Ji E Chang
Ji E Chang
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Associate Professor of Public Health Policy and Management
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Professional overview
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Ji Eun Chang, Ph.D., is an Associate Professor in the Department of Public Health Policy and Management at the New York University School of Global Public Health, where she also serves as the public health policy and management concentration director for the Ph.D. program. Professor Chang uses mixed-methods research designs and draws from qualitative, quantitative, and geospatial data to demonstrate disparities and highlight barriers faced by safety net providers and underserved patients in accessing equitable care.
Professor Chang is the principal investigator of the AI4Healthy Cities Initiative in New York City, a multi-city collaboration between the Novartis Foundation, Microsoft AI4Health, and local health officials to reduce cardiovascular health inequities through big data analytics. Dr. Chang is also the co-principal investigator of an NIH NIDA-funded study to support implementing transitional opioid programs in safety net hospitals. Dr. Chang received a B.A. in Economics from the University of California at Berkeley, an M.S. in Public Policy and Management from Carnegie Mellon University, and a Ph.D. in Public Administration from New York University in 2016. -
Education
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BA, Economics, University of California at Berkeley, Berkeley, CAMS, Public Policy and Management, Carnegie Mellon University, Pittsburgh, PAPhD, Public Administration, New York University, New York, NY
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Honors and awards
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Governor’s Scholar (2007)Regents and Chancellors’ Scholar (2005)
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Areas of research and study
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Cardiovascular DiseaseHealth DisparitiesHealth EquityPublic Health ManagementPublic Health ManagementSafety Net Providers and PatientsSubstance Use Disorders
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Publications
Publications
Poster: Suicide ideation and behavior disparities among high school students: Examining Asian and multiracial race/ethnicity
AbstractChang, J. E. (n.d.).Publication year
2023Abstract~Poster: Hospital Adoption of Harm Reduction and Risk Education Strategies to Address Substance Use Disorder
AbstractChang, J. E. (n.d.).Publication year
2023Abstract~Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them
AbstractWeeks, W. B., Chang, J. E., Pagán, J. A., Lumpkin, J., Michael, D., Salcido, S., Kim, A., Speyer, P., Aerts, A., Weinstein, J. N., Lavista, J. M., & Chang, J. E. (n.d.).Publication year
2023Journal title
PLOS global public healthVolume
3Issue
10Page(s)
e0002420AbstractWhile rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015-2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript. We found that rural counties overwhelmingly had worse measures of SDOH at the county level. With few exceptions, the measures we examined were getting worse between 2015 and 2019 in all counties, relatively more so in rural counties, resulting in the widening of rural-urban disparities in these measures. When rural-urban gaps narrowed, it tended to be in measures wherein rural counties were outperforming urban ones in the earlier period. In conclusion, our findings highlight the need for policymakers to prioritize rural settings for interventions designed to improve health outcomes, likely through improving health behaviors, clinical care, social and environmental factors, and physical environment attributes. Visualization tools can help guide policymakers and researchers with grounded information, communicate necessary data to engage relevant stakeholders, and track SDOH changes and health outcomes over time.Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them
AbstractWeeks, W. B., Chang, J. E., Pagán, J. A., Lumpkin, J., Michael, D., Salcido, S., Kim, A., Speyer, P., Aerts, A., Weinstein, J. N., & Lavista, J. M. (n.d.).Publication year
2023Journal title
PLOS global public healthVolume
3Issue
10 OctoberAbstractWhile rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015–2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript. We found that rural counties overwhelmingly had worse measures of SDOH at the county level. With few exceptions, the measures we examined were getting worse between 2015 and 2019 in all counties, relatively more so in rural counties, resulting in the widening of rural-urban disparities in these measures. When rural-urban gaps narrowed, it tended to be in measures wherein rural counties were outperforming urban ones in the earlier period. In conclusion, our findings highlight the need for policymakers to prioritize rural settings for interventions designed to improve health outcomes, likely through improving health behaviors, clinical care, social and environmental factors, and physical environment attributes. Visualization tools can help guide policymakers and researchers with grounded information, communicate necessary data to engage relevant stakeholders, and track SDOH changes and health outcomes over time.Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them
AbstractWeeks, W. B., Chang, J. E., Pagán, J. A., Lumpkin, J., Michael, D., Salcido, S., Kim, A., Speyer, P., Aerts, A., Weinstein, J. N., & Lavista, J. M. (n.d.).Publication year
2023Journal title
PLOS global public healthVolume
3Issue
10Page(s)
e0002420AbstractWhile rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015-2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript. We found that rural counties overwhelmingly had worse measures of SDOH at the county level. With few exceptions, the measures we examined were getting worse between 2015 and 2019 in all counties, relatively more so in rural counties, resulting in the widening of rural-urban disparities in these measures. When rural-urban gaps narrowed, it tended to be in measures wherein rural counties were outperforming urban ones in the earlier period. In conclusion, our findings highlight the need for policymakers to prioritize rural settings for interventions designed to improve health outcomes, likely through improving health behaviors, clinical care, social and environmental factors, and physical environment attributes. Visualization tools can help guide policymakers and researchers with grounded information, communicate necessary data to engage relevant stakeholders, and track SDOH changes and health outcomes over time.Senior Author: Team Based Care in Primary Care Settings: A Scoping Review
AbstractChang, J. E. (n.d.).Publication year
2023Abstract~Stakeholder Perspectives on Data-Driven Solutions to Address Cardiovascular Disease and Health Equity in New York City
AbstractLindenfeld, Z., Pagán, J. A., Silver, D., McNeill, E., Mostafa, L., Zein, D., Chang, J. E. E., & Chang, J. E. (n.d.).Publication year
2023Journal title
AJPM focusVolume
2Issue
3Page(s)
100093AbstractThere is growing recognition of the importance of addressing the social determinants of health in efforts to improve health equity. In dense urban environments such as New York City, disparities in chronic health conditions (e.g., cardiovascular disease) closely mimic inequities in social factors such as income, education, and housing. Although there is a wealth of data on these social factors in New York City, little is known about how to rapidly use available data sources to address health disparities.Stakeholder Perspectives on Data-Driven Solutions to Address Cardiovascular Disease and Health Equity in New York City
AbstractLindenfeld, Z., Pagán, J. A., Silver, D. R., McNeill, E., Mostafa, L., Zein, D., & Chang, J. E. (n.d.).Publication year
2023Journal title
AJPM FocusVolume
2Issue
3AbstractIntroduction: There is growing recognition of the importance of addressing the social determinants of health in efforts to improve health equity. In dense urban environments such as New York City, disparities in chronic health conditions (e.g., cardiovascular disease) closely mimic inequities in social factors such as income, education, and housing. Although there is a wealth of data on these social factors in New York City, little is known about how to rapidly use available data sources to address health disparities. Methods: Semistructured interviews were conducted with key stakeholders (N=11) from across the public health landscape in New York City (health departments, healthcare delivery systems, and community-based organizations) to assess perspectives on how social determinants of health data can be used to address cardiovascular disease and health equity, what data-driven tools would be useful, and challenges to using these data sources and developing tools. A matrix analysis approach was used to analyze the interview data. Results: Stakeholders were optimistic about using social determinants of health data to address health equity by delivering holistic care, connecting people with additional resources, and increasing investments in under-resourced communities. However, interviewees noted challenges related to the quality and timeliness of social determinants of health data, interoperability between data systems, and lack of consistent metrics related to cardiovascular disease and health equity. Conclusions: Future research on this topic should focus on mitigating the barriers to using social determinants of health data, which includes incorporating social determinants of health data from other sectors. There is also a need to assess how data-driven solutions can be implemented within and across communities and organizations.Strategies to support substance use disorder care transitions from acute-care to community-based settings : a scoping review and typology
AbstractKrawczyk, N., Rivera, B. D., Chang, J. E., Grivel, M., Chen, Y. H., Nagappala, S., Englander, H., & McNeely, J. (n.d.).Publication year
2023Journal title
Addiction Science and Clinical PracticeVolume
18Issue
1AbstractBackground: Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. Methods: We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000 and 2021 that studied interventions linking patients with SUD from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. Results: Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) or alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. Conclusions: Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology
AbstractKrawczyk, N., Rivera, B. D., Chang, J. E., Grivel, M., Chen, Y.-H. H., Nagappala, S., Englander, H., McNeely, J., & Chang, J. E. (n.d.).Publication year
2023Journal title
Addiction science & clinical practiceVolume
18Issue
1Page(s)
67AbstractAcute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies.Substance Use Disorder Program Availability in Safety-Net and Non-Safety-Net Hospitals in the US
AbstractChang, J. E., Franz, B., Pagán, J. A., Lindenfeld, Z., Cronin, C. E., & Chang, J. E. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
8Page(s)
e2331243AbstractSafety-net hospitals (SNHs) are ideal sites to deliver addiction treatment to patients with substance use disorders (SUDs), but the availability of these services within SNHs nationwide remains unknown.Substance Use Disorder Program Availability in Safety-Net and Non-Safety-Net Hospitals in the US
AbstractChang, J. E., Franz, B., Pagán, J. A., Lindenfeld, Z., & Cronin, C. E. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
8Page(s)
e2331243AbstractSafety-net hospitals (SNHs) are ideal sites to deliver addiction treatment to patients with substance use disorders (SUDs), but the availability of these services within SNHs nationwide remains unknown.Trends in the Prioritization and Implementation of Substance Use Programs by Nonprofit Hospitals : 2015-2021
AbstractChang, J. E., Cronin, C. E., Pagán, J. A., Simon, J., Lindenfeld, Z., & Franz, B. (n.d.).Publication year
2023Journal title
Journal of Addiction MedicineVolume
17Issue
4Page(s)
E217-E223AbstractObjectives Hospitalizations are an important opportunity to address substance use through inpatient services, outpatient care, and community partnerships, yet the extent to which nonprofit hospitals prioritize such services across time remains unknown. The objective of this study is to examine trends in nonprofit hospitals' prioritization and implementation of substance use disorder (SUD) programs. Methods We assessed trends in hospital prioritization of substance use as a top five community need and hospital implementation of SUD programing at nonprofit hospitals between 2015 and 2021 using two waves (wave 1: 2015-2018; wave 2: 2019-2021) by examining hospital community benefit reports. We utilized t or χ2 tests to understand whether there were significant differences in the prioritization and implementation of SUD programs across waves. We used multilevel logistic regression to evaluate the relation between prioritization and implementation of SUD programs, hospital and community characteristics, and wave. Results Hospitals were less likely to have prioritized SUD but more likely to have implemented SUD programs in the most recent 3 years compared, even after adjusting for the local overdose rate and hospital-and community-level variables. Although most hospitals consistently prioritized and implemented SUD programs during the 2015-2021 period, a 11% removed and 15% never adopted SUD programs at all, despite an overall increase in overdose rates. Conclusions Our study identified gaps in hospital SUD infrastructure during a time of elevated need. Failing to address this gap reflects missed opportunities to engage vulnerable populations, provide linkages to treatment, and prevent complications of substance use.Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity : A Scoping Review
AbstractMcNeill, E., Lindenfeld, Z., Mostafa, L., Zein, D., Silver, D. R., Pagán, J., Weeks, W. B., Aerts, A., Rosiers, S. D., Boch, J., & Chang, J. E. (n.d.).Publication year
2023Journal title
Journal of the American Heart AssociationVolume
12Issue
21AbstractBACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. METHODS AND RESULTS: After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geo-coded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. CONCLUSIONS: Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review
AbstractMcNeill, E., Lindenfeld, Z., Mostafa, L., Zein, D., Silver, D., Pagán, J., Weeks, W. B., Aerts, A., Des Rosiers, S., Boch, J., Chang, J. E. E., & Chang, J. E. (n.d.).Publication year
2023Journal title
Journal of the American Heart AssociationVolume
12Issue
21Page(s)
e030571AbstractBackground Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. Methods and Results After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geocoded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. Conclusions Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.Utilizing Publicly Available Community Data to Address Social Determinants of Health : A Compendium of Data Sources
AbstractLindenfeld, Z., Pagán, J. A., & Chang, J. E. (n.d.).Publication year
2023Journal title
Inquiry (United States)Volume
60AbstractTo compile a compendium of data sources representing different areas of social determinants of health (SDOH) in New York City. We conducted a PubMed search of the peer-reviewed and gray literature using the terms “social determinants of health” and “New York City,” with the Boolean operator “AND.” We then conducted a search of the “gray literature,” defined as sources outside of standard bibliographic databases, using similar terms. We extracted publicly available data sources containing NYC-based data. In defining SDOH, we used the framework outlined by the CDC’s Healthy People 2030, which uses a place-based framework to categorize 5 domains of SDOH: (1) healthcare access and quality; (2) education access and quality; (3) social and community context; (4) economic stability; and (5) neighborhood and built environment. We identified 29 datasets from the PubMed search, and 34 datasets from the gray literature, resulting in 63 datasets related to SDOH in NYC. Of these, 20 were available at the zip code level, 18 at the census tract-level, 12 at the community-district level, and 13 at the census block or specific address level. Community-level SDOH data are readily attainable from many public sources and can be linked with health data on local geographic-levels to assess the effect of social and community factors on individual health outcomes.Variance of US Hospital Characteristics by Safety-Net Definition
AbstractMcneill, E., Cronin, C., Puro, N., Franz, B., Silver, D. R., & Chang, J. E. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
9Page(s)
E2332392Abstract~Assessing the effectiveness of problem-solving courts on the reduction of overdose deaths in the United States: A difference-in-difference study
AbstractLindenfeld, Z., Kim, S., & Chang, J. E. (n.d.).Publication year
2022Journal title
Drug and Alcohol Dependence ReportsVolume
4Page(s)
100088AbstractBackground Criminal justice-involved populations are disproportionately more likely to have an active substance use disorder (SUD) and experience a fatal overdose. One way the criminal justice system connects individuals with SUDs to treatment is through problem-solving drug courts designed to divert offenders into treatment. The aim of this study is to assess the effect of drug court implementation on drug overdoses in U.S counties. Methods A difference-in-difference analysis of publicly available data on problem-solving courts and monthly, county-level overdose death data, was completed to understand the difference in number of overdose deaths per county per year for counties with a drug court and those without. The time frame was 2000???2012, which included 630 courts serving 221 counties. Results There was a significant effect of drug courts in reducing county overdose mortality by 2.924 (95% CI: -3.478 ??? -2.370), after controlling for annual trends. Additionally, having a higher number of outpatient SUD providers in the county (coefficient 0.092, 95% CI: 0.032 - 0.152), a higher proportion of uninsured population (coefficient 0.062, 95% CI: 0.052???0.072), and being in the Northeast region (coefficient 0.51, 95% CI: 0.313 - 0.707), was associated with higher county overdose mortality. Conclusions When considering responses to SUDs, our findings point towards drug courts as a useful component of a compendium of strategies to address opioid fatalities. Policymakers and local leaders who wish to engage the criminal justice system in efforts to address the opioid epidemic should be aware of this relationship.Obesity and Patient Activation : Confidence, Communication, and Information Seeking Behavior
AbstractChang, J. E., Lindenfeld, Z., & Chang, V. W. (n.d.).Publication year
2022Journal title
Journal of Primary Care and Community HealthVolume
13AbstractIntroduction/Objectives: Patient activation describes the knowledge, skills, and confidence that allow patients to actively engage in managing their health. Prior studies have found a strong relationship between patient activation and clinical outcomes, costs of care, and patient experience. Patients who are obese or overweight may be less engaged than normal weight patients due to lower confidence or stigma associated with their weight. The objective of this study is to examine whether weight status is associated with patient activation and its sub-domains (confidence, communication, information-seeking behavior). Methods: This repeated cross-sectional study of the 2011 to 2013 Medicare Current Beneficiary Survey (MCBS) included a nationally representative sample of 13,721 Medicare beneficiaries. Weight categories (normal, overweight, obese) were based on body mass index. Patient activation (high, medium, low) was based on responses to the MCBS Patient Activation Supplement. Results: We found no differences in overall patient activation by weight categories. However, compared to those with normal weight, people with obesity had a higher relative risk (RRR 1.24; CI 1.09-1.42) of “low” rather than “high” confidence. Respondents with obesity had a lower relative risk (RRR 0.82; CI 0.73-0.92) of “low” rather than “high” ratings of communication with their doctor. Discussion and Conclusions: Though patients with obesity may be less confident in their ability to manage their health, they are more likely to view their communication with physicians as conducive to self-care management. Given the high receptivity among patients with obesity toward physician communication, physicians may be uniquely situated to guide and support patients in gaining the confidence they need to reach weight loss goals.Patient Characteristics Associated with Phone Versus Video Telemedicine Visits for Substance Use Treatment during COVID-19
AbstractChang, J. E., Lindenfeld, Z., Thomas, T., Waldman, J., & Griffin, J. (n.d.).Publication year
2022Journal title
Journal of Addiction MedicineVolume
16Issue
6Page(s)
659-665AbstractObjectives Although video visits may offer some benefits over the telephone, not all patients may be equipped to access video telemedicine, raising questions surrounding access disparities. The aim of this study is to examine patient characteristics associated with the use of phone versus video-enabled tele-medication for opioid use disorders (MOUD) during COVID-19. Methods This study uses data from a nonurban integrated substance use disorder treatment site in New York to examine patient characteristics associated with the modality of tele-MOUD care. The provider did not offer in-person care. Multivariable regression models were used to assess the association between patient's primary mode of tele-MOUD and patient demographic characteristics. Additional analysis of new patient inductions examined associations between mode of tele-MOUD induction and 30-day follow-up receipt. Results Of the 4557 tele-MOUD encounters, 76.92% were video and 23.08% were telephone visits. Older patients had significantly higher odds of primarily using telephone (odds ratio [OR]: 0.580; 95% confidence interval [CI]: 0.045, 1.115). Patients with higher education (OR: -0.791; 95% CI: -1.418, -0.168), recent overdose (OR: -0.40; 95% CI: -0.793, -0.010), and new patients (OR: 0.484; 95% CI: -0.945, 0.023) were significantly less likely to rely on telephone. Of 336 new patient initiations, 31 were conducted by telephone while 305 were conducted through video. The mode of new patient initiation was not associated with a follow-up visit within 30 days of initiation. Conclusions Telemedicine may increase access to MOUD, though certain patients may rely on different forms of telemedicine. Attention must be paid to policies that promote equitable access to both video and telephone tele-MOUD visits.Patients’ Perspectives on the Shift to Telemedicine in Primary and Behavioral Health Care during the COVID-19 Pandemic
AbstractBerry, C., Kwok, L., Massar, R., Chang, J. E., Lindenfeld, Z., Shelley, D. R., & Albert, S. L. (n.d.).Publication year
2022Journal title
Journal of general internal medicineAbstractBackground: Studies specifically focused on patients’ perspectives on telemedicine visits in primary and behavioral health care are fairly limited and have often focused on highly selected populations or used overall satisfaction surveys. Objective: To examine patient perspectives on the shift to telemedicine, the remote delivery of health care via the use of electronic information and communications technology, in primary and behavioral health care in Federally Qualified Health Centers (FQHCs) during COVID-19. Design: Semi-structured interviews were conducted using video conference with patients and caregivers between October and December 2020. Participants: Providers from 6 FQHCs nominated participants. Eighteen patients and caregivers were interviewed: 6 patients with only primary care visits; 5 with only behavioral health visits; 3 with both primary care and behavioral health visits; and 4 caregivers of children with pediatric visits. Approach: Using a protocol-driven, rapid qualitative methodology, we analyzed the interview data and assessed the quality of care, benefits and challenges of telemedicine, and use of telemedicine post-pandemic. Key Results: Respondents broadly supported the option of home-based synchronous telemedicine visits in primary and behavioral health care. Nearly all respondents appreciated remote visits, largely because such visits provided a safe option during the pandemic. Patients were generally satisfied with telemedicine and believed the quality of visits to be similar to in-person visits, especially when delivered by a provider with whom they had established rapport. Although most respondents planned to return to mostly in-person visits when considered safe to do so, they remained supportive of the continued option for remote visits as remote care addresses some of the typical barriers faced by low-income patients. Conclusions: Addressing digital literacy challenges, enhancing remote visit privacy, and improving practice workflows will help ensure equitable access to all patients as we move to a new post-COVID-19 “normal” marked by increased reliance on telemedicine and technology.Presenting Author: Title: Integrating Harm Reduction and Medical Care: Lessons from Three Models
AbstractChang, J. E. (n.d.).Publication year
2022Abstract~Racial/ethnic disparities in the availability of hospital based opioid use disorder treatment
AbstractChang, J. E., Franz, B., Cronin, C. E., Lindenfeld, Z., Lai, A. Y., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Journal of Substance Abuse TreatmentVolume
138AbstractIntroduction: While racial/ethnic disparities in the use of opioid use disorder (OUD) treatment in outpatient settings are well documented in the literature, little is known about racial/ethnic disparities in access to hospital-based OUD services. This study examines the relationship between hospital-based or initiated OUD services and the racial/ethnic composition of the surrounding community. Methods: We constructed a dataset marking the implementation of eight OUD strategies for a 20% random sample of nonprofit hospitals in the United States based on 2015–2018 community health needs assessments. We tested the significance of the relationship between each OUD strategy and the racial/ethnic composition of the surrounding county using two-level mixed effects logistic regression models that considered the hierarchical structure of the data of hospitals within states while controlling for hospital-level county-level, and state-level covariates. Results: In both unadjusted and adjusted models, we found that hospital adoption of several OUD services significantly varied based on the percentage of Black or Hispanic residents in their communities. Even after controlling for hospital size, the overdose burden in the community, community socioeconomic characteristics, and state funding, hospitals in communities with high percentage of Black or Hispanic residents had significantly lower odds of offering the most common hospital-based programs to address OUD – including programs that increase access to formal treatment services, prescriber guidelines, targeted risk education and harm reduction, and community coalitions to address opioid use. Conclusions: Hospital adoption of many OUD services varies based on the percentage of Black or Hispanic residents in their communities. More attention should be paid to the role, ability, and strategies that hospitals can assume to address disparities among OUD treatment and access needs, especially those that serve communities with a high concentration of Black and Hispanic residents.Synchronous Home-Based Telemedicine for Primary Care : A Review
AbstractLindenfeld, Z., Berry, C., Albert, S., Massar, R., Shelley, D., Kwok, L., Fennelly, K., & Chang, J. E. (n.d.).Publication year
2022Journal title
Medical Care Research and ReviewAbstractSynchronous home-based telemedicine for primary care experienced growth during the coronavirus disease 2019 pandemic. A review was conducted on the evidence reporting on the feasibility of synchronous telemedicine implementation within primary care, barriers and facilitators to implementation and use, patient characteristics associated with use or nonuse, and quality and cost/revenue-related outcomes. Initial database searches yielded 1,527 articles, of which 22 studies fulfilled the inclusion criteria. Synchronous telemedicine was considered appropriate for visits not requiring a physical examination. Benefits included decreased travel and wait times, and improved access to care. For certain services, visit quality was comparable to in-person care, and patient and provider satisfaction was high. Facilitators included proper technology, training, and reimbursement policies that created payment parity between telemedicine and in-person care. Barriers included technological issues, such as low technical literacy and poor internet connectivity among certain patient populations, and communication barriers for patients requiring translators or additional resources to communicate.Rapid Transition to Telehealth and the Digital Divide : Implications for Primary Care Access and Equity in a Post-COVID Era
AbstractChang, J. E., Lai, A. Y., Gupta, A., Nguyen, A. M., Berry, C. A., & Shelley, D. R. (n.d.).Publication year
2021Journal title
Milbank QuarterlyVolume
99Issue
2Page(s)
340-368AbstractPolicy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. Context: The COVID-19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Methods: The study analyzed data about small primary care practices’ telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State's stay-at-home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low-income, minority or immigrant areas that were more severely impacted by COVID-19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high-SVI or low-SVI areas. We then characterized respondents’ telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. Findings: While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high-SVI areas were almost twice as likely as providers in low-SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P