Health Services Research Commons^™

Identifying Disparities In Colorectal Cancer Screening Rates In Milwaukee-Based Academic And Nonacademic Clinics, Jasmine Wiley, Jonathan J. Blaza, Will Lehmann, Deborah Simpson, Jeffrey A. Stearns, Shelby L. Pischke, Tracy L. Greiten

Journal of Patient-Centered Research and Reviews

Background: The Institute for Healthcare Improvement’s Triple Aim focuses on improving the patient’s experience of care, improving population health and reducing the per capita cost of health care. Health care systems and providers continuously seek to improve quality of care through understanding what percentage of their patients are achieving quality-of-care standards for various indicators, including immunizations, tobacco cessation, asthma and cancer screening. As health care moves toward reimbursing for value-based care, deepening our understanding of patient population characteristics within each of these conditions is vital to continuous quality improvement.

Purpose: To determine if there are race/ethnicity/age/preferred language (REAL) disparities in …

Cost-Effectiveness Of Genomic-Based Warfarin Therapy, John Weissert, Kourosh Ravvaz

Journal of Patient-Centered Research and Reviews

Background: With over 40 years of demonstrated clinical efficacy, warfarin remains the world’s most used pharmaceutical to prevent ischemic stroke in patients with atrial fibrillation (AF). However, warfarin has many challenges. Thus, despite known effectiveness, warfarin is a leading cause to drug-induced morbidity and mortality. Over 50 different warfarin therapy protocols, including a number of pharmacogenomic-based (PG) protocols, with as many as 14 independent variables, have been developed to improve safety and efficacy, thereby reducing ischemic strokes and intracranial hemorrhages (ICH).

Purpose: To conduct a preliminary cost-effectiveness study to determine the price point at which using warfarin PG dosing to …

Multi-Sectoral Partnerships And Patient-Engagement Strategies In Accountable Care Organizations, Margae Knox, Hector P. Rodriguez, Stephen M. Shortell

Frontiers in Public Health Services and Systems Research

Background: Patient-engagement strategies are increasingly recognized for enriching traditional medical care and improving population health. Accountable Care Organizations (ACOs) may be well positioned to leverage multi-sector organizational partnerships to improve the reach of their patient-engagement strategies, particularly given incentives to meet cost, quality and population health goals. Little is currently known about the relation of multi-sector partnerships and patient engagement in ACOs.

Purpose: To examine the relation of patient-engagement strategies and breadth of multi-sectoral organizational partnerships in 71 primary care practices affiliated with one of two ACOs.

Methods: Clinical and administrative leaders from each practice were surveyed. Questions assessed practice …

Using Process Mining To Assess The Fidelity Of A Home Visiting Program, Riyad Haq, Sofia Campos Vidal Pires, Julie M. Kapp, Sara Schlemper, Eduardo J. Simoes

Frontiers in Public Health Services and Systems Research

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is a federal public health initiative which supports at-risk families through evidence-based programs and promising approaches for pregnant women, and childhood development for children aged 0 to 5. These public health program funding mechanisms commonly include process evaluation mandates.

Purpose: The use of process mining was explored as a methodology to assess the fidelity of the MIECHV programs’ actual workflow to that of their intended models.

Methods: Research Electronic Data Capture (REDCap) data files that were populated with program process data elements from the local implementing agencies were …

Injury-Related Infant Deaths: A State Analysis Of A Public Health, Health Care, Policy Network, Sharla Smith, Xi Zhu, Mary Aitken

Frontiers in Public Health Services and Systems Research

Introduction: This research examines a state-level public health, health care, and policy network focused on efforts to reduce unintentional childhood injuries. The network is composed of 12 organizations: four public health, four health care, and four policy.

Methods: A 23-item survey was administered to the 12 organizations between January and June 2015. Analyses were conducted using HyperResearch and UCInet 6.

Results: More organizations worked together on assessment and planning efforts that identify and quantify the nature of at-risk infants in the community and strategies for reducing injury-related infant deaths. The Injury Prevention Center, the most central organization, interacted most frequently …

A Tool To Cost Environmental Health Services In North Carolina Local Health Departments, Nancy L. Winterbauer, Simone Singh, Ashley Tucker, Lisa M. Harrison

Frontiers in Public Health Services and Systems Research

Introduction: The cost of providing a basic set of public health services necessary not been well-described. Recent work suggests public health practitioners are unlikely to have the empirically-based financing information necessary to make informed decisions regarding practice. The purpose of this paper is to describe the development of a costing tool used to collect primary data on the number of services provided, staff employed, and costs incurred for two types of mandated environmental health services: food and lodging inspections and onsite water services.

Methods: The tool was iteratively reviewed, revised, and piloted with local health department (LHD) environmental health and …

Tuberculosis And Local Health Department Expenditures On Tuberculosis Services, Michelle P. Yip, Betty Bekemeier

Frontiers in Public Health Services and Systems Research

Background: Although tuberculosis (TB) morbidity and mortality have decreased in recent decades, challenges exist regarding disproportionate distributions of TB among specific populations and geographic areas. Inconsistent local health department (LHD) funding for TB programs poses difficulties for LHDs to sustain resources and personnel that predisposes communities to risks of future outbreaks of TB and drug-resistant TB diseases.

Purpose: This study examined relationships between annual TB incidence rates and LHD expenditures on TB-related services to elucidate potential impacts of TB incidence on LHD TB spending.

Methods: This dataset included county-level TB incidence data with comparable, annual (2000–2010) TB-related service expenditures for …

Sex Disparities In Access To Acute Stroke Care: Can Telemedicine Mitigate This Effect?, Catherine Wolff, Amelia K. Boehme, Karen Albright, Tzu-Ching Wu, Michael Mullen, Sean Savitz, Charles Branas, James Grotta, Brendan Carr

Journal of Health Disparities Research and Practice

Background: Women have more frequent and severe ischemic strokes than men, and are less likely to receive treatment for acute stroke. Primary stroke centers (PSCs) have been shown to utilize treatment more frequently. Further, as telemedicine (TM) has expanded access to acute stroke care we sought to investigate the association between PSC, TM and access to acute stroke care in the state of Texas.

Methods: Texas hospitals and resources were identified from the 2009 American Hospital Association Annual Survey. Hospitals were categorized as: (1) stand-alone PSCs not using telemedicine for acute stroke care, (2) PSCs using telemedicine for acute stroke …