NAU publications by CHER
Faculty & staff publications
NAU faculty and staff have the opportunity to publish their findings and knowledge as authors. CHER has many researchers that have been cited multiple times in major publications for their great work. The Center for Health Equity Research has accumulated all faculty publications into one, easy to navigate database.
Please type in a key word or author LAST name to search
Kumar, Amit; Roy, Indrakshi; Warren, Meghan; Shaibi, Stefany D; Fabricant, Maximilian; Falvey, Jason R; Vashist, Amit; Karmarkar, Amol M Impact of Hospital-Based Rehabilitation Services on Discharge to the Community by Value-Based Payment Programs after Joint Replacement Surgery Journal Article Physical Therapy, 2022. @article{Kumar2022, title = {Impact of Hospital-Based Rehabilitation Services on Discharge to the Community by Value-Based Payment Programs after Joint Replacement Surgery}, author = {Amit Kumar and Indrakshi Roy and Meghan Warren and Stefany D Shaibi and Maximilian Fabricant and Jason R Falvey and Amit Vashist and Amol M Karmarkar}, url = {https://doi.org/10.1093/ptj/pzab313}, doi = {10.1093/ptj/pzab313}, year = {2022}, date = {2022-01-13}, journal = {Physical Therapy}, abstract = {The purpose of this study was to examine the impact of hospital-based rehabilitation services on community discharge rates after hip and knee replacement surgery according to hospital participation in value-based care models: bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR). The secondary objective was to determine whether community discharge rates after hip and knee replacement surgery differed by participation in these models.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The purpose of this study was to examine the impact of hospital-based rehabilitation services on community discharge rates after hip and knee replacement surgery according to hospital participation in value-based care models: bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR). The secondary objective was to determine whether community discharge rates after hip and knee replacement surgery differed by participation in these models. |
Kumar, Amit; Roy, Indrakshi; Bosch, Pamela; Fehnel, Corey; Garnica, Nicholas; Cook, Jon; Warren, Meghan; Karmarkar, Amol Medicare Claim–Based National Institutes of Health Stroke Scale to Predict 30-Day Mortality and Hospital Readmission Journal Article Journal of General Internal Medicine, 2021. @article{Kumar2021, title = {Medicare Claim–Based National Institutes of Health Stroke Scale to Predict 30-Day Mortality and Hospital Readmission}, author = {Amit Kumar and Indrakshi Roy and Pamela Bosch and Corey Fehnel and Nicholas Garnica and Jon Cook and Meghan Warren and Amol Karmarkar}, url = {https://doi.org/10.1007/s11606-021-07162-0}, doi = {10.1007/s11606-021-07162-0}, year = {2021}, date = {2021-10-26}, journal = {Journal of General Internal Medicine}, abstract = {The Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for higher than expected 30-day mortality rates using methods without accounting for condition severity risk adjustment. For patients with stroke, CMS claims did not quantify stroke severity until recently, when the National Institutes of Health Stroke Scale (NIHSS) reporting began. Examine the predictive ability of claim-based NIHSS to predict 30-day mortality and 30-day hospital readmission in patients with ischemic stroke.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for higher than expected 30-day mortality rates using methods without accounting for condition severity risk adjustment. For patients with stroke, CMS claims did not quantify stroke severity until recently, when the National Institutes of Health Stroke Scale (NIHSS) reporting began. Examine the predictive ability of claim-based NIHSS to predict 30-day mortality and 30-day hospital readmission in patients with ischemic stroke. |
Roy, Indrakshi; Karmarkar, Amol; Kumar, Amit; Warren, Meghan; Pohl, Patricia; Shaibi, Stefany; Rivera-Hernandez, Maricruz; Rudolph, James Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD Journal Article Innovation in Aging, 4 (1), pp. 666–667, 2020. @article{Roy2020, title = {Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD }, author = {Indrakshi Roy and Amol Karmarkar and Amit Kumar and Meghan Warren and Patricia Pohl and Stefany Shaibi and Maricruz Rivera-Hernandez and James Rudolph}, url = {https://doi.org/10.1093/geroni/igaa057.2307}, doi = {10.1093/geroni/igaa057.2307}, year = {2020}, date = {2020-12-16}, journal = {Innovation in Aging}, volume = {4}, number = {1}, pages = {666–667}, abstract = {The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed. }, keywords = {}, pubstate = {published}, tppubtype = {article} } The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed. |
Roy, Indrakshi; Karmarkar, Amol; Kumar, Amit; Warren, Meghan; Pohl, Patricia; Rivera-Hernandez, Maricruz Utilization After Hip Fracture in Medicare Beneficiaries With ADRD Journal Article Innovation in Aging, 4 (1), pp. 59, 2020. @article{Roy2020b, title = {Utilization After Hip Fracture in Medicare Beneficiaries With ADRD}, author = {Indrakshi Roy and Amol Karmarkar and Amit Kumar and Meghan Warren and Patricia Pohl and Maricruz Rivera-Hernandez }, url = {https://doi.org/10.1093/geroni/igaa057.192}, doi = {10.1093/geroni/igaa057.192}, year = {2020}, date = {2020-12-01}, journal = {Innovation in Aging}, volume = {4}, number = {1}, pages = {59}, abstract = {The incidence of hip fracture in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. Care complexity, including extensive post-acute rehabilitation, increases substantially in patients with ADRD after hip fracture. However, there are no standardized post-acute care utilization models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute utilization varies by race/ethnicity, in this population. To investigate racial differences in post-acute care utilization following hip fracture related hospitalization in patients with ADRD. A secondary analysis was conducted on 120,179 older adults with ADRD with incident hip fracture, using 100% Medicare data (2016-2017). The primary outcome was post-acute discharge dispositions (skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home Health Care [HHC]) across various racial groups. Multinomial logistic regression examined the association between race and post-acute discharge dispositions after accounting for patient-level covariates. Compared to non-Hispanic Whites, minority racial groups have significantly lower odds of being discharged to SNF, IRF, or HHC, as compared to home. Adjusted odds ratio for Hispanics discharged to SNF was 0.28 (CI=0.24-0.31), to IRF was 0.46 (CI=0.39-0.52) and HHC was 0.64 (95% CI =0.54-0.75), as compared to home. CONCLUSION: ADRD patients have higher risk of hip fracture. Findings from this study will provide insight on how to reduce racial and ethnic disparities in post-acute care utilization in vulnerable populations.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The incidence of hip fracture in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. Care complexity, including extensive post-acute rehabilitation, increases substantially in patients with ADRD after hip fracture. However, there are no standardized post-acute care utilization models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute utilization varies by race/ethnicity, in this population. To investigate racial differences in post-acute care utilization following hip fracture related hospitalization in patients with ADRD. A secondary analysis was conducted on 120,179 older adults with ADRD with incident hip fracture, using 100% Medicare data (2016-2017). The primary outcome was post-acute discharge dispositions (skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home Health Care [HHC]) across various racial groups. Multinomial logistic regression examined the association between race and post-acute discharge dispositions after accounting for patient-level covariates. Compared to non-Hispanic Whites, minority racial groups have significantly lower odds of being discharged to SNF, IRF, or HHC, as compared to home. Adjusted odds ratio for Hispanics discharged to SNF was 0.28 (CI=0.24-0.31), to IRF was 0.46 (CI=0.39-0.52) and HHC was 0.64 (95% CI =0.54-0.75), as compared to home. CONCLUSION: ADRD patients have higher risk of hip fracture. Findings from this study will provide insight on how to reduce racial and ethnic disparities in post-acute care utilization in vulnerable populations. |
Camplain, Ricky; Baldwin, Julie A; Warren, Meghan; Camplain, Carolyn Physical Activity in People Who Are Incarcerated: A Social Justice Issue Journal Article Journal of Physical Activity and Health, 16 (5), pp. 306-307, 2019. @article{Camplain2019, title = {Physical Activity in People Who Are Incarcerated: A Social Justice Issue}, author = {Ricky Camplain and Julie A Baldwin and Meghan Warren and Carolyn Camplain}, url = {https://journals.humankinetics.com/doi/full/10.1123/jpah.2019-0055}, year = {2019}, date = {2019-05-05}, journal = {Journal of Physical Activity and Health}, volume = {16}, number = {5}, pages = {306-307}, abstract = {Every year, approximately 12 million Americans cycle in and out of jail (ie, short-term facilities that hold individuals awaiting trial and/or sentenced to a term of less than 1 y).1 Although jails allow incarcerated individuals’ recreation time to engage in physical activity,2 it is not clear to what extent these opportunities are utilized. This potential lack of engagement in physical activity is concerning, especially as some of the benefits of physical activity are immediate and may improve the day-to-day life for those who are incarcerated. For example, a single bout of moderate to vigorous physical activity will reduce blood pressure, improve insulin sensitivity, improve sleep and cognition, and reduce symptoms of anxiety symptoms and anger.3 Unfortunately, use of recreation time in the jail setting has not been described previously, thereby precluding an important area for policy intervention.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Every year, approximately 12 million Americans cycle in and out of jail (ie, short-term facilities that hold individuals awaiting trial and/or sentenced to a term of less than 1 y).1 Although jails allow incarcerated individuals’ recreation time to engage in physical activity,2 it is not clear to what extent these opportunities are utilized. This potential lack of engagement in physical activity is concerning, especially as some of the benefits of physical activity are immediate and may improve the day-to-day life for those who are incarcerated. For example, a single bout of moderate to vigorous physical activity will reduce blood pressure, improve insulin sensitivity, improve sleep and cognition, and reduce symptoms of anxiety symptoms and anger.3 Unfortunately, use of recreation time in the jail setting has not been described previously, thereby precluding an important area for policy intervention. |
Camplain, Ricky; Warren, Meghan; Baldwin, Julie; Camplain, Carolyn; Fofanov, Viacheslav Y; Trotter, Robert T Epidemiology of incarceration Characterizing jail incarceration for public health research Journal Article Epidemiology, 2019. @article{Camplain2019d, title = {Epidemiology of incarceration Characterizing jail incarceration for public health research}, author = {Ricky Camplain and Meghan Warren and Julie Baldwin and Carolyn Camplain and Viacheslav Y Fofanov and Robert T Trotter}, url = {https://journals.lww.com/epidem/Abstract/2019/07000/Epidemiology_of_Incarceration__Characterizing_Jail.14.aspx}, doi = {10.1097/EDE.0000000000001021}, year = {2019}, date = {2019-04-08}, journal = {Epidemiology}, abstract = {Background: Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to re-incarceration. Methods: We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001-2018 from jail intake and release records. Results: The median number of incarcerations during the study period was 1 (Interquartile range (IQR) 1, 2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR 0, 5). The median total days incarcerated was 3 (IQR 1, 23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been re-incarcerated. Conclusion: Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to re-incarceration. Methods: We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001-2018 from jail intake and release records. Results: The median number of incarcerations during the study period was 1 (Interquartile range (IQR) 1, 2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR 0, 5). The median total days incarcerated was 3 (IQR 1, 23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been re-incarcerated. Conclusion: Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research. |
II, Robert Trotter T; Camplain, Ricky; Eaves, Emery R; Fofanov, Viacheslav Y; Dmitrieva, Natalia O; Hepp, Crystal M; Warren, Meghan; Barrios, Brianna A; Pagel, Nicole; Mayer, Alyssa; Baldwin, Julie A Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study Journal Article JMIR Res Protoc, 7 (10), 2018. @article{II2018b, title = {Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study}, author = {Robert Trotter T II and Ricky Camplain and Emery R Eaves and Viacheslav Y Fofanov and Natalia O Dmitrieva and Crystal M Hepp and Meghan Warren and Brianna A Barrios and Nicole Pagel and Alyssa Mayer and Julie A Baldwin}, editor = {Gunther Eysenbach and Nicola Kuter}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231773/}, year = {2018}, date = {2018-10-24}, journal = {JMIR Res Protoc}, volume = {7}, number = {10}, abstract = {Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337 |
2022 |
Kumar, Amit; Roy, Indrakshi; Warren, Meghan; Shaibi, Stefany D; Fabricant, Maximilian; Falvey, Jason R; Vashist, Amit; Karmarkar, Amol M Impact of Hospital-Based Rehabilitation Services on Discharge to the Community by Value-Based Payment Programs after Joint Replacement Surgery Journal Article Physical Therapy, 2022. @article{Kumar2022, title = {Impact of Hospital-Based Rehabilitation Services on Discharge to the Community by Value-Based Payment Programs after Joint Replacement Surgery}, author = {Amit Kumar and Indrakshi Roy and Meghan Warren and Stefany D Shaibi and Maximilian Fabricant and Jason R Falvey and Amit Vashist and Amol M Karmarkar}, url = {https://doi.org/10.1093/ptj/pzab313}, doi = {10.1093/ptj/pzab313}, year = {2022}, date = {2022-01-13}, journal = {Physical Therapy}, abstract = {The purpose of this study was to examine the impact of hospital-based rehabilitation services on community discharge rates after hip and knee replacement surgery according to hospital participation in value-based care models: bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR). The secondary objective was to determine whether community discharge rates after hip and knee replacement surgery differed by participation in these models.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The purpose of this study was to examine the impact of hospital-based rehabilitation services on community discharge rates after hip and knee replacement surgery according to hospital participation in value-based care models: bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR). The secondary objective was to determine whether community discharge rates after hip and knee replacement surgery differed by participation in these models. |
2021 |
Kumar, Amit; Roy, Indrakshi; Bosch, Pamela; Fehnel, Corey; Garnica, Nicholas; Cook, Jon; Warren, Meghan; Karmarkar, Amol Medicare Claim–Based National Institutes of Health Stroke Scale to Predict 30-Day Mortality and Hospital Readmission Journal Article Journal of General Internal Medicine, 2021. @article{Kumar2021, title = {Medicare Claim–Based National Institutes of Health Stroke Scale to Predict 30-Day Mortality and Hospital Readmission}, author = {Amit Kumar and Indrakshi Roy and Pamela Bosch and Corey Fehnel and Nicholas Garnica and Jon Cook and Meghan Warren and Amol Karmarkar}, url = {https://doi.org/10.1007/s11606-021-07162-0}, doi = {10.1007/s11606-021-07162-0}, year = {2021}, date = {2021-10-26}, journal = {Journal of General Internal Medicine}, abstract = {The Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for higher than expected 30-day mortality rates using methods without accounting for condition severity risk adjustment. For patients with stroke, CMS claims did not quantify stroke severity until recently, when the National Institutes of Health Stroke Scale (NIHSS) reporting began. Examine the predictive ability of claim-based NIHSS to predict 30-day mortality and 30-day hospital readmission in patients with ischemic stroke.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for higher than expected 30-day mortality rates using methods without accounting for condition severity risk adjustment. For patients with stroke, CMS claims did not quantify stroke severity until recently, when the National Institutes of Health Stroke Scale (NIHSS) reporting began. Examine the predictive ability of claim-based NIHSS to predict 30-day mortality and 30-day hospital readmission in patients with ischemic stroke. |
2020 |
Roy, Indrakshi; Karmarkar, Amol; Kumar, Amit; Warren, Meghan; Pohl, Patricia; Shaibi, Stefany; Rivera-Hernandez, Maricruz; Rudolph, James Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD Journal Article Innovation in Aging, 4 (1), pp. 666–667, 2020. @article{Roy2020, title = {Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD }, author = {Indrakshi Roy and Amol Karmarkar and Amit Kumar and Meghan Warren and Patricia Pohl and Stefany Shaibi and Maricruz Rivera-Hernandez and James Rudolph}, url = {https://doi.org/10.1093/geroni/igaa057.2307}, doi = {10.1093/geroni/igaa057.2307}, year = {2020}, date = {2020-12-16}, journal = {Innovation in Aging}, volume = {4}, number = {1}, pages = {666–667}, abstract = {The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed. }, keywords = {}, pubstate = {published}, tppubtype = {article} } The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed. |
Roy, Indrakshi; Karmarkar, Amol; Kumar, Amit; Warren, Meghan; Pohl, Patricia; Rivera-Hernandez, Maricruz Utilization After Hip Fracture in Medicare Beneficiaries With ADRD Journal Article Innovation in Aging, 4 (1), pp. 59, 2020. @article{Roy2020b, title = {Utilization After Hip Fracture in Medicare Beneficiaries With ADRD}, author = {Indrakshi Roy and Amol Karmarkar and Amit Kumar and Meghan Warren and Patricia Pohl and Maricruz Rivera-Hernandez }, url = {https://doi.org/10.1093/geroni/igaa057.192}, doi = {10.1093/geroni/igaa057.192}, year = {2020}, date = {2020-12-01}, journal = {Innovation in Aging}, volume = {4}, number = {1}, pages = {59}, abstract = {The incidence of hip fracture in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. Care complexity, including extensive post-acute rehabilitation, increases substantially in patients with ADRD after hip fracture. However, there are no standardized post-acute care utilization models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute utilization varies by race/ethnicity, in this population. To investigate racial differences in post-acute care utilization following hip fracture related hospitalization in patients with ADRD. A secondary analysis was conducted on 120,179 older adults with ADRD with incident hip fracture, using 100% Medicare data (2016-2017). The primary outcome was post-acute discharge dispositions (skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home Health Care [HHC]) across various racial groups. Multinomial logistic regression examined the association between race and post-acute discharge dispositions after accounting for patient-level covariates. Compared to non-Hispanic Whites, minority racial groups have significantly lower odds of being discharged to SNF, IRF, or HHC, as compared to home. Adjusted odds ratio for Hispanics discharged to SNF was 0.28 (CI=0.24-0.31), to IRF was 0.46 (CI=0.39-0.52) and HHC was 0.64 (95% CI =0.54-0.75), as compared to home. CONCLUSION: ADRD patients have higher risk of hip fracture. Findings from this study will provide insight on how to reduce racial and ethnic disparities in post-acute care utilization in vulnerable populations.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The incidence of hip fracture in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. Care complexity, including extensive post-acute rehabilitation, increases substantially in patients with ADRD after hip fracture. However, there are no standardized post-acute care utilization models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute utilization varies by race/ethnicity, in this population. To investigate racial differences in post-acute care utilization following hip fracture related hospitalization in patients with ADRD. A secondary analysis was conducted on 120,179 older adults with ADRD with incident hip fracture, using 100% Medicare data (2016-2017). The primary outcome was post-acute discharge dispositions (skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home Health Care [HHC]) across various racial groups. Multinomial logistic regression examined the association between race and post-acute discharge dispositions after accounting for patient-level covariates. Compared to non-Hispanic Whites, minority racial groups have significantly lower odds of being discharged to SNF, IRF, or HHC, as compared to home. Adjusted odds ratio for Hispanics discharged to SNF was 0.28 (CI=0.24-0.31), to IRF was 0.46 (CI=0.39-0.52) and HHC was 0.64 (95% CI =0.54-0.75), as compared to home. CONCLUSION: ADRD patients have higher risk of hip fracture. Findings from this study will provide insight on how to reduce racial and ethnic disparities in post-acute care utilization in vulnerable populations. |
2019 |
Camplain, Ricky; Baldwin, Julie A; Warren, Meghan; Camplain, Carolyn Physical Activity in People Who Are Incarcerated: A Social Justice Issue Journal Article Journal of Physical Activity and Health, 16 (5), pp. 306-307, 2019. @article{Camplain2019, title = {Physical Activity in People Who Are Incarcerated: A Social Justice Issue}, author = {Ricky Camplain and Julie A Baldwin and Meghan Warren and Carolyn Camplain}, url = {https://journals.humankinetics.com/doi/full/10.1123/jpah.2019-0055}, year = {2019}, date = {2019-05-05}, journal = {Journal of Physical Activity and Health}, volume = {16}, number = {5}, pages = {306-307}, abstract = {Every year, approximately 12 million Americans cycle in and out of jail (ie, short-term facilities that hold individuals awaiting trial and/or sentenced to a term of less than 1 y).1 Although jails allow incarcerated individuals’ recreation time to engage in physical activity,2 it is not clear to what extent these opportunities are utilized. This potential lack of engagement in physical activity is concerning, especially as some of the benefits of physical activity are immediate and may improve the day-to-day life for those who are incarcerated. For example, a single bout of moderate to vigorous physical activity will reduce blood pressure, improve insulin sensitivity, improve sleep and cognition, and reduce symptoms of anxiety symptoms and anger.3 Unfortunately, use of recreation time in the jail setting has not been described previously, thereby precluding an important area for policy intervention.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Every year, approximately 12 million Americans cycle in and out of jail (ie, short-term facilities that hold individuals awaiting trial and/or sentenced to a term of less than 1 y).1 Although jails allow incarcerated individuals’ recreation time to engage in physical activity,2 it is not clear to what extent these opportunities are utilized. This potential lack of engagement in physical activity is concerning, especially as some of the benefits of physical activity are immediate and may improve the day-to-day life for those who are incarcerated. For example, a single bout of moderate to vigorous physical activity will reduce blood pressure, improve insulin sensitivity, improve sleep and cognition, and reduce symptoms of anxiety symptoms and anger.3 Unfortunately, use of recreation time in the jail setting has not been described previously, thereby precluding an important area for policy intervention. |
Camplain, Ricky; Warren, Meghan; Baldwin, Julie; Camplain, Carolyn; Fofanov, Viacheslav Y; Trotter, Robert T Epidemiology of incarceration Characterizing jail incarceration for public health research Journal Article Epidemiology, 2019. @article{Camplain2019d, title = {Epidemiology of incarceration Characterizing jail incarceration for public health research}, author = {Ricky Camplain and Meghan Warren and Julie Baldwin and Carolyn Camplain and Viacheslav Y Fofanov and Robert T Trotter}, url = {https://journals.lww.com/epidem/Abstract/2019/07000/Epidemiology_of_Incarceration__Characterizing_Jail.14.aspx}, doi = {10.1097/EDE.0000000000001021}, year = {2019}, date = {2019-04-08}, journal = {Epidemiology}, abstract = {Background: Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to re-incarceration. Methods: We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001-2018 from jail intake and release records. Results: The median number of incarcerations during the study period was 1 (Interquartile range (IQR) 1, 2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR 0, 5). The median total days incarcerated was 3 (IQR 1, 23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been re-incarcerated. Conclusion: Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Each year, 9 million individuals cycle in and out of jails. The under-characterization of incarceration as an exposure poses substantial challenges to understanding how varying levels of exposure to jail may affect health. Thus, we characterized levels of jail incarceration including recidivism, number of incarcerations, total and average number of days incarcerated, and time to re-incarceration. Methods: We created a cohort of 75,203 individuals incarcerated at the Coconino County Detention Facility in Flagstaff, Arizona, from 2001-2018 from jail intake and release records. Results: The median number of incarcerations during the study period was 1 (Interquartile range (IQR) 1, 2). Forty percent of individuals had >1 incarceration. The median length of stay for first observed incarcerations was 1 day (IQR 0, 5). The median total days incarcerated was 3 (IQR 1, 23). Average length of stay increased by number of incarcerations. By 18 months, 27% of our sample had been re-incarcerated. Conclusion: Characteristics of jail incarceration have been largely left out of public health research. A better understanding of jail incarcerations can help design analyses to assess health outcomes of individuals incarcerated in jail. Our study is an early step in shaping an understanding of jail incarceration as an exposure for future epidemiologic research. |
2018 |
II, Robert Trotter T; Camplain, Ricky; Eaves, Emery R; Fofanov, Viacheslav Y; Dmitrieva, Natalia O; Hepp, Crystal M; Warren, Meghan; Barrios, Brianna A; Pagel, Nicole; Mayer, Alyssa; Baldwin, Julie A Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study Journal Article JMIR Res Protoc, 7 (10), 2018. @article{II2018b, title = {Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study}, author = {Robert Trotter T II and Ricky Camplain and Emery R Eaves and Viacheslav Y Fofanov and Natalia O Dmitrieva and Crystal M Hepp and Meghan Warren and Brianna A Barrios and Nicole Pagel and Alyssa Mayer and Julie A Baldwin}, editor = {Gunther Eysenbach and Nicola Kuter}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231773/}, year = {2018}, date = {2018-10-24}, journal = {JMIR Res Protoc}, volume = {7}, number = {10}, abstract = {Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337 |