Medicine and Health Sciences Commons^™

The Associations Of The Level Of School Wellness Policy Implementation And School Nurse Activities To Weight Status Of School Children In Massachusetts, Mary Jane F. O'Brien

Graduate Doctoral Dissertations

The increase in prevalence of childhood obesity has prompted child health authorities to propose mandates focusing on population health efforts that may be implemented in public schools. In 2010, the federal government passed the Healthy, Hunger-Free Kids Act, reinforcing the 2004 regulations to guide school districts in development and implementation of school wellness policies.

The purpose of this secondary data analysis was an examination of the association between implementation of the school wellness policy and school nurse activities to the absolute change in percent of students with body mass index in the obese weight category between the school years 2005-2006 …

Funding Health-Related Vr Services: The Potential Impact Of The Affordable Care Act On The Use Of Private Health Insurance And Medicaid To Pay For Health-Related Vr Services, Robert Silverstein

All Institute for Community Inclusion Publications

One of the myriad of issues affecting the administration of the vocational rehabilitation (VR) program by State VR agencies under Title I of the Rehabilitation Act is how to maximize access to and use of all available funding sources to pay for VR services and supports for VR applicants and clients. In March 2010, Congress passed and the President signed into law the "Affordable Care Act" (ACA). 1 On June 28, 2012, the United States Supreme Court upheld all of the provisions of the ACA, with the exception of provisions mandating Medicaid expansion. The Supreme Court held that if a …

Information On Small Populations With Significant Health Disparities: A Report On Data Collected On The Health Of Asian Americans In Massachusetts, Carolyn Wong, Hannah Hosotani, John Her

Institute for Asian American Studies Publications

An analysis of publicly available sources of data on Asian Americans in Massachusetts with recommendations on ways to improve this collection of data.

Our report begins with a discussion of the important issues of data collection and reporting and then discusses the particular challenges of collecting and reporting on data in Massachusetts. Profiles of major datasets based on records for administrative entities are presented such as the Massachusetts Cancer Registry, hospital discharges, MassHealth, and Medicare, and mortality and natality records. This is followed by a description of major datasets based on population surveys such as the Behavioral Risk Factor Surveillance …

Supporting Healthy Lives And Vibrant Places: Learning About And Living The Collaborative Leadership Model, Lisa Deangelis, Maureen A. Scully, Andrea Wight

Emerging Leaders Program Team Projects

The 31 fellows in the 2012 UMass Boston Emerging Leaders Program (ELP) worked with community partners to investigate the theme, “Supporting Healthy Lives and Vibrant Places.” They worked in peer self-managed teams, in order to learn collaborative leadership skills first-hand, while engaging with stakeholders and issues where collaboration makes a difference. Their team projects addressed: best practices in corporate wellness initiatives, outreach to support health care access for homeless people, ways to grow awareness of the wide need for affordable housing, ideas for arts-based local economic development, broader funding sources to support innovative research on poverty, and ways to continue …

Indicators For Improving Educational, Employment, And Economic Outcomes For Youth And Young Adults With Intellectual And Developmental Disabilities: A National Report On Existing Data Sources, Jennifer Sullivan Sulewski, Agnieszka Zalewska, John Butterworth

All Institute for Community Inclusion Publications

The following report summarizes available national data on educational, employment and economic outcomes for youth and young adults with intellectual disabilities (ID) over the years 2000-2010. These data can be used to benchmark progress in improving these outcomes for young adult population across the country and within individual states. Data is reported separately for two age groups of young adults (16-21 and 22-30) in order to capture possible differences between youth likely to still be receiving school services (through age 21) and those who have moved on from the education system.

Characteristics, Management, And Depression Outcomes Of Primary Care Patients Who Endorse Thoughts Of Death Or Suicide On The Phq-9, Amy M. Bauer, Ya-Fen Chan, Hsiang Huang, Steven D. Vannoy, Jurgen Unuzter

Steven D Vannoy

BACKGROUND: With increasing emphasis on integrat- ing behavioral health services, primary care providers play an important role in managing patients with suicidal thoughts. OBJECTIVE: To evaluate whether Patient Health Questionnaire-9 (PHQ-9) Item 9 scores are associated with patient characteristics, management, and depres- sion outcomes in a primary care-based mental health program. DESIGN: Observational analysis of data collected from a patient registry. PARTICIPANTS: Eleven thousand fifteen adults en- rolled in the Mental Health Integration Program (MHIP). INTERVENTIONS: MHIP provides integrated mental health services for safety-net populations in over 100 community health centers across Washington State. Key elements of the team-based model …

Opinion: Bias Is Unavoidable, Lisa Cosgrove

Counseling and School Psychology Faculty Publication Series

It is part of the human condition to have implicit biases—and remain blissfully ignorant of them. Academic researchers, scientists, and clinicians are no exception; they are as marvelously flawed as everyone else. But it is not the cognitive bias that’s the problem. Rather, the denial that there is a problem is where the issues arise. Indeed, our capacity for self-deception was beautifully captured in the title of a recent book addressing researchers’ self-justificatory strategies, Mistakes Were Made (But Not by Me).

Influences Of Health Insurance And Primary Care On Breast And Cervical Cancer Screening Among Black Women In Boston, Gail Barlow Gall

Graduate Doctoral Dissertations

Healthy People 2010 promoted breast and cervical cancer screening to reduce cancer among all women and reduce disparities in cancer deaths between Black and White women. The REACH 2010 program targeted improving screening rates among Black women and funded a demonstration project to provide outreach, screening, patient navigation and case management for Black women in Boston. The purpose of this study was to describe associations between health insurance and primary care (having a primary care provider [PCP], quality of communications and relationship with PCP) on differences in breast and cervical cancer screening reported by Black women born in the United …

Diffusion Of The Egfr Assay: The Underutilization And The Urban/Rural Divide, Julie Ann Lynch

Graduate Doctoral Dissertations

Purpose - The EGFR assay is a molecular diagnostic test which identifies a targetable mutation in lung tumors. Guidelines call for EGFR testing for non-small cell lung cancer patients to direct first line treatment. We explored institutional and regional factors predicting the likelihood acute care hospitals ordered the assay. Methods: This was a retrospective study which analyzed US acute care hospitals (n=4780). We linked proprietary industry data for orders of the EGFR assay to public datasets that provided hospital and regional characteristics. We conducted logistic regression to identify significant characteristics that predict likelihood a hospital ordered the assay. Results - …

Evaluation Of Lift Up Your Voice! Advocacy Training For Older Adults And Their Caregivers: Executive Summary, Alison Gottlieb, Nina M. Silverstein, Kelli Barton

Gerontology Institute Publications

The Lift Up Your Voice! (LUYV) training, a component of Community Catalyst’s effort to support the Campaign for Better Care (CBC), is designed to mobilize grassroots advocacy structures of vulnerable older adults by directly engaging and empowering older adults and their caregivers. The goal of the evaluation is to assess the effectiveness LUYV in recruiting potential advocates, educating them about the health care reform, empowering them via advocacy skills training, and engaging them in state-based CBC activities.

Evaluating Effectiveness Of A Public Mental Health Re-Entry Program: Strategic Statewide Partnerships, Stephanie Hartwell

Office of Community Partnerships Posters

This study is the first ever initiative to merge administrative data base in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcome of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The Program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007 - 2011, comparing FTT clients to …

Give Us Your Poor: A National Public Education Campaign Addressing Homelessness, Barbara L. Graceffa, Center For Social Policy, University Of Massachusetts Boston

Office of Community Partnerships Posters

The objective of this campaign to create awareness that the Government alone cannot solve homelessness. The campaign also creates awareness that corporations need to be involved to help bring to scale solutions as well as promote innovation. The aim of the project is to create an awareness that collaboration between government, non-profits, academia, corporations, faith communities, and individuals is key to solving the issue.

Increasing Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward M. Miller, Cynthia Rudder

Office of Community Partnerships Posters

This project identified the facts about Nursing Facility Reimbursement by Medicaid in the states of New York and Minnesota. The results of this project are as follows: Medicaid is the main purchaser of nursing home (NH) care in the United States; States design their methods of reimbursing NHs to achieve desired policy objectives; Few consumers or resident advocates have been involved in the development or modification of state methods for reimbursing NHs; Lack of consumer involvement has resulted in payment systems that favor industry and government interests at the expense of issues important to residents and families.

Pay-For-Performance In Five State Medicaid Programs: Lessons For The Nursing Home Sector, Edward M. Miller, Julia Doherty

Office of Community Partnerships Posters

This project looks at the pay-for-performance program in five state Medicaid programs and lists the lessons that the Nursing Home Sector can learn from. They are: The federal government has traditionally sought to ensure quality outcomes through nursing home (NH) surveys conducted by state officials; Some states have begun to experiment with pay-for-performance (P4P) incentives, which provider higher Medicaid reimbursement to those facilities achieving desired outcomes; By 2007, there were 9 state P4P programs covering 20% of NHs and 16.7% of residents; Little is known about the use of P4P to promote quality and efficiency in the NH sector.

Health Careers Opportunity Program, Kunthary Thai-Johnson

Office of Community Partnerships Posters

Located on the University of Massachusetts Boston campus, the Health Careers Opportunity Program (HCOP) is an educational program funded through the federal Health Resources and Services Administration (HRSA). The mission of the program is to create a “pipeline” that starts at the middle and high schools in Boston, continues through the undergraduate programs at Tufts University and UMass Boston, and culminates in the graduate-level public health and/or medical programs at Tufts University School of Medicine or other medical schools.

Community Health Nursing Service Learning, Joyce K. Edmonds, Diane Coste

Office of Community Partnerships Posters

Through the Service Learning Course, College of Nursing and Health Sciences, RN-BS Online Program, Senior Level Course, Community Health for RN’s and NU 461, 6 credits Student Body Registered Nurses (70-105 each semester) throughout the state seeking to obtain a Bachelor in Science of Nursing. The Institute of Medicine, Future of Nursing Report recommends increasing the proportion of nurses with a baccalaureate degree to 80% by 2020. Instructional Aim Students obtain a better understanding of public health and nursing theory and practice as they further develop their professional and civic identities through meaningful service to their communities. Service Learning Requirement …

Honduras: Local, Regional And Global Partnerships To Improve Health In Olancho, Lisa Kennedy Sheldon, Hasan Bailey, Carlo Najera, Mary Roy

Office of Community Partnerships Posters

The Honduran Mission Team-New Hampshire (HMT-NH) in partnership with the Olancho Aid Foundation (OAF), works in the Olancho department to improve the health and education of the Honduran people. The HMT-NH 2012 Healthcare Team included UMass Boston faculty and a nursing student working with American and Honduran doctors and nurses to provide culturally-appropriate healthcare and collect data about the needs of the Honduran people in Olancho.

Working Together: Recruiting African American Female Caregivers And Pre-Adolescent Girls For Longitudinal Study, Teri Aronowitz, Wendy Pavlovich

Office of Community Partnerships Posters

The aim of this project is to implement an enhanced sexual communication intervention with mother-pre adolescent girls. It also aims to maintain the short term enhanced sexual communication intervention and evaluate the long term efficacy (9 months) of an enhanced sexual communication intervention with mothers and pre-adolescent girls. Finally the project aims to determine whether the constructs of the Information-Motivation-Behavioral skills (IBM) Model can account for variability in enhancing sexual communication intervention of mother and pre-adolescent girls.

Increasing Physical Activity In Inner City Youth Using Novel Interactive Gaming, Sd De Ferranti, Sk Steltz, Scott Crouter, A Kim, Sk Osganian, Jessica Whiteley, H Feldman, Laura L. Hayman, Gokids Boston, University Of Massachusetts Boston

Office of Community Partnerships Posters

The aim of this project was to assess the feasibility of participation in an afterschool physical activity program incorporating novel exercise technologies on changing physical activity level and physical fitness, compared to a nutrition education intervention alone. A second objective was to assess whether this type of intervention could modify cardiovascular risk factors and anthropometrics.

Gokids Boston Youth Fitness, Training, And Research Center, Meghan Feeley, Sarah Camhi, Dana Commesso, Gokids Boston, University Of Massachusetts Boston

Office of Community Partnerships Posters

GoKids Boston embodies innovation and leadership in youth health through life-changing programs, groundbreaking research, exceptional training opportunities, and dedication to the community with a focus on eliminating health disparities.

Institute For Community Inclusion (Ici) Leadership Education In Neurodevelopmental Disabilities (Lend) Partners With Community-Based Organizations (Cbos), David Helm, Institute For Community Inclusion, University Of Massachusetts Boston

Office of Community Partnerships Posters

This Interdisciplinary Leadership Education in Neurodevelopmental and Related Disabilities (LEND) and Maternal and Child Health Bureau (MCHB) funded-program aims at providing long-term, graduate level interdisciplinary training to health professionals and family members. The purpose of this project is to develop leadership potential to improve the health status of infants, children, and adolescents with or at risk for neurodevelopmental and related disabilities and to enhance the systems of care for these children and their families.

Inclusive National And Community Service: Bringing Together Service And Disability Communities, Paula Sotnik, Jewel Bazilio-Bellegarde, George Jesien, Felicia L. Wilczenski, Gayann Brandenburg, Debra Hart, Sheila Fesko, Stephan Hamlin-Smith, Alice Krueger

Office of Community Partnerships Posters

National service and volunteer programs, seeking to reflect the diversity of their communities, are increasing the participation of individuals with disabilities as members, volunteers, and leaders and working to ensure each individual has a meaningful service experience. In order to support their inclusive efforts, the National Service Inclusion Project (NSIP) brings together the national service and disability communities at a local, state, and national level. Through partnership building, strategic planning, and resource sharing, there have been measureable increases in numbers of service participants with disabilities and the quality of their experience.

The American Psychiatric Association’S Guideline For Major Depressive Disorder: A Commentary, Lisa Cosgrove, Allen F. Shaughnessy, Emily E. Wheeler, Kirsten E. Austad, Irving Kirsch, Harold J. Bursztajn

Counseling and School Psychology Faculty Publication Series

The American Psychiatric Association (APA) published a new guideline for Major Depressive Disorder (MDD) which will undoubtedly be used by many practitioners to guide clinical decision-making. In fact, it is non-psychiatrist clinicians who prescribe the majority of antidepressants (AD). We review the APA’s most recent guideline on MDD and report on our observations.

A Comparison Of Dsm-Iv And Dsm-5 Panel Members’ Financial Associations With Industry: A Pernicious Problem Persists, Lisa Cosgrove, Sheldon Krimsky

Counseling and School Psychology Faculty Publication Series

All medical subspecialties have been subject to increased scrutiny about the ways by which their financial associations with industry, such as pharmaceutical companies, may influence, or give the appearance of influencing, recommendations in review articles and clinical practice guidelines. Psychiatry has been at the epicenter of these concerns, in part because of high-profile cases involving ghostwriting and failure to report industry-related income, and studies highlighting conflicts of interest in promoting psychotropic drugs. The revised Diagnostic and Statistical Manual of Mental Disorders (DSM), scheduled for publication in May 2013 by the American Psychiatric Association (APA), has created a firestorm of controversy …

Increasing Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. States design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control. The incorporation of multiple, sometimes conflicting incentives into state reimbursement systems has resulted in enormously complex and demanding methodologies that inhibit consumer participation in state rating setting decisions. In turn, the lack of consumer involvement has the potential to result in the adoption of reimbursement systems that favor industry and government interests at the expense of issues important …

Dynamic Informed Consent Processes Vital For Treatment With Antidepressants, Abilash A. Gopal, Lisa Cosgrove, Itay Shuv-Ami, Emily E. Wheeler, Melissa J. Yerganian, Harold J. Bursztajn

Counseling and School Psychology Faculty Publication Series

Advances in technology and transparency have greatly accelerated the ability of clinicians to remain current with regards to being informed and informing patients about the risk/benefit ratio when considering antidepressant medication. In spite of this, the current climate of pharmaceutical industry influence on medical practice does much to hinder informed consent processes. Recent findings of previously unknown and potentially dangerous adverse effects of the second- and third-generation classes of antidepressants underscore the importance of enhancing the practice of informed consent. After considering the concept of informed consent as it has evolved over time, the authors summarize some of the newer …

Modeling The Longitudinality Of User Acceptance Of Technology With An Evidence-Adaptive Clinical Decision Support System, Michael P. Johnson Jr., Kai Zheng, Rema Padman

Public Policy and Public Affairs Faculty Publication Series

This paper presents multiple innovations associated with an electronic health record system developed to support evidence-based medicine practice, and highlights a new construct, based on the technology acceptance model, to explain end users’ acceptance of this technology through a lens of continuous behavioral adaptation and change. We show that this new conceptualization of technology acceptance reveals a richer level of detail of the developmental course whereby individuals adjust their behavior gradually to assimilate technology use. We also show that traditional models such as technology acceptance model (TAM) are not capable of delineating this longitudinal behavioral development process. Our TAM-derived analysis …

Activity Scheduling As A Core Component Of Effective Care Management For Late-Life Depression, Genevieve Riebe, Ming-Yu Fan, JüRgen UnüTzer, Steven D. Vannoy

Steven D Vannoy

Background: Activity scheduling is an established component of evidenced-based treatment for late-life depression in primary care. We examined participant records from the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial to identify activity scheduling strategies used in the context of successful depression care management (CM), associations of activity scheduling with self-reported activity engagement, and depression outcomes. Methods: This study used observational mixed methods analysis of 4335 CM session notes from 597 participants in the intervention arm of the IMPACT trial. Grounded theory was used to identify 17 distinct activity categories from CM notes. Logistic regression was used to evaluate associations …

Management Of Persistent Pain In Older Adults: The Mobilize Boston Study, Suzanne G. Leveille, Carrie Stewart

Suzanne G. Leveille

OBJECTIVES: To describe the prevalence of pharmacological (PS) and nonpharmacological (NPS) pain management approaches used by older adults with persistent pain and to identify characteristics associated with use of these approaches.

DESIGN: Population-based cohort.

SETTING: Urban and suburban communities in the

Boston, Massachusetts, area.

PARTICIPANTS: Seven hundred sixty-five adults aged 64

and older underwent a home interview and clinic examination. Those reporting any persistent pain were included in this analysis (N = 599).

MEASUREMENTS: All prescription and nonprescription

medications were recorded during the home interview.

NPS modalities for pain management were assessed using

a modification of the Pain Management Inventory. …

Evaluating The Impact Of Patients’ Online Access To Doctors’ Visit Notes: Designing And Executing The Opennotes Project, Suzanne G. Leveille

Suzanne G. Leveille

Abstract

Background: Providers and policymakers are pursuing strategies to increase patient engagement in health care.

Increasingly, online sections of medical records are viewable by patients though seldom are clinicians’ visit notes

included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We

hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes

would not lead to significant disruptions to doctors’ practices.

Methods/Design: Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse

healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; …