Gerry Fairbrother

AcademyHealth, Washington, Washington, D.C., United States

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Publications (96)240.45 Total impact

  • PEDIATRICS 05/2015; 135(6). DOI:10.1542/peds.2014-3298 · 5.30 Impact Factor
  • Diabetes Spectrum 05/2015; 28(2):132-40. DOI:10.2337/diaspect.28.2.132
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    ABSTRACT: There are many benefits of multistate collaboratives or networks to states, but at the center is that they allow for the opportunity to learn from other states and experts about the practices and policies states have implemented without the significant time lag of published research. This commentary examines these benefits and illustrates the importance of quality improvement collaborations to decision-making in state Medicaid programs. In 2007, the Medicaid Medical Directors Learning Network (MMDLN) began conducting quality improvement studies using their own state-level administrative data to better understand the major clinical issues facing the Medicaid populations and to work together on policies to improve outcomes. The three issues selected by MMDs for quality improvement monitoring to date involved an important national problem - including both morbidity and cost - and were amenable to policy solutions. The studies examined the use of antipsychotic medication in children, hospital admissions and readmissions, and early elective deliveries (i.e., elective deliveries occurring before 39 weeks). The multistate clinical quality projects conducted offer a key mechanism for achieving the goal of helping the Medicaid program deliver value-driven, high-quality, cost-effective health care in an efficient manner. These projects also provide the participating states with data to inform policies internally. In order for the quality of health care to improve, the system needs to be structured as a learning health care system; one that is always accessing evidence, implementing a variation of it (i.e., with new data sources or tools such as electronic clinical data), assessing effectiveness, and sharing results for others to repeat the cycle.
    12/2014; 2(1). DOI:10.13063/2327-9214.1061
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    ABSTRACT: The Beacon Community in Cincinnati, Ohio was an innovative, community-wide initiative to use technology to transform care. One important feature was the development of regional alerts to notify practices when patients were hospitalized or seen in the emergency department. The purpose of this paper is to describe the way in which technology engages the improvement process, and to describe the early stages of learning how to use technology to enhance quality improvement. We interviewed key Beacon leaders as well as providers and office staff in selected practices. We also collected preliminary data from practices that reflected handling of alerts, including the number of asthma related alerts received and followed up. Regional alerts, supplied by the community-wide health information exchange, were a significant addition to the quality improvement effort in that they enabled practices to identify and follow up with additional children at risk. An important finding was the substantial effort at the practice level to integrate technology into ongoing patient care. Developing the technology for community wide alerts represented a significant endeavor in the Cincinnati Beacon Community. However, the technology was just the first step. Despite extra effort and time required on the part of individual practices, they reported that the value of having alerts was high. Hospital and ED visits represent some of the most costly aspects of care, and an efficient process for intervening with children using these costly services was seen as of significant value.
    12/2014; 2(1):1047. DOI:10.13063/2327-9214.1047
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    Gerry Fairbrother, Tara Trudnak, Katherine Griffith
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    ABSTRACT: To describe the evolution of methods and share lessons learned from conducting multi-state studies with Medicaid Medical Directors (MMD) using state administrative data. There was a great need for these studies, but also much to be learned about conducting network-based research and ensuring comparability of results. This was a network-level case study. The findings were drawn from the experience developing and executing network analyses with the MMDs, as well as from participant feedback on lessons learned. For the latter, nine interviews with MMD project leads, state data analysts, and outside researchers involved with the projects were conducted. Interviews were transcribed, coded and analyzed using NVivo 10.0 analytic software. MMD study methodology involved many steps: developing research questions, defining data specifications, organizing an aggregated data collection spreadsheet form, assuring quality through review, and analyzing and reporting state data at the national level. State analysts extracted the data from their state Medicaid administrative (claims) databases (and sometimes other datasets). Analysis at the national level aggregated state data overall, by demographics and other sub groups, and displayed descriptive statistics and cross-tabs. Projects in the MMD multi-state network address high-priority clinical issues in Medicaid and impact quality of care through sharing of data and policies among states. Further, these studies contribute not only to high-quality, cost-effective health care for Medicaid beneficiaries, but also add to our knowledge of network-based research. Continuation of these studies requires funding for a permanent research infrastructure nationally, as well as at the state-level to strengthen capacity.
    12/2014; 2(1):1054. DOI:10.13063/2327-9214.1054
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    ABSTRACT: Reducing early elective deliveries has become a priority for Medicaid medical directors and their state partners. Such deliveries lead to poor health outcomes for newborns and their mothers and generate additional costs for patients, providers, and Medicaid, which pays for up to 48 percent of all births in the United States each year. Early elective deliveries are non-medically indicated labor inductions or cesarean deliveries of infants with a confirmed gestational age of less than thirty-nine weeks. This retrospective descriptive study reports the results of a perinatal project, led by the state Medicaid medical directors, that sought to coordinate quality improvement efforts related to early elective deliveries for the Medicaid population. Twenty-two states participated in the project and provided data on elective deliveries in the period 2010-12. We found that 75,131 (8.9 percent) of 839,688 Medicaid singleton births were early elective deliveries. Thus, we estimate that there are 160,000 early elective Medicaid deliveries nationwide each year. In twelve states, early-term elective deliveries declined 32 percent between 2007 and 2011. Our study offers additional evidence and new tools for policy makers pursuing strategies to further reduce the number of such deliveries. Project HOPE—The People-to-People Health Foundation, Inc.
    Health Affairs 12/2014; 33(12):2170-8. DOI:10.1377/hlthaff.2014.0534 · 4.32 Impact Factor
  • Gerry Fairbrother, Tara Trudnak Fowler, Judy Zerzan
    Health Affairs 12/2014; 33(12):2266. DOI:10.1377/hlthaff.2014.1252 · 4.32 Impact Factor
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    ABSTRACT: School-based health centers (SBHCs) are located conveniently on school campuses, providing accessible and youth-friendly care to at-risk adolescents with otherwise limited access to care. We examined aspects of quality of care and health engagement using data from seven SBHCs in Colorado and New Mexico. High school SBHC-users completed the previously-validated Youth Engagement with Health Services (YEHS!) survey on an iPad as part of a federally-funded SBHC quality improvement project. The majority of the 221 respondents were Hispanic (77%) and female (78%); median age was 16 years. The majority reported low/medium socioeconomic status and over a quarter (29%) reported being uninsured. Three-quarters reported sexual activity and 38% reported being at-risk for depression. In the past year, respondents had accessed SBHC services including: behavioral health care (25% of respondents), well-child checks (45%), reproductive health care (38%), and acute care (34%). Over 30% of respondents received all of their care at SBHCs. Almost three-quarters (71%) of respondents reported receiving all or most of their care at the SBHC (usual SBHC-users) and 29% were non-usual SBHC-users. In comparison with non-usual SBHC-users, usual SBHC-users reported a better Experience of Care score (p<.01) and a higher Health Self-Efficacy score (p<.01) indicating that SBHCs provide positive health care experiences and promote active health engagement for youth. SBHCs offer an ideal healthcare delivery option for adolescents and represent an important part of the public health care system. Adolescents with access to SBHCs receive youth-friendly primary and behavioral health services in an environment that fosters actively engaged healthcare consumers.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Reducing hospital readmissions is a way to improve care and reduce avoidable costs. However, there have been few studies of readmissions in the Medicaid population. We sought to characterize acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. We found that Medicaid readmissions were both prevalent (9.4 percent of all admissions) and costly ($77 million per state) and that they represented 12.5 percent of Medicaid payments for all hospitalizations. Five diagnostic groups appeared to drive Medicaid readmissions, accounting for 57 percent of readmissions and 49 percent of hospital payments for readmissions. The most prevalent diagnostic categories were mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications, which together accounted for 31.2 percent of readmissions. This analysis, conducted through the Medicaid Medical Directors Learning Network, allows Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population and provides a baseline for measuring improvement.
    Health Affairs 08/2014; 33(8):1337-44. DOI:10.1377/hlthaff.2013.0632 · 4.32 Impact Factor
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    ABSTRACT: In the spring 2013, 15 school-based health centers (SBHCs) across Colorado and New Mexico administered a revised version of the Youth Engagement with Health Services (YEHS!) survey that included new items measuring health engagement and refined measures of health care utilization and the receipt of needs-based anticipatory guidance. Using these results, we are able to further develop our definition of the heath engaged young person to include additional indicators of health access literacy and health self-efficacy and to examine the demographic characteristics likely to be associated with higher health engagement, like age and socio-economic status. The new 13-item youth health engagement scale demonstrates strong reliability (Cronbach’s alpha=0.851) and preliminary results suggest strong correlations between higher engagement scores and the receipt of more anticipatory guidance (p < 0.05), fewer unmet needs for guidance (p < 0.001), and a better experience with health care (p < 001). Preliminary results also suggest that engagement might be especially important for at-risk adolescents. Higher engagement scores are associated with fewer unmet needs for guidance around topics related to emotional well-being among adolescents at risk for depression (p < 0.05) and fewer unmet needs for guidance around topics related to sexual health among adolescents reporting sexual activity (p < 0.001). The implications of these results will be discussed for youth engagement activities SBHCs may undertake to improve quality of care.
    School-Based Health Alliance National School-Based Health Care Convention, Seattle, WA; 06/2014
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    ABSTRACT: The Cincinnati, Ohio, metropolitan area was one of seventeen US communities to participate in the federal Beacon Community Cooperative Agreement Program to demonstrate how health information technology (IT) could be used to improve health care. Given $13.7 million to spend in thirty-one months, the Cincinnati project involved hundreds of physicians, eighty-seven primary care practices, eighteen major hospital partners, and seven federally qualified health centers and community health centers. The thrust of the program was to build a shared health IT infrastructure to support quality improvement through data exchange, registries, and alerts that notified primary care practices when a patient visited an emergency department or was admitted to a hospital. A special focus of this program was on applying these tools to adult patients with diabetes and pediatric patients with asthma. Despite some setbacks and delays, the basic technology infrastructure was built, the alert system was implemented, nineteen practices focusing on diabetes improvement were recognized as patient-centered medical homes, and many participants agreed that the program had helped transform care. However, the experience also demonstrated that the ability to transfer data was limited in electronic health record systems; that considerable effort was required to adapt technology to support quality improvement; and that the ambitious agenda required more time for planning, training, and implementation than originally thought.
    Health Affairs 05/2014; 33(5):871-7. DOI:10.1377/hlthaff.2012.1298 · 4.64 Impact Factor
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    ABSTRACT: The purpose of this study was to create and validate a survey instrument designed to measure Youth Engagement with Health Services (YEHS!). A 61-item YEHS! survey was created through a multistaged process, which included literature review, subject matter expert opinion, review of existing validated measures, and cognitive interviewing with 41 adolescents in Colorado and New Mexico. The YEHS! was then pilot tested with a diverse group of high school students (n = 354) accessing health services at one of eight school-based health centers in Colorado and New Mexico. We conducted psychometric analyses and examined correlations between the youth health engagement scales and measures of quality of care. We created scales to measure two domains of youth health engagement: health access literacy and health self-efficacy. The youth health engagement scales demonstrated strong reliability (Cronbach's α .76 and .82) and construct validity (mean factor loading .71 and .76). Youth health engagement scores predicted higher experiences of care scores (p < .001) and receipt of more anticipatory guidance (p < .01). This study supports the YEHS! as a valid and reliable measure of youth health engagement among adolescents using school-based health centers. We demonstrate an association between youth health engagement and two quality of care measures. Additional testing is needed to ensure the reliability and validity of the instrument in diverse adolescent populations.
    Journal of Adolescent Health 04/2014; 55(3). DOI:10.1016/j.jadohealth.2014.02.008 · 2.75 Impact Factor
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    ABSTRACT: With the steady growth in Medicaid enrollment since the recent recession, concerns have been raised about care for newborns with complications. This paper uses all-payer administrative data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to examine trends from 2002 through 2009 in complicated newborn hospital stays, and explores the relationship between expected sources of payment and reasons for hospitalizations. Trends in complicated newborn stays, expected sources of payment, costs, and length of stay were examined. A logistic regression was conducted to explore likely payer source for the most prevalent diagnoses in 2009. Complicated births and hospital discharges within 30 days of birth remained relatively constant between 2002 and 2009, but average costs per discharge increased substantially (p<.001 for trend). Most strikingly, over time, the proportion of complicated births billed to Medicaid increased, while the proportion paid by private payers decreased. Among complicated births, the most prevalent diagnoses were preterm birth/low birth weight (23%), respiratory distress (18%), and jaundice (10%). The top two diagnoses (41% of newborns) accounted for 61% of the aggregate cost. For infants with complications, those with Medicaid were more likely to be complicated due to preterm birth/low birth weight and respiratory distress, while those with private insurance were more likely to be complicated due to jaundice. State Medicaid programs are paying for an increasing proportion of births and costly complicated births. Policies to prevent common birth complications have the potential to reduce costs for public programs and improve birth outcomes.
    01/2014; 4(4). DOI:10.5600/mmrr.004.04.a03
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    ABSTRACT: Purpose The purpose of this study was to create and validate a survey instrument designed to measure Youth Engagement with Health Services (YEHS!). Methods A 61-item YEHS! survey was created through a multistaged process, which included literature review, subject matter expert opinion, review of existing validated measures, and cognitive interviewing with 41 adolescents in Colorado and New Mexico. The YEHS! was then pilot tested with a diverse group of high school students (n = 354) accessing health services at one of eight school-based health centers in Colorado and New Mexico. We conducted psychometric analyses and examined correlations between the youth health engagement scales and measures of quality of care. Results We created scales to measure two domains of youth health engagement: health access literacy and health self-efficacy. The youth health engagement scales demonstrated strong reliability (Cronbach's α .76 and .82) and construct validity (mean factor loading .71 and .76). Youth health engagement scores predicted higher experiences of care scores (p < .001) and receipt of more anticipatory guidance (p < .01). Conclusions This study supports the YEHS! as a valid and reliable measure of youth health engagement among adolescents using school-based health centers. We demonstrate an association between youth health engagement and two quality of care measures. Additional testing is needed to ensure the reliability and validity of the instrument in diverse adolescent populations.
  • Lisa A. Simpson, Gerry Fairbrother
    Academic Pediatrics 11/2013; 13(6):S16–S20. DOI:10.1016/j.acap.2013.03.014 · 2.23 Impact Factor
  • Academic pediatrics 09/2013; 13(5):387-9. DOI:10.1016/j.acap.2013.06.002 · 2.23 Impact Factor
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    ABSTRACT: As part of the Colorado/New Mexico School-Based Health Center Improvement Project, we have developed and pilot tested a novel instrument designed to measure youth health engagement – the Youth Engagement with Health Services (YEHS!) survey. While existing surveys measure health care utilization and receipt of preventive care services and counseling, none, to date, have included measures of youth health engagement. The YEHS! is grounded in a positive youth development approach and incorporates measures of health care utilization with innovative items measuring adolescents’ perception of the helpfulness of Bright Futures recommended anticipatory guidance, in addition to questions that measure the sub-components of youth health engagement: health access literacy, health self-efficacy, and youth-provider partnership. In this session, we describe the results of the pilot administration of the YEHS! in eight school-based health centers across Colorado and New Mexico in May 2012. In addition, we describe how we shared the results of the survey with participating SBHCs and how the SBHCs used these results to inform their quality improvement efforts during the past school year. During this session, participants will have the opportunity to brainstorm additional quality improvement activities around the sub-domains of youth health engagement measured by the YEHS! that they can utilize in their own practice.
    School-Based Health Alliance National School-Based Health Care Convention, Washington, DC; 06/2013
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    ABSTRACT: Purpose: Patients who are more engaged with their healthcare are more likely to adhere to treatment plans, take medication, and ultimately enjoy better health outcomes. The purpose of this study is to create and evaluate a survey instrument to measure youth engagement with school-based health center (SBHC) services, evaluate the quality of care as reported by the adolescent population, and understand the importance of engagement to adolescent healthcare experiences. Methods: A 61-item Youth Engagement with Health Services Survey (YEHS!) was created through a multi-staged process which included literature review, subject matter expert opinion, and cognitive interviewing with 41 adolescents in Colorado and New Mexico. The YEHS! was then pilot tested with a diverse group of high school students (n = 354) accessing health services at one of eight SBHCs in Colorado and New Mexico. Psychometric analyses were conducted to assess the validity of scales. Descriptive and bivariate analyses were conducted. Results: A needs-based scoring approach was developed to measure five domains of anticipatory guidance: oral care, physical growth and development, social and academic competence, emotional well-being, and sexual risk reduction. Scales were created to measure experiences of care and three domains of youth health engagement: health access literacy, efficacious partnership, and SBHC involvement. Youth health engagement scales demonstrated strong reliability (mean Cronbach’s alpha = 0.85, range 0.82 to 0.91). One third of adolescents (36.2%) reported at least one unmet need in anticipatory guidance in the prior 12 months. Students for whom the SBHC was their usual source of healthcare (24.0% of sample) were more likely to report the provision of anticipatory guidance in the prior 12 months that was “helpful” in the areas of physical growth and development (P<0.05) and sexual risk reduction (P < 0.01). Students for whom the SBHC was their usual source of healthcare had higher scores on the experiences of care scale (P<0.01) and the efficacious partnership scale (P<0.001). Conclusions: Initial results indicate that the YEHS! is a feasible and reliable measure of youth engagement and the quality of care delivered at SBHCs. More testing is needed to ensure the reliability and validity of the instrument in diverse adolescent populations. The YEHS! shows promise as an instrument useful in understanding adolescent healthcare experiences and monitoring disparities in the provision of adolescent healthcare.
    Pediatric Academic Societies, Washington, DC; 05/2013
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    ABSTRACT: Purpose: Patients who are more engaged with their healthcare are more satisfied with the care they receive and are more likely to adhere to treatment plans, take medication, and ultimately enjoy better health outcomes. The purpose of this study is to create and evaluate a survey instrument designed to measure youth engagement with school-based health center (SBHC) services, evaluate the quality of care as reported by the adolescent population, and understand the importance of engagement to adolescent healthcare experiences. Methods: A 61-item Youth Engagement with Health Services Survey (YEHS!) was created through a multi-staged process which included literature review, subject matter expert opinion, and cognitive interviewing with 41 adolescents in Colorado and New Mexico. The YEHS! was then pilot tested with a diverse group of high school students (n = 354) accessing health services at one of eight SBHCs in Colorado and New Mexico. Psychometric analyses were conducted to assess the validity of scales. Descriptive and bivariate analyses were conducted. Results: A needs-based scoring approach was developed to measure five domains of anticipatory guidance: oral care, physical growth and development, social and academic competence, emotional well-being, and sexual risk reduction. Scales were created to measure experiences of care and three domains of youth health engagement: health access literacy, health self-efficacy, and SBHC involvement. Youth health engagement scales demonstrated strong reliability (mean Cronbach’s alpha = 0.85, range 0.82 to 0.91). One third of adolescents (36.2%) reported at least one unmet need in anticipatory guidance in the prior 12 months. Students for whom the SBHC was their usual source of healthcare (24.0% of sample) were more likely to report the provision of anticipatory guidance in the prior 12 months that was “helpful” in the areas of physical growth and development (P<0.05) and sexual risk reduction (P < 0.01). Students for whom the SBHC was their usual source of healthcare also had higher scores on the experiences of care scale (P<0.01) and the health self-efficacy scale (P<0.001). Conclusions: Initial results indicate that the YEHS! is a feasible and reliable measure of youth engagement and the quality of care delivered at SBHCs. Additional testing is needed to ensure the reliability and validity of the instrument in diverse adolescent populations. The YEHS! shows promise as an instrument that may be useful in understanding adolescent healthcare experiences and monitoring disparities in the provision of adolescent healthcare services.
    Society for Adolescent Health and Medicine, Atlanta, GA; 03/2013
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    ABSTRACT: BACKGROUND: The United States has experienced two shortages of heptavalent pneumococcal conjugate vaccine (PCV7). National guidelines called for deferring the third and fourth PCV7 doses from healthy children during these shortages. However, recommendations were not the same during the first and second shortages, and recommendations changed over time during each of the shortages as shortages worsened. OBJECTIVES: To measure PCV7 immunizing behavior for healthy children during shortage and non-shortage periods and assess the accuracy of the physicians' reported immunizing behavior when compared to their actual immunizing behavior. METHODS: We reviewed medical records in 14 randomly selected practices to measure actual immunizing behavior during shortage and non-shortage periods. We surveyed pediatricians in the Greater Cincinnati area to ascertain reported immunizing behavior. Actual and reported immunizing behaviors were compared. RESULTS: 2888 medical records were reviewed; surveys were obtained from 51 pediatricians (65% response rate). During periods of non-shortage, 74% of healthy children received their first two doses of PCV7 on time, whereas during periods of shortage, only 66% of healthy children received their first two doses of PCV7 on time. Compared with measured immunizing behavior from chart reviews, 54-76% of the pediatricians overestimated their compliance with guidelines to defer the fourth PCV7 dose while only 5-20% underestimated their compliance. CONCLUSIONS: Physicians often overestimated the percentage of children whose vaccine doses they deferred during vaccine shortages. Despite these findings, physicians were able to maintain high coverage with the first two PCV7 doses among healthy children.
    Vaccine 03/2013; DOI:10.1016/j.vaccine.2013.02.038 · 3.49 Impact Factor

Publication Stats

1k Citations
240.45 Total Impact Points

Institutions

  • 2012–2014
    • AcademyHealth
      Washington, Washington, D.C., United States
  • 2006–2013
    • University of Cincinnati
      Cincinnati, Ohio, United States
  • 2005–2013
    • Cincinnati Children's Hospital Medical Center
      Cincinnati, Ohio, United States
    • Cornell University
      Итак, New York, United States
  • 2011
    • Centers for Disease Control and Prevention
      • National Center for Immunization and Respiratory Diseases
      Druid Hills, GA, United States
  • 2001–2005
    • New York Academy of Medicine
      New York City, New York, United States
  • 1995–2004
    • Albert Einstein College of Medicine
      • Division of Epidemiology
      New York, New York, United States
  • 1997–2003
    • Montefiore Medical Center
      • Albert Einstein College of Medicine
      New York, New York, United States
  • 2000
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
  • 1998
    • Icahn School of Medicine at Mount Sinai
      Manhattan, New York, United States
  • 1996
    • CUNY Graduate Center
      New York, New York, United States