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Tierney AA, Mosqueda M, Cesena G, Frehn JL, Payán DD, Rodriguez HP. Telemedicine Implementation for Safety Net Populations: A Systematic Review. Telemed J E Health 2024; 30:622-641. [PMID: 37707997 PMCID: PMC10924064 DOI: 10.1089/tmj.2023.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
Background: Telemedicine systems were rapidly implemented in response to COVID-19. However, little is known about their effectiveness, acceptability, and sustainability for safety net populations. This study systematically reviewed primary care telemedicine implementation and effectiveness in safety net settings. Methods: We searched PubMed for peer-reviewed articles on telemedicine implementation from 2013 to 2021. The search was done between June and December 2021. Included articles focused on health care organizations that primarily serve low-income and/or rural populations in the United States. We screened 244 articles from an initial search of 343 articles and extracted and analyzed data from N = 45 articles. Results: Nine (20%) of 45 articles were randomized controlled trials. N = 22 reported findings for at least one marginalized group (i.e., racial/ethnic minority, 65 years+, limited English proficiency). Only n = 19 (42%) included African American/Black patients in demographics descriptions, n = 14 (31%) LatinX/Hispanic patients, n = 4 (9%) Asian patients, n = 4 (9%) patients aged 65+ years, and n = 4 (9%) patients with limited English proficiency. Results show telemedicine can provide high-quality primary care that is more accessible and affordable. Fifteen studies assessed barriers and facilitators to telemedicine implementation. Common barriers were billing/administrative workflow disruption (n = 9, 20%), broadband access/quality (n = 5, 11%), and patient preference for in-person care (n = 4, 9%). Facilitators included efficiency gains (n = 6, 13%), patient acceptance (n = 3, 7%), and enhanced access (n = 3, 7%). Conclusions: Telemedicine is an acceptable care modality to deliver primary care in safety net settings. Future studies should compare telemedicine and in-person care quality and test strategies to improve telemedicine implementation in safety net settings.
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Affiliation(s)
- Aaron A. Tierney
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Mariana Mosqueda
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Gabriel Cesena
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Jennifer L. Frehn
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Denise D. Payán
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, California, USA
| | - Hector P. Rodriguez
- Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Abstract
Introduction: Telehealth is a potential solution to persistent disparities in health and health care access by eliminating structural barriers to care. However, its adoption in urban underserved settings has been limited and remains poorly characterized. Methods: This is a prospective cohort study of patients receiving telemedicine (TM) consultation for specialty care of diabetes, hypertension, and/or kidney disease with a Federally Qualified Health Center (FQHC) as the originating site and an academic medical center (AMC) multispecialty group practice as the distant site in an urban setting. Primary data were collected onsite at a local FQHC and an urban AMC between March 2017 and March 2020, before the COVID-19 pandemic. Clinical outcomes of study participants were compared with matched controls (CON) from a sister FQHC site who were referred for traditional in-person specialty visits at the AMC. No-show rates for study participants were calculated and compared to their no-show rates for standard (STD) in-person specialty visits at the AMC during the study period. A patient satisfaction questionnaire was administered at the end of each TM visit. Results: Visit attendance data were analyzed for 104 patients (834 visits). The no-show rate was 15%. The adjusted odds ratio for no-show for TM versus STD visits was 1.03 [0.66-1.63], p = 0.87. There were no significant differences between TM and CON groups in the change from pre- to intervention periods for mean arterial pressure (p = 0.26), serum creatinine (p = 0.90), or estimated glomerular filtration rate (p = 0.56). The reduction in hemoglobin A1c was significant at a trend level (p = 0.053). Patients indicated high overall satisfaction with TM. Discussion: The study demonstrated improved glycemic control and equivalent outcomes in TM management of hypertension and kidney disease with excellent patient satisfaction. This supports ongoing efforts to increase the availability of TM to improve access to care for urban underserved populations.
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Affiliation(s)
- Guenevere V Burke
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Kareem A Osman
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Susie Q Lew
- Division of Kidney Disease & Hypertension, Department of Medicine, George Washington University, DC, USA
| | - Nicole Ehrhardt
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Richard L Amdur
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Lisa W Martin
- Division of Cardiology, Department of Medicine, George Washington University, DC, USA
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
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Panggabean B, Suharjo B, Sumarwan U, Yuliati LN. Perception study of perceived value and social influence of digital health services in Indonesia. Int J Risk Saf Med 2023; 34:367-377. [PMID: 37302043 DOI: 10.3233/jrs-220058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Healthtech has become a nascent sector of the internet economy since the emergence of the COVID-19 pandemic in 2020. Telemedicine features are facilitated, such as teleconsultation, e-diagnosis, e-prescribing, and e-pharmacy. However, the intention to use digital health services in Indonesia is still underdeveloped though the sales of other risk-free e-commerce products are high enough. OBJECTIVE This study aims to assess the human perception of perceived value and social influences regarding the intention to use digital health services. METHODS Google Forms web link is employed to disseminate a set of 4-Point Likert scale questionnaires. In total, 364 complete responses are collected. A descriptive approach is employed to process the data using Microsoft Excel and SPSS software. Validity and reliability are quantified using the item total-correlation method and Cronbach's Alpha coefficient. RESULTS Only 87 respondents (24%) ever used digital health services, of which Halodoc (92%) is the most preferred application, and teleconsultation became the most popular service to access. Out of four, the average score is 3.16 for perceived value and 2.86 for the social influence dimension. CONCLUSION Most respondents, not dependent on user experience, perceive more values obtained using digital health services, such as time and money savings, convenience, flexible order time, undiscovered identity, adventurous experience, and enjoyment. Another finding of this research proves that some social influences from family, friends, and mass media also bring effect to amplify the intention to use. A low level of trust is assumed to be the cause of a small number of users.
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Affiliation(s)
| | - Budi Suharjo
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, IPB University, Bogor, Indonesia
| | - Ujang Sumarwan
- Department of Family and Consumer Sciences, Faculty of Human Ecology, IPB University, Bogor, Indonesia
| | - Lilik Noor Yuliati
- Department of Family and Consumer Sciences, Faculty of Human Ecology, IPB University, Bogor, Indonesia
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Payán DD, Frehn JL, Garcia L, Tierney AA, Rodriguez HP. Telemedicine implementation and use in community health centers during COVID-19: Clinic personnel and patient perspectives. SSM Qual Res Health 2022; 2:100054. [PMID: 35169769 PMCID: PMC8830142 DOI: 10.1016/j.ssmqr.2022.100054] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 01/12/2023]
Abstract
In March 2020, federal and state telehealth policy changes catalyzed telemedicine adoption and use in community health centers. There is a dearth of evidence on telemedicine implementation and use in these safety net settings and a lack of information reflecting the perspectives of patients with limited English proficiency. We conducted in-depth interviews with clinic personnel and patients during the pandemic in two federally qualified health centers that primarily serve Chinese and Latino immigrants. Twenty-four interviews (clinic personnel = 15; patients who primarily speak a language other than English = 9) were completed remotely between December 2020 and April 2021. Interview scripts included questions about their telemedicine experiences, technology, resources and needs, barriers, facilitators, language access, and continued use, with a brief socio-demographic survey. Data analyses involved a primarily deductive approach and thematic analysis of transcript content. Both FQHCs adopted telemedicine in a few weeks and transitioned primarily to video and audio-only visits within two months. Findings reveal third-party language interpretation services were challenging to integrate into telemedicine video visits. Bilingual personnel who provided language concordant care were seen as essential for efficient and high-quality patient telemedicine experiences. Audio-only visits were of particular benefit to reach patients of older age, with limited English proficiency, and with limited digital literacy. Continued use of telemedicine is contingent on reimbursement policy decisions and interventions to increase patient digital literacy and technological resources. Results highlight the importance of reimbursing audio-only visits post-pandemic and investing in efforts to improve the quality of language services in telemedicine encounters.
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Affiliation(s)
- Denise D Payán
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Jennifer L Frehn
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Lorena Garcia
- Department of Public Health Sciences, School of Medicine, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Aaron A Tierney
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA
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Alhajri N, Simsekler MCE, Alfalasi B, Alhashmi M, Memon H, Housser E, Abdi AM, Balalaa N, Al Ali M, Almaashari R, Al Memari S, Al Hosani F, Al Zaabi Y, Almazroui S, Alhashemi H. Exploring Quality Differences in Telemedicine Between Hospital Outpatient Departments and Community Clinics: A Cross-Sectional Study. JMIR Med Inform 2021; 10:e32373. [PMID: 34978281 PMCID: PMC8849258 DOI: 10.2196/32373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/26/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Telemedicine is a care delivery modality that has the potential to broaden the reach and flexibility of health care services. In the United Arab Emirates, telemedicine services are mainly delivered through either integrated hospital outpatient department (OPDs) or community clinics. However, it is unknown if patients’ perceptions of, and satisfaction with, telemedicine services differ between these two types of health care systems during the COVID-19 pandemic. Objective We aimed to explore the differences in patients’ perceptions of, and satisfaction with, telemedicine between hospital OPDs and community clinics during the COVID-19 pandemic. We also aimed to identify patient- or visit-related characteristics contributing to patient satisfaction with telemedicine. Methods In this cross-sectional study that was conducted at Abu Dhabi health care centers, we invited outpatients aged 18 years or over, who completed a telemedicine visit during the COVID-19 pandemic, to participate in our study. Patients’ perceptions of, and satisfaction with, telemedicine regarding the two system types (ie, hospital OPDs and community clinics) were assessed using an online survey that was sent as a link through the SMS system. Regression models were used to describe the association between patient- and visit-related characteristics, as well as the perception of, and satisfaction with, telemedicine services. Results A total of 515 patients participated in this survey. Patients’ satisfaction with telemedicine services was equally high among the settings, with no statistically significant difference between the two setting types (hospital OPDs: 253/343, 73.8%; community clinics: 114/172, 66.3%; P=.19). Video consultation was significantly associated with increased patient satisfaction (odds ratio [OR] 2.57, 95% CI 1.04-6.33; P=.04) and patients’ support of the transition to telemedicine use during and after the pandemic (OR 2.88, 95% CI 1.18-7.07; P=.02). Patients who used video consultations were more likely to report that telemedicine improved access to health care services (OR 3.06, 95% CI 1.71-8.03; P=.02), reduced waiting times and travel costs (OR 4.94, 95% CI 1.15-21.19; P=.03), addressed patients’ needs (OR 2.63, 95% CI 1.13-6.11; P=.03), and eased expression of patients’ medical concerns during the COVID-19 pandemic (OR 2.19, 95% CI 0.89-5.38; P=.09). Surprisingly, middle-aged patients were two times more likely to be satisfied with telemedicine services (OR 2.12, 95% CI 1.09-4.14; P=.03), as compared to any other age group in this study. Conclusions These findings suggest that patient satisfaction was unaffected by the health system setting in which patients received the teleconsultations, whether they were at hospitals or community clinics. Video consultation was associated with increased patient satisfaction with telemedicine services. Efforts should be focused on strategic planning for enhanced telemedicine services, video consultation in particular, for both emergent circumstances, such as the COVID-19 pandemic, and day-to-day health care delivery.
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Affiliation(s)
- Noora Alhajri
- Khalifa University College of Medicine and Health Science, Al-Saada road, Zone 1 - Abu Dhabi, Abu Dhabi, AE
| | | | - Buthaina Alfalasi
- Zayed Military Hospital, Department of Family Medicine, Abu Dhabi, AE
| | - Mohamed Alhashmi
- Khalifa University College of Medicine and Health Science, Al-Saada road, Zone 1 - Abu Dhabi, Abu Dhabi, AE
| | - Hamda Memon
- Khalifa University College of Medicine and Health Science, Al-Saada road, Zone 1 - Abu Dhabi, Abu Dhabi, AE
| | - Emma Housser
- Khalifa University College of Medicine and Health Science, Al-Saada road, Zone 1 - Abu Dhabi, Abu Dhabi, AE
| | - Abdulhamid Mustafa Abdi
- Khalifa University College of Medicine and Health Science, Al-Saada road, Zone 1 - Abu Dhabi, Abu Dhabi, AE
| | - Nahed Balalaa
- Department of General Surgery, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, AE
| | | | - Raghda Almaashari
- Department of Dermatology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, AE
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Pourat N, Chen X, Lu C, Zhou W, Hoang H, Sripipatana A. Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study. PLoS One 2020; 15:e0242844. [PMID: 33290435 DOI: 10.1371/journal.pone.0242844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics. METHODS AND FINDINGS We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization. CONCLUSIONS Findings highlight HCs' contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.
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Fortney JC, Veith RC, Bauer AM, Pfeiffer PN, Valenstein M, Pyne JM, Dalack GW, Kramer TL, Ferro LJ, Metzger K, Shore JH, Carlo AD, Coates S, Ward‐Jones S, Larkins E, Hafer E, Shushan S, Weaver DL, Unützer J. Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations. J Rural Health 2019; 35:287-297. [PMID: 30288797 PMCID: PMC7379613 DOI: 10.1111/jrh.12323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Federally Qualified Health Centers (FQHCs) deliver care to 26 million Americans living in underserved areas, but few offer telemental health (TMH) services. The social missions of FQHCs and publicly funded state medical schools create a compelling argument for the development of TMH partnerships. In this paper, we share our experience and recommendations from launching TMH partnerships between 12 rural FQHCs and 3 state medical schools. EXPERIENCE There was consensus that medical school TMH providers should practice as part of the FQHC team to promote integration, enhance quality and safety, and ensure financial sustainability. For TMH providers to practice and bill as FQHC providers, the following issues must be addressed: (1) credentialing and privileging the TMH providers at the FQHC, (2) expanding FQHC Scope of Project to include telepsychiatry, (3) remote access to medical records, (4) insurance credentialing/paneling, billing, and supplemental payments, (5) contracting with the medical school, and (6) indemnity coverage for TMH. RECOMMENDATIONS We make recommendations to both state medical schools and FQHCs about how to overcome existing barriers to TMH partnerships. We also make recommendations about changes to policy that would mitigate the impact of these barriers. Specifically, we make recommendations to the Centers for Medicare and Medicaid about insurance credentialing, facility fees, eligibility of TMH encounters for supplemental payments, and Medicare eligibility rules for TMH billing by FQHCs. We also make recommendations to the Health Resources and Services Administration about restrictions on adding telepsychiatry to the FQHCs' Scope of Project and the eligibility of TMH providers for indemnity coverage under the Federal Tort Claims Act.
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Affiliation(s)
- John C. Fortney
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
- Department of Veterans Affairs, Health Services Research and DevelopmentCenter of Innovation for Veteran‐Centered and Value‐Driven CareSeattleWashington
| | - Richard C. Veith
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
| | - Paul N. Pfeiffer
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
- VA Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichigan
| | - Marcia Valenstein
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
- VA Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichigan
| | - Jeffrey M. Pyne
- Department of Psychiatry, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansas
- Department of Veterans Affairs, Health Services Research and DevelopmentCenter for Mental Healthcare and Outcomes ResearchLittle RockArkansas
| | - Gregory W. Dalack
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Teresa L. Kramer
- Department of Psychiatry, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - Lori J. Ferro
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
| | - Karla Metzger
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Jay H. Shore
- Helen and Arthur E. Johnson Depression CenterUniversity of Colorado Anschutz Medical CampusAuroraColorado
| | - Andrew D. Carlo
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
| | - Sara Coates
- Michigan Primary Care AssociationLansingMichigan
| | | | - Ed Larkins
- Family Medical Center of MichiganTemperanceMichigan
| | - Erin Hafer
- Community Health Plan of WashingtonSeattleWashington
| | | | - Donald L. Weaver
- National Association of Community Health CentersBethesdaMaryland
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
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Shin P, Sharac J, Rosenbaum S. Community Health Centers And Medicaid At 50: An Enduring Relationship Essential For Health System Transformation. Health Aff (Millwood) 2015; 34:1096-104. [DOI: 10.1377/hlthaff.2015.0099] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Peter Shin
- Peter Shin ( ) is an associate professor of health policy in the Department of Health Policy and Management, Milken Institute School of Public Health, the George Washington University, in Washington, D.C
| | - Jessica Sharac
- Jessica Sharac is a senior research associate in the Department of Health Policy and Management, Milken Institute School of Public Health, the George Washington University
| | - Sara Rosenbaum
- Sara Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy in the Department of Health Policy and Management, Milken Institute School of Public Health, the George Washington University
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