Urban Institute

About: Urban Institute is a nonprofit organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Medicaid & Population. The organization has 927 authors who have published 2330 publications receiving 86426 citations.

Structural embeddedness and the liability of newness among nonprofit organizations

Abstract: Ecological studies have consistently reported that younger organizations are more likely to close or disband than older organizations. This article uses neo-institutional theory and social capital theory to explore this finding. We derive hypotheses from these perspectives and test them on a panel of nonprofit organizations in Minneapolis-St Paul (USA) using event history analysis. We find that larger organizations and organizations more dependent upon private donations are less likely to close, and government funding reduces the age effect on mortality; that is, older and younger publicly funded organizations are equally likely to survive or fail. However, among older organizations, not having government funding increases chances of survival. In contrast, volunteer staffing accentuates the age effect. Older organizations that were more dependent on volunteers had a lower likelihood of closure than younger organizations dependent on volunteers, while age had no effect on closure for organizations not depe...

Clarifying Sources of Geographic Differences in Medicare Spending

Abstract: BACKGROUND Although geographic differences in Medicare spending are widely considered to be evidence of program inefficiency, policymakers need to understand how differences in beneficiaries' health and personal characteristics and specific geographic factors affect the amount of Medicare spending per beneficiary before formulating policies to reduce geographic differences in spending. METHODS We used Medicare Current Beneficiary Surveys from 2000 through 2002 to examine differences across geographic areas (grouped into quintiles on the basis of Medicare spending per beneficiary over the same period). We estimated multivariate-regression models of individual spending that included demographic and baseline health characteristics, changes in health status, other individual determinants of demand, and area-level measures of the supply of health care resources. Each group of variables was entered into the model sequentially to assess the effect on geographic differences in spending. RESULTS Unadjusted Medicare spending per beneficiary was 52% higher in geographic regions in the highest spending quintile than in regions in the lowest quintile. After adjustment for demographic and baseline health characteristics and changes in health status, the difference in spending between the highest and lowest quintiles was reduced to 33%. Health status accounted for 29% of the unadjusted geographic difference in per-beneficiary spending; additional adjustment for area-level differences in the supply of medical resources did not further reduce the observed differences between the top and bottom quintiles. CONCLUSIONS Policymakers attempting to control Medicare costs by reducing differences in Medicare spending across geographic areas need better information about the specific source of the differences, as well as better methods for adjusting spending levels to account for underlying differences in beneficiaries' health measures.

Family Support in the Prisoner Reentry Process: Expectations and Realities

Abstract: This paper examines the role of family in the prisoner reintegration process, exploring the views of soon-to-be-released prisoners regarding the family support they expect to receive as well as the...

Using Geographically Weighted Regression to Explore Local Crime Patterns

Abstract: The present research examines a structural model of violent crime in Portland, Oregon, exploring spatial patterns of both crime and its covariates. Using standard structural measures drawn from an opportunity framework, the study provides results from a global ordinary least squares model, assumed to fit for all locations within the study area. Geographically weighted regression (GWR) is then introduced as an alternative to such traditional approaches to modeling crime. The GWR procedure estimates a local model, producing a set of mappable parameter estimates and t-values of significance that vary over space. Several structural measures are found to have relationships with crime that vary significantly with location. Results indicate that a mixed model— with both spatially varying and fixed parameters—may provide the most accurate model of crime. The present study demonstrates the utility of GWR for exploring local processes that drive crime levels and examining misspecification of a global model of urban violence.

A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control Among Clients In Three States

Abstract: Food insecurity--defined as not having adequate quantity and quality of food at all times for all household members to have an active, healthy life--is a risk factor for poor diabetes control, yet few diabetes interventions address this important factor. Food pantries, which receive food from food banks and distribute it to clients in need, may be ideal sites for diabetes self-management support because they can provide free diabetes-appropriate food to people in low-income communities. Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in three states in a six-month pilot intervention that provided them with diabetes-appropriate food, blood sugar monitoring, primary care referral, and self-management support. Improvements were seen in pre-post analyses of glycemic control (hemoglobin A1c decreased from 8.11 percent to 7.96 percent), fruit and vegetable intake (which increased from 2.8 to 3.1 servings per day), self-efficacy, and medication adherence. Among participants with elevated HbA1c (at least 7.5 percent) at baseline, HbA1c improved from 9.52 percent to 9.04 percent. Although food pantries are nontraditional settings for diabetes support, this pilot study suggests a promising health promotion model for vulnerable populations. Policies supporting such interventions may be particularly effective because of food pantries' food access and distribution capacity.