Ji E Chang
Ji E Chang
Scroll
Associate Professor of Public Health Policy and Management
-
Professional overview
-
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
-
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
-
Honors and awards
-
Governor’s Scholar (2007)Regents and Chancellors’ Scholar (2005)
-
Areas of research and study
-
Cardiovascular DiseaseHealth DisparitiesHealth EquityPublic Health ManagementPublic Health ManagementSafety Net Providers and PatientsSubstance Use Disorders
-
Publications
Publications
Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services
AbstractFranz, B., Cronin, C. E., Lindenfeld, Z., Pagan, J. A., Lai, A. Y., Krawczyk, N., Rivera, B. D., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of Substance Use and Addiction TreatmentVolume
160AbstractIntroduction: Hospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use–related complications. Transitional opioid programs—which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services—have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States. Methods: Using hospital administrative data paired with county-level demographic data, we conducted bivariate and regression analyses to assess rural-urban differences in the availability of transitional opioid services including screening, addiction consult services, and MOUD in U.S general medical centers, controlling for hospital- and community-level factors. Our sample included 2846 general medical hospitals that completed the 2021 American Hospital Association (AHA) Annual Survey of Hospitals. Our primary outcomes were five self-reported measures: whether the hospital provided screening in the ED; provided screening in the inpatient setting; whether the hospital provided addiction consult services in the ED; provided addiction consult services in the inpatient setting; and whether the hospital provided medications for opioid use disorder. Results: Rural hospitals did not have lower odds of screening for OUD or other SUDs than urban hospitals, but both micropolitan rural counties and noncore rural counties had significantly lower odds of having addiction consult services in either the ED (OR: 0.74, 95 % CI: 0.58, 0.95; OR: 0.68, 95 % CI: 0.50, 0.91) or inpatient setting (OR: 0.76, 95 % CI: 0.59, 0.97; OR: 0.68, 95 % CI: 0.50, 0.93), respectively, or of offering MOUD (OR: 0.69, 95 % CI: 0.52, 0.90; OR: 0.52, 95 % CI: 0.37, 0.74). Conclusions: Our study suggests that evidence-based interventions, such as medications for opioid use disorder and addiction consult services, are less often available in rural hospitals, which may contribute to rural-urban disparities in health outcomes secondary to OUD. A priority for population health improvement should be developing implementation strategies to support rural hospital adoption of transitional opioid programs.Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services
AbstractChang, J. E., Franz, B., Cronin, C. E., Lindenfeld, Z., Pagan, J. A., Lai, A. Y. Y., Krawczyk, N., Rivera, B. D., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of substance use and addiction treatmentVolume
160Page(s)
209280AbstractHospitals are an ideal setting to stage opioid-related interventions with patients who are hospitalized due to overdose or other substance use-related complications. Transitional opioid programs-which initiate care and provide linkages upon discharge, such as screening, initiation of medications for opioid use disorder, and addiction consult services-have become the gold standard, but implementation has been uneven. The purpose of this study was to assess disparities in the availability of hospital-based transitional opioid programs, across rural and urban hospital settings in the United States.Rural-urban disparities in the availability of hospital-based screening, medications for opioid use disorder, and addiction consult services.
AbstractChang, J. E., Franz, B., Cronin, C. E., Lindenfeld, Z., Pagan, J. A., Lai, A. Y., Krawczyk, N., Rivera, B. D., & Chang, J. E. (n.d.).Publication year
2024Journal title
Journal of Substance Use and Addiction TreatmentIssue
2949-8759 (Electronic)Abstract~Suicide ideation and behavior disparities among high school students: Examining Asian and multiracial race/ethnicity groups
AbstractChoi, S., & Chang, J. E. (n.d.).Publication year
2024Abstract~Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization
AbstractChang, J. E., Lee, J. S. S., Bhatt, A., Pollack, L. M., Jackson, S. L., Chang, J. E. E., Tong, X., & Luo, F. (n.d.).Publication year
2024Journal title
Health affairs scholarVolume
2Issue
1AbstractTelehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018-2022). We used difference-in-differences methodology adjusting for patients' characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1000 persons), and number of inpatient admissions (by -32.4 per 1000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days' drug supply (by 0.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.The Ecology of Economic Distress and Life Expectancy
AbstractWeeks, W. B., Chang, J. E., Pagán, J. A., Adamson, E., Weinstein, J., & Ferres, J. M. (n.d.).Publication year
2024Journal title
International Journal of Public HealthVolume
69AbstractObjectives: To determine whether life expectancy (LE) changes between 2000 and 2019 were associated with race, rural status, local economic prosperity, and changes in local economic prosperity, at the county level. Methods: Between 12/1/22 and 2/28/23, we conducted a retrospective analysis of 2000 and 2019 data from 3,123 United States counties. For Total, White, and Black populations, we compared LE changes for counties across the rural-urban continuum, the local economic prosperity continuum, and for counties in which local economic prosperity dramatically improved or declined. Results: In both years, overall, across the rural-urban continuum, and for all studied populations, LE decreased with each progression from the most to least prosperous quintile (all p < 0.001); improving county prosperity between 2000–2019 was associated with greater LE gains (p < 0.001 for all). Conclusion: At the county level, race, rurality, and local economic distress were all associated with LE; improvements in local economic conditions were associated with accelerated LE. Policymakers should appreciate the health externalities of investing in areas experiencing poor economic prosperity if their goal is to improve population health.The Ecology of Economic Distress and Life Expectancy
AbstractChang, J. E., Weeks, W. B. B., Chang, J. E., Pagán, J. A., Adamson, E., Weinstein, J., & Ferres, J. M. L. (n.d.).Publication year
2024Journal title
International journal of public healthVolume
69Page(s)
1607295AbstractTo determine whether life expectancy (LE) changes between 2000 and 2019 were associated with race, rural status, local economic prosperity, and changes in local economic prosperity, at the county level.Toward a Consensus on Strategies to Support Opioid Use Disorder Care Transitions Following Hospitalization : A Modified Delphi Process
AbstractKrawczyk, N., Miller, M., Englander, H., Rivera, B. D., Schatz, D., Chang, J. E., Cerdá, M., Berry, C., & McNeely, J. (n.d.).Publication year
2024Journal title
Journal of general internal medicineAbstractBackground: Despite proliferation of acute-care interventions to initiate medications for opioid use disorder (MOUD), significant challenges remain to supporting care continuity following discharge. Research is needed to inform effective hospital strategies to support patient transitions to ongoing MOUD in the community. Objective: To inform a taxonomy of care transition strategies to support MOUD continuity from hospital to community-based settings and assess their perceived impact and feasibility among experts in the field. Design: A modified Delphi consensus process through three rounds of electronic surveys. Participants: Experts in hospital-based opioid use disorder (OUD) treatment, care transitions, and hospital-based addiction treatment. Main Measures: Delphi participants rated the impact and feasibility of 14 OUD care transition strategies derived from a review of the scientific literature on a scale from 1 to 9 over three survey rounds. Panelists were invited to suggest additional care transition strategies. Agreement level was calculated based on proportion of ratings within three points of the median. Key Results: Forty-five of 71 invited panelists participated in the survey. Agreement on impact was strong for 12 items and moderate for 10. Agreement on feasibility was strong for 11 items, moderate for 7, and poor for 4. Strategies with highest ratings on impact and feasibility included initiation of MOUD in-hospital and provision of buprenorphine prescriptions or medications before discharge. All original 14 strategies and 8 additional strategies proposed by panelists were considered medium- or high-impact and were incorporated into a final taxonomy of 22 OUD care transition strategies. Conclusions: Our study established expert consensus on impactful and feasible hospital strategies to support OUD care transitions from the hospital to community-based MOUD treatment, an area with little empirical research thus far. It is the hope that this taxonomy serves as a stepping-stone for future evaluations and clinical practice implementation toward improved MOUD continuity and health outcomes.Trends in the availability of comprehensive services within outpatient substance use treatment facilities from 2018 to 2022
AbstractChang, J. E., Lindenfeld, Z., Cantor, J. H., & Chang, J. E. (n.d.).Publication year
2024Journal title
The American journal of drug and alcohol abuseVolume
50Issue
5Page(s)
715-726AbstractLittle is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients' medical and social needs. To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022. We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities ( = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics. Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30-1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30-1.74), performed community outreach (OR: 2.05; 95%CI: 1.80-2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06-3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08-2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99-0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00-1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01-1.45), had significantly higher odds of adopting a comprehensive service model. Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.Trends in the availability of comprehensive services within outpatient substance use treatment facilities from 2018 to 2022
AbstractLindenfeld, Z., Cantor, J. H., & Chang, J. E. (n.d.).Publication year
2024Journal title
American Journal of Drug and Alcohol AbuseAbstractBackground: Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients’ medical and social needs. Objective: To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022. Methods: We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities (n = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics. Results: Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30–1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30–1.74), performed community outreach (OR: 2.05; 95%CI: 1.80–2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06–3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08–2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99–0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00–1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01–1.45), had significantly higher odds of adopting a comprehensive service model. Conclusion: Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.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
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.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.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 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.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.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~Exploring Barriers and Facilitators to Integrating a Harm Reduction Approach to Substance Use in Three Medical Settings
AbstractChang, J. E., Lindenfeld, Z., Hagan, H., & Chang, J. E. E. (n.d.).Publication year
2023Journal title
Journal of general internal medicineVolume
38Issue
15Page(s)
3273-3282AbstractEvidence suggests that harm reduction, a public health strategy aimed at reducing the negative consequences of a risky health behavior without requiring elimination of the behavior itself, may be a promising approach for minimizing drug-related harms while engaging individuals with substance use disorders (SUDs) in care. However, philosophical clashes between the medical and harm reduction models may pose barriers to adopting harm reduction approaches within medical settings.Facilitation of team-based care to improve HTN management and outcomes : a protocol for a randomized stepped wedge trial
AbstractShelley, D. R., Brown, D., Cleland, C. M., Pham-Singer, H., Zein, D., Chang, J. E., & Wu, W. Y. (n.d.).Publication year
2023Journal title
BMC health services researchVolume
23Issue
1AbstractBackground: There are well-established guidelines for treating hypertension (HTN), yet only half of patients with HTN meet the defined target of < 140/90. Team-based care (TBC) is an evidence-based strategy for improving blood pressure (BP) management and control. TBC is defined as the provision of health services by at least two health professionals “who work collaboratively with patients and their caregivers to accomplish shared goals to achieve coordinated, high-quality care”. However, primary care practices experience challenges to implementing TBC principles and care processes; these are more pronounced in small independent practice settings (SIPs). Practice facilitation (PF) is an implementation strategy that may overcome barriers to adopting evidence-based TBC to improve HTN management in SIPs. Methods: Using a stepped wedge randomized controlled trial design, we will test the effect of PF on the adoption of TBC to improve HTN management in small practices (< 5 FTE clinicians) in New York City, and the impact on BP control compared with usual care. We will enroll 90 SIPs and randomize them into one of three 12-month intervention waves. Practice facilitators will support SIPs to adopt TBC principles to improve implementation of five HTN management strategies (i.e., panel management, population health, measuring BP, supporting medication adherence, self-management). The primary outcome is the adoption of TBC for HTN management measured at baseline and 12 months. Secondary outcomes include the rate of BP control and sustainability of TBC and BP outcomes at 18 months. Aggregated data on BP measures are collected every 6 months in all clusters so that each cluster provides data points in both the control and intervention conditions. Using a mixed methods approach, we will also explore factors that influence the effectiveness of PF at the organization and team level. Discussion: This study will provide much-needed guidance on how to optimize adoption and sustainability of TBC in independent primary care settings to reduce the burden of disease related to suboptimal BP control and advance understanding of how facilitation works to improve implementation of evidence-based interventions. Trial registration: ClinicalTrials.gov; NCT05413252 .Facilitation of team-based care to improve HTN management and outcomes: a protocol for a randomized stepped wedge trial
AbstractChang, J. E., Shelley, D. R., Brown, D., Cleland, C. M., Pham-Singer, H., Zein, D., Chang, J. E. E., & Wu, W. Y. (n.d.).Publication year
2023Journal title
BMC health services researchVolume
23Issue
1Page(s)
560AbstractThere are well-established guidelines for treating hypertension (HTN), yet only half of patients with HTN meet the defined target ofFactors associated with the adoption of evidence-based innovations by substance use disorder treatment organizations : A study of HIV testing
AbstractBroffman, L., D'Aunno, T., D'Aunno, T., & Chang, J. E. (n.d.).Publication year
2023Journal title
Journal of Substance Abuse TreatmentVolume
144AbstractIntroduction: Though prior research shows that a range of important regulatory, market, community, and organizational factors influence the adoption of evidence-based practices (EBPs) among health care organizations, we have little understanding of how these factors relate to each other. To address this gap, we test a conceptual model that emphasizes indirect, mediated effects among key factors related to HIV testing in substance use disorder treatment organizations (SUTs), a critical EBP during the US opioid epidemic. Methods: We draw on nationally representative data from the 2014 (n = 697) and 2017 (n = 657) National Drug Abuse Treatment System Survey (NDATSS) to measure the adoption of HIV testing among the nation's SUTs and their key organizational characteristics; we also draw on data from the US Census Bureau; Centers for Disease Control; and legislative sources to measure regulatory and community environments. We estimate cross-sectional and longitudinal structural equation models (SEM) to test the proposed model. Results: Our longitudinal model of the adoption of HIV testing by SUTs in the United States identifies a pathway by which community and market characteristics (rurality and the number of other SUTs in the area) are related to key sociotechnical characteristics of these organizations (alignment of clients, staff, and harm-reduction culture) that, in turn, are related to the adoption of this EBP. Conclusions: Results also show the importance of developing conceptual models that include indirect effects to account for organizational adoption of EBPs.Hospital adoption of harm reduction and risk education strategies to address substance use disorders
AbstractLindenfeld, Z., Franz, B., Cronin, C., & Chang, J. E. (n.d.).Publication year
2023Journal title
American Journal of Drug and Alcohol AbuseVolume
49Issue
2Page(s)
206-215AbstractBackground: Hospitals are well-positioned to integrate harm reduction into their workflow. However, the extent to which hospitals across the United States are adopting these strategies remains unknown. Objectives: To assess what factors are associated with hospital adoption of harm reduction/risk education strategies, and trends of adoption across time. Methods: We constructed a dataset marking implementation of harm reduction/risk education strategies for a 20% random sample of nonprofit hospitals in the U.S (n = 489) using 2019–2021 community health needs assessments (CHNAs) and implementation strategies obtained from hospital websites. We used two-level mixed effects logistic regression to test the association between adoption of these activities and organizational and community-level variables. We also compared the proportion of hospitals that adopted these strategies in the 2019–2021 CHNAs to an earlier cohort (2015–2018.) Results: In the 2019–2021 CHNAs, 44.7% (n = 219) of hospitals implemented harm reduction/risk education programs, compared with 34.1% (n = 156) in the 2015–2018 cycle. In our multivariate model, hospitals that implemented harm reduction/risk education programs had higher odds of having adopted three or more additional substance use disorder (SUD) programs (OR: 10.5: 95% CI: 5.35–20.62), writing the CHNA with a community organization (OR: 2.14; 95% CI: 1.15–3.97), and prioritizing SUD as a top three need in the CHNA (OR: 2.63; 95% CI: 1.54–4.47.) Conclusions: Our results suggest that hospitals with an existing SUD infrastructure and with connections to community are more likely to implement harm reduction/risk education programs. Policymakers should consider these findings when developing strategies to encourage hospital implementation of harm reduction activities.Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals. LID - 10.1097/ADM.0000000000001250 [doi]
AbstractChang, J. E., Krawczyk, N., Rivera, B., Chang, J., Lindenfeld, Z., & Franz, B. (n.d.).Publication year
2023Journal title
Journal of Addiction MedicineIssue
1935-3227 (Electronic)Abstract~Integrating Harm Reduction into Medical Care : Lessons from Three Models
AbstractChang, J. E., Lindenfeld, Z., & Hagan, H. (n.d.).Publication year
2023Journal title
Journal of the American Board of Family MedicineVolume
36Issue
3Page(s)
449-461AbstractBackground: Substance use disorders (SUDs) are at a national high, with significant morbidity and mortality. Harm reduction, a public-health strategy aimed at reducing the negative consequences of a risky behavior without necessarily eliminating the behavior, represents a useful approach to engage patients with SUDs in care. The objective of this article is to describe how 3 medical practices operationalized harm reduction as a framework toward patient care and identify the common practices undertaken across these settings to integrate harm reduction and medical care. Methods: We conducted a qualitative study using in-depth, semistructured interviews with 20 staff and providers at 3 integrated harm reduction and medical care sites across New York State from March to June 2021. Interview questions focused on how harm reduction approaches were implemented, how harm reduction philosophies were demonstrated in practice, and barriers to adoption. Results: The interviews resulted in 8 main themes of integrated harm reduction medical care: 1) role of provider as both learner and informer; 2) pragmatic measures of success; 3) collaborative and interdisciplinary care teams; 4) developing a stigma-free culture; 5) creating a comfortable and welcoming physical space; 6) low-threshold care with flexible scheduling; and; 7) reaching beyond the clinic to disseminate harm reduction orientation; and 8) creating robust referral networks to enhance transitions of care. These themes existed at the patient-provider level (#1 to 3), the organizational level (#4 to 6), and the level extending beyond the clinic (#7 to 8). Conclusions: All 3 sites followed 8 common themes in delivering harm reduction–informed care, most of which are consistent with the broader movement toward patient-centered care. These practices demonstrate how medical providers may overcome some of the barriers imposed by the medical model and successfully integrate harm reduction as an orienting framework toward care delivery. (J Am Board Fam Med 2023;36:449–461.)Invited Talk: Substance Use Disorder Program Availability in Safety-Net and Non-Safety-Net Hospitals in the U.S.
AbstractChang, J. E. (n.d.).Publication year
2023Abstract~