Medicine and Health 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 …

The Impact Of The 2008 Financial Crisis On Food Security And Food Expenditures In Mexico: A Disproportionate Effect On The Vulnerable, Mireya Vilar-Compte, Sebastian Sandoval-Olascoaga, Ana Bernal-Stuart, Sandhya Shimoga, Arturo Vargas-Bustamante

Department of Public Health Scholarship and Creative Works

Objective The present paper investigated the impact of the 2008 financial crisis on food security in Mexico and how it disproportionally affected vulnerable households. Design A generalized ordered logistic regression was estimated to assess the impact of the crisis on households' food security status. An ordinary least squares and a quantile regression were estimated to evaluate the effect of the financial crisis on a continuous proxy measure of food security defined as the share of a household's current income devoted to food expenditures. Setting Both analyses were performed using pooled cross-sectional data from the Mexican National Household Income and Expenditure …

Community Health News, Georgia Southern University

Community Health Department News (2011-2018)

• Georgia Southern Examines the Association between Arthritis and Depression
• Georgia Southern Assesses the Needs of Children in a Former Slave Community
• Georgia Southern Compares Providers’ Perceptions of Challenges and Facilitators to Disability Services

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 …

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 …

Diabetes Training For Community Health Workers, Judith Aponte

Publications and Research

Background: A 2.5-month diabetes education training for community health workers (CHWs) was developed, implemented, and evaluated.

Methods: Training methods used included case studies, role-playing, and lectures. Exams were used throughout the training for its evaluation. Teaching was delivered by different ways: a one day American Diabetes Association (ADA) course; a five day Diabetes Self-Management Program (DSMP); Conversation Maps; and a series of seven National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) diabetes education booklets.

Results: Qualitative and quantitative evaluative methods were used during and after the training. The CHWs' diabetes knowledge was evaluated by a pre- and post-test …

Medicare Part B Premiums And Social Security Benefits, Sally Coberly

National Health Policy Forum

This paper describes the annual determination of beneficiaries' premiums for voluntary Medicare Part B coverage and a provision known as "hold harmless." The hold-harmless provision prevents a beneficiary's Social Security payments from being reduced as a result of an increase in the Part B premium. Because there was no cost-of-living increase for Social Security benefits for 2016, the hold-harmless provision will be in effect. This paper discusses what happens to premiums in 2016 for beneficiaries who are not held harmless—new beneficiaries, beneficiaries who do not participate in Social Security, those who are dually eligible for Medicare and Medicaid, and higher-income …

Meaningful Use Of Health Information Technology: Proving Its Worth?, Lisa Sprague

National Health Policy Forum

Health policymakers in recent years have looked to the implementation of health information technology (IT)—electronic health records and the like—as a means to improve quality, reduce costs, and achieve better health outcomes across populations. But implementing health IT in a meaningful way must go beyond purchasing medical records software. The U.S. Department of Health and Human Services (HHS) devised a set of measures and incentives for hospitals and eligible medical professionals within Medicare or Medicaid to mark successive stages of effective IT implementation. This issue brief discusses the history of meaningful use, the measures used to evaluate effectiveness, and the …

Cost Effectiveness Analysis Of Year 2 Of An Elementary School-Located Influenza Vaccination Program-Results From A Randomized Controlled Trial., Byung-Kwang Yoo, Sharon Humiston, Peter G. Szilagyi, Stanley J. Schaffer, Christine Long, Maureen Kolasa

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: School-located vaccination against influenza (SLV-I) has the potential to improve current suboptimal influenza immunization coverage for U.S. school-aged children. However, little is known about SLV-I's cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009-2010 vaccination season, an unusual H1N1 pandemic influenza season, and Year 2: 2010-2011, a more typical influenza season).

METHODS: We performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n = 9,027; …

Exploring Parental Perceptions Of Self-Efficacy, Role Modeling And Factors Contributing To Family Health Practices From An Employer-Provided Family Weight Management Program: A Mixed Methods Study, Kurt E. Vargo

FIU Electronic Theses and Dissertations

Parents provide a social learning environment where family nutrition, eating habits and physical activity are largely influenced by and correlated with parental modeling of these behaviors. Increasing self-efficacy is an important component in parents being role models because theoretically, it promotes cognitive change that supports their confidence and ability to modify behaviors that contributes to healthier family practices and biometric outcomes.

Phase one of this sequential two-phase study used biometric data (body mass index [BMI], cholesterol, glucose, and blood pressure) from parents (N = 37) participating in their employer’s family wellness initiative as dependent variables. Parental perceptions of nutrition, …

Community Health News, Georgia Southern University

Community Health Department News (2011-2018)

• Georgia Southern Examines the Impact of Health Behaviors

Predictive Factors Of Patient Satisfaction With Pharmacy Services In South Korea: A Cross-Sectional Study Of National Level Data, Sunkyung Lee, Onyeka P. Godwin, Kyungah Kim, Euni Lee

Pharmacy Faculty Articles and Research

Objectives
Patient satisfaction has emerged as a prerequisite to improving patients’ health behaviors leading to better health care outcomes. This study was to identify predictive determinants for patient satisfaction with pharmacy services using national-level data.

Methods
A cross-sectional evaluation was conducted using 2008 Korean National Health and Nutrition Examination Survey (KNHANES) data. To assess the predictive factors for patient satisfaction with pharmacy services, an ordinal logistic regression model was conducted adjusting for patient characteristics, clinical comorbidities, and perception of health.

Results
A total of 9,744 people, a representative sample of 48.2 million Koreans, participated in the 2008 KNHANES, of whom …

Healthy Corner Store Network "Heart Smarts" Program, Nyssa Entrekin, Sandra Sherman, Edd, Rickie Brawer, Mph, Phd, Mches, James D. Plumb, Md, Mph

College of Population Health Lectures, Presentations, Workshops

Objectives:

1. Identify corner stores for nutrition education and health screenings based on criteria presented.

2. Identify education strategies appropriate for a corner store setting when integrating health screenings, nutrition education and food access.

3. List at least two store owner training topics for use in a corner store setting that reinforce nutrition education and disease prevention in the store.

4. Understand methods for evaluating outcomes of an integrated educational effort.

Presented at APHA in Chicago, Illinois.

Workforce Planning & Development In Times Of Delivery System Transformation: The Stories Of Kaiser Permanente And Montefiore Health System, Patricia Pittman, Ellen Scully-Russ

Health Workforce Research Center Publications

As the implementation of the Affordable Care Act (ACA) advances, many health systems are taking bold measures to reorganize how they deliver care, and finding that in order to do so; they need to make major changes in how their healthcare workforces are organized.

Understanding what workforce changes are occurring and how they are being managed is important not just for healthcare leaders, but for policymakers as well. Traditional methods of projecting provider shortages and justifying the allocation of public funding to expand various professional pipelines are giving way to the notion that there are many models of care delivery …

Rural Adults Delay, Forego, And Strategize To Afford Their Pre-Aca Health Care, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

About 40% of non-elderly adults reported problems paying medical bills or cost-related barriers to obtaining needed medical care in 2012, difficulties that are especially pronounced for the uninsured and underinsured, the chronically-ill, and those with low incomes. Given their lower incomes and higher uninsured rates compared to urban residents, rural residents may face particular cost barriers in accessing health care. Past research has shown that, compared to urban residents, rural residents are more likely to experience higher out-of-pocket costs and delayed or foregone care as a result of cost, even when covered by private health insurance. This study provides detailed …

Out-Of-Pocket Spending Among Rural Medicare Beneficiaries, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Maine Ems Community Paramedicine Pilot Program Evaluation, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

In November 2014, the Muskie School of Public Service at the University of Southern Maine was awarded a contract to evaluate the implementation of the statewide CP Pilot Program in Maine. This report presents process level results from the evaluation. The report includes findings from interviews with the twelve community paramedicine pilot sites in Maine and with the state of Maine EMS office.

The layout of the report follows the key themes and categories from our interviews:

• Staffing
• Training
• Stakeholders and Partners
• CP Services
• CP Event
• Data Collection
• Funding
• Challenges
• Successes
• Sustainability

The report concludes with lessons learned which may …

In Search Of Safety, Negotiating Everyday Forms Of Risk: Sex Work, Criminalization, And Hiv/Aids In The Slums Of Kampala, Serena Cruz

FIU Electronic Theses and Dissertations

This dissertation offers an in-depth descriptive account of how women manage daily risks associated with sex work, criminalization, and HIV/AIDS. Primary data collection took place within two slums in Kampala, Uganda over the course of fourteen months. The emphasis was on ethnographic methodologies involving participant observation and informal and unstructured interviewing. Insights then informed document analysis of international and national policies concerning HIV prevention and treatment strategies in the context of Uganda. The dissertation finds social networks and social capital provide the basis for community formation in the sex trade. It holds that these interpersonal processes are necessary components for …

Colon Cancer Care And Survival: Income And Insurance Are More Predictive In The Usa, Community Primary Care Physician Supply More So In Canada, Kevin M. Gorey, Sindu M. Kanjeekal, Frances C. Wright, Caroline Hamm, Isaac N. Luginaah, Emma Bartfay, Guangyong Zou, Erc J. Holowaty, Nancy L. Richter

Social Work Publications

Background: Our research group advanced a health insurance theory to explain Canada’s cancer care advantages over America. The late Barbara Starfield theorized that Canada’s greater primary care-orientation also plays a critically protective role. We tested the resultant Starfield-Gorey theory by examining the effects of poverty, health insurance and physician supplies, primary care and specialists, on colon cancer care in Ontario and California.

Methods: We analyzed registry data for people with non-metastasized colon cancer from Ontario (n = 2,060) and California (n = 4,574) diagnosed between 1996 and 2000 and followed to 2010. We obtained census tract-based socioeconomic data from population …

Sex-Positive Curricula: An Investigation Of The Relationship Between Physical Fitness, Self-Concept And Sexual Functioning, Lia Jiannine

FIU Electronic Theses and Dissertations

Despite the well-recognized benefits of exercise, Americans are gaining weight in astounding proportions and levels of physical activity are on the decline. The purpose of this study was to investigate a relationship between physical fitness, self-concept and sexual health. There is a dearth of knowledge on this relationship specifically in the context of sex-negative curricula, which is the dominate discourse in the United States.

One hundred and thirty-three participants between the ages of 18 - 50 volunteered for fitness testing and data collection. Physical fitness was assessed through body fat, resting metabolic rate, cardiovascular endurance, muscular strength, muscular endurance and …

Analytic Approaches For Causal Inference With Complex Multi-Component Interventions, Glen P. Mays, Arnold J. Stromberg, Jing Li, Mark V. Williams

Health Management and Policy Presentations

Estimating the causal effects of complex, multi-component health interventions is a task with many challenges in measurement and methodology. This presentation profiles the methods being used as part of the PCORI-funded Project Achieve, a national study to estimate the comparative effectiveness of heterogeneous care transition programs designed to help hospitalized patients and their caregivers navigate care delivery systems effectively and return back to the community with optimal health and wellbeing.

Medicare's Post-Acute Care Payment: An Updated Review Of The Issues And Policy Proposals, Sally Coberly

National Health Policy Forum

Medicare spending on post-acute care provided by home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals accounted for about 10 percent of total program outlays in 2013. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems, as …

Community Health Workers: Health System Integration, Financing Opportunities, And The Evolving Role Of The Community Health Worker In A Post-Health Reform Landsacape, Mary-Beth Malcarney, Patricia Pittman, Leo Quigley, Naomi Seiler, Katie B. Horton

Health Workforce Research Center Publications

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts.

The purpose of this report is to better understand the varied landscape; to offer categories of analysis that may help inform policy, management, and research; …

Developing And Pretesting A Text Messaging Program For Health Behavior Change, Lorien C. Abroms, Robyn Whittaker, Caroline Free, Judith Mendel Van Alstyne, Jennifer M. Schindler-Ruwisch

Prevention and Community Health Faculty Publications

Background: A growing body of evidence demonstrates that text messaging-based programs (short message service [SMS]) on mobile phones can help people modify health behaviors. Most of these programs have consisted of automated and sometimes interactive text messages that guide a person through the process of behavior change.

Objective: This paper provides guidance on how to develop text messaging programs aimed at changing health behaviors.

Methods: Based on their collective experience in designing, developing, and evaluating text messaging programs and a review of the literature, the authors drafted the guide. One author initially drafted the guide and the others provided input …

Social And Behavioral Implications Of National Collegiate Athletic Association Sickle Cell Trait Screening: The Athletes' Perspective, Raymona H. Lawrence, Alison Scott, Carlton Haywood Jr., Kayin Robinson, Mondi Mason

Community Health Faculty Publications

Background: In August 2010, the National Collegiate Athletic Association (NCAA) implemented a policy mandating sickle cell trait (SCT) testing for all Division I collegiate athletes. Subsequently, all Division II-III athletes were also compelled to undergo SCT testing. This decision has met with controversy among healthcare providers, researchers, and sickle cell advocates. However, there is little information concerning the athletes’ perspective of this policy. The purpose of this paper is to report the findings of a qualitative study that explored college athletes’ perceptions of sickle cell trait SCT, NCAA policies on SCT testing, and potential implications of SCT screening.

Methods: …

Nutrition And Education In An Urbanizing Nation, Molly Pritz

Independent Study Project (ISP) Collection

Child malnutrition is a growing public health issue in Nepal, particularly in urban areas. Not eating enough, or not eating enough of healthy foods, can have life-long implications on development and cognitive ability. Because of its relevance to development within the country, many donor organizations and non-governmental organizations are working to promote child nutrition education programs. The purpose of this research is to investigate the implementation and structure of urban child nutrition educational programs involving treatment and prevention in Kathmandu, Nepal. Through qualitative interviews and field observations with three primary organizations, this research analyzes the patterns and disconnects between various …

Goddesses Versus Gynecologists: An Analysis Of The History Of Women’S Healthcare, Marion A. Mckenzie

Student Publications

Starting from the downfall of Goddess cultures in Europe, women's health care has been negatively impacted for generations. The rise of the white, male Indo-European "dominator model" along with the witch craze, caused the end of widespread wise women traditions and pharmacopeia methods. After women's traditional voice was silenced, medical colleges were established to pronounce new, "professional" knowledge. Only those who attended these universities were allowed to legally practice medicine; however, during this time, medical research and treatments for women primarily included mutilation and painful, nonsensical regimens. The horrifying state of women's healthcare has since improved, but was originally a …

How Social Determinants Of Health, Health-Seeking Behaviors, And Treatment Adherence Influence And Interact With Endemic Levels Of Pulmonary Tb And Mdr-Tb In Urban Rajasthan, Michelle Kagei

Independent Study Project (ISP) Collection

Tuberculosis, the worlds most deadly infectious disease, remains as one of the major causes of morbidity and mortality in modern-day India. The country has the highest burden of both tuberculosis as well as multidrug-resistant tuberculosis, a more recently emerging menace. This study focuses on the social determinants of health pertaining to tuberculosis, identifying and discussing “at-risk” groups in the population of urban Rajasthan. Jaipur was chosen as the field study location because of the city’s extensive levels of healthcare institutions and facilities. In order to identify common patient demographics as well as issues regarding treatment adherence, medical records and interviews …

Exploring Community Health Through The Lens Of The Community Unit In Kariobangi North And The Surrounding Areas, Maya Paris-Saper

Independent Study Project (ISP) Collection

Healthcare is a challenge in countries of the Global South. Not only do climates and trends of rapid urbanization affect the health status of many negatively, but also many health facilities are inaccessible and not of good quality, they lack enough medical personnel and lack the resources to adequately provide for patients who do not have the resources them selves. As the wealth gap increases all over the world and resources continue to be distributed unequally communicable and non-communicable health issues plague those in urban and rural settings at an alarmingly high rate and as health innovation has worked to …

Challenges Of Forecasting Physician Workforce Needs Amid Delivery System Transformation, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional …