Archived Research Posters

Primary Category: Surveillance, Community Needs Assessment, Pedagogy


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Comparative Analysis of the Effectiveness and Safety of Drug-eluting Versus Bare-metal Coronary Stents Among Patients Registered in the Multi-Payer Claims Database

Presenter: Jessica Bermudez (School of Public Health (UMD) Epidemiology and Biostatistics Master's Student)

Author(s):

Bermudez, Jessica (UMD SPH Epidemiology)

Carter-Pokras, Olivia (UMD SPH Epidemiology)

Avila-Tang, Erika (Food and Drug Administration)

Abstract: There is conflicting evidence as to whether bare metal stents (BMS) or drug-eluting stents (DES) are more effective at preventing restenosis. The purpose of this study is to compare the safety and effectiveness of BMS versus DES in the coronary artery using unconventional and potentially more efficient post-market surveillance methods. A retrospective cohort study was conducted of 217,654 Medicare, Medicaid, and private insurance beneficiaries ages 41 year and older who were treated with coronary stenting between January 2007 and December 2010. Incidence of coronary health outcomes was measured for 2-3.5 years after stent implantation using claims data and assessed using Cox proportional regression models stratified by gender and race. At baseline, DES recipients were younger, had higher rates of ischemia and high cholesterol, and had lower rates of prior myocardial infarction and hypertension compared to BMS recipients. Compared to BMS, DES use was associated with a significant reduction of myocardial infarction (HR: 0.811; CI: [0.774, 0.84]), coronary artery bypass graft (HR 0.627; CI: [0.590, 0.666]), and repeat percutaneous coronary intervention (HR 0.910; CI: [0.888, 0.933]) at a median follow-up of 659 days.
Primary Category: Health Care, Access, Insurance


Secondary Category: Family, Child, Adolescent Health (Includes Maternal & Child Health)


Year: 2015

Title: N/A

Presenter: Boudreaux, Michel

Author(s):

Boudreaux, Michel (HMD SPH Health Services Administration)

Abstract: This paper examines the long-term impact of exposure to Medicaid in early childhood on adult health and economic status. The staggered timing of Medicaid’s adoption across states created meaningful variation in cumulative exposure to Medicaid for birth cohorts that are now in adulthood. Analyses of the Panel Study of Income Dynamics data suggest exposure to Medicaid in early childhood (age 0-5) is associated with statistically significant and meaningful improvements in adult health (age 25-54), and this effect is only seen in the subgroups targeted by the program. We find no evidence of an economic effect, although these results are imprecise. Using separate data we find evidence of two mechanisms that could plausibly link Medicaid’s introduction to long-term outcomes: contemporaneous increases in health services utilization for children, and reductions in family medical debt.
Primary Category: Health Disparities


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Racial Disparities in Use of Physical Therapy among Elderly with Chronic Back Pain

Presenter: Olivia Carter-Pokras (School of Public Health (UMD) Epidemiology and Biostatistics Faculty)

Author(s):

Carter-Pokras, Olivia (SPH/EPIB)

Chen, Jie (SPH/HSA)

Abstract: Objective: Examine racial/ethnic disparities in use of physical therapy among elderly adults with chronic back pain. Methods: Cross-sectional study using Medical Expenditure Panel Survey (2000-2012). Means comparison, multivariate logistic regression, and Blinder-Oaxaca decomposition techniques were used to estimate the likelihood of receiving any physical therapy by race/ethnicity. Population Studied: Elderly adults (>=65 years), with diagnosis of back pain (ICD9=724), who self-reported having pain for more than 12 months. Our sample included 3,375 Non-Hispanic Whites (Whites), 426 Non-Hispanic Blacks (Blacks), and 439 Hispanics. Results: White seniors with chronic back pain (19.9%) were more likely to receive physical therapy than Blacks (9.9%) or Hispanics (13.4%). After taking into account socioeconomic and other access factors, Blacks with chronic back pain remained less likely to receive physical therapy than Whites (OR=0.49, p<.01). Seniors with chronic back pain who reported very good/excellent mental health (p<.01), were women (p=.02), and/or had at least 12 years of education (p<.01) were significantly more likely to receive physical therapy than other seniors. Decomposition results showed that family income was the major reason associated with disparities among Whites vs. Blacks. Implications for Policy, Delivery or Practice: Moderate evidence exists that post-treatment exercises can reduce back pain recurrences (Choi, Verbeek, Tam, Jiang, 2011). Although medically necessary outpatient physical therapy is covered under Medicare Part B ($1,940 for physical therapy in 2015), our findings suggest that socioeconomic factors drive racial disparities in receipt of physical therapy for chronic back pain, providing further evidence to support the upcoming National Pain Strategy.
Primary Category: Behavioral Health, Mental Health, Substance Abuse


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Approaches to using national and state data to understand how sexual orientation and access to healthcare affects substance abuse in adult women

Presenter: Lauren Crook (School of Public Health (UMD) Behavioral and Community Health Doctoral Student)

Author(s):

Crook, Lauren (UMD SPH Behavioral and Community Health)

Zanjani, Faika (UMD SPH Behavioral and Community Health)

Abstract: Over four million women in the United States are classified as non-heterosexual, with sexual orientations such as lesbian, bisexual, and queer. Existing research indicates that non-heterosexual women face significant burdens to accessing healthcare. Compared to heterosexual women, non-heterosexual women are more likely to be poor, uninsured, and unstably housed or homeless, creating many cost-related hurdles to care. Non-heterosexual women also have poorer health outcomes than their counterparts, including drastically high rates of alcohol, illicit drug, and tobacco use. This research seeks to utilize a unique two-pronged approach to analyze the effect of sexual orientation and access to healthcare on substance abuse outcomes, on both national and local scales. The 2013 National Health Interview Survey (NHIS), the first survey to have generalizable results to the national lesbian, gay, and bisexual (LGB) community, will provide a country-wide snapshot of this relationship. NHIS women respondents were predominantly white (74.2%) and Hispanic (17.4), with a mean age of 49 years. The 2012 California Health Interview Survey (CHIS), whose female respondents were also primarily white (60%) and Hispanic (22%), with a slightly higher mean age of 55 years, will then provide a more localized perspective. California is a unique state to examine because although it has consistently been at the nation’s forefront for advancing the health, social acceptance, and political standing of LGB individuals, it also has higher than national average rates of illicit drug use and alcohol abuse. Examining these variables on both national and state levels will provide a multidimensional picture of how these variables interact, to better understand the unique health needs of non-heterosexual women. This research will be unique by analyzing a nationally representative sample and a statewide sample of adult women, to obtain a better understanding of how sexual orientation and access to healthcare relate to substance abuse outcomes.
Primary Category: Health Care, Access, Insurance


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Medicare and Private Spending Trends From 2008 to 2012 Diverge in Texas

Presenter: Luisa Franzini (School of Public Health (UMD) HLSA Faculty)

Author(s):

Franzini, Luisa (UMD SPH)

Taychakhoonavudh, Suthira (Chulalongkorn University)

Parikh, Rohan (University of Texas SPH)

White, Chapin (RAND corporation)

Abstract: The recent relatively slow growth in health care spending masks significant differences among payers, clinical settings, and geographic areas. To better understand the spending slowdown, we focus on 2008-2012 trends in Texas among Medicare feefor- service beneficiaries and enrollees in Blue Cross Blue Shield of Texas (BCBSTX). Spending per person for Medicare grew only 1.5% per year on average, compared with 5.2% for BCBSTX. In Medicare, utilization rates were relatively flat, while prices grew more slowly than input prices. In BCBSTX, spending growth was driven by increases in negotiated prices, in particular hospital prices. We find that geographic variation declined sharply in Medicare, due to drops in spending on post–acute care in two notoriously high-spending regions but rose slightly in BCBSTX. The aggregate spending trends mask two divergent stories: spending growth in Medicare is very slow, but price increases continue to drive unsustainable spending growth among the privately insured.
Primary Category: Health Care, Access, Insurance


Secondary Category: Health Disparities


Year: 2015

Title: Preventive Care Utilization Among the Uninsured by Race/Ethnicity and Income

Presenter: Craig Holden (School of Public Health (UMD) Health Services Administration Doctoral Student)

Author(s):

Holden, Craig (UMD SPH Health Services Administration)

Chen, Jie (UMD SPH Health Services Administration)

Dagher, Rada (UMD SPH Health Services Administration)

Abstract: Background: Health insurance status affects access to preventive services. Effective use of preventive services is a key factor in the reduction of important health concerns and has the potential to enable adults to live longer, healthier lives. Purpose: To analyze the use of U.S. Preventive Services Task Force (USPSTF)-recommended preventive services among uninsured adults, with a focus on variation across race, ethnicity, and household income. Methods: Using pooled 2004–2011 Medical Expenditure Panel Survey data, this study conducted multivariate logistic regressions to estimate variation in receipt of eight USPSTF-recommended preventive services by race/ethnicity among adults aged 18 years and older uninsured in the previous year. Stratified analyses by household income were applied. Data were analyzed in 2013. Results: Uninsured adults received preventive services far below Healthy People 2020 targets. Among the uninsured, African Americans had higher odds of receiving Pap tests, mammograms, routine physical checkups, and blood pressure checks according to guidelines than whites. Moreover, compared to whites, Hispanics had higher odds of receiving Pap tests, mammograms, influenza vaccinations, and routine physical checkups and lower odds of receiving blood pressure screening and advice to quit smoking. When results were stratified by household income, racial/ethnic differences persisted except for the highest income levels (≥400% Federal Poverty Level), where they were largely non-significant. Conclusions: Generally, uninsured African American and Hispanic populations fare better than uninsured Whites in preventive service utilization. Future research should examine reasons behind these racial/ethnic differences to inform policy interventions aiming to increase preventive service utilization among the uninsured.
Primary Category: Health Care, Access, Insurance


Secondary Category: Health Literacy, Health Communications, Health Education


Year: 2015

Title: Improving Patient Engagement: An Examination of Two Federally Qualified Health Centers (FQHC)

Presenter: Meaghan McHugh (School of Public Health (UMD) Behavioral and community health Doctoral Student)

Author(s):

McHugh, Meaghan (UMD)

Boekeloo, Bradley (UMD)

Bellows, Denise (UMD)

Bulbulia, Jeannine (UMD)

Abstract: The provider-patient relationship is considered by many to be critically important in the health care continuum, especially for individuals struggling to manage multiple chronic diseases. Nowhere is this relationship more essential than for lower-income and aging populations who rely on government assistance and Medicaid, such as those who access health care through Federally Qualified Health Centers (FQHCs). As part of a continuous quality improvement initiative, FQHCs in Maryland and Washington D.C. partnered with the Prevention Research Center at the University of Maryland’s School of Public Health to examine health literacy, patient self-management and patient safety. This patient-centered research included the collection of both qualitative and quantitative data through focus groups, in-depth interviews and self-administered surveys involving both patients and providers. The 329 adult patient participants had a median age of 54yrs (including over 65% of the patients >50 years). Focus group patient demographics included 92% African American, 48% female and 88% of participating clients with household income of less than $10,000 per year. The 20 provider participants were 100% African American with most providers having worked with the FQHC for over 5 years. Researchers will describe their findings regarding patient and provider perspectives on the Affordable Care Act (ACA), effective strategies for patient-provider communication, best practices for medication adherence, and topics related to transportation and access to services.
Primary Category: Health Care, Access, Insurance


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Global Budgets and Ambulatory Care Sensitive Conditions in Maryland Hospitals

Presenter: Karoline Mortensen (School of Public Health (UMD) Health Services Administration Faculty)

Author(s):

Mortensen, Karoline (Health Services Administration)

Chen, Jie (Health Services Administration)

Perman, Chad (Health Management Associates)

Boudreaux, Michel (Health Services Administration)

Mortensen, Karoline

Abstract: Research Objective: The state of Maryland implemented global budgets in all of its 46 acute care hospitals in 2014, budgeting 95% of total hospital revenues in the state. The pilot program, Total Patient Revenue (TPR), providing global budgets for rural hospitals, began in eight rural hospitals on July 1, 2010. One major goal of this innovative budgeting strategy is to provide hospitals with financial support to invest in infrastructure to prevent ambulatory care sensitive conditions by providing preventive care to the community of patients in each hospital’s surrounding area. The goal of this investigation is examine the effectiveness of implementing innovative payment mechanisms in rural hospitals in reducing ambulatory care sensitive conditions. Study Design: The Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality (AHRQ) were used to identify discharges for ambulatory care sensitive conditions. Consistent with the AHRQ approach, we used ICD-9 codes in the discharge data to classify the PQIs: diabetes short-term and long-term complications, chronic obstructive pulmonary disease or asthma in older adults, hypertension, heart failure, dehydration, bacterial pneumonia, urinary tract infection, angina without procedure, uncontrolled diabetes, asthma in younger adults, and overall, acute, and chronic composite measures. The PQI ratio for each discharge uses the indicator for the presence of the PQI in the numerator and the population count in the patient’s county in the denominator. We use an ordinary least squares difference-in-differences estimation approach comparing ambulatory care sensitive discharge rates in treatment hospitals to those in control hospitals, accounting for hospital fixed effects. Population Studied: This analysis uses 2008-2012 data from the Hospital Cost and Utilization Project (HCUP) State Inpatient Databases (SID), encompassing the universe of 2,236,835 discharges of Maryland residents over the five year period. The experiences of the eight rural treatment hospitals that implemented TPR in 2010 are compared to the 38 control hospitals that did not adopt global budgets during the study period. Principal Findings: Ambulatory care sensitive discharge rates were statistically significantly higher in treatment than control hospitals during the study period. Multivariate regression results show that overall PQI composite rates in Maryland hospitals have dropped statistically significantly since 2010 (coefficient on the Post variable= -.0023, p<.01). However, these rates have not dropped more steeply in the treatment hospitals than the control hospitals (coefficient on the interaction between Treatment*Post= .01, p=.413). Conclusions: Ambulatory care sensitive discharge rates have dropped in the state of Maryland since 2010. These promising reductions can’t be attributed solely to the adoption of global budgets in rural hospitals, since the rates are dropping in both the treatment and control hospitals. Future research using rural control hospitals outside of the state of Maryland should be explored. Implications for Policy or Practice: Several states are watching the innovative payment mechanisms in Maryland closely as they are considering global budgets for their hospitals and all-payer payment systems. The Centers for Medicare & Medicaid Services is monitoring whether Maryland achieve the triple aim of better health, enhanced outcomes and lower per capita costs.
Primary Category: Health Care, Access, Insurance


Secondary Category: Health Disparities


Year: 2015

Title: Ambulatory Care Accreditation of Federally Qualified Health Centers and Improvements in Quality of Care

Presenter: Suma Nair (School of Public Health (UMD) HSLA Doctoral Student)

Author(s):

Nair, Suma (UMD SPH Health Services Administration)

Chen, Jie (UMD SPH Health Services Administration)

Abstract: Background: HRSA-supported federally qualified health centers (FQHCs) have a long history of participating in quality improvement activities such as ambulatory care accreditation; however, evidence of the effect of accreditation on quality of care or patient health outcomes is still lacking. Methods: We conducted a cross-sectional study of 1,198 FQHCs in the United States using 2013 Uniform Data System data. Multivariate regressions were used to estimate the association between accreditation and 14 measures of FQHC quality of care and patient health outcomes, controlling for patient and institutional characteristics. We also predicted the national estimates of accreditation supported improvement in quality of care. Results: Accredited FQHCs served large patient populations, including racial/ethnic minority patients, and had lower medical costs per patient, compared with non-accredited FQHCs. Accredited FQHCs had significantly higher performance on adult weight screening and counselling (coef=0.036, p<.05), tobacco use cessation counselling (coef=.041, p<.05), and use of lipid lowering therapy for patients with coronary artery disease (coef=.028, p<.05). Aggregated estimates showed that accreditation could have supported over 638,200 additional patients to receive weight assessment and counseling, 801,400 additional patients to receive tobacco use cessation counselling, and 29,400 additional patients with coronary artery disease to receive lipid-lowering therapy, annually. Conclusions: This is the first study to examine the relationship between FQHC accreditation and quality. Findings suggest that federal support for accreditation may improve quality of care in FQHCs; and quality recognition programs such as accreditation and patient centered medical home can serve as important levers for achieving national quality and health equity goals.
Primary Category: Family, Child, Adolescent Health (Includes Maternal & Child Health)


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Factors Associated with Contraceptive Use among Urban, African-American Adolescent Mothers

Presenter: Deirdre Quinn (School of Public Health (UMD) FMSC Doctoral Student)

Author(s):

Quinn, Deirdre (UMD SPH Family Science)

Lewin, Amy (UMD SPH Family Science)

Mitchell, Stephanie

Abstract: Adolescent mothers face many obstacles to effective parenting, including poverty, low maternal self-esteem, and low levels of social support. Experiencing a rapid repeat pregnancy can limit a mother’s educational and employment opportunities, and increase risk of preterm and low birth weight. Research has found several factors associated with repeat pregnancy among teenagers, including inconsistent contraceptive use and a non-supportive family environment. Baseline data (n=150) were collected from in-person interviews with teen mothers when their children were, on average, 2 months old. Follow-up data (n=120) were collected when children were 12 months. Examined variables include social support, social strain, depression, and being in a romantic relationship with the baby’s father. Bivariate cross-sectional analyses were conducted at the baseline and 12-month time points. At baseline, contraceptive use (any vs. none) was significantly associated with social support (r = .177, p < 0.05). Being in a romantic relationship with the father of the baby was significantly and negatively associated with maternal depression (r = -.217, p < 0.01), and significantly and positively associated with perceived social support (r = .246, p < 0.01). In addition, social support and maternal depression were significantly and negatively associated (r = -.222, p < 0.01). At 12 month follow-up, contraceptive use was no longer significantly associated with social support. Being in a romantic relationship remained significantly associated with maternal depression (r = -.247, p < 0.01) and social support (r = .276, p < 0.01). When intervention and comparison groups were analyzed separately, contraceptive use was significantly negatively associated with perceived social strain only for the comparison group. These preliminary findings suggest that support relationships and perceived support and strain may play a role in teen mothers’ contraceptive use. Further analysis will be conducted to better understand the relationship between these variables, and to control for participation in the intervention.
Primary Category: Health Literacy, Health Communications, Health Education


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Use of recommended communication techniques by Maryland nurse practitioners

Presenter: Sarah D. Radice (School of Public Health (UMD) Center for Health Literacy Staff)

Author(s):

Horowitz, Alice M. (UMD SPH Behavioral and Community Health)

Wang, Min Qi (UMD SPH Behavioral and Community Health)

Radice, Sarah D. (UMD SPH Center for Health Literacy)

Kleinman, Dushanka V. (MD SPH Epidemiology and Biostatistics)

Maybury, Catherine (UMD SPH Center for Health Literacy)

Abstract: Objectives. We examined nurse practitioners’ use of recommended communication techniques for the promotion of oral health as part of a Maryland state-wide oral health literacy assessment. Methods. A 27-item self-report survey, containing 17 communication technique items, across 5 domains, was mailed to all licensed nurse practitioners (NPs) in Maryland. Results. The effective response rate was 18.6% (N=263). More than 80% of NPs routinely used 3 of the 7 basic communication techniques: simple language, limiting to 2-3 concepts, and speaking slowly. Over half of the NPs routinely used the teach-back method. NPs who assessed their practice for patient-friendliness or who had taken a communication course reported use of more of the 7 basic communication techniques compared to those who had not done either. NPs in Maryland self-reported routinely using some health-literate and patient-centered communication practices and techniques Conclusions. Our findings should be verified with future observational research analyzing transcripts of NP-patient encounters. Graduate and continuing education for NPs should increase emphasis on health-literate and patient-centered communication techniques to improve routine use of these to promote oral health and prevent dental caries.
Primary Category: Family, Child, Adolescent Health (Includes Maternal & Child Health)


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Young Maternal Age and Babies' Apgar Score

Presenter: Lauren M Ramsey (School of Public Health (UMD) Family Science Doctoral Student)

Author(s):

Ramsey, Lauren (School of Public Health)

Hofferth, Sandra (School of Public Health)

Abstract: Background: The Apgar scoring system was developed as a tool to evaluate the physical condition of an infant shortly after delivery. Low Apgar Scores are associated with increased risk of neonatal death for infants. Teenage mothers have been found to be at increased risk for poor birth outcome, including delivering babies with lower Apgar scores. Objective: Two research questions were tested to examine the association between maternal age and babies’ Apgar score: 1) Is there an association between young maternal age and Apgar score? 2) Does inadequate prenatal care mediate the relationship between young maternal age and Apgar score? Methods: Secondary data analysis of the NCHS 2008 Cohort Linked Birth/Death data file examined associations between maternal age and the Apgar Score of the babies of 63,313 Black and White women who delivered a live birth in the U.S. Logistic and linear regression were used to conduct a mediation analysis to test the role of prenatal care utilization on the relationship between young maternal age and Apgar Score. Results: Babies of teen mothers had lower Apgar Scores than babies delivered by women who were aged 20-34. In addition, teen mothers were 50% less likely to have adequate care. Inadequate prenatal care explains 10% of the lower Apgar scores of teen mothers. Conclusion: Receiving adequate prenatal care remains an important contributor to the health of teen mothers’ babies. Improving access to timely prenatal care would be beneficial for infants born to adolescent mothers.
Primary Category: Health Disparities


Secondary Category: Health Care, Access, Insurance


Year: 2015

Title: Educating Elderly African Americans to Restore Sound (EARS)

Presenter: Jamila M. Torain (School of Medicine (UMB) Gerontology Doctoral Student)

Author(s):

Torain, Jamila (UMB SOM Gerontology)

Brown, Jessica (UMB SOM Public Health)

Resnick, Barbara (UMB SON Nursing)

St. George, Diane Marie (UMB SOM Public Health)

Abstract: Cultural sensitivity is being aware that cultural differences and similarities exist, and have an effect on values, learning, and behavior. Currently, there are a limited number of programs designed to educate elderly African Americans about age-related hearing loss. Findings reported are predominantly based on White samples. EARS was a culturally sensitive, age-related hearing loss educational program, developed to increase the awareness and knowledge of low-income (all sites were covered by the section 8 project-based subsidy) elderly African American residents of three senior housing complexes in Baltimore. The program included an interactive presentation of material, a Jeopardy-like game, a presentation on two programs that subsidize the cost of hearing aids, and a pre- and post-test. This program used relatable educational materials and employed program volunteers of similar cultural backgrounds and ethnicities. In spring 2014, a total of 54 residents participated in the one-day program. Participants were 96% elderly (65 and older) African Americans and 100% low-income. Knowledge gain was assessed by the percentage increase in number of hands raised for each question. There was a 68.5%, 14.8%, and 37% increase in number of hands raised for question topics signs of hearing loss, self-assessment, and plan to utilize services respectively. There was a 42.6%, 63%, and 63% increase in hands raised for plan to seek programs, dangers of hearing loss, and psychosocial effects respectively. Approximately 11% of residents (6/54) self-reported utilizing health services after the program. Culturally sensitive interventions may be effective in increasing knowledge in elderly African Americans with lower incomes.