Ji E Chang

Ji Chang
Ji E Chang

Assistant Professor of Public Health Policy and Management

Professional overview

Dr. Ji Eun Chang is passionate about understanding the coordination of care within and across organizations. Her research pursuits are centered on exploring the factors that contribute to care continuity, developing a measure for team-based continuity of care, and examining how work is coordinated across the social services and healthcare delivery sectors. Her previous research included exploring coordination across innovative new sites of ambulatory care such as urgent care centers and retail clinics, the integration of community health workers into patient centered medical homes, and developing cancer screening guidelines through a collaborative multi-stakeholder panel. Dr. Chang has also conducted research and evaluation projects across a range of local, federal, and international public and non-profit organizations including the NYC Health and Hospitals, the Community Health Worker Network of NYC, the DC Department of Human Services, the US Department of Health and Human Service, and the South Australian Department of Further Education, Employment, and Training.

In addition to research, Dr. Chang is enthusiastic about developing new courses in the  Public Health Policy and Management program and training students to face the workforce with skills that are both desired and needed in public health organizations.

Education

BA, Economics, University of California at Berkeley, Berkeley, CA
MS, Public Policy and Management, Carnegie Mellon University, Pittsburgh, PA
PhD, Public Administration, New York University, New York, NY

Honors and awards

Governor’s Scholar (2007)
Regents and Chancellors’ Scholar (2005)

Areas of research and study

Continuity of Care
Inter-organizational Networks
Public Health Management
Public Health Policy

Publications

Publications

Difficulty Hearing Is Associated With Low Levels of Patient Activation

Chang, J. E., Weinstein, B. E., Chodosh, J., Greene, J., & Blustein, J.

Publication year

2019

Journal title

Journal of the American Geriatrics Society
Abstract
Abstract
BACKGROUND/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.

Hearing loss is associated with low patient activation

Blustein, J., Chang, J., Weinstein, B., Greene, J., & Chodosh, J.

Publication year

2019

Journal title

Journal of the American Geriatrics Society

Coordination across ambulatory care a comparison of referrals and health information exchange across convenient and traditional settings

Chang, J., Chokshi, D., & Ladapo, J.

Publication year

2018

Journal title

Journal of Ambulatory Care Management

Volume

41

Issue

2

Page(s)

128-137
Abstract
Abstract
Urgent 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.

Hospital Readmission Risk for Patients with Self-Reported Hearing Loss and Communication Trouble

Chang, J. E., Weinstein, B., Chodosh, J., & Blustein, J. In Journal of the American Geriatrics Society.

Publication year

2018

Volume

66

Issue

11

Page(s)

2227-2228

Health reform and the changing safety net in the United States

Chokshi, D. A., Chang, J. E., & Wilson, R. M.

Publication year

2016

Journal title

New England Journal of Medicine

Volume

375

Issue

18

Page(s)

1790-1796

Convenient ambulatory care-promise, pitfalls, and policy

Chang, J. E., Brundage, S. C., & Chokshi, D. A.

Publication year

2015

Journal title

New England Journal of Medicine

Volume

373

Issue

4

Page(s)

382-388

Community health worker integration into the health care team accomplishes the triple aim in a patient centered medical home

Findley, S., Matos, S., Hicks, A., Chang, J., & Reich, D.

Publication year

2014

Journal title

Journal of Ambulatory Care Management

Volume

37

Issue

1

Page(s)

82

Preventing early readmissions

Chokshi, D. A., & Chang, J. E.

Publication year

2014

Journal title

JAMA - Journal of the American Medical Association

Volume

312

Issue

13

Page(s)

1344-1345
Abstract
Abstract
Results In 42 trials, the tested interventions prevented early readmissions (pooled random-effects relative risk, 0.82 [95%CI, 0.73-0.91]; P < .001; I2 = 31%), a finding thatwas consistent across patient subgroups. Trials published before 2002 reported interventions thatwere 1.6 times more effective than those tested later (interaction P = .01). In exploratory subgroup analyses, interventions with many components (interaction P = .001), involving more individuals in care delivery (interaction P = .05), and supporting patient capacity for self-care (interaction P = .04)were 1.4, 1.3, and 1.3 times more effective than other interventions, respectively. A post hoc regression model showed incremental value in providing comprehensive, postdischarge support to patients and caregivers.Conclusions and Relevance Tested interventions are effective at reducing readmissions, but more effective interventions are complex and support patient capacity for self-care. Interventions tested more recently are less effective.Jamainternal Medicine Preventing 30-Day Hospital Readmissions: A Systematic Reviewand Meta-analysis of Randomized Trials Aaron L. Leppin, MD; Michael R. Gionfriddo, PharmD; Maya Kessler, MD; Juan Pablo Brito, MBBS; Frances S. Mair, MD; Katie Gallacher, MBChB; ZhenWang, PhD; Patricia J. Erwin, MLS; Tanya Sylvester, BS; Kasey Boehmer, BA; Henry H. Ting, MD, MBA; M. Hassan Murad, MD; Nathan D. Shippee, PhD; Victor M. Montori, MD.Importance Reducing early (<30 days) hospital readmissions is a policy priority aimed at improving health care quality. The cumulative complexity model conceptualizes patient context. It predicts that highly supportive discharge interventions will enhance patient capacity to enact burdensome self-care and avoid readmissions.Objective To synthesize the evidence of the efficacy of interventions to reduce early hospital readmissions and identify intervention features-including their impact on treatment burden and on patients' capacity to enact postdischarge self-care-that might explain their varying effects. DATA SOURCESWe searched PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Scopus (1990 until April 1, 2013), contacted experts, and reviewed bibliographies.Study Selection Randomized trials that assessed the effect of interventions on all-cause or unplanned readmissions within 30 days of discharge in adult patients hospitalized for a medical or surgical cause for more than 24 hours and discharged to home.Data Extraction and Synthesis Reviewer pairs extracted trial characteristics and used an activity-based coding strategy to characterize the interventions; fidelity was confirmed with authors. Blinded to trial outcomes, reviewers noted the extent to which interventions placed additional work on patients after discharge or supported their capacity for self-care in accordance with the cumulative complexity model.Main Outcomes and Measures Relative risk of all-cause or unplanned readmission with or without out-of-hospital deaths at 30 days postdischarge.

Contact

ji.chang@nyu.edu 715/719 Broadway New York, NY 10003