Dual Enrollment Research Articles

Dual Enrollment in Community Colleges: The Importance of Understanding the Student Experience

Dual Enrollment in Community Colleges: The Importance of Understanding the Student Experience

U.S. History as Part of a Core Curriculum

U.S. History as Part of a Core Curriculum Megan Birk (bio) It never occurred to me that I would write a Texas-centered piece for The Middle West Review, but desperate times call for additional information. Much of the emphasis on the "civics crisis" in the U.S. over the last ten years focused on K-12 curriculum, and the startling lack of historical and governmental knowledge attained before high school graduation. But the problem runs deeper than K-12, with increasingly fewer institutions of higher education including U.S. history in their core curriculum. Texas is among the states that continues to require U.S. history as part of a public college education. Added in 1955, the relevant section of the Texas Education Code reads in part: "A college or university receiving state support or state aid from public funds may not grant a baccalaureate degree or a lesser degree or academic certificate to any person unless the person has credit for six semester hours or its equivalent in American History."1 In the middle of the Cold War, these six credits joined the six already required in Government/Political Science that were included by the Texas Legislature in 1929. Among the others states with such a mandate are California, which has "American Institutions" graduation options, and Georgia's universities which must include U.S. history with state content. Texas's requirement is not static. Recent adjustments to this law included adding equivalent surveys in Mexican American History, Native American History, African American History, U.S. Women's History, and others. At a time when departments across the country, but particularly in the Midwest, are facing death by a thousand cuts, these six hours help keep departments in Texas open. However, the shrinking campus cores, the diminishing number of degree plans allowing electives and minors, and the limitations on financial aid that cover only what is in the degree plan are affecting us all. Some [End Page 177] of us have the added issue of eyeing each legislative session with no small amount of concern about the future of tenure and the academic freedom to teach accurate U.S. history. Each time the administrative positions on campuses change hands there is worry about the ratio of full-time to contingent faculty. The six hours of required history are stabilizing to a degree. There is, however, a caveat. While history core classes provide a solid foundation of funds to colleges and departments as steady sources of Student Credit Hours (SCHs) and enable faculty to advertise and recruit for other history classes, this is by no means a monopolized system for four-year institutions. Students in Texas have been pushed into dual enrollment classes, which allows qualified students to take "college classes" in high school and earn credit prior to graduation. More and more students are arriving on campuses "core complete" because of this program designed to save the state, and ostensibly some parents, tuition money, but it comes at the cost of diminishing credit hours for departments and serious concern about the quality and content of dual enrollment classes in high school buildings. Texas also has a robust system of community colleges that are often partnered with their local university. The faculty at these institutions teach a wide array of U.S. history offerings that can be transferred to four-year schools, and many of them employ faculty with PhDs. Ironically, this surge of dual enrollment enthusiasm provided short term boosts to graduate programs across the state, as local teachers worked nights to earn the hours needed to teach those classes in high school. According to the accrediting standards of SACS (Southern Association of Colleges and Schools Commission on Colleges), eighteen hours of graduate credit are the minimums required to teach core curriculum history courses for college credit. In other words, someone doesn't even need to earn a master's degree to hypothetically qualify. A temporary increase in graduate students with the potential result of fewer undergraduates down the road was a brutal catch-22 for many departments. At my university of thirty-thousand-plus students, our history department is staffed by approximately twenty tenured and tenure-track...

High School Principals’ Perceptions of Dual Enrollment Policy in Ohio and Texas

Dual enrollment policies and programs, where students earn both high school and college credits, have been scaled up across the United States in the last two decades. In this mixed methods study, we survey high school principals in Ohio and Texas, two states with robust dual enrollment policies. The study addressed one broad research question: What are principals’ perceptions of dual enrollment access, participation, and governance? Findings revealed three main themes: (1) economic/credential student motivations for dual enrollment; (2) mixed views about rigor; (3) issues surrounding the loss of principal autonomy.

Can State Policies Reduce Racial Disparities in the Time-to-Degree? Examining the Interconnected Role of Statewide Articulation Agreements with Dual Enrollment

Can State Policies Reduce Racial Disparities in the Time-to-Degree? Examining the Interconnected Role of Statewide Articulation Agreements with Dual Enrollment

Association of Clinical Setting With Sociodemographics and Outcomes Following Endovascular Femoropopliteal Artery Revascularization in the United States.

After the Centers for Medicare and Medicaid Services modified reimbursement rates for outpatient peripheral vascular intervention in 2008 with the intent of improving access to care, providers began to increasingly perform peripheral vascular interventions in privately owned office-based clinics. Little is known about the characteristics of patients treated in this setting and their long-term outcomes as compared with those treated in hospital-based centers. In this retrospective cohort study, Medicare beneficiaries ≥66 years undergoing outpatient femoropopliteal peripheral vascular interventions in office-based clinics and hospital-based centers from 2015 to 2017 were identified. Sociodemographics, comorbidities, and institutional characteristics were compared across sites. Multivariable Cox proportional hazards models were used to estimate the adjusted associations between practice site location and outcomes. The primary outcome was the composite of major amputation or death analyzed through the end of follow-up. Among 134 869 patients, 29.9% were treated in office-based clinics and 70.1% in hospital-based centers. Patients treated in office-based clinics were more often Black (16.9% versus 11.9%), dually enrolled in Medicaid (26.3% versus 19.6%), and residents of lower-resourced regions (32.6% versus 25.6%). Over a median follow-up time of 800 days (interquartile range, 531-1119 days), patients treated in office-based clinics had reduced risks of major amputation or death compared with outpatients treated in hospital-based centers (hazard ratio, 0.92 [95% CI, 0.89-0.95]). They also had lower adjusted all-cause mortality (hazard ratio, 0.93 [95% CI, 0.90-0.96]), major lower extremity amputation (hazard ratio, 0.84 [95% CI, 0.79-0.89]), and all-cause hospitalization (hazard ratio, 0.86 [95% CI, 0.84-0.88]). These findings persisted after stratification by critical limb ischemia, race, dual enrollment, and regional socioeconomic status, as well as among operators treating patients in both clinical settings. In this large nationwide analysis of Medicare beneficiaries, office-based clinics treated a more socioeconomically disadvantaged population compared with hospital-based centers. Long-term outcomes were comparable between locations. As such, these clinics appear to be selecting lower-risk patients for outpatient peripheral vascular interventions, although there remains the possibility of unmeasured confounding.

Genetic Data Identify Dual‐enrolled Participants in Alzheimer's Disease and Related Dementia (ADRD) Studies

AbstractBackgroundIt is not unusual for Alzheimer’s Disease (AD) Research Center (ADRC) participants to enroll in additional studies such as the AD Neuroimaging Initiative (ADNI). In such cases, shared access to neuropathologic biospecimens is important to both studies, but dual‐enrollment status is not always known to acting ADRC personnel, and currently there is no centralized method to track dual enrollment. For this study, we aimed to identify individuals enrolled in ADNI and an ADRC, and identify those with autopsy data available through an ADRC but not ADNI.MethodGWAS data were obtained for ADRC participants (N=22,935) through the AD Genetics Consortium (ADGC) and for ADNI participants (N=2,048) through the Laboratory of NeuroImaging (LONI); data were compared in PLINK v1.9 by identity‐by‐descent (IBD). ADRC/ADNI matches were filtered for pi‐hat > 0.8. Genotype data from a custom‐96 SNP microarray for ADRC and ADNI samples banked at the National Centralized Repository for Alzheimer’s Disease and Related Dementias (NCRAD) were also compared to identify additional matches. Year of birth, sex, race, and ethnicity were compared within matches. Participant IDs from matches were reviewed for autopsy data available through the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS) and from ADNI, to identify participants with autopsy data available through NACC but not ADNI. We generated counts for matches that had year of death, and among those, how many had neuropathology variables.ResultWe identified 364 pairs with matched genetic (pi‐hat>0.99) and available demographic data from GWAS data, and another 52 from NCRAD genotype data. Of these, 143 matched ADRC participants had a year of death. 98 of the 143 had autopsy variables in the NACC UDS. 44 of these 98 were included in the ADNI autopsy data set (2018 version) or pending integration by the ADNI Neuropathology Core (NPC). Thus, 54 ADRC brain donors could be reported to the ADRCs as dually‐enrolled in ADNI, providing the involved ADRCs the opportunity to share these biospecimens with the ADNI NPC.ConclusionThis case study illustrates how identification of dually‐enrolled participants represents a unique opportunity to leverage data collected through multiple studies to enhance AD research.

The impact of the COVID-19 pandemic on racial disparities in patients undergoing total shoulder arthroplasty in the United States

The purpose of this study was to assess racial disparities in total shoulder arthroplasty (TSA) in the United States and to determine whether these disparities were affected by the COVID-19 pandemic. Centers for Medicare and Medicaid Services (CMS) 100% sample was used to examine primary TSA volume from April to December from 2019 to 2020. Utilization was assessed for White, Black, Hispanic, and Asian populations to determine if COVID-19 affected these groups differently. A regression model adjusted for age, sex, CMS-hierarchical condition categories (HCC) score, dual enrollment (proxy for socioeconomic status), time-fixed effects, and core-based statistical area fixed effects was used to study difference across groups. In 2019, the TSA volume per 1000 beneficiaries was 1.51 for White and 0.57 for non-White, with a 2.6-fold difference. In 2020, the rate of TSA in White patients (1.30/1000) was 2.9 times higher than non-White (0.45/1000) during the COVID-19 pandemic (P<.01). There was an overall 14% decrease in TSA volume per 1000 Medicare beneficiaries in 2020; non-White patients had a larger percentage decrease in TSA volume than White (21% vs. 14%, estimated difference; 8.7%, P=.02). Black patients experienced the most pronounced disparity with estimated difference of 10.1%, P=.05, compared with White patients. Similar disparities were observed when categorizing procedures into anatomic and reverse TSA, but not proximal humerus fracture. During the COVID-19 pandemic, overall TSA utilization decreased by 14% with White patients experiencing a decrease of 14%, and non-White patients experiencing a decrease of 21%. This trend was observed for elective TSA, while disparities were less apparent for proximal humerus fracture.

Expanding the Pipeline to Teach: Recruiting Future Urban Teachers of Color Through a Dual Enrollment Program.

This qualitative case study explores the perceptions of schools, schooling, and teaching prior to and after engagement in a dual enrollment program. Data from nine participants revealed insights into the ways pre-college students thought about careers in teaching, how experiences in the dual enrollment program shaped their interest in teaching, and their perceptions of the pathways to and aspirations for teaching. Pre-college students envisioned teaching as a career possibility due to intrinsic factors, such as intellectual interests and racial identity; these factors were reinforced by family and salient schooling experiences. The dual enrollment program confirmed prior interests in teaching through its focus on the education major, mentoring, and the opportunity to take college coursework at the host university.

Medicare's Bundled Payments For Care Improvement Advanced Model: Impact On High-Risk Beneficiaries.

Medicare's Bundled Payments for Care Improvement Advanced Model (BPCI-A) is a voluntary Alternative Payment Model in which participating hospitals are held accountable for ninety-day episodes of care. To meet spending targets, hospitals must either decrease utilization or attract a less sick patient population; this could lead to the elimination of necessary care or avoidance of patients with medical or social vulnerability. We used publicly available data on BPCI-A participation, along with Medicare claims from the period 2017-19, to examine patient selection, changes in Medicare payment, and key clinical outcomes among three groups: patients with frailty, patients with multimorbidity, and patients with dual enrollment (both Medicare and Medicaid). We found no consistent change in patient selection associated with BPCI-A participation. Patients with frailty, multimorbidity, or dual enrollment were more expensive at baseline, but Medicare payments decreased similarly in these groups compared with lower-risk patients. There were no differential negative changes in clinical outcomes between BPCI-A participants and nonparticipants among patients with medical or social vulnerability.

The State of the Humanities circa 2022

The State of the Humanities circa 2022

Equity Gaps in Dual Enrollment

This article examined root causes of the equity gaps in dual enrollment through a systematic literature review of peer-reviewed literature, public scholarship, and practitioner perspectives. Root causes identified include access barriers, lack of advising and support, lack of awareness, and financial barriers for underrepresented students, all of which contribute to lower participation rates for Black and Latinx students when compared with White and Asian students. This article serves to provide community college practitioners with a deep understanding of the factors that contribute to this problem so that they can identify interventions that will address these root causes. Suggestions for mitigating equity gaps in dual enrollment for underrepresented students through the use of targeted messaging campaigns are discussed.

Should Students Falling Behind in School Take Dual Enrollment Courses?

This study examined the effect of dual enrollment (DE) on college enrollment and degree completion for students with lower prior academic achievement who attended public high schools in Texas. We employed a propensity score matching method to reduce selection bias arising from DE participation and supplemented the analysis with a bounds test. The results showed that DE students were predicted to have a higher likelihood of entering college immediately after high school by 20 percentage points and completing a degree within four and eight years of high school graduation by 7 and 14 percentage points, respectively, compared to similar students who did not take DE courses. This evidence suggested that DE programs contributed to a reduction in educational inequities in college access and degree attainment for students at risk of academic failure. On the other hand, students who were racial or ethnic minorities and students from low-income families were not only less likely to participate in DE programs but were also predicted to have smaller participation effects on college degree attainment than their counterparts, stressing the need for higher education institutions and partnering school districts to provide more robust support to these underserved students for participating in DE programs and making a successful transition into college.

The Nursing Baccalaureate Dual Enrollment Model: Outcomes for A Community College and University Partnership.

The dual enrollment model in which universities collaborate with community colleges to provide the prelicensure Bachelor of Science in Nursing (BSN) education has been identified by the National Academy of Medicine as one of 5 viable academic progression models for transforming nursing education. The New Mexico Nursing Education Consortium (NMNEC) is a successful example of the dual enrollment model, which began in 2015 with one partnership. By 2018, 3 universities and 5 community colleges had partnered to offer the BSN jointly with the community college locations. In this retrospective, descriptive study, the 2 program types were compared to assess for differences in demographic and academic characteristics as well as program outcomes for the BSN graduates (n = 1018) from 2015 to 2018. The results of the analysis show that NMNEC has been successful in increasing the total number and diversity of BSN graduates for New Mexico. Importantly, NMNEC serves as an exemplar academic-practice partnership model because the success of the consortium would not have been possible without the involvement of practice partners. The outcomes from this study support academic-practice partnerships as instrumental in developing a better educated and more diverse nursing workforce that will improve patient outcomes and strive for health equity.

Psychiatrists Feel the Financial Pinch of MIPS

Psychiatrists Feel the Financial Pinch of MIPS

Unmet Need: Evaluating Pell as a Lever for Equitable Dual Enrollment Participation and Outcomes

Dual enrollment is an increasingly popular avenue for high school students to earn college credit. However, low-income students are underrepresented among dual enrollment participants. In this study, we use a difference-in-differences design to evaluate a unique federal pilot program that allowed high school students to access Pell Grants to fund their dual enrollment. Generally, we find a negative effect of the pilot program on dual enrollment participation, with no effect on subsequent college attendance. Our qualitative analysis suggests this initiative did not sufficiently meet students’ specific needs, required strong partnerships with high schools to ensure high school counselors informed students about the program, and involved substantial financial and administrative burden for participating institutions.

Effects of Medicaid coverage on receipt of tobacco dependence treatment among Medicaid beneficiaries with substance use disorder.

Individuals with substance use disorder (SUD) smoke cigarettes at a rate that is more than double the rate of the general population. Tobacco dependence treatment (TDT) is effective at reducing smoking, yet it is unclear whether expanding insurance coverage of these services increases TDT use among Medicaid beneficiaries with SUD. 2009-2013 Medicaid data in all 50 states and Washington DC. We conducted a retrospective analysis of the 2009-2013 de-identified Medicaid Analytic Extract (MAX) claims for a 100% national sample of fee-for-service (FFS) Medicaid adult beneficiaries. Using a difference-in-difference-in-differences analysis, we assessed the association of full TDT coverage on TDT medication use and tobacco cessation counseling services between beneficiaries with and without SUD. We adjusted for age, sex, race/ethnicity, diagnosis of co-occurring chronic illness, state tobacco taxes, and state and year fixed effects. We excluded patients not continuously enrolled in Medicaid for 12 months during the calendar year, adults aged 65 and older (given their dual enrollment in Medicaid and Medicare), minors aged 12-17, and pregnant women (for whom different TDT coverage policies apply). We separately modeled the association between full coverage of (1) counseling, (2) over-the-counter nicotine replacement therapy, and (3) prescription cessation medications on TDT medication treatment and counseling services. We found that each coverage led to increases in any TDT medication treatment and counseling services for beneficiaries with SUD. The effects of each coverage on medication treatment were greater for beneficiaries with SUD compared to beneficiaries without SUD (ranging from 4.9 to 6.1 percentage point difference). Coverage of tobacco cessation counseling, over-the-counter nicotine replacement therapy, and prescription cessation medications holds promise for reducing the wide disparities in rates of smoking between those with and without SUD.

End-Of-Life Care In Assisted Living Communities: Race And Ethnicity, Dual Enrollment Status, And State Regulations.

Assisted living communities are the final home for many of their residents, most of whom are older, frail, and cognitively or functionally impaired. Yet little is known about end-of-life care in this setting. We examined associations of both death at home and home hospice care with individual characteristics, such as race or ethnicity and dual Medicare-Medicaid enrollment; community characteristics; and the stringency of state-level assisted living regulations. Of the 100,783 fee-for-service Medicare beneficiaries residing in 16,560 assisted living communities who died in 2018-19, almost 60percent died at home, 84percent of them with home hospice. In predicting the likelihood of death at home, dual Medicare-Medicaid enrollment was more important than race or ethnicity; in contrast, race was a stronger predictor than dual enrollment for hospice care at death. Residents were less likely to die at home or with home hospice in states with lower regulatory stringency regarding assisted living communities. These findings may help inform efforts to ensure equitable access to desired end-of-life care in this setting and suggest an important role for state-level regulation.

Telemedicine, Disparities, Pharmaceuticals, And More

From the Editor-In-Chief Health AffairsVol. 41, No. 5: Telemedicine, Disparities, Pharmaceuticals & More Telemedicine, Disparities, Pharmaceuticals, And MoreAlan R. WeilPUBLISHED:May 2022Free Accesshttps://doi.org/10.1377/hlthaff.2022.00449AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSThe May issue of Health Affairs covers a range of equity topics including use of telemedicine, care quality for American Indian/Alaska Native Medicare Advantage enrollees, and the relationship between unplanned surgery and community characteristics.TelemedicineIn response to COVID-19, the Centers for Medicare and Medicaid Services significantly expanded Medicare’s telemedicine coverage. Sanuja Bose and coauthors explore the relationship between telemedicine use and the Area Deprivation Index, a composite sociodemographic measure of a neighborhood. As telemedicine use increased, they find, the highest odds of use were seen for people living in the most disadvantaged neighborhoods.Three Perspectives reflect on Bose and colleagues’ findings and the importance of equity as a priority in telehealth. Elaine Khoong notes that equitable access is challenging in a fee-for-service payment environment. Jen Lau and Janine Knudsen describe the importance of using a community-based approach to address disparities in access. Meena Seshamani adds that telehealth policy evaluation must examine equity, quality, access, and sustainability.DisparitiesThe Child Tax Credit was temporarily expanded between July and December 2021. Using survey data, Elizabeth Adams and coauthors determine that during the expansion, rates of very low food security were cut by more than half, and there were small reductions in children’s consumption of added sugar.Steven Martino and coauthors assess the quality of care received by American Indian/Alaska Native (AI/AN) Medicare Advantage enrollees. They fared better than their White counterparts on some measures and worse on others, with the differences occurring within the same health plans. The authors identify “the need to address large inequities in the treatment of alcohol or other drug dependence, COPD and diabetes—all conditions that AI/AN people suffer from at higher rates than the overall US population.”Yuqi Zhang and coauthors analyze rates of unplanned surgery among Medicare beneficiaries that preferably should be planned when there is adequate access to care. Beneficiaries who live in communities with a higher Social Vulnerability Index are more likely to undergo unplanned surgery for certain access-sensitive conditions and more likely to experience worse outcomes than their less-vulnerable counterparts.PharmaceuticalsDespite major health policy changes, Brendan Saloner and coauthors observe few changes in substance use disorder (SUD) treatment use between 2010 and 2019. Ultimately, they conclude, “increasing health insurance coverage may be insufficient, on its own, to boost SUD treatment use.”C. Joseph Ross Daval and coauthors examine the 482 new drugs and biologics approved by the Food and Drug Administration (FDA) between 2010 and 2021, with a particular focus on the ten drugs approved despite a negative advisory committee vote. They find that “the number of new approved drugs receiving advisory committee review decreased from 59 percent in 2011 to only 6 percent in 2021” and note inconsistencies in the wording of FDA questions posed to the advisory committees.Johanna Catherine Maclean and coauthors find that substantiated infant maltreatment reports with the mother as the perpetrator increased by 38.4 percent after punitive prenatal substance use policies—those that criminalize prenatal substance use or consider it to be child maltreatment—were adopted by states in 2004–18.Age-Friendly HealthChristine Ritchie and Bruce Leff describe what a care delivery system for elders focused on the home and community would look like, and they present evidence to support its importance. They define the principles that should guide its development and discuss what it would take to create it, noting that the current facility-based system, “although convenient for clinicians[, has] turned out to be suboptimal for many patients.”Rachael Bedard and coauthors provide a first-of-its-kind overview of the health of older adults incarcerated in New York City’s jail system. Referencing the premature aging of people who are incarcerated, the term “geriatric” is applied to people age fifty-five or older. This group, which accounted for 8.5 percent of all detainees in 2019, is more than three times as likely as younger detainees to have a major medical or mental health diagnosis. In an Entry Point article, Jonathan Bor describes the public health crisis of an aging prison population.Among assisted living residents enrolled in fee-for-service Medicare who died in 2018–19, Helena Temkin-Greener and coauthors report that dual Medicare-Medicaid enrollees were significantly less likely to die at home and more likely to die in hospitals or nursing homes compared with non–dual enrollees. Further, “Black residents, regardless of dual enrollment status, were significantly less likely than White residents to have been enrolled in hospice at death.” Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 May 2022 Information© 2022 Project HOPE—The People-to-People Health Foundation, Inc.PDF download

Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer.

Differential access to quality care is associated with racial disparities in ovarian cancer survival. Few studies have examined the association of multiple healthcare access (HCA) dimensions with racial disparities in quality treatment metrics, that is, primary debulking surgery performed by a gynecologic oncologist and initiation of guideline-recommended systemic therapy. We analyzed data for patients with ovarian cancer diagnosed from 2008 to 2015 in the Surveillance, Epidemiology, and End Results-Medicare database. We defined HCA dimensions as affordability, availability, and accessibility. Modified Poisson regressions with sandwich error estimation were used to estimate the relative risk (RR) for quality treatment. The study cohort was 7% NH-Black, 6% Hispanic, and 87% NH-White. Overall, 29% of patients received surgery and 68% initiated systemic therapy. After adjusting for clinical variables, NH-Black patients were less likely to receive surgery [RR, 0.83; 95% confidence interval (CI), 0.70-0.98]; the observed association was attenuated after adjusting for healthcare affordability, accessibility, and availability (RR, 0.91; 95% CI, 0.77-1.08). Dual enrollment in Medicaid and Medicare compared with Medicare only was associated with lower likelihood of receiving surgery (RR, 0.86; 95% CI, 0.76-0.97) and systemic therapy (RR, 0.94; 95% CI, 0.92-0.97). Receiving treatment at a facility in the highest quartile of ovarian cancer surgical volume was associated with higher likelihood of surgery (RR, 1.12; 95% CI, 1.04-1.21). Racial differences were observed in ovarian cancer treatment quality and were partly explained by multiple HCA dimensions. Strategies to mitigate racial disparities in ovarian cancer treatment quality must focus on multiple HCA dimensions. Additional dimensions, acceptability and accommodation, may also be key to addressing disparities.

National Evidence of the Relationship Between Dual Enrollment and Student Loan Debt

National Evidence of the Relationship Between Dual Enrollment and Student Loan Debt