Medicine and Health Sciences Commons^™

Partial Psychiatric Hospitalization Program Availability In Non-Metropolitan And Metropolitan Hospitals Nationally, Timothy Williams, Tyrone F. Borders, Lindsey Jasinski

Rural & Underserved Health Research Center Publications

Overview of Key Findings

Partial psychiatric hospitalization programs (PPHPs) are intended to reduce or avoid inpatient stays by allowing patients to reside at home while receiving intensive psychiatric services in outpatient settings.

A significantly smaller proportion of non-metropolitan than metropolitan hospitals offer PPHPs.

• 11.4% of non-metropolitan compared to 38.7% of metropolitan hospitals offer PPHPs.
• Regardless of location, hospitals that offer PPHPs have higher patient volumes and more beds than hospitals that offer PPHPs through affiliated providers or do not offer PPHPs at all.

Understanding Lung Cancer Resources And Barriers Among Worksites With Mostly Male Employees In Eight Rural Kentucky Counties: A Focus Group Discussion, Jennifer Redmond Knight, Lucy Hollingsworth Williamson, Debra K. Armstrong, Elizabeth A. Westbrook

Health Management and Policy Faculty Publications

Kentucky has the highest cancer incidence and mortality rates in the United States, and lung cancer is Kentucky's leading cause of cancer deaths. Males in Kentucky have higher lung incidence and mortality rates than females. Through support from the SelfMade Health Network, Kentucky developed a Regional Resource Lead Organization that collaboratively developed a multi-component worksite intervention on lung cancer among male populations. The intervention targets eight Kentucky counties. The first component and focus of this manuscript included focus group meetings with organizational representatives in each county that provide health, educational, and social services to men and worksites. The focus groups …

Hospital Closures And Short-Run Change In Ambulance Call Times, Sookti Chaudhary, Alison F. Davis, Kenneth R. Troske, Suzanne Troske

Rural & Underserved Health Research Center Publications

We measure one aspect of how access to emergency care through ambulance services changes for patients when a hospital closes. We empirically estimate the time needed to transport a patient to an emergency department in an ambulance in the period immediately after the hospital closes. We find urban patients in zip codes where a hospital closes have a small change in transportation time, where rural patients average an estimated 15.7 additional minutes – a 46% increase compared to the year before the closure. This increase is primarily the result of an almost 100 percent increase in the time it takes …

The Role Of The Community Health Delivery System In The Health And Well-Being Of Justice-Involved Women: A Narrative Review, Sharla A. Smith, Glen P. Mays, Tracie C. Collins, Megha Ramaswamy

Health Management and Policy Faculty Publications

Background: Over seven million imprisoned and jailed women are released into the community each year and many are ill-equipped to meet the challenges of re-integration. Upon release into their community, women are faced with uncertain barriers and challenges using community services to improve their health and well-being and reuniting with families. Few studies have identified and described the barriers of the community health delivery system (CHDS)- a complex set of social, justice, and healthcare organizations that provide community services aimed to improve the health and well-being (i.e. safety, health, the success of integration, and life satisfaction) of justice-involved women. We …

Prevalence And Correlates Of Diagnosed And Undiagnosed Hypertension In The Indigenous Kuna Population Of Panamá, Daniel R. Hanna, Rebekah J. Walker, Brittany L. Smalls, Jennifer A. Campbell, Aprill Z. Dawson, Leonard E. Egede

Center for Health Services Research Faculty Publications

Background: To determine the prevalence of hypertension and investigate sociodemographic correlates in an indigenous Kuna community living on the San Blas islands of Panama.

Methods: Data was collected from adults using a paper-based survey using a cross sectional study design. Blood pressure was measured, and hypertension defined at two cut-points: 130/80 mmHg and 140/90 mmHg. Individuals with undiagnosed hypertension had a blood pressure measurement that indicated hypertension, however, the individual had not been told by a doctor they had hypertension. Whereas individuals with diagnosed hypertension had been told by a healthcare provider that they had hypertension. Univariate tests compared diagnosed …

Suicidal Thoughts, Plans, And Attempts By Non-Metropolitan And Metropolitan Residence, Kathi Harp, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Key Findings

• Mean prevalence rates for suicidal thoughts, plans, and attempts were significantly higher (P < .05) among residents of non-metropolitan than large metropolitan counties.
• The adjusted odds of suicidal thoughts, plans, and attempts did not improve significantly from 2010 to 2016 among residents of any county type.
• The study findings suggest that suicide prevention interventions should be further targeted toward non-metropolitan counties. However, new interventions may need to be specifically developed to meet the unique needs of residents in non-metropolitan counties.

Redesigning Systems To Improve Teamwork And Quality For Hospitalized Patients (Reset): Study Protocol Evaluating The Effect Of Mentored Implementation To Redesign Clinical Microsystems, Kevin J. O'Leary, Julie K. Johnson, Milisa Manojlovich, Jenna D. Goldstein, Jungwha Lee, Mark V. Williams

Center for Health Services Research Faculty Publications

Background: A number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective …

Evaluation Of A Tennessee Statewide Initiative To Reduce Early Elective Deliveries Using Quasi-Experimental Methods, Michael P. Thompson, Ilana Graetz, Caitlin N. Mckillop, Peter H. Grubb, Teresa M. Waters

Health Management and Policy Faculty Publications

Background: Concerted quality improvement (QI) efforts have been taken to discourage the practice of early elective deliveries (EEDs), but few studies have robustly examined the impact of directed QI interventions in reducing EED practices. Using quasi-experimental methods, we sought to evaluate the impact of a statewide QI intervention to reduce the practice of EEDs.

Methods: Retrospective cohort study of vital records data (2007 to 2013) for all singleton births occurring ≥36 weeks in 66 Tennessee hospitals grouped into three QI cohorts. We used interrupted-time series to estimate the effect of the QI intervention on the likelihood of an EED birth …

Do Hospital Closures Affect Patient Time In An Ambulance?, Suzanne Troske, Alison Davis

Rural & Underserved Health Research Center Publications

When a hospital closes in a community, patients needing emergency care may spend more time in an ambulance to receive care in an emergency department (ED). We explore how hospital closures affect the time a patient travels from an incident location where 9-1-1 was called to the ED in an ambulance.

• Rural patients average an estimated 11 additional minutes in an ambulance the year after a hospital closure in their zip code, a 76% increase compared to before the closure.
• Urban and suburban patients have no change in transportation time in zip codes where a hospital closes.
• Patients over 64 …

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …

Evaluating Ways To Reduce Errors In Medication Reconciliations Performed By Nurses In A Rural Hospital Setting, Kalen T. Freeman

MPA/MPP/MPFM Capstone Projects

Medication reconciliation, also known as “med recs”, are an important part of a patient’s care during their hospitalization. A med rec is when hospital personnel generate a list of the medications the patient takes at home. Med recs are vital in the hospital admission process because home medications need to be restarted at appropriate times to fully care for the patient. Also, mistakes in a home medication list can lead to serious consequences in the patient’s health. This study focuses on med recs being performed at Marcum and Wallace Hospital in Irvine, Kentucky. More specifically, the study explores the different …

Impact Of Area-Under-The-Curve Monitoring For Vancomycin On Incidence Of Acute Kidney Injury In Orthopedic Patients, Kelli R. Keats

MPA/MPP/MPFM Capstone Projects

Vancomycin is an antibiotic used regularly in hospitals across the world. The most concerning adverse effect of vancomycin is its documented effect on kidney function. This study examines the impact of two dosing strategies of vancomycin on patients’ kidney function at the University of Kentucky Albert B. Chandler Medical Center. It specifically focuses on patients on the orthopedic service because these patients traditionally receive higher doses of vancomycin for longer periods of time due to the severity of their infections, which puts them at an increased risk of vancomycin-induced nephrotoxicity compared to other patients.

This study will serve as a …

Impact Of Prescription Opioid Access Restrictions On Alcohol-Induced Mortality In Kentucky, Changwe Park

MPA/MPP/MPFM Capstone Projects

Prescription drug monitoring programs (PDMPs) are state policy tools to combat risky opioid prescribing. Since 2012, several states began to mandate PDMP use. As mandating use laws have settled down, evaluating potential adverse events becomes possible.

In this study, I focus on alcohol-induced mortality as a potential unintended consequence via substituting alcohol for prescription opioids, since alcohol and opioids are often concurrently misused as a part of pain self-management. Therefore, the aim of this study is to analyze the unintended consequences of prescription opioid access restrictions on alcohol-induced mortality.

I compare the alcohol-induced mortality among adults during pre- and post-revision …

Emergency Room Services Used By Pediatric Patients Who Have An Established Primary Care, Rebecca J. Cooksey

DNP Projects

Background: The use of emergency room services for primary care issues is an ongoing problem. The incidence is higher in the Medicaid population and is associated with emergency room overcrowding and excessive medical costs.

Purpose: The purpose of this study was to explore the extent of and the details surrounding non-acute emergency room visits in a pediatric population within an urban primary care clinic.

Methods: This was a two-part descriptive study with both quantitative and qualitative components. A retrospective chart review of this facility’s ER data constituted the quantitative descriptive part of the study. The qualitative arm of the study …

Developing A Workflow To Evaluate Medications For Repurposing Using Health Claims Data: Application To Substance Use Disorders, Emily Ruth Hankosky

Theses and Dissertations--Pharmacy

Healthcare big data are a growing source of real-world data with which to identify and validate medications with repurposing potential. Previously, we developed a claims-based workflow to evaluate medications with potential to treat stimulant use disorders. In order to test the workflow, the framework was applied in the context of opioid use disorders (OUDs), for which there are medications with known efficacy. Using the Truven Marketscan Commercial Claims Database, a nested case-control analysis was conducted to determine the association between OUD medications (buprenorphine, naltrexone) and remission. Cases were defined as enrollees with a remission diagnosis and matched (1:4) to controls …

Evaluation Of A Palliative Care Initiative On The African Continent: Responsibly Improving Access To Pain Treatment, J. Spencer Hirschi

MPA/MPP/MPFM Capstone Projects

The African continent today faces a crisis of inadequate palliative care, in spite of the growing level of suffering of its citizens who are faced with debilitating diseases and injuries. Much of this problem stems from deeply ingrained attitudes towards opioids: while the American continent grapples with the effects of opioid overprescribing, physicians trained in Africa are taught that opioids are inappropriate for virtually all scenarios, and therefore they come to fear and avoid their use or simply remain untrained on them altogether. Patients fail to advocate for themselves out of submission to the doctor’s authority, governments remain apathetic to …