Health Services Research Commons^™

Building A Strategic Framework For Comparative Effectiveness Research In Complementary And Integrative Medicine, Claudia M. Witt, Margaret Chesney, Richard Gliklich, Lawrence Green, George Lewith, Bryan Luce, Anne Mccaffrey, Shelly Rafferty Withers, Harold C. Sox, Sean Tunis, Brian M. Berman

Dartmouth Scholarship

The increasing burden of chronic diseases presents not only challenges to the knowledge and expertise of the professional medical community, but also highlights the need to improve the quality and relevance of clinical research in this domain. Many patients now turn to complementary and integrative medicine (CIM) to treat their chronic illnesses; however, there is very little evidence to guide their decision-making in usual care. The following research recommendations were derived from a CIM Stakeholder Symposium on Comparative Effectiveness Research (CER): (1) CER studies should be made a priority in this field; (2) stakeholders should be engaged at every stage …

Drug Overdose Morbidity And Mortality In Kentucky, 2000-2010: An Examination Of Statewide Data, Including The Rising Impact Of Prescription Drug Overdose On Fatality Rates, And The Parallel Rise In Associated Medical Costs, Terry Bunn, Svetla Slavova

Kentucky Injury Prevention and Research Center Special Report

From Foreword:

Kentucky has seen an explosion in fatal poisonings, particularly prescription drug related fatalities, in the last decade. In 2009, Kentucky had the 5^th highest drug overdose rate in the US, increased from the 6^th highest drug overdose fatality rate determined in 2008 (CDC WONDER). Kentucky also had the 5^th highest nonmedical use of opioid pain relievers, and 11^th highest for opioid pain reliever sales in the nation (CDC, MMWR Report November 4, 2011). These drug overdose mortality statistics are extremely startling and only begin to reveal the devastating mental, emotional, and economic toll and …

Family Physician Access Among Trans People In Ontario: A Cross-Sectional Analysis Of Social Determinants Of Health And Inequality Issues., Xuchen Zong

Electronic Thesis and Dissertation Repository

For trans Ontarians with access to publicly insured health care, this study aimed to determine predictors of not having a family physician, as well as to identify factors that influence a trans patient’s comfort discussing trans status or trans-related health needs with their physician. Previously collected demographic and family physician access related data (n=433) were used. Multiple logistic predictive model showed that age, marital status, education, employment, income-to-needs ratio, and social support independently predicted not having a family physician. Marital status, negative trans-specific experience with family physicians, and perception of family physician's knowledge about trans health needs were identified as …

Data Acquisition Plan For The Public Health Multi-Network Practice And Outcome Variation (Mprove) Study, Glen Mays

Glen Mays

This brief details the steps to be followed in obtaining and compiling data on the core (and optional) measures of public health service delivery for the MPROVE study. MPROVE data will need to be obtained from several different sources. Data for some measures already exist in administrative records, surveillance systems, or other sources maintained by the local and state public health agencies that participate in your PBRN. For other measures, it may be necessary to obtain data from other agencies that collaborate with the public health agencies in your PBRN. In still other cases, it may be necessary to undertake …

Final Set Of Public Health Delivery Measures Selected For The Multi-Network Practice And Outcome Variation Examination (Mprove) Study, Glen Mays

Glen Mays

The Multi-Network Practice and Outcome Variation Examination Study (MPROVE) engages public health practice-based research networks (PBRNs) in the collection and analysis of measures of public health delivery across a large number of local practice settings in order to examine the causes and consequences of practice variation in public health. This document summarizes the final set of measures selected for the MPROVE study, including measures of the reach, volume, intensity, and quality of public health delivery in three domains of activity: chronic disease prevention, communicable disease control, and environmental health protection.

Recent Trends In Post-Discharge Mortality Among Patients With An Initial Acute Myocardial Infarction, Andrew Coles, Kimberly Fisher, Chad Darling, David Mcmanus, Oscar Maitas, Jorge Yarzebski, Joel Gore, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

The objectives of this study were to describe contemporary postdischarge death rates of patients hospitalized at all Worcester, Massachusetts, hospitals after initial acute myocardial infarctions (AMIs) and to examine factors associated with a poor prognosis. The medical records of patients discharged from 11 central Massachusetts medical centers after initial AMIs during 2001, 2003, 2005, and 2007 were reviewed, identifying 2,452 patients. This population was composed of predominantly older patients, men (58%), and whites. Overall, the 3-month, 1-year, and 2-year all-cause death rates were 8.9%, 16.4%, and 23.4%, respectively. Over time, reductions in postdischarge mortality were observed in crude as well …

Expanding Delivery System Research In Public Health Settings: Lessons From Practice-Based Research Networks, Glen P. Mays, Rachel A. Hogg

Health and Clinical Sciences Faculty Publications

BACKGROUND: Delivery system research to identify how best to organize, finance, and implement health improvement strategies has focused heavily on clinical practice settings, with relatively little attention paid to public health settings-where research is made more difficult by wide heterogeneity in settings and limited sources of existing data and measures. This study examines the approaches used by public health practice-based research networks (PBRNs) to expand delivery system research and evidence-based practice in public health settings.

METHODS: Practice-based research networks employ quasi-experimental research designs, natural experiments, and mixed-method analytic techniques to evaluate how community partnerships, economic shocks, and policy changes impact …

Suicides And Suicide Attempts In Kentucky, 2001–2011, Kayla Pope, Svetla Slavova

Kentucky Injury Prevention and Research Center Special Report

From Executive Summary:

1. There were 605 suicides among Kentucky residents in the year 2010, up 7% from the 567 recorded in the year 2009.

2. The Kentucky resident age-adjusted suicide rate increased from 12.8 per 100,000 population in 2009 to 13.5 per 100,000 population in 2010, a 5.5% increase.

3. Firearms were the primary means of completed suicide from 2001-2010.

4. Kentucky residents aged 45-54 were the age group that completed suicide most frequently in 2010.

5. The age-adjusted rate for Kentucky self-harm-related hospitalizations increased 7.6% from 2010-2011 (52.5 hospitalizations per 100,000 population in 2010 to 56.5 hospitalizations in …

Comparison Of Need And Supply Of Syringes For Therapeutic Injections In Pakistan, Adnan Ahmad Khan, Momina Saleem, Huma Qureshi, Rashid Jooma, Ayesha Khan

Section of Neurosurgery

Objectives: To determine the extent of shortfall in syringes by measuring the need from nationally validated sources and comparing it with position on the supply side. This was done in order to contribute to the ongoing national discussions that have focused on increasing syringe supply to curtail syringe reuse.
Methods: Using 'Injections received' data from the Pakistan Demographic Health Survey 2006-7 (N: 5429) and the National Hepatitis Survey (N: 47,043), the study estimated the number of injections received in Pakistan. We matched these against the local syringe production figures from the syringe manufacturers' association and import figures from the Federal …

"Homelike" Characteristics Of Maine's Residential Services: A Survey Of Maine's Residential Service Settings (2010), Julie T. Fralich Mba, Eileen Griffin Jd, Catherine Mcguire Bs

Disability & Aging

To better understand the nature of the residential facilities serving more than 19 percent of Maine’s Long Term Services and Supports (LTSS) population, the Maine Department of Health and Human Services commissioned the Muskie School to conduct a survey of residential facilities as part of its update to Maine’s LTSS profile. The goal of the Maine Residential Settings Characteristics Survey, conducted between July and September 2010, was to measure the "homelike" characteristics of residential settings.

The survey sample comprised a total of 636 facilities which included all licensed residential care facilities or private non-medical licensed institutions. The survey response rate …

High Prevalence Of Subclinical Atherosclerosis By Carotid Ultrasound Among Mexican Americans: Discordance With 10-Year Risk Assessment Using The Framingham Risk Score, Susan T. Laing, Beverly Smulevitz, Kristina Vatcheva, Anne R. Rentfro, David D. Mcpherson, Susan P. Fisher-Hoch, Joseph B. Mccormick

School of Mathematical and Statistical Sciences Faculty Publications and Presentations

Background: Framingham risk scores (FRS) were validated in a mostly Caucasian population. Evaluation of subclinical atherosclerosis by carotid ultrasound may improve ascertainment of risk in nonwhite populations. This study aimed to evaluate carotid intima-media thickness (cIMT) and carotid plaquing among Mexican Americans, and to correlate these markers with coronary risk factors and the FRS.

Methods/results: Participants (n = 141) were drawn from the Cameron County Hispanic Cohort. Carotid artery ultrasound was performed and cIMT measured. Carotid plaque was defined as areas of thickening >50% of the thickness of the surrounding walls. Mean age was 53.1 ± 11.7 years (73.8% female). …

Public Health Return-On-Investment Template - Demonstration Version, Glen Mays

Glen Mays

The Public Health Return on Investment (ROI) Template is designed to help public health organizations estimate the economic returns from investments made in strategies that enhance public health service delivery, including quality improvement (QI) interventions. Depending on data availability, the template can be used to support retrospective analyses of actual investments as well as prospective analyses of potential future investments. The tool is designed to analyze economic returns realized through one ore more of the following pathways: (1) Reductions in routine operating costs; (2) Increases in revenue streams; (3) Increases in the outputs produced through agency services/functions; (4) Reductions in …

Estimating Scale And Scope Effects In Public Health Delivery: Implications For Regionalization, Glen P. Mays, Rachel A. Hogg, Rick Ingram, Kristina Rabarison

Health Management and Policy Presentations

OBJECTIVES: The nation's public health delivery system comprises nearly 3000 local public health agencies that vary widely in capabilities. Economic pressures, workforce shortages, and new national accreditation standards are leading these agencies to explore mechanisms for pooling resources to enhance delivery and improve population health.

METHODS: A longitudinal cohort design is used to analyze changes in the availability and perceived effectiveness of services delivered by local public health providers. A stratified random sample of the nation's 3000 local public health agencies (n=497) were surveyed in 1998 and again in 2006 and 2011 (70% response) to measure the availability of 20 …

Estimating Scale And Scope Effects In Public Health Delivery: Implications For Regionalization, Glen P. Mays, Rachel A. Hogg, Rick Ingram, Kristina Rabarison

Glen Mays

OBJECTIVES: The nation's public health delivery system comprises nearly 3000 local public health agencies that vary widely in capabilities. Economic pressures, workforce shortages, and new national accreditation standards are leading these agencies to explore mechanisms for pooling resources to enhance delivery and improve population health. METHODS: A longitudinal cohort design is used to analyze changes in the availability and perceived effectiveness of services delivered by local public health providers. A stratified random sample of the nation's 3000 local public health agencies (n=497) were surveyed in 1998 and again in 2006 and 2011 (70% response) to measure the availability of 20 …

The Cost-Effectiveness Of Combination Treatment Consisting Of Either Cetuximab Or Panitumumab Plus Folfiri Versus Treatment With Bevacizumab Plus Folfiri As First-Line Treatment For Kras Wild-Type Metastatic Colorectal Cancer Patients In Ontario, Emmanuel M.G. Ewara

Electronic Thesis and Dissertation Repository

I conducted a cost-effectiveness analysis of combination cetuximbab or panitumumab plus FOLFIRI as first-line treatment for patients with metastatic colorectal cancer (MCRC) from the perspective of the Ontario healthcare payer. I developed a Markov decision analytical model to simulate the lifetime costs and benefits of each treatment option. The model was parameterized using data collected from administrative databases in the province of Ontario and from published clinical trials. In the base case scenario, treatment consisting of bevacizumab plus FOLFIRI was found to dominate other treatment options. The ICER values were found to be sensitive to the efficacy of first-line treatment, …

Importance Performance Analysis Pelayanan Jaminan Sosial Kesehatan Di Puskesmas Swakelola Pembina, Asmaripa Ainy, Misnaniarti Misnaniarti, Nur Alam Fajar

Kesmas

Kunjungan pasien Jaminan Sosial Kesehatan (Jamsoskes) di puskesmas pembina selama tahun 2009 adalah 24.014 orang. Kunjungan per catur wulan memperlihatkan trend yang menurun. Jumlah pengunjung puskesmas pembina pada periode bulan Januari – April 2009 adalah 9.295 orang, pada Mei – Agustus 2009 adalah 8.162 orang, dan September – Desember 2009 adalah 6.557 orang. Hal ini dapat disebabkan oleh minat masyarakat yang rendah untuk menggunakan Jamsoskes. Oleh sebab itu, perlu dilakukan kajian kualitas pelayanan Jamsoskes menurut perspektif pasien. Penelitian dengan desain cross sectional ini menggunakan data primer yang dilakukan dengan metode wawancara terstruktur atau survei. Sampel terdiri dari 100 pasien Jamsoskes …

Child Maltreatment Outpatient Visits To Kentucky Non-Federal Acute Care Hospitals, 2008-2010, Marjorie Stanek, Michael Singleton, Svetla Slavova, Terry Bunn

Kentucky Injury Prevention and Research Center Special Report

No abstract provided.

Lessons From The Trenches: Meeting Evaluation Challenges In School Health Education, Michael Young, George Denny, Joseph Donnelly

Department of Public Health Scholarship and Creative Works

BACKGROUND: Those involved in school health education programs generally believe that health education programs can play an important role in helping young people make positive health decisions. Thus, it is to document the effects of such programs through rigorous evaluations published in peer‐reviewed journals.

METHODS: This paper helps the reader understand the context of school health program evaluation, examines several problems and challenges, shows how problems can often be fixed, or prevented, and demonstrates ways in which challenges can be met. A number of topics are addressed, including distinguishing between curricula evaluation and evaluation of outcomes, types of evaluation, identifying …

Contribution Of Behavioral Risk Factors And Obesity To Socioeconomic Differences In Colorectal Cancer Incidence, Chyke Doubeni, Jacqueline Major, Adeyinka Laiyemo, Mario Schootman, Ann Zauber, Albert Hollenbeck, Rashmi Sinha, Jeroan Allison

Chyke A. Doubeni

BACKGROUND:Health behaviors are known risk factors for colorectal cancer and are more common in low socioeconomic status (SES) populations. We evaluated the extent to which behavioral risk factors and body mass index (BMI) explain SES disparities in colorectal cancer incidence, overall and by tumor location.

METHODS: We analyzed prospective National Institutes of Health-AARP Diet and Health Study data on 506 488 participants who were recruited in 1995-1996 from six US states and two metropolitan areas and followed through 2006. Detailed baseline data on risk factors for colorectal cancer, including health behaviors, were obtained using questionnaires. SES was measured by self-reported …

Seeing Recovery Through The Eyes Of Ethnic And Cultural Minorities, Linda M. Cabral, Kathy Muhr, Judith A. Savageau

Judith A. Savageau

Describes a study that sought to better understand how persons with mental health conditions from two cultural groups, Latino and Deaf/Heard of Hearing (D/HH), access recovery-oriented and peer support services. Results from this study helped to inform the Massachusetts Department of Mental Health regarding system improvements that could be made to better serve these populations.