Health Services Research Commons^™

Integrated Services Post (Posyandu) As Sociocultural Approach For Primary Health Care Issue, Oedojo Soedirham

Kesmas

Kelahiran posyandu pada tahun 1980-an merupakan usaha pemerintah Indonesia untuk meningkatkan status kesehatan masyarakat, mengikuti panggilan internasional, Deklarasi Alma Ata (Kazakhstan) tentang kesehatan masyarakat tahun 1978. Konsep kunci deklarasi tersebut adalah partisipasi masyarakat. Di Indonesia, partisipasi masyarakat disebut “gotong royong”. Masyarakat memainkan peran penting dalam meningkatkan kesehatan masing-masing. Untuk melibatkan masyarakat dalam kesehatan masyarakat, relawan harus direkrut dan dilatih untuk mengenal isu-isu kesehatan masyarakat dasar. Gagasan mengenai relawan yang disebut kader (village health worker) tersebut diajukan agar relawan sebagai bagian dari masyarakat dapat lebih mudah menyampaikan program-program kesehatan karena lebih dekat dibandingkan pejabat kesehatan masyarakat. Di dalam artikel ini dibahas …

Changes In Latitudes, Changes In Attitudes: Fqhcs And Community Clinics In A Reformed Health Care Market, Jessamyn Taylor

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 and the Supreme Court’s related decision have significantly shifted the health care landscape for safety net providers. Federally qualified health centers (FQHCs) are a mainstay of primary care for the uninsured and those with limited access to care. This paper focuses on the impact of health reform on FQHCs given the significant federal investment in them through grants, Medicaid, and Medicare reimbursement. Where noteworthy, the effect on non-FQHC community clinics is also discussed. The implications of Medicaid coverage expansions (or lack thereof in states that choose not to expand), Medicaid disproportionate …

Public Health Return On Investment: Making The Case, Glen P. Mays

Health Management and Policy Presentations

Fiscal pressures and policy imperatives have created a need for rigorous economic analyses of public health programs and policies. ROI analyses can reveal whether the benefits of public health strategies justify their costs, who realizes these benefits and costs, and under what circumstances.

Comparative Effectiveness Research And Patient Centered Outcomes Research In Public Health Settings: Design, Analysis, And Funding Considerations, Glen P. Mays

Health Management and Policy Presentations

The principles and methods of CER and PCOR have developed primarily with therapeutics in mind, but they must also be applied to the study of public health programs, policies, and delivery systems. This session surveys the emerging field, and provides examples of CER/PCOR methods applied in public health settings using practice-based research networks (PBRNs).

Drug Overdose Morbidity And Mortality In Kentucky, 2000-2010: An Examination Of Statewide Data, Including The Rising Impact Of Prescription Drug Overdose On Fatality Rates, And The Parallel Rise In Associated Medical Costs, Terry Bunn, Svetla Slavova

Kentucky Injury Prevention and Research Center Special Report

From Foreword:

Kentucky has seen an explosion in fatal poisonings, particularly prescription drug related fatalities, in the last decade. In 2009, Kentucky had the 5^th highest drug overdose rate in the US, increased from the 6^th highest drug overdose fatality rate determined in 2008 (CDC WONDER). Kentucky also had the 5^th highest nonmedical use of opioid pain relievers, and 11^th highest for opioid pain reliever sales in the nation (CDC, MMWR Report November 4, 2011). These drug overdose mortality statistics are extremely startling and only begin to reveal the devastating mental, emotional, and economic toll and …

Building A Strategic Framework For Comparative Effectiveness Research In Complementary And Integrative Medicine, Claudia M. Witt, Margaret Chesney, Richard Gliklich, Lawrence Green, George Lewith, Bryan Luce, Anne Mccaffrey, Shelly Rafferty Withers, Harold C. Sox, Sean Tunis, Brian M. Berman

Dartmouth Scholarship

The increasing burden of chronic diseases presents not only challenges to the knowledge and expertise of the professional medical community, but also highlights the need to improve the quality and relevance of clinical research in this domain. Many patients now turn to complementary and integrative medicine (CIM) to treat their chronic illnesses; however, there is very little evidence to guide their decision-making in usual care. The following research recommendations were derived from a CIM Stakeholder Symposium on Comparative Effectiveness Research (CER): (1) CER studies should be made a priority in this field; (2) stakeholders should be engaged at every stage …

"Homelike" Characteristics Of Maine's Residential Services: A Survey Of Maine's Residential Service Settings (2010), Julie T. Fralich Mba, Eileen Griffin Jd, Catherine Mcguire Bs

Disability & Aging

To better understand the nature of the residential facilities serving more than 19 percent of Maine’s Long Term Services and Supports (LTSS) population, the Maine Department of Health and Human Services commissioned the Muskie School to conduct a survey of residential facilities as part of its update to Maine’s LTSS profile. The goal of the Maine Residential Settings Characteristics Survey, conducted between July and September 2010, was to measure the "homelike" characteristics of residential settings.

The survey sample comprised a total of 636 facilities which included all licensed residential care facilities or private non-medical licensed institutions. The survey response rate …

Comparison Of Need And Supply Of Syringes For Therapeutic Injections In Pakistan, Adnan Ahmad Khan, Momina Saleem, Huma Qureshi, Rashid Jooma, Ayesha Khan

Section of Neurosurgery

Objectives: To determine the extent of shortfall in syringes by measuring the need from nationally validated sources and comparing it with position on the supply side. This was done in order to contribute to the ongoing national discussions that have focused on increasing syringe supply to curtail syringe reuse.
Methods: Using 'Injections received' data from the Pakistan Demographic Health Survey 2006-7 (N: 5429) and the National Hepatitis Survey (N: 47,043), the study estimated the number of injections received in Pakistan. We matched these against the local syringe production figures from the syringe manufacturers' association and import figures from the Federal …

Suicides And Suicide Attempts In Kentucky, 2001–2011, Kayla Pope, Svetla Slavova

Kentucky Injury Prevention and Research Center Special Report

From Executive Summary:

1. There were 605 suicides among Kentucky residents in the year 2010, up 7% from the 567 recorded in the year 2009.

2. The Kentucky resident age-adjusted suicide rate increased from 12.8 per 100,000 population in 2009 to 13.5 per 100,000 population in 2010, a 5.5% increase.

3. Firearms were the primary means of completed suicide from 2001-2010.

4. Kentucky residents aged 45-54 were the age group that completed suicide most frequently in 2010.

5. The age-adjusted rate for Kentucky self-harm-related hospitalizations increased 7.6% from 2010-2011 (52.5 hospitalizations per 100,000 population in 2010 to 56.5 hospitalizations in …

Expanding Delivery System Research In Public Health Settings: Lessons From Practice-Based Research Networks, Glen P. Mays, Rachel A. Hogg

Health and Clinical Sciences Faculty Publications

BACKGROUND: Delivery system research to identify how best to organize, finance, and implement health improvement strategies has focused heavily on clinical practice settings, with relatively little attention paid to public health settings-where research is made more difficult by wide heterogeneity in settings and limited sources of existing data and measures. This study examines the approaches used by public health practice-based research networks (PBRNs) to expand delivery system research and evidence-based practice in public health settings.

METHODS: Practice-based research networks employ quasi-experimental research designs, natural experiments, and mixed-method analytic techniques to evaluate how community partnerships, economic shocks, and policy changes impact …

High Prevalence Of Subclinical Atherosclerosis By Carotid Ultrasound Among Mexican Americans: Discordance With 10-Year Risk Assessment Using The Framingham Risk Score, Susan T. Laing, Beverly Smulevitz, Kristina Vatcheva, Anne R. Rentfro, David D. Mcpherson, Susan P. Fisher-Hoch, Joseph B. Mccormick

School of Mathematical & Statistical Sciences Faculty Publications

Background: Framingham risk scores (FRS) were validated in a mostly Caucasian population. Evaluation of subclinical atherosclerosis by carotid ultrasound may improve ascertainment of risk in nonwhite populations. This study aimed to evaluate carotid intima-media thickness (cIMT) and carotid plaquing among Mexican Americans, and to correlate these markers with coronary risk factors and the FRS.

Methods/results: Participants (n = 141) were drawn from the Cameron County Hispanic Cohort. Carotid artery ultrasound was performed and cIMT measured. Carotid plaque was defined as areas of thickening >50% of the thickness of the surrounding walls. Mean age was 53.1 ± 11.7 years (73.8% female). …

Estimating Scale And Scope Effects In Public Health Delivery: Implications For Regionalization, Glen P. Mays, Rachel A. Hogg, Rick Ingram, Kristina Rabarison

Health Management and Policy Presentations

OBJECTIVES: The nation's public health delivery system comprises nearly 3000 local public health agencies that vary widely in capabilities. Economic pressures, workforce shortages, and new national accreditation standards are leading these agencies to explore mechanisms for pooling resources to enhance delivery and improve population health.

METHODS: A longitudinal cohort design is used to analyze changes in the availability and perceived effectiveness of services delivered by local public health providers. A stratified random sample of the nation's 3000 local public health agencies (n=497) were surveyed in 1998 and again in 2006 and 2011 (70% response) to measure the availability of 20 …

Importance Performance Analysis Pelayanan Jaminan Sosial Kesehatan Di Puskesmas Swakelola Pembina, Asmaripa Ainy, Misnaniarti Misnaniarti, Nur Alam Fajar

Kesmas

Kunjungan pasien Jaminan Sosial Kesehatan (Jamsoskes) di puskesmas pembina selama tahun 2009 adalah 24.014 orang. Kunjungan per catur wulan memperlihatkan trend yang menurun. Jumlah pengunjung puskesmas pembina pada periode bulan Januari – April 2009 adalah 9.295 orang, pada Mei – Agustus 2009 adalah 8.162 orang, dan September – Desember 2009 adalah 6.557 orang. Hal ini dapat disebabkan oleh minat masyarakat yang rendah untuk menggunakan Jamsoskes. Oleh sebab itu, perlu dilakukan kajian kualitas pelayanan Jamsoskes menurut perspektif pasien. Penelitian dengan desain cross sectional ini menggunakan data primer yang dilakukan dengan metode wawancara terstruktur atau survei. Sampel terdiri dari 100 pasien Jamsoskes …

Child Maltreatment Outpatient Visits To Kentucky Non-Federal Acute Care Hospitals, 2008-2010, Marjorie Stanek, Michael Singleton, Svetla Slavova, Terry Bunn

Kentucky Injury Prevention and Research Center Special Report

No abstract provided.

The Development Of Hiv-Prevention Programs In Public Health Centers And Their Impact On Women: Opportunities For Changes In The City Of Buenos Aires - El Desarrollo De Programas De Prevención Contra El Vih Y Sus Impactos En Las Mujeres En El Primer Nivel De Atención. Oportunidades Por Cambios En La Ciudad De Buenos Aires., Anna Longo

Independent Study Project (ISP) Collection

The focus of my research is the implementation and continued efforts of HIV-prevention plans that are provided in primary care public health centers in the city of Buenos Aires. Much of the outline for these programs has been created and maintained by la Coordinación SIDA, a government-based AIDS group that works to organize and moderate public sector prevention efforts in the city. Public health centers are an effective channel through which HIV-prevention can be provided, due to the fact that they are often very integrated in their communities and tend to have a good sense of the social context that …

Achieving Consensus On Measure-Driven Child Health Quality: Maine’S Improving Health Outcomes For Children Initiative, Martha Elbaum Williamson Mpa, Nargiza Fuzailova Md, Mph, Kimberley S. Fox Mpa

Population Health & Health Policy

This brief describes Maine’s process for selecting child health quality measures, including identified strengths and limitations of the CHIPRA core measures that led to the inclusion of additional state-specific measures and the factors considered for selection. Subsequent articles will describe how measures have been implemented and used to improve child health quality and how they have been integrated into systems of care (e.g. health information technology systems, policy changes).

Design Of A Prostate Cancer Patient Navigation Intervention For A Veterans Affairs Hospital, Narissa J. Nonzee, June M. Mckoy, Alfred W. Rademaker, Peter Byer, Thanh H. Luu, Dachao Liu, Elizabeth A. Richey

Dartmouth Scholarship

Patient navigation programs have been launched nationwide in an attempt to reduce racial/ethnic and socio-demographic disparities in cancer care, but few have evaluated outcomes in the prostate cancer setting. The National Cancer Institute-funded Chicago Patient Navigation Research Program (C-PNRP) aims to implement and evaluate the efficacy of a patient navigation intervention for predominantly low-income minority patients with an abnormal prostate cancer screening test at a Veterans Affairs (VA) hospital in Chicago.

Perubahan Status Kelembagaan Dan Kualitas Pelayanan Pasien Rumah Sakit, Dadang Kusnadi

Kesmas

Kenyamanan, keamanan, dan kepuasan pelayanan pasien merupakan fenomena pelayanan yang mencerminkan kualitas. Tujuan penelitian ini adalah untuk mengetahui pengaruh implementasi kebijakan perubahan status kelembagaan rumah sakit terhadap kualitas pelayanan pasien. Penelitian ini menggunakan desain kuantitatif dan metode explanatory survey. Metode analisis meliputi regresi linier multipel dengan uji validitas product moment pearson, uji reliabilitas teknik alpha cronbach, uji hipotesis path analysis dan uji statistik (t), serta transformasi data skala likert dengan alat ukur method of succesive interval. Populasi adalah pegawai rumah sakit sebanyak 1.072 orang dan sampel sebanyak 92 orang yang ditentukan dengan teknik stratified random sampling. Data dikumpulkan dengan wawancara …

Determinan Kepatuhan Bidan Di Desa Terhadap Standar Antenatal Care, Guspianto Guspianto

Kesmas

Upaya menurunkan kematian ibu menjadi prioritas utama program pembangunan kesehatan nasional. Pelayanan antenatal care (ANC) menjadi bagian dari “Empat Pilar Safe Motherhood” sebagai kebijakan Kementerian Kesehatan untuk mempercepat penurunan angka kematian ibu (AKI). Kualitas layanan ANC dari aspek kinerja bidan di desa diukur antara lain dengan parameter tingkat kepatuhan terhadap standar ANC dalam memberikan kepuasan kepada ibu hamil. Penelitian ini bertujuan untuk mengetahui berbagai faktor yang berhubungan dengan kepatuhan bidan di desa terhadap standar ANC. Desain penelitian cross sectional ini menggunakan data sekunder Dinas Kesehatan Kabupaten Muaro Jambi dengan sampel 165 bidan di desa. Penelitian ini menemukan tingkat kepatuhan bidan …

Community Health Workers: A Front Line For Primary Care?, Lisa Sprague

National Health Policy Forum

Among the potential changes invoked in discussions on health system transformation, a need to revitalize primary care remains paramount. One way of doing this, most agree, is to move more in the direction of team-based care. Professionals such as physician assistants and nurse practitioners may be able to ease some of the physician’s clinical care load, but some populations also need help accessing services and basic health education in a familiar setting. Enter the community health worker (CHW), known by many titles and playing a variety of roles, who comes from the community he or she is serving and therefore …

Who Tended To Continue Smoking After Cancer Diagnosis: The National Health And Nutrition Examination Survey 1999-2008, Tung-Sung Tseng, Hui-Yi Lin, Sarah Moody-Thomas, Michelle Martin, Ted Chen

School of Public Health Faculty Publications

BACKGROUND: It has been estimated that there are approximately 12 million cancer survivors in the United States. Continued smoking after a cancer diagnosis is linked to adverse effects among cancer survivors on overall survival, treatment effectiveness, and quality of life. Little is known about who is more likely to quit smoking after his/her cancer diagnosis. The objective of this study is to evaluate factors associated with smoking cessation in cancer survivors, which to date has not been well studied. METHOD: The National Health and Nutrition Examination Survey (NHANES) 1999-2008 surveys were used in this study. A total of 2,374 cancer …

Bright Futures As-Is Assessment: How Child-Serving Practices, Health Systems, And The State Of Maine Use And Exchange Specific Clinical Data Related To Child Health Quality Measures, Kyra Chamberlain Ms, Rn, Martha Elbaum-Williamson Mpa, Jonathan Ives Mpm, Csm, Jin Liao M.Eng

Population Health & Health Policy

The purpose of the As Is assessment is to provide a description of Maine’s current HIT environment specifically pertaining to how EPSDT and other clinical data are entered, used, and exchanged electronically through information systems at pediatric practices, health systems, the State of Maine, and HIN. This information will inform plans currently under development by IHOC for electronic data exchange and child health measure calculation.

Faculty And Patient Evaluations Of Radiology Residents' Communication And Interpersonal Skills, Naila Nadeem, Abdul Mueed Zafar, Muhammad Nadeem Ahmad, Rukhsana Wamiq Zuberi

Department for Educational Development

Objective: To assess communication and interpersonal skills (CIS) of radiology residents through faculty and standardised patients (SP).

Methods: In this day-long objective structured clinical examination (OSCE) in January 2009, 42 radiology residents took part at six stations in Karachi, each with a standardised patient and a faculty evaluator. Each encounter lasted 15 minutes followed by independent assessments of the residents by both the evaluators.

Results: Based on rating-scale evaluations, all cases had satisfactory internal consistency (Cronbach\'s alpha 0.6 to 0.9). The alpha values were comparatively diminutive against the checklist scores. Correlation among faculty was 0.6 (p

Conclusion: Both checklists and …

The Use Of Interpreters To Improve The Quality And Safety Of Healthcare Through Better Communication In Obstetric Patients: Effect On Primary Cesarean Delivery Rate, Stephen A. Pearlman, Md

Master of Science in Healthcare Quality and Safety Capstone Presentations

Patients with limited English proficiency have poorer healthcare outcomes. An assessment of the cultural and linguistic competency of Christiana Care Health Systems revealed that our language services were not sufficiently robust and this was affecting care. Therefore, the purpose of this quality improvement study was to improve healthcare outcomes, specifically the rate of primary cesarean delivery, through improved language assistance, to patients with limited English proficiency presenting to labor and delivery. The methods employed included use of the TeamSTEPPS program to educate the staff on how to improve safety for patients with limited English proficiency, adding a live Spanish interpreter …

Stubborn, Persistent, Dangerous C.Difficile Infections. Is Improvement Possible?, Sara Townsend

Master of Science in Healthcare Quality and Safety Capstone Presentations

C.difficile also known as C.diff or CDI has developed into a dangerous infection for the United States’ health care system. While much work has been done to improve C.diff rates, health care teams have not been successful in reducing C.difficile infections. Many studies have focused on the mode of transmission of C.difficle, yet there still is not consensus on understanding how this infection is spread. Bryn Mawr Hospital, a community hospital in the suburbs of Philadelphia, Pa, has struggled to improve their C.diff rates like their peers throughout the country. While their infection rates for C.diff are …

Reinventing The 21st Century Public Health Workforce: Innovation, Evaluation & Practice-Based Research, Glen P. Mays

Health Management and Policy Presentations

Compelling opportunities exist for incorporating practice-based research to into the design, implementation, and evaluation of public health workforce training and development programs. Public Health Training Centers (PHTCs) can collaborate with practice-based research networks (PBRNs) to discover and disseminate evidence-based strategies for workforce development.

2011 Annual Report Of Child Deaths In Clark County, Nevada, Nevada Institute For Children’S Research And Policy, Tara Phebus

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 …

Patterns Of Interaction Public Health Pbrns: Insight From Network Analysis, Rachel A. Hogg, Glen P. Mays

Health Management and Policy Reports

This report presents data from a network analysis survey conducted with public health practice-based research networks (PBRNs) to examine patterns of interaction among researchers and public health practitioners who participate in the networks. These data provide a baseline for tracking the types and frequencies of interaction that occur within networks, and reveal opportunities for promoting more productive patterns of engagement in applied public health research. Over time, these types of data can reveal how and under what circumstances PBRNs facilitate the production and application of research about public health services and delivery systems. The analysis includes data on more than …

Making The Case For Public Health: Estimating Roi And Value, Glen P. Mays

Health Management and Policy Presentations

This presentation describes recent progress and new directions for estimating the value of public health strategies and infrastructure.

Measurement Of A Model Of Implementation For Health Care: Toward A Testable Theory, Joan M. Cook, Casey O'Donnell, Stephanie Dinnen, James C. Coyne, Josef I. Ruzek, Paula P. Schnurr

Dartmouth Scholarship

Greenhalgh et al. used a considerable evidence-base to develop a comprehensive model of implementation of innovations in healthcare organizations [1]. However, these authors did not fully operationalize their model, making it difficult to test formally. The present paper represents a first step in operationalizing Greenhalgh et al.'s model by providing background, rationale, working definitions, and measurement of key constructs.A systematic review of the literature was conducted for key words representing 53 separate sub-constructs from six of the model's broad constructs. Using an iterative process, we reviewed existing measures and utilized or adapted items. Where no one measure was deemed appropriate, …