Social and Behavioral Sciences Commons^™

Puerto Rico’S Community Health Centers In A Time Of Crisis, Peter Shin, Jessica Sharac, Marie Nina Luis, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2014, Puerto Rico’s twenty federally funded community health centers, operating in 71 sites located throughout the Commonwealth, served 330,736 patients, approximately one in ten Commonwealth residents. Compared to other Puerto Rico residents, health center patients are less likely to be insured. Despite considerable growth in Medicaid as a result of the supplemental funding provided under the Affordable Care Act, in 2014, 12.2% of health center patients remained uninsured.

Compared to health centers outside Puerto Rico, Puerto Rico’s health centers show a greater proportion of Medicaid patients served (69% compared to 46% outside Puerto Rico), a greater dependence on physician …

Workforce Innovations In Oral Health, Jean Moore, Margaret Langelier, Bridget Baker

Health Workforce Speaker Series

No abstract provided.

Bridging The Divide White Paper On Medication Abortion: Overview Of Research & Policy In The United States, Liz Borkowski, Julia Strasser, Amy Allina, Susan Wood

Jacobs Institute of Women's Health

Medication abortion (also called medical abortion) is a safe method of abortion available for the past 15 years in the US. The Bridging the Divide white paper summarizes the scientific evidence related to the current medication abortion process and potential changes to the process that could make it even safer and more accessible for patients, as well as policy considerations and directions for future research.

In the fall of 2000, the US Food & Drug Administration (FDA) approved the drug Mifeprex© (generic: mifepristone) for use in medication abortions. That approval included requirements that affect both patients and providers and that …

Health Center Trends: Recent Experience In Medicaid Expansion And Non-Expansion States., Peter Shin, Jessica Sharac, Julia Zur, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In thousands of medically underserved communities across the U.S., community health centers enroll lowincome people in health coverage and provide care to millions of patients. Against the backdrop of significant health center expansion over several years and a full year of expanded health coverage under the Affordable Care Act (ACA), this brief examines change between 2013 and 2014 in the volume and health coverage profile of health center patients, and health center enrollment activities and service capacity, comparing states that implemented the ACA Medicaid expansion in 2014 and states that did not expand Medicaid in 2014. The study is based …

Quality And Cost Of Diabetes Mellitus Care In Community Health Centers In The United States., Patrick Richard, Peter Shin, Tishra Beeson, Laura S. Burke, Susan F. Wood, Sara Rosenbaum

Health Policy and Management Faculty Publications

OBJECTIVE: To examine variations in the quality and cost of care provided to patients with diabetes mellitus by Community Health Centers (CHCs) compared to other primary care settings.

RESEARCH DESIGN AND METHODS: We used data from the 2005-2008 Medical Expenditure Panel Survey (N = 2,108). We used two dependent variables: quality of care and ambulatory care expenditures. Our primary independent variable was whether the respondent received care in a Community Health Centers (CHCs) or not. We estimated logistic regression models to determine the probability of quality of care, and used generalized linear models with log link and gamma distribution to …

Using A New Evidence-Based Health Workforce Innovation Research Framework To Compare Innovations In Community Health Center And Other Ambulatory Care Settings, Leah E. Masselink, Patricia Pittman, Claire Houterman

Health Workforce Research Center Publications

In the United States, changing demographics, rising costs, and the impact of new regulations and payment models arising from the Affordable Care Act have placed unprecedented pressures on healthcare providers to increase access to care, improve quality and to control costs. To meet these challenges, some providers are forming accountable care organizations (ACOs) while others are pursuing medical homes or other novel payment and care delivery models designed to help meet these challenges. Within established organizations such as federally funded community health centers (CHCs), healthcare leaders are exercising significant latitude in developing innovative solutions for meeting their patients’ needs more …

Implementation Of The International Health Regulations (2005) Through Cooperative Bioengagement, Claire J. Standley, Erin M. Sorrell, Sarah Kornblet, Julie E. Fischer, Rebecca Katz

Health Policy and Management Faculty Publications

Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency’s Cooperative Biological Engagement Program, the State Department’s Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public …

How Has The Affordable Care Act Benefitted Medically Underserved Communities? : National Findings From The 2014 Community Health Centers Uniform Data System, Jessica Sharac, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured.

The UDS data show the ACA’s …

National Advisory Council On The National Health Service Corps (Nhsc), Sara J. Rosenbaum

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Optimisations And Challenges Involved In The Creation Of Various Bioluminescent And Fluorescent Influenza A Virus Strains For In Vitro And In Vivo Applications, Monique I. Spronken, Kristy Short, Sander Herfst, Theo M. Bestebroer, Vincent P. Vaes, Erin Sorrell, + 9 More

Health Policy and Management Faculty Publications

Bioluminescent and fluorescent influenza A viruses offer new opportunities to study influenza virus replication, tropism and pathogenesis. To date, several influenza A reporter viruses have been described. These strategies typically focused on a single reporter gene (either bioluminescent or fluorescent) in a single virus backbone. However, whilst bioluminescence is suited to in vivo imaging, fluorescent viruses are more appropriate for microscopy. Therefore, the idea l reporter virus varies depending on the experiment in question, and it is important that any reporter virus strategy can be adapted accordingly. Herein, a strategy was developed to create five different reporter viruses in a …

Patient Experiences With Family Planning In Community Health Centers, Susan F. Wood, Tishra Beeson, Debora Goetz Goldberg, Holly Mead, Peter Shin, Aliyah Abdul-Wakil, Anna Rui, Bhakti Sahgal, Maya Shimony, Hallie Stevens, Sara Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Women of childbearing age represent one of the single largest groups of community health center patients, and family planning plays a critical role in the health, economic, and social circumstances of women, their children, and families. Family planning is a required service at all health centers, and the major expansion of health centers under the Affordable Care Act means that for low-income women of reproductive age this service should be increasingly available. The Quality Family Planning (QFP) Guidelines, jointly developed by the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA) and released in 2014, …

How Will Texas’ Affordable Care Act Implementation Decisions Affect The Population? A Closer Look, Sara J. Rosenbaum, Sara Rothenberg, Sara Ely

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The Affordable Care Act (ACA) gives states two key choices: Whether to expand Medicaid to cover poor uninsured adults; and whether to establish a state Exchange. No population stands to gain more from these choices than residents of Texas, who experience the nation’s highest uninsured rate. National estimates show that by not expanding Medicaid, the state has foregone coverage for 1.5 million people. County‐level estimates show that in 249 out of 254 counties, the proportion of uninsured adults exceeds 20 percent of the total adult county population. In 31 counties, the proportion of low income uninsured adults exceeds 60 percent …

Medical Education Departments: A Study Of Four Medical Schools In Sub-Saharan Africa, Elsie Kiguli-Malwadde, Zohray Talib, Hannah Wohltjen, Susan C. Connors, Jonathan Gandari, Sekelani S. Benda, Lauren A. Maggio, Susan C. Van Schalkwyk

Health Policy and Management Faculty Publications

Background

Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability.

Methods

In-depth interviews were conducted with the heads or directors …

Revising The International Health Regulations: Call For A 2017 Review Conference., Rebecca Katz, Scott F. Dowell

Health Policy and Management Faculty Publications

No abstract provided.

Can Electronic Health Records Systems Support New Payment Methods For Health Centers?, Peter Shin, Feygele Jacobs, Jeffrey Barnes, James B. Welsh, Lisa Perry, Scott D. Morgan

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably …

Alternate Payment Models For Ryan White Hiv/Aids Program Funded Services: Strategies Used By Nine Grantees, Naomi Seiler, Scott Dafflitto, Rosalind Fennell, Julia Hidalgo, Katie Horton, Mary-Beth Malcarney

Health Policy and Management Faculty Publications

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) offers Ryan White HIV/AIDS Program (RWHAP) Part A and Part B grantees some flexibility in determining the method used for paying subgrantees for core medical and support services. Many Part A and Part B grantees use a traditional “cost-based reimbursement” approach, in which subgrantees submit budgets that include personnel costs, other direct costs related to the provision of funded services, and capped indirect costs (IDCs). Some grantees, however, have developed alternative reimbursement models for core medical and/or support services. This report summarizes the reimbursement approaches taken by nine RWHAP grantees. …

Teaching Health Centers: A Promising Approach For Building Primary Care Work Force For The 21 St Century, Leighton Ku, Fitzhugh Mullan, Christine Cerrano, Zoe Barber, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Community Health Centers: A 2013 Profile And Prospects As Aca Implementation Proceeds, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2013, more than 1,200 federally funded community health centers provided access to care for low-income populations living in medically underserved communities throughout the country. The Affordable Care Act made expansion of health centers a key part of its strategy for ensuring that these communities would realize the benefits of increased health insurance coverage for their residents. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase. A key question going forward is whether health centers’ expanded capacity, developed over the past five …

Undergraduate Public Health Education: Is There An Ideal Curriculum?, Leonard H. Friedman, Joel M. Lee

Health Policy and Management Faculty Publications

No abstract provided.

Using Payment Reform Strategies To Strengthen Family Planning Services At Community Health Centers, Sara J. Rosenbaum, Peter Shin, Susan F. Wood, Jessica Sharac

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Health Care Access Dimensions And Cervical Cancer Screening In South Africa: Analysis Of The World Health Survey., Tomi F. Akinyemiju, Jasmine A. Mcdonald, Paula M. Lantz

Health Policy and Management Faculty Publications

Background

Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services.

Methods

Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple …

A Framework For Assessing The Impact Of Pharmaceutical Reimbursement Policies On Incentives To Innovate, Elizabeth Docteur, Joshua Cohen, Brian K. Bruen, Ruth Lopert, Avi Dor, Chuck Shih

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Adapting Pharmaceutical Reimbursement Policies To Manage Spending On High-Priced Drugs, Elizabeth Docteur, Ruth Lopert

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

The Core Competencies For Mental, Neurological, And Substance Use Disorder Care In Sub-Saharan Africa, Pamela Y. Collins, Seggane Musisi, Seble Frehywot, Vikram Patel

Health Policy and Management Faculty Publications

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated …

Impact Of Health Insurance Expansions On Nonelderly Adults With Hypertension., Suhui Li, Brian K. Bruen, Paula M. Lantz, David Mendez

Health Policy and Management Faculty Publications

Introduction

Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension.

Methods

We developed a state-transition model to simulate the lifetime health events of the population aged 25 to …

Should We Put Our Feet In The Water? Use Of A Survey To Assess Recreational Exposures To Contaminants In The Anacostia River., Rianna Murray, Sacoby Wilson, Laura Dalemarre, Victoria Chanse, Janet Phoenix, Lori Baranoff

Health Policy and Management Faculty Publications

The Anacostia River, a tributary of the Potomac River that flows into the Chesapeake Bay, is highly contaminated with raw sewage, heavy metals, oil and grease, trash, pathogens, excessive sediments, and organic chemicals. Despite this contamination, recreation on the river is very popular, including kayaking, canoeing, rowing, and sport fishing. There is currently no information available on the potential health risks faced by recreational users from exposure to the river’s pollutants. A total of 197 recreational users of the Anacostia River were surveyed regarding general demographic information and their recreational behavior over the previous year, including frequency and duration of …

Evaluation Of Social Media Utilization By Latino Adolescents: Implications For Mobile Health Interventions, Megan Landry, Amita Vyas, Monique Turner, Sara Nelson Glick, Susan Wood

Health Policy and Management Faculty Publications

Background: Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation.

Objectives: The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation.

Methods: This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex …

Mapping Of Networks To Detect Priority Zoonoses In Jordan, Erin M. Sorrell, Mohammad El Azhari, Nezar Maswdeh, Sarah Kornblet, Claire J. Standley, Rebecca L. Katz, Ibrahim Ablan, Julie E. Fischer

Health Policy and Management Faculty Publications

Early detection of emerging disease events is a priority focus area for cooperative bioengagement programs. Communication and coordination among national disease surveillance and response networks are essential for timely detection and control of a public health event. Although systematic information sharing between the human and animal health sectors can help stakeholders detect and respond to zoonotic diseases rapidly, resource constraints and other barriers often prevent efficient cross-sector reporting. The purpose of this research project was to map the laboratory and surveillance networks currently in place for detecting and reporting priority zoonotic diseases in Jordan in order to identify the nodes …

Comparing Cost-Effectiveness Of Hiv Testing Strategies: Targeted And Routine Testing In Washington, Dc., Amanda D Castel, Sungwoog Choi, Avi Dor, Jennifer Skillicorn, James Peterson, Nestor Rocha, Michael Kharfen

Health Policy and Management Faculty Publications

BACKGROUND: Routine HIV testing is an essential approach to identifying undiagnosed infections, linking people to care and treatment, and preventing new infections. In Washington, DC, where HIV prevalence is 2.4%, a combination of routine and targeted testing approaches has been implemented since 2006.

METHODS: We sought to evaluate the cost effectiveness of the District of Columbia (DC) Department of Health's routine and targeted HIV testing implementation strategies. We collected HIV testing data from 3 types of DC Department of Health-funded testing sites (clinics, hospitals, and community-based organizations); collected testing and labor costs; and calculated effectiveness measures including cost per new …

Clash Of The Titans: Medicaid Meets Private Health Insurance, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Throughout its first forty-eight years of life, the federal Medicaid statute lacked a viable insurance pathway for most low-income adults' ineligible for employer-sponsored coverage. In what is arguably the most important public health achievement since the enactment of Medicare and Medicaid fifty years ago, the Patient Protection and Affordable Care Act (ACA) fundamentally alters this picture. Building on earlier breakthroughs for children, the ACA restructures Medicaid to cover poor adults and juxtaposes its new architecture against an affordable and accessible private insurance market for people ineligible for employer-sponsored or government insurance.