Health Policy Commons^™

Veterans Health Administration Enrollees’ Choice Of Care Setting Relates To The Expansion Of Care Options: Evidence From Screening Colonoscopies Before And After The Mission Act, Chase S Eck, Cheng Jiang, Laura A Petersen

Center for Medical Ethics and Health Policy Staff Publications

Objective: To estimate whether those enrolled in the Veterans Health Administration (VHA) were less likely to use VHA-delivered colorectal cancer screening colonoscopies after the MISSION Act.

Data sources and study setting: Secondary data were collected on VHA-enrolled Veterans from FY2017-FY2021.

Study design: This retrospective cross-sectional study measured the volume and share of screening colonoscopies that were VHA-delivered over time and by drive time eligibility-defined as living more than 60 min away from the nearest VHA specialty-care clinic. We used a multivariable logistic regression to adjust for patient and facility factors.

Data extraction: Data were extracted for VHA enrollees (n = …

Should Secondary Pharmacogenomic Variants Be Actively Screened And Reported When Diagnostic Genome-Wide Sequencing Is Performed In A Child?, Jan M Friedman, Yvonne Bombard, Bruce Carleton, Amalia M Issa, Bartha Knoppers, Sharon E Plon, Vasiliki Rahimzadeh, Mary V Relling, Marc S Williams, Clara Van Karnebeek, Danya Vears, Martina C Cornel

Center for Medical Ethics and Health Policy Staff Publications

This white paper was prepared by the Global Alliance for Genomics and Health Regulatory and Ethics Work Stream's Pediatric Task Team to review and provide perspective with respect to ethical, legal, and social issues regarding the return of secondary pharmacogenomic variants in children who have a serious disease or developmental disorder and are undergoing exome or genome sequencing to identify a genetic cause of their condition. We discuss actively searching for and reporting pharmacogenetic/genomic variants in pediatric patients, different methods of returning secondary pharmacogenomic findings to the patient/parents and/or treating clinicians, maintaining these data in the patient's health record over …

Human Zoo Healthcare At The 1904 World’S Fair, Angel Blake

Undergraduate Research Symposium

Human Zoo Healthcare at the 1904 World’s Fair

Were precautions taken or put into place for the Human Zoo performers at the 1904 World’s Fair? This topic has been overlooked and understudied by historians, there are few articles written and we do not know the true death toll which shows the racism towards these indigenous peoples. The research for this project was conducted at the State Historical Society of Missouri, the St. Louis Mercantile Library, Newspapers.com, Archives.com, St. Louis Public Library, and the Missouri Historical Society, including research on primary sources such as official World’s Fair committee meeting minutes, hospital …

Implementing Universal Health Insurance: Case Study Of Stakeholders' Perspectives In Port Said, Egypt, Rana Hetta

Theses and Dissertations

This research delves into the multifaceted dimensions of healthcare access through the lens of stakeholders in Port Said, Egypt, following the implementation of Universal Health Insurance (UHI) policies. The central research question explores the impact of UHI policies on healthcare access in Port Said. A set of investigative questions guides this exploration, focusing on beneficiary experiences, healthcare staff perspectives, and the alignment of UHI system implementation with beneficiaries’ healthcare needs. This study seeks to comprehend the institutional and policy context of UHI in Egypt, providing insights from policymakers, healthcare workers, and beneficiaries. Port Said serves as a case study, given …

Design Of Computerized Patient Registration Application System At Tanjung Pati Health Center, Oktamianiza Oktamianiza, Vitratul Ilahi, Kalasta Ayunda Putri, Yulfa Yulia, Rahmadhani Rahmadhani

Journal of Indonesian Health Policy and Administration

One of the shortcomings of manual patient registration systems is the procedures that affect the efficiency of service care to patients. Therefore, researchers are interested in designing a computerized patient registration application using Microsoft Access software. The type of research used is Research and Development (R&D). This research was conducted at Tanjung Pati Community Health Center, with in-depth interviews with two registration officers. The research results show that the data elements needed to design the patient registration application system, sourced from the Patient Registration Book, will be developed by creating an application system using UML modeling. The application system undergoes …

The Effect Of Compensation Policy And Work Discipline On Nurse Productivity At Dr. H. Marzoeki Mahdi Mental Hospital Bogor In 2023, Icha Tiara Devi Febrianti, Helen Andriani

Journal of Indonesian Health Policy and Administration

Health worker productivity problems due to suboptimal institutional management still often occur, including at the dr. H. Marzoeki Mahdi Mental Hospital (RSJMM). Nurses are the most significant number of health workers in hospitals with a high level of patient intervention; inappropriate treatment risks decreasing work productivity. This research aims to analyze the effect of financial compensation, non-financial compensation, and work discipline on nurse productivity at RSJMM. The research study used a quantitative approach by distributing questionnaires to 205 nurses. The results showed partially (1) financial compensation has no significant effect on nurse productivity (Sig. value 0.953 > 0.05, β=0.002); (2) Non-financial …

Analysis Of Needs And Service Capacity Of Bpjs At First-Level Healthcare Facilities In Bandung District, Rizki Amalia Rahmah, Mursyid Hasan Basri

Journal of Indonesian Health Policy and Administration

The community's need for BPJS services at Primary Health Facilities (FKTP) can be well met if adequate service capacity is available. This research aims to analyze the gap between the needs and capacity of BPJS services in FKTPs in Bandung District. This quantitative study uses secondary data owned by Dinas Kesehatan Provinsi Jawa Barat and BPJS Kesehatan Kantor Cabang Soreang. The calculation of needs uses the number of BPJS participants registered in each FKTP, and the calculation of service capacity is based on the duration of service and the number of general practitioners in the FKTP. Out of the 187 …

Relationship Of Remuneration Policy To The Performance Of Specialist Doctors In The Kramat Jati Regional General Hospital In 2022, Roy Michael Suranta, Ascobat Gani, Adang Bachtiar

Journal of Indonesian Health Policy and Administration

The number and types of hospitals in Jakarta are constantly increasing, causing competition for customers or patients. Hospitals owned by the DKI Jakarta provincial government face challenges in providing specialist doctor services with the best performance for the community, this is closely related to the rewards offered to specialist doctors. One of the regional government's efforts to improve the performance of specialist doctors is by issuing regulations on remuneration for hospitals. This research aims to determine the relationship between remuneration policy and the performance of specialist doctors at Kramat Jati Regional Hospital. The research was conducted using a case study …

The Influence Of The Green Hospital Implementation Policy On The Energy Saving Behavior Of Xyz Hospital Employees Using The Theory Of Planned Behavior Approach, Dika Asmawati, Wiku Bakti Bawono Adisasmito, Masyitoh Basabih

Journal of Indonesian Health Policy and Administration

This research uses the Theory of Planned Behavior as the theoretical framework to analyze the relationship between the implementation of green hospital policy and energy-saving behaviors of employees in the hospital environment. The study's sample consists of 150 permanent employees, and the statistical data are analyzed using the Structural Equation ModelingPartial Least Square (SEM-PLS) technique. The analysis results indicate that implementing the green hospital policy influences the supportive factors of behavior: attitudes, subjective norms, and perceived behavioral control. However, the tests also reveal that subjective norms do not positively correlate with the energy-saving behaviors of employees at the hospital. The …

Personalized Trial Ethics And Institutional Review Board Submissions, Joyce P Samuel, Susan H Wootton

Faculty, Staff and Student Publications

The ethical and regulatory oversight of any clinical activity related to human subjects is commonly determined based on its categorization as either clinical practice or research. Prominent bioethicists have criticized the traditional distinctions used to delineate these categories, calling them counterproductive and outmoded, and arguing that learning and clinical practice should be deliberately and appropriately integrated. Personalized trials represent a clinical activity with characteristics that overlap both categories, making ethical and regulatory oversight requirements less straightforward. When the primary intent of the personalized trial is to assist in the conduct of individualized patient care with an emphasis on protecting the …

Legal, Policy, And Environmental Scholars Discuss Global Food Systems At Indiana Law Symposium, James Owsley Boyd

Keep Up With the Latest News from the Law School (blog)

The Indiana University Maurer School of Law and its Indiana Journal of Global Legal Studies are hosting scholars from around the country Friday and Saturday (Jan. 19-20) for an interdisciplinary discussion on one of the world’s most prevalent problems—food insecurity.

Data from the World Bank estimate more than 780 million people around the world suffered from chronic hunger in 2022. As climate change affects agricultural production and water accessibility, the problem could worsen in coming years.

“A Fragile Framework: How Global Food Systems Intersect with the International Legal Order, the Environment, and the World’s Populations” will bring together legal, policy, …

Waiving Snap Interviews During The Covid-19 Pandemic Increased Snap Caseloads, Colleen Heflin, William Clay Fannin, Leonard M. Lopoo, Siobhan O'Keefe

Center for Policy Research

Food insecurity in the United States reached historically high rates during the COVID-19 pandemic, thus substantially increasing demand for the Supplemental Nutrition Assistance Program (SNAP). To facilitate access to SNAP during the pandemic, the federal government granted state SNAP offices the option to waive the interview requirement – an administrative burden associated with the SNAP certification process. This brief summarizes findings from a recent study that used data from SNAP offices across 10 states to examine the impact of SNAP interview waivers on SNAP caseloads from January 5th to April 30th of 2021. Findings reveal that counties that implemented the …

The Million Veteran Program 1990-1991 Gulf War Era Survey: An Evaluation Of Veteran Response, Characteristics, And Representativeness Of The Gulf War Era Veteran Population, Kelly M Harrington, Rachel Quaden, Lea Steele, Drew A Helmer, Elizabeth R Hauser, Sarah T Ahmed, Mihaela Aslan, Krishnan Radhakrishnan, Jacqueline Honerlaw, Xuan-Mai T Nguyen, Sumitra Muralidhar, John Concato, Kelly Cho, J Michael Gaziano, Stacey B Whitbourne, On Behalf Of The Va Million Veteran Program

Center for Medical Ethics and Health Policy Staff Publications

To address gaps in understanding the pathophysiology of Gulf War Illness (GWI), the VA Million Veteran Program (MVP) developed and implemented a survey to MVP enrollees who served in the U.S. military during the 1990–1991 Persian Gulf War (GW). Eligible Veterans were invited via mail to complete a survey assessing health conditions as well as GW-specific deployment characteristics and exposures. We evaluated the representativeness of this GW-era cohort relative to the broader population by comparing demographic, military, and health characteristics between respondents and non-respondents, as well as with all GW-era Veterans who have used Veterans Health Administration (VHA) services and …

Budget Capping Health Care: Its Impact On Health, Susan Chen

Theses and Dissertations

The goal of a budget cap on healthcare is to constrain total healthcare expenditure without compromising quality. This paper examines the impacts of budget capping on health and behavioral health outcomes, exploiting the completed Maryland All-Payer Model and the ongoing, extensional Maryland Total Cost of Care model, both of which capped healthcare budgets in Maryland. I use data from 2011-2021 surveys of the Behavioral Risk Factor Surveillance system and generalized difference-in-difference regression models to find that budget capping improves health and behavioral health outcomes with a greater favorable effect during the Maryland Total Cost of Care model.

Fitting A Covid-19 Model Incorporating Senses Of Safety And Caution To Local Data From Spartanburg County, South Carolina, D. Chloe Griffin, Amanda Mangum

CODEE Journal

Common mechanistic models include Susceptible-Infected-Removed (SIR) and Susceptible-Exposed-Infected-Removed (SEIR) models. These models in their basic forms have generally failed to capture the nature of the COVID-19 pandemic's multiple waves and do not take into account public policies such as social distancing, mask mandates, and the ``Stay-at-Home'' orders implemented in early 2020. While the Susceptible-Vaccinated-Infected-Recovered-Deceased (SVIRD) model only adds two more compartments to the SIR model, the inclusion of time-dependent parameters allows for the model to better capture the first two waves of the COVID-19 pandemic when surveillance testing was common practice for a large portion of the population. We find …

Unveiling A Hidden Peril: Unanticipated Emergence Of Diaphragmatic Hernia After Trauma, Deepak Benny Dr, Deepak K. S Dr, Vishal S. Dharpur Dr, Priyanshi Tapadia

Radiology Teaching Files

This case report presents a rare instance of a delayed diagnosis of obstructed diaphragmatic hernia in a 57-year-old male, a year after sustaining trauma. The patient initially presented with abdominal pain and obstipation, without any overt signs of diaphragmatic injury. Diagnostic challenges were compounded by the patient's non-specific symptomatology and the absence of immediate post-traumatic complications. The report discusses the clinical presentation, diagnostic imaging, and therapeutic management, underscoring the importance of considering diaphragmatic hernia in differential diagnoses of abdominal pain post-trauma. The case highlights the necessity for heightened clinical vigilance and the pivotal role of advanced imaging techniques in diagnosing …

Unveiling The Silent Specter: A Comprehensive Exploration Of Silent Sinus Syndrome, Deepak Benny Dr, Sudha Kiran Das Dr, Shwetha R. Poojary Dr, Priyanshi Tapadia

Radiology Teaching Files

A 42-year-old individual presented to the outpatient clinic with subtle facial asymmetry noted over the past year, primarily characterized by a progressive, painless sinking of the right eye (enophthalmos). The patient reported a history of mild, intermittent nasal obstruction but no acute sinus infections, significant nasal discharge, or facial pain. Despite these mild symptoms, the patient expressed concern over the noticeable change in facial appearance and occasional double vision, which prompted a visit to the clinic.The patient described a gradual onset of the right eye appearing "sunken" without any preceding trauma, infection, or significant weight loss. Initially dismissed as a …

Pericallosal Lipoma Unveiled: A Rare Case Of Incidental Discovery And Its Clinical Implications, Deepak Benny Dr, Sachin P. Shetty Dr, Kavitha B. C Dr, Sinchana N Dr

Radiology Teaching Files

This case report delves into the incidental finding of a pericallosal lipoma during routine neuroimaging conducted for non-specific neurological symptoms. It provides a detailed examination of the lipoma's radiological features, outlines the clinical significance of such findings, and discusses the management approach adopted, including considerations for surgical intervention versus conservative monitoring. The report further explores the implications of incidental pericallosal lipomas on patient outcomes, emphasizing the need for awareness among clinicians about this rare condition and the importance of individualized patient care strategies in the context of such incidental neuroimaging discoveries.

Emerging Mania In Young Adulthood: A Case Report Of Idiopathic Fahr's Syndrome Unveiling Neuropsychiatric Dimensions, Deepak Benny Dr, Shwetha R. Poojary Dr, Kavya B. T Dr, Sudha Kiran Das Dr.

Radiology Teaching Files

This case report outlines the diagnosis and management of an 18-year-old male presenting with first episode mania, attributed to idiopathic Fahr's Syndrome. Despite having no significant past medical or psychiatric history, the patient exhibited classic manic symptoms alongside grandiose delusions. Notably, CT imaging revealed brain calcifications characteristic of Fahr's Syndrome, absent metabolic disturbances commonly associated with the disorder. This case underscores the clinical complexity of Fahr's Syndrome, illustrating its potential to manifest primarily with psychiatric symptoms and the importance of integrating neuroimaging in the psychiatric evaluation to uncover underlying neurological disorders.

Pulmonary Infarction, Manu Chaudhary Dr, Sachin P. Shetty Dr, Sinchana N Dr

Radiology Teaching Files

68 years old female presented with breathlessness and chest pain to EMD, on clinical examination her saturation was low and D-Dimer levels were significantly elevated raising the possibility of pulmonary thromboembolism. Further the patient was referred for chest radiograph and CT thorax with contrast for better evaluation and was diagnosed with pulmonary thromboembolism with pulmonary infarct. The patient was treated for the same.

An Uncommon Culprit In Sma Syndrome: Navigating Through Duodenal Adenocarcinoma-Induced Obstruction, Deepak Benny Dr, Vikram Patil, Shrisagar R A

Radiology Teaching Files

Superior Mesenteric Artery (SMA) Syndrome is an infrequent vascular compression disorder, characterized predominantly by the extrinsic obstruction of the third part of the duodenum by the SMA, leading to a spectrum of gastrointestinal symptoms. While most commonly associated with rapid weight loss and anatomical variations, its occurrence in the context of adjacent malignancies remains exceedingly rare and clinically significant.

Here I detail a compelling case of a 49-year-old male, initially presenting with nonspecific symptoms of intermittent abdominal pain and vomiting. The diagnostic journey, propelled by computed tomography (CT) and subsequent investigations, unveiled an underlying duodenal adenocarcinoma exerting extrinsic pressure, precipitating …

Maine Provider Attitudes Towards Contingency Management For Substance Use Disorders, Evelyn Ali, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

This report summarizes healthcare provider attitudes toward Contingency Management (CM), including barriers and facilitators to its implementation. A 17-question electronic survey, including the Contingency Management Beliefs Questionnaire (CMBQ), was distributed to providers across Maine. Of 131 eligible respondents, 80% reported treating SUD, yet only 27% had experience with CM. While training and organizational support were cited as barriers, overall attitudes toward CM were favorable. Providers expressed strong willingness to implement CM, citing its potential to engage clients and support treatment adherence. The report concludes that positive perceptions of CM outweigh concerns and suggests that training and organizational support could enhance …

Treatment And Recovery Beliefs Of Rural Vermont Family Members Of People With Opioid Use Disorder, Kate Peasley-Miklus Phd, Julia Shaw Mph, Katie Rosingana Ba, Mary Lindsey Smith Phd, S. Sigmon, Sarah H Heil Phd, J. Jewiss, Andrea C Villanti, Valerie S Harder

Substance Use Research & Evaluation

Purpose: Few studies have addressed beliefs about treatment for opioid use disorder (OUD) among family members of people with OUD, particularly in rural communities. This study examined the beliefs of rural family members of people with OUD regarding treatment, including medication for OUD (MOUD), and recovery. Methods: Semi-structured qualitative interviews were conducted with rural Vermont family members of people with OUD. Twenty family members completed interviews, and data were analyzed using thematic analysis. Results: Four primary themes related to beliefs about OUD treatment emerged: (1) MOUD is another form of addiction or dependency and should be used short-term; (2) essential …

Healthy Acadia Downeast Community Opioid Response Program: Year 3 Summary, Tyler Egeland Ba, Gordon Mcintire Ba, Evelyn Ali, Mary Lindsey Smith Phd, Katie Rosingana Ba

Substance Use Research & Evaluation

The Downeast Substance Treatment Network is a group of diverse organizations working to improve integration and access to treatments and services for people with substance use disorder. The consortium’s Rural Communities Opioid Response Program grant project aims to: (1) expand the reach of their treatment network, (2) increase awareness and practice of harm reduction, and (3) facilitate transitions of care to improve partner efficacy. This project included a mixed-methods evaluation led by Catherine E. Cutler Institute’s Substance Use Research and Evaluation Team (SURE). This final year 3 summary presentation includes feedback from program partners, key informants, and program clients, in …

Nicotine Addiction: A Hidden Health Crisis, Macy J. Mcgrath, Andrea Walker, Anahita Mohammadkhah

[Archive] Belmont University Research Symposium (BURS)

In the United States, nicotine addiction is an ongoing health crisis (U.S Food and Drug Administration, 2023). Pivotal to this crisis is the prevalence and ease of access to devices that deliver nicotine. Covering a broad spectrum, devices range from traditional forms of tobacco such as cigarettes, pipes, etc. to new nicotine devices such as e-cigarettes and vapes. Yet, even with the health crisis looming, more and more individuals are becoming addicted to nicotine (Ayers et al., 2011; Lyu et al., 2022; Pokhrel et al., 2021). In particular, research indicates that the 18-24 age demographic is significantly more likely to …

Qualitative Brief: Perspectives On Opioid Use Disorder Treatment Access And Engagement From Rural Family Members And People In Treatment, Katie Rosingana Ba, Evelyn Ali Mph, Tyler Egelund Ba, Mary Lindsey Smith Phd, Kate Peasley-Miklus Phd, J. Shaw

Substance Use Research & Evaluation

"This qualitative data brief provides findings from the Vermont baseline needs assessment, conducted in collaboration with research staff at the University of Southern Maine's Catherine Cutler Institute, with the goal to identify current and future opioid use disorder (OUD) treatment needs and barriers in rural Vermont. This data brief aims to identify current and future addiction treatment needs and barriers in Vermont with direct input from practitioners, community partners, and people impacted personally by opioid use. Preceptions included in this data brief are informed by semi-structured qualitative interviews conducted with family members of people with lived experience (PWLE). For more …

Time To Ask Program At Redington-Fairview General Hospital: Summary Of Participant Feedback, Mary Lindsey Smith Phd, Tyler Egeland Ba, Evelyn Ali Bs

Substance Use Research & Evaluation

The goals of the Time to Ask (TTA) education and quality improvement program are to increase the capacity of the interprofessional care team to effectively, efficiently and compassionately discuss alcohol use with their patients through screening, brief intervention, and referral (SBIRT) as well as to expand regular screening and monitoring of unhealthy alcohol use at the practices. This infographic is a summary of a participant feedback following the TTA program at Redington-Fairview General Hospital. For more information, please contact Lindsey Smith at [email protected]

Healthy Acadia Downeast Community Opioid Response Program: Year 2 Summary, Mary Lindsey Smith Phd, Evelyn Ali Bs, Katie Rosingana Ba

Substance Use Research & Evaluation

The Downeast Substance Treatment Network is a group of diverse organizations working to improve integration and access to treatments and services for people with substance use disorder. The consortium’s Rural Communities Opioid Response Program grant project aims to: (1) expand the reach of their treatment network, (2) increase awareness and practice of harm reduction, and (3) facilitate transitions of care to improve partner efficacy. This project included a mixed-methods evaluation led by Catherine E. Cutler Institute’s Substance Use Research and Evaluation Team (SURE). This year 2 summary presentation includes feedback from program partners, key informants, and program clients, in addition …

The Rural Health Action Network Enhanced Outreach Initiative: Year 2 Interim Evaluation Report, Mary Lindsey Smith Phd, Evelyn Ali Bs, Tyler Egeland Ba, Katie Rosingana Ba

Substance Use Research & Evaluation

Healthy Community Coalition (HCC), in coordination with the Rural Health Action Network (RHAN) of greater Franklin County, is implementing a multi-faceted outreach program to improve health outcomes among the rural poor living with chronic conditions in greater Franklin County, Maine. The goals of the Franklin County Rural Health Action Network Enhanced Outreach Initiative (RHAN-EOI) include: (1) Expand access to quality services; (2) Expand training for community health extenders; (3) Decrease hospital admissions, emergency department use, and costs; and (4) Improve communication and care coordination across project partners. This report highlights the implementation and progress of HCC RHAN in Year 2. …

The Impact Of Censorship On Covid-19 Policy Formation In The United States, Victor Wallis

Faculty Works

No abstract provided.