Dr. Mohammad Jalali (aka, ‘MJ’) is an Assistant Professor at Harvard Medical School and a senior scientist at MGH Institute for Technology Assessment. He was previously a research faculty at MIT Sloan School of Management and a consultant at the World Bank. MJ uses analytics and simulation-based approaches to help policymakers identify and develop high-leverage policies that not only are effective over the long haul, but also are not thwarted by unanticipated side effects. To achieve this goal, he spends a great deal of time working with decision-makers and policymakers, doing fieldwork and collecting different types of data that can inform richer models and analyses.
MJ’s work has been featured by various national and international media outlets, including Associated Press, The Hill, Newsweek, Scientific American, Business Insider, and NPR. He is an associate editor of System Dynamics Review and is on the editorial board of the Journal on Policy and Complex Systems. He is the recipient of the 2015 Dana Meadows Award, the 2015 WINFORMS Excellence Award, and the 2014 Lupina Young Researcher Award. MJ received his PhD in Systems Engineering, with a concentration on management and health care systems, from Virginia Tech in 2015.
Research approach and areas:
In his research trajectory, MJ follows three goals. First, he conducts simulation modeling and informatics research for various population-based health policies, focusing on health outcomes and cost-effectiveness. In his modeling research—drawn on theories of optimization and strategy—he analyzes the impacts of large-scale policies for prevention, screening, and treatment. MJ has developed models for obesity, post-traumatic stress disorder, and depression. He is currently working with the FDA to develop an opioid systems model, informing opioid policies at the FDA and other government agencies. Other areas of his modeling research include drug-shortages in pharmaceutical supply chains, organizational cybersecurity in health care, and the diffusion of medical technologies.
Second, MJ focuses his research on mechanisms that connect human decision-making to health care systems, because that is where many important policy-resistant problems lie. In particular, he aims to understand how and why many health policies fail to produce lasting results or create results counter to their goals.
Third, he wants his research to rigorously connect models with quantitative data. The growing complexity of health care issues, combined with the ubiquity of large amounts of data, requires increasingly sophisticated analytical methods. MJ complements his phenomenological research with methodological contributions that build bridges across methodological and application domains. For example, he has contributed to adapting various simulation-optimization approaches for model calibration and parameter estimation in dynamic models (e.g., the method of simulated moments and indirect inference), improving systematic review techniques, and developing a novel method for aggregation of prior stochastic and heterogeneous statistical findings.
Selected media coverage:
New York Times: Will Hot Weather Kill the Coronavirus Where You Live?
Washington Post: Summer weather could help fight coronavirus spread but won’t halt the pandemic
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Selected Publications
Collins, Reagan A; Herman, Tianna; Snyder, Rebecca A; Haines, Krista L; Stey, Anne; Arora, Tania K; Geevarghese, Sunil K; Phillips, Joseph D; Vicente, Diego; Griggs, Cornelia L; McElroy, Imani E; Wall, Anji E; Hughes, Tasha M; Sen, Srijan; Valinejad, Jaber; Alban, Andres; Swan, J Shannon; Mercaldo, Nathaniel; Jalali, Mohammad S; Chhatwal, Jagpreet; Gazelle, G Scott; Rangel, Erika; Yang, Chi-Fu Jeffrey; Donelan, Karen; Gold, Jessica A; West, Colin P; Cunningham, Carrie
Unspoken Truths: Mental Health Among Academic Surgeons Journal Article
In: Ann Surg, vol. 279, iss. 3, pp. 429-436, 2024, ISSN: 1528-1140.
@article{pmid37991182,
title = {Unspoken Truths: Mental Health Among Academic Surgeons},
author = {Reagan A Collins and Tianna Herman and Rebecca A Snyder and Krista L Haines and Anne Stey and Tania K Arora and Sunil K Geevarghese and Joseph D Phillips and Diego Vicente and Cornelia L Griggs and Imani E McElroy and Anji E Wall and Tasha M Hughes and Srijan Sen and Jaber Valinejad and Andres Alban and J Shannon Swan and Nathaniel Mercaldo and Mohammad S Jalali and Jagpreet Chhatwal and G Scott Gazelle and Erika Rangel and Chi-Fu Jeffrey Yang and Karen Donelan and Jessica A Gold and Colin P West and Carrie Cunningham},
doi = {10.1097/SLA.0000000000006159},
issn = {1528-1140},
year = {2024},
date = {2024-03-01},
urldate = {2024-03-01},
journal = {Ann Surg},
volume = {279},
issue = {3},
pages = {429-436},
abstract = {OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P\<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P\<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.},
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OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.
Smith, Niamh; Georgiou, Michail; Jalali, Mohammad S; Chastin, Sebastien
Planning, implementing and governing systems-based co-creation: the DISCOVER framework Journal Article
In: Health Res Policy Syst, vol. 22, no. 1, pp. 6, 2024, ISSN: 1478-4505.
@article{pmid38191430,
title = {Planning, implementing and governing systems-based co-creation: the DISCOVER framework},
author = {Niamh Smith and Michail Georgiou and Mohammad S Jalali and Sebastien Chastin},
doi = {10.1186/s12961-023-01076-5},
issn = {1478-4505},
year = {2024},
date = {2024-01-08},
urldate = {2024-01-01},
journal = {Health Res Policy Syst},
volume = {22},
number = {1},
pages = {6},
abstract = {BACKGROUND: Increasingly, public health faces challenges requiring complex, multifaceted and multi-sectoral responses. This calls for systems-based approaches that facilitate the kind of collective and collaborative thinking and working required to address complexity. While the literature on systems thinking, system dynamics and the associated methodologies is extensive, there remains little clear guidance on how to plan, govern and implement participatory systems approaches within a co-creation process.nnMETHODS: We used a three-step process to develop DISCOVER, a framework for implementing, and governing systems-based co-creation: Stage 1: We conducted a literature analysis of key texts to identify well-documented methods and phases for co-creation using a systems approach, as well as areas where gaps existed. Stage 2: We looked for the most appropriate methods and approaches to fill the gaps in the knowledge production chain. Stage 3: We developed the framework, identifying how the different tools and approaches fit together end-to-end, from sampling and recruiting participants all the way through to responding with an action plan.nnRESULTS: We devised DISCOVER to help guide researchers and stakeholders to collectively respond to complex social, health and wider problems. DISCOVER is a strategic research planning and governance framework that provides an actionable, systematic way to conceptualise complex problems and move from evidence to action, using systems approaches and co-creation. In this article, we introduce the eight-step framework and provide an illustrative case study showcasing its potential. The framework integrates complementary approaches and methods from social network analysis, systems thinking and co-creation literature. The eight steps are followed sequentially but can overlap.nnCONCLUSIONS: DISCOVER increases rigour and transparency in system approaches to tackling complex issues going from planning to action. It is being piloted in environmental health research but may be suitable to address other complex challenges and could be incorporated into research proposals and protocols for future projects.},
keywords = {},
pubstate = {published},
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BACKGROUND: Increasingly, public health faces challenges requiring complex, multifaceted and multi-sectoral responses. This calls for systems-based approaches that facilitate the kind of collective and collaborative thinking and working required to address complexity. While the literature on systems thinking, system dynamics and the associated methodologies is extensive, there remains little clear guidance on how to plan, govern and implement participatory systems approaches within a co-creation process.nnMETHODS: We used a three-step process to develop DISCOVER, a framework for implementing, and governing systems-based co-creation: Stage 1: We conducted a literature analysis of key texts to identify well-documented methods and phases for co-creation using a systems approach, as well as areas where gaps existed. Stage 2: We looked for the most appropriate methods and approaches to fill the gaps in the knowledge production chain. Stage 3: We developed the framework, identifying how the different tools and approaches fit together end-to-end, from sampling and recruiting participants all the way through to responding with an action plan.nnRESULTS: We devised DISCOVER to help guide researchers and stakeholders to collectively respond to complex social, health and wider problems. DISCOVER is a strategic research planning and governance framework that provides an actionable, systematic way to conceptualise complex problems and move from evidence to action, using systems approaches and co-creation. In this article, we introduce the eight-step framework and provide an illustrative case study showcasing its potential. The framework integrates complementary approaches and methods from social network analysis, systems thinking and co-creation literature. The eight steps are followed sequentially but can overlap.nnCONCLUSIONS: DISCOVER increases rigour and transparency in system approaches to tackling complex issues going from planning to action. It is being piloted in environmental health research but may be suitable to address other complex challenges and could be incorporated into research proposals and protocols for future projects.
Deutsch, Arielle R; Jalali, Mohammad S; Stout, Sarah; Frerichs, Leah
Equitable Policies Need Equitable Practices: Alcohol- and Substance-Exposed Pregnancy as a Case Study Journal Article
In: Health Promot Pract, vol. 25, iss. 1, pp. 17-21, 2024, ISSN: 1524-8399.
@article{pmid35778898,
title = {Equitable Policies Need Equitable Practices: Alcohol- and Substance-Exposed Pregnancy as a Case Study},
author = {Arielle R Deutsch and Mohammad S Jalali and Sarah Stout and Leah Frerichs},
doi = {10.1177/15248399221107605},
issn = {1524-8399},
year = {2024},
date = {2024-01-01},
urldate = {2022-07-01},
journal = {Health Promot Pract},
volume = {25},
issue = {1},
pages = {17-21},
abstract = {There is clear need for more effective public health policies. Coupled with calls for more effective policies, increasing demand to address public health disparities experienced by systemically marginalized and historically oppressed groups emphasizes the long-standing need for policies that improve public health equity. Such need is highlighted when examining public health issues such as alcohol- and substance-exposed pregnancy (ASEP): Current policies are ineffective at reducing ASEP, and marginalized groups experience disproportionately lower benefits and higher negative consequences as a result of such policies. Powerful strategies to develop more effective policies that can account for the complexity of such issues, such as systems science methods (SSMs), are becoming popular. However, current best practices for such methods often do not emphasize the additional efforts that will be required to develop equitable, not just effective policies. Using ASEP as an example of a crucial complex issue requiring new policy, we suggest additional steps to include in SSM projects for developing more effective policies that will also help stakeholders determine high-equity policies to reduce health disparities. These steps include modeling structural differences experienced by marginalized groups via systemic racism and oppression, incorporating existing cultural and community sources of strength and resilience as key areas for policy development, and evaluating the sustainability of policies as a dimension of efficacy. We also discuss using community-based participatory approaches as a framework for all SSM processes to ensure that policy development itself is grounded in equitable shared decision-making for marginalized individuals.},
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pubstate = {published},
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There is clear need for more effective public health policies. Coupled with calls for more effective policies, increasing demand to address public health disparities experienced by systemically marginalized and historically oppressed groups emphasizes the long-standing need for policies that improve public health equity. Such need is highlighted when examining public health issues such as alcohol- and substance-exposed pregnancy (ASEP): Current policies are ineffective at reducing ASEP, and marginalized groups experience disproportionately lower benefits and higher negative consequences as a result of such policies. Powerful strategies to develop more effective policies that can account for the complexity of such issues, such as systems science methods (SSMs), are becoming popular. However, current best practices for such methods often do not emphasize the additional efforts that will be required to develop equitable, not just effective policies. Using ASEP as an example of a crucial complex issue requiring new policy, we suggest additional steps to include in SSM projects for developing more effective policies that will also help stakeholders determine high-equity policies to reduce health disparities. These steps include modeling structural differences experienced by marginalized groups via systemic racism and oppression, incorporating existing cultural and community sources of strength and resilience as key areas for policy development, and evaluating the sustainability of policies as a dimension of efficacy. We also discuss using community-based participatory approaches as a framework for all SSM processes to ensure that policy development itself is grounded in equitable shared decision-making for marginalized individuals.
Lim, Tse Yang; Xu, Ran; Ruktanonchai, Nick; Saucedo, Omar; Childs, Lauren M; Jalali, Mohammad S; Rahmandad, Hazhir; Ghaffarzadegan, Navid
Why Similar Policies Resulted In Different COVID-19 Outcomes: How Responsiveness And Culture Influenced Mortality Rates Journal Article
In: Health Aff (Millwood), vol. 42, no. 12, pp. 1637–1646, 2023, ISSN: 1544-5208.
@article{pmid38048504,
title = {Why Similar Policies Resulted In Different COVID-19 Outcomes: How Responsiveness And Culture Influenced Mortality Rates},
author = {Tse Yang Lim and Ran Xu and Nick Ruktanonchai and Omar Saucedo and Lauren M Childs and Mohammad S Jalali and Hazhir Rahmandad and Navid Ghaffarzadegan},
doi = {10.1377/hlthaff.2023.00713},
issn = {1544-5208},
year = {2023},
date = {2023-12-01},
journal = {Health Aff (Millwood)},
volume = {42},
number = {12},
pages = {1637--1646},
abstract = {In the first two years of the COVID-19 pandemic, per capita mortality varied by more than a hundredfold across countries, despite most implementing similar nonpharmaceutical interventions. Factors such as policy stringency, gross domestic product, and age distribution explain only a small fraction of mortality variation. To address this puzzle, we built on a previously validated pandemic model in which perceived risk altered societal responses affecting SARS-CoV-2 transmission. Using data from more than 100 countries, we found that a key factor explaining heterogeneous death rates was not the policy responses themselves but rather variation in responsiveness. Responsiveness measures how sensitive communities are to evolving mortality risks and how readily they adopt nonpharmaceutical interventions in response, to curb transmission. We further found that responsiveness correlated with two cultural constructs across countries: uncertainty avoidance and power distance. Our findings show that more responsive adoption of similar policies saves many lives, with important implications for the design and implementation of responses to future outbreaks.},
keywords = {},
pubstate = {published},
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In the first two years of the COVID-19 pandemic, per capita mortality varied by more than a hundredfold across countries, despite most implementing similar nonpharmaceutical interventions. Factors such as policy stringency, gross domestic product, and age distribution explain only a small fraction of mortality variation. To address this puzzle, we built on a previously validated pandemic model in which perceived risk altered societal responses affecting SARS-CoV-2 transmission. Using data from more than 100 countries, we found that a key factor explaining heterogeneous death rates was not the policy responses themselves but rather variation in responsiveness. Responsiveness measures how sensitive communities are to evolving mortality risks and how readily they adopt nonpharmaceutical interventions in response, to curb transmission. We further found that responsiveness correlated with two cultural constructs across countries: uncertainty avoidance and power distance. Our findings show that more responsive adoption of similar policies saves many lives, with important implications for the design and implementation of responses to future outbreaks.
Stringfellow, Erin J; Lim, Tse Yang; Dong, Huiru; Zhang, Ziyuan; Jalali, Mohammad S
In: Addiction, vol. 118, no. 11, pp. 2215-2219, 2023, ISSN: 1360-0443.
@article{pmid37434347b,
title = {The association between longitudinal trends in receipt of buprenorphine for opioid use disorder and buprenorphine-waivered providers in the United States},
author = {Erin J Stringfellow and Tse Yang Lim and Huiru Dong and Ziyuan Zhang and Mohammad S Jalali},
doi = {10.1111/add.16291},
issn = {1360-0443},
year = {2023},
date = {2023-11-01},
urldate = {2023-07-01},
journal = {Addiction},
volume = {118},
number = {11},
pages = {2215-2219},
abstract = {AIMS, DESIGN AND SETTING: We sought to describe longitudinal trends in buprenorphine receipt and buprenorphine-waivered providers in the United States from 2003 to 2021 and measure whether the relationship between the two differed after capacity-building strategies were enacted nationally in 2017. This was a retrospective study of two separate cohorts covering the years 2003-21, testing whether the association between two trends in these cohorts changed comparing 2003 to 2016 and from 2017 to 2021, among buprenorphine providers in the United States, regardless of treatment setting. Patients receiving dispensed buprenorphine at retail pharmacies.nnPARTICIPANTS: All providers who have obtained a waiver to prescribe buprenorphine in the United States, and an estimate of the annual number of patients who had buprenorphine for opioid use disorder (OUD) dispensed to them at a retail pharmacy.nnMEASUREMENTS: We synthesized and summarized data from multiple sources to assess the cumulative number of buprenorphine-waivered providers over time. We used national-level prescription data from IQVIA to estimate annual buprenorphine receipt for OUD.nnFINDINGS: From 2003 to 2021, the number of buprenorphine-waivered providers in the United States increased from fewer than 5000 in the first 2 years of Food and Drug Administration (FDA) approval to more than 114 000 in 2021, while patients receiving buprenorphine products for OUD increased from approximately 19 000 to more than 1.4 million. The strength of association between waivered providers and patients is significantly different before and after 2017 (P \< 0.001). From 2003 to 2016, for each additional provider, there was an average increase of 32.1 [95% confidence interval (CI) = 28.7-35.6] patients, but an increase of only 4.6 (95% CI= 3.5-5.7) patients for each additional provider, beginning in 2017.nnCONCLUSIONS: In the United States, the relationship between the rates of growth in buprenorphine providers and patients became weaker after 2017. While efforts to increase buprenorphine-waivered providers were successful, there was less success in translating that into significant increases in buprenorphine receipt.},
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pubstate = {published},
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AIMS, DESIGN AND SETTING: We sought to describe longitudinal trends in buprenorphine receipt and buprenorphine-waivered providers in the United States from 2003 to 2021 and measure whether the relationship between the two differed after capacity-building strategies were enacted nationally in 2017. This was a retrospective study of two separate cohorts covering the years 2003-21, testing whether the association between two trends in these cohorts changed comparing 2003 to 2016 and from 2017 to 2021, among buprenorphine providers in the United States, regardless of treatment setting. Patients receiving dispensed buprenorphine at retail pharmacies.nnPARTICIPANTS: All providers who have obtained a waiver to prescribe buprenorphine in the United States, and an estimate of the annual number of patients who had buprenorphine for opioid use disorder (OUD) dispensed to them at a retail pharmacy.nnMEASUREMENTS: We synthesized and summarized data from multiple sources to assess the cumulative number of buprenorphine-waivered providers over time. We used national-level prescription data from IQVIA to estimate annual buprenorphine receipt for OUD.nnFINDINGS: From 2003 to 2021, the number of buprenorphine-waivered providers in the United States increased from fewer than 5000 in the first 2 years of Food and Drug Administration (FDA) approval to more than 114 000 in 2021, while patients receiving buprenorphine products for OUD increased from approximately 19 000 to more than 1.4 million. The strength of association between waivered providers and patients is significantly different before and after 2017 (P < 0.001). From 2003 to 2016, for each additional provider, there was an average increase of 32.1 [95% confidence interval (CI) = 28.7-35.6] patients, but an increase of only 4.6 (95% CI= 3.5-5.7) patients for each additional provider, beginning in 2017.nnCONCLUSIONS: In the United States, the relationship between the rates of growth in buprenorphine providers and patients became weaker after 2017. While efforts to increase buprenorphine-waivered providers were successful, there was less success in translating that into significant increases in buprenorphine receipt.
Tatar, Moosa; Faraji, Mohammad R; Keyes, Katherine; Wilson, Fernando A; Jalali, Mohammad S
Social vulnerability predictors of drug poisoning mortality: A machine learning analysis in the United States Journal Article
In: Am J Addict, vol. 32, no. 6, pp. 539-546, 2023, ISSN: 1521-0391.
@article{pmid37344967,
title = {Social vulnerability predictors of drug poisoning mortality: A machine learning analysis in the United States},
author = {Moosa Tatar and Mohammad R Faraji and Katherine Keyes and Fernando A Wilson and Mohammad S Jalali},
doi = {10.1111/ajad.13445},
issn = {1521-0391},
year = {2023},
date = {2023-11-01},
urldate = {2023-06-21},
journal = {Am J Addict},
volume = {32},
number = {6},
pages = {539-546},
abstract = {BACKGROUND AND OBJECTIVES: Drug poisoning is a leading cause of unintentional deaths in the United States. Despite the growing literature, there are a few recent analyses of a wide range of community-level social vulnerability features contributing to drug poisoning mortality. Current studies on this topic face three limitations: often studying a limited subset of vulnerability features, focusing on small sample sizes, or solely including local data. To address this gap, we conducted a national-level analysis to study the impacts of several social vulnerability features in predicting drug mortality rates in the United States.nnMETHODS: We used machine learning to investigate the role of 16 social vulnerability features in predicting drug mortality rates for US counties in 2014, 2016, and 2018-the most recent available data. We estimated each vulnerability feature\'s gain relative contribution in predicting drug poisoning mortality.nnRESULTS: Among all social vulnerability features, the percentage of noninstitutionalized persons with a disability is the most influential predictor, with a gain relative contribution of 18.6%, followed by population density and the percentage of minority residents (13.3% and 13%, respectively). Percentages of households with no available vehicles, mobile homes, and persons without a high school diploma are the following features with gain relative contributions of 6.3%, 5.8%, and 5.1%, respectively.nnCONCLUSION AND SCIENTIFIC SIGNIFICANCE: We identified social vulnerability features that are most predictive of drug poisoning mortality. Public health interventions and policies targeting vulnerable communities may increase the resilience of these communities and mitigate the overdose death and drug misuse crisis.},
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BACKGROUND AND OBJECTIVES: Drug poisoning is a leading cause of unintentional deaths in the United States. Despite the growing literature, there are a few recent analyses of a wide range of community-level social vulnerability features contributing to drug poisoning mortality. Current studies on this topic face three limitations: often studying a limited subset of vulnerability features, focusing on small sample sizes, or solely including local data. To address this gap, we conducted a national-level analysis to study the impacts of several social vulnerability features in predicting drug mortality rates in the United States.nnMETHODS: We used machine learning to investigate the role of 16 social vulnerability features in predicting drug mortality rates for US counties in 2014, 2016, and 2018-the most recent available data. We estimated each vulnerability feature's gain relative contribution in predicting drug poisoning mortality.nnRESULTS: Among all social vulnerability features, the percentage of noninstitutionalized persons with a disability is the most influential predictor, with a gain relative contribution of 18.6%, followed by population density and the percentage of minority residents (13.3% and 13%, respectively). Percentages of households with no available vehicles, mobile homes, and persons without a high school diploma are the following features with gain relative contributions of 6.3%, 5.8%, and 5.1%, respectively.nnCONCLUSION AND SCIENTIFIC SIGNIFICANCE: We identified social vulnerability features that are most predictive of drug poisoning mortality. Public health interventions and policies targeting vulnerable communities may increase the resilience of these communities and mitigate the overdose death and drug misuse crisis.
Vivas-Valencia, Carolina; Dong, Huiru; Stringfellow, Erin J; Russell, W Alton; Morgan, Jake R; Tadrous, Mina; Jalali, Mohammad S
Factors Associated With Abrupt Discontinuation of Long-Term High-Dose Opioid Treatment Journal Article
In: JAMA Netw Open, vol. 6, no. 11, pp. e2341416, 2023, ISSN: 2574-3805.
@article{pmid37921772,
title = {Factors Associated With Abrupt Discontinuation of Long-Term High-Dose Opioid Treatment},
author = {Carolina Vivas-Valencia and Huiru Dong and Erin J Stringfellow and W Alton Russell and Jake R Morgan and Mina Tadrous and Mohammad S Jalali},
doi = {10.1001/jamanetworkopen.2023.41416},
issn = {2574-3805},
year = {2023},
date = {2023-11-01},
journal = {JAMA Netw Open},
volume = {6},
number = {11},
pages = {e2341416},
keywords = {},
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Deutsch, Arielle R; Frerichs, Leah; Hasgul, Zeynep; Murphey, Foster; Coleman, Addie K; Bachand, Annie Y; Bettelyoun, Arlana; Forney, Paul; Tyon, Gene; Jalali, Mohammad S
How Funding Policy Maintains Structural Inequity Within Indigenous Community-Based Organizations Journal Article
In: Health Aff (Millwood), vol. 42, no. 10, pp. 1411–1419, 2023, ISSN: 1544-5208.
@article{pmid37782860,
title = {How Funding Policy Maintains Structural Inequity Within Indigenous Community-Based Organizations},
author = {Arielle R Deutsch and Leah Frerichs and Zeynep Hasgul and Foster Murphey and Addie K Coleman and Annie Y Bachand and Arlana Bettelyoun and Paul Forney and Gene Tyon and Mohammad S Jalali},
doi = {10.1377/hlthaff.2023.00483},
issn = {1544-5208},
year = {2023},
date = {2023-10-01},
journal = {Health Aff (Millwood)},
volume = {42},
number = {10},
pages = {1411--1419},
abstract = {Despite efforts to increase investment in Indigenous health and well-being in the United States, disparities remain. The way in which health-promoting organizations are funded is one key mechanism driving the systemic, long-term health disparities experienced by Indigenous people in the US. Using Indigenous-led community-based organizations (ICBOs) that provide psychosocial care as a case study, we highlight multiple ways in which policies that regulate the external funding that ICBOs depend on must change to promote equity and allow the organizations to flourish and address unmet psychosocial needs for Indigenous community members. We use a system dynamics approach to discuss how "capability traps" arise from a misfit between external funding regulations and organizations' needs for sustainability and effective care provision. We provide suggestions for reforming funding policies that focus on improving ICBO sustainability.},
keywords = {},
pubstate = {published},
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Despite efforts to increase investment in Indigenous health and well-being in the United States, disparities remain. The way in which health-promoting organizations are funded is one key mechanism driving the systemic, long-term health disparities experienced by Indigenous people in the US. Using Indigenous-led community-based organizations (ICBOs) that provide psychosocial care as a case study, we highlight multiple ways in which policies that regulate the external funding that ICBOs depend on must change to promote equity and allow the organizations to flourish and address unmet psychosocial needs for Indigenous community members. We use a system dynamics approach to discuss how "capability traps" arise from a misfit between external funding regulations and organizations' needs for sustainability and effective care provision. We provide suggestions for reforming funding policies that focus on improving ICBO sustainability.
Yildirim, Melike; Webb, Karen A; Ciaranello, Andrea L; Amick, Alyssa K; Mushavi, Angela; Chimwaza, Anesu; Claypool, Anneke; Murape, Tendayi; McCann, Nicole C; Flanagan, Clare F; Jalali, Mohammad S
In: Int J Infect Dis, vol. 134, pp. 31-38, 2023, ISSN: 1878-3511.
@article{pmid37196759,
title = {Increasing the initiation of antiretroviral therapy through optimal placement of diagnostic technologies for pediatric HIV in Zimbabwe: a modeling analysis},
author = {Melike Yildirim and Karen A Webb and Andrea L Ciaranello and Alyssa K Amick and Angela Mushavi and Anesu Chimwaza and Anneke Claypool and Tendayi Murape and Nicole C McCann and Clare F Flanagan and Mohammad S Jalali},
doi = {10.1016/j.ijid.2023.05.013},
issn = {1878-3511},
year = {2023},
date = {2023-09-01},
urldate = {2023-09-01},
journal = {Int J Infect Dis},
volume = {134},
pages = {31-38},
abstract = {OBJECTIVES: Point-of-care (POC) devices for infant HIV testing provide timely result-return and increase ART initiation. We aimed to optimally locate POC devices to increase 30-day ART initiation in Matabeleland South, Zimbabwe.nnMETHODS: We developed an optimization model to identify locations for limited POC devices at health facilities, maximizing the number of infants who receive HIV test results and initiate ART within 30 days of testing. We compared location-optimization model results to non-model-based decision heuristics, which are more practical and less data intensive. Heuristics assign POC devices based on demand, test positivity, laboratory result-return probability, and POC machine functionality.nnRESULTS: With current placement of 11 existing POC machines, 37% of all tested infants with HIV were projected to receive results, 35% to initiate ART within 30 days of testing. With optimal placement of existing machines, 46% were projected to receive results and 44% to initiate ART within 30 days, retaining 3 machines in current locations, moving 8 to new facilities. Relocation based on the highest POC device functionality would be the best-performing heuristic decision (44% receiving results and 42% initiating ART withing 30 days), although it still would not perform as well as the optimization-based approach.nnCONCLUSION: Optimal and ad-hoc heuristic relocation of limited POC machines would increase timely result-return and ART initiation, without further, often costly, interventions. Location-optimization can enhance decision-making regarding placement of medical technologies for HIV care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Point-of-care (POC) devices for infant HIV testing provide timely result-return and increase ART initiation. We aimed to optimally locate POC devices to increase 30-day ART initiation in Matabeleland South, Zimbabwe.nnMETHODS: We developed an optimization model to identify locations for limited POC devices at health facilities, maximizing the number of infants who receive HIV test results and initiate ART within 30 days of testing. We compared location-optimization model results to non-model-based decision heuristics, which are more practical and less data intensive. Heuristics assign POC devices based on demand, test positivity, laboratory result-return probability, and POC machine functionality.nnRESULTS: With current placement of 11 existing POC machines, 37% of all tested infants with HIV were projected to receive results, 35% to initiate ART within 30 days of testing. With optimal placement of existing machines, 46% were projected to receive results and 44% to initiate ART within 30 days, retaining 3 machines in current locations, moving 8 to new facilities. Relocation based on the highest POC device functionality would be the best-performing heuristic decision (44% receiving results and 42% initiating ART withing 30 days), although it still would not perform as well as the optimization-based approach.nnCONCLUSION: Optimal and ad-hoc heuristic relocation of limited POC machines would increase timely result-return and ART initiation, without further, often costly, interventions. Location-optimization can enhance decision-making regarding placement of medical technologies for HIV care.
Wongseree, Peeradon; Hasgul, Zeynep; Leerapan, Borwornsom; Iramaneerat, Cherdsak; Phisalprapa, Pochamana; Jalali, Mohammad S
Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand Journal Article
In: Prev Med, pp. 107694, 2023, ISSN: 1096-0260.
@article{pmid37660758,
title = {Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand},
author = {Peeradon Wongseree and Zeynep Hasgul and Borwornsom Leerapan and Cherdsak Iramaneerat and Pochamana Phisalprapa and Mohammad S Jalali},
doi = {10.1016/j.ypmed.2023.107694},
issn = {1096-0260},
year = {2023},
date = {2023-09-01},
journal = {Prev Med},
pages = {107694},
abstract = {BACKGROUND: Low and middle-income countries face constraints for early colorectal cancer (CRC) detection, including restricted access to care and low colonoscopy capacity. Considering these constraints, we studied strategies for increasing access to early CRC detection and reducing CRC progression and mortality rates in Thailand.nnMETHODS: We developed a system dynamics model to simulate CRC death and progression trends. We analyzed the impacts of increased access to screening via fecal immunochemical test and colonoscopy, improving access to CRC diagnosis among symptomatic individuals, and their combination.nnRESULTS: Projecting the status quo (2023-2032), deaths per 100 K people increase from 87.5 to 115.4, and CRC progressions per 100 K people rise from 131.8 to 159.8. In 2032, improved screening access prevents 2.5 CRC deaths and 2.5 progressions per 100 K people, with cumulative prevented 7 K deaths and 9 K progressions, respectively. Improved symptom evaluation access prevents 7.5 CRC deaths per 100 K with no effect on progression, totaling 35 K saved lives. A combined approach prevents 9.3 deaths and 1.8 progressions per 100 K, or 41 K and 7 K cumulatively. The combined strategy prevents most deaths; however, there is a tradeoff: It prevents fewer CRC progressions than screening access improvement. Increasing the current annual colonoscopy capacity (200K) to sufficient capacity (681 K), the combined strategy achieves the best results, preventing 15.0 CRC deaths and 10.3 CRC progressions per 100 K people, or 54 K and 30 K cumulatively.nnCONCLUSION: Until colonoscopy capacity increases, enhanced screening and symptom evaluation are needed simultaneously to curb CRC deaths, albeit not the best strategy for CRC progression prevention.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Low and middle-income countries face constraints for early colorectal cancer (CRC) detection, including restricted access to care and low colonoscopy capacity. Considering these constraints, we studied strategies for increasing access to early CRC detection and reducing CRC progression and mortality rates in Thailand.nnMETHODS: We developed a system dynamics model to simulate CRC death and progression trends. We analyzed the impacts of increased access to screening via fecal immunochemical test and colonoscopy, improving access to CRC diagnosis among symptomatic individuals, and their combination.nnRESULTS: Projecting the status quo (2023-2032), deaths per 100 K people increase from 87.5 to 115.4, and CRC progressions per 100 K people rise from 131.8 to 159.8. In 2032, improved screening access prevents 2.5 CRC deaths and 2.5 progressions per 100 K people, with cumulative prevented 7 K deaths and 9 K progressions, respectively. Improved symptom evaluation access prevents 7.5 CRC deaths per 100 K with no effect on progression, totaling 35 K saved lives. A combined approach prevents 9.3 deaths and 1.8 progressions per 100 K, or 41 K and 7 K cumulatively. The combined strategy prevents most deaths; however, there is a tradeoff: It prevents fewer CRC progressions than screening access improvement. Increasing the current annual colonoscopy capacity (200K) to sufficient capacity (681 K), the combined strategy achieves the best results, preventing 15.0 CRC deaths and 10.3 CRC progressions per 100 K people, or 54 K and 30 K cumulatively.nnCONCLUSION: Until colonoscopy capacity increases, enhanced screening and symptom evaluation are needed simultaneously to curb CRC deaths, albeit not the best strategy for CRC progression prevention.