Organization

The Stephen M. Shortell Center for Organizational Research in the Health Sector Publications

Intensity of Social Needs Case Management Services and Changes in Hospital and Emergency Department Use Among Adult Medicaid Beneficiaries

Crystal Guo
Timothy Brown
Hector P Rodriguez
Margae Knox
Mark Fleming
Elizabeth Hernandez
Daniel Brown
Amanda Brewster
2024

Objectives: We identify the association between high- and low- intensity case management services on hospital and emergency department (ED) use among CommunityConnect patients.

Background: Social needs case management services vary in intensity, including the modality, workforce specialization, and maximum caseload. CommunityConnect is a social needs case management program implemented by Contra Costa Health, a county safety-net health system in California’s San Francisco Bay Area.

Methods: Due to the endogeneity of high-...

Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis

Yunyu Xiao
Kaiwen Bi
Julie Cerel
Timothy Brown
Yifan Peng
Jyotishman Pathak
J John Mann
2024

Importance: Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies.

Objective: To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts.

Design, setting, and participants: This cross-sectional study used data from the 2003-2020 National Violent...

Primary Care Practice Characteristics Associated With Medical Assistant Staffing Ratios

Hector P Rodriguez
Alena Berube
Dorothy Hung
Stephen Shortell
Elliott Fisher
2024

This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n = 1,252) data were analyzed to examine primary care practice characteristics associated with MA per primary care clinician (PCC) staffing ratios. In 2021, few practices (11.4%) had ratios of 2 or more MAs per PCCs. Compared with system-owned practices, independent (odds ratio [OR] = 1.76, P <0.05) and medical group-owned (OR = 2.09, P <0.05) practices were more likely to have ratios of 2 or more MAs per PCCs, as were...

Safety Net Primary Care Capabilities After the COVID-19 Pandemic

Karen E Schifferdecker
Ching-Wen W Yang
Matthew B Mackwood
Hector P Rodriguez
Stephen Shortell
Ellesse-Roselee Akré
A James O'Malley
Caryn Butler
Alena Berube
Alice O Andrews
Elliott S Fisher
2024

Importance: Federally qualified health centers (FQHCs) provide care to 30 million patients in the US and have shown better outcomes and processes than other practice types. Little is known about how the COVID-19 pandemic contributed to FQHC capabilities compared with other practices.

Objective: To compare postpandemic operational characteristics and capabilities of FQHCs with non-FQHC safety net practices and non-FQHC, non-safety net practices.

Design, setting, and participants: This nationally representative survey conducted...

Rental Housing Deposits and Health Care Use

Margae Knox
Elizabeth Hernandez
Jennifer Ahern
Daniel Brown
Hector P Rodriguez
Mark Fleming
Amanda Brewster
2024

Importance: Housing deposits and tenancy supports have become new Medicaid benefits in multiple states; however, evidence on impacts from these specific housing interventions is limited.

Objective: To evaluate the association of rental housing deposits and health care use among Medicaid beneficiaries receiving social needs case management as part of a Whole-Person Care (Medicaid 1115 waiver) pilot program in California.

Design, setting, and participants: This cohort study compared changes in health care use among a group of...

Factors Associated with Patient Engagement in a Health and Social Needs Case Management Program

Christine Lo
Margae Knox
Elizabeth Hernandez
Amanda Brewster
2024

Introduction: Many patients offered case management services to address their health and social needs choose not to engage. Factors that drive engagement remain unclear. We sought to understand patient characteristics associated with engagement in a social needs case management program and variability by case manager.

Methods: Between August 2017 and February 2021, 43,347 Medicaid beneficiaries with an elevated risk of hospital or emergency department use were offered case management in Contra Costa County, California. Results were analyzed in 2022 using...

Assessing the Impact of Telemedicine Implementation in Diverse Healthcare Settings

Hector P Rodriguez
2023

Health care organizations and systems can have a large impact on how extensively telemedicine and virtual visits are used by medical practices and individual clinicians. This supplemental issue of medical care aims to advance evidence about how health care organizations and systems can best support telemedicine and virtual visit implementation. This issue includes 10 empirical studies examining the impact of telemedicine on quality of care, utilization, and/or patient care experiences, of which 6 are studies of Kaiser Permanente patients; 3 are studies of Medicaid, Medicare, and...

Health Systems and Telemedicine Adoption for Diabetes and Hypertension Care

Hector P Rodriguez
Elizabeth Ciemins
Karl Rubio
Cori Rattelman
John Cuddeback
Jeff Mohl
Salma Bibi
Stephen Shortell
2023

OBJECTIVES: The COVID-19 pandemic accelerated telemedicine use nationally, but differences across health systems are understudied. We examine telemedicine use for adults with diabetes and/or hypertension across 10 health systems and analyze practice and patient characteristics associated with greater use. STUDY

DESIGN: Encounter-level data from the AMGA Optum Data Warehouse for March 13, 2020, to December 31, 2020, were analyzed, which included 3,016,761 clinical encounters from 764,521 adults with diabetes and/or hypertension attributed to 1 of 1207 practice sites with at least 50...

Telehealth Use, Care Continuity, and Quality: Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic

Aaron Tierney
Denise Payan
Timothy Brown
Adrian Aguilera
Stephen Shortell
Hector P Rodriguez
2024
Background:

Community health centers (CHCs) pivoted to using telehealth to deliver chronic care during the coronavirus COVID-19 pandemic. While care continuity can improve care quality and patients’ experiences, it is unclear whether telehealth supported this relationship.

Objective:

We examine the association of care continuity with diabetes and hypertension care quality in CHCs before and during COVID-19 and the mediating effect of telehealth.

Research Design:

This was a cohort study.

Participants:

Electronic health record data from 166 CHCs with n=20,792 patients...

Primary Care Practice Characteristics Associated With Medical Assistant Staffing Ratios

Hector P Rodriguez
Alena Berube
Dorothy Hung
Stephen Shortell
Elliott Fisher
2024

This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n=1,252) data were analyzed to examine primary care practice characteristics associated with MA per primary care clinician (PCC) staffing ratios. In 2021, few practices (11.4%) had ratios of 2 or more MAs per PCCs. Compared with system-owned practices, independent (odds ratio [OR]=1.76, P <0.05) and medical group-owned (OR=2.09, P <0.05) practices were more likely to have ratios of 2 or more MAs per PCCs, as were practices with organizational cultures...