Thomas D'Aunno
Thomas D'Aunno
Scroll
Professor of Public Health, NYU School of Global Public Health
Professor of Management, NYU Wagner Graduate School of Public Service
-
Professional overview
-
Thomas D'Aunno, Ph.D., is Professor of Management at New York University’s Wagner Graduate School of Public Service and Professor of Public Health at NYU’s School of Global Public Health. His research interests include institutional theory, organizational change, and the performance of healthcare organizations. D’Aunno was previously a faculty member at Columbia University, the University of Chicago, the University of Michigan, and INSEAD, where he held the Novartis Chair in Healthcare Management. He is published in leading management and health journals, including Administrative Science Quarterly, the Academy of Management Journal, Academy of Management Review, Annals of the Academy of Management, the Journal of the American Medical Association, Milbank Quarterly, American Journal of Public Health and Health Affairs. He served as Editor-in-Chief of Medical Care Research and Review, 2014-2018. He also is a past chair of the Academy of Management Division of Health Care Management, and a recipient of its Provan Award for distinguished career contributions to research in healthcare management and the Fottler award for distinguished service to the field.
-
Education
-
Ph.D., Organizational Psychology, University of Michigan, Ann Arbor, MichiganUniversity of Maryland, Community-Clinical Psychology, Baltimore County, MarylandB.A., Psychology, Magna Cum Laude, University of Notre Dame, Notre Dame, Indiana
-
Publications
Publications
Telehealth Disparities in Outpatient Substance Use Disorder (SUD) Treatment among Medicaid Beneficiaries during COVID-19
AbstractD’Aunno, T., D’Aunno, T., Choi, S., Hussain, S., Wang, Y., D’Aunno, T., Mijanovich, T., & Neighbors, C. J. (n.d.).Publication year
2025Journal title
Substance Use and MisuseVolume
60Issue
7Page(s)
1007-1015AbstractBackground: We investigated racial and ethnic disparities in telehealth counseling among Medicaid-insured patients in outpatient substance use disorder (SUD) treatment clinics and assessed whether the clinic-level proportion of Medicaid-insured patients moderated these disparities. Methods: Using New York State (NYS) Medicaid and statewide treatment registry data, we analyzed 24,814 admission episodes across 399 outpatient SUD clinics during the first 6 months of COVID-19 (April–September 2020). Our outcome measure was the number of tele-counseling sessions within the first 90 days of treatment. Key independent variables included beneficiary race/ethnicity and the clinic-level proportion of Medicaid-insured patients, divided into four quartiles: lowest, second, third, and highest. Mixed effects negative binomial models assessed the associations between race/ethnicity, Medicaid proportions, and telehealth use, with interaction terms evaluating the moderating role of Medicaid proportions. Results: Black and Latinx patients received fewer telehealth sessions than non-Latinx White patients, with adjusted incidence rate ratios (aIRRs) of 0.86 (95% CI: 0.82, 0.91) for Black patients and 0.93 (95% CI: 0.88, 0.98) for Latinx patients. Black patients at clinics with the highest Medicaid proportions had higher telehealth usage rates compared to those at clinics with the lowest Medicaid proportions (aIRR, 1.20; 95% CI, 1.03–1.41). Patients in clinics with the highest Medicaid proportions were more likely to use individual telehealth counseling (aIRR, 1.02–1.88; 95% CI, 1.01–3.04). Conclusions: Significant racial disparities in telehealth use exist, with variations persisting across clinics with different Medicaid proportions. Targeted interventions are needed to address these access gaps.Telehealth Disparities in Outpatient Substance Use Disorder (SUD) Treatment among Medicaid Beneficiaries during COVID-19
AbstractD’Aunno, T., D’Aunno, T., Choi, S., Hussain, S., Wang, Y., D’Aunno, T., Mijanovich, T., & Neighbors, C. J. (n.d.).Publication year
2025Journal title
Substance Use and MisuseAbstractBackground: We investigated racial and ethnic disparities in telehealth counseling among Medicaid-insured patients in outpatient substance use disorder (SUD) treatment clinics and assessed whether the clinic-level proportion of Medicaid-insured patients moderated these disparities. Methods: Using New York State (NYS) Medicaid and statewide treatment registry data, we analyzed 24,814 admission episodes across 399 outpatient SUD clinics during the first 6 months of COVID-19 (April–September 2020). Our outcome measure was the number of tele-counseling sessions within the first 90 days of treatment. Key independent variables included beneficiary race/ethnicity and the clinic-level proportion of Medicaid-insured patients, divided into four quartiles: lowest, second, third, and highest. Mixed effects negative binomial models assessed the associations between race/ethnicity, Medicaid proportions, and telehealth use, with interaction terms evaluating the moderating role of Medicaid proportions. Results: Black and Latinx patients received fewer telehealth sessions than non-Latinx White patients, with adjusted incidence rate ratios (aIRRs) of 0.86 (95% CI: 0.82, 0.91) for Black patients and 0.93 (95% CI: 0.88, 0.98) for Latinx patients. Black patients at clinics with the highest Medicaid proportions had higher telehealth usage rates compared to those at clinics with the lowest Medicaid proportions (aIRR, 1.20; 95% CI, 1.03–1.41). Patients in clinics with the highest Medicaid proportions were more likely to use individual telehealth counseling (aIRR, 1.02–1.88; 95% CI, 1.01–3.04). Conclusions: Significant racial disparities in telehealth use exist, with variations persisting across clinics with different Medicaid proportions. Targeted interventions are needed to address these access gaps.Innovation in the Delivery of Behavioral Health Services
AbstractD’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2024Journal title
Annual Review of Public HealthVolume
45Page(s)
2.1-2.19AbstractSeveral factors motivate the need for innovation to improve the delivery of behavioral health services, including increased rates of mental health and substance use disorders, limited access to services, inconsistent use of evidence-based practices, and persistent racial and ethnic disparities. This narrative review identifies promising innovations that address these challenges, assesses empirical evidence for the effectiveness of these innovations and the extent to which they have been adopted and implemented, and suggests next steps for research. We review five categories of innovations: organizational models, including a range of novel locations for providing services and new ways of organizing services within and across sites; information and communication technologies; workforce; treatment technologies; and policy and regulatory changes. We conclude by discussing the need to strengthen and accelerate the contributions of implementation science to close the gap between the launch of innovative behavioral health services and their widespread use.Innovation in the Delivery of Behavioral Health Services
AbstractD’Aunno, T., D’Aunno, T., & Neighbors, C. J. (n.d.).Publication year
2024Journal title
Annual Review of Public HealthVolume
45Issue
1Page(s)
507-525AbstractSeveral factors motivate the need for innovation to improve the delivery of behavioral health services, including increased rates of mental health and substance use disorders, limited access to services, inconsistent use of evidence-based practices, and persistent racial and ethnic disparities. This narrative review identifies promising innovations that address these challenges, assesses empirical evidence for the effectiveness of these innovations and the extent to which they have been adopted and implemented, and suggests next steps for research. We review five categories of innovations: organizational models, including a range of novel locations for providing services and new ways of organizing services within and across sites; information and communication technologies; workforce; treatment technologies; and policy and regulatory changes. We conclude by discussing the need to strengthen and accelerate the contributions of implementation science to close the gap between the launch of innovative behavioral health services and their widespread use.Is 70% Achievable? Hospital-Level Variation in Rates of Cardiac Rehabilitation Use Among Medicare Beneficiaries
AbstractPack, Q. R., Keys, T., Priya, A., Pekow, P. S., Keteyian, S. J., Thompson, M. P., D’Aunno, T., D’Aunno, T., Lindenauer, P. K., & Lagu, T. (n.d.).Publication year
2024Journal title
JACC: AdvancesVolume
3Issue
11AbstractBackground: Despite national goals to enroll 70% of cardiac rehabilitation (CR)-eligible patients, enrollment remains low. Objectives: The purpose of this study was to evaluate how the treating hospital influences CR enrollment nationally. Methods: We included Fee-for-Service Medicare beneficiaries aged ≥66 years who were hospitalized for acute myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or heart valve repair/replacement. We examined: 1) a risk-standardized model to assess comparative hospital rates; 2) a linear regression model to identify hospital factors associated with rates of risk-standardized CR; and 3) a hierarchical generalized linear model to calculate the hospital median OR. Results: At 3,420 hospitals, we identified 264,970 eligible patients. A minority of hospitals (n = 1,446; 38%) performed cardiac surgery, but these hospitals cared for the majority (n = 242,875; 92%) of all eligible patients. Subsequent analyses were limited to these hospitals. The median risk-standardized CR enrollment rate was low (22%) and varied 10-fold across hospitals (10th, 90th percentile: 3%, 42%). Factors associated with higher hospital performance were Midwest location, higher number of hospital beds, directly affiliated CR program, and 70%. Hospitals with cardiac surgery capability care for more than 90% of all CR-eligible patients and may be a logical place to focus improvement efforts.Lost in transition : A protocol for a retrospective, longitudinal cohort study for addressing challenges in opioid treatment for transition-age adults
AbstractD’Aunno, T., D’Aunno, T., Aleksanyan, J., Choi, S., Lincourt, P., Burke, C., Ramsey, K. S., Hussain, S., Jordan, A. E., Morris, M., D’Aunno, T., Glied, S. A., McNeely, J., Elbel, B. D., Mijanovich, T., Adhikari, S., & Neighbors, C. J. (n.d.).Publication year
2024Journal title
PloS oneVolume
19Issue
8AbstractBackground In the United States, there has been a concerning rise in the prevalence of opioid use disorders (OUD) among transition-age (TA) adults, 18 to 25-years old, with a disproportionate impact on individuals and families covered by Medicaid. Of equal concern, the treatment system continues to underperform for many young people, emphasizing the need to address the treatment challenges faced by this vulnerable population at a pivotal juncture in their life course. Pharmacotherapy is the most effective treatment for OUD, yet notably, observational studies reveal gaps in the receipt of and retention in medications for opioid use disorder (MOUD), resulting in poor outcomes for many TA adults in treatment. Few current studies on OUD treatment quality explicitly consider the influence of individual, organizational, and contextual factors, especially for young people whose social roles and institutional ties remain in flux. Methods We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay. Discussion Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S.AN INTELLECTUAL HISTORY OF INSTITUTIONAL THEORY : LOOKING BACK TO MOVE FORWARD
AbstractD’Aunno, T., D’Aunno, T., Glynn, M. A., & D’aunno, T. (n.d.).Publication year
2023Journal title
Academy of Management AnnalsVolume
17Issue
1Page(s)
301-330AbstractThe advancement and growth of institutional theory over the past seven decades has brought with it an increasing plurality in its theoretical and empirical approaches, along with a number of critiques about its coherence and impact. We address these critiques, and offer remedies for overcoming the perceived challenges. We begin by examining the intellectual history of institutional theory in management and its founding discipline, sociology, from its origins in the early 1900s to the near-present, identifying key pivot points in its trajectory as well as emerging subfields. We make three novel contributions. First, we synthesize the institutional literature over the entirety of its evolution, in its social and historical contexts, to plausibly account for its development. Second, we advance an analytic narrative that highlights those critical tensions, shifts, and key pivot points that function as inflection points in institutional theory’s evolution and generate diverse subfields within it. Third, we propose an integrative conceptual model for advancing research that explicates the elements, functions, and outcomes attending institutions and institutionalization processes.Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET) : Protocol for a stepped-wedge randomized trial to facilitate clinic level changes
AbstractD’Aunno, T., D’Aunno, T., Choi, S., O’Grady, M. A., Cleland, C. M., Knopf, E., Hong, S., D’Aunno, T., Bao, Y., Ramsey, K. S., & Neighbors, C. J. (n.d.).Publication year
2023Journal title
PloS oneVolume
18Issue
6 JUNEAbstractIntroduction Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. Methods and analysis We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases—Medicaid, treatment registry, THD reporting—with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. Discussion This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE—particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.Connecting government officials & behavioral scientists to promote evidence-based decision-making : An interview with Bill de Blasio
AbstractD’Aunno, T., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2023Journal title
Behavioral Science and PolicyVolume
9Issue
2Page(s)
55-60AbstractSupporting evidence-based management and policy decisions by government officials is a key objective for behavioral scientists. Yet researchers often face formidable barriers to developing effective working relationships with government officials. In an interview, former New York City mayor Bill de Blasio argues that researchers can overcome these challenges by making a commitment to building long-term relationships and, critically, trust with government officials. Doing so requires persistence, especially because efforts to connect with officials often fail—at least at the outset. Researchers also can develop skills for communicating more effectively with officials, who are neither specialists in policy domains nor experts in research methods. He suggests highlighting core messages from complex data and beginning communication of those messages with straightforward solutions to problems; only after those proposals are under consideration should issues related to their complexities be raised. Last, de Blasio suggests that the best way for researchers to develop trusting relationships with government officials, as well as a deeper appreciation of the challenges they face, may be to devote time to government service in posts that embed them in decision-makers’ daily work. He illustrates his points with lessons from the successful adoption and implementation of policies and programs in New York City, including those that aimed to provide free prekindergarten education (Pre-K for All), respond to the COVID pandemic, reduce traffic accidents and fatalities (Vision Zero), and prevent overdose deaths through the use of supervised drug-consumption sites.Factors associated with the adoption of evidence-based innovations by substance use disorder treatment organizations : A study of HIV testing
AbstractBroffman, L., D’Aunno, T., D’Aunno, T., & Chang, J. E. (n.d.).Publication year
2023Journal title
Journal of Substance Abuse TreatmentVolume
144AbstractIntroduction: Though prior research shows that a range of important regulatory, market, community, and organizational factors influence the adoption of evidence-based practices (EBPs) among health care organizations, we have little understanding of how these factors relate to each other. To address this gap, we test a conceptual model that emphasizes indirect, mediated effects among key factors related to HIV testing in substance use disorder treatment organizations (SUTs), a critical EBP during the US opioid epidemic. Methods: We draw on nationally representative data from the 2014 (n = 697) and 2017 (n = 657) National Drug Abuse Treatment System Survey (NDATSS) to measure the adoption of HIV testing among the nation's SUTs and their key organizational characteristics; we also draw on data from the US Census Bureau; Centers for Disease Control; and legislative sources to measure regulatory and community environments. We estimate cross-sectional and longitudinal structural equation models (SEM) to test the proposed model. Results: Our longitudinal model of the adoption of HIV testing by SUTs in the United States identifies a pathway by which community and market characteristics (rurality and the number of other SUTs in the area) are related to key sociotechnical characteristics of these organizations (alignment of clients, staff, and harm-reduction culture) that, in turn, are related to the adoption of this EBP. Conclusions: Results also show the importance of developing conceptual models that include indirect effects to account for organizational adoption of EBPs.Health Systems and Social Services - A Bridge Too Far?
AbstractGlied, S. A., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2023Journal title
JAMA Health ForumVolume
4Issue
8Page(s)
E233445Abstract~Internal and Environmental Predictors of Physician Practice Use of Screening and Medications for Opioid Use Disorders
AbstractD’Aunno, T., D’Aunno, T., Miller-Rosales, C., Busch, S. H., Meara, E. R., King, A., D’Aunno, T. A., & Colla, C. H. (n.d.).Publication year
2023Journal title
Medical Care Research and ReviewAbstractMedications for opioid use disorder (MOUD) remain highly inaccessible despite demonstrated effectiveness. We examine the extent of screening for opioid use and availability of MOUD in a national cross-section of multi-physician primary care and multispecialty practices. Drawing on an existing framework to characterize the internal and environmental context, we assess socio-technical, organizational-managerial, market-based, and state-regulation factors associated with the use of opioid screening and offering of MOUD in a practice. A total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Having advanced health information technology functionality was positively associated with both screening for opioid use and offering MOUD in a practice, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models. These results suggest that improving access to information and expertise may enable physician practices to respond more effectively to the nation’s ongoing opioid epidemic.Predicting and responding to change : Perceived environmental uncertainty among substance use disorder treatment programs
AbstractFrimpong, J., Frimpong, J., Guerrero, E. G., Kong, Y., Khachikian, T., Wang, S., D’Aunno, T., D’Aunno, T., & Howard, D. L. (n.d.).Publication year
2023Journal title
Journal of Substance Use and Addiction TreatmentVolume
145AbstractIntroduction: Substance use disorder (SUD) treatment programs offering addiction health services (AHS) must be prepared to adapt to change in their operating environment. These environmental uncertainties may have implications for service delivery, and ultimately patient outcomes. To adapt to a multitude of environmental uncertainties, treatment programs must be prepared to predict and respond to change. Yet, research on treatment programs preparedness for change is sparse. We examined reported difficulties in predicting and responding to changes in the AHS system, and factors associated with these outcomes. Methods: Cross-sectional surveys of SUD treatment programs in the United States in 2014 and 2017. We used linear and ordered logistic regression to examine associations between key independent variables (e.g., program, staff, and client characteristics) and four outcomes, (1) reported difficulties in predicting change, (2) predicting effect of change on organization, (3) responding to change, and (4) predicting changes to make to respond to environmental uncertainties. Data were collected through telephone surveys. Results: The proportion of SUD treatment programs reporting difficulty predicting and responding to changes in the AHS system decreased from 2014 to 2017. However, a considerable proportion still reported difficulty in 2017. We identified that different organizational characteristics are associated with their reported ability to predict or respond to environmental uncertainty. Findings show that predicting change is significantly associated with program characteristics only, while predicting effect of change on organizations is associated with program and staff characteristics. Deciding how to respond to change is associated with program, staff, and client characteristics, while predicting changes to make to respond is associated with staff characteristics only. Conclusions: Although treatment programs reported decreased difficulty predicting and responding to changes, our findings identify program characteristics and attributes that could better position programs with the foresight to more effectively predict and respond to uncertainties. Given resource constraints at multiple levels in treatment programs, this knowledge might help identify and optimize aspects of programs to intervene upon to enhance their adaptability to change. These efforts may positively influences processes or care delivery, and ultimately translate into improvements in patient outcomes.Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care Organizations : Implications for Quality Measurement
AbstractD’Aunno, T., D’Aunno, T., Chuzi, S., Lindenauer, P. K., Faridi, K., Priya, A., Pekow, P. S., D’aunno, T., Mazor, K. M., Stefan, M. S., Spatz, E. S., Gilstrap, L., Werner, R. M., & Lagu, T. (n.d.).Publication year
2023Journal title
Journal of the American Heart AssociationVolume
12Issue
13AbstractBACKGROUND: Accountable care organizations (ACOs) aim to improve health care quality and reduce costs, including among patients with heart failure (HF). However, variation across ACOs in admission rates for patients with HF and associated factors are not well described. METHODS AND RESULTS: We identified Medicare fee-for-service beneficiaries with HF who were assigned to a Medicare Shared Savings Program ACO in 2017 and survived ≥30 days into 2018. We calculated risk-standardized acute admission rates across ACOs, assigned ACOs to 1 of 3 performance categories, and examined associations between ACO characteristics and performance categories. Among 1 232 222 beneficiaries with HF, 283 795 (mean age, 81 years; 54% women; 86% White; 78% urban) were assigned to 1 of 467 Medicare Shared Savings Program ACOs. Across ACOs, the median risk-standardized acute admission rate was 87 admissions per 100 people, ranging from 61 (minimum) to 109 (maximum) admissions per 100 beneficiaries. Compared to the overall average, 13% of ACOs performed better on risk-standardized acute admission rates, 72% were no different, and 14% performed worse. Most ACOs with better performance had fewer Black beneficiaries and were not hospital affiliated. Most ACOs that performed worse than average were large, located in the Northeast, had a hospital affiliation, and had a lower proportion of primary care providers. CONCLUSIONS: Admissions are common among beneficiaries with HF in ACOs, and there is variation in risk-standardized acute admission rates across ACOs. ACO performance was associated with certain ACO characteristics. Future studies should attempt to elucidate the relationship between ACO structure and characteristics and admission risk.Efficiency and Arbitrage in Health Services Innovation
AbstractGlied, S. A., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2022Journal title
JAMA Health ForumVolume
3Issue
3Abstract~Mixed-methods study to examine the response of opioid addiction treatment programmes to COVID-19 : a study protocol
AbstractChoi, S., Naik, R., Kiszko, K., Neighbors, C., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2022Journal title
BMJ openVolume
12Issue
7AbstractIntroduction The COVID-19 pandemic is forcing changes to clinical practice within traditional addiction treatment programmes, including the increased use of telehealth, reduced restrictions on methadone administration (eg, increased availability of take-home doses and decreased requirements for in-person visits), reduced reliance on group counselling and less urine drug screening. This paper describes the protocol for a mixed-methods study analysing organisational-level factors that are associated with changes in clinic-level practice changes and treatment retention. Methods and analysis We will employ an explanatory sequential mixed-methods design to study the treatment practices for opioid use disorder (OUD) patients in New York State (NYS). For the quantitative aim, we will use the Client Data System and Medicaid claims data to examine the variation in clinical practices (ie, changes in telehealth, pharmacotherapy, group vs individual counselling and urine drug screening) and retention in treatment for OUD patients across 580 outpatient clinics in NYS during the pandemic. Clinics will be categorised into quartiles based on composite rankings by calculating cross-clinic Z scores for the clinical practice change and treatment retention variables. We will apply the random-effects modelling to estimate change by clinic by introducing a fixed-effect variable for each clinic, adjusting for key individual and geographic characteristics and estimate the changes in the clinical practice changes and treatment retention. We will then employ qualitative methods and interview 200 key informants (ie, programme director, clinical supervisor, counsellor and medical director) to develop an understanding of the quantitative findings by examining organisational characteristics of programmes (n=25) representative of those that rank in the top quartile of clinical practice measures as well as programmes that performed worst on these measures (n=25). Ethics and dissemination The study has been approved by the Institutional Review Board of NYU Langone Health (#i21-00573). Study findings will be disseminated through national and international conferences, reports and peer-reviewed publications.Primary Care Nurse Practitioner Work Environments and Hospitalizations and ED Use Among Chronically Ill Medicare Beneficiaries
AbstractD’Aunno, T., D’Aunno, T., Poghosyan, L., Liu, J., Perloff, J., D'Aunno, T., Cato, K. D., Friedberg, M. W., & Martsolf, G. (n.d.).Publication year
2022Journal title
Medical careVolume
60Issue
7Page(s)
496-503AbstractBackground: Nurse practitioners (NPs) play a critical role in delivering primary care, particularly to chronically ill elderly. Yet, many NPs practice in poor work environments which may affect patient outcomes. Objective: We investigated the relationship between NP work environments in primary care practices and hospitalizations and emergency department (ED) use among chronically ill elderly. Research Design: We used a cross-sectional design to collect survey data from NPs about their practices. The survey data were merged with Medicare claims data. Subjects: In total, 979 primary care practices employing NPs and delivering care to chronically ill Medicare beneficiaries (n=452,931) from 6 US states were included. Measures: NPs completed the Nurse Practitioner-Primary Care Organizational Climate Questionnaire-a valid and reliable measure for work environment. Data on hospitalizations and ED use was obtained from Medicare claims. We used Cox regression models to estimate risk ratios. Results: After controlling for covariates, we found statistically significant associations between practice-level NP work environment and 3 outcomes: Ambulatory Care Sensitive (ACS) ED visits, all-cause ED visits, and all-cause hospitalizations. With a 1-unit increase in the work environment score, the risk of an ACS-ED visit decreased by 4.4% [risk ratio (RR)=0.956; 99% confidence interval (CI): 0.918-0.995; P=0.004], an ED visit by 3.5% (RR=0.965; 99% CI: 0.933-0.997; P=0.005), and a hospitalization by 4.0% (RR=0.960;99% CI: 0.928-0.993; P=0.002). There was no relationship between NP work environment and ACS hospitalizations. Conclusion: Favorable NP work environments are associated with lower hospital and ED utilization. Practice managers should focus on NP work environments in quality improvement strategies.The Relationship Between Governing Board Composition and Medicare Shared Savings Program Accountable Care Organizations Outcomes : an Observational Study
AbstractD’Aunno, T., D’Aunno, T., Reimold, K. E., Faridi, M. K., Pekow, P. S., Erban, J., Flannelly, C., Luikart, Y., Lindenauer, P. K., DeJong, C., D’Aunno, T., & Lagu, T. (n.d.).Publication year
2022Journal title
Journal of general internal medicineVolume
37Issue
10Page(s)
2462-2468AbstractBackground: Early studies of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) suggested that physician leadership was an important driver of ACO success, but it is unknown whether the demographic and professional composition of current MSSP ACO governing boards is associated with ACOs’ publicly reported outcomes. Objective: To investigate whether governing boards with higher physician participation and greater female involvement have better outcomes. Design: Cross-sectional observational study. Participants: All 2017 MSSP ACOs identified by the Center for Medicare and Medicaid Services ACO Public Use Files (PUF). Main Measures: We collected governing board composition from ACO websites in 2019. Outcome metrics included risk-standardized readmission and unplanned admissions rates. We used descriptive statistics and linear regression models to examine the association between board composition and outcomes. Key Results: Of the 339 ACOs that still existed in 2019 and had available data, 77% had physician-majority boards and 11.5% had no women on their boards. Eighty-nine percent reported a Medicare beneficiary on their board, of which about one-third had a woman representative. The average number of members on MSSP ACO boards was 12, with a mean of 67% physicians and 24% women. Board composition varied minimally by ACO characteristics, such as geographic region, number of beneficiaries, or type of participants. Higher levels of physician participation in ACO governing boards were associated with lower all-cause unplanned admission rates for patients with heart failure (p = − 0.26, p < 0.001) and for patients with multiple chronic conditions (p = − 0.28, p = 0.001). The number of women on the board was not associated with any outcome differences. Conclusions: MSSP ACO governing boards were predominately male and physician-led. Physician involvement may be important for achieving quality goals, while lack of female involvement showcases an opportunity to diversify boards.Workforce Diversity and disparities in wait time and retention among opioid treatment programs
AbstractD’Aunno, T., D’Aunno, T., Guerrero, E. G., Kong, Y., Frimpong, J. A., Frimpong, J. A., Khachikian, T., Wang, S., D’Aunno, T., & Howard, D. L. (n.d.).Publication year
2022Journal title
Substance Abuse: Treatment, Prevention, and PolicyVolume
17Issue
1AbstractBackground: Workforce diversity is a key strategy to improve treatment engagement among members of racial and ethnic minority groups. In this study, we seek to determine whether workforce diversity plays a role in reducing racial and ethnic differences in wait time to treatment entry and retention in different types of opioid use disorder treatment programs. Methods: We conducted comparative and predictive analysis in a subsample of outpatient opioid treatment programs (OTPs), who completed access and retention survey questions in four waves of the National Drug Abuse Treatment System Survey (162 OTPs in 2000, 173 OTPs in 2005, 282 OTPs in 2014, and 300 OTPs in 2017). We sought to assess the associations between workforce diversity on wait time and retention, accounting for the role of Medicaid expansion and the moderating role of program ownership type (i.e., public, non-profit, for-profit) among OTPs located across the United States. Results: We found significant differences in wait time to treatment entry and retention in treatment across waves. Average number of waiting days decreased in 2014 and 2017; post Medicaid expansion per the Affordable Care Act, while retention rates varied across years. Key findings show that programs with high diversity, measured by higher percent of African American staff and a higher percent of African American clients, were associated with longer wait times to enter treatment, compared to low diversity programs. Programs with higher percent of Latino staff and a higher percent of Latino clients were associated with lower retention in treatment compared with low diversity programs. However, program ownership type (public, non-profit and for-profit) played a moderating role. Public programs with higher percent of African American staff were associated with lower wait time, while non-profit programs with higher percent of Latino staff were related to higher retention. Conclusions: Findings show decreases in wait time over the years with significant variation in retention during the same period. Concordance in high workforce and client diversity was associated with higher wait time and lower retention. But these relations inverted (low wait time and high retention) in public and non-profit programs with high staff diversity. Findings have implications for building resources and service capacity among OTPs that serve a higher proportion of minority clients.Critical issues in alliances between management partners and accountable care organizations
AbstractD’Aunno, T., D’Aunno, T., Murray, G. F., D'Aunno, T., & Lewis, V. A. (n.d.).Publication year
2021Journal title
Health Care Management ReviewVolume
46Issue
3Page(s)
237-247AbstractBackground Despite widespread engagement of accountable care organizations (ACOs) with management partners, little empirical evidence on these alliances exists to inform policymakers or payers. Management partners may be providing a valuable service in facilitating the transition to population health management. Alternately, in some cases, partners may be receiving high fees relative to the value of services provided. Purpose The aim of this study was to use qualitative data to identify motivations for and critical issues in alliances between ACOs and management partners. Methodology/Approach We used qualitative data collected from seven ACOs (193 semistructured interviews and observational data from 12 site visits) to characterize the alliances between management partners and providers in ACOs. Results We found that ACOs sought partners to provide financing, technical expertise, and risk bearing. Tensions in partnerships arose around resources (e.g., delivery on promised resources), control (e.g., who holds decision making authority), and values (e.g., commitment to safety net mission). Some partnerships persisted, whereas others dissolved. We found that there are two different underlying models of ACO-management partner alliances in our sample: (1) short-term partnerships aimed at organizational learning and (2) long-term partnerships based on complementarity. Conclusion Our results demonstrate how ACO alliances with management partners have unfolded as a kind of natural experiment in value-based payment reform. We expect that there is wide variation in quality, expertise, and delivery by management partners. Now multiple years into many of these alliances, we may address their value, strengths, and weaknesses from the perspective of providers as well as policy makers and payers. Practice Implications Accountable care organization providers must determine whether a management partner is the best solution to the challenges they face and, if so, which alliance model to pursue. Policymakers and payers should consider short- and long-term implications of ACO-management partner alliances, including considering changing the regulatory environment.INTERPERSONAL RELATIONSHIPS, DYNAMIC REINFORCEMENT, AND ALLIANCE PERFORMANCE : A CASE STUDY FROM HEALTH CARE
AbstractMurray, G. F., Lewis, V. A., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2021Abstract~INTERPERSONAL RELATIONSHIPS, DYNAMIC REINFORCEMENT, AND ALLIANCE PERFORMANCE : A CASE STUDY FROM HEALTH CARE
AbstractMurray, G. F., Lewis, V. A., D’Aunno, T., & D’Aunno, T. (n.d.).Publication year
2021Journal title
Academy of Management Annual Meeting ProceedingsAbstract~Methodology for a six-state survey of primary care nurse practitioners
AbstractD’Aunno, T., D’Aunno, T., Harrison, J. M., Germack, H. D., Poghosyan, L., D'Aunno, T., & Martsolf, G. R. (n.d.).Publication year
2021Journal title
Nursing outlookVolume
69Issue
4Page(s)
609-616AbstractBackground: Primary care practices employing nurse practitioners (NPs) can play an important role in improving access to high quality health care services. However, most studies on the NP role in health care use administrative data, which have many limitations. Purpose: In this paper, we report the methods of the largest survey of primary care NPs to date. Methods: To overcome the limitations of administrative data, we fielded a cross-sectional, mixed-mode (mail/online) survey of primary care NPs in six states to collect data directly from NPs on their clinical roles and practice environments. Findings: While we were able to collect data from over 1,200 NPs, we encountered several challenges with our sampling frame, including provider turnover and challenges with identification of NP specialty. Discussion: In future surveys, researchers can employ strategies to avoid the issues we encountered with the sampling frame and enhance large scale survey data collection from NPs.Bundling Rapid Human Immunodeficiency Virus and Hepatitis C Virus Testing to Increase Receipt of Test Results : A Randomized Trial
AbstractD’Aunno, T., D’Aunno, T., Frimpong, J. A., Frimpong, J. A., Shiu-Yee, K., Tross, S., D'Aunno, T., Perlman, D. C., Strauss, S. M., Schackman, B. R., Feaster, D. J., & Metsch, L. R. (n.d.).Publication year
2020Journal title
Medical careVolume
58Issue
5Page(s)
445-452AbstractBACKGROUND: The overlapping human immunodeficiency virus (HIV) and hepatitis C virus (HCV) epidemics disproportionately affect people with substance use disorders. However, many people who use substances remain unaware of their infection(s).OBJECTIVE: The objective of this study was to examine the efficacy of an on-site bundled rapid HIV and HCV testing strategy in increasing receipt of both HIV and HCV test results.RESEARCH DESIGN: Two-armed randomized controlled trial in substance use disorder treatment programs (SUDTP) in New York City. Participants in the treatment arm were offered bundled rapid HIV and HCV tests with immediate results on-site. Participants in the control arm were offered the standard of care, that is, referrals to on-site or off-site laboratory-based HIV and HCV testing with delayed results.PARTICIPANTS: A total of 162 clients with unknown or negative HIV and HCV status.MEASURES: The primary outcome was the percentage of participants with self-reported receipt of HIV and HCV test results at 1-month postrandomization.RESULTS: Over half of participants were Hispanic (51.2%), with 25.3% being non-Hispanic black and 17.9% non-Hispanic white. Two thirds were male, and 54.9% reported injection as method of drug use. One hundred thirty-four participants (82.7%) completed the 1-month assessment. Participants in the treatment arm were more likely to report having received both test results than those in the control arm (69% vs. 19%, PEditors’ note
AbstractD’Aunno, T., D’Aunno, T., Sparks, J., Chapman, G., D’aunno, T., Doctor, J., Loewenstein, G., & Patel, M. (n.d.).Publication year
2020Journal title
Behavioral Science and PolicyVolume
6Issue
2Page(s)
iii-vAbstract~
Contact
tdaunno@nyu.edu
New York, NY