Karen E Lasser

• Boston University

Value-based care models, such as Medicaid accountable care organizations (ACOs), have the potential to improve access to and quality of care for pregnant and postpartum Medicaid enrollees. We leveraged a natural experiment in Massachusetts to evaluate the effects of Medicaid ACOs on quality-of-care-sensitive measures and care use across the prenata...

Importance Models predicting health care spending and other outcomes from administrative records are widely used to manage and pay for health care, despite well-documented deficiencies. New methods are needed that can incorporate more than 70 000 diagnoses without creating undesirable coding incentives. Objective To develop a machine learning (ML)...

Background The extent to which sex, racial, and ethnic groups receive advanced heart therapies equitably is unclear. We estimated the population rate of left ventricular assist device (LVAD) and heart transplant (HT) use among (non‐Hispanic) White, Hispanic, and (non‐Hispanic) Black men and women who have heart failure with reduced ejection fractio...

Background Preventing progression to moderate or severe opioid use disorder (OUD) among people who exhibit risky opioid use behavior that does not meet criteria for treatment with opioid agonists or antagonists (subthreshold OUD) is poorly understood. The Subthreshold Opioid Use Disorder Prevention (STOP) Trial is designed to study the efficacy of...

Objective: Using data on 5 years of postexpansion experience, we examined whether the coverage gains from Affordable Care Act Medicaid expansion among Black, Hispanic, and White individuals led to improvements in objective indicators of outpatient care adequacy and quality. Research design: For the population of adults aged 45-64 with no insuran...

Background Hospitalization is an opportunity to engage underserved individuals in tobacco treatment who may not otherwise have access to it. Tobacco treatment interventions that begin during hospitalization and continue for at least 1 postdischarge month are effective in promoting smoking cessation. However, there is low usage of postdischarge toba...

Purpose Patients with unmet health-related social needs (HRSNs) often experience poor health outcomes and have high levels of healthcare utilization. We describe a program where dually trained pharmacy liaison–patient navigators (PL-PNs) screen for and address HRSNs while providing medication management services to patients with high levels of acut...

Objective: To estimate changes in the emergency department (ED) visit rate, hospitalization share of ED visits, and ED visit volumes associated with Medicaid expansion among Hispanic, Black, and White adults. Data collection/extraction methods: For the population of adults aged 26-64 with no insurance or Medicaid coverage, we obtained census pop...

Importance: Patients with unmet health-related social needs are at high risk for preventable health care utilization. Prior interventions to identify health-related social needs and provide navigation services with community resources have not taken place in pharmacy settings. Objective: To evaluate an enhancement of pharmacy care to reduce hosp...

BACKGROUND Hospitalization is an opportunity to engage underserved individuals in tobacco treatment who may not otherwise have access to it. Tobacco treatment interventions that begin during hospitalization and continue for at least 1 postdischarge month are effective in promoting smoking cessation. However, there is low usage of postdischarge toba...

Background The TOPCARE and TEACH randomized controlled trials demonstrated the efficacy of a multi-faceted intervention to promote guideline-adherent long-term opioid therapy (LTOT) in primary care settings. Intervention components included a full-time Nurse Care Manager (NCM), an electronic registry, and academic detailing sessions.Objective This...

PurposeMedicare requires tobacco dependence counseling and shared decision-making (SDM) for lung cancer screening (LCS) reimbursement. We hypothesized that initiating SDM during inpatient tobacco treatment visits would increase LCS among patients with barriers to proactively seeking outpatient preventive care. Methods We collected baseline assessme...

Introduction Studies have shown mixed findings regarding the impact of immigration policy changes on immigrants’ utilization of primary care. Methods We used a difference-in-differences analysis to compare changes in missed primary care appointments over time across two groups: patients who received care in Spanish, Portuguese, or Haitian Creole,...

Importance: Current disease risk-adjustment formulas in the US rely on diagnostic classification frameworks that predate the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Objective: To develop an ICD-10-CM-based classification framework for predicting diverse health care payment, quality, and perfor...

Importance There is limited evidence on whether the Affordable Care Act Medicaid expansion beginning in 2014 improved access to elective procedures. Uninsured individuals are at higher risk of obesity and may have experienced improved uptake of bariatric surgery following Medicaid expansion. Objective To examine the association between Medicaid ex...

Background Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited.Objective Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for c...

This cross-sectional study examines whether inpatient utilization among patients with lower socioeconomic status and among those who belong to racial/ethnic minority groups changed differentially in states that expanded Medicaid following the Patient Protection and Affordable Care Act (ACA).

Introduction Adding screening for health-related social needs to tobacco treatment interventions initiated during hospitalizations may improve intervention effectiveness among vulnerable populations. Our objective was to examine the effect the acceptability and feasibility of a intervention in which a patient navigator screens for and addresses soc...

Background Resilience is the ability to adapt to adverse life events. Studies that explore diabetes self-management interventions integrating resilience in African-Americans with diabetes include few African-American men, who have higher diabetes-related mortality and complication rates compared to African-American women. Design We conducted a cro...

As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with CO...

Objective To determine whether employing the services of a pharmacy liaison to promote medication adherence (usual care), relative to a pharmacy liaison with training in motivational interviewing and as a patient navigator who systematically screens for health-related social needs and provides targeted navigation services to connect patients with a...

Introduction Hepatitis C (HCV) infection is a significant health threat, with increasing incidence rates in the setting of the opioid crisis. Many patients miss appointments and cannot initiate treatment. We implemented financial incentives to improve appointment attendance in a primary care-based HCV treatment setting. Methods We conducted a syst...

Purpose Safety-net health systems, which serve a disproportionate share of patients at high risk for hepatitis C virus (HCV) infection, may use revenue generated by the federal drug discount pricing program, known as 340B, to support multidisciplinary care. Budgetary impacts of repealing the drug-pricing program are unknown. Our objective was to co...

Introduction: This exploratory study examined the relationship between receipt of counseling by a patient navigator and socio-demographic characteristics of primary care patients enrolled in a smoking cessation trial. Methods: We grouped intervention participants (n = 177) into two categories: 1) no or some contact with the navigator or 2) minim...

Objective: To identify reasons for opioid discontinuation and post-discontinuation outcomes among patients in the Transforming Opioid Prescribing in Primary Care (TOPCARE) study. Design: In TOPCARE, an intervention to improve adherence to opioid prescribing guidelines, randomized intervention primary care providers (PCPs) received nurse care man...

Objective: One approach to potential misuse of prescription opioids by patients with chronic pain is team-based collaborative primary care, with primary care visits complemented by frequent visits with nurse care managers (NCMs) specializing in addiction care. However, little is known about the communication strategies NCMs employ in these visits....

A. CCDG Facilitator's Guide.docx B. Cases.docx C. Survey.docx

Importance While the proportion of adults who smoke cigarettes has declined substantially in the past decade, socioeconomic disparities in cigarette smoking remain. Few interventions have targeted low socioeconomic status (SES) and minority smokers in primary care settings. Objective To evaluate a multicomponent intervention to promote smoking ces...

Importance Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines. Objective To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk. De...

Objective: To examine whether Massachusetts (MA) health reform affected substance (alcohol or drug) use disorder (SUD)-related hospitalizations in acute care hospitals. Data/study setting: 2004-2010 MA inpatient discharge data. Design: Difference-in-differences analysis to identify pre- to postreform changes in age- and sex-standardized popula...

Hepatitis C virus (HCV) infection is a major public health problem. Urban safetynet hospitals are a prime location for HCV treatment delivery. Showing that physicians in primary care settings can deliver HCV infection care is important to expand treatment; models doing so in the era of newer oral HCV medications are needed. This article describes a...

Academic medical centers (AMCs) are widely perceived as providing the highest-quality medical care. To investigate disparities in access to such care, we studied the racial/ethnic and payer mixes at private AMCs of New York City (NYC) and Boston, two cities where these prestigious institutions play a dominant role in the health care system. We used...

Introduction Diabetes self-management takes place within a complex social and environmental context. This study’s objective was to examine the perceived and actual presence of community assets that may aid in diabetes control. Methods We conducted one 6-hour photovoice session with 11 adults with poorly controlled diabetes in Boston, Massachusetts...

Objective: Most inpatient care for the uninsured and other vulnerable subpopulations occurs in safety-net hospitals. As insurance expansion increases the choice of hospitals for the previously uninsured, we examined if Massachusetts health reform was associated with shifts in the volume of inpatient care from safety-net to non-safety-net hospitals...

Background: Because of residential segregation and a lack of health insurance, minorities often receive care in different facilities than whites. Massachusetts (MA) health reform provided insurance to previously uninsured patients, which enabled them to potentially shift inpatient care to nonminority-serving or nonsafety-net hospitals. Objectives...

Despite the high risk of tobacco-related morbidity and mortality among low-income persons, few studies have connected low-income smokers to evidence-based treatments. We will examine a smoking cessation intervention integrated into primary care. To begin, we completed qualitative formative research to refine an intervention utilizing the services o...

Background: Prescription opioid misuse is a significant public health problem as well as a patient safety concern. Primary care providers (PCPs) are the leading prescribers of opioids for chronic pain, yet few PCPs follow standard practice guidelines regarding assessment and monitoring. This cluster randomized controlled trial will determine wheth...

Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes. To assess clinical operations factors' effects on normalization of uncontrolled BP. Observational cohort study....

To examine the impact of Massachusetts healthcare reform on changes in rates of admission to hospital for ambulatory care sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and racial and ethnic disparities in such rates, using complete inpatient discharge data (hospital episode statistics)...

To estimate the impact of the insurance expansion in 2006 on use of knee and hip replacement procedures by race/ethnicity, area income, and the use of hospitals that predominantly serve poor people ("safety net hospitals"). Quasi-experimental difference in differences study examining change after reform in the share of procedures performed in safet...

Little is known about variability in primary care providers' (PCPs) adherence to opioid-monitoring guidelines for patients. We examined variability of adherence to monitoring guidelines among PCPs and ascertained the relationship between PCP adherence and opioid misuse by their patients. We included primary care patients receiving long-term opioids...

Objective The aim of this study was to compare adherence to opioid prescribing guidelines and potential opioid misuse in patients of resident vs attending physicians.DesignRetrospective cross-sectional study.SettingLarge primary care practice at a safety net hospital in New England.SubjectsPatients 18–89 years old, with at least one visit to the pr...

After approval, many prescription medications that patients rely on subsequently receive new black-box warnings or are withdrawn from the market because of safety concerns. We examined whether the frequency of these safety problems has increased since 1992, when the Prescription Drug User Fee Act, legislation designed to accelerate the drug approva...

Objective: Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) are documented to be used less often among racial/ethnic minorities. Insurance coverage expansions, such as the 2006 Massachusetts (MA) reform and the 2010 Affordable Care Act, have the potential to reduce disparities in access to health care. Using the quas...

To analyse changes in overall readmission rates and disparities in such rates, among patients aged 18-64 (those most likely to have been affected by reform), using all payer inpatient discharge databases (hospital episode statistics) from Massachusetts and two control states (New York and New Jersey). Difference in differences analysis to identify...

We conducted a pilot randomized controlled trial to determine the feasibility and acceptability of a patient navigation intervention. Forty-seven smokers from one safety-net hospital were randomized to either a control group, in which they received a smoking cessation brochure and a list of smoking cessation resources, or a navigation group, in whi...

Objective: There is widespread concern that large-scale insurance expansion - such as that anticipated from the Affordable Care Act - has the potential to cause sharp increases in health care utilization and costs. In the setting of Massachusetts’ landmark 2006 health care reform, we estimated pre-reform to post-reform changes in inpatient care vol...

The 2006 Massachusetts health reform substantially decreased uninsurance rates. Yet, little is known about the reform's impact on actual health care utilization among poor and minority populations, particularly for receipt of inpatient surgical procedures that are commonly initiated by outpatient physician referral. Using discharge data on Massachu...

Background: Boston Medical Center (BMC) is the primary safety net hospital for Eastern Massachusetts and has a diverse patient population with diverse insurance types. Such types include commercial and public insurance (Medicare and Medicaid) and Free Care, limited coverage funded by money distributed to safety-net institutions to care for uninsure...

Research Objective: Massachusetts (MA) health reform increased the number of insured residents, particularly among racial/ethnic minorities. Yet, it is not known if this insurance expansion translated into improvements or decreased racial/ethnic disparities in access to medical care. Ambulatory care sensitive conditions (ACSCs) such as congestive h...

Introduction: After Massachusetts (MA) health reform, the percent of uninsured residents fell, particularly among minorities. Studies have not examined the effect of this policy change on 30-day readmission rates, and disparities in such rates, following acute myocardial infarction (AMI). Hypothesis : 30-day readmission rates will decline in patien...

BACKGROUND The 2006 Massachusetts (MA) health reform increased insurance coverage to near-universal levels, but its impact on access to care or disparities in access is unclear. We examined post-reform change in racial/ethnic differences in use of two cardiovascular (CV) procedures, percutaneous transluminal coronary angioplasty (PTCA) and coronary...

Background: Following Massachusetts (MA) health reform, the percent of uninsured residents fell from 8.4% to 3.4%, with larger gains among minorities. Prior studies have not examined the effect of this policy change on 30-day readmission rates for myocardial infarction (MI). We hypothesized that racial disparities in such admissions would decline i...

BACKGROUND The 2006 Massachusetts (MA) health reform increased insurance coverage to near-universal levels, but its impact on access to care is not known. We examined post-reform change in racial/ethnic differences in use of two cardiovascular procedures - percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG)...

Patient navigators may increase colorectal cancer (CRC) screening rates among adults in underserved communities, but prior randomized trials have been small or conducted at single sites and have not included substantial numbers of Haitian Creole-speaking or Portuguese-speaking patients. We identified 465 primary care patients from 4 community healt...

Objective To compare cancer screening and flu vaccination among persons with and without unhealthy substance use. Design The authors analysed data from 4804 women eligible for mammograms, 4414 eligible for Papanicolou (Pap) smears, 7008 persons eligible for colorectal cancer (CRC) screening and 7017 persons eligible for flu vaccination. All patient...

The Food and Drug Administration issues black-box warnings (BBWs) regarding medications with serious risks, yet physician adherence to the warnings is low. We evaluated the impact of delivering BBW-based alerts about drug-drug, drug-disease, and drug-laboratory interactions for prescription medications in outpatients in an electronic health record...

Few population-based data are available on the quality of outpatient care provided by resident physicians in the US. To assess the quality of outpatient care delivered by resident and staff physicians. Cross-sectional analysis. We used chi-square tests to compare resident and staff physician performance on 19 quality indicators. Using multivariable...

To compare diabetes care and outcomes among Haitians, African Americans, and non-Hispanic whites. We analyzed data from 715 Haitian, 1,472 African American, and 466 non-Hispanic white adults with diabetes using χ² testing and multiple logistic regression. Haitians had a higher mean A1C than African Americans (8.2 ± 1.9 vs. 7.7 ± 2.0%) and non-Hispa...

In this paper we explore whether uninsured Americans with three chronic conditions were less likely than the insured to be aware of their illness or to have it controlled. Among those with diabetes and elevated cholesterol, the uninsured were more often undiagnosed. Among hypertensives and people with elevated cholesterol, the uninsured more often...

A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine...

Colorectal cancer screening rates are low among poor and disadvantaged patients. Patient navigation has been shown to increase breast and cervical cancer screening rates, but few studies have looked at the potential of patient navigation to increase colorectal cancer screening rates. The objective was to determine the feasibility and effectiveness...

This article will review population-based nationally representative data on rates of smoking and tobacco cessation in adults with and without mental illness. We begin with a review of the methods and findings from the 1991–1992 National Comorbidity Survey. This study found that 41% of persons who had a mental illness in the past month were current...

We analyzed the prevalence of chronic illnesses, including mental illness, and access to health care among US inmates. We used the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities to analyze disease prevalence and clinical measures of access to health care for inmates. Among inmates i...

Free drug samples frequently are given to children. We sought to describe characteristics of free sample recipients, to determine whether samples are given primarily to poor and uninsured children, and to examine potential safety issues. We analyzed data on 10295 US residents <18 years of age from the 2004 Medical Expenditure Panel Survey, a nation...

Elderly minority patients are less likely to receive influenza vaccination and colorectal cancer screening than are other patients. Communication between primary care providers (PCPs) and patients may affect service receipt. Encounters between 7 PCPs and 18 elderly patients were observed and audiotaped at 2 community health centers. Three investiga...

No recent national studies have assessed chronic illness prevalence or access to care among persons without insurance in the United States. To compare reports of chronic conditions and access to care among U.S. adults, by self-reported insurance status. Population-based survey. National Health and Nutritional Examination Survey (1999-2004). 12,486...

Physician income varies threefold among specialties. Lower incomes have produced shortages in primary care fields. To investigate the impact of government policy on generating income differentials among specialties. Cross-sectional analysis of the 2004 MEPS. For outpatient care, total payments made to 27 different types of specialists from five typ...

As emergency department (ED) patient volumes increase throughout the United States, are patients waiting longer to see an ED physician? We evaluated the change in wait time to see an ED physician from 1997 to 2004 for all adult ED patients, patients diagnosed with acute myocardial infarction (AMI), and patients whom triage personnel designated as n...

Semi-structured Interview Schedule: Patient interview.

Colorectal cancer screening rates are low among disadvantaged patients; few studies have explored barriers to screening in community health centers. The purpose of this study was to describe barriers to/facilitators of colorectal cancer screening among diverse patients served by community health centers. We identified twenty-three outpatients who w...

Free prescription drug samples are used widely in the United States. We sought to examine characteristics of free drug sample recipients nationwide. We analyzed data on 32681 US residents from the 2003 Medical Expenditure Panel Survey (MEPS), a nationally representative survey. In 2003, 12% of Americans received at least 1 free sample. A higher pro...

Veterans Administration health care enrollment is restricted to veterans with service-connected problems and those who are poor. We sought to determine how many veterans were uninsured, trends in veterans' coverage, and whether uninsured veterans lacked access to medical care. We analyzed annual data from 2 federal surveys, the Current Population S...

There have been a number of highly publicized safety-based drug withdrawals in the United States in recent years. We conducted a review of drugs withdrawn since 1993 and examined trends in drug withdrawals. Our objective was to determine the frequency and characteristics of withdrawn drugs and trends since 1993, and to discuss the implications of t...

The objective of this study was to ascertain how much U.S. medical students are taught about and know about military medical ethics, the Geneva Conventions, and the laws governing conscription of medical personnel. The authors developed an Internet-based questionnaire on these matters, and e-mail invitations to participate were sent to approximatel...

We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status. We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immig...

Few data are available regarding the prevalence of potentially dangerous drug-drug, drug-laboratory, and drug-disease interactions among outpatients. Our objectives were to determine how frequently clinicians prescribe drugs in violation of black box warnings for these issues and to determine how frequently such prescribing results in harm. In an o...

Ethnic diversity and lower socioeconomic populations are poorly captured in most studies of osteoporosis and fracture risk. This article describes a prospective, observational study designed to analyze risk factors for fracture in an ambulatory, ethnically diverse, urban population aged >= 55 yr. The goal of the study was to determine the number of...

The objective was to determine whether race, language, or gender concordance between primary care providers (PCPs) and patients is associated with lower missed appointment rates in neighborhood health centers. An additional objective was to determine whether site of care is a determinant of missed appointment rates. In analyses of 74,120 follow-up...

Many U.S. military veterans lack health insurance and are ineligible for care in Veterans Administration health care facilities. Using two recently released national government surveys--the 2004 Current Population Survey and the 2002 National Health Interview Survey--the authors examined how many veterans are uninsured (lacking health insurance cov...

Ethnic diversity and lower socioeconomic populations are poorly captured in most studies of osteoporosis and fracture risk. This article describes a prospective, observational study designed to analyze risk factors for fracture in an ambulatory, ethnically diverse, urban population aged > or =55 yr. The goal of the study was to determine the number...

Disparities in mammography rates have been documented for underserved populations, yet no data are available for women with mental illness in primary care settings. We analyzed data on mammography rates for 526 women age 40-70 who were new patients and completed the Primary Care Evaluation of Mental Disorders (PRIME-MD). There were no significant d...

Recently approved drugs may be more likely to have unrecognized adverse drug reactions (ADRs) than established drugs, but no recent studies have examined how frequently postmarketing surveillance identifies important ADRs. To determine the frequency and timing of discovery of new ADRs described in black box warnings or necessitating withdrawal of t...

Older studies have found that minorities in the United States receive fewer mental health services than whites. This analysis compares rates of outpatient mental health treatment according to race and ethnicity using more recent, population-based data, from the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Ca...

Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking. To assess rates of smoking and tobacco cessation in adu...

Context Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking.Objective To assess rates of smoking and tobacco...

As emergency department (ED) patient volumes increase throughout the United States, are patients waiting longer to see an ED physician? We evaluated the change in wait time to see an ED physician from 1997 to 2004 for all adult ED patients, patients di- agnosed with acute myocardial infarction (AMI), and patients whom triage personnel desig- nated...

Objectives. A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data. Methods. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 6...

Results. Among all participants, 3.1% (95% confidence interval (CI)=2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body ma...