Yvonne Jonk - Academia.edu (original) (raw)

Papers by Yvonne Jonk

Journal of Elder Abuse & Neglect

Background: Critics fear that some Veterans use Department of Veterans Affairs (VA) mental health... more Background: Critics fear that some Veterans use Department of Veterans Affairs (VA) mental health services solely to establish eligibility for posttraumatic stress disorder (PTSD) disability benefits, then drop out of treatment once their claim is approved. Objective: To examine the long-term effects of receiving VA disability benefits for PTSD on health care in the VA system. Methods: Using VA administrative data, we examined the health care utilization of a nationally representative cohort of former PTSD disability claimants. Veterans filed PTSD disability claims between 1994 and 1998. They returned mailed surveys between 1998 and 2000 (Time 1) and between 2004 and 2006 (Time 2). We examined their health care utilization for the 6 months before and after they received their surveys, comparing the health care use of successful claimants (SC+) to unsuccessful claimants (SC-). Results: Of the 3,337 Veterans in the cohort, 3,090 had at least one episode of care at a VA facility during...

Preventing chronic disease, Jan 14, 2017

Children of alcoholic parents are at increased risk for lifetime depression. However, little is k... more Children of alcoholic parents are at increased risk for lifetime depression. However, little is known about how this risk may change in magnitude across age, especially in mid-adulthood and beyond. We used a nationally representative sample (N = 36,057) of US adults from the National Epidemiologic Survey on Alcohol and Related Conditions, wave III. After adjusting for demographic characteristics, we examined the relationship between parental alcoholism and outcomes of 1) major depressive disorder, Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) and 2) DSM-5 persistent depressive disorder. To examine continuous moderation of this relationship across participants' age, we used time-varying effect models. Parental alcoholism was associated in general with a higher risk for both major depressive disorder (odds ratio [OR], 1.98, 95% confidence interval [CI], 1.85-2.11; P < .001) and persistent depressive disorder (OR, 2.28, 95% CI, 2.04-2.55; P < .001)...

... France, Frank Asche, Daniel V. Gordon, Rognvaldur Hannesson. A Dynamic Model of the Food Proc... more ... France, Frank Asche, Daniel V. Gordon, Rognvaldur Hannesson. A Dynamic Model of the Food Processing Sector in the New Market Economies of Central Europe, Robert Lyons, Rachael GoodhueGordon Rausser, Leo Simon. ...

The American Journal of Managed Care, Feb 1, 2005

Objectives: To evaluate the effectiveness of the Veterans Health Administration (VHA) in providin... more Objectives: To evaluate the effectiveness of the Veterans Health Administration (VHA) in providing treatment for tobacco dependence, accomplished by estimating national trends in the number and percent of smokers receiving smoking cessation aids (SCAs) within the VHA, trends in SCA utilization and expenditures, and the impact of lifting restrictions on patient access to SCAs. Study design and methods: All patients receiving an outpatient SCA prescription were identified within the Veterans Affairs (VA) Pharmacy Benefits Management database over a 4-year period- October 1, 1998 (n = 61 968) to September 30, 2002 (n = 76 641). Smoking prevalence was based on data from the VA's 1999 Large Health Survey of Enrollees. A subsample of sites was classified as having restricted access to SCAs if patients were required to attend smoking cessation classes. Changes in annual SCA utilization rates and expenditures by SCA type and restriction status were measured to assess changes in treatment of tobacco dependence. Results: Approximately 7% of smokers received SCA prescriptions, and SCAs accounted for less than 1% of the VHA's annual outpatient pharmacy budget in any given year. Following downward trends in the cost of 30-day SCA prescriptions, annual SCA expenditures per patient decreased over time. Expenditures were lower for restricted than unrestricted sites. More than two thirds of smokers who were prescribed medications received the nicotine patch, a quarter received bupropion sustained-release, and fewer than 10% received nicotine gum. Conclusions: Measures of SCA utilization and cost are low, stable, and less than the recommended rates in national smoking cessation guidelines, suggesting that this population of smokers is undertreated. Removing SCA restrictions is not prohibitively expensive and improves access to cost-effective care.

Evidence Report Technology Assessment, Sep 1, 2006

Evaluate treatment options for nonruptured abdominal aortic aneurysms (AAA); the relationship of ... more Evaluate treatment options for nonruptured abdominal aortic aneurysms (AAA); the relationship of hospital and physician volume to outcomes for endovascular repair (EVAR); affect of patient and AAA factors on outcomes; cost-benefits of treatments. PubMed, Cochrane Library, FDA, and other electronic websites until May 2006. Reference lists and content experts were used to identify additional reports. Randomized controlled trials (RCT) of open surgical repair (OSR), EVAR, or active surveillance, systematic reviews, nonrandomized U.S. trials, and national registries were used to assess clinical outcomes. Volume-outcome articles published after 2000 were reviewed if they reported the relationship between U.S. hospital or physician volume and outcomes, were population-based, and the analysis was adjusted for risk factors. Cost studies included at least 50 EVAR and provided data on costs or charges, and cost-effectiveness analyses. Initial or attained diameter is the strongest known predictor of rupture. The annual risk of rupture is below 1 percent for AAA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5.5 cm in diameter. Among medically ill patients unfit for OSR with AAA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=5.5 cm, the risk of rupture may be as high as 10 percent per year. Early/immediate OSR of AAA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5.5 cm (two trials n=2,226) did not reduce all-cause mortality compared with surveillance and delayed OSR. Results did not differ according to age, gender, baseline AAA diameter or creatinine concentration. Two RCT with followup of at least 2 years compared EVAR to OSR for AAA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=5.5 cm. EVAR reduced postoperative 30-day mortality compared to OSR (1.6 percent EVAR vs. 4.7 percent OSR, RR = 0.34 [0.17 to 0.65]). Early reduction in all-cause mortality with EVAR disappeared before 2 years. Post-operative complications and reinterventions were higher with EVAR. Quality of life differences were small and disappeared after 3-6 months. One RCT of patients with AAA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=5.5 cm judged medically unfit for OSR (n=338), reported no difference in all-cause mortality or AAA mortality between EVAR and no intervention (HR = 1.21; 95 percent CI 0.87 to 1.69). Forty-eight nonrandomized reports evaluated EVAR. Patient, AAA characteristics, and outcomes were similar to RCT comparing EVAR to OSR. A volume outcome relationship has been shown for OSR, but there are no data adequate to estimate the effect of hospital or physician volume on EVAR outcomes…

The feasibility of teaching intermediate microeconomics as a web-based course to non-economics ma... more The feasibility of teaching intermediate microeconomics as a web-based course to non-economics majors and the integration of several instructional technologies are presented. The lack of face to face interaction with the professor discourages undergraduate students from learning and appreciating economic theory, and may dissuade students from exploring the field.

ConsumersÃ‚Â’ concerns about food attributes related to health, safety and nutrition were ascerta... more ConsumersÃ‚Â’ concerns about food attributes related to health, safety and nutrition were ascertained by way of a mailed survey in the metropolitan area of St. Paul/Minneapolis, Minnesota, in 1993. An ordered probit analysis was conducted to determine how these concerns correlated with eating habits - specifically increasing, decreasing or making no change in the consumption of various types of meats. Those who had decreased their beef consumption were concerned about their intake of sodium, fat and cholesterol. They also preferred a variety of foods and tended to be older and better educated. Taste, appearance and guaranteed safety ranked high on a list of food attributes consumers preferred.

The purpose of this consumer survey was to learn more about consumer preferences for meat charact... more The purpose of this consumer survey was to learn more about consumer preferences for meat characteristics. Value added meat processors faced with the problem of trying to identify market niches wanted to know what types of consumers had similar preferences and what their specific preferences and concerns are. In addition, we wanted to learn more about attitudes that are believed to be changing due to new information about the relationship between diet and long term health, lifestyles that demand more convenient foods and less home cooking, the environmental impacts of cattle production, and social issues such as animal rights.

Evidence report/technology assessment, 2006

The American journal of managed care, 2005

To evaluate the effectiveness of the Veterans Health Administration (VHA) in providing treatment ... more To evaluate the effectiveness of the Veterans Health Administration (VHA) in providing treatment for tobacco dependence, accomplished by estimating national trends in the number and percent of smokers receiving smoking cessation aids (SCAs) within the VHA, trends in SCA utilization and expenditures, and the impact of lifting restrictions on patient access to SCAs. All patients receiving an outpatient SCA prescription were identified within the Veterans Affairs (VA) Pharmacy Benefits Management database over a 4-year period- October 1, 1998 (n = 61 968) to September 30, 2002 (n = 76 641). Smoking prevalence was based on data from the VA's 1999 Large Health Survey of Enrollees. A subsample of sites was classified as having restricted access to SCAs if patients were required to attend smoking cessation classes. Changes in annual SCA utilization rates and expenditures by SCA type and restriction status were measured to assess changes in treatment of tobacco dependence. Approximately...

Medical care, 2015

Health coaching interventions aim to identify high-risk enrollees and encourage them to play a mo... more Health coaching interventions aim to identify high-risk enrollees and encourage them to play a more proactive role in improving their health, improve their ability to navigate the health care system, and reduce costs. Evaluate the effect of health coaching on inpatient, emergency room, outpatient, and prescription drug expenditures. Quasiexperimental pre-post design. Health coaching participants were identified over the 2-year time period 2009-2010. Propensity scores facilitated matching eligible participants and nonparticipating controls on a one-to-one basis using nearest kernel techniques. Difference in differences logistic and generalized linear models addressed the impact of health coaching on the probability of incurring costs and levels of inpatient, emergency room, outpatient, and prescription drug expenditures, respectively. Administrative claims data were used to analyze health services expenditures preparticipation and post health coaching participation time periods. Of t...

Global Advances in Health and Medicine, 2013

Medical Care, 2005

ABSTRACT Objectives: The primary objective of this study was to examine veterans' relianc... more ABSTRACT Objectives: The primary objective of this study was to examine veterans' reliance on health care services provided by the Veterans Health Administration (VHA) within Minnesota and estimate the potential effect on uninsurance rates if all eligible veterans relied on VHA coverage. Secondary objectives were to compare veterans and nonveterans' by geographic location, demographic characteristics, health status, and health insurance coverage and to compare insured and uninsured veterans especially with regard to access to care. Research Design: Data are from the 2001 Minnesota Health Access Survey of a stratified random sample of more than 27,000 respondents, of whom 3,500 were self-identified veterans. Although all veterans were eligible to obtain health care services from the VHA in 2001, veterans not reporting VHA coverage and having no other source of insurance coverage were considered uninsured. Differences in weighted population characteristics are reported. Logistic regression analysis is used to identify factors associated with veterans' reliance on VHA coverage. Results: Veterans represented 13.4% of the state's adult population and 9.3% of the state's uninsured nonelderly adult population in 2001. Uninsured veterans were more likely to be single, unemployed, living in rural areas, and reporting constrained access to services than insured veterans. Veterans with a non-VHA source of insurance were less reliant on VHA services. Conclusions: The state's uninsurance rate would significantly decrease if VHA capacity constraints were alleviated and veterans relied on the VHA safety net. If veterans' insurance status matters in states with low uninsurance rates, VHA coverage has broader implications for states with higher veteran concentrations and higher uninsurance rates.

World Journal of Cardiovascular Diseases, 2013

Background: Heart disease is now considered an inflammatory process targeted primarily by medical... more Background: Heart disease is now considered an inflammatory process targeted primarily by medical therapy on lipid levels. Complementary and alternative medicine searches for novel non-pharmacologic therapy, including pursuing various diets. Animal studies and consumer literature suggest benefits of vinegar on lipid levels and diabetes mellitus. Our nonrandomized pilot study from our group suggested a benefit in raising high-density lipoprotein cholesterol (HDL-C). Based on this data, we conducted a randomized placebo controlled clinical trial to determine the effects of apple cider vinegar intake in those without diabetes mellitus on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides, HDL-C, Hemoglobin A1C (Hgb-A1C) and measurement of inflammation with high sensitivity CRP levels (HS-CRP). Methods: A prospective randomized, double blind, placebo-controlled clinical trial consisting of 114 participants was conducted. Participants consumed 30 mL of either apple cider vinegar or placebo for two months. Measurements were collected at baseline, eight and sixteen weeks. The primary endpoint was the change in HDL-C from baseline to eight weeks between the vinegar and placebo groups. Secondary endpoints were change from baseline to eight weeks in TC, LDL-C, triglycerides, Hgb-A1c and HS-CRP. Results: Change in serum HDL-C concentration was not significantly different between the vinegar and control groups after eight weeks of supplementation. Secondary end-points including TC, LDL-C, Hgb-A1c and HS-CRP were not statistically different at the Bonferroni corrected significance level of 0.01. No significant difference was found regardless of baseline HDL-C levels. Conclusions: We found no significant difference in HDL-C, LDL-C, triglycerides, total cholesterol, or HS-CRP levels with use of vinegar but a trend down of Hgb-A1c in this group of non-diabetic participants. Further investigation is required to define the impact of vinegar in those with diabetes mellitus.

Journal of Vascular Surgery, 2012

Objective: This study was conducted to determine the costs and comparative cost-effectiveness of ... more Objective: This study was conducted to determine the costs and comparative cost-effectiveness of two methods of abdominal aortic aneurysm (AAA) repair in the Open Versus Endovascular Repair (OVER) Veterans Affairs (VA) Cooperative Study, a multicenter randomized trial of 881 patients. Methods: The primary outcomes of this analysis were mean total health care cost per life-year and per quality-adjusted life-year (QALY) from randomization to 2 years after. QALYs were calculated from EuroQol (EQ)-5D questionnaires collected at baseline and annually. Health care utilization data were obtained directly from patients and from national VA and Medicare data sources. VA costs were obtained from national VA sources using methods previously developed by the VA Health Economics Resource Center. Costs for non-VA care were determined from Medicare claims data or billing data from the patient's health care providers.

1998 Annual meeting, August 2-5, Salt Lake City, UT, 1998

Journal of the American Dietetic Association, 2010

The Journal of Rehabilitation Research and Development, 2010

The Medicare Current Beneficiary Survey (MCBS) is a longitudinal, m ultipurpose panel survey of a... more The Medicare Current Beneficiary Survey (MCBS) is a longitudinal, m ultipurpose panel survey of a nat ionally representative sample of Medicare beneficiaries sponsored by the Centers for Medica re and Medicaid Services (CMS). The MCBS serves as a comprehensive data source on self-reported health an d socio economic stat us, health insurance, healt hcare utilization and costs, and patient satisf action. CMS uses Medicare claims data to validate s elf-reported Medicare Fee-For-Service (FFS) u tilization. Because the Veterans Health Administration (VHA) does not bill for services, CMS imputes VHA cos ts. This article addresses the quality of the MC BS dataset for conducting research on Medicare-eligible ve terans by addressing the sample's representativeness, quality of selfreported data, and accuracy of imputed VHA c ost es timates. We com pared dem ographic data from the 1 992 and 20 01 National Survey o f Veterans (NSV) with the MCBS 1 992 and 2001 Cost and Use files. We compared self-reported VHA utilization an d C MS's imputed cos ts with VHA administrative datasets. The VHA 's Pharm acy Benefits Manag ement (PBM) database is avail able from fiscal year (FY) 1999 onward, and the VHA Health Economics Resource Center's (HERC) Average C ost dat asets are avai lable from FY1998 onw ard. Wh ile the samples were comparable in terms of age, sex, and race, the MCBS respondents were in better health, less likely to be married, and mo re lik ely to be wi dowed than NSV respo ndents. MCBS underreporting rates were higher for VHA than Medicare outpatient events. Underreporting and differences between CMS's an d H ERC's co sting m ethodologies co ntributed to lower MCBS versus VH A adm inistrative person-and even tlevel costs. Alte rnatively, average annual VHA prescription costs per capita were higher in th e MCBS th an in the PBM data. Differences in socioeconomic characteristics of the N SV and MCBS samples may be attributable to differences in sampling m ethodologies. H igher u nderreporting rates for VHA versus Medicare FFS outp atient events are likely due to systemic dif ferences betwe en the VHA and private healt hcare sectors. While VHA fo rmulary discounts may not be reflected Abbreviations: CBOC = Community-Based Outpatient Clinic, CMS = Cente rs for Medicare and Medicaid Services, CP T = Current Procedure and Terminology, DSS = Decision Support System, FFS = Fee-For -Service, FY = fis cal year , HERC = Health Econo mics Resou rce Center , LO S = lengt h of stay, MCBS = Medicare Current Be neficiary Survey , NPCD = National Patien t Care Datab ase, NSV = Nati onal Survey of Veterans, OPC = o utpatient car e, PBM = Pharmacy Benefits Management, PSSG = Planning System Support Group, PTF = Patient Treatment File, SC = service connected, VA = Department of Veterans Affairs, VHA = Veterans Health Administration.

Journal of Clinical Gastroenterology, 2008

To determine the outcomes of implementing clinical care guidelines for Hepatitis C screening, eva... more To determine the outcomes of implementing clinical care guidelines for Hepatitis C screening, evaluation, and treatment in a large urban Veterans Affairs Medical Center. Little information exists regarding the actual outcomes of institutional screening programs for Hepatitis C. Retrospective review of all patients tested for Hepatitis C at the Minneapolis Veterans Affairs Medical Center from January 1, 2000 to December 31, 2001. Logistic regression was used to determine factors related to successful referral and treatment. During this period 36,422 unique patients were screened for Hepatitis C virus (HCV) risk factors, resulting in 12,485 HCV enzyme-linked immunoassay antibody tests. HCV antibodies were positive in 681 (5.4%) patients and 520 (4.2%) were HCV-RNA-positive. Of HCV-RNA-positive patients, 430 (83%) were referred, 382 (73%) attended the Hepatitis clinic, and 232 (44.6%) received liver biopsies. Patients referred had significantly fewer comorbidities, known marital status, and greater prior clinic attendance than those not referred. Overall, 124 patients with established fibrosis received antiviral therapy (32% of patients attending clinic or 24% of viremic cohort). White race, fewer major medical problems, and age less than 60 years predicted antiviral treatment. Sustained virologic response occurred in 46 (37%) of treated patients (9% of the viremic cohort). Patients with a sustained virologic response include 17 patients with stage 3 to 4 fibrosis. This screening and referral program resulted in 73% of HCV-RNA-positive patients attending a specialty Hepatitis C clinic and 24% of those most likely to benefit received antiviral therapy. Measures to increase referral, engagement in care, and antiviral treatment are needed.