Health Services Research Commons^™

Rural/Urban Disparities In Utilization Of Diabetes Self-Management Training To The Fee-For-Service Medicare Population, Christian Rhudy, Aric Schadler, Jeffery C. Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• In 2016, rural fee-for-service (FFS) Medicare beneficiaries represented 21.7% of the population diagnosed with diabetes, but only 2.7% of the population utilizing Diabetes Self-Management Training.
• Utilization of DSMT services in 2016 occurred in 76 rural counties and 309 urban counties.
• Average utilization rates of DSMT services were greater in rural counties than urban counties (5.5% vs. 2.5%).

Rural/Urban Disparities In The Utilization Of Health And Behavioral Assessments/Interventions In The Fee-For-Service Medicare Population, Christian Rhudy, Eugene Shin, Jeffery C. Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• In 2016, rural county residents represented 21.8% of the fee-for-service (FFS) Medicare population, but only 1.6% of rural FFS beneficiaries live in a county with local utilization of Health and Behavioral Assessments and Interventions (HBAI) services.
• Utilization of HBAI services in 2016 occurred in 19 (9.7%) rural counties and 176 (90.3%) urban counties.
• Average utilization rates of HBAI services were higher in rural counties than urban counties (0.7% vs. 0.4%).

Rural/Urban Disparities In Utilization Of Medical Nutrition Therapy To The Fee-For-Service Medicare Population, Christian Rhudy, Eugene Shin, Jeffery C. Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• In 2016, 21.8% of the fee-for-service (FFS) Medicare population resided in a rural county, but only 3.7% of enrollees residing in a county with utilization of Medical Nutrition Therapy (MNT) services were rural county residents.
• Utilization of MNT services in 2016 occurred in 92 rural counties and 388 urban counties.
• Average utilization rates of MNT services were greater in rural counties than urban counties (3.1% vs. 1.9%).

Major Depression, Treatment Receipt, And Treatment Sources Among Non-Metropolitan And Metropolitan Adults, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• 7.8% of non-metropolitan (weighted number of persons=2,755,020) and 7.1% of metropolitan (weighted number of persons=14,868,655) adults had past year major depression.
• Treatment receipt (seeing a health professional or using prescription medication for depressive feelings) was similar among non-metropolitan (68.0%) and metropolitan (64.6%) adults.
• A closer examination of the type and source of treatment revealed the following:

• Rates of seeing a health professional were similar among non-metropolitan (60.8%) and metropolitan (58.4%) adults, but rates of using prescription medication for depressive feelings were higher among non-metropolitan (58.2%) than metropolitan (48.6%) adults.
• Rates of visiting a general practice/family doctor …

Costs Of Maternity Leave To Support Breastfeeding; Brazil, Ghana And Mexico, Mireya Vilar-Compte, Graciela M. Teruel, Diana Flores-Peregrina, Grace J. Carroll, Gabriela S. Buccini, Rafael Perez-Escamilla

Department of Public Health Scholarship and Creative Works

Objective To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women’s weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given …

Barriers To Covid-19 Rt-Pcr Testing In Indonesia: A Health Policy Perspective, Purwa Kurnia Sucahya

Journal of Indonesian Health Policy and Administration

Indonesia has been facing a hard time accelerating the number of laboratory capacity. This study provides an overview of the data on daily tests, confirmed cases, and the challenge of Covid-19 control associated with government policy. This study utilizes data reported from 2 March to 29 April 2020 by online official sources and regulations. Initially, the government only trusted one lab for the Covid-19 test. As the number of cases increased, referral labs were increased, until 29 April 2020, there were 89 officially appointed laboratories. The daily number of testing results fluctuated and unstable, although the number of reference labs …

Impact Analysis Of The Large-Scale Social Restrictions (Psbb) Policy Implementation In Jakart, Hikmahwati Hikmahwati, Ekasafitri A.S Sangadji, Raden Roro Mega Utami

Journal of Indonesian Health Policy and Administration

Jakarta is the province with the highest population density in Indonesia and is also one of the main international gateways to enter Indonesia. These conditions cause a high risk of transmission COVID-19 in Jakarta. One of the government's decisions was applying the Large Scale Social Restrictions (PSBB) policy in Jakarta. This study is a documentation study with Sabatier and Mazmanian's top-down approach that aims to analyze the extent impact of policy implementation, in terms of the policy objectives and community compliance. Compliance analysis uses the results of the Covid-19 Outbreak Survey and Google mobility index. The result shows the compliance …

Effectiveness Of Large-Scale Social Restrictions (Psbb) Toward The New Normal Era During Covid-19 Outbreak: A Mini Policy Review, Helen Andriani

Journal of Indonesian Health Policy and Administration

The government of Indonesia has not used lockdown or quarantine as an option to tackle the spread of Coronavirus, as the impact of lockdown on small communities in the informal sector that lives from daily income will be severe. Alternatively, the government is enforcing Large-Scale Social Restrictions (Pembatasan Sosial Berskala Besar or "PSBB") to respond to the state of emergency in public health. Starting in June 2020, the government has implemented transitional PSBB in some red zone areas, including the capital Jakarta and East Java province, despite the surge in case numbers. This paper aims to investigate the effectiveness of …

Local Initiatives In Preventing Coronavirus Based On Health Policy Perceptive, Dumilah Ayuningtyas, Misnaniarti Misnaniarti, Siti Khodijah Parinduri, Fitria Aryani Susanti, Ni Nyoman Dwi Sutrisnawati,

Journal of Indonesian Health Policy and Administration

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The Effectiveness Of Covid-19 Countermeasure Policy Implementation In Seven Asean Countries, Wahyu Sulistiadi, Sri Rahayu

Journal of Indonesian Health Policy and Administration

COVID-19, which has spread to almost all countries in the world, force country's leaders to issue COVID-19 countermeasures policy that is the most effective and suitable for their country. The various ways to implement the policy depend on the COVID-19 impact that arises in the country. This study describes the implications of national policies related to COVID-19 case fatality rates up to 29 April 2020 in 7 ASEAN countries. We use analytical descriptive method on COVID-19 data that has been published in online media. The achievement on the implementation of national policy in overcoming COVID-19 in some countries provide new …

Association Between Racial Discrimination And Health‐Related Quality Of Life And The Impact Of Social Relationships, Sze Yan Liu, Genevieve Bergeron, Nneka Lundy De La Cruz, L. Hannah Gould, Amber Levanon Seligson

Department of Public Health Scholarship and Creative Works

Purpose: Interpersonal racial discrimination is associated with poor health. Social relationships may moderate the impact of discrimination and represent modifiable behaviors that can be targeted by public health interventions. We described citywide associations between self-reported racial discrimination and health-related quality of life among the overall New York City (NYC) adult residential population and by four main race/ethnicity groups and explored whether social relationships moderated health effects of discrimination.

Methods: We analyzed cross-sectional survey data from 2335 adults weighted to be representative of the NYC population. We measured exposures to lifetime interpersonal racial discrimination in nine domains using a modifed version …

Black Women Survive Breast Cancer With Community-Based Care, Shelley I. White-Means, Jill Dapremont, Barbara D. Davis, Tronlyn Thompson

Faculty Presentations

PURPOSE Community-based breast cancer support agencies who address non-medical, social determinants of health needs that serve as barriers to maximizing breast health outcomes may play a vital role in mitigating breast cancer mortality. They share a common emphasis on addressing social, economic, and psychological needs of breast cancer survivors and those at risk of breast cancer. This paper is third in a series of papers exploring why the rate of breast cancer mortality is two times higher for African American women than white women in Memphis. We sought insights from community-based breast cancer support agencies because they have a close-up …

Costing Of Actions To Safeguard Vulnerable Mexican Households With Young Children From The Consequences Of Covid-19 Social Distancing Measures, Mireya Vilar-Compte, Víctor Pérez, Graciela Teruel, Aranzazu Alonso, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

COVID-19 has imposed unprecedented challenges to society. As the pandemic evolves, the social distancing measures that have been globally enforced, while essential, are having undesirable socioeconomic side effects particularly among vulnerable populations. In Mexico, families who depend upon informal employment face increased threats to their wellbeing, and households who in addition have young children may face long-term consequences. The Mexican government has not yet taken actions, but a coalition of non-governmental organizations is advocating in partnership with academic institutions for social protection actions such as a cash transfer and basic services subsidies for families with young children, subsisting from the …

The Need For Leadership During Public Health Crises, Tanisha Adams

2020 Symposium Posters

This research is intended to educate the public health industry on the need for better crisis leadership preparations. The National Incident Management System (NIMS) is a national training program mandated by the Post-Katrina Emergency Management Reform Act of 2006. The program focuses primarily on Preparedness, Communications and Information Management, Resource Management, and Command and Management. NIMS is formatted in a way that the information can be used across a wide array of organization types. The Incident Command System (ICS) of NIMS has a "military-style, command-and-control model traditionally seen in emergency services and not in public health” (Kohn, Barnett, Galastri, Semon, …

The Evolving Management Of Aortic Valve Disease: Trends In The Utilization And Cost Of Savr, Tavr, And Medical Therapy, Andrew Goldsweig

Theses & Dissertations

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, …

The Effect Of The Timing Of A Hospice Referral And The Perceived Quality Of Care By The Family, Caitlin Tran

Nursing | Senior Theses

Hospice care is a specialized type of palliative care for patients with a time-limiting illness. Despite its benefits, hospice remains underutilized. A key reason behind the underutilization are untimely referrals, often made during the last weeks or days of the patient’s life. The purpose of this paper is to investigate the existing barriers towards hospice that play into late referrals and its effect on patient/family satisfaction. This information will be examined to propose a pilot research study for further exploration.

Oral Health-Related Quality Of Life In Us Adults With Type 2 Diabetes., Giang Truong Vu

Electronic Theses and Dissertations

This dissertation focused on the relationship between type 2 diabetes (T2DM) and oral health-related quality of life (OHRQoL) and the factors associated with this relationship in the US. The objectives of the dissertation research were a three-part process: (1) to understand the relationships of T2DM with poor OHRQoL, clarify risk and preventive factors that affect this association, and identify research gaps in the literature, (2) to analyze risk factors associated with poor OHRQoL in US adults with T2DM using a nationally representative random probability cluster sample, and (3) to apply structural equation modeling (SEM) to a simplified Andersen’s Behavioral Model …

Preventable Hospitalization Among Type 2 Diabetes Patients In Kentucky Before And After Medicaid Expansion 2010-2017., Turky Jamil Arbaein

Electronic Theses and Dissertations

Objectives: 1) Analyze county level variation in T2DM-PH rates in Kentucky before ACA (2010-2013) and after the ACA (2014-2017). 2) Analyze the relationship between county level socioeconomic factors (income per capita, percentage of uninsured people, percent of urban population, primary care and general preventive offices, population aged 65 and above, median age, household income, percentage in poverty, and unemployment rate ) and county level T2DM-PH rates before (2010-2013) and after (2014-2017) ACA implementation in Kentucky. Method: This research was conducted in two phases: Phase one of this study estimated the county-level PH variation among T2DM patients across eight years (2010-2017), …

Managing Stress In A Constantly-Changing Workforce, Lorri Burch-Hubbard

Electronic Theses and Dissertations

When staffing reductions occur in the workplace, staff left behind may face increased stress, may not be given the support they need to manage the feelings caused by the reduction. This study was conducted to evaluate the impact of stress caused by staffing reductions has on medical technologists (MT), medical technicians (MLT) and respiratory therapists (RT), and to identify any common methods of stress management used by those staff who remain in the organization.

Literature research showed the negative impact stress can have on individuals when it is not addressed, such as decreased work performance, health issues, and even the …

¡Sí, Yo Puedo Vivir Sano Con Diabetes! A Self-Management Randomized Controlled Pilot Trial For Low-Income Adults With Type 2 Diabetes In Mexico City, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Roberta Delvy, Sangchoon Jeon, Soraya Burrola-Méndez, Mariana Pardo-Carrillo, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system.

Objectives: We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City.

Methods: Participants were recruited at public …

Special Issue – July/August 2020: Sustaining A Focus On Human Experience In The Face Of Covid-19, Patient Experience Journal

Patient Experience Journal

At this critical time in our shared history, we are faced with a powerful challenge, the rapid impact of COVID-19 on our healthcare systems and community. With that acknowledgement, we are refocusing our 2020 special issue of Patient Experience Journal (PXJ) to address Sustaining a Focus on Human Experience in the Face of COVID-19. Submissions received for our initially planned special issue on patient & family experience in behavioral health will remain in review and consideration for future issues of PXJ.

There are heroic efforts taking place minute-by-minute to address the clinical and personal needs of patients, while also …

Patient Experience Journal Awards: Celebrating Our 2019 Recipients, Patient Experience Journal

Patient Experience Journal

In association with The Beryl Institute, Patient Experience Journal introduced the inaugural Patient Experience Journal (PXJ) Awards. The annual awards celebrate important contributions to the literature and articles of impact in research and practice. They also introduce groundbreaking authors who are working to expand evidence and insights on patient experience and the human experience in healthcare. The winners are selected from the articles published in PXJ and chosen by the Editorial Board of the journal. The award categories are shared and recipients introduced.

Development And Reliability Of A Patient Experience Inventory Tool For Hospitals, Agnes Barden, Nicole Giammarinaro, Natalie Bashkin, Larry Lutsky

Patient Experience Journal

This study explores the development and reliability testing of the newly developed Patient Experience Inventory for Hospitals (PXI-H). Created as an organizational self-assessment patient experience tool, it guides healthcare leaders in evaluating attitudes and behaviors as well as structures and programs impacting patient experience within a hospital setting. The PXI-H is organized within four pillars: Leadership, Education and Development, Data and Analytics and Patient-and-Family Centeredness, which were determined to be internally consistent based on examining coefficient alphas and the item-total correlations. Principal component analysis also determined items with highest loadings aligned onto the pillars in which there were assigned, confirming …

Deploying An Improvement Strategy Across A Rapidly Expanding Health System: A Framework For Repeatability And Cost-Effectiveness, Steve Meth Jd, Ms, Jan Gnida Cpxp, Karla Cardoza, Elizabeth Nikels

Patient Experience Journal

With nearly 40,000 employees and physicians spread across 14 states, a robust system was needed to engage front line teams at the point of care to meaningfully enhance patient and family communication practices in Prime Healthcare, an award-winning, community hospital system with 45 hospitals. Among its key elements, Prime’s system-wide road map for deploying relationship-centered communication tools involved identification of and investment in frontline champions, education that was synchronized with leader-deployed digital rounding, and online self-reflection modules that promoted true behavior change. This economical and easy-to-follow road map is shared for others seeking a high return on investment from their …

Implementing Inter-Professional Patient-Family Centered Plan Of Care Meetings On An Inpatient Hospital Unit, Nicolas Hernandez, Alice Fornari, Sage Rose, Leanne Tortez

Patient Experience Journal

Inpatient plan of care meetings support efforts to encourage collaborative practice and patient-family centered care and result in an effective strategy to enhance communication and patient satisfaction. Clinical team members participated in patient/family centered plan of care meetings at a community hospital in a selected inpatient unit with full time hospitalist physicians. Quantitative data were gathered pre/post implementation from the external Hospital Consumer Assessment of Health Care Providers (HCAHPS) survey. HCAHPS data were collected independently, specifically for questions related to communication between patients, family members/guardians and the medical team and also the effects of care transition. There was a slow …

Is There A Correlation Between The Patient-Doctor Relationship Questionnaire And Other Patient-Reported Experience Measures?, Amanda I. Gonzalez, Joost T.P. Kortlever, Léon Rijk, David Ring, Laura E. Brown, Lee M. Reichel

Patient Experience Journal

Patient reported experience measures (PREMs) can quantify the quality of the patient-clinician relationship, which is associated with adherence and improved health. However, the scales used to assess PREMs have large ceiling effects, which limits our ability to learn and improve. This study assessed the correlation of four PREMs: the patient-doctor relationship questionnaire (PDRQ), a measure of perceived empathy, a measure of satisfaction with the visit, and a measure of communication effectiveness. We also assessed ceiling effects. We prospectively enrolled 103 new and return patients in this cross-sectional study. Patients completed a demographic questionnaire, the PDRQ, Jefferson Scale of Patient Perceptions …

Using Shared Mental Models To Conceptualize Patients As Professionals, Decision-Makers, Collaborators, And Members Of Interprofessional Healthcare Teams, Umair Majid

Patient Experience Journal

Patient engagement has become the buzz-phrase of 21^st Century health care. Around the world, healthcare systems involve patients in a wide range of activities including drug development, research, and policy design. There are strong institutional pressures for patient engagement in healthcare activities that have been bolstered by ethical imperatives and social and organizational benefits from patient engagement. There is a trend to center efforts to cultivate engagement initiatives that are meaningful to patients and family. However, these efforts are characterized by multiple challenges, for example, tokenism and the lack of organizational support. These barriers may persist in healthcare professionals’ …

Patient Feedback: Listening And Responding To Patient Voices, Simon J. Radmore, Kathy Eljiz, David Greenfield

Patient Experience Journal

The study aim was to identify key strategies to improve organisational systems and care experiences, to confront the challenges of achieving effective patient feedback throughout a large healthcare organisation. A mixed methods exploratory approach was used. Purposive and snowball sampling, semi-structured interviews with key stakeholders, and document analysis of existing feedback processes was utilised. The setting was a large metropolitan Local Health District in Sydney, Australia. Data was examined using thematic and content analysis. Participants identified no single feedback process was able to adequately gather all feedback necessary to reflect the patient experience. Patient feedback processes that are most useful: …

Paying It Forward: A Cancer Survivor And His Wife Share Their Reflections And Recommendations As A Patient And Caregiver, Justin Sandler

Patient Experience Journal

I grew up in the north suburbs of Chicago and had a relatively normal childhood but not necessarily an easy one. Shortly after graduating from Indiana University, I moved out west and have been working in the entertainment industry ever since. My life has been a beautiful and interesting adventure with twists and turns I could have never predicted.

In 2016 it seemed like everything was really coming together. I had been happily married to my wife and business partner Mary Lou Sandler since 2011, and we had been growing our photography/film production studio for as many years. I was …

The Essential Nature Of Experience In A Time Of Crisis And Beyond, Jason A. Wolf

Patient Experience Journal

As we have engaged with community members around the world, the last few weeks have provided a unique window into the face of this crisis as we have seen not only the deadliest days on record, but have also had some of the most hopeful conversations at the same time. While we are and still will face challenges in the weeks to come, we too have seen humanity elevated in profound and powerful ways. While it can be offered with little argument that things will never be the same, in moving forward, we too can assert and I believe, that …