Health Services Research Commons^™

Leaving Home Care: Decision Making, Risk Scenarios & Services Gaps In The Home Care System, Jacey J. Vaughan, Nina M. Silverstein

Nina Silverstein

Home and community-based services (HCBS) enable older and disabled adults to age-in-place in their homes and communities by helping them function independently for as long as possible (Grabowski et al., 2010; Wong & Silverstein, 2011). Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home (e.g., Walker, 2010; Fox-Grage, Coleman, & Freiman, 2006). Medicaid is a major source of funding for long-term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional care (National Conference of State Legislatures & AARP, 2009), and older adults and their …

Current Research Projects Of The Public Health Pbrn Program, Glen P. Mays

Glen Mays

The Robert Wood Johnson Foundation’s Public Health Practice-Based Research Networks Program supports research on the organization, financing, and delivery of public health services using the infrastructure of practice-based networks (PBRNs). A Public Health PBRN brings multiple public health agencies into collaboration with an academic research partner to design and conduct studies in real-world practice settings. The program supports research through several different mechanisms, including (1) large-scale Research Implementation Awards (RIAs) conducted by established networks; (2) Quick-Strike Research Fund (QSRF) awards that support short-term, time-sensitive studies on emerging issues; and (3) supplemental Research Acceleration and Capacity Expansion (RACE) awards designed to …

Driving Qi With Research: Findings From Public Health Pbrns, Glen Mays

Glen Mays

Public health agencies are increasingly experimenting with quality improvement (QI) strategies designed to enhance the effectiveness and efficiency of their efforts. Does QI work in public health, and if so for whom and under what circumstances? What QI strategies work best for which types of public health process failures, and at what cost? Research underway through the Public Health Practice-Based Research Networks (PBRN) Program is examining these types of questions to build an evidence base for public health QI.

Overview Of The Public Health Pbrn Program, Glen Mays

Glen Mays

The Public Health Practice-Based Research Networks Program is a national program of the Robert Wood Johnson Foundation that supports the development of research networks for studying the comparative effectiveness, efficiency and equity of public health strategies deployed in real-world practice settings. A practice-based research network (PBRN) brings multiple public health agencies together with research partners to design and implement studies of population-based strategies that prevent disease and injury and promote health. Participating practitioners and researchers collaborate to identify pressing research questions of interest, design rigorous and relevant studies, execute research effectively, and translate findings rapidly into practice. As such, PBRNs …

The Science Of Public Health Delivery: Evidence, Uncertainties & Research Needs, Glen Mays

Glen Mays

Policy initiatives to reform the nation's health system increasingly recognize the need to incorporate public health and prevention strategies. The nation's delivery system for public health, however, varies widely across states and communities in its structure, authority, and capabilities. This session examines research from the growing field of public health services and systems research to identify directions for improving public health delivery.

Estimating The Value Of Public Health Services & Systems: Evidence, Uncertainties, And Research Needs, Glen Mays

Glen Mays

The Affordable Care Act authorized the largest expansion in federal funding for public health services and delivery systems in decades. These provisions, designed to support programs and services that promote health and prevent disease and injury on a population-wide basis, remain controversial because of uncertainties regarding their effectiveness in improving health and constraining medical cost growth. This session examines a series of recent studies to shed light on the health and economic value of spending on public health.

Massachusetts’ Home Care Programs And Reasons For Discharge Into Nursing Homes, Cathy M. Wong, Nina M. Silverstein

Nina Silverstein

Home and community-based services (HCBS) are a range of long-term care services intended to enable older adults and persons with disabilities to “age in place” in their own homes and communities. Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home. One study concluded that 84 percent of older Americans, aged 50 years and older, want to remain in their homes for as long as possible. Medicaid is a major source of funding for long term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional, …

Response To The Data Challenges Of The Affordable Care Act: Surveys Of Providers To Assess Access To Care For People With Disabilities And The Presence Of Accessible Exam Equipment, Nancy R. Mudrick, Mary Lou Breslin, June Isaacson Kailes

Nancy R. Mudrick

No abstract provided.

Disparities Research In Public Health Pbrns, Glen Mays

Glen Mays

Public health agencies are well positioned within the health system to play key roles in addressing oral health issues on a population-wide basis, However, current evidence reveals wide geographic variation in the delivery of public health interventions for oral health promotion. This session explores the factors contributing to this variation, and it highlights studies underway through the Public Health Practice-Based Research Networks (PBRNs) to produce more and better evidence about public health delivery and impact.

Leading Improvement Through Inquiry: Practice-Based Research Networks In Public Health, Glen Mays

Glen Mays

The field of public health has surged in public visibility and attention in recent years due to its potential to mitigate leading risks to human health and wellbeing. Advances in prevention research provide an expanding toolbox of programs, policies, and interventions to reduce health risks. As these advances occur, uncertainties loom large regarding how best to deliver efficacious public health strategies to the populations at greatest risk. The nation's local, state, and federal public health agencies—together with their peers and partners in the private and public sectors—represent a vast yet diffuse delivery system of actors charged, to greater or lesser …

The Frank J. Manning Certificate In Gerontology Alumni Survey: 21 Years Of Service To Elders, Nina M. Silverstein, Jenai Murtha, Donna Sullivan, May Jawad

Nina Silverstein

The Certificate Program in Gerontology at the University of Massachusetts Boston, a large urban university, was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. In 1984, a line item was added to the state budget by the legislature and governor establishing the Gerontology Institute at the University of Massachusetts Boston and ensuring the continuation of training, research, and policy and advocacy work on behalf of and with Massachusetts’ elders (O’Brien, 1996). Upon Frank J. Manning’s death in 1986, the program was renamed …

Aging In Place At Harbor Point: Outreach Follow-Up Of Older Adults Living In Independent Mixed-Income Apartments, Judith M. Conahan, Nina M. Silverstein, Kelly Fitzgerald

Nina Silverstein

Most older people, despite functional impairments, plan to stay in their homes and/or communities as long as possible. According to an AARP survey, 82% of adults 65+ reported that they believe that they are “very likely” or “somewhat likely” to stay in their current homes or apartments for the rest of their lives. With increasing age, housing and community characteristics and services gain importance in meeting the challenges of “aging in place.” Staying in their homes maximizes elder’s independence, sustains their social connections, and reaffirms their identity and value.

Seniors Count Follow-Up Study, Nina M. Silverstein, Heather Connors, May Jawad

Nina Silverstein

Seniors Count is an ongoing outreach initiative under the direction of Boston Mayor Thomas M. Menino with the leadership and support of Joyce Williams, Boston's Commissioner on Affairs of the Elderly. The program's purpose is to "identify and reach out to those members of the city's elderly population who live in private housing arrangements and help provide them with the information and services they [may] need" (Boston Commission on Affairs of the Elderly, 2002). Since the program's inception in 1999, it has reached over 5,500 community-dwelling elders in the City of Boston (Boston Commission on Affairs of the Elderly, 2002). …

A Survey Of Health Services And Identification Of Needs For Asian American Elderly Women In The Greater Boston Area, Connie S. Chan, Lin Zhan

Connie Chan

Over one hundred Asian American and mainstream health care providers in the greater Boston area were surveyed for this study. The authors have identified critical gaps in services for elderly Asian American women.

Using Pbrn Research To Inform Policy And Practice, Glen Mays

Glen Mays

This brief provides examples of how findings from RWJF-supported research projects underway through the public health PBRNs and the larger field of PHSSR are being used to inform public health practice and policy.

Public Health Pbrn Network Analysis Survey Instrument, Glen Mays

Glen Mays

This survey instrument was used to collect data on research activities patterns of interaction within public health practice-based research networks (PBRNs).

Social Networks Enabled Coordination Model For Cost Management Of Patient Hospital Admissions, Shahadat Uddin, Liaquat Hossain

Shahadat Uddin

In this study, we introduce a social networks enabled coordination model for exploring the effect of network position of “patient,” “physician,” and “hospital” actors in a patient-centered care network that evolves during patient hospitalization period on the total cost of coordination. An actor is a node, which represents an entity such as individual and organization in a social network. In our analysis of actor networks and coordination in the healthcare literature, we identified that there is significant gap where a number of promising hospital coordination model have been developed (e.g., Guided Care Model, Chronic Care Model) for the current healthcare …

Building A Sustainable Pbrn: Securing Ongoing Funding, Glen Mays

Glen Mays

Practice-based research networks require a diversified mix of funding to sustain their activities in research production and translation.

State-Level Influences On Buprenorphine Utilization: Variations In Opioid Addiction Treatment, Lisa M. Lines Mph, Robin E. Clark Phd

Lisa M. Lines

Research Objective: Buprenorphine is a medication used to treat opioid addiction. Physicians are required to have special Drug Enforcement Agency certification to prescribe buprenorphine. Although it is more accessible and potentially safer than methadone, the leading opioid addiction treatment modality, there appear to be state-to-state variations in rates of buprenorphine adoption and use. The purpose of this study was to identify state-level influences on the volume of buprenorphine prescribed, using a limited set of supply and demand measures. Study Design: We developed a database using data on buprenorphine prescribing and factors hypothesized to influence variations in prescribing obtained from the …

Effective Outreach: Tools Of The Trade For Heading Back-To-School, Florida Covering Kids & Families

Florida Covering Kids & Families

Effective marketing and education through outreach strategies are critical to guarantee uninsured but eligible children enroll and retain coverage in Children’s Health Insurance Programs, such as Florida KidCare. The implementation of effective outreach can eliminate enrollment barriers. The authors cite that the tools for innovative practices for effective outreach strategies include: personal contact and involvement with an outreach coalition.

Community-Based Coalitions: Influencing Policy & Practice, Florida Covering Kids & Families

Florida Covering Kids & Families

Simple approaches to outreach can increase enrollment in CHIP. The Robert Wood Johnson Foundation (2010) found community-based coalitions can be simple yet effective methods to communicate needed policy and practice changes to those “charged with implementing insurance coverage”. Community-based coalitions are able to bring to light enrollment and retention barriers increasing the awareness of stakeholders and hopefully, help to create effective solutions.

Virtual Reality In Stroke Rehabilitation: A Meta-Analysis And Practical Implications For Clinicians, Gustavo Saposnik

Gustavo Saposnik

No abstract provided.

Socioeconomic Status And Polycystic Ovary Syndrome, Sharon Stein Merkin, Ricardo Azziz, Teresa E. Seeman, Ronit Calderon-Margalit, Martha L. Daviglus, Catarina I. Kiefe, Karen A. Matthews, Barbara Sternfeld, David S. Siscovick

Catarina I. Kiefe

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common metabolic-endocrine disorder in women and is associated with a number of metabolic morbidities. We examined the association of PCOS and its components with socioeconomic status (SES) over the life course to explore the role of the environment on the development of PCOS.

METHODS: Participants included 1163 women, aged 34-39, from the Coronary Artery Risk Development in Young Adults (CARDIA) Women's Study, examined at year 16 of the CARDIA study (2001). PCOS was defined according to the 1990 National Institutes of Health (NIH) criteria.

RESULTS: Logistic regression models, adjusted for age, body mass …

Quality Improvement Quick Strike Research Projects In Public Health Pbrns, Glen P. Mays

Glen Mays

The Quality Improvement Quick Strike (QIQS) research program provides research networks participating in the Robert Wood Johnson Foundation’s Public Health PBRN Program with supplemental funding and technical assistance to conduct rapid turn-around, time-sensitive research studies that produce evidence about the effectiveness and impact of quality improvement (QI) strategies, public reporting initiatives, and accreditation activities in public health settings. Specifically, the program supports research studies that investigate the effectiveness, cost-effectiveness and/or impact of three related types strategies designed to drive quality in public health practice: (1) QI tools and processes implemented in public health settings; (2) accreditation programs and performance standards …

Creating The Organizational Capacity To Serve Families With Parental Mental Illness: The Implementation Of Family Options, Kathleen Biebel, Katherine Woolsey

Kathleen Biebel

Summary: The purpose of this presentation is to present preliminary findings describing the organizational context of a traditionally adult-serving community mental health program, Employment Options, Inc., as they implement a family-centered, strengths-based intervention for families living with parental mental illness.

Iscore: A Risk Score To Predict Stroke Mortality, Gustavo Saposnik

Gustavo Saposnik

Stroke is a leading cause of death and adult disability. The ability to estimate prognosis in acute stroke patients directly affects treatment decisions for patients. It may also guide supportive care plans, facilitate patient and/or family counseling or discussions pertaining to end-of-life decisions. At the population level, prognostic estimations may assist policymakers in conducting fair comparisons when evaluating stroke fatality among different facilities for hospital outcomes and performance assessment. Clinicians usually rely on their own personal experience or average mortality reported in observational studies, which do not account for valuable information available at the time of the hospital presentation. Unfortunately, …

Sis-Map; Suicide Risk Assessment Scale, Amresh Srivastava

Amresh Srivastava

This is a New Scale for Assessment of suicide risk to evaluate clients referals and disposition. This Copy Right to Amresh Shrivastava and Chrles Nelson

Using N-Of-1 Trials To Improve Patient Management And Save Costs, Paul A. Scuffham, Jane Nikles, Geoffrey K. Mitchell, Michael J. Yelland, Norma Vine, Christopher J. Poulos, Peter I. Pillans, Guy Bashford, Chris Del Mar, Philip J. Schluter, Paul Glasziou

Paul Glasziou

Background: N-of-1 trials test treatment effectiveness within an individual patient. Objective: To assess (i) the impact of three different N-of-1 trials on both clinical and economic outcomes over 12 months and (ii) whether the use of N-of-1 trials to target patients' access to high-cost drugs might be cost-effective in Australia. Design: Descriptive study of management change, persistence, and costs summarizing three N-of-1 trials. Participants: Volunteer patients with osteoarthritis, chronic neuropathic pain or ADHD whose optimal choice of treatment was uncertain. Interventions: Double-blind cyclical alternative medications for the three conditions. Measures: Detailed resource use, treatment and health outcomes (response) data collected …

Stakeholders' Views On The Routine Use Of N-Of-1 Trials To Improve Clinical Care And To Make Resource Allocation Decisions For Drug Use, Jane Nikles, Geoffrey K. Mitchell, Alexandra Clavarino, Michael J. Yelland, Christopher B. Del Mar

Christopher Del Mar

N-of-1 trials are empirical formal tests using a within-patient randomised, double-blind, cross-over comparison of drug and placebo (or another drug), which we adapted to study individual patients’ responses as a clinical tool to guide clinical management. We administered semi-structured interviews to gauge stakeholder perspectives on the possibility of using routine n-of-1 trials for this purpose. Stakeholders included government and non-government health care sector, and patient, clinician and consumer, organisations. Stakeholders supported more widespread implementation of n-of-1 trials, in a targeted fashion, with some caveats. Barriers to their widespread implementation included constraints on doctors’ time, doctors’ acceptance, drug company acceptance, patient …

Static Versus Dynamic Topology Of Complex Communications Network During Organizational Crisis, Shahadat Uddin

Shahadat Uddin

No abstract provided.