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
State Paid Sick Leave and Paid Sick-Leave Preemption Laws Across 50 U.S. States, 2009–2020
AbstractPagan, J., Pomeranz, J. L., Silver, D. R., Lieff, S. A., & Pagán, J. A. (n.d.).Publication year
2022Journal title
American journal of preventive medicineVolume
62Issue
5Page(s)
688-695AbstractIntroduction: Paid sick leave is associated with lower mortality risks and increased use of health services. Yet, the U.S. lacks a national law, and not all employers offer paid leave, especially to low-wage workers. States have enacted paid sick-leave laws or preemption laws that prohibit local governments from enacting paid sick-leave requirements. Methods: In 2019 and 2021, state paid sick-leave laws and preemption laws in effect in 2009–2020 were retrieved from Lexis+, coded, and analyzed for coverage and other features. Data from the U.S. Bureau of Economic Analysis were used to estimate the jobs covered by state paid sick-leave laws in 2009–2019. Results: In 2009, no state had a paid sick-leave law, and 1 state had preemption. By 2020, a total of 12 states had paid sick-leave laws, with a form of preemption (n=9) or no preemption (n=3), and 18 additional states solely preempted local laws without requiring coverage, creating a regulatory vacuum in those states. Although all state paid sick-leave laws covered private employers and required care for children and spouses, some laws exempted small or public employers or did not cover additional family members. The percentage of U.S. jobs covered by state-required paid sick leave grew from 0% in 2009 to 27.6% in 2019. Conclusions: Variation in state paid sick-leave laws, preemption, and lack of employer provision of paid sick leave to low-wage workers creates substantial inequities nationally. The federal government should enact a national paid sick-leave law.The Impact of Expanding Telehealth-Delivered Dietary Interventions on Long-Term Cardiometabolic Health
AbstractPagan, J., Li, Y., Zhang, D., Thapa, J., Li, W., Chen, Z., Mu, L., Liu, J., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Population Health ManagementVolume
25Issue
3Page(s)
317-322AbstractA healthy diet is an important protective factor to prevent cardiometabolic disease. Traditional face-to-face dietary interventions are often episodic, expensive, and may have limited effectiveness, particularly among older adults and people living in rural areas. Telehealth-delivered dietary interventions have proven to be a low-cost and effective alternative approach to improve dietary behaviors among adults with chronic health conditions. In this study, we developed a validated agent-based model of cardiometabolic health conditions to project the impact of expanding telehealth-delivered dietary interventions among older adults in the state of Georgia, a state with a large rural population. We projected the incidence of major cardiometabolic health conditions (type 2 diabetes, hypertension, and high cholesterol) with the implementation of telehealth-delivered dietary interventions versus no intervention among all older adults and 3 subpopulations (older adults with diabetes, hypertension, and high cholesterol, separately). The results showed that expanding telehealth-delivered dietary interventions could avert 22,774 (95% confidence interval [CI]: 22,091-23,457) cases of type 2 diabetes, 19,732 (19,145-20,329) cases of hypertension, and 18,219 (17,672-18,766) cases of high cholesterol for 5 years among older adults in Georgia. The intervention would have a similar effect in preventing cardiometabolic health conditions among the 3 selected subpopulations. Therefore, expanding telehealth-delivered dietary interventions could substantially reduce the burden of cardiometabolic health conditions in the long term among older adults and those with chronic health conditions.Transforming Primary Care in New York Through Patient-Centered Medical Homes : Findings From Qualitative Research
AbstractPagan, J., Weiss, L., Griffin, K., Wu, M., DeGarmo, E., Jasani, F., & Pagán, J. A. (n.d.).Publication year
2022Journal title
Journal of Primary Care and Community HealthVolume
13AbstractBackground: The patient-centered medical home (PCMH) model, an important component of healthcare transformation in the United States, is an approach to primary care delivery with the goal of improving population health and the patient care experience while reducing costs. PCMH research most often focuses on system level indicators including healthcare use and cost; descriptions of patient and provider experience with PCMH are relatively sparse and commonly limited in scope. This study, part of a mixed-methods evaluation of a multi-year New York State initiative to refine and expand the PCMH model, describes patient and provider experience with New York State PCMH and its key components. Methods: The qualitative component of the evaluation included focus groups with patients of PCMH practices in 5 New York State counties (n = 9 groups and 67 participants) and interviews with providers and practice administrators at New York State PCMH practices (n = 9 interviews with 10 participants). Through these focus groups and interviews, we elicited first-person descriptions of experiences with, as well as perspectives on, key components of the New York State PCMH model, including accessibility, expanded use of electronic health records, integration of behavioral health care, and care coordination. Results: There was evident progress and some satisfaction with the PCMH model, particularly regarding integrated behavioral health and, to some extent, expanded use of electronic health records. There was less evident progress with respect to improved access and reasonable wait times, which caused patients to continue to use urgent care or the emergency department as substitutes for primary care. Conclusions: It is critical to understand the strengths and limitations of the PCMH model, so as to continue to improve upon and promote it. Strengths of the model were evident to participants in this study; however, challenges were also described. It is important to note that these challenges are difficult to separate from wider healthcare system issues, including inadequate incentives for value-based care, and carry implications for PCMH and other models of healthcare delivery.Trends in Reported Health Care Affordability for Men and Women with Employer-Sponsored Health Insurance Coverage in the US, 2000 to 2020
AbstractPagan, J., Gupta, A., & Pagán, J. A. (n.d.).Publication year
2022Journal title
JAMAVolume
328Issue
24Page(s)
2448-2450Abstract~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.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.Bridging hospital quality leadership to patient care quality
AbstractPagan, J., Chakraborty, S., Kaynak, H., & Pagán, J. A. (n.d.).Publication year
2021Journal title
International Journal of Production EconomicsVolume
233AbstractUnderstanding what drives quality in the delivery of healthcare services is critical to improve the patient care experience. In a hospital, the integration of technology platforms and effective teamwork promote quality care, but this outcome requires that hospital leadership prioritizes technology integration and commits resources to sustain effective healthcare delivery teams. Some of these concepts have been investigated with a limited focus or in very narrow research contexts. Because these concepts do not interact in isolation, an empirical study that examines the relationships between them simultaneously is important to explore the links between hospital quality leadership (QL), technology integration (TI), healthcare team effectiveness (HTE) and patient care quality (PCQ). An online survey of 300 middle and senior-level U.S. hospital executives and quality heads completed during a four-month period is used to test the research hypotheses drawn primarily from quality management, information processing, and team effectiveness theories. The results suggest that hospital leaders should emphasize the integration of all technology systems in their hospitals and continuously encourage their healthcare teams to work effectively thereby improving the quality of patient care delivered. Based on the post-hoc results, we suggest that hospital quality leaders should recognize the difference in magnitude of the effects of HTE and TI on the four PCQ facets.Community Health Needs Predict Population Health Partnerships Among U.S. Children’s Hospitals
AbstractPagan, J., Franz, B., Cronin, C. E., Wainwright, A., Lai, A. Y., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Medical Care Research and ReviewVolume
78Issue
6Page(s)
771-779AbstractCross-sector collaboration is critical to improving population health, but data on partnership activities by children’s hospitals are limited, and there is a need to identify service delivery gaps for families. The aim of this study is to use public community benefit reports for all children’s hospitals in the United States to assess the extent to which children’s hospitals partner with external organizations to address five key health needs: health care access, chronic disease, social needs, mental health, and substance abuse. Strategies that involved partnering with community organizations were most common in addressing social needs and substance abuse. When adjusted for institutional and community characteristics hospitals in a multilevel regression model, hospitals had higher odds of partnering to address chronic illness and social needs. To encourage hospital engagement with complex social and behavioral health needs and promote health equity, support should be provided to help hospitals establish local population health networks.Do State Opioid Policies Influence Nonprofit Hospitals’ Decisions to Address Substance Abuse in Their Communities?
AbstractPagan, J., Franz, B., Cronin, C. E., Skinner, D., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Medical Care Research and ReviewVolume
78Issue
4Page(s)
371-380AbstractThe U.S. epidemic of opioid abuse calls for broad collaboration between a wide range of health care institutions and the various levels of government. Through the community benefit programs they provide, nonprofit hospitals are well positioned to be key partners in local efforts. Although substance abuse appears on approximately 90% of the most recent community health needs assessments completed by hospitals, many hospitals are not addressing substance abuse in their programmatic efforts. Given wide state variation in policies to combat opioid abuse, we assess whether state leadership to address the opioid crisis influences hospital decisions to invest in substance abuse programs. Our findings suggest that several key state policies are related to hospital investments in substance abuse initiatives. To capitalize on the community benefit responsibilities of local hospitals, policies that provide specific direction for and engagement with local hospitals may increase cooperation and investments to address substance abuse.Effects of New York’s Executive Order on Face Mask Use on COVID-19 Infections and Mortality : A Modeling Study
AbstractPagan, J., Shen, M., Zu, J., Fairley, C. K., Pagán, J. A., Ferket, B., Liu, B., Yi, S. S., Chambers, E., Li, G., Guo, Y., Rong, L., Xiao, Y., Zhuang, G., Zebrowski, A., Carr, B. G., Li, Y., & Zhang, L. (n.d.).Publication year
2021Journal title
Journal of Urban HealthVolume
98Issue
2Page(s)
197-204AbstractThere is growing evidence on the effect of face mask use in controlling the spread of COVID-19. However, few studies have examined the effect of local face mask policies on the pandemic. In this study, we developed a dynamic compartmental model of COVID-19 transmission in New York City (NYC), which was the epicenter of the COVID-19 pandemic in the USA. We used data on daily and cumulative COVID-19 infections and deaths from the NYC Department of Health and Mental Hygiene to calibrate and validate our model. We then used the model to assess the effect of the executive order on face mask use on infections and deaths due to COVID-19 in NYC. Our results showed that the executive order on face mask use was estimated to avert 99,517 (95% CIs 72,723–126,312) COVID-19 infections and 7978 (5692–10,265) deaths in NYC. If the executive order was implemented 1 week earlier (on April 10), the averted infections and deaths would be 111,475 (81,593–141,356) and 9017 (6446–11,589), respectively. If the executive order was implemented 2 weeks earlier (on April 3 when the Centers for Disease Control and Prevention recommended face mask use), the averted infections and deaths would be 128,598 (94,373–162,824) and 10,515 (7540–13,489), respectively. Our study provides public health practitioners and policymakers with evidence on the importance of implementing face mask policies in local areas as early as possible to control the spread of COVID-19 and reduce mortality.Excess Deaths During the COVID-19 Economic Downturn
AbstractPagan, J., & Pagán, J. A. (n.d.).Publication year
2021Journal title
American journal of public healthVolume
111Issue
11Page(s)
1947-1949Abstract~Genetic Variant Reinterpretation : Economic and Population Health Management Challenges
AbstractPagan, J., Pagán, J. A., Brown, H. S., Rowe, J., Schneider, J. E., Veenstra, D. L., Gupta, A., Berger, S. M., Chung, W. K., & Appelbaum, P. S. (n.d.).Publication year
2021Journal title
Population Health ManagementVolume
24Issue
3Page(s)
310-313Abstract~Projected COVID-19 epidemic in the United States in the context of the effectiveness of a potential vaccine and implications for social distancing and face mask use
AbstractPagan, J., Shen, M., Zu, J., Fairley, C. K., Pagán, J. A., An, L., Du, Z., Guo, Y., Rong, L., Xiao, Y., Zhuang, G., Li, Y., & Zhang, L. (n.d.).Publication year
2021Journal title
VaccineVolume
39Issue
16Page(s)
2295-2302AbstractBackground: Multiple candidates of COVID-19 vaccines have entered Phase III clinical trials in the United States (US). There is growing optimism that social distancing restrictions and face mask requirements could be eased with widespread vaccine adoption soon. Methods: We developed a dynamic compartmental model of COVID-19 transmission for the four most severely affected states (New York, Texas, Florida, and California). We evaluated the vaccine effectiveness and coverage required to suppress the COVID-19 epidemic in scenarios when social contact was to return to pre-pandemic levels and face mask use was reduced. Daily and cumulative COVID-19 infection and death cases from 26th January to 15th September 2020 were obtained from the Johns Hopkins University Coronavirus resource center and used for model calibration. Results: Without a vaccine (scenario 1), the spread of COVID-19 could be suppressed in these states by maintaining strict social distancing measures and face mask use levels. But relaxing social distancing restrictions to the pre-pandemic level without changing the current face mask use would lead to a new COVID-19 outbreak, resulting in 0.8–4 million infections and 15,000–240,000 deaths across these four states over the next 12 months. Under this circumstance, introducing a vaccine (scenario 2) would partially offset this negative impact even if the vaccine effectiveness and coverage are relatively low. However, if face mask use is reduced by 50% (scenario 3), a vaccine that is only 50% effective (weak vaccine) would require coverage of 55–94% to suppress the epidemic in these states. A vaccine that is 80% effective (moderate vaccine) would only require 32–57% coverage to suppress the epidemic. In contrast, if face mask usage stops completely (scenario 4), a weak vaccine would not suppress the epidemic, and further major outbreaks would occur. A moderate vaccine with coverage of 48–78% or a strong vaccine (100% effective) with coverage of 33–58% would be required to suppress the epidemic. Delaying vaccination rollout for 1–2 months would not substantially alter the epidemic trend if the current non-pharmaceutical interventions are maintained. Conclusions: The degree to which the US population can relax social distancing restrictions and face mask use will depend greatly on the effectiveness and coverage of a potential COVID-19 vaccine if future epidemics are to be prevented. Only a highly effective vaccine will enable the US population to return to life as it was before the pandemic.Reimbursement for genetic variant reinterpretation : Five questions payers should ask
AbstractPagan, J., Veenstra, D. L., Rowe, J. W., Pagán, J. A., Brown, H. S., Schneider, J. E., Gupta, A., Berger, S. M., Chung, W. K., & Appelbaum, P. S. (n.d.).Publication year
2021Journal title
American Journal of Managed CareVolume
27Issue
10Page(s)
E336-E338Abstract~Rurality and origin–destination trajectories of medical school application and matriculation in the united states
AbstractPagan, J., Mu, L., Liu, Y., Zhang, D., Gao, Y., Nuss, M., Rajbhandari-Thapa, J., Chen, Z., Pagán, J. A., Li, Y., Li, G., & Son, H. (n.d.).Publication year
2021Journal title
ISPRS International Journal of Geo-InformationVolume
10Issue
6AbstractPhysician shortages are more pronounced in rural than in urban areas. The geography of medical school application and matriculation could provide insights into geographic differences in physician availability. Using data from the Association of American Medical Colleges (AAMC), we conducted geospatial analyses, and developed origin–destination (O–D) trajectories and conceptual graphs to understand the root cause of rural physician shortages. Geographic disparities exist at a significant level in medical school applications in the US. The total number of medical school applications increased by 38% from 2001 to 2015, but the number had decreased by 2% in completely rural counties. Most counties with no medical school applicants were in rural areas (88%). Rurality had a significant negative association with the application rate and explained 15.3% of the variation at the county level. The number of medical school applications in a county was disproportional to the population by rurality. Applicants from completely rural counties (2% of the US population) represented less than 1% of the total medical school applications. Our results can inform recruitment strategies for new medical school students, elucidate location decisions of new medical schools, provide recommendations to close the rural–urban gap in medical school applications, and reduce physician shortages in rural areas.Scaling up the SNAP-ED Toolkit Interventions to Improve Fruit and Vegetable Consumption across Counties in Georgia : An Agent-Based Model
AbstractZhang, D., Thapa, J. J., Li, G., Son, H., Chen, Z., Mu, L., Li, Y., Liu, J., Pagan, J., & Giabbanelli, P. J. (n.d.). (C. R. Martin, M. J. Blas, & A. I. Psijas, Eds.).Publication year
2021AbstractThe Supplemental Nutrition Assistance Program (SNAP)-Ed Toolkit includes a set of interventions to increase the fruit and vegetable (FV) consumption of SNAP-eligible households on a limited budget. It is unclear how the interventions affect dietary choices in local populations. This study combines detailed local data with an agent-based model (ABM) to assess the potential cost-effectiveness of scaling up the SNAP-Ed Toolkit interventions in 13 selected metro-Atlanta counties in Georgia. The ABM drew insights from prior research on healthy eating choices and was empirically validated. The model predicted the actual FV consumption levels (\mathrm{R}^{2}=0.951,\ \mathrm{P} < 0.001). If the interventions could successfully enhance community healthy eating norms by 10% and 20%, they would significantly increase FV consumption. The cost per year to bring one person to consume at least two servings of FV daily) was 23 (95% confidence interval [CI]: 18-29), and 10 (95% CI: 9-12) in each scenario.Scaling up the Snap-ED toolkit interventions to improve fruit and vegetable consumption across counties in Georgia : An agent-based model
AbstractPagan, J., Zhang, D., Thapa, J. J., Li, G., Son, H., Chen, Z., Mu, L., Li, Y., Liu, J., Pagán, J. A., & Giabbanelli, P. J. (n.d.).Publication year
2021Journal title
Simulation SeriesVolume
53Issue
2Page(s)
571-582AbstractThe Supplemental Nutrition Assistance Program (SNAP)-Ed Toolkit includes a set of interventions to increase the fruit and vegetable (FV) consumption of SNAP-eligible households on a limited budget. It is unclear how the interventions affect dietary choices in local populations. This study combines detailed local data with an agent-based model (ABM) to assess the potential cost-effectiveness of scaling up the SNAP-Ed Toolkit interventions in 13 selected metro-Atlanta counties in Georgia. The ABM drew insights from prior research on healthy eating choices and was empirically validated. The model predicted the actual FV consumption levels (R2=0.951, PThe role of good governance in the race for global vaccination during the COVID-19 pandemic
AbstractPagan, J., Tatar, M., Faraji, M. R., Montazeri Shoorekchali, J., Pagán, J. A., & Wilson, F. A. (n.d.).Publication year
2021Journal title
Scientific reportsVolume
11Issue
1AbstractGovernments have developed and implemented various policies and interventions to fight the COVID-19 pandemic. COVID-19 vaccines are now being produced and distributed globally. This study investigated the role of good governance and government effectiveness indicators in the acquisition and administration of COVID-19 vaccines at the population level. Data on six World Bank good governance indicators for 172 countries for 2019 and machine-learning methods (K-Means Method and Principal Component Analysis) were used to cluster countries based on these indicators and COVID-19 vaccination rates. XGBoost was used to classify countries based on their vaccination status and identify the relative contribution of each governance indicator to the vaccination rollout in each country. Countries with the highest COVID-19 vaccination rates (e.g., Israel, United Arab Emirates, United States) also have higher effective governance indicators. Regulatory Quality is the most important indicator in predicting COVID-19 vaccination status in a country, followed by Voice and Accountability, and Government Effectiveness. Our findings suggest that coordinated global efforts led by the World Health Organization and wealthier nations may be necessary to assist in the supply and distribution of vaccines to those countries that have less effective governance.Trends in Medical School Application and Matriculation Rates Across the United States from 2001 to 2015 : Implications for Health Disparities
AbstractZhang, D., Li, G., Mu, L., Thapa, J., Li, Y., Chen, Z., Shi, L., Su, D., Son, H., & Pagan, J. (n.d.).Publication year
2021Journal title
Academic MedicineVolume
96Issue
6Page(s)
885-893AbstractPurpose Socioeconomic and geographic determinants of medical school application and matriculation may help explain the unequal distribution of physicians in the United States. This study describes trends in MD-granting medical school application and matriculation rates and explores the relationship between county median family income, proximity to a medical school, and medical school application and matriculation rates. Method Data were obtained from the Association of American Medical Colleges, including the age, gender, and Federal Information Processing Standards code for county of legal residence for each applicant and matriculant to U.S. MD-granting medical schools from 2001 through 2015. The application and matriculation rates in each county were calculated using the number of applicants and matriculants per 100,000 residents. Counties were classified into 4 groups according to the county median family income (high-income, middle-income, middle-low-income, low-income). The authors performed chi-square tests to assess trends across the study period and the association of county median family income with application and matriculation rates. Results There were 581,833 applicants and 262,730 (45.2%) matriculants to MD-granting medical schools between 2001 and 2015. The application rates per 100,000 residents during 2001-2005, 2006-2010, and 2011-2015 were 57.2, 62.7, and 69.0, respectively, and the corresponding matriculation rates were 27.5, 28.1, and 29.8. The ratios of the application rate in high-income counties to that in low-income counties during the 3 time periods were 1.9, 2.4, and 2.8, respectively. Conclusions The application and matriculation rates to MD-granting medical schools increased steadily from 2001 to 2015. Yet, applicants and matriculants disproportionately came from high-income counties. The differences in the application and matriculation rates between low-income and high-income counties grew during this period. Exploring these differences can lead to better understanding of the factors that drive geographic differences in physician access and the associated health disparities across the United States.Views on the need to implement restriction policies to be able to address COVID-19 in the United States
AbstractPagan, J., Wang, V. H., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Preventive MedicineVolume
143AbstractSeveral restriction policies implemented in many states in the United States have demonstrated their effectiveness in mitigating the spread of the coronavirus disease (COVID-19), but less is known about the differences in views on the restriction policies among different population segments. This study aimed to understand which different population groups of adults in the United States consider several key restriction policies as necessary to combat COVID-19. Survey data from Wave 64 (March 19–24, 2020) of the Pew Research Center's American Trends Panel (n=10,609) and logistic regression were used to evaluate the association between socioeconomic and demographic characteristics, employment status, political party affiliation, news exposure, census region, and opinions about COVID-19 restriction policies. The policies included restricting international travel, imposing business closures, banning large group gatherings, cancelling entertainment events, closing schools, limiting restaurants to carry-out only, and postponing state primary elections. Most survey respondents viewed COVID-19 restriction policies as necessary. Views on each restriction policy varied substantially across some population segments such as age, race, and ethnicity. Regardless of population segments, those who followed news closely or considered themselves Democrat/lean Democrat were more likely to consider all the policies as necessary than those not following the news closely or those who considered themselves Republican/lean Republican. The effectiveness of key COVID-19 restriction policies is likely to vary substantially across population groups given that views on the need to implement these policies vary widely. Tailored health messages may be needed for some population segments given divergent views on COVID-19 restriction policies.What Strategies Are Hospitals Adopting to Address the Opioid Epidemic? Evidence From a National Sample of Nonprofit Hospitals
AbstractFranz, B., Cronin, C. E., & Pagan, J. (n.d.).Publication year
2021Journal title
Public Health ReportsVolume
136Issue
2Page(s)
228-238AbstractObjectives: Hospitals are on the front lines of the opioid epidemic, seeing patients who overdose or have complicated infections, but the extent of services offered or whether services are evidence-based is not known. The objective of our study was to assess the extent to which nonprofit hospitals are addressing opioid abuse, a critical public health issue, through their community benefit work and to identify which evidence-based strategies they adopt. Methods: We reviewed community benefit documents from January 1, 2015, through December 31, 2018, for a sample (N = 446) of all nonprofit hospitals in the United States. We classified hospital opioid-related strategies into 9 categories. Using logistic regression, we predicted the likelihood of hospitals adopting various strategies to address opioid abuse. Results: Of the 446 nonprofit hospitals in our sample, 49.1% (n = 219) adopted ≥1 clinical strategy to address opioid use disorder in their community. Approximately one-quarter (26.5%; n = 118) of hospitals adopted a strategy related to treatment services for substance use disorder; 28.2% (n = 126) had ≥1 program focused on connecting patients to a primary care medical home, and 14.6% (n = 65) focused on caring for patients with opioid-related overdoses in the emergency department. We also identified factors that predicted involvement in programs that were less common than clinical strategies, but potentially effective, such as harm reduction and prescriber initiatives (both 6.3% of hospitals). Conclusions: Evidence-based prevention and treatment require strong collaboration between health care and community institutions at all levels. Effective policy interventions may exist to encourage various types and sizes of nonprofit hospitals to adopt evidence-based interventions to address opioid abuse in their communities.“Hey, We Can Do This Together” : Findings from an Evaluation of a Multi-sectoral Community Coalition
AbstractPagan, J., Realmuto, L., Weiss, L., Masseo, P., Madondo, K., Kumar, R., Beane, S., & Pagán, J. A. (n.d.).Publication year
2021Journal title
Journal of Urban HealthVolume
98Issue
5Page(s)
687-694AbstractMulti-sectoral coalitions focused on systemic health inequities are commonly promoted as important mechanisms to facilitate changes with lasting impacts on population health. However, the development and implementation of such initiatives present significant challenges, and evaluation results are commonly inconclusive. In an effort to add to the evidence base, we conducted a mixed-methods evaluation of the Claremont Healthy Village Initiative, a multi-sectoral partnership based in the Bronx, New York City. At an organizational level, there were positive outcomes with respect to expanded services, increased access to resources for programs, improved linkages, better coordination, and empowerment of local leaders—all consistent with a systemic, community building approach to change. Direct impacts on community members were more difficult to assess: perceived access to health and other services improved, while community violence and poor sanitation, which were also priorities for community members, remained important challenges. Findings suggest significant progress, as well as continued need.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.Assessment of Changes in Rural and Urban Primary Care Workforce in the United States from 2009 to 2017
AbstractPagan, J., Zhang, D., Son, H., Shen, Y., Chen, Z., Rajbhandari-Thapa, J., Li, Y., Eom, H., Bu, D., Mu, L., Li, G., & Pagán, J. A. (n.d.).Publication year
2020Journal title
JAMA network openVolume
3Issue
10AbstractImportance: Access to primary care clinicians, including primary care physicians and nonphysician clinicians (nurse practitioners and physician assistants) is necessary to improving population health. However, rural-urban trends in primary care access in the US are not well studied. Objective: To assess the rural-urban trends in the primary care workforce from 2009 to 2017 across all counties in the US. Design, Setting, and Participants: In this cross-sectional study of US counties, county rural-urban status was defined according to the national rural-urban classification scheme for counties used by the National Center for Health Statistics at the Centers for Disease Control and Prevention. Trends in the county-level distribution of primary care clinicians from 2009 to 2017 were examined. Data were analyzed from November 12, 2019, to February 10, 2020. Main Outcomes and Measures: Density of primary care clinicians measured as the number of primary care physicians, nurse practitioners, and physician assistants per 3500 population in each county. The average annual percentage change (APC) of the means of the density of primary care clinicians over time was calculated, and generalized estimating equations were used to adjust for county-level sociodemographic variables obtained from the American Community Survey. Results: The study included data from 3143 US counties (1167 [37%] urban and 1976 [63%] rural). The number of primary care clinicians per 3500 people increased significantly in rural counties (2009 median density: 2.04; interquartile range [IQR], 1.43-2.76; and 2017 median density: 2.29; IQR, 1.57-3.23; P