Program in Health Services Research

The goal of this study is to develop and evaluate novel methods to increase the validity of nonexperimental studies applying propensity score methods by using data from Medicare beneficiaries linked with a variety of sources including electronic health records and surveys evaluating trends in health and aging.

The goal of this work is to leverage data linkage to assess the long-term associations between comorbid conditions, medication burden, and long-term physical function and frailty in older cancer survivors.

The goal of this study is to assess whether differences in the measurement of key aging variables (e.g., comorbidities, frailty, and dementias) for Medicare Advantage vs. fee-for-service beneficiaries occur due to true underlying differences between populations or due to data quality.

When faced with complicated health insurance coverage decisions, it is unclear whether individuals consider their current medical conditions or potential serious health risks. Given that plan selection may have critical short- and long-term clinical and economic implications, understanding the factors associated with plan selection and how the presence and timing of a cancer diagnosis impacts coverage decisions is imperative. In this project, we will examine initial and subsequent Medicare plan choices and downstream health and financial outcomes in the event of a cancer diagnosis. Results could inform discussions regarding planned and future changes to the Medicare program and educate older Americans on strategies to optimize their selection of Medicare benefits in the context of cancer risk or diagnosis. (Funded by Leukemia & Lymphoma Society)

E-cigarette use has increased steadily among US adolescents during the past decade, in part due to the availability of e-liquids in youth-appealing flavors. Conversely, e-cigarettes have also emerged a potentially reduced harm product for adults who smoke and are unwilling or unable to stop using nicotine. Using the Population Assessment of Tobacco or Health (PATH) Survey, a nationally-representative, annual cohort study of adolescents and adults, we will investigate mechanisms by which statewide flavored e-cigarette bans affect e-cigarette and other tobacco product use as well as smoking cessation or reduction (NIDA).

The Affordable Care Act (ACA) insurance coverage expansions beginning in 2014 resulted in historic reductions in uninsurance rates among working-age adults in the states that expanded Medicaid and in the other states. An estimated 26.7 million gained either Medicaid or subsidized private insurance by 2017. This study examines the impact of ACA on racial/ethnic disparities on access to healthcare and patient outcomes. We have assembled a large database of the near-universe of individual discharge and ED records of all patients (all ages, race/ethnicity and payers) from all hospitals in 22 states from 2010 to 2017. In collaboration with researchers at Boston University School of Medicine, our agenda is to study the utilization of a wide range of inpatient and ED services – preventable hospitalizations and ED visits, cardiac procedures, knee replacement, bariatric surgery, heart transplant, LVAD use, safety-net hospital use, inpatient deaths – to add to the evidence base on ACA's longer term impact on access to healthcare, with a particular focus on Hispanics and other racial/ethnic minorities. Given their comprehensive coverage of all inpatient care, these data are suitable for studying a broad range of topics: adoption of new therapies; rare diseases and treatments; geographic variations; proximity to providers; costs; risk prediction.

The goal of this study is to improve health outcomes for rural patients in Wilkes County, North Carolina with symptoms of acute cardiovascular disease by integrating rural cardiovascular care into an existing Wake Forest University Health Sciences (WFUHS) telehealth program. (Funded by Health Resources and Services Administration).

Funder: NIH/NIA

Major Goals: To assess the intended and unintended effects of the MIPS--the most comprehensive reform of Medicare clinician reimbursement--on quality of care and patient outcomes.