About

Justin Trogdon, PhD, is a Professor in the Department of Health Policy and Management at UNC Gillings School of Global Public Health. As a health economist, his current research focuses on answering policy-relevant questions in three areas: assessing the economic burden of cancer, evaluating the cost and cost-effectiveness of policies and interventions, and developing methods to identify causal effects of policies and interventions and simulate new policies. His work aims to understand where healthcare resources are spent, identify diseases and payers that drive healthcare expenditures, and motivate policies to contain costs. Additionally, he evaluates whether policies and interventions provide good value to society and uses novel statistical and simulation models to estimate the effects of policies, especially in observational data where attribution of health and behavioral changes to specific policies is challenging.

Research topics

• Medicine
• Environmental health
• Nursing
• Internal medicine
• Immunology
• Gerontology
• Demography
• Economic growth
• Family medicine
• Risk analysis (engineering)
• Gynecology
• Marketing
• Business

Selected publications

• Predictors of community-based physical and occupational therapy use after stroke

  Archives of Physical Medicine and Rehabilitation · 2026-04-01

  articleOpen access

  OBJECTIVE: To identify individual-, hospital-, and community-level predictors of home health and outpatient physical and/or occupational therapy (PT and/or OT) following stroke. DESIGN: The COMPASS study was a pragmatic trial examining the effectiveness of a transitional care model for stroke. We conducted an observational, secondary analysis of COMPASS data linked to insurance claims. SETTING: 40 acute care hospitals in North Carolina (NC). PARTICIPANTS: 6,754 patients with stroke or transient ischemic attack discharged directly home from the hospital and who had linked NC insurance claims data. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 30-day use of PT and/or OT in the home or outpatient setting and time to first visit, number of visits, and receipt of both PT and OT in 90 days. Multivariable, generalized estimating equations examined individual-, hospital-, and community level predictors of therapy use, controlling for clinical measures. RESULTS: 28 and 35 percent of the sample used PT and/or OT in the home or outpatient setting within 30 and 90 days, respectively. Among those who received therapy within 90 days, the mean (SD) number of visits was 9.6 (9.4) and 48 percent received both PT and OT. Individual-level factors associated with 30-day use and/or a shorter time to first visit included: female sex, living in a metropolitan area, living in a more educated community, having dual Medicare/Medicaid or Medicare Advantage insurance (relative to traditional Medicare), having access to an informal caregiver, and having a primary care provider. Having Medicaid insurance was associated with lower therapy use and a longer time to first visit. Few hospital-level characteristics were predictive of therapy use or time to first visit. Community-level measures of therapist supply were associated with therapy use and shorter time to first visit. CONCLUSIONS: These findings highlight opportunities for targeted interventions to improve access to community-based rehabilitation following stroke.

  PublisherOA PDFDOI

• Design of Pay-for-Performance Programs Affects Clinical Staff Perceptions of HPV Vaccine Incentives: Evidence from a US Survey

  INQUIRY The Journal of Health Care Organization Provision and Financing · 2025-07-01

  articleOpen access1st authorCorresponding

  This study reports how 3 design features (size of incentive, who is responsible, and target goal) affect clinical staff perceptions of pay-for-performance (P4P) for HPV vaccination. We conducted a national survey of clinical staff in 2022 (N = 2527; response rate = 57%). Respondents worked in pediatrics, family medicine, or general medicine specialties in the United States and had a role in HPV vaccination for children ages 9 through 12 years. Respondents were randomized to 1 of 8 P4P scenarios representing 3 design features with 2 levels each. We used ordered logistic regression to model respondents' agreement with each of 11 statements about the P4P scenario. Statements represented domains of the Theory of Planned Behavior (attitudes, perceived behavioral control, and norms) plus 2 equity items. Relative to a $1000 incentive, a $5000 incentive was associated with favorable perceptions in 8/11 items: 5/5 attitude items and 1/2 items for each of control, norms, and equity. Incentives based on an individual provider's patients, rather than the entire clinic's patients, were associated with more agreement for 1 attitude item and 1 perceived behavioral control item. Relative to an absolute goal of 80%, a goal of 5% relative increase in HPV vaccination rates was associated with favorable perceptions for 3/5 attitude items and 1 equity item. Clinical staff perceptions of P4P for HPV vaccination were more favorable the larger the size of the incentive, when it was focused on a provider's own patients, and when the goal was a relative, rather than absolute, target.

  PublisherDOI

• Claims-Based Measures of Care Coordination and Long-Term Health Among Older Women With Endometrial Cancer

  Medical Care · 2025-08-06

  article

  BACKGROUND: Coordination of care between providers may help ensure that cancer survivors receive the appropriate health care services to improve their long-term health. We examined associations between a claims-based measure of care coordination and several health outcomes among older endometrial cancer survivors. METHODS: Using SEER-Medicare data, we identified women with endometrial cancer at ages 66+ during 2009-2015 (N=13,696). Medicare claims during years 1-3 postdiagnosis were used to calculate care density, a measure of care coordination, as the ratio of the number of patients shared among a woman's outpatient providers to the number of provider pairs seen by that patient. We estimated associations between care density tertile and hospitalizations, emergency room (ER) visits, and all-cause mortality from 3 years postdiagnosis on, and adherence to guideline-recommended follow-up during years 3-5 postdiagnosis. RESULTS: No clear trends were observed for risk of all-cause mortality, hospitalizations or ER visits according to care density category. However, for hospitalizations (HR=0.93; 95% CI: 0.87-0.99) and ER visits (HR=0.93; 95% CI: 0.88-0.98), there was a slightly lower risk in the highest care density tertile compared with the lowest. Women in the middle (OR=1.67; 95% CI: 1.40-2.00) and highest care density tertiles (OR=1.63; 95% CI: 1.36-1.96) were more likely to be adherent to follow-up recommendations than those in the lowest tertile. CONCLUSIONS: Greater care coordination during the early survivorship period may be associated with a slightly lower risk of hospitalization and ER visits and better adherence to surveillance recommendations after endometrial cancer.

  PublisherDOI

• Spending Changes After Moving to Areas With Greater ACO Participation Among Nonattributed Medicare Beneficiaries

  JAMA Network Open · 2025-02-20 · 1 citations

  articleOpen accessSenior author

  Importance: Accountable care organizations (ACOs) under the Medicare Shared Savings Program have long been envisioned as a pathway to improved care efficiency and quality of care for all Medicare beneficiaries. However, little is known about whether the changes in health care spending associated with ACOs have extended beyond ACO-attributed Medicare beneficiaries to all Medicare beneficiaries. Objective: To estimate spending changes by non-ACO-attributed Medicare beneficiaries after moving to geographic areas with greater ACO participation. Design, Setting, and Participants: This repeated cross-sectional study analyzed claims from a 20% representative sample of all Medicare beneficiaries, aged 65 to 99 years, from 2009 to 2017. The sample consisted of Medicare beneficiaries who were never attributed to an ACO and moved once across hospital service areas (HSAs) during the study period (movers) and was supplemented by a 20% random sample of beneficiaries who never moved (nonmovers). Data analysis took place from November 2022 to October 2024. Exposure: Changes in the ACO market penetration rate triggered by nonattributed Medicare beneficiaries moving across HSAs. Main Outcomes and Measures: Annual standardized Medicare spending per beneficiary on acute inpatient, outpatient facility, physician services, and total acute care as well as on hospital outpatient department, evaluation and management, and nonadmitted emergency department visits. Results: The estimation sample included 62 618 movers (388 263 beneficiary-years; mean [SD] age, 75 [7] years; 134 503 [65%] female-years) and 433 298 nonmovers (2 066 404 beneficiary-years; mean [SD] age, 76 [8] years; 1 273 154 [62%] female-years). In the base model, moving into a market with a 1-SD higher ACO penetration was associated with a 5.8% (95% CI, 4.1%-7.4%) decrease in spending on outpatient facilities and with a 1.6% (95% CI, 0.9% to 2.2%) increase in spending on physician services. Limited changes in total spending on acute inpatient and total acute care were found. These estimated changes were robust to controlling for a rich set of patient- and market-level characteristics and origin-destination HSA combinations. Conclusions and Relevance: This study provided novel evidence of market-level ACO spillovers to non-ACO-attributed Medicare beneficiaries. Although no substantial ACO spillovers in total acute care spending occurred, the substitution in spending on outpatient facility and physician services suggested that outpatient care may shift away from higher-cost facility settings for all Medicare beneficiaries in markets with greater ACO penetration.

  PublisherOA PDFDOI

• The Role of Telehealth Payment Parity on Recommended Care and Emergency Department Service Utilization Among Workers With Chronic Conditions

  Medical Care · 2025-07-07 · 2 citations

  articleCorresponding

  BACKGROUND AND OBJECTIVE: State-level telehealth payment parity, requiring equal payment rates for telehealth and in-person visits, played an important role in ensuring access to telehealth services. The objective of our study is to evaluate how improved access, driven by telehealth payment parity, affected the utilization of disease-specific recommended care management services and emergency department (ED) services among insured patients with chronic conditions. RESEARCH DESIGN: We adopted a 2-way fixed-effect difference-in-differences approach using the Merative Commercial Claims and Encounters database from 2019 to 2021. SUBJECTS: We focused on insured workers aged 19-64 with pre-existing mental health disorders or cardiometabolic risks (CMRs). MEASURES: Outcomes include psychotherapy for mental health disorders, preventive care counseling for CMRs, and ED visits. RESULTS: Telehealth payment parity was associated with a significant increase in the number of psychotherapy visits and tele-psychotherapy by 0.221 visits (95% CI: 0.050-0.391) and 0.411 visits (95% CI: 0.003-0.818) per patient per quarter, respectively. The regulation significantly reduced E.D. visits among individuals with mental health disorders by 0.003 visits (95% CI: -0.007 to 0.000) per quarter, a 25% relative decrease compared with the control at preperiod. However, payment parity was not statistically associated with increasing preventive care visits and lowering ED visits among individuals with CMRs. CONCLUSION: Telehealth payment parity has effectively promoted the adoption of psychotherapy and reduced ED visits among insured workers with mental health disorders. However, it has not significantly improved the uptake of preventive care counseling for individuals with CMRs.

  PublisherDOI

• Gains vs losses in pay-for-performance: Stated preference evidence from a U.S. survey

  UNC Libraries · 2025-03-04

  articleOpen accessSenior author

  BACKGROUND: Pay-for-performance (P4P) incentives can be paid as a bonus (gain) or a penalty (loss). Diminishing marginal utility of wealth suggests that, starting from the same initial wealth, individuals dislike losses more than they like equivalent gains. OBJECTIVE: This study reports the minimum financial gain or loss required to motivate primary care providers and clinical staff to try to increase their human papillomavirus (HPV) vaccination rates. DATA: In 2022, we conducted a national U.S. survey through WebMD's Medscape Network of clinical staff working in primary care clinics that provided HPV vaccination to children ages 9 through 12 years (N = 2,527; response rate = 57%). METHODS: We randomized respondents to one of two hypothetical HPV vaccine incentive designs: a bonus for reaching an unspecified target HPV vaccination rate and a penalty for failing to reach the unspecified target. The primary outcome is the self-reported smallest incentive amount (U.S. dollars) that would motivate participants to try and increase their HPV vaccination rates. We tested for differences across P4P designs using unadjusted responses and linear regressions adjusting for clinic and respondent characteristics. We also tested for heterogeneous responses by experience with incentizves, training, and rurality. RESULTS: The mean amount required to motivate effort was $2,155 in the gain P4P design and $1,185 in the loss P4P design (unadjusted difference =  $970 [p < 0.001], adjusted difference =  $967 [p < 0.001]). There were no heterogeneous effects by rurality or experience with incentives. Physicians reported the highest differences (in dollars) between gain and loss P4P designs. CONCLUSIONS: Stated preference data from primary care clinical staff suggests that effective P4P incentives could be half as large if designed as losses rather than gains.

  PublisherDOI

• Impact of introduction of the 9-valent human papillomavirus vaccine on vaccination coverage of youth in North Carolina

  UNC Libraries · 2025-08-27

  articleOpen access
  PublisherDOI

• Association of Patient-Provider Race/Ethnicity Concordance and Patient-Reported Shared Decision Making Among US Adults: A National Study, 2015–2021

  Journal of General Internal Medicine · 2025-12-16 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Pervasiveness and clinical staff perceptions of HPV vaccination feedback.

  UNC Libraries · 2025-11-02

  articleOpen accessSenior author

  OBJECTIVES: This study describes the use of data-based feedback, such as human papillomavirus (HPV) vaccination rates, to advance HPV vaccination uptake in pediatric and family medicine clinics. STUDY DESIGN: A survey of primary care clinical staff in the US who provided HPV vaccination to children aged 9 to 12 years (N = 2527; response rate, 57%). METHODS: The primary outcome was a mutually exclusive categorical variable that described the type of quality metrics for which providers received feedback in the past year: HPV vaccine, other pediatric vaccinations, other quality metrics, or none. Secondary outcomes were provider perceptions of HPV vaccine feedback helpfulness and their comfort with colleagues seeing their HPV vaccination rates. Logistic models adjusted for clinical staff and clinic characteristics. RESULTS: Only 36.2% (n = 916) of respondents received HPV feedback. Feedback on HPV vaccination rates was more likely in nonrural clinics (OR, 2.03; 95% CI, 1.38-2.99), clinics in systems of 5 or more (OR, 1.81; 95% CI, 1.38-2.36), and in clinics serving 50 or more children per week (OR, 3.08; 95% CI, 2.03-4.66). Hispanic, Latino, or Spanish (OR, 1.54; 95% CI, 1.00-2.36) and Black or African American clinical staff (OR, 2.12; 95% CI, 1.44-3.12) were more likely than White clinical staff to find HPV vaccine feedback helpful. Relative to pediatricians, family medicine clinical staff were less comfortable with colleagues seeing their HPV vaccination rates (OR, 0.70; 95% CI, 0.57-0.87). CONCLUSIONS: Clinical staff seldom receive feedback about HPV vaccination in primary care.

  PublisherDOI

• Assessing the determinants associated with fidelity to the 2016 world health organization antenatal care policy across states in Nigeria

  Discover Health Systems · 2025-07-21

  articleOpen accessSenior author

  This study examined the determinants associated with fidelity to five selected antenatal care (ANC) components—based on the 2016 World Health Organization ANC policy—across states in Nigeria. We conducted a cross-sectional study using a post-implementation sample, n = 1,495 women, who completed recommended eight visit ANC (8vANC), obtained from the 2021 Nigeria Multiple Indicator Cluster Survey data. Fidelity was measured as the proportion of women who cumulatively adhered to five selected ANC components—timing of first ANC visit, blood pressure measurement, tetanus vaccinations, urinalysis, and blood sample test. A binary outcome variable was generated as a fidelity index by creating a composite score from all the measures of the five components, which was categorized as ‘concordant’ and ‘partial/non-concordant’. We also used a multilevel modeling mixed effects logistic regression method for analysis and applied an implementation research approach to examine the associated determinants. Among women who completed 8vANC, 99.7% initiated their first ANC visit within 12 weeks of gestation. The rate of concordance with the five selected ANC components was 84.1%. Compared with maternal age of 15–19 years, women aged 35–39 years had higher odds of concordance (OR: 2.83, 95% CI: 1.05–7.60), whereas a parity of ≥ 4 children (OR: 0.26, 95% CI: 0.15–0.46) was associated with lower odds of concordance, compared with parity of one child. There was no statistically significant variation observed across the states. Our findings show that, among women who completed 8vANC, the likelihood of fidelity to the selected ANC components is relatively high and homogenous across states in Nigeria. However, it is imperative that advocacy efforts be specifically directed towards multiparous women to ensure adherence to all policy recommendations. Further research is needed to evaluate the degree to which the state-level implementation of the policy may have also influenced adherence to the selected ANC components.

  PublisherOA PDFDOI

Recent grants

• Cancer, Care Coordination, and Medication Use for Multiple Chronic Conditions

  NIH · $592k · 2016–2020

• Center for Health Promotion and Disease Prevention

  NIH · $10.9M · 2014–2019

Frequent coauthors

• Tony Kuo

  Southern California Clinical and Translational Science Institute

  64 shared

• Brenda Robles

  Universidad Rovira i Virgili

  64 shared

• Paul Simon

  UCLA Health

  64 shared

• Rachel Ferencik

  Georgia State University

  64 shared

• Jonathan E. Fielding

  University of California, Los Angeles

  64 shared

• Donatus U. Ekwueme

  Centers for Disease Control and Prevention

  54 shared

• Diane Orenstein

  Centers for Disease Control and Prevention

  42 shared

• Gery P. Guy

  National Center for Injury Prevention and Control

  35 shared