Health Services Administration Commons^™

Segregation By Payer In Obstetrics And Gynecology Residency Ambulatory Care Sites, Kavita Vinekar, Neena Qasba, Hannah Reiser, Erika Banks, Kavita Arora, Brownsyne Edmonds, Karen George

Department of Obstetrics and Gynecology Faculty Papers

IMPORTANCE: Many teaching hospitals in the US segregate patients by insurance status, with resident clinics primarily composed of publicly insured or uninsured patients and faculty practices seeing privately insured patients. The prevalence of this model in obstetrics and gynecology residencies is unknown.

OBJECTIVES: To examine the prevalence of payer-based segregation in obstetrics and gynecology residency ambulatory care sites nationally and to compare residents' and program directors' perceptions of differences in quality of care between payer-segregated and integrated sites.

DESIGN, SETTING, AND PARTICIPANTS: This national survey study included all 6060 obstetrics and gynecology residents and 293 obstetrics and gynecology residency program …

Challenges In Traumatic Spinal Cord Injury Care In Developing Countries - A Scoping Review, Mohammad Hosein Ranjbar Hameghavandi, Elaheh Khodadoust, Mahgol Sadat Hassan Zadeh Tabatabaei, Farzin Farahbakhsh, Zahra Ghodsi, Sabra Rostamkhani, Shahryar Ghashghaie, Mahkame Abbaszade, Arash Arbabi, Seyedeh Maede Hossieni, Mohsen Sadeghi-Naini, Rasha Atlasi, Samuel Berchi Kankam, Alexander Vaccaro, James Guest, Michael Fehlings, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

OBJECTIVE: To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care.

METHODS: We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care.

RESULTS: We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and …

Equity In Access For Veterans In The Va Community Care Program, Baligh R. Yehia, Said A. Ibrahim

Department of Medicine Faculty Papers

No abstract provided.

Practical Guidance On Establishing A Molecular Testing Pathway For Alterations In Homologous Recombination Repair Genes In Clinical Practice For Patients With Metastatic Prostate Cancer, Martin Schostak, Angela Bradbury, Alberto Briganti, David Gonzalez, Leonard Gomella, Joaquin Mateo, Frédérique Penault-Llorca, Albrecht Stenzinger, Alexander Wyatt, Anders Bjartell

Department of Urology Faculty Papers

CONTEXT: Prostate cancer is a molecularly heterogeneous disease that is amenable to diagnostic testing to identify patients potentially eligible for personalised treatments inform familial risk and provide relevant information about potential prognosis. Several guidelines support the integration of genomic testing in a shared decision-making framework so that both health care professionals (HCPs) and patients are involved in determining the best treatment approach.

OBJECTIVE: To review current guidelines on molecular diagnostic testing for homologous recombination repair (HRR) gene alterations in patients with metastatic prostate cancer, with the aim of providing practical considerations for effective guideline implementation and establishment of an appropriate …

Mortality And Major Adverse Cardiovascular Events In Hospitalized Patients With Atrial Fibrillation With Covid-19, Lucas Wang, Lawrence Hoang, Kristopher Aten, Mujahed Abualfoul, Victor Canela, Sri Prathivada, Michael Vu, Yi Zhao, Manavjot Sidhu

Faculty, Staff and Student Publications

COVID-19 results in increased incidence of cardiac arrhythmias, including atrial fibrillation (AF). However, little is known about the combined effect of AF and COVID-19 on patient outcomes. This study aimed to determine if AF, specifically new-onset AF (NOAF), is associated with increased risk of mortality and major adverse cardiovascular events (MACEs) in hospitalized patients with COVID-19. This multicenter retrospective analysis identified 2,732 patients with COVID-19 admitted between March and December 2020. Data points were manually reviewed in the patients' electronic health records. Multivariate logistic regression was used to assess if AF was associated with death or MACE. Patients with AF …

National Cross-Sectional Study On Cost Consciousness, Cost Accuracy, And National Medical Waste Reduction Initiative Knowledge Among Pediatric Hospitalists In The United States, Benjamin C Lee, Matt Hall, Ladan Agharokh, Andrew G Yu, Kavita Parikh, Samir S Shah

Faculty, Staff and Student Publications

BACKGROUND/OBJECTIVE: Despite initiatives to reduce waste and spending, there is a gap in physician knowledge regarding the cost of commonly ordered items. We examined the relationship between pediatric hospitalists' knowledge of national medical waste reduction initiatives, self-reported level of cost-consciousness (the degree in which cost affects practice), and cost accuracy (how close an estimate is to its hospital cost) at a national level.

METHODS: This cross-sectional study used a national, online survey sent to hospitalists at 49 children's hospitals to assess their knowledge of national medical waste reduction initiatives, self-reported cost consciousness, and cost estimates for commonly ordered laboratory studies, …

Fostering A High-Functioning Team In Cancer Care Using The 4r Oncology Model: Assessment In A Large Health System And A Blueprint For Other Institutions, Raymond Liu, Christine B Weldon, Elizabeth Linehan, Nancy Gordon, Thea Abbe, Marti Hennings, Henie James, Jed Katzel, Chun Ng, Megumi Tomita, Jeffrey B Velotta, Stephanie Ossowski, Lori C Sakoda, Sharon Likely Sprague, Anna Dowling, Kimberly Beringer, Arliene Ravelo, Elaine Yu, Julia R Trosman

Faculty, Staff and Student Publications

PURPOSE: Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system.

METHODS: 4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes. …

Health Workers On The Political Frontlines, Gideon Lasco

Development Studies Faculty Publications

No abstract provided.

Evaluation Of A Tennessee Statewide Initiative To Reduce Early Elective Deliveries Using Quasi-Experimental Methods, Michael P. Thompson, Ilana Graetz, Caitlin N. Mckillop, Peter H. Grubb, Teresa M. Waters

Health Management and Policy Faculty Publications

Background: Concerted quality improvement (QI) efforts have been taken to discourage the practice of early elective deliveries (EEDs), but few studies have robustly examined the impact of directed QI interventions in reducing EED practices. Using quasi-experimental methods, we sought to evaluate the impact of a statewide QI intervention to reduce the practice of EEDs.

Methods: Retrospective cohort study of vital records data (2007 to 2013) for all singleton births occurring ≥36 weeks in 66 Tennessee hospitals grouped into three QI cohorts. We used interrupted-time series to estimate the effect of the QI intervention on the likelihood of an EED birth …

A Longitudinal Analysis Of The Impact Of Child Custody Loss On Drug Use And Crime Among A Sample Of African American Mothers, Kathi L. H. Harp, Carrie B. Oser

Health Management and Policy Faculty Publications

This study examines the influence of child custody loss on drug use and crime among a sample of African American mothers. Two types of custody loss are examined: informal custody loss (child living apart from mother but courts not involved), and official loss (child removed from mother’s care by authorities).

Methods—Using data from 339 African American women, longitudinal random coefficient models analyzed the effects of each type of custody loss on subsequent drug use and crime.

Results—Results indicated that both informal and official custody loss predicted increased drug use, and informal loss predicted increased criminal involvement. Findings demonstrate …

The Use Of External Change Agents To Promote Quality Improvement And Organizational Change In Healthcare Organizations: A Systematic Review, Esra Alagoz, Ming-Yuan Chih, Mary Hitchcock, Randall Brown, Andrew Quanbeck

Health and Clinical Sciences Faculty Publications

Background: External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings.

Methods: We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified …

Objective Coding Of Content And Techniques In Workplace-Based Supervision Of An Ebt In Public Mental Health, Shannon Dorsey, Suzanne E U Kerns, Leah Lucid, Michael D Pullmann, Julie P Harrison, Lucy Berliner, Kelly Thompson, Esther Deblinger

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials.

METHODS: Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health …

Acceptability Of Hiv Testing Sites Among Rural And Urban African Americans Who Use Cocaine, D. Keith Branham, Tyrone F. Borders, Katharine E. Stewart, Geoffrey M. Curran, Brenda M. Booth

Health Management and Policy Faculty Publications

African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate …

A Clinical Score To Predict Dose Reductions Of Antidiabetes Medications With Intentional Weight Loss: A Retrospective Cohort Study., Ghanshyam Palamaner Subash Shantha, Anita Ashok Kumar, Vimal Ravi, Rohit C Khanna, Scott Kahan, Lawrence J Cheskin

Health Policy and Management Faculty Publications

Abstract

Background

We assessed the predictive accuracy of an empirically-derived score (weight loss, insulin resistance, and glycemic control: “WIG”) to predict patients who will be successful in reducing diabetes mellitus (DM) medication use with weight loss.

Methods

Case records of 121 overweight and obese patients with DM at two outpatient weight management centers were analyzed.

Results

Mean period of follow-up was 12.5 ± 3.5 months. To derive the “WIG” scoring algorithm, one point each was assigned to “W” (loss of 5% of initial body weight within the first 3 months of attempting weight loss), “I” (triglyceride [TGL]/highdensity lipoprotein ratio >3 …

Transforming Health Professions' Education Through In-Country Collaboration: Examining The Consortia Among African Medical Schools Catalyzed By The Medical Education Partnership Initiative., Zohray M. Talib, Elsie Kiguli-Malwadde, Hannah Wohltjen, Miliard Derbew, Yakub Mulla, David Olaleye, Nelson Sewankambo

Health Policy and Management Faculty Publications

BACKGROUND: African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning.

METHODS: Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These …

Evaluation Of An Emergency Department Lean Process Improvement Program To Reduce Length Of Stay, Marian J. Vermeulen, Therese A. Stukel, Astrid Guttmann, Brian H. Rowe

Dartmouth Scholarship

In recent years, lean principles have been applied to improve wait times in the emergency department (ED). In 2009, an ED process improvement program based on lean methods was introduced in Ontario as part of a broad strategy to reduce ED length of stay and improve patient flow. This study seeks to determine the effect of this program on ED wait times and quality of care. We conducted a retrospective cohort study of all ED visits at program and control sites during 3 program waves from April 1, 2007, to June 30, 2011, in Ontario, Canada. Time series analyses of …

Public Health Research Implementation And Translation: Evidence From Practice-Based Research Networks, Glen P. Mays, Rachel A. Hogg, Doris M. Castellanos-Cruz, Anna G. Hoover, Lizeth C. Fowler

Health and Clinical Sciences Faculty Publications

BACKGROUND: Research on how best to deliver efficacious public health strategies in heterogeneous community and organizational contexts remains limited. Such studies require the active engagement of public health practice settings in the design, implementation, and translation of research. Practice-based research networks (PBRNs) provide mechanisms for research engagement, but until now they have not been tested in public health settings.

PURPOSE: This study uses data from participants in 14 public health PBRNs and a national comparison group of public health agencies to study processes influencing the engagement of public health settings in research implementation and translation activities.

METHODS: A cross-sectional network …

Expanding Delivery System Research In Public Health Settings: Lessons From Practice-Based Research Networks, Glen P. Mays, Rachel A. Hogg

Health and Clinical Sciences Faculty Publications

BACKGROUND: Delivery system research to identify how best to organize, finance, and implement health improvement strategies has focused heavily on clinical practice settings, with relatively little attention paid to public health settings-where research is made more difficult by wide heterogeneity in settings and limited sources of existing data and measures. This study examines the approaches used by public health practice-based research networks (PBRNs) to expand delivery system research and evidence-based practice in public health settings.

METHODS: Practice-based research networks employ quasi-experimental research designs, natural experiments, and mixed-method analytic techniques to evaluate how community partnerships, economic shocks, and policy changes impact …

Adjusting For Under-Identification Of Aboriginal And/Or Torres Strait Islander Births In Time Series Produced From Birth Records: Using Record Linkage Of Survey Data And Administrative Data Sources, D Lawrence, D Christensen, F Mitrou, Glenn Draper, G Davis, S Mckeown, Daniel Mcaullay, G Pearson, S R Zubrick

Research outputs 2012

Background: Statistical time series derived from administrative data sets form key indicators in measuring progress in addressing disadvantage in Aboriginal and Torres Strait Islander populations in Australia. However, inconsistencies in the reporting of Indigenous status can cause difficulties in producing reliable indicators. External data sources, such as survey data, provide a means of assessing the consistency of administrative data and may be used to adjust statistics based on administrative data sources. Methods. We used record linkage between a large-scale survey (the Western Australian Aboriginal Child Health Survey), and two administrative data sources (the Western Australia (WA) Register of Births and …

Is American Health Care Uniquely Inefficient?, Alan M. Garber, Jonathan Skinner

Dartmouth Scholarship

No abstract provided.

Insights From The 2007 Disease Management Colloquium., David B Nash, Tine Hansen-Turton, Tracey Moorhead, Harry Leider, Donald F Wilson

College of Population Health Faculty Papers

No abstract provided.

How Do Hmos Achieve Savings? The Effectiveness Of One Organization's Strategies., Ann B. Flood, Allen M. Fremont, K Jin, David M. Bott

Dartmouth Scholarship

To examine how a group practice used organizational strategies rather than provider-level incentives to achieve savings for health maintenance organization (HMO) compared to fee-for-service (FFS) patients. A large group practice with a group model HMO also treating FFS patients. Data sources were all patient encounter records, demographic files, and clinic records covering 3.5 years (1986-1989). The clinic's procedures to record services and charges were identical for FFS and HMO patients. All FFS and HMO patients under age 65 who received any outpatient services during approximately 100,000 episodes of the seven study illnesses were eligible.