Medicine and Health Sciences Commons^™

Analysis Of The Efforts Of Urban And Rural Health Systems To Achieve Accountable Care Organization Target Goals For Dilated Eye Exams In Individuals With Diabetes, Michele Gilliam

Muskie School Capstones and Dissertations

This capstone project was designed to understand and analyze the completion rates for diabetic dilated eye exams within four different health systems participating in the MaineHealth Accountable Care Organizations (ACO). This research is valuable within the current US health care climate as health care providers have sought to evaluate the cost of care in terms of their value to payers. Moreover, many providers have elected to join the ACO in order to demonstrate better outcomes, improve the cost of care and to share programmatic content and tools to standardized care. Within this capstone, system level workflows and processes were evaluated …

Access To Health Care Services For Adults In Maine [Report], Erika C. Ziller Phd

Access / Insurance

On October 17, 2016, the Maine Health Access Foundation (MeHAF) released a new research brief developed with the University of Southern Maine that found significant inequality in the ability of people in Maine to access quality health care. The authors, Barbara Leonard from MeHAF and Erika Ziller from the USM Muskie School, found that income, age and education are all closely associated with Maine people’s ability to receive appropriate and timely health care. Specifically, they found that among Maine adults 18 and older, those with family incomes less than $25,000 a year, young adults, racial and ethnic minorities, and people …

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

The Reliability And Validity Of The Task Analysis Recording Procedure (Tarp), Russell Brown Psyd

All Student Scholarship

Task analysis data collection typically focuses on the acquisition of skills by recording the percentage of steps in the response chain completed independently and correctly. While useful as a measure of skill acquisition, percentage correct does not promote a step based analysis of factors that may promote or interfere with skill acquisition, including necessary prompts and the occurrence of challenging behavior. This study evaluated the reliability and validity of the Task Analysis Recording Procedure (TARP) in recording physical stereotypy, a behavior often emitted by participants with autism or other developmental disabilities, by comparing TARP obtained physical stereotypy data to that …

A Pilot Investigation Of A Multi-Tier System Of Mathematics Instruction For Prekindergarten Students, William Benjamin Roy Psyd

All Student Scholarship

A Multi-Tier System of Support (MTSS) for academic skills is widely recognized as the best practice framework for supporting all students. Additionally, the recent shift from constructivist pedagogy toward more intentional teaching of mathematics at the preschool level has encouraged more explicit mathematics instruction with younger children. In spite of these advances, there are no published best practice guidelines for implementing MTSS for mathematics at the prekindergarten level. The current study sought to investigate one possible way to implement effective instructional practices for preschool mathematics within a multi-tier system, including the use of validated screening and progress monitoring instruments. A …

Are Rural Older Adults Benefitting From Increased State Spending On Medicaid Home And Community-Based Services?, Andrew F. Coburn Phd, Eileen Griffin Jd, Deborah Thayer Mba, Zachariah T. Croll Mph, Erika C. Ziller Phd

Long Term Services and Supports

In a shift away from institutional long term services and supports (LTSS), the federal government and states have pursued an array of strategies for expanding access to home and community-based services (HCBS) over the past few decades. Yet, little is known about variations in the availability or use of Medicaid HCBS within states, across rural and urban areas. This study used the national Medicaid Analytical Extract claims data file (2008) to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS. The study found that rural Medicaid LTSS users were less likely to …

Population Health Improvement Through Coordination Of Care, Trevey Davis

Muskie School Capstones and Dissertations

The objective of this Capstone Project is to work with the Mercy Gap in Care Coordinators (GCCs) to document the value of the care coordination at Mercy Health System. A key element of this project was to develop a workflow diagram alongside the GCC in order to track patient outcomes. Additionally, the team developed a system for documenting patient outcomes that is crucial to measuring the impact of care coordination. From the data collected there are a number of outcomes that can be measured. The number of patients who are contacted for screening is measurement of patient experience. Following initial …

Health Information Exchange: A Strategy For Improving Access For Rural Veterans In The Maine Flex Rural Veterans Health Access, Karen B. Pearson Mlis, Ma, Amanda Burgess Mppm, John A. Gale Ms, Andrew F. Coburn Phd, Anush Yousefian Hansen Ms, Ma

Access / Insurance

This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …

Grant Writing In Higher Education, Amos Bean

Muskie School Capstones and Dissertations

The primary aim of this capstone was to elicit feedback from public health and grant writing practitioners and funders in order to gather data that can be used to supplement teachings and readings for a course in the Muskie School of Public Service Masters in Public Health (MPH) graduate program. Two overarching questions served as the basis for this endeavor. The primary question for public health and grant writing practitioners was, “What are the most important lessons you have learned that you think graduate students who are writing their first proposals should know?” The primary question for funders was, “What …

An Analysis Of Women’S Access To Acute Opioid Detoxification Services In Maine: Identifying The Barriers To Treatment, Karen E. Conley

Muskie School Capstones and Dissertations

The lack of treatment facilities and services for opioid use disorder in Maine, combined with an increased prevalence of addiction, creates a potential for health inequity between men and women that may be intensified by barriers in access to care. This capstone study utilized detoxification screening inquiry forms and data obtained from the Milestone Foundation’s acute opioid detoxification program to assess and categorize barriers to access by gender. A barriers model was developed based on existing literature and was to identify potential associations among and between the known barriers to accessing treatment. Barriers were described as internally or externally based, …

Adverse Childhood Experiences In Rural And Urban Contexts, Jean A. Talbot Phd, Donald Szlosek Mph, Erika C. Ziller Phd

Mental Health / Substance Use Disorders

Recent research shows that rural children are more likely than urban children to experience certain kinds of adversity. Researchers at the Maine Rural Health Research Center looked at how adverse childhood experiences (ACEs) have affected rural and urban adults. Using data from the Behavioral Risk Factor Surveillance System Assessment, this study found that, while the prevalence of ACEs was comparable in rural and urban adults, over half of rural adults surveyed reported having ACE exposure.Among those with any ACE history, about one quarter experienced four or more ACEs. Policy implications and strategies are highlighted in this brief.

Key Findings:

• Past …

A Comparison Of A Discrete Trial Teaching Procedure And An Incidental Teaching Procedure To Help Children With Developmental Disorders Acquire Sight Word Reading Skills, Adam Golonka Psyd

All Student Scholarship

Knowing how to read words that are relevant and important has the potential to help individuals with developmental disorders gain independence within both school and community settings. The current study compares the effectiveness of two teaching procedures targeting reading skills in children with developmental disorders. Discrete trial teaching (DTT) is a commonly used method of teaching multiple pre-academic and academic skills to individuals with developmental disorders. It involves a systematic presentation of stimuli, a teaching procedure, and delivery of reinforcement, and is often delivered in a mass trial format. Incidental or naturalistic teaching, on the other hand, takes place in …

Adults Using Long-Term Services And Supports: Population And Service Use Trends In Maine, Sfy 2014, Kimberly I. Snow Mhsa, Ba, Tina Gressani, Louise Olsen, Catherine Mcguire Bs, Stuart Bratesman Mpp, Karen Mauney, Jason Theriault

Disability & Aging

Prepared by research staff at the University of Southern Maine's Muskie School of Public Service for the Maine Office of Aging and Disability Services (the Office), this chartbook provides information on Maine adults who use long term services and supports. This is the first chartbook to reflect all the populations served by the Office: older adults; adults with physical disabilities; adults with intellectual disabilities/autism spectrum disorder or other related conditions; and adults with acquired brain injury. Long term services and supports are a vital lifeline for the thousands of Maine adults who need them, and they account for a significant …

Time To Ask: An Alcohol Education Pilot For Healthcare Professionals. Clinical Needs Assessment, Mary Lindsey Smith Phd, Martha Elbaum Williamson Mpa, Jennifer Pratt Ba, Rachel M. Gallo Mph, Katie Rosingana Ba, Jacey Keller Mph, Mark Richards Bs

Substance Use Research & Evaluation

No abstract provided.

Rural Opioid Abuse: Prevalence And User Characteristics, Jennifer D. Lenardson Mhs, John A. Gale Ms, Erika C. Ziller Phd

Mental Health / Substance Use Disorders

This study examined the prevalence of non-medical use of pain relievers and heroin in the past year in rural and urban areas and the socio-demographic and economic characteristics associated with their use. Additionally, we examined opioid use by age at first use as well as dependence and abuse; treatment history and perceived need for treatment; use of alcohol and other drugs; perceived risk of using drugs and availability of drugs; problems resulting from the use of drugs; driving under the influence; and illegal activities and arrest records.

Living With A Brain Injury In Maine: Individual Experiences, Perceptions, And Needs, Mary Lou Ciolfi, Eileen Griffin Jd, Jennifer Pratt, Mark Richards Bs, Sherry Gildard, Beatrice Byrne

Disability & Aging

Maine has been recognized for its recent progress in improving the lives of person with brain injury within the state. This report is the third brain injury report over the past ten years as Maine continues in its efforts to understand the service needs of persons with brain injury, broaden awareness of the impact of a brain injury, improve treatment options, and ultimately prevent brain injuries, especially in vulnerable populations. The information gained through a survey and through focus group discussions provides further context for upcoming brain injury policy decisions and resource allocation. While the causes and consequences of brain …

Addressing Unhealthy Alcohol Use In Maine: Provider And Practice Attitudes Towards Integrating Alcohol Screening And Brief Intervention Within Rural Primary Care Practices, Mary Lindsey Smith Phd, Jennifer Pratt Aa, Rachel M. Gallo Mph, Katie Rosingana Ba, J Keller, Mark Richards Bs

Substance Use Research & Evaluation

No abstract provided.