Community Health and Preventive Medicine Commons^™

Community Health Centers: A 2012 Profile And Spotlight On Implications Of State Medicaid Expansion Decisions, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2012 nearly 1,200 federally funded community health centers were providing access to care for a predominantly low-income population in medically underserved areas across the country. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase, and the ACA’s large investment in the health center program provides new resources to help meet growing needs.

This brief provides a pre-ACA snapshot of health centers that can help in understanding the impact of state decisions about the ACA Medicaid expansion on health centers as health …

Implications Of The 2014 Quality Family Planning Services Guidelines Issued By The Cdc And The Office Of Population Affairs, Sara J. Rosenbaum, Susan Wood, Merle Cunningham, Tishra Beeson, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

How Medicaid Expansions And Future Community Health Center Funding Will Shape Capacity To Meet The Nation’S Primary Care Needs: A 2014 Update, Leighton Ku, Julia Zur, Emily Jones, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Assessing The Potential Impact Of The Affordable Care Act On Uninsured Community Health Center Patients: An Update, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Health Care In The Motor City: Thriving Or Surviving?, Sally Coberly, William J. Scanlon

National Health Policy Forum

This site visit explored the forces shaping the delivery of health care in Detroit. Health care providers in Detroit face the twin challenges of controlling costs and serving a bifurcated metropolitan area that includes large numbers of uninsured, low-income, and vulnerable residents as well as more prosperous residents of a reviving inner core and the surrounding suburbs and counties. The program looked at the underlying economic, social, and physical conditions that make improving the health of the city's residents extremely challenging. Efforts to contain costs through payment innovations such as the Blue Cross Blue Shield of Michigan's Physician Group Incentive …

Annual Report 2013, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2013 calendar year, and provides a snapshot of our participants and resources.

National Spending For Long-Term Services And Supports (Ltss), 2012, Carol O'Shaughnessy

National Health Policy Forum

Long-term services and supports (LTSS) for the elderly and younger populations with disabilities are a significant component of national health care spending. In 2012, spending for these services was $219.9 billion (9.3 percent of all U.S. personal health care spending), almost two-thirds of which was paid by the federal-state Medicaid program. This publication presents data on LTSS spending by major public and private sources.

Telehealth: Into The Mainstream?, Lisa Sprague

National Health Policy Forum

Teleheath, and its subset telemedicine, extend across a range of technologies allowing patients to seek diagnosis, treatment, and other services from clinicians by electronic means. Telephone, videoconferencing, iPads, and apps are all employed. In its most established form, hospitals and medical centers use telehealth to reach patients in underserved rural areas. Proponents of telehealth suggest it can relieve medical workforce shortages; save patients time, money, and travel; reduce unnecessary hospital visits; improve the management of chronic conditions; and improve continuing medical education. But telehealth also faces ongoing challenges. States require physicians to be licensed in each state where they treat …

Differences In The Delivery Of Health Education To Patients With Chronic Disease By Provider Type, 2005-2009, Tamara S. Ritsema, Jeffrey Bingenheimer, Patty Scholting, James F. Cawley

Prevention and Community Health Faculty Publications

Introduction
Health education provided to patients can reduce mortality and morbidity of chronic disease. Although some studies describe the provision of health education by physicians, few studies have examined how physicians, physician assistants, and nurse practitioners differ in the provision of health education. The objective of our study was to evaluate the rate of health education provision by physicians, physician assistants, and nurse practitioners/certified midwives.

Methods
We analyzed 5 years of data (2005–2009) from the outpatient department subset of the National Hospital Ambulatory Medical Care Survey. We abstracted data on 136,432 adult patient visits for the following chronic conditions: asthma, …

Faith And Hiv Prevention: The Conceptual Framing Of Hiv Prevention Among Pentecostal Botswana Teenagers, Elias Mpofu, Fidelis Nkomazana, Jabulani A. Muchado, Lovemore Togarasei, Jeffrey Bingenheimer

Prevention and Community Health Faculty Publications

Background

There is a huge interest by faith-based organizations (FBOs) in sub-Saharan Africa and elsewhere in HIV prevention interventions that build on the religious aspects of being. Successful partnerships between the public health services and FBOs will require a better understanding of the conceptual framing of HIV prevention by FBOS to access for prevention intervention, those concepts the churches of various denominations and their members would support or endorse. This study investigated the conceptual framing of HIV prevention among church youths in Botswana; - a country with one of the highest HIV prevalence in the world.

Method

Participants were 213 …

Money Follows The Person (Mfp) Rebalancing Demonstration: A Work In Progress, Carol O'Shaughnessy

National Health Policy Forum

In recent years, federal and state policy efforts have expanded opportunities for people to live in home- and community-based settings rather than in nursing homes and other institutions. As part of the Deficit Reduction Act of 2005, Congress enacted the Money Follows the Person Rebalancing (MFP) program, a Medicaid demonstration to help people who need long-term services and supports (LTSS) transition from nursing homes and other institutions to their own homes or other community settings. The Patient Protection and Affordable Care Act of 2010 extended the program through September 30, 2016. Now in its eighth year of operation, MFP grants …

Effect Of A Liver Cancer Education Program On Hepatitis B Screening Among Asian Americans In The Baltimore-Washington Metropolitan Area, 2009-2010, Hee-Soon Juon, Sunmin Lee, Carol Strong, Rajiv N. Rimal, Gregory D. Kirk, Janice Bowie

Prevention and Community Health Faculty Publications

Introduction
Asian Americans have the highest incidence of hepatocellular carcinoma (HCC), the major form of primary liver cancer, of all ethnic groups in the United States. Chronic hepatitis B virus (HBV) infection is the most common cause of HCC, and as many as 1 in 10 foreign-born Asian Americans are chronically infected with HBV. We tested the effectiveness of a culturally tailored liver cancer education program for increasing screening for HBV among Chinese, Korean, and Vietnamese Americans residing in the Baltimore–Washington metropolitan area, from November 2009 through June 2010.

Methods
We used a cluster randomized controlled trial to recruit volunteer …

Assessing The Potential Impact Of State Policies On Community Health Centers’ Outreach And Enrollment Activities, Peter Shin, Jessica Sharac, Julia Zur, Carmen Alvarez, Sara Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Smokefree Moms: A Qualitative Study For The Development Of A Text-Based Intervention For Smoking Cessation In Pregnant Women, Monika Lin, Lorien C. Abroms

GW Research Days 2014

No abstract provided.

Healthy Kids Out Of School: Using Mixed Methods To Develop Principles For Promoting Healthy Eating And Physical Activity In Out-Of-School Settings In The United States., Sarah A. Sliwa, Shanti Sharma, William H. Dietz, Peter R. Dolan, Miriam E. Nelson, Molly B. Newman, Maya Rockeymoore, Christina D. Economos

Prevention and Community Health Faculty Publications

INTRODUCTION:

Widespread practices supporting availability of healthful foods, beverages, and physical activity in out-of-school-time (OST) settings would further obesity prevention efforts. The objective of this article was to describe principles to guide policy development in support of healthy eating and physical activity practices in out-of-school settings to promote obesity prevention.

METHODS:

The Institute of Medicine's L.E.A.D. framework (Locate Evidence, Evaluate it, Assemble it, and Inform Decisions) was used to identify practices relevant to children's healthful eating in most OST settings: 1) locate and evaluate information from a national survey of children's perceptions of healthful-food access; published research, reports, policies and …

Developing A Dissemination Model To Improve Intervention Reach Among West Virginia Youth Smokers, Kimberly Horn, Traci Jarrett, Andrew Anesett-Rothermel, Nancy O'Hara Tompkins, Geri Dino

Prevention and Community Health Faculty Publications

The Not-On-Tobacco program is an evidence-based teen smoking cessation program adopted by the American Lung Association (ALA). Although widely disseminated nationally via ALA Master Trainers, in recent years, adoption and implementation of the N-O-T program in West Virginia has slowed. West Virginia, unfortunately, has one of the highest smoking rates in the US. Although it is a goal of public health science, dissemination of evidence-based interventions is woefully understudied. The present manuscript reviews a theoretical model of dissemination of the Not-On-Tobacco program in West Virginia. Based on social marketing, diffusion of innovations, and social cognitive theories, the nine-phase model incorporates …

A Profile Of Community Health Center Patients: Implications For Policy, Peter Shin, Carmen Alvarez, Jessica Sharac, Sara J. Rosenbaum, Amanda Van Vleet, Julia Paradise, Rachel Garfield

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers are a key source of comprehensive primary care in medically underserved communities across the country, and their role is expected to grow as health coverage expands under the Affordable Care Act (ACA). To sharpen understanding of the health center patient population, this brief compares it to the overall low-income population, using data from the Health Center Patient Survey and the National Health Interview Survey,respectively. The pre-ACA profile of health center patients that emerges sets the stage for measuring change following implementation of the reform law and can inform health center policy, planning, and assessment moving forward.

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

How Medicaid Expansions And Future Community Health Center Funding Will Shape Capacity To Meet The Nation's Primary Care Needs, Leighton C. Ku, Julia Zur, Emily Jones, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

A new report by Drs. L. Ku, J. Zur, E. Jones, P. Shin and S. Rosenbaum examines the impact of federal and state policy decisions on community health centers and their ability to continue providing primary care to the nation's poorest residents. The report estimates that under a worst-case scenario the nation's health centers would be forced to contract, leaving an estimated 1 million low-income people without access to health care services by 2020.

A Case For Refining The Who Global Strategy On Food Safety: Perspectives From India., Subbarao M Gavaravarapu, Katherine C Smith, Rajiv N Rimal

Prevention and Community Health Faculty Publications

No abstract provided.

Seeking Value In Medicare: Performance Measurement For Clinical Professionals, Lisa Sprague

National Health Policy Forum

The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to …

Health Workforce Needs: Projections Complicated By Practice And Technology Changes, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these …

Frontiers Of The New Social Marketing, R. Craig Lefebvre

GW Health Communication and Marketing Symposium Series

No abstract provided.

The Commission On Long-Term Care: Background Behind The Mission, Carol O'Shaughnessy

National Health Policy Forum

The American Taxpayer Relief Act of 2012 (ATRA, P.L. 112-240) created a Commission on Long-Term Care charged with developing a plan for financing of long-term services and supports (LTSS) and issuing a report in September 2013. Significant research and advocacy have been devoted to LTSS financing issues and perceived inadequacies of the delivery system over the past several decades, but the most recent comprehensive review of financing options was in 1990 by the Pepper Commission. This publication presents brief background behind the mission of the Commission, including a time line of selected federal and national activities on LTSS financing and …

Assessing The Potential Impact Of The Affordable Care Act On Uninsured Community Health Center Patients: A Nationwide And State-By-State Analysis, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In this brief, we estimate the number of uninsured community health center (CHC) patients who would gain coverage under the Affordable Care Act using data from the 2009 HRSA Survey of CHC patients and 2011 Uniform Data System. We find that were all states to implement the Affordable Care Act Medicaid expansion, an estimated 5 million uninsured health center patients – or two-thirds of all uninsured patients served by CHCs nationally – would be eligible for coverage. However, over one million uninsured patients – 72% of whom live in southern states – who would have been eligible for coverage will …

Adolescents And Parents' Perceptions Of Best Time For Sex And Sexual Communications From Two Communities In The Eastern And Volta Regions Of Ghana: Implications For Hiv And Aids Education, Emmanuel Asampong, Joseph Osafo, Jeffrey Bingenheimer, Clement Ahiadeke

Prevention and Community Health Faculty Publications

Background

Adolescents and parents’ differ in their perceptions regarding engaging in sexual activity and protecting themselves from pregnancy and sexually transmitted infections (STIs). The views of adolescents and parents from two south-eastern communities in Ghana regarding best time for sex and sexual communications were examined.

Methods

Focus Group interviews were conducted with parents and adolescents (both In-school and Out-of school) from two communities (Somanya and Adidome) in the Eastern and Volta regions of Ghana with epidemiological differentials in HIV infection.

Results

Findings showed parents and adolescents agree that the best timing for sexual activity amongst adolescents is determined by socioeconomic …

Providing Outreach And Enrollment Assistance: Lessons Learned From Community Health Centers In Massachusetts, Julia Paradise, Sara J. Rosenbaum, Peter Shin, Jessica Sharac, Carmen Alvarez, Julia Zur, Leighton Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2006, major health care reform legislation was enacted in Massachusetts. In many ways a prototype for the Affordable Care Act (ACA), the Massachusetts law required nearly all state residents to obtain health insurance, and made insurance accessible and affordable by reforming the health insurance market and providing subsidies for coverage through expansions of Medicaid and CHIP and a new program for low-income adults who are not eligible for Medicaid, known as Commonwealth Care. The law also created the “Connector,” which, like the ACA’s health insurance Marketplaces, is designed to facilitate and simplify access to insurance for individuals, families, and …

Determining Who Responds Better To A Computer Vs. Human-Delivered Physical Activity Intervention: Results From The Community Health Advice By Telephone (Chat) Trial, Eric B. Hekler, Matthew P. Buman, Jennifer Otten, Cynthia M. Castro, Lauren Grieco, Bess Marcus, Robert H. Friedman, Melissa A. Napolitano, Abby C. King

Prevention and Community Health Faculty Publications

Background

Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor.

Methods

Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both …

Medicare Advantage Update: Benefits, Enrollment, And Payments After The Aca, Kathryn Linehan

National Health Policy Forum

In 2012, the Medicare program paid private health plans $136 billion to cover about 13 million beneficiaries who received Part A and B benefits through the Medicare Advantage (MA) program rather than traditional fee-for-service (FFS) Medicare. Private plans have been a part of the program since the 1970s. Debate about the policy goals—Should they cost less per beneficiary than FFS Medicare? Should they be available to all beneficiaries? Should they be able to offer additional benefits?—has long accompanied Medicare's private plan option. This debate is reflected in the history of Medicare payment policy, and policy decisions over the …