Jose Pagan
Jose Pagan
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Chair and Professor of the Department of Public Health Policy and Management
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Professional overview
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Dr. Pagán received his PhD in economics from the University of New Mexico and is a former Robert Wood Johnson Foundation Health & Society Scholar with expertise in health economics and population health. He has led research, implementation, and evaluation projects on the redesign of health care delivery and payment systems. He is interested in population health management, health care payment and delivery system reform, and the social determinants of health. Over the years his research has been funded through grants and contracts from the Department of Defense, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the European Commission, and the Robert Wood Johnson Foundation, among others.
Dr. Pagán is Chair of the Board of Directors of NYC Health + Hospitals, the largest public healthcare system in the United States. He also served as Chair of the National Advisory Committee of the Robert Wood Johnson Foundation’s Health Policy Research Scholars and was a member of the Board of Directors of the Interdisciplinary Association for Population Health Science and the American Society of Health Economists.
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Areas of research and study
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Applied EconomicsHealth EconomicsPopulation HealthPublic Health Policy
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Publications
Publications
A Call to Increase Health Data Availability in US Territories - Not Too Small to Count
AbstractPagan, J., Marie McSorley, A. M., Wheatley, A., & Pagán, J. A. (n.d.).Publication year
2023Journal title
JAMA Health ForumVolume
4Issue
9Page(s)
E233088Abstract~A decision-making model to optimize the impact of community-based health programs
AbstractPagan, J., Pérez, E., Li, Y., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Preventive MedicineVolume
149AbstractHospitals and clinics are increasingly interested in building partnerships with community-based organizations to address the social determinants of health. Choosing among community-based health programs can be complex given that programs may have different effectiveness levels and implementation costs. This study develops a decision-making model that can be used to evaluate multiple key factors that would be relevant in resource allocation decisions related to a set of community-based health programs. The decision-making model compares community-based health programs by considering funding limitations, program duration, and participant retention until program completion. Specifically, the model allows decision makers to select the optimal mix of community-based health programs based on the profiles of the population given the above constraints. The model can be used to improve resource allocation in communities, ultimately contributing to the long-term goal of strengthening cross-sector partnerships and the integration of services to improve health outcomes.A generic solution? Pharmaceuticals and the politics of the similar in Mexico
AbstractPagan, J., Hayden, C. P., Callon, M., Ecks, S., Pagán, J. A., Puig, A., & van der Geest, S. (n.d.).Publication year
2007Journal title
Current AnthropologyVolume
48Issue
4Page(s)
475-495AbstractIn 1997 and 1998 the Mexican government encouraged the introduction of generic drugs into Mexico, Latin America's biggest and fastest-growing pharmaceutical market. In contrast to the situation in Brazil, where anti-retrovirals and HIV/AIDS treatment have been the centerpiece of a powerful state-led generics "revolution," in Mexico the move to cheaper, copied medicines has made its strongest mark in the private sector. The rapidly growing pharmaceutical chain Farmacias Similares, whose populist nationalism ("Mexican Products to Help Those Who Have the Least"), affiliated laboratories, political movements, health clinics, and motto - "The Same But Cheaper" - have begun to transform the face of health care provision in that country, raises important questions about whether the emergence of a market for generic medicines does in fact signal the reassertion of "the public" in and for Mexican public health. How does the copied pharmaceutical configure a particular set of political practices and discourses launched in the name of the (Mexican) public interest?A news media analysis of the economic and reputational penalties of the hospital readmissions reduction program
AbstractPagan, J., Winborn, M. S., Alencherril, J., & Pagán, J. A. (n.d.).Publication year
2014Journal title
Inquiry (United States)Volume
51Issue
1Page(s)
1-5AbstractSection 3025 of the Affordable Care Act (ACA) of 2010 established the Hospital Readmissions Reduction Program (HRRP), an initiative designed to penalize hospitals with excess 30-day readmissions. This study investigates whether readmission penalties under HRRP impose significant reputational effects on hospitals. Data extracted from 2012 to 2013 news stories suggest that the higher the actual penalty, the higher the perceived cost of the penalty, the more likely it is that hospitals will state they have no control over the low-income patients they serve or that they will describe themselves as safety net providers. The downside of being singled out as a low-quality hospital deserving a relatively high penalty seems to be larger than the upside of being singled out as a high-quality hospital facing a relatively low penalty. Although the financial burden of the penalties seems to be low, hospitals may be reacting to the fact that information about excess readmissions and readmission penalties is being released widely and is scrutinized by the news media and the general public.A quasi-experimental study of New York City's sodium warning regulation and hypertension prevalence, 2005–2020
AbstractPagan, J., Maxey, N. J., Pagán, J. A., Rhodes-Bratton, B., Phalke, A., Wizentier, M. M., Kaphingst, K. A., Goodman, M., & Bather, J. R. (n.d.).Publication year
2025Journal title
Preventive Medicine ReportsVolume
56AbstractObjective: To quantify temporal trends in age-adjusted hypertension prevalence in New York City before and after implementation of a menu labeling regulation requiring sodium warning icons at chain restaurants. Methods: Using data from the New York City Community Health Survey, segmented regression models assessed: (1) the average annual percent change (AAPC) of age-adjusted hypertension prevalence during the pre-regulation period (2005–2015), (2) the annual percent change (APC) from 2015 to 2016 (regulation onset association), (3) the AAPC of age-adjusted hypertension prevalence during the regulation period (2016–2020), and (4) the percentage-point difference between the AAPCs of the pre-regulation and regulation periods. Results: We found a statistically significant average annual percent increase in the age-adjusted hypertension prevalence among the Hispanic population during the pre-regulation period (2005–2015 AAPC: 1.3 %, 95 % CI: 0.3 % to 2.3 %). The regulation's onset was significantly associated with a 4.2 % (95 % CI: 0.4 % to 8.0 %) increase in the age-adjusted hypertension prevalence among females from 2015 to 2016. During the regulation era, we observed statistically significant average annual percent decreases in age-adjusted hypertension prevalence among Black (2016–2020 AAPC: −1.9 %; 95 % CI: −2.5 % to −1.3 %) and female (2016–2020 AAPC: −3.5 %; 95 % CI: −5.0 % to −2.1 %) subgroups. Conclusions: Findings suggest a potential positive impact of the sodium warning regulation on hypertension prevalence. The decreasing trends in hypertension prevalence among female and Black populations suggest that sodium reduction policies may have differential impacts across subgroups. These empirical insights underscore the importance of sustained sodium reduction policies.Access to conventional medical care and the use of complementary and alternative medicine
AbstractPagan, J., Pagán, J. A., & Pauly, M. V. (n.d.).Publication year
2005Journal title
Health AffairsVolume
24Issue
1Page(s)
255-262AbstractThe use of complementary and alternative medicine (CAM) in the United States has greatly increased during the past decade. Using survey data from the 2002 National Health Interview Survey (NHIS), we show that adults who did not get, or delayed, needed medical care because of cost in the prior twelve months were also more likely than all other adults to use CAM. Recent increases in CAM use could be the result of not only the desire for individual empowerment and patient dissatisfaction with conventional medicine, as has been claimed, but also of increases in the relative cost of conventional health care.Access to health care for migrants returning to Mexico
AbstractPagan, J., Ross, S. J., Pagán, J. A., & Polsky, D. (n.d.).Publication year
2006Journal title
Journal of health care for the poor and underservedVolume
17Issue
2Page(s)
374-385AbstractContinued migration from Mexico over the past several decades has created a large population of elderly Mexicans in the U.S. There is no system in Mexico for those Mexicans who would like to retire there to obtain health insurance during their retirement years. Using a nationally representative dataset of Mexican elders, we explore the current state of health insurance status for Mexican elders with a history of migration to the U.S. We find a robust negative association between years spent in the U.S. and the probability of being insured. Coordination between the U.S. and Mexico on policy options to insure Mexicans migrants may prove beneficial to the social security systems in both countries as well as to migrants themselves.Acculturation and healthy lifestyle habits among Hispanics in United States-Mexico border communities
AbstractPagan, J., Ghaddar, S., Brown, C. J., Pagán, J. A., & Díaz, V. (n.d.).Publication year
2010Journal title
Revista Panamericana de Salud Publica/Pan American Journal of Public HealthVolume
28Issue
3Page(s)
190-197AbstractObjective. To explore the relationship between acculturation and healthy lifestyle habits in the largely Hispanic populations living in underserved communities in the United States of America along the U.S.-Mexico border. Methods. A cross-sectional study was conducted from April 2006 to June 2008 using survey data from the Alliance for a Healthy Border, a program designed to reduce health disparities in the U.S.-Mexico border region by funding nutrition and physical activity education programs at 12 federally qualified community health centers in Arizona, California, New Mexico, and Texas. The survey included questions on acculturation, diet, exercise, and demographic factors and was completed by 2 381 Alliance program participants, of whom 95.3% were Hispanic and 45.4% were under the U.S. poverty level for 20Chi-square (χ2) and Student's t tests were used for bivariate comparisons between acculturation and dietary and physical activity measures. Linear regression and binary logistic regression were used to control for factors associated with nutrition and exercise. Results. Based on univariate tests and confirmed by regression analysis controlling for so- ciodemographic and health variables, less acculturated survey respondents reported a significantly higher frequency of fruit and vegetable consumption and healthier dietary habits than those who were more acculturated. Adjusted binary logistic regression confirmed that individuals with low language acculturation were less likely to engage in physical activity than those with moderate to high acculturation (odds ratio 0.75, 95% confidence interval 0.59-0.95). Conclusions. Findings confirmed an association between acculturation and healthy lifestyle habits and supported the hypothesis that acculturation in border community populations tends to decrease the practice of some healthy dietary habits while increasing exposure to and awareness of the importance of other healthy behaviors.Acculturation and the use of complementary and alternative medicine
AbstractPagan, J., Su, D., Li, L., & Pagán, J. A. (n.d.).Publication year
2008Journal title
Social Science and MedicineVolume
66Issue
2Page(s)
439-453AbstractThe use of complementary and alternative medicine (CAM) has been growing substantially in the US in recent years. Such a growth in CAM use coincides with an ongoing increase in the proportion of the foreign-born population in the US. The main objective of this study is to examine the relation between acculturation and the use of CAM therapies among immigrants. Data from a CAM supplement to the 2002 National Health Interview Survey were analyzed to estimate the effects of acculturation on the likelihood of using different CAM therapies over the past 12 months prior to the survey. The results suggest that the level of acculturation-as measured by nativity/length of stay in the US and language of interview-is strongly associated with CAM use. As immigrants stay longer in the US or as their use of English becomes more proficient, the likelihood that they use CAM therapies increases as well, and it gradually approaches the level of CAM use by native-born Americans. Moreover, this relation between acculturation and CAM use generally persists even after the effects of socioeconomic status, health insurance coverage, self-reported health status, and other demographic variables have all been taken into consideration. The substantially lower rates of CAM use by recent immigrants and its possible causes warrant further research.Addressing practical issues of predictive models translation into everyday practice and public health management : A combined model to predict the risk of type 2 diabetes improves incidence prediction and reduces the prevalence of missing risk predictions
AbstractPagan, J., Vettoretti, M., Longato, E., Zandonà, A., Li, Y., Pagán, J. A., Siscovick, D., Carnethon, M. R., Bertoni, A. G., Facchinetti, A., & Di Camillo, B. (n.d.).Publication year
2020Journal title
BMJ Open Diabetes Research and CareVolume
8Issue
1AbstractIntroduction Many predictive models for incident type 2 diabetes (T2D) exist, but these models are not used frequently for public health management. Barriers to their application include (1) the problem of model choice (some models are applicable only to certain ethnic groups), (2) missing input variables, and (3) the lack of calibration. While (1) and (2) drives to missing predictions, (3) causes inaccurate incidence predictions. In this paper, a combined T2D risk model for public health management that addresses these three issues is developed. Research design and methods The combined T2D risk model combines eight existing predictive models by weighted average to overcome the problem of missing incidence predictions. Moreover, the combined model implements a simple recalibration strategy in which the risk scores are rescaled based on the T2D incidence in the target population. The performance of the combined model was compared with that of the eight existing models using data from two test datasets extracted from the Multi-Ethnic Study of Atherosclerosis (MESA; n=1031) and the English Longitudinal Study of Ageing (ELSA; n=4820). Metrics of discrimination, calibration, and missing incidence predictions were used for the assessment. Results The combined T2D model performed well in terms of both discrimination (concordance index: 0.83 on MESA; 0.77 on ELSA) and calibration (expected to observed event ratio: 1.00 on MESA; 1.17 on ELSA), similarly to the best-performing existing models. However, while the existing models yielded a large percentage of missing predictions (17%-45% on MESA; 63%-64% on ELSA), this was negligible with the combined model (0% on MESA, 4% on ELSA). Conclusions Leveraging on existing literature T2D predictive models, a simple approach based on risk score rescaling and averaging was shown to provide accurate and robust incidence predictions, overcoming the problem of recalibration and missing predictions in practical application of predictive models.Advancing the use of evidence-based decision-making in local health departments with systems science methodologies
AbstractPagan, J., Li, Y., Kong, N., Lawley, M., Weiss, L., & PagÁn, J. A. (n.d.).Publication year
2015Journal title
American journal of public healthVolume
105Page(s)
S217-S222AbstractObjectives: We assessed how systems science methodologies might be used to bridge resource gaps at local health departments (LHDs) so that they might better implement evidence-based decision-making (EBDM) to address population health challenges. Methods: We used the New York Academy of Medicine Cardiovascular Health Simulation Model to evaluate the results of a hypothetical program that would reduce the proportion of people smoking, eating fewer than 5 fruits and vegetables per day, being physically active less than 150 minutes per week, and who had a body mass index (BMI) of 25 kg/m2 or greater. We used survey data from the Behavioral Risk Factor Surveillance System to evaluate health outcomes and validate simulation results. Results: Smoking rates and the proportion of the population with a BMI of 25 kg/m2 or greater would have decreased significantly with implementation of the hypothetical program (P < .001). Two areas would have experienced a statistically significant reduction in the local population with diabetes between 2007 and 2027 (P < .05). Conclusions: The use of systems science methodologies might be a novel and efficient way to systematically address a number of EBDM adoption barriers at LHDs.Agent-based modeling of chronic diseases : A narrative review and future research directions
AbstractPagan, J., Li, Y., Lawley, M. A., Siscovick, D. S., Zhang, D., & Pagán, J. A. (n.d.).Publication year
2016Journal title
Preventing Chronic DiseaseVolume
13Issue
5AbstractThe United States is experiencing an epidemic of chronic disease. As the US population ages, health care providers and policy makers urgently need decision models that provide systematic, credible prediction regarding the prevention and treatment of chronic diseases to improve population health management and medical decision-making. Agent-based modeling is a promising systems science approach that can model complex interactions and processes related to chronic health conditions, such as adaptive behaviors, feedback loops, and contextual effects. This article introduces agent-based modeling by providing a narrative review of agent-based models of chronic disease and identifying the characteristics of various chronic health conditions that must be taken into account to build effective clinical- and policy-relevant models. We also identify barriers to adopting agent-based models to study chronic diseases. Finally, we discuss future research directions of agent-based modeling applied to problems related to specific chronic health conditions.Agent-based models and spatial enablement : a simulation tool to improve health and wellbeing in big cities
AbstractPagan, J., Pala, D., Holmes, J., Pagàn, J., Parimbelli, E., Rocca, M. T., Casella, V., & Bellazzi, R. (n.d.). (D. Riaño, S. Wilk, & A. ten Teije, Eds.).Publication year
2019Page(s)
79-83AbstractAs the percentage of the population living in urban areas is constantly increasing throughout the world, big cities’ municipalities and public health policy makers have to deal with raising socioeconomic disparities and need for environmental interventions to reduce pollution and improve wellbeing. The PULSE project, funded by the EU commission under the H2020 program, aims at providing an instrument that assesses health and wellbeing in cities through sensing technologies and data integration. The system has been deployed in 7 cities – Barcelona, Birmingham, Keelung, New York, Paris, Pavia and Singapore – and includes several state-of-the-art technologies, such as a smartphone App, a WebGIS, air quality sensors, a Decision Support System and dashboards. A crucial aspect of the project is the direct involvement of the citizens and the creation of Public Health Observatories (PHOs) that can help taking informed decisions and organize targeted interventions. To this end, PHOs are provided with powerful visual analytics to study different areas of the city, and with simulation tools that can be used to model the effect of interventions of public health authorities the city. In this paper, a first agent-based simulation model, based on the results of spatio-temporal data analytics, is presented. The model simulates the effect of traffic pollution, industrial land use and green areas on the probability of asthma hospitalizations in an area of East Harlem, one the neighborhoods with the highest asthma hospitalizations rate in New York City.Aligning Health Care and Social Services to Reduce Hospitalizations and Emergency Department Visits : An Evaluation of the Community Care Connections Program
AbstractPagan, J., Akiya, K., Fisher, E., Wells, A., Li, Y., Peck, C., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Medical careVolume
59Issue
8Page(s)
671-678AbstractBackground: Integration of social services in health care delivery is increasingly recognized as a potential strategy for improving health and reducing the use of acute care services. Collaborative models that provide older adults with case management, linkages to social services, and assistance with health care navigation have emerged as promising strategies. Objective: The objective of this study was to evaluate the Community Care Connections (CCC) program, a cross-sector collaboration designed to align social and health care services for older adults. Research Design: We compared hospitalizations and emergency department (ED) visits 90 days after enrollment with a propensity score-matched group of non-CCC patients. Subgroup analyses were also conducted for adults with hypertension, diabetes, and high cholesterol. Subjects: A total of 1004 patients enrolled in CCC between June 1, 2016, and November 15, 2018, and 1004 matched patients from the same metropolitan area. Measures: Mean hospitalizations and ED visits per patient 90 days after CCC enrollment. Results: Mean hospitalizations were lower among CCC patients 90 days after enrollment than among non-CCC adults [difference=-0.039, 95% confidence interval (CI): -0.077 to -0.001, P=0.044]. They were also lower among CCC patients with hypertension (difference=-0.057, 95% CI: -0.103 to -0.010, P=0.017). However, 90 days after enrollment mean ED visits were higher among CCC patients relative to non-CCC adults (difference=0.238, 95% CI: 0.195-0.281, PAligning social and health care services : The case of Community Care Connections
AbstractPagan, J., Fisher, E. M., Akiya, K., Wells, A., Li, Y., Peck, C., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Preventive MedicineVolume
143AbstractThe Community Care Connections (CCC) program aims to align social and healthcare services to improve health outcomes in older adults with complex medical and social needs. This study assessed changes in healthcare utilization before and after CCC program participation. Between June 2016 and March 2019, 1214 adults with complete data who provided informed consent participated in the CCC program. CCC client data were linked with data on hospitalizations, emergency department (ED) visits, and observation stays 90 days before and after program start. Data analysis examined changes in health care utilization 90 days after program start, compared to 90 days before. Hospitalizations decreased by 30% (Change = −0.029, 95% Confidence Interval (CI) = −0.053, −0.005), ED visits decreased by 29% (Change = −0.114, 95% CI = -0.163, −0.066), and observation stays decreased by 23% (Change = −0.041, 95% CI = -0.073, −0.009) during the post period. ED visits decreased by 37% (Change = −0.140, 95% CI = -0.209, −0.070) for those with hypertension and by 30% (Change = −0.109, 95% CI = -0.199, −0.020) for those with high cholesterol, while observation stays decreased by 46% (Change = −0.118, 95% CI = -0.185, −0.052) for those with diabetes and by 44% (Change = −0.082, 95% CI = -0.150, −0.014) for those with high cholesterol during the post period. Connecting older adults with social services through the healthcare delivery system may lead to decreases in hospitalizations, ED visits, and observation stays. Implementation of cross-sector partnerships that address non-clinical factors that impact the health of older adults may reduce the use of costly healthcare services.Alliance for a healthy border : Factors related to weight reduction and glycemic success
AbstractPagan, J., Wang, X., Ghaddar, S., Brown, C., Pagán, J. A., & Balboa, M. (n.d.).Publication year
2012Journal title
Population Health ManagementVolume
15Issue
2Page(s)
90-100AbstractWe examined the factors related to success in achieving weight reduction and glycemic control in Alliance for a Healthy Border (AHB), a chronic disease prevention program implemented from 2006 to 2009 through 12 federally qualified community health centers serving primarily Hispanics in communities located along the US-Mexico border region. We analyzed data from Phase I of AHB using logistic regression to examine the determinants of success in achieving weight reduction and glycemic control among the participants in AHB programs. Factors affecting weight reduction success were sex, age, employment status, income, insurance, diabetes, baseline body mass index (BMI), smoking status, family history of diabetes, session type, program duration, and physical activity changes. Factors affecting achievement of glycemic success included sex, age, employment status, diabetes, baseline BMI, family history of diabetes, program duration, and physical activity changes. We found that the AHB interventions were more successful in reducing participants' HbA1c level than BMI. In addition to sociodemographic factors, participants with better baseline health conditions (ie, participants without diabetes or family history of diabetes, normal BMI, former smokers) were more likely to achieve success after the interventions. Of the 4 key features defining each of the 12 interventions, session type and program duration were associated with success. Within a relatively short time period, physical activity improvements had a stronger effect on weight reduction and glycemic success than improvements in dietary habits. The effectiveness of diabetes and cardiovascular disease prevention programs can be improved substantially by considering these factors during program design and structure.Alliance for a healthy border : Obesity prevention in underserved U.S.- Mexico border communities
AbstractPagan, J., Ghaddar, S., Brown, C. J., & Pagán, J. A. (n.d.).Publication year
2014Page(s)
243-254Abstract~An agent-based model for ideal cardiovascular health
AbstractPagan, J., Li, Y., Kong, N., Lawley, M. A., & Pagan, J. A. (n.d.).Publication year
2016Page(s)
241-258Abstract~An Initial Assessment of Gender Pay Gaps in Costa Rica and El Salvador : (presented at the 1996 BALAS Conference, ITESM, Monterrey, NL, Mexico)
AbstractDavila, A., & Pagan, J. (n.d.).Publication year
1996Page(s)
335-45Abstract~An Integrated, Clinician-focused Telehealth Monitoring System to Reduce Hospitalization Rates for Home Health Care Patients with Diabetes
AbstractPagan, J., Pagán, J. A., Chen, H. F., & Kalish, M. C. (n.d.).Publication year
2011Journal title
Journal of Primary Care & Community HealthVolume
2Issue
3Page(s)
153-156AbstractDiabetes is one of the leading causes of death and disability in the United States, and hospitalization rates related to this health condition are high and costly to the United States health care system. The purpose of this study was to examine the effect of an integrated, clinician-focused telehealth monitoring system on the probability of hospitalization for home health care patients with diabetes. The study included 2009 data from 699 Medicare beneficiaries receiving home health services in Texas and Louisiana. Propensity score matching, logistic regression, and post-estimation parameter simulation were used to assess how telehealth affects the probability of hospitalization during the first 30 days of home health care. The 30-day hospitalization probability for telehealth and non-telehealth patients was 7% and 19%, respectively. Patients in the telehealth group had a 12 (95% confidence interval = 4.2-20.3) percentage point-lower probability of hospitalization within the first 30 days of home health care than non-telehealth matched patients. The results suggest that telehealth monitoring systems that integrate skilled clinicians with critical care experience can lead to substantially lower hospitalization rates during the first 30 days of home health care, large cost savings, and more effective home health management of patients with diabetes.Assessing lifestyle interventions to improve cardiovascular health using an agent-based model
AbstractLi, Y., Kong, N., Lawley, M., & Pagan, J. (n.d.). (A. Tolk, L. Yilmaz, S. Y. Diallo, & I. O. Ryzhov, Eds.).Publication year
2015Page(s)
1221-1232AbstractCardiovascular disease (CVD) is the leading cause of death in the United States (US) and places a heavy economic burden on the healthcare system. Recognizing the importance of CVD prevention, in recent years the American Heart Association (AHA) began to emphasize the need to increase awareness of key risk factors of CVD and proposed a new concept called ideal cardiovascular health. Based on this concept, we developed an agent-based model that is designed to capture individual health progression and study emergent CVD-related population health outcomes (diabetes, myocardial infarction, stroke and death) over a specified time period. We present some preliminary numerical results, which demonstrate the predictive validity of the model and show how the model could be used in practice by assessing the impact of a set of hypothetical lifestyle interventions on CVD-related health outcomes. Our model is designed to help policy-makers assess and compare different intervention programs targeting CVD prevention for the population of their interest.Assessing long-term health and cost outcomes of patient-centered medical homes serving adults with poor diabetes control
AbstractPagan, J., Pagán, J. A., & Carlson, E. K. (n.d.).Publication year
2013Journal title
Journal of Primary Care and Community HealthVolume
4Issue
4Page(s)
281-285AbstractThe patient-centered medical home (PCMH) is an integrated primary care delivery model particularly suited for patients with poor diabetes control. Although PCMH models targeting adults with diabetes have shown some early success, little is known about the long-term benefits of medical homes in terms of health and cost outcomes. The performance of a PCMH model in adults with poor diabetes control was assessed using simulated controlled trial data obtained from the Archimedes model of disease progression and health care utilization. Using the Cardio-Metabolic Risk data set, we compared health and cost outcomes over a 20-year period between adults with poor diabetes control (HbA1c >9%) receiving standard care and these same adults receiving care under a PCMH model with a 49% HbA1c intervention improvement rate at a per-beneficiary per-month care management cost of $20 per month. The results suggest that the PCMH model has the potential to not only reduce the proportion of the population with bilateral blindness, foot amputations, and myocardial infarctions-and the mortality rate-but it can also do so in a cost-effective manner ($7898 per quality-adjusted life year). The PCMH model is cost saving for the population 50 to 64 years old and it is particularly cost-effective for men ($883 per quality-adjusted life year). Moreover, these effects are relatively large for adults 30 to 49 years old (lower bilateral blindness and death rates), women (lower foot amputation and death rates), and men (lower bilateral blindness and myocardial infarction rates). The PCMH model has potential long-term benefits to both patients with poor diabetes control as well as health care systems and providers willing to invest in this health care delivery approach.Assessing quality across healthcare subsystems in Mexico
AbstractPagan, J., Puig, A., Pagán, J. A., & Wong, R. (n.d.).Publication year
2009Journal title
Journal of Ambulatory Care ManagementVolume
32Issue
2Page(s)
123-131AbstractRecent healthcare reform efforts in Mexico have focused on the need to improve the efficiency and equity of a fragmented healthcare system. In light of these reform initiatives, there is a need to assess whether healthcare subsystems are effective at providing high-quality healthcare to all Mexicans. Nationally representative household survey data from the 2006 Encuesta Nacional de Salud y Nutrición (National Health and Nutrition Survey) were used to assess perceived healthcare quality across different subsystems. Using a sample of 7234 survey respondents, we found evidence of substantial heterogeneity in healthcare quality assessments across healthcare subsystems favoring private providers over social security institutions. These differences across subsystems remained even after adjusting for socioeconomic, demographic, and health factors. Our analysis suggests that improvements in efficiency and equity can be achieved by assessing the factors that contribute to heterogeneity in quality across subsystems.Assessing the Impact of Language Access Regulations on the Provision of Pharmacy Services
AbstractWeiss, L., Scherer, M., Chantarat, T., Oshiro, T., Padgen, P., Pagan, J., Rosenfeld, P., & Yin, H. S. (n.d.).Publication year
2019Journal title
Journal of Urban HealthVolume
96Issue
4Page(s)
644-651AbstractApproximately 25 million people in the United States are limited English proficient (LEP). Appropriate language services can improve care for LEP individuals, and health care facilities receiving federal funds are required to provide such services. Recognizing the risk of inadequate comprehension of prescription medication instructions, between 2008 and 2012, New York City and State passed a series of regulations that require chain pharmacies to provide translated prescription labels and other language services to LEP patients. We surveyed pharmacists before (2006) and after (2015) implementation of the regulations to assess their impact in chain pharmacies. Our findings demonstrate a significant improvement in capacity of chains to assist LEP patients. A higher proportion of chain pharmacies surveyed in 2015 reported printing translated labels, access and use of telephone interpreter services, multilingual signage, and documentation of language needs in patient records. These findings illustrate the potential impact of policy changes on institutional practices that impact large and vulnerable portions of the population.Assessing the need for microenterprises in Mexico to borrow start-up capital
AbstractHeino, H., & Pagan, J. (n.d.).Publication year
2001Journal title
Journal of MicrofinanceVolume
3Issue
1Page(s)
131-44Abstract~