Digital Commons Network^™

Health Equity & Obesity Management: An Improvement Project In A Federally Qualified Healthcare Center In Central Harlem, Brianna Bouchez

Doctor of Nursing Practice Scholarly Projects

Description of the problem: Obesity is a growing healthcare problem worldwide with extraordinary costs to the individual's health and the healthcare system. Individuals most affected by obesity include socioeconomically disadvantaged individuals, often with limited resources to seek specialized care.

Available knowledge: Various weight-loss interventions exist but access and success rates vary. Weight loss is often modest and additional factors such as social determinants of health, health literacy, and patient motivation are all factors important to the success of an intervention.

Specific Aims: The purpose of this quality improvement project was to improve self-regulatory weight loss behaviors and increase weight loss …

The Impact Of The 2010 Affordable Care Act On Reducing Racial/Ethnic Disparties In Primary Care Acess And The Delivery Of Diabetes Preventive Care In The United States, Adrianna Nava

Graduate Doctoral Dissertations

A key focus of the 2010 Patient Protection and Affordable Care Act (ACA) was to improve access to healthcare services in the United States (U.S.) (Stolberg & Pear, 2010). The research purpose was to assess the impact of the ACA’s Medicaid expansion and insurance subsidies on reducing racial/ethnic disparities in coverage, access and the delivery of primary care services, specifically diabetes prevention. Diabetes disproportionately affects minority populations, with inequities reported in the delivery of diabetes care to minorities (Chow, Foster, Gonzalez & McIver, 2012). The Modified Quality Health Outcomes Model was used to guide this research. Statistical analyses were conducted …

How Will Public Health And Primary Care Come Together In Massachusetts?, Javier Crespo

Public Affairs Capstones Collection

The Patient Protection and Affordable Care Act aims to place public health and prevention practice closer to the clinical care delivery system by mandating basic preventive services and creating a national prevention plan. The Massachusetts health care system has a number of elements that can help foster closer linking of public health practices in the primary care setting. This research set out to examine whether the current healthcare system in Massachusetts will enable public health and primary care integration as intimated upon by the Affordable Care Act. This study will assess the current connection between public health and primary care …

Integrating Mental Health And Primary Care, Stephen Thielke, Steven D. Vannoy, JüRgen UnüTzer

Steven D Vannoy

No abstract provided.

The Road To Universal Health Coverage In Massachusetts: A Story In Three Parts, John E. Mcdonough

New England Journal of Public Policy

In 1988, the Massachusetts Legislature passed a new law, a “play or pay” employer mandate, requiring all employers with six or more workers to provide health insurance coverage for their employees. A few years later, with Medicaid identified as a “Budget Buster,” the Weld administration sought deregulation as the way to cut costs and expand access by establishing MassHealth, which dropped the employer mandate and expanded Medicaid, and eventually distinguished Massachusetts as the state with the greatest percent of covered citizens. But MassHealth enrollment has declined as premium costs have risen, and the Uncompensated Care Pool is once again faced …

Performance And Accountability In Human Services: Ownership And Responsibility Of Professionals, Anna-Marie Madison

New England Journal of Public Policy

The recent frenzy of grant makers and government agencies in requiring impact evaluations of all grant recipients has created consternation among human service providers. To ensure their agencies' survival and worker job security, the leaders are faced with meeting the demands offunder-driven programming. Agencies seeking funding must comply with funder-defined needs and accountability criteria rather than their public missions. This article describes the use of mission-based performance evaluation rather than funder compliance to demonstrate accountability for mission accomplishment.

Labor's Response To Hospital And Workplace Transformation, Enid Eckstein

New England Journal of Public Policy

The health care industry and the nation's hospitals are in the throes of revolutionary change. The shift to managed care resulted in fundamental changes in the delivery of care and the structure of health care, For the past ten years, hospitals have actively been merging and creating large-scale integrated delivery systems. Employers, eager to expand market share and reduce costs, are engaged in radical reorganization of the hospital and the structure of work from which no group is immune. Physicians, nurses, technicians, and housekeepers are all affected by these changes. Hospitals are reducing their personnel, shifting work outside the hospital, …

Improving Workforce Conditions In Private Human Service Agencies: A Partnership Between A Union And Human Service Providers, James Green

New England Journal of Public Policy

In 1995 the Service Employees International Union Local 509 and four Massachusetts human service providers signed an unusual agreement to forge a partnership in which employers would remain neutral while the union approached its workers with an offer to advocate in the state legislature for greater funding for private human service employees and to promote cooperative relations with their employers. This study examines the context of the agreement and the pressures on public employee unions and small human service providers whose workforce copes with low wages, high turnover, meager benefits, and poor public image as well as the give-and-take between …

Long-Term Care Policy: Where Are We Going?, Gerontology Institute, University Of Massachusetts Boston, Omb Watch

Gerontology Institute Publications

Millions of Americans suffer from physical or mental conditions that make it difficult for them to live fully independent lives. These are the frail elderly, disabled and chronically ill persons of all ages, and many mentally ill or mentally retarded persons. They need help to manage daily activities, whether they live in their own homes or in nursing homes.

Such care can be extremely expensive, since it often must be provided for many years, even a lifetime. Today, those costs are met largely by the individuals themselves or by their families and by public programs for low-income persons.

For many …