Medicine and Health Sciences Commons^™

Trust In Integrated Medical Care Using A Population-Based Normative Approach, Heather Summers

Theses and Dissertations

The role of integrated care partnerships in addressing health care and social needs to achieve whole person care is important as health care costs rise and quality of care outcomes are incentivized. Medicaid reform and 1115 Medicaid waiver programs are implemented statewide as innovative programs aimed at achieving cost savings and improved clinical quality of care outcomes. Understanding how cross sector partnerships can meet the needs of individuals through integrated care cross sectoral coordination between government, social services and managed care is needed. This research study examined the role of normative care values, vision, trust, shared care, and leadership. The …

Effectiveness Of Financial Incentives In Improving Breast Cancer Screening Among Medicaid Recipients, James B. Sherwood

Theses and Dissertations

Breast cancer remains one of the leading causes of death among women. Roughly 2.4 million women are diagnosed annually with breast cancer throughout the world. Although breast cancer survival rates are favorable for the United States compared to other nations (90% 5-year survival for non-metastatic disease), it comes at a high cost. The United States spends an estimated $30 billion annually on breast cancer treatment. In addition, disparities in breast cancer survival rates also exist in the United States. Women Medicaid recipients, who are predominately minorities (60%), are more likely to die of breast cancer due to their high rates …

Did Medicaid Expansion Under The Affordable Care Act Reduce The Likelihood That People Report Employment Status Changes Due To Health, U.S., 2009-2017, Songyuan Deng

Theses and Dissertations

Medicaid expansion of Affordable Care Act (ACA) extended coverage to low-income working adults. While Medicaid expansion led to increased healthcare use and national healthcare expenditures, current studies do not examine the effects of Medicaid expansion on health status from the perspective of social roles, for example, changes in employment status. This study use data from the Current Population Survey to examine the association between Medicaid expansion and the probability to attribute part-time work or not-in-labor- force to health issues among people with family annual income no more than 138 of Federal Poverty Level, with a difference-in-differences study design. We found …

Factors That Predict Lien Payouts, Viktoria Chudsky

Theses and Dissertations

The purpose of this research is to find ways to increase Medicaid collections in order to promote citizens’ access to government sponsored programs. This research paper is written to observe which variables increase reimbursement funds that will be reinjected into Medicaid and Public Assistance programs. The study looks at client and law firm characteristics such as the settlement amount, the client’s age, how long the case has been open in the MAESTRO system for, the client’s borough of residence, and the defending law firm’s location to identify if any of these characteristics influence the amount of recoupment. The firms’ names …

The Prescribing Patterns Of Gabapentin And Pregabalin In A Medicaid Population Amid The Opioid Epidemic, Sarah Sullivan

Theses and Dissertations

OBJECTIVE: Drug overdoses continue to be the leading cause of accidental death in the United States resulting in a nationwide crisis. Opioids, many of them prescription, are now the primary cause of drug overdose related deaths. Gabapentinoids are being promoted by the Centers for Disease Control and Prevention as a safer alternative to opioids and have steadily been rising in prescribing rates. However, growing concern is mounting on the potential for gabapentinoid misuse. The goal of this dissertation was to deepen the knowledge and understanding of how gabapentinoids are currently being prescribed, with an emphasis on their co-prescribing with an …

Adverse Birth Outcomes Among Women With Physical Disabilities: A Retrospective Cohort Study In South Carolina, Iffat Nahar

Theses and Dissertations

Motherhood is precious in women’s lives. Among women, ages 21-64, 12.5% are living with a disabling condition, according to the Disability Status report: SC 2008. Although childbearing among women with disabilities is increasing, there are limited publications about the pregnancy outcomes. The objective of this study is to document the adverse neonatal outcomes of the pregnancies and to evaluate if early prenatal care is a protective factor for low birthweight and prematurity among the women with physical disabilities. This study used a retrospective cohort study design, with data from linked hospital discharge records and vital records (birth certificates) for all …

The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests, Abeer Alharbi

Theses and Dissertations

Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes …

Examination Of The Association Of Receipt Of Opioid Therapy And Lung Cancer Patient Survival Rates Among South Carolina Medicaid Recipients, Jametta Sade Magwood

Theses and Dissertations

Introduction: Lung cancer is a high pain cancer that can require the attention of clinical specialists. Already vulnerable populations, like those that inhabit rural areas, when dealing with chronic diseases, like lung cancer, need and deserve adequate medical attention. However, rural communities often lack clinical specialists and are left without the needed care. It is necessary to investigate the current availability of treatment options (medications) available to cancer patients in rural communities. Gaining this knowledge can result in economic savings and improvement of the quality of life for rural populations.

Methods: Medicaid data from 1996-2010 was used to …

Soil Arsenic And Lead Concentrations And Preterm Birth: Investigating Racial Disparities, Sources, Neighborhood Effects, And Spatial Patterns, Pamela Harley Thornton Davis

Theses and Dissertations

Preterm birth, generally defined as birth at <37 weeks of gestation, is an important public health issue that has multiple risk factors related to characteristics of both the mother and her environment. The purpose of this dissertation was to examine potential sources of spatially interpolated (kriged) environmental concentrations of arsenic (As) and lead (Pb) in residential soils and preterm birth in a Medicaid population of mothers giving birth in South Carolina (SC) from 1996-2001. The first objective was to investigate if a racial disparity existed for estimated soil As and Pb concentrations, after adjusting for proximal and distal sources of these metals (including distance and direction to industrial facilities) in a subset of SC Medicaid mothers living in areas of SC where soil samples were collected and analyzed for these metals. The second objective was to test the hypothesis that estimated soil As and Pb concentrations were associated with increased odds of early (<34 weeks) and late (34-36 weeks) preterm births in the same subset of SC Medicaid mothers, after adjusting for individual and neighborhood level risk factors, and examine if measure of neighborhood deprivation and racial residential segregation modified these associations. The third objective was to examine if early and all preterm births, aggregated at the county level, varied spatially and/or temporally in SC for all Medicaid mothers giving birth from 1996-2001 in Bayesian models.

For the first objective, black mothers had significantly higher estimated As and Pb soil concentrations than white mothers in the study population (adjusted betas were 0.12 and 0.22 for As and Pb, respectively; all p<0.006), and proximal sources of metals (e.g., percent of Census block group are covered by roads) were more strongly associated with estimated soil As and Pb concentrations than composite As and Pb releases from industrial facilities categorized by distance from and direction to Census block groups in which maternal residences were located.

For the second objective, estimated soil concentration of neither As nor Pb were associated with increased odds of early or late preterm birth after adjusting for maternal and neighborhood level risk factors. Only individual level covariates were associated with these birth outcomes, and associations were stronger for early as compared to late preterm births. Neighborhood deprivation and racial …

An Evaluation Of Prenatal Care Clinic Selection And The Association With Subsequent Process/Outcome Measures Among Medicaid Beneficiaries, Lynn Vanderwielen

Theses and Dissertations

In 2010 Medicaid financed approximately 48% of all births in the United States and nearly 30% of all births in Virginia. Due to strict state-specific eligibility criteria, many low-income women qualify for Medicaid coverage exclusively as a result of pregnancy status. As the nation moves forward with the Patient Protection and Affordable Care Act (PPACA), state-elected Medicaid expansion has the potential to expand services to women of reproductive age that would precede pregnancy events and offer continuous access to care postpartum. Despite this potential influx of newly insured women, little is known about how this population may make decisions regarding …

The Impact Of Medicaid Reform On Dental Practice Setting, Barrett W. R. Peters

Theses and Dissertations

Purpose: To assess the impact of dental Medicaid reform in Virginia on dental practice settings (private practice, corporate practice and safety net clinics). Methods: This retrospective cohort study of 16.2 million dental claims is from the Virginia Department of Medical Assistance Services, which included claims for providers participating in Virginia’s Medicaid program during a 10-year period (2002-2012). The dividing date for the reform was July 1, 2005. The outcome measure was mean claims per participating provider. A Poisson regression model was used to predict the mean number of claims per provider with the following predictors: reform period, practice setting, provider …

Differential Effects Of The Great Recession On Minority Populations, Samuel Towne

Theses and Dissertations

Times of severe economic flux may burdend individuals at differing levels. The Great Recession affected individuals differently by racial group. Vulnerable individuals who may already be burdened by economic strains and health disparities may benefit from state policies that work to improve the health and health care access of individuals. Medicaid Generosity for parents or childless adults is associated with differences in individuals' health status and reporting forgone medical care. Individuals in states that have higher levels of Medicaid eligibility defined as eligibility in relation to the percent of the Federal Poverty Level report lower levels of poor or fair …

Dental Plan Performance With Medicaid Reform In Virginia, James Reed

Theses and Dissertations

Purpose: To assess the effect of dental Medicaid reforms in the state of Virginia on dental plan performance. Methods: This project is a retrospective cohort study of 825,000 dental claims obtained from the Virginia Department of Medical Assistance Services. This cohort includes dental claims for children enrolled in Virginia’s Medicaid program from July 1, 2002 through June 30, 2008. The independent variable was enrollment pre or post policy reform with July 1, 2005 as the period dividing date. The dependent variable was dental benefit utilization measured as the average number of restorative, preventative, and total procedures. Statistical methods include Welch’s …

Examining California’S Assembly Bill 1629 And The Long-Term Care Reimbursement Act: Did Nursing Home Nurse Staffing Change?, Matthew Krauchunas

Theses and Dissertations

California’s elderly population over age 85 is estimated to grow 361% by the year 2050. Many of these elders are frail and highly dependent on caregivers making them more likely to need nursing home care. A 1998 United States Government Accountability Office report identified poor quality of care in California nursing homes. This report spurred multiple Assembly Bills in California designed to increase nursing home nurse staffing, change the state’s Medi-Cal reimbursement methodology, or both. The legislation culminated in Assembly Bill (AB) 1629, signed into law in September 2004, which included the Long-Term Care Reimbursement Act. This legislation changed the …

The Effect Of Medicaid Policy Reform On Dental Utilization Rates For Children, Matthew Winheim

Theses and Dissertations

Background: Regular access to dental services is a well-known factor in the oral health and development of children.1 As such, the United States federal government mandates each state to include dental services for children enrolled in Medicaid through the age of 21. Despite this mandate, the utilization rate of dental services among Medicaid enrolled children has remained remarkably low.2 In July 2005, Virginia implemented a sweeping Medicaid policy reform titled “Smiles for Children,” specifically aiming to increase Medicaid pediatric dental utilization rates. The purpose of this study aims to assess the effect of this 2005 policy reform on the utilization …

Treatment Outcomes And Retention In Medicaid And Non-Medicaid Orthodontic Patients, Ashkan Ghaffari

Theses and Dissertations

Medicaid orthodontic patients have been shown to miss more appointments and break more appliances than self-pay patients, indicating a greater tendency toward non-compliance. Lack of compliance during the post-treatment phase can be detrimental to retention. The purpose of this study was to determine whether there is a difference in PAR score changes between Medicaid and non-Medicaid patients during and after orthodontic treatment. PAR scores were determined using study models of 43 Medicaid and 39 non-Medicaid patients before and at the end of active treatment, and 24 Medicaid and 42 non-Medicaid patients at the end of treatment and at an average …

The Effect Of A Nominal Fee On Treatment Choices For Children Needing Dental Rehabilitation, D'Audra M. Cole

Theses and Dissertations

Objective: The purpose of the study was to determine if a co-payment resulted in a differential preference for general anesthesia (GA) or oral sedation (OS) and, if so, to examine whether age, the number of appointments, perceived risks of treatment, child's awareness during treatment, or insurance type appeared to play a role in this preference.Methods: Using a cross-sectional survey design, questionnaires were distributed to caregivers of patients in the waiting room of the Virginia Commonwealth University Pediatric Dental Clinic. Two different questionnaires were distributed randomly. Both surveys described a scenario with the need for dental treatment under general anesthesia (GA) …

Assessing The Relationship Between Socioeconomic Variables And Risk Of Overweight Among Children 6 Years Of Age, Marilyn Cochon Batan

Theses and Dissertations

Background: The percentage of overweight children has tripled in the last thirty years. Inconsistent findings are published regarding the relationship between socioeconomic variables and being overweight in childhood.Objective: To determine whether socioeconomic variables are associated with risk of being overweight among six year olds. Methods: Six year olds with BMI data were selected from the National Survey of Children's Health (n=4,362). Variables were coded and a low socioeconomic index was created. Using population weights, descriptive statistics were generated and regression was utilized to assess the relationship between socioeconomic variables and being 'at risk' for overweight. Socioeconomic variables were also compared …

Effect Of Medicaid/Schip And Wic On Oral Health Of Low-Income Children, Dahlia Naqib

Theses and Dissertations

Oral caries is the most prevalent chronic disease among US children, and disproportionately impacts those of low socioeconomic status. Studies have shown that the Special Supplemental Nutrition Program for Women Infants and Children (WIC) improves access to dental care among Medicaid children. This study investigated the impact of WIC, Medicaid, and the State Children's Health Insurance Program (SCHIP) on the prevalence of dental caries among low-income children. The 1999-2000 and 2001-2002 NHANES data were utilized for this analysis. Children 2-4 years old who participated in WIC, Medicaid, or SCHIP, or who were uninsured, and for whom both interview and complete …

Appointment Keeping Behavior Of Medicaid Vs. Non-Medicaid Orthodontic Patients, Bryan P. Horsley

Theses and Dissertations

State Medicaid programs were established to care for the poor by eliminating financial barriers and increasing their ability to be treated within the mainstream of the heath care system. The number of children eligible for Medicaid services is increasing, yet the number of Medicaid providers remains low. Health care providers cite failed appointments as being a major problem with Medicaid patients and one of the largest deterrents to participating. The purpose of this study was to determine whether a difference in appointment keeping behavior exists between Medicaid and non-Medicaid orthodontic patients. During a twelve-month period, a tally of appointments was …

A Rural Vs. Urban Analysis Of Procedures Provided To Medicaid Recipients By Pediatric, General, And Public Health Dentists In The Commonwealth Of Virginia: Fiscal Years 1994-1995, Frank Carmen Pettinato

Theses and Dissertations

Purpose: The purpose of this study was to report the distribution of procedures provided to Virginia Medicaid children by three types of dental providers in rural and urban areas. Methods: Medicaid claims filed for dental patients younger than 21 were obtained and analyzed for fiscal years 1994 and 1995. Dental providers were categorized according to their practice type: general practice (GP), pediatric (PD) and public health (PH) dentists. Each type of practice was categorized as practicing in a Metropolitan, Urban, Rural or Completely Rural location and evaluated for percentages of preventive, diagnostic, and corrective services provided.Results: The number of procedures …