Medicine and Health Sciences Commons^™

Cultural Competency: Across Cultures Between Physicians And Patients, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.

A Culture Of One. Every Healthcare Encounter Is A Cultural Encounter, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.

Access To Hospital Interpreter Services For Limited English Proficient Patients In New Jersey: A Statewide Evaluation, Glenn Flores, Sylvia Torres, Linda Holmes, Debbie Salas-Lopez, Mara Youdelman, Sandra Tomany-Korman

Debbie Salas-Lopez MD, MPH

CONTEXT/OBJECTIVES: We surveyed New Jersey (NJ) hospitals to assess current language services and identify policy recommendations on meeting limited English proficiency (LEP) patients' needs.

METHODS: Survey with 37 questions regarding hospital/patient features, interpreter services, and resources/policies needed to provide quality interpreter services.

RESULTS: Sixty-seven hospitals responded (55% response rate). Most NJ hospitals have no interpreter services department, 80% provide no staff training on working with interpreters, 31% lack multilingual signs, and 19% offer no written translation services. Only 3% of hospitals have full-time interpreters, a ratio of 1 interpreter:240,748 LEP NJ residents. Most hospitals stated third-party reimbursement for interpreters would …

Effects Of Medicare Payment Reform: Evidence From The Home Health Interim And Prospective Payment Systems, Peter Huckfeldt, Neeraj Sood, Jose Escarce, David Grabowski, Joseph Newhouse

Peter J. Huckfeldt

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service towards episode-based payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.

Fertility Desires Among Hiv-Infected Men And Women In Los Angeles County: Client Needs And Provider Perspectives, Sebastian Linnemayr, Deborah Mindry, Glenn Wagner, Jordan Lake, Amber Smith, Molly Quinn, Risa Hoffmann

Sebastian Linnemayr

Combination antiretroviral therapy for persons living with HIV/AIDS (PLHA) has extended life expectancy, and enabled PLHA to live productive lives that can include having children. Despite calls to address childbearing for PLHA there has been limited attention to developing safe conception programs. This research sought to assess the childbearing desires of PLHA and the experiences of health care providers serving this population. Research entailed a brief cross-sectional client survey given to HIV-infected men and women over age 18 at two Los Angeles County clinics administered over an 8-week period. Focus group discussions were conducted with providers at each clinic site. …

Medicare Payment Reform And Provider Entry And Exit, Peter Huckfeldt, Neeraj Sood, John Romley, Alessandro Malchiodi, Jose Escarce

Peter J. Huckfeldt

Objective. To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services …

The Impact Of Natural Disasters On Child Health And Investments In Rural India, Sebastian Linnemayr, Ashlesha Datar, Jenny Liu, Chad Stecher

Sebastian Linnemayr

No abstract provided.

A Profile Of Nonurgent Emergency Department Use In An Urban Pediatric Hospital, Katrina Kubicek, Deborah Liu, Christy Beaudin, Jocelyn Supan, George Weiss, Yang Lu, Michele Kipke

Yang Lu

Objectives: This study was designed to develop a descriptive profile of parents and caregivers who bring their children to the emergency department (ED) for nonurgent issues and to explore the reasons for presenting to an urban hospital pediatric ED for nonurgent conditions. Such work is necessary to develop effective interventions.

Methods: A total of 106 parents/caregivers whose child was triaged with a nonemergent/urgent condition completed a 15- to 20-minute computerized survey (English and Spanish) in an urban pediatric ED.

Results: Most respondents described themselves as Latino (76%) and foreign born (62%). About one half (49%) reported having an annual income …

Do Tournaments Have Incentive Effects?, Ronald Ehrenberg, Michael Bognanno

Ronald G. Ehrenberg

Much attention has been devoted to studying models of tournaments or situations in which an individual's payment depends only on his or her output or rank relative to that of other competitors. Academic interest derives from the fact that under certain sets of assumptions, tournaments have desirable normative properties because of the incentive structures they provide. Our paper uses nonexperimental data to test whether tournaments actually elicit effort responses. We focus on professional golf tournaments because information on the incentive structure (prize distribution) and measures of individual output (players' scores) are both available. We find strong support for the proposition …

A Qualitative Exploration Of The Economic And Social Effects Of Microcredit Among People Living With Hiv/Aids In Uganda, Sebastian Linnemayr, Glenn Wagner, Yashodhara Rana, James Balya, Lydia Buzaalirwa

Sebastian Linnemayr

HIV medical care, including antiretroviral therapy (ART), is often successful in restoring physical health and functioning. But in developing countries, HIV medical care is often insufficient to achieve social and economic health, and hence innovative economic support programs are much needed. We conducted semistructured interviews with 30 adults receiving ART and microcredit loans operated by Uganda Cares. Using content analysis, we explored the impact of the microcredit loans on the economic, social, and psychological well-being of respondents. Most respondents indicated that the microcredit loans played a positive role in their lives, helped them to keep their children in school and …

Diabetes Management For Low-Income Patients In Los Angeles: Two Strategies Improved Disease Control In The Short Term, Peter Huckfeldt, Daniella Meeker, Anne Peters, Jeffrey Guterman, Guillermo Diaz, Dana Goldman

Peter J. Huckfeldt

Health care providers serving vulnerable patients in Los Angeles have developed programs intended to increase diabetes control through more-intensive patient education and engagement. We examined two programs, the first using a short-term intensive intervention by a care team including nurses and a specialist, and the second integrating case management and clinical pharmacy programs into primary care in a community clinic. We show evidence that both models improved short-term disease control, as measured by reductions in HbA1c and low-density lipoprotein (sometimes referred to as “bad” cholesterol). However, integrating case management and clinical pharmacy programs into a primary care setting was less …

Factors Associated With Intention To Conceive And Its Communication To Providers Among Hiv Clients In Uganda, Glenn Wagner, Sebastian Linnemayr, Cissy Kityo, Peter Mugyenyi

Sebastian Linnemayr

Persons living with HIV/AIDS (PLHA) must discuss their fertility intentions with healthcare providers to receive the support needed to have children safely and limit transmission risks. However, few quantitative studies have examined correlates of fertility intentions, let alone the communication of such intentions with providers. We examined the prevalence and correlates of intentions to have children, and comfort discussing such plans with one's providers, in HIV clients at two HIV clinics in Uganda. Cross-sectional self-report data were collected from 233 patients who had primary partners. Bivariate correlates significant at the P < 0.10 level were included in logistic regression analysis. Of the 233 participants, 103 (44%) reported an intention to conceive a child in the near future. In multivariate analysis, younger age of both the patient and their partner, better physical health functioning and higher internalized HIV stigma were associated with having fertility intentions. One-third (35%) of those with fertility intentions expressed having difficulty discussing these intentions with their providers, which was associated with receiving care at the rural clinic and greater internalized HIV stigma. These findings highlight the need for reproductive health services that help clients accept themselves as PLHA and their fertility rights, thus promoting patient-doctor communication needed to promote safe child conception and delivery outcomes.

School And Residential Neighborhood Food Environment And Diet Among California Youth., Ruopeng An, Roland Sturm

Roland Sturm

Abstract BACKGROUND: Various hypotheses link neighborhood food environments and diet. Greater exposure to fast-food restaurants and convenience stores is thought to encourage overconsumption; supermarkets and large grocery stores are claimed to encourage healthier diets. For youth, empirical evidence for any particular hypothesis remains limited. PURPOSE: This study examines the relationship between school and residential neighborhood food environment and diet among youth in California. METHODS: Data from 8226 children (aged 5-11 years) and 5236 adolescents (aged 12-17 years) from the 2005 and 2007 California Health Interview Survey were analyzed in 2011. The dependent variables are daily servings of fruits, vegetables, juice, …

Medicare’S Bundled Payment Pilot For Acute And Postacute Care: Analysis And Recommendations On Where To Begin, Neeraj Sood, Peter Huckfeldt, Jose Escarce, David Grabowski, Joseph Newhouse

Peter J. Huckfeldt

In the National Pilot Program on Payment Bundling, a subset of Medicare providers will receive a single payment for an episode of acute care in a hospital, followed by postacute care in a skilled nursing or rehabilitation facility, the patient’s home, or other appropriate setting. This article examines the promises and pitfalls of bundled payments and addresses two important design decisions for the pilot: which conditions to include, and how long an episode should be. Our analysis of Medicare data found that hip fracture and joint replacement are good conditions to include in the pilot because they exhibit strong potential …

Pharmaceutical Use Following Generic Entry: Paying Less And Buying Less, Peter Huckfeldt, Christopher Knittel

Peter J. Huckfeldt

We study the effects of generic entry on prices and utilization using both event study models that exploit the differential timing of generic entry across drug molecules and cast studies. Our analysis examines drugs treating hypertension, high blood pressure, type 2 diabetes, and depression using price and utilization data from the Medical Expenditure Panel Survey. We find that utilization of drug molecules starts decreasing in the two years prior to generic entry and continues to decrease in the years following generic entry, despite decreases in prices offered by generic versions of a drug. This decrease coincides with the market entry …

Medical Expenditure Measures In The Health And Retirement Study, Dana Goldman, Julie Zissimopoulos, Yang Lu

Yang Lu

This paper reviews out-of-pocket (OOP) medical expenditure measures collected in the Health and Retirement Study (HRS). Medical expenditures are an important cost of poor health. Medical expenditure measures are important for understanding retirement decisions, financial preparation for retirement, and predicting the consequences of health care reform, particularly Medicare reform. Despite the comprehensiveness of the HRS, there are always limitations to what can be learned from population interviews. To assess the quality of current HRS measures of OOP spending, we compare various measures of OOP spending across survey waves to the Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey …

Almost Random: Evaluating A Large-Scale Randomized Nutrition Program In The Presence Of Crossover, Sebastian Linnemayr, Harold Alderman

Sebastian Linnemayr

Large-scale randomized interventions have the potential to uncover the causal effect of programs applying to a large population, thereby improving on the insights gained from currently dominant smaller randomized studies. However, the external validity gained through larger interventions typically risks deviation from the randomization protocol. This paper investigates the impact of the Nutrition Enhancement Program, which aims to improve child nutrition in Senegal. The analysis deals with deviation from the planned treatment and suggests approaches for combining ex-post adjustments such as propensity score matching with the randomized treatment plan. The authors do not detect a strong overall program impact on …

Economic Status And Coping Mechanisms Of Individuals Seeking Hiv Care In Uganda, Sebastian Linnemayr, Brooke Stearns Lawson, Peter Glick, Glenn Wagner

Sebastian Linnemayr

This study uses novel data to conduct a comprehensive evaluation of the demographic and economic circumstances facing HIV-positive individuals who have just entered HIV care in Uganda. While the provision of HIV care and ART may improve physical health, to achieve the broader goal of improving the quality of life and socioeconomic viability of people living with HIV/AIDS, appropriate social and economic programs may need to complement treatment. We report results from baseline data of a longitudinal, prospective cohort study with a 12-month follow-up period in two Ugandan HIV clinics. We use t-tests to examine differences across sample subpopulations and …

Not Enough Fruit And Vegetables Or Too Many Cookies, Candies, Salty Snacks, And Soft Drinks?, Roland Sturm, Deborah Cohen, Tom Farley, Molly Scott, R Bluthenthal

Roland Sturm

No abstract provided.

Consumption Smoothing And Hiv/Aids: The Case Of Two Communities In South Africa, Sebastian Linnemayr

Sebastian Linnemayr

HIV/AIDS threatens to overstretch the already frail informal safety nets in countries heavily affected by the epidemic, potentially making it difficult for households with HIV‐positive members to keep up appropriate consumption levels when experiencing shocks. These households may, in addition, face exclusion from informal insurance networks because of widespread stigmatization. Surprisingly, the resilience of informal networks to HIV‐related shocks and their uncertain worth for afflicted households in particular have not been empirically tested to date. Using 3 years of a novel panel data set from two poor South African communities experiencing HIV‐related illnesses and deaths, we investigate the ability of …

Soda Taxes, Soft Drink Consumption, And Children's Body Mass Index, Roland Sturm, L Powell, J Chriqui, F Chaloupka

Roland Sturm

No abstract provided.

Anemia In Low-Income Countries Is Unlikely To Be Addressed By Economic Development Without Additional Programs, Sebastian Linnemayr, Harold Alderman

Sebastian Linnemayr

Although governments may decline to invest in iron fortification or supplementation influenced by the view that income growth will address the problem, the data do not support this view. Looking at the rates of anemia among children and adult women across 40 Demographic and Health Surveys from 32 countries, this study found that although anemia rates do decrease as income increases, the decrease is modest. Indeed, overall anemia rates decline roughly a quarter as fast as income increases and at only half the speed at which rates of underweight decline.

Zoning For Health? The Year-Old Ban On New Fast-Food Restaurants In South La, Roland Sturm, Deborah Cohen

Roland Sturm

No abstract provided.

Affordability And Obesity: Issues In The Multifunctionality Of Agricultural/Food Systems, Roland Sturm

Roland Sturm

No abstract provided.

Determinants Of Malnutrition In Senegal: Individual, Household, Community Variables, And Their Interaction, Sebastian Linnemayr, Harold Alderman, Abdoulaye Ka

Sebastian Linnemayr

The relationship between poverty and nutrition is a two-sided one: on the one hand, economic growth (which is generally associated with an eradication of poverty) leads to reduced malnutrition. On the other hand, nutrition is one of the key ingredients for human capital formation, which in turn represents one of the fundamental factors of growth. There are numerous studies that show the correlates of malnutrition using both household- and community-level variables. However, few of these studies allow for the potential endogeneity of community infrastructure or indicate their interplay with characteristics of the mother. The current study considers the socio-economic determinants …

Effectiveness Of A Community-Based Intervention To Improve Nutrition In Young Children In Senegal: A Difference In Difference Analysis, Harold Alderman, Biram Ndiaye, Sebastian Linnemayr, Abdoulaye Ka, Claudia Rokx, Khadidiatou Dieng, Menno Mulder-Sibanda

Sebastian Linnemayr

There are few studies of community growth promotion as a means of addressing malnutrition that are based on longitudinal analysis of large-scale programmes with adequate controls to construct a counterfactual. The current study uses a difference in difference comparison of cohorts to assess the impact on the proportion of underweight children who lived in villages receiving services provided by the Senegal Nutrition Enhancement Project between 2004 and 2006. The project, designed to extend nutrition and growth promotion intervention into rural areas through non-governmental organisation service providers, significantly lowered the risk of a child having a weight more than 2 sd …

Stemming The Global Obesity Epidemic: What Can We Learn From Data About Social And Economic Trends?, Roland Sturm

Roland Sturm

No abstract provided.