Hsien-Yen Chang

Hsien-Yen Chang
Johns Hopkins University | JHU · Department of Health Policy & Management

Ph.D.

About

90
Publications
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3,356
Citations

Publications

Publications (90)
Article
Background: An individual's risk for future opioid overdoses is usually assessed using a 12-month "lookback" period. Given the potential urgency of acting rapidly, we compared the performance of alternative predictive models with risk information from the past 3, 6, 9, and 12 months. Methods: We included 1,014,033 Maryland residents aged 18-80 w...
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Background: The Overuse Index (OI), previously called the Johns Hopkins Overuse Index, is developed and validated as a composite measure of systematic overuse/low-value care using United States claims data. However, no information is available concerning whether the external validation of the OI is sustained, especially for international applicati...
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Background The spread of COVID-19 has highlighted the long-standing health inequalities across the U.S. as neighborhoods with fewer resources were associated with higher rates of COVID-19 transmission. Although the stay-at-home order was one of the most effective methods to contain its spread, residents in lower-income neighborhoods faced barriers...
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Background Three claims-based pharmacy markers (complex, costly and risky medications) were developed to help automatically identify patients for comprehensive medication management. Objective To evaluate the association between newly-developed markers and healthcare outcomes. Methods This was a two-year retrospective cohort study using PharMetri...
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We compared risks of clinical outcomes, mortality and healthcare costs among new users of different classes of anti-diabetic medications. This is a population-based, retrospective, new-user design cohort study using the Taiwan National Health Insurance Database between May 2, 2015 and September 30, 2017. An individual was assigned to a medication g...
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Purpose The COVID-19 pandemic’s impact on buprenorphine treatment for opioid use disorder among adolescents and young adults (AYAs) is unknown. Methods We used IQVIA Longitudinal Prescription Claims, including US AYAs aged 12–29 with at least 1 buprenorphine fill between January 2018 and August 2020, stratifying by age group and insurance. We comp...
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BACKGROUND: Patient effort to comply with complex medication instructions is known to be related to nonadherence and subsequent medical complications or health care costs. A widely used Medication Regimen Complexity Index (MRCI) has been used with electronic health records (EHRs) to identify patients who could benefit from pharmacist intervention....
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Health care providers are increasingly using clinical measures derived from electronic health records (EHRs) for risk stratification and predictive modeling. EHR-specific data elements such as prescriptions, laboratory results, and vital signs have been shown to improve risk prediction models. In this study, the value of EHR-based blood pressure (B...
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Background: A small proportion of high-need patients persistently use the bulk of healthcare services and incur disproportionate costs. Population health management (PHM) programs often refer to these patients as persistent high users/utilizers (PHUs). Accurate PHU prediction enables PHM programs to better align scarce healthcare resources with hi...
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Clinical trials investigating cardiovascular safety of dipeptidyl peptidase-IV inhibitors (DPP-4i) among patients with cardiovascular and renal disease rarely recruit patients with renal impairment, despite associations with increased risk for major adverse cardiovascular events (MACE). We investigated the risk of MACE associated with the use of DP...
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BACKGROUND: Pharmacists optimize medication use and ensure the safe and effective delivery of pharmacotherapy to patients using comprehensive medication management (CMM). Identifying and prioritizing individual patients who will most likely benefit from CMM can be challenging. Health systems have far more candidates for CMM than there are clinical...
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Background: The COVID-19 pandemic has impacted communities differentially, with poorer and minority populations being more adversely affected. Prior rural health research suggests such disparities may be exacerbated during the pandemic and in remote parts of the U.S. Objectives: To understand the spread and impact of COVID-19 across the U.S., co...
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Objective: In the United States (USA), HIV preexposure prophylaxis (PrEP) use is suboptimal. Population-level metrics on PrEP use are limited and focus on prescriptions issued rather than how much prescriptions are picked up. We introduce PrEP reversals, defined as when patients fail to pick up PrEP prescriptions at the pharmacy point-of-sale, as...
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Background: A high proportion of healthcare services are persistently utilized by a small subpopulation of patients. To improve clinical outcomes while reducing cost and utilization, population health management programs often provide targeted interventions to patients who may become persistent high users/utilizers (PHUs). Enhanced prediction and...
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Multiple indices are available to measure medication adherence behaviors. Medication adherence measures, however, have rarely been extracted from electronic health records (EHRs) for population-level risk predictions. This study assessed the value of medication adherence indices in improving predictive models of cost and hospitalization. This study...
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This study aimed to assess the impact of coronavirus disease (COVID-19) prevalence in the United States in the week leading to the relaxation of the stay-at-home orders (SAH) on future prevalence across states that implemented different SAH policies. We used data on the number of confirmed COVID-19 cases as of August 21, 2020 on county level. We cl...
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Background: Nonfilling of prescribed medications is a worldwide problem of serious concern. Studies of health care costs and utilization associated with medication nonadherence frequently rely on claims data and usually focus on patients with specific conditions. Past studies also have little agreement on whether higher medication costs associated...
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Traditionally, risk-adjustment models do not address the characteristics of minority populations, such as race or socioeconomic status. This study aimed to evaluate the added value of place-based social determinants on risk-adjustment models in explaining health care costs and utilization. Statewide commercial claims from the Maryland Medical Care...
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Introduction: The spread of Coronavirus Disease 2019 (COVID-19) across the United States has highlighted the long-standing nationwide health inequalities with socioeconomically challenged communities experiencing a higher burden of the disease. We assessed the impact of neighborhood socioeconomic characteristics on the COVID-19 prevalence across se...
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Background: Nonadherence to medication regimens can lead to adverse health care outcomes and increasing costs. Objectives: To (a) assess the level of medication complexity at an outpatient setting using population-level electronic health record (EHR) data and (b) evaluate its association with medication adherence measures derived from medication...
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Importance Responding to the opioid crisis requires tools to identify individuals at risk of overdose. Given the expansion of illicit opioid deaths, it is essential to consider risk factors across multiple service systems. Objective To develop a predictive risk model to identify opioid overdose using linked clinical and criminal justice data. Des...
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Importance Hypocalcemia is a common complication of total thyroidectomy. Objectives To identify factors associated with hypocalcemia after total thyroidectomy and to explore the association between hypocalcemia, magnesium disorders, and costs of care. Design, Setting, and Participants A retrospective cross-sectional analysis was performed using d...
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Objective To examine whether initiation of interleukin (IL)-17, IL-12/23 or tumour necrosis factor (TNF) inhibitor is associated with an increased risk of serious infection among real-world psoriasis (PsO) or psoriatic arthritis (PsA) patients. Methods We assembled a retrospective cohort of commercially insured adults in the USA diagnosed with PsO...
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Background: Although buprenorphine is an evidence-based treatment for opioid use disorder (OUD), it is unknown whether buprenorphine use may affect patients’ adherence to treatments for chronic, unrelated conditions. Objectives: To quantify the effect of buprenorphine treatment on patient adherence to 5 therapeutic classes: (1) antilipids; (2) ant...
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Background: Predicting which individuals who are prescribed buprenorphine for opioid use disorder are most likely to experience an overdose can help target interventions to prevent relapse and subsequent consequences. Methods: We used Maryland prescription drug monitoring data from 2015 to identify risk factors for nonfatal opioid overdoses that...
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Background Overuse is a leading contributor to the high cost of health care in the United States. Overuse harms patients and is a definitive waste of resources. The Johns Hopkins Overuse Index (JHOI) is a normalized measure of systemic health care services overuse, generated from claims data, that has been used to describe overuse in Medicare benef...
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Background: Payers and providers still primarily use ordinary least squares (OLS) to estimate expected economic and clinical outcomes for risk adjustment purposes. Penalized linear regression represents a practical and incremental step forward that provides transparency and interpretability within the familiar regression framework. This study cond...
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Background: Using electronic health records (EHRs) for population risk stratification has gained attention in recent years. Compared with insurance claims, EHRs offer novel data types (eg, vital signs) that can potentially improve population-based predictive models of cost and utilization. Objective: To evaluate whether EHR-extracted body mass i...
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Purpose In October 2014, the US Drug Enforcement Agency moved hydrocodone combination products (HCPs) from schedule III to II of the Controlled Substances Act, further restricting their access. The aim of the study is to quantify the effect of hydrocodone's “upscheduling” on the use of opioid and nonopioid analgesics among chronic users. Methods U...
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Importance Expanding Medicaid eligibility could affect prescriptions of buprenorphine with naloxone, an established treatment for opioid use disorder, and opioid pain relievers (OPRs). Objective To examine changes in prescriptions of buprenorphine with naloxone and OPRs after the US Affordable Care Act Medicaid expansion. Design, Setting, and Par...
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Importance Results of clinical trials suggest that canagliflozin, a sodium-glucose cotransporter 2 (SGLT-2) inhibitor for treating type 2 diabetes, may be associated with lower extremity amputation. Objective To quantify the association between the use of oral medication for type 2 diabetes and 5 outcomes (lower extremity amputation, peripheral ar...
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Background: Previous studies on high-risk opioid use have only focused on patients diagnosed with an opioid disorder. This study evaluates the impact of various high-risk prescription opioid use groups on healthcare costs and utilization. Methods: This is a retrospective cohort study using QuintilesIMS health plan claims with independent variabl...
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Background: Using electronic health records (EHRs), in addition to claims, to systematically identify patients with factors associated with adverse outcomes (geriatric risk) among older adults can prove beneficial for population health management and clinical service delivery. Objective: To define and compare geriatric risk factors derivable fro...
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Aims: (1) To characterize the amount of prescription opioids prescribed for high-risk patients by low-volume prescribers; (2) to quantify how high- and low-volume prescribers differ systematically in their prescribing patterns. Design: Cross-sectional study using 2015 longitudinal, all-payer QuintilesIMS pharmacy claims. We conducted an aggregat...
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Objective: Establishing one price for all bundled services for a particular illness, which has become the key to healthcare reform efforts, is designed to encourage health professionals to coordinate their care for patients. Limited information is available, however, concerning whether bundled payments are associated with changes in patient outcom...
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Background: Risk adjustment models are traditionally derived from administrative claims. Prescription fill rates-extracted by comparing electronic health record prescriptions and pharmacy claims fills-represent a novel measure of medication adherence and may improve the performance of risk adjustment models. Objective: We evaluated the impact of...
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Objective: To examine associations between quality, complications, and costs in commercially insured patients treated for laryngeal cancer. Study design: Retrospective cross-sectional analysis of MarketScan Commercial Claim and Encounters data (Truven Health Analytics, Ann Arbor, Michigan, U.S.A.). Methods: We evaluated 10,969 patients diagnos...
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Objectives/hypothesis: To examine associations between treatment, complications, and costs in patients with laryngeal cancer. Study design: Retrospective cross-sectional analysis of MarketScan Commercial Claim and Encounters data. Methods: We evaluated 10,969 patients diagnosed with laryngeal cancer from 2010 to 2012 using cross-tabulations an...
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Importance: The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. Objective: We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. Design, s...
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Background: There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, however, have been traditionally...
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Background: Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrat...
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Importance: The treatment of oropharyngeal cancer has undergone a paradigm shift in the past 2 decades, with an increase in the use of nonoperative treatment owing to poor functional outcomes associated with traditional surgical approaches. Transoral robotic surgery (TORS) allows surgical resection of oropharyngeal cancer (OPC) with less morbidity...
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Background Thirty-day readmission rates after acute myocardial infarction (AMI) and heart failure are important patient outcome metrics. Early post-discharge physician follow-up has been promoted as a method of reducing 30-day readmission rates. However, the relationships between early post-discharge follow-up and 30-day readmission for AMI and hea...
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This article aims to evaluate the real world risk of gastrointestinal bleeding among users naïve to dabigatran. We adopted a self-controlled case series design. We sampled 1215 eligible adult participants who were continuous insured users between July 1, 2010 and March 31, 2012 with use of dabigatran and at least one gastrointestinal bleeding episo...
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Importance Process quality measure performance has improved significantly with public reporting, requiring reevaluation of process–outcome relationships and the emerging role of patient perspectives on care. Objective To evaluate associations between heart failure patient perspectives of care and publicly reported processes and outcomes. Design C...
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Background Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida. Methods We used IMS Health’s LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (interve...
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Background: High-cost users in a period may not incur high-cost utilization in the next period. Consistent high-cost users (CHUs) may be better targets for cost-saving interventions. Objectives: To compare the characteristics of CHUs (patients with plan-specific top 20% medical costs in all 4 half-year periods across 2008 and 2009) and point hig...
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Background Improving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs. Methods Using S...
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Purpose: Readmissions to a different hospital may place patients at increased risk for poor outcomes and may increase their overall costs of care. We evaluated whether mortality and costs differ for patients with colon cancer on the basis of whether patients are readmitted to the index hospital or to a different hospital within 30 days of discharg...
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Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue. We evaluated trends in DXA ordering before and after Choosing Wisely recommendations were released. We found no significant difference in ordering trends suggesting that other initiatives are needed to change behavior. Intr...
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Background: States have attempted to reduce prescription opioid abuse through strengthening the regulation of pain management clinics; however, the effect of such measures remains unclear. We quantified the impact of Texas's September 2010 "pill mill" law on opioid prescribing and utilization. Methods: We used the IMS Health LRx LifeLink databas...
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BACKGROUND: Dabigatran is a direct thrombin inhibitor approved by the FDA in October 2010 for the treatment of nonvalvular atrial fibrillation. Little is known regarding patient adherence to this therapy. OBJECTIVE: To examine adherence and persistence to dabigatran among adults with atrial fibrillation. METHODS: We used IMS Health's LifeLink Healt...
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Prescription Drug Monitoring Program (PDMP) and pill mill laws are among the principal means states use to reduce prescription drug abuse and diversion, yet little high-quality evidence exists regarding their effect. To quantify the effect of Florida's PDMP and pill mill laws on overall and high-risk opioid prescribing and use. We applied comparati...
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Women with pregnancy complications benefit from closer monitoring postpartum and beyond. Increased postpartum emergency room (ER) use may indicate unmet need for outpatient obstetrics and primary care. The purpose of this study was to evaluate whether women with pregnancy complications (gestational diabetes [GDM], gestational hypertension, and pree...
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BACKGROUND Patients with cancer frequently transition between different types of specialists and across care settings. This study explored how frequently the surgical and medical oncology care of stage III colon cancer patients occurred across more than 1 hospital and whether this was associated with mortality and costs.METHODS This was a retrospec...
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Objectives To determine the real world safety of dabigatran or rivaroxaban compared with warfarin in terms of gastrointestinal bleeding. Design Retrospective cohort study. Setting Large administrative database of commercially insured people in United States from 1 October 2010 through 31 March 2012. Participants Enrollees with a prescription of war...
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Collaboration between specialists is essential for achieving high-value care in patients with complex cancer needs. We explore how collaboration between oncologists and surgeons affects mortality and cost for patients requiring multispecialty cancer care. This was a retrospective cohort study of patients with stage III colon cancer from SEER-Medica...
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To examine the relationship between different anti-diabetic therapies (dipeptidyl peptidase-4 (DPP-4), metformin and sulfonylureas) and risk of acute pancreatitis among type 2 diabetic patients in Taiwan, and explore each drug's dose-response relationship. We derived a nationwide retrospective cohort of patients with type 2 diabetes in Taiwan. The...
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PurposeWe quantified the degree to which the August 2010 reformulation of abuse-deterrent OxyContin affected its use, as well as the use of alternative extended-release and immediate-release opioids.Methods We used the IMS Health National Prescription Audit, a nationally representative source of prescription activity in the USA, to conduct a segmen...
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The per capita number of outpatient visits in which an antipsychotic drug was supplied or prescribed increased approximately 660% among children and 380% among adolescents between the mid-1990s and the mid-2000s in the United States,¹ prompting concerns about possible inappropriate prescribing. The most recent revisions to the DSM-5 were intended i...
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Overuse can be defined as use of a service when the risk of harm exceeds its likely benefit. Yet, there has been little work with composite measures of overuse. Our goal was to create a composite measure of overuse with claims data. Observational study using 5% of Medicare claims from 2008. All inpatient and outpatient settings of care, excluding n...
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Objectives To describe changes in the prevalence and severity of pain and prescribing of non-opioid analgesics in U.S. emergency departments from 2000-2010. Methods Analysis of serial cross-sectional data regarding emergency department visits from the National Hospital Ambulatory Medical Care Survey. Visits were limited to patients ≥ 18 years old...
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Importance In 2011, an estimated 26.8 million US adults used prescription medications for mental illness.Objective To estimate the numbers and rates of adverse drug event (ADE) emergency department (ED) visits involving psychiatric medications among US adults between January 1, 2009, and December 31, 2011.Design and Setting Descriptive analyses...
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Background: Because pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy, are risk factors for diabetes and cardiovascular disease, post-delivery follow-up is recommended. Objective: To determine predictors of post-delivery primary and obstetric care utilization in women with and without...
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To describe changes in the prevalence and severity of pain and prescribing of non-opioid analgesics in US emergency departments (EDs) from 2000 to 2010. Analysis of serial cross-sectional data regarding ED visits from the National Hospital Ambulatory Medical Care Survey. Visits were limited to patients ≥18 years old without malignancy. Outcome meas...
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Health care quality is frequently described with measures representing the overall performance of a health care system. Despite the growing attention to overuse of health care resources, there is little experience with aggregate measures of overuse. To identify a set of possible indicators of overuse that can be operationalized with claims data and...
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Objective: Bariatric surgery can reduce the risk of obesity-related complications of pregnancy, but may cause essential nutrient deficiencies. To assess adherence to laboratory testing guidelines, we examined frequency of testing for and diagnosis of deficiency during preconception and pregnancy using claims data in women with a delivery and baria...
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Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of nonmalignant pain. The aim of the study was to characterize the diagnosis and management of nonmalignant pain in ambulatory, office-based settings in the United States between 2000 and 2010. Serial cross-sectional and multivaria...
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Background: Because laboratory test results are less available to researchers than claims data, a claims-based indicator of diabetes improvement would be valuable. Objectives: To determine whether a decrease in medication use for diabetes parallels clinical improvement in glycemic control. Study design: This was a retrospective cohort study us...
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Objective: Previous randomized clinical trials and their meta-analyses have raised the possibility that thiazolidinediones (rosiglitazone and pioglitazone) may increase the risk of pneumonia. We aimed to test the hypothesis that thiazolidinediones may increase the risk of pneumonia. Design: Population based case-control study using a new user desig...