Health and Medical Administration Commons^™

Health Care Crisis: Potential Solutions To The Perverse Reimbursement System And The Fragmented Care Delivery System, Britney Ryan

Senior Theses and Projects

The American health care system is in a serious crisis. We have very high health care expenditures, but receive very low quality health outcomes. It is time for America to address the problems of our health care system head on, starting with the fee-for-service reimbursement structure and the fragmented care delivery system. This paper provides a comparative analysis of the systems in place in France and Japan to draw conclusions about possible solutions for the United States. This paper also discusses successful health care institutions within America and why they work. Finally, the potential results of the Affordable Care Act …

Evidence-Based Decision Making To Improve Public Health Practice, Ross C. Brownson, Jonathan E. Fielding, Christopher M. Maylahn

Frontiers in Public Health Services and Systems Research

Despite the many accomplishments of public health, greater attention on evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about 15 years ago. 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 in decision making, conducting sound evaluation, and disseminating what is learned. Core competencies for EBPH are emerging, including not only technical skills but also attention to administrative practices in public health agencies. To better bridge evidence and practice, the concepts …

Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Sara Rosenbaum, Maureen Byrnes, Amber M. Rieke

Frontiers in Public Health Services and Systems Research

The Patient Protection and Affordable Care Act (ACA) revises federal tax exemption standards for nonprofit hospitals by clarifying and augmenting their community benefit obligations. The ACA amendments followed the 2009 launch of Schedule H – the form on which hospital community benefit, financial, and institutional activities are reported and which must be appended to each facility’s annual Form 990 nonprofit institution information return. Schedule H effectively creates a nationwide, standardized, facility-specific, transparent, and fully publicly accessible reporting system covering the nation’s more than 2,900 nonprofit hospitals. Schedule H delineates financial assistance and bad debt, and requires identification of community health …

Lessons From The Trenches: Meeting Evaluation Challenges In School Health Education, Michael Young, George Denny, Joseph Donnelly

Department of Public Health Scholarship and Creative Works

BACKGROUND: Those involved in school health education programs generally believe that health education programs can play an important role in helping young people make positive health decisions. Thus, it is to document the effects of such programs through rigorous evaluations published in peer‐reviewed journals.

METHODS: This paper helps the reader understand the context of school health program evaluation, examines several problems and challenges, shows how problems can often be fixed, or prevented, and demonstrates ways in which challenges can be met. A number of topics are addressed, including distinguishing between curricula evaluation and evaluation of outcomes, types of evaluation, identifying …

El Dengue En Puerto López La Incidencia Y El Nivel De Conocimiento De La Gente Sobre Las Enfermedades Transmitidas Por Los Mosquitos, Mckenzie Momany

Independent Study Project (ISP) Collection

This study took place in Puerto López, Manabí, Ecuador and focuses primarily on the level of knowledge the townspeople have about dengue and how it is transmitted. It also looks at the incidence of dengue in the town and across neighborhoods. In order to carry out this study, I spent a month living in the coastal town of Puerto López and interviewed 50 townspeople – 10 in each of the five neighborhoods of Jonas Gonzalez, Miraflores, Luís Gencón, San Alejo, and the central neighborhood. Interviewees were questioned about their past history of dengue, as well as their knowledge of the …

Relationships And Context As A Means For Improving Disease Prevention And Sexual Health Messages, Lisa D. Lieberman

Department of Public Health Scholarship and Creative Works

In many ways, the HIV epidemic changed the discourse about sex in the United States and worldwide (Ehrhardt, 1992; Everett, 1986) and continues to drive approaches to sex education. After a period of rapid growth in the late 1980s (approximately 150,000 new infections per year), by the late 1990s, HIV rates in the United States slowed to some 40,000 new infections annually (Centers for Disease Control and Prevention [CDC], 2001), and new HIV infections continue to hover around that number. The first successful examples of behavior change that resulted in decreased HIV transmission emerged from …

Do No Harm: Perceptions Of Short-Term Health Camps In Nepal, Dena Seabrook

Independent Study Project (ISP) Collection

Short-term health camps are a growing form of delivering health care services to needy populations. Often these camps, usually lasting around 2 weeks, are led by I/NGOs in developing nations like Nepal and are staffed with volunteers from the Global North. These camps are largely ungoverned, and there are no evaluative techniques in place to monitor the effectiveness of the work done, raising concerns about the unintended consequences of short-term health camps camps. Nepal is particularly vulnerable to this issue because of the vast number of I/NGOs currently operating within its boundaries.

This research sought to expand the conversation surrounding …

Understanding Social Marketing In A Not-For-Profit Ngo Setting: An Internship With Pace In Eastern Uganda, Veronica L. Tuerffs

Independent Study Project (ISP) Collection

The organization PACE (Programme for Accessible health, Communication and Education) focuses on generating a positive health impact throughout Uganda by the means of social marketing and other proven, evidence based techniques. An internship with the organization took place over the course of six weeks and was conducted under the A2L (Access to Life) program which is located in four of the country’s eastern districts. The focus of the health and sales communication internship was the implementation of PACE’s marketing scheme on their life-saving products and how the products and organization are perceived.

Any of the information gathered during this time …

The Evolution Of College Health: A Story Of Education For Justice, Raymond Quirolgico

Raymond Quirolgico

Health has gained prominence in the public consciousness as a matter of security and equity. Therefore the need for the health promotion profession to orient itself in terms of social justice and not simply biomedical diagnostics is critical. This session will weave together a personal narrative of transitional journeys with original research about ACHA’s organizational evolution and cross-disciplinary theories and institutionally relevant practices to highlight the challenge of public health in this modern leadership context.

A Case Study Of Primary Healthcare Services In Isu, Nigeria, Raymond Ogu. Chimezie

Walden Dissertations and Doctoral Studies

Access to primary medical care and prevention services in Nigeria is limited, especially in rural areas, despite national and international efforts to improve health service delivery. Using a conceptual framework developed by Penchansky and Thomas, this case study explored the perceptions of community residents and healthcare providers regarding residents' access to primary healthcare services in the rural area of Isu. Using a community-based research approach, semistructured interviews and focus groups were conducted with 27 participants, including government healthcare administrators, nurses and midwives, traditional healers, and residents. Data were analyzed using Colaizzi's 7-step method for qualitative data analysis. Key findings included …

The Influence Of Community Support Services In Reducing Potentially Preventable Readmissions, Camille Rose Bash

Walden Dissertations and Doctoral Studies

Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this …

Physician Decision Criteria Regarding Omega-3 Dietary Supplements, Warren P. Lesser

Walden Dissertations and Doctoral Studies

American Heart Association officials and other expert cardiologists recommend omega-3 (n-3) dietary supplementation for the secondary prevention of cardiovascular disease, a prevalent health problem in the United States. Physicians' lack of understanding of possible n-3 preventive health benefits results in underprescribing n-3 dietary supplements and lower n-3 dietary supplement product sales. N-3 dietary supplement marketers do not understand physician n-3 prescribing decision criteria enough to optimize high-impact communication to physicians to increase n-3 dietary supplement product use. The purpose of this phenomenological research study was to improve n-3 marketers' understanding of how physicians reach decisions to prescribe or recommend products …

Learning Style Needs And Effectiveness Of Adult Health Literacy Education, Leah A. Grebner

Walden Dissertations and Doctoral Studies

Low health literacy impacts an individual's ability to comprehend communication from healthcare providers, reduces access to healthcare, and contributes to increased mortality. The purpose of this study was to evaluate the impact of learning style on adult health literacy education. The health belief model, protection motivation theory, the transtheoretical model, and social cognitive theory were used to analyze the data in this study, and to further develop effective health literacy education. The research questions addressed the effectiveness of educational intervention adjusted to their appropriate learning style in comparison to a standardized health literacy intervention and potential difference, according to type …

An Examination Of Awareness Of Over-The-Counter Nonsteroidal Anti-Inflammatory Drugs And Adverse Events, Michelle Popa

Walden Dissertations and Doctoral Studies

The elderly population is among the fastest growing populations in the United States. Finding and consuming medications safely and effectively are challenging endeavors for this population. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a widely consumed class of medications among the elderly population, with 70% of individuals consuming over-the-counter (OTC) NSAIDs once a week and 34% using them daily. The purpose of this quantitative study was to determine whether (a) patients are aware of the risks associated with the consumption of NSAIDs, and (b) there are differences in awareness based upon specific demographic characteristics and levels of patient-physician communication. The health belief …

Care Coordination, Family-Centered Care And Functional Ability In Children With Special Health Care Needs In The United States, Madeline Marti-Morales

Walden Dissertations and Doctoral Studies

Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children's functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, …

Experiences Of Older African American Women With Breast Cancer Screening And Abnormal Mammogram Results, Marshalee George

Walden Dissertations and Doctoral Studies

Even with access to well-known breast cancer treatment centers, older African American women continue to have higher breast cancer mortality compared to their European American counterparts. Researchers have theorized relationships among diagnostic delay, socioeconomic status (SES) factors, beliefs, culture, and breast cancer mortality in African American women ages 40 to 64, but these same relationships among African American women ages 65 to 80 have not been investigated. The purpose of this qualitative study was to describe older African American women's experiences with abnormal mammograms. The quality-caring model and critical race theory were used through narration to show the association of …

Chhs November E-Newsletter, College Of Health And Human Services, Western Kentucky University, Vashon S. Wells, Editor

College of Health & Human Services Publications

No abstract provided.

Colloquium - Gender, Law And Health Care: New Perspectives For Teaching And Scholarship: The Role Of Gender In Law And Health Care, Karen H. Rothenberg

Karen H. Rothenberg

No abstract provided.

Issues For Dsm-V: The Role Of Culture In Psychiatric Diagnosis, Renato D. Alarcón, Anne E. Becker, Roberto Lewis-Fernández, Robert C. Like, Prakash Desai, Edward Foulks, Junius Gonzales, Helena Hansen, Alex Kopelowicz, Francis G. Lu, María A. Oquendo, Annelle Primm

Publications from Provost Junius J. Gonzales

No abstract provided.

Intake Of Coffee And Tea And Risk Of Ovarian Cancer: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

There is some evidence from case-control studies that coffee consumption might be positively associated with ovarian cancer risk, whereas the epidemiologic evidence regarding tea consumption and ovarian cancer is inconsistent. To date, there have been few prospective studies of these associations. Therefore, we examined ovarian cancer risk in association with both coffee and tea intake in a prospective cohort study of 49,613 Canadian women enrolled in the National Breast Screening Study (NBSS) who completed a self-administered food frequency questionnaire between 1980 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending …

Dietary Fiber Intake And Ovarian Cancer Risk: A Prospective Cohort Study, Stephanie A. Navarro Silvera, Meera Jain, Geoffrey R. Howe, Anthony B. Miller, Thomas E. Rohan

Department of Public Health Scholarship and Creative Works

There is some evidence from case–control studies that dietary fiber intake might be inversely associated with ovarian cancer risk, but there are limited prospective data. Therefore, we examined ovarian cancer risk in association with intake of dietary fiber in a prospective cohort of 49,613 Canadian women enrolled in the National Breast Screening Study (NBSS), who completed a self-administered food frequency questionnaire between 1980 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending between 1998 and 2000. Data from the food frequency questionnaire were used to estimate intake of total dietary …

Enhancement Of Claims Data To Improve Risk Adjustment Of Hospital Mortality, Michael Pine, Harmon S. Jordan, Anne Elixhauser, Donald E. Fry, David C. Hoaglin, Barbara Jones, Roger Meimban, David Warner, Junius Gonzales

Publications from Provost Junius J. Gonzales

Context Comparisons of risk-adjusted hospital performance often are important components of public reports, pay-for-performance programs, and quality improvement initiatives. Risk-adjustment equations used in these analyses must contain sufficient clinical detail to ensure accurate measurements of hospital quality.

Objective To assess the effect on risk-adjusted hospital mortality rates of adding present on admission codes and numerical laboratory data to administrative claims data.

Design, Setting, and Patients Comparison of risk-adjustment equations for inpatient mortality from July 2000 through June 2003 derived by sequentially adding increasingly difficult-to-obtain clinical data to an administrative database of 188 Pennsylvania hospitals. Patients were hospitalized for acute myocardial …

Commentary: Community Partnered Research: Driving Sensemaking, Managing Knowledge, And Moving Mental Health Care To New Heights, Junius J. Gonzales, Carmen Moten

Publications from Provost Junius J. Gonzales

No abstract provided.

What Is Comprehensive Sexuality Education Really All About? Perceptions Of Students Enrolled In An Undergraduate Human Sexuality Course, Eva Goldfarb

Department of Public Health Scholarship and Creative Works

The purpose of this study was to use qualitative evaluation techniques to explore the perceptions of students enrolled in undergraduate human sexuality classes regarding their expectations for the course as well as outcomes. One hundred forty-eight students were surveyed at the beginning and again at the end of the semester-long course. While pregnancy and STI prevention were considered important components of their courses, other outcomes associated with positive, healthy sexuality were given greater emphasis. Results suggest that while primary and secondary level sexuality education have been increasingly focused on abstinence-only education with a focus on pregnancy and STI reduction, this …

Casting Health Messages In Terms Of Responsibility For Dietary Change: Increasing Fruit And Vegetable Consumption, Pamela Williams-Piehota, Ashley R. Cox, Stephanie A. Navarro Silvera, Linda Z. Mowad, Sharon Garcia, Nicole A. Katulak, Peter Salovey

Department of Public Health Scholarship and Creative Works

Objective

To compare the effectiveness of messages emphasizing the importance of either personal or social responsibility for dietary behavior change in increasing fruit and vegetable intake.

Design/Setting

Randomly assigned individually or socially oriented messages were delivered at baseline, 1 week, and 2 and 3 months later. Telephone surveys were conducted at baseline and 1 and 4 months later.

Participants

528 callers to a cancer information hotline who were not meeting the “5 A Day” dietary recommendation.

Interventions

A brief telephone-delivered message and 3 mailings of pamphlets and promotional items encouraging fruit and vegetable intake that emphasized either personal or social …

Race, Gender, And Partnership In The Patient-Physician Relationship, Lisa Cooper-Patrick, Joseph J. Gallo, Junius Gonzales, Hong Thi Vu, Neil R. Powe, Christine Nelson, Daniel E. Ford

Publications from Provost Junius J. Gonzales

Context Many studies have documented race and gender differences in health care received by patients. However, few studies have related differences in the quality of interpersonal care to patient and physician race and gender.

Objective To describe how the race/ethnicity and gender of patients and physicians are associated with physicians' participatory decision-making (PDM) styles.

Design, Setting, and Participants Telephone survey conducted between November 1996 and June 1998 of 1816 adults aged 18 to 65 years (mean age, 41 years) who had recently attended 1 of 32 primary care practices associated with a large mixed-model managed care organization in an urban …

Functioning And Well-Being Of Patients In A Consultation-Liaison Psychiatry Clinic, Steven A. Epstein, Junius Gonzales, Patricia Stockton, David M. Goldstein, Bonnie L. Green

Publications from Provost Junius J. Gonzales

Outpatient consultation-liaison (C-L) psychiatry clinics are valuable settings for research and teaching endeavors. However, little is known about psychiatric symptoms and health status of persons treated in such settings. In this study, 80 persons seen in an outpatient C-L psychiatry clinic were compared with 100 persons seen in a mood disorder clinic on a variety of self-report instruments. Outpatient C-L clinic patients were found to have significantly poorer health status than mood clinic patients on the following domains as measured by the RAND instrument: general health perception, pain, physical functioning, and role functioning due to physical problems. Both groups had …

Colloquium - Gender, Law And Health Care: New Perspectives For Teaching And Scholarship: The Role Of Gender In Law And Health Care, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

Mental Disorders In Primary Care Services: An Update, Junius Gonzales, Kathryn M. Magruder, Samuel J. Keith

Publications from Provost Junius J. Gonzales

Frank mental disorders, such as depression and panic disorder, are prevalent in primary care; they cause people substantial suffering and interfere with daily functioning. Even subthreshold or "subsyndromal" conditions, with fewer symptoms than necessary for making a diagnosis, cause substantial morbidity. Recent literature on mental disorders in primary care, where many, if not most, people with mental health problems are seen, is reviewed with focus on recognition and diagnosis issues, management of these problems in primary care, obstacles to accurate diagnosis and appropriate treatment, and prevention issues. In addition to a review of recent research, there is an effort to …

Rust V. Sullivan And The Control Of Knowledge, Dorothy E. Roberts

All Faculty Scholarship

No abstract provided.