for unforeseen consequences. While accepting, patients were concerned that prediction models can miss individuals who required services and might perpetuate biases. Conclusion: Emergency clinicians, ED staff, and patients expressed mostly positive views about using predictive modeling for HRSNs. Yet, clinicians, staff, and patients listed several contingent factors impacting the acceptance and implementation of HRSN prediction models in the ED.
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    Access to Recovery and Recidivism Among Former Prison Inmates
    (Sage, 2015) Ray, Bradley; Grommon, Eric; Buchanan, Victoria; Brown, Brittany; Watson, Dennis P.; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
    Access to Recovery (ATR) is a SAMHSA-funded initiative that offers a mix of clinical and supportive services for substance abuse. ATR clients choose which services will help to overcome barriers in their road to recovery, and a recovery consultant provides vouchers and helps link the client to these community resources. One of ATR’s goals was to provide services to those involved in the criminal justice system in the hopes that addressing substance abuse issues could reduce subsequent criminal behaviors. This study examines this goal by looking at recidivism among a sample of clients in one state’s ATR program who returned to the community after incarceration. Results suggest there were few differential effects of service selections on subsequent recidivism. However, there are significant differences in recidivism rates among the agencies that provided ATR services. Agencies with more resources and a focus on prisoner reentry had better recidivism outcomes than those that focus only on substance abuse services.
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    Achieving an Optimal Childhood Vaccine Policy
    (American Medical Association, 2017-09-01) Opel, Douglas J.; Schwartz, Jason L.; Omer, Saad B.; Silverman, Ross D.; Duchin, Jeff; Kodish, Eric; Diekema, Douglas S.; Marcuse, Edgar K.; Orenstein, Walt; Health Policy and Management, School of Public Health
    Policies to remove parents' ability to opt-out from school immunization requirements on the basis of religious or personal beliefs (ie, nonmedical exemptions) may be a useful strategy to increase immunization rates and prevent outbreaks of vaccine-preventable disease. However, there is uncertainty about the effectiveness of this strategy and the range of possible outcomes. We advocate for a more deliberative process through which a broad range of outcomes is scrutinized and the balance of values underlying the policy decision to eliminate nonmedical exemptions is clearly articulated. We identify 3 outcomes that require particular consideration before policies to eliminate nonmedical exemptions are implemented widely and outline a process for making the values underlying such policies more explicit.
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    Adoption of Best Practices in Behavioral Health Crisis Care by Mental Health Treatment Facilities
    (APA, 2023-09-01) Burns, Ashlyn; Menachemi, Nir; Yeager, Valerie A.; Vest, Joshua R.; Mazurenko, Olena; Health Policy and Management, School of Public Health
    Objective: The authors aimed to examine adoption of behavioral health crisis care (BHCC) services included in the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) best practices guidelines. Methods: Secondary data from SAMHSA’s Behavioral Health Treatment Services Locator in 2022 were used. BHCC best practices were measured on a summated scale capturing whether a mental health treatment facility (N=9,385) adopted BHCC best practices, including provision of these services to all age groups: emergency psychiatric walk-in services, crisis intervention teams, onsite stabilization, mobile or offsite crisis responses, suicide prevention, and peer support. Descriptive statistics were used to examine organizational characteristics (such as facility operation, type, geographic area, license, and payment methods) of mental health treatment facilities nationwide, and a map was created to show locations of best practices BHCC facilities. Logistic regressions were performed to identify facilities’ organizational characteristics associated with adopting BHCC best practices. Results: Only 6.0% (N=564) of mental health treatment facilities fully adopted BHCC best practices. Suicide prevention was the most common BHCC service, offered by 69.8% (N=6,554) of the facilities. A mobile or offsite crisis response service was the least common, adopted by 22.4% (N=2,101). Higher odds of adopting BHCC best practices were significantly associated with public ownership (adjusted OR [AOR]=1.95), accepting self-pay (AOR=3.18), accepting Medicare (AOR=2.68), and receiving any grant funding (AOR=2.45). Conclusions: Despite SAMHSA guidelines recommending comprehensive BHCC services, a fraction of facilities have fully adopted BHCC best practices. Efforts are needed to facilitate widespread uptake of BHCC best practices nationwide.
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    Adoption of Health Information Technology Among US Nursing Facilities
    (Elsevier, 2018-12-19) Vest, Joshua R.; Jung, Hye-Young; Wiley, Kevin; Kooreman, Harold; Pettit, Lorren; Unruh, Mark A.; Health Policy and Management, School of Public Health
    Objectives: Nursing facilities have lagged behind in the adoption interoperable health information technology (i.e. technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption. Design: Cross-sectional survey. Setting & participants: We surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations’ health information technology usage and characteristics. Measurements: Using questions adopted from existing instruments, the survey measured nursing home’s EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for eight determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources and slack resources. A series of regression models estimated the association between potential determinants and technology adoption. Results: 84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39; 95%CI = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%). Conclusions/Implications: An organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policymakers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities.
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    Adverse Childhood Experiences (ACEs) and Their Impact on Substance Misuse & Overall Health
    (The Center for Health Policy, 2018-03-01) Balio, Casey; Greene, Marion S.
    Adverse childhood experiences (ACEs) encompass a wide variety of distressing events, including emotional, physical, or sexual abuse; witnessing maternal domestic violence; or living with a household member who has a substance use disorder, is mentally ill or suicidal, or is currently or was ever incarcerated during the first 18 years of a child’s life. According to most recent estimates, nearly half of Indiana’s youth have experienced at least one ACE in their life. ACEs are linked to many risk behaviors, including substance use, which can adversely affect health outcomes.
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    Adverse Childhood Experiences (ACEs) and their Impact on Substance Misuse & Overall Health
    (The Center for Health Policy, 2018-03-01) Balio, Casey; Greene, Marion S.
    Adverse childhood experiences (ACEs) encompass a wide variety of distressing events, including emotional, physical, or sexual abuse; witnessing maternal domestic violence; or living with a household member who has a substance use disorder, is mentally ill or suicidal, or is currently or was ever incarcerated during the first 18 years of a child’s life. According to most recent estimates, nearly half of Indiana’s youth have experienced at least one ACE in their life. ACEs are linked to many risk behaviors, including substance use, which can adversely affect health outcomes.
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    Adverse Childhood Experiences (ACEs) and their Impact on Substance Misuse & Overall Health
    (Richard M. Fairbanks School of Public Health, 2018-03) Balio, Casey; Greene, Marion
    Adverse childhood experiences (ACEs) encompass a wide variety of distressing events, including emotional, physical, or sexual abuse; witnessing maternal domestic violence; or living with a household member who has a substance use disorder, is mentally ill or suicidal, or is currently or was ever incarcerated during the first 18 years of a child’s life. According to most recent estimates, nearly half of Indiana’s youth have experienced at least one ACE in their life. ACEs are linked to many risk behaviors, including substance use, which can adversely affect health outcomes.