Jose Pagan
Jose Pagan
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Chair and Professor of the Department of Public Health Policy and Management
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Professional overview
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Dr. Pagán received his PhD in economics from the University of New Mexico and is a former Robert Wood Johnson Foundation Health & Society Scholar with expertise in health economics and population health. He has led research, implementation, and evaluation projects on the redesign of health care delivery and payment systems. He is interested in population health management, health care payment and delivery system reform, and the social determinants of health. Over the years his research has been funded through grants and contracts from the Department of Defense, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the European Commission, and the Robert Wood Johnson Foundation, among others.
Dr. Pagán is Chair of the Board of Directors of NYC Health + Hospitals, the largest public healthcare system in the United States. He also served as Chair of the National Advisory Committee of the Robert Wood Johnson Foundation’s Health Policy Research Scholars and was a member of the Board of Directors of the Interdisciplinary Association for Population Health Science and the American Society of Health Economists.
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Areas of research and study
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Applied EconomicsHealth EconomicsPopulation HealthPublic Health Policy
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Publications
Publications
Trends and sociodemographic disparities in sugary drink consumption among adults in New York City, 2009–2017
AbstractJiang, N., Yi, S. S., Russo, R., Bu, D. D., Zhang, D., Ferket, B., Zhang, F. F., Pagán, J. A., Wang, Y. C., Li, Y., & Pagan, J. (n.d.).Publication year
2020Journal title
Preventive Medicine ReportsVolume
19AbstractDespite efforts to decrease sugary drink consumption, sugary drinks remain the largest single source of added sugars in diets in the United States. This study aimed to examine trends in sugary drink consumption among adults in New York City (NYC) over the past decade by key sociodemographic factors. We used data from the 2009–2017 NYC Community Health Survey to examine trends in sugary drink consumption overall, and across different age, gender, and racial/ethnic subgroups. We conducted a test of trend to examine the significance of change in mean sugary drink consumption over time. We also conducted multiple zero-inflated negative binomial regression to identify the association between different sociodemographic and neighborhood factors and sugary drink consumption. Sugary drink consumption decreased from 2009 to 2014 from 0.97 to 0.69 servings per day (p < 0.001), but then plateaued from 2014 to 2017 (p = 0.01). Although decreases were observed across all age, gender and racial/ethnic subgroups, the largest decreases over this time period were observed among 18–24 year old (1.75 to 1.22 servings per day, p < 0.001); men (1.12 to 0.86 servings per day, p < 0.001); Blacks (1.45 to 1.14 servings per day, p < 0.001); and Hispanics (1.26 to 0.86 servings per day, p < 0.001). Despite these decreases, actual mean consumption remains highest in these same sociodemographic subgroups. Although overall sugary drink consumption has been declining, the decline has slowed in more recent years. Further, certain age, gender and racial/ethnic groups still consume disproportionately more sugary drinks than others. More research is needed to understand and address the root causes of disparities in sugary drink consumption.Why Are Some US Nonprofit Hospitals Not Addressing Opioid Misuse in Their Communities?
AbstractCronin, C. E., Franz, B., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2020Journal title
Population Health ManagementVolume
23Issue
6Page(s)
407-413AbstractThe US opioid epidemic is national in scope, but many local solutions have been shown to have efficacy. Many nonprofit hospitals have the resources and infrastructure to lead these community-based efforts, but there is evidence that some organizations are not adopting opioid services as part of their community benefit requirements to assess and address critical community health needs. This paper assesses why hospitals do not address opioid abuse after completing a community health needs assessment. For a 20% random sample of nonprofit hospitals, a unique data set was constructed of hospital efforts to address opioid abuse using the most recent publicly available community health needs assessments and implementation strategies adopted by hospitals (calendar years 2015, 2016, 2017, or 2018). Multinomial logistic regression was used to assess the relationship between 5 different reasons hospitals cited for not addressing opioid abuse and both hospital and community characteristics. Results indicate that opioid abuse was not addressed by 32% (143) of hospitals in their formal implementation strategies. State community benefit laws, county overdose level, county poverty rate, hospital region, and hospital system membership all were significantly related to the reasons hospitals cited for not addressing opioid abuse as part of their community health engagement. Hospitals in communities with significant substance abuse needs and few institutional resources may need support to address opioid misuse and adopt treatment and harm reduction initiatives. Policies that support hospital-public health partnerships may be especially important to assist hospitals to address nonmedical or behavioral health needs in their communities.Agent-based models and spatial enablement : a simulation tool to improve health and wellbeing in big cities
AbstractPala, D., Holmes, J., Pagàn, J., Parimbelli, E., Rocca, M. T., Casella, V., Bellazzi, R., & Pagan, J. (n.d.). (D. Riaño, S. Wilk, & A. ten Teije, Eds.).Publication year
2019Page(s)
79-83AbstractAs the percentage of the population living in urban areas is constantly increasing throughout the world, big cities’ municipalities and public health policy makers have to deal with raising socioeconomic disparities and need for environmental interventions to reduce pollution and improve wellbeing. The PULSE project, funded by the EU commission under the H2020 program, aims at providing an instrument that assesses health and wellbeing in cities through sensing technologies and data integration. The system has been deployed in 7 cities – Barcelona, Birmingham, Keelung, New York, Paris, Pavia and Singapore – and includes several state-of-the-art technologies, such as a smartphone App, a WebGIS, air quality sensors, a Decision Support System and dashboards. A crucial aspect of the project is the direct involvement of the citizens and the creation of Public Health Observatories (PHOs) that can help taking informed decisions and organize targeted interventions. To this end, PHOs are provided with powerful visual analytics to study different areas of the city, and with simulation tools that can be used to model the effect of interventions of public health authorities the city. In this paper, a first agent-based simulation model, based on the results of spatio-temporal data analytics, is presented. The model simulates the effect of traffic pollution, industrial land use and green areas on the probability of asthma hospitalizations in an area of East Harlem, one the neighborhoods with the highest asthma hospitalizations rate in New York City.Assessing the Impact of Language Access Regulations on the Provision of Pharmacy Services
AbstractWeiss, L., Scherer, M., Chantarat, T., Oshiro, T., Padgen, P., Pagan, J., Rosenfeld, P., & Yin, H. S. (n.d.).Publication year
2019Journal title
Journal of Urban HealthVolume
96Issue
4Page(s)
644-651AbstractApproximately 25 million people in the United States are limited English proficient (LEP). Appropriate language services can improve care for LEP individuals, and health care facilities receiving federal funds are required to provide such services. Recognizing the risk of inadequate comprehension of prescription medication instructions, between 2008 and 2012, New York City and State passed a series of regulations that require chain pharmacies to provide translated prescription labels and other language services to LEP patients. We surveyed pharmacists before (2006) and after (2015) implementation of the regulations to assess their impact in chain pharmacies. Our findings demonstrate a significant improvement in capacity of chains to assist LEP patients. A higher proportion of chain pharmacies surveyed in 2015 reported printing translated labels, access and use of telephone interpreter services, multilingual signage, and documentation of language needs in patient records. These findings illustrate the potential impact of policy changes on institutional practices that impact large and vulnerable portions of the population.Decoding Nonadherence to Hypertensive Medication in New York City : A Population Segmentation Approach
AbstractLi, Y., Jasani, F., Su, D., Zhang, D., Shi, L., Yi, S. S., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2019Journal title
Journal of Primary Care and Community HealthVolume
10AbstractObjective: Nearly one-third of adults in New York City (NYC) have high blood pressure and many social, economic, and behavioral factors may influence nonadherence to antihypertensive medication. The objective of this study is to identify profiles of adults who are not taking antihypertensive medications despite being advised to do so. Methods: We used a machine learning–based population segmentation approach to identify population profiles related to nonadherence to antihypertensive medication. We used data from the 2016 NYC Community Health Survey to identify and segment adults into subgroups according to their level of nonadherence to antihypertensive medications. Results: We found that more than 10% of adults in NYC were not taking antihypertensive medications despite being advised to do so by their health care providers. We identified age, neighborhood poverty, diabetes, household income, health insurance coverage, and race/ethnicity as important characteristics that can be used to predict nonadherence behaviors as well as used to segment adults with hypertension into 10 subgroups. Conclusions: Identifying segments of adults who do not adhere to hypertensive medications has practical implications as this knowledge can be used to develop targeted interventions to address this population health management challenge and reduce health disparities.Diabetes Management Through Remote Patient Monitoring : The Importance of Patient Activation and Engagement with the Technology
AbstractSu, D., Michaud, T. L., Estabrooks, P., Schwab, R. J., Eiland, L. A., Hansen, G., Devany, M., Zhang, D., Li, Y., Pagán, J. A., Siahpush, M., & Pagan, J. (n.d.).Publication year
2019Journal title
Telemedicine and e-HealthVolume
25Issue
10Page(s)
952-959AbstractBackground: The documented efficacy and promise of telemedicine in diabetes management does not necessarily mean that it can be easily translated into clinical practice. An important barrier concerns patient activation and engagement with telemedicine technology. Objective: To assess the importance of patient activation and engagement with remote patient monitoring technology in diabetes management among patients with type 2 diabetes. Methods: Ordinary least squares and logistic regression analyses were used to examine how patient activation and engagement with remote patient monitoring technology were related to changes in hemoglobin A1c (HbA1c) for 1,354 patients with type 2 diabetes monitored remotely for 3 months between 2015 and 2017. Results: Patients with more frequent and regular participation in remote monitoring had lower HbA1c levels at the end of the program. Compared to patients who uploaded their biometric data every 2 days or less frequently, patients who maintained an average frequency of one upload per day were less likely to have a postmonitoring HbA1c > 9% after adjusting for selected covariates on baseline demographics and health conditions. Conclusions: Higher levels of patient activation and engagement with remote patient monitoring technology were associated with better glycemic control outcomes. Developing targeted interventions for different groups of patients to promote their activation and engagement levels would be important to improve the effectiveness of remote patient monitoring in diabetes management.Implementing Project Extension for Community Healthcare Outcomes for Geriatric Mental Healthcare in Long-Term Care Facilities
AbstractHasselberg, M. J., Fisher, E., Conwell, Y., Jacobowitz, D., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2019Journal title
Journal of the American Medical Directors AssociationVolume
20Issue
12Page(s)
1651-1653Abstract~Measuring Efforts of Nonprofit Hospitals to Address Opioid Abuse After the Affordable Care Act
AbstractFranz, B., Cronin, C. E., Wainwright, A., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2019Journal title
Journal of Primary Care and Community HealthVolume
10AbstractObjectives: To assess the strategies that nonprofit hospitals are adopting to address opioid abuse after requirements for community engagement expanded in the Affordable Care Act. Methods: We constructed a dataset of implementation activities for a 20% random sample of nonprofit hospitals in the United States. Using logistic regression, we assessed the extent to which strategies adopted are new, existing, or primarily partnerships. Using negative binomial regression, we assessed the total number of strategies adopted. We controlled for hospital and community characteristics as well as state policies related to opioid abuse. Results: Most strategies adopted by hospitals were new and clinical in nature and the most common number of strategies adopted was one. Hospitals in the Northeast were more likely to adopt a higher number of strategies and to partner with community-based organizations. Hospitals that partner with community-based organizations were more likely to adopt strategies that engage in harm reduction, targeted risk education, or focus on addressing social determinants of health. Conclusions: Community, institutional, and state policy characteristics predict hospital involvement in addressing opioid abuse. These findings underscore several opportunities to support hospital-led interventions to address opioid abuse.Patient Perception and Cost-Effectiveness of a Patient Navigation Program to Improve Breast Cancer Screening for Hispanic Women
AbstractLi, Y., Carlson, E., Hernández, D. A., Green, B., Calle, T., Kumaresan, T., Madondo, K., Martinez, M., Villarreal, R., Meraz, L., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2019Journal title
Health EquityVolume
3Issue
1Page(s)
280-286AbstractPurpose: Hispanic women are less likely to be screened for breast cancer than non-Hispanic women, which contributes to the disproportionate prevalence of advanced-stage breast cancer in this population group. Patient navigation may be a promising approach to help women overcome the complexity of accessing multiple health care services related to breast cancer screening and treatment. The goal of this study is to assess patient perception and cost-effectiveness of a multilevel, community-based patient navigation program to improve breast cancer screening among Hispanic women in South Texas. Methods: We used mixed methods - including focus groups of program participants and a microsimulation model of breast cancer - to evaluate the effectiveness and cost-effectiveness of the program on the target population. Program data from 2013 to 2016 were collected and used to conduct the analyses. Results: Focus groups showed that the patient navigation program improved patient knowledge, attitudes, and behaviors regarding breast health and increased the mammography screening rate from 60% to 80%. Cost-effectiveness analysis showed that the program could increase life expectancy by 0.71 years and yield an incremental cost-effectiveness ratio of $3120 per quality-adjusted life year compared to no intervention. Conclusion: The 3-year multilevel, community-based patient navigation program effectively increased mammography screening uptake and adherence and improved knowledge and behaviors on breast health among program participants. Future research is needed to translate and disseminate the program to other socioeconomic and demographic groups to test its robustness and design.Preface
AbstractPagán, J., Mokhtari, M., Aloulou, H., Abdulrazak, B., Cabrera, M. F., & Pagan, J. (n.d.).Publication year
2019Journal title
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics)Volume
11862 LNCSPage(s)
v-viAbstract~Spatial enablement to support environmental, demographic, socioeconomics and health data integration and analysis for big cities : A case study with asthma hospitalizations in New York City
AbstractPala, D., Pagán, J., Parimbelli, E., Rocca, M. T., Bellazzi, R., Casella, V., & Pagan, J. (n.d.).Publication year
2019Journal title
Frontiers in MedicineVolume
6Issue
APRAbstractThe percentage of the world's population living in urban areas is projected to increase in the next decades. Big cities are heterogeneous environments in which socioeconomic and environmental differences among the neighborhoods are often very pronounced. Each individual, during his/her life, is constantly subject to a mix of exposures that have an effect on their phenotype but are frequently difficult to identify, especially in an urban environment. Studying how the combination of environmental and socioeconomic factors which the population is exposed to influences pathological outcomes can help transforming public health from a reactive to a predictive system. Thanks to the application of state-of-the-art spatially enabled methods, patients can be stratified according to their characteristics and the geographical context they live in, optimizing healthcare processes and the reducing its costs. Some public health studies focusing specifically on urban areas have been conducted, but they usually consider a coarse spatial subdivision, as a consequence of scarce availability of well-integrated data regarding health and environmental exposure at a sufficient level of granularity to enable meaningful statistical analyses. In this paper, we present an application of highly fine-grained spatial resolution methods to New York City data. We investigated the link between asthma hospitalizations and a combination of air pollution and other environmental and socioeconomic factors. We first performed an explorative analysis using spatial clustering methods that shows that asthma is related to numerous factors whose level of influence varies considerably among neighborhoods. We then performed a Geographically Weighted Regression with different covariates and determined which environmental and socioeconomic factors can predict hospitalizations and how they vary throughout the city. These methods showed to be promising both for visualization and analysis of demographic and epidemiological urban dynamics, that can be used to organize targeted intervention and treatment policies to address the single citizens considering the factors he/she is exposed to. We found a link between asthma and several factors such as PM2.5, age, health insurance coverage, race, poverty, obesity, industrial areas and recycling. This study has been conducted within the PULSE project, funded by the European Commission, briefly presented in this paper.The Impact of Ritual Bathing in a Holy Hindu River on Waterborne Diseases
AbstractRoy Chowdhury, S., Bohara, A. K., Katuwal, H., Pagán, J. A., Thacher, J. A., & Pagan, J. (n.d.).Publication year
2019Journal title
Developing EconomiesVolume
57Issue
1Page(s)
36-54AbstractIn this paper, we identify the role of religious practices on individual outcomes by examining if bathing in polluted river water for religious reasons affects the likelihood of missing days at work. To exploit the relationship, we use a primary survey (N = 1,200) of the residents of Kathmandu Valley, Nepal on their Bagmati River water usage. Probit and negative binomial estimation strategies reveal that bathing in river water, driven by traditional and cultural norms, is significantly associated with a higher probability of missing work. Among other factors, accessibility to personal sanitation facilities have a negative and significant correlation with the likelihood of missing work due to health reasons.Assessing the role of access and price on the consumption of fruits and vegetables across New York City using agent-based modeling
AbstractLi, Y., Zhang, D., Thapa, J. R., Madondo, K., Yi, S., Fisher, E., Griffin, K., Liu, B., Wang, Y., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2018Journal title
Preventive MedicineVolume
106Page(s)
73-78AbstractMost residents in New York City (NYC) do not consume sufficient fruits and vegetables every day. Difficulties with access and high prices of fruits and vegetables in some neighborhoods contribute to different consumption patterns across NYC neighborhoods. We developed an agent-based model (ABM) to predict dietary behaviors of individuals at the borough and neighborhood levels. Model parameters were estimated from the 2014 NYC Community Health Survey, United States Census data, and the literature. We simulated six hypothetical interventions designed to improve access and reduce the price of fruits and vegetables. We found that all interventions would lead to increases in fruit and vegetable consumption but the results vary substantially across boroughs and neighborhoods. For example, a 10% increase in the number of fruit/vegetable vendors combined with a 10% decrease in the prices of fruits and vegetables would lead to a median increase of 2.28% (range: 0.65%–4.92%) in the consumption of fruits and vegetables, depending on neighborhood. We also found that the impact of increasing the number of vendors on fruit/vegetable consumption is more pronounced in unhealthier local food environments while the impact of reducing prices on fruits/vegetable consumption is more pronounced in neighborhoods with low levels of education. An agent-based model of dietary behaviors that takes into account neighborhood context has the potential to inform how fruit/vegetable access and pricing strategies may specifically work in tandem to increase the consumption of fruits and vegetables at the local level.Cost-effectiveness analysis of intensive hypertension control in China
AbstractXie, X., He, T., Kang, J., Siscovick, D. S., Li, Y., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2018Journal title
Preventive MedicineVolume
111Page(s)
110-114AbstractChina has the largest population of adults with hypertension in the world. Recent clinical trials have shown that intensive hypertension control can help patients achieve lower blood pressure and reduce the incidence of major cardiovascular disease (CVD) events, but this level of hypertension control also incurs additional costs to patients and society and may result in a substantial increase in adverse events. The objective of this study is to assess the cost-effectiveness of intensive hypertension control to inform health policymakers and health care delivery systems in China in their decision-making regarding hypertension treatment strategies. We developed a Markov based simulation model of hypertension to assess the impact of intensive and standard hypertension control strategies for the Chinese population who are diagnosed with hypertension. Model parameters were estimated based on the best available data and the literature. We projected that intensive hypertension control would avert about 2.2 million coronary heart disease events and 4.4 million stroke events for all hypertensive patients in China in 10 years compared to standard hypertension control. The incremental cost-effectiveness ratio (ICER) for intensive hypertension control was estimated at 7876 CNY per quality-adjusted life year (QALY) compared to standard hypertension control. Intensive hypertension control would be more cost-effective than standard hypertension control in China. Our findings indicated that China should consider expanding intensive hypertension control among hypertensive patients given its great potential in preventing CVD.Power Up for Health—Participants’ Perspectives on an Adaptation of the National Diabetes Prevention Program to Engage Men
AbstractRealmuto, L., Kamler, A., Weiss, L., Gary-Webb, T. L., Hodge, M. E., Pagán, J. A., Walker, E. A., & Pagan, J. (n.d.).Publication year
2018Journal title
American Journal of Men's HealthVolume
12Issue
4Page(s)
981-988AbstractThe National Diabetes Prevention Program (NDPP) has been effectively translated to various community and clinical settings; however, regardless of setting, enrollment among men and lower-income populations is low. This study presents participant perspectives on Power Up for Health, a novel NDPP pilot adaption for men residing in low-income communities in New York City. We conducted nine interviews and one focus group with seven participants after the program ended. Interview and focus group participants had positive perceptions of the program and described the all-male aspect of the program and its reliance on male coaches as major strengths. Men felt the all-male adaptation allowed for more open, in-depth conversations on eating habits, weight loss, body image, and masculinity. Participants also reported increased knowledge and changes to their dietary and physical activity habits. Recommendations for improving the program included making the sessions more interactive by, for example, adding exercise or healthy cooking demonstrations. Overall, findings from the pilot suggest this NDPP adaptation was acceptable to men and facilitated behavior change and unique discussions that would likely not have occurred in a mixed-gender NDPP implementation.Remote Patient Monitoring and Clinical Outcomes for Postdischarge Patients with Type 2 Diabetes
AbstractMichaud, T. L., Siahpush, M., Schwab, R. J., Eiland, L. A., Devany, M., Hansen, G., Slachetka, T. S., Boilesen, E., Tak, H. J., Wilson, F. A., Wang, H., Pagán, J. A., Su, D., & Pagan, J. (n.d.).Publication year
2018Journal title
Population Health ManagementVolume
21Issue
5Page(s)
387-394AbstractThe objective of this study was to evaluate changes in clinical outcomes for patients with type 2 diabetes (T2D) after a 3-month remote patient monitoring (RPM) program, and examine the relationship between hemoglobin A1c (HbA1c) outcomes and participant characteristics. The study sample included 955 patients with T2D who were admitted to an urban Midwestern medical center for any reason from 2014 to 2017, and used RPM for 3 months after discharge. Clinical outcomes included HbA1c, weight, body mass index (BMI), and patient activation scores. Logistic regression was used to estimate the likelihood of having a postintervention HbA1c 9%. Most patients experienced decreases in HbA1c (67%) and BMI (58%), and increases in patient activation scores (67%) (P < 0.001 in all 3 cases) at the end of RPM. Logistic regression analyses revealed that among patients who had HbA1c >9% at baseline, men (odds ratio [OR] = 3.72; 95% confidence interval [CI], 1.43-9.64), those who had increased patient activation scores after intervention (OR = 1.05; 95% CI, 1.01-1.09), those who had higher baseline patient activation scores, and those who had a greater number of biometric data uploads during the intervention (OR = 1.02; 95% CI, 1.00-1.04) were more likely to have reduced their HbA1c toCost-effectiveness of a patient navigation program to improve cervical cancer screening
AbstractLi, Y., Carlson, E., Villarreal, R., Meraz, L., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Journal title
American Journal of Managed CareVolume
23Issue
7Page(s)
429-434AbstractOBJECTIVES: To assess the cost-effectiveness of a community-based patient navigation program to improve cervical cancer screening among Hispanic women 18 or older in San Antonio, Texas. STUDY DESIGN: We used a microsimulation model of cervical cancer to project the long-term cost-effectiveness of a community-based patient navigation program compared with current practice. METHODS: We used program data from 2012 to 2015 and published data from the existing literature as model input. Taking a societal perspective, we estimated the lifetime costs, life expectancy, and quality-adjusted life-years and conducted 2-way sensitivity analyses to account for parameter uncertainty. RESULTS: The patient navigation program resulted in a per-capita gain of 0.2 years of life expectancy. The program was highly cost-effective relative to no intervention (incremental cost-effectiveness ratio of $748). The program costs would have to increase up to 10 times from $311 for it not to be cost-effective. CONCLUSIONS: The 3-year community-based patient navigation program effectively increased cervical cancer screening uptake and adherence and improved the cost-effectiveness of the screening program for Hispanic women 18 years or older in San Antonio, Texas. Future research is needed to translate and disseminate the patient navigation program to other socioeconomic and demographic groups to test its robustness and design.Delivery and Payment Redesign to Reduce Disparities in High Risk Postpartum Care
AbstractHowell, E. A., Padrón, N. A., Beane, S. J., Stone, J., Walther, V., Balbierz, A., Kumar, R., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Journal title
Maternal and Child Health JournalVolume
21Issue
3Page(s)
432-438AbstractPurpose This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women. Description A large health care system, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for women identified as high-risk. The program includes a social work/care management component and a payment system redesign with a cost-sharing arrangement between the health system and the Medicaid managed care plan to cover the cost of staff, clinician education, performance feedback, and clinic/clinician financial incentives. The goal is to enroll 510 high-risk postpartum mothers. Assessment The primary outcome of interest is a timely postpartum visit in accordance with NCQA healthcare effectiveness data and information set guidelines. Secondary outcomes include care process measures for women with specific high-risk conditions, emergency room visits, postpartum readmissions, depression screens, and health care costs. Conclusion Our evidence-based program focuses on an important area of maternal health, targets racial/ethnic disparities in postpartum care, utilizes an innovative payment reform strategy, and brings together insurers, researchers, clinicians, and policy experts to work together to foster health and wellness for postpartum women and reduce disparities.Identifying policy levers and opportunities for action across states to achieve health equity
AbstractBerenson, J., Li, Y., Lynch, J., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Journal title
Health AffairsVolume
36Issue
6Page(s)
1048-1056AbstractIn the United States, steps to advance health equity often take place at the state and local levels rather than the national level. Using publicly available data sources, we developed a scorecard for all fifty states and the District of Columbia that measures indicators of the use of five evidence-based policies to address domains related to health equity. The indicators are the cigarette excise tax rate, a state's Medicaid expansion status and the size of its coverage gap, percentage of four-year olds enrolled in state-funded pre-kindergarten, minimum wage level, and the presence of state-funded housing subsidy programs and homelessness prevention and rapid rehousing programs. We found that states varied significantly in their implementation of the selected policies and concluded that a variety of approaches to encourage policy changes at the state level will be needed to create healthier and more equitable communities. We describe promising, feasible state-level approaches for states to "do something, do more, do better" when they take action on the five selected policies that can promote health equity.Integrating principles from behavioral economics into patient navigation programs targeting cancer screening
AbstractLi, Y., Wilson, F. A., Villarreal, R., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Page(s)
127-140Abstract~Nutrition Label Use and Sodium Intake in the U.S.
AbstractZhang, D., Li, Y., Wang, G., Moran, A. E., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Journal title
American journal of preventive medicineVolume
53Issue
6Page(s)
S220-S227AbstractIntroduction High sodium intake is a major risk factor for hypertension, but evidence is limited on which interventions are effective in reducing sodium consumption. This study examined the associations between frequent use of nutrition labels and daily sodium intake and the consumption of high-sodium foods in the U.S. Methods Using the 2007–2008 and 2009–2010 Flexible Consumer Behavior Survey, this study compared sodium intake measured from the 24-hour dietary recalls, availability of salty snacks at home, and frequencies of eating frozen meals/pizzas between frequent (i.e., always or most of the time) and infrequent nutrition label users. Also, the study examined the association between nutrition label use and sodium-related dietary behaviors across different demographic and socioeconomic groups. Data were analyzed in 2016. Results Frequent users of nutrition labels consumed 92.79 mg less sodium per day (95% CI= −160.21, −25.37), were less likely to always or most of the time have salty snacks available at home (OR=0.86, 95% CI=0.76, 0.97), but were just as likely to eat frozen meals or pizzas (incidence rate ratio=0.96, 95% CI=0.84, 1.08) compared with infrequent label users. The associations between nutrition label use and sodium intake differed considerably across age, gender, and socioeconomic groups. Conclusions Frequent use of nutrition labels appears to be associated with lower consumption of sodium and high-sodium foods in the U.S. Given this small reduction, interventions such as enhancing nutrition label use could be less effective if implemented without other strategies.Systems science simulation modeling to inform urban health policy and planning
AbstractLi, Y., Boufford, J. I., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Page(s)
151-166AbstractMore than half of the population in the world lives in cities and urban populations are still rapidly expanding. Increasing population growth in cities inevitably brings about the intensification of urban health problems. The multidimensional nature of factors associated with health together with the dynamic, interconnected environment of cities moderates the effects of policies and interventions that are designed to improve population health. With the emergence of the “Internet of Things” and the availability of “Big Data,” policymakers and practitioners are in need of a new set of analytical tools to comprehensively understand the social, behavioral, and environmental factors that shape population health in cities. Systems science, an interdisciplinary field that draws concepts, theories, and evidence from fields such as computer science, engineering, social planning, economics, psychology, and epidemiology, has shown promise in providing practical conceptual and analytical approaches that can be used to solve urban health problems. This chapter describes the level of complexity that characterizes urban health problems and provides an overview of systems science features and methods that have shown great promise to address urban health challenges. We provide two specific examples to showcase systems science thinking: one using a system dynamics model to prioritize interventions that involve multiple social determinants of health in Toronto, Canada, and the other using an agent-based model to evaluate the impact of different food policies on dietary behaviors in NewYork City. These examples suggest that systems science has the potential to foster collaboration among researchers, practitioners, and policymakers from different disciplines to evaluate interconnected data and address challenging urban health problems.Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care
AbstractFisher, E., Hasselberg, M., Conwell, Y., Weiss, L., Padrón, N. A., Tiernan, E., Karuza, J., Donath, J., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Journal title
Population Health ManagementVolume
20Issue
5Page(s)
342-347AbstractHealth care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO® (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health) - a remote learning and mentoring program - is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.Using systems science to inform population health strategies in local health departments : A case study in San Antonio, Texas
AbstractLi, Y., Padrón, N. A., Mangla, A. T., Russo, P. G., Schlenker, T., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Journal title
Public Health ReportsVolume
132Issue
5Page(s)
549-555AbstractObjectives: Because of state and federal health care reform, local health departments play an increasingly prominent role leading and coordinating disease prevention programs in the United States. This case study shows how a local health department working in chronic disease prevention and management can use systems science and evidence-based decision making to inform program selection, implementation, and assessment; enhance engagement with local health systems and organizations; and possibly optimize health care delivery and population health. Methods: The authors built a systems-science agent-based simulation model of diabetes progression for the San Antonio Metropolitan Health District, a local health department, to simulate health and cost outcomes for the population of San Antonio for a 20-year period (2015-2034) using 2 scenarios: 1 in which hemoglobin A1c (HbA1c) values for a population were similar to the current distribution of values in San Antonio, and the other with a hypothetical 1-percentage-point reduction in HbA1c values. Results: They projected that a 1-percentage-point reduction in HbA1c would lead to a decrease in the 20-year prevalence of end-stage renal disease from 1.7% to 0.9%, lower extremity amputation from 4.6% to 2.9%, blindness from 15.1% to 10.7%, myocardial infarction from 23.8% to 17.9%, and stroke from 9.8% to 7.2%. They estimated annual direct medical cost savings (in 2015 US dollars) from reducing HbA1c by 1 percentage point ranging from $6842 (myocardial infarction) to $39 800 (endstage renal disease) for each averted case of diabetes complications. Conclusions: Local health departments could benefit from the use of systems science and evidence-based decision making to estimate public health program effectiveness and costs, calculate return on investment, and develop a business case for adopting programs.Who does not reduce their sodium intake despite being advised to do so? A population segmentation analysis
AbstractLi, Y., Berenson, J., Moran, A. E., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2017Journal title
Preventive MedicineVolume
99Page(s)
77-79AbstractExcessive sodium intake is linked to an increased risk for hypertension and cardiovascular disease. Although health care providers and other health professionals frequently provide counseling on healthful levels of sodium consumption, many people who consume sodium in excess of recommend levels still do not watch or reduce their sodium intake. In this study, we used a population segmentation approach to identify profiles of adults who are not watching or reducing their sodium intake despite been advised to do so. We analyzed sodium intake data in 125,764 respondents sampled in 15 states, the District of Columbia and Puerto Rico through the Behavioral Risk Factor Surveillance System to identify and segment adults into subgroups according to differences in sodium intake behaviors. We found that about 16% of adults did not watch or reduce their sodium intake despite been told to do so by a health professional. This proportion varied substantially across the 25 different population subgroups identified. For example, about 44% of adults 18 to 44 years of age who live in West Virginia were not reducing their sodium intake whereas only about 7.2% of black adults 65 years of age and older with diabetes were not reducing their sodium intake. Population segmentation identifies subpopulations most likely to benefit from targeted and intensive public health and clinical interventions. In the case of sodium consumption, population segmentation can guide public health practitioners and policymakers to design programs and interventions that change sodium intake in people who are resistant to behavior change.