Health Services Research Commons^™

Strengthening The Science Of Public Health Delivery Through Public Health Services Research, Glen P. Mays

Health Management and Policy Presentations

This session notes recent progress from the field of public health services and systems research (PHSSR) concerning the most promising directions for improving the delivery and impact of public health services, programs, and policies.

Navigating Veterans With An Abnormal Prostate Cancer Screening Test: A Quasi-Experimental Study, Melissa A. Simon, Narissa J. Nonzee, June M. Mckoy, Dachao Liu, Thanh Ha Luu, Peter Byer, Elizabeth A. Eklund, Elizabeth A. Richey

Dartmouth Scholarship

Prostate cancer disproportionately affects low-income and minority men. This study evaluates the impact of a patient navigation intervention on timeliness of diagnostic resolution and treatment initiation among veterans with an abnormal prostate cancer screen.MethodsParticipants were enrolled between 2006 and 2010. The intervention involved a social worker and lay health worker navigation team that assisted patients in overcoming barriers to care. For navigated (n = 245) versus control (n = 245) participants, we evaluated rates of diagnostic resolution and treatment and adjusted for race, age, and Gleason score.

Diffusion Of Innovation Across A National Local Health Department Network: A Simulation Approach To Policy Development Using Agent-Based Modeling, Mark Orr, Jacqueline Merrill

Frontiers in Public Health Services and Systems Research

The network that local health officials use to communicate about professional issues is sparsely connected, which may limit the spread of innovative practices. We used agent-based simulation modeling to find out if a policy to promote more connections improved the network’s capability to diffuse innovation. We found that unanticipated effects could result, depending on the requirements of the policy and the proportion of health officials involved. With carefully crafted assumptions and reliable data it is possible to untangle complex processes using simulation modeling. The results represent how the world might actually work which may provide useful decision support for policymakers …

Analysis Of Local Health Department Factors That Accelerate Population-Based Intervention Strategies: Preliminary Findings, M. Elizabeth Gyllstrom, Kim J. Gearin, William Riley

Frontiers in Public Health Services and Systems Research

Introduction: This practice-based research study capitalized on the statewide implementation of a comprehensive, locally-driven initiative to implement evidence-based policy, system and environmental changes related to obesity and tobacco use. The study examined local health department (LHD) performance and factors such as organizational quality improvement (QI) maturity, structure and governance.

Methods: State health department staff reviewed grant reports and documentation pertaining to all LHD grantees, which collectively represented all 87 counties and 4 cities in Minnesota (MN), in order to designate grantees as either: “Exceeds Expectations,” “Meets Expectations” or “Approaching Expectations.” A study team of state, local and academic partners then …

Community Health Assessment By Local Health Departments: Presence Of Epidemiologist, Governance, And Federal And State Funds Are Critical, Gulzar H. Shah, Barbara Laymon, Julia Joh Elligers, Carolyn Leep, Christine B. Bhutta

Frontiers in Public Health Services and Systems Research

Using the data from the National Association of County and City Health Officials’ (NACCHO) 2010 Profile of Local Health Departments (LHDs) our study investigates whether or not infrastructural characteristics of LHDs were associated with completion of community health assessment (CHA). Our results show that local and shared LHD governance, greater share of revenue from federal and state sources, smaller population size in LHD jurisdiction, and having an epidemiologist significantly increased the odds of CHA completion in the past, after controlling for community characteristics and other independent variables. These findings have important implications for LHDs, PHAB and its partners.

Application Of Situational Leadership To The National Voluntary Public Health Accreditation Process, Kristina Rabarison, Richard C Ingram, James W. Holsinger Jr.

Health Management and Policy Faculty Publications

Successful navigation through the accreditation process developed by the Public Health Accreditation Board (PHAB) requires strong and effective leadership. Situational leadership, a contingency theory of leadership, frequently taught in the public health classroom, has utility for leading a public health agency through this process. As a public health agency pursues accreditation, staff members progress from being uncertain and unfamiliar with the process to being knowledgeable and confident in their ability to fulfill the accreditation requirements. Situational leadership provides a framework that allows leaders to match their leadership styles to the needs of agency personnel. In this paper, the application of …

Pattern Of Emergency Department Visits By Elderly Patients: Study From A Tertiary Care Hospital, Karachi, Jabeen Fayyaz, Munawar Khursheed, Mohammed Umer Mir, Uzma Rahim Khan

Department of Emergency Medicine

Background

Worldwide the proportion of elderly people in the population is increasing. Currently in Pakistan 7.3 million people (5.6% of total population) are more than 60 years old. This age shift has emerged as an important health issue and is associated with an increased utilization of emergency services by the elderly. We carried out this study to assess the pattern of elderly patients (>60 years) who visit emergency departments in comparison to young adults (18–60 years).

Methods

Data was collected retrospectively of patients aged 18 years or more who visited the Emergency Department (ED) of Aga Khan University Hospital, …

Challenges Of Containing New Hiv Infections In Ethiopia: Unacknowledged Transmission Route, Dessu Sam

Capstone Collection

As the main goal of the Partnership Framework (PF) between the Government of Ethiopia (GoE) and the U.S. Government (USG), Ethiopia has set a national target of reducing new HIV infections by 50% by the end of 2014 (National Target). Funded by the USG, the PF provides a five-year joint strategic plan (2010-2014) for cooperation to support Ethiopia’s national HIV/AIDS response (PEPFAR, 2010). Ethiopia has an estimated adult prevalence of 1.5% and about a million people living with HIV/AIDS (PLWHA) (ECSA & IFC, 2012), among countries most affected by the epidemic. The International Labor Organization (ILO) projection for 2015 indicates …

2012 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 …

Geomapping Telehealth Access To Developmental-Behavioral Pediatrics, Neelkamal S. Soares, Andrew O. Johnson, Nitish Patidar

Health Management and Policy Faculty Publications

Background: Geographic information systems (GIS) mapping is fairly novel in describing utilization of health services. Our study is the first to use GIS to demonstrate that telehealth pediatric specialty service access would create substantial savings in travel time and distance compared with accessing a tertiary-care center for similar service.

Materials and Methods: A retrospective chart review of telehealth encounters and geocoding of patients' address were done with actual travel along road calculations to estimate travel time and distance for a visit, compared with a hypothetical visit to the nearest tertiary-care site for the similar service.

Results: Over a 2-year period, …

The Unseen And Untold Issues Of Clinical Trials And Research Ethics In Pakistan., Shahan Waheed, Emaduddin Siddiqui

Department of Emergency Medicine

No abstract provided.

Procedural Rates, Economic Costs, And Geographic Variation Of Primary And Revision Lumbar Total Disc Replacement, Anthony J. Wheeler

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Lumbar total disc replacement (TDR) surgery is a new procedure that treats degenerative disc disease, a remarkably common, disabling, and costly condition. Three distinct studies were conducted to address the longevity, costs, and geographic variation of the lumbar TDR procedure.

These three studies found lumbar TDR to have a revision burden and economic revision burden that has remained consistent since this procedure’s introduction in the
mid-2000s. The economic revision burden made this a lower-cost procedure than lumbar fusion, with a tradeoff in terms of revision burden being higher for lumbar TDR. The overall rate at which this procedure is performed …

Medicare Advantage Update: Benefits, Enrollment, And Payments After The Aca, Kathryn Linehan

National Health Policy Forum

In 2012, the Medicare program paid private health plans $136 billion to cover about 13 million beneficiaries who received Part A and B benefits through the Medicare Advantage (MA) program rather than traditional fee-for-service (FFS) Medicare. Private plans have been a part of the program since the 1970s. Debate about the policy goals—Should they cost less per beneficiary than FFS Medicare? Should they be available to all beneficiaries? Should they be able to offer additional benefits?—has long accompanied Medicare's private plan option. This debate is reflected in the history of Medicare payment policy, and policy decisions over the …

The Historical, Political, Social, And Individual Factors That Have Influenced The Development Of Aging And Disability Resource Centers And Options Counseling, Sheryl Dejoy Elliott

Dissertations and Theses

This thesis reports on the perspectives and experiences of policymakers, advocates, agency supervisors, and experts in the field of gerontology, about the development of Aging and Disability Resource Centers (ADRC) programs and Options Counseling (OC). By examining the foundations upon which ADRCs and OC are built, this study sought to inform future research about the effectiveness of existing practice, increase understanding of best practices, and clarify whether these emerging services are accomplishing original goals.

ADRCs and OC intend to address long-term care issues and healthcare needs by providing a single entry point to the social service system. ADRCs offer information, …

What’S In A Username? Finding Local Health Departments On Twitter, Jenine K. Harris, Ryan C. Maier, Nina Jolani

Frontiers in Public Health Services and Systems Research

Social media platforms such as Twitter may be useful for local health departments (LHDs) in providing the essential service of educating and informing constituents.¹ However, health departments have relatively few Twitter followers overall.¹ One of the challenges that may be associated with following LHDs on Twitter is knowing how to find an LHD Twitter feed. With no suggested or required conventions for LHDs adopting social media, practitioners are left to independently develop their name and description, resulting in much variety. This report examines the names and descriptions for LHDs using Twitter and uses the Twitter people search function …

Best Practice Use To Address Tobacco-Related Disparities By California Community Coalitions, Rodney K. Mccurdy

Frontiers in Public Health Services and Systems Research

Tobacco-related disparities (TRDs) are a major public health concern. This study surveyed community tobacco coalition project directors in California to determine the usage of 11 CDC-published best practices to address TRDs. Response rate was 80 percent. Communities had implemented, on average, one-half of the 11 practices surveyed. Differences were observed between rankings for best practice implementation and perceived level of importance in addressing TRDs in the community. Resource constraints and community context were the highest reported barriers to best practice use. Study findings could assist tobacco program officials and local coalitions in addressing TRDs in their communities.

Integrated Health Care Systems: A Holistic Approach To Medicine, Tatiana Kaehler

Independent Study Project (ISP) Collection

This paper examines how the strengths of both allopathic and traditional medical systems are harnessed in integrated health care systems – a system which “consciously targets and harnesses people’s links with biodiversity for health care reasons” (Quansah, personal communication, July 1, 2013). It uses examples of integrated health care in Madagascar to prove that integrated health care systems offers health care in an affordable and accessible manner, while also promoting cultural sustainability and conservation of biodiversity. By recognizing and establishing integrated health care systems throughout the world, global health disparities can be addressed and various health goals can be accomplished.

Fanta Fanafody: Malagasy Traditional Medicine In A Globalized World, Mary Buswell

Independent Study Project (ISP) Collection

This study investigates the relationship between traditional medicine and globalization in Madagascar. Information from interactions and interviews with both traditional and allopathic healers is used to study the current healthcare system and provide direction for the establishment of an Integrated Health Care System (IHCS). This study finds that traditional medicine and globalization have a closer and more reciprocal relationship than it would initially appear, and that traditional medicine is very adaptable to change. Because of this, it is proposed that globalization and technology could be tools to bring traditional and allopathic medicine together in an IHCS to resolve the health …

Chhs July 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.

Assessing The Effectiveness Of Nutrition And Physical Activity Self-Assessment For Child Care (Nap Sacc) For Changes In Physical Activity Behavior, Policy, And Environment In Nebraska Family Child Care Homes, Katie K. Bolte

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Nebraska is the first state to utilize NAP SACC and to modify the evidence-based program for family child care homes (FCCHs). The purpose of this study was to conduct a secondary data analysis to assess the effectiveness of a modified version of the NAP SACC approach in achieving changes in physical activity behavior, policy, and environment in Nebraska FCCHs caring for children ages 2-5 years. Results from this study will be used to improve the NAP SACC physical activity components for FCCHs and will help to inform trainers and the Nebraska Department of Health and Human Services, Nutrition and Activity …

The Identification And Classification Of Flow Disruptions In The Operating Room During Laparoscopic Cholecystectomy And Open Hernia Repair Procedures, Sacha N. Duff

Doctoral Dissertations and Master's Theses

The operating room is one of the most complex work environments in healthcare; it is estimated that at least 7% of adverse events due to medical error occur in the operating room. Flow disruptions are events that cause a "break" in the primary surgical task, or the loss of any team member's situational awareness. An empirical link between flow disruptions and surgical errors in the OR has been established; therefore, identifying and classifying the specific flow disruptions present during different types of procedures should facilitate the development of evidence-based interventions. The goal of this study was to identify and classify …

Health System Contributions To Public Health Activities Amid Policy And Economic Change: Estimating Complementarities, Substitutions, And Network Effects, 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, potentially changing the structure of public health delivery systems and expanding the delivery of strategies that improve population health. 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 …

Cms's Proposed Rule Implementing The Aca-Mandated Medicaid Dsh Reductions, Kathryn Linehan

National Health Policy Forum

State Medicaid programs make Medicaid disproportionate share hospital (DSH) payments to hospitals to help offset costs of uncompensated care for Medicaid and uninsured patients. Unlike most Medicaid spending, annual DSH allotments for each state are capped. Under the Patient Protection and Affordable Care Act of 2010 (ACA), DSH payments will decrease starting in fiscal year (FY) 2014 and continuing through FY 2020. This paper describes the proposed rule for reducing these federal allotments, which was released on May 15, 2013, by the Centers for Medicare & Medicaid Services (CMS). Comments on the proposed rule are due July 12, 2013.

2014 …

Modeling To Assess Value: Is It Ready For Prime Time?, Jaime J. Caro, Mdcm, Frcpc, Facp

Jefferson School of Population Health Fellows’ Day

Jaime Caro is Senior Vice President, Research, at a consulting firm, where he leads development and application of novel techniques in health economics, multi-criteria decision analysis, benefit-risk analysis, comparative effectiveness, and epidemiology. He led the Caro Research Institute for more than a decade, until CRI was acquired in 2007. Dr. Caro trained at McGill University, where he practiced internal medicine and continues as adjunct Professor of Medicine, as well as of Epidemiology and Biostatistics. He is also adjunct professor at the Massachusetts College of Pharmacy and Health Sciences and lecturer at Thomas Jefferson University School of Population Health.

Out-Of-Pocket Costs And Prescription Reversals: The Case Of Oral Linezolid, Margaret K. Pasquale, Anthony M. Louder, Michael C. Deminski, Richard B. Chambers, Seema Haider

Jefferson School of Population Health Fellows’ Day

Kim A. Caldwell, RPh

Employed by Humana Inc., Kim is the Director of Pharmacy Professional Affairs for Humana Pharmacy Solutions. In this role, he and his team serve to liaison between HPS business owners, Humana Public Affairs, and key professional and trade partners. They serve as the pharmacy subject matter experts aligned with key business and regulatory issues, including visits with members of federal and state legislatures as well as the interface with state boards of pharmacy and key trade organizations. Previously, he started and directed Competitive Health Analytics, Inc. (CHA) a business unit within Humana Inc. for the first …

Hospital Contributions To Public Health Activities Before And After Aca: Incentives, Constraints & Crowd-Out, Glen P. Mays

Health Management and Policy Presentations

Research Objective: The Affordable Care Act created enhanced IRS requirements for not-for-profit hospitals regarding the provision of community benefits, potentially stimulating new approaches to community health needs assessment, priority setting, and engagement with public health agencies and other community stakeholders. Yet the economic downturn has constrained hospital earnings and increased demand for uncompensated care, potentially crowding out hospital contributions to public health activities. This study uses data from 1998-2012 on a national cohort of communities to examine: (1) the extent and nature of change in hospital contributions to public health activities; and (2) the economic, institutional, and policy-related factors that …

Frontiers In Public Health Services And Systems Research: Accelerating And Expanding Knowledge Transfer In Public Health Settings, Glen P. Mays

Health Management and Policy Presentations

As part of the "Meet the Editors" panel on publishing health services research, this presentation discusses the new open-access journal Frontiers in Public Health Services and Systems Research. This journal serves as a vehicle for rapidly disseminating newly emerging and preliminary findings from studies that examine the organization, financing, and delivery of public health services. The goal is to stimulate research collaboration and accelerate knowledge transfer from research projects to policy and administrative decision-makers within the public health system.

Building Medical Homes For Children: Measuring Outcomes For Policy And Program Development, Kimberley S. Fox Mpa

Population Health & Health Policy

No abstract provided.

Empowerment-Based Positive Youth Development: A New Understanding Of Healthy Development For African American Youth, Raphael Travis Jr., Tamara Leech

Department of Public Health Scholarship and Creative Works

A shift occurred in research about adolescents in the general population. Research is moving away from deficits toward a resilience paradigm and understanding trajectories of positive youth development. This shift has been less consistent in research and practice with African American youth. A gap also exists in understanding whether individual youth development dimensions generate potential in other dimensions. This study presents an empowerment-based positive youth development model. It builds upon existing research to present a new vision of healthy development for African American youth that is strengths-based, developmental, culture-bound, and action-oriented. It emphasizes the relationship between person and environment, the …

Early Detection Of Zoonotic Emerging Infectious Diseases, Thomas Cotter, Earl Stoddard Iii

Homeland Security Publications

No abstract provided.