Health Services Research Commons^™

Emerging Disparities Among Self-Pay Trauma Patients, Michelle Chino Dr, Deborah A. Kuhls, Mark K. Markarian, Sam Holland, John J. Fildes

Journal of Health Disparities Research and Practice

Preliminary results from a study of trauma patients in Southern Nevada are yielding some unexpected findings with implications for both trauma centers and the growing Hispanic population. Hispanic patients are more likely to be self pay irrespective of income level and employment status when compared to non-Hispanic patient groups. Further, self pay Hispanics, unlike their non-Hispanic, self pay counterparts, tend to be employed, have families, and report stable living conditions. The implication is that the financial and social cost of traumatic injury may place a significant burden on trauma centers, patients, their families and the community.

Developing A Preference Assessment Tool For Use Among Minority And Low Literacy Primary Care Patients, Sarah T. Hawley, Maria Jibaja-Weiss, Partha Krishnamurthy, Sally W. Vernon, Natoshia Hebert, Robert Volk

Journal of Health Disparities Research and Practice

Incorporating patients’ preferences into healthcare decisions has been identified as one mechanism for reducing health disparities. Some research suggests that providers need to tailor medical recommendations to the preferences of their patients. Yet there are few tools to facilitate clarification of preferences for health services. This paper reports the process of testing an innovative preference elicitation technique—conjoint analysis—among minorities and low literacy patients using the example of colorectal cancer (CRC) screening. CRC screening exemplifies preference-sensitive healthcare as there exist several screening options. However, screening rates among minorities are low. Better methods for preference assessment could improve patient-provider communication and increase …

Expanding The Evidence Base For Accreditation And Qi: Progress In Practice-Based Research Networks, Glen P. Mays

Health Management and Policy Presentations

Studies that examine the implementation and impact of quality improvement strategies in public health are underway through the Public Health Practice-Based Research Networks.

Estimating Medical Cost Offsets Attributable To Public Health Spending, Glen P. Mays

Health Management and Policy Presentations

BACKGROUND: Policy strategies for reforming the U.S. health care system to control costs and improve health outcomes include the possibility of expanded support for public health activities that are designed to prevent disease and promote health on a population-wide basis. These activities include efforts to monitor and report on community health status, investigate and control disease outbreaks, educate the public about health risks and prevention strategies, develop and enforce laws and regulations to protect health, and inspect and assure the safety and quality of water, food, air and other resources necessary for health. The Patient Protection and Affordable Care Act …

Determinants Of Patient's Satisfaction With Health Care System In Pakistan: A Critical Review, Maliha Naseer, Aysha Zahidie, Babar Tasneem Shaikh

Community Health Sciences

Patient satisfaction with health care services is considered an important factor of quality health care. Although research on patient satisfaction has become standard in many developed country, in countries such as Pakistan the concept of patient satisfaction is still relatively neglected. This study aimed to find out the determinants of patient satisfaction from existing literature in Pakistan.The literature search was carried out by using the database of Medscape, Medline, PakMedinet and PubMed, without any language restriction using MeSH words as “patient satisfaction AND health care system in Pakistan” and “Determinants of patient satisfaction AND Pakistan”. Twenty-one articles were found which …

Physicians’ Experiences And Opinions Regarding Strategies To Improve Care For Minority Patients, Jared W. Klein, Lindsay O. Schubiner, Margaret Gadon, Matthew K. Wynia

Journal of Health Disparities Research and Practice

Objective: To assess the views and experiences of a select group of physicians interested in minority health issues regarding promising strategies to improve minority care. Methods: Physicians were asked to respond to a 17-item survey assessing the level of agreement, frequency of implementation of and interest in learning more about 7 promising strategies for alleviating disparities. Results: Most physicians (75-95%) agreed that the 7 proposed strategies could be useful to improve the quality of care provided to minority patients, but only 40-66% of physicians had implemented the strategies sometimes or often in their practices. Between 22 and …

The Science Of Public Health Practice: Using Pbrns For Delivery System Research In Public Health Settings, Glen P. Mays

Health Management and Policy Presentations

PBRN research tests strategies for improving the delivery of services that promote health and prevent disease and injury on a population-wide basis.

A Measurement Of Readiness For Tennessee Hospitals To Implement “Meaningful Use” Criteria Resulting From The American Recovery And Reinvestment Act, 2009, Kathryn Wallin Wilhoit

Electronic Theses and Dissertations

In 2009, the American Recovery and Reinvestment Act was signed into law. This legislation provided for monetary rewards for those acute-care hospitals that meet "meaningful use" computerization and reporting criteria.

The study used a descriptive, nonexperimental design to answer three research questions (1) What is the level of readiness to meet "meaningful use" criteria in the Tennessee Hospital Association (THA) member hospitals; (2) What is the level of readiness to meet "meaningful use" criteria in the rural THA member hospitals; and (3) Is there a difference in the readiness to meet "meaningful use" criteria between rural and urban THA member …

Revised: An Early Assessment Of The Potential Impact Of Texas’ “Affiliation” Regulation On Access To Care For Low-Income Women, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Baseline Serum Prolactin In Drug-Naive, Firstepisode Schizophrenia And Outcome At Five Years: Is It A Predictive Factor?, Amresh Srivastava, Megan Johnston, Yves Bureau, Nilesh Shah

Data and Test Instruments

Objective: Serum prolactin is influenced by antipsychotic use but its relationships with psychopathology and general functioning are not clear. This study aimed to assess these relationships. Design: Serum prolactin levels were measured in patients with schizophrenia before being treated with antipsychotics and at various follow-up points. Setting: The study was conducted in a nongovernmental psychiatric treatment center in Mumbai, India. Participants: The participants included 30 male and 30 female drug-naïve patients with schizophrenia and 31 control participants. Measurements: The severity of psychopathology at baseline, three weeks, six weeks, and five years following treatment was assessed using a modified Brief Psychiatric …

Rural Implications Of Geographic Rating Of Health Insurance Premiums, Andrew F. Coburn Phd, Erika C. Ziller Phd, Zachariah T. Croll Ba, Elizabeth Kilbreth Phd

Access / Insurance

This brief examines how and to what extent states allow health plans to vary premiums by geographic rating area and, using insurance data from selected states, assesses the direction and magnitude of variations in rural and urban geographic rating factors. The authors conclude with a discussion of strategies that federal and state policymakers might use to help ensure that premium variations based on geography are justified. KEY POINTS: There is no clear pattern of geographic rating factors favoring rural or urban areas. This lack of a clear pattern suggests that health plans may use geographic rating for business purposes other …

Health Professions Education And Professional Obligations, Lisa Sprague

National Health Policy Forum

While there are differences in academic degree and length of time spent preparing to practice, all health professionals must meet certain requirements to commence and remain in practice in the United States. This Basic outlines the educational requirements of the various professions and the processes designed to demonstrate continuing competence in practice.

Investing In A Healthier Future: Iom Dissemination Workshop, Glen P. Mays

Health Management and Policy Presentations

This session discusses strategies for implementing new financing strategies and funding mechanisms for public health services.

Perbandingan Tingkat Kepuasan Kerja Perawat Dan Kepuasan Pasien, Jamilla Upik Noras, Ratu Ayu Dewi Sartika

Kesmas

Perawat adalah ujung tombak pemberi pelayanan langsung pada pasien selama 24 jam. Tujuan penelitian adalah untuk membandingkan tingkat kepuasan kerja perawat dengan kepuasan pasien terhadap pelayanan keperawatan kelas 3 di Rumah Sakit Umum Pusat (RSUP) X Jakarta. Penelitian ini bersifat deskriptif dengan desain studi cross sectional, pendekatan kuantitatif dan kualitatif. Populasi adalah seluruh perawat yang bertugas sebagai pelaksana keperawatan kelas 3 sebanyak 40 orang ser- ta pasien yang dirawat di ruang rawat inap kelas 3 sebanyak 120 orang. Pengambilan sampel dilakukan secara purposive sampling sesuai dengan kriteria inklusi dan ekslusi. Hasil pengukuran kuantitatif menunjukkan bah- wa tingkat kepuasan kerja perawat …

Patterns Of Interaction In Public Health Research Networks: Insight From Network Analysis, Glen P. Mays

Health Management and Policy Presentations

OBJECTIVES: Studies from the past three decades have found evidence of wide variation in public health practices and policies across states and communities despite an expanding evidence base of efficacious public health strategies, suggesting gaps in implementation and translation processes. Practice-based research networks (PBRNs) are expected to accelerate research participation and translation. This study uses social network analysis methods with twelve Public Health PBRNs to study processes influencing the implementation and translation of research within diverse public health settings.

DATA and METHODS: A cross-sectional network analysis survey was validated and fielded with participants in two cohorts of public health PBRNs …

Public Health Governance And Population Health Outcomes, Scott P. Hays, Janine Toth, Matthew J. Poes, Peter F. Mulhall, David M. Remmert, Thomas W. O'Rourke

Frontiers in Public Health Services and Systems Research

Research reviews have identified a gap in understanding the diversity of health department governance structures and in understanding how the variations in governing relates to health outcomes. This report details the categorization of local public health governance and reveals that certain governance types may be better suited to achieve better population health outcomes. State systems achieve the poorest health outcomes, but the best health outcomes are achieved when the political branches have a key role in local public health governance. Public health systems should consider greater local control and involvement in governance; but local governance should include the political branches …

Using State And Local Health Survey Data To Advance Phssr, Glen P. Mays

Health Management and Policy Presentations

State and local health survey data can be used to evaluate the implementation and impact of public health delivery innovations in real-world practice settings.

Harnessing The Potential Of Comparative Effectiveness Research And Delivery System Innovation Through Practice-Based Research, Glen P. Mays

Health Management and Policy Presentations

Testing delivery system innovations in health care and public health allows the practice-based research enterprise to lead the way toward gains in health and economic efficiency.

Long-Term Services And Supports (Ltss): Arlington County's Integrated Approach, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum sponsored a local site visit looking at community-based aging programs and long-term services and supports (LTSS) in Arlington County, Virginia. Arlington County human services are integrated under an umbrella agency in the Department of Human Services (DHS) which administers multiple programs for the elderly and people with disabilities. These include the Older Americans Act services, Medicaid LTSS, transportation services, a nursing case management program, and mental health services for those living in nursing homes and assisted living facilities. Arlington County integrates its aging and disability programs under the auspices of an Administration on Aging-funded Aging …

A Social Controversy: Autism Spectrum Disorder's Correlation To The Measles-Mumps-Rubella Vaccination, Lindsay A. Frye

Senior Honors Theses

A 1998 research study lead by Dr. Andrew Wakefield linked the measles-mumps-rubella (MMR) vaccination as a probable cause to autism spectrum disorder. This publication has started a significant debate among healthcare professionals and instigated an anti-vaccination movement within the general population. This vaccination controversy was started by parents who readily accepted Wakefield’s findings as truth and frequently would choose to withdrawal the administration of vaccinations from their children’s care plans. There has also been disapproval by healthcare professionals over Wakefield’s study since numerous research teams have been unable to replicate his findings. This disagreement surrounding the MMR vaccination is likely …

Racial Disparities In Cancer Screening Among Women With Chronic Joint Pain, Edith M. Williams, Laurene Tumiel-Berhalter, Christopher Purdy, Adrianne Ransom, Judith Anderson

Journal of Health Disparities Research and Practice

Chronic pain related disorders and breast and cervical cancer are more prevalent among African-American women compared with non-Hispanic White women. However, few studies address how racial differences in the context of comorbidity may compound these disparities. This study used secondary analysis of the National Health Interview Survey (NHIS) to assess racial differences in breast and cervical cancer screening and patient education among adult women with chronic joint pain conditions. Statistical analyses included chi-square and independent samples t-tests. African-American women compared with non-Hispanic White women were less likely to receive a pap smear or mammogram within the last two years and …

Pay-For-Performance In Five State Medicaid Programs: Lessons For The Nursing Home Sector, Edward M. Miller, Julia Doherty

Office of Community Partnerships Posters

This project looks at the pay-for-performance program in five state Medicaid programs and lists the lessons that the Nursing Home Sector can learn from. They are: The federal government has traditionally sought to ensure quality outcomes through nursing home (NH) surveys conducted by state officials; Some states have begun to experiment with pay-for-performance (P4P) incentives, which provider higher Medicaid reimbursement to those facilities achieving desired outcomes; By 2007, there were 9 state P4P programs covering 20% of NHs and 16.7% of residents; Little is known about the use of P4P to promote quality and efficiency in the NH sector.

Increasing Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward M. Miller, Cynthia Rudder

Office of Community Partnerships Posters

This project identified the facts about Nursing Facility Reimbursement by Medicaid in the states of New York and Minnesota. The results of this project are as follows: Medicaid is the main purchaser of nursing home (NH) care in the United States; States design their methods of reimbursing NHs to achieve desired policy objectives; Few consumers or resident advocates have been involved in the development or modification of state methods for reimbursing NHs; Lack of consumer involvement has resulted in payment systems that favor industry and government interests at the expense of issues important to residents and families.

Do No Harm: Perceptions Of Short-Term Health Camps In Nepal, Dena Seabrook

Independent Study Project (ISP) Collection

Short-term health camps are a growing form of delivering health care services to needy populations. Often these camps, usually lasting around 2 weeks, are led by I/NGOs in developing nations like Nepal and are staffed with volunteers from the Global North. These camps are largely ungoverned, and there are no evaluative techniques in place to monitor the effectiveness of the work done, raising concerns about the unintended consequences of short-term health camps camps. Nepal is particularly vulnerable to this issue because of the vast number of I/NGOs currently operating within its boundaries.

This research sought to expand the conversation surrounding …

Access To Healthcare For The Poor: Will The Affordable Care Act Address Income-Related Health Disparities In The United States?, Sonya Fabricant

Independent Study Project (ISP) Collection

Background: Low-income populations live shorter and less healthy lives in the United States due to a complexity of social, environmental and behavioral factors. These populations also face significant barriers in accessing health services. In 2010, the Patient Protection and Affordable Care Act (PPACA) passed, marking the first major reform of the American healthcare system since the 1960s. This paper evaluates its potential to address health disparities through changes to medical care delivery. Methodology: Results were compiled from government documents, reports from research institutes, journal articles, and an expert interview. A section-analysis was also performed, evaluating the strengths and weaknesses of …

Can Kawasaki Disease Be Managed?, Alberto Coustasse, Julius Larry, Doohee Lee

Management Faculty Research

Kawasaki Disease (KD) is the leading cause of acquired cardiovascular disease among children, but management of KD has received relatively little attention. In the US alone, about 5500 cases were estimated in 2009. KD is most common among Asian and Pacific Islander children but can affect all ethnicities and races. Timely and accurate diagnosis remains critical, but difficult: the etiology of KD is unknown, and no accurate diagnostic laboratory test has been developed. Continuing medical education can help physicians, clinicians, and nurse practitioners accurately diagnose and treat KD. A registry specific to KD or a surveillance system may be necessary …

Conocimientos Y Conductas Sexuales En Trabajadores Migrantes (Arica, Chile), Anna Conley

Independent Study Project (ISP) Collection

Background: The HIV/AIDS epidemic continues to be prevalent and to expand in Chile, as in many other regions of Latin America and around the world. Furthermore, it continues to concentrate in distinct, vulnerable populations. Migrant workers represent one such vulnerable population. The HIV/AIDS epidemic disproportionately impacts migrant workers because of the social, economic, and psychological factors that are involved in both migratory behaviors and disease construction.

Aim: This study identified sexual health knowledge and sexual health behavior in the migrant laborer population of Arica, Chile. More specifically, it identified risk factors for HIV/AIDS and explored possible strategies for a preventative …

Early Intervention Of Psychosis And Re! Ections For Programmes In India, Amresh Srivastava

Data and Test Instruments

Mental illness is perhaps the most common and most debilitating among non-communicable diseases. Schizophrenia, for example, normally occurs before the age of 25, affect the most productive years of life. The World Economic Forum graphically illustrates that mental illnesses will be a major contributor to the erosion of gross domestic product over the next 20 years. The developed world has established programs that have proven to be clinically and economically effective and sustainable.[1] Early intervention has played an important role in demonstrating that outcome can be improved if patients are treated in the early phase of illness. It is believed …

Developing Unique Engineering Solutions To Improve Patient Safety, Bradley Watts, Douglas Van Citters, Brian Shiner, Peter Mills

Dartmouth Scholarship

Many efforts to improve healthcare safety have focused on redesigning processes of care or retraining clinicians. Far less attention has been focused on the use of new technologies to improve safety. We present the results of a unique collaboration between the VA National Center for Patient Safety (NCPS) and the Thayer School of Engineering at Dartmouth College. Each year, the NCPS identifies safety problems across the VA that could be addressed with newly-engineered devices. Teams of Thayer students and faculty participating in a senior design course evaluate and engineer a solution for one of the problems. Exemplar projects have targeted …

Conflict Situation For Health Care Workers: A Case Study Of The Occupational Challenges In Kasangati Health Centre Iv And Their Implications For Patient Care., Shannon Mcdowell

Independent Study Project (ISP) Collection

Many factors influence a country’s ability to provide quality health services for its people. Particularly, quality health care hinges upon the availability of properly trained and equipped health care workers (HCWs) to deliver effective care. Resource-strained countries committed to the Millennium Development Goals are confronting the reality that shortages and uneven distribution of HCWs threaten their capacities to encourage and establish healthy communities. A scarcity in HCWs is one challenge of public health initiatives and places stress on existing HCWs. Other challenges faced by HCWs severely affect performance, motivation, and overall care-giving ability.

This study aims to examine the particular …