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Article ; Online: Data aggregation hides Pacific Islander health disparities.

Taparra, Kekoa / Pellegrin, Karen

2022 Volume 400, Issue 10345, Page(s) 2–3

MeSH term(s)	Asian Americans ; Data Aggregation ; Humans ; Native Hawaiian or Other Pacific Islander
Language	English
Publishing date	2022-06-16
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(22)01100-X
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Article ; Online: The Daniel K. Inouye College of Pharmacy Scripts: Pharm2Pharm: Leveraging Medication Expertise Across the Continuum of Care.

Pellegrin, Karen L

Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health

2015 Volume 74, Issue 7, Page(s) 248–252

MeSH term(s)	Community Pharmacy Services/economics ; Continuity of Patient Care ; Hawaii ; Humans ; Medical Informatics ; Medication Reconciliation ; Medication Therapy Management/economics ; Medication Therapy Management/organization & administration ; Models, Organizational ; Pharmacy Service, Hospital/economics ; Professional Competence
Language	English
Publishing date	2015-07
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2653459-9
ISSN	2165-8242 ; 2165-8218
ISSN (online)	2165-8242
ISSN	2165-8218
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Article ; Online: Social determinants predict whether Medicare beneficiaries are offered a Comprehensive Medication Review.

Lee, Merton / Zarowitz, Barbara J / Pellegrin, Karen / Cooke, Catherine E / Fleming, Sean P / Brandt, Nicole

Research in social & administrative pharmacy : RSAP

2022 Volume 19, Issue 1, Page(s) 184–188

Abstract: Background: Medication reviews through Medicare's Medication Therapy Management (MTM) program may improve patient outcomes and lower health system costs, but these effects could be limited by a program design that does not address social determinants of ...

Abstract	Background: Medication reviews through Medicare's Medication Therapy Management (MTM) program may improve patient outcomes and lower health system costs, but these effects could be limited by a program design that does not address social determinants of health. Objective: To analyze the effects of social determinants of health on the odds of an eligible Medicare beneficiary not being offered Comprehensive Medication Review (CMR). Methods: Using the full 100% sample of the 2016 Part D Medication Therapy Management Data File linked to Medicare Master Beneficiary Summary File, a retrospective, cross-sectional analysis was conducted to determine which social and demographic variables are most strongly associated with being eligible for a CMR but not being offered one. Descriptive statistics were generated using SAS studio 3.8. Results: Variables associated with the highest odds of not receiving a CMR when eligible are residence in Louisiana OR 1.79 (95%CI 1.70-1.88), receiving the LIS OR 1.76 (1.73-1.79), dual eligibility for Medicare and Medicaid OR 1.25 (1.12-1.41), and Black race OR 1.19 (1.16-1.21). Conclusions: Social determinants of health, most strongly geography and low-income status, predict being eligible for but not being offered CMR. Race continues to be a factor in disparate access to MTM services.
MeSH term(s)	Aged ; United States ; Humans ; Medicare Part D ; Retrospective Studies ; Cross-Sectional Studies ; Medication Review ; Social Determinants of Health ; Medication Therapy Management
Language	English
Publishing date	2022-09-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2022.09.015
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Article ; Online: A brief survey to identify priorities for improving clinician recruitment and retention: results from Hawai'i Island physicians.

Pellegrin, Karen L

Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health

2012 Volume 71, Issue 4 Suppl 1, Page(s) 45–49

Abstract: Background: In light of the documented physician shortage on Hawai'i Island, the Hawai'i Clinician Recruitment and Retention survey was designed and implemented to assess perceptions of quality of life and the work environment among clinicians on Hawai' ... ...

Abstract	Background: In light of the documented physician shortage on Hawai'i Island, the Hawai'i Clinician Recruitment and Retention survey was designed and implemented to assess perceptions of quality of life and the work environment among clinicians on Hawai'i Island and to identify aspects of the environment on Hawai'i Island that predict responses to questions regarding recruitment and retention. Methods: The respondents were 127 Hawai'i Island clinicians, specifically 96 physicians, 15 nurses, five pharmacists, four physician assistants, two social workers, and five "other" healthcare workers. The internal reliability of the survey was high (alpha=.91) and its convergent validity was supported by the significant correlation of item total scores with anchor items that measured overall ratings of the environment and likelihood of recruitment and retention. Given the small number of non-physician clinicians responding, descriptive analyses included only physicians. Physicians who indicated they plan to retire within 5 years were excluded from the correlation analyses to focus on patterns within the target group for retention. Results: Overall, results indicate that, while the majority of physicians who relocated to Hawai'i Island did so primarily for the quality of life, the best predictors of retention are financial sustainability, professional opportunities, community support, and access to good K-12 schools. Survey results also indicate that Hawai'i Island will lose 32% of its current physicians within the next five years due to retirement or other causes. Discussion: These findings indicate that increased urgency to find solutions is warranted.
MeSH term(s)	Attitude of Health Personnel ; Hawaii ; Health Personnel/psychology ; Humans ; Personnel Loyalty ; Personnel Selection ; Quality Control
Language	English
Publishing date	2012-04-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2653459-9
ISSN	2165-8242 ; 2165-8218
ISSN (online)	2165-8242
ISSN	2165-8218
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Article: Socioeconomic variables explain rural disparities in US mortality rates: Implications for rural health research and policy.

Long, Alexander S / Hanlon, Alexandra L / Pellegrin, Karen L

SSM - population health

2018 Volume 6, Page(s) 72–74

Abstract: Objectives: Rural disparities in age-adjusted mortality are growing in the United States. While socioeconomic variables have been found to explain significant variation in life expectancy across US counties, previous research has not examined the role ... ...

Abstract	Objectives: Rural disparities in age-adjusted mortality are growing in the United States. While socioeconomic variables have been found to explain significant variation in life expectancy across US counties, previous research has not examined the role of socioeconomic variables in explaining rural mortality disparities. The purpose of this study was to quantify the rural mortality disparity after controlling for socioeconomic variables. Methods: Recursive partitioning, or tree regression, was used to fit models predicting premature mortality across counties in the United States, adjusted for age, median income, and percent in poverty in 4 time periods (from 2004 to 2012) with and without inclusion of an urban-rural variable. Results: We found median income and percent in poverty explained about 50% of the variation in age-adjusted premature mortality rates across US counties in each of the four time periods. After controlling for these socioeconomic variables, rural mortality disparities largely disappeared, explaining less than 2% of the variance in premature mortality. Conclusions: Addressing poverty and other socioeconomic issues should be a priority to improve health in rural communities. Interventions designed to target social determinants of health in rural areas are needed to address the growing rural mortality disparity that is largely explained by measures of poverty and income. Researchers examining rural health disparities should routinely include socioeconomic variables in their analyses.
Language	English
Publishing date	2018-08-31
Publishing country	England
Document type	Journal Article
ISSN	2352-8273
ISSN	2352-8273
DOI	10.1016/j.ssmph.2018.08.009
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Article ; Online: Understanding the Socioeconomic and Geographical Characteristics of Beneficiaries Receiving a Comprehensive Medication Review.

Chou, Joshua / Pellegrin, Karen / Cooke, Catherine E / Zarowitz, Barbara / Hanlon, Alexandra / Lozano, Alicia / Brandt, Nicole J

Journal of managed care & specialty pharmacy

2021 Volume 26, Issue 10, Page(s) 1276–1281

Abstract: Background: Medicare Part D sponsors are required to offer medication therapy management (MTM) programs to eligible beneficiaries. Recent studies have demonstrated that there have been racial/ethnic disparities in MTM eligibility criteria. For example, ... ...

Abstract	Background: Medicare Part D sponsors are required to offer medication therapy management (MTM) programs to eligible beneficiaries. Recent studies have demonstrated that there have been racial/ethnic disparities in MTM eligibility criteria. For example, compared with non-Hispanic White beneficiaries, Hispanic and non-Hispanic Black beneficiaries are less likely to be eligible for MTM. However, there is limited evidence for socioeconomic and geographical characteristics of those who are eligible and receive MTM services. Objective: To describe the demographic, socioeconomic, and geographic characteristics of Medicare beneficiaries who received MTM services. Methods: As part of a previous study, a national survey evaluated a convenience sample of perspectives of Medicare beneficiaries on the MTM standardized format. The survey was distributed through Medicare Part D plans to beneficiaries receiving MTM services from 2017-2018. As part of the survey, respondents could provide their ZIP codes. Geographical variables, such as the National Center for Health Statistics (NCHS) urban-rural classification scheme and economic research service (ERS) county typology codes, were then applied to respondents' ZIP codes, allowing for the classification of counties or census tracts by urbanization and economic dependence measures. Descriptive statistics are reported for demographic, geographical, and socioeconomic information. Results: Of the 300 (of 434) respondents who provided their ZIP codes, 51.3% were aged 65-74 years; 50% were male; and 66.7% had at least a college education. There were 82.7% who self-identified as White, while only 8% self-identified as Hispanic or Black/African American. The majority of respondents (58.4%) lived in large metropolitan areas as defined by the NCHS urban-rural classification scheme. Respondents' counties were characterized by economic dependence with 14.0% of respondents living in federal/state government-dependent counties and 12.7% living in recreation-dependent counties. Conclusions: The majority of respondents who provided their ZIP codes identified themselves as White and lived in large metropolitan areas. Respondents who identified themselves as Hispanic or Black/African American were not well represented. This study provides geographical and socioeconomic characteristics of Medicare beneficiaries who received MTM services and highlights racial/ethnic differences. Further work is needed to confirm geographical and socioeconomic disparities among beneficiaries who received MTM services. Disclosures: No outside funding supported this study. Pellegrin is a member of the AMCP MTM Advisory Group. The other authors have nothing to disclose.
MeSH term(s)	Black or African American/statistics & numerical data ; Aged ; Aged, 80 and over ; Female ; Healthcare Disparities/economics ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data ; Hispanic or Latino/statistics & numerical data ; Humans ; Male ; Medicare Part D/economics ; Medicare Part D/statistics & numerical data ; Medication Therapy Management/economics ; Medication Therapy Management/statistics & numerical data ; Middle Aged ; Rural Population/statistics & numerical data ; Socioeconomic Factors ; Surveys and Questionnaires ; United States ; Urban Population/statistics & numerical data ; White People/statistics & numerical data
Language	English
Publishing date	2021-09-30
Publishing country	United States
Document type	Journal Article
ISSN	2376-1032
ISSN (online)	2376-1032
DOI	10.18553/jmcp.2020.26.10.1276
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Article: Demystifying and improving organizational culture in health-care.

Pellegrin, Karen L / Currey, Hal S

Advances in health care management

2011 Volume 10, Page(s) 3–23

Abstract: Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most ...

Abstract	Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most leaders. The first step toward understanding organizational culture is to measure it properly. This chapter describes methods for measuring culture in health-care organizations and how these methods were implemented in a large academic medical center. Because of the consistent empirical link between the dimension of communication, other culture dimensions, and employee satisfaction, special attention is focused in this area. Specifically, a case study of successful communication behaviors during a major "change management" initiative at a large academic medical center is described. In summary, the purpose of this chapter is to demystify the concept of culture and demonstrate how to improve it.
MeSH term(s)	Academic Medical Centers/organization & administration ; Academic Medical Centers/standards ; Delivery of Health Care/organization & administration ; Delivery of Health Care/standards ; Humans ; Interdisciplinary Communication ; Job Satisfaction ; Leadership ; Organizational Case Studies ; Organizational Culture ; Organizational Innovation ; Quality Improvement/organization & administration ; Quality Improvement/standards
Language	English
Publishing date	2011-08-30
Publishing country	Netherlands
Document type	Journal Article
ISSN	1474-8231
ISSN	1474-8231
DOI	10.1108/s1474-8231(2011)0000010007
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Article ; Online: A Statewide Medication Management System: Health Information Exchange to Support Drug Therapy Optimization by Pharmacists across the Continuum of Care.

Pellegrin, Karen / Chan, Francis / Pagoria, Natalie / Jolson-Oakes, Sheena / Uyeno, Reece / Levin, Andrew

Applied clinical informatics

2018 Volume 9, Issue 1, Page(s) 1–10

Abstract: Background: While evidence generally supports the use of medication management technology, systems are typically implemented and evaluated piecemeal rather than as part of a comprehensive model for medication management. Systems to support drug therapy ... ...

Abstract	Background: While evidence generally supports the use of medication management technology, systems are typically implemented and evaluated piecemeal rather than as part of a comprehensive model for medication management. Systems to support drug therapy optimization, increasingly a key role of pharmacists in our healthcare system, have not yet been reported. Objective: Our objective is to describe the design, implementation, and use of health information technology to support the hospital and community pharmacists' management of medications for high-risk patients statewide in the "Pharm2Pharm" model of care. Our aims were to make it easier for the pharmacists to access information needed to identify and resolve drug therapy problems using best practices for medication management and communicate with other members of the care team. Methods: The pharmacist's roles and the medication management processes guided the design of the supporting technology, which was implemented after the Pharm2Pharm model was launched and the pharmacists' technology needs were assessed. Priorities for technology included sending care transition documents from hospital to community pharmacist securely and efficiently, access to medical records, including medications and laboratory results, documentation, and patient tracking. Implementation and use of the technology were documented. Results: Communications, medication management, and population management solutions were implemented to support the Pharm2Pharm model. The pharmacists delivering services through this model adopted and meaningfully used this technology to support their work. Conclusion: Implementing technology with value outside of the Pharm2Pharm model was a strategic approach to investment. This work emphasizes the importance of shifting the focus of technology from supporting a specific piece of the medication management process to supporting the goal of optimizing medication regimens. Health information exchange systems can provide important technology needed to integrate pharmacists into care teams as they are deployed to improve patient outcomes.
MeSH term(s)	Continuity of Patient Care ; Delivery of Health Care ; Drug Therapy ; Health Information Exchange ; Humans ; Medication Therapy Management ; Pharmacists
Language	English
Publishing date	2018-01-03
Publishing country	Germany
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0037-1620262
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Article ; Online: Recruitment of rural healthcare professionals for live continuing education.

Holuby, Ronnie Scott / Pellegrin, Karen L / Barbato, Anna / Ciarleglio, Anita

Medical education online

2015 Volume 20, Issue 1, Page(s) 28958

Abstract: Introduction The availability of rural healthcare is a growing concern in the United States as fewer healthcare providers choose to work in rural areas. Accessing quality continuing education (CE) for rural healthcare practitioners (HCPs) remains a ... ...

Abstract	Introduction The availability of rural healthcare is a growing concern in the United States as fewer healthcare providers choose to work in rural areas. Accessing quality continuing education (CE) for rural healthcare practitioners (HCPs) remains a challenge and may pose a barrier to quality care. Methods To maximize attendance at a live, in-person, free CE program focusing on geriatric medication and issues specifically targeted to HCPs in rural areas, two methods were implemented sequentially. The first method used formal advertising implemented by a professional marketing service to promote CE events. The second method enlisted local healthcare organizations and physician groups to promote the CE event to their employees. Cost per attendee was calculated for comparison. Results Professional marketing services recruited 31 HCPs (March 2011) and resulted in a per-participant recruitment cost of US$428.62. Local healthcare organizations and physician groups' marketing recruited 48 HCPs (July-August 2011) and resulted in a per-participant recruitment cost of US$55.19. Discussion Providing free CE coordinated through local healthcare organizations and physician groups was the most cost-effective method of recruiting rural HCPs for CE. Formal advertising added cost without increasing the number of participants per event. Although this is the first study of the cost-effectiveness of recruitment methods targeting HCPs in rural areas, results are consistent with research on cost-effectiveness of outreach to rural lay community members.
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Journal Article
ISSN	1087-2981
ISSN (online)	1087-2981
DOI	10.3402/meo.v20.28958
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Article ; Online: Improving Accuracy and Relevance of Race/Ethnicity Data: Results of a Statewide Collaboration in Hawaii.

Pellegrin, Karen L / Miyamura, Jill B / Ma, Carolyn / Taniguchi, Ronald

Journal for healthcare quality : official publication of the National Association for Healthcare Quality

2015 Volume 38, Issue 5, Page(s) 314–321

Abstract: Current race/ethnicity categories established by the U.S. Office of Management and Budget are neither reliable nor valid for understanding health disparities or for tracking improvements in this area. In Hawaii, statewide hospitals have collaborated to ... ...

Abstract	Current race/ethnicity categories established by the U.S. Office of Management and Budget are neither reliable nor valid for understanding health disparities or for tracking improvements in this area. In Hawaii, statewide hospitals have collaborated to collect race/ethnicity data using a standardized method consistent with recommended practices that overcome the problems with the federal categories. The purpose of this observational study was to determine the impact of this collaboration on key measures of race/ethnicity documentation. After this collaborative effort, the number of standardized categories available across hospitals increased from 6 to 34, and the percent of inpatients with documented race/ethnicity increased from 88 to 96%. This improved standardized methodology is now the foundation for tracking population health indicators statewide and focusing quality improvement efforts. The approach used in Hawaii can serve as a model for other states and regions. Ultimately, the ability to standardize data collection methodology across states and regions will be needed to track improvements nationally.
MeSH term(s)	Continental Population Groups ; Cooperative Behavior ; Data Accuracy ; Hawaii ; Healthcare Disparities/ethnology ; Humans ; Quality Improvement
Language	English
Publishing date	2015-06-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1472097-8
ISSN	1945-1474 ; 1062-2551
ISSN (online)	1945-1474
ISSN	1062-2551
DOI	10.1097/01.JHQ.0000462679.40135.76
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