340B Drug Pricing Program
The 340B Drug Pricing Program has provided enrolled health care organizations (“covered entities”) deep acquisition cost discounts for outpatient medications since 1992. In 2010, HRSA promulgated guidelines to expand the program’s reach by allowing dispensing of 340B priced drugs through registered contract pharmacies nationwide. The 2010 contract pharmacy guidelines have led to a substantial expansion of 340B contract pharmacy arrangements. Since 2010, the percentage of all 340B covered entities that have an arrangement with at least one contact pharmacy has doubled from 10 percent to approximately 20 percent. The number of unique pharmacies that serve as a 340B contract pharmacy has grown by 770 percent in the same time period. In partnership with Walgreen Co., we are evaluating national impact of the 340B program’s expansion to include contract pharmacies by examining the extent and nature of 340B covered entities, their registered contract pharmacies, and medications prescribed under the program.
Racial Disparities and Diabetes Quality of Care
We are using 10 years of national data from the National Health and Nutrition Examination Survey (NHANES) to characterize the U.S. adult diabetic population in terms of their individualized, guideline-suggested glycemic targets and describe the extent to which non-Hispanic whites, non-Hispanic blacks, and Hispanics meet or exceed those targets. This analysis also looks at whether individualization of A1C targets for diabetics will have an impact on racial disparities in diabetes quality of care compared to general A1C targets.
Diabetes Prevention Program Project
The purpose of this project is to synthesize and organize existing evidence regarding diabetes prevention in such a way that policymakers can easily see what programs or combination of programs are likely to produce sizeable health improvements at reasonable cost for the state of New York as well as the entire United States.
Comparative Effectiveness of Dynamic Patterns of Glucose Lowering Therapies
In type 2 diabetes care, there is currently significant uncertainty regarding how to best use glucose lowering therapies in combination and how rapidly changes in therapies should be made. The proposed studies using the Veterans Health Administration type 2 diabetes cohort will provide a useful taxonomy of dynamic patterns of glucose lowering therapies, identify patterns of glucose lowering therapies that increase rates of diabetes outcomes, and identify the sub-populations where the risks for adverse events are highest. Optimizing complex treatment decisions for individuals with type 2 diabetes has the potential to improve the length and quality of life of the millions of adults living with the disease.
National Social Life, Health, and Aging Project
The National Social Life, Health and Aging Project (NSHAP) is a longitudinal study of older adults designed to examine mechanisms by which social factors (e.g., intimate relationships, social networks) affect and are affected by health. In 2005-06, questionnaire and biomeasure data were collected from a nationally-representative sample of 3,005 community-dwelling adults 57-85 (W1). These referent respondents were reinterviewed in 2010-11, together with coresident spouses/partners (W2). We plan to reinterview all surviving referent respondents and W2 spouses/partners in 2015-16 (W3). This third wave will allow NSHAP investigators and the broader research community to: 1) test the overarching hypothesis that older adults with strong, functioning relationships have better health trajectories; 2) examine how those who experience a major social or health event from W1 to W2 respond in W3; 3) explore the extent to which health and social relationships are produced and maintained in a larger context (i.e., couple, household, family, community); and 4) estimate causal models of the effect of social relationships on health and vice versa. While NSHAP’s W1 and W2 provide extensive health and social information, W3 will allow researchers to trace pathways of health and mortality for individuals and intimate partnerships within social context.
Longitudinal Evaluation of Personalized Decision Support for Older Diabetes Patients
The overall objective of our research program in geriatric diabetes is to identify effective ways of delivering diabetes care that may improve the health outcomes of this important diabetes sub-population. A fundamental research question in the field is whether or not highly individualized diabetes care may lead to better health outcomes compared to standard diabetes care. With better individualization, it is believed that providers will be better able to provide the specific care that an individual patient needs by accurately identifying older patients who are likely and unlikely to benefit from intensive glycemic control, identifying patients at great risk for geriatric syndromes, and eliciting the treatment goals and preferences of older diabetes patients.
Chicago Center for Diabetes Translation Research (CCDTR)
The Chicago Center for Diabetes Translation Research (CCDTR) aims to expand its role as one of the pioneering national leaders in investigating the translation of diabetes research findings into real-world practice, with a particular emphasis on improving the quality of care and outcomes for vulnerable populations and reducing racial and ethnic disparities in health care. The Specific Aims of the CCDTR are: 1) To create an environment that encourages and supports innovative diabetes research to translate scientific findings into real-world practice, with a special focus on improving the care and outcomes of vulnerable populations and reducing racial and socioeconomic disparities. 2) To serve as a local, regional, and national resource to improve diabetes translation research in community health centers and other safety net settings by forming partnerships with the Chicago Department of Public Health, ACCESS Community Health Network, MidWest Clinicians’ Network, Association of Asian Pacific Islander Community Health Organizations, and National Association of Community Health Centers.
Improving Diabetes Care and Outcomes on the South Side of Chicago
The primary goal of this project is to test whether a multi-factorial intervention can improve the quality of care and outcomes of diabetes patients living in predominantly low-income African-American communities, through collaboration between community health centers, an academic medical center, and community-based organizations.
An Evaluation of the Commonwealth Fund’s Medical Home Safety-Net Initiative
This proposal evaluates an intervention to implement the patient-centered medical home in 65 safety net clinics in 5 states. The evaluation answers whether the clinics become medical homes, what the clinical and economic outcomes are, and what is associated with successful program implementation.
Case Studies on the Cost of Medical Home Transformation and Maintenance in the Safety Net
Little is known about the cost to primary care practices of transforming to the patient-centered medical home (PCMH), especially in the safety net. Our current study of a 5 state, 65 practice demonstration project to transform safety net practices into medical homes will assess the costs faced by a small sample of practices during the demonstration. We propose adding long-term follow-up data collection to our study, in order to assess the maintenance costs and sustainability of the PCMH after the demonstration project has ended. In addition, we propose to increase the sample size of our study to 9 practices (adding 3) in order to improve our ability to compare the cost experience of primary care practices in different settings (urban versus rural location; large versus small practices). The data collected from these case studies will help to paint an important picture of what the costs of medical home transformation are for a variety of practices over time.
Use of Public Health Technology to Support Chronic Disease Control
The objective of this project is to present ways in which federal, state, and local stakeholders can work together to promote successful models for enhancing public health practice using health IT, particularly chronic disease management.