Robin E Clark

Robin E Clark
University of Massachusetts Medical School | UMMS · Department of Family Medicine and Community Health

PhD

About

123
Publications
11,760
Reads
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5,973
Citations
Additional affiliations
October 2003 - September 2014
University of Massachusetts Medical School
Position
  • Senior Director of Research and Evaluation

Publications

Publications (123)
Article
Full-text available
Objective Develop and implement a prescription opioid registry in 10 diverse health systems across the US and describe trends in prescribed opioids between 2012 and 2018. Materials and Methods Using electronic health record and claims data, we identified patients who had an outpatient fill for any prescription opioid, and/or an opioid use disorder...
Article
Objective: This cross-sectional study examined the association between nursing home quality and admission of working-age persons (ages 22-64 years) with serious mental illness. Methods: The study used 2015 national Minimum Data Set 3.0 and Nursing Home Compare (NHC) data. A logistic mixed-effects model estimated the likelihood (adjusted odds rat...
Article
Objectives Persons aged <65 years account for a considerable proportion of US nursing home residents with schizophrenia. Because they are often excluded from psychiatric and long-term care studies, a contemporary understanding of the characteristics and management of working-age adults (22-64 years old) with schizophrenia living in nursing homes is...
Article
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Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experi...
Article
Homelessness during pregnancy poses significant health risks for mothers and infants. As health care providers increase their emphasis on social determinants of health, it is important to understand how unstable housing contributes to complications during pregnancy. We linked data about emergency shelter enrollees with Massachusetts Medicaid claims...
Presentation
US guidelines regarding when to stop routine breast cancer surveillance with mammography screening remain unclear. Consequently, it is unclear if a long-term care population receives this service. The objectives of this cross-sectional study were to estimate the extent to which mammography screening occurs among US long-term care nursing home resid...
Article
Objective: United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mamm...
Article
Objectives: To describe longitudinal health service utilization and expenditures for homeless family members before and after entering an emergency shelter. Methods: We linked Massachusetts emergency housing assistance data with Medicaid claims between July 2008 and June 2015, constructing episodes of health care 12 months before and 12 months a...
Article
Aims: To identify factors associated with the receipt of specialty substance use treatment among adults with opioid use disorders (OUD). Design: Cross-sectional study based on 2010-2014 National Surveys on Drug Use and Health (NSDUH). Setting and participants: Adults with a past-year OUD (n = 2488). The sample is representative of non-institut...
Article
Purpose The purpose of this study was to explore perceptions of experiences and challenges with methadone maintenance treatment (MMT) and obstetrical care among pregnant and postpartum women enrolled in a methadone maintenance program. Research Design The study featured a grounded theory approach including two focus groups with pregnant and postpa...
Article
Background and Aims Unintended pregnancy rates are high among women with substance use disorders (SUDs), which could be explained partly by lower use of and adherence to contraception. We aimed to test: (1) the association of SUD with prescription contraceptive use, contraceptive method selection and adherence; (2) whether practices participating i...
Article
This report describes the process of providing integrated care for patients with substance use disorders at three sites in central Massachusetts: Edward M. Kennedy Community Health Center, Family Health Center of Worcester, and Community Healthlink. It identifies common practices that improve care coordination and presents key findings.
Article
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Background: Sofosbuvir (SOF)- or simeprevir (SIM)-containing regimens are highly effective for treating chronic hepatitis C virus (HCV) infection. These regimens, however, are expensive. Most payers have implemented prior authorization (PA) requirements to ensure that patients who can benefit most have priority for these medications. While many Me...
Conference Paper
Background: The Expanded Gaming Act was passed by the Massachusetts Legislature (2011) permitting three casinos and a slots parlor. Previous research explored associations between gambling behavior, socio-demographic characteristics, and mental health disorders. Research is needed to better understand correlations between gambling and diagnosis of...
Article
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Objectives: We examined factors associated with frequent hospitalizations and emergency department (ED) visits among Medicaid members who were homeless. Methods: We included 6494 Massachusetts Medicaid members who received services from a health care for the homeless program in 2010. We used negative binomial regression to examine variables asso...
Article
Clinical trials show that opioid agonist therapy (OAT) with methadone or buprenorphine is more effective than behavioral treatments, but state policymakers remain ambivalent about covering OAT for long periods. We used Medicaid claims for 52,278 Massachusetts Medicaid beneficiaries with a diagnosis of opioid abuse or dependence between 2004 and 201...
Article
Background: Buprenorphine is the most frequently prescribed medication for treating substance use disorders in the United States, but few studies have evaluated the structure of treatment delivered in real-world settings. The purpose of this study is to investigate adherence to current buprenorphine treatment guidelines using administrative data f...
Conference Paper
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Research Objective 12 states currently place lifetime limits on the duration of opioid agonist treatment (OAT) with methadone or buprenorphine. Limits range from 6 to 36 months with most set at 12 months. We analyze the duration, outcomes and costs of opioid treatment among Massachusetts Medicaid members to understand the potential impact of trea...
Article
Persons who abuse opioids or are dependent on opioids are at elevated risk for arrest. Co-occurring behavioral health problems may exacerbate that risk, although the extent of any such increase has not been described. This study examines such risk factors among 40,238 individuals with a diagnosis of opioid abuse or dependence who were enrolled in t...
Article
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Objectives: This study had two aims: to measure the prevalence of long-term prescribing of high doses of antipsychotics and antipsychotic polypharmacy in a large Canadian province and to estimate the relative contributions of patient-, physician-, and hospital-level factors. Methods: Government hospital discharge, physician, and pharmaceutical c...
Article
Objective To assess the impact of a 2008 dose-based prior authorization policy for Massachusetts Medicaid beneficiaries using buprenorphine + naloxone for opioid addiction treatment. Doses higher than 16 mg required progressively more frequent authorizations.Data SourcesMediciaid claims for 2007 and 2008 linked with Department of Public Health (DPH...
Article
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This presentation details the impact of state Medicaid programs placing lifetime limits on buprenorphine therapy for individuals with opioid dependence. The research reveals that setting limits does not save money or help the patient.
Article
Policy interventions that attempt to influence patient care can be hard to implement and their desired outcomes can be slow to achieve. The efforts of the Centers for Medicare and Medicaid Services (CMS) to reduce preventable infections by withholding payment for additional expenses related to catheter-associated urinary tract infections (CAUTI) il...
Article
Full-text available
Objective: Despite the large number of Latinos living in the United States, little research has evaluated the effectiveness of different vocational rehabilitation programs for individuals with severe mental illness in this rapidly growing minority population. This article presents a secondary analysis of a randomized, controlled trial comparing su...
Conference Paper
Research Objective In the MA PCMHI, a state-wide, three-year multi-payer demonstration of patient centered medical home implementation, we collected quantitative data at pre-intervention and at the mid-point of the project using the Medical Home Implementation Quotient (MHIQ) from TransforMED. Our objectives were: to evaluate the progress toward ad...
Conference Paper
Objective: We examined factors associated with frequent hospitalizations and emergency department (ED) visits among Medicaid insured homeless individuals to help states prepare for the upcoming Medicaid expansion. This study provides a unique perspective since most individuals in existing homeless studies are uninsured. Methods: We identified 6,4...
Article
Objectives: We studied 6494 Boston Health Care for the Homeless Program (BHCHP) patients to understand the disease burden and health care utilization patterns for a group of insured homeless individuals. Methods: We studied merged BHCHP data and MassHealth eligibility, claims, and encounter data from 2010. MassHealth claims and encounter data pr...
Article
Abuse of prescription opioids is an increasing national concern. Recent reports point to growing rates of overdose, addiction, emergency department visits, and death attributable to nonmedical use of prescription pain medications.1,2Opioid misuse and addiction has an especially important impact on Medicaid programs; rates of drug abuse among covere...
Article
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This presentation discusses the impact of prior authorization on Buprenorphine dose, relapse, and cost for opioid addiction treatment for Massachusetts Medicaid members. Presented at the AcademyHealth Annual Research Meeting 2013.
Article
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Background: Clozapine remains the antipsychotic of choice for people who, having met the criteria for a diagnosis of schizophrenia or a related psychotic disorder, do not respond adequately to other antipsychotic medications. Utilization rates appear highly variable across jurisdictions, with an overall tendency toward underuse. This paper describ...
Article
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Antisocial personality disorder (ASPD) is an important correlate of substance abuse severity in the addiction population and in people with co-occurring serious mental illness and addiction. Because family members often provide vital supports to relatives with co-occurring disorders, this study explored the correlates of ASPD in 103 people with co-...
Article
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Substance use disorders have a profound impact on the course of severe mental illnesses and on the family, but little research has evaluated the impact of family intervention for this population. To address this question, a randomized controlled trial was conducted comparing a brief (2-3 mo) Family Education (ED) program with a longer-term (9-18 mo...
Article
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Objective: Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability. Methods: Individual-level data were obtained for women enrolled in Massachusetts Medicaid Managed Care plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screen...
Article
We examined the 12-month diagnosed prevalence of behavioral health disorders (BHDs) and dementia among elderly Medicare and Medicaid members in Massachusetts by primary payment source group (dual eligible, Medicare only, and Medicaid only) and age group (65-74 years, 75-84 years, and 85 years and older). A retrospective cross-sectional study. Medic...
Conference Paper
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Background: Buprenorphine, used to treat opioid addiction, requires physicians to have special Drug Enforcement Agency certification to prescribe. There are wide geographic variations in buprenorphine use. The purpose of this study was to identify state-level influences on buprenorphine prescribing using a limited set of supply and demand measures....
Article
To examine the association between mental illness and chronic physical conditions in older adults and investigate whether co-occurring substance use disorders (SUDs) are associated with greater risk of chronic physical conditions beyond mental illness alone. A retrospective cross-sectional study. Medicare and Medicaid programs in Massachusetts. Mas...
Article
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Many state Medicaid programs restrict access to buprenorphine, a prescription medication that relieves withdrawal symptoms for people addicted to heroin or other opiates. The reason is that officials fear that the drug is costlier or less safe than other therapies such as methadone. To find out if this is true, we compared spending, the use of serv...
Article
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Despite the demonstrated need to increase screening mammography utilization and strong evidence that mail and telephone outreach to women can increase screening, most managed care organizations have not adopted comprehensive outreach programs. The uncertainty about optimum strategies and cost effectiveness have retarded widespread acceptance. While...
Article
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The study investigated whether Massachusetts beneficiaries of Medicare, Medicaid, or both programs who have behavioral disorders have higher rates of diabetes-related complications and hospitalizations. This was a retrospective study using merged Medicare and Medicaid claims data from Massachusetts in 2004 and 2005. The study included beneficiaries...
Article
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This presentation describes barriers to evidence-based medication development, availability, and use; and introduces some of the scientific tools and approaches, such as comparative effectiveness research, that address these barriers. Context: Medication-assisted treatment for opioid dependence.
Article
To examine factors affecting prenatal and postpartum care for an insured, but vulnerable, population. Individual-level data on three measures of care adequacy were obtained for Massachusetts Medicaid Managed Care women who met the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set denominator criteria for th...
Article
Some studies have shown that patients entering buprenorphine treatment differ from those in other modalities. This study compares Massachusetts Medicaid beneficiaries who received buprenorphine, methadone or other treatment for opioid addiction in 2007. Patients' characteristics and comorbidities were identified through claims data, and association...
Article
Full-text available
To investigate whether Medicare and/or Medicaid beneficiaries with behavioral health disorders (BHDs) receive lower quality diabetes care. Retrospective observational study using merged Medicare and Medicaid claims data from Massachusetts in calendar years 2004 and 2005. The study included beneficiaries who had type 2 diabetes, stayed at nursing ho...
Article
Many state Medicaid programs restrict access to buprenorphine, a prescription medication that relieves withdrawal symptoms for people addicted to heroin or other opiates. The reason is that officials fear that the drug is costlier or less safe than other therapies such as methadone. To find out if this is true, we compared spending, the use of serv...
Article
Objective: Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability. Methods: Individual-level data were obtained for women enrolled in Massachusetts Medicaid Managed Care plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screen...
Conference Paper
Objective: Analyze disparities in prenatal and postpartum care for an insured, but vulnerable, population. Design: Individual-level data were obtained for women who met the NCQA’s Health Plan Employer Data and Information Set (HEDIS) denominator criteria for prenatal and postpartum quality of care measures. Two measures were collected for prenatal...
Article
Full-text available
Citation: Clark RE, Leung G, Lin W, O’Connell E and Zhang J. Behavioral Health Service Use and Expenditures in Massachusetts Medicare and Medicaid Members Aged 55 and Over, 2005. Center for Health Policy and Research. October 2009. [Government report] Summary: This report describes behavioral health service use and expenditures for Massachusetts Me...
Article
The relative performance of asthma care quality measures has not been evaluated in Medicaid populations. Using complete claims and pharmaceutical data for 19,076 patients with persistent asthma (based on Health Effectiveness and Data Information Set criteria) in five Medicaid populations, we compared the following two measures of asthma care qualit...
Article
Clients with severe mental illness and substance use disorder (i.e., dual disorders) frequently have contact with family members, who may provide valuable emotional and material support, but have limited skills and knowledge to promote recovery. Furthermore, high levels of family conflict and stress are related to higher rates of relapse. The prese...
Article
Most health insurance plans monitor ambulatory care quality using the Healthcare Effectiveness Data and Information Set (HEDIS), publicly reporting results at the plan level. Plan-level comparisons obscure the influence of patients served or settings where care is delivered. Mental illness, substance abuse, and other physical comorbidities, particu...
Article
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Little is known about ethnic and racial disparities in mental health care among Medicaid beneficiaries. The association between ethnicity and race and the utilization of mental health care was explored in six Medicaid programs. The analysis distinguished between different settings of care, including community-based, outpatient hospital, inpatient,...
Article
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This study measured the impact of substance use disorders on Medicaid expenditures for behavioral and physical health care among beneficiaries with behavioral health disorders. Claims for Medicaid beneficiaries with behavioral health diagnoses in 1999 from Arkansas, Colorado, Georgia, Indiana, New Jersey, and Washington were analyzed. Behavioral he...
Article
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The purpose of this study was to investigate whether the presence of substance-related disorders or mental illness may affect the quality of medication management in asthma care. Claims from 1999 for adult Medicaid patients with persistent asthma from five states were analyzed. Sample sizes ranged from 1,207 to 5,815. The adjusted odds of meeting t...
Article
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This report describes the 12-month diagnosed prevalence of behavioral health disorders (BHDs) among Massachusetts Medicare and Medicaid (MassHealth) members 55 years of age and older during calendar year 2005. Although population-based estimates of prevalence of BHDs among the elderly are available in only a few selected studies, none of them descr...
Article
: National goals for improving asthma outcomes include decreasing emergency room utilization and increasing adherence to outpatient treatment guidelines. Few studies have examined the impact of substance use disorders on asthma treatment. The objective of this study was to describe correlations between substance use disorders and patterns of health...
Article
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Medicaid agencies are beginning to turn to care management to reduce costs and improve health care quality. One challenge is selecting members at risk of costly, preventable service utilization. Using claims data from the State of Vermont, we compare the ability of three pre-existing health risk predictive models to predict the top 10 percent of me...
Article
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Fear of losing health insurance is believed to be a significant work barrier for people with disabilities in the US. We examined the relationship of different types of daily activity limitations to work outcomes among adults with a variety of disabling conditions for whom the risk of losing health insurance has been removed by enrolling in a Medica...
Article
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This study described the locations and patterns of psychiatric and substance abuse treatment for Medicaid beneficiaries with co-occurring mental and substance use disorders in five states. Medicaid beneficiaries aged 21 to 65 with psychiatric or substance use disorders were identified with claims and encounter records. Groups were further divided i...
Article
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The quadrant model was developed to organize the heterogeneous group of persons with co-occurring psychiatric and substance use disorders and to anticipate differential use of systems of care. The purpose of the study presented here was to test the feasibility of applying the model to classify persons with co-occurring disorders, examine the reliab...
Article
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The Ticket to Work and Work Incentives Improvement Act of 1999 removes work disincentives and promotes access to vocational services for people with disabilities. This study calculated the amount of payments that would have been made to employment service providers if study participants had been enrolled in the Ticket program. Data were from 450 So...
Article
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Working-age adults with severe disabilities face many barriers to reaching their employment potential. One important barrier is the concern that working will result in the loss of Medicaid benefits, which cover many needed healthcare services for people with disabilities at little or no cost. Now offered by over 30 states, Medicaid buy-in programs...
Article
Over the past 50 years, psychosocial treatment has played an increasingly prominent role in helping persons with mental illness live in communities rather than in institutions. This paper briefly reviews evidence for and discusses three forms of treatment-assertive community treatment, supported employment, and cognitive behavior treatment-which ha...
Article
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Few studies have explored correlates of antisocial personality disorder (ASPD) and psychopathy among individuals with severe mental illness and co-occurring substance use disorder. This study examined the reliability and validity of measures of ASPD and psychopathy among 203 clients with dual disorders and their prospective relationship to criminal...
Article
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Health care utilization and cost data have challenged analysts because they are often correlated over time, highly skewed, and clumped at 0. Traditional approaches do not address all these problems, and evaluators of mental health and substance abuse interventions often grapple with the problem of how to analyze these data in a way that accurately...
Article
There is concern about an increasing incidence of kernicterus in healthy term neonates in the United States. Although the incidence of kernicterus is unknown, several potential strategies that are intended to prevent kernicterus have been proposed by experts. It is necessary to assess the costs, benefits, and risks of such strategies before widespr...
Article
The authors compared 3 approaches to vocational rehabilitation for severe mental illness (SMI): the individual placement and support (IPS) model of supported employment, a psychosocial rehabilitation (PSR) program, and standard services. Two hundred four unemployed clients (46% African American, 30% Latino) with SMI were randomly assigned to IPS, P...
Article
BACKGROUND: Benzodiazepines have many benefits for persons with severe mental disorders, but they may also lead to or exacerbate substance abuse. An American Psychiatric Association taskforce established practice guidelines in 1990 to assist physicians in managing these and other potential side effects of benzodiazepine use. The objectives of this...
Article
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The little information available about prescribing patterns for persons with posttraumatic stress disorder comes from male combat-veteran populations treated through programs of the Department of Veterans Affairs. The objective of this study was to comprehensively evaluate prescribing patterns for persons with a diagnosis of posttraumatic stress di...