Public Health Commons^™

Self-Injurious Behaviors In Prisons: A Nationwide Survey Of Correctional Mental Health Directors, Kenneth L. Appelbaum, Judith A. Savageau, Robert L. Trestman, Jeffrey L. Metzner

Judith A. Savageau

Self-injurious behavior (SIB) by inmates has serious health, safety, operational, security and fiscal consequences. Serious incidents require a freeze in normal facility operations. Injuries that need outside medical attention create additional security risks, including potential escape attempts. The interruption of normal operations, diversion of staff, cost of outside care, and drain on medical and mental health resources all have significant fiscal consequences. This session will present the results and implications of a survey of the Mental Health Directors in all 51 state and federal prison systems on the extent of SIB by inmates, including incidence and prevalence, adverse consequences, and …

Evaluation Of The Massachusetts Peer Specialist Training And Certification Program (Phase Two), Linda M. Cabral, Kathy Muhr, Laura A. Sefton, Judith A. Savageau

Judith A. Savageau

Most public mental health systems are shifting to a recovery-oriented system of care; however, offering recovery-oriented and peer support services to various cultural and linguistic groups is challenging. This study sought to better understand how persons with mental health conditions from two cultural groups – Latinos and Deaf and Hard of Hearing (D/HH) - access recovery-based services. Interviews with national key informants were conducted prior to data collection to better formulate instruments. Cultural brokers, identified as leaders in their communities who also have mental health conditions, were hired to aid in recruitment and data collection. Interviews and focus groups were …

Contracting Of Primary Health Care Services In Pakistan: Is Up-Scaling A Pragmatic Thinking, Babar Shaikh, F. Rabbani, Najibullah Safi, Zia Dawar

Fauziah Rabbani

Quite often, public health care systems in developing countries are struggling because of incompetence and a lack of provider responsiveness to the needs of consumers. On the contrary, the private sector dominates the system of health provision. In recent years, contracting has been experimented as an approach to ensure delivery of comprehensive public health services in an efficient, effective, superior and fair manner and has generally thrived well. The state's healthcare system in Pakistan has suffered a lot, owing to structural fragmentation, resource scarcity, inefficiency and lack of functional specificity, gender insensitivity and inaccessibility. However, partnering with the private sector …

A Cross-Sectional Analysis Of Pharmaceutical Industry-Funded Events For Health Professionals In Australia, Alice Fabbri, Quinn Grundy, Barbara Mintzes, Swestika Swandari, Ray Moynihan, Emily Walkom, Lisa A Bero

Ray Moynihan

OBJECTIVES:

To analyse patterns and characteristics of pharmaceutical industry sponsorship of events for Australian health professionals and to understand the implications of recent changes in transparency provisions that no longer require reporting of payments for food and beverages.

DESIGN:

Cross-sectional analysis.

PARTICIPANTS AND SETTING:

301 publicly available company transparency reports downloaded from the website of Medicines Australia, the pharmaceutical industry trade association, covering the period from October 2011 to September 2015.

RESULTS:

Forty-two companies sponsored 116 845 events for health professionals, on average 608 per week with 30 attendees per event. Events typically included a broad range of health professionals: …

Association Of A Communication Training Program With Use Of Antipsychotics In Nursing Homes, Jennifer Tjia, Jacob N. Hunnicutt, Laurie Herndon, Carolyn R. Blanks, Kate L. Lapane, Susan Wehry

Jennifer Tjia

Importance: Off-label antipsychotic prescribing in nursing homes (NHs) is common and is associated with increased risk of mortality in older adults. Prior large-scale, controlled trials in the NH setting failed to show meaningful reductions in antipsychotic use.

Objective: To quantify the influence of a large-scale communication training program on NH antipsychotic use called OASIS.

Design, Setting, and Participants: This investigation was a quasi-experimental longitudinal study of NHs in Massachusetts enrolled in the OASIS intervention. Participants were residents living in NHs between March 1, 2011, and August 31, 2013. The data were analyzed from December 2015, to March 2016, and from …

Health Care Transitions For Adolescents And Young Adults With Special Health Care Needs: Where Are We Now?, Nicole Mubanga, Dennis J. Baumgardner, Jessica J. F. Kram

Dennis J. Baumgardner, MD

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to …

Pain And Pharmacologic Pain Management In Long-Stay Nursing Home Residents, Jacob N. Hunnicutt, Christine M. Ulbricht, Jennifer Tjia, Kate L. Lapane

Jennifer Tjia

Prior studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set (MDS) 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after these important initiatives of: 1) prevalence and correlates of persistent pain; and 2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in United States NHs between 2011-2012 with 2 MDS assessments 90 days apart. Pain was categorized as persistent (pain …

The Relationship Between Quality Improvement And Health Information Technology Use In Local Health Departments, Kendra Johnson, Kim K. Nguyen, Shimin Zheng, Robin P. Pendley

Shimin Zheng

This research examined if there is a relationship between engagement in quality improvement (QI) and health information technology (HIT) for local health departments (LHDs) controlling for workforce, finance, population, and governance structure. This was a cross-sectional study that analyzed data obtained from the Core questions and Module 1 in the NACCHO 2010 Profile of LHDs. Descriptive statistics, bivariate analyses, and logistic regression analyses were conducted. Findings suggest that LHD engagement in QI has a relationship with utilization of HIT including electronic health records, practice management systems, and electronic syndromic surveillance systems. This study provides baseline information about the HIT use …

Continuing Development Of An All Payer Health Care System In Maryland, David P. Paul Iii, Taeko Matsumoto, Alberto Coustasse, Lama Mohammed Bakhamis, Mary Lynn Harshbarger

Alberto Coustasse, DrPH, MD, MBA, MPH

The state of Maryland, in collaboration with the Centers for Medicare and Medicaid, developed the first all-payer system model in the U.S. in 1971, and some 35 years later in response to financial pressures, modernized this program. The focus of the modernized program was to improve overall per capita expenditure, quality of care, and the outcome of Marylanders’ health. This study showed positive change in moving its healthcare delivery model from volume-driven care to value-driven coordinated care. Maryland hospitals have changed their mindsets to achieve the Triple Aim of cost reduction, health improvement, and quality of care improvement for the …

The Academic And Health Policy Conference On Correctional Health: Evaluation Of Its Academic And Scientific Impact, Judith A. Savageau, Warren J. Ferguson, Laura A. Sefton

Judith A. Savageau

Background: There is limited research and research dissemination on the care of detained persons, often due to barriers to conducting research in correctional settings. Additionally, while concerns exist about the quality of care delivered to inmates, only a small number of academic health science centers provide health care services behind bars. To strengthen the field of academic criminal justice health (ACJH), the Academic and Health Policy Conference on Correctional Health (AHPCCH) was launched in 2007. Objective: To assess the merits of the conference as a stimulus to advance the field of ACJH.

Methods: Two hundred ninety-one individuals were identified who …

The Alzheimer’S Association Dementia Care Coordination Program: A Process Evaluation, Executive Summary, Nina Silverstein, Frank Porell, Pamela Nadash

Nina Silverstein

The Massachusetts/New Hampshire (MA/NH) Chapter of the Alzheimer's Association has long sought ways to systematically increase the number of families who utilize its services and support. According to the Alzheimer’s Association’s 2015 Alzheimer’s Disease Facts and Figures, there are 142,000 individuals living with Alzheimer’s disease in Massachusetts and New Hampshire, and the Alzheimer’s Association estimates that less than 30% of those individuals and their caregivers take advantage of its programs (Alzheimer’s Association, 2015). The MA/NH Chapter recognized that one major barrier to accessing services is a model that relies on families taking the initiative to seek out assistance.

In …

Clinical Topic Review 2013 - Behavioral Health Screening Among Masshealth Children And Adolescents, Judith A. Savageau, Georgianna Willis, Kathy Muhr, David M. Keller, Gideon Aweh, Elizabeth O'Connell

Judith A. Savageau

Results from the 2013 evaluation suggest that the Children’s Behavioral Health Initiative had a large impact on formal behavioral health screening and treatment utilization among children and adolescents enrolled in MassHealth.

Clinical Topic Review: Behavioral Health Screening For Children With Well Visits, Judith A. Savageau, Linda M. Cabral, Jack Gettens, Elizabeth O'Connell, Lana Miller, Susan Maguire

Judith A. Savageau

The first Clinical Topic Review was conducted in order to better understand how behavioral health screenings were occurring for children and adolescents during well visits prior to the implementation of a requirement that primary care providers perform behavioral health screening using a standardized behavioral health screening tool during every well child visit.

The Double-Edged Sword Of Health Care Integration: Consolidation And Cost Control, Erin C. Fuse Brown, Jaime S. King

Erin C. Fuse Brown

The average family of four in the United States spends $25,826 per year on health care. American health care costs so much because we both overuse and overpay for health care goods and services. The Affordable Care Act's cost control policies focus on curbing overutilization by encouraging health care providers to integrate to promote efficiency and eliminate waste, but the the cost control policies largely ignore prices. This article examines this overlooked half of health care cost control policy: rising prices and the policy levers held by the states to address them. We challenge the conventional wisdom that reducing overutilization …

Recruitment And Retention Of Community Health Center Primary Care Physicians Post Ma Health Care Reform: 2008 Vs. 2013 Physician Surveys, Judith A. Savageau, Linda J. Cragin, Warren J. Ferguson, Laura A. Sefton, Joan Pernice

Judith A. Savageau

OBJECTIVES: In 2008 and 2013, the University of Massachusetts Medical School and the Massachusetts League of Community Health Centers surveyed community health center (CHC) primary care physicians (PCPs) to identify factors related to preparedness, recruitment and retention. The survey was repeated to determine the impact of Massachusetts health care reform.

METHODS: An online survey was sent to 677 PCPs at 46 CHCs. New questions addressed patient-centered redesign, language competencies, and interprofessional care.

ESULTS: With 48% responding, PCPs were significantly more prepared in 2013 to practice in a CHC. Intent to continue practicing in a CHC was related to age, length …