Medicine and Health Sciences Commons^™

What Does A Successful, Sustainable Telemedicine Program Look Like? An Inside View Of Six Telemedicine Programs In Maine, Edwina Ducker

Muskie School Capstones and Dissertations

The purpose of this capstone is to better understand the successes and lessons learned in the development and implementation of successful programs to help guide future decision making when planning a new program. The study relies on semi-structured interviews with Telehealth forum members and staff from a select number of telemedicine programs for its primary data source. Initially, secondary data sources and members from the Maine Telehealth Forum were used to inform the development of the list of programs to be interviewed. The programs interviewed include; a behavioral health, two specialties, a home health, a primary care, and a hospital …

Adults With Intellectual Disability Or Autism Spectrum Disorder. Executive Summary, Kimberly I. Snow Mhsa, Ba, Stuart Bratesman Mpp, Taryn Bowe, Julie T. Fralich Mba

Disability & Aging

This chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

Multiple Roles Of Medicaid ...And The Administrative Capacity To Support Them, Eileen Griffin Jd

Disability & Aging

Slides presented at the NAMD 2014 Fall Conference, November 4, 2014

Effects Of 5-Aza-2' Deoxycitidine And Sulforaphane On Major Histocompatibility Complex (Mhc) Classes I And Ii Surface Expression In Human Acute T-Cell Leukemia Cell Jurkat, Ali Salam Abdullah Ms

All Student Scholarship

The immune system cells recognize and kill cancer cells by engaging the tumor antigens on the surfaces of cancer cells presented by the Major Histocompatibility Complex (MHC). Cancer cells can escape from immune system cells recognition and/or killing by down-regulating the MHC expression through genetic or epigenetic mechanisms.

Mainecare Health Homes Enrollment In The First Year Of Implementation, Kimberley S. Fox Mpa, Carolyn E. Gray Mph, Katherine Rosingana

Population Health & Health Policy

The MaineCare Health Homes Initiative is designed to improve care coordination for MaineCare members with complex chronic medical conditions. The program is being implemented in two stages: Health Homes (HH), which began in January 2013, focuses on members with chronic health conditions. Behavioral Health Homes (BHH), which began in April 2014, is designed to meet the needs of people with Severe Mental Illness (SMI) or Serious Emotional Disturbances (SED).

The HH first stage builds off the State’s existing multi-payer Patient Centered Medical Home (PCMH) Pilot project and Medicare Advanced Primary Care Practice (MAPCP) Demonstration by providing addon payments to qualifying …

A Review Of Mental Health Rehabilitation Technician Qualifications And Training Procedures, Kimberly I. Snow Mhsa, Ba, Nadine Erdis Msw, Janice Daley Msw

Disability & Aging

This report was prepared by Kimberly Irvin Snow, Nadine Edris, and Janice Daley of the University of Southern Maine's Muskie School of Public Service and submitted to the Maine Department of Health and Human Service, Office of Substance Abuse and Mental Health Services. Results of this report were also presented in a webinar on November 21, 2014.

The authors investigated the training and certification processes used by other states for their mental health case management workforce. Ten states were selected for indepth comparative review because they provide a certification process for case managers, provide case management services similar to those …

Using Chipra Immunization Measures For Primary Care Quality Improvement: Leveraging Registry Data From The State Of Maine’S Immunization Information System To Calculate Practice-Level Quality Measures, Kyra Chamberlain

Muskie School Capstones and Dissertations

This report describes key challenges and successes of a federally-funded, cross-organizational effort to use registry data from the State of Maine’s Immunization Information System to calculate childhood and adolescent immunization measures in support of a nine-month, multi-practice learning collaborative which resulted in significant increases in immunization rates and adoption of recommended immunization-related office system procedures. Also highlighted are lessons learned about promoting the use of standardized immunization measures for quality improvement (QI), supporting primary care practices in using and understanding data for QI activities, and emphasizing the value of public-private collaboration in achieving shared goals.

Profile Of Rural Residential Care Facilities: A Chartbook, Jennifer D. Lenardson Mhs, Eileen Griffin Jd, Zachariah T. Croll Mph, Erika C. Ziller Phd, Andrew F. Coburn Phd

Long Term Services and Supports

Section I examines differences in rural and urban RCF characteristics. Section II explores differences in the characteristics and functional status of RCF residents. Section III profiles the services provided by rural and urban RCFs and Section IV examines rural-urban differences in admission and discharge policies and how these might reflect options for aging-in-place in rural and urban RCFs. The final section discusses policy implications for providing residential care in rural areas as part of a broader continuum of LTSS services.

Implications Of Rurality And Psychiatric Status For Diabetic Care Use Among Adults With Diabetes, Jean A. Talbot Phd, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, David Hartley Phd

Access / Insurance

This research examined patterns of diabetic preventive care use among adults with diabetes, to determine whether these patterns varied according to respondents’ rural/urban residence or psychiatric status (i.e., the presence/absence of a mental health diagnosis). Specifically, we considered whether rural people with diabetes are less likely than urban peers to use diabetic preventive services; whether having a mental health diagnosis affects preventive service use among diabetics; and, whether rural/ urban differences in service use vary depending on the presence or absence of a mental health diagnosis.

Substance Abuse Trends In Maine: State Epidemiological Profile 2014, Tim Diomede

Muskie School Capstones and Dissertations

This report takes into account the primary objectives of the Office of Substance Abuse and Mental Health Services (SAMHS): to identify substance abuse patterns in defined geographical areas, establish substance abuse trends, detect emerging substances, and provide information for policy development and program planning. It also highlights all the prevention priorities identified in the SAMHS strategic prevention plan: underage drinking, high-risk drinking among 18-25 year olds, misuse of prescription drugs among 18-25 year olds, and marijuana use in 12-25 year olds; as well as monitors the progress being made to address these priorities. This report includes data available through December …

Fact Sheet #3: How Do Parents Rate Dental Services For Children In Mainecare?, Jean A. Talbot Phd, Mary Lindsey Smith Phd, Msw, Kimberley S. Fox Mpa

Population Health & Health Policy

The annual Survey of Children Served by MaineCare, which collects an abundance of data on the experiences of MaineCare families, provides important information on how parents evaluate the dental care that their children receive.

Fact Sheet #2: How Do Mainecare Providers Perform On Childhood Screening And Prevention?, Jean A. Talbot Phd, Mary Lindsey Smith Phd, Msw, Kimberley S. Fox Mpa

Population Health & Health Policy

The annual Survey of Children Served by MaineCare, which collects a wealth of data on the experiences of MaineCare families, examines the extent to which MaineCare providers follow Bright Futures guidelines during well-child visits. This fact sheet presents findings on Bright Futures adherence from the 2013 survey.

An Assessment Of The Health Needs Of Maine Veterans And Their Access To Veterans Administration Health Care Services, Kristin Brawn

Muskie School Capstones and Dissertations

On a state level, only a few assessments have been conducted, which indicate that Maine veterans are also experiencing similar mental and physical health issues; however, it does not appear that the adequacy of Maine’s VHA services to meet the needs of Maine’s veterans has been comprehensively evaluated. It is unknown whether the physical and mental health needs of Maine’s veterans are currently being met. Therefore, this project proposes to determine if there is a similar problem among Maine’s veterans in regard to health issues and lack of access to VHA health services, as has been reported at the national …

Integrated Care Management In Rural Communities, Eileen Griffin Jd, Andrew F. Coburn Phd

Mental Health / Substance Use Disorders

No abstract provided.

Integrated Care For Older Adults In Rural Communities, Eileen Griffin Jd, Andrew F. Coburn Phd

Mental Health / Substance Use Disorders

Recognizing that traditional models of health care delivery and payment often produce fragmented and costly care and poor outcomes for those with the highest needs, many reforms under the Affordable Care Act (ACA) focus on realigning payment incentives and integrating care. These reforms presuppose the existence of supporting infrastructure and capacity, including dedicated care management staffing and health information technology and exchange. With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), this brief reviews the opportunities and challenges these reform initiatives present for rural communities: How easily …

Strategic Planning In The Non Profit Sector: Creating A Strategic Plan For Affinity 2014-2017, Emilee Taplin-Lacey

Muskie School Capstones and Dissertations

The purpose of engaging in the creation of a strategic plan for Affinity is to integrate knowledge acquired through participation in the Public Policy and Nonprofit Management Master’s Degree program at the Muskie School of Public Service. In addition, my facilitation of a strategic planning process for Affinity is meant to meet the requirements of graduation and represents my capstone project in this regard.

Rural Residents More Likely To Be Enrolled In High-Deductible Health Plans, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

Access / Insurance

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance …

High Deductible Health Insurance Plans In Rural Areas, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, Andrew F. Coburn Phd

Access / Insurance

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance …

Fact Sheet #1: How Family-Centered Is Mainecare?, Jean A. Talbot Phd, Mary Lindsey Smith Phd, Msw, Kimberley S. Fox Mpa

Population Health & Health Policy

Parent reports on family experiences of care can provide health plans, systems and providers with crucial information on their performance in the domain of family-centeredness. The Maine Department of Health and Human Services (DHHS) conducts an annual survey to gather this kind of information for MaineCare, the state of Maine’s Medicaid and Child Health Insurance (CHIP) program.

Blood Pressure Monitoring Of Hypertensive Patients In Primary Care: Barriers And Facilitators To Ambulatory, Office, And Home Blood Pressure Monitoring In The Context Of The Triple Aim, Elizabeth Andrews

Muskie School Capstones and Dissertations

Hypertension represents a population health issue in that many patients are misdiagnosed and over-or-under medicated. Research has indicated that overestimating the true blood pressure by 5 mmHg leads to over 30 million Americans being inappropriately treated with blood pressure medication (Handler, 2009). Blood pressure measurements taken in the office are often inaccurate due to patient behaviors, improper technique, and observer errors, yet providers are still using this method to diagnose hypertension. Therefore, considering other methods of blood pressure for the diagnosis and management of hypertension is important to the healthcare quality for millions of Americans.

The main objective of this …

Between The Lines: Somali Women And Medical Interpretation Experiences, Amin Sheikh

Muskie School Capstones and Dissertations

Many studies have investigated the health care experiences of Somali women. However, there is little research that looks at Somali women’s experiences with language barriers and their language preferences. In my capstone, I explore language barriers in the health care system from the perspective of non-English speaking immigrant Somali women with children living in the Lewiston-Auburn area.

Gender Differences Between Overall Resistance Work And Overall Energy Costs, Stephanie Lomasney, Amanda Lessard, Abby Steitz, Meg Bosse

Thinking Matters Symposium Archive

No abstract provided.

Pillow Talk: The Epigenetic And Physiological Effects Of Sleep Deprivation, Jennifer D. Cotter

Thinking Matters Symposium Archive

Circadian rhythms, or the 24-hour biological cycles of living cells, function as the body’s internal clock. Although circadian rhythms and sleep are very different processes, they are closely related to one another as these cycles play an important role in sleeping and waking patterns. Recent studies have shown that lack of sleep or sleep of poor quality can disrupt circadian rhythms and may actually cause cognitive disorders and memory loss, facilitate false memory production, and even alter gene expression in humans. This literature review is focused on identifying the epigenetic and physiological effects of disruptions and desynchronization in circadian rhythms …

Conservative Treatment Of Anterior Cruciate Ligament Deficiency, Brandan Holmquist

Thinking Matters Symposium Archive

The purpose of this literature review is to present a simple protocol for the treatment of Anterior Cruciate Ligament deficiency for one plane athletes like some track athletes and baseball and softball designated players whom defer surgical intervention until after the season is completed.

Trends In Youth Marijuana Use: Comparison Of Maine And National Data, Macklin Gaynor

Thinking Matters Symposium Archive

• The implications of recent medical marijuana laws and their impact on youth are poorly understood. • New research has shown teen perceptions of marijuana’s harmfulness are at their lowest levels in 20 years. • It is unclear if these shifting perceptions will result in increased usage.

Conservative Treatment For Meniscus Rehabilitation, Nicole Spencer, Julie Willis

Thinking Matters Symposium Archive

The purpose of this review is to produce a nonsurgical treatment plan for meniscus injuries using therapeutic exercise, to eventually prepare the athlete for return to play after the sustained injury. Using therapeutic exercises, a rehabilitation program can be created for athletes who do not wish to pursue surgery. The treatment plan was designed for a soccer player who had a partially torn meniscus.

How Spinocerebellar Ataxia Affects The Body And The Family, Anthony Simpson

Thinking Matters Symposium Archive

This poster project is a literature review that examines the causes, effects, and research being done to treat and prevent some forms of Ataxia. Ataxia is a disorder of the nervous system that causes tremors, and problems with walking, balance, memory, and mood disorders. There are many forms of Ataxia, all affecting various genes, but all have the devastating effect of the loss of the ability to move around without aid. Mental ability is not affected, yet the patient loses the ability to control their body. Most forms are caused by genetic mutations. For example, Fragile X associated tremor/ataxia syndrome …

A Difference In Aerobic And Anaerobic Energy Costs During Weightlifting, Sarah Shapiro, Deline Dwelly

Thinking Matters Symposium Archive

Energy expenditure is usually estimated by total oxygen uptake. However, with weightlifting, very little oxygen is utilized during the lift. The majority of oxygen uptake happens during recovery (Excess Post-Exercise Oxygen Consumption, EPOC). The purpose of this study is to determine the significance of the anaerobic and EPOC phases during weightlifting exercises in estimation of total energy cost. We gathered data from 42 subjects (60 averaged trials) aging between 18 and 35 years. Each subject chose a comfortable weight and lifted to a cadence of 1.5 sec up and 1.5 sec down. Tests were given on two different occasions. We …

Habilitation Training Curriculum: Is It Useful?, Ryan K. Cole, Christine Wyman

Thinking Matters Symposium Archive

Alzheimer’s disease is the most common form of dementia, affecting approximately five million Americans. Paul Raia, PhD, Vice President, Clinical Services at the Alzheimer’s Association, MA/NH Chapters, developed a training curriculum called Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum. The Alzheimer’s Association’s Maine Chapter has been implementing this training in care facilities across Maine. The purpose of this project was to evaluate if this training is perceived as useful in direct care settings.A secondary goal of the project was to determine if this training should be adapted for use in other settings in which professionals of varying …

Inhibition Mechanisms Of Type 2 Diabetes, Jalise Maree Cotton

Thinking Matters Symposium Archive

Type 2 Diabetes (T2D) is the most common form of diabetes mellitus which affects approximately 8.3% of the popula@on (diabetes.org 2013). T2D is most oDen brought on by reduced sensi@vity to insulin receptors. This is thought to be caused by a muta@on in the gene Insulin Receptor Substrate-­‐ 1 (IRS-­‐1). It is the suppression of IRS-­‐1 that leads to inac@va@on of signaling molecules insulin signaling pathways causing insulin resistance (Victor D. H. et al). This literature review will focus on the major mechanisms of inhibi@on of the insulin signaling pathways.