Christal Ramos - Academia.edu (original) (raw)

Papers by Christal Ramos

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from South Carolina’s... more This brief highlights the major strategies, lessons learned, and outcomes from South Carolina’s experience during the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from North Carolina&#39... more This brief highlights the major strategies, lessons learned, and outcomes from North Carolina's experience in the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from Oregon’s experie... more This brief highlights the major strategies, lessons learned, and outcomes from Oregon’s experience during the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from North Carolina&#39... more This brief highlights the major strategies, lessons learned, and outcomes from North Carolina's experience in the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from Florida’s experi... more This brief highlights the major strategies, lessons learned, and outcomes from Florida’s experience during the first 5 years of the quality demonstration funded by the Centers for Medicare Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from South Carolina’s... more This brief highlights the major strategies, lessons learned, and outcomes from South Carolina’s experience during the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Health Affairs, 2021

States' decisions to expand Medicaid may have important implications for their hospitals'... more States' decisions to expand Medicaid may have important implications for their hospitals' financial ability to weather the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the effects of the Affordable Care Act (ACA) Medicaid expansion on hospital finances in 2017 to update earlier findings. The analysis also explored how the ACA Medicaid expansion affects different types of hospitals by size, ownership, rurality, and safety-net status. We found that the early positive financial impact of Medicaid expansion was sustained in fiscal years 2016 and 2017 as hospitals in expansion states continued to experience decreased uncompensated care costs and increased Medicaid revenue and financial margins. The magnitude of these impacts varied by hospital type. As COVID-19 has brought hospitals to a time of great need, findings from this study provide important information on what hospitals in states that have yet to expand Medicaid could gain through expansion and what is at risk should any reversal of Medicaid expansions occur.

Journal of Racial and Ethnic Health Disparities, 2019

Though they have comparable prevalence of mental illness, American racial and ethnic minorities a... more Though they have comparable prevalence of mental illness, American racial and ethnic minorities are less likely to receive mental health services than white Americans. Minorities are often part of racial and ethnic social networks, which may affect mental health service utilization in two ways. While these networks can encourage service utilization by working as a channel of knowledge spillover and social support, they can also discourage utilization by stigmatizing mental illness. This study examined the association of racial and ethnic social networks with mental health service utilization and depression diagnosis in the USA. Using the 2012 Behavioral Risk Factor Surveillance System (BRFSS) data, a multilevel mixed-effect generalized linear model was adopted, controlling for predisposing, need, and enabling factors of mental health service utilization. The association of racial and ethnic social networks with mental health service utilization and depression diagnosis was significant and negative among African Americans. Despite having a comparable number of bad mental health days, the association was insignificant among Hispanic, Asian, and non-Hispanic white respondents. An African American living in a county where all residents were African American was less likely to utilize mental health services by 84.3-86.8% and less likely to be diagnosed with depression by 76.0-84.8% than an African American living in a county where no residents were African American. These results suggest racial and ethnic social networks can discourage mental health service utilization and should be engaged in efforts to improve mental health, particularly among African American communities in the USA.

Medical care research and review : MCRR, Jun 1, 2016

Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White patients. Th... more Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White patients. The purpose of this study was to identify factors that drive this disparity at the system, provider, and patient levels. A mixed methods study combined descriptive analysis of 2007 Medicare claims data and thematic analysis of 19 clinician interviews, 8 minority patient focus groups and 8 one-on-one interviews with minority heart patients across three communities. The disparity between White and non-White CR use ranged from 7 to 11 percentage points among study sites (p < .05). Key themes suggest disparities are driven by (a) flawed financing and reimbursement that creates disincentives to invest in CR programs, (b) a health care system whose priorities are misaligned with the needs of patients, and (c) subjective decision-making around referral processes. These findings suggest that the health care system needs to address multiple levels of problems to mitigate disparities in CR use.

Despite the potential benefits, health care providers were initially slow to adopt electronic hea... more Despite the potential benefits, health care providers were initially slow to adopt electronic health records (EHRs). To promote the widespread adoption and use of health IT, Congress passed The Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act of 2009, with the ultimate aim of improving quality, safety, and efficiency of the U.S. health care system. These provisions includes incentive payment programs and technical assistance for eligible health professionals and hospitals to adopt, implement, or upgrade certified electronic health records (EHRs) and to achieve the Meaningful Use (MU) of health information technology (IT). 1,2 To achieve the ultimate aims of HITECH, health care organizations must not only successfully implement but also optimally and meaningfully use EHRs, a process that involves significant investment, technical complexity, changes in workflow, and numerous other challenges. The purpose of this literature review is to provide examples of how organizations are implementing and optimizing EHRs, and summarize "lessons learned" from peer-reviewed publications and the gray literature. Common Themes and Lessons Learned This paper is organized around different stages of the EHR implementation process (planning and vendor selection, workflow and software design, training and user support, and optimization and modification) and explores each stage through multiple perspectives (organizational, professional, and technical perspectives). Planning and Vendor Selection The literature suggests the planning stage of EHR implementation is critical to whether or not implementation will ultimately be successful. Selection of systems that will best meet the organization's needs, obtaining staff buy-in, defining the implementation strategy, and determining the pace at which implementation will occur are key issues during this stage. The literature suggests that from the start, it is important for organizations to consider their technical needs, the perspectives of staff from all levels of the organization, and the organizational culture and environment in which the system will be implemented. In addition to relationships with vendors and consultants, partnerships with external stakeholders are also important in order to share and exchange patient information. 3 Smaller organizations with fewer resources have also entered into networks or partnerships to "piggy back" off a larger organization's system. However, some smaller organizations have found the systems of larger hospitals to be too complex for their needs.

Background: In light of increasing diversity in the patient population, the purpose of this analy... more Background: In light of increasing diversity in the patient population, the purpose of this analysis is to examine hospital use of bilingual nurses to care for patients with language needs. Methods: The primary datasource was 899 completed telephone surveys of hospital human resources directors fielded in 2008, representing nearly 20 percent of hospitals in the U.S., with supporting data from interviews with provider associations. The nationwide sample was adjusted by ownership, teaching status, urban/rural market, and geography to reflect the national hospital industry. Using descriptive statistics, we examined how many hospitals train staff to access language services, the requirement of this training for nurses compared to other staff, and collection of information on nurses' language abilities. Results: The majority of hospitals require language services training for some staff (69 percent of the 83 percent offering training). Training was most frequently mandatory for nurse...

Journal of the American Academy of Physician Assistants, 2012

Journal of the American Academy of Physician Assistants, 2014

Patient Education and Counseling, 2010

This paper identifies common obstacles impeding effective self-management among patients with hea... more This paper identifies common obstacles impeding effective self-management among patients with heart disease and explores how for disadvantaged patients access barriers interfere with typical management challenges to undermine patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; efforts to care for their illnesses. We convened 33 focus group discussions with heart patients in 10 U.S. communities. Using content analysis, we identified and grouped the most common barriers that emerged in focus group discussions. We identified nine major themes reflecting issues related to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ability to care for and manage their heart conditions. We grouped the themes into three domains of interest: (1) barriers that interfere with getting necessary services, (2) barriers that impede the monitoring and management of a heart condition on a daily basis, and (3) supports that enable self-management and improve care. For disadvantaged populations, typical problems associated with self-management of a heart condition are aggravated by substantial obstacles to accessing care. Ensuring disadvantaged patients with chronic heart conditions are linked to formal systems of care, such as cardiac rehabilitation programs, could better develop patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; self-management skills, reduce barriers to receiving care and improve the overall health outcomes of these patients.

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from South Carolina’s... more This brief highlights the major strategies, lessons learned, and outcomes from South Carolina’s experience during the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from North Carolina&#39... more This brief highlights the major strategies, lessons learned, and outcomes from North Carolina's experience in the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from Oregon’s experie... more This brief highlights the major strategies, lessons learned, and outcomes from Oregon’s experience during the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from North Carolina&#39... more This brief highlights the major strategies, lessons learned, and outcomes from North Carolina's experience in the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from Florida’s experi... more This brief highlights the major strategies, lessons learned, and outcomes from Florida’s experience during the first 5 years of the quality demonstration funded by the Centers for Medicare Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Mathematica Policy Research Reports, 2015

This brief highlights the major strategies, lessons learned, and outcomes from South Carolina’s... more This brief highlights the major strategies, lessons learned, and outcomes from South Carolina’s experience during the first 5 years of the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Health Affairs, 2021

States' decisions to expand Medicaid may have important implications for their hospitals'... more States' decisions to expand Medicaid may have important implications for their hospitals' financial ability to weather the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the effects of the Affordable Care Act (ACA) Medicaid expansion on hospital finances in 2017 to update earlier findings. The analysis also explored how the ACA Medicaid expansion affects different types of hospitals by size, ownership, rurality, and safety-net status. We found that the early positive financial impact of Medicaid expansion was sustained in fiscal years 2016 and 2017 as hospitals in expansion states continued to experience decreased uncompensated care costs and increased Medicaid revenue and financial margins. The magnitude of these impacts varied by hospital type. As COVID-19 has brought hospitals to a time of great need, findings from this study provide important information on what hospitals in states that have yet to expand Medicaid could gain through expansion and what is at risk should any reversal of Medicaid expansions occur.

Journal of Racial and Ethnic Health Disparities, 2019

Though they have comparable prevalence of mental illness, American racial and ethnic minorities a... more Though they have comparable prevalence of mental illness, American racial and ethnic minorities are less likely to receive mental health services than white Americans. Minorities are often part of racial and ethnic social networks, which may affect mental health service utilization in two ways. While these networks can encourage service utilization by working as a channel of knowledge spillover and social support, they can also discourage utilization by stigmatizing mental illness. This study examined the association of racial and ethnic social networks with mental health service utilization and depression diagnosis in the USA. Using the 2012 Behavioral Risk Factor Surveillance System (BRFSS) data, a multilevel mixed-effect generalized linear model was adopted, controlling for predisposing, need, and enabling factors of mental health service utilization. The association of racial and ethnic social networks with mental health service utilization and depression diagnosis was significant and negative among African Americans. Despite having a comparable number of bad mental health days, the association was insignificant among Hispanic, Asian, and non-Hispanic white respondents. An African American living in a county where all residents were African American was less likely to utilize mental health services by 84.3-86.8% and less likely to be diagnosed with depression by 76.0-84.8% than an African American living in a county where no residents were African American. These results suggest racial and ethnic social networks can discourage mental health service utilization and should be engaged in efforts to improve mental health, particularly among African American communities in the USA.

Medical care research and review : MCRR, Jun 1, 2016

Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White patients. Th... more Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White patients. The purpose of this study was to identify factors that drive this disparity at the system, provider, and patient levels. A mixed methods study combined descriptive analysis of 2007 Medicare claims data and thematic analysis of 19 clinician interviews, 8 minority patient focus groups and 8 one-on-one interviews with minority heart patients across three communities. The disparity between White and non-White CR use ranged from 7 to 11 percentage points among study sites (p < .05). Key themes suggest disparities are driven by (a) flawed financing and reimbursement that creates disincentives to invest in CR programs, (b) a health care system whose priorities are misaligned with the needs of patients, and (c) subjective decision-making around referral processes. These findings suggest that the health care system needs to address multiple levels of problems to mitigate disparities in CR use.

Despite the potential benefits, health care providers were initially slow to adopt electronic hea... more Despite the potential benefits, health care providers were initially slow to adopt electronic health records (EHRs). To promote the widespread adoption and use of health IT, Congress passed The Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act of 2009, with the ultimate aim of improving quality, safety, and efficiency of the U.S. health care system. These provisions includes incentive payment programs and technical assistance for eligible health professionals and hospitals to adopt, implement, or upgrade certified electronic health records (EHRs) and to achieve the Meaningful Use (MU) of health information technology (IT). 1,2 To achieve the ultimate aims of HITECH, health care organizations must not only successfully implement but also optimally and meaningfully use EHRs, a process that involves significant investment, technical complexity, changes in workflow, and numerous other challenges. The purpose of this literature review is to provide examples of how organizations are implementing and optimizing EHRs, and summarize "lessons learned" from peer-reviewed publications and the gray literature. Common Themes and Lessons Learned This paper is organized around different stages of the EHR implementation process (planning and vendor selection, workflow and software design, training and user support, and optimization and modification) and explores each stage through multiple perspectives (organizational, professional, and technical perspectives). Planning and Vendor Selection The literature suggests the planning stage of EHR implementation is critical to whether or not implementation will ultimately be successful. Selection of systems that will best meet the organization's needs, obtaining staff buy-in, defining the implementation strategy, and determining the pace at which implementation will occur are key issues during this stage. The literature suggests that from the start, it is important for organizations to consider their technical needs, the perspectives of staff from all levels of the organization, and the organizational culture and environment in which the system will be implemented. In addition to relationships with vendors and consultants, partnerships with external stakeholders are also important in order to share and exchange patient information. 3 Smaller organizations with fewer resources have also entered into networks or partnerships to "piggy back" off a larger organization's system. However, some smaller organizations have found the systems of larger hospitals to be too complex for their needs.

Background: In light of increasing diversity in the patient population, the purpose of this analy... more Background: In light of increasing diversity in the patient population, the purpose of this analysis is to examine hospital use of bilingual nurses to care for patients with language needs. Methods: The primary datasource was 899 completed telephone surveys of hospital human resources directors fielded in 2008, representing nearly 20 percent of hospitals in the U.S., with supporting data from interviews with provider associations. The nationwide sample was adjusted by ownership, teaching status, urban/rural market, and geography to reflect the national hospital industry. Using descriptive statistics, we examined how many hospitals train staff to access language services, the requirement of this training for nurses compared to other staff, and collection of information on nurses' language abilities. Results: The majority of hospitals require language services training for some staff (69 percent of the 83 percent offering training). Training was most frequently mandatory for nurse...

Journal of the American Academy of Physician Assistants, 2012

Journal of the American Academy of Physician Assistants, 2014

Patient Education and Counseling, 2010

This paper identifies common obstacles impeding effective self-management among patients with hea... more This paper identifies common obstacles impeding effective self-management among patients with heart disease and explores how for disadvantaged patients access barriers interfere with typical management challenges to undermine patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; efforts to care for their illnesses. We convened 33 focus group discussions with heart patients in 10 U.S. communities. Using content analysis, we identified and grouped the most common barriers that emerged in focus group discussions. We identified nine major themes reflecting issues related to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ability to care for and manage their heart conditions. We grouped the themes into three domains of interest: (1) barriers that interfere with getting necessary services, (2) barriers that impede the monitoring and management of a heart condition on a daily basis, and (3) supports that enable self-management and improve care. For disadvantaged populations, typical problems associated with self-management of a heart condition are aggravated by substantial obstacles to accessing care. Ensuring disadvantaged patients with chronic heart conditions are linked to formal systems of care, such as cardiac rehabilitation programs, could better develop patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; self-management skills, reduce barriers to receiving care and improve the overall health outcomes of these patients.