About

Professor Mark Fleming is an Associate Professor in the Department of Community Health Sciences at UC Berkeley Public Health. His expertise focuses on critical approaches to social and structural determinants of health, including housing and homelessness, mental health and substance use crisis response, and health care services and technology. His training is in anthropology and sociology, and his research employs ethnographic, community-based participatory, and mixed methods to explore issues related to health disparities, social determinants, and healthcare access. His academic background includes a PhD in Medical Anthropology from the University of California, San Francisco and Berkeley, an MS in Sociology from the University of Wisconsin, Madison, and a BA in Biology from Oberlin College. Professor Fleming teaches courses such as Theories of Health and Social Behavior and Introduction to Qualitative Methods in Public Health Research. His work has been featured in media articles discussing health service utilization among shelter-in-place hotel residents and strategies to address homelessness services in San Francisco.

Research topics

• Medicine
• Computer Science
• Business
• Sociology
• Political Science
• Medical emergency
• Marketing
• Family medicine
• Public relations
• Psychiatry
• Nursing
• Psychology
• Process management
• Applied psychology

Selected publications

• Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program

  BMJ Open Quality · 2022 · 20 citations

  • Sociology
  • Political Science
  • Computer Science

  OBJECTIVE: Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers. SETTING: Case management program for high-risk, complex patients run by an integrated, county-based public health system. PARTICIPANTS: 30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March-November 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: The analysis intended to identify characteristics of success working with patients. RESULTS: Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients' mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics. CONCLUSIONS: Themes emphasise the importance of compassion for complexity in patients' lives, and success as a step-by-step process that is built over longitudinal relationships.

  DOI

• Association of Shelter-in-Place Hotels With Health Services Use Among People Experiencing Homelessness During the COVID-19 Pandemic

  JAMA Network Open · 2022 · 36 citations

  1st authorCorresponding
  • Medicine
  • Medical emergency
  • Family medicine

  Importance: Some jurisdictions used hotels to provide emergency noncongregate shelter and support services to reduce the risk of COVID-19 infection among people experiencing homelessness (PEH). A subset of these shelter-in-place (SIP) hotel guests were high users of acute health services, and the association of hotel placement with their service use remains unknown. Objective: To evaluate the association of SIP hotel placements with health services use among a subset of PEH with prior high acute health service use. Design, Setting, and Participants: This study used a matched retrospective cohort design comparing health services use between PEH with prior high service use who did and did not receive a SIP hotel placement, from April 2020 to April 2021. The setting was 25 SIP hotels in San Francisco, California, with a daily capacity of 2500 people. Participants included PEH who were among the top 10% high users of acute medical, mental health, and substance use services and who had 3 or more emergency department (ED) visits in the 9 months before the implementation of the SIP hotel program. Data analysis for this study was performed from February 2021 to May 2022. Exposures: SIP hotel placement with on-site supportive services. Main Outcomes and Measures: The primary outcomes were ED visits, hospitalizations and bed days, psychiatric emergency visits, psychiatric hospitalizations, outpatient mental health and substance use visits, and outpatient medical visits. Results: Of 2524 SIP guests with a minimum of 90-day stays, 343 (13.6%) met criteria for high service use. Of 686 participants with high service use (343 SIP group; 343 control), the median (IQR) age was 54 (43-61) years, 485 (70.7%) were male, 283 (41.3%) were Black, and 337 (49.1%) were homeless for more than 10 years. The mean number of ED visits decreased significantly in the high-user SIP group (1.84 visits [95% CI, 1.52-2.17 visits] in the 90 days before SIP placement to 0.82 visits [95% CI, 0.66-0.99 visits] in the 90 days after SIP placement) compared with high-user controls (decrease from 1.33 visits [95% CI, 1.39-1.58 visits] to 1.00 visits [95% CI, 0.80-1.20 visits]) (incidence rate ratio [IRR], 0.60; 95% CI, 0.47-0.75; P < .001). The mean number of hospitalizations decreased significantly from 0.41 (95% CI, 0.30-0.51) to 0.14 (95% CI, 0.09-0.19) for SIP guests vs 0.27 (95% CI, 0.19-0.34) to 0.22 (95% CI, 0.15-0.29) for controls (IRR, 0.41; 95% CI, 0.27-063; P < .001). Inpatient hospital days decreased significantly from a mean of 4.00 (95% CI, 2.44-5.56) to 0.81 (95% CI, 0.40-1.23) for SIP guests vs 2.27 (95% CI, 1.27-3.27) to 1.85 (95% CI, 1.06-2.65) for controls (IRR, 0.25; 95% CI, 0.12-0.54; P < .001), as did psychiatric emergency visits, from a mean of 0.03 (95% CI, 0.01-0.05) to 0.01 (95% CI, 0.00-0.01) visits for SIP guests vs no change in the control group (IRR, 0.25; 95% CI, 0.11-0.51; P < .001). Conclusions and Relevance: These findings suggest that in a population of PEH with high use of acute health services, SIP hotel placement was associated with significantly reduced acute care use compared with high users without a placement.

  DOI

Frequent coauthors

• Nancy J. Burke

  University of California, Merced

  24 shared

• Amanda L. Brewster

  University of California, Berkeley

  23 shared

• Margae Knox

  University of California, Berkeley

  21 shared

• Irene H. Yen

  University of California, Merced

  16 shared

• Janet K. Shim

  University of California, San Francisco

  15 shared

• Ariana Thompson‐Lastad

  13 shared

• Meredith Van Natta

  11 shared

• Nadia Safaeinili

  Stanford University

  10 shared

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