51
|
Franz B, Cronin CE, Wainwright A, Lai AY, Pagán JA. Community Health Needs Predict Population Health Partnerships Among U.S. Children's Hospitals. Med Care Res Rev 2020; 78:771-779. [PMID: 33100155 DOI: 10.1177/1077558720968999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cross-sector collaboration is critical to improving population health, but data on partnership activities by children's hospitals are limited, and there is a need to identify service delivery gaps for families. The aim of this study is to use public community benefit reports for all children's hospitals in the United States to assess the extent to which children's hospitals partner with external organizations to address five key health needs: health care access, chronic disease, social needs, mental health, and substance abuse. Strategies that involved partnering with community organizations were most common in addressing social needs and substance abuse. When adjusted for institutional and community characteristics hospitals in a multilevel regression model, hospitals had higher odds of partnering to address chronic illness and social needs. To encourage hospital engagement with complex social and behavioral health needs and promote health equity, support should be provided to help hospitals establish local population health networks.
Collapse
|
52
|
Zhang D, Son H, Shen Y, Chen Z, Rajbhandari-Thapa J, Li Y, Eom H, Bu D, Mu L, Li G, Pagán JA. Assessment of Changes in Rural and Urban Primary Care Workforce in the United States From 2009 to 2017. JAMA Netw Open 2020; 3:e2022914. [PMID: 33112401 PMCID: PMC7593812 DOI: 10.1001/jamanetworkopen.2020.22914] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Access to primary care clinicians, including primary care physicians and nonphysician clinicians (nurse practitioners and physician assistants) is necessary to improving population health. However, rural-urban trends in primary care access in the US are not well studied. OBJECTIVE To assess the rural-urban trends in the primary care workforce from 2009 to 2017 across all counties in the US. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study of US counties, county rural-urban status was defined according to the national rural-urban classification scheme for counties used by the National Center for Health Statistics at the Centers for Disease Control and Prevention. Trends in the county-level distribution of primary care clinicians from 2009 to 2017 were examined. Data were analyzed from November 12, 2019, to February 10, 2020. MAIN OUTCOMES AND MEASURES Density of primary care clinicians measured as the number of primary care physicians, nurse practitioners, and physician assistants per 3500 population in each county. The average annual percentage change (APC) of the means of the density of primary care clinicians over time was calculated, and generalized estimating equations were used to adjust for county-level sociodemographic variables obtained from the American Community Survey. RESULTS The study included data from 3143 US counties (1167 [37%] urban and 1976 [63%] rural). The number of primary care clinicians per 3500 people increased significantly in rural counties (2009 median density: 2.04; interquartile range [IQR], 1.43-2.76; and 2017 median density: 2.29; IQR, 1.57-3.23; P < .001) and urban counties (2009 median density: 2.26; IQR. 1.52-3.23; and 2017 median density: 2.66; IQR, 1.72-4.02; P < .001). The APC of the mean density of primary care physicians in rural counties was 1.70% (95% CI, 0.84%-2.57%), nurse practitioners was 8.37% (95% CI, 7.11%-9.63%), and physician assistants was 5.14% (95% CI, 3.91%-6.37%); the APC of the mean density of primary care physicians in urban counties was 2.40% (95% CI, 1.19%-3.61%), nurse practitioners was 8.64% (95% CI, 7.72%-9.55%), and physician assistants was 6.42% (95% CI, 5.34%-7.50%). Results from the generalized estimating equations model showed that the density of primary care clinicians in urban counties increased faster than in rural counties (β = 0.04; 95% CI, 0.03 to 0.05; P < .001). CONCLUSIONS AND RELEVANCE Although the density of primary care clinicians increased in both rural and urban counties during the 2009-2017 period, the increase was more pronounced in urban than in rural counties. Closing rural-urban gaps in access to primary care clinicians may require increasingly intensive efforts targeting rural areas.
Collapse
|
53
|
Pagán JA, Brown HS, Rowe J, Schneider JE, Veenstra DL, Gupta A, Berger SM, Chung WK, Appelbaum PS. Genetic Variant Reinterpretation: Economic and Population Health Management Challenges. Popul Health Manag 2020; 24:310-313. [PMID: 32905743 DOI: 10.1089/pop.2020.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
54
|
Howell EA, Balbierz A, Beane S, Kumar R, Wang T, Fei K, Ahmed Z, Pagán JA. Timely Postpartum Visits for Low-Income Women: A Health System and Medicaid Payer Partnership. Am J Public Health 2020; 110:S215-S218. [PMID: 32663077 DOI: 10.2105/ajph.2020.305689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A health care system and a Medicaid payer partnered to develop an educational intervention and payment redesign program to improve timely postpartum visits for low-income, high-risk mothers in New York City between April 2015 and October 2016. The timely postpartum visit rate was higher for 363 mothers continuously enrolled in the program than for a control group matched by propensity score (67% [243/363] and 56% [407/726], respectively; P < .001). An innovative partnership between a health care system and Medicaid payer improved access to health care services and community resources for high-risk mothers.
Collapse
|
55
|
Jiang N, Yi SS, Russo R, Bu DD, Zhang D, Ferket B, Zhang FF, Pagán JA, Wang YC, Li Y. Trends and sociodemographic disparities in sugary drink consumption among adults in New York City, 2009-2017. Prev Med Rep 2020; 19:101162. [PMID: 32714777 PMCID: PMC7369330 DOI: 10.1016/j.pmedr.2020.101162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/18/2020] [Accepted: 07/05/2020] [Indexed: 12/02/2022] Open
Abstract
Despite efforts to decrease sugary drink consumption, sugary drinks remain the largest single source of added sugars in diets in the United States. This study aimed to examine trends in sugary drink consumption among adults in New York City (NYC) over the past decade by key sociodemographic factors. We used data from the 2009-2017 NYC Community Health Survey to examine trends in sugary drink consumption overall, and across different age, gender, and racial/ethnic subgroups. We conducted a test of trend to examine the significance of change in mean sugary drink consumption over time. We also conducted multiple zero-inflated negative binomial regression to identify the association between different sociodemographic and neighborhood factors and sugary drink consumption. Sugary drink consumption decreased from 2009 to 2014 from 0.97 to 0.69 servings per day (p < 0.001), but then plateaued from 2014 to 2017 (p = 0.01). Although decreases were observed across all age, gender and racial/ethnic subgroups, the largest decreases over this time period were observed among 18-24 year old (1.75 to 1.22 servings per day, p < 0.001); men (1.12 to 0.86 servings per day, p < 0.001); Blacks (1.45 to 1.14 servings per day, p < 0.001); and Hispanics (1.26 to 0.86 servings per day, p < 0.001). Despite these decreases, actual mean consumption remains highest in these same sociodemographic subgroups. Although overall sugary drink consumption has been declining, the decline has slowed in more recent years. Further, certain age, gender and racial/ethnic groups still consume disproportionately more sugary drinks than others. More research is needed to understand and address the root causes of disparities in sugary drink consumption.
Collapse
|
56
|
Li Y, Jasani F, Su D, Zhang D, Shi L, Yi SS, Pagán JA. Decoding Nonadherence to Hypertensive Medication in New York City: A Population Segmentation Approach. J Prim Care Community Health 2020; 10:2150132719829311. [PMID: 30767604 PMCID: PMC6378427 DOI: 10.1177/2150132719829311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Nearly one-third of adults in New York City (NYC) have high blood pressure and many social, economic, and behavioral factors may influence nonadherence to antihypertensive medication. The objective of this study is to identify profiles of adults who are not taking antihypertensive medications despite being advised to do so. Methods: We used a machine learning–based population segmentation approach to identify population profiles related to nonadherence to antihypertensive medication. We used data from the 2016 NYC Community Health Survey to identify and segment adults into subgroups according to their level of nonadherence to antihypertensive medications. Results: We found that more than 10% of adults in NYC were not taking antihypertensive medications despite being advised to do so by their health care providers. We identified age, neighborhood poverty, diabetes, household income, health insurance coverage, and race/ethnicity as important characteristics that can be used to predict nonadherence behaviors as well as used to segment adults with hypertension into 10 subgroups. Conclusions: Identifying segments of adults who do not adhere to hypertensive medications has practical implications as this knowledge can be used to develop targeted interventions to address this population health management challenge and reduce health disparities.
Collapse
|
57
|
Prado AM, Pearson AA, Bertelsen NS, Pagán JA. Connecting healthcare professionals in Central America through management and leadership development: a social network analysis. Global Health 2020; 16:34. [PMID: 32295622 PMCID: PMC7161258 DOI: 10.1186/s12992-020-00557-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/13/2020] [Indexed: 11/20/2022] Open
Abstract
Background Leadership and management training has become increasingly important in the education of health care professionals. Previous research has shown the benefits that a network provides to its members, such as access to resources and information, but ideas for creating these networks vary. This study used social network analysis to explore the interactions among Central American Healthcare Initiative (CAHI) Fellowship alumni and learn more about information sharing, mentoring, and project development activities among alumni. The CAHI Fellowship provides leadership and management training for multidisciplinary healthcare professionals to reduce health inequities in the region. Access to a network was previously reported as one of the top benefits of the program. Results Information shared from the work of 100 CAHI fellows from six countries, especially within the same country, was analyzed. Mentoring relationships clustered around professions and project types, and networks of joint projects clustered by country. Mentorship, which CAHI management promoted, and joint project networks, in which members voluntarily engaged, had similar inclusiveness ratios. Conclusion Social networks are strategic tools for health care leadership development programs to increase their impact by promoting interactions among participants. These programs can amplify intergenerational and intercountry ties by organizing events, provide opportunities for alumni to meet, assign mentors, and support collaborative action groups. Collaborative networks have great value to potentiate health professionals’ leadership and management capabilities in a resource-constrained setting, such as the Global South.
Collapse
|
58
|
Franz B, Cronin CE, Skinner D, Pagán JA. Do State Opioid Policies Influence Nonprofit Hospitals' Decisions to Address Substance Abuse in Their Communities? Med Care Res Rev 2019; 78:371-380. [PMID: 31583961 DOI: 10.1177/1077558719880090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The U.S. epidemic of opioid abuse calls for broad collaboration between a wide range of health care institutions and the various levels of government. Through the community benefit programs they provide, nonprofit hospitals are well positioned to be key partners in local efforts. Although substance abuse appears on approximately 90% of the most recent community health needs assessments completed by hospitals, many hospitals are not addressing substance abuse in their programmatic efforts. Given wide state variation in policies to combat opioid abuse, we assess whether state leadership to address the opioid crisis influences hospital decisions to invest in substance abuse programs. Our findings suggest that several key state policies are related to hospital investments in substance abuse initiatives. To capitalize on the community benefit responsibilities of local hospitals, policies that provide specific direction for and engagement with local hospitals may increase cooperation and investments to address substance abuse.
Collapse
|
59
|
Hasselberg MJ, Fisher E, Conwell Y, Jacobowitz D, Pagán JA. Implementing Project Extension for Community Healthcare Outcomes for Geriatric Mental Healthcare in Long-Term Care Facilities. J Am Med Dir Assoc 2019; 20:1651-1653. [PMID: 31466936 DOI: 10.1016/j.jamda.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
|
60
|
Li Y, Carlson E, Hernández DA, Green B, Calle T, Kumaresan T, Madondo K, Martinez M, Villarreal R, Meraz L, Pagán JA. Patient Perception and Cost-Effectiveness of a Patient Navigation Program to Improve Breast Cancer Screening for Hispanic Women. Health Equity 2019; 3:280-286. [PMID: 31236527 PMCID: PMC6588102 DOI: 10.1089/heq.2018.0089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: Hispanic women are less likely to be screened for breast cancer than non-Hispanic women, which contributes to the disproportionate prevalence of advanced-stage breast cancer in this population group. Patient navigation may be a promising approach to help women overcome the complexity of accessing multiple health care services related to breast cancer screening and treatment. The goal of this study is to assess patient perception and cost-effectiveness of a multilevel, community-based patient navigation program to improve breast cancer screening among Hispanic women in South Texas. Methods: We used mixed methods-including focus groups of program participants and a microsimulation model of breast cancer-to evaluate the effectiveness and cost-effectiveness of the program on the target population. Program data from 2013 to 2016 were collected and used to conduct the analyses. Results: Focus groups showed that the patient navigation program improved patient knowledge, attitudes, and behaviors regarding breast health and increased the mammography screening rate from 60% to 80%. Cost-effectiveness analysis showed that the program could increase life expectancy by 0.71 years and yield an incremental cost-effectiveness ratio of $3120 per quality-adjusted life year compared to no intervention. Conclusion: The 3-year multilevel, community-based patient navigation program effectively increased mammography screening uptake and adherence and improved knowledge and behaviors on breast health among program participants. Future research is needed to translate and disseminate the program to other socioeconomic and demographic groups to test its robustness and design.
Collapse
|
61
|
Franz B, Cronin CE, Wainwright A, Pagán JA. Measuring Efforts of Nonprofit Hospitals to Address Opioid Abuse After the Affordable Care Act. J Prim Care Community Health 2019; 10:2150132719863611. [PMID: 31387443 PMCID: PMC6686324 DOI: 10.1177/2150132719863611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To assess the strategies that nonprofit hospitals are adopting to address opioid abuse after requirements for community engagement expanded in the Affordable Care Act. Methods: We constructed a dataset of implementation activities for a 20% random sample of nonprofit hospitals in the United States. Using logistic regression, we assessed the extent to which strategies adopted are new, existing, or primarily partnerships. Using negative binomial regression, we assessed the total number of strategies adopted. We controlled for hospital and community characteristics as well as state policies related to opioid abuse. Results: Most strategies adopted by hospitals were new and clinical in nature and the most common number of strategies adopted was one. Hospitals in the Northeast were more likely to adopt a higher number of strategies and to partner with community-based organizations. Hospitals that partner with community-based organizations were more likely to adopt strategies that engage in harm reduction, targeted risk education, or focus on addressing social determinants of health. Conclusions: Community, institutional, and state policy characteristics predict hospital involvement in addressing opioid abuse. These findings underscore several opportunities to support hospital-led interventions to address opioid abuse.
Collapse
|
62
|
Su D, Michaud TL, Estabrooks P, Schwab RJ, Eiland LA, Hansen G, DeVany M, Zhang D, Li Y, Pagán JA, Siahpush M. Diabetes Management Through Remote Patient Monitoring: The Importance of Patient Activation and Engagement with the Technology. Telemed J E Health 2018; 25:952-959. [PMID: 30372366 DOI: 10.1089/tmj.2018.0205] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The documented efficacy and promise of telemedicine in diabetes management does not necessarily mean that it can be easily translated into clinical practice. An important barrier concerns patient activation and engagement with telemedicine technology. Objective: To assess the importance of patient activation and engagement with remote patient monitoring technology in diabetes management among patients with type 2 diabetes. Methods: Ordinary least squares and logistic regression analyses were used to examine how patient activation and engagement with remote patient monitoring technology were related to changes in hemoglobin A1c (HbA1c) for 1,354 patients with type 2 diabetes monitored remotely for 3 months between 2015 and 2017. Results: Patients with more frequent and regular participation in remote monitoring had lower HbA1c levels at the end of the program. Compared to patients who uploaded their biometric data every 2 days or less frequently, patients who maintained an average frequency of one upload per day were less likely to have a postmonitoring HbA1c > 9% after adjusting for selected covariates on baseline demographics and health conditions. Conclusions: Higher levels of patient activation and engagement with remote patient monitoring technology were associated with better glycemic control outcomes. Developing targeted interventions for different groups of patients to promote their activation and engagement levels would be important to improve the effectiveness of remote patient monitoring in diabetes management.
Collapse
|
63
|
Michaud TL, Siahpush M, Schwab RJ, Eiland LA, DeVany M, Hansen G, Slachetka TS, Boilesen E, Tak HJ, Wilson FA, Wang H, Pagán JA, Su D. Remote Patient Monitoring and Clinical Outcomes for Postdischarge Patients with Type 2 Diabetes. Popul Health Manag 2018; 21:387-394. [PMID: 29583057 DOI: 10.1089/pop.2017.0175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The objective of this study was to evaluate changes in clinical outcomes for patients with type 2 diabetes (T2D) after a 3-month remote patient monitoring (RPM) program, and examine the relationship between hemoglobin A1c (HbA1c) outcomes and participant characteristics. The study sample included 955 patients with T2D who were admitted to an urban Midwestern medical center for any reason from 2014 to 2017, and used RPM for 3 months after discharge. Clinical outcomes included HbA1c, weight, body mass index (BMI), and patient activation scores. Logistic regression was used to estimate the likelihood of having a postintervention HbA1c <9% by patient characteristics, among those who had baseline HbA1c >9%. Most patients experienced decreases in HbA1c (67%) and BMI (58%), and increases in patient activation scores (67%) (P < 0.001 in all 3 cases) at the end of RPM. Logistic regression analyses revealed that among patients who had HbA1c >9% at baseline, men (odds ratio [OR] = 3.72; 95% confidence interval [CI], 1.43-9.64), those who had increased patient activation scores after intervention (OR = 1.05; 95% CI, 1.01-1.09), those who had higher baseline patient activation scores, and those who had a greater number of biometric data uploads during the intervention (OR = 1.02; 95% CI, 1.00-1.04) were more likely to have reduced their HbA1c to <9% at the end of RPM. RPM for postdischarge patients with T2D might be a promising approach for HbA1c control with increased patient engagement. Future studies with study designs that include a control group should provide more robust evidence.
Collapse
|
64
|
Realmuto L, Kamler A, Weiss L, Gary-Webb TL, Hodge ME, Pagán JA, Walker EA. Power Up for Health-Participants' Perspectives on an Adaptation of the National Diabetes Prevention Program to Engage Men. Am J Mens Health 2018. [PMID: 29540130 PMCID: PMC6131458 DOI: 10.1177/1557988318758786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The National Diabetes Prevention Program (NDPP) has been effectively
translated to various community and clinical settings; however,
regardless of setting, enrollment among men and lower-income
populations is low. This study presents participant perspectives on
Power Up for Health, a novel NDPP pilot
adaption for men residing in low-income communities in New York City.
We conducted nine interviews and one focus group with seven
participants after the program ended. Interview and focus group
participants had positive perceptions of the program and described the
all-male aspect of the program and its reliance on male coaches as
major strengths. Men felt the all-male adaptation allowed for more
open, in-depth conversations on eating habits, weight loss, body
image, and masculinity. Participants also reported increased knowledge
and changes to their dietary and physical activity habits.
Recommendations for improving the program included making the sessions
more interactive by, for example, adding exercise or healthy cooking
demonstrations. Overall, findings from the pilot suggest this NDPP
adaptation was acceptable to men and facilitated behavior change and
unique discussions that would likely not have occurred in a
mixed-gender NDPP implementation.
Collapse
|
65
|
Li Y, Zhang D, Thapa JR, Madondo K, Yi S, Fisher E, Griffin K, Liu B, Wang Y, Pagán JA. Assessing the role of access and price on the consumption of fruits and vegetables across New York City using agent-based modeling. Prev Med 2018; 106:73-78. [PMID: 28987339 DOI: 10.1016/j.ypmed.2017.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 01/13/2023]
Abstract
Most residents in New York City (NYC) do not consume sufficient fruits and vegetables every day. Difficulties with access and high prices of fruits and vegetables in some neighborhoods contribute to different consumption patterns across NYC neighborhoods. We developed an agent-based model (ABM) to predict dietary behaviors of individuals at the borough and neighborhood levels. Model parameters were estimated from the 2014 NYC Community Health Survey, United States Census data, and the literature. We simulated six hypothetical interventions designed to improve access and reduce the price of fruits and vegetables. We found that all interventions would lead to increases in fruit and vegetable consumption but the results vary substantially across boroughs and neighborhoods. For example, a 10% increase in the number of fruit/vegetable vendors combined with a 10% decrease in the prices of fruits and vegetables would lead to a median increase of 2.28% (range: 0.65%-4.92%) in the consumption of fruits and vegetables, depending on neighborhood. We also found that the impact of increasing the number of vendors on fruit/vegetable consumption is more pronounced in unhealthier local food environments while the impact of reducing prices on fruits/vegetable consumption is more pronounced in neighborhoods with low levels of education. An agent-based model of dietary behaviors that takes into account neighborhood context has the potential to inform how fruit/vegetable access and pricing strategies may specifically work in tandem to increase the consumption of fruits and vegetables at the local level.
Collapse
|
66
|
Zhang D, Li Y, Wang G, Moran AE, Pagán JA. Nutrition Label Use and Sodium Intake in the U.S. Am J Prev Med 2017; 53:S220-S227. [PMID: 29153124 PMCID: PMC5808587 DOI: 10.1016/j.amepre.2017.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION High sodium intake is a major risk factor for hypertension, but evidence is limited on which interventions are effective in reducing sodium consumption. This study examined the associations between frequent use of nutrition labels and daily sodium intake and the consumption of high-sodium foods in the U.S. METHODS Using the 2007-2008 and 2009-2010 Flexible Consumer Behavior Survey, this study compared sodium intake measured from the 24-hour dietary recalls, availability of salty snacks at home, and frequencies of eating frozen meals/pizzas between frequent (i.e., always or most of the time) and infrequent nutrition label users. Also, the study examined the association between nutrition label use and sodium-related dietary behaviors across different demographic and socioeconomic groups. Data were analyzed in 2016. RESULTS Frequent users of nutrition labels consumed 92.79 mg less sodium per day (95% CI= -160.21, -25.37), were less likely to always or most of the time have salty snacks available at home (OR=0.86, 95% CI=0.76, 0.97), but were just as likely to eat frozen meals or pizzas (incidence rate ratio=0.96, 95% CI=0.84, 1.08) compared with infrequent label users. The associations between nutrition label use and sodium intake differed considerably across age, gender, and socioeconomic groups. CONCLUSIONS Frequent use of nutrition labels appears to be associated with lower consumption of sodium and high-sodium foods in the U.S. Given this small reduction, interventions such as enhancing nutrition label use could be less effective if implemented without other strategies.
Collapse
|
67
|
Li Y, Padrón NA, Mangla AT, Russo PG, Schlenker T, Pagán JA. Using Systems Science to Inform Population Health Strategies in Local Health Departments: A Case Study in San Antonio, Texas. Public Health Rep 2017; 132:549-555. [PMID: 28813636 DOI: 10.1177/0033354917722149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Because of state and federal health care reform, local health departments play an increasingly prominent role leading and coordinating disease prevention programs in the United States. This case study shows how a local health department working in chronic disease prevention and management can use systems science and evidence-based decision making to inform program selection, implementation, and assessment; enhance engagement with local health systems and organizations; and possibly optimize health care delivery and population health. METHODS The authors built a systems-science agent-based simulation model of diabetes progression for the San Antonio Metropolitan Health District, a local health department, to simulate health and cost outcomes for the population of San Antonio for a 20-year period (2015-2034) using 2 scenarios: 1 in which hemoglobin A1c (HbA1c) values for a population were similar to the current distribution of values in San Antonio, and the other with a hypothetical 1-percentage-point reduction in HbA1c values. RESULTS They projected that a 1-percentage-point reduction in HbA1c would lead to a decrease in the 20-year prevalence of end-stage renal disease from 1.7% to 0.9%, lower extremity amputation from 4.6% to 2.9%, blindness from 15.1% to 10.7%, myocardial infarction from 23.8% to 17.9%, and stroke from 9.8% to 7.2%. They estimated annual direct medical cost savings (in 2015 US dollars) from reducing HbA1c by 1 percentage point ranging from $6842 (myocardial infarction) to $39 800 (end-stage renal disease) for each averted case of diabetes complications. CONCLUSIONS Local health departments could benefit from the use of systems science and evidence-based decision making to estimate public health program effectiveness and costs, calculate return on investment, and develop a business case for adopting programs.
Collapse
|
68
|
Puig A, Pagán JA, Soldo BJ. Envejecimiento, salud y economía. La Encuesta Nacional sobre Salud y Envejecimiento en México. ACTA ACUST UNITED AC 2017. [DOI: 10.20430/ete.v73i290.549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
México vive una transición demográfica en la cual el porcentaje de la población mayor de 50 años crece aceleradamente como resultado de un aumento considerable en la esperanza de vida. Dicha población tiene necesidades particulares que deben de ser tomadas en cuenta en la formulación de políticas, sobre todo en materia de acceso a servicios de salud y seguridad social. En este artículo presentamos una descripción general de la Encuesta Nacional de Salud y Envejecimiento (Enasem), un estudio de panel que comenzó en 2001 y que ofrece una oportunidad única para abordar temas demográficos y económicos complejos por medio de la exploración de las características personales, transferencias socioeconómicas e indicadores de salud para una muestra de 15 186 adultos de edad media y avanzada. También presentamos los resultados más relevantes de diferentes estudios que han utilizado la Enasem hasta la fecha. Nuestra revisión indica que México enfrenta desafíos considerables para satisfacer la demanda de servicios médicos para una población que es amenazada por una creciente presencia de enfermedades crónicas, sobre todo para la población de edad avanzada que no cuenta con cobertura de seguro médico.
Collapse
|
69
|
Li Y, Carlson E, Villarreal R, Meraz L, Pagán JA. Cost-effectiveness of a patient navigation program to improve cervical cancer screening. THE AMERICAN JOURNAL OF MANAGED CARE 2017; 23:429-434. [PMID: 28817782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of a community-based patient navigation program to improve cervical cancer screening among Hispanic women 18 or older in San Antonio, Texas. STUDY DESIGN We used a microsimulation model of cervical cancer to project the long-term cost-effectiveness of a community-based patient navigation program compared with current practice. METHODS We used program data from 2012 to 2015 and published data from the existing literature as model input. Taking a societal perspective, we estimated the lifetime costs, life expectancy, and quality-adjusted life-years and conducted 2-way sensitivity analyses to account for parameter uncertainty. RESULTS The patient navigation program resulted in a per-capita gain of 0.2 years of life expectancy. The program was highly cost-effective relative to no intervention (incremental cost-effectiveness ratio of $748). The program costs would have to increase up to 10 times from $311 for it not to be cost-effective. CONCLUSIONS The 3-year community-based patient navigation program effectively increased cervical cancer screening uptake and adherence and improved the cost-effectiveness of the screening program for Hispanic women 18 years or older in San Antonio, Texas. Future research is needed to translate and disseminate the patient navigation program to other socioeconomic and demographic groups to test its robustness and design.
Collapse
|
70
|
Berenson J, Li Y, Lynch J, Pagán JA. Identifying Policy Levers And Opportunities For Action Across States To Achieve Health Equity. Health Aff (Millwood) 2017; 36:1048-1056. [DOI: 10.1377/hlthaff.2017.0004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
71
|
Li Y, Berenson J, Moran AE, Pagán JA. Who does not reduce their sodium intake despite being advised to do so? A population segmentation analysis. Prev Med 2017; 99:77-79. [PMID: 28189807 DOI: 10.1016/j.ypmed.2017.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/22/2017] [Accepted: 01/28/2017] [Indexed: 10/20/2022]
Abstract
Excessive sodium intake is linked to an increased risk for hypertension and cardiovascular disease. Although health care providers and other health professionals frequently provide counseling on healthful levels of sodium consumption, many people who consume sodium in excess of recommend levels still do not watch or reduce their sodium intake. In this study, we used a population segmentation approach to identify profiles of adults who are not watching or reducing their sodium intake despite been advised to do so. We analyzed sodium intake data in 125,764 respondents sampled in 15 states, the District of Columbia and Puerto Rico through the Behavioral Risk Factor Surveillance System to identify and segment adults into subgroups according to differences in sodium intake behaviors. We found that about 16% of adults did not watch or reduce their sodium intake despite been told to do so by a health professional. This proportion varied substantially across the 25 different population subgroups identified. For example, about 44% of adults 18 to 44years of age who live in West Virginia were not reducing their sodium intake whereas only about 7.2% of black adults 65years of age and older with diabetes were not reducing their sodium intake. Population segmentation identifies subpopulations most likely to benefit from targeted and intensive public health and clinical interventions. In the case of sodium consumption, population segmentation can guide public health practitioners and policymakers to design programs and interventions that change sodium intake in people who are resistant to behavior change.
Collapse
|
72
|
Fisher E, Hasselberg M, Conwell Y, Weiss L, Padrón NA, Tiernan E, Karuza J, Donath J, Pagán JA. Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care. Popul Health Manag 2017; 20:342-347. [PMID: 28106511 DOI: 10.1089/pop.2016.0087] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO® (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.
Collapse
|
73
|
Li Y, Berenson J, Gutiérrez A, Pagán JA. Leveraging the Food Environment in Obesity Prevention: the Promise of Systems Science and Agent-Based Modeling. Curr Nutr Rep 2016. [DOI: 10.1007/s13668-016-0179-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
74
|
Su D, Pratt W, Stimpson JP, Wong R, Pagán JA. Uninsurance, underinsurance, and health care utilization in Mexico by US border residents. J Immigr Minor Health 2016; 16:607-12. [PMID: 23624848 DOI: 10.1007/s10903-013-9828-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Using data from the 2008 Cross-Border Utilization of Health Care Survey, we examined the relationship between United States (US) health insurance coverage plans and the use of health care services in Mexico by US residents of the US-Mexico border region. We found immigrants were far more likely to be uninsured than their native-born counterparts (63 vs. 27.8 %). Adults without health insurance coverage were more likely to purchase medications or visit physicians in Mexico compared to insured adults. However, adults with Medicaid coverage were more likely to visit dentists in Mexico compared to uninsured adults. Improving health care access for US residents in the southwestern border region of the country will require initiatives that target not only providing coverage to the large uninsured population but also improving access to health care services for the large underinsured population.
Collapse
|
75
|
Philpot LM, Stockbridge EL, Padrón NA, Pagán JA. Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads. Popul Health Manag 2016; 19:206-11. [DOI: 10.1089/pop.2015.0077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|