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
Agent-based modeling of chronic diseases : A narrative review and future research directions
AbstractLi, Y., Lawley, M. A., Siscovick, D. S., Zhang, D., Pagán, J. A., & Pagan, J. (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.An agent-based model for ideal cardiovascular health
AbstractLi, Y., Kong, N., Lawley, M. A., Pagan, J. A., & Pagan, J. (n.d.).Publication year
2016Page(s)
241-258Abstract~Does telemedicine improve treatment outcomes for diabetes? A meta-analysis of results from 55 randomized controlled trials
AbstractSu, D., Zhou, J., Kelley, M. S., Michaud, T. L., Siahpush, M., Kim, J., Wilson, F., Stimpson, J. P., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2016Journal title
Diabetes Research and Clinical PracticeVolume
116Page(s)
136-148AbstractAims: To assess the overall effect of telemedicine on diabetes management and to identify features of telemedicine interventions that are associated with better diabetes management outcomes. Methods: Hedges's g was estimated as the summary measure of mean difference in HbA1c between patients with diabetes who went through telemedicine care and those who went through conventional, non-telemedicine care using a random-effects model. Q statistics were calculated to assess if the effect of telemedicine on diabetes management differs by types of diabetes, age groups of patients, duration of intervention, and primary telemedicine approaches used. Results: The analysis included 55 randomized controlled trials with a total of 9258 patients with diabetes, out of which 4607 were randomized to telemedicine groups and 4651 to conventional, non-telemedicine care groups. The results favored telemedicine over conventional care (Hedges's g = -0.48, p < 0.001) in diabetes management. The beneficial effect of telemedicine were more pronounced among patients with type 2 diabetes (Hedges's g = -0.63, p < 0.001) than among those with type 1 diabetes (Hedges's g = -0.27, p = 0.027) (Q = 4.25, p = 0.04). Conclusions: Compared to conventional care, telemedicine is more effective in improving treatment outcomes for diabetes patients, especially for those with type 2 diabetes.Leveraging the Food Environment in Obesity Prevention : the Promise of Systems Science and Agent-Based Modeling
AbstractLi, Y., Berenson, J., Gutiérrez, A., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2016Journal title
Current Nutrition ReportsVolume
5Issue
4Page(s)
245-254AbstractUnderstanding (and reshaping) the neighborhood food environment has emerged as an important pathway to change diet and reduce obesity risk. Dietary behaviors and the development of obesity are complex processes which feature interactions among multiple biological, behavioral, environmental, and cultural factors. Systems science, especially agent-based modeling, offers an effective approach to help identify the best strategies to leverage the food environment in ways that can improve dietary behaviors and prevent obesity. With support from existing literature, this study presents a conceptual framework that describes the pathways through which food environment influences dietary behaviors and obesity. The paper articulates the rationale for using systems science to understand the dynamics and interactions of food environment, dietary behaviors, and obesity. Two specific agent-based models depicting the food environment are presented to demonstrate the promise of systems science to inform the design and implementation of public health interventions and policies for improving dietary behaviors and preventing obesity.NYC’s New High Sodium Warning Label : Can it Make a Real Difference in Health?
AbstractLi, Y., & Pagan, J. (n.d.).Publication year
2016Abstract~Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads
AbstractPhilpot, L. M., Stockbridge, E. L., Padrón, N. A., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2016Journal title
Population Health ManagementVolume
19Issue
3Page(s)
206-211AbstractThree out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211)Social Norms and the Consumption of Fruits and Vegetables across New York City Neighborhoods
AbstractLi, Y., Zhang, D., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2016Journal title
Journal of Urban HealthVolume
93Issue
2Page(s)
244-255AbstractConsumption of fruits and vegetables is associated with a lower risk of developing many chronic health conditions such as diabetes and cardiovascular disease. While five or more servings of fruits and vegetables per day are recommended, only 50 % of New York City (NYC) residents consume two or more servings per day. In addition, there is wide variation in dietary behaviors across different neighborhoods in NYC. Using a validated agent-based model and data from 34 NYC neighborhoods, we simulate how a mass media and nutrition education campaign strengthening positive social norms about food consumption may potentially increase the proportion of the population who consume two or more servings of fruits and vegetables per day in NYC. We found that the proposed intervention results in substantial increases in daily fruit and vegetable consumption, but the campaign may be less effective in neighborhoods with relatively low education levels or a relatively high proportion of male residents. A well-designed, validated agent-based model has the potential to provide insights on the impact of an intervention targeting social norms before it is implemented and shed light on the important neighborhood factors that may affect the efficacy of the intervention.Advancing the use of evidence-based decision-making in local health departments with systems science methodologies
AbstractLi, Y., Kong, N., Lawley, M., Weiss, L., PagÁn, J. A., & Pagan, J. (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.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.Chronic pain and health care spending : An analysis of longitudinal data from the medical expenditure panel survey
AbstractStockbridge, E. L., Suzuki, S., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2015Journal title
Health Services ResearchVolume
50Issue
3Page(s)
847-870AbstractObjective To estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration. Data Source Medical Expenditure Panel Survey (MEPS) data (2008-2011; N = 26,671). Study Design Differences in annual expenditures for adults at different levels of pain that interferes with normal work, as measured by the SF-12, were estimated using recycled predictions from two-part logit-generalized linear regression models. Principal Findings "A little bit" of chronic pain-related interference was associated with a $2,498 increase in total adjusted expenditures over no pain interference (pCost-Effectiveness Analysis of a Colonoscopy Screening Navigator Program Designed for Hispanic Men
AbstractWilson, F. A., Villarreal, R., Stimpson, J. P., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2015Journal title
Journal of Cancer EducationVolume
30Issue
2Page(s)
260-267AbstractAlthough Hispanic men are at higher risk of developing colon cancer compared to non-Hispanic white men, colonoscopy screening among Hispanic men is much lower than among non-Hispanic white men. University Health System (UHS) in San Antonio, Texas, instituted a Colorectal Cancer Male Navigation (CCMN) Program in 2011 specifically designed for Hispanic men. The CCMN Program contacted 461 Hispanic men 50 years of age and older to participate over a 2-year period. Of these age-eligible men, 370 were screened for CRC after being contacted by the navigator. Using participant and program data, a Markov model was constructed to determine the cost-effectiveness of the CCMN Program. An average 50-year-old Hispanic male who participates in the CCMN Program will have 0.3 more quality-adjusted life-years (QALYs) compared to a similar male receiving usual care. Life expectancy is also predicted to increase by 6 months for participants compared to non-participants. The program results in net health care savings of $1,148 per participant ($424,760 for the 370 CCMN Program participants). The incremental cost-effectiveness ratio is estimated at $3,765 per QALY in favor of the navigation program. Interventions to reduce disparities in CRC screening across ethnic groups are needed, and this is one of the first studies to evaluate the economic benefit of a patient navigator program specifically designed for an urban population of Hispanic men. A colorectal cancer screening intervention which relies on patient navigators trained to address the unique needs of the targeted population (language barriers, transportation and scheduling assistance, colon cancer, and screening knowledge) can substantially increase the likelihood of screening and improve quality of life in a cost-effective manner.Do You Speak My Language? When Patient Care Meets Cost- Effectiveness
AbstractSaloner, B., & Pagan, J. (n.d.).Publication year
2015Abstract~Why do pets have better web portals for medical records than humans?
AbstractPagan, J. (n.d.).Publication year
2015Abstract~A news media analysis of the economic and reputational penalties of the hospital readmissions reduction program
AbstractWinborn, M. S., Alencherril, J., Pagán, J. A., & Pagan, J. (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.Alliance for a healthy border : Obesity prevention in underserved U.S.- Mexico border communities
AbstractGhaddar, S., Brown, C. J., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2014Page(s)
243-254Abstract~Correlation between Cocaine Prices and Purity with Trends in Emergency Department Visits in a Major Metropolitan Area
AbstractZhu, H., Wilson, F. A., Stimpson, J. P., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2014Journal title
Journal of Urban HealthVolume
91Issue
5Page(s)
1009-1018AbstractIllicit drug use not only causes acute and chronic adverse health outcomes but also results in a significant burden to health care providers. The objective of this study is to examine the relationship between cocaine prices and purity with emergency department (ED) visits for the Chicago-Naperville-Joliet metropolitan area. Our primary outcome was number of cocaine-related ED visits per quarter provided by the Drug Abuse Warning Network. The predictor variables of cocaine purity and price were provided by the System to Retrieve Information from Drug Evidence database. Autoregressive integrated moving average (ARIMA) regressions were used to estimate the effects of cocaine price and purity on cocaine-related ED visits. Although cocaine prices did not change substantially over time, cocaine purity decreased by over 30 % between 2006 and 2010. ARIMA regression results suggest that cocaine-related ED visits were not significantly associated with powder or crack cocaine prices; however, a decrease in powder cocaine purity was associated with 2,081 fewer ED visits overall from 2007 to 2010. The cocaine trade continues to be a major public health and law enforcement threat to large metropolitan cities like Chicago. Regular monitoring of cocaine purity levels may provide early warning of impending changes in cocaine-related ED visits for law enforcement and health care providers.Examining Medicare’s Hospital Readmissions Reduction Program
AbstractPagan, J. (n.d.).Publication year
2014Abstract~Fatal crashes from drivers testing positive for drugs in the U.S., 1993-2010
AbstractWilson, F. A., Stimpson, J. P., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2014Journal title
Public Health ReportsVolume
129Issue
4Page(s)
342-350AbstractObjective. Illegal drug use is a persistent problem, prescription drug abuse is on the rise, and there is clinical evidence that drug use reduces driving performance. This study describes trends in characteristics of drivers involved in fatal motor vehicle crashes who test positive for drugs. Methods. We used the Fatality Analysis Reporting System-a census of motor vehicle crashes resulting in at least one fatality on U.S. public roads-to investigate suspected drug use for the period 1993-2010. Results. Drugged drivers who were tested for drug use accounted for 11.4% of all drivers involved in fatal motor vehicle crashes in 2010. Drugged drivers are increasingly likely to be older drivers, and the percentage using multiple drugs increased from 32.6% in 1993 to 45.8% in 2010. About half (52.4%) of all drugged drivers used alcohol, but nearly three-quarters of drivers testing positive for cocaine also used alcohol. Prescription drugs accounted for the highest fraction of drugs used by drugged drivers in fatal crashes in 2010 (46.5%), with much of the increase in prevalence occurring since the mid-2000s. Conclusions. The profile of a drugged driver has changed substantially over time. An increasing share of these drivers is now testing positive for prescription drugs, cannabis, and multiple drugs. These findings have implications for developing interventions to address the changing nature of drug use among drivers in the U.S.Patient-centered medical home features and expenditures by medicare beneficiaries
AbstractStockbridge, E. L., Philpot, L. M., Paǵan, J. A., & Pagan, J. (n.d.).Publication year
2014Journal title
American Journal of Managed CareVolume
20Issue
5Page(s)
379-385AbstractObjectives: To determine the impact of individual features of the patientcentered medical home (PCMH) care model on next-year healthcare expenditures including outpatient, inpatient, emergency department, pharmacy, and total healthcare expenditures among Medicare beneficiaries 65 years and older. Study Design: Analysis of retrospective longitudinal survey data. Methods Longitudinal files from the Medical Expenditure Panel Survey were analyzed. Differences in expenditures for individuals whose usual sources of care did or did not have different PCMH features were estimated using recycled predictions from generalized linear regression models. Results: Having little to no difficulty contacting the regular source of care over the telephone during regular business hours was associated with significantly lower total and inpatient expenditures over the next year (differences of $2867 and $3736, respectively). Having a regular source of care with office hours at night or on weekends was associated with significantly lower outpatient, emergency department, and other expenditures (differences of $535, $103, and $328, respectively). Pharmacy expenditures were significantly higher for individuals whose usual source of care inquired about medications and treatments prescribed by other doctors (difference of $362). Conclusions: This study points out the need to identify how individual PCMH features impact healthcare expenditures across different policy-relevant categories. Practices that have not fully adopted a PCMH model can still make progress in improving quality and controlling costs by adopting even some modest features of the PCMH model.Psychological distress and emergency department utilization in the United states : Evidence from the medical expenditure panel survey
AbstractStockbridge, E. L., Wilson, F. A., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2014Journal title
Academic Emergency MedicineVolume
21Issue
5Page(s)
510-519AbstractObjectives Psychological distress not only has substantial health and social consequences, but is also associated with emergency department (ED) use. Previous studies have typically used cross-sectional data to focus on the relation between serious psychological distress and dichotomized ED utilization measures, without assessing the volume of ED use or examining nonserious levels of psychological distress. The objective of this study was to explore the association between ED utilization volume and the full spectrum of psychological distress. Methods Data from Panel 14 of the Medical Expenditure Panel Survey (MEPS; 2009-2010, n = 9,743) provided a nationally representative sample of U.S. individuals. ED utilization volume and three specifications of the Kessler Psychological Distress Scale (K6) were analyzed: a dichotomous serious/no serious psychological distress measure, a five-category ordinal measure, and a scale measure with a range of 0 to 24. Negative binomial-logit hurdle regression models were used to analyze how the different specifications of the K6 psychological distress measure were related to ED use. Results Adults with serious psychological distress in 2009 had 1.59 (95% confidence interval [CI] = 1.15 to 2.20) times greater adjusted odds of having one or more ED visits in 2010 than those without serious psychological distress. Nonserious psychological distress levels in 2009 were also associated with increased adjusted odds of having at least one ED visit in 2010. The K6 scores showed a dose-response relationship in terms of the adjusted odds of having one or more ED visits. The adjusted odds ratios (ORs) were 1.86 (95% CI = 1.37 to 2.54) for adults with K6 scores at or above 11, OR 1.76 (95% CI = 1.38 to 2.25) for adults with K6 scores between 6 and 10, OR 1.33 (95% CI = 1.05 to 1.68) for adults with K6 scores between 3 and 5, and OR 1.17 (95% CI = 0.92 to 1.48) for adults with K6 scores of 1 or 2. In addition, the adjusted odds of having one or more ED visits in 2010 significantly increased with increasing psychological distress in 2009 (OR = 1.04, 95% CI = 1.03 to 1.06). Each additional point added to the K6 scale results in an increase in the adjusted odds of an ED visit. Conclusions Even a low level of psychological distress, and not just serious psychological distress, may be an early indicator of future ED use. These results highlight the need to develop novel responses to better manage or avert ED use not only for adults with serious psychological distress but also for those who are experiencing even mild symptoms of psychological distress.Share of Mass Transit Miles Traveled and Reduced Motor Vehicle Fatalities in Major Cities of the United States
AbstractStimpson, J. P., Wilson, F. A., Araz, O. M., & Pagan, J. (n.d.).Publication year
2014Journal title
Journal of Urban HealthVolume
91Issue
6Page(s)
1136-1143AbstractThe USA leads the developed world in motor vehicle fatalities, presenting a critical public health threat. We examined whether an increasing share of mass transit use, relative to vehicle miles traveled on public roads, was associated with reduced motor vehicle fatalities. We used annual city-level data for the USA from 1982–2010 provided by the Fatality Accident Reporting System, the Texas A&M Transportation Institute, the Census Bureau, and the National Oceanic and Atmospheric Administration to estimate a structural equation model of the factors associated with mass transit miles and motor vehicle fatalities. The final analytic data included 2,900 observations from 100 cities over 29 years. After accounting for climate, year, and the economic costs of driving, an increasing share of mass transit miles traveled per capita was associated with reduced motor vehicle fatalities. The costs of congestion to the average commuter and gas prices were positively associated with increasing the share of mass transit miles traveled. The economic costs of driving increased over time, while both the fatality rate and the share of mass transit miles traveled decreased over time. Increasing the share of mass transit miles traveled may be associated with fewer motor vehicle miles traveled. Increasing mass transit uptake may be an effective public health intervention to reduce motor vehicle fatalities in cities.The community diabetes education (CoDE) program : Cost-effectiveness and health outcomes
AbstractPrezio, E. A., Pagán, J. A., Shuval, K., Culica, D., & Pagan, J. (n.d.).Publication year
2014Journal title
American journal of preventive medicineVolume
47Issue
6Page(s)
771-779AbstractConclusions A simulated clinical trial suggests that a community health worker-led diabetes intervention is a cost-effective way to reduce diabetes-related complications for uninsured Mexican Americans during a 20-year horizon in comparison to usual medical care.Background Limited evidence exists regarding the long-term effects of community health worker-led diabetes management programs on health outcomes and cost-effectiveness, particularly in low-income, ethnic minority populations.Purpose To examine the long-term cost-effectiveness and improvements in diabetes-related complications of a diabetes education and management intervention led by community health workers among uninsured Mexican Americans.Methods Clinical data, changes in hemoglobin A1c over 12 months, and costs from an RCT of 180 uninsured Mexican Americans with type 2 diabetes conducted in 2006 were utilized for secondary analyses in 2012. Simulation modeling was used to estimate long-term cost and health outcomes using the validated Archimedes Model. The absolute differences for the incremental cost-effectiveness ratios and cumulative incidence of diabetes-related complications were derived by comparing intervention and control groups.Results During a 20-year time horizon, participants who received the intervention would be expected to have significantly lower hemoglobin A1c levels (pUninsurance, underinsurance, and health care utilization in Mexico by US border residents
AbstractSu, D., Pratt, W., Stimpson, J. P., Wong, R., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2014Journal title
Journal of Immigrant and Minority HealthVolume
16Issue
4Page(s)
607-612AbstractUsing data from the 2008 Cross-Border Utilization of Health Care Survey, we examined the relationship between United States (US) health insurance coverage plans and the use of health care services in Mexico by US residents of the US-Mexico border region. We found immigrants were far more likely to be uninsured than their native-born counterparts (63 vs. 27.8 %). Adults without health insurance coverage were more likely to purchase medications or visit physicians in Mexico compared to insured adults. However, adults with Medicaid coverage were more likely to visit dentists in Mexico compared to uninsured adults. Improving health care access for US residents in the southwestern border region of the country will require initiatives that target not only providing coverage to the large uninsured population but also improving access to health care services for the large underinsured population.Using systems science for population health management in primary care
AbstractLi, Y., Kong, N., Lawley, M. A., Pagán, J. A., & Pagan, J. (n.d.).Publication year
2014Journal title
Journal of Primary Care and Community HealthVolume
5Issue
4Page(s)
242-246AbstractObjectives: Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. Methods: The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. Results: The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period ofAssessing long-term health and cost outcomes of patient-centered medical homes serving adults with poor diabetes control
AbstractPagán, J. A., Carlson, E. K., & Pagan, J. (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.