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.
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Hunter, Wynn G; Zafar, Yousuf S; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Barnett, Jamison A; Ubel, Peter A Discussing health care expenses in the oncology clinic: Analysis of cost conversations in outpatient encounters Journal Article Journal of Oncology Practice, 12 (11), pp. e944-e956, 2017. @article{Hunter2017, title = {Discussing health care expenses in the oncology clinic: Analysis of cost conversations in outpatient encounters}, author = {Wynn G Hunter and Yousuf S Zafar and Ashley Hesson and Kelly J Davis and Christine Kirby and Jamison A Barnett and Peter A Ubel}, url = {http://ascopubs.org/doi/abs/10.1200/JOP.2017.022855}, year = {2017}, date = {2017-08-23}, journal = {Journal of Oncology Practice}, volume = {12}, number = {11}, pages = {e944-e956}, abstract = {Purpose: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-patient cost conversations by determining the content of cost conversations in breast cancer clinic visits. Methods: We performed content analysis of transcribed dialogue from 677 outpatient appointments for breast cancer management. Encounters featured 677 patients with breast cancer visiting 56 oncologists nationwide from 2010 to 2013. Results: Cost conversations were identified in 22% of visits (95% CI, 19 to 25) and had a median duration of 33 seconds (interquartile range, 19 to 62). Fifty-nine percent of cost conversations were initiated by oncologists (95% CI, 51 to 67), who most commonly brought up costs for antineoplastic agents. By contrast, patients …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Purpose: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-patient cost conversations by determining the content of cost conversations in breast cancer clinic visits. Methods: We performed content analysis of transcribed dialogue from 677 outpatient appointments for breast cancer management. Encounters featured 677 patients with breast cancer visiting 56 oncologists nationwide from 2010 to 2013. Results: Cost conversations were identified in 22% of visits (95% CI, 19 to 25) and had a median duration of 33 seconds (interquartile range, 19 to 62). Fifty-nine percent of cost conversations were initiated by oncologists (95% CI, 51 to 67), who most commonly brought up costs for antineoplastic agents. By contrast, patients … |
Brown, Gregory D; Hunter, Wynn G; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Barnett, Jamison A; Byelmac, Dmytro; Ubel, Peter A Discussing out-of-pocket expenses during clinical appointments: An observational study of patient-psychiatrist interactions Journal Article Psychiatric Services, 68 (6), pp. 610-617, 2017. @article{Brown2017, title = {Discussing out-of-pocket expenses during clinical appointments: An observational study of patient-psychiatrist interactions}, author = {Gregory D Brown and Wynn G Hunter and Ashley Hesson and Kelly J Davis and Christine Kirby and Jamison A Barnett and Dmytro Byelmac and Peter A Ubel}, url = {https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201600275}, year = {2017}, date = {2017-05-19}, journal = {Psychiatric Services}, volume = {68}, number = {6}, pages = {610-617}, abstract = {Objective: High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. Methods: The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Results: Patients’ health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%–43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. Methods: The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Results: Patients’ health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%–43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute … |
Hunter, Wynn G; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A Patient-physician discussions about costs: Definitions and impact on cost conversation incidence estimates Journal Article BMC Health Services Research, 16 (1), pp. 108, 2016. @article{Hunter2016b, title = {Patient-physician discussions about costs: Definitions and impact on cost conversation incidence estimates}, author = {Wynn G Hunter and Ashley Hesson and Kelly J Davis and Christine Kirby and Lillie D Williamson and Jamison A Barnett and Peter A Ubel}, url = {https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1353-2}, year = {2016}, date = {2016-12-01}, journal = {BMC Health Services Research}, volume = {16}, number = {1}, pages = {108}, abstract = {Nearly one in three Americans are financially burdened by their medical expenses. To mitigate financial distress, experts recommend routine physician-patient cost conversations. However, the content and incidence of these conversations are unclear, and rigorous definitions are lacking. We sought to develop a novel set of cost conversation definitions, and determine the impact of definitional variation on cost conversation incidence in three clinical settings. Retrospective, mixed-methods analysis of transcribed dialogue from 1,755 outpatient encounters for routine clinical management of breast cancer, rheumatoid arthritis, and depression, occurring between 2010–2014. We developed cost conversation definitions using summative content analysis. Transcripts were evaluated independently by at least two members of our multi-disciplinary team to determine cost conversation incidence using each definition. Incidence estimates were compared using Pearson’s Chi-Square Tests. Three cost conversation definitions emerged from our analysis: (a) Out-of-Pocket (OoP) Cost -- discussion of the patient’s OoP costs for a healthcare service; (b) Cost/Coverage -- discussion of the patient’s OoP costs or insurance coverage; (c) Cost of Illness-- discussion of financial costs or insurance coverage related to health or healthcare. These definitions were hierarchical; OoP Cost was a subset of Cost/Coverage, which was a subset of Cost of Illness. In each clinical setting, we observed significant variation in the incidence of cost conversations when using different definitions; breast oncology: 16, 22, 24 % of clinic visits contained cost conversation (OOP Cost, Cost …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Nearly one in three Americans are financially burdened by their medical expenses. To mitigate financial distress, experts recommend routine physician-patient cost conversations. However, the content and incidence of these conversations are unclear, and rigorous definitions are lacking. We sought to develop a novel set of cost conversation definitions, and determine the impact of definitional variation on cost conversation incidence in three clinical settings. Retrospective, mixed-methods analysis of transcribed dialogue from 1,755 outpatient encounters for routine clinical management of breast cancer, rheumatoid arthritis, and depression, occurring between 2010–2014. We developed cost conversation definitions using summative content analysis. Transcripts were evaluated independently by at least two members of our multi-disciplinary team to determine cost conversation incidence using each definition. Incidence estimates were compared using Pearson’s Chi-Square Tests. Three cost conversation definitions emerged from our analysis: (a) Out-of-Pocket (OoP) Cost -- discussion of the patient’s OoP costs for a healthcare service; (b) Cost/Coverage -- discussion of the patient’s OoP costs or insurance coverage; (c) Cost of Illness-- discussion of financial costs or insurance coverage related to health or healthcare. These definitions were hierarchical; OoP Cost was a subset of Cost/Coverage, which was a subset of Cost of Illness. In each clinical setting, we observed significant variation in the incidence of cost conversations when using different definitions; breast oncology: 16, 22, 24 % of clinic visits contained cost conversation (OOP Cost, Cost … |
2017 |
Hunter, Wynn G; Zafar, Yousuf S; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Barnett, Jamison A; Ubel, Peter A Discussing health care expenses in the oncology clinic: Analysis of cost conversations in outpatient encounters Journal Article Journal of Oncology Practice, 12 (11), pp. e944-e956, 2017. @article{Hunter2017, title = {Discussing health care expenses in the oncology clinic: Analysis of cost conversations in outpatient encounters}, author = {Wynn G Hunter and Yousuf S Zafar and Ashley Hesson and Kelly J Davis and Christine Kirby and Jamison A Barnett and Peter A Ubel}, url = {http://ascopubs.org/doi/abs/10.1200/JOP.2017.022855}, year = {2017}, date = {2017-08-23}, journal = {Journal of Oncology Practice}, volume = {12}, number = {11}, pages = {e944-e956}, abstract = {Purpose: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-patient cost conversations by determining the content of cost conversations in breast cancer clinic visits. Methods: We performed content analysis of transcribed dialogue from 677 outpatient appointments for breast cancer management. Encounters featured 677 patients with breast cancer visiting 56 oncologists nationwide from 2010 to 2013. Results: Cost conversations were identified in 22% of visits (95% CI, 19 to 25) and had a median duration of 33 seconds (interquartile range, 19 to 62). Fifty-nine percent of cost conversations were initiated by oncologists (95% CI, 51 to 67), who most commonly brought up costs for antineoplastic agents. By contrast, patients …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Purpose: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-patient cost conversations by determining the content of cost conversations in breast cancer clinic visits. Methods: We performed content analysis of transcribed dialogue from 677 outpatient appointments for breast cancer management. Encounters featured 677 patients with breast cancer visiting 56 oncologists nationwide from 2010 to 2013. Results: Cost conversations were identified in 22% of visits (95% CI, 19 to 25) and had a median duration of 33 seconds (interquartile range, 19 to 62). Fifty-nine percent of cost conversations were initiated by oncologists (95% CI, 51 to 67), who most commonly brought up costs for antineoplastic agents. By contrast, patients … |
Brown, Gregory D; Hunter, Wynn G; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Barnett, Jamison A; Byelmac, Dmytro; Ubel, Peter A Discussing out-of-pocket expenses during clinical appointments: An observational study of patient-psychiatrist interactions Journal Article Psychiatric Services, 68 (6), pp. 610-617, 2017. @article{Brown2017, title = {Discussing out-of-pocket expenses during clinical appointments: An observational study of patient-psychiatrist interactions}, author = {Gregory D Brown and Wynn G Hunter and Ashley Hesson and Kelly J Davis and Christine Kirby and Jamison A Barnett and Dmytro Byelmac and Peter A Ubel}, url = {https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201600275}, year = {2017}, date = {2017-05-19}, journal = {Psychiatric Services}, volume = {68}, number = {6}, pages = {610-617}, abstract = {Objective: High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. Methods: The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Results: Patients’ health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%–43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: High out-of-pocket expenses for medical treatment have been associated with worse quality of life, decreased treatment adherence, and increased risk of adverse health outcomes. Treatment of depression potentially has high out-of-pocket expenses. Limited data characterize psychiatrist-patient conversations about health care costs. Methods: The authors conducted content analysis from 422 outpatient psychiatrist-patient visits for medication management of major depressive disorder in community-based private practices nationwide from 2010 to 2014. Results: Patients’ health care expenses were discussed in 38% of clinic visits (95% confidence interval [CI]= 33%–43%). Uninsured patients were significantly more likely to discuss expenses than were patients enrolled in private or public plans (64%, 44%, and 30%, respectively; p<.001). Sixty-nine percent of cost conversations lasted less than one minute … |
2016 |
Hunter, Wynn G; Hesson, Ashley; Davis, Kelly J; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A Patient-physician discussions about costs: Definitions and impact on cost conversation incidence estimates Journal Article BMC Health Services Research, 16 (1), pp. 108, 2016. @article{Hunter2016b, title = {Patient-physician discussions about costs: Definitions and impact on cost conversation incidence estimates}, author = {Wynn G Hunter and Ashley Hesson and Kelly J Davis and Christine Kirby and Lillie D Williamson and Jamison A Barnett and Peter A Ubel}, url = {https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1353-2}, year = {2016}, date = {2016-12-01}, journal = {BMC Health Services Research}, volume = {16}, number = {1}, pages = {108}, abstract = {Nearly one in three Americans are financially burdened by their medical expenses. To mitigate financial distress, experts recommend routine physician-patient cost conversations. However, the content and incidence of these conversations are unclear, and rigorous definitions are lacking. We sought to develop a novel set of cost conversation definitions, and determine the impact of definitional variation on cost conversation incidence in three clinical settings. Retrospective, mixed-methods analysis of transcribed dialogue from 1,755 outpatient encounters for routine clinical management of breast cancer, rheumatoid arthritis, and depression, occurring between 2010–2014. We developed cost conversation definitions using summative content analysis. Transcripts were evaluated independently by at least two members of our multi-disciplinary team to determine cost conversation incidence using each definition. Incidence estimates were compared using Pearson’s Chi-Square Tests. Three cost conversation definitions emerged from our analysis: (a) Out-of-Pocket (OoP) Cost -- discussion of the patient’s OoP costs for a healthcare service; (b) Cost/Coverage -- discussion of the patient’s OoP costs or insurance coverage; (c) Cost of Illness-- discussion of financial costs or insurance coverage related to health or healthcare. These definitions were hierarchical; OoP Cost was a subset of Cost/Coverage, which was a subset of Cost of Illness. In each clinical setting, we observed significant variation in the incidence of cost conversations when using different definitions; breast oncology: 16, 22, 24 % of clinic visits contained cost conversation (OOP Cost, Cost …}, keywords = {}, pubstate = {published}, tppubtype = {article} } Nearly one in three Americans are financially burdened by their medical expenses. To mitigate financial distress, experts recommend routine physician-patient cost conversations. However, the content and incidence of these conversations are unclear, and rigorous definitions are lacking. We sought to develop a novel set of cost conversation definitions, and determine the impact of definitional variation on cost conversation incidence in three clinical settings. Retrospective, mixed-methods analysis of transcribed dialogue from 1,755 outpatient encounters for routine clinical management of breast cancer, rheumatoid arthritis, and depression, occurring between 2010–2014. We developed cost conversation definitions using summative content analysis. Transcripts were evaluated independently by at least two members of our multi-disciplinary team to determine cost conversation incidence using each definition. Incidence estimates were compared using Pearson’s Chi-Square Tests. Three cost conversation definitions emerged from our analysis: (a) Out-of-Pocket (OoP) Cost -- discussion of the patient’s OoP costs for a healthcare service; (b) Cost/Coverage -- discussion of the patient’s OoP costs or insurance coverage; (c) Cost of Illness-- discussion of financial costs or insurance coverage related to health or healthcare. These definitions were hierarchical; OoP Cost was a subset of Cost/Coverage, which was a subset of Cost of Illness. In each clinical setting, we observed significant variation in the incidence of cost conversations when using different definitions; breast oncology: 16, 22, 24 % of clinic visits contained cost conversation (OOP Cost, Cost … |