Public Health Commons^™

Capitated Contracting In The Department Of Radiology, David C. Levin

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

National Biotech Organization Chooses Philadelphia For Annual Meeting, Morton D. Sosland

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Biotechnology Program Prepares Future Researchers, Lydia E. Mcmorrow, Shirley E. Greening

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

The Outpatient Experience Through The Eyes Of The Patient, Elizabeth Dunn, Carmhiel Brown

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Health Policy Newsletter Goes On-Line!, Anthony J. Frisby

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

From The Editor: Can Case Management Help?, David B. Nash

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Credits

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Nash At Monash, David B. Nash

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Adoption Of Zidovudine In Clinical Practice: Differences Between Specialists And Generalists, Leona E. Markson, Leon E. Cosler, Barbara J. Turner

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Evaluating The Management Of Heart Failure In The Inpatient Setting, Cristina Gruta

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Cancer Screening In Primary Care: Obstacles For Physicians, Richard C. Wender

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Uses Of Magnetic Resonance Imaging In Assessing Severity And Forecasting Motor Recovery Of Traumatic Spinal Cord Injury, Claire M. Spettell, Adam E. Flanders

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Health Care And The "Iway", Rodney B. Murray

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

From The Editor: The Usqa Managed Care Fellowship At Jefferson, David B. Nash

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Visit Satisfaction And The Use Of Tailored Health Behavior Communications In Primary Care, Chris N. Sciamanna, Scott P. Novak, Thomas K. Houston, Robert Gramling, Bess H. Marcus

College of Population Health Faculty Papers

BACKGROUND: Though studies suggest that computer-tailored health communications can help patients improve health behaviors, their effect on patient satisfaction, when used in health care settings, has yet to be examined. METHODS: A computer application was developed to provide tailored, printed feedback for patients and physicians about two of the most common adverse health behaviors seen in primary care, smoking and physical inactivity. Ten primary care providers and 150 of their patients were recruited to use the program in the office before their visit. After the visit, patients completed a self-report survey that addressed demographics, computer use history, satisfaction with the …

Cardiovascular Comorbidities Among Public Health Clinic Patients With Diabetes: The Urban Diabetics Study, Jessica M. Robbins, Chris N. Sciamanna, David A. Webb

College of Population Health Faculty Papers

BACKGROUND:We sought to determine the frequency and distribution of cardiovascular comorbidities in a large cohort of low-income patients with diabetes who had received primary care for diabetes at municipal health clinics.

METHODS:Outpatient data from the Philadelphia Health Care Centers was linked with hospital discharge data from all Pennsylvania hospitals and death certificates.

RESULTS:Among 10,095 primary care patients with diabetes, with a mean observation period of 4.6 years (2.8 after diabetes diagnosis), 2,693 (14.3%) were diagnosed with heart disease, including 270 (1.4%) with myocardial infarction and 912 (4.8%) with congestive heart failure. Cerebrovascular disease was diagnosed in 588 patients (3.1%). Over …

Diagnosing Crohn's Disease: An Economic Analysis Comparing Wireless Capsule Endoscopy With Traditional Diagnostic Procedures, Neil I. Goldfarb, Laura T. Pizzi, Joseph P. Fuhr Jr., Christopher Salvador, Vanja Sikirica, Asher Kornbluth, Blair Lewis

College of Population Health Faculty Papers

The purpose of this study was to review economic considerations related to establishing a diagnosis of Crohn's disease, and to compare the costs of a diagnostic algorithm incorporating wireless capsule endoscopy (WCE) with the current algorithm for diagnosing Crohn's disease suspected in the small bowel. Published literature, clinical trial data on WCE in comparison to other diagnostic tools, and input from clinical experts were used as data sources for (1) identifying contributors to the costs of diagnosing Crohn's disease; (2) exploring where WCE should be placed within the diagnostic algorithm for Crohn's; and (3) constructing decision tree models with sensitivity …

Jefferson Medical College Annual Report, 2004, Thomas J. Nasca

Jefferson Medical College Administrative Documents and Reports

No abstract provided.

Impact Of Appropriate Pharmaceutical Therapy For Chronic Conditions On Direct Medical Costs And Workplace Productivity: A Review Of The Literature, Neil Goldfarb, Christine Weston, Christine W. Hartmann, Mirko Sikirica, Albert Crawford, Hope He, Jamie Howell, Vittorio Maio, Janice Clarke, Bhaskar Nuthulaganti, Nicole Cobb

College of Population Health Faculty Papers

This paper presents the findings of a literature review investigating the economic impact of appropriate pharmaceutical therapy in treating four prevalent chronic conditions - asthma, diabetes, heart failure, and migraine. The goal of the review was to identify high-quality studies examining the extent to which appropriate pharmaceutical therapy impacts overall medical expenditure (direct costs) and workplace productivity (indirect costs). The working hypothesis in conducting the review was that the costs of pharmaceuticals for the selected chronic conditions are offset by savings in direct and indirect costs in other areas. The literature provides evidence that appropriate drug therapy improves the health …

Inadequate Physician Knowledge Of The Effects Of Diet On Blood Lipids And Lipoproteins., Mary M. Flynn, Chris N. Sciamanna, Kevin C. Vigilante

College of Population Health Faculty Papers

BACKGROUND:To assess the nutrition knowledge of physicians on the basic effects of diet on blood lipids and lipoproteins.

METHODS:Anonymous mailed dietary knowledge surveys to 6000 randomly selected physicians in the United States licensed in either Internal Medicine or Cardiology.RESULTS:Response rate: 16% (n = 639). Half of the physicians did not know that canola oil and 26% did not know olive oil were good sources of monounsaturated fat. Ninety-three percent (84% of cardiologists vs. 96% of internists; p < 0.001) did not know that a low-fat diet, in general, would increase blood triglycerides. Approximately three-quarters (70% of cardiologists vs. 77% of internists; p < 0.01) did not know a low-fat diet would decrease HDL-c and almost half (45%) thought that a low-fat diet would not change HDL-c.

CONCLUSIONS:If physicians are to implement dietary and cholesterol management guidelines, they will likely need to become more knowledgeable about nutrition.

Overview, David B. Nash

College of Population Health Faculty Papers

No abstract available.

Filling The Gaps In Physician Communication. The Role Of The Internet Among Primary Care Patients, Chris N. Sciamanna, Melissa Clark, Joseph Diaz, Stephanie Newton

College of Population Health Faculty Papers

BACKGROUND:

Millions of people use the Internet as a source for health information yet little is understood about how the use of the Internet for health information is related to the doctor-patient relationship.

OBJECTIVE:

We conducted the present study to understand the association between one’s interest in using the Internet for general and quality-oriented health information and attitudes about one’s communications with health care provider(s).

DESIGN:

Cross-sectional survey.

SETTING:

Four community-based primary care practices in Rhode Island.

MEASUREMENTS:

A single self-administered survey included items to measure: interest in using the Internet to look for general and quality-oriented information and a …

Care Management For Persistent Pain: An Introduction, Christine W. Hartmann, Neil I. Goldfarb, Susan S. Kim, Bhaskar R. Nuthulaganti, Raafat Seifeldin

College of Population Health Faculty Papers

Persistent pain is a frequently occurring condition with significant economic, clinical, and humanistic implications, for both individuals and society. Current literature, however, points to unresolved issues with regard to its identification, assessment, diagnosis, and treatment, and a number of suggestions have been made for improving the quality of care for pain sufferers. Because persistent pain shares many of the salient features of other chronic conditions such as diabetes and congestive heart failure, it is reasonable to believe that the adoption of a coordinated approach to care management could substantially improve the quality of care. Several strategiesincluding identification, appropriate referral, education, …

The Jeffcare Preceptor Model For Asthma: A Primary Care Physician Tutorial Training Model, Jeffrey L. Lenow, Robert Bales, Stanton N. Smullens

College of Population Health Faculty Papers

The societal and economic impact of asthma is a well-documented phenomenon in this country. Despite improved knowledge and techniques of care, there have been signs of worsening morbidity/mortality and a seeming disconnect between physician and patients as regards communication of care strategies. In an attempt to fashion innovative educational strategies to enhance primary care physician (PCP) and caregiver efficiencies in improving patient outcomes (clinical and financial), the "Preceptor" model of one-to-one PCP/asthma specialist has been developed. Review of utilization and prescribing data demonstrates a clear pattern of statistically significant cost improvement in the aggregate care setting, as well as improved …

The Effectiveness Of Heart Failure Disease Management: Initial Findings From A Comprehensive Program, Janice L. Clarke, David B. Nash

College of Population Health Faculty Papers

A prevalent, chronic condition among members of the mushrooming elderly population in the United States, heart failure (HF) is a logical focus for population-based disease management. Evidence supporting the premise that multidisciplinary interventions can significantly improve clinical outcomes while decreasing the cost of medical care for people with HF is steadily mounting. A growing number of controlled and observational studies focus on the effects of HF disease management on re-admission rates, length of stay, and improvement in appropriate diagnostic testing and prescribing. This paper describes a large-scale, comprehensive HF program and reports on clinical quality, utilization, and financial outcomes observed …

Predicting High Utilization Of Emergency Department Services Among Patients With A Diagnosis Of Psychosis In A Medicaid Managed Care Organization, Tammy K. Girts, Albert G. Crawford, Neil I. Goldfarb, Mark Bachleda, Amy Grogg

College of Population Health Faculty Papers

Studies have demonstrated increased utilization of medical services for patients with behavioral health diagnoses. Medicaid managed care organizations (MMCOs) that operate under behavioral health carve-outs face the challenge of effectively targeting disease management initiatives in the absence of information on behavioral diagnoses. This study sought to develop a predictive model of emergency department (ED) utilization for patients where a diagnosis of psychosis could be identified from a claim associated with a medical service provider visit. A retrospective cohort analysis was performed using medical and pharmacy claims from an MMCO in Philadelphia, Pennsylvania, to identify patients known to have a diagnosis …

Patient Attitudes Toward Using Computers To Improve Health Services Delivery, Chris N. Sciamanna, Joseph A. Diaz, Puja Myne

College of Population Health Faculty Papers

BACKGROUND:The aim of this study was to examine the acceptability of point of care computerized prompts to improve health services delivery among a sample of primary care patients.

METHODS:Primary data collection. Cross-sectional survey. Patients were surveyed after their visit with a primary care provider. Data were obtained from patients of ten community-based primary care practices in the spring of 2001.

RESULTS:Almost all patients reported that they would support using a computer before each visit to prompt their doctor to: "do health screening tests" (92%), "counsel about health behaviors (like diet and exercise)" (92%) and "change treatments for health conditions" (86%). …

Strong Partnerships Make Good Partners: Insights About Physician-Hospital Relationships From A Study Of Physician Executives, Marc A. Bard, Michael L. Buehler, Andrew L. Epstein, David B. Nash, John P. O'Connor

College of Population Health Faculty Papers

While physicians are likely to respond favorably in concept to hospital-based disease management and other clinical programs, they are less likely to accept their structural and functional characteristics. Because of their role at the hospital-physician interface, hospital physician executives are often tasked with implementing such programs. Given the challenges involved, a deeper understanding of the role of these executives in building the hospital-physician relationship will therefore be an important contribution. To this end, we surveyed senior physician executives at hospitals and health systems (n = 326), to assess their view of the hospital-physician relationship at their institutions, focusing especially on …

Economic And Health Outcomes Of Capsule Endoscopy: Opportunities For Improved Management Of The Diagnostic Process For Obscure Gastrointestinal Bleeding, Neil I. Goldfarb, Amy Phillips, Mitchell Conn, Blair S. Lewis, David B. Nash

College of Population Health Faculty Papers

The estimated annual incidence of gastrointestinal bleeding in the United States is approximately 100 episodes per 100,000 persons, resulting in 300,000 hospitalizations annually. Diagnostic tools such as radiologic studies and endoscopic examination often fail to identify a source of bleeding, resulting in a cycle of repetitive testing over months or even years. Costs associated with the diagnostic process, and with interim treatment for anemia and other symptoms, can be significant. The diagnostic process also takes a toll on the patient, in terms of worry, pain, and discomfort. Capsule endoscopy, a technology that received FDA clearance in August, 2001, consists of …

Building Jefferson's Future, Douglas J. Macmaster Jr., Paul C. Brucker

Thomas Jefferson University Administrative Documents and Reports

2002 Annual report of Thomas Jefferson University.