Total Dollars Research Articles

Outcomes of Pharmacist-Led Treatment of Hepatitis C in the Virginia Department of Corrections.

A higher proportion of people in correctional settings have, or are at risk for, hepatitis C virus (HCV) due to socioeconomic factors, mental health concerns, substance use disorders, history of high-risk experiences, and more. Compared with the general population, the prevalence of HCV is 10 times higher among people who are incarcerated. The objective of this retrospective cohort study was to describe the HCV treatment cascade in a pharmacist-led clinic model, from referral through treatment completion and documentation of cure. Pharmacists in the Virginia Department of Corrections, in collaboration with Virginia Commonwealth University, established and led a telemedicine HCV clinic. A total of 1,040 incarcerated individuals with chronic HCV infection were treated between January 2020 and January 2022. In this study, the clinical endpoint was the number of patients achieving a 12-week sustained virological response (SVR12), which is considered cure of an HCV infection. The economic endpoint was total dollars spent per patient to achieve the SVR12. Participants were HCV treatment naïve, positive for HCV genotypes 1-6, not concurrently infected with HIV, and without decompensated liver disease. The overall cure rate was 97% with no discontinuation due to adverse effects. The cost-to-cure ratio was $23,223/person achieving SVR12.

Trauma Informed Care Can Enhance Whole Person Care to Meet the Quadruple Aim

Objective: Whole person care typically includes a biopsychosocial, interdisciplinary treatment approach with the intent of improved health outcomes and savings in total dollars spent on healthcare providers and services. Its multidimensional approach to a patient’s physical and mental health makes it the model of choice for achieving the quadruple aim of healthcare reform. However, we argue that whole person care is incomplete in its current form due to its lack of attention to the public health impact of stress and psychological trauma. Methods: We used seminal articles, original research and theory, and a variety of databases such as PubMed, and Google Scholar to research our topic. Results: Whole person care would benefit from the integration of traumainformed care practices, so that it can better meet the quadruple aim by addressing these broader public health concerns. Trauma-informed care was selected because it understands, recognizes, and responds appropriately to trauma in patients and providers, which enhances the effectiveness of healthcare delivery and reduces the impact of social inequity. Conclusion: Integrating traumainformed care into whole person care can help achieve the quadruple aim, as well as the newly proposed fifth aim of advancing health equity, because social inequity increases stress and exposure to psychological trauma.

Facial plating industry payments: An analysis of the open payments database.

To compare industry payments from facial plating companies to plastic surgery, oral and maxillofacial surgery (OMFS), and otolaryngology (OHNS). The Open Payments Database was queried from 2016 to 2021 to identify all industry disbursements related to facial plating products from Stryker, Zimmer Biomet, Depuy Synthes Products, Acumed, and KLS Martin. Total dollars, number of payments, and specialists paid were compared between plastic surgery, OMFS, and OHNS. Funding was correlated to estimated case volume and number of licensed surgeons determined by literature review. From 2016 through 2021, OMFS received an average of $786,497 annually, followed by plastic surgery ($765,482), and OHNS ($184,484). On average, facial plating companies distributed 2256, 963, and 917 yearly payments to 699 oral and maxillofacial surgeons, 378 plastic surgeons, and 354 otolaryngologists, respectively. Total dollars, number of payments, and specialists paid were significantly different between specialties (p < .05). Facial trauma coverage is 39.6% by plastic surgery, 36.6% by OMFS, and 23.3% by OHNS. There are 7560 licensed oral and maxillofacial surgeons, 4948 plastic surgeons, and 11,778 otolaryngologists in the United States. Decreased payment to OHNS was more than could be accounted for by case volume alone. The facial plating industry allocates more funding dollars to OMFS and plastic surgery compared to OHNS. OMFS receives the greatest number of payments to the most specialists compared to plastic surgery and OHNS. Engagement between OHNS and the facial plating industry is a potential area of growth in the future.Level of evidence: Level 4.

The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

Effect of Financial Incentives and Default Options on Food Choices of Adults With Low Income in Online Retail Settings

Despite recent growth in online redemption of Supplemental Nutrition Assistance Program (SNAP) benefits, no previous work has tested the impact of economic and behavioral economic strategies on food purchasing behaviors in an online grocery retail setting among adults with low income. To examine the extent to which financial incentives and default shopping cart options influence fruit and vegetable purchases. This randomized clinical trial used an experimental online grocery store for adults who currently or have ever received SNAP benefits. From October 7 to December 2, 2021, participants were instructed to shop for a week's worth of groceries for their household, with a budget tailored to household size; no payment was taken. Random assignment to 1 of 4 conditions: no intervention, 50% discount on eligible fruits and vegetables, prefilled shopping carts with tailored fruit and vegetable items (ie, default options), or a combination of the discount and default options. The primary outcome was the percentage of nondiscounted dollars spent on eligible fruit and vegetables per basket. Of 2744 participants, mean (SD) age was 46.7 (16.0) years, and 1447 (52.7%) identified as women. A total of 1842 participants (67.1%) reported currently receiving SNAP benefits and 1492 (54.4%) reported shopping online for groceries in the previous 12 months. Participants spent a mean (SD) 20.5% (23.5%) of total dollars on eligible fruits and vegetables. Compared with no intervention, those in the discount condition spent 4.7% (98.3% CI, 1.7%-7.7%) of more total dollars on eligible fruits and vegetables; those in the default condition, 7.8% (98.3% CI, 4.8%-10.7%) more; and those in the combination condition, 13.0% (98.3% CI, 10.0%-16.0%) more (P < .001 for all). There was no difference between the discount and the default conditions (P = .06), but the effect in the combination condition was significantly larger than both discount and default conditions (P < .001). Default shopping cart items were purchased by 679 participants (93.4%) in the default condition and 655 (95.5%) in the combination condition, whereas 297 (45.8%) in the control and 361 (52.9%) in the discount conditions purchased those items (P < .001). No variation was observed by age, sex, or race and ethnicity, and results were similar when those who reported never shopping online for groceries were excluded. In this randomized clinical trial, financial incentives for fruits and vegetables and default options, especially in combination, led to meaningful increases in online fruit and vegetable purchases among adults with low income. ClinicalTrials.gov Identifier: NCT04766034.

Leveraging ambulatory care pharmacist expertise in medication appeals to overcome access barriers: A descriptive report

AbstractIntroductionPrescription prior authorization (PA) and prohibitive out‐of‐pocket costs are encountered across all specialties of care. These barriers are burdensome for prescribers and patients due to the multiple steps required to gain approval for payer reimbursement for medications.ObjectivesThe primary objective was to characterize clinical pharmacist impact on medication appeals and high cost resolution.MethodsThis was a retrospective review of medication access intervention data collected from January 1, 2021, through July 31, 2021, at an academic medical center where five clinical pharmacists are embedded across 11 specialty and family medicine clinics. Intervention data was documented for both specialty and nonspecialty prescriptions. The primary end point quantified and characterized interventions based on access issues, defined as insurance denial or high out‐of‐pocket cost. Additional end points included time to appeal determination, total time spent on appeal activities, the incidence of denials, duration of the interruption, and assistance dollars secured for cost‐related barriers.ResultsOver the 7‐mo period, there were 531 prescriptions identified for clinical pharmacist access intervention. Of the total interventions collected, 42% (n = 221) were appeals for insurance denials and 58% (n = 310) addressed high out‐of‐pocket cost. The approval rate of appeals was 94% (n = 208). The majority of appeals (89%) were submitted within 3 d. The median time to appeal determination was five calendar days. The estimated time spent on appeal activities by the clinical pharmacists was 6.8 work wk. There were 51 patients of therapy interruption. The total assistance dollars secured for high out‐of‐pocket costs reached an estimated $1 953 200 over the report period.ConclusionThis report characterizes an approach to effectively manage medication appeals and cost resolution through embedded clinical pharmacists. Leveraging embedded pharmacists' clinical knowledge and familiarity with payer processes in medication appeals achieved a 94% approval rate. The current payer process places a burden disproportionately on prescribers and patients, delaying or preventing medication access.

Evaluating the impact of a sleep health education and a personalised smartphone application on sleep, productivity and healthcare utilisation among employees: results of a randomised clinical trial

ObjectivesWe evaluated an online Sleep Health and Wellness (SHAW) programme paired with dayzz, a personalised sleep training programme deployed via smartphone application (dayzz app) that promotes healthy sleep and treatment...

Valuation of losses and damages resulting from the Fundão's dam failure: An emergy perspective

In 2015, the ‘Fundão’ dam's failure in Brazil released 44 million m3 of tailings that traveled 670 km in the ‘Doce’ river watershed crossing 40 municipalities and two states until reaching the Atlantic Ocean. Since then, a public civil action (PCA) is responsible for litigation processes, and recently established a value of US$ 43.8 billion to repair losses and damages, a value that brings doubts about its accuracy in expressing the loses and damages of the disaster. This claims for alternative methods for its monetary quantification than the current tradicional economic ones. Among others biophysical approaches, the emergy accounting appears as a powerful tool due to its donor side perspective that objectively quantifies value and recognizes energy quality. This study aims to use emergy accounting as method to firstly identify and then quantify the impacts of ‘Fundão’ dam's failure, considering exclusively the negative direct and immediate impacts. Three categories are considered to quantify loses and damages: (I) suppressed stocks in the mud passage and deposition areas (MPDA), (II) social disruption, and (III) changes in landscape. For all the three scenarios of turnover times (Tt), results show that about 98% of total emergy in the suppressed stocks are related to (II) and (III), while only 2% in average is related to (I). This discrepancy highlights the importance of accounting for (II) and (III) since they are often disregarded or not directly considered by traditional economic approaches. From a macroeconomic perspective, the highest total emergy-based dollars (emdollar, EmUS$) found for scenario #3 reached EmUS$ 149.18 billion, a value 3.4 times higher than the US$ 43.8 billion established by PCA. This higher value is equivalent to the annual emergy demanded by the Ecuador economy with 18 million inhabitants. Rather than providing an accurate monetary value for the ‘Fundão’ disaster repair, this study contributes for the advancement of discussions about using biophysical methods such as emergy accounting that allows tracking all numbers for objective verification as alternative to the traditional economic approaches in quantifying losses and damages of high proportion disasters.

An Analysis of Otolaryngology's NIH Research Funding Compared to Other Specialties.

To compare NIH funding in the field of Otolaryngology to other medical and surgical specialties between 2009 and 2019. Data was collected from the NIH RePORTER database on funding dollars received by each specialty from 2009 to 2019. Along with data on total active physicians per specialty using the Physician Specialty Data Book, comparisons were drawn between Otolaryngology and other medical and surgical specialties with regards to trends in total funding and NIH funding dollars per physician. The distributions of grant funding, within Otolaryngology from various NIH institutes among principal investigators, organizations, and subspecialties were further explored. There were 3810 grants (1147 unique projects) for a total of $1 276 198 555 funded by the NIH to Otolaryngology departments from 2009 to 2019. Statistically insignificant funding increases (P > .05) caused otolaryngology to fall from first to fourth in funding among studied specialties. The National Institute on Deafness and Other Communication Disorders funded 57% of all unique projects, and 57.2% of all unique NIH projects were otology related. Most projects were basic science related. The top 10 principal investigators obtained 22.3% of the total NIH funding for Otolaryngology. The top 3 organizations over the studied period comprised 26.55% of the total funding, generating a combined 729 grants. Among principal investigators, 63.0% had a PhD degree, 25.3% had an MD, and 9.6% had an MD/PhD. NIH funding in Otolaryngology has remained stable and is highly concentrated among a small number of organizations, geographic regions, and principal investigators. Recent initiatives by academic communities have sought to address funding disparities by incorporating diversity and inclusion into clinician-scientist pipelines. We urge our colleagues to strive toward identification of the factors that contribute to successful acquisition of funding and implementation of a more conducive institutional infrastructure to produce research.

0347 Sleep health education and a personalized smartphone application improve sleep and productivity and reduce healthcare utilization among employees: Results of a randomized clinical trial

Abstract Introduction Sleep deficiency and undiagnosed or untreated sleep disorders are pervasive among employed adults, yet are often ignored in the context of workplace health promotion. Smartphone applications (apps) are a promising, scalable approach to improving sleep among employees. We evaluated an online sleep education program followed by access to a mobile sleep training program, the dayzz app, that promotes healthy sleep, sleep disorders awareness and intervention. Methods In a sample of daytime employees affiliated with a large healthcare organization, we evaluated the intervention (sleep education at baseline plus access to the personalized app for up to 9 months) in a parallel group, randomized controlled trial. Participants were randomly assigned to either the experimental condition that received the intervention in months 1 through 9 or the control group that was assigned to receive the intervention in month 10. In a prespecified data analysis plan, the experimental and control groups were compared in months 1 through 9; no outcome data was collected thereafter. We collected data on employee sleep, workplace outcomes, and healthcare utilization, monthly throughout the study. Results The final cohort was comprised of 794 participants assigned to the experimental and 561 to the control condition. Those assigned to the experimental condition were more likely to maintain consistent sleep schedules (OR:1.40;95%CI:1.12-1.75) and less likely to experience fatigue and sleepiness (OR:1.30;95%CI:1.08-1.57). At the 9-month follow-up assessment, the experimental group reported significantly longer sleep duration than the control group on work (experimental: 7.20hrs; control: 6.99hrs, p=0.01) and free (experimental: 8.26hrs; control: 8.04hrs, p=0.03) nights. The odds of poor sleep quality at follow-up were lower in the experimental condition (OR:0.79,95%CI:0.63-0.98) as compared to control. Mean total dollars lost due to presenteeism was less among experimental compared to control participants (p=0.0001), corresponding to an average of $274 saved per person per month. Finally, participants in the experimental group were less likely to report mental health visits (p=0.01) and had a lower rate of overall healthcare utilization (p=0.03), compared to the control group. Conclusion Results from this randomized clinical trial demonstrate that a digital workplace sleep wellness program can be beneficial to both employees and employers, by improving employee sleep and fatigue, increasing work productivity, and reducing direct healthcare costs. Support (If Any) This study was funded by dayzz Live Well Ltd.

Emergency medicine research: 2030 strategic goals.

All academic medical specialties have the obligation to continuously create new knowledge that will improve patient care and outcomes. Emergency medicine (EM) is no exception. Since its origins over 50years ago, EM has struggled to fulfill its research mission. EM ranks last among clinical specialties in the percentage of medical school faculty who are National Institutes of Health (NIH)-funded principal investigators (PIs; 1.7%) and the percentage of medical school departments with NIH-funded PIs (33%). Although there has been a steady increase in the number of NIH-funded projects and total NIH dollars, the slowing growth in the number of NIH-funded PIs and lack of growth in the number of EM departments with NIH-funded PIs is cause for concern. In response, the Association of Academic Chairs of Emergency Medicine (AACEM) Research Task Force proposes a set of 2030strategic goals for the EM research enterprise that are based on sustaining historic growth rates in NIH funding. These goals have been endorsed by the AACEM Executive Committee and the boards of Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), and American Academy of Emergency Medicine (AAEM). The 2030strategic goals include 200NIH-funded projects led by 150 EM PIs in at least 50 EM departments with over $100M in annual funding resulting in over 3% of EM faculty being NIH-funded PIs. Achieving these goals will require a targeted series of focused strategies to increase the number of EM faculty who are competitive for NIH funding. This requires a coordinated, intentional effort with investments at the national, departmental, and individual levels. These efforts are ideally led by medical school department chairs, who can create the culture and provide the resources needed to be successful. The specialty of EM has the obligation to improve the health of the public and to fulfill its research mission.

Otolaryngologists Trail Other Specialties in Industry Payments From Dermal Filler Companies.

Dermal filler (DF) is a widely used nonsurgical option for facial rejuvenation with a rapidly expanding market. Physician payments by DF industry leaders have yet to be characterized. We sought to investigate trends in physician-industry payments by DF companies over 6 years. Differences in payments based on physician specialty and time were characterized. Database review. The Open Payments Database was queried from 2013 to 2018. Payments made by the three largest DF companies by market share to otolaryngologists, plastic surgeons, and dermatologists were analyzed. Total dollars paid, number of payments made, type of payments made, and total number of specialists paid were recorded. One-way ANOVA was used for statistical analysis. Otolaryngologists, plastic surgeons, and dermatologists received average annual payments of $0.36 million, $6.3 million, and $6.6 million respectively (P < .001). An average of 330 otolaryngologists, 2,128 plastic surgeons, and 5,980 dermatologists were paid annually (P < .001). Accredited speaking arrangements, consulting fees, and royalty/licensing fees comprised the majority of dollars paid to physicians. Average physician payment by DF companies exceeds $12 million annually, with otolaryngologists receiving significantly less compared to plastic surgeons and dermatologists. NA Laryngoscope, 132:301-306, 2022.

Data shows surge in contributions, grantmaking at nation's donor‐advised funds

New data from some of the biggest administrators of donor‐advised funds (DAFs) show that 2020 was a banner year for the fast‐growing sector, with Fidelity Charitable, Schwab Charitable, and the National Philanthropic Trust all showing major surges in grants and total dollars awarded from their DAF clients.

Using Reverse Auctions to Stretch Broadband Subsidy Dollars: Lessons from the Recovery Act of 2009

Twelve years ago, the federal government awarded hundreds of grants for broadband infrastructure with stimulus funds from the Recovery Act of 2009. In this study, I review the subsidy allocations from the Broadband Technology Opportunities Program and compare actual outcomes with those that a reverse auction or random lottery may have yielded. My analysis shows that a reverse auction might have connected nearly twice as many buildings for the same total subsidy dollars relative to the results from the grant review process. Moreover, the grant review process used by the NTIA did only slightly better in subsidy-dollars-per-building-connected than a random lottery probably would have. Lessons from the Recovery Act are drawn from public data on proposed and awarded projects from application files for stimulus funds. I conclude that the government likely overpaid for broadband by using grant review rather than a reverse auction. The analysis strongly implies that future broadband grants be distributed using market-based methods to get better returns on investment from infrastructure funds.

The Anti-Poverty, Targeting, and Labor Supply Effects of the Proposed Child Tax Credit Expansion

The proposed change under the American Families Plan (AFP) to the Tax Cuts and Jobs Act (TCJA) Child Tax Credit (CTC) would increase maximum benefit amounts to $3,000 or $3,600 per child (up from $2,000 per child) and make the full credit available to all low and middle-income families regardless of earnings or income. We estimate the anti-poverty, targeting, and labor supply effects of the expansion by linking survey data with administrative tax and government program data which form part of the Comprehensive Income Dataset (CID). Initially ignoring any behavioral responses, we estimate that the expansion of the CTC would reduce child poverty by 34% and deep child poverty by 39%. The expansion of the CTC would have a larger anti-poverty effect on children than any existing government program, though at a higher cost per child raised above the poverty line than any other means-tested program. Relatedly, the CTC expansion would allocate a smaller share of its total dollars to families at the bottom of the income distribution—as well as families with the lowest levels of long-term income, education, or health—than any existing means-tested program with the exception of housing assistance. We then simulate anti-poverty effects accounting for labor supply responses. By replacing the TCJA CTC (which contained substantial work incentives akin to the EITC) with a universal basic income-type benefit, the CTC expansion reduces the return to working at all by at least $2,000 per child for most workers with children. Relying on elasticity estimates consistent with mainstream simulation models and the academic literature, we estimate that this change in policy would lead 1.5 million workers (constituting 2.6% of all working parents) to exit the labor force. The decline in employment and the consequent earnings loss would mean that child poverty would only fall by 22% and deep child poverty would not fall at all with the CTC expansion.

The Anti-Poverty, Targeting, and Labor Supply Effects of Replacing a Child Tax Credit with a Child Allowance

The proposed change under the American Families Plan (AFP) to the Tax Cuts and Jobs Act (TCJA) Child Tax Credit (CTC) would increase maximum benefit amounts to $3,000 or $3,600 per child (up from $2,000 per child) and make the full credit available to all low and middle-income families regardless of earnings or income. We estimate the anti-poverty, targeting, and labor supply effects of the expansion by linking survey data with administrative tax and government program data which form part of the Comprehensive Income Dataset (CID). Initially ignoring any behavioral responses, we estimate that the expansion of the CTC would reduce child poverty by 34% and deep child poverty by 39%. The expansion of the CTC would have a larger anti-poverty effect on children than any existing government program, though at a higher cost per child raised above the poverty line than any other means-tested program. Relatedly, the CTC expansion would allocate a smaller share of its total dollars to families at the bottom of the income distribution—as well as families with the lowest levels of long-term income, education, or health—than any existing means-tested program with the exception of housing assistance. We then simulate anti-poverty effects accounting for labor supply responses. By replacing the TCJA CTC (which contained substantial work incentives akin to the Earned Income Tax Credit) with a universal basic income-type benefit, the CTC expansion reduces the return to working at all by at least $2,000 per child for most workers with children. Relying on elasticity estimates consistent with mainstream simulation models and the academic literature, we estimate that this change in policy would lead 1.5 million workers (constituting 2.6% of all working parents) to exit the labor force. The decline in employment and the consequent earnings loss would mean that child poverty would only fall by 22% and deep child poverty would not fall at all with the CTC expansion.

Relative value units and reimbursement for primary and revision total shoulder arthroplasty

BackgroundRelative value units (RVU), based on physician work and case expenses, are reimbursement and payment rates set by the Center for Medicare and Medicaid Services. Total shoulder arthroplasty (TSA) is performed less frequently than total hip and knee arthroplasty and may take longer to perform yet has a similar RVU assignment. The purpose of this study is to determine differences in RVU/minute and dollars/minute for primary and revision TSA and to compare the RVUs/minute and dollars/minute of shoulder arthroplasty to published reports of hip and knee arthroplasty. MethodsIn this retrospective cohort study, data were collected through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the years 2006 to 2018. Current procedural terminology (CPT) code 23472 was used to identify all primary TSA cases (N = 16,719), and CPT codes 23473 and 23474 were used for revision TSA cases (N = 948). Work RVU, operation time, and RVU per minute were compared between the primary and revision shoulder cohorts. The conversion factor for RVU to dollar was provided by the U.S. Centers for Medicare and Medicaid Services, and dollars per minute calculations were performed for the 2 cohorts. Multiple regression analysis was performed to control for age, gender, race, BMI, and American Society of Anesthesiologists classification. Univariate and multivariate analyses with a significance set at P < .05 were utilized for the study. ResultsThe mean operation times for primary and revision TSA were 109.42 minutes and 122.39 minutes, respectively (P < .001). This resulted in an RVU per minute of 0.233 for the primary shoulder cohort compared to 0.265 for the revision cohort (P < .001). Revision shoulder cases were valued higher with a dollars per minute of $9.56, whereas the dollars per minute for primary shoulder cases was $8.39 (P < .001). Multiple regression analysis showed a positive correlation between revision total shoulder cases and dollars per minute. ConclusionThe RVU per minute and reimbursement in dollars per minute of operative time are higher for revision TSA than for primary TSA. Compared with published reports on total hip and knee arthroplasty, primary TSA has lower RVU/minute assignment and lower dollars/minute reimbursement. Level of EvidenceLevel III; Retrospective Cohort Comparative Study

Debunking the High Cost of Healthy Diets: Consumer Behavior Predicts Dietary Energy Density in a Nationally Representative Sample of US Adults

Dietary energy density (ED; kcal/g) is an established marker for diet quality and a risk factor for obesity. Previous studies have suggested that low-ED diets cost more than high-ED diets, adding an economic contribution to the obesity epidemic. This study evaluated the relationship between consumer behavior (money spent on food) and dietary energy density in a nationally representative sample of US adults. Data from 10,622 adult participants in the 2013-2016 NHANES were used for this study. The NHANES is a large cross-sectional survey conducted by the CDC and NCHS. Consumer behavior was evaluated by examining total dollars spent on food, as well as dollars spent at various categories of food stores & restaurants. Dietary ED was calculated using multiple methods. Multivariate regression models were then used to evaluate the relationship between consumer behavior, defined as money spent in four categories (groceries, take-out, dining out, other food purchases) and dietary energy density. Low-ED diets did not cost more than high-ED diets overall, though low-ED diets contained more servings of fruits (1.6 vs 0.4), vegetables (2.2 vs 0.9) and fiber (21 vs 13g), and fewer added sugars (15 vs. 18 tsp), solid fats (28 vs 39g), all p's < 0.01. Differences in spending patterns were identified. A positive linear trend between money spent on fast food/takeout and dietary energy density (p < 0.001) was observed. Additionally, individuals in the lowest quartile of ED spent more at grocery stores per person than individuals in the highest quartile of ED ($182 vs. $150 p = 0.04). Spending pattern and consumer choices are associated with dietary ED in this cross-sectional analysis of a nationally representative population sample. Identifying eating behaviors associated with diets high in energy density may inform future investigations that intervene on dietary habit for promotion of healthy eating and prevention of weight gain.

P92 Controlling for Confounding Factors in a Multi-Component Farmers’ Market Intervention

<h3>Background</h3> Despite federal funding to encourage SNAP EBT use at farmers' markets, only $22 million or 0.03% of the $70 billion total SNAP dollars are spent in these direct-to-consumer channels. <h3>Objective</h3> The objective of this study was to determine if confounding factors such as weather or other market activities have an impact on SNAP sales compared to typical market days. <h3>Study Design, Setting, Participants</h3> This 4-year, quasi-experimental study used a multi-component intervention at a medium-sized, weekday, year-round farmers' market in northern California. Total SNAP sales were collected over 54 baseline and 136 intervention market days, respectively. SNAP recipients were the target population, however several intervention components were available to all market shoppers. The multi-component intervention included SNAP outreach (ie, on-site eligibility screening, SNAP application assistance, and SNAP material distribution), SNAP signage, financial incentives (ie, Market Match), and nutrition education including food tastings highlighting market produce, recipe cards, posters, and market education. <h3>Measurable Outcome/Analysis</h3> The primary outcome measure was SNAP sales. Data about potentially confounding factors including bad weather (ie, rain, heat advisory conditions, and poor air quality) and unusual circumstances (ie, school field trips, WIC distribution days, federal holidays, and issues with the intervention programming) were also collected for each market day. Mann-Whitney tests were run for the baseline and intervention periods separately to assess if these factors had an impact on sales. <h3>Results</h3> During the baseline period, SNAP sales were significantly lower on the 9 market days that experienced bad weather (<i>P</i> = .01). However, bad weather did not have a significant impact on SNAP sales during the intervention period. Unusual circumstances did not have a significant impact on SNAP sales during the baseline or intervention periods. <h3>Conclusions</h3> In order to determine which market days to include in subsequent SNAP sales analyses, confounding factors should be investigated.

NIH funding trends to US medical schools from 2009 to 2018.

Total NIH funding dollars have increased from 2009–2018. We questioned whether this growth has occurred proportionately around the country and throughout allopathic medical schools. Therefore, we compared the trend in NIH grant funding from 2009 to 2018 for United States allopathic medical schools among historically top-funded schools, private and public schools, and by region of the country. Changes in both unadjusted and real funding dollars over time revealed a significant difference. Region was the only significant factor for mean percent change in funding from 2009–2018, with the Western region showing a 33.79% increase in purchasing power. The Northeastern region showed a -6.64% decrease in purchasing power while the Central and Southern regions reported changes of 2.46% and -6.08%, respectively. The mean percent increases were more proportional and nonsignificant in the public vs. private institutions comparison, at -3.41% and 4.75%, respectively. Likewise, the top-funded institutions vs. other institutions comparisons demonstrated modest, nonsignificant differences. However, although the relative changes might be proportional, the absolute increases evidence a pattern of growing cumulative advantage that favor the highest-funded institutions and private institutions. The potential consequences of this disproportionate increase include health science education, biomedical research, and patient access disparities in large parts of the country. The NIH and the scientific community should explore potential solutions in its funding models.