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Davidoff A.J.,Agency for Healthcare Research and Quality | Gardner L.D.,Epidemiology and Public Health | Zuckerman I.H.,IMPAQ International LLC | Hendrick F.,ReSearch Pharmaceutical Services | And 2 more authors.
Medical Care | Year: 2014

BACKGROUND:: In prior research, we developed a claims-based prediction model for poor patient disability status (DS), a proxy measure for performance status, commonly used by oncologists to summarize patient functional status and assess ability of a patient to tolerate aggressive treatment. In this study, we implemented and validated the DS measure in 4 cohorts of cancer patients: early and advanced non-small cell lung cancers (NSCLC), stage IV estrogen receptor-negative (ER-) breast cancer, and myelodysplastic syndromes (MDS). DATA AND METHODS:: SEER-Medicare data (1999-2007) for the 4 cohorts of cancer patients. Bivariate and multivariate logistic regression tested the association of the DS measure with designated cancer-directed treatments: early NSCLC (surgery), advanced NSCLC (chemotherapy), stage IV ER- breast cancer (chemotherapy), and MDS (erythropoiesis-stimulating agents). Treatment model fit was compared across model iterations. RESULTS:: In both unadjusted and adjusted results, predicted poor DS was strongly associated with a lower likelihood of cancer treatment receipt in all 4 cohorts [early NSCLC (N=20,280), advanced NSCLC (N=31,341), stage IV ER- breast cancer (N=1519), and MDS (N=6058)] independent of other patient, contextual, and disease characteristics, as well as the Charlson Comorbidity Index. Inclusion of the DS measure into models already controlling for other variables did not significantly improve model fit across the cohorts. CONCLUSIONS:: The DS measure is a significant independent predictor of cancer-directed treatment. Small changes in model fit associated with both DS and the Charlson Comorbidity Index suggest that unobserved factors continue to play a role in determining cancer treatments. © 2014 by Lippincott Williams & Wilkins.


Erdem E.,IMPAQ International LLC | Concannon T.W.,Tufts University
Journal of Comparative Effectiveness Research | Year: 2012

Background: Medicare claims data sets have been used widely in outcomes research over the last decade. In 2010, the Centers for Medicare & Medicaid Services established a program to create de-identified basic standalone public use files (PUFs) from Medicare claims data, each one containing claims information from a 5% sample of beneficiaries. Methods: We conducted a series of structured key informant interviews with research stakeholders to compile recommendations that would guide the creation of these PUFs. In this paper, we describe the interview methodology and present our findings. Fifteen researchers, representing a range of clinical health services and health policy expertise, were interviewed. Results: All respondents supported the use of Medicare claims in comparative effectiveness research and responded favorably to the creation of PUFs for this purpose. The interviews resulted in administrative-, technical- and content-related recommendations, some of which led to important changes in the PUFs. Discussion: A primary trade-off in the development of the proposed PUFs involved assuring maximum research utility of the files while assuring security of beneficiaries' protected health information. Protection of protected health information was considered a requirement. Given this constraint, the proposed PUFs may be most useful for two primary activities in comparative effectiveness research: first, working through the beginning stages of a research project; and second, examining high-level questions. © 2012 Future Medicine Ltd.


Gundersen C.G.,Urbana University | Garasky S.B.,IMPAQ International LLC
Journal of Nutrition | Year: 2012

Food insecurity is one of the leading public health challenges facing children in the United States today. Reducing food insecurity and its attendant consequences requires an understanding of the determinants of food insecurity. Although previous work has greatly advanced our understanding of these determinants, the role of one of the oft-speculated important determinants of food insecurity, household financial management skills, has not been considered. To address this research lacuna, we use a recently conducted survey, the Survey of Household Finances and Childhood Obesity, that has information on specific financial management practices, impressions of financial management skills, and households' food insecurity. The sample included 904 households with children. Within this sample, 19.3% were food insecure and, for our central financial management skill variable, the mean value was 3.55 on a 5-point scale. Probit regression models estimated the probability of a household being food insecure as conditional on financial management skills and other covariates. We found a large and significant inverse relationship between a respondent's use of specific financial management practices and food insecurity and between a respondent's confidence in his or her financial management skills and food insecurity. That is, households with greater financial management abilities are less likely to be food insecure. This finding also holds when the sample is restricted to households with incomes <200% of the poverty line. These results suggest that improving households- financial management skills has the potential to reduce food insecurity in the United States. © 2012 American Society for Nutrition.


Erdem E.,IMPAQ International LLC | Prada S.I.,Research Center for Social Protection and Health Economics | Prada S.I.,ICESI University | Haffer S.C.,MediCaid
Medicare and Medicaid Research Review | Year: 2013

Objective: Analyze differences in Medicare Fee-for-Service utilization (i.e., program payments) by beneficiary characteristics, such as gender, age, and prevalence of chronic conditions. Methods: Using the 2008 and 2010 Chronic Conditions Public Use Files, we conduct a descriptive analysis of enrollment and program payments by gender, age categories, and eleven chronic conditions. Results: We find that the effect of chronic conditions on Medicare payments is dramatic. Average Medicare payments increase significantly with the number of chronic conditions. Finally, we quantify the effect of individual conditions and find that "Stroke/Transient Ischemic Attack" and "Chronic Kidney Disease" are the costliest chronic conditions for Part A, and "Cancer" and "Chronic Kidney Disease" are the costliest for Part B.


Ampaabeng S.K.,IMPAQ International LLC | Tan C.M.,University of North Dakota
Journal of Health Economics | Year: 2013

We examine the role of early childhood health in human capital accumulation. Using a unique data set from Ghana with comprehensive information on individual, family, community, school quality characteristics and a direct measure of intelligence together with test scores, we examine the long-term cognitive effects of the 1983 famine on survivors. We show that differences in intelligence test scores can be robustly explained by the differential impact of the famine in different parts of the country and the impacts are most severe for children under two years of age during the famine. We also account for model uncertainty by using Bayesian Model Averaging. © 2013 Elsevier B.V.


Kahn K.L.,RAND Corporation | Kahn K.L.,University of California at Los Angeles | Weinberg D.A.,IMPAQ International LLC | Leuschner K.J.,RAND Corporation | And 3 more authors.
Medical Care | Year: 2014

BACKGROUND:: Historically, the ability to accurately track healthcare-associated infections (HAIs) was hindered due to a lack of coordination among data sources and shortcomings in individual data sources. OBJECTIVES:: This paper presents the results of the evaluation of the HAI data and the monitoring component of the Action Plan, focusing on context (goals), inputs, and processes. RESEARCH DESIGN:: We used the Content-Input-Process- Product framework, together with the HAI prevention system framework, to describe the transformative processes associated with data and monitoring efforts. RESULTS:: Six HAI priority conditions in the 2009 Action Plan created a focus for the selection of goals and activities. Key Action Plan decisions included a phased-in data and monitoring approach, commitment to linking the selection of priority HAIs to highly visible national 5-year prevention targets, and the development of a comprehensive HAI database inventory. Remaining challenges relate to data validation, resources, and the opportunity to integrate electronic health and laboratory records with other provider data systems. CONCLUSIONS:: The Action Plan's data and monitoring program has developed a sound infrastructure that builds upon technological advances and embodies a firm commitment to prioritization, coordination and alignment, accountability and incentives, stakeholder engagement, and an awareness of the need for predictable resources. With time, and adequate resources, it is likely that the investment in data-related infrastructure during the Action Plan's initial years will reap great rewards. © 2014 by Lippincott William and Wilkins.


Cataife G.,IMPAQ International LLC | Weinberg D.A.,IMPAQ International LLC | Wong H.-H.,Health-U | Kahn K.L.,RAND Corporation
Medical Care | Year: 2014

BACKGROUND:: The Surgical Care Improvement Project (SCIP) has developed a set of process compliance measures in an attempt to reduce the incidence of surgical site infections (SSIs). Previous research has been inconclusive on whether compliance with these measures is associated with lower SSI rates. OBJECTIVES:: To determine whether hospitals with higher levels of compliance with SCIP measures have lower incidence of SSIs and to identify the measures that are most likely to drive this association. DATA AND METHODS:: Analysis of linked SCIP compliance rates and SSIs on 295 hospital groups observed annually over the study period 2007-2010. A hospital group comprises all hospitals sharing identical categories for location by state, teaching status, bed size, and urban/rural location. We used a generalized linear model regression with logistic link and binomial family to estimate the association between 3 SCIP measures and SSI rates. RESULTS:: Hospital groups with higher compliance rates had significantly lower SSI rates for 2 SCIP measures: antibiotic timing and appropriate antibiotic selection. For a hospital group of median characteristics, a 10% improvement in the measure provision of antibiotic 1 hour before intervention led to a 5.3% decrease in the SSI rates (P<0.05). Rural hospitals had effect sizes several times larger than urban hospitals (P<0.05). A third-core measure, Timely Antibiotic Stop, showed no robust association. CONCLUSIONS:: This analysis supports a clinically and statistically meaningful relationship between adherence to 2 SCIP measures and SSI rates, supporting the validity of the 2 publicly available healthcare-associated infection metrics. © 2014 by Lippincott William and Wilkins.


Weinberg D.A.,IMPAQ International LLC | Kahn K.L.,RAND Health | Kahn K.L.,University of California at Los Angeles
Medical Care | Year: 2014

BACKGROUND:: In response to the growing concern about healthcare-associated infections (HAIs), US Department of Health and Human Services (HHS) developed the National Action Plan to Prevent Healthcare-associated Infections. A key focus of the Action Plan is the setting of HAI metrics and targets and the enhancement and development of data systems to support HAI surveillance. OBJECTIVES:: To identify and assess the strengths and weaknesses of HHS data systems available for surveillance of catheter-associated urinary tract infections, surgical site infections, and Clostridium difficile infections. To present national data from each of the data systems and assess concordance in trends over time. RESEARCH DESIGN:: Literature review on data system characteristics and HAI measurement. Graphical and descriptive analyses of longitudinal HAI rates from HHS data systems. MEASURES:: HAI rate information expressed as prevalence rates or standardized infection ratios. RESULTS:: We identified four HHS data systems-Medicare claims data, Healthcare Cost and Utilization Project, Medicare Patient Safety Monitoring System, and National Healthcare Safety Network-capable of surveillance of at least one of the HAIs under study. Surgical site infection and Clostridium difficile infection rates display concordance in trends, although there is no evidence of concordance in catheter-associated urinary tract infections rates. We have identified a number of desirable HAI data system characteristics: clinically valid; provide information on a broad range of HAIs; have large sample size to support statistical inference; be representative of the United States; and display consistency in cohort, surveillance protocols, and data collection methodology. CONCLUSIONS:: Although the data systems included in this study vary along the desirable data system dimensions we identified, trends in HAI rates are generally concordant across the data systems. This increases confidence in observed trends. © 2014 by Lippincott William and Wilkins.


Battles J.B.,Agency for Healthcare Research and Quality | Farr S.L.,IMPAQ International LLC | Weinberg D.A.,IMPAQ International LLC
Medical Care | Year: 2014

INTRODUCTION:: The Agency for Healthcare Research and Quality (AHRQ's) Patient Safety Program is responsive to AHRQ's mission of quality improvement in healthcare. As part of this program, AHRQ has invested in projects to prevent healthcare-associated infections (HAIs), and funding has increased significantly over the last decade. AHRQ-funded projects have focused on generating new knowledge and promoting the nationwide implementation of proven HAI prevention measures in diverse healthcare settings. OBJECTIVES:: To provide insight to AHRQ's HAI prevention strategies by: first, discussing the context and structure of AHRQ's HAI research portfolio and funding decisions; secondly, describing the process of prevention practice implementation and lessons learned; and third, explaining the outcomes and national impact of the AHRQ program. RESULTS AND CONCLUSIONS:: In the early 2000s, AHRQ identified HAIs as an important and preventable public health threat and built their HAI-prevention portfolio based on National Action Plan priorities, available resources, advice from experts, and the state of science. This paper describes major contributions that have emerged from AHRQ-funded HAI projects. The projects examined, many of which focus on implementation of HAI prevention practices, yield useful lessons learned for future implementation and research endeavors and show significant impact of AHRQ's program in reducing HAIs. © 2014 by Lippincott William and Wilkins.


Grant
Agency: NSF | Branch: Continuing grant | Program: | Phase: AISL | Award Amount: 600.89K | Year: 2015

Most students who pursue math have chosen to do so by high school. Elementary and middle school experiences are thus vitally important in attracting students to STEM. Research consistently points to after-school as a golden opportunity to increase students exposure to high-quality math learning opportunities and to develop the key influencers of math participation and persistence: interest and identity. However, more research on how and under what conditions after-school programs can foster these factors is needed. The role of identity in math education has been particularly neglected. The proposed research project addresses this gap by studying the implementation and outcomes of After-School Math PLUS (ASM+), an after-school math program designed to address all aspects of math identity and thus have a positive effect on this key influencer of math participation and achievement. Improving Math Identity is a Research-in-Service to Practice project funded by the Advancing Informal STEM Learning (AISL) Program which seeks to advance new approaches to, and evidence-based understanding of, the design and development of STEM learning in informal environments.

The team will study the impact of ASM+ through a rigorous randomized controlled trial of 30 elementary-level after-school sites in South Carolina serving predominately low-income and minority students (15 treatment using ASM+; 15 control using Mixing in Math). Sites selected into the study must serve fourth and fifth graders and must operate five days a week. Through an implementation study, data will be collected in order to assess the program and understand the experiences of group leaders and students in the ASM+ program and at comparison sites. Data sources include surveys, interviews, observations, and administrative data collected from the treatment and control sites. The study will investigate how and to what extent ASM+ develops fourth and fifth grade students math identity and increases math engagement and interest. It will explore whether increasing identity, engagement, and interest leads to greater skill development and academic achievement.

This research is being conducted by IMPAQ International LLC, a social science and public policy research and evaluation firm in collaboration with Educational Equity at FHI 360, a global development and education organization. The research addresses the need to enhance students math identity at an early age and, as a result, change students educational and career aspirations. The ultimate goal is to broaden participation in STEM by underrepresented groups. Results will inform the development of interventions designed to motivate and retain students in STEM, particularly in informal settings. Knowledge gained from this research will be broadly disseminated to practitioners, researchers, program developers, and policy makers.

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