OOIR: Observatory of International Research

Papers

(The TQCC of Population Health Management is 4. The table below lists those papers that are above that threshold based on CrossRef citation counts [max. 250 papers]. The publications cover those that have been published in the past four years, i.e., from 2021-06-01 to 2025-06-01.)

Article	Citations
One Year Out: The Five Ds of COVID-19	66
Impact of Social Capital on the Availability of Health Care Services	53
Health Equity Is Key to Better Population Health	51
More Patient Data? Be Careful What You Wish for…AI’s Role in Making Clinical Data Exchange Useful	34
COVID-19 Vaccination, Morbidity, and Mortality During a 12-Month Period in Israel: Can We Maintain a “Herd Immunity” State?	33
COVID-19 and the Urgent Need for New Therapies for Obesity	31
Examining the Association of Social Needs with Future Health Care Utilization in an Older Adult Population: Which Needs Are Most Important?	27
Implementation of Medications for Alcohol and Opioid Use Disorders in a Value-Based Organization-Unlocking Value by Addressing Unmet Needs for Medicaid and Dually-Eligible Beneficiaries	27
Improve Patient-Centered Care, Decrease Provider Burnout, Maximize Z Codes, Minimize Hierarchical Condition Category Codes	25
A Population Health Proposal for Increasing Breast Cancer Screening to Reduce Racial Disparities in Breast Cancer: Getting the Village Back Together	25
A Scoping Review of Behavioral Interventions Addressing Medical Financial Hardship	22
Optimizing Hierarchical Condition Category-Risk Adjustment Factor Management in Population Health Using Rapid Process Improvement Methods	21
Evaluation of the Impact of Discharge Clinic Follow-Up Interventions on 30-Day Readmission Rates	21
A Tale of 4 Babies: Health Equity at the Center of the Quadruple Aim	19
Call for Special Issue Papers: Reducing Health Disparities in Underserved Populations	19
Perceived Stigma in Health Care Settings Mediates the Relationships Between Depression, Diabetes, and Hypertension	17
Letter to the Editor: Pivoting Care Coordination Efforts Based on Risk and Return	17
Social Needs Screening in Academic Health Systems: A Landscape Assessment	16
COVID-19 Deaths and the Impact of Health Disparities, Hospital Characteristics, Community, Social Distancing, and Health System Competition	15
Medicaid Acceptance Varies by Physician Seniority and Specialty in California	15
Prior Authorization: Process Redesign with a Focus on Value-Based Care	15
Leveraging Digital Medicine to Support Providers and Their Patients in Managing Serious Mental Illness	14
The Impact of the Affordable Care Act on Disparities in Utilization of Cardiovascular Preventive Services by Socioeconomic Status	14
Innovations in Population Health: Improving Outcomes for Patients with Chronic Kidney Disease	14
COVID-19 Vaccine Equity: Codesigning Public Health Interventions with Community Partners	14

Social Intervention by the Numbers: Evidence Behind the Specific Public Health Guidelines in the COVID-19 Pandemic	13
Transitional Care for Older Adults: Demonstration of the Role of a Partnership Payvider	12
Ambulatory Care Utilization Among Medicare Beneficiaries with Depression	12
Operation Allies Welcome Medical Response Unit at Philadelphia International Airport: A Framework for Medical Triage of High Volume of Displaced Persons Arriving by Air	12
Measuring What Matters: Beyond Quality Performance Measures in Caring for Adults with Obesity	11
Bridging the Digital Divide: A Practical Roadmap for Deploying Medical Artificial Intelligence Technologies in Low-Resource Settings	11
Impact of COVID-19 on Behavioral Health Services Use Among Medicaid Enrollees with Chronic Behavioral Needs by Race and Ethnicity	10
Successful Implementation of an All-or-None Diabetes Measure in 10 US Health Systems	10
The Impact of Personal and Historical Factors That Contribute to Medicare Readmissions	10
What Are the Roles of Community Health Workers in Medicaid Managed Care? Results from a National Study	10
Use of a Blood Biomarker Test Improves Economic Utility in the Evaluation of Older Patients Presenting with Cognitive Impairment	10
A Conceptual Framework for Building Individual and Team Capabilities to Provide Effective Longitudinal, Relationship-Based Clinical Case Management	10
Cost-Effectiveness of Outreach Strategies for Stool-Based Colorectal Cancer Screening in a Medicaid Population	10
The Payvider: An Evolving Model	9
Body Mass Index and All-Cause and Cardiovascular Mortality in United States Adults With and Without Atherosclerotic Cardiovascular Disease: Findings from the National Health Interview Survey	9
Enhanced Primary Care for Severe Mental Illness Reduces Inpatient Admission and Emergency Room Utilization Rates	9
Evaluating the Financial Sustainability of the School-Based Telemedicine Asthma Management Program	9
Using Quality Measures to Drive Improvements in Immunization Rates: Findings from a Real-World Evaluation from 3 US Health Care Organizations	9
Reimagining Diabetes Quality Measurement to Advance Quality Care	9
Using Health Plan Authorization Data to Predict Hospitalizations and Readmissions in a Combined Commercial and Medicaid Population	9
Evaluation of Risk Factors for Hepatitis C Virus Infection Among Philadelphia's Shelter-Bound, Homeless Population: Data from a Student-Run Hepatitis C Virus Screening Initiative	8
Construction of a Pediatrics Risk Score to Predict High Health Care Costs Among a Community Health Center Cohort	8
Leveraging Technology for Value-Based Kidney Care	8
Increasing Statin-Prescribing and Low-Density Lipoprotein Cholesterol Control in Secondary Atherosclerotic Cardiovascular Disease Prevention: A Collaborative Approach	8
What Is Old Needs to Be New Again	8
Assessing the Added Value of Blood Pressure Information Derived from Electronic Health Records in Predicting Health Care Cost and Utilization	7
Limitations to Health Care Quality Measurement: Assessing Hospital Variation in Risk of Cardiac Events After Noncardiac Surgery	7
Reducing Health Disparities in Underserved Populations: A Spotlight on Health Inequities	7
Impact of COVID-19 on the Quadruple Aim	7
A Review of the MINDSPACE Framework for Nudging Health Promotion During Early Stages of the COVID-19 Pandemic	7
Interventions to Increase Affordable Care Act Marketplace Enrollment: A Systematic Review and Meta-Analysis	7
Correction to: Addressing Social Needs in Clinical Settings: Early Lessons from Accountable Health Communities, by Laura B. Beidler, et al. Popul Health Manag 2023; (vol. 26, no. 5; 283-	7
The Cost of Unhealthy Days: A New Value Assessment	7
Engaging Stakeholder Advisors Around Health-Related Social Needs Research, Policy, and Practice Priorities	7
Individual- and Community-Level Predictors of Hospital-at-Home Outcomes	7
Health Resources and Services Administration-Funded Health Centers Reduce Health Care Expenditures of California Medicaid Managed Care Beneficiaries with Complex Needs	6
Medicaid Cost Savings from Provision of Contraception to Beneficiaries in South Carolina, 2012–2018	6
Social Isolation Associated with Future Health Care Utilization	6
Health Inequality Among Older Adults with Percutaneous Coronary Intervention and Universal Health Coverage in Japan	6
The Future of Population Health	6
Value-Based Pay-for-Performance Gaps in the Care Delivery Framework for a Large-Scale Health System	6
Mistrust, Neighborhood Deprivation, and Telehealth Use in African Americans with Diabetes	6
What Is a Center of Excellence?	6
Transitioning from In-Person to Telemedicine Within Primary Care Behavioral Health During COVID-19	6
Health Insurance Status of Adults with Hepatitis in the United States: Implications of Results from the National Health Interview Survey, 2013–2018	6
Cost Reduction and Utilization Patterns in a Medicare Accountable Care Organization Using Home-Based Palliative Care Services	6
Multisector Partnerships and Service Colocation to Increase Adoption of Influenza Vaccines and Address Food Insecurity	6
An Increase in the Use of ICD-10 Z-Codes for Social Risks and Social Needs: 2015 to 2019	5
An Analysis of Ambulance Transport and Out-of-Network Emergency Department Utilization in an Accountable Care Organization	5
The Future of Chronic Disease Management	5

Estimating Cost Savings of Care Coordination for Older Adults: Evidence from the Iowa Return to Community Program	5
Major Economic Losses Associated with Inadequate Control of High Blood Pressure: Time for a Major Change	5
Addressing Social Determinants of Health in Family Medicine Practices	5
Patient Post-discharge Transitions and Inpatient Readmissions Impose Costly Burdens for Employers and Carriers	5
For Profit, but Socially Determined: The Rise of the SDOH Industry	5
The Academic Payvider Model: Commentary	5
Sickle Cell Disease in an Older Adult Population: A Retrospective Review of Health Care Resource Utilization	5
Developing a Strategy to Increase Lung Cancer Screening in Areas of Need	5
Neighborhood-level Social Determinants of Health Improve Prediction of Preventable Hospitalization and Emergency Department Visits Beyond Claims History	5
Challenge of Managing Chronic Kidney Disease: Patient and Caregiver Perspectives	5
Implementation of E-Consults in an Integrated Health System for a Value Population	5
Reducing the Emergency Department Revolving Door Syndrome for the Poor, Uninsured, and Chronically Ill Patient in Los Angeles: Process Improvement Recommendations from a County Health Program Evaluati	5
Hospital Safety-Net Burden is Associated with Perioperative Outcomes in Primary Total Hip Arthroplasty: A Multistate Retrospective Analysis, 2015–2020	5
Impact of Pan-Ethnic Expanded Carrier Screening in Improving Population Health Outcomes: Proceedings from a Multi-Stakeholder Virtual Roundtable Summit, June 25, 2020	5
Evidence and Implications of the Affordable Care Act for Racial/Ethnic Disparities in Diabetes Health During and Beyond the Pandemic	5
Impact of Health Literacy on Medication Adherence Among Black Medicaid Beneficiaries with Hypertension in Delaware: A Cross-Sectional Study	4
Social Determinants of Health and Comorbidities Among Individuals with Atherosclerotic Cardiovascular Disease: The Behavioral Risk Factor Surveillance System Survey	4
Systematic Review of Care Coordination Interventions Linking Health and Social Services for High-Utilizing Patient Populations	4
The Impact of Expanding Telehealth-Delivered Dietary Interventions on Long-Term Cardiometabolic Health	4
Tackling Ethnic Health Disparities Through Community Health Worker Programs: A Scoping Review on Their Utilization During the COVID-19 Outbreak	4
Addressing Social Needs in Clinical Settings: Early Lessons from Accountable Health Communities	4
A Path to Risk: Critical Elements of a Structured Approach	4
Assessing the Relationship Between Behavioral Health Integration and Alcohol-Related Treatment Among Patients with Medicaid	4
Reimagining Our Public Health Systems: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems	4
Letter to the Editor: Public Health Reform Efforts Should More Effectively Engage Public Health Professionals and the General Public	4
The Unfortunate State of Population Health: Its Omnipresent Promise and Industry's Continued Failure of Vision and Commitment	4
Home-Based Primary Care: A Solution for Our Frail Elderly Patients	4
The Minority and Rural Coronavirus Insights Study: Design and Baseline Characteristics of a Minority Cohort	4
Hospital-at-Home: The Good, the Bad, and the Ugly	4
Relationship of Clinician Care Team Composition and Diabetes Quality Outcomes	4
The Impact of Public Health Funding on Population Health Outcomes	4