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Article ; Online: Health Services Research as a Vehicle for Informed Policy Advocacy.

Jella, Tarun K / Schmidt, Jenna E / Cwalina, Thomas B

Academic medicine : journal of the Association of American Medical Colleges

2022 Volume 97, Issue 12, Page(s) 1730–1731

MeSH term(s)	Humans ; Policy ; Health Services Research
Language	English
Publishing date	2022-11-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	96192-9
ISSN	1938-808X ; 1040-2446
ISSN (online)	1938-808X
ISSN	1040-2446
DOI	10.1097/ACM.0000000000004968
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Article ; Online: Appointment wait times for surgical care in the Veterans Health Administration and Community Care Program.

Friedl, Sophia L / Jella, Tarun K / Cwalina, Thomas B / Vallier, Heather A

Surgery

2023 Volume 174, Issue 6, Page(s) 1371–1375

Abstract: Background: The Veterans Health Administration has been criticized for long wait times; however, studies indicate that Veterans Health Administration wait times are shorter than those for the Veterans Health Administration's Community Care Program. ... ...

Abstract	Background: The Veterans Health Administration has been criticized for long wait times; however, studies indicate that Veterans Health Administration wait times are shorter than those for the Veterans Health Administration's Community Care Program. Previous studies have analyzed primary care wait times, but few have compared surgical specialties. Methods: Using a publicly available data set of veteran appointments compiled from the Veterans Health Administration's Corporate Data Warehouse, a nationally representative database containing 623,868 surgical consults from January 1 to June 30, 2021, mean differences in wait times between the Veterans Health Administration and the Community Care Program were calculated across surgical specialties. Results: In total, 49.6% of the surgical consults placed during the study period were for the Community Care Program. Across all surgical specialties, wait times were shorter in the Veterans Health Administration. Cardiothoracic surgery had the shortest mean wait times (23.1 days Veterans Health Administration; 30.0 days Community Care Program). The greatest difference in wait times was observed in plastic surgery, with Community Care Program appointments occurring 15.8 days later than Veterans Health Administration appointments on average. Conclusion: Across all surgical specialties, the Veterans Health Administration had shorter wait times than the Community Care Program during the study period.
MeSH term(s)	Humans ; Waiting Lists ; Veterans Health ; Appointments and Schedules ; Veterans ; Referral and Consultation
Language	English
Publishing date	2023-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.08.017
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Article ; Online: Underutilization of Social Determinants of Health Billing Codes May Bias Surgical Disparities Research.

Jella, Tarun K / Cwalina, Thomas B / Wright, James M

Spine

2021 Volume 46, Issue 12, Page(s) E702–E703

MeSH term(s)	Clinical Coding ; Humans ; Social Determinants of Health
Language	English
Publishing date	2021-04-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	752024-4
ISSN	1528-1159 ; 0362-2436
ISSN (online)	1528-1159
ISSN	0362-2436
DOI	10.1097/BRS.0000000000004055
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Article ; Online: Considerations for Reducing Bias While Addressing Racial/Ethnic Disparities in Academic Surgery.

Acuña, Alexander J / Jella, Tarun K / Kamath, Atul F

JAMA surgery

2021 Volume 156, Issue 10, Page(s) 990–991

MeSH term(s)	Ethnicity ; Humans ; Racial Groups
Language	English
Publishing date	2021-06-29
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2021.2325
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Article ; Online: Concurrent Mental Illness and Financial Barriers to Mental Health Care Among a Nationally Representative Sample of Orthopaedic Trauma Survivors.

Jella, Tarun K / Cwalina, Thomas B / Vallier, Heather A

Journal of orthopaedic trauma

2022 Volume 36, Issue 12, Page(s) 665–673

Abstract: Objectives: To understand prevalence and factors associated with concurrent mental illness and financial barriers to mental health care after orthopaedic trauma.: Design: This is a retrospective, cross-sectional study.: Setting: Interview-based ... ...

Abstract	Objectives: To understand prevalence and factors associated with concurrent mental illness and financial barriers to mental health care after orthopaedic trauma. Design: This is a retrospective, cross-sectional study. Setting: Interview-based survey was conducted across representative sample of 30,000 US households. Patients/participants: The study included 2,309 survey respondents reporting a fracture over the past 3 months, between 2004 and 2017. Intervention: Screening for financial barriers to mental health care. Main outcome measurements: Prevalence and factors associated with concurrent mental illness and financial barriers to mental health care based on sociodemographic and injury characteristics were the main outcome measurements. Results: Of the 2309 orthopaedic trauma survivors included in our analysis, 203 patients [7.8%, 95% confidence interval (CI): 6.4%-9.2%] were determined to experience severe mental illness, of whom 54 (25.3%, 95% CI: 18.0%-32.6%) and 86 (40.9%, 95% CI: 31.5%-50.2%) reported financial barriers to counseling and pharmacotherapy, respectively. Factors associated with concurrent severe mental illness and cost barriers to care were 45 to 64 years of age [adjusted odds ratios (AOR) 5.1, 95% CI: 1.7-15, P = 0.004], income below 200% of the Federal Poverty Threshold (AOR 2.5, 95% CI: 1.2-5.3, P = 0.012), and unemployment at the time of injury (AOR 3.9, 95% CI: 1.4-11, P = 0.009). Conclusions: Approximately one half of orthopaedic trauma survivors with severe mental illness face financial barriers to some form of mental health services. Younger, minority, and low socioeconomic status patients are most affected. These data suggest the presence of postdiagnosis disparities in mental health access that may be improved through direct provision and subsidization of integrated mental health support services for high-risk populations. Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
MeSH term(s)	Humans ; Mental Health ; Cross-Sectional Studies ; Retrospective Studies ; Orthopedics ; Mental Disorders/epidemiology ; Mental Disorders/therapy ; Mental Disorders/psychology ; Survivors
Language	English
Publishing date	2022-11-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	639099-7
ISSN	1531-2291 ; 0890-5339
ISSN (online)	1531-2291
ISSN	0890-5339
DOI	10.1097/BOT.0000000000002433
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Article ; Online: In Reply to the Letter to the Editor Regarding "Demographic Analysis of Financial Hardships Faced by Brain Tumor Survivors".

Desai, Ansh / Jella, Tarun K / Cwalina, Thomas B / Wright, Christina / Wright, James

World neurosurgery

2022 Volume 158, Page(s) 340

MeSH term(s)	Brain Neoplasms ; Demography ; Financial Stress ; Humans ; Survivors
Language	English
Publishing date	2022-07-21
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2021.12.054
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Article ; Online: Measuring food insecurity among a national sample of children with recurrent acute otitis media.

Cwalina, Thomas B / Xu, James R / Pham, Jessica / Jella, Tarun K / Otteson, Todd

American journal of otolaryngology

2023 Volume 45, Issue 2, Page(s) 104186

Abstract: Introduction: Acute otitis media is one of the most common reasons for pediatric medical visits in the United States. Additionally, past studies have linked food insecurity and malnutrition with increased infections and worse health outcomes. However, ... ...

Abstract	Introduction: Acute otitis media is one of the most common reasons for pediatric medical visits in the United States. Additionally, past studies have linked food insecurity and malnutrition with increased infections and worse health outcomes. However, there is a lack of information on the risk factors for food insecurity in specific patient populations, including the pediatric recurrent acute otitis media (RAOM) population. Methods: The 2011 to 2018 National Health Interview Survey (NHIS) datasets were used to obtain a national estimate of the presentation of food insecurity within pediatric patients with RAOM. Relevant sociodemographic information and prevalence were identified. A multivariable logistic regression model was used to determine sociodemographic risk factors. Calculations were conducted using R with the "survey" package to account for the clustering and sampling of the NHIS. Results: Of 3844 children with RAOM who responded to the food insecurity module, 20.8 % (19.0-22.6 %) were food insecure. Age, race/ethnicity, percentage of federal poverty level status, insurance status, and self-reported health status were significant and were not independent of food insecurity status. Using multivariable regression, this study found the following sociodemographic risk factors: age 6-10 and age > 10 (reference: age 0-2); Black (reference: Non-Hispanic White); 100 % to 200 % and <100 % federal poverty level (reference: >200 % federal poverty level); public insurance or uninsured status (reference: private insurance); and poor to fair self-reported health status (reference: good to excellent). Discussion: Children with RAOM who were older, Black, less insured, living in lower-income households, and of poorer health had a greater association with being food insecure. Due to the frequency of RAOM pediatric visits, identifying at-risk groups as well as incorporating food insecurity screening and food referral programs within clinical practice can enable otolaryngologists to reduce disparities and improve outcomes in a targeted approach.
MeSH term(s)	Child ; Humans ; United States/epidemiology ; Infant, Newborn ; Infant ; Child, Preschool ; Ethnicity ; Poverty ; Otitis Media/epidemiology ; Risk Factors ; Food Insecurity
Language	English
Publishing date	2023-12-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	604541-8
ISSN	1532-818X ; 0196-0709
ISSN (online)	1532-818X
ISSN	0196-0709
DOI	10.1016/j.amjoto.2023.104186
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Article ; Online: Financial stress among skin cancer patients: a cross-sectional review of the 2013-2018 National Health Interview Survey.

Cwalina, Thomas B / Jella, Tarun K / Tripathi, Raghav / Carroll, Bryan T

Archives of dermatological research

2022 Volume 315, Issue 4, Page(s) 1003–1010

Abstract: Financial stress among skin cancer patients may limit treatment efficacy by forcing the postponement of care or decreasing adherence to dermatologist recommendations. Limited information is available quantifying the anxiety experienced by skin cancer ... ...

Abstract	Financial stress among skin cancer patients may limit treatment efficacy by forcing the postponement of care or decreasing adherence to dermatologist recommendations. Limited information is available quantifying the anxiety experienced by skin cancer patients from both healthcare and non-healthcare factors. Therefore, the present study sought to perform a retrospective cross-sectional review of the 2013-2018 cycles of the National Health Interview Survey (NHIS) to determine the prevalence, at-risk groups, and predictive factors of skin cancer patient financial stress. Survey responses estimated that 11.45% (95% Cl 10.02-12.88%) of skin cancer patients experience problems paying medical bills, 20.34% (95% Cl 18.97-21.71%) of patients worry about the medical costs, 13.73% (95% Cl 12.55-14.91%) of patients worry about housing costs, and 37.48% (95% Cl 35.83-39.14%) of patients worry about money for retirement. Focusing on at-risk groups, black patients, uninsured patients, and patients with low incomes (< 200% poverty level) consistently experienced high rates of financial stress for each of the four measures. Multivariable logistic regression revealed low education, lack of insurance, and low income to be predictive of financial stress. These findings suggest that a considerable proportion of skin cancer patients experience financial stress related to both healthcare and non-healthcare factors. Where possible, the additional intricacy of treating patients at risk of high financial stress may be considered to optimize patient experience and outcomes.
MeSH term(s)	Humans ; Health Expenditures ; Cross-Sectional Studies ; Financial Stress ; Retrospective Studies ; Skin Neoplasms/epidemiology
Language	English
Publishing date	2022-02-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	130131-7
ISSN	1432-069X ; 0340-3696
ISSN (online)	1432-069X
ISSN	0340-3696
DOI	10.1007/s00403-022-02330-6
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Article ; Online: Assessing financial insecurity among common eye conditions: a 2016-2017 national health survey study.

Hom, Grant L / Cwalina, Thomas B / Jella, Tarun K / Singh, Rishi P

Eye (London, England)

2021 Volume 36, Issue 10, Page(s) 2044–2051

Abstract: Objective: To explore the prevalence and demographics of financial insecurity in individuals with eye disease in the United States.: Methods: This retrospective cross-sectional study analysed questions from the nationally representative 2016-2017 ... ...

Abstract	Objective: To explore the prevalence and demographics of financial insecurity in individuals with eye disease in the United States. Methods: This retrospective cross-sectional study analysed questions from the nationally representative 2016-2017 National Health Interview Survey (NHIS) with the eye conditions macular degeneration, diabetic retinopathy, glaucoma, and cataract. Data was analysed as a whole and then further analysed by condition. Evaluated topics indicated financial insecurity such as individuals reporting difficulty paying bills among eye conditions studied and by demographics. Results: Survey responses estimated that the overall prevalence of reporting problems paying or unable to pay bills were 12.49% (95% C.I. 11.62-13.36%) among patients with eye conditions. The overall prevalence of patients delaying care was 6.77% (95% C.I. 6.17-7.36%) and 17.06% (95% C.I. 15.99-18.14%) of individuals with eye conditions reported worrying about housing payments. Multivariable logistic regression revealed that demographics who more frequently had difficulty paying medical bills include individuals age 45-64 (3.33 aOR, C.I. 2.79-3.98, p < 0.001), blacks (1.90 aOR, C.I., 1.48-2.45, p < 0.001), Hispanics (1.51 aOR, C.I. 1.07-2.12, p = 0.020), and those 100-200% of the federal poverty line (2.16 aOR, C.I. 1.76-2.66, p < 0.001) or below the poverty line (1.93 aOR, C.I. 1.48-2.53, p < 0.001). Conclusion: There are several demographics with eye disease that self-report financial insecurity. There should be greater concern for financial insecurity among diabetic retinopathy and glaucoma patients. Ophthalmologists should consider engaging in proactive discussions with at-risk patients to reduce potential non-adherence secondary to financial insecurity.
MeSH term(s)	Cross-Sectional Studies ; Diabetic Retinopathy/epidemiology ; Glaucoma/epidemiology ; Health Surveys ; Humans ; Middle Aged ; Retrospective Studies ; United States/epidemiology
Language	English
Publishing date	2021-08-23
Publishing country	England
Document type	Journal Article
ZDB-ID	91001-6
ISSN	1476-5454 ; 0950-222X
ISSN (online)	1476-5454
ISSN	0950-222X
DOI	10.1038/s41433-021-01745-1
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Article ; Online: Declining Geographic Access to High-Volume Revision Total Hip Arthroplasty Surgeons: A National Medicare Analysis.

Jella, Tarun K / Manyak, Grigory A / Cwalina, Thomas B / Roth, Alexander L / Mesko, Nathan W / Kamath, Atul F

The Journal of arthroplasty

2023 Volume 38, Issue 7 Suppl 2, Page(s) S103–S110

Abstract: Background: While trends in the economics of revision THA (revTHA) procedures have been well-described from the standpoint of both hospitals and surgeons, their population-level effects of these trends on patient access are not well-understood.: ... ...

Abstract	Background: While trends in the economics of revision THA (revTHA) procedures have been well-described from the standpoint of both hospitals and surgeons, their population-level effects of these trends on patient access are not well-understood. Methods: The Medicare fee-for-service provider utilization and payment public use files were used to extract data for primary and revTHA for beneficiaries between 2013 and 2019. Primary and revTHA procedures were identified using the Healthcare Common Procedure Coding System code; 27130 for primaries and 27132, 27134, 27137, or 27138 for revisions. Geospatial analyses were performed by aggregating surgeon practice locations at the level of individual counties, hospital service areas, and hospital referral regions. Results: The number of high-volume primary THA surgeons within the Medicare population increased by 17.6% over the study period (3,838 in 2013 to 4,515 in 2019). Conversely, the number of high-volume revTHA surgeons decreased by 36.1% (178 in 2013 to 129 in 2019). Linear regression revealed a significant increase and decrease in high-volume primary (β = 109.07, P ≤ .001) and revision (β = -13.04, P = .011) THA surgeons, respectively. Over the study period, the number of counties with at least 1 high-volume primary THA surgeon increased by 6.1% (1,194 to 1,267), while the number of counties with at least 1 high-volume revTHA surgeon decreased by 30.2% (159 to 111). Conclusion: The present findings of declining geographic access may represent a consequence of shifting economic incentives and declining reimbursements for the care of complicated revTHA patients.
MeSH term(s)	Humans ; Aged ; United States ; Arthroplasty, Replacement, Hip ; Medicare ; Hospitals ; Surgeons ; Fee-for-Service Plans
Language	English
Publishing date	2023-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2023.01.006
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