Center for Health Care Research & Policy

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MD-PhD Student Alexander C. Tsai, along with Center Faculty, Publish a Manuscript in the Journal Health Services Research
MD-PhD student Alexander C. Tsai, along with Center faculty Mark E. Votruba, PhD and Randall D. Cebul, MD, and former Case faculty member John Bridges, PhD (now of the University of Heidelberg), published a manuscript in the journal Health Services Research in the February 2006 issue. The study, "Overcoming Bias in Estimating the Volume-Outcome Relationship", examines the relationships between volume and outcomes of care for patients with congestive heart failure using a novel instrumental variables strategy based on the geographic distribution of patients and hospitals in Northeast Ohio. (posted 2/2006)

Access to the Health Care System Depends Not Only on a Person’s Characteristics and Choices, But Also on the Community in Which the Person Lives
Access to the health care system depends not only on a person’s characteristics and choices, but also on the community in which the person lives, according to a study published in the June 2005 issue of Medical Care by David Litaker, M.D., Siran Koroukian, and Center faculty member Thomas E. Love, Ph.D. “Context and Healthcare Access: Looking Beyond the Individual” reports on social, economic and health system characteristics of more than 16,000 adult Ohio residents obtained through a 1998 telephone survey. Persisting disparities in health status increase the need for programs that promote equitable access to health care. Even after accounting for social and economic characteristics of individuals, whether someone will have a usual source of health care (about 18% of Ohio adult residents had no such access) is persistently related to the economic characteristics of their home community. Policy changes may be more effective if they look beyond individual characteristics to address economic factors in communities with poor health care access.

Disease Prevention and Health Promotion in Medical Education: Reflections from an Academic Health Center
Case`s curricula in prevention and community health were inventoried in detail by Dr. David Litaker, Center Director, Dr. Randall Cebul, and other School of Medicine faculty and reported in the July, 2004 issue of Academic Medicine. Findings were compared with national recommendations and the perceptions of Case`s recent graduates about the adequacy of their preparation in these areas. The authors make recommendations about how these subjects can be better integrated throughout the curriculum and reinforced through formal practice- and community-based opportunities in students` training.

Higher Managed Care Penetration in a Region is Associated with More Problems with Health Care Access Among Ohioans
Using information from over 15,000 respondents to the Ohio Family Health Survey, authors David Litaker, M.D., and Randall Cebul, M.D., report that higher managed care penetration in a region is associated with more problems with health care access among Ohioans, although the most important predictor of poor access remains inadequate health care insurance. [View the Article]

CWRU MD-PhD Student Receives Award for Best Poster in Health Policy at AMSA Meeting.
Alexander C. Tsai, MA, a fourth year CWRU MD-PhD student in Health Services Research, was awarded the prize for Best Poster in Health Policy at the 53rd national meeting of the American Medical Student Association, held March 22nd in Washington, DC. The paper: "Characterizing payments for emergency department care: do the uninsured pay their way?", was co-authored by fellow HSR students Josh Sarver and Rita Cydulka, MD along with past Center faculty member David W. Baker, MD, MPH. Way to go, Alex!

Joshua H. Tamayo-Sarver recently completed his dissertation on the role of patient race in physicians` decisions to prescribe opioid analgesia.
Mr.Tamayo-Sarver was guided by CHRP faculty member Neal Dawson. The Agency for Healthcare Research and Quality (AHRQ) supported the $32,400 study that consisted of building a theoretical model of rapid clinical decision-making, a secondary data analysis of racial/ethnic disparities in analgesia prescribing in emergency departments, a study to determine factors physicians report are important in the decision to prescribe opioid analgesics, and a study to determine the effect of patient race and desirable social characteristics on physicians` decision-making.

The study team established that racial/ethnic disparities exist in the prescription of opioid analgesics in the emergency department, but that these disparities are likely the result of differences in patient-provider communication that differ systematically by patient race/ethnicity. This contrasts with the long-held but unproven notion that physicians are racially/ethnically biased in their treatment decisions based only on patient race/ethnicity. "This study finally begins to open up the black-box of racial/ethnic disparities," notes Mr. Tamayo-Sarver, "and builds are understanding of how, and under what context, the disparities arise. With this understanding, targeted interventions to address the problem can finally be developed."

AHRQ-supported HSR Student Accomplishments: 1998-2002.
As part of CWRU`s application to renew it`s HSR training program, we were pleased to assemble this impressive list of our trainees` publications, presentations, and awards! Link.

The 2003 list of students in the dual degree MD-PhD program in Medicine & Health Services Research (offered at the Case Western Reserve University School of Medicine).

Study Examines Web Sites That Sold Anthrax Treatment
Web sites selling the prescription-only medication ciprofloxacin (also known by its brand name Cipro) sprang up quickly following an anthrax outbreak in October 2001, according to a new study by researchers from the CWRU School of Medicine, namely Alexander Tsai, a fourth-year medical student. See similar articles in The Plain Dealer and the CWRU Magazine.

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