Health Services Administration Commons^™

Building The Science Of Public Health Delivery: Advances In Public Health Services And Systems Research, Glen P. Mays

Health Management and Policy Presentations

Efforts to improve the health and economic performance of the U.S. health system require evidence about how best to deliver public health strategies that protect health and prevent disease and injury on a population-wide basis. The field of public health services and systems research is building a "science of delivery" in public health that complements the evidence-based practice movement in medical care.

From The Frontier: Translating Research To Practice...A Story Of Economic Survival, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

This article is number two in the series From the Frontier: Translating Research to Practice. The narrative describes the interactions between a local health department director and two academicians in addressing the impact of the 2008 financial crisis. In a first set of activities, practice-academic partners used Financial and Operational Ratio and Trend Analysis to identify periods of a negative total margin and the impact of that on the agency’s declining fund balance. The use of private sector processes of retrenchment, repositioning, and reorganization led to a financial turnaround for the agency. In a second set of activities, practice-academic …

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Today, over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow.

In the Affordable Care Act (ACA), Congress invested $11 billion over five years to expand the health center program, to broaden access to care in lower-income communities as …

Improving Access To Children's Mental Health Care: Lessons From A Study Of Eleven States, Donna Behrens, Julia Graham Lear, Olga Acosta Price

Center for Health and Health Care in Schools

Implementation of the Patient Protection and Affordable Care Act (ACA) is well underway, creating long-overdue opportunities for growing the capacity of child and adolescent mental health systems and meeting children’s pressing needs. The good news is that as of January 1, 2014, coverage of mental health conditions and substance use disorders will be required as part of the broad Essential Benefits package of services under the ACA. While states will determine specific benefits, it is widely accepted that mental health and substance abuse coverage will substantially increase, though the details remain to be determined.1 Additionally, as a result of this …

Rfid Technology Selection And Economic Justification For Healthcare Asset Tracking, Tyler Robert Peabody, Tali Freed

Master's Theses

Although Radio Frequency Identification (RFID) and Real-Time Location System (RTLS) technologies for inventory tracking have been growing in popularity, the healthcare industry has been reluctant to adopt these technologies. One of the primary reasons for this lack of enthusiasm has been the risk associated with electromagnetic interference between RFID/RTLS systems and medical equipment functionality. The other reason has been the substantial cost and complexity of implementing RFID/RTLS in healthcare organizations. In this study, we show that there are several ways to safely install RFID/RTLS systems to improve the inventory management processes of hospitals and clinics. We then analyze the inventory …

Medical Tourism And International Healthcare Options, David Conley, Andrew Sikula Sr., William Willis, Alberto Coustasse

Management Faculty Research

Medical tourism has evolved from traveling to the United States (U.S.) and a select few other countries, such as India and Thailand, to a global trend in affordable alternative healthcare. Medical tourism in the U.S. and in other countries has evolved because of cost and lengthy waiting periods. Some insurance companies are marketing kidney transplants and joint replacements through medical choice programs in order to save overall expense. As an economical approach to controlling rising health care costs in the U.S., medical tourism is becoming a valid alternative.

Health Policy & Management News, Georgia Southern University

Health Policy & Community Health: News & Publications (2011-2018)

• A Merged Model for Quality Improvement

Using Learning Collaboratives To Improve Public Health Emergency Preparedness Systems, Michael A. Stoto, Harold Cox, Melissa Higdon, Kerry Dunnell, Donald Goldmann

Frontiers in Public Health Services and Systems Research

The U.S. National Health Security Strategy calls for the development and wide-spread implementation of quality improvement (QI) tools in public health emergency preparedness (PHEP), including the development of “learning collaboratives,” a structured way for organizations with common interests to close the gap between potential and practice by learning from each other. To test this approach, we developed and assessed separate learning collaboratives focused on PHEP emergency communications and on the use of Medical Reserve Corps (MRC) volunteers. Although participants carried out improvement projects that they felt were useful, each collaborative struggled to identify a common theme, participation was limited, and …

Evidence-Based Decision Making To Improve Public Health Practice, Ross C. Brownson, Jonathan E. Fielding, Christopher M. Maylahn

Frontiers in Public Health Services and Systems Research

Despite the many accomplishments of public health, greater attention on evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about 15 years ago. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Core competencies for EBPH are emerging, including not only technical skills but also attention to administrative practices in public health agencies. To better bridge evidence and practice, the concepts …

The "Coopetition" Model: Caring For San Diego's Low-Income Population, Lisa Sprague, Jessamyn Taylor

National Health Policy Forum

This site visit explored aspects of health care delivery for Medicaid beneficiaries and the uninsured in a California county marked by a diverse population, dominant managed care, and stakeholder dedication to solving problems in a spirit of "coopetition." The program looked at the impact of California's Bridge to Reform (the state's Medicaid section 1115 waiver) on federally qualified health centers and the people they serve. Eligibility and enrollment expansions in the Low Income Health Program and Medi-Cal, health information technology adoption and its use to improve care delivery and health, and patient-centered medical homes and care coordination were discussed. The …

Estimating The Health And Economic Effects Of Public Health Spending, Glen P. Mays

Health Management and Policy Presentations

Preventable health conditions account for more than 75% of the $2.7 trillion spent annually on health care in the U.S., yet less than 5% of these expenditures are devoted to public health programs and services that are designed to prevent and control disease and injury rather than to treat the downstream consequences of these conditions. Such limited expenditures in public health may contribute to the higher rates of preventable morbidity, mortality and excess medical costs experienced in the U.S. compared to other high-income countries. In this presentation, I update previous estimates of the health effects and medical cost offsets associated …

Neonatal Outcomes After Preterm Birth By Mothers' Health Insurance Status At Birth: A Retrospective Cohort Study, Kristjana Einarsdóttir, Fatima A. Haggar, Amanda T. Langridge, Anthony S. Gunnell, Helen Leonard, Fiona J. Stanley

Research outputs 2013

Background: Publicly insured women usually have a different demographic background to privately insured women, which is related to poor neonatal outcomes after birth. Given the difference in nature and risk of preterm versus term births, it would be important to compare adverse neonatal outcomes after preterm birth between these groups of women after eliminating the demographic differences between the groups. Methods: The study population included 3085 publicly insured and 3380 privately insured, singleton, preterm deliveries (32–36 weeks gestation) from Western Australia during 1998–2008. From the study population, 1016 publicly insured women were matched with 1016 privately insured women according to …

Health Policy & Management News, Georgia Southern University

Health Policy & Community Health: News & Publications (2011-2018)

• Barriers to Cervical Cancer Screening

Assisted Living: Facilities, Financing, And Oversight, Carol O'Shaughnessy

National Health Policy Forum

This publication briefly describes assisted living facilities that provide long-term services and supports to people with functional or cognitive impairments who do not need the level of skilled nursing care offered in nursing homes but cannot live independently. It also describes selected resident characteristics, reviews cost and financing arrangements, and reviews state responsibilities for regulation and oversight of assisted living facilities.

Health Policy & Management News, Georgia Southern University

Health Policy & Community Health: News & Publications (2011-2018)

• JPHCOPH Examines Impact of Economic Recession

Commentary: Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Laura L. Hitchcock

Frontiers in Public Health Services and Systems Research

In Hospital Tax-Exempt Policy: A Comparison of Schedule H and State Community Benefit Reporting Systems, Rosenbaum et aldescribe the numerous variations between current state law in 24 states and federal requirements regarding nonprofit hospitals’ community benefit activities. The potential for nonprofit hospitals to help shape community health is great, and how states choose to address requirements regarding community benefit, and potentially reinforce the new federal requirements to incentivize hospital participation in addressing root causes of poor health, should be of significant interest to the public, policy makers and public and population health experts, given the large percentage of …

Learning By Doing For Public Health Improvement, Glen P. Mays

Frontiers in Public Health Services and Systems Research

All too often, the knowledge gained through learning-by-doing in public health fails to be fully harvested and disseminated because of missed opportunities to carefully study the experiences and innovations occurring in practice. The field of public health services and systems research (PHSSR) has emerged to capitalize on these opportunities before they are missed.

Family Caregivers: The Primary Providers Of Assistance To People With Functional Limitations And Chronic Impairments, Carol O'Shaughnessy

National Health Policy Forum

An extensive body of research conducted over the past several decades has documented that family or other unpaid caregivers provide the majority of care to people who need assistance because of functional limitations or multiple and complex chronic conditions. Families play a central role not only in assisting impaired family members with personal care needs, but also in helping them coordinate health care and supportive services, and, increasingly, providing and/or supervising home-based medical care. This paper presents background information on family caregiving, briefly describes federal programs that provide direct assistance to caregivers, and discusses possible future policy and practice directions.

Public Health Expenditures, Public Health Delivery Systems, And Population Health, Glen P. Mays

Health Management and Policy Presentations

This seminar examines a series of approaches for estimating the health and economic effects attributable to public health expenditures in the U.S., along with a novel method for estimating economies of scale and scope in the delivery of public health services. The use of instrumental-variables techniques and network analytic methods are described in these research approaches.

The Community Living Assistance Services And Supports (Class) Act: Major Legislative Provisions, Carol O'Shaughnessy

National Health Policy Forum

Update (January 3, 2013) — In 2010, Congress enacted the Community Living Assistance Services and Supports (CLASS) Act as part of the Patient Protection and Affordable Care Act (P.L. 111-148). The CLASS Act was repealed as part of the American Taxpayer Relief Act of 2012 signed by the President on January 2, 2013.

During 2011 the Department of Health and Human Services (HHS) conducted an analysis of possible CLASS implementation options consistent with the statutory requirements that the program be actuarially solvent over a 75-year period and self-funded. After a 19-month period of analysis, HHS officials stated in testimony before …

The Institutional Context That Supports Team-Based Care For Older Adults, Anna Foucek Tresidder

Dissertations and Theses

The aging population in the U.S. is dramatically increasing; it is predicted that not only will individuals live longer but also that they will live with multiple chronic diseases that could require high levels of medical and social resources. While the aging population increases, the number of health care providers choosing to specialize in caring for the elderly is decreasing just as dramatically. Teams are believed to be a possible response to more efficiently use the providers available, take advantage of alternative provider types, and integrate a range of health and social services to meet patient needs more effectively. Interdisciplinary …

Patient Understanding Of Coordinated Medical Treatment Success Within The Minnesota Medical Home Model: An Exploratory Qualitative Inquiry, Jeremy F. Stockinger

Theses and Dissertations

The US health care system is often described as a complex, fragmented system where patients experience less access, coordinated, and comprehensive care that is ultimately more costly (Rosenberg, 2009). The problem addressed in this study was to understand coordinated medical treatment in the medical home model from the patient perspective. This study provides the opportunity to increase the understanding of the factors affecting coordinated medical treatment success.

State Foodborne Illness Surveillance And Response Laws: Compilation And Analysis, Stephanie David, Jenna Burton, Chris Chadwick, Rebecca Katz

Health Policy and Management Faculty Publications

Objective

To document and assess the variation in state legislation relating to foodborne disease surveillance and outbreak response for all 50 states and the District of Columbia by creating a database and appendix of laws and regulations that will be made available to researchers and policymakers.

Introduction

Foodborne illnesses sicken 48 million and kill 3,000 Americans every year, presenting an enduring threat to the public’s health. In just the past three years alone, the United States has experienced at least four major multistate outbreaks in food. Despite this growing problem, efforts to prevent foodborne illness pose a particular public health …

Rural Acute Myocardial Infarction Survey (Ramis), Nikiah Nudell Ba, Nrp, Tom Bouthillet Nremt-P, Don Rice Md, John A. Gale Ms, Gary Wingrove Emt-P

Rural Hospitals (Flex Program)

The purpose of this study is to evaluate why current treatment goals for patients with Acute Myocardial Infarction (AMI) are not being achieved despite a large body of evidence supporting regionalized ST Elevation Myocardial Infarction (STEMI) systems. An online survey tool,developed by the research project team, was used to poll the Critical Access Hospitals in Nebraska in order to understand delay factors and other barriers to executing a STEMI system in a rural area. The authors found that the rural STEMI care system lacks a coordinated systems considered to be essential for urban areas. Several areas of potential failure in …

The Core Competencies For Public Health Professionals, Center For Leadership In Public Health Practice

Florida Public Health Training Center

Core competencies for public health professionals are competencies that represent a set of skills, knowledge, and attitudes necessary for the broad practice of public health, as they apply to front-line staff, senior-level staff, and supervisory and management staff. We will describe the Core Competencies for Public Health Professionals by defining the related key terminology, reviewing how the Core Competencies are designed for all public health professionals at the various stages of their career, and presenting the Domains of the Core Competencies.

Cultural Competency In Health Care: Framework, Training And Evaluation - A Review Of The Literature, Diana Salas Coronado

Center for Social Policy Publications

Healthcare professionals are now more aware of the challenges they face when providing healthcare services to a culturally and racially diverse population. Cultural competency has emerged as a framework for understanding health disparities among racial and ethnic groups in particular, but also for women, the elderly, sexual orientation and gender identity, people with disabilities, and religious minorities. Although there are several definitions of cultural competency, each emphasizes the need for healthcare systems and providers to be aware of and responsive to patients’ cultural perspectives and backgrounds. One example defines cultural competency as “a set of congruent behaviors, attitudes, and policies …

The Relationship Between Electronic Health Record Implementation And Outcomes Of Care For Three Cardiovascular Procedures, Deshia Ann Leonhirth

Theses and Dissertations

Background. The U.S. healthcare movement to improve quality and patient outcomes has prompted investigations into tools that can assist in these aims. Electronic health records (EHRs) are one tool proposed by the Institute of Medicine (IOM). The objective of this original dissertation research was to examine the relationship between electronic health record functionalities and two outcomes of care as proxies for quality: risk-adjusted mortality for abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) and log estimated cost-per-discharge. Methods. This study used 2009-2010 hospital inpatient administrative discharge data from the Nationwide Inpatient Sample (NIS), …

Assessment Of The Effectiveness Of An Innovative Screening Colonoscopy Protocol In Producing High Quality Performance And Outcomes By Trained Primary Care Physicians, Yi Jhen Li

Theses and Dissertations

Colorectal cancer (CRC) is the 3rd most prevalent cancer and 2nd leading cause of cancer death in the U.S. Colonoscopies have been recommended as the preferred screening method to prevent cancer by removing polyps before they transform into cancer. Although colonoscopy every 10 years is considered to be the preferred screening method, it is not perfect mainly owing to the variable quality of screening colonoscopy under community-based practice conditions. Although the effectiveness of colonoscopy in preventing CRC is documented, screening colonoscopy coverage in the US population remains low. This is partly due to low colonoscopy capacity due to a shortage …

Differential Effects Of The Great Recession On Minority Populations, Samuel Towne

Theses and Dissertations

Times of severe economic flux may burdend individuals at differing levels. The Great Recession affected individuals differently by racial group. Vulnerable individuals who may already be burdened by economic strains and health disparities may benefit from state policies that work to improve the health and health care access of individuals. Medicaid Generosity for parents or childless adults is associated with differences in individuals' health status and reporting forgone medical care. Individuals in states that have higher levels of Medicaid eligibility defined as eligibility in relation to the percent of the Federal Poverty Level report lower levels of poor or fair …

Examining The Role Of Electronic Medical Record Generated Provider Reminders On Provider Offering Of Breast Cancer Screening Services, Charles Beverley, Jr.

Theses and Dissertations

Introduction:Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for increasing the offering of preventive care in breast cancer. This study examines the impact of EMR usage, and EMR generated provider reminders on physician ordering or providing of mammography screenings.

Methods:This study used survey data from the 2008-2010 National Ambulatory Medical Care Survey (NAMCS). Our sample included non-federal office-based …