23 results on '"Katherine Diaz Vickery"'
Search Results
2. Notes from the Field: COVID-19 Vaccination Coverage Among Persons Experiencing Homelessness — Six U.S. Jurisdictions, December 2020–August 2021
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Adam Gerstenfeld, David Yeh, Laura Zeilinger, Martha P Montgomery, Emily Mosites, Rachael Gibbs, Nathalie C Washington, Blair Harrison, Alicia H Chang, Ayodele Gomih, Isaac Ghinai, Katherine Diaz Vickery, Antea Cooper, Hannah K Brosnan, Katerina S Stylianou, Cathy Ngo, Nikki Thomas-Campbell, Karrie-Ann Toews, Mary Kate Schroeter, Najibah Rehman, Ashley A Meehan, and Tyler N.A. Winkelman
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medicine.medical_specialty ,COVID-19 Vaccines ,Vaccination Coverage ,Health (social science) ,Coronavirus disease 2019 (COVID-19) ,Epidemiology ,business.industry ,Health, Toxicology and Mutagenesis ,Field (Bourdieu) ,MEDLINE ,COVID-19 ,General Medicine ,United States ,Health Information Management ,Family medicine ,Vaccination coverage ,Ill-Housed Persons ,medicine ,Humans ,business ,Notes from the Field - Published
- 2021
3. COVID-19 Vaccination Of People Experiencing Homelessness And Incarceration In Minnesota
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Riley D, Shearer, Katherine Diaz, Vickery, Peter, Bodurtha, Paul E, Drawz, Steve, Johnson, Jessica, Jeruzal, Stephen, Waring, Alanna M, Chamberlain, Anupam B, Kharbanda, Josh, Leopold, Blair, Harrison, Hattie, Hiler, Rohan, Khazanchi, Rebecca, Rossom, Karen L, Margolis, Nayanjot Kaur, Rai, Miriam Halstead, Muscoplat, Yue, Yu, R Adams, Dudley, Niall A M, Klyn, and Tyler N A, Winkelman
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COVID-19 Vaccines ,Minnesota ,Prisoners ,Prisons ,Ill-Housed Persons ,Vaccination ,COVID-19 ,Humans - Abstract
We used data from a statewide public health-health system collaboration to describe trends in COVID-19 vaccination rates by racial and ethnic groups among people experiencing homelessness or incarceration in Minnesota. Vaccination completion rates among the general population and people incarcerated in state prisons were substantially higher than those among people experiencing homelessness or jail incarceration.
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- 2022
4. Clinic- and Community-Based SARS-CoV-2 Testing Among People Experiencing Homelessness in the United States, March-November 2020
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Lauryn Berner, Ashley Meehan, Joseph Kenkel, Martha Montgomery, Victoria Fields, Ankita Henry, Alaina Boyer, Emily Mosites, and Katherine Diaz Vickery
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COVID-19 Testing ,SARS-CoV-2 ,Ill-Housed Persons ,Public Health, Environmental and Occupational Health ,COVID-19 ,Humans ,Ambulatory Care Facilities ,United States - Abstract
Objective: SARS-CoV-2 testing is a critical component of preventing the spread of COVID-19. In the United States, people experiencing homelessness (PEH) have accessed testing at health clinics, such as those provided through Health Care for the Homeless (HCH) clinics or through community-based testing events at homeless service sites or encampments. We describe data on SARS-CoV-2 testing among PEH in US clinic- and community-based settings from March through November 2020. Methods: We conducted a descriptive analysis of data from HCH clinics and community testing events. We used a standardized survey to request data from HCH clinics. We developed and made publicly available an online data entry portal to collect data from community-based organizations that provided testing for PEH. We assessed positivity rates across clinics and community service sites serving PEH and used generalized linear mixed models to account for clustering. Results: Thirty-seven HCH clinics reported providing 280 410 tests; 3.2% (n = 8880) had positive results (range, 1.6%-4.9%). By race, positivity rates were highest among people who identified as >1 race (11.6%; P < .001). During the reporting period, 22 states reported 287 community testing events and 14 116 tests; 7.1% (n = 1004) had positive results. Among facility types, day shelters (380 of 2697; 14.1%) and inpatient drug/alcohol rehabilitation facilities (32 of 251; 12.7%) reported the highest positivity rates. Conclusions: While HCH clinic data provided results for a larger number of patients, community-based testing data showed higher positivity rates. Clinic data demonstrated racial disparities in positivity. Community-based testing data provided information about SARS-CoV-2 transmission settings. Although these data provide information about testing, standard surveillance systems are needed to better understand the incidence of disease among PEH.
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- 2022
5. Development and Implementation of an Interdisciplinary Intensive Primary Care Clinic for High-Need High-Cost Patients in a Safety Net Hospital
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Nathan D. Shippee, Floyd Webb, Paul Johnson, Mark Linzer, William G. Heegaard, and Katherine Diaz Vickery
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Adult ,Male ,Adolescent ,Leadership and Management ,Safety net ,media_common.quotation_subject ,Ambulatory Care Facilities ,Young Adult ,medicine ,Per capita ,Financial stress ,Humans ,Program Development ,Fee-for-service ,health care economics and organizations ,Aged ,media_common ,Patient Care Team ,Health Services Needs and Demand ,Primary Health Care ,Health Policy ,Public Health, Environmental and Occupational Health ,Original Articles ,Middle Aged ,medicine.disease ,Payment ,Primary care clinic ,Female ,Patient Care ,sense organs ,Medical emergency ,Business ,Safety-net Providers - Abstract
In 2010, payment for some of Hennepin County Medical Center's highest need patients changed from fee for service to a per capita formula. This financial stress led the institution to employ a population health lens that revealed a significant concentration of spending on a small segment of the population. Finding high rates of potentially avoidable inpatient and emergency care, an organizational effort was initiated to attempt to manage this high-need, high-cost population more effectively. A freestanding interdisciplinary intensive primary care clinic was developed. Nurses led a risk stratification process to identify eligible patients for co-located medical, care coordination, and social services from multidisciplinary care teams. Workflows to engage the population were designed to reduce readmissions and inappropriate use of emergency services. Soon after opening, the clinic added mental health and substance use professionals. For people entering the clinic between January 2010 and July 2017, utilization and financial data were collected for the year before (pre) and after (post) enrollment (n = 487). Bivariate statistics and outlier analyses facilitated comparisons between pre/post enrollment. Patients visited the new clinic twice per month on average and outpatient costs almost doubled. Overall costs were 16% lower, with the largest decrease seen in inpatient costs. This experience has led to ongoing investment, replication, and expansion of the model. An interdisciplinary intensive primary care clinic for high-utilizing, underserved patients is a promising intervention. Multidisciplinary teams and ongoing institutional support are critical to program success. Payment reform is essential to the development of such programs.
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- 2020
6. Tobacco use among non-elderly adults with and without criminal justice involvement in the past year: United States, 2008–2016
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Andrew M. Busch, Tyler N.A. Winkelman, and Katherine Diaz Vickery
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Adult ,Male ,medicine.medical_specialty ,lcsh:Social pathology. Social and public welfare. Criminology ,Adolescent ,030508 substance abuse ,Disparities ,Disease ,lcsh:HV1-9960 ,Young Adult ,03 medical and health sciences ,symbols.namesake ,Sex Factors ,0302 clinical medicine ,Health care ,Prevalence ,Tobacco Smoking ,Humans ,Medicine ,030212 general & internal medicine ,Poisson regression ,lcsh:R5-920 ,Social work ,Cigarettes ,business.industry ,Prisoners ,Research ,Public health ,Tobacco control ,Smoking ,Age Factors ,General Medicine ,Middle Aged ,Patient Acceptance of Health Care ,United States ,Health psychology ,Tobacco use ,Criminal justice ,Socioeconomic Factors ,symbols ,Female ,0305 other medical science ,business ,lcsh:Medicine (General) ,Demography - Abstract
Background Tobacco use remains the leading cause of preventable disease and death in the United States and is concentrated among disadvantaged populations, including individuals with a history of criminal justice involvement. However, tobacco use among individuals with a history of criminal justice involvement has been understudied in the United States, and data are needed to inform policy and practice. Methods We used data from the 2008–2016 National Survey on Drug Use and Health (unweighted N = 330,130) to examine trends in tobacco use, categories of tobacco use, characteristics of cigarette use, and health care utilization and tobacco use screening among individuals (aged 18–64) with and without a history of criminal justice involvement in the past year. We used multiple logistic and Poisson regression models with predictive margins to provide adjusted prevalence estimates. Results The weighted sample in each year was, on average, representative of 8,693,171 individuals with a history of criminal justice involvement in the past year and 182,817,228 individuals with no history of criminal justice involvement in the past year. Tobacco use was significantly more common among individuals with a history of criminal justice involvement compared with individuals with no criminal justice involvement, and disparities increased over time (Difference in adjusted relative differences: − 10.2% [95% CI − 17.7 to − 2.7]). In 2016, tobacco use prevalence was more than two times higher among individuals with a history of criminal justice involvement (62.9% [95% CI 59.9–66.0] vs. 27.6% [95% CI 26.9–28.3]). Individuals with a history of criminal justice involvement who smoked reported a significantly earlier age of cigarette initiation, more cigarettes used per day, and higher levels of nicotine dependence and chronic obstructive pulmonary disease. Individuals with a history of criminal justice involvement were less likely to report an outpatient medical visit in the past year and, among those reporting an outpatient medical visit, were less likely to be asked about tobacco use, but paradoxically, more likely to report being advised to quit. Conclusions Novel programs and tobacco control policies are needed to address persistently high rates of tobacco use and reduce cardiovascular morbidity and mortality among individuals with a history of criminal justice involvement.
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- 2019
7. Electronic cigarette use patterns and chronic health conditions among people experiencing homelessness in MN: a statewide survey
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Katherine Diaz Vickery, Becky R Ford, Eleanor L S Leavens, Sandra J. Japuntich, Andrew M. Busch, Olamide Ojo-Fati, and Tyler N.A. Winkelman
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Adult ,Male ,medicine.medical_specialty ,Minnesota ,Population ,Disease ,Electronic Nicotine Delivery Systems ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Epidemiology ,Medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,education ,Asthma ,education.field_of_study ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Vaping ,010102 general mathematics ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Tobacco Products ,medicine.disease ,Mental health ,Health equity ,Ill-Housed Persons ,Female ,Biostatistics ,business ,Research Article - Abstract
Background Adults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness. Methods Adults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer). Results Frequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes. Conclusions During a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study.
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- 2020
8. Facilitating Visit Attendance with Staff Reminder Calls in a Safety-Net Clinic
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Miamoua Vang, Ellen Coffey, Nathan D. Shippee, Rebecca Freese, Katherine Diaz Vickery, and Mark Linzer
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business.industry ,Safety net ,Reminder Systems ,Attendance ,medicine.disease ,Appointments and Schedules ,Internal Medicine ,Medicine ,Humans ,Patient Compliance ,Medical emergency ,business ,Concise Research Report ,Safety-net Providers - Published
- 2020
9. Experiences with Work and Participation in Public Programs by Low-Income Medicaid Enrollees Using Qualitative Interviews
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Alan Manivannan, Nathan D. Shippee, Katherine Diaz Vickery, and Melissa Adkins-Hempel
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Employment ,Eligibility Determination ,Medicare ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,Medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,0101 mathematics ,Poverty ,Aged ,Original Research ,Medicaid managed care ,business.industry ,Medicaid ,010102 general mathematics ,Public relations ,Transparency (behavior) ,United States ,Work (electrical) ,Income Support ,business ,Criminal justice - Abstract
BACKGROUND: Centers for Medicare & Medicaid Services (CMS) began encouraging governors to implement work requirements for Medicaid enrollees using section 1115 waivers in 2018. Significant controversy surrounds such attempts, but we know little about the perceptions and experiences of enrollees. OBJECTIVE: To characterize experiences of work and its relationship to participation in Medicaid and other public programs among potential targets of Medicaid work requirements. DESIGN: In-depth, semi-structured, one-time qualitative interviews. PARTICIPANTS: 35 very low-income, non-disabled Medicaid expansion enrollees participating in a county-sponsored Medicaid managed care plan as a part of a larger study. APPROACH: We used a biographical narrative interpretive method during interviews including questions about the use of employment and income support and other public programs including from state and federal disability programs. Our team iteratively coded verbatim transcripts allowing for emergent themes. KEY RESULTS: Interview data revealed high motivation for, and broad participation in, formal and informal paid work. Eight themes emerged: (1) critical poverty (for example, “I’m not content, but what choices do I have?”); (2) behavioral and physical health barriers to work; (3) social barriers: unstable housing, low education, criminal justice involvement; (4) work, pride, and shame; (5) inflexible, unstable work (for example, “Can I have a job that will accommodate my doctor appointments?…Will my therapy have to suffer? You know? So it’s a double edged sword.”); (6) Medicaid supports the ability to work; (7) lack of transparency and misalignment of program eligibility (for example, “It’s not like I don’t want to work because I would like to work. It’s just that I don’t want to be homeless again, right?”); and (8) barriers, confusion, and contradictions about federal disability. CONCLUSIONS: We conclude that bipartisan solutions prioritizing the availability of well-paying jobs and planful transitions off of public programs would best serve very low-income, work-capable Medicaid enrollees.
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- 2019
10. Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health
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Nathan D. Shippee, Rodney A. Hayward, Dana Soderlund, Peter Bodurtha, Katherine Diaz Vickery, John E. Connett, Matthew M. Davis, Ross Owen, Mark Linzer, David M. Vock, and Jeremiah S Menk
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Adult ,Male ,medicine.medical_specialty ,Marginal structural model ,Subgroup analysis ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,Poverty ,Accountable Care Organizations ,Primary Health Care ,Medicaid managed care ,Medicaid ,business.industry ,Patient Protection and Affordable Care Act ,030503 health policy & services ,Health Policy ,Emergency department ,Middle Aged ,Patient Acceptance of Health Care ,United States ,Integrated care ,Family medicine ,Female ,Emergency Service, Hospital ,0305 other medical science ,business - Abstract
Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.
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- 2018
11. Awareness of Payment Reform: a Survey of Patients, Staff, and Providers in Safety Net Primary Care Clinics
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Katherine F. Guthrie, Katherine Diaz Vickery, Eileen M. Harwood, Becky R Ford, and Mark Linzer
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Primary Health Care ,business.industry ,Payment reform ,Safety net ,Primary care ,United States ,Nursing ,Health Care Reform ,Surveys and Questionnaires ,Internal Medicine ,Medicine ,Humans ,business ,Concise Research Report ,Safety-net Providers - Published
- 2019
12. Team-Based Care: Caring for the team under payment reform
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Mark Linzer, Katherine Diaz Vickery, Katherine F. Guthrie, and Becky R Ford
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Reimbursement Mechanisms ,Medical education ,Payment reform ,business.industry ,Health Care Reform ,Internal Medicine ,MEDLINE ,Medicine ,Humans ,business ,Concise Research Report ,United States - Published
- 2019
13. Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees
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Mark S. Legler, Erik Erickson, Nathan D. Shippee, Tyler N.A. Winkelman, Ross Owen, Katherine Diaz Vickery, Courtney Hougham, Latasha Jennings, Renee Van Siclen, and Peter Bodurtha
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Adult ,Male ,Chronic condition ,Urban Population ,Substance-Related Disorders ,Minnesota ,Eligibility Determination ,Insurance Coverage ,Article ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Criminal Law ,Patient Protection and Affordable Care Act ,Health care ,Humans ,030212 general & internal medicine ,Social determinants of health ,Human services ,health care economics and organizations ,Insurance, Health ,Primary Health Care ,business.industry ,Medicaid ,030503 health policy & services ,Public sector ,Public Health, Environmental and Occupational Health ,United States ,Housing ,Female ,0305 other medical science ,business ,Emergency Service, Hospital ,Criminal justice ,State Government - Abstract
Background: The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors. Objective: The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees. Research Design: We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement. Measures: Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes. Results: We found 6 archetypes of cross-sector involvement: The “Low Contact” class (33.9%) had little involvement in any public sector; “Primary Care” (26.3%) had moderate, stable health care utilization; “Health and Human Services” (15.3%) had high rates of health care and cash assistance utilization; “Minimal Criminal History” (11.0%) had less serious criminal justice involvement; “Cross-sector” (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; “Extensive Criminal History” (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs. Conclusions: Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.
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- 2018
14. A Community-Powered, Asset-Based Approach to Intersectoral Urban Health System Planning in Chicago
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HwaJung Choi, Stacy Tessler Lindau, Jennifer A. Makelarski, Amber Matthews, Katherine Diaz Vickery, and Matthew M. Davis
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Economic growth ,Population ,Business system planning ,Institute of medicine ,AJPH Research ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Urban planning ,Humans ,030212 general & internal medicine ,Sociology ,City Planning ,education ,Chicago ,education.field_of_study ,030505 public health ,Data collection ,Data Collection ,Economic sector ,Commerce ,Urban Health ,Public Health, Environmental and Occupational Health ,Censuses ,Census ,0305 other medical science ,Delivery of Health Care ,Urban health - Abstract
Objectives. To describe, and provide a nomenclature and taxonomy for classifying, the economic sectors and functional assets that could be mobilized as partners in an intersectoral health system. Methods. MAPSCorps (Meaningful, Active, Productive Science in Service to Community) employed local youths to conduct a census of all operating assets (businesses and organizations) on the South Side of Chicago, Illinois, in 2012. We classified assets by primary function into sectors and described asset and sector distribution and density per 100 000 population. We compared empirical findings with the Institute of Medicine’s (IOM’s) conceptual representation and description of intersectoral health system partners. Results. Fifty-four youths mapped a 62-square-mile region over 6 weeks; we classified 8376 assets into 23 sectors. Sectors with the most assets were food (n = 1214; 230/100 000 population), trade services (n = 1113; 211/100 000), and religious worship (n = 974;185/100 000). Several large, health-relevant sectors (2499 assets) were identified in the region but not specified in the IOM’s representation. Governmental public health, central to the IOM concept, had no physical presence in the region. Conclusions. Local youths identified several thousand assets across a broad diversity of sectors that could partner in an intersectoral health system. Empirically informed iteration of the IOM concept will facilitate local translation and propagation.
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- 2016
15. Medicaid expansion and mental health: A Minnesota case study
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Laura Guzman-Corrales, Katherine Diaz Vickery, Dana Soderlund, Scott T. Shimotsu, Mark Linzer, Ross Owen, and Pam Clifford
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Adult ,Male ,Mental Health Services ,Gerontology ,Minnesota ,Population ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Patient Protection and Affordable Care Act ,medicine ,Humans ,030212 general & internal medicine ,education ,Applied Psychology ,Retrospective Studies ,education.field_of_study ,Medicaid ,business.industry ,Mental Disorders ,030503 health policy & services ,Middle Aged ,Mental illness ,medicine.disease ,Mental health ,United States ,Integrated care ,Psychiatry and Mental health ,Housing ,Female ,0305 other medical science ,business ,Psychosocial - Abstract
INTRODUCTION The health status and psychosocial needs of the Medicaid expansion population have been estimated but not measured. This population includes childless adults predicted to have high rates of mental illness, especially among the homeless. Given limitations in access to mental health services, it is unclear how prepared the U.S. health care system is to care for the needs of the expansion population. METHOD Using enrollment and claims data from the Minnesota Department of Human Services, this study presents prevalence rates of mental illness diagnoses and measures of unstable housing in Minnesota's childless-adult early Medicaid expansion population. Rates are compared with prior predictions of serious psychological distress and mental illness constructed from the National Survey on Drug Use and Health (NSDUH) using χ2 and t tests. RESULTS Diagnoses of mental illness in Minnesota's childless-adult early Medicaid expansion population were more than 15% higher than prevalence measures of mental illness/distress for the current Medicaid population. Diagnosis rates fell within confidence intervals of estimates of mental illness for Minnesota's Medicaid expansion population. Almost 1 in 3 enrollees had a marker of unstable housing; of this group, half had mental illness and/or distress. DISCUSSION Findings support predictions of the high burden of mental illness and unstable housing among the Medicaid expansion population. Minnesota offers lessons to other regions working to care for such populations: (a) the use of flexible financing structures to build integrated care systems and (b) passage of legislation to allow data sharing among mental health, social services, and medical care.
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- 2016
16. Cross-Sector Service Use Among High Health Care Utilizers In Minnesota After Medicaid Expansion
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Ross Owen, Katherine Diaz Vickery, Peter Bodurtha, Courtney Hougham, Mark S. Legler, Matthew M. Davis, Erik Erickson, and Tyler N.A. Winkelman
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Adult ,medicine.medical_specialty ,Minnesota ,Population ,Service use ,Health Services Accessibility ,03 medical and health sciences ,Insurance Claim Review ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Cooperative Behavior ,education ,health care economics and organizations ,education.field_of_study ,Cross sector ,business.industry ,Medicaid ,030503 health policy & services ,Health Policy ,Mental Disorders ,Patient Protection and Affordable Care Act ,Age Factors ,Middle Aged ,Patient Acceptance of Health Care ,United States ,Family medicine ,0305 other medical science ,business - Abstract
Childless adults in the Medicaid expansion population have complex social and behavioral needs. This study compared the cross-sector involvement of Medicaid expansion enrollees who were high health care utilizers to that of other expansion enrollees in Hennepin County, Minnesota. We examined forty-six months of annualized utilization and cost data for expansion-eligible residents with at least twelve months of enrollment (N = 70,134) across health care, housing, criminal justice, and human service sectors. High health care utilizers, approximately 7 percent of our sample, were disproportionately American Indian, younger, and significantly more likely than other expansion enrollees to have mental health (88.1 percent versus 48.0 percent) or substance use diagnoses (79.2 percent versus 29.6 percent). Total cross-sector public spending was nearly four times higher for high health care users ($25,337 versus $6,786), and their non-health care expenses were 2.4 times higher ($7,476 versus $3,108). High levels of cross-sector service use suggest that there are opportunities for collaboration that may result in cost savings across sectors.
- Published
- 2018
17. Bottleneck or Magnifying Glass? Monitoring the Health-Care System's Vital Signs through Emergency Departments
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Katherine Diaz Vickery, Matthew M. Davis, and Kori Sauser
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Magnifying glass ,MEDLINE ,Vital signs ,Patient Readmission ,Vulnerable Populations ,Centers for Medicare and Medicaid Services, U.S ,Bottleneck ,law.invention ,Reimbursement Mechanisms ,law ,Mentally Ill Persons ,Health care ,Patient Protection and Affordable Care Act ,Humans ,Medicine ,business.industry ,Health Policy ,Health Plan Implementation ,Public Health, Environmental and Occupational Health ,medicine.disease ,United States ,Commentary ,Medical emergency ,Emergency Service, Hospital ,business ,Delivery of Health Care ,Program Evaluation - Published
- 2015
18. Identifying Homeless Medicaid Enrollees Using Enrollment Addresses
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Stephanie Abel, Lillian Gelberg, Danielle Robertshaw, Peter Bodurtha, Katherine Diaz Vickery, Laura Guzman-Corrales, Elyse Reamer, Dana Soderlund, and Nathan D. Shippee
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Gerontology ,Urban Population ,Minnesota ,Insurance Claim Review ,03 medical and health sciences ,0302 clinical medicine ,Claims data ,Postal service ,Medicine ,Humans ,Innovative HSR Methods ,030212 general & internal medicine ,Postal Service ,030505 public health ,business.industry ,Medicaid ,Health Policy ,United States ,Test (assessment) ,Needs assessment ,Ill-Housed Persons ,0305 other medical science ,business ,Psychosocial ,Healthcare system - Abstract
Objective To design and test the validity of a method to identify homelessness among Medicaid enrollees using mailing address data. Data Sources/Study Setting Enrollment and claims data on Medicaid expansion enrollees in Hennepin and Ramsey counties who also provided self-reported information on their current housing situation in a psychosocial needs assessment. Study Design Construction of address-based indicators and comparison with self-report data. Principal Findings Among 1,677 enrollees, 427 (25 percent) self-reported homelessness, of whom 328 (77 percent) had at least one positive address indicator. Depending on the type of addresses included in the indicator, sensitivity to detect self-reported homelessness ranged from 30 to 76 percent and specificity from 79 to 97 percent. Conclusions An address-based indicator can identify a large proportion of Medicaid enrollees who are experiencing homelessness. This approach may be of interest to researchers, states, and health systems attempting to identify homeless populations.
- Published
- 2017
19. How Other Countries Use Deprivation Indices-And Why The United States Desperately Needs One
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Winston Liaw, Andrew Bazemore, Peter Crampton, Stephen Petterson, Robert L. Phillips, Katherine Diaz Vickery, Daniel J. Exeter, and Mark Carrozza
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Economic growth ,medicine.medical_specialty ,Population health ,Resource Allocation ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,Health policy ,Health Services Needs and Demand ,030505 public health ,Population Health ,business.industry ,Health Policy ,Public health ,International health ,Censuses ,Health equity ,United Kingdom ,United States ,Health promotion ,Socioeconomic Factors ,Health education ,Business ,Public Health ,Health Expenditures ,0305 other medical science ,New Zealand - Abstract
Integrating public health and medicine to address social determinants of health is essential to achieving the Triple Aim of lower costs, improved care, and population health. There is intense interest in the United States in using social determinants of health to direct clinical and community health interventions, and to adjust quality measures and payments. The United Kingdom and New Zealand use data representing aspects of material and social deprivation from their censuses or from administrative data sets to construct indices designed to measure socioeconomic variation across communities, assess community needs, inform research, adjust clinical funding, allocate community resources, and determine policy impact. Indices provide these countries with comparable data and serve as a universal language and tool set to define organizing principles for population health. In this article we examine how these countries develop, validate, and operationalize their indices; explore their use in policy; and propose the development of a similar deprivation index for the United States.
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- 2016
20. Accountable Communities for Health: Moving From Providing Accountable Care to Creating Health
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Edward P. Ehlinger, Katherine Diaz Vickery, and Renuka Tipirneni
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medicine.medical_specialty ,HRHIS ,Accountable Care Organizations ,business.industry ,Public health ,International health ,Population health ,Patient Acceptance of Health Care ,Public relations ,United States ,Health promotion ,Special Reports ,Patient-Centered Care ,Environmental health ,Health care ,medicine ,Humans ,Community Health Services ,Social determinants of health ,Family Practice ,business ,Health policy ,Quality of Health Care - Abstract
Lessons from community-oriented primary care in the United States can offer insights into how we could improve population health by integrating the public health, social service, and health care sectors to form accountable communities for health (ACHs). Unlike traditional accountable care organizations (ACOs) that address population health from a health care perspective, ACHs address health from a community perspective and consider the total investment in health across all sectors. The approach embeds the ACO in a community context where multiple stakeholders come together to share responsibility for tackling multiple determinants of health. ACOs using the ACH model provide a roadmap for embedding health care in communities in a way that uniquely addresses local social determinants of health.
- Published
- 2015
21. Preparing the Next Generation of Family Physicians to Improve Population Health: A CERA Study
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Katherine Diaz, Vickery, Kirsten, Rindfleisch, Janice, Benson, Judith, Furlong, Viviana, Martinez-Bianchi, and Caroline R, Richardson
- Subjects
Community Medicine ,Humans ,Internship and Residency ,Curriculum ,Family Practice ,Schools, Medical - Abstract
Family medicine leaders cite population health as a key tenet in the strategic plan outlining family medicine's role in improving America's health. Yet little is known about current practice in training family physicians in this area. This study describes the current practice and teaching of community medicine and population health in family medicine residency programs to support the broader goal of preparing the next generation of family physicians to deliver comprehensive primary care while improving population health.Questions were added to the 2013 Council of Academic Family Medicine Educational Research Alliance (CERA) program directors (PD) survey detailing current teaching practices and identifying self-rated exemplary programs. Multivariate logistic regression models were built to predict program strength.A quarter of responding PDs (n=56) self-rate the strength of their community medicine curriculum; they are more likely to: have a faculty champion, have strong public health partnerships, teach community-oriented primary care well, and tend to serve densely populated regions (500K). PDs ranked "knowledge and use of community resources" (n=142, 63%) and "teamwork" (n=127, 57%) as areas of community medicine taught best and research/evaluation (n=120, 54%) and population health (n=105, 47%) as areas not taught well. Resident/faculty time are cited as barriers to curricular success (n=144, 64% and n=134, 60%).Family medicine is well poised to take leadership in the teaching and practice of population health. Yet improvements are still needed and may be supported by dedicated time for faculty/residents, development of faculty champions, and targeted training in rural and suburban areas.
- Published
- 2015
22. Changes in Quality of Life Among Enrollees in Hennepin Health: A Medicaid Expansion ACO
- Author
-
Mark Linzer, Nathan D. Shippee, Katherine Diaz Vickery, Sarah Turcotte Manser, Laura Guzman-Corrales, Cindy L. Cain, Jessica Richards, and Tom Walton
- Subjects
Adult ,Male ,Mental Health Services ,Program evaluation ,medicine.medical_specialty ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Cost Savings ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Qualitative Research ,Accountable Care Organizations ,Primary Health Care ,Medicaid ,business.industry ,Qualitative comparative analysis ,Patient Protection and Affordable Care Act ,030503 health policy & services ,Health Policy ,Middle Aged ,United States ,Integrated care ,Family medicine ,Quality of Life ,Extended care ,Female ,0305 other medical science ,business ,Psychology ,Qualitative research - Abstract
Despite limited program evaluations of Medicaid accountable care organizations (ACOs), no studies have examined if cost-saving goals negatively affect quality of life and health care experiences of low-income enrollees. The Hennepin Health ACO uses an integrated care model to address the physical, behavioral, and social needs of Medicaid expansion enrollees. As part of a larger evaluation, we conducted semistructured interviews with 35 primary care using Hennepin Health members enrolled for 2 or more years. Using fuzzy set qualitative comparative analysis, we assessed enrollee complexity and use of the care model and improvements in quality of life. We found improved quality of life was consistently associated with strong bonds to primary care, consistent mental health care, and support from extended care team members. Comprehensive, integrated care models within ACOs may improve quality of life for low-income Medicaid enrollees through coordinated primary and mental health care.
- Published
- 2018
23. Increased Likelihood of Missed Appointments ('No Shows') for Racial/Ethnic Minorities in a Safety Net Health System
- Author
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Anne Roehrl, Nancy A. Garrett, Katherine Diaz Vickery, Laura Guzman-Corrales, Maribet McCarty, Mark Linzer, and Scott T. Shimotsu
- Subjects
Adult ,medicine.medical_specialty ,Cross-sectional study ,Safety net ,education ,Psychological intervention ,Ethnic group ,lcsh:Computer applications to medicine. Medical informatics ,Vulnerable Populations ,03 medical and health sciences ,Race (biology) ,Appointments and Schedules ,0302 clinical medicine ,Risk Factors ,Ethnicity ,Research Letter ,Medicine ,Humans ,030212 general & internal medicine ,Community and Home Care ,Primary Health Care ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Patient Acceptance of Health Care ,Mental illness ,medicine.disease ,Health equity ,Country of origin ,United States ,Cross-Sectional Studies ,Family medicine ,lcsh:R858-859.7 ,0305 other medical science ,business - Abstract
Missed appointments have been linked to adverse outcomes known to affect racial/ethnic minorities. However, the association of missed appointments with race/ethnicity has not been determined. We sought to determine the relationships between race/ethnicity and missed appointments by performing a cross-sectional study of 161 350 patients in a safety net health system. Several race/ethnicity categories were significantly associated with missed appointment rates, including Hispanic/Latino patients, American Indian/Alaskan Native patients, and Black/African American patients, as compared with White non-Hispanic patients. Other significant predictors included Mexico as country of origin, medical complexity, and major mental illness. We recommend additional research to determine which interventions best reduce missed appointments for minority populations in order to improve the care of vulnerable patients.
- Published
- 2015
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