Jeffrey S Harman

University of Florida, Gainesville, Florida, United States

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Publications (76)175.52 Total impact

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    ABSTRACT: Physicians in the U.S. are adopting electronic health records (EHRs) at an unprecedented rate. However, little is known about how EHR use relates to physicians' care decisions. Using nationally representative data, we estimated how using practice-based EHRs relates to opioid prescribing in primary care.
    Journal of Medical Systems 11/2014; 38(11):138. · 1.78 Impact Factor
  • Swathy Sundaram, Jeffrey S Harman, Robert L Cook
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    ABSTRACT: Postpartum depression (PPD) is common and associated with significant health outcomes and other consequences. Identifying persons at risk may improve screening and detection of PPD. This exploratory study sought to identify the morbidities that associate with 1) PPD symptoms and 2) PPD diagnosis.
    Women s Health Issues 07/2014; 24(4):e381-8. · 1.61 Impact Factor
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    ABSTRACT: There is growing and sustained recognition that Patient-Centered Medical Homes (PCMHs) represent a viable approach to dealing with the fragmentation of care faced by many individuals, including those living with diabetes. The National Committee for Quality Assurance (NCQA) has spearheaded a program that recognizes medical practices that adopt key elements of the PCMH. Even though practices can achieve the same level of recognition, it is unclear whether all PCMHs deliver care in the same manner and how these differences can be associated with patient ratings of their experience with care.
    Journal of primary care & community health. 06/2014;
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    ABSTRACT: Research Objectives: The AIM of this study was to compare the distribution of nationally certified nurse practitioners’ (NP) practice location between states with and without restrictions on NP independent practice to determine whether states which allow for independent NP practice are more likely to have NPs practicing in medically underserved areas (MUAs). Study Design: Geographic Information System (GIS) methods were conducted that pinpointed descriptive locations of NPs, all 241,618 practicing primary care physicians (PCPs) in the U.S, and MUAs and Health Professional Shortage Areas (HPSAs) to a spatial mapping surface. To quantify the distribution of NPs and PCPs in each state, geospatial databases that summarized the spatial dispersal of NPs and PCPs and highlight disparities and clusters were created. The probability of a MUA/HPSA having no primary health care provider and the probability of having an NP but no PCP in the MUA/HPSA was calculated and compared. Population Studied: Mailing addresses for NPs and PCPs were acquired from American Association of Nurse Practitioners and the American Medical Association (AMA) Master file respectively: NP data included 21,211 addresses records and the AMA Master file data had 241,618 addresses of PCPs. Principal Findings: We successfully geocoded 99.76% of NP and 99.99% of PCP addresses. Just over one in five MUAs had no primary health care providers (21%) overall, with the highest percentage occurring in states which allowed for independent NP practice (29%), followed by states that required complete supervision (21%) and states that only required supervision of prescribing (17%). There were greater odds of MUA having an NP but no PCPs in states with the least restrictions on NP independent practice, (p=.08). Conclusions: There is an unequal distribution of primary health care providers (NPs and PCPs) in the US such that some geographic areas (MUAs) have few or no providers. Although states that allow for independent NP practice had the highest proportion of MUAs/HPSAs with no primary care providers, those states were more likely to have MUAs that did not have access to a PCP but did have access to a NP. Implications for Policy, Delivery or Practice: Implementation of the Affordable Care Act this year will create millions of new consumers who will be able to afford care, but with the shortage of primary care providers in medically underserved areas, care may not be available to them. Because the conduit to NP autonomy and full scope of practice is limited by state-based practice regulations imposed by state boards of nursing some states negatively impact the NPs’ authority to provide primary care to the full extent of their education, certification, and training, including their ability to prescribe medications and order tests, to be reimbursed, and to be primary care providers of record.
    AcademyHealth 2014 Annual Research Meeting (ARM), San Diego Convention Center, CA; 06/2014
  • Swathy Sundaram, Jeffrey S. Harman, Robert L. Cook
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    ABSTRACT: Purpose Postpartum depression (PPD) is common and associated with significant health outcomes and other consequences. Identifying persons at risk may improve screening and detection of PPD. This exploratory study sought to identify the morbidities that associate with 1) PPD symptoms and 2) PPD diagnosis. Methods Data from the 2007 and 2008 Pregnancy Risk Assessment Monitoring System were analyzed from 23 states and 1 city (n = 61,733 pregnancies); 13 antenatal morbidities were included. To determine whether antenatal morbidity predictors of PPD would differ based on PPD symptoms versus a diagnosis, each of the 13 antenatal morbidities were examined in separate logistic regression models with each PPD outcome. For each objective, two samples were examined: 1) Women from all states and 2) women from Alaska and Maine, the two states that included both PPD symptoms and PPD diagnosis measures in their questionnaires. Control variables included demographic and sociodemographic variables, pregnancy variables, antenatal and postpartum health behaviors, and birth outcomes. Main Findings Having vaginal bleeding (odds ratio [OR], 1.42; OR, 1.76), kidney/bladder infection (OR, 1.59; OR, 1.63), nausea (OR, 1.50; OR, 1.80), preterm labor (OR, 1.54; OR, 1.51), or being on bed rest (OR, 1.34; OR, 1.56) associated with both PPD symptoms and PPD diagnosis, respectively. Being in a car accident associated with PPD symptoms only (OR, 1.65), whereas having hypertension (OR, 1.94) or a blood transfusion (OR, 2.98) was associated with PPD diagnosis only. Among women from Alaska or Maine, having preterm labor (OR, 2.54, 2.11) or nausea (OR, 2.15, 1.60) was associated with both PPD symptoms and PPD diagnosis, respectively. Having vaginal bleeding (OR, 1.65), kidney/bladder infection (OR, 1.74), a blood transfusion (OR, 3.30), or being on bed rest (OR, 1.87) was associated with PPD symptoms only, whereas having diabetes before pregnancy (OR, 5.65) was associated with PPD diagnosis only. Conclusions The findings of this exploratory study revealed differences in the antenatal morbidities that were associated with PPD symptoms versus diagnosis in both samples, and can assist prenatal care providers in prioritizing and screening for these morbidities that are associated with PPD during pregnancy. Additional research is warranted to confirm the results of this study in other samples and populations. Developing strategies to 1) improve general awareness of PPD and the appropriate antenatal morbidity risk factors to focus on in clinical settings, and 2) increase screening for the antenatal morbidities determined to be predictors of PPD in this study are warranted in preventing PPD.
    Women's Health Issues. 01/2014; 24(4):e381–e388.
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    ABSTRACT: Subarachnoid hemorrhage (SAH) is a particularly devastating type of stroke which is responsible for one third of all stroke-related years of potential life lost before age 65. Surgical treatment has been shown to decrease both morbidity and mortality after subarachnoid hemorrhage. We hypothesized that payer status other than private insurance is associated with lower allocation to surgical treatment for patients with SAH and worse outcomes.
    PLoS ONE 01/2014; 9(8):e105124. · 3.53 Impact Factor
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    ABSTRACT: To determine the impact of Florida's Medicaid Demonstration 4 years post-implementation on per member per month (PMPM) Medicaid expenditures and whether receiving care through HMOs versus provider service networks (PSNs) in the Demonstration was associated with PMPM expenditures. Florida Medicaid claims from two fiscal years prior to implementation of the Demonstration (FY0405, FY0506) and the first four fiscal years after implementation (FY0607-FY0910) from two urban Demonstration counties and two urban non-Demonstration counties. A difference-in-difference approach was used to compare changes in enrollee expenditures before and after implementation of the Demonstration overall and specifically for HMOs and PSNs. Claims data were extracted for enrollees in the Demonstration and non-Demonstration counties and collapsed into monthly amounts (N = 26,819,987 person-months). Among SSI enrollees, the Demonstration resulted in lower increases in PMPM expenditures over time ($40) compared with the non-Demonstration counties ($186), with Demonstration PSNs lowering PMPM expenditures by $7 more than HMOs. Savings were also seen among TANF enrollees but to a lesser extent. The Medicaid Demonstration in Florida appears to result in lower PMPM expenditures. Demonstration PSNs generated slightly greater reductions in expenditures compared to Demonstration HMOs. PSNs appear to be a promising model for delivering care to Medicaid enrollees.
    Health Services Research 11/2013; · 2.29 Impact Factor
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    Christopher A Harle, Jeffrey S Harman, Shuo Yang
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    ABSTRACT: Clinical inertia, the failure to adjust antihypertensive medications during patient visits with uncontrolled hypertension, is thought to be a common problem. This retrospective study used 5 years of electronic medical records from a multispecialty group practice to examine the association between physician and patient characteristics and clinical inertia. Hierarchical linear models (HLMs) were used to examine (1) differences in physician and patient characteristics among patients with and without clinical inertia, and (2) the association between clinical inertia and future uncontrolled hypertension. Overall, 66% of patients experienced clinical inertia. Clinical inertia was associated with one physician characteristic, patient volume (odds ratio [OR]=0.998). However, clinical inertia was associated with multiple patient characteristics, including patient age (OR=1.021), commercial insurance (OR=0.804), and obesity (OR=1.805). Finally, patients with clinical inertia had 2.9 times the odds of uncontrolled hypertension at their final visit in the study period. These findings may aid the design of interventions to reduce clinical inertia.
    Journal of Clinical Hypertension 11/2013; 15(11):820-824. · 2.36 Impact Factor
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    ABSTRACT: Medicare ceased payment for some hospital-acquired infections beginning October 1, 2008, following provisions in the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005. We examined the association of this policy with declines in rates of vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infection (CAUTI). Discharge data from the Florida Agency for Healthcare Administration from 2007 to 2011. We compared rates of hospital-acquired vascular catheter-associated infections (HA-VCAI) and catheter-associated urinary tract infections (HA-CAUTI) before and after implementation of the new policy (January 2007 to September 2008 vs. October 2008 to September 2011). This pre-post, retrospective, interrupted time series study was further analyzed with a generalized hierarchical logistic regression, by estimating the probability of a patient acquiring these infections in the hospital, post-policy compared to pre-policy. Pre-policy, 0.12% of admitted patients were diagnosed with CAUTI; of these, 32% were HA-CAUTI. Similarly, 0.24% of admissions were diagnosed as VCAI; of these, 60% were HA-VCAI. Post-policy, 0.16% of admissions were CAUTIs; of these, 31% were HA-CAUTI. Similarly, 0.3% of admissions were VCAIs and, of these, 45% were HA-VCAI. There was a statistically significant decrease in HA-VCAIs (OR: 0.571 (p < 0.0001)) post-policy, but the reduction in HA-CAUTI (OR: 0.968 (p < 0.4484)) was not statistically significant. The results suggest Medicare non payment policy is associated with both a decline in the rate of hospital-acquired VCAI (HA-VCAI) per quarter, and the probability of acquiring HA-VCAI post- policy. The strength of the association could be overestimated, because of concurrent ongoing infection control interventions.
    Medicare & medicaid research review. 01/2013; 3(3).
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    ABSTRACT: Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents-the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments.
    Journal of Aging & Social Policy 01/2013; 25(1):65-82. · 0.60 Impact Factor
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    ABSTRACT: Florida Medicaid recently concluded a five year Medicaid managed care demonstration program in 5 counties. A key component of the demonstration was that beneficiaries enroll in one of two types of managed care plans: traditional HMOs and provider service networks (PSNs). There are two structural differences between these two plan types: PSNs were reimbursed based on fee for service, HMOs were capitated; and PSNs were owned by local physician groups or hospitals, most of the HMOs were national organizations. This study explores whether beneficiary reports and ratings of care vary by health plan type, and also before or after mandated Medicaid managed care was introduced. This study involves a secondary analysis of 4 years of CAHPS surveys (n=20,157) of Medicaid beneficiaries. Mulitvariate ordered logit regression models were used to determine whether there were differences in 9 reports and 4 ratings of care by plan type (HMO, PSN) and whether there were changes in reports and ratings before and after mandated Medicaid managed care was introduced. The likelihood of providing a high rating for overall health care declined after the demonstration was implemented (OR .74 95% CI .59,.92). However after the demonstration was initiated, beneficiaries were more likely to provide favorable reports of aspects of their care such as finding a doctor or nurse (OR 1.40 95% CI 1.06, 1.83) or getting care right away (OR 1.48 95% CI 1.08, 2.04), compared to before implementation. PSN enrollees compared to HMO enrollees after implementation relative to before implementation were more likely to provide better ratings for overall health care (OR 1.30 95% CI 1.04, 1.63), personal doctor (OR 1.33 95% CI 1.07, 1.67), and a more favorable report of their doctor spending enough time (OR 1.46 95% CI 1.17, 1.83). PSN enrollees were also more likely to provide specialty care with a favorable rating (OR 1.52 95% CI 1.09, 2.11) compared to HMO enrollees. Findings suggest that although beneficiaries are more likely to rate their overall care negatively after mandated managed care some aspects of their care may have improved , notably the ability to find a doctor and the interactions with that clinician. Experiences under PSN arrangements appear to be preferable to the HMO arrangement.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: BACKGROUND:: Private equity has acquired multiple large nursing home chains within the last few years; by 2009, it owned nearly 1,900 nursing homes. Private equity is said to improve the financial performance of acquired facilities. However, no study has yet examined the financial performance of private equity nursing homes, ergo this study. PURPOSE:: The primary purpose of this study is to understand the financial performance of private equity nursing homes and how it compares with other investor-owned facilities. It also seeks to understand the approach favored by private equity to improve financial performance-for instance, whether they prefer to cut costs or maximize revenues or follow a mixed approach. METHODOLOGY/APPROACH:: Secondary data from Medicare cost reports, the Online Survey, Certification and Reporting, Area Resource File, and Brown University's Long-term Care Focus data set are combined to construct a longitudinal data set for the study period 2000-2007. The final sample is 2,822 observations after eliminating all not-for-profit, independent, and hospital-based facilities. Dependent financial variables consist of operating revenues and costs, operating and total margins, payer mix (census Medicare, census Medicaid, census other), and acuity index. Independent variables primarily reflect private equity ownership. The study was analyzed using ordinary least squares, gamma distribution with log link, logit with binomial family link, and logistic regression. FINDINGS:: Private equity nursing homes have higher operating margin as well as total margin; they also report higher operating revenues and costs. No significant differences in payer mix are noted. PRACTICE IMPLICATIONS:: Results suggest that private equity delivers superior financial performance compared with other investor-owned nursing homes. However, causes for concern remain particularly with the long-term financial sustainability of these facilities.
    Health care management review 05/2012; · 1.30 Impact Factor
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    ABSTRACT: Electronic medical records (EMR) are commonly believed to improve quality of care. Primary care patients with multiple chronic conditions have potentially greater opportunity to benefit from receiving care at practices with EMRs if these systems help coordinate complex care. To examine how chronic conditions impact the odds that depressed patients receive depression treatment in primary care practices with EMRs compared to practices without EMRs. The study uses logistic regression to analyze cross-sectional data of primary care physician office visits in freestanding, office-based practices from the 2006-2008 National Ambulatory Medical Care Surveys. All visits to primary care providers made by patients ages 18 and older with physician-identified depression (N = 3,467). Outcomes include depression treatment which is defined as receipt or ordering of antidepressant medication and/or mental health counseling. EMRs were associated with significantly lowered odds that depressed patients received depression treatment (OR = 0.75, p = 0.009, 95% CI: 0.61-0.93); however when stratified by the number of chronic conditions, this association was observed only in patients with three or more chronic conditions (OR = 0.50, p > 0.001, 95% CI: 0.36-0.70). EMRs did not have a significant association with depression treatment for patients with two or fewer chronic conditions. EMRs appear to have an unintended negative association with depression care provided during visits made by primary care patients with multiple chronic conditions.
    Journal of General Internal Medicine 02/2012; 27(8):962-7. · 3.28 Impact Factor
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    ABSTRACT: As the childhood obesity epidemic escalates, impacted communities with limited resources are uncertain of how best to respond. A novel way to inform childhood obesity prevention policy and intervention is to create a community place-based analysis system that allows for the analysis of obesity prevalence in comparison to variables associated with the energy balance of individuals such as diet, physical activity levels, and socioeconomic status. Currently underutilized in obesity prevention, GIS is ideal for broad-level analysis since it offers advantages related to the layering of different variables (such as food environment compared to active living context), spatial pattern visualization, and data documentation and storage. GIS can help target resources by highlighting communities with health disparities, food poverty, and few safe places where children can play. Additionally, layering multiple variables will allow policymakers to better understand complex environmental circumstances that may be contributing to obesity and design multifaceted interventions that address multiple contributors. This presentation highlights the outcomes from the prototype development of Healthy Kids GIS, a system offering online interactive mapping and a geospatial library for users of varied skill levels. Hundreds of geospatial datasets representative of broad obesity measures from public and private sources were collected, standardized, and organized to build a comprehensive geospatial database. Prototypes at the national, state and local levels were employed in partnership with pilot communities to elicit feedback and explore data resources and tool functionality. The challenges with building Healthy Kids GIS and the strategy used to produce a multi-dimensional GIS will be discussed.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: The high childhood obesity prevalence in different places stresses the importance of developing policy and interventions targeted specifically to unique circumstances of communities. Currently underutilized in childhood obesity prevention, GIS offers a method for visually comprehending the multiple spatial aspects of childhood obesity and the associated risk factors prevalent in different places. If used effectively, GIS has the potential to inform policy and interventions and ultimately, could be used to track progress (or lack thereof) with meeting intended objectives. Using the power of GIS, the University of Florida has developed a place-based interactive mapping and analysis system for analyzing Childhood Obesity issues and prevention measures. This system, referred to as Healthy Kids GIS, includes a tiered geospatial database and map prototypes at the national, state, and local map scales and GIS analysis tools tailored for different places. For example, a GIS reporting tool was developed that highlights the socioeconomic characteristics of schools with high obesity prevalence in the State of Arkansas and Alachua County, Florida. Representative of common childhood obesity measures, hundreds of geospatial datasets from public and private sources were collected, formatted, and organized to build a comprehensive geospatial database. This poster illustrates the conceptual framework guiding the development of this dynamic GIS, highlights important geospatial data resources for measuring childhood obesity, and visually demonstrates mapping and tool applications.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: Growing health system quality challenges and financial constraints warrant a paradigm shift in the organization and delivery of the health care system. There are both state and national level debates for the establishment of a Patient Centered Medical Home (PCMH) as the centerpiece of primary care reform. While most states and the Centers for Medicare and Medicaid Services (CMS) have implemented demonstrations to test this model of care, limited empirical evidence is available to date. PCMH is characterized as accessible, family centered, coordinated, continuous, culturally competent and compassionate. This research seeks to estimate the impact of PCMH on health care utilization and expenditure for chronically ill adults. This is a cross-sectional design that identifies a sub-population of chronically ill adults living with asthma, diabetes, chronic obstructive pulmonary disorder (COPD), hypertension depression, arthritis, coronary heart disease and stroke adults (<18 years) ages old in the Medical Expenditure Panel Survey (2004 -2007). This analysis was restricted to individuals who had a usual source of care. To ascertain the construct of a PCMH, an exploratory factor analysis was conducted on nineteen theoretically based items. A Principle Component Analysis was used to extract a sixteen item measure with a Crohnbach alpha of 0.64. Multiple regression models assessed the association between evidence of medical homeness and healthcare outcome (total expenditure, physician office visits, emergency room visits, prescription drugs, inpatient discharges, and nights in hospital) among 3,125 chronically ill adults. The primary independent variable of interest was whether an individual's care showed evidence of medical homeness. Individuals who reported having more chronic conditions had a greater odds (OR = 1.07, 95% Confidence Interval CI: 1.02 -1.13) of experiencing care that showed evidence of medical homeness. Respondents who reported being in poor health (OR = 1.43, CI: 1.02 - 2.07), fair health (OR = 1.71, CI: 1.32 - 2.98) and good health (OR = 2.06, CI: 1.37 - 4.02) had greater odds of care that showed evidence of medical homeness. Conversely, individuals who reported a higher physical functioning score of SF-12 had a lower odds (OR = 0.99, CI: 0.98 - 0.99) of having care that showed evidence of medical homeness. Evidence of medical homeness was significantly associated for one of the utilization models, prescription drug (IRR = 0.32, p-value = 0.00). These findings suggest that medical homes could impact healthcare expenditures and utilization.
    139st APHA Annual Meeting and Exposition 2011; 10/2011
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    ABSTRACT: This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period. Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing levels and deficiency citations for 663 Florida nursing homes between 2002 and 2005. Using a generalized estimating equation approach in SAS Proc Genmod, we estimate the relationship between CNA and licensed nursing staff, and facilities' total deficiency score and quality of care deficiency scores-calculated using the Centers for Medicare and Medicaid Services' Nursing Home Compare Five-Star Quality Rating System, which accounts for the complexity of the scope and severity of the cittions. Our results confirmed that higher CNA staffing levels were predictors of lower total deficiency scores and quality of care deficiency scores after controlling for facility characteristics. With a large sample size, repeated measure design, and advanced methods, we have found a relationship between CNA staffing and nursing home quality.
    The Gerontologist 05/2011; 51(5):610-6. · 2.48 Impact Factor
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    ABSTRACT: Many factors have been shown to be associated with ESRD patient placement on the waiting list and receipt of kidney transplantation. Our study aim was to evaluate factors and assess the interplay of patient characteristics associated with progression to transplantation in a large cohort of referred patients from a single institution. We examined 3029 consecutive adult patients referred for transplantation from 2003 to 2008. Uni- and multivariable logistic models were used to assess factors associated with progress to transplantation including receipt of evaluations, waiting list placement, and receipt of a transplant. A total of 56%, 27%, and 17% of referred patients were evaluated, were placed on the waiting list, and received a transplant over the study period, respectively. Older age, lower median income, and noncommercial insurance were associated with decreased likelihood to ascend steps to receive a transplant. There was no difference in the proportion of evaluations between African Americans (57%) and Caucasians (56%). Age-adjusted differences in waiting list placement by race were attenuated with further adjustment for income and insurance. There was no difference in the likelihood of waiting list placement between African Americans and Caucasians with commercial insurance. Race/ethnicity, age, insurance status, and income are predominant factors associated with patient progress to transplantation. Disparities by race/ethnicity may be largely explained by insurance status and income, potentially suggesting that variable insurance coverage exacerbates disparities in access to transplantation in the ESRD population, despite Medicare entitlement.
    Clinical Journal of the American Society of Nephrology 05/2011; 6(7):1760-7. · 5.07 Impact Factor
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    ABSTRACT: To identify (1) the association between pre-pregnancy BMI (PP-BMI) and PPD symptoms, and (2) the association between PP-BMI and PPD symptoms after considering PNC utilization as a moderating variable. Data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed from 15 states. The study design utilized two risk-adjustment approaches. One approach included all women in the dataset and used statistical analyses to risk-adjust for pregnancy risk status, and the other approach, through a sensitivity analysis, modified the design of the study by truncating the sample to include only women with healthy pregnancies. An initial association was seen between obesity and PPD symptoms, and PNC and PPD symptoms in the multivariate analyses. However, the inclusion of case-mix variables into the multivariate models removed these associations. Overall, for both approaches, there was no indication of a moderating effect of PNC utilization. Results also revealed that many of the women were significantly affected by a variety of high-risk maternal morbidity (case-mix) variables. Although PNC is important for the health of mothers and babies, it does not appear to moderate the association of PP-BMI and PPD symptoms. However, since this study revealed associations between several high-risk maternal morbidities (included as case-mix variables), and PPD symptoms, it is recommended that future research further investigate the possible association of these morbidities with PPD symptoms. For practice, it is suggested that PNC providers focus on their patients, and establish suitable interventions accordingly.
    Maternal and Child Health Journal 05/2011; 16(3):656-67. · 2.24 Impact Factor
  • Kathryn Rost, Yi-Ping Hsieh, Stan Xu, Jeffrey Harman
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    ABSTRACT: Depressed women have greater than three times the odds of hospitalization as clinically comparable men. The objective of this study is to understand if these gender differences emerge in admissions decisions after depressed individuals' arrival at the emergency room (ER). We used multivariate logistic regression to examine gender differences in hospitalization after 6266 ER visits for depressive symptoms in the nationally representative 1998-2007 National Hospital Ambulatory Care Medical Survey. ER visits by depressed women have only 0.82 the odds of hospitalization (95% confidence interval [CI] 0.70-0.96, p=0.02) in models adjusted for sociodemographic, clinical, and system covariates. Sensitivity analyses demonstrate gender differences in visits by patients with no injury but not in visits by patients with self-inflicted injury. These findings suggest that admission decisions after ER visits are not responsible for the increased risk of hospitalization previously reported in depressed women, as ER visits by women with depressive symptoms actually have lower odds of hospitalization than visits by men. We encourage further research to explore the causes and consequences of this practice pattern to move toward rational delivery systems committed to providing comparable treatment to clinically comparable individuals regardless of gender.
    Journal of Women's Health 03/2011; 20(5):719-24. · 1.90 Impact Factor

Publication Stats

978 Citations
175.52 Total Impact Points


  • 2002–2014
    • University of Florida
      • • College of Public Health and Health Professions
      • • Department of Clinical and Health Psychology
      • • Department of Health Services Research, Management and Policy
      Gainesville, Florida, United States
    • Childrens Hospital of Pittsburgh
      • Department of Pediatrics
      Pittsburgh, PA, United States
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 2011
    • Florida State University
      • Department of Medical Humanities & Social Sciences
      Tallahassee, FL, United States
  • 2010
    • Texas A&M University System Health Science Center
      • School of Rural Public Health
      Bryan, TX, United States
  • 2008
    • Emory University
      • Department of Health Policy and Management
      Atlanta, GA, United States
  • 2007
    • Case Western Reserve University
      • Department of Pediatrics (University Hospitals Case Medical Center)
      Cleveland, OH, United States
  • 2000–2006
    • University of Pittsburgh
      • • School of Medicine
      • • Department of Psychiatry
      Pittsburgh, PA, United States
  • 2005
    • North Florida and South Georgia Veterans Health System
      Gainesville, Florida, United States
  • 2004–2005
    • The Ohio State University
      • Department of Psychology
      Columbus, OH, United States
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States