Kevin Fiscella
Dados Biográficos
| ID | 1260416 |
|---|---|
| NOME | Kevin Fiscella |
| PRENOMES | Kevin |
| SOBRENOME | Fiscella |
| ASSINATURA | FISCELLA K |
| AFILIAÇÕES | University of Rochester |
| ORCID | 0000-0003-3613-8012 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 45 |
| TOTAL DE CITAÇÕES | 337 |
| TOTAL COMO AUTOR | 45 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1995 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 7 |
Advancing equity and value in United States healthcare
This review underscores the importance of culturally tailored interventions, community engagement and outreach, and policy reforms in addressing equity and value in healthcare. There is a significant gap in research directly tackling healthcare inequities. Future research should focus on system accountability, addressing structural inequities, and developing new care models to enhance equity and value
Can a Clinic-Based Community Health Worker Intervention Buffer the Negative Impact of the Covid-19 Pandemic on Health and Well-Being of Low-Income Families during Early Childhood
We examined changes in self-reported mental health, physical health, and emotional support among low-income parents with children ages 0-2 years old from pre-pandemic to pandemic periods and compared changes in parental health among parents who did versus did not have access to a clinic-based community health worker intervention supporting parents at early childhood preventive care visits. We utilized longitudinal parent survey data from pre-COVI…
Strategies to Promote Equity in Covid-19 Antiviral Treatment
The SARS-CoV-2 pandemic has had a disproportionate effect on Black and Indigenous people, racial and ethnic minorities, and other historically marginalized groups. Paxlovid and molnupiravir reduce hospitalization by 89% and 31%, respectively. 2 These drugs complement COVID-19 infusion therapeutics, eg, remdesivir and sotrovimab. 2 To date, inequities have emerged in receipt of COVID-19 vaccines and monoclonal antibody (mAb) treatment. 3,4 Prescri…
Exploring the Role of Provider–Patient Communication in Women’s Sexual Health and Pre-Exposure Prophylaxis Care in the Primary Care Settings in New York State of the United States
Findings suggested that a navigation and assistance system for PrEP care in patients and providers is urgently needed. Future studies should facilitate PrEP discussion, engagement, and monitoring in primary care settings
Aligning Payment and Policies With Health Care Value and Equity
The US health care system often fails to deliver value (ie, outcomes relative to spending) or equity (ie, ensuring fairness in process or outcomes by race, ethnicity, social class, etc). A central question confronting the Biden-Harris administration is: Which policy and payment reforms will improve health care value and equity? In this Viewpoint, we propose starting with hypertension control and blood pressure (BP) equity as a national vital sign…
Anti-racism Training Using the Biopsychosocial Model
Rochester, New York is home to George Engel and the Biopsychosocial (BPS) model. Rochester was also home to Fredrick Douglas and a stop on the Underground Railroad. More recently, Rochester, New York is also where Daniel Prude died at the hands of the police. In this article, we discuss how our department of family medicine has incorporated race and racism into the BPS model and how we have used it to help primary care trainees become more effect…
Disparities in Pancreatic Cancer Treatment and Outcomes
Disparities by race and SES exist in the diagnosis and treatment of pancreatic cancer that are largely driven by race and SES. Improved understanding of underlying causes could inform interventions
Community-Based, Preclinical Patient Navigation for Colorectal Cancer Screening Among Older Black Men Recruited From Barbershops
Objectives. To test the effectiveness of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer (CRC) screening among older Black men. Methods. We conducted a 3-parallel-arm, randomized trial among 731 self-identified Black men recruited at barbershops between 2010 and 2013 in New York City. Participants had to be aged 50 years or older, not be up-to-date on CRC screening, have uncontrolled high blood pressu…
The Inmate Exception and Reform of Correctional Health Care
Racial and Ethnic Disparities in the Quality of Health Care
The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are availa…
Impact of HIV Testing and Counseling (HTC) Knowledge on HIV Prevention Practices Among Traditional Birth Attendants in Nigeria
Nigeria is second in the world for the number of people with HIV and has a high rate of mother-to-child transmission (MTCT). Over 60% of births in Nigeria occur outside of health care facilities, and because of this, Traditional Birth Attendants (TBAs) play a significant role in maternal and child health. It is important that TBAs be knowledgeable about HIV prevention. The purpose of this study was to determine the impact of HIV testing and couns…
Activation of persons living with HIV for treatment, the great study
ClinicalTrials.gov Identifier: NCT02165735, 6/13/2014
Mortality Risk Prediction
BACKGROUND: Predicting risk of premature death is one of the most basic tasks in medicine and public health, but has proven to be difficult over the long term even with the best prognostic models. One popular strategy has been to improve prognostic models with candidate genes and other novel biomarkers. However, the gains in predictive power have been modest and the costs have been high, leading to a demand for cost-effective alternatives. We con…
Measurement confounding affects the extent to which verbal IQ explains social gradients in mortality
BACKGROUND: IQ is thought to explain social gradients in mortality. IQ scores are based roughly equally on Verbal IQ (VIQ) and Performance IQ tests. VIQ tests, however, are suspected to confound true verbal ability with socioeconomic status (SES), raising the possibility that associations between SES and IQ scores might be overestimated. We examined, first, whether two of the most common types of VIQ tests exhibited differential item functioning …
Psychometric Evaluation of the Patient Satisfaction With Logistical Aspects of Navigation (PSN-L) Scale Using Item Response Theory
BACKGROUND: Patient navigation--the provision of logistical, educational, and emotional support needed to help patients "navigate around" barriers to high-quality cancer treatment offers promise. No patient-reported outcome measures currently exist that assess patient navigation from the patient's perspective. We use a partial independence item response theory model to report on the psychometric properties of the Patient Satisfaction with Navigat…
Retracted
Self‐Reported Cancer Screening Among Elderly Medicare Beneficiaries
Purpose: We examined the rural‐urban disparity of screening for breast cancer and colorectal cancer (CRC) among the elder Medicare beneficiaries and assessed rurality's independent impact on receipt of screening. Methods: Using 2005 Medicare Current Beneficiary Survey, we applied weighted logistic regression to estimate the overall rural‐urban disparity and rurality's independent impact on cancer screening, controlling for patient, and area facto…
Health Characteristics Associated With Gaining and Losing Private and Public Health Insurance
BACKGROUND: Millions of Americans lack or lose health insurance annually, yet how health characteristics predict insurance acquisition and loss remains unclear. OBJECTIVE: To examine associations of health characteristics with acquisition and loss of private and public health insurance. RESEARCH DESIGN AND PARTICIPANTS: Prospective observational analysis of 2000 to 2007 Medical Expenditure Panel Survey data for persons aged 18 to 63 on entry, enr…
The Relative Health Burden of Selected Social and Behavioral Risk Factors in the United States
Objectives. We sought to quantify the potential health impact of selected medical and nonmedical policy changes within the United States. Methods. Using data from the 1997–2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996–2002 Medical Expenditure Panel Surveys, we calculated age-specific health-related quality-of-life scores and mortality probabilities for 8 social and behavioral risk factors. We then use…
Why The Nation Needs A Policy Push On Patient-Centered Health Care
The phrase "patient-centered care" is in vogue, but its meaning is poorly understood. This article describes patient-centered care, why it matters, and how policy makers can advance it in practice. Ultimately, patient-centered care is determined by the quality of interactions between patients and clinicians. The evidence shows that patient-centered care improves disease outcomes and quality of life, and that it is critical to addressing racial, e…
Protection of Racial/Ethnic Minority Populations During an Influenza Pandemic
Racial/ethnic minority populations experience worse health outcomes than do other groups during and after disasters. Evidence for a differential impact from pandemic influenza includes both higher rates of underlying health conditions in minority populations, increasing their risk of influenza-related complications, and larger socioeconomic (e.g., access to health care), cultural, educational, and linguistic barriers to adoption of pandemic inter…
Effects of an Ongoing Epidemic on the Annual Influenza Vaccination Rate and Vaccination Timing Among the Medicare Elderly
Objectives. We assessed short-term responsiveness of influenza vaccine demand to variation in timing and severity of influenza epidemics since 2000. We tested the hypothesis that weekly influenza epidemic activity is associated with annual and daily influenza vaccine receipt. Methods. We conducted cross-sectional survival analyses from the 2000–2001 to 2004–2005 influenza seasons among community-dwelling elderly using the Medicare Current Benefic…
Post Partum Discharge Against Medical Advice
Knowledge and Beliefs About Health Promotion and Preventive Health Care Among Somali Women in the United States
We explored conceptualizations of health promotion and experiences with preventive health services among African refugee women. We asked 34 resettled Somali refugee women about their beliefs and experiences regarding health promotion and common preventive health care services in the United States. Interviews were audiotaped, transcribed, and analyzed using a grounded theory approach. Key themes were the importance of good hygiene, an adequate sou…
Physicians’ Responses to Patients’ Medically Unexplained Symptoms
OBJECTIVE: To understand how physicians communicate may contribute to the mistrust and poor clinical outcomes observed in patients who present with medically unexplained symptoms (MUS). METHODS: After providing informed consent, 100 primary care physicians in greater Rochester, New York, were visited by two unannounced covert standardized patients (actors, or SPs) portraying two chest pain roles: classic symptoms of gastroesophageal reflux diseas…
Sociodemographics, self-rated health, and mortality in the US
Retracted
Measuring patient-centered communication in Patient-Physician consultations
Why The Nation Needs A Policy Push On Patient-Centered Health Care
The phrase "patient-centered care" is in vogue, but its meaning is poorly understood. This article describes patient-centered care, why it matters, and how policy makers can advance it in practice. Ultimately, patient-centered care is determined by the quality of interactions between patients and clinicians. The evidence shows that patient-centered care improves disease outcomes and quality of life, and that it is critical to addressing racial, e…
Does psychological distress contribute to racial and socioeconomic disparities in mortality
Being black or poor are powerful predictors of mortality. Although psychological distress has been proposed as mediating the effects of race and socioeconomic status on mortality, this hypothesis has not been previously directly tested. We used data from the National Health and Nutrition Examination I (NHANES I), a nationally representative sample from the U.S, and the NHANES I Epidemiological Follow-up Survey (NHEFS) of subsequent mortality to t…
Protection of Racial/Ethnic Minority Populations During an Influenza Pandemic
Racial/ethnic minority populations experience worse health outcomes than do other groups during and after disasters. Evidence for a differential impact from pandemic influenza includes both higher rates of underlying health conditions in minority populations, increasing their risk of influenza-related complications, and larger socioeconomic (e.g., access to health care), cultural, educational, and linguistic barriers to adoption of pandemic inter…
Studying physician effects on patient outcomes
The Relative Health Burden of Selected Social and Behavioral Risk Factors in the United States
Objectives. We sought to quantify the potential health impact of selected medical and nonmedical policy changes within the United States. Methods. Using data from the 1997–2000 National Health Interview Surveys (linked to mortality data through 2002) and the 1996–2002 Medical Expenditure Panel Surveys, we calculated age-specific health-related quality-of-life scores and mortality probabilities for 8 social and behavioral risk factors. We then use…
Measurement confounding affects the extent to which verbal IQ explains social gradients in mortality
BACKGROUND: IQ is thought to explain social gradients in mortality. IQ scores are based roughly equally on Verbal IQ (VIQ) and Performance IQ tests. VIQ tests, however, are suspected to confound true verbal ability with socioeconomic status (SES), raising the possibility that associations between SES and IQ scores might be overestimated. We examined, first, whether two of the most common types of VIQ tests exhibited differential item functioning …
Community-Based, Preclinical Patient Navigation for Colorectal Cancer Screening Among Older Black Men Recruited From Barbershops
Objectives. To test the effectiveness of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer (CRC) screening among older Black men. Methods. We conducted a 3-parallel-arm, randomized trial among 731 self-identified Black men recruited at barbershops between 2010 and 2013 in New York City. Participants had to be aged 50 years or older, not be up-to-date on CRC screening, have uncontrolled high blood pressu…
The Inmate Exception and Reform of Correctional Health Care
Alcohol and Opiate Withdrawal in US Jails
We sought to estimate the number of arrestees at risk for inadequately treated drug and alcohol withdrawal in US jails. We used Arrestee Drug Abuse Monitoring Program data to estimate prevalence rates of alcohol and opiate dependence. Our results revealed rates of alcohol and opiate dependency among arrestees of approximately 12% and 4%, respectively; only 28% of jail administrators reported that their institutions had ever detoxified arrestees. …
Does prenatal care improve birth outcomes? A critical review
OBJECTIVE: To evaluate evidence that prenatal care improves birth outcomes. DATA SOURCES: The MEDLINE data base was searched for appropriate studies for the years 1966-1994; a review of published studies was also conducted. METHODS OF STUDY SELECTION: Published observational and experimental studies of prenatal care that met specified criteria were selected. DATA EXTRACTION AND SYNTHESIS: Studies were graded based on the system used by the United…
Poverty or income inequality as predictor of mortality
Objective: To determine the effect of inequality in income between communities independent of household income on individual all cause mortality in the United States. Design: Longitudinal cohort study. Subjects: A nationally representative sample of 14 407 people aged 25-74 years in the United States from the first national health and nutrition examination survey. Setting: Subjects were followed from initial interview in 1971-5 until 1987. Comple…
Does psychological distress contribute to racial and socioeconomic disparities in mortality
Being black or poor are powerful predictors of mortality. Although psychological distress has been proposed as mediating the effects of race and socioeconomic status on mortality, this hypothesis has not been previously directly tested. We used data from the National Health and Nutrition Examination I (NHANES I), a nationally representative sample from the U.S, and the NHANES I Epidemiological Follow-up Survey (NHEFS) of subsequent mortality to t…
Skepticism Toward Medical Care and Health Care Utilization
OBJECTIVES: As health care moves toward systems that assume accountability for defined populations, there has been increasing emphasis on developing performance measures for those systems and their providers, with little attention given to patient demand or attitudinal factors. The impact of skepticism toward health care providers on health behavior and health care utilization was assessed using a cross-sectional analysis of data from the 1987 Na…
Does Skepticism Towards Medical Care Predict Mortality
OBJECTIVES: Attitudes towards medical care have a strong effect on utilization and outcomes. However, there has been little attention to the impact on outcomes of doubts about the value of medical care. This study examines the impact of skepticism toward medical care on mortality using data from the 1987 National Medical Expenditure Survey (NMES). METHODS: A nationally representative sample from the United States comprising 18,240 persons (> or =…
Inequality in Quality
Socioeconomic and racial/ethnic disparities in health care quality have been extensively documented. Recently, the elimination of disparities in health care has become the focus of a national initiative. Yet, there is little effort to monitor and address disparities in health care through organizational quality improvement. After reviewing literature on disparities in health care, we discuss the limitations in existing quality assessment for iden…
Impact of Patient Socioeconomic Status on Physician Profiles
BACKGROUND: Patient education has been shown to affect physician performance profiles. It is not known whether census-derived measures of patient socioeconomic status (SES) show comparable effects. OBJECTIVE: The objective of this study was to compare the effects on physician profiles for patient satisfaction and physical and mental health of adjustment for patient SES derived from patient addresses geocoded to the census block group level, zip c…
Disparities in Health Care by Race, Ethnicity, and Language Among the Insured
BACKGROUND: Racial and ethnic disparities in health care have been well documented, but poorly explained. OBJECTIVE: To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care. RESEARCH DESIGN: Cross-sectional analysis of the Community Tracking Survey (1996-1997). SUBJECTS: Adults 18 to 64 years with private or Medicaid health insurance. MEASURES: Independent variables included race, ethni…
Effect of Patient Socioeconomic Status on Physician Profiles for Prevention, Disease Management, and Diagnostic Testing Costs
BACKGROUND: Previous research shows patient socioeconomic status (SES) affects physician profiles for health status and satisfaction, but effects on other aspects of care are not known. OBJECTIVE: To examine the effect of patient SES on physician profiles for preventive care, disease management, and diagnostic testing costs. RESEARCH DESIGN: Cross-sectional analysis of a managed care claims data. SUBJECTS: Five hundred sixty-eight physicians and …
Effects of Patient and Physician Practice Socioeconomic Status on the Health Care of Privately Insured Managed Care Patients
BACKGROUND: Previous research shows that patient socioeconomic status (SES) affects health care, but little is known about the relative effects of patient and physician practice SES among privately insured patients. OBJECTIVE: To examine the effects of patient and physician practice SES on prevention, disease management, utilization, and cost expenditures. DESIGN: Cross-sectional analyses of claims data. SUBJECTS: Primary care physicians (568) an…
Sociodemographics, self-rated health, and mortality in the US
Health Disparities Based on Socioeconomic Inequities
Health is unevenly distributed across socioeconomic status. Persons of lower income, education, or occupational status experience worse health and die earlier than do their better-off counterparts. This article discusses these disparities in the context of urban medical practice. The article begins with a discussion of the complex relationship among socioeconomic status, race, and health in the United States. It highlights the effects of institut…
Jail Management of Arrestees/Inmates Enrolled in Community Methadone Maintenance Programs
Alcohol and Opiate Withdrawal in US Jails
We sought to estimate the number of arrestees at risk for inadequately treated drug and alcohol withdrawal in US jails. We used Arrestee Drug Abuse Monitoring Program data to estimate prevalence rates of alcohol and opiate dependence. Our results revealed rates of alcohol and opiate dependency among arrestees of approximately 12% and 4%, respectively; only 28% of jail administrators reported that their institutions had ever detoxified arrestees. …
Socioeconomic Status Disparities in Healthcare Outcomes
From the University of Rochester School of Medicine & Dentistry, Departments of Family Medicine and Community & Preventive Medicine, Rochester, New York. Reprints: Kevin Fiscella, MD, MPH, University of Rochester School of Medicine & Dentistry, Departments of Family Medicine and Community & Preventive Medicine, 1381 South Avenue, Rochester, NY 14620. E-mail: [email protected]
Patient Trust
BACKGROUND: Patients' trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients. METHODS: We assessed physician behavior and length of visit using audio tapes of encounters of 2 unannounced standardized patients (SPs) with 100 community-based primary care ph…
Measuring patient-centered communication in Patient-Physician consultations
Physicians’ Responses to Patients’ Medically Unexplained Symptoms
OBJECTIVE: To understand how physicians communicate may contribute to the mistrust and poor clinical outcomes observed in patients who present with medically unexplained symptoms (MUS). METHODS: After providing informed consent, 100 primary care physicians in greater Rochester, New York, were visited by two unannounced covert standardized patients (actors, or SPs) portraying two chest pain roles: classic symptoms of gastroesophageal reflux diseas…
Connoisseurs of Care? Unannounced Standardized Patients’ Ratings of Physicians
BACKGROUND: Patient satisfaction surveys can be informative, but bias and poor response rates may limit their utility as stable measures of physician performance. Using unannounced standardized patients (SPs) may overcome some of these limitations because their experience and training make them able judges of physician behavior. OBJECTIVES: We sought to understand the reliability of unannounced SPs in rating primary care physicians when covertly …
Mammography Self-Report and Mammography Claims
BACKGROUND: National self-report surveys show minimal racial disparity in mammography, whereas analyses of administrative data show large disparity. METHODS: Using the 1998-2002 Medicare Current Beneficiary Surveys, which contain participants' self-report and claims data, we developed multivariable adjusted models examining factors associated with self-reported mammography and self-reported mammography verified by billing records. RESULTS: No rac…
Studying physician effects on patient outcomes
Post Partum Discharge Against Medical Advice
Knowledge and Beliefs About Health Promotion and Preventive Health Care Among Somali Women in the United States
We explored conceptualizations of health promotion and experiences with preventive health services among African refugee women. We asked 34 resettled Somali refugee women about their beliefs and experiences regarding health promotion and common preventive health care services in the United States. Interviews were audiotaped, transcribed, and analyzed using a grounded theory approach. Key themes were the importance of good hygiene, an adequate sou…
Protection of Racial/Ethnic Minority Populations During an Influenza Pandemic
Racial/ethnic minority populations experience worse health outcomes than do other groups during and after disasters. Evidence for a differential impact from pandemic influenza includes both higher rates of underlying health conditions in minority populations, increasing their risk of influenza-related complications, and larger socioeconomic (e.g., access to health care), cultural, educational, and linguistic barriers to adoption of pandemic inter…
Effects of an Ongoing Epidemic on the Annual Influenza Vaccination Rate and Vaccination Timing Among the Medicare Elderly
Objectives. We assessed short-term responsiveness of influenza vaccine demand to variation in timing and severity of influenza epidemics since 2000. We tested the hypothesis that weekly influenza epidemic activity is associated with annual and daily influenza vaccine receipt. Methods. We conducted cross-sectional survival analyses from the 2000–2001 to 2004–2005 influenza seasons among community-dwelling elderly using the Medicare Current Benefic…
Medicine (41 obras) · Environmental health (20 obras) · Nursing (18 obras) · Family medicine (16 obras) · Health care (15 obras) · Population (14 obras) · Gerontology (13 obras) · Political science (13 obras) · Psychology (13 obras) · Public health (13 obras)