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
A Year After Implementation of the Telehealth Waiver : Being Offered and Utilizing Video-Specific Telehealth Among Dual-Eligible Medicare Recipients During the COVID-19 Pandemic
AbstractChoi, J., Kim, G., Choi, S., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of Public Health Management and PracticeVolume
30Issue
2Page(s)
255-266AbstractObjective: Telehealth is an essential tool to provide access to care while reducing infection exposure for high-risk populations during the COVID-19 pandemic. Our study aims to examine factors associated with telehealth availability and usage among Medicare and dual-eligible recipients 1 year after implementation of the Medicare’s temporary telehealth waiver. Design, Setting, and Participant: A cross-sectional, phone survey with a national representative sample of Medicare recipients. We obtained a final study sample from the Winter 2021 COVID-19 Supplement of Medicare Current Beneficiary Survey dataset (N = 10 586). We examined associations for being offered and having had telehealth visits or any video telehealth visits during the pandemic since November 1, 2020. Main Outcome Measures: Our primary outcomes were being offered any telehealth, being offered any video telehealth, having had any telehealth visit, and having had any video telehealth. Results: Although dual eligibility was not significantly associated with being offered or having had any telehealth services during the pandemic, those who were dual eligible were more likely to have had video telehealth visits (adjusted odds ratio = 1.39, 95% confidence interval 1.04-1.86, P = .03) compared with those with non-dual eligibility. Recipients with disability eligibility, technology access, and severe chronic conditions were more likely to have been offered or have had telehealth. At the same time, those who lived in the nonmetropolitan area were less likely to have been offered or have had telehealth, including video telehealth. Conclusions: Our findings suggest that the federal waivers to expand telehealth services were successful in continuing care for vulnerable Medicare recipients. The providers’ specific outreach and intervention efforts to offer telehealth visits are crucial for dual-eligible recipients. To increase video telehealth uptake, technology access and services to rural areas should be prioritized.A Year After Implementation of the Telehealth Waiver: Being Offered and Utilizing Video-Specific Telehealth Among Dual-Eligible Medicare Recipients During the COVID-19 Pandemic
AbstractChang, J. E., Choi, J., Kim, G., Choi, S., & Chang, J. E. E. (n.d.).Publication year
2025Journal title
Journal of public health management and practice : JPHMPVolume
30Issue
2Page(s)
255-266AbstractTelehealth is an essential tool to provide access to care while reducing infection exposure for high-risk populations during the COVID-19 pandemic. Our study aims to examine factors associated with telehealth availability and usage among Medicare and dual-eligible recipients 1 year after implementation of the Medicare's temporary telehealth waiver.Aboriginal employment and training: moving beyond supply and demand
AbstractCavazos, R., & Chang, J. E. (n.d.).Publication year
2012Abstract~Academy Health Annual Research Meeting Health Disparities Special Session Coordinator and Moderator: AI Applications in Health and Public Health: Cross-Sector Strategies to Mitigate Bias
AbstractChang, J. E. (n.d.).Publication year
2023Abstract~An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health
AbstractWeeks, W. B., Chang, J. E., Pagán, J. A., Aerts, A., Weinstein, J. N., & Ferres, J. L. (n.d.).Publication year
2023Journal title
International Journal for Equity in HealthVolume
22Issue
1AbstractBackground: Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. Methods: For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group’s 2015–2019 Distressed Community Index Scores. Results: With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. Conclusions: In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health
AbstractChang, J. E., Weeks, W. B., Chang, J. E., Pagán, J. A., Aerts, A., Weinstein, J. N., & Ferres, J. L. L. (n.d.).Publication year
2023Journal title
International journal for equity in healthVolume
22Issue
1Page(s)
181AbstractSocioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level.Assessing Differences in Social Determinants of Health Screening Rates in a Large, Urban Safety-Net Health System
AbstractLindenfeld, Z., Chen, K., Kapur, S., & Chang, J. E. (n.d.).Publication year
2023Journal title
Journal of Primary Care and Community HealthVolume
14AbstractIntroduction/Objective: Previous studies have evaluated the implementation of standardized social determinants of health (SDOH) screening within healthcare settings, however, less is known about where screening gaps may exist following initial implementation based on facility characteristics. The objective of this study is to assess differences in screening rates for SDOH at a large, urban healthcare system. Methods: We used electronic health record data obtained from NYC Health + Hospitals primary care sites from 2019 to 2022. We calculated the mean number of visits that were SDOH screened by visit type, facility size, and the percentages of community characteristics. We conducted 4 logistic regression models predicting the odds of screening for any SDOH and for specific SDOH needs (housing, food, and medical cost assistance) based on facility type, facility size, and the socioeconomic characteristics of the surrounding community. Results: Among the 3 212 650 visits included, 16.90% were SDOH screened. Across all 4 multivariate logistic regression models predicting SDOH screening, a visit had significantly lower odds of being screened if based at a midsize or small facility, if it was a telemedicine visit, or based at a facility located in a zip-code with a higher percentage of SDOH needs. Conclusions: Our study found important differences in SDOH screening rates at a large, NYC-based health system based on size, visit type, and community level characteristics. In particular, our findings point to barriers related to facility size and telemedicine workflow that should be addressed to increase uptake of SDOH screening within different visits and facility types.Assessing Differences in Social Determinants of Health Screening Rates in a Large, Urban Safety-Net Health System
AbstractChang, J. E., Lindenfeld, Z., Chen, K., Kapur, S., & Chang, J. E. E. (n.d.).Publication year
2023Journal title
Journal of primary care & community healthVolume
14Page(s)
21501319231207713AbstractPrevious studies have evaluated the implementation of standardized social determinants of health (SDOH) screening within healthcare settings, however, less is known about where screening gaps may exist following initial implementation based on facility characteristics. The objective of this study is to assess differences in screening rates for SDOH at a large, urban healthcare system.Assessing the effectiveness of problem-solving courts on the reduction of overdose deaths in the United States: A difference-in-difference study
AbstractChang, J. E., Lindenfeld, 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.Association of Hospital Decision-making and Adoption of Health-Related Social Needs Programs Among US Hospitals
AbstractChang, J. E., Zein, D., Cronin, C., Puro, N., & McNeil, E. (n.d.).Publication year
2025Journal title
JAMA Network OpenAbstract~Association of Medicaid expansion and 1115 waivers for substance use disorders with hospital provision of opioid use disorder services : a cross sectional study
AbstractChang, J. E., Cronin, C. E., Lindenfeld, Z., Pagán, J. A., & Franz, B. (n.d.).Publication year
2023Journal title
BMC health services researchVolume
23Issue
1AbstractIntroduction: Opioid-related hospitalizations have risen dramatically, placing hospitals at the frontlines of the opioid epidemic. Medicaid expansion and 1115 waivers for substance use disorders (SUDs) are two key policies aimed at expanding access to care, including opioid use disorder (OUD) services. Yet, little is known about the relationship between these policies and the availability of hospital based OUD programs. The aim of this study is to determine whether state Medicaid expansion and adoption of 1115 waivers for SUDs are associated with hospital provision of OUD programs. Methods: We conducted a cross-sectional study of a random sample of hospitals (n = 457) from the American Hospital Association’s 2015 American Hospital Directory, compiled with the most recent publicly available community health needs assessment (2015–2018). Results: Controlling for hospital characteristics, overdose burden, and socio-demographic characteristics, both Medicaid policies were associated with hospital adoption of several OUD programs. Hospitals in Medicaid expansion states had significantly higher odds of implementing any program related to SUDs (OR: 1.740; 95% CI: 1.032–2.934) as well as some specific activities such as programs for OUD treatment (OR: 1.955; 95% CI: 1.245–3.070) and efforts to address social determinants of health (OR: 6.787; 95% CI: 1.308–35.20). State 1115 waivers for SUDs were not significantly associated with any hospital-based SUD activities. Conclusions: Medicaid expansion was associated with several hospital programs for addressing OUD. The differential availability of hospital-based OUD programs may indicate an added layer of disadvantage for low-income patients with SUD living in non-expansion states.Association of Telehealth Utilization Among Patients with Heart Disease with Fewer Emergency Department Visits and Hospitalizations during COVID-19 Pandemic
AbstractChang, J. E., Lee, J., Bhatt, A., Jackson, S., Ton, X., Chang, J., Pollack, M., & Luo, F. (n.d.).Publication year
2024Journal title
Health Affairs ScholarIssue
2047-9980 (Electronic)Abstract~Barriers and Facilitators to Establishing Partnerships for Substance Use Disorder Care Transitions Between Safety-Net Hospitals and Community-Based Organizations
AbstractChang, J. E., Lindenfeld, Z., Franz, B., Lai, A. Y. Y., Pagán, J. A., Fenstemaker, C., Cronin, C. E., & Chang, J. E. E. (n.d.).Publication year
2024Journal title
Journal of general internal medicineVolume
39Issue
12Page(s)
2150-2159AbstractThe effectiveness of hospital-based transitional opioid programs (TOPs), which aim to connect patients with substance use disorders (SUD) to ongoing treatment in the community following initiation of medication for opioid use disorder (MOUD) treatment in the hospital, hinges on successful patient transitions. These transitions are enabled by strong partnerships between hospitals and community-based organizations (CBOs). However, no prior study has specifically examined barriers and facilitators to establishing SUD care transition partnerships between hospitals and CBOs.Community health worker integration into the health care team accomplishes the triple aim in a patient centered medical home
AbstractFindley, S., Matos, S., Hicks, A., Chang, J. E., & Reich, D. (n.d.).Publication year
2014Journal title
Journal of Ambulatory Care ManagementVolume
37Issue
1Page(s)
82Abstract~Comparing Rates of Undiagnosed Hypertension and Diabetes in Patients With and Without Substance Use Disorders
AbstractChang, J. E., Lindenfeld, Z., Chen, K., Kapur, S., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of general internal medicineVolume
39Issue
9Page(s)
1632-1641AbstractIndividuals with substance use disorders (SUDs) have increased risk for developing chronic conditions, though few studies assess rates of diagnosis of these conditions among patients with SUDs.Comparing Rates of Undiagnosed Hypertension and Diabetes in Patients with and without Substance Use Disorders
AbstractChang, J. E., Lindenfeld, Z., Chen, K., Kapur, S., & Chang, J. (n.d.).Publication year
2024Journal title
Journal of General Internal MedicineAbstract~Contributing Author: Identifying and Characterizing Models of Substance Use Treatment in Outpatient Substance Use Disorder Treatment Facilities
AbstractChang, J. E. (n.d.).Publication year
2023Abstract~Convenient ambulatory care-promise, pitfalls, and policy
AbstractChang, J. E., Brundage, S. C., & Chokshi, D. A. (n.d.).Publication year
2015Journal title
New England Journal of MedicineVolume
373Issue
4Page(s)
382-388Abstract~Convenient care: retail clinics and urgent care centers in New York state
AbstractChang, J. E., Brundage, S. C., Burke, G., & Chokshi, D. A. (n.d.).Publication year
2015Abstract~Coordination across ambulatory care a comparison of referrals and health information exchange across convenient and traditional settings
AbstractChang, J. E., Chokshi, D., & Ladapo, J. (n.d.).Publication year
2018Journal title
Journal of Ambulatory Care ManagementVolume
41Issue
2Page(s)
128-137AbstractUrgent care centers have been identified as one means of shifting care from high-cost emergency departments while increasing after-hours access to care. However, the episodic nature of urgent care also has the potential to fragment care. In this study, we examine the adoption of 2 coordination activities—referrals and the electronic exchange of health information—at urgent care centers and other ambulatory providers across the United States. We find that setting is significantly associated with both health information exchange and referrals. Several organization-level variables and environment-level variables are also related to the propensity to coordinate care.Difficulty Hearing Is Associated With Low Levels of Patient Activation
AbstractChang, J. E., Weinstein, B. E., Chodosh, J., Greene, J., & Blustein, J. (n.d.).Publication year
2019Journal title
Journal of the American Geriatrics SocietyAbstractBACKGROUND/OBJECTIVES: Patient activation encompasses the knowledge, skills, and confidence that equip adults to participate actively in their healthcare. Patients with hearing loss may be less able to participate due to poor aural communication. We examined whether difficulty hearing is associated with lower patient activation. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: A nationally representative sample of Americans aged 65 years and older (n = 13 940) who participated in the Medicare Current Beneficiary Survey (MCBS) during the years 2011 to 2013. MEASUREMENT: Self-reported degree of difficulty hearing (“no trouble,” “a little trouble,” and “a lot of trouble”) and overall activation based on aggregated scored responses to 16 questions from the MCBS Patient Activation Supplement: low activation (below the mean minus 0.5 SDs), high activation (above the mean plus 0.5 SDs), and medium activation (the remainder). Sociodemographic and self-reported clinical measures were also included. RESULTS: “A little trouble” hearing was reported by 5655 (40.6%) of respondents, and “a lot of trouble” hearing was reported by 893 (6.4%) of respondents. Difficulty hearing was significantly associated with low patient activation: in analyses using multivariable multinomial logistic regression, respondents with “a little trouble” hearing had 1.42 times the risk of low vs high activation (95% confidence interval [CI] = 1.27-1.58), and those with “a lot of trouble” hearing had 1.70 times the risk of low vs high activation (95% CI = 1.29-2.11), compared with those with “no trouble” hearing. CONCLUSIONS: Nearly half of people aged 65 years and older reported difficulty hearing, and those reporting difficulty were at risk of low patient activation. That risk rose with increased difficulty hearing. Given the established link between activation and outcomes of care, and in view of the association between hearing loss and poor healthcare quality and outcomes, clinicians may be able to improve care for people with hearing loss by attending to aural communication barriers.Discrimination in Medical Settings across Populations: Evidence From the All of Us Research Program
AbstractChang, J. E., Wang, V. H.-C. H., Cuevas, A. G., Osokpo, O. H. H., Chang, J. E. E., Zhang, D., Hu, A., Yun, J., Lee, A., Du, S., Williams, D. R., & Pagán, J. A. (n.d.).Publication year
2024Journal title
American journal of preventive medicineVolume
67Issue
4Page(s)
568-580AbstractDiscrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations.Examining the Relationship Between Local Governmental Expenditures on the Social Determinants of Health and County-Level Overdose Deaths, 2017-2020
AbstractChang, J. E., Lindenfeld, Z., Mauri, A. I., & Chang, J. E. (n.d.).Publication year
2025Journal title
Journal of public health management and practice : JPHMPVolume
31Issue
1Page(s)
20-28AbstractPrior studies have examined the social determinants of health (SDOH) characteristics of counties with elevated rates of overdose deaths. However, this research often ignores variation in upstream governmental investment in these SDOH categories.Examining the Relationship between Local Governmental Expenditures on the Social Determinants of Health and County-Level Overdose Deaths, 2017-2020
AbstractLindenfeld, Z., Mauri, A. I., & Chang, J. E. (n.d.).Publication year
2025Journal title
Journal of Public Health Management and PracticeVolume
31Issue
1Page(s)
20-28AbstractContext Prior studies have examined the social determinants of health (SDOH) characteristics of counties with elevated rates of overdose deaths. However, this research often ignores variation in upstream governmental investment in these SDOH categories. Objective To examine the association of local governmental investments in SDOH with drug overdose mortality at the county level, controlling for demographic and socioeconomic characteristics. Design Longitudinal analysis from 2017 to 2020. Setting United States counties. Participants 3126 counties. Main Outcome and Measures The primary study outcome was county overdose death rates per 100 000 population taken from the Centers for Disease Control and Prevention. The main predictor of interest was the per capita average of local governmental expenditures in public health, social service, and education drawn from the US Census of Governments, categorized into quartiles. Covariates included county-level socioeconomic and demographic characteristics as well as county-level SUD services from the AHRQ SDOH Database. Results In longitudinal multivariate linear regression models with state and year fixed effects, counties in the highest 3 quartiles of SDOH spending had significantly lower rates of overdose deaths compared with counties in the lowest quartile of SDOH spending; in particular, counties in quartile 2 had an average of 9.09 fewer overdose deaths per 100 000 population (95% CI: -12.58, -5.60), counties in quartile 3 had an average of 13.18 fewer deaths per 100 000 population (95% CI: -17.56; -8.80), and counties in quartile 4 had an average of 13.92 deaths per 100 000 population (95% CI: -19.16, -8.68). Conclusions Our findings demonstrate that higher levels of local governmental investments in SDOH were associated with significantly lower rates of overdose death in US counties after controlling for socioeconomic and demographic characteristics. Going forward, research should focus on determining causality in this relationship, the mechanisms through which this relationship occurs, as well as assess the impact of local public health expenditures allocated toward SUD prevention and treatment specifically on substance use outcomes at the local level.Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017-2020
AbstractChang, J. E., Lindenfeld, Z., Silver, D., Pagán, J. A., Zhang, D. S. S., & Chang, J. E. E. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
5Page(s)
e0304256AbstractDespite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017-2020.