Michigan's Program Research Articles

Annals for Educators - 19 November 2019.

Annals for Educators - 19 November 2019.

Web Exclusive. Annals for Hospitalists Inpatient Notes - Reaching for Higher Value in Health Care by Bringing Together Clinicians and Researchers-The Michigan Program on Value Enhancement.

Web Exclusives19 November 2019Annals for Hospitalists Inpatient Notes - Reaching for Higher Value in Health Care by Bringing Together Clinicians and Researchers—The Michigan Program on Value EnhancementGeoffrey D. Barnes, MD, MSc and Eve A. Kerr, MD, MPHGeoffrey D. Barnes, MD, MScMichigan Program on Value Enhancement, Michigan Medicine Quality Department and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan (G.D.B., E.A.K.)Search for more papers by this author and Eve A. Kerr, MD, MPHMichigan Program on Value Enhancement, Michigan Medicine Quality Department and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan (G.D.B., E.A.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2980 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hospitalists frequently serve as clinical leaders of quality improvement (QI) projects. Their first-hand knowledge of clinical care processes and breadth of clinical expertise make them perfectly suited for these roles. In many health systems, these clinical QI leads are paired with QI staff or “performance improvement coaches” who have process expertise in one or more QI methodologies (e.g., Lean).However, even with a clinician-QI staff partnership, many well-intentioned QI projects are limited by suboptimal design and analysis. Hospitalists who work in this space should consider collaborating with health services researchers who can assist with rigorous preintervention assessments, innovative intervention design, ...

Assessing improvements in socio-ecological system governance using mixed methods and the quality governance framework and its diagnostic capacity tool

We face extreme and unprecedented socio-ecological systems (SES) governance challenges given advances in technology, global biophysical change, human behavior, and our abilities to seek resilience through policy decisions. The associated demands to rapidly adapt and shift our trajectories for improved SES outcomes provide a great impetus for humans to improve upon complex SES governance quality. Building on theories derived from polycentric, participatory, network-based practices, structured deliberative decision processes, and capacities that align with resilient systems thinking, a Quality Governance Framework (QGF) and Diagnostic Capacity Tool (DCT) were developed to diagnose SES governance quality that could improve outcomes for a cleanup and redevelopment program in Michigan. The QGF and its DCT were found to be reliable and valid. Using a subset of the DCT measurements and other respondent data, this research uses a mixed methods approach to further test and validate the QGF and DCT. The cleanup program was in its third year of transitioning from a more hierarchical form of governance to one that is more participatory. The results indicate further convergence in ratings between previously disparate practitioner populations and increases in the perceptions of improved governance quality and resilient SES outcomes. Respondents’ open-ended feedback and program metrics correlate with the DCT findings and provide further validity for the QGF and competencies associated with quality governance measured with the DCT. This research contributes to the growing body of empirical evidence that can assess governance quality and illuminates how governance quality can be diagnosed to treat and improve SES outcomes.

Spatial variation in teens’ crash rate reduction following the implementation of a graduated driver licensing program in Michigan

Motor vehicle crashes are a leading cause of injury, and teen drivers contribute disproportionately to that burden. Graduated Driver Licensing (GDL) programs are effective at reducing teen crash risk, but teen crash rates remain high. Between-state variation in the teen crash rate reduction following GDL implementation has been documented, but this is the first study to examine small-area variation in such a reduction. Fusing together crash data from the Michigan State Police, census data, and organizational data (alcohol outlet, movie theatre, and school locations), we analyzed spatial correlates of teen injury crash, and place-based features that modified the injury crash rate difference following GDL implementation. Specifically, using census-based units, we estimated changes in injury crash rates among teens using negative binomial regression controlling for spatial autocorrelation, and tested whether any measured spatial characteristics modified the crash rate change in the pre versus post GDL periods. There was a substantial reduction in teen crashes after GDL implementation (RR = 0.66, 95%CI: [0.65, 0.67]), and this effect was robust across gender and time-of-day (light/dark). We found evidence that this reduction varied across space; areas with more alcohol outlets corresponded to a larger daytime crash rate reduction post-GDL, while areas near schools corresponded to a smaller daytime crash rate reduction. Concentrations of movie theatres corresponded to larger post-GDL crash rate reductions after dark. Maximizing the substantial successes of GDL programs requires understanding why crash rate reductions were larger in some areas following GDL implementation, and harnessing that understanding to improve its effectiveness across a state, focusing on identifying priorities for improving driver training (e.g., by parents and driver educators), law enforcement, and future policy changes to current GDL laws.

Are Michigan State University medical school (MSU-CHM) alumni more likely to practice in the region of their graduate medical education primary care program compared to non-MSU-CHM alumni?

BackgroundOver the past 10 years, three new MD schools have been created in the state of Michigan, while the Michigan State University College of Human Medicine (MSU-CHM) has increased their class size to 850 students. The aim of this study was to determine if MSU-CHM alumni who graduate from an MSU-affiliated primary care residency from a single graduate medical education (GME) training program in Michigan are more likely to go on to practice in close proximity to the location of their training program immediately after graduation compared to non MSU-CHM alumni. Changes over time in the proportion of primary care graduates who received fellowship training immediately following residency were also compared between these groups.MethodsA review of historical data was performed for all 2000–2016 primary care (Family Medicine, FM; Internal Medicine, IM; Internal Medicine-Pediatrics, IMP; Pediatrics, Peds) program graduates sponsored by Grand Rapids Medical Education Partners (GRMEP). Study variables included primary care program, gender, age at graduation, fellowship training, practice location immediately after graduation and undergraduate medical education location. Summary statistics were calculated for the data. Comparisons were made using the chi-square test or Fisher’s Exact test when appropriate. Significance was assessed at p < 0.05.ResultsThere were 478 primary care program graduates who went into practice immediately following graduation, 102 of whom also graduated from MSU-CHM. Just over half of the graduates were female and the average age at graduation was 32 years. There were 152 FM, 150 IM, 50 IMP and 126 Peds graduates. Those that graduated from both MSU-CHM and GRMEP were more likely to practice in Michigan immediately after residency training (79.4% vs 52.0%; p < 0.001), as well as within 100 miles of GRMEP (71.6% vs 46.4%; p < 0.001). There were 8% of MSU-CHM primary care graduates who went on to fellowship training from 2000 to 2009, increasing to 34% from 2010 to 2016 (p < 0.001).ConclusionMedical school graduates of MSU-CHM who receive GME training in primary care are more likely to practice medicine within close proximity to their training site than non MSU-CHM graduates. However, plans for fellowship after training may add one caveat to this finding.

450 Million Asset Management Grant Program in Michigan: What Have We Learned?

450 Million Asset Management Grant Program in Michigan: What Have We Learned?

Alternatives to the Gypsy Moth Eradication Program in Michigan

Alternatives to the Gypsy Moth Eradication Program in Michigan

Predicting Blood-Lead Levels Among U.S. Children at the Census Tract Level

Abstract Efforts to prevent childhood lead exposure are hindered by difficulty in predicting where exposure is concentrated in the absence of childhood blood-lead data. To help fill that gap, we created and validated a regression model to estimate childhood lead exposure in every census tract in the United States. Publicly available factors that were the most predictive of childhood blood-lead concentration were identified by a literature review and an evaluation of childhood blood-lead level (BLL) records from a public health surveillance program in Michigan (543,295 records for the years 1999–2009). The predictive power of the regression model was validated through a comparison to blood-lead surveillance program data from Massachusetts (833,951 records for the years 2000–2009), Texas (838,368 records for the years 1999–2009), and National Health and Nutrition Examination Survey (NHANES) datasets. The regression model identified percentage of pre-1960 housing, percentage of population below poverty line,...

Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement.

Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a local Federal Healthy Start (HS) program in Michigan that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women's health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services.

What Matters Most? A Mixed Methods Study Identifying Key Elements of an Effective Home-Based Palliative Program in Michigan (S787)

What Matters Most? A Mixed Methods Study Identifying Key Elements of an Effective Home-Based Palliative Program in Michigan (S787)

Exploring the potential role of public drain managers in motivating agricultural conservation practices

Abstract A current lawsuit by the Des Moines Water Works against three upstream Iowa counties raises the prospect that agricultural drain managers nationwide will bear greater responsibility to promote conservation practices that protect downstream water quality. To date, however, an institutional and administrative approach for doing so is lacking. A pilot program in southwestern Michigan introduced a new method for apportioning drain management costs that rewards landowners who use conservation practices known to reduce sedimentation. The logic of the program is that as each parcel deposits less sediment into a drain, the cost of maintaining that drain will decline. We describe the program, review its performance relative to a number of criteria, and discuss its prospects for replication elsewhere. Several Michigan drain commissioners have expressed interest in replicating the approach which reduced participating landowners' drain assessments by 21 percent in the pilot program. The details of the program are quite specific to the case in Michigan, but institutionally it offers a way forward that could be applied widely.

Teacher Teams and School Processes in Scaling-Up a Content Literacy Innovation in High Schools - Final Report: The Evaluation of the Scale-Up of Reading Apprenticeship Through the Reading Apprenticeship Improving Secondary Education (Raise) Project

We report on the scaling up of a high school content literacy intervention, Reading Apprenticeship, over a period of four years as part of the independent evaluation of an Investing in Innovation grant from the U.S. Department of Education to WestEd’s Strategic Literacy Institute (SLI). The goal of our scale-up study was to understand the school processes that support successful implementation and promote scaling of an innovation. We focused on teachers, principals and other school-level program leadership who were also the focus for SLI’s innovation designed to support scale. The logic model that our work was guided by built on research literature that provided insights into scale-up as increasing local ownership and depth of commitment, as well as growth in numbers. We provided formative feedback to SLI while contributing to the empirical methods and evidence for studying scale-up processes.Study Design: The scale-up study was conducted in parallel to a RCT in which 22 treatment and 20 control schools from Pennsylvania and California participated for three years. In the scale-up portion of the evaluation, a total of 239 schools in four cohorts adopted the program in Pennsylvania, Michigan, Indiana, and Utah. Our study focused on the scale-up teachers and schools but also compared these to teachers and schools in the RCT treatment group. Surveys of teachers and principals, as well as records of participation in project activities provided a rich longitudinal dataset. In addition, four schools served as case studies where school leaders and program support staff were interviewed over two years to offer a concrete picture of decision processes and resources. We used descriptive statistics from surveys of the larger sample to track changes over time in features of program implementation, as well as resulting changes in attitudes and commitment among teachers. Regression methods were used to identify predictors of increased or decreased participation. We used these predictors in comparing the scale-up and RCT as contexts for the implementation and impact of Reading Apprenticeship.Findings: Over the five years of the project, the scale-up of RAISE reached approximately 533,000 students, and 1,719 teachers in 239 schools in four states. During the first year of RAISE implementation, teachers and administrators in the Scale-up schools reported high levels of buy-in and commitment to the initiative. Teachers were successfully integrating Reading Apprenticeship practices into their instruction and cited collaboration and support from other teachers as the most effective means at building their capacity to implement what they learned during the RAISE professional development. Teachers and administrators identified competing initiatives as a primary challenge to implementing and sustaining RAISE long term and, as we found through our case study work, schools faced unique and localized challenges as they navigated their way through the scale-up. In the second and third year of implementation we found that trends in the uptake of RAISE activities and enthusiasm for the initiative decreased or leveled off by the third year. We also found a greater spread in responses across schools by the third year, calling for further investigation into school-level processes and the characteristics of schools that may be associated with the gain or loss of RAISE participants over time.Through this investigation, we found that teacher participation in team meetings during the first year and school-wide commitment (rather than individual commitment and actual classroom usage by the teachers) predicted the increase in number of teachers participating in a school. Such increases were less likely where the school did not see regular participation in team meetings in the first year and there was less commitment among teachers to school-wide success. Increases were unrelated to demographics and resources available to the school and unrelated to many characteristics and actions of administrators. We hypothesized that a process, consistent with SLI’s innovation for scaling Reading Apprenticeship, which involved a cross-disciplinary teacher team within the school, led to increased and sustained program participation. As a final step, we compared the characteristics of Scale-up and RCT treatment schools. Scale-up schools had more of the characteristics associated with growth suggesting greater long term sustainability than in RCT schools. We raise the issue of whether the implementation under the constraints of the RCT is a good model for measuring impact in the context of scaling up an innovation.

Abstract 211: Influence of Parental Education on Nutritional and Lifestyle Choices of Project Healthy Schools Students

Background: Prior research has shown that dietary beliefs and activity levels of parents significantly mediate dietary and physical behaviors of their children. However, there is limited research regarding the influence of parental education on children’s health. This study analyzes the differences in dietary and lifestyle behaviors of 6th grade students with more educated parents compared to those with less educated parents. Methods: Data were taken from 6048 students in 41 schools involved in Project Healthy Schools (PHS), a middle school-based intervention program in Michigan. Students were divided into two groups based on their parents’ education levels, as selected in a health behavior survey given to the students. Students were included in the “More Educated” group if they had at least one parent with a college or Master’s/Professional degree. Students with neither parent having completed a college degree were classified as the “Less Educated” group. Students’ baseline survey responses to nutritional and lifestyle questions were compared using a Wilcoxon rank-sum test. Results: Students with more educated parents reported eating more fruits and vegetables per day, exercising more frequently, and spending less time in front of a screen. The more educated group were more likely to eat breakfast (0.70 vs. 0.53 on a 0-3 scale p&lt;.0001), less likely to eat school lunch (1.11 vs 1.39 on a 0-2 scale; p&lt;.0001), and less likely to have a TV in their bedroom (0.53 vs. 0.70 on a 0-1 scale; p&lt;.0001). Conclusions: It was observed that students with more educated parents made healthier dietary choices, exercised more often, spent less time in front of screens, and participated more often in other healthy lifestyle choices. These observations may be partially attributed to higher income levels in more educated parents, which may increase students’ access to healthier resources; however, this study certainly highlights the importance of parental influence on a child’s health. Future efforts will encourage more parental involvement in Project Healthy Schools.

Induction of adipose-derived stem cells on injectable nanofibrous spongy microspheres for vascularized adipose tissue regeneration in vivo

Event Abstract Back to Event Induction of adipose-derived stem cells on injectable nanofibrous spongy microspheres for vascularized adipose tissue regeneration in vivo Yasmine Doleyres1, Xiaobing Jin2 and Peter X. Ma1, 2, 3, 4 1 University of Michigan, Macromolecular Science and Engineering Program, United States 2 University of Michigan, Department of Biologic and Materials Sciences, United States 3 University of Michigan, Department of Biomedical Engineering, United States 4 University of Michigan, Department of Materials Science and Engineering, United States Soft tissue defects in the craniofacial region or the breast region often occur due to congenital defects, traumatic injury, or cancer occurring in the underlying tissue[1]. Correcting these defects in the case of facial reconstruction can be done by transplanting adipose (fat) tissue from another area of the body into the facial region or in the case of reconstruction following breast cancer can be done through autologous tissue transplantation, if available, or using silicone or saline-filled implants. The problem with these options is that between 20-90% of transplanted fat tissue often resorbs within a couple months after being transplanted due to lack of vascularization and implants often fail because of capsular constriction and become infected, leading to multiple surgeries in both cases[1]-[8]. The most ideal option would be to regenerate one’s own adipose tissue just as it is naturally produced by the body. Lasting tissue regeneration options for in vivo adipose tissue have yet to be developed, and this is the goal of this project. Novel nanofibrous spongy (porous) microspheres (NF-SMS) have been developed and appear to be a suitable scaffolding or cell-carrying material for the differentiation and growth of adipose-derived stem cells (ASCs). These microspheres made of poly-L-lactic acid (PLLA) have a nanofibrous architecture that well-mimics the cells’ natural extracellular matrix and also allows for cells to pack the interior of the microspheres[9]. A high number of cells are able to pack into the interior of the microspheres and the high cell attachment on the microspheres is critical for adipose tissue regeneration as high cell-cell contact is necessary for tissue growth. Adipogenesis of the isolated ASCs is induced for 3-4 days in growth medium containing Dexamethasone, Indomethacin, and 3-isobuytl-1-methylxanthine (IBMX)[10],[11]. The cells are then combined with the microspheres for a few hours and subsequently injected subcutaneously in a nude mouse model for testing. Early in vitro experiments comparing the growth and differentiation of the cells on the NF-SMS against enclosed nanofibrous hollow microspheres as a control show increased cell attachment and integration on the NF-SMS. The cells on the NF-SMS also showed greater Nile Red lipid staining and overall positive results in vitro. Current in vivo experiments are being done and are incorporating poly(lactic-co-glycolic acid) (PLGA) nanoparticles loaded with insulin for sustained released of insulin from these particles during the early period of growth (1-2 weeks). Insulin appears to be very critical in the adipogenesis pathway and should be crucial in helping to produce substantial tissue in vivo[12]-[14]. These PLGA nanoparticles are injected along with the microsphere-cell complexes. Having a patient regenerate adipose tissue from their own pre-adipocyte cells will be advantageous because it eliminates the need for something foreign in the body and multiple invasive surgeries. Ensuring that the adipose tissue produced does not resorb as is the case in previous research attempts would be done by functionalizing the microsphere scaffolds with an angiogenic factor, which is the next goal of this project.

An Electronic Asthma Self-Management Intervention for Young African American Adults

Health disparities are seen in many chronic conditions including asthma. Young African American adults represent a population at high risk for poor asthma outcomes due to both their minority status and the difficult transition from adolescence to adulthood. Recruitment and retention has been challenging in this demographic stratum, and traditional asthma education is often not feasible. The objective of this study was to develop and assess the feasibility of an electronic asthma self-management program for young African American adults. A total of 44 African American adults (age 18-30 years) with uncontrolled persistent asthma were enrolled in an asthma self-management program. The 6-week Breathe Michigan program (predicated on the social cognitive theory) was tailored specifically to the concerns and preferences of young African American adults. The entire program was completed electronically, without any specialized human support. At 2 weeks and 3 months after program completion, participants were contacted for follow-up. A total of 89% of enrolled subjects completed the 6-week intervention, and 77% were available for evaluation at 3 months. All subjects completing the 2-week postprogram survey reported that the program was helpful, and 97% would recommend it to others. Asthma control as measured by the Asthma Control Test improved from 16.1 to 19.3 (P < .01), and asthma quality of life as measured by the Mini Asthma Quality of Life Questionnaire improved from 4.0 to 5.1 (P < .01). The Breathe Michigan program is feasible for recruitment and retention, and demonstrated an improvement in asthma control and quality of life for young African American adults.

Estimating the cost to U.S. health departments to conduct HIV surveillance.

HIV case surveillance is a primary source of information for monitoring HIV burden in the United States and guiding the allocation of prevention and treatment funds. While the number of people living with HIV and the need for surveillance data have increased, little is known about the cost of surveillance. We estimated the economic cost to health departments of conducting high-quality HIV case surveillance. We collected primary data on the unit cost and quantity of resources used to operate the HIV case surveillance program in Michigan, where HIV burden (i.e., the number of HIV cases) is moderate to high (n=14,864 cases). Based on Michigan's data, we projected the expected annual HIV surveillance cost for U.S., state, local, and territorial health departments. We based our cost projection on the variation in the number of new and established cases, area-specific wages, and potential economies of scale. We estimated the annual total HIV surveillance cost to the Michigan health department to be $1,286,524 ($87/case), the annual total cost of new cases to be $108,657 ($133/case), and the annual total cost of established cases to be $1,177,867 ($84/case). Our projected median annual HIV surveillance cost per health department ranged from $210,600 in low-HIV burden sites to $1,835,000 in high-HIV burden sites. Our analysis shows that a systematic approach to costing HIV surveillance at the health department level is feasible. For HIV surveillance, a substantial portion of total surveillance costs is attributable to maintaining established cases.

Prenatal Tobacco Exposure and Cotinine in Newborn Dried Blood Spots

Tobacco smoking by pregnant women is a major public health hazard with both short- and long-term effects on offspring. This study describes the presence and level of the nicotine metabolite cotinine in newborn dried blood spots (DBS) and compares it with the reported maternal smoking recorded on state birth registries. We hypothesize that cotinine in DBS may be a useful measure of newborn in utero tobacco exposure. An observational, cross-sectional study of 1414 DBS obtained from California, Michigan, New York, and Washington newborn screening programs was carried out. Cotinine levels in DBS were quantified by liquid chromatography tandem mass spectrometry analysis and compared with maternal smoking as reported in vital statistics data. Cotinine ≥0.3 ng/g was detected in 35% of newborn DBS, including DBS of 29% of newborns whose mothers reportedly did not smoke cigarettes during pregnancy, some of whom were presumably exposed to environmental tobacco smoke. Twelve percent of the newborn DBS had cotinine levels that were ≥9.0 ng/g (equivalent to 6 ng/mL plasma, a level that indicates active smoking of the mother), although 41% of the mothers of these infants reportedly did not smoke. These data confirm that reported smoking during pregnancy is an imperfect measure of prenatal tobacco smoke exposure. Cotinine assessment in newborns may improve surveillance of tobacco use during pregnancy.

G122(P) Mismatching Michigan?

Neonatal infections increase mortality, prolong hospital stay and worsen neurodevelopmental outcomes. The Matching Michigan (MM) program initiated in UK Jan 2011, is a care-bundle focused on reducing healthcare-associated infections.Our report...

Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings: Recommendations from a Multidisciplinary Expert Panel

Noncognitive neuropsychiatric symptoms (NPS) of dementia (aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition) affect individuals with dementia nearly universally across dementia stages and etiologies. NPS are associated with poor outcomes for individuals with dementia and caregivers, including excess morbidity and mortality, greater healthcare use, and earlier nursing home placement, as well as caregiver stress, depression, and difficulty with employment. Although the Food and Drug Administration has not approved pharmacotherapy for NPS, psychotropic medications are frequently used to manage these symptoms, but in the few cases of proven pharmacological efficacy, significant risk of adverse effects may offset benefits. There is evidence of efficacy and limited potential for adverse effects of nonpharmacological treatments, typically considered first line, but their uptake as preferred treatments remains inadequate in real-world clinical settings. Thus, the field currently finds itself in a predicament in terms of management of these difficult symptoms. It was in this context that the University of Michigan Program for Positive Aging, working in collaboration with the Johns Hopkins Alzheimer's Disease Research Center and Center for Innovative Care in Aging sponsored and convened a multidisciplinary expert panel in Detroit, Michigan, in fall 2011 with three objectives: to define critical elements of care for NPS in dementia; to construct an approach describing the sequential and iterative steps of managing NPS in real-world clinical settings that can be used as a basis for integrating nonpharmacological and pharmacological approaches; and to discuss how the approach generated could be implemented in research and clinical care.

Use of Supplemental Nutritional Assistance Program Benefits by Unemployment Insurance Applicants in Michigan during the Great Recession

During the Great Recession, both the Supplementary Nutrition Assistance Program (SNAP) and the federal-state unemployment insurance (UI) program experienced dramatic increases in participation. Using Michigan program administrative data on all SNAP (2006-2011) recipients and all UI (2001-2010) applicants, we examine SNAP use before and after UI application. Both past and future receipts of SNAP are highly negatively correlated with meeting UI income and job separation eligibility requirements. Unemployment insurance applicants with insufficient wage credits or job separations because of quitting or employer discharge are much more likely to have received SNAP in the past. Furthermore, such UI applicants are also more likely to receive SNAP soon after applying for UI benefits. The data also indicate that as of the start of the Great Recession, UI applicants who received SNAP subsequent to UI filing began receiving those benefits sooner compared with UI applicants prior to the downturn. The models also suggest that SNAP receipt after UI application was higher among ineligible UI applicants, applicants who quit or were fired from prior jobs, those with prior recent SNAP receipt, prime age workers, females, those with education of less than a high school diploma, those having three to five years’ prior job tenure, and those with a separating job in retail trade, health care, or hospitality.