Health Services Research Commons^™

Evaluating Quality Improvement To Improve Hiv Reporting, Nandi A. Marshall, William C. Livingood, Angela Peden, Gulzar H. Shah, Russ Toal, Dayna Alexander, Alesha Wright, Sandra Jump, Shelby Freeman, Kay Davis, Lynn Woodhouse, Kellie Penix

Frontiers in Public Health Services and Systems Research

The incorporation and evaluation of Quality Improvement into Georgia’s public health systems continues to be a focus of the Georgia Public Health Practice Based Research Network. This report describes the process, preliminary results and lessons learned from incorporating Quality Improvement into one of Georgia’s public health districts.

Online Social Networks To The Rescue: Fulfilling The Ten Essential Public Health Services, Melanie D. Mason, Maureen P. Bezold

Frontiers in Public Health Services and Systems Research

Budget cuts and shortages in the public health workforce have contributed to the reduction of public health services in 91% of state health departments (SHDs). To adjust for these changes, health departments must discover novel ways to deliver essential public health services to their constituents. Researchers conducted a retrospective analysis of the content published on SHDs’ Twitter pages to determine if online social networks were used to fulfill the ten essential public health services. While 42 SHDs had a Twitter page, the volume and content of tweets varied. Although tweets were posted that related to all ten of the essential …

Commentary: Moving Beyond The Numbers, Effectively Using Research To Influence Policy, F. Douglas Scutchfield, Marylou Wallace

Frontiers in Public Health Services and Systems Research

This seventh issue of Frontiers reflects the variety of PHSSR. One emerging theme, however, is the notion of public health and its role in policy and policy development. PHSSR focuses on several potential users, researchers, practitioners and policy makers. As it concerns policy makers, PHSSR delivers research that allows them to make decisions about policy change that not only influences public health status, but creates healthy conditions. In this way, PHSSR essentially influences decisions about support for public health services.

The National Longitudinal Survey Of Public Health Systems: Selected Findings And Applications, Glen P. Mays

Health Management and Policy Presentations

This presentation reviews the National Longitudinal Survey of Public Health Systems and its applicability for monitoring the effects of the Affordable Care Act on public health delivery within the U.S.

Exploring The Effects Of Multi-Level Protective And Risk Factors On Child And Parenting Outcomes In Families Participating In Healthy Start/Healthy Families Oregon (Hs/Hfo), Peggy Nygren

Dissertations and Theses

While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical base of this study was a social ecological model of interactive influences including individual parent, family, and neighborhood level factors to predict outcomes. Protective Factor Index (PFI) and Risk Factor Index (RFI) predictors were developed to explore potential multi-level protective factor buffering effects on key child development and parenting outcomes. Participants were first time mothers enrolled in a randomized controlled study of the Healthy Start/ Healthy …

A Profile Of Community Health Center Patients: Implications For Policy, Peter Shin, Carmen Alvarez, Jessica Sharac, Sara J. Rosenbaum, Amanda Van Vleet, Julia Paradise, Rachel Garfield

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers are a key source of comprehensive primary care in medically underserved communities across the country, and their role is expected to grow as health coverage expands under the Affordable Care Act (ACA). To sharpen understanding of the health center patient population, this brief compares it to the overall low-income population, using data from the Health Center Patient Survey and the National Health Interview Survey,respectively. The pre-ACA profile of health center patients that emerges sets the stage for measuring change following implementation of the reform law and can inform health center policy, planning, and assessment moving forward.

Chhs December 2013 E-Newsletter, Dr. John Bonaguro, Dean, Vashon S. Wells, Editor, Wku College Of Health & Human Services

College of Health & Human Services Publications

No abstract provided.

Telemental Health In Today's Rural Health System, David Lambert Phd, John A. Gale Ms, Anush Yousefian Hansen Ms, Ma, Zachariah T. Croll Ba, David Hartley Phd, Mha

Mental Health / Substance Use Disorders

Telemental health has long been promoted in rural areas to address chronic access barriers to mental health care. While support and enthusiasm for telemental health in rural areas remains quite high, we lack a clear picture of the reality of telemental health in rural areas, compared to its promise. This Research & Policy Brief reports on the first part of our study—the online survey of 53 telemental health programs—and describes the organizational setting, services provided, and the staff mix of these programs. We draw from our telephone interviews with 23 of these programs to help describe the organizational context of …

Factors Influencing The Decision And Ability To Seek Health Services Among Hiv/Aids Patients In Tanzania, Savitri Grover

Masters Theses & Specialist Projects

Understanding the barriers to treatment for individuals with HIV/AIDS in developing countries could have a major impact on their ability to seek healthcare services. The purpose of this study is to quantitatively analyze the effect of daily activities and structural factors, which act as barriers to seeking health services for individuals living with HIV/AIDS in Tanzania.

The study is based on the hypothesis that (1) Individuals living with HIV/AIDS who face both personal and structural barriers have poor health compared to those not facing the barriers. (2) Individuals living with HIV/AIDS demonstrate different decisions and abilities to seek health services …

2013 Survey Of Children Served By Mainecare, Jean A. Talbot Phd, Deborah Thayer Mba, Zachariah T. Croll Mph, Kimberley Fox Mpa

Medicaid

These survey results help identify areas for improvement for future initiatives both for the MaineCare program and for providers serving this population. Key Findings: MaineCare higher than the national average on most patient experience measures. Significant improvements in MaineCare provider/family communication and care coordination. MaineCare lower than national average on customer service, availability of treatment choices, and care coordination among providers. Patient experience generally similar for Medicaid and CHIP enrollees. Many MaineCare children have special health care needs. 35% of children enrolled in MaineCare have special health care needs, according to the 2013 survey. Experience of children with special health …

Public Health Research Implementation And Translation: Evidence From Practice-Based Research Networks, Glen P. Mays, Rachel A. Hogg, Doris M. Castellanos-Cruz, Anna G. Hoover, Lizeth C. Fowler

Health and Clinical Sciences Faculty Publications

BACKGROUND: Research on how best to deliver efficacious public health strategies in heterogeneous community and organizational contexts remains limited. Such studies require the active engagement of public health practice settings in the design, implementation, and translation of research. Practice-based research networks (PBRNs) provide mechanisms for research engagement, but until now they have not been tested in public health settings.

PURPOSE: This study uses data from participants in 14 public health PBRNs and a national comparison group of public health agencies to study processes influencing the engagement of public health settings in research implementation and translation activities.

METHODS: A cross-sectional network …

Diagnosis And Acute Management Of Patients With Concussion At Children's Hospitals., Jeffrey D. Colvin, Cary Thurm, Brian M. Pate, Jason G. Newland, Matt Hall, William P. Meehan Iii

Manuscripts, Articles, Book Chapters and Other Papers

Objectives: To describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients.

Design: Cross-sectional study.

Setting: Children's hospitals participating in the Pediatric Health Information System in the USA during a 10-year period.

Patients: All emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion.

Main outcome measures: The proportion of concussion patients …

“Many Miles To Go …”: A Systematic Review Of The Implementation Of Patient Decision Support Interventions Into Routine Clinical Practice, Glyn Elwyn, Isabelle Scholl, Caroline Tietbohl, Mala Mann, Adrian G. K. Edwards, Catharine Clay

Dartmouth Scholarship

Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings.

Estimating The Costs Of Public Health Services, Glen P. Mays

Health Management and Policy Presentations

The National Academy of Sciences Institute of Medicine recommended in 2012 that the federal government undertake work to identify the components and costs of a "minimum package" of public health programs, services, and capabilities that should be available in every American community. This presentation summarizes work that is currently underway through the Robert Wood Johnson Foundation-supported Public Health Practice-Based Research Networks (PBRN) Program to estimate the costs of public health delivery.

From (Un)Willingness To Involvement: Development Of A Successful Study Brand For Recruitment Of Diverse Msm To A Longitudinal Hiv Research, Paula M. Frew, Victoria A. Williams, Eve T. Shapiro, Travis Sanchez, Eli S. Rosenberg, Vincent L. Fenimore, Patrick S. Sullivan

Environmental & Global Health Faculty Research

Background. HIV continues to be a major concern among MSM, yet Black MSM have not been enrolled in HIV research studies in proportionate numbers to White MSM. We developed an HIV prevention research brand strategy for MSM. Methods. Questionnaires and focus groups were conducted with 54 participants. Descriptive statistics and chi-square analyses were performed and qualitative data were transcribed and content analyzed to identify common themes. Results. Formative research results indicated that younger Black MSM (18–29 years) were less likely to think about joining prevention studies compared to older (≥30 years) Black MSM (, ). Qualitative and quantitative results indicate …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

New Health Delivery Networks: Merging Public Health And Health Care Systems, Glen P. Mays

Health Management and Policy Presentations

Incomplete coordination between medical care and public health delivery systems can result in significant missed opportunities for improving population health and constraining overall resource use. This lecture uses insight from the field of public health services and systems research (PHSSR) to examine: (1) why medical care and public health systems often fail to connect; (2) what are the potential health and economic consequences of these failures; and (3) what are the opportunities for connecting medical care and public health delivery to improve population health.

Recessions, Risks And Reforms: Changes In Inter-Organizational Activities To Improve Public Health, Glen P. Mays

Health Management and Policy Presentations

Research Objective: The Affordable Care Act created new incentives for hospitals, insurers, employers, public health agencies, and others to contribute to activities designed to promote health and prevent disease an injury. At the same time, the economic recession has constrained government and private sector spending on health and health care, necessitating changes in the scope and scale of public health delivery. This study uses data from the 1998-2012 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, with a focus on hospitals, insurers, employers, and primary …

Who Benefits From Public Health Spending And How Long Does It Take: Estimating Community-Specific Spending Effects, Glen P. Mays

Health Management and Policy Presentations

Objectives: Spending on public health and prevention strategies varies widely across states and communities. The Patient Protection and Affordable Care Act of 2010 (ACA) authorized the largest expansion in federal public health spending in decades, with the goals of improving population health and helping to moderate growth in medical care spending. To produce evidence needed to inform these investments, this study (1) estimates the effects of public health spending patterns within communities on preventable mortality and subsequent medical care spending; and (2) uses the methods of local instrumental variables developed by Heckman and Vytlacil and Basu to estimate how the …

Update On Public Health Financing & Economic Studies From The Phssr And Pbrn Programs, Glen P. Mays

Health Management and Policy Presentations

As part of the Public Health Financing Roundtable at APHA, this session provides an update on public health financing and economics studies underway through the Public Health Services and Systems Research (PHSSR) Program and the Public Health Practice-Based Research Networks (PBRN) Program, supported by the Robert Wood Johnson Foundation.

Chhs November 2013 E-Newsletter, Vashon S. Wells, Editor, Dr. John Bonaguro, Dean, Wku College Of Health & Human Services

College of Health & Human Services Publications

No abstract provided.

How Could, Should, And Would Physicians Use Facebook With Patients, Joy Peluchette, Katherine Karl, Alberto Coustasse

Management Faculty Research

After reviewing the benefits and risks of social media, we examine online discussion boards to determine the thoughts of physicians and patients regarding the use of Facebook to communicate with one another about health-related issues. Of the 290 comments analyzed, we found 42 percent were opposed to physicians using Facebook. Additionally, most (51.7 were opposed to physicians being Facebook “friends” with patients. Most opponents expressed concerns about privacy and the need to maintain professional boundaries in the physician-patient relationship. We provide suggestions for how healthcare administrators can effectively manage their social media presence and provide assistance to physicians.

Models For Identifying Patients At Risk Of Hospitalization: Use In Medical Homes In Emilia-Romagna Region, Italy, Vittorio Maio Pharmd, Ms, Msph, Guiseppina Rossi Md, Stefano Del Canale Md, Phd, Massimo Fabi Md, Ettore Brianti Md, Stefano Sforza Ms, Mary Robeson Ms, Scott Keith Phd, Joseph S. Gonnella Md, Daniel Z. Louis Ms

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Seeking Value In Medicare: Performance Measurement For Clinical Professionals, Lisa Sprague

National Health Policy Forum

The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to …

Public Health Services & Systems Research: Building The Science Of Public Health Delivery, Glen P. Mays

Health Management and Policy Presentations

The extreme heterogeneity in how public health activities are organized, financed, and implemented across U.S. states and communities provides compelling opportunities for research on the comparative effectiveness and efficiency of public health delivery. This talk highlights some of the most compelling and policy-relevant opportunities for research on public health organization and financing issues, and examines some of the ongoing studies in the field.

Health Workforce Needs: Projections Complicated By Practice And Technology Changes, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these …

Preliminary Findings From An Interventional Study Using Network Analysis To Support Management In Local Health Departments In Florida, Chin S. Park, Hado Byon, Jonathan W. Keeling, Leslie M. Beitsch, Jacqueline A. Merrill

Frontiers in Public Health Services and Systems Research

Management is the core service that integrates and coordinates essential public health services. Managers of local health departments (LHDs) are experts in practice but may not have expertise in organizational management. We conducted an evidence-based training intervention in 10 LHDs in Florida to support managers’ decision-making on organizational integration and coordination. We deployed a standard survey to collect organizational network measurements pre and post intervention. We presented results as evidence-based performance feedback and interviewed managers to document how they used the results in the context of each organization. Post intervention we found unexpected, significantly higher network centralization in daily work. …

Characteristics Of A Local Health Department Associated With The Use Of The Health Equity Index, Moira A. Lawson, Sharon Mierzwa, Michael Knapp

Frontiers in Public Health Services and Systems Research

Local health departments are tasked with understanding and addressing health inequities in the populations they serve. To meaningfully address health inequities, local health departments have identified the need for credible local data to better understand the relationship between community conditions and health outcomes. Yet, when given access to these data, we observe a very large variation in the level of interest between local health departments.

In this study, we offered Connecticut’s Local health departments access to the Health Equity Index, a web based tool that provides data on health outcomes and community conditions at the state, municipal or neighborhood levels. …

Evaluating Use Of Custom Survey Reports By Local Health Departments, Nadya M. Belenky, Christine A. Bevc, Elizabeth Mahanna, Carol Gunther-Mohr, Mary V. Davis

Frontiers in Public Health Services and Systems Research

This report demonstrates how providing survey feedback, like comparative reports, to survey respondents can result in improvement activities. For each of the past three years (2010-2013), the North Carolina Institute for Public Health (NCIPH) has invited local health departments (LHDs) from 40 states to participate in a preparedness capacities survey. In addition, NCIPH fielded a six-question evaluation survey to a subset of LHDs (n=70) to determine how LHDs use these reports. LHDs that reported using their custom reports compared their preparedness capacities to other LHDs, conducted strategic planning (e.g., benchmarking, setting preparedness goals), planned staff trainings, and disseminated the report …