Medicine and Health Sciences Commons^™

Geographic Variation In The Implementation Of Public Health Services: Organizational, Economic, And Network Determinants, Glen P. Mays

Glen Mays

An expanding body of research-tested public health interventions exist to prevent disease and injury and promote health on a population-wide basis, such as those profiled in the CDC’s Guide to Community Prevention Services, but adoption and implementation of these strategies vary widely across states and communities. Public health services are delivered through diffuse constellations of governmental agencies and their private-sector and community-based counterparts using implementation mechanisms that are poorly understood. The studies in this panel examine how organizational, economic, and inter-organizational network characteristics influence the implementation of public health services across states and communities.

Inter-Organizational Network Effects On Public Health Service Implementation, Outcomes, And Disparities Across U.S. Communities, Glen P. Mays

Glen Mays

Background: The Affordable Care Act created new incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing inter-organizational relationships and expanding implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities; (2) whether network changes attenuate or exacerbate disparities in public health implementation across communities; and (3) how network changes affect preventable mortality and resource use.Methods: We follow a longitudinal cohort of 360 …

Correspondence Between Self-Report And Interview-Based Assessments Of Antisocial Personality Disorder, Laura Guy, Norman Poythress, Kevin Douglas, Jennifer Skeem, John Edens

Norman Poythress

Antisocial personality disorder (ASPD) is associated with suicide, violence, and risk-taking behavior and can slow response to first-line treatment for Axis I disorders. ASPD may be assessed infrequently because few efficient diagnostic tools are available. This study evaluated 2 promising self-report measures for assessing ASPD--the ASPD scale of the Personality Diagnostic Questionnaire-4 (PDQ-4; S. E. Hyler, 1994) and the Personality Assessment Inventory (PAI; L. Morey, 1991, 2007)--as well as the ASPD module of the Structured Clinical Interview for DSM-IV Axis II (SCID-II; M. B. First, R. L. Spitzer, M. Gibbon, J. B. W. Williams, and L. S. Benjamin, 1997). The …

Factors Differentiating Successful Versus Unsuccessful Malingerers, John Edens, Laura Guy, Randy Otto, Jacqueline Buffington, Tara Tomicic, Norman Poythress

Norman Poythress

Relatively little is known about the processes in which "successful" malingerers engage to avoid detection. This study summarizes the response strategies used by participants (N = 540) instructed to feign a specific mental disorder while completing various self-report instruments designed to detect faking. Postexperiment questionnaires indicated that those who were able to appear symptomatic while avoiding being detected as feigning (n = 60) were more likely to endorse a lower rate of legitimate symptoms, to avoid overly unusual or bizarre items, and to base their responses on their own personal experiences.

Effects Of Cost Sharing On Seeking Care For Serious And Minor Symptoms. Results Of A Randomized Controlled Trial, Martin Shapiro, John Ware, Cathy Sherbourne

Martin Shapiro

To estimate the effect of cost sharing on seeking care for serious and minor symptoms, we analyzed data for 3539 persons aged 17 to 61 from the Rand Health Insurance Experiment. Participants were randomly assigned to a free-care group or to insurance plans requiring them to pay part of the costs (cost-sharing group). Annual surveys were administered to determine if participants had serious and minor symptoms during the preceding month and whether they saw a physician. Serious symptoms were judged by a panel of physicians to warrant care in most instances; minor symptoms were judged neither to be severe nor …

Priority Setting In Indigenous Health: Why We Need An Explicit Decision Making Approach, Michael E. Otim, Ranmalie Jayasinha, Margaret Kelaher, Edward Shane Houston, Ian P. Anderson, Stephen Jan

Michael E Otim

Indigenous Australians have significantly poorer health outcomes than the non-Indigenous population worldwide. The Australian government has increased its investment in Indigenous health through the "Closing the Health Gap" initiative. Deciding where to invest scarce resources so as to maximize health outcomes for Indigenous peoples may require improved priority setting processes. Current government practice involves a mix of implicit and explicit processes to varying degrees at the macro and meso decision making levels. In this article, we argue that explicit priority setting should be emphasized in Indigenous health, as it can ensure that the decision making process is accountable, systematic, and …

Assessment Of Breast Cancer Treatment Delay Impact On Prognosis And Survival: A Look At The Evidence From Systematic Analysis Of The Literature, Faustine Williams

Faustine Williams

Perceiving One's Heart Condition To Be Cured Following Hospitalization For Acute Coronary Syndromes: Implications For Patient-Provider Communication, Molly Waring, David Mcmanus, Stephenie Lemon, Joel Gore, Milena Anatchkova, Richard Mcmanus, Arlene Ash, Robert Goldberg, Catarina Kiefe, Jane Saczynski

Richard H. McManus

OBJECTIVE: We examined the proportion of patients perceiving their heart condition to be cured following hospitalization for ACS and identified characteristics associated with these perceptions.

METHODS: We conducted a prospective cohort study of adults hospitalized with ACS (N=396). Patient interviews during hospitalization and one week post-discharge provided demographic and psychosocial characteristics. Medical records provided clinical characteristics. At one week, patients who rated "My heart condition is cured" as "definitely true" or "mostly true" were considered to perceive their heart condition cured.

RESULTS: Participants were aged 60.7 (SD:11.0) years, 26.5% female, and 89.0% non-Hispanic white; 16.7% had unstable angina, 59.6% NSTEMI, …

Estimating Health And Economic Gains From Public Health Delivery System Transformation, Glen Mays

Glen Mays

Objectives: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health system change; and (2) the effects of these changes on preventable mortality and resource use. Methods: …

Understanding The Value Of Multi-Sector Health System Interactions, Glen P. Mays

Glen Mays

Recent research examines the health and economic value of multi-organizational and multi-sectoral approaches for the delivery of public health services. This presentation examines how data on these multi-organizational delivery systems and their impact can be used to solve collective action problems and stimulate collaborative solutions in public health.

Kentucky's Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays

Glen Mays

This session examines recent progress toward the 2012 Institute of Medicine recommendation to identify the components and costs of a "minimum package" of public health services and foundational capabilities to be available across the U.S. Research about the health and economic benefits of Foundational Public Health Services has begun to shape Kentucky's strategic plan for transforming the public health system.

How Could, Should, And Would Physicians Use Facebook With Patients, Joy Peluchette, Katherine Karl, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

After reviewing the benefits and risks of social media, we examine online discussion boards to determine the thoughts of physicians and patients regarding the use of Facebook to communicate with one another about health-related issues. Of the 290 comments analyzed, we found 42 percent were opposed to physicians using Facebook. Additionally, most (51.7 were opposed to physicians being Facebook “friends” with patients. Most opponents expressed concerns about privacy and the need to maintain professional boundaries in the physician-patient relationship. We provide suggestions for how healthcare administrators can effectively manage their social media presence and provide assistance to physicians.

Analytic Approaches For Causal Inferences With Complex Multi-Component Interventions: Project Achieve's Study Of Managing Care Transitions, Glen P. Mays

Glen Mays

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.

Ideas For A Healthy Baby--Reducing Disparities In Use Of Publicly Reported Quality Data: Study Protocol For A Randomized Controlled Trial, Sarah L. Goff, Penelope S. Pekow, Katharine O. White, Tara Lagu, Kathleen M. Mazor, Peter K. Lindenauer

Sarah L. Goff MD

BACKGROUND: Publicly reported performance on quality measures is intended to enable patients to make more informed choices. Despite the growing availability of these reports, patients' use remains limited and disparities exist. Low health literacy and numeracy are two barriers that may contribute to these disparities. Patient navigators have helped patients overcome barriers such as these in other areas, such as cancer care and may prove useful for overcoming barriers to using publicly reported quality data. METHODS/DESIGN: The goals of this study are: to determine the efficacy of a patient navigator intervention to assist low-income pregnant women in the use of …

Trends In Health Care Delivery Systems: Implications For Cancer Prevention And Control, Glen P. Mays

Glen Mays

The Affordable Care Act and larger economic forces are leading both health care providers and public health agencies to renegotiate their roles and responsibilities within the U.S. health system. This session reviews major changes occurring in both health care and public health delivery systems, with a focus on the implications for cancer prevention and control. The information infrastructure created by cancer registries and other health information systems are increasingly important for enabling greater coordination, alignment and accountability within the nation's changing delivery systems.

The National Health Security Preparedness Index: Proposed Updates For 2015-16, Glen P. Mays

Glen Mays

The U.S. Centers for Disease Control and Prevention (CDC) initiated development of the National Health Security Preparedness Index in 2012 to create a platform for measuring the nation’s progress in preparing for, responding to, and recovering from disasters and other large-scale emergencies that pose risks to health and well-being in the United States. As a measurement tool, the Index is designed to summarize levels of preparedness achieved within individual states and for the nation as a whole. This session summarizes proposed updates to the Index for 2015-16 that are designed to improve the validity and reliability of Index measures and …

Improving The National Health Security Preparedness Index: Recommended Updates For 2015-16, Glen P. Mays

Glen Mays

This report describes proposed updates in methodology and measures for the 2015-16 release of the National Health Security Preparedness Index

Using Research And Roi To Drive Partnerships In Public Health Delivery Systems, Glen P. Mays

Glen Mays

Stimulating public-private partnerships (PPP) for health and economic development initiatives requires research that can answer key questions: (1) what are the health and economic returns likely to be realized; (2) over what time frames and with what certainty; (3) what investments are required to achieve results; and (4) what are the implementation strategies most likely to succeed. This presentation reviews ongoing research on the PPPs used to deliver public health services in the U.S., and explores the lessons this research offers PPPs in low and middle income countries. We examine how scientific evidence on public health delivery systems and their …

Estimating Patient-Centered And Community-Centered Treatment Effects: Examples From Medical Care And Public Health, Glen P. Mays

Glen Mays

Health services researchers face growing clinical and policy imperatives for estimating how the effectiveness of medical and public health interventions vary across patients, population groups, and community settings. Recent advances in local instrumental variables estimation techniques allow for the estimation of person-specific and community-specific treatment effects in the presence of unobserved heterogeneity. This presentation explores examples from both medicine and public health following the local IV methods developed by Basu et al. (2013).

Foundational Public Health Services And Health System Reform: Evidence, Economics, And Implementation, Glen P. Mays

Glen Mays

The Institute of Medicine's 2012 report on public health financing recommended a national initiative to identify the components and costs of a "minimum package" of public health programs and infrastructure that should be available in every U.S. community. In response, efforts are now underway to reach consensus on a set of "Foundational Public Health Services" for the nation, and to identify resource requirements for implementing these services. This presentation reviews existing research on the current availability of Foundational Public Health Services across the U.S. and the health and economic effects attributable to these services. We also review progress on ongoing …

Fundamentals Of Economic Evaluation For Public Health, Glen P. Mays

Glen Mays

This workshop provides an overview of the design and implementation of economic evaluation studies of public health programs and policies. Strategies for integrating economic evaluation principles, measurement strategies, analytic approaches, and results into the routine operations of public health agencies are examined.

Characteristics, Treatment Practices, And In-Hospital Outcomes Of Older Adults Hospitalized With Acute Myocardial Infarction, Han-Yang Chen, David Mcmanus, Jane Saczynski, Jerry Gurwitz, Joel Gore, Jorge Yarzebski, Robert Goldberg

Jorge L. Yarzebski

OBJECTIVES: To examine overall and decade-long trends (1999-2009), characteristics, treatment practices, and hospital outcomes in individuals aged 65 and older hospitalized for acute myocardial infarction (AMI) and to describe how these factors varied in the youngest, middle, and oldest-old individuals.

DESIGN: Retrospective cohort study.

SETTING: Population-based Worcester Heart Attack Study.

MEASUREMENTS: Analyses were conducted to examine the sociodemographic and clinical characteristics, cardiac treatments, and hospital outcomes of older adults in three age strata (65-74, 75-84, > /=85).

PARTICIPANTS: The study sample consisted of 3,851 individuals aged 65 and older hospitalized with AMI every other year between 1999 and 2009; 32% were …

Rural-Urban Difference In Female Breast Cancer Diagnosis In Missouri, Faustine Williams, Stephen Jeanetta, David J. O'Brien, John L. Fresen

Faustine Williams

Medicaid Crowd-Out Of Other Public Health Spending: Modeling Economic And Health Effects, Glen P. Mays

Glen Mays

MOTIVATION: Thirty states are expanding Medicaid eligibility under the Affordable Care Act (ACA) as of 2015, and while federal funds cover most costs for newly eligible recipients, states must share the additional costs of covering previously-eligible state residents who enroll in Medicaid. States, together with their local government counterparts, also provide the vast majority (87%) of public sector funds for public health programs designed to promote health and prevent disease and injury on a population-wide basis. Fiscal constraints and generous federal matching funds create strong budgetary incentives for states to channel their health-related spending to Medicaid rather than to other …

Community Members’ Assessment Of The Physical Activity Environments In Their Neighborhood Parks: Utility Of The Community Stakeholder Park Audit Tool, Anna Greer, Richard Marcello, Rochelle Graveline

Anna E. Greer

Objective. This study engaged community members to describe physical activity (PA) environments in parks and to examine if the PA environment in parks was related to the economic characteristics of households near parks. Method. Twenty-four Bridgeport, adult residents examined the PA environments in 21 Bridgeport, Connecticut, parks using the Community Stakeholder Park Audit Tool (CPAT) during the summer, 2013. ESRI’s Geographical Information System was used to identify the economic characteristics (i.e., median household income, percentage of households below the poverty line; from 2010 Census data) of households within 0.5 miles of a park. Descriptive and inferential statistics were used to …

The Association Of Natural Elements And Trail Use By Adults, Anna E. Greer, Julian A. Reed, Steve P. Hooker

Anna E. Greer

We used the System for Observing Play and Recreation in Communities to examine the association between variations in natural elements (ie, season, weather, and temperature) and adults’ use of a rail-trail in South Carolina (2006-2009). Most (62%) of the 4,468 trail users observed were walkers; 38% were observed participating in vigorous physical activity. Adults were most often observed using the trail during the summer (32%), sunny weather (78%), and moderate temperatures (54%). When promoting trail use among adults, natural elements should be considered.

Use And Nonuse Of A Rail Trail Conversion For Physical Activity: Implications For Promoting Trail Use, Anna Greer, Julian Reed

Anna E. Greer

There is limited research examining both use and nonuse of trails for physical activity. Purpose: Such research might enable health educators to better promote physical activity on trails. Methods: We used random digit dialing methods to survey 726 respondents in 2012. Results:The majority (75.1%) of respondents reported not using the trail in the previous 6 months. The odds of using the trail were greater among adults compared to older adults and those with a high school degree or college degree compared to those with less than a high school degree. Fifteen percent of trail users reported using the trail regularly …

A Meta-Analysis Of Crew Resource Management/Incident Command Systems Implementation Studies In The Fire And Emergency Services, John C. Griffith, Donna L. Roberts, Ronald T. Wakeham

John Griffith

The presentation will summarize a meta-analysis of studies on Crew Resource Management/Incident Command System implementation in the fire and emergency services. The need for using participative leadership tools such as CRM evolved from an NTSB recommendation that followed United Airlines Flight 173 crash in 1978. NASA, civilian and military aviation communities implemented Crew Resource Management (CRM) training to improve decisionmaking during flight operations. Maintenance Resource Management (MRM) was a variant of CRM and first appeared in a Federal Aviation Administration circular in 2000. CRM was adopted by the medical community in the 1990s, specifically in the surgical and nursing areas, …

Today’S Librarian And Building An Evaluation Team, Judith A. Savageau, Len L. Levin

Judith A. Savageau

Blog post to AEA365, a blog sponsored by the American Evaluation Association (AEA) dedicated to highlighting Hot Tips, Cool Tricks, Rad Resources, and Lessons Learned for evaluators. The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. Evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness.

Using Network Analysis To Understand Public Health Delivery Systems & Community Health Initiatives, Glen P. Mays

Glen Mays

The increasingly connected world of health care delivery relies on an expanding frontier of multi-stakeholder structures and processes, from interdisciplinary patient-centered care teams, to virtual accountable care organizations (ACOs), to complex community-level interventions. This session highlights recent advances in applying social network analysis (SNA) methods to study the implementation and impact of these types of innovations. This methods workshop examines the benefits and limits of novel SNA applications based on the expanding availability of large, linkable electronic clinical and administrative data sources with dependent data structures. This paper profiles examples of using SNA principles and methods to study the implementation …