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Prevention can be grouped into three levels: primary prevention, secondary prevention, and tertiary prevention. Primary prevention refers to taking precautions to remove or reduce disease risk factors (e.g., immunization, ceasing or not starting smoking). Secondary prevention refers to early detection of diseases in order to reverse or slow the course and improve prognosis (e.g., routine measurement of blood pressure, or HPV screening for cervical cancer). Lastly, tertiary prevention refers to minimizing the effects of established disease (e.g., improving lipid profiles in patients with cardiovascular disease).
What We Do
Mass screening of asymptomatic individuals can diagnose diseases at most treatable earlier stages. From society's perspective, while a small fraction of the population (i.e., patients who have disease) benefits from screening as a result of early detection and improved survival, the vast majority of the remaining population (i.e., the disease-free population) receives little or no benefit. In addition, mass screening is costly and false-positive test results may trigger unnecessary invasive diagnostic procedures (e.g., biopsy following a false-positive mammogram), complications from the screening procedures resulting in morbidity and mortality (e.g., perforation during a colonoscopy), and overtreatment (i.e., detecting and treating cancers that would not surface in the absence of screening). Hence, tailoring screening strategies based on patients' needs and expectations can improve overall health outcomes and patient satisfaction, and appropriate allocation of medical resource for screening is important for the public, payers, and policymakers. We develop optimization models, carefully calibrated with statistical tools to rigorously analyze patients' data, to allow capturing several important dynamics in disease screening decisions and provide a framework to analyze and answer important policy questions.
Access to Pediatric Primary Care
Child development affects subsequent life chances through the risks of unhealthy behaviors, chronic diseases, malnutrition, mental-health problems, and criminality in later life. Along with good nutrition and wellness, primary care is a paramount ingredient for healthy child development. Ensuring equitable and effective access to pediatric primary care offers health policy makers significant opportuni¬ties for improvement because investments during the early years of life have the greatest poten¬tial to reduce health disparities within a generation. We focus on three directions in assisting policy makers in their endeavor to improve access to primary care for all children. We derive small area estimates for two access dimensions, accessibility and availability, which offer opportunities for interventions at a low geographic granularity. We identify specific populations and communities in most need for improvement. Last, we match potential policy interventions with the communities in need of intervening in improving pediatric primary care.