Justin Blackburn
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The Economic Burden of Untreated Mental Illness in Indiana: Translating Evidence into Policy
Justin Blackburn, Ph.D., is an Associate Professor of Health Policy and Management at the Richard M. Fairbanks School of Public Health in Indianapolis. He is also the Health Policy Ph.D. Program Director and the Scientific Director Wellbeing Informed by Science and Evidence in Indiana (WISE Indiana), a research partnership between the Indiana Clinical and Translational Science Institute and the Indiana Family and Social Services Administration (FSSA). He earned an MPH in epidemiology from the University of Kentucky College of Public Health and a Ph.D. in epidemiology from the University of Alabama at Birmingham School of Public Health. He has published over 90 peer-reviewed articles, served on 27 dissertation research committees, and generated over $2 million in research funding.
Dr. Blackburn's research primarily involves leveraging large administrative data sets to evaluate public health policy and outcomes at the state, local, and national level. He is a frequent collaborator with state and local public health agencies, and has applied methodologically innovative approaches to evaluate important public health topics including dental health services and outcomes, long-term care policy and outcomes, Medicaid and CHIP coverage, and measuring health care quality. In a new study, Dr. Blackburn and his co-researchers, revealed the economic burden of untreated mental illness in Indiana, which results in $4.2 billion spent annually. Dr. Blackburn's use of data to inform health policies for the benefit of community members is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.
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Item The Economic Burden of Untreated Mental Illness in Indiana: Translating Evidence into Policy(Center for Translating Research Into Practice, IU Indianapolis, 2024-03-22) Blackburn, JustinWellbeing Informed by Science and Evidence in Indiana (WISE Indiana) is a partnership with the Indiana Clinical and Translational Sciences Institute’s Monon Collaborative and the Indiana Family and Social Services Administration (FSSA) to engage Indiana’s nationally-recognized academic experts to evaluate and inform Indiana practices, programs and policies. The WISE Indiana team determined that the value of untreated mental illness in Indiana is over $4 billion.Item Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality(Wolters Kluwer, 2018) Albright, Karen C.; Huang, Lei; Blackburn, Justin; Howard, George; Mullen, Michael; Bittner, Vera; Muntner, Paul; Howard, Virginia; Health Policy and Management, School of Public HealthObjective: To determine black-white differences in 1-year recurrent stroke and 30-day case fatality after a recurrent stroke in older US adults. Methods: We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries with fee-for-service health insurance coverage who were hospitalized for ischemic stroke between 1999 and 2013. Hazard ratios for recurrent ischemic stroke and risk ratios for 30-day case fatality comparing blacks to whites were calculated with adjustment for demographics, risk factors, and competing risk of death when appropriate. Results: Among 128,789 Medicare beneficiaries having an ischemic stroke (mean age 80 years [SD 8 years], 60.4% male), 11.1% were black. The incidence rate of recurrent ischemic stroke per 1,000 person-years for whites and blacks was 108 (95% confidence interval [CI], 106-111) and 154 (95% CI 147-162) , respectively. The multivariable-adjusted hazard ratio for recurrent stroke among blacks compared with whites was 1.36 (95% CI 1.29-1.44). The case fatality after recurrent stroke for blacks and whites was 21% (95% CI 21%-22%) and 16% (95% CI 15%-18%), respectively. The multivariable-adjusted relative risk for mortality within 30 days of a recurrent stroke among blacks compared with whites was 0.82 (95% CI 0.73-0.93). Conclusion: The risk of stroke recurrence among older Americans hospitalized for ischemic stroke is higher for blacks compared to whites, while 30-day case fatality after recurrent stroke remains lower for blacks.Item Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study(Sage, 2023-03-22) Mills, Carol A.; Tran, Yvette; Yeager, Valerie A.; Unroe, Kathleen T.; Holmes, Ann; Blackburn, Justin; Health Policy and Management, School of Public HealthAvoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive and require dedicated clinical staff, although nursing homes are chronically understaffed. The OPTIMISTIC project was one of seven programs selected by CMS as “enhanced care & coordination providers” and was implemented from 2012 to 2020. This qualitative study explores the perceptions of the nurses that piloted a virtual care support project developed to expand the program’s reach through telehealth, and specifically considered how nurses perceived the effectiveness of this program. Relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of the implementation of virtual care support programs within nursing homes.Item Quantifying Electronic Health Record Data Quality in Telehealth and Office-Based Diabetes Care(Thieme, 2022) Wiley, Kevin K.; Mendonca, Eneida; Blackburn, Justin; Menachemi, Nir; De Groot, Mary; Vest, Joshua R.; Health Policy and Management, School of Public HealthObjective: Data derived from the electronic health record (EHR) are commonly reused for quality improvement, clinical decision-making, and empirical research despite having data quality challenges. Research highlighting EHR data quality concerns has largely been examined and identified during traditional in-person visits. To understand variations in data quality among patients managing type 2 diabetes mellitus (T2DM) with and without a history of telehealth visits, we examined three EHR data quality dimensions: timeliness, completeness, and information density. Methods: We used EHR data (2016-2021) from a local enterprise data warehouse to quantify timeliness, completeness, and information density for diagnostic and laboratory test data. Means and chi-squared significance tests were computed to compare data quality dimensions between patients with and without a history of telehealth use. Results: Mean timeliness or T2DM measurement age for the study sample was 77.8 days (95% confidence interval [CI], 39.6-116.4). Mean completeness for the sample was 0.891 (95% CI, 0.868-0.914). The mean information density score was 0.787 (95% CI, 0.747-0.827). EHR data for patients managing T2DM with a history of telehealth use were timelier (73.3 vs. 79.8 days), and measurements were more uniform across visits (0.795 vs. 0.784) based on information density scores, compared with patients with no history of telehealth use. Conclusion: Overall, EHR data for patients managing T2DM with a history of telehealth visits were generally timelier and measurements were more uniform across visits than for patients with no history of telehealth visits. Chronic disease care relies on comprehensive patient data collected via hybrid care delivery models and includes important domains for continued data quality assessments prior to secondary reuse purposes.Item Decreasing deceased donor transplant rates among children (≤6 years) under the new kidney allocation system(Elsevier, 2018) Shelton, Brittany A.; Sawinski, Deirdre; Ray, Christopher; Reed, Rhiannon D.; MacLennan, Paul A.; Blackburn, Justin; Young, Carlton J.; Gray, Stephen; Yanik, Megan; Massie, Allan; Segev, Dorry L.; Locke, Jayme E.; Health Policy and Management, School of Public HealthThe Kidney Allocation System (KAS) was implemented in December 2014 with unknown impact on the pediatric waitlist. To understand the effect of KAS on pediatric registrants, deceased donor kidney transplant (DDKT) rate was assessed using interrupted time series analysis and time-to-event analysis. Two allocation eras were defined with an intermediary washout period: Era 1 (01/01/2013-09/01/2014), Era 2 (09/01/2014-03/01/2015), and Era 3(03/01/2015-03/01/2017). When using Cox proportional hazards, there was no significant association between allocation era and DDKT likelihood as compared to Era 1 (Era 3: aHR: 1.07, 95% CI: 0.97-1.18, P = .17). However, this was not consistent across all subgroups. Specifically, while highly sensitized pediatric registrants were consistently less likely to be transplanted than their less sensitized counterparts, this disparity was attenuated in Era 3 (Era 1 aHR: 0.04, 95%CI: 0.01-0.14, P < .001; Era 3 aHR: 0.33, 95% CI: 0.21-0.53, P < .001) whereas the youngest registrants aged 0-6 experienced a 21% decrease in DDKT likelihood in Era 3 as compared to Era 1 (aHR: 0.79, 95% CI: 0.64-0.98, P = .03). Thus, while overall DDKT likelihood remained stable with the introduction of KAS, registrants ≤ 6 years of age were disadvantaged, warranting further study to ensure equitable access to transplantation.Item Improving Communication in Nursing Homes Using Plan-Do-Study-Act Cycles of an SBAR Training Program(Sage, 2023) Kay, Samantha; Unroe, Kathleen T.; Lieb, Kristi M.; Kaehr, Ellen W.; Blackburn, Justin; Stump, Timothy E.; Evans, Russell; Klepfer, Sarah; Carnahan, Jennifer L.; Medicine, School of MedicineBackground: Incomplete communication between staff and providers may cause adverse outcomes for nursing home residents. The Situation-Background-Assessment-Recommendation (SBAR) tool is designed to improve communication around changes in condition (CIC). An adapted SBAR was developed for the Centers for Medicare and Medicaid Services demonstration project, OPTIMISTIC, to increase its use during a resident CIC and to improve documentation. Methods: Four Plan-Do-Study-Act (PDSA) cycles to develop and refine successive protocol implementation of the OPTIMISTIC SBAR were deployed in four Indiana nursing homes. Use of SBAR, documentation quality, and participant surveys were assessed pre- and post-intervention implementation. Results: OPTIMISTIC SBAR use and documentation quality improved in three of the four buildings. Participants reported improved collaboration between nurses and providers after SBAR intervention. Conclusion: Successive PDSA cycles implementing changes in an OPTIMISTIC SBAR protocol for resident CIC led to an increase in SBAR use, improved documentation, and better collaboration between nursing staff and providers.Item Mood Disorder Episodes & Diagnosis in Different Settings: What Can We Learn?(Juniper, 2018) Sen, Bisakha; Blackburn, Justin; Morrisey, Michael A.; Kilgore, Meredith; Menachemi, Nir; Caldwell, Cathy; Becker, David; Health Policy and Management, School of Public HealthObjective: Over the past two decades in proportion of costs of mood disorders among children paid for by government insurance programs has increased substantially. The objective of this study is to gain a more in-depth understanding of patterns of mood disorder diagnosis (MDOD) among enrollees in the Alabama Children’s Health Insurance Program, ALL Kids. Method: A retrospective study using claims data from ALL Kids from 2008-2014 was conducted. The proportion of ‘initial’ MDOD incidents occurring in different care settings (inpatient/ED, physician’s office, outpatient), and the predictors of these incidents, were investigated. Patterns of repeated MDOD inpatient/ED incidents were examined. Results: Multinomial logistic regression results show black enrollees have higher relative risk ratios (RRR) of having a MDOD in inpatient/ED setting (RRR: 1.52, p< 0.01), as do Hispanics (RRR: 1.30, p< 0.01). Enrollees who receive the initial diagnosis in an inpatient/ED setting are at high risk of subsequent MDOD incidents in an inpatient setting/ED. There is no significant racial or ethnic difference in the subsequent number of inpatient/ED visits conditional on the location of the initial diagnosis. Conclusions: The pattern of repeated MDOD incidents in inpatient/ED settings may be indicative of acuity of conditions, lack of access to alternate sources of care for mood disorders, or poor adherence to treatment and inadequate home care. Enrollees who do have such an incident may be strong candidates for case management, potentially improving enrollee outcomes as well as reducing program costs by averting avoidable inpatient/ED MDOD incidents.Item Economic Burden Associated With Untreated Mental Illness in Indiana(American Medical Association, 2023) Taylor, Heather L.; Menachemi, Nir; Gilbert, Amy; Chaudhary, Jay; Blackburn, JustinImportance There is a paucity of systematically captured data on the costs incurred by society—individuals, families, and communities—from untreated mental illnesses in the US. However, these data are necessary for decision-making on actions and allocation of societal resources and should be considered by policymakers, clinicians, and employers. Objective To estimate the economic burden associated with untreated mental illness at the societal level. Design, Setting, and Participants This cross-sectional study used multiple data sources to tabulate the annual cost of untreated mental illness among residents (≥5 years old) in Indiana in 2019: the US National Survey on Drug Use and Health, the National Survey of Children’s Health, Indiana government sources, and Indiana Medicaid enrollment and claims data. Data analyses were conducted from January to May 2022. Main Outcomes and Measures Direct nonhealth care costs (eg, criminal justice system, homeless shelters), indirect costs (unemployment, workplace productivity losses due to absenteeism and presenteeism, all-cause mortality, suicide, caregiver direct health care, caregiver productivity losses, and missed primary education), and direct health care costs (disease-related health care expenditures). Results The study population consisted of 6 179 105 individuals (median [SD] age, 38.0 [0.2] years; 3 132 806 [50.7%] were women) of whom an estimated 429 407 (95% CI, 349 526-528 171) had untreated mental illness in 2019. The economic burden of untreated mental illness in Indiana was estimated to be $4.2 billion annually (range of uncertainty [RoU], $2.1 billion-$7.0 billion). The cost of untreated mental illness included $3.3 billion (RoU, $1.7 billion-$5.4 billion) in indirect costs, $708.5 million (RoU, $335 million-$1.2 billion) in direct health care costs, and $185.4 million (RoU, $29.9 million-$471.5 million) in nonhealth care costs. Conclusion and Relevance This cross-sectional study found that untreated mental illness may have significant financial consequences for society. These findings put into perspective the case for action and should be considered by policymakers, clinicians, and employers when allocating societal resources and funding. States can replicate this comprehensive framework as they prioritize key areas for action regarding mental health services and treatments.Item Hospital Partnerships for Population Health: A Systematic Review of the Literature(Wolters Kluwer, 2021) Ellis Hilts, Katy; Yeager, Valerie A.; Gibson, P. Joseph; Halverson, Paul K.; Blackburn, Justin; Menachemi, Nir; Health Policy and Management, School of Public HealthThe U.S. healthcare system continues to experience high costs and suboptimal health outcomes that are largely influenced by social determinants of health. National policies such as the Affordable Care Act and value-based payment reforms incentivize healthcare systems to engage in strategies to improve population health. Healthcare systems are increasingly expanding or developing new partnerships with community-based organizations to support these efforts. We conducted a systematic review of peer-reviewed literature in the United States to identify examples of hospital-community partnerships; the main purposes or goals of partnerships; study designs used to assess partnerships; and potential outcomes (e.g., process- or health-related) associated with partnerships. Using robust keyword searches and a thorough reference review, we identified 37 articles published between January 2008 and December 2019 for inclusion. Most studies employed descriptive study designs (n = 21); health needs assessments were the most common partnership focus (n = 15); and community/social service (n = 21) and public health organizations (n = 15) were the most common partner types. Qualitative findings suggest hospital-community partnerships hold promise for breaking down silos, improving communication across sectors, and ensuring appropriate interventions for specific populations. Few studies in this review reported quantitative findings. In those that did, results were mixed, with the strongest support for improvements in measures of hospitalizations. This review provides an initial synthesis of hospital partnerships to address population health and presents valuable insights to hospital administrators, particularly those leading population health efforts.Item Differential Impact of Hospital and Community Factors on Medicare Readmission Penalties(Wiley, 2018) Aswani, Monica S.; Kilgore, Meredith L.; Becker, David J.; Redden, David T.; Sen, Bisakha; Blackburn, Justin; Health Policy and Management, School of Public HealthObjective: To identify hospital/county characteristics and sources of regional heterogeneity associated with readmission penalties. Data sources/study setting: Acute care hospitals under the Hospital Readmissions Reduction Program from fiscal years 2013 to 2018 were linked to data from the Annual Hospital Association, Centers for Medicare and Medicaid Services, Medicare claims, Hospital Compare, Nursing Home Compare, Area Resource File, Health Inequity Project, and Long-term Care Focus. The final sample contained 3,156 hospitals in 1,504 counties. Data collection/extraction methods: Data sources were combined using Medicare hospital identifiers or Federal Information Processing Standard codes. Study design: A two-level hierarchical model with correlated random effects, also known as the Mundlak correction, was employed with hospitals nested within counties. Principal findings: Over a third of the variation in readmission penalties was attributed to the county level. Patient sociodemographics and the surrounding access to and quality of care were significantly associated with penalties. Hospital measures of Medicare volume, percentage dual-eligible and Black patients, and patient experience were correlated with unobserved area-level factors that also impact penalties. Conclusions: As the readmission risk adjustment does not include any community-level characteristics or geographic controls, the resulting endogeneity bias has the potential to disparately penalize certain hospitals.