Student Achievements

This summer was extremely exciting for our Ph.D. students. They were involved with many interesting and challenging activities and had many accomplishments including:

• Successfully defended dissertations
• Publications in peer-reviewed journals
• Presentations at academic conferences
• Accepted presentations for future academic conferences
• More student achievements

Successfully Defended Dissertations

Two of our Ph.D. students successfully defended their dissertations in August: Kim Arcoleo and Trish Bauch. Congratulations, Kim and Trish!

• Kim defended her dissertation topic, “Variations in Parental Illness Representations of Children with Asthma:  The Impact on the Use of Complementary and Alternative Medicine and Symptom Severity." The purpose of her dissertation was to explain the disparities in children’s asthma outcomes based on race, poverty, and education. She used the theoretical framework of the Common Sense Model of Illness Representation. Sixty-five percent of the mothers were using complementary or alternative medicine with their children; CAM use was highest among minority, poor, and less educated mothers, and 53% of these mothers did not disclose CAM use to their health care provider. Illness representations were significant predictors of anti-inflammatory medication use but not CAM. A new pathway explaining poor asthma outcomes was identified. Kim utilized LISREL for her structural equations models and programmed her own likelihood functions. Kim is now an Assistant Professor at the College of Nursing and Healthcare Innovation at Arizona State University.

• Trish completed her defense of “Examining Care Coordination for Children and Adolescents with Emotional, Behavioral and Psychological Problems: An Application at Hillside Family of Agencies.” Her dissertation consisted of both a qualitative study and a quantitative study. Her theoretical model added primary worker turnover to Evans’ Logic Model for intensive case management. While turnover and its interaction with employed did not turn out to be statistically significant in most of the regression models that Trish estimated, they were associated with favorable patient discharge. Three of the five dependent variables were associated with youth having had previous contact with the juvenile justice system or being at risk for such contact. This was found to be related to being discharged to the same or a worse level of care, having an unstable living situation at discharge, and having an unfavorable reason for discharge. Trish has joined the Hillside Family of Agencies as Senior Research Analyst.

Publications in Peer-Reviewed Journals

• Andre Chappel had his first manuscript accepted for publication: “Small Rural Hospitals and High-Risk Surgery: How Would Regionalization Affect Surgical Volume and Hospital Revenue?” He found that if all aortic aneurysm repairs, major cardiothoracic procedures, carotid endarterectomies, cystectomies, and pancreatectomies in New York State were regionalized to higher volume hospitals, no small rural hospitals would experience significant impact in terms of rural hospital procedure volume and revenue. Andre is the first author. His coauthors are Randall S. Zuckerman of the Mithoefer Center for Rural Surgery, Bassett Healthcare, Cooperstown, New York, and Samuel R. G. Finlayson of the Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and the VA Outcomes Group, White River Junction, Vermont. In September Andre will be presenting their findings at the second annual Rural Surgery Symposium sponsored by the Mithoefer Center.

• Shubing Cai is Peter Veazie’s co-author on a manuscript accepted for publication by Medical Hypotheses: “A Proposed Connection between Medication Adherence, Patient Sense of Uniqueness, and the Personalization of Information.”

Presentations at Academic Conferences

12th Annual National Research Service Award (NRSA) Trainees Research Conference held by the Agency for Healthcare Research and Quality (AHRQ) in Seattle in June

Two of our Ph.D. students, Trish Bauch and Matt Testa-Wojteczko, were chosen to give podium presentations at the NRSA Trainees Research Conference. This is a great honor. There were only 28 podium presentations at the conference.

• The title of Trish’s presentation was “System Factors and Analytic Measures in Evaluating a System of Care for Children and Adolescents: A Qualitative Evaluation.” This topic is part of her dissertation (more to follow, below). Clinicians identified several factors as being either facilitators of or barriers to effective care coordination. The barriers include clinician inability to accurately define a system of care, inadequate communication between providers and coordinators of care, and burdens of paperwork that at times inhibit effective care coordination. Factors that facilitated effective care coordination include an enhanced level of cooperation within the entire agency, and  improved communication within the agency and affiliates. Unfortunately, Trish was ill and unable to attend.
• Matt spoke on “The ‘Style” Pricing Model: Using Physician Practice Variation to Remedy Inefficiencies in Health Insurance.” Matt’s talk was the last of the day but was so scintillating that the audience remained well after the scheduled close of the session to ask questions, make suggestions, and in general debate with him about his paper. The “Style” model is a novel health insurance pricing scheme that is potentially less restrictive in scope of benefits, administratively less burdensome, and more effective at health care cost containment than other contemporaneous pricing structures. At the same time it also offers the possibility of capturing a broad portion of the uninsured, providing improved access to care for the newly covered and significant advantages for insurers. Matt’s co-author is Charles Phelps, one of the nation’s leading health economists who has been the Provost of the University for many years.
• Maggie Holland presented a poster on her “Survey of Connecticut Nurse-Midwives on Compensation and Benefits.” She reported that compensation and employment structures vary widely among Connecticut midwives. Full-time midwives in Connecticut average 70 hours per week, have a mean salary of $79,554, and 87% have oncall responsibilities. A ‘typical’ Connecticut midwife had an ‘average’ full-time work week consisting of two 24-hour call days per week and three 7-hour office days, seeing 19 to 24 patients per office day.

AcademyHealth Annual Research Meeting in Seattle in June

Eight of our Ph.D. students attended the AcademyHealth Annual Research Meeting. Four of them, Irena Pesis-Katz, Maggie Holland, Huai-Che Shih, and Hangsheng Liu, had oral presentations and posters. Our eight attendees included our two newest Ph.D. students, Kevin Makino and Shuolun Ruan, who are M.D./Ph.D. students.

• Irena’s oral presentation was on “Pay-for-Performance – The Impact on Patient Quality of Care in a Community Setting.”
• Maggie’s poster displayed information about “A Survey of Connecticut Nurse-Midwives on Practice Patterns.” The Certified Nurse-Midwives reported significant variations in practices. For example, nine advanced techniques are performed by 14% to 44% of respondents, including ultrasounds, water birth, and repair of 3rd and 4th degree lacerations. Some of these variations are directed by the practices in which they work, while others are the result of the midwife’s own choice and experience.
• The title of Huai-Che’s poster was “Effect of the Prospective Payment System on Case-Mix of Medicare Home Health Care Users.” He reported on the impact of the distribution of chronic conditions and the Centers for Medicare and Medicaid Services’ (CMS) Hierarchical Condition Categories (HCC) model on Medicare home health care users’ case-mix. He found, first, that there was not a significance change in the distribution of the number of chronic conditions after the implementation of PPS, and, second, that PPS status was not significantly associated with the number of chronic conditions in a Poisson regression model.
• “Effect of Sample Size on Models’ Performances in Predicting Medical Expenditures” was Hengsheng’s poster topic. He investigated the association between sample size and various regression models’ performances in predicting the medical expenditures. He found that logged Ordinary Least Squares (OLS) models do not out-perform other models in predicting the medical expenditures for the non-institutionalized elderly, while simple OLS is advantagous. The best models included square-root transformed OLS with heteroscedastic retransformation, Poisson generalized linear models (GLM) and simple OLS. This pattern persisted even in small sample sizes.

Accepted Presentations for Future Academic Conferences

• Maggie Holland had an abstract accepted for an oral presentation at the Annual Meeting of the Society for Medical Decision Making in October: “When Is Genetic Testing for Breast Cancer Susceptibility Genes Acceptable?” Maggie also planned, organized, and taught a new two-week Stata Programming course for the second-year students prior to the start of the Fall Semester.
• Five students had abstracts accepted for the Annual Meeting of the American Public Health Association (APHA) in Boston this coming November. They include Huai-Che Shih, Irena Pesis-Katz, Hangsheng Liu, Chunyu Li, and Shubing Cai.
• Two of Huai-Che’s abstracts were chosen as finalists for APHA student awards: Patient Case-Mix of Medicare Home Health Care Before and After the Balanced Budget Act: Effects on Dual Eligible Beneficiaries” by the Gerontological Health Section, and “Shifts in Financing Distribution and Service Intensity of Medicare/Medicaid Dual Eligible Beneficiaries Before and After the Balanced Budget Act” by the Medical Care Section.

More Student Achievements

• Chunyu Li successfully defended her dissertation proposal, “Racial and Ethnic Disparities in Depression Recognition, Access to Healthcare, and Healthcare Services Use among the U.S. Elderly.” Her Committee consists of Bruce Friedman, PhD, Chair, Yeates Conwell, MD, Psychiatry, Kevin Fiscella, MD, Family Medicine, and Andy Dick, PhD, Senior Health Economist at RAND.
• Our three second-year students – Maggie Holland, Feng Qian, better known as Johnson, and Matt Testa-Wojteczko – passed their Comprehensive Exam.
• Matt spent July and August working with health economist Andy Dick at the RAND Corporation in Pittsburgh, studyingthe impact of shiftingmedical care costs on consumer access to health care.
• In between rotations in the Emergency Department, Kevin Makino took a calculus course.
• Shuolun Ruan was able to spend two weeks shadowing a physician in theInternal Medicine Emergency Department of Changsha Central Hospital in China. Over the two weeks she saw everything from minor colds and low fevers to hydrocephaly and a tonic clonic seizure. Here she did rotations in the Trauma Unit and the Emergency Department.
• Hong Hu worked on a study with Bruce Friedman comparing the reliability of subject self-report health care utilization data reported on a daily prospective basis with facility (hospital and nursing home) data, Medicare claims data, and data abstracted from primary care physician records.
• Nan (Tracy) Zheng worked for Helena Temkin-Greener. She established a database for Helena’s study on quality of care in nursing homes in New York State, did a literature review about how researchers use deficiency citation data as quality indicators for nursing homes, and did a literature review on hospice care in nursing homes.
• Ethan Corona worked on the Multicenter Automatic Defibrillator Implantation Trial (MADIT) evaluation.
• Ying Xian spent the summer at Excellus on his Excellus Fellowship. Ying has also been working on a literature review for a conceptual model that explains cardiac surgery mortality.