Improving data access democratizes and diversifies science.

The foundation of the scientific method rests on access to data, and yet such access is often restricted or costly. We investigate how improved data access shifts the quantity, quality, and diversity of scientific research. We examine the impact of reductions in cost and sharing restrictions for satellite imagery data from NASA's Landsat program (the longest record of remote-sensing observations of the Earth) on academic science using a sample of about 24,000 Landsat publications by over 34,000 authors matched to almost 3,000 unique study locations. Analyses show that improved access had a substantial and positive effect on the quantity and quality of Landsat-enabled science. Improved data access also democratizes science by disproportionately helping scientists from the developing world and lower-ranked institutions to publish using Landsat data. This democratization in turn increases the geographic and topical diversity of Landsat-enabled research. Scientists who start using Landsat data after access is improved tend to focus on previously understudied regions close to their home location and introduce novel research topics. These findings suggest that policies that improve access to valuable scientific data may promote scientific progress, reduce inequality among scientists, and increase the diversity of scientific research.

Effect of Social Needs Case Management on Hospital Use Among Adult Medicaid Beneficiaries : A Randomized Study.

BACKGROUND: Case management programs assisting patients with social needs may improve health and avoid unnecessary health care use, but little is known about their effectiveness. OBJECTIVE: This large-scale study assessed the population-level impact of a case management program designed to address patients' social needs. DESIGN: Single-site randomized encouragement design with administrative enrollment from an eligible population and intention-to-treat analysis. Study participants were enrolled between August 2017 and December 2018 and followed for 1 year. (ClinicalTrials.gov: NCT04000074). SETTING: Contra Costa County, an economically and culturally diverse community in the San Francisco Bay Area. PARTICIPANTS: 57 972 randomized enrollments of adult Medicaid patients at elevated risk for health care use (top 15%) to the intervention or control group. INTERVENTION: Enrollees were offered 12 months of social needs case management, which provided more intensive services to patients with higher demonstrated needs. MEASUREMENTS: Medical use was measured via emergency department (ED) visits and inpatient admissions, some of which were classified as avoidable. RESULTS: Participants in the intervention group visited the ED at ratios of 0.96 (95% CI, 0.91 to 1.00) for all visits and 0.97 (CI, 0.92 to 1.03) for avoidable visits relative to the control group. The intervention group was hospitalized at ratios of 0.89 (CI, 0.81 to 0.98) for all admissions and 0.72 (CI, 0.55 to 0.88) for avoidable admissions. LIMITATIONS: Only 40% of the intervention group engaged with the program. The program was in continual development during the trial period. CONCLUSION: Although social needs case management programs may reduce health care use, these savings may not cover full program costs. More work is needed to identify ways to increase patient uptake and define characteristics of successful programs. PRIMARY FUNDING SOURCE: Contra Costa Health Services via the Medicaid waiver program.

The Matthew effect in science funding.

A classic thesis is that scientific achievement exhibits a "Matthew effect": Scientists who have previously been successful are more likely to succeed again, producing increasing distinction. We investigate to what extent the Matthew effect drives the allocation of research funds. To this end, we assembled a dataset containing all review scores and funding decisions of grant proposals submitted by recent PhDs in a €2 billion granting program. Analyses of review scores reveal that early funding success introduces a growing rift, with winners just above the funding threshold accumulating more than twice as much research funding (€180,000) during the following eight years as nonwinners just below it. We find no evidence that winners' improved funding chances in subsequent competitions are due to achievements enabled by the preceding grant, which suggests that early funding itself is an asset for acquiring later funding. Surprisingly, however, the emergent funding gap is partly created by applicants, who, after failing to win one grant, apply for another grant less often.

Hospitalizations reduce health care utilization of household members.

OBJECTIVE: To examine whether the financial burden of hospitalizations affects the health care utilization of household members of the admitted patient. DATA SOURCES: We utilized health care claims data from the Massachusetts All-Payer Claims Database, 2010-2015, to identify emergency hospitalizations of patients on family insurance plans and the health care utilization of the family members on those plans. STUDY DESIGN: We used an event-study analysis to compare health care spending and utilization of family members of a hospitalized individual and family members of an individual who was hospitalized 1 year later. We examine whether such hospitalizations were associated with changes in medical spending, the frequency of ambulatory office visits, other ambulatory care, and preventive care. DATA COLLECTION/EXTRACTION METHODS: The analyses include household members of patients with an emergency admission and a length of stay between 5 and 90 days. PRINCIPAL FINDINGS: Unexpected hospital admissions reduced household members' health care spending and utilization by more than 6.4% (95% confidence interval [CI]: -8.2%, -4.5%) on average in the year following the hospitalization. Household members had fewer ambulatory visits with primary care physicians (PCPs), fewer referrals to specialists, and reduced utilization of other ambulatory care, including high-value preventive services. These changes were observed for both children and adults and were exacerbated if members of the household had previously been on Medicaid. The reduction in utilization was less pronounced when the admitted patient and household member shared the same PCP and when their health insurance plan had a family deductible. CONCLUSIONS: Compared with families without a hospitalized family member, family members of hospitalized individuals reduced their medical spending and utilization, including a substantial reduction in the use of preventive care. This study highlights the challenges of providing continuity in care when families face financial hardship.

Game changer: the topology of creativity.

This article examines the sociological factors that explain why some creative teams are able to produce game changers--cultural products that stand out as distinctive while also being critically recognized as outstanding. The authors build on work pointing to structural folding--the network property of a cohesive group whose membership overlaps with that of another cohesive group. They hypothesize that the effects of structural folding on game changing success are especially strong when overlapping groups are cognitively distant. Measuring social distance separately from cognitive distance and distinctiveness independently from critical acclaim, the authors test their hypothesis about structural folding and cognitive diversity by analyzing team reassembly for 12,422 video games and the career histories of 139,727 video game developers. When combined with cognitive distance, structural folding channels and mobilizes a productive tension of rules, roles, and codes that promotes successful innovation. In addition to serving as pipes and prisms, network ties are also the source of tools and tensions.