Health Policy Commons^™

The Patient Patient: The Importance Of Knowing Your Navigator, Sarah M. Wheeler Phd, Julie E. Gilbert Phd, Melissa Kaan Mba, Eric Klonikowski, Claire Mb Holloway Md Phd Frcsc

Patient Experience Journal

In Ontario, Diagnostic Assessment Programs (DAPs) have been implemented to improve the quality of care patients receive during the diagnostic phase of the cancer journey. Patient navigators play a critical role in this model by coordinating care and providing information and support to patients and their families. The objectives of this study were 1) to determine whether patient navigation in DAPs is associated with a better patient experience and 2) to examine whether patient navigation in DAPs modifies the effect of wait times and patient volumes on patient experience. Data reflecting patients’ experience within the DAP were collected via survey …

Rush To Judgment: The Sti-Treatment Trials And Hiv In Sub-Saharan Africa, Eileen Stillwaggon, Larry Sawers

Economics Faculty Publications

Introduction: The extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence.

Discussion: Examination of the …

The Impact Of Disability: A Comparative Approach To Medical Resource Allocation In Public Health Emergencies, Katie Hanschke, Leslie E. Wolf, Wendy F. Hensel

Faculty Publications By Year

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people.

A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when …

Adults With Intellectual Disability Or Autism Spectrum Disorder. Executive Summary, Kimberly I. Snow Mhsa, Ba, Stuart Bratesman Mpp, Taryn Bowe, Julie T. Fralich Mba

Disability & Aging

This chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

Current Perspectives On Primary Care Workforce, Kathleen Klink

Health Workforce Speaker Series

No abstract provided.

Giving The Homeless Population A Chance To Become Healthier: An Initial Needs Assessment Of The Homeless Population Of Portland, Maine, Annarae Andresen, Oana Butnarasu, Jayme Keith, Sarah Kou, Dana Mccoy, Stephanie Sheehan, Jessica Takatsuki, Zoe Hull, Ian Imbert, Suzanne Dunn, Tara Lonneman, Marissa Prezanno, Catherine Bixby

Homeless Needs Assessment

Research poster stemming from IPEC mini-grant student project Homeless Needs Assessment. The project was designed to assess the greatest needs for people experiencing homelessness in Portland, Maine. UNE Students from several healthcare professions partnered together to provide a holistic approach to the community needs with hopes of developing and implementing intervention strategies. Goal was to conduct surveys of at least 100 homeless individuals.

Psychiatric Boarding In U.S. Eds: A Multifactorial Problem That Requires Multidisicplinary Solutions, Zaynah Abid, Andrew C. Meltzer, Danielle Lazar, Jesse M. Pines

Center for Health Care Quality

ED visits for psychiatric conditions make up an ever-increasing share of all ED visits. Patients with psychiatric complaints have a significantly greater length-of-stay in the ED than patients with non-psychiatric complaints. Prolonged boarding in the ED for psychiatric patients is associated with lower quality care for psychiatric patients and further contributes to overall ED crowding.

Redefining Frequent Emergency Department Users, Amy Waldner, Maria Raven, Danielle Lazar, Jesse Pines

Center for Health Care Quality

Frequent ED users are perceived to be a costly population that often abuse or misuse ED services due to a combination of unmet social needs and medical conditions that, in theory, could be treated outside of the ED at a lower cost. The reality is that factors contributing to frequent ED use are more varied and complex than originally believed.

Barriers To Successful Cervical Cancer Screening In Rural Kwazulu-Natal, Cato Manor, And Cape Town, Amanda Comai

Independent Study Project (ISP) Collection

In 2000, the South African Department of Health produced a nationwide policy intended to combat the growing crisis of cervical cancer. Nearly fifteen years later, however, the disease remains a significant cause of death among certain female populations, especially those who are rural, poor, and HIV-positive. It is undeniable that challenges of access, awareness, resource demand, and stigmatization stand in the way of complete policy enactment.

In this study, I explore in detail the barriers that prevent successful implementation of the policy. My research combines interviews with a variety of individuals and participant observation at the Cancer Association of South …

Quality Of Emergency Departments In Amman Evaluated By The Availability Of Essential Emergency Equipment, Seif Laeth Sari Nasir

Independent Study Project (ISP) Collection

The present study aims to determine the quality of emergency health care in Jordan by assessing the availability of essential emergency equipment in emergency departments in Amman. This study uses a cross-­‐sectional questionnaire assessing the accessibility of equipment and medication in emergency departments, as well as eliciting the opinions of the participants regarding the future development of the emergency medical sector in Jordan. The questionnaires were distributed to the physician directors of every participating hospital emergency department in Amman, and completed by the physician director excepting two cases, one of which was completed by the head staff nurse, and the …

Later School Start Times In Adolescence: Time For A Change, Paul Kelley, Clark Lee

Homeland Security Publications

This briefing paper summarizes the latest research on the subject of chronic sleep deprivation on education and health in adolescents, explores policy options to address this education and public health issue, and sets forth the recommendation that education start times be adjusted appropriately for U.S adolescents.

Strengths And Limitations Of The Design Of Helen Keller International’S Childsight® Program Based On Lessons Learned Through The Implementation In Vietnam, 2011-2013, Bradley J. Owen

Capstone Collection

The ophthalmology sector in Vietnam currently faces many challenges. The Asia- Pacific Region, including Vietnam, is reported to have the most cases of uncorrected refractive error in the world at approximately 62 million people. A 2009 study implemented by the World Health Organization also concluded that the Western Pacific region, including Southeast Asia, has 3.98% of the population suffering from uncorrected refractive error, with an estimated cost to the region’s GDP of 111 billion dollars, or .86% of regional GDP (Smith, et al. 2009). In Vietnam alone it is estimated that one in five children suffer from some form of …

The Advanced Practice Nurse And Patient-Centered Medical Home: Maintaining Patient Focus, Meeting The Institute For Healthcare Improvement Triple Aim Through The Electronic Health Record, Aileen Teresa Twomey

Seton Hall University DNP Final Projects

The Federal Government enacted the Heath Information Technology for Economic and Clinical Health Act (HITECH) in 2009, which incentivized providers to use electronic health records (EHR) for meaningful use (MU); the Patient-Centered Medical Home (PCMH) stems from the Act. Research by the National Council on Quality Assurance (NCQA) shows that primary care practices have a positive influence on the health of patients, families and communities. These positive influences are related to their ability to deliver first-contact access, and to develop long-term therapeutic relationships that focus on the person rather than the disease, improving patient health outcomes and reducing health care …

Racial Disparities In The Use Of Cardiac Revascularization: Does Local Hospital Capacity Matter?, Suhui Li, Arnold Chen, Katherine H. Mead

Health Policy and Management Faculty Publications

Objective: To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources: Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design: The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical …

Healthy Aging In Massachusetts: Reporting Indicators, Identifying Resources & Activating Allies, Elizabeth Dugan, Frank Porell, Nina Silverstein, Ruth Palombo, Chae Man Lee, Kristina Turk

Office of Community Partnerships Posters

In Massachusetts, a Healthy Aging Collaborative comprised of a diverse group of stakeholders has been formed for multiple purposes: information sharing around healthy aging, idea generation, partnership building and activity mapping.

Improving Health Outcomes For Children (Ihoc) First Steps Phase I Initiative: Improving Immunizations For Children And Adolescents, Kimberley S. Fox Mpa, Carolyn E. Gray Mph

Population Health & Health Policy

This report, co-authored by Kimberley Fox and Carolyn Gray, provides a final evaluation of the initial phase of First STEPS (Strengthening Together Early Preventive Services), a learning collaborative led by Maine Quality Counts to support 24 pediatric and family practices in improving their childhood immunization rates. The evaluation found that all participating practices had higher immunization rates after participating in First STEPS. On average, overall child immunization rates increased by 5.1% at 12 months and 7.1% at 15 months, and average immunization rates across practices increased significantly from 74.2% to 81.3%. Practices also reported significant improvement in the use of …

Enhancing Communication Between Scientists, Government Officials, And The Lay Public: Advancing Science And Protecting The Public's Welfare Through Better Multi-Stakeholder Interfacing, Clark J. Lee, Patrick P. Rose, Earl Stoddard Iii

Homeland Security Publications

No abstract provided.

Household Catastrophic Medical Expenses In Eastern China: Determinants And Policy Implications, Xiaohong Li, Jay J. Shen, Jun Lu, Mei Sun, Chengyue Li, Fengshui Chang, Mo Hao

School of Public Health Faculty Research

Background: Much of research on household catastrophic medical expenses in China has focused on less developed areas and little is known about this problem in more developed areas. This study aimed to analyse the incidence and determinants of catastrophic medical expenses in eastern China.

Methods: Data were obtained from a health care utilization and expense survey of 11,577 households conducted in eastern China in 2008. The incidence of household catastrophic medical expenses was calculated using the method introduced by the World Health Organization. A multi-level logistic regression model was used to identify the determinants.

Results: The incidence of household catastrophic …

A Discourse Analysis Of Ontario's Family Health Teams, Rachelle Ashcroft

Theses and Dissertations (Comprehensive)

Inspired by critical social work practice, this study engages in a discourse analysis of Ontario’s Family Health Team (FHT) model. The purpose for this study is threefold; namely, a) to deepen our understanding of health discourses promoted by Ontario’s FHT model; b) to explore how Ontario’s FHT model compares to Haggerty, Burge, Lévesque, Gass, Pineault, Beaulieu, & Santor’s (2007) conceptual model of PHC; and c) to promote critical reflection in order to help inform decisions on how to improve quality of care and enhance health equity in FHTs. This study is guided using the overarching question: What health care practices …

The Closure Of New Orleans' Charity Hospital After Hurricane Katrina: A Case Of Disaster Capitalism, Kenneth Brad Ott

LSU New Orleans Theses and Dissertations

Abstract

Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, …

Attitudes, Beliefs, And Practices Of Providers And Key Opinion Leaders On Emergency Contraception In India, M.E. Khan, Deepthi S. Varma, Isha Bhatnagar, Anvita Dixit, Martha Brady

Reproductive Health

The Population Council undertook this study to assess the knowledge, attitudes, and practices regarding emergency contraception (ECP) among providers in public and private facilities and pharmacies in India. The objectives of the study were to: assess providers' knowledge of ECP's biological mechanism; understand providers' knowledge and attitudes about ECP's safety, effectiveness, and availability as an OTC drug; and identify providers' definitions of “repeated use” and profiling women who are “repeated users” of ECP. This study's findings show that most providers, including doctors and some KOLs, were incorrectly informed about ECP's mechanism of action. Service guidelines are necessary for accurate and …

Increase In Caesarean Deliveries After The Australian Private Health Insurance Incentive Policy Reforms, Kristjana Einarsdottir, Anna Kemp, Fatima Haggar, Rachael Moorin, Anthony Gunnell, David Preen, Fiona Stanley, C. D'Arcy Holman

Research outputs 2012

Background: The Australian Private Health Insurance Incentive (PHII) policy reforms implemented in 1997–2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA). Methods and Findings: All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the …

Key Opinion Leaders' Views Regarding Emergency Contraception In India, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief explores the views of key opinion leaders (KOLs) in the field of reproductive health and family welfare on provision of emergency contraception (ECPs). The study’s objective was to gain a better understanding of how the attitudes and beliefs of KOLs might influence policy and program implementation, either encouraging or opposing ECP promotion and service delivery. Results suggest strong support by the majority of KOLs to continue the sale of ECP as an over-the-counter drug. KOLs also emphasized the importance of comprehending and addressing the main barriers to ECP provision and use: poor knowledge, lack of training, moral …

Providers' Attitudes And Practices Regarding Emergency Contraception In India: Key Findings, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief reports key findings of a study in India that explored providers’ knowledge of how emergency contraception (ECP) works and its safety and effectiveness, their perceptions of the frequency of repeat use, their provision of ECP, and their attitudes toward women who seek it. Many of the findings of this study are encouraging. Most providers believed that ECP is an effective and safe method to prevent pregnancy and that it cannot induce abortion, and half supported the over-the-counter provision of ECP. Nevertheless, the study revealed many biases and gaps in knowledge. Recommendations include a number of ways to …

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …

Providers' And Key Opinion Leaders' Attitudes And Practices Regarding Emergency Contraception In Senegal: Key Findings, Babacar Mane, Martha Brady, Saumya Ramarao, Fatou Bintou Mbow

Reproductive Health

This study examines providers’ and key opinion leaders’ knowledge, attitudes, and practices regarding the emergency contraceptive pill (ECP) in Senegal, and synthesizes the findings to suggest program and policy recommendations. Analysis of providers’ opinions and beliefs reveals that although many providers believe ECP is a safe product, persistent negative views remain. KOLs and providers recognize the importance of ECP for preventing unintended pregnancy and are supportive of the integration of ECP into national guidelines. They note, however, the need to improve accessibility and quality of provision. Given the magnitude of sexual violence and abuse, considerable interest exists in devising strategies …

Attitudes, Croyances Et Pratiques Des Leaders D'Opinion Clés (Loc) Et Des Prestataires Sur La Contraception D'Urgence (Cu) Au Sénégal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In Senegal, initiatives for mainstreaming the emergency contraceptive pill (ECP) in the family planning program are fairly recent. Service statistics indicate, however, that ECP distribution through the public sector is very low. While most users access ECPs through the private sector, the volume of sales is not clear, due to the absence of an operational information system of EC distribution through pharmacies. In an effort to strengthen EC provision in Senegal and reposition EC within the FP program, the Population Council conducted a study in collaboration with the Reproductive Health Division of the Ministry of Health, Senegal to document the …

Critical Issues For Integrating Srh And Hiv/Aids Services To Provide Dual Protection Against Unintended Pregnancy And Hiv/Sti Acquisition, Population Council

Reproductive Health

This document reports on a one-day symposium that was held by the STEP UP (Strengthening Evidence for Programming on Unintended Pregnancy) Research Program Consortium, coordinated by the Population Council. STEP UP generates policy-relevant research to promote an evidence-based approach for improving access to family planning and safe abortion in Bangladesh, Ghana, India, Kenya, and Senegal. The symposium’s objectives were to review and discuss critical and emerging issues around integrating SRH and HIV and AIDS services to enable dual protection, including new directions in dual protection technology and behaviour change interventions. The meeting also provided an opportunity to discuss the programmatic …

An Examination Of Factors Affecting Non-Urgent Use Of Emergency Department Services By Patients With "Universal" Healthcare, Gregory Smith Feltenberger

Health Services Research Dissertations

The purpose of this research is to examine the factors affecting non-urgent utilization of emergency department (ED) services by individuals with "universal" healthcare using the Behavioral Model of Health Services Use. Since Air Force Medical Service beneficiaries have free and unlimited use of the full-range of healthcare services, they are ideally suited for this study. The findings of this research may also apply to other populations with free or low-cost access to healthcare (i.e., universal or single-payer healthcare). Using secondary data extracted from the Air Force Medical Service's electronic health record system at several military hospitals, this study will present …

Massachusetts Senior Legal Assistance Project Needs Evaluation: Current Demand For Legal Services, Alison Gottlieb, Lauren A. Martin, Ellen A. Bruce

Gerontology Institute Publications

The Gerontology Institute at the University of Massachusetts Boston was contracted to conduct a statewide needs assessment for the MSLAP. As agreed upon by the MSLAP Advisory Board, the focus of this assessment was to analyze the demand for services Massachusetts legal service providers have experienced recently as a means to understanding the legal needs of Massachusetts elders (age 60 and older). A second needs assessment was conducted by the Massachusetts Executive Office of Elder Affairs. That needs assessment surveyed home care workers and other elder agency personnel to gauge their assessment of elders’ legal needs in Massachusetts. Read together, …