Health Services Research Commons^™

Premium Assistance In Medicaid And Schip: Ace In The Hole Or House Of Cards?, Cynthia Shirk, Jennifer Ryan

National Health Policy Forum

This issue brief explores the use of premium assistance in publicly financed health insurance coverage programs. In the context of Medicaid and the State Children’s Health Insurance Program (SCHIP), premium assistance entails using federal and state funds to subsidize the premiums for the purchase of private insurance coverage for eligible individuals. This paper considers the evolution of premium assistance and some of the statutory and administrative limitations, as well as private market factors, that have prevented widespread enrollment in Medicaid or SCHIP premium assistance programs. Finally, this issue brief offers some ideas for potential legislative and/or programmatic changes that could …

Don't Bring Me Your Tired, Your Poor: The Crowded State Of America's Emergency Departments, Jessamyn Taylor

National Health Policy Forum

If the time comes, people expect that the emergency department (ED) will have the resources necessary to treat them in a timely, high-quality manner. Increasingly, however, EDs may not be able to meet that expectation. Hospitals in urban areas with large populations, high population growth, and higher-than-average numbers of uninsured are particularly crowded: ambulances are often diverted to other hospitals and patients are frequently forced to “board” in the hallways (while they wait to be transferred to another facility or part of the hospital). This issue brief places EDs in the context of the U.S. health care system and its …

Predictors Of Influenza Immunization Among Home Care Clients In Ontario, John P. Hirdes, Dawn M. Dalby, R. Knight Steel, G. Iain Carpenter, Roberto Bernabei, John N. Morris, Brant E. Fries

Kinesiology and Physical Education Faculty Publications

Background: This study examined factors associated with the receipt of influenza vaccination among Ontario home care clients.

Methods: Home care clients were assessed, as part of a routine home visit, during a pilot study of the Resident Assessment Instrument – Home Care (RAI-HC) in 12 Ontario Community Care Access Centres (CCACs). The RAI-HC is a multidimensional assessment that identifies clients’ needs and level of functional ability. Multiple logistic regression was used to identify factors associated with influenza immunization in the two years prior to assessment.

Results: The overall rate of immunization reached about 80% by 2002. Factors …

Clark County Child Death Review: 2006 Annual Report, Nevada Institute For Children’S Research And Policy

Nevada Institute for Children's Research and Policy Reports

The primary goal of all Child Death Review Teams is to prevent future child deaths. The child death review process enables jurisdictions to come together in a collaborative, multidisciplinary forum to openly discuss detailed circumstances in an effort to gain a better understanding of child deaths. The team provides a venue for representatives from a variety of both public and private agencies as well as community organizations to share information in a confidential and non-threatening environment. The National Center for Child Death Review (hereinafter, National Center), which is supported by the Maternal and Child Health Bureau of the U.S. Department …

The Electronic Health Record In Practice: Why, How, And What Next?, Lisa Sprague, Sally Coberly

National Health Policy Forum

This local site visit was intended to allow participants to observe the electronic health record (EHR) as used in practice by two U.S. leaders in technology and quality, the Veterans Health Administration (VHA) and Kaiser Permanente (KP). The VHA has employed an EHR system since 1997; KP is in the process of implementing a standard system for all clinicians nationwide. The site visit was designed to provide an opportunity for participants to explore both the expected benefits from EHR adoption and the specific lessons these two large, integrated delivery systems have learned in their transition from paper to electronic records. …

Outcomes Associated With A Home Care Telehealth Intervention, Faith Hopp, Peter Woodbridge, Usha Subramanian, Laurel Copeland, David Smith, Julie Lowery

Social Work Faculty Publications

To determine whether adding telehealth technology to traditional home care services increases health-related quality of life (HRQOL) and home care satisfaction, and decreases resource utilization among home care patients. This trial included 37 home care patients receiving services in a Veterans Affairs medical center, randomized into intervention and control groups. Outcome measures included patient satisfaction and HRQOL at baseline and 6-month follow- up, and the use of inpatient and outpatient services before and during the 6-month study period. Intervention group patients reported greater improvement in the mental health component of HRQOL, (t = 2.27; df = 15; p = …

Using The Outcome Questionnaire 45.2 In Obesity Treatment, Adam L. Arechiga

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to determine if the Outcome Questionnaire 45.2 (OQ-45) can be used in the treatment of obesity to predict participant dropout and initial treatment success, in terms of weight loss (Lambert et. al, 2002a). The OQ-45 has been used with success to predict dropout from psychotherapy in clinical populations. It was hypothesized that higher pretreatment OQ-45 scores would be associated with less program completion and less weight loss by the end of treatment.

Method: The study employed a non-experimental time series design. Seventy-eight participants were recruited from the three local obesity treatment programs, which …

Energy Balance And Breast Cancer Risk: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Jain Meera, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

While there is evidence that breast cancer risk is positively associated with body mass index (in postmenopausal women) and energy intake and inversely associated with physical activity, few studies have examined breast cancer risk in association with energy balance, the balance between energy intake and expenditure. Therefore, in the cohort study reported here, we studied the independent and combined associations of vigorous physical activity, energy consumption, and body mass index (BMI), with breast cancer risk. The investigation was conducted in 49,613 Canadian women who were participants in the National Breast Screening Study (NBSS) and who completed self- administered lifestyle and …

Student Vollunteers In The Hospice Setting, Sarah Brugger

Senior Honors Projects

The purpose of this study was to determine the frequency of use of student volunteers in the hospice setting across the country. Hospice agencies were asked to answer a questionnaire regarding their use of student volunteers and the disadvantages or benefits that they have experienced. One hundred percent of the participants indicated that they use students as volunteers in their agency. The student’s youthful outlook, fresh perspective, and enthusiasm were the most frequently cited benefits. The main disadvantage of using students centered around commitment issues, such as the unavailability of students during school breaks. The results of this study suggest …

La Story: Improving Care Management For The Chronically Ill And Chronically Underserved, Eileen Salinsky, Jessamyn Taylor

National Health Policy Forum

This Los Angeles-based site visit examined safety net and private sector efforts to improve care coordination for underserved and vulnerable populations, including the homeless, the uninsured, the undocumented, and individuals with chronic conditions like diabetes, asthma, and severe mental illness. The visit highlighted challenges and innovations in the use of disease management programs, information systems, performance incentives, and managed care as tools for improving care coordination.

Perceived Smoking Environment And Smoking Initiation Among Multi-Ethnic Urban Girls, Tracy R. Nichols, Amanda Birnbaum, Sara Birnel, Gilbert J. Botvin

Department of Public Health Scholarship and Creative Works

Purpose

To examine associations between the perceived smoking environment and smoking initiation among urban multi-ethnic adolescent girls in New York City.

Methods

Self-report surveys completed in grades 7, 8, and 9 assessed girls’ (n = 858) smoking initiation, and perceived smoking environment (family smoking, friends’ smoking, smoking norms, and cigarette availability). Carbon monoxide breath samples were collected from girls using a variation of the bogus pipeline procedure.

Results

Differences were found in smoking prevalence with white girls reporting the highest prevalence of smoking at baseline and the greatest increase in smoking prevalence from seventh to eighth grade. Black girls reported …

Data Integration And Storage: Managing And Using Home And Community-Based Services Data For Quality Improvement, Carolyn E. Gray Mph, Maureen Booth Mrp, Ma

Disability & Aging

This paper reports on data integration from a program manager’s perspective. The paper is not meant to be an exhaustive research document, nor does it single out any one correct approach. The paper is meant to facilitate communication between program units and analytic staff and serve as one reference for states as they continue to improve upon data collection techniques and use this information for ongoing quality management and improvement.

Medicaid In 2006: A Trip Down The Yellow Brick Road?, Jennifer Ryan

National Health Policy Forum

This issue brief explores the continuing evolution of the Medicaid program on several fronts. It discusses the benefits and cost-sharing flexibility that is included in the Deficit Reduction Act of 2005 (DRA) and examines the implications of these provisions for states, beneficiaries, and providers. The paper also explores recent trends in section 1115 waiver development and considers the use of waivers as a vehicle for restructuring Medicaid financing systems and for testing completely new approaches to health care delivery. The role of section 1115 waivers in the context of the DRA and as a mechanism for continued state innovation is …

Reliability, Effect Size, And Responsiveness And Intraclass Correlation Of Health Status Measures Used In Randomized And Cluster-Randomized Trials, Paula Diehr, Lu Chen, Donald L. Patrick, Ziding Feng, Yutaka Yasui

UW Biostatistics Working Paper Series

Background: New health status instruments are described by psychometric properties, such as Reliability, Effect Size, and Responsiveness. For cluster-randomized trials, another important statistic is the Intraclass Correlation for the instrument within clusters. Studies using better instruments can be performed with smaller sample sizes, but better instruments may be more expensive in terms of dollars, lost opportunities, or poorer data quality due to the response burden of longer instruments. Investigators often need to estimate the psychometric properties of a new instrument, or of an established instrument in a new setting. Optimal sample sizes for estimating these properties have not been studied …

Sensitivity Of The Hazard Ratio To Non-Ignorable Treatment Assignment In An Observational Study, Nandita Mitra, Daniel F. Heitjan

UPenn Biostatistics Working Papers

In non-randomized studies, estimation of treatment effects generally requires adjustment for imbalances in observed covariates. One such method, based on the propensity score, is useful in many applications but may be biased when the assumption of strongly ignorable treatment assignment is violated. Because it is not possible to evaluate this assumption from the data, it is advisable to assess the sensitivity of conclusions to violations of strong ignorability. Lin et al [1] have implemented this idea by investigating how an unmeasured covariate may affect the conclusions of an observational study. We extend their method to assess sensitivity of the treatment …

Rebalancing Long-Term Care: The Role Of The Medicaid Hcbs Waiver Program, Cynthia Shirk

National Health Policy Forum

This paper reviews the history and background of the Medicaid home and community-based services (HCBS) waiver program. It describes the eligibility, benefits, and financing structure, as well as the trends in program expenditures over time. The paper considers the contribution of the HCBS waiver program toward improving access to community-based care for Medicaid beneficiaries who are elderly and disabled and discusses the barriers that remain. This paper also summarizes the provisions included in the recently enacted Deficit Reduction Act of 2005 that may further expand Medicaid HCBS and considers how it may continue the process of redefining the concept of …

Hormonal And Reproductive Factors And Risk Of Glioma: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

The etiology of glioma, the most commonly diagnosed malignant brain tumor among adults in the United States, is poorly understood. Given the lower incidence rate of glioma in women than in men, it has been hypothesized that reproductive and hormonal factors may be involved in the etiology of glioma. We conducted a secondary analysis of data from the National Breast Screening Study, which included 89,835 Canadian women, aged 40–59 years at recruitment between 1980 and 1985. Linkages to national cancer and mortality databases yielded data on cancer incidence and deaths from all causes, respectively, with follow‐up ending between 1998 and …

Analysis Of Patient Information: An Empirical Modeling Approach, Tony A. Murphy

Theses and Dissertations

With rising costs and increasing complexities, many hospitals seek to better understand the intricate details of their operations. Increasingly, these organizations have a strong desire to accurately predict the resources required to effectively treat their patient load. This research investigates patient length-of-stay in a hospital neurological unit using an empirical modeling approach. Factors significantly affecting patient length of stay were identified and used to construct a regression model. The predictive model provides hospital decision makers with a compact tool to input what-if scenarios and predict future patient treatment lengths, thus, allowing the hospital to properly allocate resources.

Fitness, Knowledge, Progress: Assessing Physician Qualification, Lisa Sprague

National Health Policy Forum

The informed and empowered consumer is an ideal invoked by many would-be health care reformers. An actual consumer wishing to don the mantle of power may be hindered by the scarcity of information available, particularly with respect to choosing among physicians. How is one to know who is best qualified? This issue brief looks at the basics of physician qualification and the processes by which physicians are licensed, credentialed, and board-certified. It examines how the evolution of these processes (for example, the move from lifetime certification to ongoing maintenance of certification) affects clinicians and their patients. The rise of quality …

Different Public Health Interventions Have Varying Effects, Paula Diehr, Anne B. Newman, Liming Cai, Ann Derleth

UW Biostatistics Working Paper Series

Objective: To compare performance of one-time health interventions to those that change the probability of transitioning from one health state to another. Study Design and Setting: We used multi-state life table methods to estimate the impact of eight types of interventions on several outcomes. Results: In a cohort beginning at age 65, curing all the sick persons at baseline would increase life expectancy by 0.23 years and increase years of healthy life by .54 years. An equal amount of improvement could be obtained with a 12% decrease in the probability of getting sick, a 16% increase in the probability of …

Health Benefits In Retirement: Set For Extinction?, Mark Merlis

National Health Policy Forum

Nearly 18 million people rely on employer-provided retiree health benefits to fill gaps in Medicare’s coverage or to provide basic insurance until they reach Medicare age. Rising costs have led many employers to limit benefits, require participants to pay a larger share of the costs, or stop offering coverage at all for workers who have not yet retired. This background paper describes recent developments in retiree health benefits, possible future trends, and policy options for slowing the erosion of coverage or providing alternative ways for retirees to meet their expected medical expenses.

Carotenoid, Vitamin A, Vitamin C, And Vitamin E Intake And Risk Of Ovarian Cancer: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

It is thought that oxidative stress resulting to repeated ovulation may increase the risk of ovarian cancer by inducing DNA damage (1). Consumption of antioxidants may, therefore, decrease ovarian cancer risk by counteracting oxidative stress and the resultant DNA damage (2, 3). Currently, the epidemiologic evidence regarding associations between antioxidants and risk of ovarian cancer is mixed (4-12). Of the two prospective studies, Kushi et al. (4) and Fairfield et al. (7) both reported no association between β-carotene and ovarian cancer risk. In addition, Fairfield et al. …

Commentary: Community Partnered Research: Driving Sensemaking, Managing Knowledge, And Moving Mental Health Care To New Heights, Junius J. Gonzales, Carmen Moten

Publications from Provost Junius J. Gonzales

No abstract provided.

The Vaccine Industry: Does It Need A Shot In The Arm?, Eileen Salinsky, Cole Werble

National Health Policy Forum

This paper broadly examines the scientific, regulatory, and economic factors that contribute to constrained vaccine production capacity, periodic vaccine shortages, and perceptions of inadequate investment in new vaccine product development. It describes the vaccine development and production processes and summarizes how regulatory requirements influence these activities. Market dynamics related to vaccine supply and demand are also explored, including an examination of the industry’s cost structure, potential market size, and purchaser price sensitivity. A broad range of policy interventions designed to address shortcomings of the vaccine market are considered.

Survey Findings: Children Served By Mainecare, 2005, Catherine Ormond, Deborah Thayer

Disability & Aging

No abstract provided.

Community Participation In Tribal Diabetes Programs, Carolyn Smith-Morris

Anthropology Research

No abstract provided.

Need For Cognition And Message Complexity In Motivating Fruit And Vegetable Intake Among Callers To The Cancer Information Service, Pamela Williams-Piehota, Judith Pizarro, Stephanie A. Navarro Silvera, Linda Mowad, Peter Salovey

Department of Public Health Scholarship and Creative Works

This field experiment examined the impact of an individual's need for cognition (NFC; the tendency to enjoy thinking deeply about issues), complex versus simple messages, and the interaction of NFC and message type on encouraging fruit and vegetable consumption. Callers to the Cancer Information Service of the National Cancer Institute (N = 517) were asked to participate in the experiment at the end of their call. Individual NFC was assessed, and participants were assigned randomly to receive a telephone message promoting fruit and vegetable consumption that was either complex and multifaceted or simple and straightforward. Similarly constructed brochures were …

Barriers To The Dissemination Of Four Harm Reduction Strategies: A Survey Of Addiction Treatment Providers In Ontario, Karen L. Hobden, John A. Cunningham

Wayne State University Associated BioMed Central Scholarship

Abstract

A sample of service providers at addictions agencies' in Ontario were interviewed by telephone to assess attitudes toward, anticipated internal and external barriers to implementing, and expected benefits of four harm reduction strategies: needle exchange, moderate drinking goals, methadone treatment, and provision of free condoms to clients. Respondents were also asked to define harm reduction, list its most important elements, and describe what they find most troubling and most appealing about harm reduction. Attitudes toward harm reduction in general and the services provided at each agency were also assessed. Results indicated that the service providers surveyed had positive attitudes …

Economic Rationality And Health And Lifestyle Choices For People With Diabetes., Rachel M. Baker

Professor Rachel Baker

Economic rationality is traditionally represented by goal-oriented, maximising behaviour, or 'instrumental rationality'. Such a consequentialist, instrumental model of choice is often implicit in a biomedical approach to health promotion and education. The research reported here assesses the relevance of a broader conceptual framework of rationality (which includes 'procedural' and 'expressive' rationality as complements to an instrumental model of rationality) in a health context (type 2 diabetes).

Q methodology was used to derive 'factors' underlying health and lifestyle choices, based on factor analysis of the results of a card sorting procedure undertaken by 27 respondents with type 2 diabetes. These factors …

Q Methodology In Health Economics, Rachel M. Baker, Carl Thompson, Russel Mannion

Professor Rachel Baker

The recognition that health economists need to understand the meaning of data if they are to adequately understand research findings which challenge conventional economic theory has led to the growth of qualitative modes of enquiry in health economics. The use of qualitative methods of exploration and description alongside mainstream quantitative techniques gives rise to a number of epistemological, ontological and methodological challenges: difficulties in accounting for subjectivity in choices, the need for rigour and transparency in method, and problems of disciplinary acceptability to health economists. This paper introduces Q methodology as a means of overcoming some of these challenges. The …