Health and Medical Administration Commons^™

Editorial Comment: Cost-Effectiveness Analysis For Prioritization Of Limited Public Health Resources - Tuberculosis Interventions In Texas, Kaja M. Abbas

Frontiers in Public Health Services and Systems Research

Public health departments have limited evidence to understand and analyze the costs and benefits of different health programs, including tuberculosis control and prevention programs. The study by Miller et. al addresses this challenge to estimate costs and benefits of tuberculosis prevention programs in Texas and identify cost-effective diagnostic and treatment combinations, thereby improving the evidence-based decision making power of the public health departments.

Editorial Comment: Differences In Definitions Of Ebph And Evidence: Implications For Communication With Practitioners, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Through interviews of 12 members of an expert panel – importantly, involving both practitioners and researchers/academicians – Aronson and colleagues sought to understand how evidence-based public health (EBPH) is defined, what counts as “evidence”, and what EBPH actually looks like when operationalized in a local health department. What Aronson and colleagues have shown us is how critical it is that in both creating and implementing EBPH, especially in practice-based research, practitioner and researcher/academician develop a shared understanding of EBPH before the dance begins, especially for practice-based research.

Differences In Definitions Of Ebph And Evidence: Implications For Communication With Practitioners., Robert E. Aronson, Kay Lovelace, Mark Smith, Gulzar H. Shah

Frontiers in Public Health Services and Systems Research

In this study, we interviewed twelve members of an expert panel to elicit their views on Evidence-based Public Health (EBPH), including how they define EBPH, what constitutes “evidence”, and what LHDs do that can be described as EBPH. Telephone interviews lasting 60 minutes were recorded and transcribed for basic content analysis. Experts differed in their definitions of EBPH and their views of what constitutes evidence. Definitions of EBPH ranged from the adoption and implementation of rigorously tested interventions to the application of evidence to decision making for population health improvement. Views on what constitutes evidence also varied, from strict “evidence …

Integrating Housing & Health: A Health-Focused Evaluation At Bud Clark Commons, Core The Center For Outcomes Research & Education Providence Health & Services

Articles, Abstracts, and Reports

No abstract provided.

Electronic Health Record Documentation: Is It An Accurate Indicator Of Quality Of Care For Mechanically Ventilated Patients?, Joetta Powell

Applied Research Projects

Background: Ventilator associated pneumonia is one of the leading hospital acquired infections associated with increased mortality and lengths of stay in mechanically ventilated patients.

Hypothesis: It is hypothesized that the introduction of chlorhexidine gluconate will show reduction in the incidences of ventilator associated pneumonia and a greater reduction with tooth brushing vs oral swabbing. It is also hypothesized that the electronic health record will provide more evidence of quality of care than an external EHR sources.

Methods: The non-randomized, non-sampled population included 98 patient records that met the inclusion criteria. The external tool, Automated Vent Bundle tool provided information as …

Annual Report 2013, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2013 calendar year, and provides a snapshot of our participants and resources.

National Spending For Long-Term Services And Supports (Ltss), 2012, Carol O'Shaughnessy

National Health Policy Forum

Long-term services and supports (LTSS) for the elderly and younger populations with disabilities are a significant component of national health care spending. In 2012, spending for these services was $219.9 billion (9.3 percent of all U.S. personal health care spending), almost two-thirds of which was paid by the federal-state Medicaid program. This publication presents data on LTSS spending by major public and private sources.

Telehealth: Into The Mainstream?, Lisa Sprague

National Health Policy Forum

Teleheath, and its subset telemedicine, extend across a range of technologies allowing patients to seek diagnosis, treatment, and other services from clinicians by electronic means. Telephone, videoconferencing, iPads, and apps are all employed. In its most established form, hospitals and medical centers use telehealth to reach patients in underserved rural areas. Proponents of telehealth suggest it can relieve medical workforce shortages; save patients time, money, and travel; reduce unnecessary hospital visits; improve the management of chronic conditions; and improve continuing medical education. But telehealth also faces ongoing challenges. States require physicians to be licensed in each state where they treat …

Diffusion Theory And Knowledge Dissemination, Utilization And Integration, Lawrence W. Green, Judith M. Ottoson, César García, Robert A. Hiatt, Maria L. Roditis

Frontiers in Public Health Services and Systems Research

Part of the Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, Health Policy Commons, Health Services Administration Commons, Health Services Research Commons, and the Public Health Education and Promotion Commons

Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners …

Community Health Assessment By Local Health Departments: Future Questions, Kay Lovelace

Frontiers in Public Health Services and Systems Research

This "Letter to the Editor" is a response to the article "Community Health Assessment by Local Health Departments: Presence of Epidemiologist, Governance, and Federal and State Funds are Critical" published in volume 2, issue 6 of this journal. It considers how LHDs develop CHAs in complex jurisdictions, the roles of other professionals in the development of CHAs, and the conduct, quality, and use of CHAs.

Diffusion Theory And Knowledge Dissemination, Utilization And Integration, Lawrence W. Green, Judith M. Ottoson, César García, Robert A. Hiatt, Maria L. Roditis

All Faculty Scholarship for the College of the Sciences

Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners in decision making, conducting sound evaluation, and disseminating what is learned. The usual application of these principles has overemphasized the scientific evidence as the starting point, whereas this review suggests engaging the community …

Money Follows The Person (Mfp) Rebalancing Demonstration: A Work In Progress, Carol O'Shaughnessy

National Health Policy Forum

In recent years, federal and state policy efforts have expanded opportunities for people to live in home- and community-based settings rather than in nursing homes and other institutions. As part of the Deficit Reduction Act of 2005, Congress enacted the Money Follows the Person Rebalancing (MFP) program, a Medicaid demonstration to help people who need long-term services and supports (LTSS) transition from nursing homes and other institutions to their own homes or other community settings. The Patient Protection and Affordable Care Act of 2010 extended the program through September 30, 2016. Now in its eighth year of operation, MFP grants …

A Medical Error: To Disclose Or Not To Disclose, Lubna Ghazal, Zulekha Saleem, Gulzar Amlani

School of Nursing & Midwifery

Human error can occur in any profession. Medical errors are most commonly occurring errors in a health care system, which are responsible to delay patient’s recovery and produce harm to patient. However, being as a health care professional, it is the requirement of professional code of ethics to do well and not to harm our patients. Historically, many of these errors were not disclosed to patients but the trend is emerging for more open disclosure of medical errors to patients and their families. The aim of this paper is to explain medical error and analyze this concept in the light …

Financial Advantages Of Hospitals’ Relationships With Accountable Care Organizations, David P. Paul Iii, Rodrigo Carmago, Thaisa Carmago, Stacie Deslich, Alberto Coustasse

Management Faculty Research

Accountable care organizations are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision-making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of the study suggest that ACOs based in a larger hospital organizations are more likely to meet CMS criteria for formation because of financial and …

Drive And Tension - Coordinated Care Organization (Cco) Case Studie, K Bruce Bayley, Lauren Broffman, Kristin Brown, Jill Rissi, Lucy Savitz

Articles, Abstracts, and Reports

No abstract provided.

The Impact Of The Electronic Medical Record On Health Information Management Staff In Two Southeastern States, Betsy W. Bradley

Applied Research Projects

Health information management (HIM) staffs in health care facilities have a long history of managing medical records in a paper format. Since 2009, with the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH), health care facilities have been rapidly changing from a paper medical record system to an electronic system. The adoption of electronic record systems has reduced or eliminated paper medical record forms which consequently changed many HIM staff’s jobs. A survey of HIM professionals was conducted in two southeastern states to determine any increase or decrease in HIM staff numbers and to identify …

Adoption Of Health Information Technology In Nursing Homes, Robert Smiley

Applied Research Projects

Background: Comprehensive knowledge about the level of Health Information Technology (HIT) adoption in Nursing Homes remains subpar to 21st century healthcare standards.

Objective: This study is to determine the factors that will aid in the adoption of HIT in Nursing Homes in the New York metropolitan area.

Methods: A pilot survey was issued to employees at three Nursing Homes to collect data that would aid in the adoption of HIT in Nursing Homes in the New York metropolitan area.

Study Design: A 16 question survey was administered to twenty-one employees at three separate Nursing Homes in the New York metropolitan …

Meaningful Use: Electronic Clinical Quality Measure Reporting, Rhonda K. Denzel

Applied Research Projects

The adoption of health information technology and the meaningful use of electronic health records is a byproduct of the 2009 American Recovery and Reinvestment Act (ARRA). One measure of ARRA is the Health Information and Technology for Economic and Clinical Health (HITECH) Act which authorizes the Centers for Medicare and Medicaid Services (CMS) to provide monetary incentives to hospitals and providers who demonstrate meaningful use of certified electronic health records (EHRs).

The electronic reporting of clinical quality measures is but one requirement for demonstrating meaningful use. Reporting of clinical quality measures has been around for 25 plus years as a …

Meaningful Use – Is It Worth It?, Karen Perry Callahan

Applied Research Projects

The world of medicine has long been an ever changing environment. The advancements and progress in both knowledge and techniques has made patient care and treatment an increasingly successful endeavor. Physicians are often eager to embrace any new technology in the medical field that allows them to better care for their patients. The problem with new medical technology is that unless this technology can be shared or related to others, it is somewhat useless.

The medical profession has been somewhat reluctant to come to terms with the use of computer technology and its many benefits. Generally embedded in the use …

An Analysis Of Waiting Time Reduction In A Private Hospital In The Middle East, Husam Asfoor

Applied Research Projects

The study of patient’s waiting time reduction have been receiving attention since the implementation of recent changes in the healthcare quality indicators. However, there is still many areas of improvement the healthcare industry could implement to improve waiting time and positively affect patient satisfaction. This is especially crucial for private healthcare organizations since it has a direct effect on their bottom-line.

In this study, we examine the patient waiting time between the registration stage and the vital sign stage at a private hospital in the Middle East country of United Arab Emirates.

By retrieving the data logs from the EHR …

Integrated System Post-Implementation Evaluation And Use Assessment, Anne L. Pedigo

Applied Research Projects

Part of a well-designed health informatics implementation process includes the mechanisms put in place to help the day-to-day operators of the systems. Continual appraisal of these methods necessitates up-to-date investigations. Understanding critical elements which support a positive transition of health information technology (HIT) within healthcare facilities is the objective of the following research. To help develop these findings, a prospective post-implementation and use assessment survey was conducted on two hospitals in Central Texas. The population studied included RN case managers, social workers and supportive staff in the Continuum of Care departments at two Scott & White Healthcare acute care facilities. …

Evaluating Quality Improvement To Improve Hiv Reporting, Nandi A. Marshall, William C. Livingood, Angela Peden, Gulzar H. Shah, Russ Toal, Dayna Alexander, Alesha Wright, Sandra Jump, Shelby Freeman, Kay Davis, Lynn Woodhouse, Kellie Penix

Frontiers in Public Health Services and Systems Research

The incorporation and evaluation of Quality Improvement into Georgia’s public health systems continues to be a focus of the Georgia Public Health Practice Based Research Network. This report describes the process, preliminary results and lessons learned from incorporating Quality Improvement into one of Georgia’s public health districts.

Efficiency In Public Health Service Delivery: An Analysis Of Clinical Health Services Provided By Local Health Departments In Florida, Simone R. Singh

Frontiers in Public Health Services and Systems Research

The ability of local health departments (LHDs) to provide public health services to improve the health of their communities depends to a large extent on their financial resources. More money by itself, however, does not necessarily translate into better population health. LHDs also have to use their resources in an efficient manner to achieve the best possible outcomes. This article first describes two techniques that LHDs can use to assess their efficiency at providing public health services: process costing, a technique used by management accountants, and stochastic frontier analysis, a technique used by economists. Using data for LHDs in Florida, …

Commentary: Moving Beyond The Numbers, Effectively Using Research To Influence Policy, F. Douglas Scutchfield, Marylou Wallace

Frontiers in Public Health Services and Systems Research

This seventh issue of Frontiers reflects the variety of PHSSR. One emerging theme, however, is the notion of public health and its role in policy and policy development. PHSSR focuses on several potential users, researchers, practitioners and policy makers. As it concerns policy makers, PHSSR delivers research that allows them to make decisions about policy change that not only influences public health status, but creates healthy conditions. In this way, PHSSR essentially influences decisions about support for public health services.

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Seeking Value In Medicare: Performance Measurement For Clinical Professionals, Lisa Sprague

National Health Policy Forum

The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to …

Health Workforce Needs: Projections Complicated By Practice And Technology Changes, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these …

Preliminary Findings From An Interventional Study Using Network Analysis To Support Management In Local Health Departments In Florida, Chin S. Park, Hado Byon, Jonathan W. Keeling, Leslie M. Beitsch, Jacqueline A. Merrill

Frontiers in Public Health Services and Systems Research

Management is the core service that integrates and coordinates essential public health services. Managers of local health departments (LHDs) are experts in practice but may not have expertise in organizational management. We conducted an evidence-based training intervention in 10 LHDs in Florida to support managers’ decision-making on organizational integration and coordination. We deployed a standard survey to collect organizational network measurements pre and post intervention. We presented results as evidence-based performance feedback and interviewed managers to document how they used the results in the context of each organization. Post intervention we found unexpected, significantly higher network centralization in daily work. …

Characteristics Of A Local Health Department Associated With The Use Of The Health Equity Index, Moira A. Lawson, Sharon Mierzwa, Michael Knapp

Frontiers in Public Health Services and Systems Research

Local health departments are tasked with understanding and addressing health inequities in the populations they serve. To meaningfully address health inequities, local health departments have identified the need for credible local data to better understand the relationship between community conditions and health outcomes. Yet, when given access to these data, we observe a very large variation in the level of interest between local health departments.

In this study, we offered Connecticut’s Local health departments access to the Health Equity Index, a web based tool that provides data on health outcomes and community conditions at the state, municipal or neighborhood levels. …