UMBC Emergency and Distaster Health Systems

Permanent URI for this collectionhttp://hdl.handle.net/11603/38

The Department of Emergency Health Services offers a unique opportunity for the education of future Emergency Medical Services, Emergency Public Health, and Emergency Management professionals. This is accomplished by providing a broad liberal-arts and sciences education which enhances the graduate employment opportunities as pre-hospital providers, policy makers, and managers.The Department of Emergency Health Services also provides a cutting edge education for advancement to graduate, medical, and professional studies. The Graduate program is primarily focused on preparing professionals for leadership roles in Disaster Health, Emergency Public Health and Policy Development. The two-track curriculum is designed to provide graduate level training and education to health care providers, researchers, educators, policy makers, and administrators. An Education concentration can be combined with either track. A post-baccalaureate certificate in Emergency Management is also offered. The Academic Department of Emergency and Disaster Health Systems offers a unique opportunity for the education of future Emergency Medical Services, Emergency Public Health, and Emergency Management professionals. This is accomplished by providing broad liberal arts and sciences education which enhances the graduate employment opportunities as pre-hospital providers, policymakers, and managers. The Department of Emergency and Disaster Health Systems also provides a cutting-edge education for advancement to graduate, medical, and professional studies. The Graduate program is primarily focused on preparing professionals for leadership roles in Disaster Health, Emergency Public Health, and Policy Development. The two-track curriculum is designed to provide graduate-level training and education to health care providers, researchers, educators, policymakers, and administrators. An Education concentration can be combined with either track. A post-baccalaureate certificate in Emergency Management is also offered. As of Fall 2017, in conjunction with the School of Public Policy, we now offer concentrations in Emergency Health or Emergency Management within the Public Policy Ph.D. program.

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Introduction to Correlation and Regression Analysis
(SAS Institute, 2008) Stockwell, Ian
SAS® has many tools that can be used for data analysis. From Freqs and Means to Tabulates and Univariates, SAS can present a synopsis of data values relatively easily. However, there is a difference between what the data are, and what the data mean. In order to take this next step, I would like to go beyond the basics and introduce correlation and hypothesis testing using regression models. A brief statistical background will be included, along with coding examples for correlation and linear regression.
Estimating the Costs to Mississippi Medicaid Attributable to Tobacco Using Paid Amounts to Providers for Tobacco-Related Illnesses
(The Hilltop Institute, 2019-06-03) Woodcock, Cynthia; Stockwell, Ian; Middleton, Alice; Idala, David; Betley, Charles
Research Objective: Estimating the costs of tobacco-related illness incurred by...
Cost-Effective Care Coordination for People With Dementia at Home
(Oxford University Press, 2020-05-01) Willink, Amber; Davis, Karen; Johnston, Deirdre M.; Black, Betty; Reuland, Melissa; Stockwell, Ian; Amjad, Halima; Lyketsos, Constantine G.; Samus, Quincy M.
People with dementia (PWD) represent some of the highest-need and highest-cost individuals living in the community. Maximizing Independence (MIND) at Home is a potentially cost-effective and scalable home-based dementia care coordination program that uses trained, nonclinical community workers as the primary contact between the PWD and their care partner, supported by a multidisciplinary clinical team with expertise in dementia care.Cost of care management services based on actual time spent by care management personnel over first 12 months of MIND at Home intervention was calculated for 342 MIND at Home recipients from Baltimore, Maryland and surrounding areas participating in a Centers for Medicare and Medicaid Services (CMS) funded Health Care Innovation Award demonstration project. Difference-in-differences analysis of claims-based Medicaid spending of 120 dually-eligible MIND at Home participants with their propensity score matched comparison group (n = 360).The average cost per enrollee per month was $110, or $1,320 per annum. Medicaid expenditures of dually-eligible participants grew 1.12 percentage points per quarter more slowly than that of the matched comparison group. Most savings came from slower growth in inpatient and long-term nursing home use. Net of the cost of the 5-year MIND at Home intervention, 5-year Medicaid savings are estimated at $7,052 per beneficiary, a 1.12-fold return on investment.Managed care plans with the flexibility to engage community health workers could benefit from a low-cost, high-touch intervention to meet the needs of enrollees with dementia. Limitations for using and reimbursing community health workers exist in Medicare fee-for-service, which CMS should address to maximize benefit for PWD.
Exploring the Relationship Between Nursing Staff and Family Members' Appraisal of Resident Care in Nursing Homes: The Role of Facility Ownership
(MDPI, 45699) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, Ian
Background/Objectives: To address long-standing staffing challenges and elevating care standards in the United States, new legislation will require a minimum of 0.55 h per resident day (HPRD) of registered nurse (RN) care, 2.45 HPRD of certified nursing aide (CNA) care, and a combined total of 3.48 HPRD across any combination of nursing staff. We examine differences in family members? views of care quality between facilities meeting the minimum staffing requirements and those that do not and whether there is any difference in those associations by facility ownership. Methods: This cross-sectional study utilized public data from 218 Medicare and Medicaid-certified nursing facilities in Maryland, collected in 2023. We used regression analyses to examine the association between staffing requirements and quality of care ratings, considering facility ownership status as a potential moderator. Results: Compared to facilities with CNA staffing levels below the cut off, facilities that met the CNA staffing requirement were rated more favorably by family members in overall quality and across the subdomains of staffing, care, activities, and security. In contrast, meeting the RN 0.55 cut off was not associated with family ratings across any quality domain. A facility for-profit status did not moderate the relationship between staffing and family ratings. Conclusions: These results suggest that CNA staff time is a significant driver of care quality and that non-profit facilities may already be closer to meeting new federal requirements. These findings highlight the need for regulations that support the minimum nursing staffing requirements to enhance care quality. Future research should identify the specific factors contributing to higher quality care in non-profit facilities and explore ways to implement these practices in for-profit settings.
If FEMA didn't exist, could states handle the disaster response alone?
(The Conversation, 2025-02-10) Xie, Ming
FEMA pools national resources to help states quickly manage disasters. Without that federal support, each state would be left to build its own expensive response capabilities.
Behavioral, Cognitive, and Functional Risk Factors for Repeat Hospital Episodes Among Medicare-Medicaid Dually Eligible Adults Receiving Long-Term Services and Supports
(Sage, 2024-09-26) Fakeye, Oludolapo; Rana, Prashant; Han, Fei; Henderson, Morgan; Stockwell, Ian
Repeat hospitalizations adversely impact the well-being of adults dually eligible for Medicare and Medicaid in the United States. This study aimed to identify behavioral, cognitive, and functional characteristics associated with the risk of a repeat hospital episode (HE) among the statewide population of dually eligible adults in Maryland receiving long-term services and supports prior to an HE between July 2018 and May 2020. The odds of experiencing a repeat HE within 30 days after an initial HE were positively associated with reporting difficulty with hearing (adjusted odds ratio, AOR: 1.10 [95% confidence interval: 1.02-1.19]), being easily distractible (AOR: 1.09 [1.00-1.18]), being self-injurious (AOR: 1.33 [1.09-1.63]), and exhibiting verbal abuse (AOR: 1.15 [1.02-1.30]). Conversely, displaying inappropriate public behavior (AOR: 0.62 [0.42-0.92]) and being dependent for eating (AOR: 0.91 [0.83-0.99]) or bathing (AOR: 0.79 [0.67-0.92]) were associated with reduced odds of a repeat HE. We also observed differences in the magnitude and direction of these associations among adults 65 years of age or older relative to younger counterparts.
Behind the Curtain: Comparing Predictive Models Performance in 2 Publicly Insured Populations
(Wolters Kluwer Health, 2024-11) Sun, Ruichen; Henderson, Morgan; Goetschius, Leigh; Han, Fei; Stockwell, Ian
Introduction: Predictive models have proliferated in the health system in recent years and have been used to predict both health services utilization and medical outcomes. Less is known, however, on how these models function and how they might adapt to different contexts. The purpose of the current study is to shed light on the inner workings of a large-scale predictive model deployed in 2 distinct populations, with a particular emphasis on adaptability issues. Methods: We compared the performance and functioning of a predictive model of avoidable hospitalization in 2 very different populations: Medicaid and Medicare enrollees in Maryland. Specifically, we assessed characteristics of the risk scores from March 2022 for the 2 populations, the predictive ability of the scores, and the driving risk factors behind the scores. In addition, we created and assessed the performance of an “unadapted” model by applying coefficients from the Medicare model to the Medicaid population. Results: The model adapted to, and performed well in, both populations, despite demographic differences in these 2 groups. However, the most salient risk factors and their relative weightings differed, sometimes dramatically, across the 2 populations. The unadapted Medicaid model displayed poor performance relative to the adapted model. Conclusions: Our findings speak to the need to “peek behind the curtain” of predictive models that may be applied to different populations, and we caution that risk prediction is not “one size fits all”: for optimal performance, models should be adapted to, and trained on, the target population.
Demand-Side Approaches: Supporting Healthier Food Choices
(IFPRI, 2024-05-28) Kim, Sunny S.; Koyratty, Nadia; Blake, Christian E.; Kumar, Neha
Understanding the drivers of individual food choices, consumer behavior, and food demand is essential to reshaping food systems
Association between long-term exposure to ambient air pollution and lesion ischemia in patients with atherosclerosis
(Elsevier, 2023-12-11) Xu, Muwu; Hou, Zhihui; Koyratty, Nadia; Huang, Conghong; Mu, Lina; Zhu, Kexin; Yu, Guan; LaMonte, Michael J.; Budoff, Matthew J.; Kaufman, Joel D.; Wang, Meng; Lu, Bin
Background and aims: Air pollution has been associated with coronary artery disease. The underlying mechanisms were understudied, especially in relation to coronary stenosis leading to myocardial ischemia. Advances in computed tomography (CT) allow for novel quantification of lesion ischemia. We aim to investigate associations between air pollution exposures and fractional flow reserve on CT (CT-FFR), a measure of coronary artery blood flow. Methods: CT-FFR, which defines a ratio of maximal myocardial blood flow compared to its normal value (range: 0–100%), was characterized in 2017 patients with atherosclerosis between 2015 and 2017. Exposures to ozone (O3), nitrogen dioxide (NO2), and fine particulate matter (PM2.5) were estimated using high-resolution exposure models. Linear and logistic regression models were used to assess the association of each air pollutant with CT-FFR and with the prevalence of clinically relevant myocardial ischemia (CT-FFR <75%). Results: Participants were on average 60.1 years old. Annual mean O3, NO2, PM2.5 were 61, 47 and 60 µg/m3, respectively. Mean CT-FFR value was 76.9%. In the main analysis, a higher level of O3 was associated with a lower CT-FFR value (-1.74%, 95% CI: -2.85, -0.63 per 8 µg/m3) and a higher prevalence of myocardial ischemia (odds ratio: 1.32, 95% CI: 1.05–1.65), adjusting for potential confounders such as risk factors and plaque phenotypes, independent of the effects of exposure to NO2 and PM2.5. No associations were observed for PM2.5 or NO2 with CT-FFR. Conclusions: Long-term exposure to O3 is associated with lower CT-FFR value in atherosclerotic patients, indicating higher risk of lesion ischemia.
Dietary Predictors of Urinary Biomarkers of Pyrethroids in the General Population – A Scoping Review
(Elsevier, 2024-02-01) Koyratty, Nadia; Olson, James R.; Kawyn, Marissa; Curl, Cynthia L.; Kordas, Katarzyna
Background Pyrethroid pesticides are ubiquitous environmental contaminants, contributing to chronic and potentially harmful exposure among the general population. Although studies have measured pesticide residues on agricultural products, the link between food intake and concentrations of pyrethroid biomarkers in urine remains unclear. Objective This scoping review aims to analyze peer-reviewed publications investigating dietary predictors of pyrethroid exposure through urinary biomarkers. We assess existing evidence, identify research gaps, and highlight current limitations. Methods We conducted a comprehensive search using PubMed and Google Scholar. Eligible studies examined associations between diets, food items or dietary components, and measured urinary pyrethroid biomarkers. No geographical restriction was applied to our search. Results were summarized in themes referring to study characteristics, relevant outcomes, biomarker measurement, dietary assessment and statistical analyses. Results We identified 20 relevant articles. Most studies presented evidence on associations between the consumption of organic diets or food items and reduced concentrations of 3-phenobenzoic acid metabolites in urine. There was less evidence for diet affecting other pyrethroid-specific biomarkers. Dietary assessment methodologies and recall periods varied, as did the number and timing of urine collections. Many studies did not control for potential alternative pyrethroid sources, exposure to other pesticides, or demographic and socioeconomic characteristics. Conclusion Researchers should consider standardized dietary assessment, chemical analyses of foods consumed, adequate recall time, and food preparation methods. Consistency in biomarker measurement, including urine collection time and corrections for specific gravity or creatinine, is needed. Ensuring the validity of such studies also requires larger samples and appropriate control for confounders.
Nutrition and diet profile: Sri Lanka
(CGIAR, 2024-08-02) Koyratty, Nadia; Silva, Renuka; Ranathunga, Thilanka; Olney, Deanna K.
Sri Lanka faces a double burden of malnutrition with the co-existence and persistence of multiple forms of malnutrition, e.g., stunting, wasting, underweight, overweight/ obesity, anemia, and micronutrient deficiences. Inadequate intake of many micronutrients is common across several population groups in Sri Lanka, indicating low intake of nutrient-dense foods such as F&Vs and animal-source foods. A diverse diet with adequate intake of nutrient-dense foods should be encouraged to address nutrient gaps among Sri Lankans and reduce the risk of NCDs. Many government-issued diet- and nutrition-related policies, strategies, and programs have been adopted in Sri Lanka. However, these often do not place enough emphasis on F&Vs. While national food based dietary guidelines exist, as well as other guidelines and policies, there is uncertainty about the level of public awareness and the population’s adherence to the recommendations. Evaluations of diet- and nutrition-related interventions are also scarce, indicating a need for rigorous evidence on what works to help guide programs and policies that aim to improve diet and nutrition outcomes among Sri Lankans.
P-293. Epidemiology of Extraintestinal Invasive Escherichia coli Infections in 9 U.S. Communities, 2023
(Oxford University Press, 2025-01-29) Grome, Heather N.; Brandenburg, Joshua M.; Grass, Julian E.; Parker, Erin; Johnston, Helen; Driscoll, Jennifer; Rebolledo, Paulina; Smith, Gillian; Wilson, Lucy; Luckman, Emily; Zipprich, Jennifer; Garcia, Marco; Hoffman, Marisa; Flores, Kristina; Che Looi, Hsioa; Tellerman, Julia; O’Brien, Shannon C.; Muleta, Daniel; Denzie, Olivia; Guh, Alice
Extraintestinal invasive Escherichia coli (iEC) is a leading cause of sepsis and hospitalization, but US surveillance for iEC has been frequently limited to multidrug-resistant (MDR) strains and hospitalized cohorts. To describe the incidence and clinical characteristics of MDR and non-MDR iEC and inform prevention and vaccine development, CDC’s Emerging Infections Program piloted active population- and laboratory-based surveillance in 9 US sites. Among surveillance area residents ( > 7.3 million people), an incident iEC case was the first isolation of E. coli in a 30-day period from a normally sterile body site (June–August 2023). Demographic, clinical, and laboratory characteristics were assessed by chart review. Annual incidence rates by surveillance area were estimated by multiplying total case number by 4 and used 2022 US census data for denominators. Among 1345 iEC cases in 1334 patients, E. coli was isolated from blood in 1223 (90.9%) and from other sterile sites in 122 (9.1%). Median age was 68 years (IQR 55–79); 766 (57.0%) were female. Overall estimated annual crude incidence rate was 74.5 cases per 100,000 population (range by area 51.3–95.6) and was higher for persons aged ≥ 60 vs < 60 years (228.5 vs 30.4). Cases were most commonly community associated (554, 41.2%) or health care associated community onset (633, 47.1%). Most case-patients (1194, 88.8%) had comorbidities; diabetes was most common (457, 34.0%). Of all cases, 762 (56.7%) were associated with urinary tract infection (UTI), 192 (14.3%) with recurrent UTI, and 213 (15.8%) had a urinary catheter in the 2 days before collection of the iEC-defining specimen. Among 1160 hospitalized cases, median length of stay was 5 days (IQR 3–9), 103 (8.9%) died. Of reported E. coli susceptibilities, 144/500 (28.8%) were fluoroquinolone-resistant, 185/1345 (13.8%) were extended-spectrum β-lactamase producing, and 3/1345 (0.2%) carbapenem-resistant. The burden of iEC disease was substantial compared to other invasive pathogens and primarily affected older adults. Over half of infections accompanied UTIs and involved hospitalization. Continued surveillance to monitor trends over time, inform vaccine development and evaluation, and advise prevention efforts are needed.
Nursing Facility Characteristics Are Differentially Associated With Family Satisfaction and Regulatory Star Ratings
(Southern Gerontological Society, 2025-01-08) Millar, Roberto J.; Diehl, Christin; Kusmaul, Nancy; Stockwell, Ian
Research suggests that nursing facility structural characteristics are important contributors toward residents’ quality of care. We use 2021 data from 220 Maryland nursing facilities to examine associations between two different quality-of-care metrics: family satisfaction and Care Compare five-star quality ratings. We used descriptive statistics to explore differences in quality metrics across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and resident census (1–60, 61–120, and 121+). Relationships were examined across overall ratings, as well as across subdomains of the two frameworks (e.g., staffing). Family members of residents in non-profit, rural, and low-census facilities rated facilities higher. Non-profit and low-resident census facilities were more likely to be rated four or five stars, while no significant association was observed across geographic location, or interactions across structural factors. Findings emphasize the need for comprehensive quality-of-care frameworks that explore quality care across stakeholders and types of facilities.
Family Care Partners and Paid Caregivers: National Estimates of Role-Sharing in Home Care
(Oxford University Press, 2024-12-09) Fabius, Chanee D.; Gallo, Joseph J.; Burgdorf, Julia; Samus, Quincy M.; Skehan, Maureen; Stockwell, Ian; Wolff, Jennifer L.
We describe “role-sharing” in home care, defined as family care partners and paid caregivers assisting with the same task(s).We studied 440 participants in the 2015 National Health and Aging Trends Study (NHATS) receiving paid help with self-care, mobility, or medical care. We describe patterns in receiving paid help only, help from care partners only, and role-sharing. We examine whether sole reliance on paid help or role-sharing differs by Medicaid-enrollment and dementia status.Half (52.9%) of care networks involved role-sharing. Care networks involving role-sharing more often occurred among older adults with dementia (48.7% vs. 25.6%, p<0.001) and less often for those who were Medicaid-enrolled (32.1% vs. 49.4%, p<0.01). Those living with dementia more often experienced role-sharing in eating (OR 3.9 [95% CI 1.20, 8.50]), bathing (OR 2.7, [95% CI 1.50, 4.96]), dressing (OR 2.1 [95% CI 1.14, 3.86]), toileting (OR 2.9 [95% CI 1.23, 6.74]), and indoor mobility (OR 2.8 [95% CI 1.42, 5.56]), and less often received help solely from paid helpers with medication administration (OR 0.24, [95% CI 0.12, 0.46]). Medicaid-enrollees more often received paid help only in dressing (OR 2.0 [95% CI 1.12, 3.74]), outdoor (OR 2.4 [95% CI 1.28, 4.36]) and indoor mobility (OR 4.3 [95% CI 2.41, 7.62]), and with doctor visits (OR 2.8 [95% CI 1.29, 5.94]).Role-sharing is common, especially among older adults living with dementia who are not Medicaid-enrolled. Strategies supporting information sharing and collaboration in home-based care merit investigation.
Care Compare Star Ratings and Family Satisfaction in Maryland Nursing Facilities: A Comparison by Facility Structure
(2024-02-22) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, Ian
These findings were presented at the Gerontological Society of America’s (GSA) 2023 meeting in Tampa, Florida. Part of a Center and Institute Departmentally-Engaged Research (CIDER) award, this is part of several studies focused on examining quality of care in Maryland nursing facilities.
Validating the Disaster Food Security Scale for Rural U.S. Populations
(Natural Hazards Center, 2023) Clay, Lauren; Koyratty, Nadia; Josephson, Anna; Shanks, Carmen Byker
Although there is a large body of evidence on food security and food systems, similar research is limited in disaster settings. Rural areas are especially at risk for adverse disaster consequences. The goal of this project is to validate the Disaster Food Security Scale (DFSS) for rural populations. Rural population-specific validation is needed to ensure that the scale reliably measures barriers to food security in rural populations, which may have different concerns and issues during disasters when compared to the general or non-rural populations. To validate the DFSS-Rural, the DFSS survey was administered to a national U.S. sample of households that recall a disaster in their community in the past five years. Survey data were analyzed for validity and non-rural and rural populations were compared. The disaster food security construct created through the scale development process was unidimensional allowing the administration and scoring of a single composite scale to capture multiple aspects of food security in a disaster context. The DFSS scale measures food security disruption from a systems perspective, and therefore, identifies where a disruption is occurring in the food system chain and can provide information for public health and emergency management officials, communities, and community service organizations about specific opportunities for intervention to improve food security and improve health outcomes.
US Climate Disasters and Health Disparities: Scoping Review Protocol
(OSF, 2024-08-29) Clay, Lauren; Schreiber, Kerstin; Gillman, Arielle; Tompkins, Dera; Butera, Gisela
This scoping review aims to synthesize the state of science on climate disasters and health disparities in the United States. The review will identify health disparity outcomes, populations, and methodological approaches studied to date and discuss gaps and opportunities for future research to undertake.
Association Between Social Determinants of Health, COVID-19 Stressors, and Mental Health Among New York Residents Early in the Pandemic
(Cambridge University Press, 2024-10-22) Riobueno-Naylor, Alexa; Clay, Lauren; Aubé, Samantha S.; Lai, Betty S.
ObjectiveThe COVID-19 pandemic is a disaster event. Exposure to stressors during and after disaster events is associated with negative mental health symptoms. To inform targeted COVID-19 recovery efforts, data are needed to understand which stressors play a key role in this relationship.MethodsCross-sectional survey data (demographics, impacts of COVID-19, social determinants of health, depression, and anxiety) were collected online from adults living in New York state between May and June 2020. Differences in the proportion of stressors (COVID-19 and social determinants) experienced by race/ethnicity were assessed using chi-square analyses. Logistic regression was used to assess which factors were associated with increased odds of depression and anxiety.ResultsA majority (n = 258, 62.2%) of the 415 respondents reported being directly impacted by the pandemic. Non-white respondents reported a significantly larger proportion of stressors compared to white respondents. Under half of respondents reported depression (n = 171, 41.2%) and anxiety (n = 164, 39.5%). Healthcare and food concerns were associated with increased odds of depression and anxiety, and economic concerns were associated with increased odds of anxiety.ConclusionsFindings underscore the need to respond to the COVID-19 mental health crisis by addressing social determinants of health.
Nurse Staffing in Nursing Facilities and Family Members' Appraisal of Resident Care
(2024-06-29) Millar, Roberto; Diehl, Christin; Cannon-Jones, Stephanie; Kusmaul, Nancy; Stockwell, Ian
Multi-scalar and multi-dimensional conceptions of social capital and mental health impacts after disaster: the case of Hurricane Harvey
(Wiley, 2022-01-11) Smiley, Kevin T.; Clay, Lauren; Ross, Ashley D.; Chen, Yu-An
While much research investigates how social capital relates to mental health after disasters, less work employs a multi-scalar, multi-dimensional social capital framework. This study applies such a construct to an analysis of novel survey data of approximately 1,000 rural and urban Texans after Hurricane Harvey struck the United States in August 2017. On the individual level, it finds that greater social support is linked to fewer mental health impacts, but that greater civic and organisational engagement is connected to greater mental health impacts. At the community level, it finds that neither a density of bridging social capital organisations nor of bonding social capital organisations is associated with poorer mental health, although a greater number of bonding organisations is related to negative mental health impacts on rural residents. The paper concludes by focusing on how individual and community social capital relationships with mental health are contingent on measurement, scale, and rural or urban location.

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