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Articles 1 - 30 of 41
Full-Text Articles in Medicine and Health Sciences
A Decentralized, Patient-Centered Approach To Diabetes Disease Management In The Primary Care Setting, Michael Toscani, John P. O'Connor, David B. Nash
A Decentralized, Patient-Centered Approach To Diabetes Disease Management In The Primary Care Setting, Michael Toscani, John P. O'Connor, David B. Nash
College of Population Health Faculty Papers
Although many disease management programs have been developed for diabetes, no single design has proved best for all providers and patient populations. Cost effectiveness is especially relevant to diabetes programs because significant costs of the disease may come from complications that occur later in life, while the costs of the program are incurred immediately. For this reason, diabetes disease management programs with positive outcomes and low implementation costs are of particular importance. We report here on the outcomes of a pilot test of the Steps to Health program developed by Abbott Laboratories. The Steps to Health program was designed to …
From Product Dispensing To Patient Care: The Role Of The Pharmacist In Providing Pharmaceutical Care As Part Of An Integrated Disease Management Approach, Laura T. Pizzi, Jean M. Menz, Geneen R. Graber, Dong-Churl Suh
From Product Dispensing To Patient Care: The Role Of The Pharmacist In Providing Pharmaceutical Care As Part Of An Integrated Disease Management Approach, Laura T. Pizzi, Jean M. Menz, Geneen R. Graber, Dong-Churl Suh
College of Population Health Faculty Papers
During the past decade, the profession of pharmacy has changed dramatically. The Doctor of Pharmacy degree has replaced the Bachelor of Science degree as the first professional degree offered at most accredited U.S. pharmacy schools. Advanced clinical training is now a mainstay of pharmacy training, and this has enabled pharmacists to contribute to disease management efforts. In addition, technological improvements in prescription processing have afforded pharmacists more time to participate in disease management activities. This paper describes how the role of the pharmacist has changed and reviews the results of programs involving pharmacists as disease management providers in the areas …
Meeting Employees' Information Needs In An Evolving Health Care Marketplace, Lise Rybowski
Meeting Employees' Information Needs In An Evolving Health Care Marketplace, Lise Rybowski
National Health Policy Forum
This background paper explores the role of information in an evolving health care marketplace. It notes that, in a softening economy, many employers seeking relief from escalating health care expenses shift costs onto employees. Some try to make their retreat more palatable by offering employees both more options for how and where they receive health care and more control over how and where the money is spent. This paper discusses the changes that are likely to occur over the next decade in the ways that people make decisions about health plans and providers, the implications for consumers' information needs, and …
The Importance Of Individualized Pharmaceutical Therapy In The Treatment Of Diabetes Mellitus, David B. Nash, Jennifer B. Koenig, Karen D. Novielli, Renee Liberoni, Miriam Reisman
The Importance Of Individualized Pharmaceutical Therapy In The Treatment Of Diabetes Mellitus, David B. Nash, Jennifer B. Koenig, Karen D. Novielli, Renee Liberoni, Miriam Reisman
College of Population Health Faculty Papers
Individualized pharmaceutical care for patients with diabetes is necessary for several reasons. First, diabetes is a highly complex disease caused by the interplay among genetic, physiological, and environmental factors that vary from individual to individual. Second, the profile of patients with diabetes has evolved to include people of all ages and socioeconomic backgrounds, with varying medical histories and health behaviors. Third, diabetes often occurs concurrently with other medical conditions, especially in certain groups, such as the elderly. While the treatment goals for all patients with diabetes are the sameto stabilize and maintain healthy blood glucose levels to prevent serious complicationsthe …
The Disappearing State Surpluses: How Come, How Long, And How Will They Affect Social Service Programs?, Randy Desonia
The Disappearing State Surpluses: How Come, How Long, And How Will They Affect Social Service Programs?, Randy Desonia
National Health Policy Forum
This issue brief focuses on the impact of budget shortfalls being experienced by many states after several years of strong revenue growth. It describes the structure and sources of state revenues and spending and the causes of the shortfall. It also summarizes the fiscal trends and federal policies that could result in significant budget shortfalls in the future.
Primary Care Case Management: Lessons For Medicare?, Lisa Sprague
Primary Care Case Management: Lessons For Medicare?, Lisa Sprague
National Health Policy Forum
This issue brief looks at primary care case management (PCCM) as a tool that states have used to manage the delivery of care to their Medicaid populations, an alternative to contracting with commercial managed care plans. (States had found PCCM a flexible means of advancing state policy goals, including quality improvement, disease management, and coverage of special-needs populations.) The issue brief considers provider and beneficiary perspectives on PCCM as well as state agency objectives and accomplishments. Finally, it raises the question of adapting the PCCM model for Medicare.
Emergency Preparedness From A Health Perspective: Preparing For Bioterrorism At The Federal, State, And Local Levels, Robin J. Strongin
Emergency Preparedness From A Health Perspective: Preparing For Bioterrorism At The Federal, State, And Local Levels, Robin J. Strongin
National Health Policy Forum
Despite the good intentions prior to and in the aftermath of the terrorist attacks of September 11, 2001, the existence of significant gaps in the country's preparedness became increasingly clear in the weeks that followed. This background paper provides an overview of the state of bioterrorism preparedness at all levels of government, identifying both the gaps and the steps being taken to close them. A series of reference materials, including a suggested reading list and Web site addresses, are listed at the end of the paper.
Health Insurance Family Style: Public Approaches To Reaching The Uninsured, Jennifer Ryan
Health Insurance Family Style: Public Approaches To Reaching The Uninsured, Jennifer Ryan
National Health Policy Forum
This issue brief explores existing and potential opportunities to further expand the availability of health coverage for the uninsured and the underinsured, given downturns in the economy and the resulting state budget shortfalls. It also considers the implications of the Health Insurance Flexibility and Accountability (HIFA) initiative announced in August 2001 by the Centers for Medicare and Medicaid Services. Finally, the issue brief describes legislative options for health care reform being debated in Washington, including tax credit incentives, employer-based coverage subsidies and the potential for additional federal funding for public coverage expansions through Medicaid and the State Children's Health Insurance …
Pain Control In Healthcare Organizations: Developing Effective Disease Management Programs, C. Richard Chapman, Stephen D. Lande, Bill H. Mccarberg, David B. Nash
Pain Control In Healthcare Organizations: Developing Effective Disease Management Programs, C. Richard Chapman, Stephen D. Lande, Bill H. Mccarberg, David B. Nash
College of Population Health Faculty Papers
Although medicine possesses the knowledge and technology for preventing or relieving most pain, poor pain control is still widespread. Unrelieved pain causes unnecessary suffering and increases health care expenditures. Among the barriers to improving pain control are poor provider education in pain management, misguided beliefs about the inevitability of pain and the dangers of pain medication, provider resistance to changing practice patterns, and administrative resistance to implementing improvements that incur short-term costs but lead to long-term savings. In short, poor pain relief in America's health care institutions is a system issue, and improvement requires a system-wide change. An effective program …
Mission Possible? Maintaining The Safety Net In Urban And Rural Colorado, Karen Matherlee
Mission Possible? Maintaining The Safety Net In Urban And Rural Colorado, Karen Matherlee
National Health Policy Forum
This site visit examined urban safety-net concerns in Denver and rural safety-net issues in three communities in the eastern part of Colorado. The Denver segment featured Denver Health, an integrated health system that provides a continuum of services to diverse vulnerable populations. It explored delivery and financing issues for the system itself and in relation to payers, providers, and consumers (particularly through Community Voices) in its catchment area. The eastern Colorado segment focused on delivery and financing issues in Rocky Ford (community health center/migrant health services concerns), Limon (certified rural health center topics), and Hugo (critical-access hospital matters). The visit …
W-2 In 2001: Wisconsin Works At Welfare Reform, Jennifer Ryan, Randy Desonia
W-2 In 2001: Wisconsin Works At Welfare Reform, Jennifer Ryan, Randy Desonia
National Health Policy Forum
This site visit took federal participants to Wisconsin, widely regarded as one of the pioneers of welfare reform. This site visit focused on Wisconsin Works (W-2), a statewide effort to reduce the state's welfare caseload and send clients to work. In particular, site visitors examined welfare reform policy, service delivery, and financing issues in Milwaukee, at that time the home of 85 percent of W-2 participants. Site visit participants heard from state officials, private-sector representatives, researchers, and advocates on the structure of W-2, its operating policies, and the effects of program implementation on low-income families. They toured a variety of …
Medicare Coverage: Lessons From The Past, Questions For The Future, Robin J. Strongin
Medicare Coverage: Lessons From The Past, Questions For The Future, Robin J. Strongin
National Health Policy Forum
This paper describes the Medicare coverage process for emerging technologies and the ways it has changed over time. Issues addressed include both the national coverage process and local medical review policies, which account for 90 percent of the coverage determinations. The paper also includes a discussion of the relationship between the coverage process and technology assessment, payment systems and the ongoing debate over coverage criteria and levels of evidence.
Income Support Policy And The U.S. Child Support System, Jane Koppelman
Income Support Policy And The U.S. Child Support System, Jane Koppelman
National Health Policy Forum
This paper examines the economic profile of custodial and noncustodial parents and the status of the federal/state child support enforcement system. It discusses the reasons for the historically low rate of child support collection; the prospects for new computerized systems to improve the rates of both paternities established and payments collected; ways the system can sustain funding; and the extent to which child support payments can improve the well-being of low-income families.
Pharmacy Benefit Managers: A Model For Medicare?, Veronica V. Goff
Pharmacy Benefit Managers: A Model For Medicare?, Veronica V. Goff
National Health Policy Forum
This issue brief uses large-employer experiences with pharmacy benefit managers (PBMs) to shed light on their potential as Medicare outpatient drug benefit administrators. PBM management techniques are discussed, as well as employer perspectives on PBM strengths and weaknesses and lessons learned. Considerations for Medicare policy are also examined. The brief built on a previous NHPF issue brief entitled The ABCs of PBMs.
Federal And State Perspectives On Gme Reform, Karen Matherlee
Federal And State Perspectives On Gme Reform, Karen Matherlee
National Health Policy Forum
This issue brief examines financial support of graduate medical education (GME), a standard budget item in the federal Medicare program and in some state Medicaid programs. It looks at objections to the way in which GME dollars are distributed, especially in terms of variations in Medicare GME payments across states. It explores various reform proposals that are circulating to address this and other GME problems and the odds for major reform.
Nurse Workforce: Condition Critical, Wakina Scott
Nurse Workforce: Condition Critical, Wakina Scott
National Health Policy Forum
This issue brief provides an overview of the current nursing shortage. It discusses the multiple factors that make this shortage in the nurse workforce different from earlier ones. It also examines steps taken by nursing schools, the health care industry, the federal government, and states to address this issue.
Youth Violence Prevention: How Does The Health Care Sector Respond?, Anthony S. Raden
Youth Violence Prevention: How Does The Health Care Sector Respond?, Anthony S. Raden
National Health Policy Forum
This background paper examines the health care sector's response to the complex problems associated with youth violence, identifies the unique challenges health professionals face in dealing with young victims and perpetrators of violence, and raises questions about the ability of health professionals in various types of practice settings to assume a more proactive role in preventing youth violence.
The Field Of Disease Management At The Crossroads: An Interview With David B. Nash, Md, Mba, T. J. Basting
The Field Of Disease Management At The Crossroads: An Interview With David B. Nash, Md, Mba, T. J. Basting
College of Population Health Faculty Papers
As David B. Nash, MD, MBA, takes the helm of Disease Management as Editor-in-Chief, the practice of disease management—now a decade old—depends on its practitioners to continue to provide "economic proof of concept." This effort to accrue the credibility needed to design and fund programs will provide further evidence that new technologies can be integrated into care programs across large populations to reduce costs while improving healthcare and access to it.
Quality Improvement Tools In Disease Management, Lisa E. Paddock, Amy L. Phillips, Peter Chodoff
Quality Improvement Tools In Disease Management, Lisa E. Paddock, Amy L. Phillips, Peter Chodoff
College of Population Health Faculty Papers
Disease management programs require constant monitoring to assure quality and address problems efficiently. To initiate continuous quality improvement in a disease management program, there are several methods available to identify potential problems within the program that may be affecting quality. Some common quality improvement instruments include the Plan-Do-Check-Act model, check sheets, and so forth. Whatever model is used, Statistical Process Control using flow charts, histograms, Pareto diagrams, scatter diagrams, control charts, and cause-and-effect diagrams provides a better understanding about how the organization's processes are functioning. These tools facilitate problem recognition and allow an organization to meet established standards of quality …
Perceptions Of The Family Mealtime Environment And Adolescent Mealtime Behavior: Do Adults And Adolescents Agree?, Kerri N. Boutelle, Leslie A. Lytle, David M. Murray, Amanda Birnbaum, Mary Story
Perceptions Of The Family Mealtime Environment And Adolescent Mealtime Behavior: Do Adults And Adolescents Agree?, Kerri N. Boutelle, Leslie A. Lytle, David M. Murray, Amanda Birnbaum, Mary Story
Department of Public Health Scholarship and Creative Works
The family mealtime environment has great potential to affect the eating behaviors of youth in the family. It is difficult to determine the important elements of a healthy mealtime environment because a valid assessment of the family environment is so difficult to obtain. The objective of this study is to examine the level of agreement between adult and adolescent perceptions of the family mealtime environment and adolescent mealtime behavior. A telephone survey was used to query adult and adolescent family members about how they perceive the family mealtime environment and the adolescent's mealtime behavior. A convenience sample of 282 adult/adolescent …
State-Based Pharmaceutical Assistance Programs: Temporary Fix Or Lessons For Medicare?, Robin J. Strongin
State-Based Pharmaceutical Assistance Programs: Temporary Fix Or Lessons For Medicare?, Robin J. Strongin
National Health Policy Forum
By early 2001, more than one-half of the states had established some type of pharmaceutical assistance programs for the elderly. This issue brief considers specific program parameters, such as eligibility criteria, cost-sharing arrangements, program administration, and marketing and outreach. It also considers programs in the broader context of a future Medicare outpatient prescription drug benefit.
Tanf And Work Support Services: On The Job In Greater Philadelphia, Lisa Sprague
Tanf And Work Support Services: On The Job In Greater Philadelphia, Lisa Sprague
National Health Policy Forum
This site visit looked at programs in the greater Philadelphia area to move welfare recipients into employment and support services aimed at keeping them employed. Four years after implementation of the Personal Responsibility and Work Opportunity Reconciliation Act, welfare caseloads were much reduced, but challenges remained. Pennsylvania officials described their plans to assist beneficiaries who would reach their five-year lifetime cash assistance limit beginning in 2002. Site visitors met with state and county assistance office staff, employers, consumer advocates, and employment and training contractors. They participated in discussions of how work support services, such as medical assistance, child care, and …
Quality In The Making: Perspectives On Programs And Progress, Lisa Sprague
Quality In The Making: Perspectives On Programs And Progress, Lisa Sprague
National Health Policy Forum
This background paper considered the evolution of quality evaluation efforts, tracing their development from early initiatives to keep track of patients after surgery through the various guidelines, surveys, and measurement tools currently in use. It looked at both quality assurance and quality improvement strategies, highlighting the different philosophies that guide them. The paper examined the roles of purchasers, providers, consumers, and governments in furthering a quality agenda. Both regulatory and voluntary approaches were assessed.
The Health Care Safety Net In A Time Of Fiscal Pressures, Richard Hegner
The Health Care Safety Net In A Time Of Fiscal Pressures, Richard Hegner
National Health Policy Forum
This background paper reviewed the role played by the health care safety net in serving the nation's uninsured, underinsured, and indigent populations as well as those Americans who experience problems in obtaining access to health care. Against the backdrop of the March 2000 Institute of Medicine report, America's Health Care Safety Net: Intact But Endangered, the paper examined the recurrent choice in U.S. health policy between underwriting public insurance and subsidizing direct provision of health care. It recounted a number of reasons for direct federal interest in the safety net — including the important role played by Medicaid, the major …
Welfare Reform And The Well-Being Of Families: Successes To Date And Challenges Ahead, Jane Koppelman
Welfare Reform And The Well-Being Of Families: Successes To Date And Challenges Ahead, Jane Koppelman
National Health Policy Forum
This issue brief discusses a key issue in evaluating the 1996 Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA): the status of families after the implementation of this landmark welfare reform program. The new block grant program to states to administer the Temporary Assistance to Needy Families(TANF) program has been extremely effective when measured by lower welfare rolls and higher work rates and earnings for recipients. However, an equally important dimension described by the paper is what is known about longer-term effects and the status of people who have left welfare, with special emphasis on how children have …
Welfare Reform And Substance Abuse: Innovative State Strategies, Ginger P. Parra
Welfare Reform And Substance Abuse: Innovative State Strategies, Ginger P. Parra
National Health Policy Forum
This issue brief highlights key facts about the impact of substance abuse on welfare reform and recipients of Temporary Assistance to Needy Families, or TANF. After outlining some of the data on the incidence of substance abuse as well as its costs and treatment, it concludes by describing innovative state welfare programs attempting to lower barriers to employment and self-sufficiency.
Chief Medical Officers' Perceptions Of Disease Management Programs, Gang Xu, Lisa E. Paddock, John P. O'Connor, David B. Nash, Mark Zitter
Chief Medical Officers' Perceptions Of Disease Management Programs, Gang Xu, Lisa E. Paddock, John P. O'Connor, David B. Nash, Mark Zitter
College of Population Health Faculty Papers
The purpose of this article is to examine chief medical officers' (CMOs) perception of disease management programs. Five open-ended questions, each addressing a major issue in the development of disease management programs, were given to 31 CMOs who attended a series of invitation-only conferences on disease management in the fall of 1999. Qualitative data analysis was conducted using the transcripts on each of the issues. Overall, the CMOs viewed the emergence of capitated disease management programs positively. They considered the population of a program to be the contractual patients and/or those at risk for the target disease. On the issue …
Measurement Of The Impact Of Winona Health Online, David B. Nash, David Shulkin, Florence Comite, Ron Loeppke, Bruce Van Cleave, Robert Kane, Jon Christianson, Douglas Pousma
Measurement Of The Impact Of Winona Health Online, David B. Nash, David Shulkin, Florence Comite, Ron Loeppke, Bruce Van Cleave, Robert Kane, Jon Christianson, Douglas Pousma
College of Population Health Faculty Papers
The purpose of this article is to present the methodology to study the clinical and financial outcomes associated with the use of Winona Health Online, a novel community-wide interactive healthcare Website in Winona, Minnesota. Outcome methodology was developed by the University of Minnesota School of Public Health and the Carlson School of Management in cooperation with nationally recognized outcomes and disease state management experts, healthcare practitioners in Winona, statisticians, and health economists. The main areas of measurement include health status, satisfaction, cost and utilization of services, and clinical quality.
Massachusetts Adult Tobacco Survey: Tobacco Use And Attitudes After Seven Years Of The Massachusetts Tobacco Control Program, Technical Report & Tables 1993 — 2000, Lois Biener, Amy Nyman, Anthony M. Roman, Catherine A. Flynn, Alison B. Albers
Massachusetts Adult Tobacco Survey: Tobacco Use And Attitudes After Seven Years Of The Massachusetts Tobacco Control Program, Technical Report & Tables 1993 — 2000, Lois Biener, Amy Nyman, Anthony M. Roman, Catherine A. Flynn, Alison B. Albers
Center for Survey Research Publications
The Massachusetts Tobacco Control Program was launched in October of 1993. At that time, the Center for Survey Research conducted the Massachusetts Tobacco Survey (MTS), a comprehensive survey of adults and teens living in Massachusetts. The purpose of the survey was to collect baseline data on the prevalence of tobacco use among adults and teens in the Commonwealth and on issues related to the likelihood of smoking cessation or initiation. The survey also assessed the prevalence of restrictive smoking policies, and attitudes about tobacco control measures. The baseline data serve as a standard against which the impact of various programs …
An Assessment Of Selected Sub-Systems Of The Egyptian Norplant® Program, Fatma El-Zanaty, Laila Nawar, Ramadan Hamed
An Assessment Of Selected Sub-Systems Of The Egyptian Norplant® Program, Fatma El-Zanaty, Laila Nawar, Ramadan Hamed
Reproductive Health
The Egyptian Ministry of Health and Population and FRONTIERS discussed the need for investigating service delivery aspects of the Egyptian NORPLANT® program. This study emerged from those consultations. The study provides a comprehensive assessment of the program: how services are administered and used through the ongoing Introduction Program as it approaches five years of operation. The report lists major findings with program implications and offers recommendations regarding quality of care; tracking and locating NORPLANT® users; program sustainability; and information, education, and communication strategies.