Health Services Research Commons^™

Preventive Health Service Use Among Rural Women, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Jaclyn Janis Bsn, Rn

Access / Insurance

Preventive health services and screenings are an important component in the continuum of care provided to individuals across all ages. Yet, research has shown that rural residents generally use fewer preventive health services and screenings. This study used the National Health Interview Survey to examine receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and receipt of the HPV vaccine) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services, and that some of the differences may be …

Expanding International Health Curriculum For The Internal Medicine Residency At Mmc, Brian King, Hassan Mahmoud, Anthony Pastore

Thinking Matters Symposium Archive

While internal medicine residents at Maine Medical Center provide care for many refugees and immigrants, there is not a formal international health curriculum to equip residents to care for this vulnerable population. Since 2002, 3,793 refugees have arrived in Maine for resettlement. Our aim was to survey residents about their interest in added international health instruction and design an educational curriculum for these physicians.

Opioid Use Treatment Via Telemedicine: Treatment Options For Rural Maine, Benjamin Knapp

Thinking Matters Symposium Archive

The ongoing opioid crisis has overwhelmed the traditional opioid use disorder (OUD) treatment resources across America. The treatment resources in rural communities have been especially hard hit as geographic and financial barriers limit service capacity. Telemedicine, or medicine delivered via remote means, has been proposed as a potential solution to the lack of conventional opioid treatment resources in rural Maine. Current legalities in the US prohibit telemedicine being used to prescribe opioid agonist drugs, and insurance reimbursement for telemedicine remains a major barrier. This qualitative content analysis looks at the existing research on telemedicine's treatment efficacy for use with OUD …

Identifying Challenges Different Provider Group Encounter In Managing Opioid Use Disorder, Chinonye Anumaka

Muskie School Capstones and Dissertations

The Centers for Disease and Control (CDC) describes opioid use disorder (OUD) also known as opioid addiction as the problematic pattern of opioid use leading to clinically significant impairment or distress. In 2016, about 2.1 million people were diagnosed of OUD in the US. In Maine, York County has the third highest drug overdose response and had 166 deaths occurring between 2012-2016. York County is a designated medically underserved area and has a shortage of provider workforce and limited treatment infrastructure. To further understand the challenges providers in York County encounter in managing patients with OUD, 6 focus groups was …

A Comparative Analysis Of Primary Care Practice Payment Models: Practice And System Level Implications, Travis Masood

Muskie School Capstones and Dissertations

EXECUTIVE SUMMARY

The purpose of this capstone was to (1) assess the likely effects of various primary care practice reimbursement models on quality of care and costs, (2) assess each reimbursement model’s applicability relative to practice size, and (3) analyze each model’s practice and system level implications. This was done through the conduction of a comparative analysis of current practice reimbursement models. The questions addressed in this analysis include:

• What are the primary, practice reimbursement models currently being used?
• What are the implications of these models on quality and costs?
• Are these reimbursement models applicable in all practice types (e.g. …

Access To Health Care Services For Adults In Maine [Policy Brief], Erika C. Ziller Phd, Barbara Leonard Mph, Amanda Burgess Mppm, Nathan Paluso Mph

Access / Insurance

This data brief by researchers at the Maine Health Access Foundation and the University of Southern Maine's Maine Rural Health Research Center found ongoing inequality in the ability of people in Maine to get quality health care. The report examines data from 2014-2016 and shows that Maine people, of all income groups, report difficulties in paying medical costs. Research has also found the ability to seek timely and appropriate health care is impacted by income levels, educational background, race and ethnicity.
This brief provides an update to the 2016 study (available in Digital Commons: https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1038&context=insurance)

For more information, please …

Rural Health Clinic Participation In The Merit-Based Incentive System And Other Quality Reporting Initiatives: Challenges And Opportunities, John A. Gale Ms, Zachariah T. Croll Mph, Andrew F. Coburn Phd

Rural Health Clinics

Rural Health Clinics (RHCs) are an important source of primary care in underserved rural communities with more than 4,200 RHCs providing primary care services to rural Medicare and Medicaid beneficiaries in 44 states. In light of the growing emphasis on quality reporting, it is important to understand factors influencing RHC readiness to participate in quality reporting including the Merit-Based Incentive Payment System (MIPS), Medicaid, and commercial payer quality reporting programs. The exclusion of RHCs from CMS’s quality reporting programs and value-based initiatives may potentially create a perception among consumers and policymakers that RHCs are unable to meet the requirements of …

Lung Cancer Screening Provider Survey, Lindsay Mcfarren

Muskie School Capstones and Dissertations

The purpose of this capstone project is to evaluate provider knowledge, attitudes, and behaviors around lung cancer screening in Maine. To evaluate these elements, a survey will be developed and administered to primary care physicians in Maine through three physician specialty societies. The survey will be developed keeping existing literature and previous studies of a similar nature in mind. This survey is being developed in collaboration with the Center for Outcomes Research and Evaluation (CORE), a branch of Maine Medical Center Research Institute. The Evidence- Based Public Health Framework will be used to outline and ground this capstone project.

Residential Settings And Healthcare Use Of The Rural "Oldest-Old" Medicare Population, Nathan Paluso Mph, Zachariah T. Croll Mph, Deborah Thayer Mba, Jean A. Talbot Phd, Mph, Andrew F. Coburn Phd

Long Term Services and Supports

The aging of the baby boom generation is projected to dramatically increase the population aged 65 and older in the coming decades. In particular, those aged 85 and older (the ‘oldest old’) are expanding at a faster rate than any other age group and by 2050 are expected to make up 4.5 percent of the population, compared to 1.9 percent in 2012. Faster growth in the percentage of older people (65+) in rural than in urban areas is likely to challenge the healthcare and long term services and supports (LTSS) capacity in many rural communities.

This study used Medicare Current …

The Role Of Rural Hospitals In Addressing Opioid And Other Substance Use Problems, John A. Gale Ms

Mental Health / Substance Use Disorders

Webinar presentation to the Small Rural Hospital Transition project addressing issues of rural opioid and other substance use issues, focusing on the role of rural hospitals, and the importance of community engagement. Component parts of an effective opioid/substance use system of care include prevention, treatment, and recovery. Models must be adapted to the geographic, resource, and cultural realities of rural areas. Examples of strategies are provided.

Palliative Players: Project Development And Initial Implementation, Eliza Eager

Muskie School Capstones and Dissertations

The Palliative Players are screened and trained hospice volunteers who provide a low-cost, sustainable, role-playing resource for use teaching communication skills to healthcare workers who discuss serious illness with patients and their families. The Palliative Players project was conceived and developed in early 2017 by Dr. Lauren Michalakes, Medical Director of Palliative Care at Coastal Healthcare Alliance (CHA); Sarah Dwelley, RN; Flic Shooter, Director of Hospice Volunteers of Waldo County (HVOWC); and Eliza Eager, Project Coordinator; to provide believable, emotive simulated patients (SPs) for role-play in workshops teaching healthcare workers communication tools and skills for use in conversations with patients …

After Closure: Options For Pursuing A High Performance Rural Health System, Andrew F. Coburn Phd

Rural Hospitals (Flex Program)

Presented at the 2017 National Rural Health Association Annual Meeting. Coburn, a member of the Rural Policy Research Institute Panel, discussed the following key questions: What kind of rural health system is possible in places that cannot support a full-service hospital? How does a rural community navigate the transition from hospital-centric care toward new models that deliver high performance? What implementation support will be needed? Coburn noted that there is no single model for re-configuring the rural health system after hospital closure; local assets, affiliations and partnerships, financial and delivery flexibility and capacities must be critically assessed to determine the …

New Outpatient Experience Survey Design: A Quality Improvement Case Study, Nathan Paluso

Muskie School Capstones and Dissertations

The purpose of this capstone project is to evaluate the implementation process for a new survey methodology introduced by Maine Medical Partners (MMP), by following the Plan-Do-Study-Act (PDSA) quality improvement cycle framework. This new survey has been implemented to collect data on patients’ experiences in the MMP outpatient facilities, and is offered to the patients via iPad at check-out after their appointment. Through observation at MMP practices and MMP staff interviews, strengths and weaknesses of the implementation process have been identified. Evidence-based solutions pertaining to the identified weaknesses have been selected through a literature review and are incorporated in recommendations …

The Role Of Public Versus Private Health Insurance In Ensuring Health Care Access & Affordability For Low-Income Rural Children, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Amanda Burgess Mppm

Access / Insurance

Medicaid and the Children’s Health Insurance Program (CHIP) have played a critical role in ensuring access to health insurance coverage among children and have been particularly important sources of coverage for rural children. More than 35.5 million children were enrolled in Medicaid or CHIP in September 2016—accounting for just over half of total Medicaid and CHIP enrollment. Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of that coverage in ensuring access to affordable healthcare for rural children. Using data from the 2011-2012 National Survey of Children’s Health, this study …

A Guide For Assessing Older Adults’ Needs On Maine Islands, Beatrice Byrne

Muskie School Capstones and Dissertations

This template may help Maine island communities identify older adults’ needs and island resources, in order to allow older adults to age in the island communities.

Three interviews with island health leaders, one community conversation with older islanders, and one pilot test provided information about what to include in the template.

The template includes a demographic survey, guides for conducting semi-structured interviews and group conversations with older adults and caregivers, a guide and worksheet for analyzing the data, a guide for assessing community resources, a guide for dissemination, and a list of additional resources.

Prevention Of Drug Use And Treatment Of Drug Use Disorders In Rural Settings, John A. Gale Ms

Mental Health / Substance Use Disorders

This Guide on Prevention of Drug Use and Treatment of Drug Use Disorders in Rural Settings was prepared by the United Nations Office on Drugs and Crime (UNODC) Drug Prevention and Health Branch (DHB), in the context of the global project Treatnet II: OFID-UNODC Programme to prevent HIV/AIDS through Treatnet Phase II, with the aim of providing an awareness-raising tool and guidance for policymakers, public health officials, local authorities and other stakeholders in dealing with substance use issues in rural settings in their respective countries. This Guide will serve as an awareness-raising tool and guidance for policymakers, public health officials, …

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Policy Brief], John A. Gale Ms, Anush Yousefian Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Little is known about what states with large rural populations are doing to combat opioid use disorders (OUD) in rural communities. This qualitative study identified rural challenges to the provision of OUD prevention, treatment, and recovery services and explored promising strategies to tackle the opioid crisis in rural communities.

Rural Opioid Prevention And Treatment Strategies: The Experience In Four States [Working Paper], John A. Gale Ms, Anush Hansen Ms,Ma, Martha Elbaum Williamson Mpa

Mental Health / Substance Use Disorders

Although opioid use rates are comparable in rural and urban counties, rural opioid users tend to be younger, unmarried, have lower incomes, and are more likely to lack health insurance, all vulnerabilities that may negatively impact their ability to seek treatment and recover. Additionally, the rural health care system is characterized by numerous resource, workforce, access, and geographic challenges that complicate the delivery of specialized care for OUDs in rural communities. The nature and scope of the opioid crisis vary across rural communities and require multifaceted, community-based strategies to address the problem. Based on interviews with key stakeholders in Indiana, …

Mental Health Status And Access To Health Care Services For Adults In Maine, Erika C. Ziller Phd, Barbara Leonard Mph

Access / Insurance

Maine people with poor mental health describe significant challenges with affordability and access to health care. A new report released by the Maine Health Access Foundation (MeHAF) and the University of Southern Maine, Mental Health Status and Access to Health Care Service for Adults in Maine, describes how adults 18 and older in Maine who report depression and poor mental health have many barriers to getting health care. These results have important implications for planning in a time when major changes in health insurance coverage are expected.

Analyzing data from the ongoing federal/state public health survey, the Behavioral Risk …

Development Of Health Education Materials To Prevent Sexually Transmitted Infections Among University Of Southern Maine Students, Lily Parenteau

Muskie School Capstones and Dissertations

The purpose of this project was to develop health education materials that can be used to educate college students about the risks, symptoms, and prevention measures associated with chlamydia and gonorrhea infections, as well as provide information about current disease information in the state of Maine.

Urine Cotinine In Children And Parental Behavior Modification: A Pilot Study, Teresa Lachance

Muskie School Capstones and Dissertations

“Urine Cotinine in Children and Parental Behavior Modification” was designed by Dr. Deirdre Burns, a pediatrician at the Barbara Bush Children’s Hospital (BBCH). It was implemented as a pilot study to determine whether urine cotinine testing in children who are admitted to the hospital for respiratory illness and tracking parental smoking behaviors over time was feasible. Parents were given a brief survey to assess their current smoking behaviors and to understand their readiness to quit smoking. They received smoking cessation materials provided by the Breathe Easy Coalition of Maine. These materials outline information about second-hand and third-hand smoke, and encourage …

A Secondary Analysis In Support Of The Community Health Needs Assessment For Oasis Free Clinics, Jillian Wheeler

Muskie School Capstones and Dissertations

Oasis Free Clinics offer free medical and dental services to uninsured, low income adults living in Sagadahoc County, Maine (with the exception of the town of Richmond) and the towns of Brunswick, Freeport, and Harpswell in Cumberland County and Durham in Androscoggin County. Oasis has filled a critical need in providing affordable health care to the working poor with the absence of Medicaid expansion in the state of Maine. The clinic offers wellness checks, women's wellness, prenatal care, chronic disease management, limited mental health counseling, a prescription assistance program and dental care.

Oasis Free Clinics will conduct a Community Health …

Analysis Of The Efforts Of Urban And Rural Health Systems To Achieve Accountable Care Organization Target Goals For Dilated Eye Exams In Individuals With Diabetes, Michele Gilliam

Muskie School Capstones and Dissertations

This capstone project was designed to understand and analyze the completion rates for diabetic dilated eye exams within four different health systems participating in the MaineHealth Accountable Care Organizations (ACO). This research is valuable within the current US health care climate as health care providers have sought to evaluate the cost of care in terms of their value to payers. Moreover, many providers have elected to join the ACO in order to demonstrate better outcomes, improve the cost of care and to share programmatic content and tools to standardized care. Within this capstone, system level workflows and processes were evaluated …

Access To Health Care Services For Adults In Maine [Report], Erika C. Ziller Phd

Access / Insurance

On October 17, 2016, the Maine Health Access Foundation (MeHAF) released a new research brief developed with the University of Southern Maine that found significant inequality in the ability of people in Maine to access quality health care. The authors, Barbara Leonard from MeHAF and Erika Ziller from the USM Muskie School, found that income, age and education are all closely associated with Maine people’s ability to receive appropriate and timely health care. Specifically, they found that among Maine adults 18 and older, those with family incomes less than $25,000 a year, young adults, racial and ethnic minorities, and people …

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

Health Information Exchange: A Strategy For Improving Access For Rural Veterans In The Maine Flex Rural Veterans Health Access, Karen B. Pearson Mlis, Ma, Amanda Burgess Mppm, John A. Gale Ms, Andrew F. Coburn Phd, Anush Yousefian Hansen Ms, Ma

Access / Insurance

This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.

Population Health Improvement Through Coordination Of Care, Trevey Davis

Muskie School Capstones and Dissertations

The objective of this Capstone Project is to work with the Mercy Gap in Care Coordinators (GCCs) to document the value of the care coordination at Mercy Health System. A key element of this project was to develop a workflow diagram alongside the GCC in order to track patient outcomes. Additionally, the team developed a system for documenting patient outcomes that is crucial to measuring the impact of care coordination. From the data collected there are a number of outcomes that can be measured. The number of patients who are contacted for screening is measurement of patient experience. Following initial …

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …

Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

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The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Rural Adults Delay, Forego, And Strategize To Afford Their Pre-Aca Health Care, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

About 40% of non-elderly adults reported problems paying medical bills or cost-related barriers to obtaining needed medical care in 2012, difficulties that are especially pronounced for the uninsured and underinsured, the chronically-ill, and those with low incomes. Given their lower incomes and higher uninsured rates compared to urban residents, rural residents may face particular cost barriers in accessing health care. Past research has shown that, compared to urban residents, rural residents are more likely to experience higher out-of-pocket costs and delayed or foregone care as a result of cost, even when covered by private health insurance. This study provides detailed …