Public Health Commons^™

Effects Of The Needle Exchange Program And Its Current Status In West Virginia, Thomas Norton, Amber Graves, Anthony Uriarte, Katherine Duty, Alberto Coustasse

Management Faculty Research

Excerpt:

One of the main problems that have impacted the state of healthcare in West Virginia has been the rising costs of treatments for bloodborne infections (Bates et al., 2019). Bloodborne pathogens and their resulting diseases have commonly spread by exchanging contaminated needles (Denault & Gardner, 2021). In West Virginia, Needle Exchange Programs (NEPs) have been implemented to reduce the transmission of certain infections, such as HIV, hepatitis B, and hepatitis C, which have been more common among drug users (Beck & Kersey, 2018). In 2015, West Virginia had the second-highest rate of cases of hepatitis C Virus (HCV) in …

Harm Reduction In West Virginia: Do Needle Exchange Programs Reduce Disease And Decrease Costs?, Katie Duty, Amber Graves, Anthony Uriate, Stacie Deslich, Alberto Coustasse, Thomas Norton

Management Faculty Research

Needle Exchange Programs (NEP)s were created to help users exchange used needles for new sterile ones and become aware of treatment and rehabilitation options. This study aimed to determine the effectiveness of NEPs and their impact on reducing HIV and Hepatitis C infections in West Virginia and decreasing health care costs for the community. Based on studies conducted on the past implementation of needle exchange programs, it is suggested that there has been evidence that closing these programs can have a broad societal impact on the spread of HIV and hepatitis C and the associated costs. In addition, the community …

Prenatal Opioid Maintenance In The U.S. And Its Effect On Neo-Natal Abstinence Syndrome: The Case Of West Virginia's Opioid Epidemic, Morgan Ruley, Alberto Coustasse

Management Faculty Research

In 2017, West Virginia’s opioid epidemic was the cause of about 1000 deaths. Opioid abuse has become an issue among pregnant mothers and has increased the effects of Neonatal Abstinence Syndrome (NAS) in infants. The purpose of this study was to evaluate the participation of prenatal opioid maintenance to determine if it has decreased the amount of treatment needed for NAS in infants in West Virginia. The methodology utilized a literature review complemented with a semi-structured interview. Thirty-six sources were referenced for this literature review. It was found that Buprenorphine Maintenance Therapy had the most positive effect on NAS after …

The Effectiveness Of Needle Exchange Programs In The United States And West Virginia, Margie J. Phillips, Alberto Coustasse, Sara Johnson, Briana Washington

Management Faculty Research

Needle Exchange Programs (NEPs) have been controversial aspects of public health care due to conflicting beliefs and opinions for public policies. NEPs have allowed Injection Drug Users the ability to exchange their used equipment for clean, unused supplies. Research into the effectiveness of needle exchange programs and the impact it has had on the reduction of HIV and viral hepatitis infections in people who inject drugs. Injection Drug Users have accounted for 10% of HIV transmission cases in West Virginia, and this state has been ranked as the highest in the whole United States for incidents of Hepatitis C. NEPs …

Benefits Of The 340b Drug Discount Program, Jarrett Gerlach, Sarah Mcsweeney, Angela Swearingen, Nitesh Patil, Alberto Coustasse

Management Faculty Research

Introduction: The 340B Drug Discount Program required drug manufacturers provide discounted outpatient drugs to healthcare organizations which serve vulnerable patient populations to allow these institutions to offer more services to more people. As the 340B program expanded, controversy has centered on which entities have benefited from the program. Many healthcare organizations sold 340B drugs to well-insured patients at full price, and thus have been financially rewarded. Amendments to the program have permitted 340B providers to utilize contract pharmacies to dispense 340B medication, which has furthered the debate over which stakeholders are benefiting from the program.

Purpose of the Study: The …

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

Management Faculty Research

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 …

Is The Nationwide Health Information Network Feasible?, Tyler Godby, Christian Gomes, Jazmine Valle, Alberto Coustasse

Management Faculty Research

Nationwide Health Information Network (NHIN) use in healthcare facilities was examined for utilization and efficacy, although the advantages are abundant, healthcare facilities have been reluctant to adopt it due to associated costs. The purpose of this study was to analyze the feasibility of a U.S NHIN by exploring and determining the benefits of and assessing the barriers to its implementation. The results of this study suggest that implementation and utilization of NHIN by healthcare industry stakeholders leads to an increased quality of patient care, increased patient-provider communication, and cost savings opportunities. Increased quality of care is achieved by reducing adverse …

Financial Advantages Of Hospitals’ Relationships With Accountable Care Organizations, David P. Paul Iii, Rodrigo Carmago, Thaisa Carmago, Stacie Deslich, Alberto Coustasse

Management Faculty Research

Accountable care organizations are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision-making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of the study suggest that ACOs based in a larger hospital organizations are more likely to meet CMS criteria for formation because of financial and …

How Could, Should, And Would Physicians Use Facebook With Patients, Joy Peluchette, Katherine Karl, Alberto Coustasse

Management Faculty Research

After reviewing the benefits and risks of social media, we examine online discussion boards to determine the thoughts of physicians and patients regarding the use of Facebook to communicate with one another about health-related issues. Of the 290 comments analyzed, we found 42 percent were opposed to physicians using Facebook. Additionally, most (51.7 were opposed to physicians being Facebook “friends” with patients. Most opponents expressed concerns about privacy and the need to maintain professional boundaries in the physician-patient relationship. We provide suggestions for how healthcare administrators can effectively manage their social media presence and provide assistance to physicians.

Massachusetts Health Care Reform: Is It Working?, Joshua Mcadoo, Julian Irving, Stacie Deslich, Alberto Coustasse

Management Faculty Research

Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts health care reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion …

Medical Tourism And International Healthcare Options, David Conley, Andrew Sikula Sr., William Willis, Alberto Coustasse

Management Faculty Research

Medical tourism has evolved from traveling to the United States (U.S.) and a select few other countries, such as India and Thailand, to a global trend in affordable alternative healthcare. Medical tourism in the U.S. and in other countries has evolved because of cost and lengthy waiting periods. Some insurance companies are marketing kidney transplants and joint replacements through medical choice programs in order to save overall expense. As an economical approach to controlling rising health care costs in the U.S., medical tourism is becoming a valid alternative.

Can Kawasaki Disease Be Managed?, Alberto Coustasse, Julius Larry, Doohee Lee

Management Faculty Research

Kawasaki Disease (KD) is the leading cause of acquired cardiovascular disease among children, but management of KD has received relatively little attention. In the US alone, about 5500 cases were estimated in 2009. KD is most common among Asian and Pacific Islander children but can affect all ethnicities and races. Timely and accurate diagnosis remains critical, but difficult: the etiology of KD is unknown, and no accurate diagnostic laboratory test has been developed. Continuing medical education can help physicians, clinicians, and nurse practitioners accurately diagnose and treat KD. A registry specific to KD or a surveillance system may be necessary …

Treating Methicillin-Resistant Staphylococcus Aureus With The Drug Vancomycin In A Home Infusion Therapy Setting, Joshua L. Webb, Alberto Coustasse, Dennis Emmett

Management Faculty Research

The basic purpose of this paper is to examine the effects the home infusion therapy has on the cost, duration of, and effectiveness of treatment between those individuals under 60 and those 60 and over. The results show that those 60 and over had a slightly higher cost/day. The older age group had slightly smaller treatment duration, then the younger group. The number of adverse effects was small. The results suggest that home infusion therapy appears to be a viable alternative to hospitalization.

Challenges And Opportunities For Developing Countries From Medical Tourism, Avinash M. Waikar, Samuel D. Cappel, Uday S. Tate

Management Faculty Research

Wikipedia defines “Medical Tourism” as the act of traveling to other countries to obtain medical, dental and surgical care. Rapid expansion of facilities for patients abroad has helped to spur this industry’s growth. Regardless of the destination, U.S. citizens are increasingly embracing the benefits of medical tourism due to dramatically rising U.S. healthcare costs. Medical care in countries such as India, Mexico, Thailand and Singapore can cost as little as ten percent of the cost of comparable care in the U.S. for some procedures. Statistical analysis revealed the costs to be significantly lower for many of these countries. Currently, patients …

Is Uncompensated Care Affecting Quality Assurance Of Rural Hospitals?, Doohee Lee, Chris Dixon, Paul Kruszynski, Alberto Coustasse

Management Faculty Research

Healthcare disparities in rural areas remain significant in the U.S. healthcare industry. Uncompensated care makes healthcare disparities in rural areas worse and rural hospitals are unfavorably positioned to compete with urban hospitals in the economic downturn marketplace. How uncompensated care affects quality care among rural hospitals has been lightly investigated. As many rural residents experience difficulty accessing high quality care and the importance of establishing quality care practice standards in a rural setting, we conducted a systematic literature review to identify some quality care barriers and opportunities, suggested strategies to strengthen the position of rural hospitals in response to uncompensated …

Management Of Kawasaki Disease In Texas: Policy Implications, Alberto Coustasse, Doohee Lee, Cody Arvidson, Julius J. Larry Iii, Witold Migala

Management Faculty Research

Kawasaki Disease (KD) is the leading cause of acquired cardiovascular disease among children, but KD has received little attention on its management from a policy perspective. The core objective of this paper is to review the literature, identify problems related to KD, and evaluate and offer some policy alternatives to effectively prevent and treat KD epidemiologically in Texas. Policy options suggested in this paper include, among others, (1) establishing a mandatory national KD registry system (along with active surveillance), (2) introducing sentinel providers, (3) requiring mandatory reporting of KD by hospitals, and (4) sponsoring policy KD research and practice.

Uncompensated Care Cost: A Pilot Study Using Hospitals In A Texas County, Alberto Coustasse, Andrea L. Lorden, Vishal Nemarugommula, Karan P. Singh

Management Faculty Research

The financial ramifications of uncompensated care cost (UCC) on the healthcare industry have been difficult to quantify. With the lack of a standardized definition of uncompensated care and the need to account for the uninsured, indigent, and immigrant populations, the authors identified $190 million of UCC from Southwestern border hospitals for emergency room treatment of undocumented immigrants and $934 million of uncompensated care charges for 23 hospitals in a Texas county, which translated to $353 million of UCC. Although lawmakers passed the Medicare Prescription Drug Improvement and Modernization Act (2003) to address the growing imbalance, the shortfall of funds highlights …

Kawasaki Syndrome In Texas, Alberto Coustasse, Julius J. Larry, Witold Migala, Cody Arvidson, Karan P. Singh

Management Faculty Research

The authors examined hospitalization rates of Kawasaki Syndrome (KS) among Texas children to isolate clusters, identify demographic disparities, and suggest possible causative factors. Using a retrospective cross-sectional study design, they studied 330 KS cases from 2,818,460 hospital discharges. The majority of the cases (61.5%) occurred within the 1-4-years-old category, representing the highest hospitalization rate (14.3 per 100,000 children). Almost 75% of the KS population was less than 5 years old, with hospitalization rates approximately 8 times higher than that of all other children (p < .05). KS diagnosis occurred for only 49.4% of all KS cases upon admission. Along with high-density clusters identified in major metropolitan areas, the authors found the highest rates of KS among Asian and Pacific Islander and non-Hispanic black children. Genetic predispositions and access to healthcare issues may explain the results. The authors recommend improving educational initiatives with healthcare providers and establishing KS as a reportable condition.

Ethical Considerations Of Genetic Presymptomatic Testing For Huntington's Disease, Alberto Coustasse, Alicia Pekar, Andrew Sikula Sr., Sue Lurie

Management Faculty Research

The aim of this literature review was to determine if there is adequate ethical justification for presymptomatic genetic testing on potential Huntington's disease patients. Huntington's disease is a neurological genetic disorder characterized by midlife onset which consists of cognitive, physical, and emotional deterioration. Although genetic testing has traditionally been guided by the principle of autonomy, severe psychological consequences such as depression, anxiety, survival guilt, and suicide have complicated the ethical issue of providing a presymptomatic yet definitive diagnosis for an incurable disease. An analysis of available articles yielded inconclusive findings, namely due to insufficient evidence, self-selection bias of test participants, …

To The Bitter End: Disparities In End-Of-Life Care, Alberto Coustasse, Theresa Quiroz, Sue G. Lurie

Management Faculty Research

Although technological advancements have provided the means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient, bioethical, legal, and moral concerns related to disparities in care still arise in the United States. These concerns call into question the necessity to continue life-sustaining or palliative care treatments when patients and/or families are faced with end-of-life decisions. This study will focus on various historical, clinical cultural, and ethical issues that have placed this dilemma into a controversial public spectrum, by using case studies retrieved from referenced literature, which illustrate disparities …

A Case Study Of School Age Female Minority Athletes Who Became Pregnant, Floyd Jones Phd, Jennifer Y. Mak, Phyllis A. Jones Ed

Management Faculty Research

The purpose of this study is to provide an in-depth understanding of ''What had happened to the urban minority female athletes who became pregnant while playing high school basketball?'' The study wanted to provide a qualitative analysis of rich narrative data collected from questionnaire interviews of two separate groups (one in Pittsburgh, the other in New York City). The findings of this study suggest that in fact urban female African-Americans athletes still received benefits from sports participation.

Medical Malpractice Reform: A Societal Crisis Or Fear Marketing?, Phil Rutsohn, Andrew Sikula Sr.

Management Faculty Research

This paper explores the primary issues surrounding the malpractice crisis currently facing the healthcare system and asks the question ‘is it truly a crisis or is it an effective marketing campaign waged by interested parties?’ The authors discuss the primary issues presented by both the supporters of tort reform and the opposition to tort reform. As is true for many issues in healthcare, final analysis suggests that tort reform is needed or not needed depends on the analysts' role in the system. The authors argue that the evidence suggests malpractice reform will produce desired results if the goal is to …

The Case Of South African And Chilean Health Systems: Comparison Of Financial, Economic And Health Indicators, Alberto Coustasse, Peter Hilsenrath, Patricio Silva Rojas

Management Faculty Research

The purpose of this study is to identify similarities and differences between healthcare systems of South Africa and Chile. The World Health Report 2000, the Human Development Index, and financial indicators were used for comparison. Chile showed better performance than South Africa in most of the measures used. Significant progress has been made in South Africa, bringing better education, healthcare and housing to the deprived black majority. However, the HIV/AIDS epidemic, weighs heavily on health indicators. Chile decentralized its health services and implemented economic reforms during the 1980's and has had steady improvement in its healthcare indicators. Finally, these counties …

Ethics, Physician Incentives And Managed Care, Alberto Coustasse, Douglas Mains, Kristine Lykens

Management Faculty Research

The authors review the principle features of the managed care system in an effort to understand the ethical assumptions inherent in managed care. The interrelationships among physician incentives, responsibilities of patients and the physician-patient relationship are examined in light of the ethical concerns identified in the managed care system. The managed care system creates ethical tensions for those who influence the allocation of scare resources.

Managed care’s administrative controls have increasingly changed the doctor-patient relationship to the business person-consumer relationship. Managed care goals of quality and access demand that physicians be both patient advocate and organizational advocate, even though these …

Comparative Cost Analysis Of Crrt In Icu/Ccu Patients Undergoing Cardiovascular Surgery Vs. Other Procedures At A Texas Hospital, Tejaswi Belavadi, Alberto Coustasse, Douglas Mains, Antonio A. Rene

Management Faculty Research

The purpose of this study was to conduct a comparative analysis of hospital costs incurred by patients undergoing Cardiovascular Surgery (CVS) and patients undergoing other medical procedures who received Continuous Renal Replacement Therapy (CRRT) in a teaching hospital. A total of 117 patients were identified through review of medical charts for the period of January 1999 to August 2002. Twenty one percent of them were identified having CVS. Eighty-eight percent of the CVS patients admitted to the ICU for CRRT died compared to 67% for non-CVS patients (p=0.047). Average actual costs of hospitalization were $47,225 for CVS patients and $51,724 …

Physician Incentives: Managed Care And Ethics, Douglas A. Mains, Alberto Coustasse, Kristine Lykens

Management Faculty Research

The authors review the principle features of the managed care system in an effort to understand the ethical assumptions inherent in managed care. The interrelationships among physician incentives, responsibilities of patients and the physician-patient relationship are examined in light of the ethical concerns identified in the managed care system. The managed care system creates ethical tensions for those who influence the allocation of scare resources. Managed care's administrative controls have increasingly changed the doctor-patient relationship to the businessperson-consumer relationship. Managed care goals of quality and access demand that physicians be both patient advocate and organizational advocate, even though these roles …