Person: Haas, Jennifer
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Haas
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Jennifer
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Haas, Jennifer
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Publication Effects Of The ACA’s Health Insurance Marketplaces On The Previously Uninsured: A Quasi-Experimental Analysis(Health Affairs (Project Hope), 2018) Goldman, Anna; McCormick, Danny; Haas, Jennifer; Sommers, BenjaminDescriptive studies have suggested that the Affordable Care Act’s (ACA) health insurance Marketplaces improved access to care. However, no quasi-experimental evidence is currently available to support these findings. We use longitudinal survey data to compare previously- uninsured adults to adults who had employer-sponsored insurance (ESI) prior to the ACA, in the income range eligible for subsidized Marketplace coverage (138-400% of poverty). Among the previously-uninsured group, the ACA led to a significant decline in the uninsurance rate (-10.8 percentage points), decreased barriers to medical care, increased use of outpatient services and prescriptions drugs, and increased identification of high blood pressure, compared to a control group with stable ESI. Changes were largest among those with incomes between 138-250% of poverty, who were eligible for the ACA’s cost-sharing reductions. Our quasi-experimental approach provides rigorous new evidence that the ACA’s Marketplaces led to improvements in several important health care outcomes, particularly among lower-income adults.Publication Use of Practice-Based Research Network Data to Measure Neighborhood Smoking Prevalence(Centers for Disease Control and Prevention, 2013) Linder, Jeffrey A; Rigotti, Nancy; Brawarsky, Phyllis; Kontos, Emily Z.; Park, Elyse; Klinger, Elissa V.; Marinacci, Lucas; Li, Wenjun; Haas, JenniferIntroduction: Practice-Based Research Networks (PBRNs) and health systems may provide timely, reliable data to guide the development and distribution of public health resources to promote healthy behaviors, such as quitting smoking. The objective of this study was to determine if PBRN data could be used to make neighborhood-level estimates of smoking prevalence. Methods: We estimated the smoking prevalence in 32 greater Boston neighborhoods (population = 877,943 adults) by using the electronic health record data of adults who in 2009 visited one of 26 Partners Primary Care PBRN practices (n = 77,529). We compared PBRN-derived estimates to population-based estimates derived from 1999–2009 Behavioral Risk Factor Surveillance System (BRFSS) data (n = 20,475). Results: The PBRN estimates of neighborhood smoking status ranged from 5% to 22% and averaged 11%. The 2009 neighborhood-level smoking prevalence estimates derived from the BRFSS ranged from 5% to 26% and averaged 13%. The difference in smoking prevalence between the PBRN and the BRFSS averaged −2 percentage points (standard deviation, 3 percentage points). Conclusion: Health behavior data collected during routine clinical care by PBRNs and health systems could supplement or be an alternative to using traditional sources of public health data.Publication State Medicaid Eligibility and Care Delayed Because of Cost(New England Journal of Medicine (NEJM/MMS), 2013) Clark, Cheryl; Ommerborn, Mark; Coull, Brent; Pham, Do Quyen; Haas, JenniferPublication Pharmacosurveillance without borders: electronic health records in different countries can be used to address important methodological issues in estimating the risk of adverse events(Elsevier BV, 2016) Tamblyn, Robyn; Girard, Nadyne; Dixon, William G.; Haas, Jennifer; Bates, David W.; Sheppard, Thérèse; Eguale, Tewodros; Buckeridge, David; Abrahamowicz, Michal; Forster, AlanObjectives: Evaluate methodological advantages and limitations of an international pharmacosurveillance system based on electronic health records (EHRs). Study Design and Settings: Type 2 diabetes was used as an exemplar. Cohorts of newly treated diabetics were followed in each country (Quebec, Canada; Massachusetts, United States; Manchester, UK) from 2009 to 2012 using local EHR systems. Cox proportional hazards models were used to assess the risk of cardiovascular events. Results: A total of 44,913 newly treated diabetics were identified; 82.6% (United States) to 93.1% (Canada) were started on biguanides; 13% of patients failed to fill initial prescriptions. An increased risk of cardiovascular events with sulfonylureas was observed when dispensing [hazard ratio (HR): 2.83] vs. EHR prescribing (HR: 2.47) data were used. The addition of clinical data produced a threefold to 10-fold increase in comorbidity for obesity and renal disease, but had no impact on the risk of different hypoglycemic therapies. The risk of cardiovascular events with sulfonylureas was higher in the United States [HR: 3.4; 95% confidence interval (CI): 2.1, 5.5] compared to England (HR: 1.3; 95% CI: 1.1, 1.6). Conclusion: An international surveillance system based on EHRs may provide more timely information about drug safety and new opportunities to estimate potential sources of bias and health system effects on drug-related outcomes.Publication The Divide Between Breast Density Notification Laws and Evidence-Based Guidelines for Breast Cancer Screening(American Medical Association (AMA), 2015) Haas, Jennifer; Kaplan, Celia P.Publication An Electronic Health Record–Based Intervention to Improve Tobacco Treatment in Primary Care(American Medical Association (AMA), 2009) Linder, Jeffrey A; Rigotti, Nancy; Schneider, Louise; Kelley, Jennifer H. K.; Brawarsky, Phyllis; Haas, JenniferBackground: To improve the documentation and treatment of tobacco use in primary care, we developed and implemented a 3-part electronic health record enhancement: (1) smoking status icons, (2) tobacco treatment reminders, and (3) a Tobacco Smart Form that facilitated the ordering of medication and fax and e-mail counseling referrals. Methods: We performed a cluster-randomized controlled trial of the enhancement in 26 primary care practices between December 19, 2006, and September 30, 2007. The primary outcome was the proportion of documented smokers who made contact with a smoking cessation counselor. Secondary outcomes included coded smoking status documentation and medication prescribing. Results: During the 9-month study period, 132 630 patients made 315 962 visits to study practices. Coded documentation of smoking status increased from 37% of patients to 54% (+17%) in intervention practices and from 35% of patients to 46% (+11%) in control practices (P<.001 for the difference in differences). Among the 9589 patients who were documented smokers at the start of the study, more patients in the intervention practices were recorded as nonsmokers by the end of the study (5.3% vs 1.9% in control practices; P<.001). Among 12 207 documented smokers, more patients in the intervention practices made contact with a cessation counselor (3.9% vs 0.3% in control practices; P<.001). Smokers in the intervention practices were no more likely to be prescribed smoking cessation medication (2% vs 2% in control practices; P=.40). Conclusion: This electronic health record–based intervention improved smoking status documentation and increased counseling assistance to smokers but not the prescription of cessation medication.Publication Racial segregation and disparities in breast cancer care and mortality(Wiley-Blackwell, 2008) Haas, Jennifer; Earle, Craig C.; Orav, John E.; Brawarsky, Phyllis; Keohane, Marie; Neville, Bridget A.; Williams, David R.Objectives: To examine whether residential segregation is a mediator of racial/ ethnic disparities in breast cancer care and breast cancer mortality, or has a differential effect by race/ ethnicity. Methods: Data from the Surveillance, Epidemiology and End Results-Medicare database on white, black, and Hispanic women age 66 to 85 years with breast cancer were examined to look at the receipt of adequate breast cancer care. Results: Blacks were less likely than whites to receive adequate breast cancer care (odds ratio {OR} 0.78; 95% confidence interval {CI} 0.71 - 0.86). Individuals, both black and white, who lived in areas with greater black segregation were less likely to receive adequate breast cancer care (0.73; 0.64 – 0.82). Black segregation was a mediator of the black/ white disparity in breast cancer care, explaining 8.9% of the difference. After adjustment, adequate care for Hispanics did not significantly differ from whites, but individuals, both Hispanic and white, who lived in areas with greater Hispanic segregation were less likely to receive adequate breast cancer care (0.73; 0.61 – 0.89). While Blacks experienced greater breast cancer mortality than whites, black segregation did not substantially mediate the black-white disparity in survival, and was not significantly associated with mortality (hazard ratio 1.03; CI 0.87– 1.21). Breast cancer mortality did not differ between Hispanics and whites. Conclusions: Among seniors, segregation mediates some of the black-white disparity in breast cancer care, but not mortality. Individuals who live in more segregated areas are less likely to receive adequate breast cancer care.Publication Diffusion of digital breast tomosynthesis among women in primary care: associations with insurance type(John Wiley and Sons Inc., 2017) Clark, Cheryl R.; Tosteson, Tor D.; Tosteson, Anna N. A.; Onega, Tracy; Weiss, Julie E.; Harris, Kimberly A.; Haas, JenniferAbstract Digital breast tomosynthesis (DBT) has shown potential to improve breast cancer screening and diagnosis compared to digital mammography (DM). The FDA approved DBT use in conjunction with conventional DM in 2011, but coverage was approved by CMS recently in 2015. Given changes in coverage policies, it is important to monitor diffusion of DBT by insurance type. This study examined DBT trends and estimated associations with insurance type. From June 2011 to September 2014, DBT use in 22 primary care centers in the Dartmouth ‐Brigham and Women's Hospital Population‐based Research Optimizing Screening through Personalized Regimens research center (PROSPR) was examined among women aged 40–89. A longitudinal repeated measures analysis estimated the proportion of DBT performed for screening or diagnostic indications over time and by insurance type. During the study period, 93,182 mammograms were performed on 48,234 women. Of these exams, 16,506 DBT tests were performed for screening (18.1%) and 2537 were performed for diagnosis (15.7%). Between 2011 and 2014, DBT utilization increased in all insurance groups. However, by the latest observed period, screening DBT was used more frequently under private insurance (43.4%) than Medicaid (36.2%), Medicare (37.8%), other (38.6%), or no insurance (32.9%; P < 0.0001). No sustained differences in use of DBT for diagnostic testing were seen by insurance type. DBT is increasingly used for breast cancer screening and diagnosis. Use of screening DBT may be associated with insurance type. Surveillance is required to ensure that disparities in breast cancer screening are minimized as DBT becomes more widely available.Publication Toward a better understanding of patient-reported outcomes in clinical practice(Managed Care & Healthcare Communications, 2014) Bitton, Asaf; Onega, Tracy; Tosteson, Anna N.A.; Haas, JenniferCurrent shifts toward patient-centered healthcare and accountable payment options point to the more personalized production of better health, not just healthcare, as a next organizational paradigm. Transformation to a system geared toward promoting health requires us to think broadly about what it means to engage patients meaningfully, to give them a voice in their health and care, and to capture more of their varied experience and attitudes beyond the provider visit. The collection and use of patient-reported outcome data into electronic health records represents an important step forward for the transition to a more patient-centered health system. We set out an agenda for better understanding how and when patient-reported outcomes may improve patient health and care experience.Publication Association Between Language Proficiency and the Quality of Primary Care Among a National Sample of Insured Latinos(Ovid Technologies (Wolters Kluwer Health), 2007) Pippins, Jennifer R.; Alegria, Margarita; Haas, JenniferContext: Latinos experience substantial barriers to primary care. Limited English language proficiency may be a mechanism for these deficiencies, even for Latinos with health coverage. Objective: To determine the relationship between English language proficiency and the experience of primary care reported by insured Latinos. Design, Setting, Participants: Analysis of the National Latino and Asian American Study (NLAAS), a nationally representative household survey, 2002–2003. This analysis was restricted to Latinos who reported current health insurance (n=1,792), and included information on ethnic subgroups. Main Outcome Measures: Four outcomes addressed different aspects of the quality of primary care: 1) not having a regular source of care or lacking continuity of care; 2) difficulty getting an appointment over the phone, 3) long waits in the waiting room, and 4) difficulty getting information or advice by phone. Results: English language proficiency was associated with the experience of primary care for three of the four outcomes. Insured Latinos with poor/fair English language proficiency were more likely than those with good/excellent proficiency to report not having a regular source of care or lacking continuity (odds ratio {OR} 2.20, 95% confidence interval {CI} 1.60–3.02), long waits (OR 1.88, CI 1.34–2.64), and difficulty getting information/advice by phone (OR 1.76, 95% CI 1.25– −2.46). Conclusions: Among insured Latinos, low English language proficiency is associated with worse reports of the quality of primary care. These results suggest that interventions to address limited English proficiency may be important to improving the quality of primary care for this rapidly growing population.