Health Services Administration Commons^™

The Hospitalist: Better Value In Inpatient Care?, Lisa Sprague

National Health Policy Forum

From perhaps a few hundred practitioners in 1996 to an estimated 30,000 today, the discipline called hospital medicine has shown remarkably rapid growth. It represents a fundamental separation of the inpatient and outpatient components of internal and family medicine. The split has implications for the quality and efficiency of care delivery, the outlook for the physician workforce, and the development of new models such as accountable care organizations (ACOs).

Medicare's Bundling Pilot: Including Post-Acute Care Services, Laura A. Dummit

National Health Policy Forum

Fee-for-service Medicare, in which a separate payment is made for each service, rewards health care providers for delivering more services, but not necessarily coordinating those services over time or across settings. To help address these concerns, the Patient Protection and Affordable Care Act of 2010 requires Medicare to experiment with making a bundled payment for a hospitalization plus post-acute care, that is, the recuperative or rehabilitative care following a hospital discharge. This bundled payment approach is intended to promote more efficient care across the acute/post-acute episode because the entity that receives the payment has financial incentives to keep episode costs …

Substance Abuse In Georgia, The Burruss Institute Of Public Service And Research

Georgia Journal of Public Policy

In order to create a snapshot of substance use and abuse in Georgia, the Burruss Institute of Public Service and Research requested access to data from the National Survey on Drug Use and Health conducted on behalf of the Substance Abuse and Mental Health Services Administration (SAMHSA), a unit of the Department of Health and Human Services (HHS).  SAMHSA would not provide access to the raw data; instead, the Institute was given a series of tables with estimates of the average annual number of users of various substances among Georgians ages 12 and older between the years 2002 and 2008. …

Evaluation Of A Quality Management Initiative And Hiv Ambulatory Services Performance In Thailand, Meemon Natthani

Electronic Theses and Dissertations

The accomplishment of pilot implementation of the HIVQUAL-T model, an innovative HIV care quality management tool, has led to an authoritative decision to scale up the use of the model nationwide in Thailand. However, the level of implementing this model varies across target hospitals. Some hospitals have fully adopted the model by conducting quality improvement (QI) activities following performance measurement (PM) results while others have partially adopted only PM or have not used this model at all. The differential level of implementation could be a contributing factor accounting for discrepancies in the quality of care across different HIV ambulatory care …

Increasing Organ Donation In Ireland : Social Marketing And Infrastructural Improvements., Ronan O'Sullivan

Theses

There were over 600 patients on the organ waiting list in Ireland in November 2010. This is a substantial increase on the 414 patients on the waiting list in 2008. Ireland also witnessed a dramatic decline in the number of donors from 90 donors in 2009 to 58 donors in 2010. This thesis focuses on investigating the current state of organ donation in the Republic of Ireland, with the eventual goal of recommending alterations to improve the system. In depth- interviews were conducted with eleven leading personnel from the fields of organ donation and social marketing in Ireland as well …

Local Public Health System Partnerships: A Mixed Methods Multi-State Study, Priscilla A. Barnes

Dissertations

The purpose of this three-paper dissertation was to conduct a mixed methods multi-state examination of specific partnership-related activities among local public health systems (LPHSs) as well as to explore perceptions of LPHS practitioners regarding partnership practices.

In the first paper, secondary data analysis of questions from the National Public Health Performance Standards Program (NPHPSP, n = 110) was used to determine the frequency that partnership activities were conducted optimally (> 75% of the time) and whether any associations existed between three different partnership capacities. Activities were matched with relational, organizational, and programmatic capacities from the Collaborative Capacity Framework. Overall, 86% …

Self-Insurance And The Potential Effects Of Health Reform On The Small-Group Market, Kathryn Linehan

National Health Policy Forum

The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers—most often those in very large firms—are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA …

The Elder Justice Act: Addressing Elder Abuse, Neglect, And Exploitation, Carol O'Shaughnessy

National Health Policy Forum

Elder abuse, neglect, and exploitation is a social problem that affects older people across all socioeconomic groups and care settings. Although national data on the full extent of the problem are elusive, one study found that 11 percent of older people living in community settings had experienced physical, emotional, or sexual abuse, or potential neglect during one year. Abuse and neglect of residents of nursing facilities and other institutions have been a continuing concern of policymakers and advocates for many years. The Elder Justice Act (EJA), enacted as part of the Patient Protection and Affordable Care Act (PPACA) on March …

Aging And Disability Resource Centers (Adrcs): Federal And State Efforts To Guide Consumers Through The Long-Term Services And Supports Maze, Carol O'Shaughnessy

National Health Policy Forum

Since 2003, the U.S. Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS) have made a series of grants to states to develop Aging and Disability Resource Centers (ADRCs). The ADRC program’s purpose is to help people of all ages, disabilities, and income levels more easily access long-term services and supports through single points of entry, make more efficient use of care options, and maximize the services available. Almost $111 million in joint AoA-CMS funding has been devoted to the ADRC initiative since its inception in fiscal year 2003. As of October 2010, 325 ADRC sites …

Premium Assistance: An Update, Cynthia Shirk

National Health Policy Forum

This background paper explores the use of premium assistance in publicly financed health insurance coverage programs. In Medicaid and the Children’s Health Insurance Program, premium assistance involves using federal and state funds to subsidize premiums for the purchase of private insurance coverage for eligible individuals. This paper reviews the statutory authority for premium assistance, including two new options made available under the Children’s Health Insurance Program Reauthorization Act of 2009. It examines the status of premium assistance programs in the states and offers some insights into how premium assistance programs may fare under the Patient Protection and Affordable Care Act.

El Papel De La Educación Y Las Ong’S En Mejorar El Acceso A Derechos Para Inmigrantes: El Caso De Los Derechos Sexuales Y Reproductivos = The Role Of Education And Ngo’S In Helping Immigrants Obtain Better Access To Their Rights: The Specific Case Of Sexual And Reproductive Rights, Amy Torres

Independent Study Project (ISP) Collection

In January of 2004, Argentina approved a new immigration law that guaranteed the protection of human rights for all immigrants in the country regardless of their legal status with the State. Among the rights explicitly guaranteed by this law were the right to migrate, the right to education and the right to health care. While this law represents a significant advance by the Argentine government in protecting the human rights of immigrants, oppressive mechanisms still remain in everyday practices that inhibit actual access to their rights.

Considering the changes in the law and the breach between the laws and everyday …

The Primary Care Safety Net: Strained, Transitioning, Critical, Jessamyn Taylor

National Health Policy Forum

This background paper examines the primary care safety net. It describes key primary care safety net providers, including federally qualified health centers, free clinics, local health departments, and safety net hospital outpatient departments and clinics, among others. The paper also explores the changing role of the primary care safety net in a post–health reform marketplace.

High Hopes: Public Health Approaches To Reducing The Need For Health Care, Michele J. Orza

National Health Policy Forum

Driven in part by a desire to contain health care costs, policymakers are looking beyond medical care for opportunities to reduce the need for expensive services. This paper briefly reviews current public health concepts and strategies for improving health that emphasize nonmedical factors such as behavior, socioeconomic status, and environment. It also provides examples of how these concepts and strategies undergird many of the public health provisions of the Patient Protection and Affordable Care Act, other legislation, and several programs and initiatives. These concepts include prevention, health in all policies, global health, the One Health Initiative, and climate change and …

Cesarean And Vbac Rates Among Immigrant Vs. Native-Born Women: A Retrospective Observational Study From Taiwan Cesarean Delivery And Vbac Among Immigrant Women In Taiwan, Jung Chung Fu, Sudha Xirasagar Mbbs., Ph.D, Jihong Liu Sc.D., Janice C. Probst

Publications

Background. Cultural and ethnic roots impact women's fertility and delivery preferences This study investigated whether the likelihood of cesarean delivery, primary cesarean, and vaginal delivery after cesarean (VBAC) varies by maternal national origin. Methods. We conducted a nation-wide, population-based, observational study using secondary data from Taiwan. De-identified data were obtained on all 392,246 singleton live births (500 g; 20 weeks) born to native-born Taiwanese, Vietnamese and mainland Chinese-born mothers between January 1 2006 and December 31 2007 from Taiwan's nation-wide birth certificate data. Our analytic samples consisted of the following: for overall cesarean likelihood 392,246 births, primary cesarean 336,766 (excluding …

Renewing Health Services Management Research: Redrawing The Citizen-Client In Irish Health Care Policy, Vivienne Byers

Conference Papers

Ireland has a history of health policy which is not explicit as to its aims and objectives. In light of this fact, this paper examines the position and direction of the Irish Health Services, five years on from the advent of the setting up of the Health Services Executive (HSE) and the restructuring of the health services. The Irish health system policy is guided by the Health Strategy of 2001; in that there should be equitable distribution of health services focused on the need of the citizen-client, and also by the Primary Care Strategy (2001:7); in that there should be …

Predictors Of Obesity Among Post Graduate Trainee Doctors Working In A Tertiary Care Hospital Of Public Sector In Karachi, Pakistan, Sajid Mahmood, Muhammad Kazim Rahim Najjad, Nasir Ali, Naeem Yousuf, Yasir Hamid

Community Health Sciences

Objectives: To identify the predictors of obesity among post graduate trainee doctors working in a tertiary care hospital of public sector at Karachi, Pakistan.
Methods: A cross sectional analytical study was conducted at one of the tertiary care hospitals of public sector in Karachi. Information was collected from 117 post graduate trainee doctors via pre-tested self administered questionnaire and standard tools were used for height and weight measurement. Obesity was defined as body mass index (BMI) > or =23 by using South Asian cut-off points. SPSS version 16 was used for data analysis, and logistic regression technique was applied to come …

Governmental Public Health: An Overview Of State And Local Public Health Agencies, Eileen Salinsky

National Health Policy Forum

The Patient Protection and Affordable Care Act significantly expands federal support for community prevention and public health. This paper describes the governmental public health infrastructure at both the state and local level in terms of organizational structure, activities, financing, workforce, partnerships, and performance improvement efforts.

Rural Versus Urban: Tennessee Health Administrators' Strategies On Recruitment And Retention For Allied Health Professionals., Derek Ray Slagle

Electronic Theses and Dissertations

There is a growing interest in understanding recruitment, retention, and turnover of allied health professionals considering employment trends and workforce mobility, an increased need to understand the healthcare delivery system, and the dynamic nature of the allied health workforce especially for rural areas. A survey was sent to allied health administrators across a variety of allied health disciplines from the state of Tennessee hospitals in order to gauge opinions on retention and recruitment strategies. Overall successful strategies for recruitment and retention of allied health professionals were reported as well as differences between urban and rural areas, differences among allied health …

Program Evaluation Of A Community-Based Door-Through-Door Medical Escort Service, Lauren A. Martin

Gerontology Institute Publications

This report summarizes the program evaluation findings of a Boston-based organization’s Medical Escort program. This “door-through-door” service strives to provide medical transportation, physical assistance, and emotional support to elders on their way to the doctor’s office, during medical appointments and on the way back home again. By offering added assistance the program attempts to remove environmental barriers associated with access to health care. This evaluation combines previously collected program statistics with surveys (32) from program volunteers and phone interviews (78) with recipients.

Drive Alive: Teen Seat Belt Survey Program, Katie M. Burkett, Steve Davidson, Carol Cotton, James Barlament, Laurel Loftin, James H. Stephens, Martin Dunbar, Ryan Butterfield

Health Policy & Management: Faculty Publications (2006-2018)

Objective: To increase teen seat belt use among drivers at a rural high school by implementing the Drive Alive Pilot Program (DAPP), a theory-driven intervention built on highway safety best practices.

Methods: The first component of the program was 20 observational teen seat belt surveys conducted by volunteer students in a high school parking lot over a 38-month period before and after the month-long intervention. The survey results were published in the newspaper. The second component was the use of incentives, such as gift cards, to promote teen seat belt use. The third component involved disincentives, such as increased police …

Examining The Interrater Reliability Of The Comprehensive Inventory Of Mental Health And Recovery And Rehabilitation Services (Cimhrrs), Robert W. Johnson

Department of Psychology: Dissertations, Theses, and Student Research

This dissertation is one step in the continuing development, evaluation, and validation of the Comprehensive Inventory of Mental Health and Recovery and Rehabilitation Services (CIMHRRS). The CIMHRRS is an instrument to guide comprehensive assessment of programs that provide integrated services to people with serious mental illness (SMI).

The project described in this dissertation evaluated three key aspects of its performance in real world application: practical feasibility, internal consistency and reliability, and ability to distinguish between different programs. Investigators utilized a combination of principles and methods, associated with psychometric scale development, field methods, and program evaluation. Using a structured site review …

Medicare Physician Fees: The Data Behind The Numbers, Laura A. Dummit

National Health Policy Forum

Medicare’s physician fee schedule distributes nearly $60 billion annually and is a critical determinant of individual physicians’ incomes, beneficiaries' access to health care services, and Medicare spending, as well as the basis for physician fees used by many private payers. The Centers for Medicare & Medicaid Services (CMS) relies on data derived from expert judgment and other sources to update the fee schedule. Although CMS’s methods and data for maintaining the fee schedule have improved over the years, concerns remain about medical specialty society involvement and the lack of an effective ”counterweight” to vested interests in establishing and updating the …

Tapping The Potential Of The Health Care Workforce: Scope-Of-Practice And Payment Policies For Advanced Practice Nurses And Physician Assistants, Robert Cunningham

National Health Policy Forum

Expanding coverage and increasing delivery of team-based care are likely to entail a growing role in the
health system for advanced practice nurses (APNs), physician assistants (PAs), and other nonphysician clinicians. These professions have already grown rapidly and have increased access to primary and specialty care, especially in rural and other underserved areas. This background paper provides an overview of the role of APNs and PAs. It reviews the primary features of the training and credentialing of these health professions, including the impact of public policies and market forces on their growth and deployment. It describes variations in state scope-of-practice …

Keeping Health Insurance After A Job Loss: Cobra Continuation Coverage And Subsidies, Kathryn Linehan

National Health Policy Forum

Many Americans under 65 have health insurance through an employer. Beginning in 1985, a federal law known as COBRA required that eligible workers and their dependents have the option to continue employer-based group health coverage when employment is terminated. Because premiums for COBRA coverage can be very expensive, the 111th Congress included provisions in the American Recovery and Reinvestment Act of 2009 (and subsequent legislation) to temporarily subsidize premiums for those who have lost their jobs since September 2008. This issue brief outlines the eligibility rules for COBRA as well as the current COBRA subsidies. It also discusses the possible …

Health Care Shortage Designations: Hpsa, Mua, And Tbd, Eileen Salinsky

National Health Policy Forum

A wide variety of federal programs designed to improve access to health care services rely on specific criteria to designate areas and populations eligible for funding and other types of aid. Two related yet distinct designations, the Health Professional Shortage Area (HPSA) and the Medically Underserved Area (MUA), are most commonly used to identify underserved people or places. This background paper reviews the methodologies currently utilized in these designations, identifies the federal programs that use these designations to allocate resources, describes proposals that have been advanced to consolidate and improve these designations, and discusses key issues and challenges for future …

Heath Care Spending: Why Is Miami An Outlier?, Laura A. Dummit, Mary Ellen Stahlman

National Health Policy Forum

The National Health Policy Forum’s site visit to Miami focused on the complex factors that drive health care spending and is the latest in a series on the dynamics of health care markets. Miami has long been recognized as having among the highest Medicare per capita spending in the country, along with high rates of uninsured, strong managed care presence, and a history of health care fraud. This colorful health care market brings into stark relief many of the reasons for high and growing health care spending across the country. It also highlights several issues involved in building and maintaining …

Emergency Department Staff Adherence To Bad News Delivery Recommendations, Kristen R. Myers

Loma Linda University Electronic Theses, Dissertations & Projects

Emergency department (ED) staff is responsible for giving bad news regarding death, diagnoses, and other traumatic losses to patients and loved ones. Individuals receiving traumatic and sudden bad news are at increased risk of serious psychological and physiological consequences of disrupted grief. Despite published recommended practices for providers to help prevent maladaptive grief responses, little research is available on actual bad news delivery practices and factors promoting or hindering adherence to recommendations, and no study specifically explored the ED context.

The study used a qualitative design to explore bad news delivery practices, awareness of recommendations, factors perceived to hinder or …

Physician Assessment: Measuring Competence And Performance, Lisa Sprague

National Health Policy Forum

No abstract provided.

Improving Sexual Health, P.U.L.S.E., And E.R.O.S. At California Polytechnic State University, San Luis Obispo, Megan (Meg) Rust

Psychology and Child Development

This project is designed to update and refine EROS educators’ knowledge of sexual health and to gain insight into Cal Poly students’ general knowledge of sexual health.  Educators are given extensive training during the entire quarter before they begin their positions, but information is constantly changing. This project intends to initiate up to date informational tools that can be revised as new psychological or medical discoveries are made in the realm of sexuality and sexual health.

Contracting Of Primary Health Care Services In Pakistan: Is Up-Scaling A Pragmatic Thinking, Babar Shaikh, F. Rabbani, Najibullah Safi, Zia Dawar

Community Health Sciences

Quite often, public health care systems in developing countries are struggling because of incompetence and a lack of provider responsiveness to the needs of consumers. On the contrary, the private sector dominates the system of health provision. In recent years, contracting has been experimented as an approach to ensure delivery of comprehensive public health services in an efficient, effective, superior and fair manner and has generally thrived well. The state's healthcare system in Pakistan has suffered a lot, owing to structural fragmentation, resource scarcity, inefficiency and lack of functional specificity, gender insensitivity and inaccessibility. However, partnering with the private sector …