Public Health Commons^™

Maine Ems Community Paramedicine Pilot Program Evaluation, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

In November 2014, the Muskie School of Public Service at the University of Southern Maine was awarded a contract to evaluate the implementation of the statewide CP Pilot Program in Maine. This report presents process level results from the evaluation. The report includes findings from interviews with the twelve community paramedicine pilot sites in Maine and with the state of Maine EMS office.

The layout of the report follows the key themes and categories from our interviews:

• Staffing
• Training
• Stakeholders and Partners
• CP Services
• CP Event
• Data Collection
• Funding
• Challenges
• Successes
• Sustainability

The report concludes with lessons learned which may …

Workforce Planning & Development In Times Of Delivery System Transformation: The Stories Of Kaiser Permanente And Montefiore Health System, Patricia Pittman, Ellen Scully-Russ

Health Workforce Research Center Publications

As the implementation of the Affordable Care Act (ACA) advances, many health systems are taking bold measures to reorganize how they deliver care, and finding that in order to do so; they need to make major changes in how their healthcare workforces are organized.

Understanding what workforce changes are occurring and how they are being managed is important not just for healthcare leaders, but for policymakers as well. Traditional methods of projecting provider shortages and justifying the allocation of public funding to expand various professional pipelines are giving way to the notion that there are many models of care delivery …

Necessity Of Analytics In Today’S Healthcare Revenue Cycle, Kristen N. Thomas

Applied Research Projects

Because of the recently growing pressures to improve quality and reduce costs, healthcare organizations are rapidly adopting IT in order to improve their operations and clinical care. As a result, an accumulation of vast amounts of data are becoming available for use. It is important for healthcare to use this data. Strome (2010) states that healthcare analytics is the application of statistical tools and techniques to healthcare-related data in order to study past situations (i.e., operational performance or clinical outcomes) to improve the quality and efficiency of clinical and business processes and performance. With the introduction of healthcare analytical tools, …

The Personal Health Record (Phr): The Effects On Patient Healthcare Outcomes?, Bonita R. Payne

Applied Research Projects

Electronic transmission of data is on the rise, due to the Affordable Care Act and provisions to make healthcare information more accessible, complete, and transparent. The Personal Health Record (PHR) application is a tool used to provide assistance to the goal of patient-centered and patient-centric care. Its purpose is to encourage consumers to become more participatory and informed in their healthcare treatment and healthcare needs. Since its inception, it has been questionable as to whether consumers and providers are seeing any improvements in the services provided or the care rendered. Since, the development and implementation of PHR applications, there has …

Hipaa Violations On Social Media, Tamesha Helen Parris

Applied Research Projects

With the rise of social media networks such as Facebook and Twitter, healthcare professionals and students pursing healthcare careers communicate, collaborate, and network on an array of websites and apps. With the use of social media, the users can reach a large audience in a matter of seconds, with this ease; users can transmit information and has presented challenges in the form of unauthorized disclosure of patient’s health information on social media sites. The purpose of this study is to see if the number of HIPAA violations increased due to the use of social media and what steps are healthcare …

Health Literacy Improves Health Care Quality, Rebecca Cook

Applied Research Projects

A lack of knowledge about health literacy is a cause for quality healthcare concern as the world advances in health information technology. Many patients struggle to understand and navigate their health and well-being as a result of lack of understanding of the treatment plan due to low literacy skills. Several federal policy initiatives promote health literacy as the responsibility of the healthcare organization. Improving health outcomes through health literacy should be a commitment of healthcare organization through providing clear communication, simplified forms, assistance, and even follow-up calls. Three major initiatives will combat health literacy to include the Affordable Care Act; …

Maintaining The Master Patient Index: The Impact Of Patient Registration Processes On Data Integrity, Matthew Biddle

Applied Research Projects

The master patient index is one of the most important components within a healthcare system. It ensures that an individual patient is given a unique identifier that is used across the various separate clinical, financial and administrative systems and ensures that all information about that patient is organized and complete. Ensuring the MPI is accurate is critical since errors can have significant costs- both financially and in terms of patient outcomes. Patient registrars are the first line of defense when it comes to correctly identifying incoming patients and is where many errors in the MPI occur. Errors can be simple …

Analisis Alur Proses Penerimaan Pasien Rawat Inap Di Rumah Sakit “X” Tahun 2015 Dengan Pendekatan Lean Hospital, Pretty Kristianti Dewi

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Lean hospital is lean methods used in hospitals, is a continuous effort made to eliminate waste and increase value added in patient care in hospitals. This method is very appropriate to analyze the process flow of inpatient admission in "X" hospital by making Current State Value Stream Map derived from observation, interviews and review of documents. Then through the application of Lean Tools, Future State Value Stream Map was made as the idea of improvement for short and medium/long term in the process. The results showed there were 31 total events with value added time process is just 44,9% at …

Analisis Faktor-Faktor Yang Berhubungan Dengan Kepatuhan Pasien Tuberkulosis Paru Tahap Lanjutan Untuk Minum Obat Di Rs Rumah Sehat Terpadu Tahun 2015, Dewi Hapsari Wulandari

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

This research discussed on the This thesis aims to determine the factors that associated compliance patien lung Tuberculosis to swallowing drug at Rumah Sehat Terpadu Dompet Dhuafa Hospital 2015This research used mix methods approach with cross sectional design. This research found that there is still non compliances patient lung tuberculosis to swallowing medicine. The compliance is related on behavior (Predisposisi, Enabling, dan Reinforcing) and non behavior factor. To increase the compliance this research suggest to hospital support fot TB DOTS program, intens of counseling, support the PMO, availability of drug, and frequent recording dan reporting.

Penggunaan Konsep Lean Untuk Meningkatkan Efisiensi Pelayanan Instalasi Farmasi Rawat Jalan Di Rumah Sakit Anna Medika Bekasi, Dima Lintya Siti Karima Zahra

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The National Health Insurance which was launched on January 1, 2014, is a form of transformation and reformation of health services in Indonesia. In implementation of the JKN, Hospital Pharmacy Installation is forced to improve its quality service sustainably in order to achieve cost effective and efficient service. Lean is a management system that fully focuses on effiency with the objectives to reduce stock, service cycle time and cost. Research was conducted on outpatient pharmacy installation service at Anna Medika Bekasi Hospital in April to May 2016. It focuses on prescription process flow of non-pulvis medicine using action research method …

Analisis Kualitas Dan Kuantitas Tenaga Keperawatan Terhadap Persepsi Insiden Keselamatan Pasien Di Rs X Jakarta Tahun 2015, Evelyne Sumihar Friyanti

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Patient safety has become a very important issue in health care. Everyone wants to get health care that is safe and free from unwanted injuries. Through this study, analyzed the quality and quantity of nurse perceptions of patient safety incidents in the hospital X. The study was conducted on 44 nurses and midwives using cross sectional design to examine the relationship between the variables of knowledge, education, ease of use tools, work experience, discipline and the number of nurses on patient safety incidents.

Analisis Faktor Yang Berhubungan Dengan Waktu Tunggu Pemeriksaan Foto Toraks Pasien Rawat Jalan Di Instalasi Radiologi Rumah Sakit Dr. Mohammad Hoesin Palembang Tahun 2015, Muhammad Yusri

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Department of Radiology Dr. Mohammad Hoesin hospital in Palembang 2014, many patients perform chest x ray examination, whom were patients radiographic outpatient. The waiting time radiographic services in RSMH not in accordance with the Standard Minimum Service Hospital less than 3 hours. This study aims to determine the factors associated with waiting time chest X-ray. This research was conducted by measuring the waiting time to 68 selected respondents The result showed radiographic waiting time 184.44 minutes. Based on statistical test found the waiting time in the reading room is the photo that most affect the length of waiting time radiographic.

Analisis Faktor-Faktor Yang Berhubungan Dengan Efektivitas Komunikasi Perawat Dan Pasien Di Ruang Rawat Inap Rumah Sakit Harapan Mulia Kabupaten Bekasi Tahun 2015, Prasetyaningtyas Agustrianti

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The study aims to determine the factors associated with the effectiveness of nurse and patient communication atinpatient unit in Harapan Mulia Hospitallocated in Bekasi Regency.It is a quantitative study with cross-sectional design.Samples are the total population amounted to 30 nurses with 60 patients as respondentsconducted in March - May 2015. The results showed that 53.3% of patients perceived that nurses’s communication was effective, further analysis with logistic regression showed no significant relationship between the characters nurses, physical and mental fatigue, language, leadership and management support for hospitals, facilities and reward with the nurses and patients communication effectiveness.

Analisis Besaran Biaya Obat Beberapa Penyakit Rawat Jalan Dan Faktor- Faktor Yang Mempengaruhi Di Rs. Awal Bros Bekasi Tahun 2014, Hastuti Hadiningsih

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The background of this study is the high bill outpatient drug costs when compared with the costs borne by BPJS by embracing INA CBG's tariff system. So, we need a more in-depth analysis of the factors that affect the amount of health care costs. This study uses a cross-sectional study with quantitative methods, by looking at factors of age, sex, prescription drugs, doctor and health insurance status in accordance with the secondary data obtained through medical records and bills medicine outpatient services. And based on the results of the study, factors that affect the cost of the drug is age, …

Understanding The Value Of Multi-Sector Health System Interactions, Glen P. Mays

Health Management and Policy Presentations

Recent research examines the health and economic value of multi-organizational and multi-sectoral approaches for the delivery of public health services. This presentation examines how data on these multi-organizational delivery systems and their impact can be used to solve collective action problems and stimulate collaborative solutions in public health.

Kentucky’S Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays

Health Management and Policy Presentations

This session examines recent progress toward the 2012 Institute of Medicine recommendation to identify the components and costs of a "minimum package" of public health services and foundational capabilities to be available across the U.S. Research about the health and economic benefits of Foundational Public Health Services has begun to shape Kentucky's strategic plan for transforming the public health system.

Analytic Approaches For Causal Inference With Complex Multi-Component Interventions, Glen P. Mays, Arnold J. Stromberg, Jing Li, Mark V. Williams

Health Management and Policy Presentations

Estimating the causal effects of complex, multi-component health interventions is a task with many challenges in measurement and methodology. This presentation profiles the methods being used as part of the PCORI-funded Project Achieve, a national study to estimate the comparative effectiveness of heterogeneous care transition programs designed to help hospitalized patients and their caregivers navigate care delivery systems effectively and return back to the community with optimal health and wellbeing.

Medicare's Post-Acute Care Payment: An Updated Review Of The Issues And Policy Proposals, Sally Coberly

National Health Policy Forum

Medicare spending on post-acute care provided by home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals accounted for about 10 percent of total program outlays in 2013. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems, as …

The Impact Of Antenatal Care On Maternal Mental Health In Rural Maharashtra, Cameron Barker

India: Public Health, Policy Advocacy, and Community

This study seeks to understand the major mental health concerns experienced by pregnant women and recent mothers in rural villages in Maharashtra and how these concerns are impacted by different elements of holistic antenatal and postnatal care. The risk factors that may lead to poor maternal mental health are strongly tied to social factors and vary from community to community. Unfortunately, in most developing countries mental health takes a back seat to other health issues deemed more pressing. This is especially true for female specific illnesses, given that the overall health of women and girl children is often neglected. The …

The Perception Of Menstruation And Treatment Of Menstrual Ailments Among Tibetan Women In Mcleod Ganj, Himachal Pradesh, Kara Spafford

India: Public Health, Policy Advocacy, and Community

Despite recent incorporation of quality of life assessments into goal setting, menstrual ailments are still left out of public health initiatives in developing countries. Due to lack of studies on perceptions of menstruation and treatment options for menstrual ailments, the specific health needs of Tibetan women are not met. The present study seeks to determine how Tibetan women are influenced by societal views of menstruation and to explore access to treatment for menstrual problems in McLeod Ganj, Himachal Pradesh. A total of thirty-seven semi-structured interviews were conducted among Tibetan doctors at Men-Tsee-Khang (Tibetan Medical and Astronomy Institute) and Tibetan women …

How Social Determinants Of Health, Health-Seeking Behaviors, And Treatment Adherence Influence And Interact With Endemic Levels Of Pulmonary Tb And Mdr-Tb In Urban Rajasthan, Michelle Kagei

Independent Study Project (ISP) Collection

Tuberculosis, the worlds most deadly infectious disease, remains as one of the major causes of morbidity and mortality in modern-day India. The country has the highest burden of both tuberculosis as well as multidrug-resistant tuberculosis, a more recently emerging menace. This study focuses on the social determinants of health pertaining to tuberculosis, identifying and discussing “at-risk” groups in the population of urban Rajasthan. Jaipur was chosen as the field study location because of the city’s extensive levels of healthcare institutions and facilities. In order to identify common patient demographics as well as issues regarding treatment adherence, medical records and interviews …

Community Health Workers: Health System Integration, Financing Opportunities, And The Evolving Role Of The Community Health Worker In A Post-Health Reform Landsacape, Mary-Beth Malcarney, Patricia Pittman, Leo Quigley, Naomi Seiler, Katie B. Horton

Health Workforce Research Center Publications

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts.

The purpose of this report is to better understand the varied landscape; to offer categories of analysis that may help inform policy, management, and research; …

The Conceptualization Of Self-Identity Among Residents Of Appalachia Ohio, Jessica L. Krok-Schoen, Angela L. Palmer-Wackerly, Phokeng M. Dailey, Janice L. Krieger

Department of Communication Studies: Faculty Publications

Social identity and its association to culture, place, and health is an important, but understudied, area of research. One social group that illustrates this connection between place and identity is people living in Appalachia. This exploratory mixed-method study investigates the appropriateness of the self-concept of Ohio Appalachian adults with cancer as “Appalachian,” the context associated with that identity and its association with community identification, rural identity, Appalachian Regional Commission (ARC) status, demographic data, and clinical trial (CT) enrollment. Forty-nine adults with cancer residing in Appalachia were recruited. Participants were cancer patients who (1) were offered a randomized clinical cancer trial; …

Challenges Of Providing Timely Feedback To Residents: Faculty Perspectives, Tabassum Zehra, M. Tariq, Afaq Motiwala, Syeda Kauser Ali, John Boulet

Department for Educational Development

Objective

To explore faculty's perceptions of challenges in providing verbal feedback to the Residents and suggest ways to overcome the barriers.

Methods

As part of a larger study on feedback assessment, five focus group discussions were conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, during faculty development workshops held from January to June 2010. Qualitative grounded theory was used to explore faculty perceptions of challenges in providing verbal feedback to the Residents.

Results

Of the 54 faculty members, 49(91%) participated. Four themes that emerged were 'time constraint' indicating high patient load; 'faculty related issues' indicating faculty's apprehension …

Hispanic Ethnicity Is Associated With Increased Hospital Charges After Radical Cystectomy In The United States, Mark D. Tyson, Erik P. Castle

Journal of Health Disparities Research and Practice

Objective: To examine the impact of race and ethnicity on financial charges associated with radical cystectomy (RC).

Data Sources/Study Setting: The Nationwide Inpatient Sample was used to identify patients who underwent RC for bladder cancer between 1998 and 2010.

Study Design: The primary outcome was total hospital charges adjusted for inflation. Multivariate analysis was performed using a generalized linear model on the logarithmically transformed outcome variable (total hospital charges) after adjusting for age, sex, race, Elixhauser comorbidities, surgical approach, year, primary payer, hospital and surgeon annual RC volume, hospital characteristics, and postoperative complications.

Principle findings: A total of 14,873 patients …

Challenges Of Forecasting Physician Workforce Needs Amid Delivery System Transformation, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional …

Dual Use Of Va And Non-Va Hospitals By Veterans With Multiple Hospitalizations, Alan N. West, Mary E. Charlton, Mary Vaughan-Sarrazin

Dartmouth Scholarship

Background: Veterans who are hospitalized in both VA and non-VA hospitals within a short timespan may be at risk for fragmented or conflicting care. To determine the characteristics of these “dual users,” we analyzed administrative hospital discharge data for VA-enrolled veterans of any age in seven states, including any VA or non-VA hospitalizations they had in 2004 – 2007. Method: For VA enrollees in Arizona, Iowa, Louisiana, Florida, South Carolina, Pennsylvania, or New York in 2007, we merged 2004 – 2007 discharge data for all VA hospitalizations and all non-VA hospitalizations listed in state health department or hospital association databases. …

A Comparison Of A Multistate Inpatient Ehr Database To The Hcup Nationwide Inpatient Sample., Jonathan P Deshazo, Mark A Hoffman

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The growing availability of electronic health records (EHRs) in the US could provide researchers with a more detailed and clinically relevant alternative to using claims-based data.

METHODS: In this study we compared a very large EHR database (Health Facts©) to a well-established population estimate (Nationwide Inpatient Sample). Weighted comparisons were made using t-value and relative difference over diagnoses and procedures for the year 2010.

RESULTS: The two databases have a similar distribution pattern across all data elements, with 24 of 50 data elements being statistically similar between the two data sources. In general, differences that were found are consistent …

Presence Of Athletic Trainers In Michigan High Schools, Monica Lininger, Gayle Thompson

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Context: Each year an estimated 1.4 million sports related injuries occur annually to student-athletes at the high school level. It has been over 20 years since a systematic investigation into the presence of athletic trainers to treat these injuries in the state of Michigan has been conducted. Within the past 5 years in Michigan, licensure as well as several laws and regulations have been enacted for athletic trainers.

Purpose: To investigate the prevalence of athletic trainers in secondary schools in Michigan.

Design: Cross-sectional study.

Setting: Questionnaires were given to all 400 athletic directors in attendance of the Michigan Interscholastic Athletic …

Local Health Departments’ Costs Of Providing Environmental Health Services, Simone Singh, Nancy L. Winterbauer, Ashley Tucker, Lisa Macon Harrison

Frontiers in Public Health Services and Systems Research

Background: A detailed understanding of the costs that local health departments (LHDs) incur in the provision of public health services plays an important role in their efforts to provide services in an effective and efficient manner. However, surprisingly little evidence exists about the key cost components that LHDs incur in the provision of services.

Purpose: The purpose of this report was to provide empirical estimates of LHDs’ cost structure.

Methods: Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per …