Hsien‐Yen Chang
Biographic Data
| ID | 7731086 |
|---|---|
| NAME | Hsien‐Yen Chang |
| GIVEN NAMES | Hsien‐Yen |
| FAMILY NAME | Chang |
| SIGNATURE | CHANG H Y |
| AFFILIATIONS | Johns Hopkins University |
| ORCID | 0000-0002-7997-4822 |
| VERIFIED | Yes |
| TOTAL WORKS | 18 |
| TOTAL CITATIONS | 0 |
| AUTHOR COUNT | 18 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2011 |
| LATEST PUBLICATION YEAR | 2024 |
| H-INDEX | 0 |
County-Level Factors Associated with Reversal of Insurer-Approved HIV Pre-Exposure Prophylaxis Prescriptions in the United States, 2018
Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic
BACKGROUND: The coronavirus disease-2019 pandemic has been associated with large increases in opioid-related mortality, yet it is unclear whether specific subpopulations were especially likely to discontinue buprenorphine treatment for opioid use disorder as the pandemic ensued. OBJECTIVE: The aim was to assess predictors of buprenorphine discontinuation in the early months of the coronavirus disease-2019 pandemic (April-July 2020) compared with …
Differential impact of mitigation policies and socioeconomic status on Covid-19 prevalence and social distancing in the United States
Neighborhoods with varying levels of socioeconomic disadvantage reacted differently to the implementation and relaxation of COVID-19 mitigation policies. Policymakers should consider investing more resources in disadvantaged counties as the pandemic may not stop until most neighborhoods have it under control
Assessing the Impact of Neighborhood Socioeconomic Characteristics on Covid-19 Prevalence Across Seven States in the United States
Introduction: The spread of Coronavirus Disease 2019 (COVID-19) across the United States has highlighted the long-standing nationwide health inequalities with socioeconomically challenged communities experiencing a higher burden of the disease. We assessed the impact of neighborhood socioeconomic characteristics on the COVID-19 prevalence across seven selected states (i.e., Arizona, Florida, Illinois, Maryland, North Carolina, South Carolina, and…
The Impact of Various Risk Assessment Time Frames on the Performance of Opioid Overdose Forecasting Models
BACKGROUND: An individual's risk for future opioid overdoses is usually assessed using a 12-month "lookback" period. Given the potential urgency of acting rapidly, we compared the performance of alternative predictive models with risk information from the past 3, 6, 9, and 12 months. METHODS: We included 1,014,033 Maryland residents aged 18-80 with at least 1 opioid prescription and no recorded death in 2015. We used 2015 Maryland prescription dr…
Chronic Disease Medication Adherence After Initiation of Buprenorphine for Opioid Use Disorder
BACKGROUND: Although buprenorphine is an evidence-based treatment for opioid use disorder (OUD), it is unknown whether buprenorphine use may affect patients' adherence to treatments for chronic, unrelated conditions. OBJECTIVES: To quantify the effect of buprenorphine treatment on patient adherence to 5 therapeutic classes: (1) antilipids; (2) antipsychotics; (3) antiepileptics; (4) antidiabetics; and (5) antidepressants. RESEARCH DESIGN: This wa…
Defining and Assessing Geriatric Risk Factors and Associated Health Care Utilization Among Older Adults Using Claims and Electronic Health Records
BACKGROUND: Using electronic health records (EHRs), in addition to claims, to systematically identify patients with factors associated with adverse outcomes (geriatric risk) among older adults can prove beneficial for population health management and clinical service delivery. OBJECTIVE: To define and compare geriatric risk factors derivable from claims, structured EHRs, and unstructured EHRs, and estimate the relationship between geriatric risk …
Assessing the Impact of Body Mass Index Information on the Performance of Risk Adjustment Models in Predicting Health Care Costs and Utilization
BACKGROUND: Using electronic health records (EHRs) for population risk stratification has gained attention in recent years. Compared with insurance claims, EHRs offer novel data types (eg, vital signs) that can potentially improve population-based predictive models of cost and utilization. OBJECTIVE: To evaluate whether EHR-extracted body mass index (BMI) improves the performance of diagnosis-based models to predict concurrent and prospective hea…
Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype
BACKGROUND: Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures. STUDY DESIGN:…
Evaluating the Impact of Prescription Fill Rates on Risk Stratification Model Performance
BACKGROUND: Risk adjustment models are traditionally derived from administrative claims. Prescription fill rates-extracted by comparing electronic health record prescriptions and pharmacy claims fills-represent a novel measure of medication adherence and may improve the performance of risk adjustment models. OBJECTIVE: We evaluated the impact of prescription fill rates on claims-based risk adjustment models in predicting both concurrent and prosp…
Effect of Direct-to-Consumer Advertising on Statin Use in the United States
IMPORTANCE: The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. OBJECTIVE: We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. DESIGN, SETTING, AND PARTICIPANTS: We conducted an ecological study for 75 designated market areas from 2005 to 2…
Comparing Population-based Risk-stratification Model Performance Using Demographic, Diagnosis and Medication Data Extracted From Outpatient Electronic Health Records Versus Administrative Claims
BACKGROUND: There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, however, have been traditionally derived from claims or encounter systems. This study evaluates the challenges and opportunities of us…
Identifying Consistent High-cost Users in a Health Plan
BACKGROUND: High-cost users in a period may not incur high-cost utilization in the next period. Consistent high-cost users (CHUs) may be better targets for cost-saving interventions. OBJECTIVES: To compare the characteristics of CHUs (patients with plan-specific top 20% medical costs in all 4 half-year periods across 2008 and 2009) and point high-cost users (PHUs) (top users in 2008 alone), and to build claims-based models to identify CHUs. RESEA…
An Index for Measuring Overuse of Health Care Resources With Medicare Claims
BACKGROUND: Overuse can be defined as use of a service when the risk of harm exceeds its likely benefit. Yet, there has been little work with composite measures of overuse. OBJECTIVE: Our goal was to create a composite measure of overuse with claims data. DESIGN: Observational study using 5% of Medicare claims from 2008. SETTING: All inpatient and outpatient settings of care, excluding nursing homes. PARTICIPANTS: Older Americans receiving health…
Identifying Possible Indicators of Systematic Overuse of Health Care Procedures With Claims Data
BACKGROUND: Health care quality is frequently described with measures representing the overall performance of a health care system. Despite the growing attention to overuse of health care resources, there is little experience with aggregate measures of overuse. OBJECTIVE: To identify a set of possible indicators of overuse that can be operationalized with claims data and to describe variation in these indicators across the hospital referral regio…
Ambulatory Diagnosis and Treatment of Nonmalignant Pain in the United States, 2000–2010
BACKGROUND: Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of nonmalignant pain. OBJECTIVE: The aim of the study was to characterize the diagnosis and management of nonmalignant pain in ambulatory, office-based settings in the United States between 2000 and 2010. DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional and multivariate regression analyses of the National Amb…
Impact of Bariatric Surgery on Health Care Utilization and Costs Among Patients With Diabetes
Sugerman, Harvey J. MD, FACS*; Blackstone, Robin P. MD†; Dixon, John B. MD, PhD‡; Kral, John G. MD, PhD§; Wolfe, Bruce M. MD∥ Author Information
Morbidity Trajectories as Predictors of Utilization
BACKGROUND: Little is known about how morbidity levels progress over time and the implications of these morbidity trajectories for healthcare utilization. OBJECTIVES: To identify and compare characteristics of people in different morbidity trajectories and to evaluate how morbidity trajectories impact the performance of diagnostic risk-adjustment models. RESEARCH DESIGN: Morbidity trajectories were derived from 3-year (2002 to 2004) of claims fro…
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Morbidity Trajectories as Predictors of Utilization
BACKGROUND: Little is known about how morbidity levels progress over time and the implications of these morbidity trajectories for healthcare utilization. OBJECTIVES: To identify and compare characteristics of people in different morbidity trajectories and to evaluate how morbidity trajectories impact the performance of diagnostic risk-adjustment models. RESEARCH DESIGN: Morbidity trajectories were derived from 3-year (2002 to 2004) of claims fro…
Impact of Bariatric Surgery on Health Care Utilization and Costs Among Patients With Diabetes
Sugerman, Harvey J. MD, FACS*; Blackstone, Robin P. MD†; Dixon, John B. MD, PhD‡; Kral, John G. MD, PhD§; Wolfe, Bruce M. MD∥ Author Information
Ambulatory Diagnosis and Treatment of Nonmalignant Pain in the United States, 2000–2010
BACKGROUND: Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of nonmalignant pain. OBJECTIVE: The aim of the study was to characterize the diagnosis and management of nonmalignant pain in ambulatory, office-based settings in the United States between 2000 and 2010. DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional and multivariate regression analyses of the National Amb…
Identifying Possible Indicators of Systematic Overuse of Health Care Procedures With Claims Data
BACKGROUND: Health care quality is frequently described with measures representing the overall performance of a health care system. Despite the growing attention to overuse of health care resources, there is little experience with aggregate measures of overuse. OBJECTIVE: To identify a set of possible indicators of overuse that can be operationalized with claims data and to describe variation in these indicators across the hospital referral regio…
An Index for Measuring Overuse of Health Care Resources With Medicare Claims
BACKGROUND: Overuse can be defined as use of a service when the risk of harm exceeds its likely benefit. Yet, there has been little work with composite measures of overuse. OBJECTIVE: Our goal was to create a composite measure of overuse with claims data. DESIGN: Observational study using 5% of Medicare claims from 2008. SETTING: All inpatient and outpatient settings of care, excluding nursing homes. PARTICIPANTS: Older Americans receiving health…
Identifying Consistent High-cost Users in a Health Plan
BACKGROUND: High-cost users in a period may not incur high-cost utilization in the next period. Consistent high-cost users (CHUs) may be better targets for cost-saving interventions. OBJECTIVES: To compare the characteristics of CHUs (patients with plan-specific top 20% medical costs in all 4 half-year periods across 2008 and 2009) and point high-cost users (PHUs) (top users in 2008 alone), and to build claims-based models to identify CHUs. RESEA…
Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype
BACKGROUND: Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures. STUDY DESIGN:…
Evaluating the Impact of Prescription Fill Rates on Risk Stratification Model Performance
BACKGROUND: Risk adjustment models are traditionally derived from administrative claims. Prescription fill rates-extracted by comparing electronic health record prescriptions and pharmacy claims fills-represent a novel measure of medication adherence and may improve the performance of risk adjustment models. OBJECTIVE: We evaluated the impact of prescription fill rates on claims-based risk adjustment models in predicting both concurrent and prosp…
Effect of Direct-to-Consumer Advertising on Statin Use in the United States
IMPORTANCE: The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. OBJECTIVE: We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. DESIGN, SETTING, AND PARTICIPANTS: We conducted an ecological study for 75 designated market areas from 2005 to 2…
Comparing Population-based Risk-stratification Model Performance Using Demographic, Diagnosis and Medication Data Extracted From Outpatient Electronic Health Records Versus Administrative Claims
BACKGROUND: There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, however, have been traditionally derived from claims or encounter systems. This study evaluates the challenges and opportunities of us…
Defining and Assessing Geriatric Risk Factors and Associated Health Care Utilization Among Older Adults Using Claims and Electronic Health Records
BACKGROUND: Using electronic health records (EHRs), in addition to claims, to systematically identify patients with factors associated with adverse outcomes (geriatric risk) among older adults can prove beneficial for population health management and clinical service delivery. OBJECTIVE: To define and compare geriatric risk factors derivable from claims, structured EHRs, and unstructured EHRs, and estimate the relationship between geriatric risk …
Assessing the Impact of Body Mass Index Information on the Performance of Risk Adjustment Models in Predicting Health Care Costs and Utilization
BACKGROUND: Using electronic health records (EHRs) for population risk stratification has gained attention in recent years. Compared with insurance claims, EHRs offer novel data types (eg, vital signs) that can potentially improve population-based predictive models of cost and utilization. OBJECTIVE: To evaluate whether EHR-extracted body mass index (BMI) improves the performance of diagnosis-based models to predict concurrent and prospective hea…
Chronic Disease Medication Adherence After Initiation of Buprenorphine for Opioid Use Disorder
BACKGROUND: Although buprenorphine is an evidence-based treatment for opioid use disorder (OUD), it is unknown whether buprenorphine use may affect patients' adherence to treatments for chronic, unrelated conditions. OBJECTIVES: To quantify the effect of buprenorphine treatment on patient adherence to 5 therapeutic classes: (1) antilipids; (2) antipsychotics; (3) antiepileptics; (4) antidiabetics; and (5) antidepressants. RESEARCH DESIGN: This wa…
Assessing the Impact of Neighborhood Socioeconomic Characteristics on Covid-19 Prevalence Across Seven States in the United States
Introduction: The spread of Coronavirus Disease 2019 (COVID-19) across the United States has highlighted the long-standing nationwide health inequalities with socioeconomically challenged communities experiencing a higher burden of the disease. We assessed the impact of neighborhood socioeconomic characteristics on the COVID-19 prevalence across seven selected states (i.e., Arizona, Florida, Illinois, Maryland, North Carolina, South Carolina, and…
The Impact of Various Risk Assessment Time Frames on the Performance of Opioid Overdose Forecasting Models
BACKGROUND: An individual's risk for future opioid overdoses is usually assessed using a 12-month "lookback" period. Given the potential urgency of acting rapidly, we compared the performance of alternative predictive models with risk information from the past 3, 6, 9, and 12 months. METHODS: We included 1,014,033 Maryland residents aged 18-80 with at least 1 opioid prescription and no recorded death in 2015. We used 2015 Maryland prescription dr…
Differential impact of mitigation policies and socioeconomic status on Covid-19 prevalence and social distancing in the United States
Neighborhoods with varying levels of socioeconomic disadvantage reacted differently to the implementation and relaxation of COVID-19 mitigation policies. Policymakers should consider investing more resources in disadvantaged counties as the pandemic may not stop until most neighborhoods have it under control
Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic
BACKGROUND: The coronavirus disease-2019 pandemic has been associated with large increases in opioid-related mortality, yet it is unclear whether specific subpopulations were especially likely to discontinue buprenorphine treatment for opioid use disorder as the pandemic ensued. OBJECTIVE: The aim was to assess predictors of buprenorphine discontinuation in the early months of the coronavirus disease-2019 pandemic (April-July 2020) compared with …
County-Level Factors Associated with Reversal of Insurer-Approved HIV Pre-Exposure Prophylaxis Prescriptions in the United States, 2018
Medicine (18 works) · Internal Medicine (13 works) · Internal Medicine (13 works) · Family medicine (10 works) · Health care (10 works) · Emergency Medicine (9 works) · Emergency Medicine (9 works) · Environmental health (6 works) · Medical prescription (6 works) · Chronic Disease Management Strategies (5 works)