Public Health Commons^™

Are Bay County Florida Healthcare Facilities Ready For Pama Imaging Cds Mandate?, Kelly Johnson

Applied Research Projects

The Electronic Health Record (EHR) has been a major player on the healthcare scene in recent years. Its use has ushered in a new phase of focus on quality healthcare combined with and aided by technological integration. Within this technological integration have come adjutant tools including Clinical Decision Support (CDS) tools. Among these applications are those focused on appropriate imaging by use of CDS designed according to Appropriate Use Criteria (AUC). The imaging CDS tools are available to aid the provider in selecting the appropriate imaging study for the clinical indications present. The Protecting Access to Medicare Act (PAMA) passed …

Progress Toward Eliminating Mother To Child Transmission Of Hiv In Kenya: Review Of Treatment Guideline Uptake And Pediatric Transmission At Four Government Hospitals Between 2010 And 2012., Sarah Finocchario-Kessler, Kristine F. Clark, Samoel Khamadi, Brad J. Gautney, Vincent Okoth, Kathy Goggin, Hitsystem Study Team

Manuscripts, Articles, Book Chapters and Other Papers

We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p's < 0.001). Pediatric HIV infection was halved (8.6-4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.

The Interpretive Approach As A Means Of Understanding The Misunderstood, Doreen Molloy, Joyce Hendricks, Anne Williams

Research outputs 2014 to 2021

People’s experiences of health and illness are important areas of health research and practice. The interpretive process, and more significantly the biographical approach (Denzin, 1989), is an approach in which there is a focus on personal epiphanies which shape and reflect the stories people tell of their experiences. Dolby-Stahl (1985) contends stories of personal experience sit within the genre of folklore and that the reading of such stories must take into account the social, cultural, and historical contexts which influence and give meaning to experience.

Analysis Of The Efforts Of Urban And Rural Health Systems To Achieve Accountable Care Organization Target Goals For Dilated Eye Exams In Individuals With Diabetes, Michele Gilliam

Muskie School Capstones and Dissertations

This capstone project was designed to understand and analyze the completion rates for diabetic dilated eye exams within four different health systems participating in the MaineHealth Accountable Care Organizations (ACO). This research is valuable within the current US health care climate as health care providers have sought to evaluate the cost of care in terms of their value to payers. Moreover, many providers have elected to join the ACO in order to demonstrate better outcomes, improve the cost of care and to share programmatic content and tools to standardized care. Within this capstone, system level workflows and processes were evaluated …

Analisis Kepuasan Pasien Tni Sebelum Dan Sesudah Penerapan Jkn Di Ruang Rawat Inap Kelas Ii Rs Dik Pusdikkes Kodiklat Tni Ad, Ernawati Ernawati

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Patient satisfaction is one of indicator of health care quality measurement and can be used as a benchmark for the hospital. The purpose of this study was to describe the characteristic of TNI patients who are JKN’s based on age, sex, education and rank, determine the performance of member RS DIK PUSDIKKES Kodiklat TNI AD for TNI patients with Servqual method as well as knowing the difference of services before and after impletation of JKN. This is a quantitative study with cross sectional approach using descriptive analysis and cartesian diagram. The study was conducted for 3 months on 100 patients …

Pengendalian Persediaan Obat Kemoterapi Melalui Pendekatan Analisis Abc Indeks Kritis Di Ruang Pencampuran Instalasi Farmasi Rsup Dr. Mohammad Hoesin Palembang Tahun 2015, Layla Izzatul Khuriyati

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

One of the featured services at RSMH is integrated chemotherapy services. One of the resources in support of these services is a pharmaceutical supplies including the Chemotherapy drugs are relatively expensive. In conducting the inventory control Dr. Mohammad Hoesin Hospital not classify drugs based on user value, investment value and criticality of drugs through certain methods. So in this study aims to conduct chemotherapy drug control approach ABC Analysis Critical Index in the Cytostatica Handling Room of Pharmacy Instalation RSUP Dr. Mohammad Hoesin Palembang. This study design using operational research with quantitative and qualitative descriptive analysis. The results showed that …

Rencana Pengembangan Cssd (Central Sterile And Supplies Department) Berdasarkan Kebutuhan Di Rs Meilia Tahun 2015, Lintang Kusuma Delia

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

To meet the requirements of Peraturan Menteri Kesehatan RI number 56 2014 and JKN in 2015, RS Meilia need the planning of CSSD development that refers to the literature, regulations, guidelines and standards of the Ministry of Health of Indonesia and also refers to the analysis of internal and external factors in the RS Meilia CSSD to reach an ideal CSSD. The analytical results are RS Meilia has been preparing since the beginning of the construction of the hospital to hold a separate CSSD unit. In addition, there is a problem about the distribution flow of dirty goods and sterile …

Analisis Perbedaan Tarif Rumah Sakit Dan Tarif Ina-Cbg’S Pelayanan Rawat Jalan Di Rsud Budhi Asih Jakarta Tahun 2015, Hotma Dumaris

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

There is a fundamental change of hospital’s payment system in Indonesia since the Indonesian National Health Insurance was implemented (January 2014). The former retrospective payment system was changed into prospective payment system with Indonesia Case Base Groups (INA-CBG) as expense base. This change forced hospital to propose a new efforts to adjust the rate difference between the previous hospital based-tariff system and the latter INA-CBG-based-tariff system in order to assure the health service quality. This study aims to find out hospital’s efforts to adjust the tariff difference between the hospital-based- tariff system and INA-CBG-based-tariff-system.This is a quantitative as well as …

Analisis Biaya Layanan Diabetes Melitus Dengan Komplikasi Dan Faktor Penentu Inefisiensi Penanganan Diabetes Melitus Di Rawat Inap Rsud Banyuasin Tahun 2015, Fahrul Rahman

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Since JKN was offiacially administered in general hospital on January 1st, 2014, there has been changing in hospital administration payment from the restrospective system (free for services) to the prospective system (INA-CBG’s). It is planned in 2019 that all the people in Indonesia is registered in BPJS (Universal Heath Coverage) as one of the facilities for public healt services provided by Banyuasin general hospital (RSUD Banyuasin) which ains to provide qualified services, yet still considering effiencies due to the lach of the government subsidies. This study aimed to analyze the cost and identify determinant factor in handling Diabetes Melitus with …

Analisis Perencanaan Dan Pengendalian Persediaan Obat Antibiotik Di Rsud Cicalengka Tahun 2014, Gita Gilang Kencana

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Poor planning and controlling of drug in RSUD Cicalengka has resulted excess inventory and potential Hospital losses. This operational research was using ABC Critical Index Analysis Method, Safety Stock, Economic Order Quantity (EOQ) and Reorder Point (ROP). Stock evaluation using Inventory Turnover Ratio (ITOR) was also conducted. The result of ABC Critical Index Analysis showed that were seven antibiotics need to be prioritized. The estimation of antibiotic drug in group A for year 2015 was done using Single Exponential Smoothing Method. Safety stock for Cefadroxil Kaps 500 mg (5x10) as much as 344, EOQ as much as 1476 and ROP …

Hubungan Faktor Risiko Ergonomi Dan Keluhan Cumulative Trauma Disorders Pada Dokter Gigi Di Pt. X Tahun 2014, Hany Winihastuti

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Dentist’s works have kind of risks related with Cumulative Trauma Disorders (CTDs). This research’s aim is to explain ergonomic factors and CTDs that happens to dentist. Cross sectional method is used in this research along with 44 dentis in hospitals and cliniques X as samples. The usage of RULA and MB Ruler in this research is supported the researcher to assess the work’s postures on the upper arm, forearm, wrist, neck, torso and leg.The study found that dentists who complained of CTDs as much as 72.7%. Bivariate analysis showed a relationship between the duration and the incidence of complaints CTDs …

Chemical Reactions: Marijuana, Opioids, And Our Families, Denise A. Hines Ph.D, Staci Gruber Ph.D, John F. Kelly Ph.D, Kathleen M. Palm Reed, Hilary Smith Connery M.D., Ph.D.

Mosakowski Institute for Public Enterprise

Chemical Reactions: Marijuana, Opioids, and Our Families is the seventh Massachusetts Family Impact Seminar. This seminar was designed to emphasize a family perspective in policymaking on issues related to the legalization of marijuana and managing the opioid abuse crisis in the Commonwealth. In general, Family Impact Seminars analyze the consequences an issue, policy, or program may have for families.

Access To Health Care Services For Adults In Maine [Report], Erika C. Ziller Phd

Access / Insurance

On October 17, 2016, the Maine Health Access Foundation (MeHAF) released a new research brief developed with the University of Southern Maine that found significant inequality in the ability of people in Maine to access quality health care. The authors, Barbara Leonard from MeHAF and Erika Ziller from the USM Muskie School, found that income, age and education are all closely associated with Maine people’s ability to receive appropriate and timely health care. Specifically, they found that among Maine adults 18 and older, those with family incomes less than $25,000 a year, young adults, racial and ethnic minorities, and people …

Recruiting And Retaining Individuals With Serious Mental Illness And Diabetes In Clinical Research: Lessons Learned From A Randomized, Controlled Trial., Stephanie W. Kanuch M.Ed., Kristin A. Cassidy Ma, Neal Dawson Md, Melanie Athey Ms, Edna Fuentes-Casiano Mssw, Martha Sajatovic Md

Journal of Health Disparities Research and Practice

Abstract: Recruitment and retention of individuals with serious mental illness (SMI) and comorbid diabetes mellitus (DM) in research studies can be challenging with major impediments being difficulties reaching participants via telephone contact, logistic difficulties due to lack of transportation, ongoing psychiatric symptoms, and significant medical complications. Research staff directly involved in recruitment and retention processes of this study reviewed their experiences. The largest barriers at the macro, mediator, and micro levels identified in this study were inclement weather, transportation difficulties, and intermittent and inaccessible telephone contact. Barrier work-around practices included using the health system’s EHR to obtain current phone numbers, …

Using Electronic Health Record Data To Improve Community Health Assessment, Brian E. Dixon, Jian "Frank" Zou, Karen F. Comer, Marc Rosenman, Jennifer L. Craig, P Gibson

Frontiers in Public Health Services and Systems Research

Background: Community health assessments assist health departments in identifying health needs as well as disparities, and they enable linking of needs with available interventions. Electronic health record (EHR) systems possess growing volumes of clinical and administrative data, making them a valuable source of data for ongoing community health assessment.

Purpose: To produce population health indicators using data from EHR systems that could be combined and visually displayed alongside social determinants data, and to provide data sets at geographic levels smaller than a county.

Methods: Data from multiple EHR systems used by major health systems covering >90% of the population in …

Financial Hardship From Purchasing Medications For Senior Citizens Before And After The Medicare Modernization Act Of 2003 And The Patient Protection And Affordable Care Act Of 2010: Findings From 1998, 2001, And 2015, Anthony W. Olson, Jon C. Schommer, David A. Mott, Lawrence M. Brown

Pharmacy Faculty Articles and Research

BACKGROUND: The Medicare Modernization Act of 2003 (Medicare Part D) added prescription drug coverage for senior citizens aged 65 years and older and applied managed care approaches to contain costs. The Patient Protection and Affordable Care Act of 2010 (ACA) had the goals of expanding health care insurance coverage and slowing growth in health care expenditures.

OBJECTIVES: To (a) describe the proportion of senior citizens who had prescription drug insurance coverage and the proportion who experienced financial hardship from purchasing medications in 2015, and (b) compare the findings with those collected in 1998 and 2001.

METHODS: Data were obtained in …

A Test Of The Behavioral Model Of Health Services Use On Non-Emergent Emergency Department Use, Moira Crosby Mcmanus

Health Services Research Dissertations

Even though emergency departments (EDs) were created to treat trauma and emergent cases, there has been an increase in emergency department (ED) utilization for non-emergent reasons over the past half of a century. As non-emergent utilization grows as a result of the ED becoming a prevalent substitute for primary care, overcrowding of the ED and increased wait times will continue. Additionally, unnecessary cost to both the ED and the patient will be incurred. Previous research has examined and determined various reasons and risk factors driving non-emergent ED use, among them the influence of living location and the number of non-emergent …

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

School Policy, Food And Physical Activity Environment, And Childhood Obesity, Ruicui Liu

Health Services Research Dissertations

The purpose of this study is to examine the effect of school food and physical activity environments on energy balance-related behaviors and Body Mass Index (BMI) and to simulate the effect of school-based nutrition and physical activity policies on childhood obesity prevention. Four models based on the Social Ecological Framework of childhood obesity were developed. Parameters of these models were calibrated and validated with empirical data derived from the Early Childhood Longitudinal Study – Kindergarten Class of 1998-99 and the 2003-2004 National Health and Nutrition Examination Study. The correlation between observed and simulated BMI was 0.85 for 5th grade children …

The Effects Of Job Characteristics On Home Care Workers’ Well-Being And Job Performance: Understanding The Psychosocial Effects Of Relational Care, Emily C. Franzosa

Dissertations, Theses, and Capstone Projects

Home care workers are the lowest-paid and most precarious segment of the health care industry. Although these workers provide critical, non-medical support that allows elderly and disabled individuals to remain in their homes, the workforce is highly unstable, due to low wages, a lack of supportive benefits like health coverage, paid leave and retirement support, poor working conditions and a physically and emotionally demanding workload. But a lack of consensus around the nature and value of home care has made “quality”, in terms of both jobs and care provision, difficult to define, measure or improve. While home care is a …

Pharmacy Use By Dual-Eligible Non-Elderly Veterans With Private Healthcare Insurance, Brian C. Lund, Mary E. Charlton, Alan N. West

Dartmouth Scholarship

The Veterans Health Administration (VHA) is the largest nationally integrated healthcare system in the United States, operating 168 medical centers and more than 1000 community based outpatient clinics. However, many veterans seek care outside the VHA system, particularly when they are also covered by state or federal programs such as Medicare or Medicaid, or have access to private health insurance, often through employment. Concerted efforts have been made to facilitate communication and coordinate care between VHA and private sector healthcare, but concurrent use of these systems adds to an already fragmented U.S health care system.

Dying Among Older Adults In Switzerland: Who Dies In Hospital, Who Dies In A Nursing Home?, Xhyljeta Luta, Radoslaw Panczak, Maud Maessen, Matthias Egger, David Goodman

Dartmouth Scholarship

Background: Institutional deaths (hospitals and nursing homes) are an important issue because they are often at odds with patient preference and associated with high healthcare costs. The aim of this study was to examine deaths in institutions and the role of individual, regional, and healthcare supply characteristics in explaining variation across Swiss Hospital Service Areas (HSAs).

Methods: Retrospective study of individuals ≥66 years old who died in a Swiss institution (hospital or nursing homes) in 2010. Using a two-level logistic regression analysis we examined the amount of variation across HSAs adjusting for individual, regional and healthcare supply measures. The outcome …

Decreasing Patient Cost And Travel Time Through Pediatric Rheumatology Telemedicine Visits., Elizabeth A. Kessler, Ashley K. Sherman, Mara L. Becker

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: There is a critical shortage of pediatric rheumatologists in the US. Substantial travel to clinics can impose time and monetary burdens on families. The aim of this study was to evaluate the cost of in-person pediatric rheumatology visits for families and determine if telemedicine clinics resulted in time and cost savings. Factors associated with interest in telemedicine were also explored.

METHODS: Surveys were offered to parents and guardians of patients in Pediatric Rheumatology follow-up clinics in Kansas City, Missouri, the primary site of in-person care, and at a telemedicine outreach site 160 miles away, in Joplin, Missouri. Survey questions …

Local Health Departments’ Involvement In Hospitals’ Implementation Plans, Simone Singh, Erik Carlton

Frontiers in Public Health Services and Systems Research

Background: More than half of all local health departments (LHDs) in the U.S. are involved in collaborations with nonprofit hospitals on a community health needs assessment (CHNA), yet little is known about the role that LHDs play in hospitals’ implementation plans.

Purpose: This study aims to explore the current state of hospital–LHD collaborations around the implementation plan using data from a survey of LHDs across the country.

Methods: The study sample included 457 LHDs that completed both the 2015 Forces of Change survey and the 2013 Profile survey conducted by the National Association of County and City Health Officials. Univariate …

Multi-Sectoral Partnerships And Patient-Engagement Strategies In Accountable Care Organizations, Margae Knox, Hector P. Rodriguez, Stephen M. Shortell

Frontiers in Public Health Services and Systems Research

Background: Patient-engagement strategies are increasingly recognized for enriching traditional medical care and improving population health. Accountable Care Organizations (ACOs) may be well positioned to leverage multi-sector organizational partnerships to improve the reach of their patient-engagement strategies, particularly given incentives to meet cost, quality and population health goals. Little is currently known about the relation of multi-sector partnerships and patient engagement in ACOs.

Purpose: To examine the relation of patient-engagement strategies and breadth of multi-sectoral organizational partnerships in 71 primary care practices affiliated with one of two ACOs.

Methods: Clinical and administrative leaders from each practice were surveyed. Questions assessed practice …

Using Process Mining To Assess The Fidelity Of A Home Visiting Program, Riyad Haq, Sofia Campos Vidal Pires, Julie M. Kapp, Sara Schlemper, Eduardo J. Simoes

Frontiers in Public Health Services and Systems Research

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is a federal public health initiative which supports at-risk families through evidence-based programs and promising approaches for pregnant women, and childhood development for children aged 0 to 5. These public health program funding mechanisms commonly include process evaluation mandates.

Purpose: The use of process mining was explored as a methodology to assess the fidelity of the MIECHV programs’ actual workflow to that of their intended models.

Methods: Research Electronic Data Capture (REDCap) data files that were populated with program process data elements from the local implementing agencies were …

A Framework To Address Challenges In Communicating The Developmental Origins Of Health And Disease, Liana Winett, Lawrence Wallack, Dawn M. Richardson, Janne Boone-Heinonen, Lynne C. Messer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts “upstream” to …

Putting Parity Into Practice – Integrating Opioid-Use Disorder Treatment Into The Hospital Setting, Laura Fanucchi, Michelle R. Lofwall

Center for Health Services Research Faculty Publications

No abstract provided.

An Examination Of African Americans' Utilization Of Health Care, Brittany Powell

Dissertations

The study examined the relationship between perceptions of discrimination, social support, quality of health care received, and utilization of health care services among African Americans. Data was analyzed from 99 African American respondents that completed either an online or paper questionnaire. The responses demonstrated significant relationships existed between discrimination and quality of health care as well as social support and utilization of health care. Results concluded that the more discrimination one perceives, the lower quality of health care they are to expect, and therefore they are less likely to utilize services. However, the data also reflected that even in the …

A Livelihood Intervention To Improve Economic And Psychosocial Well-Being In Rural Uganda: Longitudinal Pilot Study, Bernard Kakuhikire, Diego Suquillo, Elly Atuhumuza, Rumbidzai Mushavi, Jessica M. Perkins, Atheendar S. Venkataramani, Sheri D. Weiser, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

HIV and poverty are inextricably intertwined in sub-Saharan Africa. Economic and livelihood intervention strategies have been suggested to help mitigate the adverse economic effects of HIV, but few intervention studies have focused specifically on HIV positive persons. We conducted three pilot studies to assess a livelihood intervention consisting of an initial orientation and loan package of chickens and associated implements to create poultry microenterprises. We enrolled 15 HIV-positive and 22 HIV-negative participants and followed them for up to 18 months. Over the course of follow-up, participants achieved high chicken survival and loan repayment rates. Median monthly income increased, and severe …