Health Services Research Commons^™

Learning From Near Misses In Medication Errors: A Bayesian Approach, Jessica A. Myers, Francesca Dominici, Laura Morlock

Johns Hopkins University, Dept. of Biostatistics Working Papers

Medical errors originating in health care facilities are a significant source of preventable morbidity, mortality, and healthcare costs. Voluntary error report systems that collect information on the causes and contributing factors of medi- cal errors regardless of the resulting harm may be useful for developing effective harm prevention strategies. Some patient safety experts question the utility of data from errors that did not lead to harm to the patient, also called near misses. A near miss (a.k.a. close call) is an unplanned event that did not result in injury to the patient. Only a fortunate break in the chain of …

Medicaid Financing: How The Fmap Formula Works And Why It Falls Short, Christie Provost Peters

National Health Policy Forum

Medicaid costs for health and long-term care services for low-income individuals are substantial. As a result, each state’s “match rate,” or federal medical assistance percentage (FMAP), which determines the share of Medicaid benefit costs the federal government pays, has enormous implications for state budgets and state economies, as well as for Medicaid beneficiaries and providers. Shifts in the FMAP from year to year, even minor ones, can mean the gain or loss of tens or hundreds of millions of federal matching dollars, depending on the size of the state’s Medicaid program. This paper explains the FMAP formula, examines the limitations …

Psychological Distress And Change In A Pediatric Obesity Population, Amy Rebecca Beck

Loma Linda University Electronic Theses, Dissertations & Projects

Pediatric overweight and obesity is a growing national epidemic with 15 percent of children ages 6-19 considered obese and at least 22 percent considered overweight. While there is considerable research pointing to contributing factors of obesity, there is a paucity of research which elucidates what contributes to successful intervention. Considering that by the year 2050, nearly 50 million Americans may be obese, understanding the factors delineating success of weight loss and prevention is a necessity. The purpose of this study was to utilize archival data from the LLU Growing Fit Program to evaluate the levels of psychological distress experienced by …

Primary Care Physician Supply, Physician Compensation, And Medicare Fees: What Is The Connection?, Laura A. Dummit

National Health Policy Forum

Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a …

Tending To Richmond's Children: Community Strategies To Bridge Service Gaps, Judith D. Moore, Jessamyn Taylor

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to Richmond, Virginia, in October 2008 to explore social and environmental determinants of children’s health, including the impacts that poverty and exposure to lead-based paint have on birth outcomes, child development, and school readiness; and the community's efforts to address them. Though not large in population terms, Richmond faces many of the social and economic problems often common in larger urban areas—concentrated poverty, migration of wealth and services to the surrounding counties, a high infant mortality rate, and troubled schools. The site visit explored community strategies to improve birth outcomes and …

Medicaid And Mental Health Services, Cynthia Shirk

National Health Policy Forum

Medicaid is the largest payer of mental health services in the United States, contributing more than any other private or public source of funding. This background paper highlights the variety of services and supports needed by individuals with mental illness and Medicaid’s increasing role in mental health coverage. It provides an overview of Medicaid coverage of mental health services and identifies some of the key challenges in providing that coverage.

Study Design And Biostatistics For The Bedside Healthcare Professional., Sherrine Eid Mph

Department of Community Health and Health Studies

No abstract provided.

Covering All Kids: States Setting The Pace, Jennifer Ryan, Safiya Mojerie

National Health Policy Forum

Providing health insurance coverage for the uninsured is a challenge that has remained unresolved for decades. In the absence of a national solution, states have initiated their own efforts to expand access to health insurance coverage, particularly for children. This issue brief provides a history and status of state universal children’s coverage initiatives and features several states that appear to be setting the pace by developing successful strategies for expansion and cultivating the political will and leadership needed to institute them. In highlighting some of the key lessons that can be learned from states’ experiences, this paper may inform the …

The Effectiveness Of Treatment In An Inpatient And Outpatient Psychiatric Facility, Timothy Quan Tran

Loma Linda University Electronic Theses, Dissertations & Projects

The present study is aimed at examining treatment outcome in a large psychiatric facility that provides both inpatient and outpatient services to a broad range of patients. Not only will patient outcomes be assessed at a facility-wide level, but patient outcomes on the various units/programs in the facility will also be assessed and compared. It is expected that, facility wide, patients will show significant improvement on the outcome measure from admission to discharge, but that patient outcomes will differ across the various units/programs in the facility. In sum, the results of the paired-sample t-test and effect size obtained in this …

Is American Health Care Uniquely Inefficient?, Alan M. Garber, Jonathan Skinner

Dartmouth Scholarship

No abstract provided.

Community-Based Long-Term Care In Milwaukee: Wisconsin Still Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum has made two site visits to Wisconsin in two years. The first, in August 2007, focused on an overview of Family Care, the state's managed long-term care program, and looking at service delivery in a rural setting. The August 2008 site visit focused on the operations of MCOs and Family Care service providers in the urban environment of Milwaukee. Issues examined included the link between housing and social services, care management, capitation and rate-setting, measuring quality, and integrating people with disabilities into a program that initially targeted the elderly.

Strong As The Weakest Link: Medical Response To A Catastrophic Event, Eileen Salinsky

National Health Policy Forum

Natural disasters and acts of terrorism have placed a spotlight on the ability of health care providers to surge in response to catastrophic conditions. This paper reviews the status of efforts to develop the capacity and capabilities of the health care system to respond to disasters and other mass casualty events. Strategies for adapting routine medical practices and protocols to the demands posed by extraordinary circumstances and scarce resources are summarized. Existing federal roles, responsibilities, and assets relative to the contributions of state and local government and the private sector are described, including specific programmatic activities such as the Strategic …

Positioning Hospice Care Within The Black And Hispanic Communities, Carol Armstrong

Graduate Theses

Nationally, hospice care and the signing of advance directives are underutilized by minority populations. Research on this phenomenon includes cultural differences, access to medical care and language barriers. A retrospective study of 1,817 closed patient charts from a local hospice was conducted to determine significant differences among the White, Black and Hispanic patient populations. The number of White patients admitted to both hospice homecare and to the hospice inpatient was significantly greater than the number of admissions of either the Black or Hispanic patients. There were no significant findings in the total number of services provided to each of the …

Medicare Demonstrations, Amanda Cassidy

National Health Policy Forum

This publication provides an overview of Medicare demonstration projects, including what they are, how and by whom they are initiated, and how they differ from research projects. This document highlights several significant demonstrations in Medicare history and outlines several current demonstration projects. Key considerations in designing, implementing and evaluating demonstrations are mentioned.

Medicaid And Schip Waivers, Cynthia Shirk

National Health Policy Forum

No abstract provided.

The Fundamentals Of Medicare Demonstrations, Amanda Cassidy

National Health Policy Forum

Demonstrations are experiments that test Medicare policy changes without permanently changing the Medicare program. They allow policymakers to learn about the potential impact and operational challenges of a proposed modification to Medicare, but in a more controlled environment and on a limited basis. Since demonstrations can affect hundreds of thousands of beneficiaries and providers and involve millions of dollars, they are often controversial. This paper describes the basics of Medicare demonstrations, including what they are, how they are initiated, and why they are undertaken. The paper also explores the relationship between demonstrations and other research projects. The primary challenges in …

Shaping Medicaid And Schip Through Waivers: The Fundamentals, Cynthia Shirk

National Health Policy Forum

The use of waivers has become one of the key vehicles for innovation in Medicaid and the State Children’s Health Insurance Program (SCHIP). This background paper examines the use of research, demonstration, and program waiver authorities to test new approaches to the delivery of and payment for health care and long-term care services. The paper reviews the statutory basis and mechanics of demonstrations and program waivers, as well as their history and political context in shaping Medicaid and SCHIP. It also explores the ways the changing state-federal relationship and the ever-growing demand for state flexibility have driven waiver policy. Finally, …

Clark County Child Death Review: 2007 Annual Report, Nevada Institute For Children’S Research And Policy

Nevada Institute for Children's Research and Policy Reports

The primary goal of all Child Death Review Teams is to prevent future child deaths. The child death review process enables jurisdictions to come together in a collaborative, multidisciplinary forum to openly discuss detailed circumstances in an effort to gain a better understanding of child deaths. The team provides a venue for representatives from a variety of both public and private agencies as well as community organizations to share information in a confidential and non-threatening environment. The National Center for Child Death Review (hereinafter, National Center), which is supported by the Maternal and Child Health Bureau of the U.S. Department …

A Geospatial Approach For New Perspectives On Satisfaction With Health Services In Malawi, Gideon Mazinga

Loma Linda University Electronic Theses, Dissertations & Projects

This dissertation explored the spatial pattern of user satisfaction with health services and factors, including policies that potentially explain the variation in the district-level of user satisfaction with health services. Nationwide secondary data was extracted from the 2002 Core Social Welfare Indicators Survey and the National Health Services Statistics databases obtained from National Statistics of Malawi. The National Health Facilities inventory obtained from the Malawi diffusion project was also geocoded to display the distribution of health care facilities in the country. Spatial autocorrelation and regression modeling techniques were applied on the national representative data set.

The spatial autocorrelation test revealed …

Hiv Risk Among Nursing Students In Rwanda : Self-Efficacy, Knowledge And Attitudes, Jacqueline Wosinski

Loma Linda University Electronic Theses, Dissertations & Projects

Acquired immune deficiency syndrome (AIDS) is the leading cause of death in sub-Saharan Africa. With a prevalence rate of 3.1% in 2006, Rwanda is one of the hardest hit countries. Nurses are often the leading health professionals in rural communities and at the forefront of the fight against the HIV pandemic. Little has been written on how nurses are prepared to intervene successfully along the continuum of HIV prevention and care. A mixed-methods sequential exploratory approach was used to explore this question.

In the first phase, cognitive, socio-psychological, and environmental factors of nursing education in Rwanda in regard to HIV …

Cultural Beliefs About Health Professionals, Attributions For Mistreatment, And Continuity Of Cancer-Related Care, Jennifer Anne Tucker

Loma Linda University Electronic Theses, Dissertations & Projects

This research examined attributions for health care mistreatment, related emotions, and the role of cultural beliefs about health care professionals as determinants of cancer-related continuity of care among Anglo and Latino women in Southern California. This research was guided by Betancourt’s model of culture adapted for the study of health behavior (Betancourt & Flynn, 2008) and Weiner’s (1996) attribution theory of motivation and emotion. As predicted, higher levels of negative cultural beliefs about health professionals resulted in lower intentions for continuity of care indirectly through mediating psychological perceptions of intentionality for mistreatment, controllability of its causes, and anger toward the …

The Impact Of Being Born With Cleft And Cleft Reparative Surgery On Overall Health And Speech Outcomes, Khatansuudal Evsanaa

Master's Theses

Orofacial cleft is one of the most common and treatable birth defects in the world. If left untreated, orofacial cleft can impair normal speech development, growth, and could lead to a number of health consequences later in life. The main motivation of the study is to measure the impact of being born with cleft and the cleft reparative surgery on overall speech and health cleft for teenagers in India using difference-in-differences approach along with household fixed effects method. An overall health outcome was measured using height, weight, grip strength and BMI, and the speech acceptability was measured using a “Universal …

The Changing Role Of Physicians In Disaster Management And Hospital Incident Command, F. Matthew Mihelic, M. David Stockton, Stephen A. Cole, Gregory H. Blake

Faculty Publications

Recent changes in governmental policy toward disaster medicine and hospital incident command foreshadow a significant change in the role that physicians will play in disaster preparedness and response. The distinct discipline of Disaster Medicine has received authoritative recognition and promotion in the recent Homeland Security Presidential Directive 21, and recently established guidelines for incident command within hospitals have included a new position designated as “Medical/Technical Specialist(s)” that will assist the Incident Commander in disaster-related decision-making. This is a multidisciplinary position, and its functions can be filled by one or more individuals. As physician training and competency in Disaster Medicine increases, …

Designing A Successful Practice-Based Research Network In Public Health: Key Concepts, Glen P. Mays, Sharla A. Smith

Health Management and Policy Reports

Successful public health practice-based research networks (PBRNs) will require organizational, financial, and intellectual resources that allow practitioners and researchers to mount relevant studies in real-world public health settings. This brief outlines characteristics likely to be important to the success of public health PBRNs, based on the experience of PBRNs in other practice settings

Self-Efficacy, Physical Activity, And Aerobic Fitness In Middle School Children: Examination Of A Pedometer Intervention Program, Dana M. Manley

Theses and Dissertations (ETD)

The purpose of this study was to examine the relationships among self-efficacy levels, physical activity, aerobic fitness, and body composition (relative body mass index; RBMI) and to determine whether a school-based pedometer intervention program would improve those variables and prevent weight gain in sixth and seventh graders in rural mid-South middle schools. Bandura’s Social Cognitive Theory served as the theoretical basis for the study.Methods: A quasi-experimental pre-test, post-test design was used. The sample, recruited from two rural middle schools in Kentucky, consisted of 116 sixth and seventh grade students (98% Caucasian, 51% male, age=11.65±0.71). Anthropometric assessment of height, weight, …

Pengembangan Dan Aplikasi Sistem Informasi Usaha Kesehatan Sekolah (Uks) Di Kabupaten Purwakarta, Johari Johari

Kesmas

Pencapaian kegiatan Usaha Kegiatan Sekolah dari Standar Pelayanan Minimal di Kabupaten Purwakarta, tahun 2005 masih jauh dibawah target standar pelayanan minimal secara nasional. Cakupan tersebut meliputi deteksi dini tumbuh kembang anak balita dan prasekolah (74,57%), pemeriksaan kesehatan siswa oleh tenaga terlatih (61,82%) pelayanan kesehatan remaja (51,17%). Penelitian ini bertujuan membangun sistem informasi UKS di Kabupaten Purwakarta dalam upaya mendukung pelaksanaan manajemen UKS Metode yang digunakan berdasarkan System Development Life Cycle (SDLC) yang meliputi tahap perencanaan, analisis, perancangan dan implementasi sistem/ uji coba prototype. Pengumpulan data dan informasi dilakukan melalui wawancara mendalam, telah dokumen dan observasi. Unit kerja yang menjadi obyek …

Primary Care: A Mandatory Requirement For Effective Health Care, Waris Qidwai

Department of Family Medicine

No abstract provided.

Productivity Spillovers In Healthcare: Evidence From The Treatment Of Heart Attacks, Amitabh Chandra, Douglas O. Staiger

Dartmouth Scholarship

A large literature in medicine documents variation across areas in the use of surgical treatments that is unrelated to outcomes. Observers of this phenomena have invoked “flat of the curve medicine” to explain these facts, and have advocated for reductions in spending in high-use areas. In contrast, we develop a simple Roy model of patient treatment choice with productivity spillovers that can generate the empirical facts. Our model predicts that high-use areas will have higher returns to surgery, better outcomes among patients most appropriate for surgery, and worse outcomes among patients least appropriate for surgery, while displaying no relationship between …

The Aging Services Network: Accomplishments And Challenges In Serving A Growing Elderly Population, Carol O'Shaughnessy

National Health Policy Forum

In 1965, Congress enacted the Older Americans Act, establishing a federal agency and state agencies to address the social services needs of the aging population. The mission of the Older Americans Act is broad: to help older people maintain maximum independence in their homes and communities and to promote a continuum of care for the vulnerable elderly. In successive amendments, the Act created area agencies on aging and a host of service programs. The “aging services network,” broadly described, refers to the agencies, programs, and activities that are sponsored by the Older Americans Act. The Act’s funding for services is …

Abstracts In High Profile Journals Often Fail To Report Harm, Enrique Bernal-Delgado, Elliot S. Fisher

Dartmouth Scholarship

To describe how frequently harm is reported in the abstract of high impact factor medical journals. We carried out a blinded structured review of a random sample of 363 Randomised Controlled Trials (RCTs) carried out on human beings, and published in high impact factor medical journals in 2003. Main endpoint: 1) Proportion of articles reporting harm in the abstract; and 2) Proportion of articles that reported harm in the abstract when harm was reported in the main body of the article. Analysis: Corrected Prevalence Ratio (cPR) and its exact confidence interval were calculated. Non-conditional logistic regression was used.