Medicine and Health Sciences Commons^™

Understanding Parents' Views Toward The Newly Enacted Hpv Vaccine School Entry Policy In Puerto Rico: A Qualitative Study, Vivian Colón-López, Diana T. Medina-Laabes, Roxana Soto Abreu, Olga L. Díaz Miranda, Ana P. Ortiz, María E. Fernández, Pamela C. Hull

Behavioral Science Faculty Publications

BACKGROUND: The Human papillomavirus vaccine (HPV) is an essential tool for the prevention of HPV-related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least one dose of HPV vaccination in girls and boys aged 11 and 12 years, taking effect in August 2018. Our study aimed to examine parents' and guardians' views of unvaccinated children about the process of implementation of the new HPV vaccination school entry policy in Puerto Rico and identify potential barriers and facilitators related to the implementation of this requirement.

METHODS: During April through November 2019, we conducted three …

Blood Transfusion Errors Within A Health System: A Review Of Root Cause Analyses, Elizabeth A. Lancaster, Elizabeth K. Rhodus, Mary B. Duke, Andrew M. Harris

Sanders-Brown Center on Aging Faculty Publications

Introduction
Blood transfusions are lifesaving treatments which require critical attention to processes and details. If processes are not followed, grievous errors can lead to sentinel events. A review of investigations completed due to reported events will show the error trends associated with systems used throughout the blood transfusion process.

Methods
This study employed root cause analyses (RCAs) within the Veterans Health Administration (VHA) to review the events leading to blood transfusion errors. Data was pulled from the RCA databases within the VA National Center for Patient Safety. The time frame was October 2014 to August 2019. A total of 53 …

Boosting Patient Mobility And Function On A General Medical Unit By Enhancing Interprofessional Care, Audrey M. Johnson, Janice Kuperstein, Rachel Hogg-Graham, Preetham Talari, A. Kelly, Esther E. Dupont-Versteegden

Health and Clinical Sciences Faculty Publications

Low mobility during hospitalization remains prevalent despite associated negative consequences. The goal of this quality improvement (QI) project was to increase patient mobility and function by adding a physical therapist (PT) to an existing interprofessional care team. A mobility technician assisted treatment group patients with mobility during hospitalization based on physical therapist recommendations. Change in functional status and highest level of mobility achieved by treatment group patients was measured from admission to discharge. Observed hospital length of stay (LOS), LOS index, and 30-day all cause hospital readmission comparisons between treatment group and a comparison group on the same unit, and …

Measurement Matters: Changing Penalty Calculations Under The Hospital Acquired Condition Reduction Program (Hacrp) Cost Hospitals Millions, Olga A. Vsevolozhskaya, Karina C. Manz, Pierre M. Zephyr, Teresa M. Waters

Biostatistics Faculty Publications

BACKGROUND: Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. We posit that some of this disconnect may be driven by frequent scoring updates. The sensitivity of the HACRP penalties to updates in the program's scoring methodology has not been independently evaluated.

METHODS: We used …

Multicultural Competencies Of Healthcare Professionals And Disability-Inclusive In Telehealth During The Covid-19 Pandemic, Si-Yi Chao, Keith B. Wilson, Carrie L. Acklin

Early Childhood, Special Education, and Counselor Education Faculty Publications

There is evidence that people with disabilities are more likely to be discriminated against and to have disproportionate health care disparities compared to people who are able-bodied during the devastating COVID-19 pandemic. In light of COVID-19, telehealth has been transformed to the primary health care delivery due to social restrictions of most, globally. Disability-inclusive telehealth design can promote culturally diverse groups access and more accurate COVID-19 information, knowledge, public health measures, and guidelines of preventive strategies for acquiring COVID-19. Applying multicultural competencies is required for healthcare providers to maximize health engagement and outcomes of PWD. In many areas of health …

Translating Provider And Staff Engagement Results To Actionable Planning And Outcomes, Roberto Cardarelli, Madeline Slimack, Ginny Gottschalk, Michael Ruszkowski, Jessica Sass, Kristen Brown, Rachel Kikendall, John J. Allard, Kelly Burgess, Maggie Luoma, Wanda Gonsalves

Family and Community Medicine Faculty Publications

Staff and provider engagement leads to better quality and experience of care and less turnover and burnout. In this program, we describe an approach to better understand underlying factors that lead to low staff and provider engagement and address such factors by creating actionable plans that drive improved engagement measures. Focus groups were conducted with staff, advance practice providers, and faculty to better understand low scored areas in an annual third-party engagement survey. Focus group results were analyzed, and thematic action plans were then developed by a leadership team. These plans and the status of addressing the identified issues were …

Health Insurance Literacy Among International College Students: A Qualitative Analysis, Adebola Adegboyega, Chigozie Nkwonta, Jean Edward

Nursing Faculty Publications

In this qualitative descriptive study, we examine health insurance literacy among a group of international college students. They were recruited from a public, co-educational Southeastern university in the United States during the fall semester of 2016 to participate in semistructured interviews. Data were gathered through a demographic questionnaire, two focus group discussions, and individual interviews. Interview sessions were audio-recorded, transcribed, and analyzed using a thematic analysis approach. Three themes emerged, including knowledge of health insurance options and benefits information, affordability, and unmet expectations. These findings show the need for higher education institutions to develop a plan to integrate international students …

Reporter's Occupation And Source Of Adverse Device Event Reports Contained In The Fda's Maude Database, Kevin T. Kavanagh, Raeford E. Brown, Steve S. Kraman, Lindsay E. Calderon, Sean P. Kavanagh

Anesthesiology Faculty Publications

Introduction: A review of the medical device adverse events submitted to the United States Food & Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was undertaken to determine the major sources of the information.

Methods: The reporter’s occupation and source of the medical device report were determined for acquisition dates Jan 1, 1997 to Dec 31, 2018. A total of 7,766,737 adverse event records were analyzed.

Results: 96.6% of reports originated with the manufacturer. Patients (patients/family/friend) were the most frequent submitter of reports directly to the FDA, almost five times as often as physicians. Nurses submitted reports …

Prevalence And Practice For Rare Diseases In Primary Care: A National Cross-Sectional Study In The Usa, Ara Jo, Samantha Larson, Peter Carek, Michael R. Peabody, Lars E. Peterson, Arch G. Mainous

Family and Community Medicine Faculty Publications

Objectives There are more than 7000 rare diseases in the USA, and they are prevalent in 8% of the population. Due to life-threatening risk and limited therapies, early detection and treatment are critical. The purpose of this study was to explore characteristics of visits for patients with rare diseases seen by primary care physicians (PCPs).

Design The study used a cross sectional study using a national representative dataset, the National Ambulatory Medical Care Survey for the years 2012–2014.

Setting Primary care setting.

Participants Visits to PCPs (n=22 306 representing 354 507 772 office visits to PCPs).

Primary outcome measures Prevalence …

Patient And Hospital Characteristics Predictive Of Inferior Vena Cava Filter Usage In Venous Thromboembolism Patients: A Study From The 2013 To 2014 Nationwide Readmissions Database, Amie Goodin, Ming Chen, Driss Raissi, Qiong Han, Hong Xiao, Joshua Brown

Radiology Faculty Publications

To examine the association between patient and hospital characteristics and inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE).

The 2013 to 2014 Nationwide Readmissions Database was used to define a cohort of patients with VTE aged ≥ 18 after a primary VTE diagnosis. Comorbidities of interest were classified via diagnosis codes and IVCF placement was identified via procedure code. Chi square analysis tested differences between patient and hospital-level characteristics and whether or not IVCFs were placed. A hierarchical logistic regression model estimated the relationship between patient-level factors (demographics, socioeconomic status, comorbidities), hospital-level factors (bed size, teaching …

Clinical Performance Measures And Quality Improvement System Considerations For Dental Education, Joseph W. Parkinson, Gregory G. Zeller

Oral Health Practice Faculty Publications

Quality improvement and quality assurance programs are an integral part of providing excellence in health care delivery. The Dental Quality Alliance and the Commission on Dental Accreditation recognize this and have created standards and recommendations to advise health care providers and health care delivery systems, including dental schools, on measuring the quality of the care delivered to patients. Overall health care expenditures have increased, and the Affordable Care Act has made health care, including dentistry, available to more people in the United States. These increases in cost and in the number of patients accessing care contribute to a heightened interest …

Valuing And Financing Multi-Sector Population Health Initiatives, Glen P. Mays

Health Management and Policy Presentations

Large-scale multi-sector health improvement initiatives can be difficult to initiate and sustain over time due to uncertainties about their health and economic impact. This presentation reviews research on multi-sector population health initiatives, and examines several alternative approaches for sustainable financing.

Multi-Sector Contributions To Public Health Delivery Systems: Economic, Institutional & Policy Determinants, Glen P. Mays

Health Management and Policy Presentations

The United States faces growing public and policy demands to improve health status on a population-wide basis. This session reviews new research from the Robert Wood Johnson Foundation's Systems for Action research program about the implementation of population health activities in communities across the U.S. Using 16 years of data on a national cohort of metropolitan communities, we show that substantial growth has occurred in the array of organizations and sectors that contribute to population health activities, especially in the years following Affordable Care Act implementation. We also show that this growth has not occurred evenly across the U.S., with …

Aligning Delivery & Financing Systems To Build A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

The Robert Wood Johnson Foundation's Systems for Action research program uses strong social science methods to discover ways of aligning medical, public health, and social service systems in ways that improve health and wellbeing. This session profiles several of the studies now underway through this new program.

Health Care, Employers And Population Health, Glen P. Mays

Health Management and Policy Presentations

Data from the National Longitudinal Survey of Public Health Systems show that hospital and employer contributions to population health activities vary widely across U.S. communities. As peripheral participants in the organizational networks that support population health activities, these stakeholders bring novel information and resources to multi-sector work. This fact may explain the tendency for population health improvement activities to be more effective when hospitals and employers are involved.

Transforming Public Health Delivery Systems For Population Health Improvement, Glen P. Mays

Health Management and Policy Presentations

A growing body of empirical research documents the health and economic benefits of multi-sector health improvement initiatives. In this session we share research that points to the delivery system features --including institutions, infrastructure, and incentives -- that lead to effective population health improvement strategies.

National Health Security Preparedness Index Joint Workgroup Meeting On Model Design And Analytic Methodology, Glen P. Mays

Health Management and Policy Presentations

This workgroup meeting of the National Health Security Preparedness Index reviews results from the 2016 release of the Index and examines opportunities for enhancing the Index measures and analytic methodologies for subsequent releases.

Comprehensive Public Health Delivery Systems: Using Foundational Capabilities To Achieve Health Impact And Equity, Glen P. Mays

Health Management and Policy Presentations

Achieving health equity requires building more comprehensive systems. Using data from a nationally representative cohort of U.S. communities, this session will explore the characteristics of Comprehensive Public Health Delivery Systems, the structures and processes needed to build such systems, and the health and economic benefits attributable to these systems.

Learning Objectives:

• Compare innovative ways to structure local health departments that maximize resources to enhance service delivery to the community.
• Discuss ways local health departments can build strategic alliances to implement successful collaborations that address health threats in the community.

Affordable Care Act Implementation And Multi-Sector Contributions To Population Health, Glen P. Mays

Health Management and Policy Presentations

Research Objective: The Affordable Care Act established 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 degree and nature of change in multi-sectoral contributions to public health activities; and (2) the extent to which these system changes are attributable to key ACA provisions including coverage expansions, Prevention and Public Health funding, …

Integrating Delivery And Financing Systems Across Sectors To Build A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

The delivery and financing systems for medical care, public health, and social and community services are powerful determinants of health and wellbeing for families and communities across the U.S. Unfortunately, these systems interact in complex and often poorly understood ways through fragmented funding streams, organizational relationships, information flows, and governance and decision-making structures. This session will feature new studies underway through the Robert Wood Johnson Foundation’s Systems for Action (S4A) Research Program to test multi-sector strategies for integrating delivery and financing systems to improve population health.

Featured speakers:

David Meltzer, MD, PhD, University of Chicago Urban Labs. Expanding a Comprehensive …

New Directions In Public Health Systems Research: The U.S. Context, Glen P. Mays

Health Management and Policy Presentations

Public health services and delivery systems have the potential to improve population health and reduce health inequities by intervening on pathways that connect social and economic determinants to health outcomes. This session profiles the developing field of public health services and systems research (PHSSR) in the United States and new research directions to better understand the current and potential impact of public health delivery systems on social and economic drivers of health. We discuss emerging opportunities for cross-national comparative research on public health delivery systems in the U.S. and Canada.

Public Health Spending And Its Contributions To The Total Spend On Health, Glen P. Mays

Health Management and Policy Presentations

This presentation provides an overview of recent research on governmental public health expenditures and their interaction with medical spending, carried out through the Robert Wood Johnson Foundation supported initiatives on Public Health Services and Systems Research (PHSSR) and the new Systems for Action research program. This work illustrates the value of tracking resource use across multiple sectors that influence health and well-being in American communities. As such, this work can inform the ongoing dialogue about methodologies for summarizing total health spending for the U.S. and for state and local areas.

Learning From Geographic Variation And Change In Preparedness: The 2016 National Health Security Preparedness Index, Glen P. Mays

Health Management and Policy Presentations

The 2016 release of the National Health Security Preparedness Index tracks the nation's progress in preparing for disasters and other emergencies that create health risks for large groups of people. Recent improvements in the Index computational methodologies and measures allow results to be compared validly across states and over time. The Index aggregates more than 130 individual measures from nearly 60 data sources into valid composite measures for 6 domains and 19 subdomains that reflect core functional areas of emergency preparedness and response. Improvements in normalization, weighting, imputation, and confidence interval construction enhance the validity and reliability of Index estimates …

Measuring Progress To Comprehensive Public Health Systems, National Preparedness, And A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

This update describes recent progress on two national health measurement initiatives: The National Health Security Preparedness Index and the National Longitudinal Survey of Public Health Systems. These longitudinal data sources offer valuable perspectives on how health security practices and public health delivery systems are changing across the U.S.

Learning From Variation And Change: The 2016 Release Of The National Health Security Preparedness Index, Glen P. Mays

Health Management and Policy Presentations

The 2016 release of the National Health Security Preparedness Index uses an improved computational methodology and validated set of measures to more accurately track national and state progress in protecting the public from the health effects of disasters, outbreaks and other large-scale emergencies. This presentation provides a preview of the new methodology and results.

Understanding The Value Of Multi-Sector Partnerships To Improve Population Health, Glen P. Mays

Health Management and Policy Presentations

We review recent research concerning multi-sectoral partnerships aimed at improving health status on a population-wide basis, with a particular focus on implementation strategies and on health and economic impact. While still preliminary and emerging, research indicates that large health benefits are possible through collective actions that engage the medical, public health, and social sectors. Mechanisms for aligning incentives, dividing responsibilities equitably, and measuring progress regularly appear critical to success.

Measuring Comprehensive Public Health Delivery Systems And Their Contributions To Population Health, Glen P. Mays, Rick Ingram

Health Management and Policy Presentations

We review methods for measuring the structure of public health delivery systems using data from the National Longitudinal Survey of Public Health Systems. A growing body of research using these measures demonstrates how multiple sectors contribute to core public health functions, and how these functions influence community health status over time. We end with a summary of how the Comprehensive Public Health System measure will be used in monitoring the impact of the 21st Century Public Health System initiative.

Aligning Delivery & Financing Systems To Advance A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

The Robert Wood Johnson Foundation's Systems for Action Research Program supports research on how best to organize, finance, and deliver the constellation of services and supports that promote health and well-being in American communities, including but extending beyond the medical care and public health sectors. This session describes work underway through the S4A program and future research priorities, building on a strong scientific foundation in the fields of health services research (HSR) and public health services & systems research (PHSSR).

Integrating Health Services & Systems: What We Know, Think We Know, And Need To Learn, Glen P. Mays

Health Management and Policy Presentations

The delivery and financing systems for medical care, public health, and social and community services pursue many common goals and serve overlapping groups of families and communities. Unfortunately, in most American communities these systems interact in complex and often poorly understood ways through fragmented funding vehicles, information flows, governance and decision-making structures, institutional relationships, implementation rules and strategies, and professional and interpersonal connections. New research approaches are required to untangle these interactions and expose novel pathways of influence that can support equitable improvements in service delivery, resource use, health impact, and wellbeing. This presentation will summarize evidence from recent studies …

Measuring Multi-Sector Contributions To Public Health Delivery Systems & Population Health, Glen P. Mays

Health Management and Policy Presentations

The National Longitudinal Survey of Public Health Systems has followed a nationally-representative cohort of U.S. communities since 1998 to measure the scope of public health activities implemented in each community and the range of organizations and sectors that contribute to each activity. With 16 years of follow-up observations, this survey allows us to study the effects of demographic, economic, and policy shocks on public health delivery systems, and estimate the health effects attributable to delivery system change.