Mark Carrozza - Academia.edu (original) (raw)

Papers by Mark Carrozza

Research paper thumbnail of Exploring Environmental, Patient, and Workforce Factors Influencing Health Center Early Access to Prenatal Care

Context: The Health Resources and Services Administration (HRSA) Health Center Program plays an i... more Context: The Health Resources and Services Administration (HRSA) Health Center Program plays an important role in providing prenatal care in the U.S., serving more than 560,000 primarily low-income women in 2021. Access to early prenatal care, particularly for low-income and racial and ethnic minority women, is affected by a complex set of interrelated factors, including geographic context, rurality, and the maternity care workforce. Objective: This research explores environmental, patient, and workforce factors influencing health center early access to prenatal care and assesses if the relationship between these factors and early access to prenatal care vary by health center rural status. Study Design: In this cross-sectional analysis, we create health center service area measures as proxies for geographic context and use spatial regression techniques. Population Studied: HRSA Health Center Program Awardees and Look-Alikes. Outcome Measure: Early access to prenatal care. Results: We find significant differences in early prenatal care by health center rural status. The results also show that factors at multiple levels significantly influence health center early prenatal care, including service area (social deprivation and usual source of care), patient (the percentage of black patients and the percentage of patients best served in non-English language), organizational (the percentage of virtual visits and prenatal care referral status), and workforce (the number of family physician FTEs). However, the results show that some of these factors vary in influence depending on the rural status of health centers. Conclusions: These findings suggest that geographic context and rural status are important factors contributing to health center access to early prenatal care. Specifically, rural health centers with higher numbers of family physician FTEs and lower percentages of patients best served in non-English have higher rates of early prenatal care, while urban health centers with higher rates of virtual visits have higher rates of early prenatal care. Health center interventions to improve access to prenatal care should be tailored interventions based on their rural status and multi-level factors including patient, organizational, and service area characteristics.

Research paper thumbnail of Factors Influencing Preventable Hospitalizations vary by Geographic Region

Context: Several studies have documented that multiple factors that contribute, including geograp... more Context: Several studies have documented that multiple factors that contribute, including geography, to preventable hospitalizations. Other studies identified preventable hospitalization hot spots in the Appalachia and Mississippi Delta regions. Objective: To determine if factors associated with preventable hospitalizations are different in the Appalachia and Delta regions (compared to the rest of the US). Study Design and Analysis: Cross sectional approach included hot spot mapping and spatial regime modeling. First, we modeled preventable hospitalizations with hierarchical condition category [HCC] risk scores, social deprivation index [SDI], rurality, hospital beds per 100,000, primary care physicians (PCP) per 100,000, and the percentage of black Medicare beneficiaries as independent variables. We also included a spatial regime variable, which models Appalachia and Delta regions separately, and a Chow test to determine if coefficients for models are significantly different. Setting/Dataset: Centers for Medicare and Medicaid (CMS) public use file (PUF), Robert Wood Johnson County Health Rankings, Robert Graham Center (SDI); US Counties (n=3,141). Outcome Measures: Preventable Hospitalizations (rates of hospital stays for ambulatory-sensitive conditions per 100,000 Medicare enrollees). Results: The model performed better for non-Appalachia/Delta counties (r2 = .33) compared to the Delta (r2 = .17) and Appalachia (r2 = .30) models. All independent variables were significant (and in the expected direction) in the non-Appalachia/Delta model, while only three were significant in the Delta and Appalachia models (SDI, hospital beds, HCC). Chow test revealed that coefficients varied significantly across the models for all independent variables except SDI and PCP rates. Conclusions: Consistent with previous literature, we find that the factors associated with preventable hospitalizations vary by region. Indeed, capturing the effects of hospital capacity, social deprivation, and population illness burden on rates of ACSC admissions is robust across diverse population segments, and point to challenges in characterizing those in regions such as the Delta and Appalachia.

Research paper thumbnail of The development and implementation of quality assurance programs to support nutritional measurements

Analytical and Bioanalytical Chemistry, 2013

The National Institute of Standards and Technology administers quality assurance programs devoted... more The National Institute of Standards and Technology administers quality assurance programs devoted to improving measurements of nutrients and related metabolites in foods, dietary supplements, and serum and plasma samples. These programs have been developed in collaboration with the National Institutes of Health to assist measurement communities in their efforts to achieve accurate results that are comparable among different laboratories and over time. Targeted analytes include micronutrients, botanical markers, nutritional elements, contaminants, fatty acids, and vitamin D metabolites.

Research paper thumbnail of Creating a National Scorecard on Primary Care – Implementing the NASEM Report

Economic or policy analysis

Research paper thumbnail of Targeting High-Need, High-Minority Geographies for Behavioral Health

Behavioral, psychosocial, and mental illness

Research paper thumbnail of Spatial Social Polarization and Access to Mental Health Services

Research paper thumbnail of Exploring Health Center Geographic Variation of Flu Vaccination Coverage & the Impact of COVID-19

Screening, prevention, and health promotion

Research paper thumbnail of Using Mapping to Identify Priority Areas for Combating the Opioid Epidemic in the State of Virginia

Behavioral, psychosocial, and mental illness

Research paper thumbnail of Calling Your Aunt Bertha for Social Assets: Family Medicine and Social Determinants of Health

Journal of Primary Care & Community Health

Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the Un... more Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the United States. Primary care practices are, increasingly, expected by payers and policy makers to assess patients’ social needs. Resource referral platforms provide physicians with information and referral systems for community resources. One commonly used platform is Aunt Bertha/Find Help (AB/FH). The American Academy of Family Physicians (AAFP) Neighborhood Navigator (NN) tool allows physicians and laypeople to search for resources using AB/FH. We sought to describe what users were searching for and to identify patterns to inform resource allocation. Methods: This was a descriptive study of the AAFP’s NN tool. Searches of NN were analyzed to describe what users were searching for. Results: From 2018 to April 2022 there were 168 135 searches. The most common searches were for food and housing insecurity (22%, 21%) and health care referral (20.6%) with 22% more searches in the winter than t...

Research paper thumbnail of The Global Access to Data Resources: Where's the Metadata?

IASSIST Quarterly, 1998

The Global Access to Data Resources: Where's the Metadata?

Research paper thumbnail of Congruence of Patient Self-Rating of Health with Family Physician Ratings

Journal of the American Board of Family Medicine : JABFM

A single self-rated health (SRH) question is associated with health outcomes, but agreement betwe... more A single self-rated health (SRH) question is associated with health outcomes, but agreement between SRH and physician-rated patient health (PRPH) has been poorly studied. We studied patient and physician reasoning for health ratings and the role played by patient lifestyle and objective health measures in the congruence between SRH and PRPH. Surveys of established family medicine patients and their physicians, and medical record review at 4 offices. Patients and physicians rated patient health on a 5-point scale and gave reasons for the rating and suggestions for improving health. Patients' and physicians' reasons for ratings and improvement suggestions were coded into taxonomies developed from the data. Bivariate relationships between the variables and the difference between SRH and PRPH were examined and all single predictors of the difference were entered into a multivariable regression model. Surveys were completed by 506 patients and 33 physicians. SRH and PRPH ratings ...

Research paper thumbnail of Home Alone: The Impact of Maternal Employment on Delinquency

Social Problems, 2001

Recently, conservative commentators and parenting experts have been outspoken about the potential... more Recently, conservative commentators and parenting experts have been outspoken about the potential nega-tive effects of maternal employment. Specifically, there appears to be a pervasive belief that delinquency is one unfortunate consequence of maternal work. Using data ...

Research paper thumbnail of Does Financial Self-Efficacy Explain Gender Differences in Retirement Saving Strategies?

Journal of Women & Aging, 2003

Research indicates that women remain less financially prepared for retirement than are men. Littl... more Research indicates that women remain less financially prepared for retirement than are men. Little research has examined the gender difference in use of retirement plans. The present research assessed the gender difference in use of employer-sponsored and private retirement plans, and sought to account for this difference. Social status and human capital factors, occupation and industry of employment, and sense of financial self-efficacy were expected to account for gender differences. Findings indicated gender has no relationship with use of private retirement plans. However, females were found to be less likely to use an employer-sponsored plan, and this was largely accounted for by gender differences in occupation.

Research paper thumbnail of A test of Palmore's Facts on Aging Quizzes as alternate measures

Journal of Aging Studies, 2002

Research paper thumbnail of Toward a Better Way to Measure Customer Satisfaction Levels in Public Housing: A Report from Cincinnati

Housing Studies, 2000

... A 1991 Newcastle, England study approximated the experimental ideal by compar-ing survey resu... more ... A 1991 Newcastle, England study approximated the experimental ideal by compar-ing survey results for one area where a post-repairs inspection ... Davis & Denton (1987, p. 2) note that customersatisfaction surveys can play an important public relations role in that they can ...

Research paper thumbnail of GIS, Data Democratization, and Public Health

• The web portal uses a combination of state, county, and census tract data to provide social, be... more • The web portal uses a combination of state, county, and census tract data to provide social, behavioral, and economic context for detailed local area data such as state and communitylevel health survey data, birth and death certificates, and the location of ...

Research paper thumbnail of Family Physicians Are Using Neighborhood Navigator to Address Social Determinants of Health

American Family Physician, 2023

Research paper thumbnail of Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia

The Annals of Family Medicine

Research paper thumbnail of Identifying health centers in areas with low COVID-19 vaccination rates & high rates of vaccine hesitancy

COVID-19

Context: Large numbers of US adults are vaccinated, but COVID-19 vaccine hesitancy remains high. ... more Context: Large numbers of US adults are vaccinated, but COVID-19 vaccine hesitancy remains high. Health centers funded by the Health Resources and Services Administration (HRSA) have played a major role in COVID-19 vaccinations and have the potential to vaccinate even larger numbers of people. Objective: To identify U.S. counties with low COVID-19 vaccination rates and high rates of vaccine hesitancy, explore the characteristics of these counties and health center presence in these areas, and identify priority health centers for targeted vaccine outreach. Study Design: Cross-sectional geospatial analysis of county-level COVID-19 vaccination rates and COVID-19 vaccination hesitancy. Bivariate Local Moran's I using GeoDa software to identify clusters of counties with low COVID-19 vaccination rates and high rates of COVID-19 vaccine hesitancy. Geographic Information Systems (GIS) mapping to overlay health centers with county-level data.

Research paper thumbnail of ORIGINAL RESEARCH Using Geographic Information Systems (GIS) to Identify Communities in Need of Health Insurance

Background: Our. practice-based research network (PBRN) is conducting an outreach intervention to... more Background: Our. practice-based research network (PBRN) is conducting an outreach intervention to increase health insurance coverage for patients seen in the network. To assist with outreach site selec-tion, we sought an understandable way to use electronic health record (EHR) data to locate uninsured patients. Methods: Health insurance information was displayed within a web-based mapping platform to dem-onstrate the feasibility of using geographic information systems (GIS) to visualize EHR data. This study used EHR data from 52 clinics in the OCHIN PBRN. We included cross-sectional coverage data for pa-tients aged 0 to 64 years with at least 1 visit to a study clinic during 2011 (n 228,284). Results: Our PBRN was successful in using GIS to identify intervention sites. Through use of the maps, we found geographic variation in insurance rates of patients seeking care in OCHIN PBRN clinics. Insurance rates also varied by age: The percentage of adults without insurance ranged from 13.2...

Research paper thumbnail of Exploring Environmental, Patient, and Workforce Factors Influencing Health Center Early Access to Prenatal Care

Context: The Health Resources and Services Administration (HRSA) Health Center Program plays an i... more Context: The Health Resources and Services Administration (HRSA) Health Center Program plays an important role in providing prenatal care in the U.S., serving more than 560,000 primarily low-income women in 2021. Access to early prenatal care, particularly for low-income and racial and ethnic minority women, is affected by a complex set of interrelated factors, including geographic context, rurality, and the maternity care workforce. Objective: This research explores environmental, patient, and workforce factors influencing health center early access to prenatal care and assesses if the relationship between these factors and early access to prenatal care vary by health center rural status. Study Design: In this cross-sectional analysis, we create health center service area measures as proxies for geographic context and use spatial regression techniques. Population Studied: HRSA Health Center Program Awardees and Look-Alikes. Outcome Measure: Early access to prenatal care. Results: We find significant differences in early prenatal care by health center rural status. The results also show that factors at multiple levels significantly influence health center early prenatal care, including service area (social deprivation and usual source of care), patient (the percentage of black patients and the percentage of patients best served in non-English language), organizational (the percentage of virtual visits and prenatal care referral status), and workforce (the number of family physician FTEs). However, the results show that some of these factors vary in influence depending on the rural status of health centers. Conclusions: These findings suggest that geographic context and rural status are important factors contributing to health center access to early prenatal care. Specifically, rural health centers with higher numbers of family physician FTEs and lower percentages of patients best served in non-English have higher rates of early prenatal care, while urban health centers with higher rates of virtual visits have higher rates of early prenatal care. Health center interventions to improve access to prenatal care should be tailored interventions based on their rural status and multi-level factors including patient, organizational, and service area characteristics.

Research paper thumbnail of Factors Influencing Preventable Hospitalizations vary by Geographic Region

Context: Several studies have documented that multiple factors that contribute, including geograp... more Context: Several studies have documented that multiple factors that contribute, including geography, to preventable hospitalizations. Other studies identified preventable hospitalization hot spots in the Appalachia and Mississippi Delta regions. Objective: To determine if factors associated with preventable hospitalizations are different in the Appalachia and Delta regions (compared to the rest of the US). Study Design and Analysis: Cross sectional approach included hot spot mapping and spatial regime modeling. First, we modeled preventable hospitalizations with hierarchical condition category [HCC] risk scores, social deprivation index [SDI], rurality, hospital beds per 100,000, primary care physicians (PCP) per 100,000, and the percentage of black Medicare beneficiaries as independent variables. We also included a spatial regime variable, which models Appalachia and Delta regions separately, and a Chow test to determine if coefficients for models are significantly different. Setting/Dataset: Centers for Medicare and Medicaid (CMS) public use file (PUF), Robert Wood Johnson County Health Rankings, Robert Graham Center (SDI); US Counties (n=3,141). Outcome Measures: Preventable Hospitalizations (rates of hospital stays for ambulatory-sensitive conditions per 100,000 Medicare enrollees). Results: The model performed better for non-Appalachia/Delta counties (r2 = .33) compared to the Delta (r2 = .17) and Appalachia (r2 = .30) models. All independent variables were significant (and in the expected direction) in the non-Appalachia/Delta model, while only three were significant in the Delta and Appalachia models (SDI, hospital beds, HCC). Chow test revealed that coefficients varied significantly across the models for all independent variables except SDI and PCP rates. Conclusions: Consistent with previous literature, we find that the factors associated with preventable hospitalizations vary by region. Indeed, capturing the effects of hospital capacity, social deprivation, and population illness burden on rates of ACSC admissions is robust across diverse population segments, and point to challenges in characterizing those in regions such as the Delta and Appalachia.

Research paper thumbnail of The development and implementation of quality assurance programs to support nutritional measurements

Analytical and Bioanalytical Chemistry, 2013

The National Institute of Standards and Technology administers quality assurance programs devoted... more The National Institute of Standards and Technology administers quality assurance programs devoted to improving measurements of nutrients and related metabolites in foods, dietary supplements, and serum and plasma samples. These programs have been developed in collaboration with the National Institutes of Health to assist measurement communities in their efforts to achieve accurate results that are comparable among different laboratories and over time. Targeted analytes include micronutrients, botanical markers, nutritional elements, contaminants, fatty acids, and vitamin D metabolites.

Research paper thumbnail of Creating a National Scorecard on Primary Care – Implementing the NASEM Report

Economic or policy analysis

Research paper thumbnail of Targeting High-Need, High-Minority Geographies for Behavioral Health

Behavioral, psychosocial, and mental illness

Research paper thumbnail of Spatial Social Polarization and Access to Mental Health Services

Research paper thumbnail of Exploring Health Center Geographic Variation of Flu Vaccination Coverage & the Impact of COVID-19

Screening, prevention, and health promotion

Research paper thumbnail of Using Mapping to Identify Priority Areas for Combating the Opioid Epidemic in the State of Virginia

Behavioral, psychosocial, and mental illness

Research paper thumbnail of Calling Your Aunt Bertha for Social Assets: Family Medicine and Social Determinants of Health

Journal of Primary Care & Community Health

Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the Un... more Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the United States. Primary care practices are, increasingly, expected by payers and policy makers to assess patients’ social needs. Resource referral platforms provide physicians with information and referral systems for community resources. One commonly used platform is Aunt Bertha/Find Help (AB/FH). The American Academy of Family Physicians (AAFP) Neighborhood Navigator (NN) tool allows physicians and laypeople to search for resources using AB/FH. We sought to describe what users were searching for and to identify patterns to inform resource allocation. Methods: This was a descriptive study of the AAFP’s NN tool. Searches of NN were analyzed to describe what users were searching for. Results: From 2018 to April 2022 there were 168 135 searches. The most common searches were for food and housing insecurity (22%, 21%) and health care referral (20.6%) with 22% more searches in the winter than t...

Research paper thumbnail of The Global Access to Data Resources: Where's the Metadata?

IASSIST Quarterly, 1998

The Global Access to Data Resources: Where's the Metadata?

Research paper thumbnail of Congruence of Patient Self-Rating of Health with Family Physician Ratings

Journal of the American Board of Family Medicine : JABFM

A single self-rated health (SRH) question is associated with health outcomes, but agreement betwe... more A single self-rated health (SRH) question is associated with health outcomes, but agreement between SRH and physician-rated patient health (PRPH) has been poorly studied. We studied patient and physician reasoning for health ratings and the role played by patient lifestyle and objective health measures in the congruence between SRH and PRPH. Surveys of established family medicine patients and their physicians, and medical record review at 4 offices. Patients and physicians rated patient health on a 5-point scale and gave reasons for the rating and suggestions for improving health. Patients' and physicians' reasons for ratings and improvement suggestions were coded into taxonomies developed from the data. Bivariate relationships between the variables and the difference between SRH and PRPH were examined and all single predictors of the difference were entered into a multivariable regression model. Surveys were completed by 506 patients and 33 physicians. SRH and PRPH ratings ...

Research paper thumbnail of Home Alone: The Impact of Maternal Employment on Delinquency

Social Problems, 2001

Recently, conservative commentators and parenting experts have been outspoken about the potential... more Recently, conservative commentators and parenting experts have been outspoken about the potential nega-tive effects of maternal employment. Specifically, there appears to be a pervasive belief that delinquency is one unfortunate consequence of maternal work. Using data ...

Research paper thumbnail of Does Financial Self-Efficacy Explain Gender Differences in Retirement Saving Strategies?

Journal of Women & Aging, 2003

Research indicates that women remain less financially prepared for retirement than are men. Littl... more Research indicates that women remain less financially prepared for retirement than are men. Little research has examined the gender difference in use of retirement plans. The present research assessed the gender difference in use of employer-sponsored and private retirement plans, and sought to account for this difference. Social status and human capital factors, occupation and industry of employment, and sense of financial self-efficacy were expected to account for gender differences. Findings indicated gender has no relationship with use of private retirement plans. However, females were found to be less likely to use an employer-sponsored plan, and this was largely accounted for by gender differences in occupation.

Research paper thumbnail of A test of Palmore's Facts on Aging Quizzes as alternate measures

Journal of Aging Studies, 2002

Research paper thumbnail of Toward a Better Way to Measure Customer Satisfaction Levels in Public Housing: A Report from Cincinnati

Housing Studies, 2000

... A 1991 Newcastle, England study approximated the experimental ideal by compar-ing survey resu... more ... A 1991 Newcastle, England study approximated the experimental ideal by compar-ing survey results for one area where a post-repairs inspection ... Davis & Denton (1987, p. 2) note that customersatisfaction surveys can play an important public relations role in that they can ...

Research paper thumbnail of GIS, Data Democratization, and Public Health

• The web portal uses a combination of state, county, and census tract data to provide social, be... more • The web portal uses a combination of state, county, and census tract data to provide social, behavioral, and economic context for detailed local area data such as state and communitylevel health survey data, birth and death certificates, and the location of ...

Research paper thumbnail of Family Physicians Are Using Neighborhood Navigator to Address Social Determinants of Health

American Family Physician, 2023

Research paper thumbnail of Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia

The Annals of Family Medicine

Research paper thumbnail of Identifying health centers in areas with low COVID-19 vaccination rates & high rates of vaccine hesitancy

COVID-19

Context: Large numbers of US adults are vaccinated, but COVID-19 vaccine hesitancy remains high. ... more Context: Large numbers of US adults are vaccinated, but COVID-19 vaccine hesitancy remains high. Health centers funded by the Health Resources and Services Administration (HRSA) have played a major role in COVID-19 vaccinations and have the potential to vaccinate even larger numbers of people. Objective: To identify U.S. counties with low COVID-19 vaccination rates and high rates of vaccine hesitancy, explore the characteristics of these counties and health center presence in these areas, and identify priority health centers for targeted vaccine outreach. Study Design: Cross-sectional geospatial analysis of county-level COVID-19 vaccination rates and COVID-19 vaccination hesitancy. Bivariate Local Moran's I using GeoDa software to identify clusters of counties with low COVID-19 vaccination rates and high rates of COVID-19 vaccine hesitancy. Geographic Information Systems (GIS) mapping to overlay health centers with county-level data.

Research paper thumbnail of ORIGINAL RESEARCH Using Geographic Information Systems (GIS) to Identify Communities in Need of Health Insurance

Background: Our. practice-based research network (PBRN) is conducting an outreach intervention to... more Background: Our. practice-based research network (PBRN) is conducting an outreach intervention to increase health insurance coverage for patients seen in the network. To assist with outreach site selec-tion, we sought an understandable way to use electronic health record (EHR) data to locate uninsured patients. Methods: Health insurance information was displayed within a web-based mapping platform to dem-onstrate the feasibility of using geographic information systems (GIS) to visualize EHR data. This study used EHR data from 52 clinics in the OCHIN PBRN. We included cross-sectional coverage data for pa-tients aged 0 to 64 years with at least 1 visit to a study clinic during 2011 (n 228,284). Results: Our PBRN was successful in using GIS to identify intervention sites. Through use of the maps, we found geographic variation in insurance rates of patients seeking care in OCHIN PBRN clinics. Insurance rates also varied by age: The percentage of adults without insurance ranged from 13.2...