Expected Start July 2023: Principal-Investigator, “Assessing Policies and Systems to Improve Maternal and Infant Health in Kentucky,” funded by a State-University Partnership with the Kentucky Cabinet for Health and Family Services and the University of Louisville.> Abstract
The goal of this project is to assist KY CHFS in better understanding inputs and outcomes related to maternity care for women and infants enrolled in Kentucky Medicaid. This research will help CHFS identify and target groups of women and infants with elevated risks of health complications around pregnancy and birth. Findings from this research will support the development of systems and policies for improving the health of women of childbearing age, prenatal and postpartum experiences and outcomes, and infant health in Kentucky.
July 2022 – present: Co-Investigator, “The Cost of Gun Violence in Louisville,” funded by the Whitney/Strong Organization, Louisville Metro Office for Safe and Healthy Neighborhoods (OSHN), and the Jewish Heritage Fund for Excellence (JHFE).> Abstract
The goal of this project is to estimate the economic impact of gun violence in Louisville. The economic measure we focus on is residential property sale values, which is just one measure of the potential overall cost, but is a measure that is also economically meaningful for the Louisville Metro government through its impact on property taxes. My role as Co-Investigator is conducting all of the quantitative data analysis for the project. To measure the impact of gun violence on property values, we link reports of shootings from the Louisville Metro Police Department (LMPD) with home sales information from Jefferson County Property Valuation Administration (PVA). The empirical approach is a spatial difference-in-differences (DD) design, comparing the sale price of properties located within a certain distance of a shooting to those farther away, before versus after the shooting occurs.
January 2022 – present: Co-Investigator, “Louisville Metro Crisis Call Diversion Program Pilot Evaluation,” funded by Louisville Metro Government.
Part of a research team at the University of Louisville evaluating the Louisville Crisis Call Diversion Program (CCDP) pilot that launched in March 2022. The goals of the CCDP pilot are:
- Provide support to callers in the Fourth Division [a police-designated area of Louisville] who are experiencing a behavioral health crisis
- Deflect non-emergent calls away from Louisville Metro Police Department
The CCDP pilot evaluation includes both a process and impact evaluation centering on four research questions:
- To what extent was the CCDP implemented as designed and how was it adapted to meet community needs and expectations? (Process)
- To what extent do individuals in crisis receive needed assistance and what type of assistance is provided? (Process)
- How does the CCDP contribute to community safety? (Impact)
- What are the economic implications of the deflection efforts? (Impact)
This mixed-methods evaluation used both quantitative and qualitative data to answer these questions and provide insight into the pilot and expansion potential across Louisville Metro. My role as Co-Investigator is leading the quantitative evaluation focused on the economic implications of the deflection efforts (RQ4). This involves developing a framework and model for evaluation, and analyzing the data collected to determine cost effectiveness. The framework and findings were presented to Louisville Metro council in a preliminary report in summer 2022, and we are now collecting more data to update our analysis as the pilot program expands and progresses.
2020 – 2021: Co-Principal Investigator, “The Effect of Increased Access to Free School Meals on Emergency Department Visits and Inpatient Hospital Utilization,” funded by the Methodist Le Bonheur Center for Healthcare Economics Research, University of Memphis.> Abstract
The goal of this project was to study health impacts of the Community Eligibility Provision (CEP) policy, which provides expanded access to free school meals students in low-income areas, thereby reducing food insecurity. The health outcomes we focused on were emergency department visits and hospital discharges for conditions related to malnutrition and hunger. The empirical strategy is a difference-in-differences design (DD), comparing hospital admissions for the selected conditions in zip codes with and without access to CEP, before versus after CEP was implemented.
2015 – 2016: Principal Investigator, “The Effects of Consolidation on Inpatient Safety and Mortality,” funded by the 2016 Kirk Dornbush Summer Research Grant, Vanderbilt University, and the 2015 College of Arts and Science Summer Research Award, Vanderbilt University.> Abstract
This study analyzes the effect of hospital consolidation on inpatient safety indicators and mortality as a clinical measure of hospital quality. I analyze within- hospital changes in mortality rates and rates of adverse safety events for various patient subsets, before and after consolidation. Fixed effects estimates reveal mixed results on the effect of hospital acquisitions on quality of inpatient health care and outcomes. There is evidence of longer lengths of stay for some groups of patients with specific admitting diagnoses (increasing their costs), but no associated change in mortality. Instead, I found that hospitals improved mortality rates only in the specific procedure of coronary artery bypass grafts, but not the others studied, and slightly improved quality of care by decreasing the number of postoperative hip fractures and preventing respiratory failure for surgical patients after surgery in hospitals. Conversely, there is also a worsening of quality of caring for perioperative hemorrhages or hematomas after an acquisition. Given that the overall the welfare changes are specific to the patient’s diagnosis and the procedures performed, and that the number of patients involved in these specific procedures is relatively low, the health and life improvements might not outweigh the economic costs associated with decreased competition.
2014: Principal Investigator, “Quantifying Travel Costs: A Case Study Analyzing the Welfare Effects of a Hospital Merger in South Carolina,” funded by the 2014 Kirk Dornbush Summer Research Grant, Vanderbilt University.> Abstract
This study analyzes the predicted effects of a proposed hospital merger in South Carolina utilizing a travel cost model of demand similar to that used by the Federal Trade Commission. The model examines the change in consumer welfare that results from counterfactually removing each of the relevant hospitals from the consumer choice sets. Since consumers do not generally pay prices directly for health services, but instead have insurance that covers some portion of the costs, travel time is used as a proxy for the price that consumers pay when choosing any given hospital. The travel cost method of analyzing hospital mergers used by the FTC has been criticized in the literature for generating unrealistic estimates of the opportunity cost of time. Within this study, I compare the travel cost model predictions to those generated in a model that does not use time in determining the consumer choice. I then calculate the predicted merger effects. I find that features of the travel cost model account for about 52% of the explained change in willingness to pay that drives bargaining and market power for merging hospitals.