Social and Behavioral Sciences Commons^™

Improving Community Health Through Hospital Community Benefit Spending: Charting A Path To Reform, Sara J. Rosenbaum, Maureen Byrnes, Sara Rothenberg, Rachel Gunsalus

Health Policy and Management Faculty Publications

No abstract provided.

Caution Is Needed In Designing Pharmacy Coverage., Steven A Farmer, William B Borden

Health Policy and Management Faculty Publications

Introduction

Pharmaceuticals are a critical component of modern medical care and have contributed substantially to health and quality of life. They are also expensive, accounting for ≈10% of US health care costs.1 By the end of this year, Medicare beneficiaries are expected to spend $343 billion on medications, and drug spending is projected to grow faster than both the inpatient and outpatient care categories.2Commercial and public payers use a range of mechanisms to constrain these costs, including formularies, tiered copayments, and preauthorization. These coverage policies may have potent impacts on medication usage, and their effects deserve close …

The Methods Behind 2015 Informatics Capacity And Needs Assessment Study, Gulzar H. Shah

Health Policy and Management Faculty Publications

The 2015 Informatics Needs and Capacity of Local Health Departments (LHDs) survey is the most recent comprehensive source of quantitative data on LHD informatics. Conducted by the National Association of County & City Health Officials (NACCHO), this is the third nationally representative quantitative study of LHD informatics since 2009. The previous 2 comprehensive quantitative assessments were conducted by NACCHO in 2009-2010 and 2011. Given that public health informatics is rapidly evolving, the 2015 Informatics survey is a much-needed country-wide assessment of the current informatics needs and capacities of LHDs. This article outlines detailed methodology used in the 2015 Informatics survey, …

Urgent Challenges For Local Public Health Informatics, Joseph P. Gibson, Gulzar H. Shah, Laura C. Streichert, Linda Verchick

Health Policy and Management Faculty Publications

This editorial highlights the urgent challenges for local public health informatics and provides solutions to face these challenges.

Public Health Staff Development Needs In Informatics: Findings From A National Survey Of Local Health Departments, Barbara L. Massoudi, Kelley Chester, Gulzar H. Shah

Health Policy and Management Faculty Publications

Context: Public health practice is information-intensive and information-driven. Public health informatics is a nascent discipline, and most public health practitioners lack necessary skills in this area.

Objective: To describe the staff development needs of local health departments (LHDs) related to informatics.

Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County & City Health Officials.

Participants: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%).

Main Outcome Measure(s): Outcome measures included LHDs' specific staff development needs related to informatics. …

Electronic Health Records And Meaningful Use In Local Health Departments: Updates From The 2015 Naccho Informatics Assessment Survey, Karmen S. Williams, Gulzar H. Shah

Health Policy and Management Faculty Publications

Background: Electronic health records (EHRs) are evolving the scope of operations, practices, and outcomes of population health in the United States. Local health departments (LHDs) need adequate health informatics capacities to handle the quantity and quality of population health data.

Purpose: The purpose of this study was to gain an updated view using the most recent data to identify the primary storage of clinical data, status of data for meaningful use, and characteristics associated with the implementation of EHRs in LHDs.

Methods: Data were drawn from the 2015 Informatics Capacity and Needs Assessment Survey, which used a stratified random sampling …

Using Information Systems To Improve A Mid-Sized Local Health Department’S Effectiveness In A Time Of Rapid Change, Kay Lovelace, Gulzar H. Shah

Health Policy and Management Faculty Publications

Background: Informatics capacity building is resource and personnel intensive. Many local health departments (LHDs) face tradeoffs between using their resources to carry out existing mandates and using resources to build their capacity, for example, through informatics, to deliver essential services in a more effective and efficient manner.

Objective: The purpose of this case study is to describe how a mid-sized LHD built and used information systems to support its strategic objectives, clinical services, and surveillance.

Methods: The mid-sized LHD described here was chosen for its “best practices” in informatics capacity building and use by NACCHO's study advisory committee. To conduct …

Local Health Departments' Partners And Challenges In Electronic Exchange Of Health Information, Gulzar H. Shah, Joshua Vest, Kay Lovelace, J. Mac Mccullough

Health Policy and Management Faculty Publications

Background: Unprecedented amounts of data are produced by the health care and other sectors, presenting opportunities for local health departments (LHDs) to access these data. LHDs will need to participate in health information exchange (HIE) with a number of partners in order to benefit from these data resources. LHDs' participation in HIEs with specific partners has not been studied.

Objectives: To describe the level of and challenges in LHD participation in HIE with other partners, and variation by LHD population size and governance type.

Data and Methods: This research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, …

Informatics As A Strategic Priority And Collaborative Processes To Build A Smarter, Forward-Looking Health Department, Kay Lovelace, Gulzar H. Shah

Health Policy and Management Faculty Publications

This article was published in the Journal of Public Health Management and Practice.

Interoperability Of Information Systems Managed And Used By The Local Health Departments, Gulzar H. Shah, Jonathon P. Leider, Huabin Luo, Ravneet Kaur

Health Policy and Management Faculty Publications

Background: In the post-Affordable Care Act era marked by interorganizational collaborations and availability of large amounts of electronic data from other community partners, it is imperative to assess the interoperability of information systems used by the local health departments (LHDs).

Objectives: To describe the level of interoperability of LHD information systems and identify factors associated with lack of interoperability.

Data and Methods: This mixed-methods research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling …

Control Of The Public Health It Physical Infrastructure: Findings From The 2015 Informatics Capacity And Needs Assessment Survey, Kelley Chester, Barbara L. Massoudi, Gulzar H. Shah

Health Policy and Management Faculty Publications

Background: Despite improvements in information technology (IT) infrastructure in public health, there is still much that can be done to improve the adoption of IT in state and local health departments, by better understanding the impact of governance and control structures of physical infrastructure.

Objective: To report out the current status of the physical infrastructure control of local health departments (LHDs) and to determine whether there is a significant association between an LHD's governance status and control of the physical infrastructure components.

Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in …

An Iterative, Low-Cost Strategy To Building Information Systems Allows A Small Jurisdiction Local Health Department To Increase Efficiencies And Expand Services, Kay Lovelace, Gulzar H. Shah

Health Policy and Management Faculty Publications

Objective and Methods: The objective of this case study was to describe the process and outcomes of a small local health department's (LHD's) strategy to build and use information systems. The case study is based on a review of documents and semi-structured interviews with key informants in the Pomperaug District Health Department. Interviews were recorded, transcribed, coded, and analyzed.

Results and Conclusions: The case study here suggests that small LHDs can use a low-resource, incremental strategy to build information systems for improving departmental effectiveness and efficiency. Specifically, we suggest that the elements for this department's success were simple information systems, …

Assessing Skills And Capacity For Informatics: Activities Most Commonly Performed By Or For Local Health Departments, Kate Drezner, Lisa Mckeown, Gulzar H. Shah

Health Policy and Management Faculty Publications

Objective: To describe the informatics activities performed by and for local health departments.

Design: Analysis of data from the 2015 Informatics Capacity and Needs Assessment Survey of local health departments conducted by the Jiann-Ping Hsu College of Public Health at Georgia Southern University in collaboration with the National Association of County & City Health Officials.

Participants: 324 local health departments.

Main Outcome Measure(s): Informatics activities performed at or for local health departments in use and analysis of data, system design, and routine use of information systems.

Results: A majority of local health departments extract data from information systems (69.5%) and …

How Medicaid And Other Public Policies Affect Use Of Tobacco Cessation Therapy, United States, 2010-2014., Leighton Ku, Erin Brantley, Tyler Bysshe, Erika Steinmetz, Brian K. Bruen

Health Policy and Management Faculty Publications

INTRODUCTION: State Medicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state. This article assesses the effects of changes in Medicaid benefit policies, general tobacco policies, smoking norms, and public health programs on the use of cessation therapy among Medicaid smokers.

METHODS: We used longitudinal panel analysis, using 2-way fixed effects models, to examine the effects of changes in state policies and characteristics on state-level use of Medicaid tobacco cessation medications from 2010 through 2014.

RESULTS: Medicaid policies that require patients to …

Health Departments’ Engagement In Emergency Preparedness Activities: The Influence Of Health Informatics Capacity, Gulzar H. Shah, Bobbie J. Newell, Ruth E. Whitworth

Health Policy and Management Faculty Publications

Background: Local health departments (LHDs) operate in a complex and dynamic public health landscape, with changing demands on their emergency response capacities. Informatics capacities might play an instrumental role in aiding LHDs emergency preparedness. This study aimed to explore the extent to which LHDs’ informatics capacities are associated with their activity level in emergency preparedness and to identify which health informatics capacities are associated with improved emergency preparedness.

Methods: We used the 2013 National Profile of LHDs study to perform Poisson regression of emergency preparedness activities.

Results: Only 38.3% of LHDs participated in full-scale exercises or drills for an emergency …

Current Practices Of Obesity Pharmacotherapy, Bariatric Surgery Referral And Coding For Counselling By Healthcare Professionals, Christine Petrin, Scott Kahan, Monique Turner, C. Gallagher, William Dietz

Health Policy and Management Faculty Publications

Introduction

Rates of obesity pharmacotherapy use, bariatric surgery and intensive behavioural counselling have been extremely low.

Objectives

The primary objective of this study was to survey healthcare provider beliefs, practice and knowledge regarding obesity management.

Methods

Primary care physicians (PCPs), OB‐GYN physicians and nurse practitioners (NPs) responded to a web‐based survey related to drug therapy practice, bariatric surgery referral and reimbursement coding practice.

Results

Rates of reported use of obesity pharmacotherapy appear to be increasing among PCPs, which is likely related to the approval of four new obesity pharmacotherapy agents since 2012. Rates of pharmacotherapy use among OB‐GYNs and NPs …

The Carefirst Patient-Centered Medical Home Program: Cost And Utilization Effects In Its First Three Years, Alison Cuellar, Lorens A. Helmchen, Gilbert Gimm, Jay Want, Sriteja Burla, Bradley Kells, Iwona Kicinger, Len M. Nichols

Health Policy and Management Faculty Publications

Background

Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time.

Objective

To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits.

Design

We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized …

Georgia’S Rural Hospital Closures: The Common-Good Approach To Ethical Decision-Making, Randi G. Bastain, Marcus Garner, John S. Barron, Emmanuel A. Akowuah, William A. Mase

Health Policy and Management Faculty Publications

Background: Critical access hospitals provide several essential services to local communities. Along with the functions associated with providing necessary medical care, they also offer employment opportunities and other economic benefits to the communities they serve. Since 2010, the number of rural hospitals closures has steadily increased. The common-good approach to ethical decision-making provides a framework that aids in evaluation of the effects that hospital closures have on rural residents and communities.

Methods: This analysis includes results of a systematic overview of peer-reviewed literature to address the following research questions: 1) How have state policies and the adoption of Medicaid expansion …

A Clinical Score To Predict Dose Reductions Of Antidiabetes Medications With Intentional Weight Loss: A Retrospective Cohort Study., Ghanshyam Palamaner Subash Shantha, Anita Ashok Kumar, Vimal Ravi, Rohit C Khanna, Scott Kahan, Lawrence J Cheskin

Health Policy and Management Faculty Publications

Abstract

Background

We assessed the predictive accuracy of an empirically-derived score (weight loss, insulin resistance, and glycemic control: “WIG”) to predict patients who will be successful in reducing diabetes mellitus (DM) medication use with weight loss.

Methods

Case records of 121 overweight and obese patients with DM at two outpatient weight management centers were analyzed.

Results

Mean period of follow-up was 12.5 ± 3.5 months. To derive the “WIG” scoring algorithm, one point each was assigned to “W” (loss of 5% of initial body weight within the first 3 months of attempting weight loss), “I” (triglyceride [TGL]/highdensity lipoprotein ratio >3 …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc, Hildi J. Hagedorn, Randall Brown, Michael Dawes, Eric Diepernick, Donald Myrick, Elizabeth M. Oliva, Todd H. Wagner, Jennifer P. Wisdom, Alex Harris

Health Policy and Management Faculty Publications

Background: Only 7.8% of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation components. …

The Impact Of Reimbursement Policies And Practices On Healthcare Technology Innovation, Brian K. Bruen, Elizabeth Docteur, Ruth Lopert, Joshua Cohen, Joseph Dimasi, Avi Dor, Peter Neumann, Regina Desantis, Chuck Shih

Health Policy and Management Faculty Publications

No abstract provided.

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc., Hildi Hagedorn, Randall Brown, Michael Dawes, Eric Dieperink, Donald Hugh Myrick, Elizabeth Oliva, Todd Wagner, Jennifer P. Wisdom, Alex Harris

Health Policy and Management Faculty Publications

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation …

Workforce Planning And Development In Times Of Delivery System Transformation, Patricia Pittman, Ellen Scully-Russ

Health Policy and Management Faculty Publications

Background

As implementation of the US Affordable Care Act (ACA) advances, many domestic health systems are considering major changes in how the healthcare workforce is organized. The purpose of this study is to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment.

Methods

Informed by the theory of loosely coupled systems (LCS), we use a case study design to examine how workforce changes are being managed in Kaiser Permanente and Montefiore Health System. We conducted site visits with in-depth interviews with 8 to 10 stakeholders in each organization.

Results

Both …

Local Health Departments’ Activities To Address Health Disparities And Inequities: Are We Moving In The Right Direction?, Gulzar H. Shah, John P. Sheahan

Health Policy and Management Faculty Publications

Context: Health disparities are among the critical public health challenges.

Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement.

Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities.

Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four …

Use Of Pooled State Administrative Data For Mental Health Services Research., Kimberly Eaton Hoagwood, Susan Essock, Joseph Morrissey, Anne Libby, Sheila Donahue, Benjamin Druss, Molly Finnerty, Linda Frisman, Meera Narasimhan, Bradley D Stein, Jennifer P. Wisdom, Judy Zerzan

Health Policy and Management Faculty Publications

State systems are a rich, albeit challenging, laboratory for policy-relevant services research studies. State mental health authorities routinely devote resources to collect data for state planning and reporting purposes. However, these data are rarely used in cross-state comparisons to inform state or federal policy development. In 2008, in response to key recommendations from the National Institute of Mental Health (NIMH) Advisory Council’s “The Road Ahead: Research Partnership to Transform Services,” (http://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/road-ahead.pdf), NIMH issued a request for applications (RFA) to support studies on the impact of state policy changes on access, cost, quality and outcomes of care for individuals …

Building Capacity In Implementation Science Research Training At The University Of Nairobi., George O Osanjo, Julius O Oyugi, Isaac O Kibwage, Walter O Mwanda, Elizabeth N Ngugi, Fredrick C Otieno, Wycliffe Ndege, Mara Child, Carey Farquhar, Jeremy Penner, Zohray Talib, James N Kiarie

Health Policy and Management Faculty Publications

BACKGROUND: Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science.

METHODS: This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc., Hildi J Hagedorn, Randall Brown, Michael Dawes, Eric Dieperink, Donald Hugh Myrick, Elizabeth M Oliva, Todd H Wagner, Jennifer P. Wisdom, Alex H S Harris

Health Policy and Management Faculty Publications

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation …