|As part of its mission to increase health policy research at William & Mary, the Schroeder Center for Health Policy awards annual summer fellowships to support intensive student research experiences involving data analysis, writing, and presentation. These fellowships also support interaction between students and faculty from both William & Mary and Eastern Virginia Medical School (EVMS) as part of an initiative to bridge the activities of the Schroeder Center and EVMS’s Brock Institute for Community and Global Health.|
Below are the 2017 fellowship awardees from William & Mary and their projects:
1. Racial Disparities Among Hospital Acquired Infections in Virginia Hospitals by Cara Alcorn (B.A., Class of 2018)
Hospital-acquired infections (HAIs) are both a major threat to patient safety and a contributing factor to rising healthcare costs. The World Health Organization defines a HAI as an “infection acquired during hospital care which are not present or incubating at admission.” An estimated 2 million patients suffer from hospital-acquired infections every year, and $9.8 billion is spent each year treating them. Prior research suggests that racial minorities are more likely to develop HAIs, which may contribute to disparities in health outcomes.
Cara’s study sought to understand the extent of HAIs in adults ages 65 and over and potential racial disparities in HAIs in Virginia’s hospitals. She used hospital discharge data from January 2012 to October 2015 to identify hospitalizations during which a hospital-acquired infection occurred for patients treated for pneumonia, surgeries related to cancer, surgeries not related to cancer, and acute myocardial infarction (AMI) and heart failure. Cara examined three types of hospital-acquired infections: clostridium difficile infection (CDI), catheter associated urinary tract infections (CAUTI), and catheter associated bloodstream infections (CLABSI).
Using linear regression models, Cara found that HAIs are uncommon in Virginia, with less than 2.5% of patients developing a CDI and less than 1% acquiring either a CAUTI or CLABSI. Consistent with prior research, she found that the longer a patient stayed in the hospital, the more likely the patient developed a hospital-acquired infection. Generally, Cara did not find evidence of racial disparities in HAIs in Virginia’s hospitals. However, contrary to previous research, Cara found that African Americans in Virginia’s hospitals were significantly less likely than whites to acquire a catheter associated urinary tract infection.
2. Effects of the Affordable Care Act on Young Adults with Asthma by Paige Anders (B.A., Economics, Class of 2018)
Prior studies have shown that men and women often receive different levels of treatment for health issues that should not be affected by the patient’s gender. This type of bias could cause women to experience a lower standard of care and could result in adverse health consequences.
Paige’s study examined the impact of expanded private insurance coverage on gender disparities in healthcare utilization among young adults with asthma in the Virginia population. To measure private insurance coverage expansions, Paige used the natural experiment created by the dependent coverage mandate in the Affordable Care Act (ACA). Effective in 2010, the dependent coverage mandate required that all private plans that offer dependent child coverage make the coverage available until a child reaches the age of 26. Because adult children just above the age 26 threshold and adolescents under age 18 were not impacted by this mandate, this provision created both a treatment group (adults aged 19-25) and a control group (persons over age 26).
Paige used hospital discharge records for non-pregnancy related admissions for 2008 and 2009 (pre-ACA years) and 2012 through the third quarter of 2015 (post-ACA years). She focused on young adults ages 19 – 25 years old and older adults ages 27 – 30. Using a difference-in-difference regression model, she found evidence that the ACA’s dependent coverage mandate helped to decrease hospitalizations where asthma was a primary diagnosis. Among women, for example, there was an approximate 40% reduction in asthma hospitalizations for both the primary diagnosis of asthma and respiratory specific admissions. In addition, Paige found decreased gender discrepancies in hospital utilization between men and women with asthma.
3. Does Unemployment Affect Substance Abuse Hospitalizations? by Yash Singh (B.A., Economics, Class of 2018)
Deaths and hospitalizations from opioids and other illicit substances are rising in Virginia and across the nation. While many factors affect one’s likelihood of abusing and being hospitalized for conditions related to alcohol, tobacco, and illicit drugs, the state of the economy is thought to be a potential influence on substance abuse behaviors and hospitalizations.
Using patient-level data from the Virginia Health Information for 2012 through the third quarter of 2015 and locality-level data from the U.S. Bureau of Labor Statistics and the American Community Survey, Yash’s study examined how local quarterly level unemployment rates affected both the rate of substance abuse hospitalizations and the intensity of treatment for those already admitted. Yash focused on 251,810 discharges of patients between the ages of 18 and 64 diagnosed with some sort of substance abuse disorder at Virginia’s short-term acute care hospitals.
Yash found evidence that as the unemployment rate rose in a locality, the rate of substance abuse admissions declined significantly in more impoverished localities. In addition, as unemployment rates rose, the intensity of care also declined (except in the case of length of stay). Yash did not find evidence that these effects were a result of the patient group having the largest increase in drug abuse using more hospital care. Instead, he found that hospitals were less likely to admit uninsured patients during periods of “recessions” compared to private or publically insured patients.
FUNDING OPPORTUNITIES FOR SUMMER 2018
In late January/early February, the Schroeder Center will announce health policy fellowship opportunities for the summer 2018. Please return to this site for additional information at that time. In the meantime, if you should have general questions about the Schroeder Center – Brock Institute Summer Fellowship Program, please contact Professor Jennifer Mellor, Director of the Schroeder Center for Health Policy, at firstname.lastname@example.org.