Where are They Now? C2E2 Alumni Nathaniel Bell tells his story

I am a health geographer focusing on the determinants of injury risk and outcomes of trauma care. I have a Ph.D. in Geography from Simon Fraser University and was a Research Trainee within C2E2 (2010 – 2013) while completing my postdoctoral fellowship within the Department of Surgery under the mentorship of Professor Boris Sobolev and Dr. Richard Simons.  I am presently an Assistant Professor in the College of Nursing at the University of South Carolina with the goal of promoting outcomes research in trauma care.

I currently have two major projects underway that in many ways build on research initiated at C2E2. The first focuses on changes to State Medicaid policies on post-acute outcomes and utilization of healthcare services among Medicaid recipients. Here I am focusing on outcomes of care among patients hospitalized from of a traumatic brain injury (TBI). Medicaid recipients often account for over half of all TBI discharges in the United States. Furthermore, many health services are not a specifically defined category of Medicaid benefits and coverage remains at state discretion. The goal of this work is to demonstrate whether such policy changes have affected healthcare costs, emergency department encounters, as well as narrowed treatment gaps with publically insured beneficiaries.

The second project advocates for extending hospital performance measures to include adjustment for a patient’s socioeconomic position, or status (SES). The Centers for Medicare and Medicaid Services (CMS) recently began penalizing hospitals with excess readmissions within thirty days of hospital discharge. At the same time, federal reimbursement for uninsured hospitalizations has fallen due to the expansion of the Affordable Care Act. At issue is that the CMS readmission measures unfairly penalize safety-net hospitals, which care for a disproportionate number of vulnerable populations. However, for SES adjustment on hospital readmissions to work, valid and reliable measures of performance must be available. This is currently not possible given that many of the challenges of validity and reliability that resulted from the 2011 changes the Canadian Census have been exhibited in the switch to the American Community Survey (ACS). My goal is to contribute a methodological and conceptual framework to understand, analyze, and improve how the ACS can be used for surveillance and risk-adjustment.

I am very excited about these projects and I see a number of opportunities to continue collaborating with senior scientists at C2E2. For example, the similarities in standards of trauma care between both countries in light of what are often profound differences in social, economic, and geographic structures offers up numerous potential for understanding and responding to determinants of injury risk and outcomes of trauma care. Such work is particularly relevant given that injury remains the leading cause of potential years of life lost and disability in both countries, particularly among disadvantaged populations.