Health Services Research Commons^™

Perspectives From The Society For Pediatric Research: Advice On Sustaining Science And Mentoring During Covid-19, Catherine S Forster, Suong T Nguyen, Weston T Powell, Daniel J Moore, Jacqueline Ho, Melvin B Heyman, Tara L Wenger, Fernando Gonzalez, Margaret Hostetter, Andrew Nowalk, Caroline E Rassbach, Debra Boyer, Pnina Weiss, Rebecca L Blankenburg, Jordan S Orange, Kate G Ackerman, Audrea M Burns, National Pediatric Physician-Scientist Collaborative Workgroup

Faculty, Staff and Students Publications

The COVID-19 pandemic will leave an indelible mark on the careers of current medical trainees. Given the disruptions to medical education, economic impact on institutions, and the uncertainties around future job prospects, trainees are facing unprecedented challenges. This situation is especially concerning for futures of pediatric physician-scientist trainees, where concerns regarding maintaining the pipeline were well documented prior to the emergence of COVID-19. In this Perspectives article, we leverage the unique expertise of our workgroup to address concerns of physician-scientist trainees and to provide suggestions on how to navigate career trajectories in the post-COVID-19 era. We identified and addressed four …

We Won't Go There: Barriers To Accessing Maternal And Newborn Care In District Thatta, Pakistan, Muhammad Asim, Sarah Saleem, Zarak Hussain Ahmed, Imran Naeem Abbasi, Farina Abrejo, Zafar Fatmi, Sameen Siddiqi

Community Health Sciences

Accessibility and utilization of healthcare plays a significant role in preventing complications during pregnancy, labor, and the early postnatal period. However, multiple barriers can prevent women from accessing services. The aim of this study was to explore the multifaceted barriers that inhibit women from seeking maternal and newborn health care in Thatta, Sindh, Pakistan. This study employed an interpretive research design using a purposive sampling approach. Pre-tested, semi-structured interview guides were used for data collection. The data were collected through eight focus group discussions with men and women, and six in-depth interviews with lady health workers and analyzed through thematic …

Article Processing Charge Waiver Policies As A Barrier To Oncology Scholarship In Low-And Lower-Middle-Income Countries, Ulysses G. Gardner Jr., Petria S. Thompson, Jason C. Burton, Caleb Stewart, Clifton D. Fuller, Michael K. Rooney, Ethan B. Ludmir

MEDI 9331 Scholarly Activities Clinical Years

No abstract available

Using Macros In Microsoft Excel To Facilitate Cleaning Of Research Data, Justin Bauzon, Caleb Murphy, Sandhya Wahi-Gururaj

School of Medicine Faculty Research

Background: Retrospective chart review studies may be delayed by inability to export clean clinical data from an electronic medical record (EMR) or data repository. Macros are pre-programmed procedures that can be used in Microsoft Excel to help streamline the process of cleaning clinical datasets. Objectives: To demonstrate how macros may be useful for researchers at community hospitals and smaller academic health centers that lack informatics support. Methods: Using an intrinsic function of our institution’s EMR, vital signs and lab results from 20 individual hospitalizations were exported to a spreadsheet. Two macros were developed to sort through these datasets and output …

Development Of An On-Job Mentorship Programme To Improve Nursing Experience For Enhanced Patient Experience Of Compassionate Care, Alma Arshad Hookmani, Naureen Lalani, Noureen Sultan, Aly Zubairi, Ayesha Hussain, Babar Hasan, Muneera A. Rasheed

Department of Paediatrics and Child Health

Background: Evidence suggests improvement in nursing staff satisfaction, competence, and retention after implementation of evidence-based mentorship programmes. When guided by a framework of compassion, mentoring as a caring action can not only build healthy, transformative relationships but a similar behavior is reciprocated to patients which subsequently can drive patient experience of care. However, examples of on-job mentorship programs for nurses in low- and middle-income countries (LMIC) are limited.
Objective: The objective of the study was to develop an on-job nursing mentorship programme using a compassionate framework aimed at improving nurses' experience and thus enhancing patient experience in a tertiary care …

What Predicts How Safe People Feel In Their Neighborhoods And Does It Depend On Functional Status?, Alfredo J. Velasquez, Jason A. Douglas, Fangqi Guo, Jennifer W. Robinette

Health Sciences and Kinesiology Faculty Articles

Feeling unsafe in one's neighborhood is related to poor health. Features of the neighborhood environment have been suggested to inform perceptions of neighborhood safety. Yet, the relative contribution of these features (e.g., uneven sidewalks, crime, perceived neighborhood physical disorder) on perceived neighborhood safety, particularly among people with disabilities who may view themselves as more vulnerable, is not well understood. We examined whether sidewalk quality assessed by third party raters, county-level crime rates, and perceived neighborhood disorder would relate to neighborhood safety concerns, and whether functional limitations would exacerbate these links. Using data from the 2012/2014 waves of the Health and …

Living Environment Considerations On Obesity Prevention Behaviors And Self-Efficacy Among Chinese Americans, Doreen Liou, Jessica A. Karasik

Department of Nutrition and Food Studies Scholarship and Creative Works

The aim of this study is to ascertain if the living environment (type of residential neighborhood and number of household members) will elucidate differences in obesity risk reduction behaviors and self-efficacy in Chinese Americans. A cross-sectional survey design was used to recruit participants from Los Angeles County and New York City metropolitan areas. A total of 650 adults were recruited from diverse socioeconomic backgrounds. Descriptive statistics were measured for 19 behaviors reflecting food intake and portion size control and items measuring self-efficacy and attitudes. T-tests were applied for the two categories of living environment. The mean age of the sample …

Exploring Barriers And Enablers Of Service Provision For Survivors Of Human Trafficking In The Bay Area: An Action Research Study, Pooja Sripad

Reproductive Health

Despite increasing recognition of public health and rights issues associated with human trafficking globally and in the United States following the Trafficking Victims Protection Act of 2000, there has been limited research on how to systematically strengthen service access for survivors of sex and labor trafficking. The experience of service providers may provide insight into how trafficking survivor responses and service networks function in California’s Bay Area. This study explores provider perspectives on existing service networks and collaboration dynamics, including the barriers to and enablers of long-term service provision and survivor follow-up. A participatory research design included qualitative interviews with …

The Association Of Demographics, Social And Personal/Family Characteristics With Treatment Utilization Among Young Adults With Opioid Use Disorder In The United States, Marva L. Frederick

Dissertations, Theses, and Capstone Projects

Background

Opioid use disorder is a life-threatening medical condition and an ongoing public health problem in the United States. Treatment is necessary to combat opioid use disorder and to minimize the health-associated problems. Opioid use disorder is treatable with life-extending medications. Studies that examined treatment utilization among young adults with opioid use disorder in the United States was scarce. This study investigated the characteristics posited in the Andersen Behavioral Model of health utilization which may be associated with treatment utilization, among young adults with opioid use disorder in the United States. The urgency posed by the continuing opioid crisis in …

Making Hospitals Health Promotive, Shelina Bhamani, Areeba Zainab Makhdoom

Department of Obstetrics & Gynaecology

No abstract provided.

Use Of Electronic Health Records To Manage Tobacco Screening And Treatment In Rural Primary Care, Jean A. Talbot Phd, Erica C. Ziller Phd, Carly Milkowski Mph

Mental Health / Substance Use Disorders

Researchers at the Maine Rural Health Research Center, University of Southern Maine examined whether the use of electronic health records by rural primary care physicians facilitates their use of best practices in addressing tobacco dependence. The study used the National Ambulatory Medicare Care Survey (2012-2015) to explore how rurality and use of tobacco-related electronic health record functions were related to smoking status documentation and cessation treatment at adult primary care visits. Rural-urban comparisons were also examined.

The authors conclude that rural primary care physicians were at least as successful as their urban counterparts in leveraging electronic health records to enhance …

Factors Shaping Uptake Of Antenatal Care In Surabaya Municipality, Indonesia: A Qualitative Study, Lisa Jones, Nyoman Anita Damayanti, Nicola Wiseman, Neil Harris

Kesmas

Five focus group discussions (FGDs) with 61 pregnant women were conducted in June and July 2019 at primary health care (PHC) services within five urban areas of Surabaya, Indonesia. In addition, five semi-structured interviews with five midwives were carried out to explore the experiences of pregnant women accessing Antenatal Care (ANC) and the factors shaping uptake of ANC services. Data were audio-recorded, transcribed, and translated into English, and analyzed using thematic analysis. Findings from focus group discussions suggested that fears of negative diagnosis before initial ANC appointment and personal beliefs and myths surrounding pregnancy may delay uptake of ANC. Further, …

Association Between Self-Reported Fatigue And Sarcopenia Measures Among Elderly In Selangor, Malaysia, Maria Justine, Aliff Latir, Nadhirah Noor, Angelbeth Joanny, Izzaty Iskandar, Maisarah Sakinah Amirul Faizi, Dzulhelmi Edinan

Kesmas

The association between fatigue and sarcopenia is not well understood, therefore, this study aimed to compare the sarcopenia measures among elderly with mild and severe fatigue and to determine whether fatigue severity is associated with sarcopenia measures. This was a cross-sectional study conducted on201 elderly (age = 68.45±6.30 years). The elderly was classified into either mild or severe fatigue based on the Fatigue Severity Scale (FSS), meanwhile, sarcopenia measures include SARC-F score, muscle mass (ASM/height2), calf circumference (CC), upper (handgrip) and lower limb muscle strength, as well as physical performance (gait speed). Data were analyzed using independent t-tests and logistic …

Geographic Accessibility Towards Primary Health Care In Karawang District, Nabila Ramadina, Mulya Nurmansyah Ardisasmita, Budi Sujatmiko

Kesmas

Health accessibility refers to the availability of health care services accessible to the community as required. However, the convenience of accessing such services vary throughout regions due to geography. Hence differences in geographic accessibility can be an obstacle to accessing health care. This study characterized the influence of geographic accessibility on primary health care (PHC) in Karawang District. A cross-sectional study was conducted in November 2019 in five sub-districts of Karawang District. Respondents were interviewed using questionnaires to collect geographic (mileage and travel time from respondents’ house to nearest PHC) and transportation (mode of transportation and transportation cost) data. In …

Correlation Between Care Burden And Mental Health With The Perceived Social Support Of Patients Relatives In Turkey, Mehtap Şahi̇ngöz Tahta, Elçin Balci

Kesmas

The people providing care for relatives always need support and accompaniment from their families and friends. This study aimed to evaluate the correlation among the care burden, mental health and social support perceptions of the patients’ relatives that provide long-term care for patients receiving service from the home care service (HCS) unit in one city. This descriptive study was carried out with the relatives of patients receiving service from home health units. Among the relatives providing care for a total of 859 patients, those that did not comply with the inclusion criteria were excluded, which made a total population of …

Accelerating The Provision Of Safe Water Supply In Urban And Rural Areas Of Indonesia, Sumengen Sutomo, Salord Sagala, Bebi Sutomo, Sri Winarti, Gelant Sanjaya

Kesmas

Over the past 100 years, the provision of a safe water supply to drink in Indonesia has been slowly progressed with low coverage. The majority of the population does not have access to safe water. Morbidity and mortality of water-related diseases, including diarrhea, are very high. The provision of safe water is not a technological issue but good water management that comprises content, institutional, and communication layer. This paper provided information for strategic and operational decisions to accelerate the provision of safe water services in urban and rural areas. Benchmarking good water management with the characteristics of the water supply …

Disparities In Covid-19 Rates Among Various Demographics And Lack Of Racial Representation In Medical Texts, Diangelo Gonzalez

Celebration of Learning

The 2019 novel coronavirus (COVID-19) outbreak, which originated in Wuhan, China in December of 2019, has impacted nations all over the globe. Given the health disparities which existed within the United States prior to the COVID-19 pandemic, this pandemic continued to pose a significant challenge to the health of the public. The aims of this research study were twofold: (1) to analyze the incidence rates of COVID-19 among different racial and ethnic groups within the United States and (2) to describe the occurrence of diversity within medical texts. Overall, the COVID-19 pandemic exacerbated health disparities within the United States. Understanding …

Association Between Post-Hospital Clinic And Telephone Follow-Up Provider Visits With 30-Day Readmission Risk In An Integrated Health System, Huong Q. Nguyen, Aileen Baecker, Timothy Ho, Dan N. Huynh, Heather L. Watson, Jing Li, Ernest Shen

Center for Health Services Research Faculty Publications

BACKGROUND: Follow-up visits with clinic providers after hospital discharge may not be feasible for some patients due to functional limitations, transportation challenges, need for physical distancing, or fear of exposure especially during the current COVID-19 pandemic.

METHODS: The aim of the study was to determine the effects of post-hospital clinic (POSH) and telephone (TPOSH) follow-up provider visits versus no visit on 30-day readmission. We used a retrospective cohort design based on data from 1/1/2017 to 12/31/2019 on adult patients (n = 213,513) discharged home from 15 Kaiser Permanente Southern California hospitals. Completion of POSH or TPOSH provider visits within …

Does Supportive Supervision Intervention Improve Community Health Worker Knowledge And Practices For Community Management Of Childhood Diarrhea And Pneumonia? Lessons For Scale-Up From Nigraan And Nigraan Plus Trials In Pakistan, Wafa Aftab, Suneel Piryani, Fauziah Rabbani

Community Health Sciences

Background: Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan's Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.
Methods: The intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, …

Health Service Utilization And Expenditure In Cardio-Metabolic Conditions In The United States Adults, Kavita Mosalpuria

Theses & Dissertations

Metabolic syndrome is multicomponent risk factor for cardiovascular diseases (CVD) and type 2 diabetes that reflects the clustering of at least 3 cardiometabolic risk factors, among hypertension, impaired glucose regulations, hypercholesterolemia, and obesity. CVD are the leading cause of death in the U.S. CVD occur at earlier age and is a major cause of death and disability among people with diabetes. As compared to Japan, 13.3% to 44% of the excess CVD mortality in the U.S. can be explained by the metabolic syndrome. The prevalence of metabolic syndrome was 34.3% in 2007 to 2014 and it increases with age. Metabolic …

Development And Psychometric Properties Of Surveys To Assess Patient And Family Caregiver Experience With Care Transitions, Joann Sorra, Katarzyna Zebrak, Deborah Carpenter, Theresa Famolaro, John Rauch, Jing Li, Terry Davis, Huong Q. Nguyen, Megan Mcintosh, Suzanne Mitchell, Karen B. Hirschman, Carol Levine, Jessica Miller Clouser, Jane Brock, Mark V. Williams

Center for Health Services Research Faculty Publications

Background

The purpose of this study was to develop and administer surveys that assess patient and family caregiver experiences with care transitions and examine the psychometric properties of the surveys. The surveys were designed to ask about 1) the transitional care services that matter most to patients and their caregivers and 2) care outcomes, including the overall quality of transitional care they received, patient self-reported health, and caregiver effort/stress.

Methods

Survey items were developed based on a review of the literature, existing surveys, focus groups, site visits, stakeholder and expert input, and patient and caregiver cognitive interviews. We administered mail …

Conflicts Of Interest: An Invisible Force Shaping Health Systems And Policies, Afifah Rahman-Shepherd, Priya Balasubramaniam, Meenakshi Gautham, Eleanor Hutchinson, Freddy E. Kitutu, Robert Marten, Mishal S. Khan

Community Health Sciences

No abstract provided.

Patient Reported Outcomes In Sickle Cell Disease Examined Within A Conceptual Model, Swapandeep Mushiana, Marsha Treadwell Phd, Sherif M. Badawy Md, Ms, Liliana Preiss Phd, Allison King Md Mph Phd, Barbara Kroner Phd, Yumie Chen Bs, Jeffrey Glassberg, Victor Gordeuk Md, Nirmish Shah Md, Angie Snyder Phd Mph, Theodore Wun Md

Doctoral Dissertations

Objective: To examine the relations between patient reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 – 45 years enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD related factors and barriers to care would independently contribute to functioning as measured using the PRO domains. Additionally, pain and other SCD related complications are expected to impact the relation between the variables. Methods: Participants completed a 48-item survey that included socio-demographics and PRO measures, such as social functioning, pain impact emotional distress, and cognitive functioning. …

Building Patient Participation In Quality Of Care Through The Healthcare Stories Project: A Demonstration Program In New York State Hiv Clinics, Abigail Baim-Lance, Freda Coren, Margaret Brown, Hazel Lever, Daniel Tietz, Bruce Agins

Patient Experience Journal

There is growing recognition that patients should play a central role in defining, assessing, and improving the quality of healthcare, thereby enhancing patient experiences. Healthcare organizations struggle to meet these goals, which require becoming more patient-centered and patient-involved. The Healthcare Stories Project (HCSP), a demonstration program of the NYS Department of Health AIDS Institute, aimed to address this. HCSP comprises three, stepwise activities to: 1) Capture how patients define and experience ‘quality of care’ in the clinic; 2) Engage patients and providers as equal partners in understanding and improving the quality of care; and through partnerships, 3) Support the building …

The Right Premtm: Rasch Analysis Of A New Patient Reported Experience Measure For Use By Older People In Hospital, Louise Heuzenroeder, Jyoti Khadka, Alison Kitson

Patient Experience Journal

Healthcare rights exist to protect older people from harm and to empower older people to participate in their care with independence, choice and control. Multiple investigations revealing abuse provide evidence that older people’s rights are being breached. Older people must have the opportunity to report on their experience of care against their rights. The Right PREM^TM is a new instrument designed to measure older people’s experience of care against their healthcare rights. The objective of this cross-sectional validation study was to assess the psychometric properties of a new instrument to measure the experience of care consistent with the healthcare …

Measuring Cancer Care Experiences Of Aboriginal And Torres Strait Islander People In Australia: Trial Of A New Approach That Privileges Patient Voices, Monica Green, Joan Cunningham, Kate Anderson, Kalinda Griffiths, Gail Garvey

Patient Experience Journal

This study examined a new method for measuring the care experiences of Aboriginal and Torres Strait Islander people with cancer: the Indigenous People’s Experiences of Cancer Care Survey (IPECCS). The study assessed IPECCS’s: 1) performance; 2) ability to elicit information useful for service improvements; and 3) implementation potential. Three participant groups were recruited from five Australian cancer treatment sites: 1) Aboriginal and Torres Strait Islander people with cancer (+/- support person); 2) interviewers; and 3) health services staff. Trained interviewers administered IPECCS to participants with cancer in audiotaped sessions. Paper forms and transcripts were compared to assess performance, and problems/potential …

Sociodemographic Characteristics And Patient And Family Experience Survey Response Biases, Lauren N. Brinkman, Myra S. Saeed, Andrew F. Beck, Michael C. Ponti-Zins, Ndidi I. Unaka, Mary C. Burkhardt, Jareen Meinzen-Derr, Samuel P. Hanke

Patient Experience Journal

Enhancing Patient and Family Experience (PFE) is vital to the delivery of quality healthcare services. Sociodemographic differences affect health outcomes and experiences, but research is limited on biases in PFE survey methodology. We sought to assess survey participation rates across sociodemographic characteristics. This retrospective study analyzed a health system’s ambulatory PFE survey data, collected January 1 – July 31, 2019. Outcomes of interest were rates of survey response, completion, and comments. Predictors included respondent-reported race, ethnicity, language, and measure of social deprivation attached to a respondent’s home address. Addresses were geocoded to census tracts. The tract’s degree of socioeconomic deprivation …

Cost-Effectiveness Analysis Of Tisagenlecleucel, Blinatumomab, And Clofarabine For Treatment Of B-Cell Precursor Acute Lymphoblastic Leukemia, Kamron Lotfi

Pharmaceutical Sciences (MS) Theses

Acute lymphoblastic leukemia (ALL) is a common type of adolescent and young adult leukemia in the United States (U.S.). Patients who are refractory or relapsed after receiving two or more lines of systemic therapy have the option of taking tisagenlecleucel. Due to the high cost of this treatment, a cost-effectiveness analysis was performed to assess the treatments for tisagenlecleucel, clofarabine combination, and blinatumomab. Objectives

The objective of this study is to evaluate the cost-effectiveness of tisagenlecleucel; clofarabine, etoposide, cyclophosphamide; and blinatumomab for the treatment of relapse- refractory ALL for adolescents and young adults from the U.S. health care payer perspective. …

Factors Affecting Maternal-Care During Labour At Maternity Centres Of Karachi, Pakistan: Exploratory Study, Nirmal Shahzaib, Tazeen Saeed Ali, Nousheen Pradhan, Farina Abrejo, Shahnaz Shahid Ali, Amir Ali Samnani

School of Nursing & Midwifery

Globally 529,000 women die every year due to harmful consequences of childbirth. This study aimed to explore the barriers and facilitators that influence the provision of quality care during labour at maternity centres in Karachi, Pakistan. The qualitative exploratory study design was used to study such factors from public and private maternity health facilities of Karachi, Pakistan. A total of 12 in-depth interviews were conducted through purposive sampling by using validated semi-structured interview guide. Data was analysed using content analysis manually. Among major barriers, unhygienic environment, lack of basic equipment, supplies and medicine, unprofessional attitude of staff, physical infrastructre and …

Women's Perceptions On The Effects Of Covid-19 On Access And Use Of Private Sector Family Planning Services In Nigeria: The Integrate Project, The Integrate Project

Reproductive Health

In Nigeria, Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are the first point of care for many common illnesses. Although CPs and PPMVs are not formally recognized as family planning (FP) service providers, 22% of modern contraceptive users report receiving their last method from a PPMV and 12% from a private pharmacy. PPMVs are popular for FP because of their widespread availability, consistent drug stocks, extended hours, personable interactions, and lack of separate fees for consultations. As in many places, the COVID-19 pandemic poses unprecedented challenges to health services in Nigeria. By limiting person-to-person contact, especially during …