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Item The relationship between preventive dental care and overall medical expenditures(MJH Life Sciences, 2024-02-01) Taylor, Heather L.; Holmes, Ann M.; Menachemi, Nir; Schleyer, Titus; Sen, Bisakha; Blackburn, Justin; Health Policy and Management, Richard M. Fairbanks School of Public HealthObjectives: To examine the relationship between preventive dental visits (PDVs) and medical expenditures while mitigating bias from unobserved confounding factors. Study design: Retrospective data analysis of Indiana Medicaid enrollment and claims data (2015-2018) and the Area Health Resources Files. Methods: An instrumental variable (IV) approach was used to estimate the relationship between PDVs and medical and pharmacy expenditures among Medicaid enrollees. The instrument was defined as the number of adult enrollees with at least 1 nonpreventive dental claim per total Medicaid enrollees within a Census tract per year. Results: In naive analyses, enrollees had on average greater medical expenditures if they had a prior-year PDV (β = $397.21; 95% CI, $184.23-$610.18) and a PDV in the same year as expenditures were measured (β = $344.81; 95% CI, $193.06-$496.56). No significant differences in pharmacy expenditures were observed in naive analyses. Using the IV approach, point estimates of overall medical expenditures for the marginal enrollee who had a prior-year PDV (β = $325.17; 95% CI, -$708.03 to $1358.37) or same-year PDV (β = $170.31; 95% CI, -$598.89 to $939.52) were similar to naive results, although not significant. Our IV approach indicated that PDV was not endogenous in some specifications. Conclusions: This is the first study to present estimates with causal inference from a quasi-experimental study of the effect of PDVs on overall medical expenditures. We observed that prior- or same-year PDVs were not related to overall medical or pharmacy expenditures.Item Letter from the Editor(Society of Practitioners of Health Impact Assessment, 2022) Stone, Cynthia; Health Policy and Management, Richard M. Fairbanks School of Public HealthItem Health Impact Assessment: The Impacts of Increasing Tree Canopy Coverage in Marion County, Indiana(Society of Practitioners of Health Impact Assessment, 2022) Kampman, Haleigh; Whitlock, Annika; Hosler, Heidi; Health Policy and Management, Richard M. Fairbanks School of Public HealthBackground: Urban tree canopies help to address issues of climate change related to all dimensions of health. Certain areas of the city of Indianapolis are more prone to the negative effects that lack of tree coverage can cause. This assessment explored the short term and potential long-term impacts of the efforts to increase the tree canopy coverage in vulnerable areas of Indianapolis. This effort was a collaboration of faculty members from the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis Department of Public Works, Keep Indianapolis Beautiful, and the Indianapolis Office of Sustainability. Methods: Our team used the standard seven-step Health Impact Assessment (HIA) process to make the recommendations provided. Using direct observation of the neighborhood, secondary data collection, literature review, and a key stakeholder interview, we examined key dimensions of health including environmental, physical, and personal health outcomes resulting from increased tree canopy coverage within census tract 3505 of Marion County, Indiana. Results: Increasing the percentage of tree canopy coverage in census tract 3505 – Crown Hill has significant positive health impacts with minimal negative outcomes. Such impacts may be, but are not subject to, lower temperatures, reduced cases of respiratory and cardiac infections/illnesses, promoting animal life, increasing neighborhood property values and filtering pollutants that result from human production activity. Conclusions: Further implementation of the Thrive Indianapolis project has broad positive implications for the community members living in this area. While few negative implications were found, we make recommendations to mitigate these effects while attempting to supplement the current project plan with a focus on the effects to human health.Item Ten Years of SOPHIA(Society of Practitioners of Health Impact Assessment, 2021) Powers, Gina; Stone, Cynthia; Health Policy and Management, Richard M. Fairbanks School of Public HealthIn 2021, the Society of Practitioners of Health Impact Assessment (SOPHIA) celebrates its 10-year anniversary. As part of the celebration, we asked founding SOPHIA members and key SOPHIA leaders to reflect on the organization’s formation in 2011, to share their thoughts on SOPHIA’s key challenges and to highlight important accomplishments. Respondents also weighed in on the future of SOPHIA and the value of SOPHIA membership. Research was conducted using written surveys, interviews, and review of written material. Surveys were sent in July of 2021 to eleven active SOPHIA members, many of whom have served as president, vice president, board member or founding member for SOPHIA. Of the eight survey recipients who were interviewed or completed the written survey, nearly all have been conducting Health Impact Assessments (HIAs) for 10 or more years. Survey respondents’ HIA experience included assessments focused on a variety of policies, projects and programs, including housing, land use, economic security, the built environment, transportation, immigration policies, minimum wage policies, criminal justice and more. This article includes information gleaned through written material review; however, it is largely based on the feedback, insights and experiences shared by survey respondents verbally and in writing.Item 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 HealthIntroduction: 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.Item The Relationship Between Dental Provider Density and Receipt of Dental Care Among Medicaid-enrolled Adults(Johns Hopkins University, 2024) Taylor, Heather L.; Menachemi, Nir; Holmes, Ann; Sen, Bisakha; Schleyer, Titus; Blackburn, Justin; Health Policy and Management, Richard M. Fairbanks School of Public HealthObjective: We sought to measure the association of dental provider density and receipt of dental care among Medicaid-enrolled adults. Methods: We used four years of Indiana Medicaid claims and enrollment data (2015 to 2018) and the Area Health Resources File to examine the relationship between any dental visit (ADV) or any preventive dental visit (PDV) and three county-level measures of dental provider density (the total number of Medicaid-participating dentists, a binary indicator of a federally qualified health center (FQHC) with a Medicaid-participating dentist, and the overall county dentist-to-population ratio). Results: The likelihood of ADV or PDV increased with greater density of Medicaid-participating dentists as well as dentists accepting Medicaid working at an FQHC within the county. The overall dentist-to-population ratio was not associated with dental care use among the adult Medicaid population. Conclusion: Dentist participation in Medicaid program may be a modifiable barrier to Medicaid-enrolled adults' receipt of dental care.Item Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health(Wolters Kluwer, 2023) Leider, Jonathon P.; Shah, Gulzar H.; Yeager, Valerie A.; Yin, Jingjing; Madamala, Kusuma; Health Policy and Management, Richard M. Fairbanks School of Public HealthBackground and objectives: Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay. Design: Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models. Results: In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees' intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one's supervisor. Conclusions: Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover. Implications: Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries.Item 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 HealthDecades 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.Item Strengths, weaknesses, opportunities, and threats for the nation’s public health information systems infrastructure: synthesis of discussions from the 2022 ACMI Symposium(Oxford University Press, 2023-05-05) Acharya, Jessica C.; Staes, Catherine; Allen, Katie S.; Hartsell, Joel; Cullen, Theresa A.; Lenert, Leslie; Rucker, Donald W.; Lehmann, Harold P.; Dixon, Brian E.; Health Policy and Management, Richard M. Fairbanks School of Public HealthObjective: The annual American College of Medical Informatics (ACMI) symposium focused discussion on the national public health information systems (PHIS) infrastructure to support public health goals. The objective of this article is to present the strengths, weaknesses, threats, and opportunities (SWOT) identified by public health and informatics leaders in attendance. Materials and methods: The Symposium provided a venue for experts in biomedical informatics and public health to brainstorm, identify, and discuss top PHIS challenges. Two conceptual frameworks, SWOT and the Informatics Stack, guided discussion and were used to organize factors and themes identified through a qualitative approach. Results: A total of 57 unique factors related to the current PHIS were identified, including 9 strengths, 22 weaknesses, 14 opportunities, and 14 threats, which were consolidated into 22 themes according to the Stack. Most themes (68%) clustered at the top of the Stack. Three overarching opportunities were especially prominent: (1) addressing the needs for sustainable funding, (2) leveraging existing infrastructure and processes for information exchange and system development that meets public health goals, and (3) preparing the public health workforce to benefit from available resources. Discussion: The PHIS is unarguably overdue for a strategically designed, technology-enabled, information infrastructure for delivering day-to-day essential public health services and to respond effectively to public health emergencies. Conclusion: Most of the themes identified concerned context, people, and processes rather than technical elements. We recommend that public health leadership consider the possible actions and leverage informatics expertise as we collectively prepare for the future.Item Evolving availability and standardization of patient attributes for matching(Oxford University Press, 2023-10-12) Deng, Yu; Gleason, Lacey P.; Culbertson, Adam; Chen, Xiaotian; Bernstam, Elmer V.; Cullen, Theresa; Gouripeddi, Ramkiran; Harle, Christopher; Hesse, David F.; Kean, Jacob; Lee, John; Magoc, Tanja; Meeker, Daniella; Ong, Toan; Pathak, Jyotishman; Rosenman, Marc; Rusie, Laura K.; Shah, Akash J.; Shi, Lizheng; Thomas, Aaron; Trick, William E.; Grannis, Shaun; Kho, Abel; Health Policy and Management, Richard M. Fairbanks School of Public HealthVariation in availability, format, and standardization of patient attributes across health care organizations impacts patient-matching performance. We report on the changing nature of patient-matching features available from 2010-2020 across diverse care settings. We asked 38 health care provider organizations about their current patient attribute data-collection practices. All sites collected name, date of birth (DOB), address, and phone number. Name, DOB, current address, social security number (SSN), sex, and phone number were most commonly used for cross-provider patient matching. Electronic health record queries for a subset of 20 participating sites revealed that DOB, first name, last name, city, and postal codes were highly available (>90%) across health care organizations and time. SSN declined slightly in the last years of the study period. Birth sex, gender identity, language, country full name, country abbreviation, health insurance number, ethnicity, cell phone number, email address, and weight increased over 50% from 2010 to 2020. Understanding the wide variation in available patient attributes across care settings in the United States can guide selection and standardization efforts for improved patient matching in the United States.