Medicine and Health Sciences Commons^™

Leaving Home Care: Decision Making, Risk Scenarios & Services Gaps In The Home Care System, Jacey J. Vaughan, Nina M. Silverstein

Gerontology Institute Publications

Home and community-based services (HCBS) enable older and disabled adults to age-in-place in their homes and communities by helping them function independently for as long as possible (Grabowski et al., 2010; Wong & Silverstein, 2011). Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home (e.g., Walker, 2010; Fox-Grage, Coleman, & Freiman, 2006). Medicaid is a major source of funding for long-term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional care (National Conference of State Legislatures & AARP, 2009), and older adults and their …

Effects Of Voluntary Public Reporting On The Nurse Sensitive Measures Of Falls And Falls With Injury In Hospitals: A Massachusetts Perspective, Patricia Noga

Graduate Doctoral Dissertations

Background: Interest and efforts in the health care industry to be transparent by collecting and publicly reporting performance measures about healthcare quality and cost has increased in recent years. The National Quality Forum (NQF) endorsed a set of 15 national quality measures for nursing-sensitive care that could be used for public accountability and quality improvement, including measures of patient falls and falls with injury. Patient falls have been among the largest category of reported incidents in hospitals, and are a serious concern for healthcare leaders and healthcare team members. In 2006, Massachusetts hospitals began voluntarily publicly reporting the nurse sensitive …

The Role Of Home Environments In Residential Adjustment Decision Making In Later Life, Kimberly Joy Stoeckel

Graduate Doctoral Dissertations

Using the nationally representative Health and Retirement Study, this research explored the multi-faceted influence of the accessibility of housing environments on the occurrence and characteristics of residential adjustments made by older adults aged 70 or older. A range of housing adjustment outcomes were examined, including home modifications and relocation into age-segregated senior housing. Analysis of the accessibility gains following relocation was also included in the empirical analyses.

The Ecological Theory of Aging (Lawton & Nahemow, 1973) provided the conceptual framework for the research. The longitudinal design of the HRS empirically advanced understanding of the key theoretical constructs by sensitizing the …

Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota For State Policymakers, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. State governments design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control.

Often, participation in the process of developing Medicaid payment policy is limited to state agency officials and providers of care and, occasionally, union representatives and state legislative staff. Invited less frequently to reimbursement policy discussions are consumer representatives. Lack of consumer involvement in the development of state rate setting systems has the potential to result in the …

A Primer For Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. To ensure that providers behave appropriately, the federal and state governments have established an extensive set of regulations that nursing homes must comply with if they are to be reimbursed for patients insured by Medicaid. Consumers exert considerable influence here by focusing on regulations and enforcement of non-compliance.

States also seek to align providers’ interests with those of other interested parties through controls and incentives built into state reimbursement systems, including with respect to facility cost and quality, access to care, payment equity, service capacity, and budgetary …

Community-University Research Partnerships For Workers' And Environmental Health In Campinas Brazil, Maria Inês Monteiro, Carlos Eduardo Siqueira, Heleno Rodrigues Correa-Filho

C. Eduardo Siqueira

Three partnerships between the University of Campinas, community, and pubLic health care services are discussed in this article. A theoretical framework underpins the critical reviews of their accomplishments following criteria proposed by scholars of community-university partnerships and community-based participatory research. The article concludes that despite the significant achievements, there still remain important barriers for their development due to performance criteria that do not value research that partner with communities, health care services, or labor unions.

Patient-Provider Communication Data: Linking Process And Outcomes In Oncology Care, Lisa Kennedy Sheldon, Fangxin Hong, Donna L. Berry

Nursing Faculty Publication Series

Overview: Patient–provider communication is vital to quality patient care in oncology settings and impacts health outcomes. Newer communication datasets contain patient symptom reports, real-time audiofiles of visits, coded communication data, and visit outcomes. The purpose of this paper is to: (1) review the complex communication processes during patient–provider interaction during oncology care; (2) describe methods of gathering and coding communication data; (3) suggest logical approaches to analyses; and (4) describe one new dataset that allows linking of patient symptoms and communication processes with visit outcomes. Challenges: Patient–provider communication research is complex due to numerous issues, including human subjects’ concerns, methods …

Heterogeneity And Data Analysis, Peter J. Taylor

Working Papers on Science in a Changing World

This working paper is a discussion paper for a September 2011 meeting of the research group of Prof. Di Cook on data visualization and exploratory data analysis at Iowa State University. A taxonomy of eleven kinds of heterogeneity is presented, followed by a set of vignettes that illustrate some of the meanings and sketch some implications, then a series of images that illustrate the heterogeneities. Several of the vignettes speak to a broad contention about heterogeneity and control: In relation to modern understandings of heredity and development over the life course, research and application of resulting knowledge are untroubled by …

Senior Transportation Abstracts: A Focus On Options, Helen Kerschner, Nina M. Silverstein

Gerontology Institute Publications

This collection of abstracts represents a publication of importance for understanding the needs, challenges, solutions, and/or every day issues related to senior transportation services. While several of the abstracts include information about senior driver safety, the collection’s primary purpose is to present a holistic approach to transportation options for older adults. Such a collection is timely because, although the practice of providing transportation to older adults is not new, research and preparation of practical informational and technical materials related to older adult transportation service needs and service delivery are quite recent.

Massachusetts Senior Legal Assistance Project Needs Evaluation: Current Demand For Legal Services, Alison Gottlieb, Lauren A. Martin, Ellen A. Bruce

Gerontology Institute Publications

The Gerontology Institute at the University of Massachusetts Boston was contracted to conduct a statewide needs assessment for the MSLAP. As agreed upon by the MSLAP Advisory Board, the focus of this assessment was to analyze the demand for services Massachusetts legal service providers have experienced recently as a means to understanding the legal needs of Massachusetts elders (age 60 and older). A second needs assessment was conducted by the Massachusetts Executive Office of Elder Affairs. That needs assessment surveyed home care workers and other elder agency personnel to gauge their assessment of elders’ legal needs in Massachusetts. Read together, …

Heterogeneity, Control, Social Infrastructure, And Possibilities Of Participation: Their Interplay In Modern Understandings Of Heredity And In Interpretation Of Science, Peter J. Taylor

Working Papers on Science in a Changing World

This working paper is a prospectus for research, writing, and engagement. It consists of vignettes, sketches of lines of inquiry, and proposals for engagement, all of which concern modern understandings of heredity and development over the life course as well as the social interpretation of science. The various items address a range of areas of science and of its interpretation: heritability studies, the social uses of genetic information, gene-by-environment interaction, personalized medicine, IQ paradoxes, racial group membership, biobanks, and life events and difficulties research. Fresh perspectives in these areas are opened up by examining the ways that research and application …

A Learning Collaborative Of Cmhcs And Chcs To Support Integration Of Behavioral Health And General Medical Care, Steven D. Vannoy, Barbara Mauer, John Kern, Kamaljeet Girn, Charles Ingoglia, Jeannie Campbell, Laura Galbreath, JüRgen UnüTzer

Steven D Vannoy

Objective: Integration of general medical and mental health services is a growing priority for safety-net providers. The authors describe a project that established a one-year learning collaborative focused on integration of services between community health centers (CHCs) and community mental health centers (CMHCs). Specific targets were treatment for general medical and psychiatric symptoms related to depression, bipolar dis- order, alcohol use disorders, and metabolic syndrome. Methods: This ob- servational study used mixed methods. Quantitative measures included 15 patient-level health indicators, practice self-assessment of resources and support for chronic disease self-management, and participant satisfaction. Results: Sixteen CHC-CMHC pairs were selected for …

Chronic Disease Self-Management Programs: Relevance For Persons With Dementia, Nina M. Silverstein, Alison S. Gottlieb

Gerontology Institute Publications

The context for this study is the work of the Healthy Brain Initiative. The CDC has established a cooperative agreement with the Alzheimer’s Association to develop and implement a multifaceted approach to look at cognitive health as a public health issue. Late in 2010, the Association commissioned a review of the major chronic disease prevention programs from a systems approach to begin to understand the source of findings that Medicare beneficiaries with Alzheimer’s and related disorders are much higher cost than those simply with a single chronic disease and no AD. This led to the conclusion that Chronic Disease Self‐Management …

The Role Of Situated Learning In Experiential Education: An Ethnographic Study Of The Knowledge-Construction Process Of Pharmacy Students During Their Clinical Rotations, Paul Difrancesco

Graduate Doctoral Dissertations

The purpose of this study was to explore learning through the social construction of new knowledge by pharmacy students engaged in experiential learning. Academic leaders and practitioners are responding to calls for the redesign of experiential education that will better prepare future pharmacists for practice. This has broad implications for educational programs and health care delivery.

Situated learning theory served as the theoretical framework for this study. The previous research of Lave and Wenger (1991); Bailey, Hughes, and Moore (2004); and others guided this research. Situated learning theory informed the research questions, which focused on understanding how students constructed knowledge …

Building A Learning Community For Dental Hygiene Faculty, Nancy Baccari

Critical and Creative Thinking Capstones Collection

Have you ever felt isolated in your work environment that left you feeling perplexed and stuck only to find out that colleagues felt the same way you did but had no idea to work around it? Through this practioner’s narrative, I journey through my struggle of teacher isolation to my action plan to make it better. Finding a way to identify my feelings, strengths and weaknesses and move towards change to improve my own work environment describes my experience in the Critical and Creative Thinking (CCT) graduate program. This new awareness changed the way I see myself as a leader …

My Journey To Develop An Innovative Approach To Unplanned Pregnancy, Gina Dillon Podolsky

Critical and Creative Thinking Capstones Collection

This paper is my personal journey in developing the non-profit Pennies for Pause that addresses the issue of unplanned pregnancy in the 18-29 populations through the use of incentives, social media, long-acting reversible contraception and the development of critical and creative thinking skills. The paper begins with an insight into my family, how my own thinking skills developed informally throughout my life, and how my personal experiences lead to the development of the 501 (c)(3) organization Pennies for Pause. It also provides insight into my casual observations that I used to create theories, which I then researched, S.C.A.M.P.E.R.E.D, and then …

The Implementation Of Conflict Management Training Into The Post Anesthesia Care Setting For Staff Nurses During Yearly Competency Day, Ann Leary

Critical and Creative Thinking Capstones Collection

I am a Nurse in Charge of the Post Anesthesia Care Unit (PACU) at Brigham and Women’s Hospital in Boston and believe conflict can be managed better by using critical and creative thinking skills. Conflicts in the healthcare workplace are common and can take on a variety of forms: nurse to physician, nurse to nurse, and nurse to patient/family. Both my research and experience suggests that nurses commonly avoid conflict, rather than engaging in collaborative problem solving about conflict, which would often lead to better solutions. The Critical and Creative Thinking Program has given me the confidence and provided the …

The Importance Of Metrics And Communication In Cafeteria School Policy, Andre Sanchez, Atreya Chakraborty

Interdisciplinary Perspectives: a Graduate Student Research Showcase

Obesity has become an epidemic amongst American youth in the 21st century, and is spreading not only into other developed nations such as the UK and Australia, but is also beginning to effect developing nations such as India (Bhardwaj, 2008). It is estimated that nationwide, childhood obesity affects around 17% of American children (Center For Disease Control, 2011). Obesity has been linked to many health disorders, including but not limited to, heart disease and diabetes. Subsequently, this rise in childhood obesity is having a severe impact on the healthcare services sector in America, with some studies suggesting childhood obesity in …

Antidepressants And Breast And Ovarian Cancer Risk: A Review Of The Literature And Researchers' Financial Associations With Industry, Lisa Cosgrove, Ling Shi, David E. Creasey, Maria Anaya-Mckivergan, Jessica A. Myers, Krista F. Huybrechts

Counseling and School Psychology Faculty Publication Series

Background

Antidepressant (AD) use has been purported to increase the risk of breast and ovarian cancer, although both epidemiological and pre-clinical studies have reported mixed results [1]–[6]. Previous studies in a variety of biomedical fields have found that financial ties to drug companies are associated with favorable study conclusions [7].

Methods and Findings

We searched English-language articles in MEDLINE, PsychINFO, the Science Citations Index and the Cochrane Central Register of Controlled Clinical Trials (through November 2010). A total of 61 articles that assessed the relationship between breast and ovarian cancer and AD use and articles that examined the effect of …

Caring For Women: A Profile Of The Midwifery Workforce In Massachusetts, Christa M. Kelleher, Dorothy Brewin

Publications from the Center for Women in Politics and Public Policy

This profile of the Commonwealth’s midwifery workforce provides state-level data on the demographic characteristics, employment context, and practice scope of midwives. It also offers a snapshot of populations served by mid-wives and public policy issues that affect midwives and midwifery care in Massachusetts. The report is based on a survey administered to midwives living and/or working in the state supplemented by in-depth interviews with five midwives, one obstetrician, and one state public health official. This report uniquely analyzes data collected from both certified nurse-midwives (CNMs) and directentry midwives (DEMs), including certified professional midwives (CPMs); this summary distinguishes between these two …

Hopelessness And Suicidal Ideation In Iraq And Afghanistan War Veterans Reporting Subthreshold And Threshold Posttraumatic Stress Disorder, Matthew Jakupcak, Katherine D. Hoerster, Alethea Varra, Steven D. Vannoy, Bradford Felker, Stephen Hunt

Steven D Vannoy

Abstract: We examined hopelessness and suicidal ideation in association with subthreshold and threshold posttraumatic stress disorder (PTSD) in a sample of Iraq and Afghanistan War Veterans (U.S., N 􏰀 275) assessed within a specialty VA postdeployment health clinic. Veterans completed paper-and-pencil questionnaires at intake. The military version of the PTSD Checklist was used to determine PTSD levels (No PTSD; subthreshold PTSD; PTSD), and endorsement of hopelessness or suicidal ideation were used as markers of elevated suicide risk. Veterans were also asked if they received mental health treatment in the prior 6 months. Veterans reporting subthreshold PTSD were 3 times more …

Report On The Chelsea School Nursing Program, Edward J. Collins, Jr. Center For Public Management, University Of Massachusetts Boston

Edward J. Collins Center for Public Management Publications

At the request of the Chelsea Public Schools, the Collins Center conducted an analysis of the school health services delivery system. The research included: (1) Review of City and School documents, (2) Interviews and on‐site visits, (3) Review of related research, and (4) Conversations with other experts. Like most urban school systems, Chelsea is facing the challenges of increased educational, social, and health care needs of its students and dwindling financial resources. Despite this, it was clear that the nurses and staff care deeply about their work and the children they serve. An innovative and cooperative network within each school …

Research To Practice: The Influential Role Of The Job Developer: Increasing Self-Determination And Family Involvement During The Job Search, Jaimie Ciulla Timmons, Ashley Wolfe

Research to Practice Series, Institute for Community Inclusion

Job developers can influence decision-making during the job search and placement process. For a study exploring the employment decisions of people with intellectual and/or developmental disabilities (IDD), researchers interviewed 16 individuals with IDD, their family members, and professionals involved in their job search. Participants were asked what factors, circumstances, or people affected their decisions about work. The job developer was consistently named the most influential person in the job-search process.

Massachusetts’ Home Care Programs And Reasons For Discharge Into Nursing Homes, Cathy M. Wong, Nina M. Silverstein

Gerontology Institute Publications

Home and community-based services (HCBS) are a range of long-term care services intended to enable older adults and persons with disabilities to “age in place” in their own homes and communities. Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home. One study concluded that 84 percent of older Americans, aged 50 years and older, want to remain in their homes for as long as possible. Medicaid is a major source of funding for long term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional, …

Conflicts Of Interest In Clinical Practice Guidelines, Lisa Cosgrove, Allen F. Shaughnessy

Counseling and School Psychology Faculty Publication Series

Clinical practice guidelines are used increasingly across medical specialties and settings, making evaluation of their utility and validity a critical public health issue. In this paper, we describe some of the challenges that specialty organizations face as they try to ensure that their guidelines are trustworthy and useful. We examine the practice guidelines for Major Depressive Disorder recently published by the American Psychiatric Association (APA), identify five sources of potential bias that may affect the guideline development process and offer suggestions based on our review. For example, even for mild depression, this guideline privileges pharmacotherapy over other interventions, despite questions …

Risk Factors For Driving Cessation Vary By Race And Ethnicity, Elizabeth Dugan, Frank Porell, Chae Man Lee

Gerontology Institute Publications

Driving is related to our identity and independence as well as allowing us to get needed goods, services, and social opportunities that enrich daily life. Yet with increasing age, the risk for developing threats to medical fitness to drive increases. Driving cessation is related to a long list of negative outcomes, such as: depression, social isolation, diminished access to health care, and diminished quality of life. We investigated risks for driving cessation, paying close attention to racial differences. This study used data from the Health and Retirement Study (HRS), 1998-2008. The study included N=46, 528 older people (age 65 and …

State Agency Promising Practice: New Hampshire - Translating Research Into A Position Statement About Integrated Employment, Jennifer Bose, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

New Hampshire’s Bureau of Developmental Services, Department of Vocational Rehabilitation, other state and local service providers, advocates, and families are committed to increasing the employment rate and the quality of employment outcomes for people with developmental disabilities. These stakeholders met to craft an employment position statement. They framed their discussions according to factors that research has found to be common to “high-performing” states in providing integrated employment opportunities. Then they developed an employment position statement that satisfied all the groups involved, and communicated their shared belief in the importance of integrated employment as a means toward community inclusion.

State Agency Promising Practice: Nevada’S Regional Forums - Creating A Shared Responsibility For Improving Employment, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

The Nevada Governor’s Council on Developmental Disabilities sought to engage community stakeholders and acquire knowledge to further the employment agenda by funding three regional summits. Using the State Employment Leadership Network’s (SELN)* selfassessment preliminary findings as a basis, the summit steering committee created a framework for summit participants. Through a rigorous planning process and comprehensive 2-day summits in three regions of the state, Nevada was able to create a shared, multistakeholder plan of action with the goal of improving the current employment support system for individuals with developmental disabilities.

State Agency Promising Practice: Oregon’S Employment Support Website - Communicating The Employment First Policy, Jennifer Bose, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

In 2009, the state of Oregon adopted its Employment First policy. When Oregon’s Office of Developmental Disabilities Services (DDS) decided to promote the implementation of this policy, it began by updating its existing employment website. The redesigned website (http:// www.dhs.state.or.us/dd/supp_emp/) emphasizes the value of integrated employment over other outcomes, and the importance of building community-wide conversations, with the goal of achieving integrated employment for people with developmental disabilities. The website shares the value of integrated employment with all targeted audiences by highlighting resources and illustrating employment successes. It was also designed to share information on the Oregon’s progress and concrete …

Suicide-Related Discussions With Depressed Primary Care Patients In The Usa: Gender And Quality Gaps. A Mixed Methods Analysis, Steven D. Vannoy, Lynne S. Robins

Steven D Vannoy

Objective: To characterise suicide-risk discussions in depressed primary-care patients. Design: Secondary analysis of recordings and self reports by physicians and patients. Descriptive statistics of depression and suicide-related discussion, with qualitative extraction of disclosure, enquiry and physician response. Setting: 12 primary-care clinics between July 2003 and March 2005. Participants: 48 primary-care physicians and 1776 adult patients. Measures: Presence of depression or suicide-related discussions during the encounter; patient and physician demographics; depression symptom severity and suicide ideation as measured by the Patient Health Questionnaire (PHQ9); physician’s decision-making style as measured by the Medical Outcomes Study Participatory Decision-Making Scale; support for autonomy as …