Health Services Research Commons^™

The Impact Of The Chinese Rural Healthcare System On Infectious Disease: A Study Of The History And Reform Of Chinese Healthcare, And The Global Implications Of Infectious Disease Control In China, John Barbadoro

Independent Study Project (ISP) Collection

China’s healthcare system has gone through significant changes in the 20^th and 21^st centuries. These changes have mirrored not only the political focus of the time, but also the social issues facing China. The NRCMCS for rural residents is a cheap annual fee that covers a percentage of medical costs. There are two urban equivalents, the BMIUE and BMIUR for urban employees through their job, and residency respectively. Despite the focus on cheaper healthcare for rural residents, the problems of income inequality and mistrust in the medical system are major problems that affect the health of this large …

La Contaminación De La Cuenca Matanza-Riachuelo: Análisis De La Respuesta Institucional Con Respecto A La Salud De La Población Del Barrio De La Boca., Ishaira Nieto Rosas

Independent Study Project (ISP) Collection

La intención de esta investigación fue presentar un panorama de la respuesta de diferentes organizaciones del barrio de La Boca a los riegos de salud ambiental con respecto a la contaminación histórica y continua de la Cuenca Matanza-Riachuelo. Basado en el entendimiento que la salud es el completo bienestar físico, mental y social, este proyecto abordó el tema de contaminación ambiental a través de la participación en un taller de monitoreo social de la Cuenca y entrevistas con miembros del Equipo Local de Salud Ambiental del CESAC 41, el Presidente de la Asociación de Vecinos de La Boca y comerciantes …

Annual Report 2012, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2012 calendar year, and provides a snapshot of our resources.

Cost Estimation Methods: Strategies And Examples For Public Health Services & Systems Research, Glen P. Mays

Health Management and Policy Presentations

This webinar reviews methods for conducting cost studies in public health settings, including strategies for estimating the financial and ecnomic costs of delivering public health services, and analytic approaches to identifying factors that influence delivery costs. These types of studies are of increasing importance to policy and practice stakeholders given the need for evidence about the return-on-investment (ROI) generated through public health delivery.

Monitoring Qi Maturity Of Public Health Organizations And Systems In Minnesota: Promising Early Findings And Suggested Next Steps, Kimberly J. Miner Gearin, M. Elizabeth Gyllstrom, Brenda M. Joly, Renee S. Frauendienst, Julie Myhre, William Riley

Frontiers in Public Health Services and Systems Research

Public health departments and systems are increasing investments in quality improvement. This paper presents methods used to identify a select number of items from a previously validated QI Maturity Tool as the basis for calculating organizational and system-level QI maturity scores that could be followed over time. Findings suggest that the abbreviated tool measures variation in QI maturity across LHDs, and differences in scores among divisions within a state health department. Minnesota has incorporated the abbreviated tool into an annual reporting system for the MN Local Public Health Act, thereby enabling stakeholders to monitor a system median score and distribution …

Using The Qi Maturity Tool To Classify Agencies Along A Continuum, Brenda M. Joly, Maureen Booth, Prashant Mittal, Yan Zhang

Frontiers in Public Health Services and Systems Research

Major investments have been made to encourage health departments to implement quality improvement (QI) efforts. Yet, there are few empirically tested tools for public health agencies that assess these efforts and classify health departments along a QI continuum. This paper presents a new classification scheme for measuring QI Maturity in public health agencies based on a validated tool. The findings can be used to establish benchmarks, make comparisons and conduct future research linking QI and population health outcomes.

Rediscovering The Core Of Public Health, Steven Teutsch, Jonathan E. Fielding

Frontiers in Public Health Services and Systems Research

The success of public health has been its ability to understand contemporary health problems, to communicate the needs successfully, to identify solutions, and to implement them through programs and policies. In the past 50 years, those successes can be attributed largely to control of infectious disease, improved maternal and child health, delivery of other personal health care services, and changes in behaviors, particularly smoking. Yet health is primarily a product of our social, cultural, and physical environments. To continue to improve the nation’s health and reduce disparities, public health needs to return to its historical roots and engage with other …

Accelerating And Expanding Knowledge Transfer In Public Health Settings: Frontiers In Phssr, Glen P. Mays

Health Management and Policy Presentations

Creating a "rapid-learning" system in public health requires mechanisms for the continuous exchange of knowledge and evidence among researchers, practice settings, and policy decision-makers. The open-access platform Frontiers in Public Health Services and Systems Research provides a new mechanism for this exchange.

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 …

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 …

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 …

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.

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 …

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 …

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 …

Legal Issues With The Electronic Health Record, Hannah Jackson

Applied Research Projects

Introduction

The purpose of this paper is to make readers aware of the legal issues in the electronic health record (EHR) and the risks involved so they can be prepared. It is also to help provide solution to those who are already dealing with the risks. The goal of this Project is to reach out to health care facilities who are about to embark on a new chapter in health care that we call, the EHR. Everyone should know the risks of a product before purchasing and that is what my research will show.

Method

I used The Journal of …

Electronic Health Record Incentive Program Demonstrates Adoption Association With Improved Care, Keith Rosenbaum

Applied Research Projects

This study used Meaningful Use (MU) payment information as a proxy for electronic health record (EHR) adoption linked to Centers for Medicare and Medicaid (CMS) data indicating quality to demonstrate the association of EHR adoption with improved care. The CMS quality indicators used were comprised of data from the value-based purchasing (VBP) program, readmission reduction program, and hospital compare mortality data. Results showed a positive association of EHR adoption with the VBP data, which most closely aligns the MU achievement period with the quality measure period. Readmission and mortality data showed negative and neutral associations, respectively, with a less aligned …

Anesthesia Information Management Systems: A Review Of The History, The Products, And The Adoption Of These Systems, Emily G. Hoffner

Applied Research Projects

Anesthesia Information Management Systems (AIMS) have been growing in popularity and use over the past decade, but widespread adoption of these systems by anesthesia groups and hospitals across the country is yet to occur. The promise of AIMS reaches beyond basic anesthesia recordkeeping into a realm of complex, integrated systems with enhanced billing, improved regulatory requirements, improved communication amongst caregivers, and reduced medical-legal exposure. In fact, AIMS have been shown to improve patient care and can increase the financial performance of a group. Despite the documented benefits of AIMS, adoption of these systems is low. This paper will review the …

Correctional Telemedicine And Its Benefits For Female Inmates, Chelsea Oliver

Applied Research Projects

The purpose of this study is to identify health issues that are specific to the female population of correctional institutions and how telemedicine would be beneficial in providing healthcare to same. A questionnaire was developed using information from literature on the topics obtained from a variety of places. Once the questionnaire was completed, a randomly selected group of telemedicine providers received the questionnaire, along with an introduction and information on the study that was being conducted.

The barriers of this study came from telemedicine providers either not responding to the questionnaire entirely or the providers only being able to answer …

Closing The Meaningful Use Gap Between Small And Large Practices, Crystal L. Jones

Applied Research Projects

The Lack of Meaningful Use Awareness in small practices is very prevalent. One may ask why there is such a gap in MU Awareness amongst small and large practices. The answer is quite the same across the board for small practices, “Cost”. This misfortune has resulted in many small practice physicians and staff being objective to the adoption of an electronic health record system. They are indifferent about the penalties that will be enforced soon, if they do not follow suite with the guidelines mandated by the ARRA. Essentially, this thesis will provide statistical data on the adoption rate of …

An Evaluation Of The Role Of The Originator Of Catastrophic Edits/Data Overwrites Within The Veteran Health Administration, Britney Braxton

Applied Research Projects

Objective: To determine which job function causes or creates a large number of Catastrophic Edit/ Data Overwrites within VHA.

Methods: The study is based on data extracted from the Catastrophic Edits Monthly Reports reported by the HC IdM Team staff on the CEs that have occurred on the MPI. Catastrophic Edits (CEs) reported by the HC IdM team between November 2011 through December 2012 are examined.

Result: Out of the 2736 Potential Identity Changes, 115 actually resulted in a CE. The number of CEs created by each job title ranged from 1% by Employee Health Clerk to 28% by Eligibility …