Steven M Asch
Datos Biográficos
| ID | 197239 |
|---|---|
| NOMBRE | Steven M Asch |
| NOMBRES | Steven M |
| APELLIDO | Asch |
| FIRMA | ASCH S M |
| AFILIACIONES | VA Palo Alto Health Care System |
| ORCID | 0000-0001-5838-5335 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 46 |
| TOTAL DE CITAS | 88 |
| TOTAL COMO AUTOR | 46 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1997 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2025 |
| ÍNDICE H | 5 |
Fragmented Financing in Emergency Department Use Among US Veterans
This cross-sectional study uses US Veterans Affairs Health Care System administrative data crossed with New York state’s all claims database to identify emergency department visits by enrollees from 2016 to 2020
Are Rates of Skin Procedures Higher in Veterans Health Administrations Purchased Care Than Veterans Health Administrations Delivered Care
BACKGROUND: To improve access to care, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program, allowing enrollees to receive care outside VA facilities if they met eligibility requirements tied to wait times, travel, and availability of services. VA-purchased care has grown significantly to more than $32 billion in 2024, representing 24% of VA's medical care budget. OBJECTIVES: To compare the annual utilization of skin pr…
TeleHelp Ukraine
Background: Humanitarian crises frequently garner solidarity and robust volunteer recruitment among health care communities. However, a common obstacle is matching providers to those in need across geographic and other barriers. We examined the application of a decentralised governance strategy in establishing an emergency telemedicine response, TeleHelp Ukraine (THU). Methods: Using a case study approach, we explored how global networking and te…
Hypertension Control During the Coronavirus Disease 2019 Pandemic
DESIGN: Retrospective cohort study. OBJECTIVE: We sought to examine whether disruptions in follow-up intervals contributed to hypertension control. BACKGROUND: Disruptions in health care were widespread during the coronavirus disease 2019 pandemic. PATIENTS AND METHODS: We identified a cohort of individuals with hypertension in both prepandemic (March 2019-February 2020) and pandemic periods (March 2020-February 2022) in the Veterans Health Admin…
Integrating Patient and Expert Perspectives to Conceptualize High-Quality Palliative Cancer Care for Symptoms in the US Veterans Health Administration
Quality measurement is typically the domain of clinical experts and health system leaders; patient/caregiver perspectives are rarely solicited. We aimed to describe and integrate clinician and patient/caregiver conceptualizations of high-quality palliative symptom care for patients receiving care for advanced cancer within the US Veterans Health Administration in the context of existing quality measures. We conducted a secondary qualitative analy…
Pandemic Through the Lens of Black Barbershops
How Should We Organize Care for Patients With Human Immunodeficiency Virus and Comorbidities? A Multisite Qualitative Study of Human Immunodeficiency Virus Care in the United States Department of Vete…
BACKGROUND: With human immunodeficiency virus (HIV) now managed as a chronic disease, health care has had to change and expand to include management of other critical comorbidities. We sought to understand how variation in the organization, structure and processes of HIV and comorbidity care, based on patient-centered medical home (PCMH) principles, was related to care quality for Veterans with HIV. RESEARCH DESIGN: Qualitative site visits were c…
Community Urgent Care Use Following Implementation of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act
BACKGROUND: Effective June 6, 2019, Veterans Affairs (VA) began offering a new urgent care (UC) benefit that provides eligible Veterans with greater choice and access to care for the treatment of minor injuries and illnesses in their local communities. OBJECTIVES: The aim was to describe trends in UC use, identify predictors of UC benefit use, and understand the factors associated with community UC use versus VA emergency department (ED) or urgen…
An Incentive to Innovate
PROBLEM: Many health care systems in the United States are shifting from a fee-for-service reimbursement model to a value-based payment model. To remain competitive, health care administrators must engage frontline clinicians in their efforts to reduce costs and improve patient outcomes. Engaging physicians and other clinicians is challenging, however, as many feel overwhelmed with clinical responsibilities and do not view cost reduction as in th…
Comorbidity Assessment Is Uneven Across Veterans Health Administration and Medicare for the Same Patient
OBJECTIVE: Compare comorbidity identification in Medicare and Veterans Health Administration (VA) data for the purposes of risk adjustment. DATA SOURCES: Analysis of Medicare and VA datasets for dually-enrolled Veterans receiving care in both settings, fiscal years 2010-2014. STUDY DESIGN: A retrospective analysis of administrative data for a national sample of cancer decedents. DATA EXTRACTION METHODS: Comorbidities were evaluated using Elixhaus…
Impact of Health Aid Investments on Public Opinion of the United States
Objectives. To assess whether increasing health aid investments affected public opinion of the United States in recipient populations. Methods. We linked health aid data from the United States to nationally representative opinion poll surveys from 45 countries conducted between 2002 and 2016. We exploited the abrupt and substantial increase in health aid when the US President’s Emergency Plan for AIDS Relief (PEPFAR) and President’s Malaria Initi…
Intensive Outpatient Program Effects on High-need Patients’ Access, Continuity, Coordination, and Engagement
OBJECTIVE: The intensive and varied services required by high-need patients have inspired a number of new care delivery models; however, evidence of their effectiveness is mixed. This study evaluated whether augmenting a patient-centered medical home (PCMH) with intensive outpatient management enhances high-need patients' care processes. RESEARCH DESIGN: Retrospective analysis using differences-in-differences and χ tests. SUBJECTS: Of 545 high-ne…
Patient and provider perspectives on the development of personalized medicine
Social Isolation and Medicare Spending
Objectively isolated seniors have higher Medicare spending, driven by increased hospitalization and institutionalization, and face greater mortality. Policies supporting social connectedness could reap significant savings
Crowdsourced Health Data
Objectives. To determine the generalizability of crowdsourced, electronic health data from self-selected individuals using a national survey as a reference. Methods. Using the world’s largest crowdsourcing platform in 2015, we collected data on characteristics known to influence cardiovascular disease risk and identified comparable data from the 2013 Behavioral Risk Factor Surveillance System. We used age-stratified logistic regression models to …
Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation
BACKGROUND: The Veterans Choice Program (VCP), enacted by Congress after concerns surfaced about access, enables veterans to receive care outside Veterans Health Administration (VHA) facilities. Veterans who face long wait times, large driving distances, or particular hardships are eligible for VCP. Prior purchased care programs were comparatively limited in scope. OBJECTIVES: We sought to describe utilization of VHA-provided and purchased outpat…
Sex Differences in Mental Health and Substance Use Disorders and Treatment Entry Among Justice-involved Veterans in the Veterans Health Administration
BACKGROUND: Over half of veterans in the criminal justice system have mental health or substance use disorders. However, there is a critical lack of information about female veterans in the criminal justice system and how diagnosis prevalence and treatment entry differ by sex. OBJECTIVES: To document prevalence of mental health and substance use disorder diagnoses and treatment entry rates among female veterans compared with male veterans in the …
Retaining Homeless Veterans in Outpatient Care
Objectives. We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. Methods. We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated c…
Development and Evaluation of an Internet and Personal Health Record Training Program for Low-income Patients With HIV or Hepatitis C
BACKGROUND: Vulnerable populations face difficulties accessing and using the internet and personal health record (PHR) systems for health-related purposes. Populations disconnected from the internet also tend to be disconnected from health care services. OBJECTIVES: To develop and evaluate an intervention to increase skills in health-related internet and PHR use for vulnerable populations with limited computer and internet experience. RESEARCH DE…
Is Emergency Department Crowding Associated With Increased “Bounceback” Admissions
OBJECTIVE: Emergency department (ED) crowding is linked with poor quality of care and worse outcomes, including higher mortality. With the growing emphasis on hospital performance measures, there is additional concern whether inadequate care during crowded periods increases a patient's likelihood of subsequent inpatient admission. We sought to determine if ED crowding during the index visit was associated with these "bounceback" admissions. METHO…
Provider-related Barriers to Rapid HIV Testing in U.S. Urban Non-profit Community Clinics, Community-based Organizations (CBOs) and Hospitals
Implementing an HIV Rapid Testing Intervention for Homeless Veterans in Shelter Settings within Los Angeles County, USA
We implemented and evaluated an HIV rapid testing intervention in collaboration withthe US Department of Veterans Affairs and the Los Angeles County Department ofHealth to 1) increase HIV testing/receipt of results, and 2) increase veteran access to VA homeless services.Ninety-seven veterans recruited in 9 shelters as part of the Los Angeles Homeless Services Authority (LAHSA) emergency shelter program were randomized (2-to-1 ratio) into one of t…
Cost of OraQuick oral fluid rapid HIV testing at 35 community clinics and community-based organizations in the USA
The US Centers for Disease Control and Prevention recommends the expanded use of rapid HIV antibody tests in community settings to increase the proportion of persons who are aware of their HIV status. The cost of providing rapid testing services in these settings is not known. We conducted a cost survey of non-profit community clinics and community-based organizations (CBOs). The final study sample for the cost analyses included 28 community clin…
Body Mass Index, Neighborhood Fast Food and Restaurant Concentration, and Car Ownership
Eating away from home and particularly fast food consumption have been shown to contribute to weight gain. Increased geographic access to fast food outlets and other restaurants may contribute to higher levels of obesity, especially in individuals who rely largely on the local environment for their food purchases. We examined whether fast food and restaurant concentrations are associated with body mass index and whether car ownership might modera…
Terrorism-Related Fear and Avoidance Behavior in a Multiethnic Urban Population
Objectives. We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. Methods. We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 l…
Body Mass Index, Neighborhood Fast Food and Restaurant Concentration, and Car Ownership
Eating away from home and particularly fast food consumption have been shown to contribute to weight gain. Increased geographic access to fast food outlets and other restaurants may contribute to higher levels of obesity, especially in individuals who rely largely on the local environment for their food purchases. We examined whether fast food and restaurant concentrations are associated with body mass index and whether car ownership might modera…
Residential Segregation and Latino, Black and White Mortality in New York City
Delays and Unmet Need for Health Care Among Adult Primary Care Patients in a Restructured Urban Public Health System
Objectives. We estimated the prevalence and determinants of delayed and unmet needs for medical care among patients in a restructured public health system. Methods. We conducted a stratified cross-sectional probability sample of primary care patients in the Los Angeles County Department of Health Services. Face-to-face interviews were conducted with 1819 adult patients in 6 languages. The response rate was 80%. The study sample was racially/ethni…
Terrorism-Related Fear and Avoidance Behavior in a Multiethnic Urban Population
Objectives. We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. Methods. We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 l…
Social Isolation and Medicare Spending
Objectively isolated seniors have higher Medicare spending, driven by increased hospitalization and institutionalization, and face greater mortality. Policies supporting social connectedness could reap significant savings
Crowdsourced Health Data
Objectives. To determine the generalizability of crowdsourced, electronic health data from self-selected individuals using a national survey as a reference. Methods. Using the world’s largest crowdsourcing platform in 2015, we collected data on characteristics known to influence cardiovascular disease risk and identified comparable data from the 2013 Behavioral Risk Factor Surveillance System. We used age-stratified logistic regression models to …
Retaining Homeless Veterans in Outpatient Care
Objectives. We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. Methods. We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated c…
Scope of Rapid HIV Testing in Private Nonprofit Urban Community Health Settings in the United States
Objectives. We examined patterns of rapid HIV testing in a multistage national random sample of private, nonprofit, urban community clinics and community-based organizations to determine the extent of rapid HIV test availability outside the public health system. Methods. We randomly sampled 12 primary metropolitan statistical areas in 4 regions; 746 sites were randomly sampled across areas and telephoned. Staff at 575 of the sites (78%) were reac…
Medical necessity and defined coverage benefits in the Oregon Health Plan
The policy debate in Oregon has primarily focused on the Prioritized List of Services. However, little information is available on how defined coverage benefits and managed care affect the role of medical necessity in determining care for Medicaid patients. This issue is important because medical necessity determinations are currently used by many states to limit extraneous health care costs but require resource-intensive oversight, are open to w…
The Communicable Disease Impact of Eliminating Publicly Funded Prenatal Care for Undocumented Immigrants
National Estimates of HIV-Related Symptom Prevalence From the HIV Cost and Services Utilization Study
OBJECTIVES: The objectives of this study were (1) to estimate the prevalence, bothersomeness, and variation of HIV-related symptoms in a nationally representative sample of HIV-infected adults receiving medical care and (2) to evaluate new aggregate measures of symptom frequency and bothersomeness. METHODS: Beginning in January 1996, 76% of a multistage national probability sample of 4,042 HIV-infected adults receiving medical care were interview…
Quality Enhancement Research Initiative for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
The Veterans Health Administration (VHA) sees ≈17,000 human immunodeficiency virus (HIV)-infected patients each year, which makes it the largest provider of HIV care in the United States. HIV causes chronic progressive disease that leads to early death. Newer combination antiretroviral treatments ar
Measuring Medication
BACKGROUND: Medication measurement is crucial in assessing quality for chronic conditions yet agreement of alternate data sources remains uncertain. OBJECTIVES: To evaluate medication agreement between interviews, medical records, and pharmacy data; to assess data source contribution to attributing medication exposure; and to describe the impact of combining data sources on models that predict medication use. RESEARCH DESIGN: Prospective cohort s…
The Quality of Health Care Delivered to Adults in the United States
BACKGROUND: We have little systematic information about the extent to which standard processes involved in health care--a key element of quality--are delivered in the United States. METHODS: We telephoned a random sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences. We also received written consent to copy their medical records for the most recent two-year period and used thi…
Quality of Health Care for Women
The QA Tools system offers an alternative approach to evaluating health system performance. Potential advantages include the richness of the information produced by the system, the ability to create summary scores for consumers and purchasers, and the system-level performance information for use in quality improvement activities
Delays and Unmet Need for Health Care Among Adult Primary Care Patients in a Restructured Urban Public Health System
Objectives. We estimated the prevalence and determinants of delayed and unmet needs for medical care among patients in a restructured public health system. Methods. We conducted a stratified cross-sectional probability sample of primary care patients in the Los Angeles County Department of Health Services. Face-to-face interviews were conducted with 1819 adult patients in 6 languages. The response rate was 80%. The study sample was racially/ethni…
Accommodating Ethnic Diversity
BACKGROUND: Studies have confirmed ethnic disparities in the use of hospice services and identified barriers that minorities face in accessing care. OBJECTIVES: We sought to determine whether hospices provide services that might affect minority participation. RESEARCH DESIGN: We surveyed California hospices to determine whether programs use diverse health care providers and volunteers, offer translation, diverse spiritual care, or outreach materi…
Does the Collaborative Model Improve Care for Chronic Heart Failure
BACKGROUND: Organizationally based, disease-targeted collaborative quality improvement efforts are widely applied but have not been subject to rigorous evaluation. We evaluated the effects of the Institute of Healthcare Improvement's Breakthrough Series (IHI BTS) on quality of care for chronic heart failure (CHF). RESEARCH DESIGN: We conducted a quasi-experiment in 4 organizations participating in the IHI BTS for CHF in 1999-2000 and 4 comparable…
You Are Where You Shop
Residential Segregation and Latino, Black and White Mortality in New York City
Hospital Utilization for Injection Drug Use-Related Soft Tissue Infections in Urban versus Rural Counties in California
The Quality of Pharmacologic Care for Adults in the United States
BACKGROUND: Despite rising annual expenditures for prescription drugs, little systematic information is available concerning the quality of pharmacologic care for adults in the United States. We evaluated how frequently appropriate pharmacologic care is ordered in a national sample of U.S. residents. METHODS: The RAND/UCLA Modified Delphi process was used to select quality-of-care indicators for adults across 30 chronic and acute conditions and p…
Quality indicators for depression care in HIV patients
HIV patients are at increased risk for depression. However, a comprehensive set of quality of care indicators for depression in the context of HIV does not exist. We report the results of a recent expert panel convened to develop a comprehensive set of HIV depression quality indicators. We systematically reviewed the depression and HIV depression literature to provide the evidence for the quality indicators. The HIV depression quality indicators …
Enhancing Organizational Change and Improvement Prospects
Most research on why health care quality improvement implementation succeeds or fails focuses on front-line or provider-based factors. However, background factors related to the structures and processes of projects themselves also pose challenges. Using a focused ethnographic assessment approach, we undertook a case study to characterize particularly challenging background factors in an ongoing implementation effort. We found that the organizatio…
Scope of Rapid HIV Testing in Private Nonprofit Urban Community Health Settings in the United States
Objectives. We examined patterns of rapid HIV testing in a multistage national random sample of private, nonprofit, urban community clinics and community-based organizations to determine the extent of rapid HIV test availability outside the public health system. Methods. We randomly sampled 12 primary metropolitan statistical areas in 4 regions; 746 sites were randomly sampled across areas and telephoned. Staff at 575 of the sites (78%) were reac…
A routine thing
Increasing HIV testing is a necessary step toward control of the disease. Many experts suggest routinely offering HIV testing to specific population segments. We explore provider discourse regarding an HIV test implementation project with the aim of illuminating a structurally emergent clinician strategy for promoting testing and the socio-cultural factors underlying it. Twenty US Veterans Affairs Healthcare System clinical care providers were in…
Implementing an HIV Rapid Testing Intervention for Homeless Veterans in Shelter Settings within Los Angeles County, USA
We implemented and evaluated an HIV rapid testing intervention in collaboration withthe US Department of Veterans Affairs and the Los Angeles County Department ofHealth to 1) increase HIV testing/receipt of results, and 2) increase veteran access to VA homeless services.Ninety-seven veterans recruited in 9 shelters as part of the Los Angeles Homeless Services Authority (LAHSA) emergency shelter program were randomized (2-to-1 ratio) into one of t…
Cost of OraQuick oral fluid rapid HIV testing at 35 community clinics and community-based organizations in the USA
The US Centers for Disease Control and Prevention recommends the expanded use of rapid HIV antibody tests in community settings to increase the proportion of persons who are aware of their HIV status. The cost of providing rapid testing services in these settings is not known. We conducted a cost survey of non-profit community clinics and community-based organizations (CBOs). The final study sample for the cost analyses included 28 community clin…
Body Mass Index, Neighborhood Fast Food and Restaurant Concentration, and Car Ownership
Eating away from home and particularly fast food consumption have been shown to contribute to weight gain. Increased geographic access to fast food outlets and other restaurants may contribute to higher levels of obesity, especially in individuals who rely largely on the local environment for their food purchases. We examined whether fast food and restaurant concentrations are associated with body mass index and whether car ownership might modera…
Terrorism-Related Fear and Avoidance Behavior in a Multiethnic Urban Population
Objectives. We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. Methods. We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 l…
Race and Sex Differences in the Receipt of Timely and Appropriate Lung Cancer Treatment
BACKGROUND: Previous research suggests that disparities in non-small-cell lung cancer (NSCLC) survival can be explained in part by disparities in the receipt of cancer treatment. Few studies, however, have considered race and sex disparities in the timing and appropriateness of treatment across stages of diagnosis. OBJECTIVE: To evaluate the relationship of sex and race with the receipt of timely and clinically appropriate NSCLC treatment for eac…
Adherence to Quality Indicators and Survival in Patients With Breast Cancer
BACKGROUND: International initiatives increasingly advocate physician adherence to clinical protocols that have been shown to improve outcomes, yet the process-outcome relationship for adhering to breast cancer care protocol is unknown. OBJECTIVE: This study explores whether 100% adherence to a set of quality indicators applied to individuals with breast cancer is associated with better survival. RESEARCH DESIGN AND SUBJECTS: Ten quality indicato…
The Impact of Integrated HIV Care on Patient Health Outcomes
BACKGROUND: Control of viral replication through combination antiretroviral therapy (cART) improves patient health outcomes. Yet many HIV-infected patients have comorbidities that pose social and clinical barriers to achieving viral suppression. Integration of subspecialty services into HIV primary care may overcome such barriers. OBJECTIVE: To evaluate effect of integrated HIV care (IHC) on suppression of HIV replication. RESEARCH DESIGN: A retr…
Medicine (44 obras) · Family medicine (23 obras) · Health care (20 obras) · Environmental health (19 obras) · Nursing (19 obras) · Internal Medicine (15 obras) · Population (14 obras) · Internal Medicine (13 obras) · Gerontology (12 obras) · HIV/AIDS Research and Interventions (11 obras)