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Health Information Access

The Southeastern Librarian

The National Network of Libraries of Medicine, Southeastern Atlantic Region, wishes to remind libraries in the region that they provide training and assistance with health information access to the public.

Redesigning Practice To Improve Care Delivery (Boston), Laura A. Dummit, Lisa Sprague

National Health Policy Forum

This site visit focused on how the practice of medicine is changing or can be changed to improve care delivery across the spectrum of patient populations. Regarded as a “medical Mecca,” Boston is home to the academic health centers and teaching hospitals where many of the nation’s physicians are trained. As a center of innovation, Boston prides itself on its high bar with respect to standards of care. Panels addressed the used of clinical information technology (IT) in the physician’s office, in the hospital, and community-wide. Participants observed how IT is being used to further the mission of community health …

Medicare Advantage Snps: A New Opportunity For Integrated Care?, Christie Provost Peters

National Health Policy Forum

Medicare Advantage special needs plans (SNPs) are a new type of coordinated care plan established by the Medicare Prescription Drug, Improvement and Modernization Act. SNPs were created to encourage greater access to Medicare managed care for certain special needs populations: the institutionalized, persons dually eligible for Medicare and Medicaid, and the chronically ill. Some view SNPs as a new opportunity to integrate acute and long-term care services as well as Medicare and Medicaid financing. Others, however, question the degree to which full integration will become a widespread reality. This issue brief examines the SNP option and the promises and challenges …

El Vih En La Ciudad De Buenos Aires: Obstáculos En El Acceso Al Tratamiento En El Sector Público, Erica Tai-Le Bliss

Independent Study Project (ISP) Collection

The focus of my research is the access to HIV treatment in the public health sector in Buenos Aires. HIV testing and treatment are guaranteed, by law, financed completely by the government for patients in the public health sector who do not have any private insurance or social work insurance plan. Over three quarters of the registered cases of HIV are patients in the public sector. Although health care is free in the Capital, many patients don’t take HIV tests, seek treatment or eventually stop taking their medication. To investigate the motivations of the patients, I interviewed three sectors that …

A Report From The Forum Session “Implementing The Medicare Prescription Drug Benefit: Continuing Challenges For States”, Lee Partridge

National Health Policy Forum

This National Health Policy Forum Meeting Report provides an overview and discussion of a technical session that took place on July 12, 2005. The meeting was designed to re-visit issues discussed at a similar meeting in July 2004, which was intended to offer a state perspective on the implementation of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the new Medicare prescription drug benefit. This report provides an update on the implementation issues identified in 2004—including outreach, education and enrollment; coordination of care for individuals who are “dually eligible” for Medicare and Medicaid; and the cost …

One Pill, Many Prices: Variation In Prescription Drug Prices In Selected Government Programs, Dawn Gencarelli

National Health Policy Forum

This paper updates a June 2002 National Health Policy Forum Issue Brief, "Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?" Since the release of that paper, Congress enacted the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, which created a new, comprehensive outpatient prescription drug benefit and reduced Medicare’s reliance on the average wholesale price (AWP) in paying for prescription drugs. This paper discusses the continued use of AWP as well as other pricing benchmarks that pertain to prescription drugs. It explains the relevance of these pricing mechanisms to different government programs and …

Clinical Preventive Services: When Is The Juice Worth The Squeeze?, Eileen Salinsky

National Health Policy Forum

This paper provides an overview of clinical preventive services, including a definition of such services and the role of the U.S. Preventive Services Task Force in recommending which services should be routinely offered to patients. It also describes efforts to analyze the cost effectiveness of clinical preventive services and reviews the insurance coverage policies of private and public payers. Barriers to increased uptake of appropriate services are discussed and policy relevant issues are summarized.

Caring For "Ryan White": The Fundamentals Of Hiv/Aids Treatment Policy, Jessamyn Taylor

National Health Policy Forum

This background paper provides an overview of the HIV/ AIDS epidemic in the United States and discusses how treatment of the disease and the populations most affected by it have changed over time. The federal government’s domestic and global efforts in prevention, research, and treatment of the disease are highlighted. The paper outlines the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, a set of programs that fund treatment services for uninsured and underinsured individuals living with HIV/AIDS, and places it in the context of other federal programs that fund treatment for HIV/AIDS. Policy issues for Ryan White’s potential congressional …

Keeping Track Of Care: Quality And Technology At Lifebridge Health System (Baltimore), Judith Moore

National Health Policy Forum

This one-day site visit focused on quality and technology in acute, post-acute and long-term care at Sinai Hospital and Levindale Hebrew Geriatric Center and Hospital, both components of LifeBridge Health System in Baltimore. Participants traced the treatment paths of hypothetical cardiac and cancer patients through the hospital and explored the range of home- and community-based as well as institutional care available through the geriatric center. The role of clinical information technology was highlighted in both settings.

The Relationship Of Attitude, Self-Efficacy, Physician, And Significant Other Influence To Type 2 Diabetes Outcomes, Heidi A. Larson

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this study was to investigate the Theory of Planned Behavior (TPB) and its' relationship to Type 2 diabetes outcomes. One hundred and sixty-two adults ages 45 to 75 with Type 2 diabetes were recruited from two physicians' offices in the Midwest. Participants completed instruments that assessed (a) diabetes-specific attitude, (b) diabetes-specific self-efficacy, ( c) physician influence, ( d) significant other influence, and ( e) diabetes-specific quality of life. A measurement of metabolic control was also obtained. Multiple regressions were performed using (a) quality of life and (b) metabolic control as criterion variables. Attitude, self-efficacy, and physician influence …

Development And Validation Of An Anthropometrically Based Prediction Equation For Estimating The Percent Body Fat Of Post-Menopausal Black Females, Leanne Petry, Lloyd L. Laubach, Peter W. Hovey, Nikki Lynn Rogers, Bradford Towne, William Cameron Chumlea

Population and Public Health Sciences Faculty Publications

Anthropometric equations developed specifically for the estimation of body composition parameters in Black females are limited. Data from the Lifespan Health Research Center were used to develop a new, easy to use equation to estimate the percent body fat of post-menopausal Black females using simple and easy to collect anthropometrics. The body composition of 72 post-menopausal Black females was measured by Dual Energy X-ray Absorptiometry (DXA). Validation (N=55) and cross-validation groups (N=17) were randomly assigned. Prediction models were developed using stepwise multiple regression analyses with percent body fat as the dependent variable and various anthropometrics as the independent variables. The …

Mental Health And Juvenile Justice: Moving Toward More Effective Systems Of Care, Jane Koppelman

National Health Policy Forum

This issue brief discusses the mental health needs of youth who are involved with the juvenile justice system, how they come into contact with the system, and the evidence of the availability and quality of mental health services for such youth. The paper also explores public policy options for avoiding dependence on the juvenile justice system as a last resort for treating youth with mental disorders.

Specialty Hospitals: Can General Hospitals Compete?, Laura A. Dummit

National Health Policy Forum

The rapid increase in specialty cardiac, surgical, and orthopedic hospitals has captured the attention of general hospitals and policymakers. Although the number of specialty hospitals remains small in absolute terms, their entry into certain health care markets has fueled arguments about the rules of “fair” competition among health care providers. To allow the smoke to clear, Congress effectively stalled the growth in new specialty hospitals by temporarily prohibiting physicians from referring Medicare or Medicaid patients to specialty hospitals in which they had an ownership interest. During this 18-month moratorium, which expired June 8, 2005, two mandated studies of specialty hospitals …

Local Coverage Initiatives: Solution Or Band-Aid For The Uninsured?, Jennifer Ryan

National Health Policy Forum

This issue brief surveys health coverage expansion initiatives that are operating on the county or local level, often without the benefit of federal funding. The paper explores the circumstances that have made these initiatives possible and considers the ongoing barriers that local policymakers face in sustaining the programs. Descriptions of four initiatives illustrate the range and variety of programs in operation today and offer both best practices and lessons learned for other communities. The paper also includes a brief analysis of the key elements that make up a successful coverage initiative. Finally, this issue brief considers the role of local …

Children With Special Health Care Needs: Minding The Gaps, Christie Provost Peters

National Health Policy Forum

This background paper examines the issue of children with special health care needs and their interaction with the health care system. Results from recent national and state surveys and studies were used to review the medical expenditures, utilization, and insurance coverage of these children. The paper also discusses weaknesses within the private and public delivery and financing systems that may hinder the access of certain families with children with special health care needs to important services.

Rural Methamphetamine Abuse: An Ethnographic Perspective, Rocky L. Sexton, Robert G. Carlson

Population and Public Health Sciences Faculty Publications

No abstract provided.

Stimulant Abuse In Ohio And The Rural South, Robert G. Carlson

Population and Public Health Sciences Faculty Publications

This paper summarizes the methods and findings from two NIDA-supported studies of methamphetamine (MA) abuse in rural Ohio, Kentucky, and Arkansas, conducted by researchers at the Wright State University Boonshoft School of Medicine, the University of Arkansas for Medical Sciences, and the University of Kentucky. In addition, patterns of MA abuse among young adult MDMA/ecstasy users in urban central Ohio are described. Finally, preliminary findings from the Ohio Substance Abuse Monitoring Network on trends in methamphetamine abuse in Dayton, Ohio, are presented.

Public Health Advocacy To Change Corporate Practices: Implications For Health Education Practice And Research, Nicholas Freudenberg

Publications and Research

Corporate practices, such as advertising, public relations, lobbying, litigation, and sponsoring scientific research, have a significant impact on the health of the people in the United States. Recently, health professionals and advocates have created a new scope of practice that aims to modify corporate practices that harm health. This article describes how corporate policies influence health and reviews recent health campaigns aimed at changing corporate behavior in six industries selected for their central role in the U.S. economy and their influence on major causes of mortality and morbidity. These are the alcohol, automobile, food, gun, pharmaceutical, and tobacco industries. The …

Hospital Oversight In Medicare: Accreditation And Deeming Authority, Lisa Sprague

National Health Policy Forum

To be eligible to receive payment from Medicare, hospitals must be certified to meet certain conditions. Hospitals may gain such credentials by choosing to be reviewed by a state certification agency under contract to the Centers for Medicare & Medicaid Services or to be accredited by either the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association. This issue brief looks at how accreditation of hospitals developed and how it continues to change. It considers the legal and practical reasons that a majority of hospitals choose accreditation and why some hospitals do not, along with broader consideration …

Evaluation Of Over-The-Counter Sales As A Syndromic Surveillance Method For Waterborne Disease In New Mexico, Camilla M. Bustamante

Health, Exercise, and Sports Sciences ETDs

This research evaluates the use of Over-the-Counter anti-diarrheal medications as a potential syndromic indicator and surveillance mechanism for waterborne disease in New Mexico. The purpose was to determine the usefulness of such data for either supplemental or stand alone use in a system for waterborne disease surveillance. The use of syndromic indicators for waterborne disease was elevated in 1993 after an outbreak of cryptosporidium was detected in Milwaukee Wisconsin by an alert pharmacist who noticed increased sales of over-the-counter medications over a period of time. In 2001, terrorist threats for anthrax exposure to U.S. populations further prompted funding and research …

Parents' Perception Of Their Children's Asthma, 2002-2008: A Community-Based Study, John M. Pascoe, William Spears, Shalini Forbis, Jessica L. Saunders

Population and Public Health Sciences Faculty Publications

Childhood asthma is a chronic health condition that is one of the leading causes of hospitalizations and missed school days for children. It also affects the lives of both asthmatic children and their families.

Health Insurance Coverage For Small Employers, Dawn Gencarelli

National Health Policy Forum

For workers of small employers, access to affordable health insurance coverage is a growing concern. This paper examines the problems these firms and their employees face in obtaining health insurance coverage they can afford. The degree to which these challenges become obstacles varies greatly, depending on, for instance, the size of the employer and the characteristics of its employees. Reviewed here are these challenges to access, as well as some of the efforts made through state and federal reforms to address them, including rules regarding guaranteed issue and guaranteed renewability. This paper also explores some of the more recent initiatives …

Fundamentals Of Underwriting In The Nongroup Health Insurance Market: Access To Coverage And Options For Reform, Mark Merlis

National Health Policy Forum

Although the majority of Americans with health insurance obtain coverage through their employers, many individuals must negotiate the nongroup insurance market alone. Insurers use a process called medical underwriting to identify applicants with current or recent medical problems. Because these applicants are likely to cost the insurer more in claims than a healthier person, insurers may charge them higher premiums or restrict or deny coverage. This background paper reviews the practice of underwriting, state and federal regulation of insurers offering nongroup health coverage, and several proposed options for improving access to coverage for applicants who are in poor health.

Health Savings Accounts: The Fundamentals, Beth Fuchs, Julie A. James

National Health Policy Forum

This paper explores the fundamentals of health savings accounts (HSAs). While not intended to be an exhaustive review of these accounts, it describes their intellectual and legislative origins and the mechanics of how they work, explores the early returns on how they are faring in the insurance market, and identifies major issues and controversies that they raise. The paper looks specifically at the basic rules for HSAs and the requirements for health insurance that qualifies as a high-deductible health plan (HDHP) for HSA purposes. Also considered are issues related to provider payments under HSAs and the administration of the benefit …

Correlates Of In-Home Smoking Behavior Of Parents With Newborns, James Kyung Jo

Loma Linda University Electronic Theses, Dissertations & Projects

Secondhand smoke has been shown to have adverse health effects on young children. It is associated with various health effects such as respiratory infections, Sudden Infant Death Syndrome (SIDS), and asthma. Because of the dangers secondhand smoke poses to young children, there is a need for educating parents about the dangers of secondhand smoke as well as determining factors associated with secondhand smoke exposure among children. Understanding these factors may be first step toward developing strategies to reduce ETS exposure.

The study examined correlates of in-home smoking behavior of parents with newborns by analyzing 657 respondents who filled out the …

Exploring California's Rural Health System: From The Redwood Forests To The Baja Border, Eileen Salinsky, Jessamyn Taylor

National Health Policy Forum

This three day site visit to California explored the state’s rural health system with a particular focus on the financial health of inpatient and outpatient providers and how that affects access to care. The role of telemedicine as a tool for expanding access was explored as well as the special needs of vulnerable populations such as farmworkers. Participants learned how state and federal regulation and payment policies and state budget deficits impact the viability of rural health systems.

How Should Health Departments Manage Prenatal Care?, Julianne Nesbit

Master of Public Health Program Student Publications

Objective: To compare how health departments in the southwest district of Ohio manage prenatal care, defined as preventative care provided immediately preceding, during, and following pregnancy, to determine if there is a better management technique based on cost and/or characteristics of jurisdictions.

Design: Qualitative descriptive analysis of prenatal services at local health departments in the southwest district of Ohio for 2004.

Setting and Participants: Health Departments in the southwest district of Ohio.

Main Outcome Measures: Comparison of the types of services currently being used to provide prenatal care services (i.e., direct, contracted, combination, or no service) including budgeting and cost …

Understanding The Relative Importance Of Positive And Negative Social Exchanges: Examining Specific Domains And Appraisals, Jason T. Newsom, Karen S. Rook, Masami Nishishiba, Dara H. Sorkin, Tyrae Mahan

Community Health Faculty Publications and Presentations

Negative social exchanges have been more reliably related to psychological health than have positive social exchanges. Little research, however, has sought to understand how underlying appraisal processes link such exchanges to psychological health. This study examined the frequencies of occurrence and appraisals of four parallel domains of positive and negative exchanges in relation to positive well-being and psychological distress in a national sample of 916 older adults. Structural equation analyses revealed that negative exchanges were related both to less well-being and greater psychological distress, whereas positive exchanges were related only to positive well-being. Furthermore, results supported a process in which …

The Effects Of Ppa And Nicotine Gum On Cessation Rates And Post Cessation Weight Gain In Women., Theodore Cooper, R. Klesges, M. Debon, S. Zbikowski, K. Johnson, L. Clemens

Selected Works Temporary Series

No abstract provided.

Community-Based Participatory Research: Defining Community Stakeholders, Laurene M. Tumiel-Berhalter, Robert Watkins, Carlos J. Crespo

Community Health Faculty Publications and Presentations

Community-based participatory research requires the participation of community stakeholders to inform the process. The West Side Community Asthma Project, a community-based participatory research program to study the effects of the environment on asthma conducted in Buffalo, N. Y, identified a stakeholders group of community leaders and activists. Creative strategies have been implemented to reach out to other community residents to invite them to participate in the participatory process.