Health Services Research Commons^™

The Prescription Drug Safety Net: Access To Pharmaceuticals For The Uninsured, Jack Hoadley

National Health Policy Forum

This background paper provides an overview of organized programs that provide access to prescription drug products for uninsured persons, with an emphasis on manufacturer-sponsored pharmacy assistance programs (PAPs) and the federal 340B drug pricing program. It summarizes the chief characteristics of these programs and reviews concerns regarding the reach and efficiency of these efforts. The paper begins with a brief examination of the number of people who lack insurance coverage for prescription drugs and discusses the influence of this gap in coverage on health status. The paper also describes informal mechanisms providers frequently use to help uninsured patients fill their …

Oversight Hearings On Science And Environmental Regulatory Decisions, David Michaels

Health Policy and Management Congressional Testimonies

No abstract provided.

Wellness Program Effect On The Health Parameters Of Female Employees Aged 25 To 60 Years Of Age Targeting Physical Activity And Nutrition Therapy., Adrienne J. Poag

Electronic Theses and Dissertations

The purpose of the study was to determine if the health parameters of female employees would improve, as measured in the posttest data, following the completion of a 12-week employee wellness program. The participants included 17 female employees from the Carter County Health Department located in Elizabethton, Tennessee. The principle investigator assessed the changes in the pretests and posttests and analyzed the data using SPSS. The results showed on average an increase in fruit and vegetable consumption and in the number of days exercised per week as well as improved diastolic blood pressure and triglyceride levels. The employees who experienced …

The Fundamentals Of Health Savings Accounts And High-Deductible Health Plans, Beth Fuchs, Lisa Potetz

National Health Policy Forum

This background paper updates and expands on a previous NHPF document that looked at the fundamentals of health savings accounts (HSAs) and high-deductible health plans (HDHPs), their intellectual and legislative origins, and the ways they work. In addition to updating information on the HDHP/HSA marketplace, this paper presents a description of how the HDHP combined with the HSA works for enrollees. Using a question and-answer format, it then addresses some of the more complicated details of these arrangements, looking first at the HDHPs and then the HSAs. This closer examination suggests some potential policy challenges for lawmakers, the focus of …

What Have You Done For Me Lately? Assessing Hospital Community Benefit, Eileen Salinsky

National Health Policy Forum

This issue brief reviews key aspects of the ongoing policy debate related to not-for-profit hospitals, the advantages they derive from tax exemption, and the benefits they provide to communities served. It provides a historical context for how federal standards for assessing hospitals’ tax-exempt status have evolved and describes recent activities to explore additional policy changes. Legislative and regulatory actions at the state and local level are also examined. Evidence on the performance of not-for-profit hospitals in comparison to their for-profit competitors on measures of cost, quality, and access is summarized, and perspectives on the need to preserve a not-for-profit presence …

Weighted Likelihood Method For Grouped Survival Data In Case-Cohort Studies With Application To Hiv Vaccine Trials, Zhiguo Li, Peter B. Gilbert, Bin Nan

The University of Michigan Department of Biostatistics Working Paper Series

Grouped failure time data arise often in HIV studies. In a recent preventive HIV vaccine efficacy trial, immune responses generated by the vaccine were measured from a case-cohort sample of vaccine recipients, who were subsequently evaluated for the study endpoint of HIV infection at pre-specified follow-up visits. Gilbert et al. (2005) and Forthal et al. (2007) analyzed the association between the immune responses and HIV incidence with a Cox proportional hazards model, treating the HIV infection diagnosis time as a right censored random variable. The data, however, are of the form of grouped failure time data with case-cohort covariate sampling, …

Review Of Access And Quality Of Care In Schip Using Standardized National Performance Measures, Terence A. Partridge

National Health Policy Forum

The State Children's Health Insurance Program (SCHIP) has proven to be a critical addition to public coverage programs for low-income children since its inception ten years ago. Tracking the number of children enrolled, however, is only part of the story. This technical paper reviews access and quality for children enrolled in SCHIP by examining information on four primary and preventive care health measures submitted to the Centers for Medicare & Medicaid Services by states in their 2005 annual reports. The paper concludes that the data examined for this paper indicate that children enrolled in SCHIP are receiving not only coverage …

Competition And Collaboration: The Spirit Of St. Louis, Laura A. Dummit, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to St. Louis, Missouri, on April 3-5, 2007, to consider the relationships between hospitals and physicians—and the degree of alignment in their financial, organizational, and policy goals—as a foundation for a new round of discussions on how to reform the health care system. St. Louis offered an interesting venue for these investigations because it is home to two major medical schools, three large hospital systems, and a physician community dominated by small practices. Site visit participants were able to converse with community, business, medical school, hospital, and physician leaders to learn …

Defining Programmatic Access To Healthcare For People With Disabilities, Nancy R. Mudrick, Silvia Yee

Social Work - All Scholarship

People with disabilities face disability-related barriers that affect their receipt of health care. These often are discussed in terms of three categories: financial, structural, and programmatic barriers. Financial barriers may involve the lack of insurance, inability to pay for care, or coverage limitations for such items as durable medical equipment and medication. Structural barriers primarily arise from the architectural characteristics of health care delivery settings, such as parking location, building entrances, stairs and ramps, and bathrooms. Programmatic barriers are barriers involving the processes used to deliver health care. This category is the least understood, yet an important factor for access …

Preps Surveillance: Summary Of Cognitive Interviews And Recommendations For Preps Surveillance Measures, Lois Biener, Karen Bogen

Center for Survey Research Publications

A review of existing research on population awareness of potentially reduced exposure tobacco products (PREPs) as well as results of cognitive interviews suggest that awareness of PREPs is quite low at this time, except in active test-markets. In order to monitor changes in awareness and perceptions of, and receptivity to these products over time, we have proposed using a set of questions as well as coding conventions that appear to result in reasonably accurate estimates of awareness of a particular group of products. The recommended items, which performed will in cognitive interviews, are presented in Appendix D of this report. …

Health Care Price Transparency And Price Competition, Mark Merlis

National Health Policy Forum

Growing numbers of consumers are in health plans that give them incentives to be more cost-conscious. Yet complex pricing systems and limited information may make it hard to choose among providers and treatment options. This report examines steps that insurers and others have taken to make better price information available, possible government measures to further promote price transparency or to simplify price comparisons, and the likely effects on consumer behavior and provider competition.

Finding The Fastest Way To Her Heart: Linking Clinical And Policy Pathways, Paula Johnson, Brian R. Schuetz, Shelley M. Stark, Dora Tovar

New England Journal of Public Policy

The Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital in Boston, integrates research, clinical practice, and policy analysis with practical application to emerging women’s health issues. Recently, an interdisciplinary team of practitioners examined pathways to improving women’s heart health. Beginning with the evidence that a heart-healthy diet leads to improved health outcomes for women with cardiovascular disease, the Connors Center team charted a course of intellectual exploration that culminated in a broader community dialogue on how to improve access to healthy and affordable food. Through clinical experiences, research activities, and an ongoing interchange …

Fairfax County's Commitment: A Housing And Health Continuum For Seniors, Judith D. Moore, Lisa Sprague

National Health Policy Forum

This one-day site visit focused on the range of services made available to seniors by Fairfax County, Virginia, including senior centers, adult day health care, and assisted living and independent housing. Services to low-income residents were emphasized. Participants were introduced to the different agencies and funding streams involved and were able to observe how county officials have acted on a stated commitment to help seniors who wish to age in place, staying in the county and in their own homes rather than in a nursing home or other institution. The day included tours of two Fairfax County multiservice sites, in …

Determinan Pemilihan Tempat Persalinan Di Kabupaten Cirebon, Tahun 2004, Deti Adipriati

Kesmas

Lebih dari 90% kematian ibu disebabkan komplikasi obstetrik yang sering tidak dapat diramalkan pada saat kehamilan. Pada umumnya kematian Ibu dan kejadian kesakitan setelah bayi lahir adalah akibat kegagalan untuk menanggulangi komplikasi persalinan. Kebanyakan komplikasi itu terjadi pada saat atau sekitar persalinan. SDKI 2003 melaporkan bahwa 9% persalinan dilakukan di fasilitas pemerintah dan 31% pada fasilitas swasta, sedangkan 59% masih dilakukan di rumah. Pertolongan persalinan di rumah, dimana sistem rujukan tidak dikembangkan dengan tepat, memiliki pengaruh yang besar terhadap kelangsungan hidup ibu dan bayi. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berpengaruh dalam menentukan pemilihan tempat persalinan di Kabupaten Cirebon …

A Cohort Study Of Reproductive And Hormonal Factors And Renal Cell Cancer Risk In Women, Gc Kabat, Stephanie A. Navarro Silvera, Ab Miller, Te Rohan

Department of Public Health Scholarship and Creative Works

We examined the association of reproductive and hormonal factors with renal cell cancer risk in a cohort study of 89 835 Canadian women. Compared with nulliparous women, parous women were at increased risk (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.02–3.09), and there was a significant gradient of risk with increasing levels of parity: relative to nulliparous women, women who had X5 pregnancies lasting 4 months or more had a 2.4-fold risk (HR 1⁄4 2.41, 95% CI 1⁄4 1.27–4.59, P for trend 0.01). Ever use of oral contraceptives was associated with a modest reduction in risk. No associations were …

Convenient Care Clinics: The Future Of Accessible Health Care, Tine Hansen-Turton, Sandra Ryan, Ken Miller, Mona Counts, David B. Nash

College of Population Health Faculty Papers

The need for accessible, affordable, quality health care in the United States has never been greater. In response to this need, convenient care clinics (CCCs) are being launched across the country to help provide care to meet the basic health needs of the public. In CCCs, highly qualified health care providers diagnose and treat common health problems, triage patients to the appropriate level of care, advocate for a medical home for all patients, and reduce unnecessary visits to emergency rooms and Urgent Care Clinics. CCCs have been called a "disruptive innovation" because they are consumer driven. They serve as a …

Association Between Frequency Of Telephonic Contact And Clinical Testing For A Large, Geographically Diverse Diabetes Disease Management Population, Carter R. Coberley, Matthew Mcginnis, Patty M. Orr, Sadie S. Coberley, Adam Hobgood, Brent Hamar, Bill Gandy, James Pope, Laurel Hudson, Pam Hara, Dexter Shurney, Janice L. Clarke, Albert Crawford, Neil I. Goldfarb

College of Population Health Faculty Papers

Diabetes disease management (DM) programs strive to promote healthy behaviors, including obtaining hemoglobin A1c (A1c) and low-density lipoprotein (LDL) tests as part of standards of care. The purpose of this study was to examine the relationship between frequency of telephonic contact and A1c and LDL testing rates. A total of 245,668 members continuously enrolled in diabetes DM programs were evaluated for performance of an A1c or LDL test during their first 12 months in the programs. The association between the number of calls a member received and clinical testing rates was examined. Members who received four calls demonstrated a 24.1% …

Final Report Technical Assistance To Improve Quality Oversight Of The Oklahoma Advantage Waiver, Maureen Booth, Louise Olsen

Disability & Aging

No abstract provided.

Estimating The Empirical Lorenz Curve And Gini Coefficient In The Presence Of Error, Chaya S. Moskowitz, E. S. Venkatraman, Elyn Riedel, Colin B. Begg

Memorial Sloan-Kettering Cancer Center, Dept. of Epidemiology & Biostatistics Working Paper Series

The Lorenz curve is a graphical tool that is widely used to characterize the concentration of a measure in a population, such as wealth. It is frequently the case that the measure of interest used to rank experimental units when estimating the empirical Lorenz curve, and the corresponding Gini coefficient, is subject to random error. This error can result in an incorrect ranking of experimental units which inevitably leads to a curve that exaggerates the degree of concentration (variation) in the population. We explore this bias and discuss several widely available statistical methods that have the potential to reduce or …

The Impact Of Medicare Special Needs Plans On State Procurement Strategies For Dually Eligible Beneficiaries In Long-Term Care, Paul Saucier, Brian Burwell, Thomson Medstat

Disability & Aging

No abstract provided.

Nevada Institute For Children's Research And Policy Legislative Bills-2007 Session, The Nevada Institute For Children’S Research And Policy

Nevada Institute for Children's Research and Policy Reports

Legislative Bills-2007 Session for Nevada Institute for Children's Research and Policy.

Learning From The Grandmothers: Incorporating Indigenous Principles Into Qualitative Research, Charlotte Loppie

Aboriginal Policy Research Consortium International (APRCi)

In this article, the author describes the process she undertook to incorporate Indigenous principles into her doctoral research about the midlife health experiences of elder Aboriginal women in Nova Scotia, Canada. By employing qual- itative methods within the context of an Indigenous worldview, she gained knowledge of and developed competence in Aboriginal health research. The emergent partnership among Aboriginal community research facilitators, participating Mi’kmaq women, and the researcher provided many opportunities for the researcher to incorporate the paradigmatic and methodological traditions of Western science and Indigenous cultures. The application of these principles to this study might provide a useful example …

The Use Of Telehealth For Diabetes Management: A Qualitative Study Of Telehealth Provider Perceptions, Faith P. Hopp, Mary M. Hogan, Peter A. Woodbridge, Julie C. Lowery

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use.

Methods

We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States.

Results

Findings suggest that MMD program enrollment is limited by both …

Day Of Dialogue—Insights And Evidence From Product Introduction: Lessons For Microbicides, Martha Brady, C. Elizabeth Mcgrory

HIV and AIDS

This report summarizes key issues and themes emerging from a Population Council Day of Dialogue held in March 2007. The Council convened this meeting of experts in the fields of product development, introduction, and social marketing; clinical trials; and reproductive health and HIV/AIDS in order to identify key features that can be used to guide efforts to introduce microbicides.

Developing Regional Operations Research Training Capacity In South Asia, M.E. Khan, James R. Foreit, Sohini Roychowdhury, F. Ram, Chander Shekhar

Reproductive Health

This project’s overall objective was to create a self-sustaining regional operations research (OR) training and research center for South Asia at the International Institute of Population Sciences (IIPS), in Mumbai, India. The goal was to institutionalize operations research (OR) in IIPS by building the teaching and research capabilities of the faculty and research team. Capacity building was accomplished through a training of trainers that included an OR workshop in Nepal, two four-day OR workshops for program managers, one ten-day OR workshop for researchers, and a four-day scientific-writing course for researchers and program managers to provide guidelines for preparing research articles …

Disparities In Health And Well-Being Among Latinos In Washington Heights/Inwood, 2000–2005, Ana Motta-Moss

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report analyzes how well the residents of Washington Heights/Inwood (WH/IN) have fared on selected health indicators set forth by the NYC Department of Health and Mental Hygene between 2000 and 2005.

Methods: Data on Latinos and other racial/ethnic groups were obtained from the U.S. Census Bureau American Community Survey, reorganized for public use by the Minnesota Population Center, University of Minnesota, IPUMSusa. Cases in the dataset were weighted and analyzed to produce population estimates.

Results: Immigrant families in particular face a multitude of health concerns, as well as specific barriers to accessing health care services. The socioeconomic and …

The Cost-Effectiveness Of Improving Diabetes Care In U.S. Federally Qualified Community Health Centers, Elbert S. Huang, Qi Zhang, Sydney E. S. Brown, Melinda L. Drum, David O. Meltzer, Marshall H. Chin

Community & Environmental Health Faculty Publications

Objective. To estimate the incremental cost-effectiveness of improving diabetes care with the Health Disparities Collaborative (HDC), a national collaborative quality improvement (QI) program conducted in community health centers (HCs).

Data Sources/Study Settings. Data regarding the impact of the Diabetes HDC program came from a serial cross-sectional follow-up study (1998, 2000, 2002) of the program in 17 Midwestern HCs. Data inputs for the simulation model of diabetes came from the latest clinical trials and epidemiological studies.

Study Design. We conducted a societal cost-effectiveness analysis, incorporating data from QI program evaluation into a Monte Carlo simulation model of diabetes.

Data Collections/Extraction …

Chronic Care At The Crossroads: Exploring Solutions For Chronic Care Management. Report On The Us Summit., Janice L Clarke

College of Population Health Faculty Papers

Report on the US Summit

Bolivia: Marketing And Economic Analyses Help Ngos Develop Strategies For Sustainability, Frontiers In Reproductive Health

Reproductive Health

Many nongovernmental organizations (NGOs) face reduced funding for reproductive health services and are seeking ways to assess and enhance their ability to generate income to cover their service costs. In 2004, following a workshop on financial sustainability presented by the Population Council’s FRONTIERS Program, three Bolivian NGOs—Prosalud; the Center for Research, Education, and Services (CIES); and the Association of Rural Health Programs (APSAR)—developed operations research studies to improve their financial sustainability. The Prosalud and CIES studies included a cost-recovery study, a study measuring clients’ willingness to pay for services, and a market segmentation study to compare the NGOs’ services with …

Mainstreaming And Scaling Up The Kenya Adolescent Reproductive Health Project, Ian Askew, Humphres Evelia

Reproductive Health

From 1999–2003, FRONTIERS implemented a Global Agenda program of operations research (OR) projects to address the reproductive health (RH) needs of adolescents in four countries—Bangladesh, Kenya, Mexico, and Senegal. The project was implemented in two districts of Western Province in Kenya and was known as the Kenya Adolescent Reproductive Health Project (KARHP). The project supported a public sector, multisectoral intervention to enhance young people’s knowledge and behavior regarding HIV prevention and RH. Implemented jointly with PATH, this OR project demonstrated that such an intervention could be implemented by the public sector, that it was acceptable to communities, that its influence …