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Social Sciences

Tom Clark, PhD
ECAS: Political Science
The Effects of Panel Assignment on the US Court of Appeals in Death Penalty Cases

The United States stands out among developed democracies for its use of the death penalty in criminal justice. The Supreme Court has held that in order for the practice to withstand constitutional scrutiny, it must be applied in a fair and consistent manner. However, whether and the extent to which the death penalty is applied fairly and consistently is an empirical question. Past research demonstrates the application of the death penalty is correlated with suspicious covariates. We tackle a more fundamental question, which implications even beyond the death penalty: does the geographical organization of our country's judicial system undermine the ability to apply the law fairly and consistently? Along with my co-authors, we use the random assignment of three judge panels on the US Court of Appeals to measure the preferences of individual judges for granting relief in death penalty appeals, and how they are aggregated into decisions. Using a pilot dataset, we provide evidence that judges on the US Court of Appeals for the 5th, 6th, 9th, and 11th Circuits apply highly inconsistent thresholds for relief from death penalty sentences. This has implications for whether the death penalty is applied consistently and what the consequences of any variation might be. The proposed funding will support collection of data to complete the pilot data collection and then examine the extent to which en banc and Supreme Court review reduce the inconsistencies that arise as well as the ultimate effects of random panel assignment on whether and when appellants are executed.

Jennifer Mascaro, PhD
SOM: Family and Prevention Medicine
A longitudinal investigation of Family and meditation for healthcare trainee well- being and empathy

For many medical trainees, the stress of academic demands undermines student well-being and impairs the social cognitive skills that are a core aspect of clinical caregiving. Few academic courses or interventions have proven successful for enhancing empathy and well-being in ways that persevere in the face of stress and suffering and that enable sustained trainee well-being. The proposed study is designed to (1) investigate the feasibility of a mobile phone application- (app) delivered meditation program for Emory surgery residents and Physician Assistant (PA) students, and (2) test whether the program will reduce trainee incivility and burnout and enhance well-being and empathy. To this end, PA students and surgery residents will be randomized to either receive 8 weeks of app-delivered meditation programming or to a wait-list control group. Prior to, and again after meditating, we will assess trainee-reported incivility, burnout, and well-being. We will also assess trainees’ ability to accurately read patients’ emotions using a dynamic patient empathic accuracy task conducted in the functional MRI (fMRI) scanner, and we will investigate brain activity during the task. In an exploratory analysis, we will examine the methodological utility of high resolution MRI for assessing vagus nerve morphology as a novel neuromarker of meditation training. This pilot study will inform a future randomized, active controlled trial that will be conducted across multiple trainee and physician populations.

Adam Wilk, PhD
SPH: Health Policy and Management
Quality of Care among Medicaid Managed Care- Enrolled Children with Chronic Illnesses Receiving Care at Georgia Community Health Centers

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people, including children and the disabled. Given the high and rising proportion of state budgets committed to Medicaid programs, states have a strong incentive to contain costs in Medicaid. This incentive may intensify in the coming years if, as many anticipate, Congress seeks to convert the programs federal funding into block grants, which would grow at a slower rate than has federal Medicaid support historically. Since the 1990s, one way many states have sought to contain Medicaid spending is by administering Medicaid benefits through privately operated Medicaid Managed Care (MMC) plans. MMC plans have the potential to deliver cost savings relative to traditional state-run fee-for-service Medicaid by employing a range of cost containment tools such as reimbursement rate negotiation, provider network restrictions, prior authorization, and utilization management, that may also affect clinicians care decisions and, consequently, the quality of care received by beneficiaries. It is not well understood how MMC beneficiaries care outcomes are affected by the use of these tools, nor do we know how the variable use of these tools across MMC plans in one state may contribute to variation in MMC beneficiaries care. Understanding these relationships more fully is critical for enabling states to pursue greater efficiency in Medicaid without compromising beneficiaries quality of care. Yet information about MMC plans use of cost containment tools and how they are structured and implemented is often proprietary. Consequently, evidence as to how MMC plans affect beneficiaries quality of care is mixed and scattershot. Our proposed study would help to fill this knowledge gap in the context of chronically ill children and adolescents, ages 1-18 (collectively children hereafter), who are enrolled in Georgia Medicaid or Peachcare for Kids (Peachcare, the states Childrens Health Insurance Program, which provides health insurance to many low-income families ineligible for Medicaid), both of which Georgia administers through MMC plans. Our focal chronic conditions will be asthma and attention-deficit/hyperactivity disorder (ADHD). We will gather detailed information about MMC plans and other factors affecting care for this population by surveying clinicians (e.g., physicians, nurse practitioners) practicing at community health centers (CHCs) where Medicaid and Peachcare enrollees and other low-income children disproportionately seek care. We will construct the survey using well-validated survey instruments from the peer-reviewed literature. We will use the survey data to conduct both pairwise correlation and simple regression analyses to identify any associations between MMC plans use of different cost containment tools and clinician perceptions about the quality of care delivered to patients at CHCs. These associations will be identified two ways: first, we will compare the quality of care provided to Medicaid/Peachcare enrollees versus comparable non-enrolled children within the same CHCs, and, second, we will compare quality across CHCs with varying levels of exposure to enrollees of Georgia’s three established MMC plans and their associated cost containment tools. Our planned analyses would be among the first to examine cost containment tool-specific effects on quality of care for chronically ill Medicaid beneficiaries. The survey data would also open the door to follow-on, extramurally fundable research projects designed to address important, related research questions about the potentially disruptive impact of a new entrant MMC plan on clinician-perceived quality of care, the effects of MMC plans cost containment tools on other measures of quality and care coordination generated using linked administrative claims data, and the differential effects of MMC plans cost containment tools on quality across care settings, among others.