2017 New Investigators | AcademyHealth

Danielle N. Atkins, Ph.D., M.P.A.
Research Topic: Maternal and Child Health (funded by March of Dimes)
Institution: University of Central Florida
Research Title: The Effect of Prenatal Substance Use Policies on Maternal Substance Abuse and Infant Health

Substance use and abuse during pregnancy can cause severe, life-long harm to the baby. Tennessee was the first state to criminalize prenatal substance abuse in 2014. In other states, variation over time exists in how prenatal substance abuse is handled by the law. For example, prenatal substance abuse is treated as child abuse in many states. Other states require mandatory reporting or testing by health care professionals. Using state policy variation, this study investigates the effect of state-level punitive policies addressing prenatal substance abuse on maternal and infant health outcomes. The public policy data are drawn from the Guttmacher Institute’s State Policies in Brief: Substance Abuse During Pregnancy and additional legal research. The infant and maternal outcomes data will be gathered from the Hospital Cost and Utilization Project (HCUP) State Inpatient Database (SID) from 1996-2014. These data include the universe of inpatient discharge records from community hospitals by state. Using the SID, the number of discharges for the following ICD-9 codes will be identified: 1) drug dependence in pregnancy; 2) drug dependence in delivery; and 3) neonatal abstinence syndrome. Rates of these outcomes will be created using total birth counts by state and year from Vital Statistics data. A difference-in-difference model will be used to investigate the effect of state-specific policies on prenatal substance use and consequences for maternal and newborn health. This study will add to the body of knowledge about the effects of policies aimed at deterring substance abuse during pregnancy, which has important clinical and policy implications.

Danielle Atkins is an assistant professor in the Department of Health Management and Informatics at the University of Central Florida. She received her Ph.D. (2013) and M.P.A. (2009) at the University of Georgia in the Department of Public Administration and Policy. Her research centers around the relationship between public policy and health outcomes. She is interested in how public policy affects health outcomes in both intended and unintended ways. Her research focuses on issues related to maternal and child health, reproductive health, substance abuse, and risky behaviors. She is currently working on several projects examining the relationships between policies regulating women’s access to healthcare and maternal and infant health outcomes, substance abuse policy and overdose outcomes, and prenatal substance abuse policies and maternal and infant health outcomes.

Amanda Brewster, Ph.D., M.Sc.
Research Topic: Community Interventions for Healthcare (funded by AcademyHealth)
Institution: Yale School of Public Health
Research Title: Linking Health Care and Social Services for Older Adults: Which Strategies Reduce Avoidable Utilization and Contain Costs?

Social services represent a critical complement to health care for older adults who have complex, high-cost health needs such as multiple chronic conditions, mental illness, and cognitive impairment. Although policy innovations are motivating health care providers to consider social determinants of health, limited evidence exists on effective strategies for collaboration between health care organizations and social service agencies. Area Agencies on Aging (AAAs) – a network of over 600 organizations that assist older adults in nearly every community of the U.S. – have pioneered links between social services and health care in recent years, and the experiences of AAAs may offer important lessons about collaboration strategies that improve population health outcomes. This project proposes to examine whether AAAs’ adoption of three types of strategies for linking health care and social serves have been associated with changes in health outcomes. Using survey data from the nationwide network of AAAs, we will seek to examine whether (1) establishing new partnerships, (2) supporting care transitions, and (3) engaging with Medicaid managed care organizations are associated with improvement in county-level measures of avoidable hospitalization and health care costs.

Amanda Brewster is a post-doctoral researcher at the Yale Global Health Leadership Institute, where she focuses on organizational change, inter-organizational relationships, and quality improvement in health care. Her research has examined hospital efforts to reduce readmissions, including the process by which innovations become embedded in routines. She is currently studying how health care organizations initiate and sustain collaborative relationships with social service agencies to address patients’ non-medical needs, using mixed methods and organizational network analysis. Dr. Brewster received her Ph.D. in health services research from Boston University.

Cara McDermott, Pharm.D., Ph.D., M.Sc.
Research Topic: Combatting Low Value Care (funded by Altarum Institute)
Institution: University of Washington School of Medicine
Research Title: Care Coordination and Low-Value Care at End-of-Life Among Patients with Advanced Cancer

Following the Affordable Care Act, there is increased focus on improving value in health care and provision of advanced care planning for patients. Value-based cancer care delivery is at the nexus of these priorities, and organizations such as the American Society of Clinical Oncology have noted that additional research is needed to guide value considerations in cancer care delivery. Low-value care, which is care lacking sufficient evidence of benefit or care not in accordance with patient goals, often occurs near death for cancer patients. Hospitalization and emergency department visits for commonly occurring conditions among the dying, such as dehydration, pain management, and constipation are examples of potentially avoidable, low-value care that are not beneficial if the condition could be ameliorated in a home setting, thus avoiding time, hassle, and expenditures to patients and families. Targeted care coordination, whereby patients are informed of various care options for end-of-life care provision and plan care in accordance with their goals of care, may allow patients to avoid such low-value care. Using existing partnerships between the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center and local insurers, we will study insurer-provided care coordination for enrollees in Washington State with advanced cancer and the association with patterns of healthcare utilization in the last month of life. Findings from this study will help determine how patients perceive and utilize care coordination services in this setting and inform future interventions to improve care coordination and value-based care delivery for patients facing life-limiting illness.

Cara McDermott, Pharm.D., Ph.D., M.Sc. is a T32 post-doctoral research fellow with the Cambia Palliative Care Center of Excellence at the University of Washington School of Medicine and an Affiliate Investigator with the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center. Her research examines care delivery, medication use, and healthcare utilization among older adults with cancer and other comorbidities. In recent projects she investigated the impact of depression on cancer treatment and end-of-life care for older adults with lung cancer, healthcare utilization and associated out-of-pocket costs for patients with hematologic malignancies, and healthcare utilization at end of life among commercially insured adults with cancer. Dr. McDermott holds a B.A. from Princeton University, a Pharm.D. from the University of Washington, and M.Sc. and Ph.D. degrees from the Pharmaceutical Outcomes and Research Policy Program at the University of Washington School of Pharmacy.

Caitlin C. Murphy, Ph.D., M.P.H.
Research Topic: Prescription Medication Use and Polypharmacy (funded by AcademyHealth)
Institution: University of Texas Southwestern Medical Center
Research Title: Patterns of Prescription Medication Use and Polypharmacy Among Cancer Survivors

The population of cancer survivors is rapidly growing and expected to reach 26.1 million in the next 25 years. Most cancer survivors must manage other chronic conditions (e.g., diabetes, cardiovascular disease) that may be exacerbated by cancer-related toxicities that persist after completing active treatment or appear years later. Long-term and late effects of cancer, combined with the need for heightened vigilance and monitoring of cancer and other chronic conditions, make cancer survivors potentially more vulnerable to the adverse effects of polypharmacy (e.g., drug interactions, non-adherence). Variously defined, polypharmacy captures a wide range of medication-related behaviors, including concurrent use of a large number of medications for the treatment of one or more conditions, use of potentially inappropriate prescription medications, and under- and overuse of appropriate medications. Understanding the relationship between polypharmacy and chronic conditions is critical to improving delivery of high-quality survivorship care. Leveraging data from the Medical Expenditures Panel Survey, this project will examine patterns of prescription medication use, polypharmacy, and prescription expenditures in a nationally representative sample of cancer survivors. Results will inform the design of future intervention studies to improve management of multiple chronic conditions and complex medication regimens in cancer survivors.

Caitlin Murphy is an assistant professor in the Department of Clinical Sciences and member of the Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center. As an epidemiologist with expertise in health services research, Dr. Murphy has experience using quantitative methods to evaluate cancer care delivery. Her research program focuses on optimizing delivery of oral anticancer therapies, including measuring adherence, managing complex dosing regimens, and identifying and reporting toxicities. Dr. Murphy received her Ph.D. in epidemiology from the University of North Carolina at Chapel Hill, where she was a fellow in the Digestive Disease Epidemiology Program (T32 DK007634).

Sayeh Nikpay, Ph.D., M.P.H.
Research Topic: Medicaid Managed Care (funded by Association for Community Affiliated Plans)
Institution: Vanderbilt University
Research Title: Impact of Coordination in Medicaid Managed Care Markets: Evidence from Tennessee

Insurance markets have become more consolidated over the last decade, resulting in both higher premiums for consumers and diminished revenue for providers. Medicaid managed care markets have also become more consolidated, yet few studies have explored the impact of these changes on providers or patient outcomes. In 2013, the state of Tennessee mandated that three Medicaid managed care organizations (MCOs) be available state-wide by 2014, resulting in region-specific changes in Medicaid insurance market concentration. I propose to investigate the effect Tennessee’s state-mandated change in Medicaid managed care concentration on measures of physician and hospital Medicaid participation as well as health care utilization among Medicaid beneficiaries. The proposed project will use data on managed care market concentration, physician and hospital data, and longitudinal encounter data from Medicaid managed care organizations participating in the Tennessee Medicaid program, which include office-based and hospital-based care, pharmacy, and dental care utilization. The proposed study will use a difference-in-differences design to compare the change in provider or patient-level measures between counties that did and did not experience a change in Medicaid managed care market concentration. This project will explore the benefits of increased choice of Medicaid managed care providers on access to care for low-income populations. In addition to addressing an important gap in the peer-reviewed health services literature, my findings will provide state policymakers with evidence on the impact of mandating greater choice for Medicaid managed care beneficiaries on access to care.

Sayeh Nikpay is an assistant professor in the Department of Health Policy at the Vanderbilt University School of Medicine. She is a health policy researcher with training in economics, and experience working with both state and federal policymakers to analyze health policies. Her research focuses primarily on the impact of the Affordable Care Act on hospitals including the effect of the Medicaid expansion on hospital uncompensated care, payer mix, and financial position, and hospitals’ compliance with new community benefit requirements. Other areas of interest include the relationship between Medicaid expansion and physician participation in the Medicaid program, the impact of Medicaid expansion on coverage and retirement decisions, and the effect of the Affordable Care Act on economic wellbeing. Dr. Nikpay received an M.P.H., and Ph.D. in Health Policy from the University of Michigan (2009, 2014) and a B.A. in Biology from Macalester College (2005). She was a staff economist at the Council of Economic Advisers from 2010-2011, and a postdoctoral fellow at the University of Michigan Institute for Healthcare Policy and Innovation from 2014-2015.