A Randomized Trial of Letters To Encourage Prescription Monitoring Program Use And Safe Opioid Prescribing with Adam Sacarny, David Powell, Ian Williamson, Weston Merrick, and Mireille Jacobson. Health Affairs. 2023; 42(1) : 140-9.
Abstract: To facilitate safer prescribing of opioids and other drugs, nearly all states operate prescription monitoring programs (PMPs), which collect and share data on controlled substance dispensing. Policy makers have sought to raise clinicians’ engagement with these programs but lack evidence on effective interventions. Working with the Minnesota Prescription Monitoring Program, we conducted a randomized trial to assess whether letters to clinicians increased program use and decreased risky coprescribing of opioids with benzodiazepines or gabapentinoids. In March 2021 we randomly assigned 12,000 coprescribers to either a control arm or one of three study arms sent differing letters. The respective letters highlighted a new mandate to check the PMP before prescribing, provided information about coprescribing risks with a list of coprescribed patients, or contained both messages combined. Letters highlighting the mandate alone or along with coprescribing information increased PMP search rates by 4.5 and 4.0 percentage points, respectively, with no significant effect on coprescribing. These letters also increased PMP account-holding rates among clinicians. Effects persisted for at least eight months. The letter with only coprescribing information had no detected effects on key outcomes. Our results support the use of simple letter interventions as evidence-based tools to increase PMP engagement and potentially facilitate better-informed prescribing.
See Working Papers section for an update on the Undergraduate Women in Economics Challenge.
Economics is among the most popular undergraduate majors. However, even at the best research universities and liberal arts colleges men outnumber women by two to one, and overall there are about 2.5 males to every female economics major. The Undergraduate Women in Economics (UWE) Challenge was begun in 2015 for one year as a randomized controlled trial with 20 treatment and 68 control schools to evaluate the impact of light-touch interventions to recruit and retain female economics majors. Treatment schools received funding, guidance, and access to networking with other treatment schools to implement programs such as providing better information about the application of economics, exposing students to role models, and updating course content and pedagogy. Using 2001-2021 data from the Integrated Postsecondary Education Data System (IPEDS) on graduating BAs, we find that UWE was effective in increasing the fraction of female BAs who majored in economics relative to men in liberal arts colleges. Large universities did not show an impact of the treatment, although those that implemented their own RCTs showed moderate success in encouraging more women to major in economics. We speculate on the reasons for differential treatment impact.
Work in Progress
Abstract: Prescription drug monitoring programs (PDMPs)—online systems that health care providers and pharmacists can use to query patient prescription records—are one of the most widely-used state tools in regulating the prescribing and dispensing of opioids. However, the staggered adoption of PDMPs over time has created opportunities for patients to evade monitoring by going to a state that does not have a PDMP. This paper evaluates how spillovers attributable to policy non-coordination between neighboring states impact the effectiveness of PDMPs. I find that after prescribers gain access to PDMPs, opioid volume and prescription opioid deaths decrease in counties with a PDMP that are insulated from opportunities for evasion. I find a similar effect in counties with a PDMP that are exposed to evasion. This suggests that exposure to evasion through proximity to non-PDMP areas does not significantly attenuate the policy effect. I also find evidence that opioid volume and prescription opioid deaths decrease in counties without a PDMP that are exposed to spillovers from counties with the policy. Illicit opioid deaths are not affected in any counties with a PDMP but decrease in counties without a PDMP that are exposed to spillovers. I discuss the potential mechanisms through which spillovers may operate.
Patient Cost Sharing and Prescription Drug Trends: Evidence from Japan. [Draft available upon request.]
Abstract: This paper studies the impact of a change in patient cost sharing on total prescription drug spending. I exploit a feature of the Japanese health care system, where an individual’s coinsurance rate is determined primarily by their age. I contribute to the existing literature by investigating heterogeneous effects by patient sex and drug therapeutic class (focusing on cardiovascular drugs, antibiotics, vitamins, antihistamines, and psychotropic drugs). I find that for the whole sample, price elasticity for spending ranges from −0.12 to −0.23. This is comparable to previous estimates of price elasticity of spending for general medical services (−0.2). I find no evidence of heterogeneous effects by sex over the whole sample of prescriptions, but I do find statistically significant differences between women and men within therapeutic drug classes. I also conduct exploratory analysis on the effect of changes in patient cost sharing on the volume of prescriptions. I estimate a price elasticity of demand between −0.33 and −0.69, which is larger than previous estimates of demand elasticity for general medical services (−0.16 to −0.2). I also find evidence that physicians do not respond on the intensive margin by prescribing more expensive medications. Although Japanese patients are more likely to be prescribed brand-name drugs, patients on generics may be more price sensitive to changes in patient cost sharing. Overall, the findings suggest that physicians respond by prescribing a greater quantity of medications, either on the extensive or the intensive margin.
Abstract: There is a persistent gender gap among elementary, middle, and high school students in terms of STEM test scores and choice of STEM college majors. Previous studies have shown that role model interventions – which expose students to information about inspirational individuals of the same gender, race, or background – could have a positive impact on those students’ academic performance. We conduct a randomized controlled trial in China that exposes students to female role models in STEM fields through a series of short educational videos. Our contribution to the literature is to test how role model interventions impact cognitive outcomes through changes in non-cognitive traits such as self-esteem. We control for grading bias by administering multiple-choice math and logic exams and also for various parent and teacher characteristics that may affect student outcomes.
Abstract: Curriculum Open-access Resources for Economics (CORE) is an alternative curriculum to teach introductory economics. The goal of the CORE USA Project is to expand student reach and to inspire a more diverse student body to pursue economics long-term by making course content more relevant and accessible. We conduct two confidential surveys with students enrolled in spring 2020 introductory economics courses at Columbia University and Barnard College. The two surveys, conducted at the start and end of the semester, ask students about their reasons for enrolling in the course, their interest in the field of economics and career aspirations, and their opinions about markets and traits important for success as an economist. The surveys also assess their knowledge of economic concepts and data literacy. We compare responses for student enrolled in courses that use CORE to those of students enrolled in courses that follow a more traditional curriculum. We complement our quantitative research with qualitative findings from focus groups conducted in spring 2020 and spring 2021.
Abstract: The US federal government shutdown for 35 days from December 2018 to January 2019, the longest shutdown in the country's history. The shutdown caused a disruption in the administration of several federal benefit programs, including the Supplemental Nutrition Assistance Program (SNAP). The disruption resulted in a positive liquidity shock to SNAP beneficiaries, who received some benefits earlier than scheduled. While providing slack in how beneficiaries could spend other income, the disruption potentially exacerbated the "end-of-cycle gap" that occurs when benefits run out before the end of the month. Using Nielsen Consumer Panel data, I study how consumption of SNAP-eligible goods responds to the positive liquidity shock in areas with low share vs. high share of SNAP beneficiaries.
Abstract: The high nurse turnover rate is an acute issue for Japan's health care system. In the recent decades, the government has promoted the Child Care and Family Care Leave Law and the work-life balance (WLB) programs outlined in it as tools to alleviate workplace stress and retain workers. I conduct a cross-sectional study of hospitals and nurses in Ibaraki Prefecture to learn about the implementation of the WLB programs and factors associated with nurse stress and work satisfaction. I design and run two surveys: a survey of all hospitals in the prefecture and a follow-up survey of nurses at six of these hospitals. I do not find a strong association between the nurse turnover rate and WLB program implementation, WLB program use, or the prioritization of nurse WLB in the workplace. I do find that hospitals that place a higher priority on nurses' WLB are more likely to implement certain types of WLB programs and to report nurses using them. The nurse survey identifies correlated sources of stress for nurses. I also find that greater social support from supervisors and coworkers is strongly correlated with fewer workplace conflicts as well as lower scores on various stress measures.
This study was conducted as part of the 2013-14 Fulbright Program.