Health Services Research Commons^™

Metro-Urbam Mental Health In Developing Countries: From Origin To Outcome: An Indian Experience, Amresh Srivastava

Data and Test Instruments

Metro-Urban Mental health in developing countries: from origins to outcome: an Indian experience Amresh Shrivastava: MD,DPM,MRCPsych, Executive Director: Mental Health Resource Foundation, and Prerana Charitable Trust, Mumbai, India. Assistant professor, Department of Psychiatry, University of Western Ontario, London, Ontario, Canada Address of presenting author E Mail: [email protected] 467, Sunset Drive, Regional Mental Health care, St.Thomas, Ontario, Canada, N5H 3V9 Phone: 519-631-8510 x 49252, fax 519-631-2512. and 519-641-3833 The life of the mentally ill in large metropolitan areas is presumed to be more Challenging. The impact of urbanization on service utilization and outcome is not clearly known. The present paper discusses …

Hand Hygiene Compliance Rates In The United States--A One-Year Multicenter Collaboration Using Product/Volume Usage Measurement And Feedback., Maryanne Mcguckin, Richard Waterman, John Govednik

College of Population Health Faculty Papers

Hand hygiene (HH) is the single most important factor in the prevention of health care-acquired infections. The 3 most frequently reported methods of measuring HH compliance are: (1) direct observation, (2) self-reporting by health care workers (HCWs), and (3) indirect calculation based on HH product usage. This article presents the results of a 12-month multicenter collaboration assessing HH compliance rates at US health care facilities by measuring product usage and providing feedback about HH compliance. Our results show that HH compliance at baseline was 26% for intensive care units (ICUs) and 36% for non-ICUs. After 12 months of measuring product …

State Report Of Unmet Needs For Quarter 3 Fy '09 (Jan- Mar '09), Helen Hemminger Mmhs

Disability & Aging

No abstract provided.

The Children's Health Insurance Program (Chip): The Fundamentals, Jennifer Ryan

National Health Policy Forum

This background paper provides a brief overview of the fundamental elements of the Children’s Health Insurance Program (CHIP). CHIP, which served more than 7 million children in federal fiscal year 2008, is a jointly funded federal-state partnership that was originally enacted in 1997 as a complement to the Medicaid program. CHIP is designed to provide health insurance coverage for children in families who earn too much to qualify for Medicaid but cannot afford to purchase private insurance coverage. The program was reauthorized in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, which included several changes and additions to …

Show Me The Money: The Implications Of Schedule H, Eileen Salinsky

National Health Policy Forum

Responding to policymakers' concerns, the Internal Revenue Service (IRS) implemented significant new hospital community benefit reporting under Schedule H of its revised Form 990, the return used by tax-exempt organizations. This issue brief considers the policy implications of the quantitative and qualitative information that hospitals are now mandated to report through Schedule H, including the costs associated with charity care, bad debt, and the unreimbursed costs of Medicaid and Medicare. The paper examines unresolved issues related to the new reporting requirements, such as controversies regarding the scope of Schedule H, and considers the potential for these reports to influence IRS …

Schedule H: New Community Benefit Reporting Requirements For Hospitals, Eileen Salinsky

National Health Policy Forum

In recent years, some policymakers have questioned whether not-for-profit hospitals benefit the communities they serve at a level commensurate with the tax exemptions they receive as charitable organizations. This background paper reviews the new community benefit reporting requirements hospitals will face in 2009 under Schedule H of the Internal Revenue Service's revised Form 990 (the return used by organizations exempt from federal income tax). The paper provides a descriptive summary of the quantitative and qualitative information to be reported on Schedule H, such as charity care, bad debt, and the unreimbursed costs of Medicaid and Medicare.

Coordinating Care For People With Multiple Chronic Conditions: The Guided Care Model And Other Innovative Approaches, Judith D. Moore, Carol O'Shaughnessy

National Health Policy Forum

The Forum sponsored two site visits to explore the Johns Hopkins University's research and demonstration program on Guided Care, in April and August 2009. Guided Care is a patient-centered medical home model that uses an interdisciplinary approach to coordinating health care for older people with multiple chronic conditions. Guided Care nurses located in primary care practices work with Medicare patients on a long-term basis, coordinate their care among various providers, provide transitional care, and assist patients with self-management skills. Site visit participants learned about the complexities of caring for frail Medicare patients, some of whom see multiple physicians and other …

Implications For Child Welfare Teaching And Human Services Personnel Perspectives Experiences Of Children With Special Needs, Sarah Huesmann

Honors Capstones

Capstone submitted as a graduation requirement for the BSU Honors Program.

The Medicaid Drug Rebate Program, Christie Provost Peters

National Health Policy Forum

The Medicaid Drug Rebate Program helps lower Medicaid spending on outpatient prescription drugs by ensuring states receive discounts similar to those provided to private purchasers. Based on manufacturer reported pricing data, Medicaid drug rebates generate significant revenue for the states (and the federal government) that helps offset Medicaid prescription drug expenditures. This publication describes the Medicaid Drug Rebate Program and reviews how it works.

Overview Of Mapping Applications In Health Research, Helen Hemminger Mmhs

Disability & Aging

No abstract provided.

Prevention Of Mother-To-Child Transmission (Pmtct) Of Hiv In The Sub-Saharan Africa Region With A Focus On Uganda, Emily K. Franks

Senior Honors Theses

With the rise of the HIV/AIDS epidemic in the past thirty years, people of all ages, infants to elderly alike, all over the world, suffer from its adverse effects. Even an unborn baby in-utero can contract this virulent infection by means of mother-to-child transmission (MTCT) (Sweeney, 2005). Infants and children diseased in this way comprise 90% of the estimated 800,000 new cases of HIV in children seen each year, but the region hit hardest, however, is Sub-Saharan Africa, with the country of Uganda historically having the highest incident rate for a time (Stringer, E.M., et al. 2008). Therefore, the purpose …

Elder Abuse: A Policy Analysis, Cortni Davis

Undergraduate Research Conference

Elder abuse is a growing social problem in the United States. It takes on many forms, and is prevalent throughout various cultures. Elder Abuse Reporting Laws have been enacted throughout various states to prevent and intervene in elder abuse cases. California’s Financial Abuse Reporting Act of 2005 is one among many laws in the United States which was formed to help ensure social justice for the elderly citizens of America.

Health Care-Associated Infections: Is There An End In Sight?, Lisa Sprague

National Health Policy Forum

Health care–associated infections (HAIs) have emerged as a significant concern in policy as well as clinical circles. An HAI is an infection acquired during treatment for another condition. Some of the HAI-causing bacteria have become drug-resistant; methicillin-resistant Staphylococcus aureus, or MRSA, is a familiar example. Tied to perhaps 100,000 deaths and $20 billion in health care costs each year, HAIs have given rise to state laws, legislative proposals at the federal level, public-private initiatives, and work at the hospital system and individual hospital level. However, much remains to be done. This issue brief reviews the prevalence of HAIs and the …

Nevada Medicaid And Check Up Programs: Barriers To Enrollment And Utilization, The Nevada Institute For Children’S Research And Policy, Denise Tanata Ashby, Jennifer Waddoups, Tara Phebus

Nevada Institute for Children's Research and Policy Reports

This study offers only a brief look at some of the barriers Nevada children and families face with Medicaid and Nevada Check Up. Strengthening the Medicaid and Nevada Check Up programs is vital to improving children’s health care access and utilization in Nevada. By developing and implementing legislation to improve public health insurance coverage, access, and utilization in Nevada, policymakers can ensure a brighter, happier, and healthier future for Nevada’s children and families.

Stigma And Discrimination In Schizophrenia, Amresh Srivastava

Data and Test Instruments

Title: Stigma and Discrimination: The Mumbai Experience Main Author: Amresh Shrivastava MD, DPM, MRCPsych, University of Western Ontario, London, Ontario, Canada. Co-Authors: Gopa Sarkhel, MA, Iyer Sunita MA, Thakar Meghana MA, Shah Nilesh, MD, DPM Address of Presenter: Executive Director, Mental health foundation of India (PRERANA Charitable Trust) Mumbai, India; Currently at Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada Address: Regional mental health care, 467 Sunset Drive, St. Thomas, N5N 3V9, St. Thomas, Ontario, Canada Phone: 1-5196318510; Fax: 1-519-631-2512. E-mail: [email protected] Background: People with schizophrenia suffer from stigma and discrimination to a great extent, and this …

Reauthorizing Schip: A Summary Of Selected Issues, Jennifer Ryan, Cynthia Shirk

National Health Policy Forum

This document provides a brief overview of some of the policy and programmatic issues that were addressed in legislation to reau¬thorize the State Children’s Health Insurance Program (Title XXI of the Social Security Act) during the summer and fall of 2007. This overview provides a background for understanding the elements for a second round of reauthorization that will likely be debated in the early days of the 111th Congress. The paper reviews several of the key issues under discussion and summarizes some of the related provisions in the reauthorization bills that were considered in 2007.

Summary Of Findings From The 2009 Child Death Review Annual Report, Nevada Institute For Children's Research And Policy Reports

Nevada Institute for Children's Research and Policy Reports

The 2009 Annual Report of Child Deaths in Clark County, Nevada provides data regarding all infant, child, and fetal (over 20 weeks gestation) deaths occurring in Clark County in 2009. This represents the second year that the Child Death Review Team in Clark County reviewed 100% of the child deaths referred to the team by the Clark County Office of the Coroner/Medical Examiner; this includes all natural deaths, as well as all accidents, homicides, suicides, and undetermined cases. The team also reviewed all fetal deaths over 20 weeks gestation.

Childhood Lead Poisoning Prevention Program: 2008-2009 Annual Report, Southern Nevada Health District

Nevada Institute for Children's Research and Policy Reports

The goal of the Southern Nevada Health District Childhood Lead Poisoning Prevention Program (CLPPP) is to eliminate lead poisoning as a significant health risk for children living in the state of Nevada. These efforts started in Clark County, where over 70 percent of the state’s population resides, with the hope of expanding to Northern and rural Nevada by the end of the grant term.

Ethical Considerations Of Genetic Presymptomatic Testing For Huntington's Disease, Alberto Coustasse, Alicia Pekar, Andrew Sikula Sr., Sue Lurie

Management Faculty Research

The aim of this literature review was to determine if there is adequate ethical justification for presymptomatic genetic testing on potential Huntington's disease patients. Huntington's disease is a neurological genetic disorder characterized by midlife onset which consists of cognitive, physical, and emotional deterioration. Although genetic testing has traditionally been guided by the principle of autonomy, severe psychological consequences such as depression, anxiety, survival guilt, and suicide have complicated the ethical issue of providing a presymptomatic yet definitive diagnosis for an incurable disease. An analysis of available articles yielded inconclusive findings, namely due to insufficient evidence, self-selection bias of test participants, …

Risk Assessment For Suicide Behaviour : Clinical Challenges, Amresh Srivastava, Charles Nelson

Data and Test Instruments

This is an audio-visual about risk assessment of suicide behavior. Part 1. Reformulating the concept of RISK and a New instrument for assessment: Risk assessment is an important clinical responsibility, which can be ‘life-saving’. Literature on risk factors has become voluminous; however a traditional risk assessment does not take into account the most relevant factors. This reflects the prevailing conceptualization of risk, which has not been fully and completely tied to clinical outcomes. Psychopathology is currently understood in biopsychosocial terms. A more progressive conceptualization of risk should consider the interplay of both, risk and protective factors. The present work proposes …

Commercial Sex Workers In Five Ethiopian Cities: A Baseline Survey For Usaid Targeted Hiv Prevention Program For Most-At-Risk Populations, Woldemariam Girma, Annabel Erulkar

HIV and AIDS

This report presents findings from a baseline survey of commercial sex workers (CSWs) that was undertaken in five Ethiopian cities. 2,050 CSWs were interviewed for the survey. CSW were disproportionally young and came from extremely disadvantaged backgrounds. Most respondents also cited negative working standards from another profession, or family responsibilities as reasons leading to sex work. Condom use was very high but use may be inconsistent or over-reported and should be studied further. Findings also propose additional advocacy for positive peer support groups, more HIV testing for at-risk populations, and addressing violence among CSWs and other Ethiopian women.

Integration Of Services: Making Integrated Services A Reality, Frontiers In Reproductive Health

Reproductive Health

Programs seeking to provide a more comprehensive RH service may establish or strengthen referrals between related yet separately provided services that enable a client to receive the range of needed services. There are two main rationales for integrating services. First, many clients have needs for several services; and second, there is an expectation that providing integrated or linked services can be more efficient programmatically. Little empirical evidence exists to support these underlying rationales, or to guide policies and programs in organizing services effectively and efficiently. Lessons from FRONTIERS have demonstrated not only the demand for multiple services, but also the …

Kawasaki Syndrome In Texas, Alberto Coustasse, Julius J. Larry, Witold Migala, Cody Arvidson, Karan P. Singh

Management Faculty Research

The authors examined hospitalization rates of Kawasaki Syndrome (KS) among Texas children to isolate clusters, identify demographic disparities, and suggest possible causative factors. Using a retrospective cross-sectional study design, they studied 330 KS cases from 2,818,460 hospital discharges. The majority of the cases (61.5%) occurred within the 1-4-years-old category, representing the highest hospitalization rate (14.3 per 100,000 children). Almost 75% of the KS population was less than 5 years old, with hospitalization rates approximately 8 times higher than that of all other children (p < .05). KS diagnosis occurred for only 49.4% of all KS cases upon admission. Along with high-density clusters identified in major metropolitan areas, the authors found the highest rates of KS among Asian and Pacific Islander and non-Hispanic black children. Genetic predispositions and access to healthcare issues may explain the results. The authors recommend improving educational initiatives with healthcare providers and establishing KS as a reportable condition.

Provision Of Health Care Services In Canada: Challenges And Opportunities, Rosa Rodriguez-Monguio, Enrique Seoane-Vazquez, Fernando Antoñanzas Villar

Pharmacy Faculty Articles and Research

The Canadian health care system provides comprehensive coverage of hospital and outpatient care, including therapeutic, diagnostic and preventive services. The level of coverage of services varies across the country. This study examines the key characteristics of the Canadian health and long-term care systems; presents a structured analysis of the insurance, financing and provision of health and long-term care services in Canada; describes the main challenges of the Canadian health and long-term care systems; and concludes with feasible opportunities for the Canadian health policy.

Main challenges to the Canadian system are related to population ageing; prevalence of avoidable diseases caused by …

Quality Improvement In Small Office Settings: An Examination Of Successful Practices., Daniel Wolfson, Elizabeth Bernabeo, Brian Leas, Shoshanna Sofaer, Gregory Pawlson, Donna Pillittere

College of Population Health Faculty Papers

BACKGROUND: Physicians in small to moderate primary care practices in the United States (U.S.) (<25>physicians) face unique challenges in implementing quality improvement (QI) initiatives, including limited resources, small staffs, and inadequate information technology systems 23,36. This qualitative study sought to identify and understand the characteristics and organizational cultures of physicians working in smaller practices who are actively engaged in measurement and quality improvement initiatives.

METHODS: We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39) that used performance data to drive quality improvement activities.

RESULTS: Physicians indicated that benefits to performing measurement and …

2009 Legislative Briefing Book, Nevada Institute For Children’S Research And Policy, Unlv, School Of Public Health, The Children’S Advocacy Alliance, Southern Nevada Area Health Education Center, Denise Tanata Ashby, Amanda Haboush, Tara Phebus, Jennifer Waddoups

Nevada Institute for Children's Research and Policy Reports

The purpose of the Nevada Institute for Children’s Research and Policy (NICRP) Legislative Briefing Book is to provide a quick snapshot of some of the most pressing issues facing Nevada’s children in order to provide advocates and policymakers with a stepping stone in creating positive changes to improve the lives of Nevada’s children. While this book will not cover every issue facing our children, it is intended to highlight those of greatest concern, covering issues in education, health, safety and security, and the juvenile justice system. Diligent efforts need to be made during the 2009 Legislative Session to improve policies, …

Maximizing Utilization Of Research, Frontiers In Reproductive Health

Reproductive Health

Operations research (OR) can only be judged successful if results are utilized for making decisions to strengthen RH/FP policies and service delivery. How can this best be achieved? How can both process and impact of OR be measured? Drawing from ten years of FRONTIERS in Reproductive Health OR experience, a number of key principles for promoting research utilization, illustrated with documented examples, are presented here. One important first step is clarifying terms used, almost interchangeably, in research utilization, as it incorporates a range of ways in which research can be used for making decisions to strengthen RH/FP policies and programs. …

Gender And Reproductive Health Services: Putting Gender Perspective Into Practice, Frontiers In Reproductive Health

Reproductive Health

Promoting gender equity is widely acknowledged as important for improving reproductive health (RH) programs, as gender shapes all aspects of RH service delivery. Thus promoting gender equity—fairness and justice in responsibilities and access to benefits for women, men, girls, and boys—is a major goal for RH programs. But how can programs operationalize the concept of gender perspective when delivering family planning (FP) and other RH services? What impact does this have on use and effectiveness? FRONTIERS projects have improved understanding of the impact of gender issues on RH and have helped identify effective actions for incorporating gender perspective into services. …

Financial Sustainability Of Reproductive Health Services—Understanding Costs: An Essential Skill In Reproductive Health Programs, Frontiers In Reproductive Health

Reproductive Health

Reproductive health (RH) services remain a low priority for most developing country health programs and face continuing reductions in donor funding and competition from other priorities, such as HIV and malaria. Thus, it is important to understand the costs of interventions and to compare them with existing or alternative service-delivery strategies. FRONTIERS studies provide important lessons about measuring costs and effectiveness of public and nongovernmental programs, planning for costing during scale-up, and improving understanding of issues influencing financial sustainability. This is one of eight Legacy Papers synthesizing major lessons learned in research conducted under the FRONTIERS in Reproductive Health Program. …

Female Genital Mutilation/Cutting: Change Is Possible, Frontiers In Reproductive Health

Reproductive Health

Changing long-standing cultural practices—even when such practices are harmful—is difficult, but the impressive success in reducing the acceptability and incidence of female genital mutilation/cutting (FGM/C) in several settings shows it is possible. Research by FRONTIERS in Burkina Faso, Egypt, Ethiopia, Kenya, Mali, and Senegal has provided insight into the sociocultural and religious underpinnings of FGM/C and has identified approaches that, over time, have contributed to individual and community decisions to abandon the practice. This information can help reduce the risk of undergoing FGM/C faced by three million girls and women every year. This is one of eight Legacy Papers synthesizing …