Community Health and Preventive Medicine Commons^™

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 …

Factors Associated With Early Growth In Egyptian Infants: Implications For Addressing The Dual Burden Of Malnutrition., Justine A Kavle, Valerie L Flax, Ali Abdelmegeid, Farouk Salah, Seham Hafez, Magda Ramzy, Doaa Hamed, Gulsen Saleh, Rae Galloway

Prevention and Community Health Faculty Publications

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID-funded maternal and child health integrated programme. We sought to determine if growth patterns …

Impact Evaluation Of A Policy Intervention For Hiv Prevention In Washington, Dc, Monica S. Ruiz, Allison O'Rourke, Sean T. Allen

Prevention and Community Health Faculty Publications

Syringe exchange programs (SEPs) lower HIV risk. From 1998 to 2007, Congress prohibited Washington, DC, from using municipal revenue for SEPs. We examined the impact of policy change on IDU-associated HIV cases. We used surveillance data for new IDU-associated HIV cases between September 1996 and December 2011 to build an ARIMA model and forecasted the expected number of IDU-associated cases in the 24 months following policy change. Interrupted time series analyses (ITSA) were used to assess epidemic impact of policy change. There were 176 IDU-associated HIV cases in the 2 years post-policy change; our model predicted 296 IDU-associated HIV cases …

Longitudinal Analysis Of Electronic Health Records On Staffing Mix In Community Health Centers, Bianca K. Frogner, Xiaoli Wu, Jeongyoung Park, Patricia Pittman

Health Workforce Research Center Publications

Community health centers (CHCs) have long faced clinical staffing challenges especially in rural areas of the US due to providers perceiving a lack of socioeconomic opportunities. A recent study found that CHCs are adaptable and manage to maintain productivity levels across different staffing configurations by leveraging the clinical staff available. What is unknown is how two major changes in the health care landscape—adoption of an electronic health record (EHR) system and recognition of being a patient-centered medical home (PCMH)—have impacted staffing in CHCs, which may in turn have productivity implications.

How Has The Affordable Care Act Benefitted Medically Underserved Communities? : National Findings From The 2014 Community Health Centers Uniform Data System, Jessica Sharac, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured.

The UDS data show the ACA’s …

Patient Experiences With Family Planning In Community Health Centers, Susan F. Wood, Tishra Beeson, Debora Goetz Goldberg, Holly Mead, Peter Shin, Aliyah Abdul-Wakil, Anna Rui, Bhakti Sahgal, Maya Shimony, Hallie Stevens, Sara Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Women of childbearing age represent one of the single largest groups of community health center patients, and family planning plays a critical role in the health, economic, and social circumstances of women, their children, and families. Family planning is a required service at all health centers, and the major expansion of health centers under the Affordable Care Act means that for low-income women of reproductive age this service should be increasingly available. The Quality Family Planning (QFP) Guidelines, jointly developed by the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA) and released in 2014, …

How Will Texas’ Affordable Care Act Implementation Decisions Affect The Population? A Closer Look, Sara J. Rosenbaum, Sara Rothenberg, Sara Ely

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The Affordable Care Act (ACA) gives states two key choices: Whether to expand Medicaid to cover poor uninsured adults; and whether to establish a state Exchange. No population stands to gain more from these choices than residents of Texas, who experience the nation’s highest uninsured rate. National estimates show that by not expanding Medicaid, the state has foregone coverage for 1.5 million people. County‐level estimates show that in 249 out of 254 counties, the proportion of uninsured adults exceeds 20 percent of the total adult county population. In 31 counties, the proportion of low income uninsured adults exceeds 60 percent …

The Star Rating System And Medicare Advantage Plans, Lisa Sprague

National Health Policy Forum

With nearly 30 percent of Medicare beneficiaries opting to enroll in Medicare Advantage (MA) plans instead of fee-for-service Medicare, it’s safe to say the MA program is quite popular. The Centers for Medicare & Medicaid Services (CMS) administers a Star Ratings program for MA plans, which offers measures of quality and service among the plans that are used not only to help beneficiaries choose plans but also to award additional payments to plans that meet high standards. These additional payments, in turn, are used by plans to provide additional benefits to beneficiaries or to reduce cost sharing—added features that are …

Can Electronic Health Records Systems Support New Payment Methods For Health Centers?, Peter Shin, Feygele Jacobs, Jeffrey Barnes, James B. Welsh, Lisa Perry, Scott D. Morgan

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably …

Annual Report 2014, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2014 calendar year, and provides a snapshot of our audience and resources.

Using Neuroscience To Create A Paradigm Shift In Addiction Treatment And Theory, Tabitha E.H. Moses

Student Works

Drug abuse has long fascinated philosophers and scientists. Many different models have attempted to elucidate the mechanism behind drug addiction and analyze whether an addict has a choice in his behavior. The problem with these models is that they seem to suggest only two ways of viewing addiction. These models suggest either that a person cannot control his addiction and is therefore deserving of treatment, or that suggest a person can control their addictions and is not deserving of treatment, and instead needs threats of punishment to stop their behavior. I believe these approaches are too simplistic and do not …

Teaching Health Centers: A Promising Approach For Building Primary Care Work Force For The 21 St Century, Leighton Ku, Fitzhugh Mullan, Christine Cerrano, Zoe Barber, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

How Far Will They Go?: Assessing The Travel Distance Of Current And Former Drug Users To Access Harm Reduction Services, Sean Allen, Monica S. Ruiz, Allison O'Rourke

Prevention and Community Health Faculty Publications

Background

Prior research has explored spatial access to syringe exchange programs (SEPs) among people who inject drugs (PWID), but little is known about service utilization by former PWID who continue to access services (e.g., HIV screenings and referrals for social services) at harm reduction providers. The purpose of this research is to examine differences in access to SEPs between current and former PWID seeking services at a mobile SEP in Washington, DC.

Findings

A geometric point distance estimation technique was applied to data collected as part of a PWID population estimation study that took place in Washington, DC, in March …

Community Health Centers: A 2013 Profile And Prospects As Aca Implementation Proceeds, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2013, more than 1,200 federally funded community health centers provided access to care for low-income populations living in medically underserved communities throughout the country. The Affordable Care Act made expansion of health centers a key part of its strategy for ensuring that these communities would realize the benefits of increased health insurance coverage for their residents. 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. A key question going forward is whether health centers’ expanded capacity, developed over the past five …

The Public Health Service, Jennifer Jenson

National Health Policy Forum

This document provides an overview of the Public Health Service (PHS) within the U.S. Department of Health and Human Services, including a brief history and discussion of the agencies and offices that constitute the PHS today. Information on the mission, key programs, and budgets of PHS agencies and offices is also included.

Health Policy Essentials: Common Health Care Acronyms, National Health Policy Forum

National Health Policy Forum

No abstract provided.

Relative Value Units (Rvus), Sally Coberly

National Health Policy Forum

This publication reviews Medicare's relative value units (RVUs), which are assigned to each physician service to represent the resources required to provide the service relative to all other physician services. Three types of resources are included: physician work, that is, the physician time and effort; practice expenses, such as clinical staff and equipment; and professional liability insurance. Each service's RVUs are multiplied by a common dollar conversion factor to determine the Medicare payment.

Evaluating Obesity Prevention Efforts: What Have We Learned? Highlights From A Conversation Of Funders And Evaluators, Sumner M. Redstone Global Center For Prevention And Wellness

Sumner M. Redstone Global Center for Prevention and Wellness

Table of contents:

Executive Summary

Introduction

State of the Obesity Epidemic

The Community Context for Interventions and Evaluations

Investments to Date: Where Is the Strongest Agreement About What Works?

Early Care and Education Environments

Schools/Learning Environments

Parks, Trails, Open Spaces, and Recreation

Land Use and Transportation

The Next Tier: Mixed or Promising Results for Healthy Food Retail Interventions

Implementing Interventions: The Crucial Role of "How"

Other Topics

Summary and Next Steps

Appendix A: Citations and Resources for Key Elements/Components

Using Payment Reform Strategies To Strengthen Family Planning Services At Community Health Centers, Sara J. Rosenbaum, Peter Shin, Susan F. Wood, Jessica Sharac

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

The Evidence Does Not Speak For Itself: The Role Of Research Evidence In Shaping Policy Change For The Implementation Of Publicly Funded Syringe Exchange Programs In Three Us Cities, Sean T. Allen, Monica S. Ruiz, Allison O'Rourke

Prevention and Community Health Faculty Publications

BACKGROUND:

A breadth of literature exists that explores the utilization of research evidence in policy change processes. From this work, a number of studies suggest research evidence is applied to change processes by policy change stakeholders primarily through instrumental, conceptual, and/or symbolic applications, or is not used at all. Despite the expansiveness of research on policy change processes, a deficit exists in understanding the role of research evidence during change processes related to the implementation of structural interventions for HIV prevention among injection drug users (IDU). This study examined the role of research evidence in policy change processes for the …

Quit4baby: Results From A Pilot Test Of A Mobile Smoking Cessation Program For Pregnant Women, Lorien C. Abroms, Pamela R. Johnson, Christina L. Heminger, Judith M. Van Alstyne, Leah E. Leavitt, Jennifer M. Schindler-Ruwisch, Jessica A. Bushar

Prevention and Community Health Faculty Publications

Background: Text messaging (short message service, SMS) programs have been shown to be effective in helping adult smokers quit smoking. This study describes the results of a pilot test of Quit4baby, a smoking cessation text messaging program for pregnant smokers that was adapted from Text2quit.

Objective: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program.

Methods: Pregnant women enrolled in Text4baby and who were current smokers or had quit within the last 4 weeks (n=20) were enrolled in Quit4baby. Those under the age of 18, not …

Quit4baby: Results From A Pilot Test Of A Mobile Smoking Cessation Program For Pregnant Women, Lorien C. Abroms, Judy M. Van Alstyne, Christina L. Heminger, Leah E. Leavitt, Jennifer M. Schindler-Ruwisch

GW Research Days 2015

Background: Text messaging programs have been shown to be effective in helping adult smokers quit smoking. This study describes the results of a pilot test of Quit4baby, a smoking cessation text messaging program for pregnant smokers that was adapted from Text2quit.

Objective: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program.

Methods: Pregnant women enrolled in Text4baby and who were current smokers or had quit within the last 4 weeks (N=20) were enrolled in Quit4baby. Those under age 18, not pregnant, not current smokers, …

Tracking Global Fund Hiv/Aids Resources Used For Sexual And Reproductive Health Service Integration: Case Study From Ethiopia, Sangeeta Mookherji, Samantha Ski, Dale Huntington

Global Health Faculty Publications

Objective/Background

The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) strives for high value for money, encouraging countries to integrate synergistic services and systems strengthening to maximize investments. The GF needs to show how, and how much, its grants support more than just HIV/AIDS, TB and malaria.

Sexual and Reproductive Health (SRH) has been part of HIV/AIDS grants since 2007. Previous studies showed the GF PBF system does not allow resource tracking for SRH integration within HIV/AIDS grants. We present findings from a resource tracking case study using primary data collected at country level.

Methods

Ethiopia was the study …

Dose-Response Effects Of The Text4baby Mobile Health Program: Randomized Controlled Trial, William Douglas Evans, Peter E. Nielsen, Daniel R. Szekely, Jasmine W. Bihm, Elizabeth A. Murray, Jeremy Snider, Lorien C. Abroms

Prevention and Community Health Faculty Publications

BACKGROUND:

Mobile health (mHealth) is growing rapidly, but more studies are needed on how to optimize programs, including optimal timing of messaging, dose of exposure, and value of interactive features. This study evaluates final outcomes of text4baby (a text message service for pregnant and postpartum women) from a randomized trial performed in a population of pregnant female soldiers and family members.

OBJECTIVE:

The study aims were to evaluate (1) treatment effects and (2) dose-response effects of text4baby on behavioral outcomes compared to control (no text4baby) condition.

METHODS:

The study was a randomized trial of text4baby at Madigan Army Medical Center. …

Cost Effectiveness Of A Mail-Delivered Individually Tailored Physical Activity Intervention For Latinas Vs. A Mailed Contact Control, Britta Larsen, Todd Gilmer, Dori Pekmezi, Melissa A. Napolitano, Bess H. Marcus

Prevention and Community Health Faculty Publications

Background

Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas.

Methods

Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) …

Interpersonal Communication As An Agent Of Normative Influence: A Mixed Method Study Among The Urban Poor In India, Rajiv N. Rimal, Pooja Sripad, Ilene S. Speizer, Lisa M. Calhoun

Prevention and Community Health Faculty Publications

Background

Although social norms are thought to play an important role in couples’ reproductive decisions, only limited theoretical or empirical guidance exists on how the underlying process works. Using the theory of normative social behavior (TNSB), through a mixed-method design, we investigated the role played by injunctive norms and interpersonal discussion in the relationship between descriptive norms and use of modern contraceptive methods among the urban poor in India.

Methods

Data from a household survey (N = 11,811) were used to test the underlying theoretical propositions, and focus group interviews among men and women were then conducted to obtain …

Assessing Seasonality Of Travel Distance To Harm Reduction Service Providers Among Persons Who Inject Drugs., Sean T. Allen, Monica S. Ruiz, Amira Roess, Jeff Jones

Prevention and Community Health Faculty Publications

BACKGROUND: Prior research has examined access to syringe exchange program (SEP) services among persons who inject drugs (PWID), but no research has been conducted to evaluate variations in SEP access based on season. This is an important gap in the literature given that seasonal weather patterns and inclement weather may affect SEP service utilization. The purpose of this research is to examine differences in access to SEPs by season among PWID in the District of Columbia (DC).

FINDINGS: A geometric point distance estimation technique was applied to records from a DC SEP that operated from 1996 to 2011. We calculated …

Consumer Assessment Of Healthcare Providers And Systems (Cahps) Surveys: Assessing Patient Experience, Lisa Sprague

National Health Policy Forum

This publication provides an overview of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys, which are widely used by both public and private health plans and providers to assess the patient's experience of health care. Included is information on survey contents, how surveys are tailored to different users, and how the resulting information is collected, reported, and used to help consumers make choices and providers carry out quality improvement, as well as its role in pay-for-performance reimbursement.

Integrating Stages Of Change Models To Cast New Vision On Interventions To Improve Global Retinoblastoma And Childhood Cancer Outcomes, Meaghann S. Weaver, Christina L. Heminger, Catherine G. Lam

Prevention and Community Health Faculty Publications

Background: Retinoblastoma, the most common intraocular tumor globally, represents a curable cancer when diagnosed early and treated promptly. Delay to diagnosis, lag time prior to treatment initiation, and abandonment of treatment including upfront treatment refusal, represent stark causes of high retinoblastoma mortality rates in low- and middle- income settings, particularly regions in Africa. While a health delivery-based approach has been a historic focus of retinoblastoma treatments globally and is essential to quality care, this is necessary but not adequate. Retinoblastoma is a compelling disease model to illustrate the potential insights afforded in theory-informed approaches to improve outcomes that integrate public …

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 …