Public Health Commons^™

Surgeon Practices And Attitudes Toward The Control Of Surgical-Site Infections In Jordan, Sara Ali Mater

Independent Study Project (ISP) Collection

The purpose of this study was to determine the attitudes and practices of Jordanian surgeons on the control of surgical-site infections, evaluated by the Center of Disease Control’s guidelines toward the prevention of surgical-site infections, in addition to gaining respondents opinions on infection control in Jordan. This study was conducted through the distribution of 75 questionnaires given to surgeons at five hospitals in Jordan. Additional insight on SSI infection control was gained through interviews with two cardiac surgeons and three infection control directors. The results of the survey were compared with the Center for Disease Control’s guide to surgical-site infection …

Racial Disparities In Access To Community Water Supply Service In Wake County, North Carolina, Jacqueline Macdonald Gibson, Nicholas Defelice, Daniel Sebastian, Hannah Leker

Frontiers in Public Health Services and Systems Research

Anecdotal evidence suggests that historically African American communities on the fringes of cities and towns in North Carolina have been systematically denied access to municipal drinking water service. This paper presents the first statistical analysis of the role of race in determining water access in these fringe areas, known as extraterritorial jurisdictions. Using publicly available property tax data, we quantified the percentage of residences with municipal water service in each census block in Wake County (the second-largest by population in North Carolina). Using the resulting water service maps plus 2010 U.S. Census data, we employed a logistic regression to assess …

Economies Of Scale And Scope In Public Health: An Analysis Of Food Hygiene Services Provided By Local Health Departments In Florida, Simone Singh, Patrick M. Bernet

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) across the United States deliver a range of essential public health services, yet little is known about the costs that LHDs incur in providing these services and the factors that may cause costs to vary both within and across health departments. This report first describes the variations in the costs of one core public health activity commonly provided by LHDs: food hygiene services. It then analyzes the factors that drive LHDs' cost of service provision focusing on the role of economies of scale and economies of scope. Using data for all LHDs in Florida for 2008 …

Editorial Comment: Temporal Trends In Preparedness Capacity, Gulzar H. Shah

Frontiers in Public Health Services and Systems Research

In view of the critical role local health departments (LHDs) play among agencies responsible for responding to natural and man-made emergencies, Bevc et al. examined the LHDs’ emergency preparedness and capacity. They compared LHDs in North Carolina with those across the country for preparedness along eight domains. Significant declines in emergency preparedness were noted from 2010 to 2012 for five out of eight domains, raising questions about our national priority concerning this important function of public health agencies. These findings have numerous implications, some of which are covered in this commentary.

Measures Of Highly Functioning Health Coalitions: Corollaries For An Effective Public Health System, Priscilla A. Barnes, Paul C. Erwin, Ramal Moonesinghe

Frontiers in Public Health Services and Systems Research

In Tennessee, health coalitions provide guidance in conducting community assessments, health improvement plans and policies and delivering of health and human services, which are considered core functions of public health. In fact, it has been postulated that these coalitions may serve as the organizational embodiment of the local public health system (LPHS). This study identifies functional characteristics of 63 Tennessee County Health Councils (CHCs), advisory councils to local and regional governmental public health agencies on broad issues of health, that contribute to its ability to operate as the primary advising entity of the LPHS. Exploratory factor analysis was conducted on …

Patient Engagement: The Missing Measure In The Patient-Centered Medical Home, Manisha Verma Md, Mph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Assessing Health Conditions And Medication Use Among The Homeless Community In Long Beach, California, Mok Thoong Chong, Jason Yamaki, Megan Harwood, Richard D'Assalenaux, Ettie Rosenberg, Okezie Aruoma, Anupam Bishayee

Pharmacy Faculty Articles and Research

Objective: Persons experiencing homelessness are a vulnerable population and are at increased risk for morbidity and all-cause mortality compared to the general population. This study sought to evaluate medication use, regular physician visits, and identify health conditions among the homeless population of Long Beach, California.

Methods: Two "brown bag" medication review events were held at homeless shelters in the Long Beach area. Demographic information, medication use, and comorbid disease states were obtained through surveys.

Findings: Three-fourths of the cohort (95 participants) consisted of males, and the average age of participants was 48 years. Psychiatric disorders and cardiovascular disease were the …

Infectious Diseases, Bert Chapman

Libraries Faculty and Staff Scholarship and Research

Provides information about the role of infectious diseases in the early years of U.S. History, with particular emphasis on how they impacted injuries sustained in military conflict.

Modeling Solutions For Prevention Of Medicare Insolvency For The Baby Boomer Generation (Born 1946 - 1964), Gregory Thomas Scott

Health Services Research Dissertations

Medicare, a United States social insurance program operated by the United States federal government, began operating in a deficit in the year 2010. More funding was expended than revenue received for medical care, creating significant shortfalls for the Medicare Trust Fund. This study examined possible initiatives to describe Medicare funding related to issues as financial shortfalls utilizing mathematical modeling and simulation. The Park Conceptual Model is a framework created to identify internal and external changes that influence bankruptcies related to municipalities, and this Model served as the theoretical basis for this study.

The following study addressed insolvency as negative cash …

Learning From Networks: Care Transitions, Market Competition, & Community Interventions, Glen P. Mays

Health Management and Policy Presentations

Social network analysis methods offer many avenues of inquiry for studying new developments in health policy and health care delivery. The expanding availability of large linkable electronic clinical and administrative data sources allows for novel SNA applications with dependent data structures. Opportunities include the study of delivery patterns within accountable care organizations (ACOs), and other multi-provider networks, price and quality competition within new health insurance exchanges, and population health effects attributable to complex community-level interventions.

Does Medicaid Crowd Out Other Public Health Spending? Projecting Aca’S Health & Economic Effects, Glen P. Mays

Health Management and Policy Presentations

Research Objective: Twenty-six states are expanding Medicaid eligibility under the Affordable Care Act (ACA) in 2014, and while federal funds cover most costs for newly eligible recipients, states must share the additional costs of covering previously-eligible state residents who newly enroll in Medicaid in response to ACA’s expanded outreach and enrollment incentives. States, together with their local government counterparts, also provide the vast majority (87%) of public sector funds for public health programs designed to promote health and prevent disease and injury on a population-wide basis. Fiscal constraints and generous federal matching funds create strong budgetary incentives for states to …

Patient Safety Culture And High Reliability Organizations, Jared D. Padgett

Walden Dissertations and Doctoral Studies

A 1999 evaluation of case studies performed by staff from the Institute of Medicine found that between 40,000 and 98,000 patients died from preventable errors, while 43,598 individuals died in car accidents that year. A 2011 report increased that estimate nearly 10 times. Widespread preventable patient harm still occurs despite an increase in healthcare regulations. High-reliability organization theory has contributed to improved safety and may potentially reverse this trend. This explorative single case study explored how the perceptions and experiences of nursing and respiratory staff affected the successful transition of a healthcare organization into a reliability-seeking organization. Fourteen participants from …

Dr. Kingsmore, Dr. Goggin Honored With Endowed Chairs, Children's Mercy Hospital

Our Story Continues

No abstract provided.

Practice-Based Learning: Opportunities And Implications For Stem Education, Glen P. Mays

Health Management and Policy Presentations

This presentation examines how practice-based research strategies have been used to produce new knowledge and stimulate learning about how to improve the organization, financing, and delivery of public health services. I consider how practice-based research strategies can be adapted to advance knowledge and practice related to science, technology, engineering and mathematics (STEM) education and application.

How Will Public Health And Primary Care Come Together In Massachusetts?, Javier Crespo

Public Affairs Capstones Collection

The Patient Protection and Affordable Care Act aims to place public health and prevention practice closer to the clinical care delivery system by mandating basic preventive services and creating a national prevention plan. The Massachusetts health care system has a number of elements that can help foster closer linking of public health practices in the primary care setting. This research set out to examine whether the current healthcare system in Massachusetts will enable public health and primary care integration as intimated upon by the Affordable Care Act. This study will assess the current connection between public health and primary care …

Maximizing Roi: Laboratories And The Value Of Next-Generation Public Health, Glen P. Mays

Health Management and Policy Presentations

Laboratories serve as information engines for the public health enterprise, and their importance to population health improvement is likely to grow considerably under U.S. health reform. This session will examine the changing landscape of public health responsibilities within a reforming U.S. health system, and the current and potential roles for public health laboratories in improving the health and economic value of investments in public health. The session examines key changes in the organization, financing, and delivery of public health services that are occurring through innovations to better integrate public health and medical care delivery, and the current and potential roles …

Public Health Services & Systems Research And The Reforming U.S. Health System, Glen P. Mays

Health Management and Policy Presentations

This session reviews progress in the field of public health services & systems research (PHSSR), with a specific focus on findings that can inform the implementation and impact of health reform strategies on the U.S. public health system.

Producing Population Health: Collective Action Requires Infrastructure, Incentives & Evidence, Glen P. Mays

Health Management and Policy Presentations

Population health improvement strategies are collective action problems that require targeted infrastructure, incentives, and information to succeed. Research on collective action problems and solutions in public health and other spheres of practice offer insight for the successful scale and spread of population health innovations.

Robust System For Infection Control: An Industrial Systems Engineering Approach, Sundaravel Vinay Swarup Achudhan

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Health care delivery in the United States needs improvement. Each year about 98,000 people die as a result of medical errors and the United States is outranked by a number of developed countries in life expectancy, mortality and comorbidity. Healthcare quality is determined based on the quality of the service provided to the patient during their visit. Apart from the traditional problem solving design and development tools used to improve healthcare quality, The National Academy of Engineering and the Institute of Medicine recommend systems engineering principle and systems engineering tools to be used in health care to improve the industry. …

More Than A Diagnosis: Enabling Medical Students To Understand And Address The Patient’S Psychological Needs, Paige Jarmuz

Renée Crown University Honors Thesis Projects - All

Patient-centered care is a framework for providing medical services in a humanistic, patient-focused manner. Although there are many proposed dimensions, it is simply the perspective of caring for the patient as a person with psychosocial needs, not just a diagnosis. Extensive literature review was completed to gain understanding of the application of patient-centered care in undergraduate medical education, as well as the evidence behind implementing patient-centered methods. Aspects of patient-centered care may be taught in many medical schools but their importance warrants a stronger focus. Incorporating aspects of patient- centered care is not only most ethical, but also is also …

Caregiving And The Experience Of Health And Illness In Children Living With Hiv/Aids In Gulu District Northern Uganda: An Ethnographic Research Narrative, Constantine S.L. Loum Phd

Patient Experience Journal

In this paper we discuss the experience of caregiving for children living with HIV in a resource poor environment in Gulu municipality in northern Uganda; the main research questions of the study were: what are the perceptions of caregivers on the care of children with HIV, and what barriers and enablers exist that undermine or promote better care for children respectively? The experience of caregivers and their perceptions on managing HIV in children is believed to shape the health seeking behaviour towards treatment and efforts to cope with its negative impact on the body. Women and children are the greatest …

The Role Of Governing Boards In Improving Patient Experience: Attitudes And Activities Of Health Service Boards In Victoria, Australia, Marie Bismark, Susan Biggar, Catherine Crock, Jennifer M. Morris, David M. Studdert

Patient Experience Journal

The authors sought to determine the attitudes of public health service board members and senior executives toward patient experience and to describe the governance activities of the boards in this area. The study was based on an online survey of 322 board members from 85 public health services and semi-structured interviews with 35 board members and senior executives from 13 public health services in Victoria, Australia. The results showed that while some health service boards had high aspirations and clear plans for improving patient experience, others remained sluggish or even cynically resistant to changing their existing models of care. Interviewees …

Patients’ Experiences In The Uk: Future Strategic Directions, Sophie Staniszewska, Neil Churchill

Patient Experience Journal

Over the last decade policy has emphasised the importance of a good patient experience as a cornerstone of high quality health and social care in the UK, with many initiatives attempting to develop patient-centred practice. More recently, the Francis Inquiry has addressed the significant failings in care identified at Mid Staffordshire NHS Foundation Trust in England and has been pivotal in raising the importance of patient experience.¹ The Francis report made 290 recommendations, with many emphasizing the importance of patient experience through their focus on specific ways in which the quality of experiences can be enhanced, for example, by …

What Matters Most To Patients? Participative Provider Care And Staff Courtesy, Andrew H. Van De Ven

Patient Experience Journal

Although there is growing recognition of the importance of having satisfied patients, we know little about what aspects of care matter most to patients. The sources of patient satisfaction and how care delivery can influence them need more empirical study. The objective of this study was to identify which aspects of a patient’s experience of care are most important to patient satisfaction, and how dimensions of care relate to clinic size, economic performance, and employee job satisfaction. To explore our question, longitudinal survey data were obtained on patients and employees over two years (1996 and 1997). Relationships between patient satisfaction …

Psychometric Properties Of The New Patients’ Expectations Questionnaire, Ann Bowling Bsc, Msc, Phd, Gene Rowe Phd

Patient Experience Journal

The authors explore the development of the Patients’ Expectations Questionnaire (PEQ) and examination of psychometric characteristics it encompasses by reviewing surveys of primary care and hospital outpatients before and after their clinic visit. Three scales were developed for Pre-visit Ideal and Realistic expectations, and Post-visit Experiences (met expectations), based on literature review, semi-structured interviews, and subsequently piloted and refined. Patients completed the questionnaire about their ideal and realistic expectations before they saw the doctor, and were asked if their expectations had been met afterwards. The results show the scales met acceptability criteria for reliability (Cronbach’s alphas exceeded α 0.70), administration …

Factors In Patients’ Experience Of Hospital Care: Evidence From California, 2009–2011, Edmund R. Becker Phd, Jason M. Hockenberry Phd, Jaeyong Bae Ma, Ariel C. Avgar Phd, Sandra S. Liu Phd, Mba, Ira Wilson Md, Msc, Arnold Milstein Md, Mph

Patient Experience Journal

The use of measures of patient-centered care to evaluate hospital care is mandated by The Patient Protection and Affordable Care Act of 2010. Using three years of data from 315 California acute-care hospitals and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, we seek to evaluate patients’ hospital-care experience by (1) analyzing patients’ experience-of-care scores in light of these hospitals’ patient profiles, structural characteristics, and outcomes in 2011, and (2) determining and analyzing the extent of changes in patients’ experience of care over the three-year period 2009–2011. For 2011, we find significant …

Veterans’ Experiences Of Patient-Centered Care: Learning From Guided Tours, Sara M. Locatelli Phd, Stephanie Turcios Bs, Cepep, Sherri L. Lavela Phd, Mph, Mba

Patient Experience Journal

In this paper the authors seek to examine Veterans’ experiences with patient-centered care (PCC) at 2 United States Veterans Affairs (VA) facilities. The authors conduct their research through a process of guided tours, in which the participant leads the evaluator through an environment and shares thoughts, feelings, and experiences. Tours were conducted in April 2013 with 30 Veterans receiving care at these VA facilities. Via the tours participants discussed aspects of the environment of care, and described some as ‘welcoming,’ while describing others as ‘chaotic.’ Participants provided multiple examples of PCC, frequently defining PCC in terms of accessibility of appointments, …

Patient Care Experiences And Perceptions Of The Patient-Provider Relationship: A Mixed Method Study, Jennifer Tabler Ms, Debra L. Scammon Ms, Phd, Jaewhan Kim Phd, Timothy Farrell Md, Andrada Tomoaia-Cotisel Mph, Mha, Michael K. Magill Md

Patient Experience Journal

Improving interpersonal continuity of care—the personal relationship forged between a patient and their primary care provider (PCP) over time—is often considered a goal of primary care. Continuity of care is frequently assessed in terms of longitudinal continuity, or the proportion of encounters with one practitioner, overlooking aspects of the patient-provider relationship that are key to interpersonal continuity of care. Further, few studies explore patients’ perspectives regarding which care experiences enhance or detract from the patient-provider relationship. This study, using focus group interviews, a patient experience CAHPS-PCMH survey, and electronic medical records, explored how patients’ experiences at 10 primary care clinics …

The Impact Of The Resident Duty Hour Regulations On Surgical Patients’ Perceptions Of Care, Shital Shah Phd, Mary Katherine Krause Ms, Fache, Francis Fullam Ma, Susan Vanderberg-Dent Md, Amie E. Solber Ms

Patient Experience Journal

Implementation of the 2003 Accreditation Council for Graduate Medical Education (ACGME) resident duty-hour regulations and access to publicly reported patient satisfaction measures have challenged administrators and clinicians to balance resident’s educational experience, patient care quality, and patients’ satisfaction and perceptions. A pre-post retrospective study design investigated association between implementation of ACGME regulations and patient satisfaction/perceptions using multinomial logistic regressions. The sample consisted of all surgical inpatients (July 2001 – June 2005), who responded to surveys at an academic medical center. Patients gave lower ratings for physician interactions (patient-physician interaction time, clinical updates, and courtesy) following the implementation of post-duty hour …

Physician-Led Patient Experience Improvement Efforts: The Connect Program, An Emerging Innovation, Harris P. Baden Md, Jennifer E. Scott Mha

Patient Experience Journal

In 2009, the leadership of the Children’s University Medical Group (CUMG) embarked on an effort to answer the question, “What would it take to promote and foster a culture of service amongst the medical staff?” The challenge was to engage the physician group in leading patient and family experience improvements within Seattle Children’s. In this article, an innovative, physician-designed and led approach to improving the patient experience is described. The effort focuses on encouraging local, grass roots strategies rooted in readily available and validated best practices. In support of that effort, novel tools that were developed and deployed …