Public Health Commons^™

Inter-Organizational Network Effects On The Implementation Of Public Health Services, Glen P. Mays

Health Management and Policy Presentations

Background: The Affordable Care Act created new incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing inter-organizational relationships and expanding implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities; (2) whether network changes attenuate or exacerbate disparities in public health implementation across communities; and (3) how network changes affect preventable mortality and resource use.

Methods: We follow a longitudinal cohort of …

Puerto Rico’S Community Health Centers In A Time Of Crisis, Peter Shin, Jessica Sharac, Marie Nina Luis, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2014, Puerto Rico’s twenty federally funded community health centers, operating in 71 sites located throughout the Commonwealth, served 330,736 patients, approximately one in ten Commonwealth residents. Compared to other Puerto Rico residents, health center patients are less likely to be insured. Despite considerable growth in Medicaid as a result of the supplemental funding provided under the Affordable Care Act, in 2014, 12.2% of health center patients remained uninsured.

Compared to health centers outside Puerto Rico, Puerto Rico’s health centers show a greater proportion of Medicaid patients served (69% compared to 46% outside Puerto Rico), a greater dependence on physician …

The Impact Of Ciwa-Ar Tool On Healthcare Professionals, Laronda Tinsley

Applied Research Projects

Alcohol is one of the most abused substances worldwide. The regular consumption of alcohol can lead to dependency which depresses the central nervous system. Consequently, when a heavy drinker is no longer consuming alcohol, the central nervous system is no longer suppressed and may go into a hyperexcitable state known as alcohol withdrawal syndrome (AWS). Symptoms can vary from mild to life threatening. Patients who experience alcohol withdrawal symptoms often have a more complicated hospitalization, an extended length of stay, and increased utilization of intensive care and medical services. The Clinical Institute Withdrawal Assessment of Alcohol Scale-revised (CIWA-Ar) is a …

Measuring Quality Of Health Care In Type Ii Diabetes Mellitus Patients Using Certified Electronic Health Records, Tracey A. Hines

Applied Research Projects

Great strides have been made in health care over the past six years after the implementation of the policy known as meaningful use by the Center of Medicare and Medicaid Services. Health care subsidies and monetary incentive programs were created for eligible professionals and critical area hospitals to encourage the use of certified electronic health records in an effort to improve quality care of all acute and chronically ill patients, as well as provide routine examinations for healthy individuals.

Patients diagnosed with type II diabetes mellitus were studied using a certified electronic health record system for compliance in physician ordered …

Clinical Support Personnel In The U.S. Hospitals: Job Trends From 2010-2014, Patricia Pittman, Suhui Li, Xinxin Han

Health Workforce Research Center Publications

The use of various forms of Clinical Support Personnel (CSP), who perform healthcare tasks under the supervision of registered nurses and other licensed healthcare providers has been used as a primary strategy for managing professional shortages (Huston, 1996; Zimmerman, 2000), while at the same time reducing costs (Orne, Garland, O’Hara, Perfetto, & Stielau, 1998; Keenan, 2003). The purpose of this analysis is to better understand how hospitals are using CSP, and to explore changes that may have occurred since the 2010 passage of the Affordable Care Act. We use the term CSP to refer to a portion of the allied …

Medicare Part B Premiums And Social Security Benefits, Sally Coberly

National Health Policy Forum

This paper describes the annual determination of beneficiaries' premiums for voluntary Medicare Part B coverage and a provision known as "hold harmless." The hold-harmless provision prevents a beneficiary's Social Security payments from being reduced as a result of an increase in the Part B premium. Because there was no cost-of-living increase for Social Security benefits for 2016, the hold-harmless provision will be in effect. This paper discusses what happens to premiums in 2016 for beneficiaries who are not held harmless—new beneficiaries, beneficiaries who do not participate in Social Security, those who are dually eligible for Medicare and Medicaid, and higher-income …

Meaningful Use Of Health Information Technology: Proving Its Worth?, Lisa Sprague

National Health Policy Forum

Health policymakers in recent years have looked to the implementation of health information technology (IT)—electronic health records and the like—as a means to improve quality, reduce costs, and achieve better health outcomes across populations. But implementing health IT in a meaningful way must go beyond purchasing medical records software. The U.S. Department of Health and Human Services (HHS) devised a set of measures and incentives for hospitals and eligible medical professionals within Medicare or Medicaid to mark successive stages of effective IT implementation. This issue brief discusses the history of meaningful use, the measures used to evaluate effectiveness, and the …

Irish Gms Cost Projections And Its Implications Between 2016 And 2026, Aisling Conway Lenihan, Noel Woods

Dept. of Management & Enterprise Publications

Introduction: Ireland had one of the highest pharmaceutical spends per capita in the EU in 2012. The General Medical Services (GMS) scheme is the largest community drug scheme in Ireland with approximately 40% of the population eligible for free drugs and appliances in 2012. The total cost of GMS prescriptions increased by 414% between 1998 and 2012. This paper projects Irish GMS cost from 2016 to 2026 and examines the implications of the estimated impact on GMS expenditure.

Method: Central Statistics Office (CSO) population projections (2013) and HSE-PCRS GMS population prescription data (2012) were used to develop four variables; population, …

Predictive Factors Of Patient Satisfaction With Pharmacy Services In South Korea: A Cross-Sectional Study Of National Level Data, Sunkyung Lee, Onyeka P. Godwin, Kyungah Kim, Euni Lee

Pharmacy Faculty Articles and Research

Objectives
Patient satisfaction has emerged as a prerequisite to improving patients’ health behaviors leading to better health care outcomes. This study was to identify predictive determinants for patient satisfaction with pharmacy services using national-level data.

Methods
A cross-sectional evaluation was conducted using 2008 Korean National Health and Nutrition Examination Survey (KNHANES) data. To assess the predictive factors for patient satisfaction with pharmacy services, an ordinal logistic regression model was conducted adjusting for patient characteristics, clinical comorbidities, and perception of health.

Results
A total of 9,744 people, a representative sample of 48.2 million Koreans, participated in the 2008 KNHANES, of whom …

Estimating Health & Economic Gains From Public Health Delivery System Transformation, Glen P. Mays

Health Management and Policy Presentations

Objectives: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health system change; and (2) the effects of these changes on preventable mortality and resource use. Methods: …

Social Networking Patterns And Attitudes Towards Patient Privacy, Frank Davison

Applied Research Projects

Sharing ideas with others having common interests is primal and the

best indication of this is the exploding world of social networking. Social

media sites have become self-reported newscasts where we post our daily

activities as a matter of permanent public record. Are we losing our

expectation of privacy? What impact could this have on patient privacy?

Do individuals who are accustomed to sharing personal information on

social networks have a relaxed attitude towards patient privacy? Does this

vary according to age, gender, or racial background?

This study explores correlations between attitudes on social

networking and patient privacy and how …

Necessity Of Analytics In Today’S Healthcare Revenue Cycle, Kristen N. Thomas

Applied Research Projects

Because of the recently growing pressures to improve quality and reduce costs, healthcare organizations are rapidly adopting IT in order to improve their operations and clinical care. As a result, an accumulation of vast amounts of data are becoming available for use. It is important for healthcare to use this data. Strome (2010) states that healthcare analytics is the application of statistical tools and techniques to healthcare-related data in order to study past situations (i.e., operational performance or clinical outcomes) to improve the quality and efficiency of clinical and business processes and performance. With the introduction of healthcare analytical tools, …

The Personal Health Record (Phr): The Effects On Patient Healthcare Outcomes?, Bonita R. Payne

Applied Research Projects

Electronic transmission of data is on the rise, due to the Affordable Care Act and provisions to make healthcare information more accessible, complete, and transparent. The Personal Health Record (PHR) application is a tool used to provide assistance to the goal of patient-centered and patient-centric care. Its purpose is to encourage consumers to become more participatory and informed in their healthcare treatment and healthcare needs. Since its inception, it has been questionable as to whether consumers and providers are seeing any improvements in the services provided or the care rendered. Since, the development and implementation of PHR applications, there has …

Hipaa Violations On Social Media, Tamesha Helen Parris

Applied Research Projects

With the rise of social media networks such as Facebook and Twitter, healthcare professionals and students pursing healthcare careers communicate, collaborate, and network on an array of websites and apps. With the use of social media, the users can reach a large audience in a matter of seconds, with this ease; users can transmit information and has presented challenges in the form of unauthorized disclosure of patient’s health information on social media sites. The purpose of this study is to see if the number of HIPAA violations increased due to the use of social media and what steps are healthcare …

Video Visits: A Closer Look At Patient Satisfaction And Quality Of Virtual Medical Care, Saddia Cheema

Applied Research Projects

Electronic medical services via video visits has revolutionized the delivery of medical care by Physicians and medical staff alike. Its steady evolution and progression towards the future of healthcare has provided insight on how to better serve patients and community members seeking care. This study will explore patient satisfaction and the quality of virtual medical care services provided by Physicians thru video visits as well as the impact of minimizing the spread of communicable diseases. Statistical data was gathered from a major U.S. healthcare company evaluating survey responses as well as feedback provided by member experience who visited with their …

Health Literacy Improves Health Care Quality, Rebecca Cook

Applied Research Projects

A lack of knowledge about health literacy is a cause for quality healthcare concern as the world advances in health information technology. Many patients struggle to understand and navigate their health and well-being as a result of lack of understanding of the treatment plan due to low literacy skills. Several federal policy initiatives promote health literacy as the responsibility of the healthcare organization. Improving health outcomes through health literacy should be a commitment of healthcare organization through providing clear communication, simplified forms, assistance, and even follow-up calls. Three major initiatives will combat health literacy to include the Affordable Care Act; …

Maintaining The Master Patient Index: The Impact Of Patient Registration Processes On Data Integrity, Matthew Biddle

Applied Research Projects

The master patient index is one of the most important components within a healthcare system. It ensures that an individual patient is given a unique identifier that is used across the various separate clinical, financial and administrative systems and ensures that all information about that patient is organized and complete. Ensuring the MPI is accurate is critical since errors can have significant costs- both financially and in terms of patient outcomes. Patient registrars are the first line of defense when it comes to correctly identifying incoming patients and is where many errors in the MPI occur. Errors can be simple …

Understanding The Value Of Multi-Sector Health System Interactions, Glen P. Mays

Health Management and Policy Presentations

Recent research examines the health and economic value of multi-organizational and multi-sectoral approaches for the delivery of public health services. This presentation examines how data on these multi-organizational delivery systems and their impact can be used to solve collective action problems and stimulate collaborative solutions in public health.

Kentucky’S Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays

Health Management and Policy Presentations

This session examines recent progress toward the 2012 Institute of Medicine recommendation to identify the components and costs of a "minimum package" of public health services and foundational capabilities to be available across the U.S. Research about the health and economic benefits of Foundational Public Health Services has begun to shape Kentucky's strategic plan for transforming the public health system.

Analytic Approaches For Causal Inference With Complex Multi-Component Interventions, Glen P. Mays, Arnold J. Stromberg, Jing Li, Mark V. Williams

Health Management and Policy Presentations

Estimating the causal effects of complex, multi-component health interventions is a task with many challenges in measurement and methodology. This presentation profiles the methods being used as part of the PCORI-funded Project Achieve, a national study to estimate the comparative effectiveness of heterogeneous care transition programs designed to help hospitalized patients and their caregivers navigate care delivery systems effectively and return back to the community with optimal health and wellbeing.

Way Forward On Healthcare?, William H. Lane

English Faculty Publications

In the wake of a remarkable visit from Pope Francis, is it time to ask, WWFD? What would Francis do with our half-fixed, highly fragmented healthcare system? [excerpt]

Medicare's Post-Acute Care Payment: An Updated Review Of The Issues And Policy Proposals, Sally Coberly

National Health Policy Forum

Medicare spending on post-acute care provided by home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals accounted for about 10 percent of total program outlays in 2013. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems, as …

Challenges Of Providing Timely Feedback To Residents: Faculty Perspectives, Tabassum Zehra, M. Tariq, Afaq Motiwala, Syeda Kauser Ali, John Boulet

Department for Educational Development

Objective

To explore faculty's perceptions of challenges in providing verbal feedback to the Residents and suggest ways to overcome the barriers.

Methods

As part of a larger study on feedback assessment, five focus group discussions were conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, during faculty development workshops held from January to June 2010. Qualitative grounded theory was used to explore faculty perceptions of challenges in providing verbal feedback to the Residents.

Results

Of the 54 faculty members, 49(91%) participated. Four themes that emerged were 'time constraint' indicating high patient load; 'faculty related issues' indicating faculty's apprehension …

Challenges Of Forecasting Physician Workforce Needs Amid Delivery System Transformation, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional …

Trends In Health Care Delivery Systems: Implications For Cancer Prevention And Control, Glen P. Mays

Health Management and Policy Presentations

The Affordable Care Act and larger economic forces are leading both health care providers and public health agencies to renegotiate their roles and responsibilities within the U.S. health system. This session reviews major changes occurring in both health care and public health delivery systems, with a focus on the implications for cancer prevention and control. The information infrastructure created by cancer registries and other health information systems are increasingly important for enabling greater coordination, alignment and accountability within the nation's changing delivery systems.

The National Health Security Preparedness Index: Proposed Updates For 2015-16, Glen P. Mays

Health Management and Policy Presentations

The U.S. Centers for Disease Control and Prevention (CDC) initiated development of the National Health Security Preparedness Index in 2012 to create a platform for measuring the nation’s progress in preparing for, responding to, and recovering from disasters and other large-scale emergencies that pose risks to health and well-being in the United States. As a measurement tool, the Index is designed to summarize levels of preparedness achieved within individual states and for the nation as a whole. This session summarizes proposed updates to the Index for 2015-16 that are designed to improve the validity and reliability of Index measures and …

Preparedness Of Hospitals In The Republic Of Ireland For An Influenza Pandemic, An Infection Control Perspective, Mary Reidy, Fiona Ryan, Dervla Hogan, Seán Lacey, Claire Buckley

Department of Mathematics Publications

When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective.

Using Research And Roi To Drive Partnerships In Public Health Delivery Systems, Glen P. Mays

Health Management and Policy Presentations

Stimulating public-private partnerships (PPP) for health and economic development initiatives requires research that can answer key questions: (1) what are the health and economic returns likely to be realized; (2) over what time frames and with what certainty; (3) what investments are required to achieve results; and (4) what are the implementation strategies most likely to succeed. This presentation reviews ongoing research on the PPPs used to deliver public health services in the U.S., and explores the lessons this research offers PPPs in low and middle income countries. We examine how scientific evidence on public health delivery systems and their …

How Has The Affordable Care Act Benefitted Medically Underserved Communities? : National Findings From The 2014 Community Health Centers Uniform Data System, Jessica Sharac, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured.

The UDS data show the ACA’s …

Estimating Patient-Centered And Community-Centered Treatment Effects: Examples From Medical Care And Public Health, Glen P. Mays

Health Management and Policy Presentations

Health services researchers face growing clinical and policy imperatives for estimating how the effectiveness of medical and public health interventions vary across patients, population groups, and community settings. Recent advances in local instrumental variables estimation techniques allow for the estimation of person-specific and community-specific treatment effects in the presence of unobserved heterogeneity. This presentation explores examples from both medicine and public health following the local IV methods developed by Basu et al. (2013).