About

Theresa I. Shireman is the Director of the Center for Gerontology and Health Care Research and a Professor in the Department of Health Services, Policy & Practice at the School of Public Health. She is a health services researcher with expertise in pharmaceutical policy, pharmacoepidemiology, and health economic evaluations. Her significant research contributions include understanding medication use and effects in people on chronic dialysis, developing novel methodologies for tracking medication exposure over time, creating bleeding risk prediction models for warfarin in older adults with atrial fibrillation, and conducting health economic evaluations of expensive therapeutic agents. Her work has involved managing numerous contracts with State Medicaid agencies to evaluate pharmaceutical use in vulnerable populations, including children with disabilities and individuals with diabetes. Current research projects focus on the impact of Medicaid prescription cap policies on adherence and costs among people living with HIV, federal initiatives to reduce antipsychotic use in nursing home residents, and outcomes and quality of care among insured transgender populations. She teaches graduate courses and mentors graduate students and post-doctoral fellows, contributing to the advancement of health services research in areas such as cardiovascular drugs, end-stage renal disease, kidney transplantation, Medicaid, Medicare, multiple sclerosis, pharmacoeconomics, and transgender health.

Research topics

• Medicine
• Internal medicine
• Gerontology
• Political Science
• Sociology
• Environmental health
• Demography
• Psychology
• Psychiatry
• Social psychology

Selected publications

• Impact of national partnership to improve dementia care on antipsychotic use duration for dementia residents in nursing homes

  The Journals of Gerontology Series A · 2026-02-26

  articleOpen access1st authorCorresponding

  BACKGROUND: Federal policies have successfully targeted the prevalence of antipsychotic (AP) exposure in NHs, but the duration of treatment among nursing home (NH) residents has not been reported. We evaluated AP duration and discontinuation within six months in residents with dementia. METHODS: Retrospective cohort study of long-stay NH residents with dementia who newly initiated an AP medication. We evaluated changes in AP duration and discontinuation within six months relative to two federal initiatives: National Partnership to Improve Dementia Care (2012) and inclusion of AP use measures in the NH Star Ratings (2015). We accounted for resident and facility characteristics in a competing-risks analysis establishing the relationship between the two policy periods and AP outcomes. RESULTS: There were 43 668 new episodes of AP initiation among 38 275 residents. The duration of treatment within six months declined from 125.9 days in the pre-Partnership period to 120.5 days and 120.6 days in the post-Partnership and post-Five Star periods, respectively. Those who initiated APs after the Partnership [adjusted hazard ratio (aHR) = 1.17; confidence interval, 1.10-1.24] and after the Five Star Rating change (aHR = 1.19; 95% CI, 1.07-1.32) policy periods were more likely to stop the medication within 6 months as compared to those who initiated during the prior period. CONCLUSIONS: Federal policies designed to reduce AP prescribing in NH residents with dementia had a nominal impact on treatment duration within the first six months, with more than half continuing treatment beyond 6 months.

  PublisherDOI

• Medication and Acute Care Use in Young Adults With Opioid Use Subject to Medicaid Prescription Caps

  JAMA Health Forum · 2026-05-22

  articleOpen access

  Importance: State Medicaid prescription cap policies (ie, limiting the monthly number of covered prescriptions) may impede access to medications for opioid use disorder (OUD) and other chronic conditions. Yet, these policies remain understudied among those who become subject to caps at age 21 years. Objective: To evaluate the association of prescription cap policies with medication and acute care use among young adults with OUD. Design, Setting, and Participants: This study identified a cohort of young adults diagnosed with OUD using T-MSIS Analytic Files from January 1, 2016, to December 31, 2021. Data analysis was conducted from July 2025 to December 2025. The study compared outcomes between prescription cap and noncap states using a difference-in-differences analysis where a 2-month policy phase-in window was applied before and after age 21 years and effects estimated across the full follow-up period and the early (months 3-6), mid (months 7-9), and late (months 10-12) periods since the 21st birthday. Exposures: Becoming exposed to prescription caps at age 21 years. Main Outcomes and Measures: Monthly use (any and count) of buprenorphine, overall prescriptions, inpatient hospitalizations, and emergency department (ED) visits 12 months before vs after participant reached the age of 21. Results: This study analyzed 15 526 individuals from 26 non-prescription cap states and 1769 from 8 states with prescription cap policies. Most individuals were female (noncap states, 8156 [52.5%]; cap states, 1033 [58.4%]) and White (noncap states, 9512 [61.3%]; cap states, 705 [39.9%]). The baseline monthly prevalence for noncap and cap states was 39.3% vs 40.2% for any prescription receipt, 7.5% vs 3.1% for buprenorphine receipt, 3.2% vs 4.8% for hospitalizations, and 14.1% vs 18.7% for ED visits. After adjustment, cap policies were associated with a 4.7% (95% confidence limit [CL], -9.9% to -0.2%) lower prevalence of any prescription receipt and 12.7% (95% CL, -18.7%, -6.7%) fewer total monthly prescriptions 10 to 12 months after participants reached the age of 21. Cap states had more hospitalizations during postperiod months 10 to 12 (6.0%; 95% CL, 0.3%-10.0%) and more ED visits in postperiod months 3 to 6 (4.7%; 95% CL, 1.0%-10.0%) and months 7 to 9 (8.3%; 95% CL, 3.3%-13.3%). Buprenorphine use did not significantly change after cap implementation. Conclusions and Relevance: In this cohort study, Medicaid prescription caps were associated with lower overall use of prescription medications and greater frequency of acute care use among young adults with OUD.

  PublisherDOI

• Center for Gerontology & Healthcare Research.

  PubMed · 2026-04-01

  article1st authorCorresponding
  Publisher

• Intersectional HIV disparities among transgender Medicare beneficiaries of color

  AIDS · 2026-04-29

  article

  We compared the prevalence of HIV across race and ethnicity groups for transgender and gender-diverse (trans) and cisgender Medicare beneficiaries using quantitative intersectional analysis of Medicare claims data from 2011 to 2020. We found that approximately 61% of the excess HIV prevalence among trans Asian and Pacific Islander beneficiaries, 62% among Hispanic beneficiaries, and 78% among Black beneficiaries is associated with the intersection of racialized and gendered experience.

  PublisherDOI

• Association of Pharmacologic and Nonpharmacologic Management of Acute Low Back Pain with Overdose Hospitalizations: A Nested Case-Control Study

  Journal of Integrative and Complementary Medicine · 2025-04-03 · 2 citations

  article

  Among Medicare beneficiaries with new episodes of aLBP, treatment with only nonpharmacologic therapies was protective of overdose hospitalizations. However, any treatment with opioids and/or gabapentinoids, alone or combined with nonpharmacologic therapies, was associated with increased odds of overdose hospitalization. Implementation research is needed to inform successful adoption of nonpharmacologic pain therapies especially in subgroups with increased risk of adverse outcomes.

  PublisherDOI

• Effects of Visitation Restriction on Antipsychotic Drug Use among Nursing Home Residents with ADRD during the COVID-19 Pandemic

  Journal of the American Medical Directors Association · 2025-02-07

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Mental Health Changes in US Transgender Adults Beginning Hormone Therapy Via Telehealth: Longitudinal Cohort Study

  Journal of Medical Internet Research · 2025-01-13 · 1 citations

  articleOpen access

  BACKGROUND: Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the United States is not well known. OBJECTIVE: This study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in depression, anxiety, and suicide ideation over a 3-month period. METHODS: This cohort study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in mental health over a 3-month period. Data were collected at baseline and 3 months later among adults who had their first GAHT visit between August and November 2023. The study included adults aged 18 years and older initiating GAHT for the first time, with a final sample of 342 adults across 43 states (192 initiated estrogen and 150 initiated testosterone therapy). The primary outcomes were depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the General Anxiety Disorder-7 (GAD-7), and suicide ideation in the past 2 weeks. RESULTS: Before GAHT initiation, 40% (136/342) of participants reported depression (PHQ-9 ≥10), 36% (120/342) reported anxiety (GAD-7 ≥8), and 25% (91/342) reported suicidal ideation. By follow-up, significant reductions were observed in PHQ-9 (-2.4, 95% CI -3.0 to -1.8) and GAD-7 scores (-1.5, 95% CI -2.0 to -1.0). Among those with elevated symptoms, 40% (48/120) to 42% (56/133) achieved a clinically meaningful response (≥50% reduction in baseline scores), and 27% (36/133) to 28% (33/120) achieved remission (PHQ-9 or GAD-7 score <5). Of those with suicide ideation at baseline, 60% (50/83) had none at follow-up. CONCLUSIONS: This study highlights the important relationship between telehealth-delivered GAHT and mental health, emphasizing the importance of accessible and timely care.

  PublisherDOI

• Association of state medicaid prescription cap policies with trajectories of buprenorphine use for opioid use disorder

  Journal of Substance Use and Addiction Treatment · 2025-06-09 · 4 citations

  article
  PublisherDOI

• Trends and Disparities in the Use of Opioid, Gabapentinoid, and Nonpharmacologic Pain Therapies Among Medicare Beneficiaries With Acute Low Back Pain, 2016–2019

  Medical Care Research and Review · 2025-05-29 · 1 citations

  articleOpen access

  Contemporary practice guidelines recommend nonpharmacologic therapies instead of prescription opioids as first-line treatment for many pain types, including acute low back pain (aLBP). This serial cross-sectional study describes trends in the annual prevalence of physical therapy (PT), chiropractic care, gabapentinoids, and prescription opioid receipt among Medicare beneficiaries diagnosed with aLBP from 2016 to 2019, overall and within key demographic, clinical, and geographic subgroups. Overall, changes in PT (5.5%-6.7%), chiropractic care (11.0%-11.7%), and gabapentinoid (9.6%-8.9%) receipt were limited, whereas prescription opioid use substantially decreased (26.2%-17.8%). Prescription opioid receipt was higher among individuals under age 65, American Indian/Alaskan Native, non-Hispanic Black/African American, and Hispanic individuals, individuals with opioid use disorder, and in Southern states, while the use of nonpharmacologic pain therapies remained low among these subgroups. It is essential to promote equitable access to multimodal and guideline-recommended approaches for aLBP management including nonpharmacologic therapies.

  PublisherOA PDFDOI

• Characterizing disparities in the HIV care continuum among U.S. transgender and cisgender Medicare beneficiaries, 2008–2017

  AIDS Care · 2025-01-31

  articleOpen accessSenior author

  Although HIV is more prevalent among transgender and gender-diverse individuals than cisgender people, a dearth of research has compared the HIV-related care engagement of these populations. Using 2008-2017 Medicare data, we identified TGD (trans feminine and non-binary [TFN], trans masculine and non-binary [TMN], unclassified gender) and cisgender (male, female) beneficiaries with HIV and explored within and between gender group differences in the predicted probability of engagement in the HIV Care Continuum. Transgender and gender-diverse individuals had a higher predicted probability of every HIV-related care outcome vs. cisgender individuals, with TFN individuals showing the highest probability of HIV care visit engagement, sexually transmitted infection screening, and antiretroviral treatment receipt and persistence. Notably, except for sexually transmitted infection screening, cisgender females and TMN people had a slightly lower probability of engaging in HIV-related care than TFN people and cisgender males. Although transgender and gender-diverse beneficiaries living with HIV had better engagement in the HIV Care Continuum than cisgender individuals, findings highlight disparities in engagement for TMN individuals and cisgender females, though engagement was still low for Medicare beneficiaries of all genders. Interventions are needed to reduce HIV care engagement barriers for all Medicare beneficiaries.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01DK080111

  NIH · $1.4M · 2013

• Data Management and Methods Core

  NIH · $54.2M · 2007–2029

• Data Management and Methods Core

  NIH · $5.0M · 2007–2024

Frequent coauthors

• Brandon D. L. Marshall

  Brown University

  66 shared

• Andrew R. Zullo

  Brown University

  49 shared

• Roland C. Merchant

  46 shared

• Tingting Zhang

  45 shared

• Edward F. Ellerbeck

  45 shared

• Anna E. Wentz

  VA New Jersey Health Care System

  44 shared

• Tao Liu

  42 shared

• Ralph C. Wang

  University of California, San Francisco

  40 shared

Education

• Ph.D., Health Services, Policy and Practice

  Brown University

  2000

• M.S., Health Services, Policy and Practice

  Brown University

  1995

• B.A., Public Policy

  University of California, Berkeley

  1992