Medicine and Health Sciences Commons^™

The Earth Biogenome Project 2020: Starting The Clock., Harris A Lewin, Stephen Richards, Erez Lieberman Aiden, Miguel L Allende, John M Archibald, Miklós Bálint, Katharine B Barker, Bridget Baumgartner, Katherine Belov, Giorgio Bertorelle, Mark L Blaxter, Jing Cai, Nicolette D Caperello, Keith Carlson, Juan Carlos Castilla-Rubio, Shu-Miaw Chaw, Lei Chen, Anna K Childers, Jonathan A Coddington, Dalia A Conde, Montserrat Corominas, Keith A. Crandall, Andrew J Crawford, Federica Dipalma, Richard Durbin, Thankgod E Ebenezer, Scott V Edwards, Olivier Fedrigo, Paul Flicek, Giulio Formenti, Richard A Gibbs, M Thomas P Gilbert, Melissa M. Goldstein, Jennifer Marshall Graves, Henry T Greely, Igor V Grigoriev, Kevin J Hackett, Neil Hall, David Haussler, Kristofer M Helgen, Carolyn J Hogg, Sachiko Isobe, Kjetill Sigurd Jakobsen, Axel Janke, Erich D Jarvis, Warren E Johnson, Steven J M Jones, Elinor K Karlsson, Paul J Kersey, Jin-Hyoung Kim, W John Kress, Shigehiro Kuraku, Mara K N Lawniczak, James H Leebens-Mack, Xueyan Li, Kerstin Lindblad-Toh, Xin Liu, Jose V Lopez, Tomas Marques-Bonet, Sophie Mazard, Jonna A K Mazet, Camila J Mazzoni, Eugene W Myers, Rachel J O'Neill, Sadye Paez, Hyun Park, Gene E Robinson, Cristina Roquet, Oliver A Ryder, Jamal S M Sabir, H Bradley Shaffer, Timothy M Shank, Jacob S Sherkow, Pamela S Soltis, Boping Tang, Leho Tedersoo, Marcela Uliano-Silva, Kun Wang, Xiaofeng Wei, Regina Wetzer, Julia L Wilson, Xun Xu, Huanming Yang, Anne D Yoder, Guojie Zhang

Health Policy and Management Faculty Publications

No abstract provided.

Medicare Support For Dental And Podiatry Graduate Medical Education Programs., Candice Chen, Yoonkyung Chung, Geoffrey Broadbent, Elizabeth Mertz

Health Policy and Management Faculty Publications

Importance: Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in graduate medical education (GME) payments to teaching hospitals, including explicit support for dental and podiatry programs, little is known about the level or distribution of this public investment in the oral health and podiatry workforce.

Objective: To examine Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018, as well as the distribution of federal support among states, territories, and the District of Columbia.

Design, Setting, and Participants: This cross-sectional …

Va Medical-Legal Partnerships: Implementation Guidance And Suggested Measures, Jennifer Trott, Kimberly Lattimore, Joel Teitelbaum, Marsha Regenstein

Health Policy and Management Faculty Publications

No abstract provided.

Activating Nursing To Address Unmet Needs In The 21st Century, Patricia Pittman

Health Policy and Management Faculty Publications

No abstract provided.

The Trans Pacific Partnership Agreement, Intellectual Property And Medicines: Differential Outcomes For Developed And Developing Countries, Deborah Gleeson, Joel Lexchin, Ruth Lopert, Burcu Kilic

Health Policy and Management Faculty Publications

The final text of the Trans Pacific Partnership Agreement (TPP), agreed between the 12 negotiating countries in 2016, included a suite of intellectual property provisions intended to expand and extend pharmaceutical company exclusivities on medicines. It drew wide criticism for including such provisions in an agreement that involved developing countries (Vietnam, Peru, Malaysia, Mexico, Chile and Brunei Darussalam) because of the effect on delaying the introduction of low-cost generics. While developing nations negotiated transition periods for implementing some obligations, all parties would have eventually been expected to meet the same standards had the TPP come into force. While the TPP …

Relative Roles Of Race Versus Socioeconomic Position In Studies Of Health Inequalities: A Matter Of Interpretation, Amani Nuru-Jeter, Elizabeth Michaels, Marilyn D. Thomas, Alexis Reeves, Roland Thorpe, Thomas A. Laveist

Health Policy and Management Faculty Publications

An abundance of research has documented health inequalities by race and socioeconomic position (SEP) in the United States. However, conceptual and methodological challenges complicate the interpretation of study findings, thereby limiting progress in understanding health inequalities and in achieving health equity. Fundamental to these challenges is a lack of clarity about what race is and the implications of that ambiguity for scientific inquiry. Additionally, there is wide variability in how SEP is conceptualized and measured, resulting in a lack of comparability across studies and significant misclassification of risk. The objectives of this review are to synthesize the literature regarding common …

Influence Of Pharmaceutical Marketing On Medicare Prescriptions In The District Of Columbia, Susan Wood, Joanna Podrasky, Meghan Mcmonagle, Janani Raveendran, Tyler Bysshe, Alycia Hogenmiller, Adriane Fugh-Berman

Health Policy and Management Faculty Publications

Importance

Gifts from pharmaceutical companies are believed to influence prescribing behavior, but few studies have addressed the association between industry gifts to physicians and drug costs, prescription volume, or preference for generic drugs. Even less research addresses the effect of gifts on the prescribing behavior of nurse practitioners (NPs), physician assistants (PAs), and podiatrists.

Objective

To analyze the association between gifts provided by pharmaceutical companies to individual prescribers in Washington DC and the number of prescriptions, cost of prescriptions, and proportion of branded prescriptions for each prescriber.

Design

Gifts data from the District of Columbia’s (DC) AccessRx program and the …

Barriers And Facilitators To The Integration Of Mental Health Services Into Primary Health Care: A Systematic Review Protocol., Edith K Wakida, Dickens Akena, Elialilia S Okello, Alison Kinengyere, Ronald Kamoga, Arnold Mindra, Celestino Obua, Zohray M Talib

Health Policy and Management Faculty Publications

Background

Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works.

Methods

This review will use the SPIDER (Sample, Phenomenon of Interest, Design, …

Supporting And Retaining Village Health Teams: An Assessment Of A Community Health Worker Program In Two Ugandan Districts., Daniel C Mays, Edward J O'Neil, Edison A Mworozi, Benjamin J Lough, Zachary J Tabb, Ashlyn E Whitlock, Edward M Mutimba, Zohray M Talib

Health Policy and Management Faculty Publications

Background

Uganda’s national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, we examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. We report on findings from a standardized survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to …

Religious Coping And Types And Sources Of Information Used In Making Prostate Cancer Treatment Decisions., Janice V Bowie, Caryn N Bell, Altovise Ewing, Ballington Kinlock, Ashley Ezema, Roland J Thorpe, Thomas A Laveist

Health Policy and Management Faculty Publications

Treatment experiences for prostate cancer survivors can be challenging and dependent on many clinical and psychosocial factors. One area that is less understood is the information needs and sources men utilize. Among these is the influence of religion as a valid typology and the value it may have on treatment decisions. The objective of this study was to assess the relationship between race, religion, and cancer treatment decisions in African American men compared with White men. Data were from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 877 African American and White men. The main …

Use Of Prostate-Specific Antigen Testing In Medicare Beneficiaries: Association With Previous Evaluation, G S. Cooper, T D. Kou, M D. Schluchter, A Dor, S M. Koroukian, S P. Kim

Health Policy and Management Faculty Publications

Objective: Determine uptake of prostate-specific antigen (PSA) testing in Medicare beneficiaries according to previous receipt of PSA testing. Methods: A 5% random sample of men aged 67 years or older without a previous diagnosis of prostate cancer was identified through 2009-2012 Medicare claims. We measured the annualized frequency of PSA screening among men due for PSA testing, stratified by PSA testing use in the previous 2 years, and clustered by ordering provider. Results: Throughout the study period, PSA testing use was consistently higher for men with previous screening than for men without previous screening. For men without previous screening, there …

Geographic Variation Within The Military Health System, Linda G. Kimsey, Samuel Olaiya, Chad Smith, Andrew Hoburg, Stuart R. Lipsitz, Tracey Koehlmoos, Louis L. Nguyen, Joel S. Weissman

Health Policy and Management Faculty Publications

Background: This study seeks to quantify variation in healthcare utilization and per capita costs using system-defined geographic regions based on enrollee residence within the Military Health System (MHS).

Methods: Data for fiscal years 2007 – 2010 were obtained from the Military Health System under a data sharing agreement with the Defense Health Agency (DHA). DHA manages all aspects of the Department of Defense Military Health System, including TRICARE. Adjusted rates were calculated for per capita costs and for two procedures with high interest to the MHS- back surgery and Cesarean sections for TRICARE Prime and Plus enrollees. Coefficients of variation …

The Cost Of Cost-Sharing: The Impact Of Medicaid Benefit Design On Influenza Vaccination Uptake, Charles Stoecker, Alexandra M Stewart, Megan Lindley

Health Policy and Management Faculty Publications

ncome persons. State Medicaid policy may affect the uptake of recommended adult vaccinations. We examined the impact of three aspects of Medicaid benefit design (coverage for vaccines, prohibiting cost-sharing, and copayment amounts) on vaccine uptake in the fee-for-service Medicaid population 19–64 years old. We combined previously published reports to obtain state Medicaid policy information from 2003 and 2012. Data on influenza vaccination uptake were taken from the Behavioral Risk Factor Surveillance System. We used a differences-in-differences framework, controlling for national trends and state differences, to estimate the effect of each benefit design factor on vaccination uptake in different Medicaid-eligible populations. …

Influence Of Pharmaceutical Marketing On Medicare Prescriptions In The District Of Columbia., Susan F Wood, Joanna Podrasky, Meghan A Mcmonagle, Janani Raveendran, Tyler Bysshe, Alycia Hogenmiller, Adriane Fugh-Berman

Health Policy and Management Faculty Publications

Importance

Gifts from pharmaceutical companies are believed to influence prescribing behavior, but few studies have addressed the association between industry gifts to physicians and drug costs, prescription volume, or preference for generic drugs. Even less research addresses the effect of gifts on the prescribing behavior of nurse practitioners (NPs), physician assistants (PAs), and podiatrists.

Objective

To analyze the association between gifts provided by pharmaceutical companies to individual prescribers in Washington DC and the number of prescriptions, cost of prescriptions, and proportion of branded prescriptions for each prescriber.

Design

Gifts data from the District of Columbia’s (DC) AccessRx program and the …

Multimorbidity: Constellations Of Conditions Across Subgroups Of Midlife And Older Individuals, And Related Medicare Expenditures, Siran Koroukian, Nicholas Schiltz, David Warner, Jiayang Sun, Kurt Strange, Charles Given, Avi Dor

Health Policy and Management Faculty Publications

Introduction:

The Department of Health and Human Services’ 2010 Strategic Framework on Multiple Chronic Conditions called for the identification of common constellations of conditions in older adults.

Objectives:

To analyze patterns of conditions constituting multimorbidity (CCMM) and expenditures in a US representative sample of midlife and older adults (50–64 and ≥65 years of age, respectively).

Design:

A cross-sectional study of the 2010 Health and Retirement Study (HRS; n=17,912). The following measures were used: (1) count and combinations of CCMM, including (i) chronic conditions (hypertension, arthritis, heart disease, lung disease, stroke, diabetes, cancer, and psychiatric conditions), (ii) functional limitations (upper …

Improving Community Health Through Hospital Community Benefit Spending: Charting A Path To Reform, Sara J. Rosenbaum, Maureen Byrnes, Sara Rothenberg, Rachel Gunsalus

Health Policy and Management Faculty Publications

No abstract provided.

Caution Is Needed In Designing Pharmacy Coverage., Steven A Farmer, William B Borden

Health Policy and Management Faculty Publications

Introduction

Pharmaceuticals are a critical component of modern medical care and have contributed substantially to health and quality of life. They are also expensive, accounting for ≈10% of US health care costs.1 By the end of this year, Medicare beneficiaries are expected to spend $343 billion on medications, and drug spending is projected to grow faster than both the inpatient and outpatient care categories.2Commercial and public payers use a range of mechanisms to constrain these costs, including formularies, tiered copayments, and preauthorization. These coverage policies may have potent impacts on medication usage, and their effects deserve close …

The Methods Behind 2015 Informatics Capacity And Needs Assessment Study, Gulzar H. Shah

Health Policy and Management Faculty Publications

The 2015 Informatics Needs and Capacity of Local Health Departments (LHDs) survey is the most recent comprehensive source of quantitative data on LHD informatics. Conducted by the National Association of County & City Health Officials (NACCHO), this is the third nationally representative quantitative study of LHD informatics since 2009. The previous 2 comprehensive quantitative assessments were conducted by NACCHO in 2009-2010 and 2011. Given that public health informatics is rapidly evolving, the 2015 Informatics survey is a much-needed country-wide assessment of the current informatics needs and capacities of LHDs. This article outlines detailed methodology used in the 2015 Informatics survey, …

Urgent Challenges For Local Public Health Informatics, Joseph P. Gibson, Gulzar H. Shah, Laura C. Streichert, Linda Verchick

Health Policy and Management Faculty Publications

This editorial highlights the urgent challenges for local public health informatics and provides solutions to face these challenges.

Public Health Staff Development Needs In Informatics: Findings From A National Survey Of Local Health Departments, Barbara L. Massoudi, Kelley Chester, Gulzar H. Shah

Health Policy and Management Faculty Publications

Context: Public health practice is information-intensive and information-driven. Public health informatics is a nascent discipline, and most public health practitioners lack necessary skills in this area.

Objective: To describe the staff development needs of local health departments (LHDs) related to informatics.

Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County & City Health Officials.

Participants: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%).

Main Outcome Measure(s): Outcome measures included LHDs' specific staff development needs related to informatics. …

Electronic Health Records And Meaningful Use In Local Health Departments: Updates From The 2015 Naccho Informatics Assessment Survey, Karmen S. Williams, Gulzar H. Shah

Health Policy and Management Faculty Publications

Background: Electronic health records (EHRs) are evolving the scope of operations, practices, and outcomes of population health in the United States. Local health departments (LHDs) need adequate health informatics capacities to handle the quantity and quality of population health data.

Purpose: The purpose of this study was to gain an updated view using the most recent data to identify the primary storage of clinical data, status of data for meaningful use, and characteristics associated with the implementation of EHRs in LHDs.

Methods: Data were drawn from the 2015 Informatics Capacity and Needs Assessment Survey, which used a stratified random sampling …

Using Information Systems To Improve A Mid-Sized Local Health Department’S Effectiveness In A Time Of Rapid Change, Kay Lovelace, Gulzar H. Shah

Health Policy and Management Faculty Publications

Background: Informatics capacity building is resource and personnel intensive. Many local health departments (LHDs) face tradeoffs between using their resources to carry out existing mandates and using resources to build their capacity, for example, through informatics, to deliver essential services in a more effective and efficient manner.

Objective: The purpose of this case study is to describe how a mid-sized LHD built and used information systems to support its strategic objectives, clinical services, and surveillance.

Methods: The mid-sized LHD described here was chosen for its “best practices” in informatics capacity building and use by NACCHO's study advisory committee. To conduct …

Local Health Departments' Partners And Challenges In Electronic Exchange Of Health Information, Gulzar H. Shah, Joshua Vest, Kay Lovelace, J. Mac Mccullough

Health Policy and Management Faculty Publications

Background: Unprecedented amounts of data are produced by the health care and other sectors, presenting opportunities for local health departments (LHDs) to access these data. LHDs will need to participate in health information exchange (HIE) with a number of partners in order to benefit from these data resources. LHDs' participation in HIEs with specific partners has not been studied.

Objectives: To describe the level of and challenges in LHD participation in HIE with other partners, and variation by LHD population size and governance type.

Data and Methods: This research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, …

Informatics As A Strategic Priority And Collaborative Processes To Build A Smarter, Forward-Looking Health Department, Kay Lovelace, Gulzar H. Shah

Health Policy and Management Faculty Publications

This article was published in the Journal of Public Health Management and Practice.

Interoperability Of Information Systems Managed And Used By The Local Health Departments, Gulzar H. Shah, Jonathon P. Leider, Huabin Luo, Ravneet Kaur

Health Policy and Management Faculty Publications

Background: In the post-Affordable Care Act era marked by interorganizational collaborations and availability of large amounts of electronic data from other community partners, it is imperative to assess the interoperability of information systems used by the local health departments (LHDs).

Objectives: To describe the level of interoperability of LHD information systems and identify factors associated with lack of interoperability.

Data and Methods: This mixed-methods research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling …

Control Of The Public Health It Physical Infrastructure: Findings From The 2015 Informatics Capacity And Needs Assessment Survey, Kelley Chester, Barbara L. Massoudi, Gulzar H. Shah

Health Policy and Management Faculty Publications

Background: Despite improvements in information technology (IT) infrastructure in public health, there is still much that can be done to improve the adoption of IT in state and local health departments, by better understanding the impact of governance and control structures of physical infrastructure.

Objective: To report out the current status of the physical infrastructure control of local health departments (LHDs) and to determine whether there is a significant association between an LHD's governance status and control of the physical infrastructure components.

Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in …

An Iterative, Low-Cost Strategy To Building Information Systems Allows A Small Jurisdiction Local Health Department To Increase Efficiencies And Expand Services, Kay Lovelace, Gulzar H. Shah

Health Policy and Management Faculty Publications

Objective and Methods: The objective of this case study was to describe the process and outcomes of a small local health department's (LHD's) strategy to build and use information systems. The case study is based on a review of documents and semi-structured interviews with key informants in the Pomperaug District Health Department. Interviews were recorded, transcribed, coded, and analyzed.

Results and Conclusions: The case study here suggests that small LHDs can use a low-resource, incremental strategy to build information systems for improving departmental effectiveness and efficiency. Specifically, we suggest that the elements for this department's success were simple information systems, …

Assessing Skills And Capacity For Informatics: Activities Most Commonly Performed By Or For Local Health Departments, Kate Drezner, Lisa Mckeown, Gulzar H. Shah

Health Policy and Management Faculty Publications

Objective: To describe the informatics activities performed by and for local health departments.

Design: Analysis of data from the 2015 Informatics Capacity and Needs Assessment Survey of local health departments conducted by the Jiann-Ping Hsu College of Public Health at Georgia Southern University in collaboration with the National Association of County & City Health Officials.

Participants: 324 local health departments.

Main Outcome Measure(s): Informatics activities performed at or for local health departments in use and analysis of data, system design, and routine use of information systems.

Results: A majority of local health departments extract data from information systems (69.5%) and …

How Medicaid And Other Public Policies Affect Use Of Tobacco Cessation Therapy, United States, 2010-2014., Leighton Ku, Erin Brantley, Tyler Bysshe, Erika Steinmetz, Brian K. Bruen

Health Policy and Management Faculty Publications

INTRODUCTION: State Medicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state. This article assesses the effects of changes in Medicaid benefit policies, general tobacco policies, smoking norms, and public health programs on the use of cessation therapy among Medicaid smokers.

METHODS: We used longitudinal panel analysis, using 2-way fixed effects models, to examine the effects of changes in state policies and characteristics on state-level use of Medicaid tobacco cessation medications from 2010 through 2014.

RESULTS: Medicaid policies that require patients to …

Health Departments’ Engagement In Emergency Preparedness Activities: The Influence Of Health Informatics Capacity, Gulzar H. Shah, Bobbie J. Newell, Ruth E. Whitworth

Health Policy and Management Faculty Publications

Background: Local health departments (LHDs) operate in a complex and dynamic public health landscape, with changing demands on their emergency response capacities. Informatics capacities might play an instrumental role in aiding LHDs emergency preparedness. This study aimed to explore the extent to which LHDs’ informatics capacities are associated with their activity level in emergency preparedness and to identify which health informatics capacities are associated with improved emergency preparedness.

Methods: We used the 2013 National Profile of LHDs study to perform Poisson regression of emergency preparedness activities.

Results: Only 38.3% of LHDs participated in full-scale exercises or drills for an emergency …