Health Policy Commons^™

Ambulance Deserts: Geographic Disparities In The Provision Of Ambulance Services [Chartbook], Yvonne Jonk Phd, Carly Milkowski Mph, Zachariah Croll Mph, Karen Pearson Mlis, Ma

Emergency Medical Services (EMS)

This chartbook begins with a broad overview of ambulance services including common types of organizational structure(s) and workforce and reimbursement issues. The methods section provides our definition of ambulance deserts and describes how ambulance deserts are illustrated in the national and state maps. The results section begins with an overall description of the prevalence of ambulance deserts in rural and urban counties across the 41 states for which data were available at the time, and the variation in the percent of people living in ambulance deserts across the four census regions. States are ranked in terms of the percent of …

Western Maine Addiction And Recovery Initiative's Substance Misuse Prevention And Wellness Day: Year 1 Feedback Survey For Ohchs And Telstar, Tyler Egeland Ba, Evelyn Ali Bs, Mary Lindsey Smith Phd

Substance Use Research & Evaluation

As part of the evaluation of the Western Maine Addiction Recovery Initiative’s (WMARI) HRSA Rural Communities Opioid Response Program grant, staff from the Catherine Cutler Institute developed a survey to gather feedback from individuals who participated in the SUD Day events. Two separate PRE/POST surveys were deployed at each high school (OHCHS and Telstar) to assess knowledge gain, beliefs, and satisfaction. For more information, please contact Lindsey Smith at [email protected]

Living And Dying In 'Cancer Alley': Using Human Rights Law And Environmental Justice To Create A Litigation Framework For Marginalized Communities, Neeharika Sistu

Honors Scholar Theses

Cancer Alley, Louisiana is a poignant example of the intersection between environmental justice, legal harm, and human rights abuses. This thesis dissects the laws and policies underpinning the creation of Cancer Alley with special attention to how they constitute human rights abuses under the International Covenant on Civil and Political Rights and the International Convention on the Elimination of All Forms of Racial Discrimination.

Then, by performing a comprehensive analysis of litigation surrounding environmental justice in Louisiana, this thesis scrutinizes the efficacy of environmental law in creating environmental justice and suggests the integration of international human rights law and environmental …

Attitudes Towards Gluten Free Foods And Celiac Disease In Italy, Joellyn Speredelozzi

Senior Honors Projects

This project addresses the perception and realities of living with Celiac’s Disease in Italy. I combine a literature review with my own anecdotal experiences as an individual with Celiac’s Disease who has lived and studied in Italy. In my paper, I first describe the high awareness of gluten-free living that I noted the first time I studied abroad, being the impetus of this project. I follow this with the history and science of Celiac’s Disease for those who may be unaware of this serious chronic medical condition. I then continue to describe personal experiences I had while living in Naples, …

Evaluating Community Based Trauma Among Behavioral Health Workers, Leslie M. Santillan Pina

Capstone Projects and Master's Theses

Due to the national lack of service providers, current providers are experiencing high levels of stress/trauma because of workload, expectations, and the emotional toll these essential jobs have. Monterey County Behavioral Health Bureau is a public government agency that provides mental health services to the community. The purpose of this capstone is to allow clinicians to express the factors that contribute to the stressors of their jobs in hopes of creating change that will alleviate the trauma they experience. This project had three focus group interviews and one key informant interview that gave expected results based on the contributing factors …

Developing The Food Navigator Role At Everyone's Harvest, Chase Rodriguez

Capstone Projects and Master's Theses

Everyone’s Harvest (EH) is a 501(c)(3) non-profit that operates farmers’ markets. In order to reduce hunger in Monterey County, Everyone's Harvest offers several food assistance programs for low-income people including the Market Match (MM) incentive program which matches CalFresh money, modern day food stamps, dollar for dollar. The problem is that in Monterey County 1 in 4 adults and 1 in 3 children are food insecure. The purpose of the Food Navigator (FN) at EH is to engage with the local community and connect low-income people with food assistance resources, primarily the MM program. This project was a role development …

National Cancer Control Plan Of The Korea: Current Status And The Fourth Plan (2021-2025), Kyu-Tae Han, Jae Kwan Jun, Jeong-Soo Im

Faculty, Staff and Student Publications

Cancer management has become a major policy goal for the government of the Korea. As such, the government introduced the National Cancer Control Plan (NCCP) to reduce the individual and social burdens caused by cancer and to promote national health. During the past 25 years, 3 phases of the NCCP have been completed. During this time, the NCCP has changed significantly in all aspects of cancer control from prevention to survival. The targets for cancer control are increasing, and although some blind spots remain, new demands are emerging. The government initiated the fourth NCCP in March 2021, with the vision …

Ethical Hazards Of Health Data Governance In The Metaverse, Kristin Kostick-Quenet, Vasiliki Rahimzadeh

Center for Medical Ethics and Health Policy Staff Publications

Metaverse-enabled healthcare is no longer hypothetical. Developers must now contend with ethical, legal and social hazards if they are to overcome the systematic inefficiencies and inequities that exist for patients who seek care in the real world.

The Continuing Rise Of The Opioid Epidemic In Appalachian Regions: A Public Health Analysis Of Regional Programs And Potential Solutions, Holly Frye

Undergraduate Honors Theses

The purpose of this study is to closely analyze opioid overdose response efforts on county, state, and federal levels in designated Appalachian regions in order to better understand program methodology standards that ensure success in combating the opioid epidemic in Appalachia. All data sources used are publicly available and contain de-identifiable population health information. During research on this topic, how to define the opioid epidemic, identification of root causes, and existing response effort methodology were addressed. The existing response methods of county, state, and federal programs are expensive and hard to implement with limited success. While the complexity of response …

A Concept Analysis Of The Patient Experience, Tanja Avlijas Rn, Mscn, Janet E. Squires Rn, Phd, Michelle Lalonde Rn, Phd, Chantal Backman Rn, Phd

Patient Experience Journal

Patient experience, an essential indicator of quality patient care, is of increasing importance to hospitals that want to improve and maintain strong patient experience metrics to remain competitive in the business of healthcare. The aim of this study was to clarify the concept of the patient experience by identifying its existing definitions, methods of measurement, and underlying themes and attributes, to differentiate it from similar concepts and propose an operational and theoretical definition to guide valid and reliable development of future assessment tools. Walker and Avant’s eight-step methodology served as the framework for this concept analysis. A literature search, using …

The Proposed Eu Directives For Ai Liability Leave Worrying Gaps Likely To Impact Medical Ai, Mindy Duffourc, Sara Gerke

Faculty Scholarly Works

Two newly proposed Directives impact liability for artificial intelligence in the EU: a Product Liability Directive (PLD) and an AI Liability Directive (AILD). While these proposed Directives provide some uniform liability rules for AI-caused harm, they fail to fully accomplish the EU’s goal of providing clarity and uniformity for liability for injuries caused by AI-driven goods and services. Instead, the Directives leave potential liability gaps for injuries caused by some black-box medical AI systems, which use opaque and complex reasoning to provide medical decisions and/or recommendations. Patients may not be able to successfully sue manufacturers or healthcare providers for some …

The Effects Of Multiple Micronutrient Fortified Beverage And Responsive Caregiving Interventions On Early Childhood Development, Hemoglobin, And Ferritin Among Infants In Rural Guatemala, Alysse J. Kowalski, Victor Alfonso Mayen, Silvia De Ponce, Kaley B. Lambden, Nick Tilton, Lisa M. Villanueva, Ana M. Palacios, Greg A. Reinhart, Kristen M. Hurley, Maureen M. Black

Health Policy & Community Health: Faculty Publications

Undernutrition and a lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a 6-month 2 × 2 cluster-randomized trial to assess the effects of multiple micronutrient-fortified beverages and responsive caregiving interventions among infants 6–18 months in 72 community sectors in southwest Guatemala. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development) and socioemotional development (Brief Infant Toddler Socio-Emotional Assessment) and measured ferritin and hemoglobin on a subsample. The trial was analyzed using linear mixed models. At the baseline, the mean age (SD) was …

Framing The Family: A Qualitative Exploration Of Factors That Shape Family-Level Experience Of Pediatric Genomic Sequencing, Hadley Stevens Smith, Emily S Bonkowski, Madison R Hickingbotham, Raymond Belanger Deloge, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Families of children with rare and undiagnosed conditions face many psychosocial and logistical challenges that may affect their approach to decisions about their child’s care and their family’s well-being. As genomic sequencing (GS) is increasingly incorporated into pediatric diagnostic workups, assessing the family-level characteristics that shape the experience of pediatric GS is crucial to understanding how families approach decision-making about the test and how they incorporate the results into their family life. We conducted semi-structured interviews with parents and other primary caregivers of pediatric patients who were evaluated for a suspected genetic condition and who were recommended to have GS …

Framing The Family: A Qualitative Exploration Of Factors That Shape Family-Level Experience Of Pediatric Genomic Sequencing, Hadley Stevens Smith, Emily S Bonkowski, Madison R Hickingbotham, Raymond Belanger Deloge, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Families of children with rare and undiagnosed conditions face many psychosocial and logistical challenges that may affect their approach to decisions about their child’s care and their family’s well-being. As genomic sequencing (GS) is increasingly incorporated into pediatric diagnostic workups, assessing the family-level characteristics that shape the experience of pediatric GS is crucial to understanding how families approach decision-making about the test and how they incorporate the results into their family life. We conducted semi-structured interviews with parents and other primary caregivers of pediatric patients who were evaluated for a suspected genetic condition and who were recommended to have GS …

Comparing Levels Of Situational Empathy Based On Medium Of Exposure To Covid-19 Mortality Information And Proximity To Others, Beth Durkin

Honors Projects

In response to the COVID-19 pandemic, many people expressed a lax attitude to the policies put in place to keep the public safe despite the high risk of infection and its devastating effects on health across the United States. It is possible that this response may be partially due to a “numbness to numbers,” a phenomenon that describes diminished empathy for a large group of people experiencing a negative event (eg. COVID-19). The present study explored the relationship between levels of situational empathy and the medium of exposure to COVID-19 mortality information (eg. personal story or fact sheet) in an …

A Better Life: Factors That Help And Hinder Entry And Retention In Mat From The Perspective Of People In Recovery, Adam D. Baus, Martha Carter, Jennifer Boyd, Erin Mcmullen, Trey Bennett, Alexandra Persily, Danielle M. Davidov, Christa Lilly

Journal of Appalachian Health

Introduction: Opioid addiction and opioid-related overdoses and deaths are serious public health problems nationally and in West Virginia, in particular. Medication-assisted treatment (MAT) is an effective yet underutilized treatment for opioid use disorder (OUD).

Purpose: Research examining factors that help individuals succeed in MAT has been conducted from provider and program perspectives, but little research has been conducted from the perspective of those in recovery.

Methods: This study, co-developed with individuals in recovery, took place in West Virginia-based MAT programs using an exploratory sequential mixed methods approach. The survey was open February through August 2021. Data were analyzed late 2021 …

Medicaid-Insured Older Adults On Snap May Have Stronger Medication Adherence, Colleen Heflin, Chinedum O. Ojinnaka, Irma A. Arteaga, Leslie Hodges, Gabriella Alphonso

Center for Policy Research

For older adults with hypertension, medication adherence is critical to decreasing hospitalization, poor health outcomes, and healthcare costs. The Supplemental Nutrition Assistance Program (SNAP)—the largest food and nutrition assistance program in the United States—could protect against medication non-adherence. This brief summarizes the findings from a recent study, which linked Missouri Medicaid administrative claims data to SNAP data from 2006 to 2014. The findings suggest that longer and consistent receipt of SNAP benefits was associated with higher levels of antihypertensive medication adherence among Medicaid-insured individuals aged 60 years and older.

Medicaid-Insured Older Adults On Snap May Have Stronger Medication Adherence, Colleen Heflin, Chinedum O. Ojinnaka, Irma A. Arteaga, Leslie Hodges, Gabriella Alphonso

Population Health Research Brief Series

For older adults with hypertension, medication adherence is critical to decreasing hospitalization, poor health outcomes, and healthcare costs. The Supplemental Nutrition Assistance Program (SNAP)—the largest food and nutrition assistance program in the United States—could protect against medication non-adherence. This brief summarizes the findings from a recent study, which linked Missouri Medicaid administrative claims data to SNAP data from 2006 to 2014. The findings suggest that longer and consistent receipt of SNAP benefits was associated with higher levels of antihypertensive medication adherence among Medicaid-insured individuals aged 60 years and older.

Environmental And Social Factors Associated With High Chronic Kidney Disease Mortality Rates In Municipalities Of Guatemala: An Ecological Study Of Municipal-Level Mortality Data, Alejandro Cerón

Anthropology: Faculty Scholarship

The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009–2019 period for each of the country’s 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009–2019 period. Average crude mortality rate for …

Exploring Hapi Incidence In Patients Admitted Through The Ed: A Quality Improvement Initiative, Alexa L. Tietgens

DNP Projects

Each year in the U.S., pressure injuries, or PIs, are responsible for more than 60,000 patient deaths and billions of dollars’ worth of treatment costs. Research shows that roughly 95% of all PIs are preventable by following evidence-based practice guidelines which include early identification of patients at risk, frequent skin assessments, and implementation of prevention strategies. However, the ED environment creates unique risks for PI development due to the routine use of hard surfaces (i.e., stretchers, backboards, exam tables) and frequent hospital overcrowding. Although nurses play a pivotal role in PI prevention, frequent staffing shortages, high patient acuity levels, and …

Financial Rewards Tied To Quality Measures Lead Home Health Agencies To Exaggerate Their Improvements, Jun Li, Meher Chahal

Population Health Research Brief Series

More than 4 million people in the United States use home health care each year, but the quality varies and is often poor. In 2016, the Centers for Medicare & Medicaid Services (CMS) began rewarding and penalizing home health agencies for their performance on a set of predetermined quality measures in an experiment called the Home Health Value-Based Purchasing (HHVBP) program. This brief summarizes the results of a recent study evaluating the program’s impact on quality measures within the HHVBP and whether there was a relationship between incentive size and apparent quality. Findings suggest that while financial rewards improved the …

(Un)Weighted Assumptions: Anti-Fatness & Health, Kieran Chase, Nell Carpenter, Madysen Schreiber

OHSU-PSU School of Public Health Annual Conference

This lecture/discussion session aims to expand and add nuance to public health students’, professors’, and practitioners’ understanding of the interplay between body size and health. We will begin by naming and challenging common assumptions about the relationship between bodyweight and health outcomes. We will then argue for the consideration of weight-related stigma as a Fundamental Cause of Disease as defined by Phelan and Link, and for institutionally embedded anti-fat bias at the policy level (e.g., insurance policy, medical equipment) as a cause of population health inequity as defined in Whitehead’s Health Equity Framework. We offer these frameworks in contrast to, …

Maternal Healthcare Access And Obstetric Complications: A Cause And Effect Relationship?, Lena Sharara

Independent Study Project (ISP) Collection

Poverty-stricken migrant women, named ‘Kayayei or Kayayo’ because of the nature of their job in the informal sector, have high birth rates and are said to have many barriers affecting their access to maternal health resources. In this study, Kayayei in Madina Market were interviewed and both quantitative and qualitative data were gathered to determine whether a relationship exists between access to maternal health and the obstetric complications and outcomes experienced by Kayayei. A Chi-Squared Test of Independence and a Qualitative Content Analysis were both used to analyze the data. Due to a non-significant p-value, it was found that the …

Migrants Sans Papiers: The Impact Of Cantonal Program And Policy Discrepancies On Undocumented Migrant Healthcare Utilization In Switzerland, Denise Peng

Independent Study Project (ISP) Collection

While Switzerland houses what is generally considered one of the best healthcare systems globally, regional policy discrepancies leave undocumented migrants (UDM) in precarious conditions that threaten the nation’s claim to universal health coverage. Critical analyses of existing UDM-catering structures in different cantons, the Swiss Confederation member states, reveal that local discrepancies in healthcare utilization are functional gradients of cantonal support and public endorsement. Relationships with these authorities are instrumental in steering health outcomes not only with program funding and outreach but also management of studies to better understand UDM health determinants and inform future preventative measures.

UDM services and initiatives …

Observaciones De La Medicina Mapuche Y El Mito De La Medicina Interculturalidad En Chile Con La Machi Rosita Barboza, Anat Gilligan-Steinberg

Independent Study Project (ISP) Collection

Chile cuenta con un sistema de salud intercultural, que promueve el acceso a servicios de salud culturalmente competentes para la población indígena. A través de mi pasantía con la machi Rosita Barboza, acompañándola a centros de salud, en ceremonias de sanación mapuche y ayudando en la preparación y distribución de remedios; he llegado a la conclusión de que no es más que un mito de la interculturalidad. Existe un conflicto constante entre las definiciones de salud occidental e indígena, que impiden la disponibilidad de salud complementaria. La salud occidental se basa en una definición biomédica de la salud, la cosmovisión …

Inclusión Cultural En Fonasa: Parto Aymara Como Un Estudio De Caso, Madison Singleton

Independent Study Project (ISP) Collection

Los primeros años de la década de 2000s sirven como un período legal transformador en Chile, debido al auge de los grupos de representación indígena y la introducción de la ley 20.584 que asegura un modelo de interculturalidad en los servicios de salud. El objetivo de esta investigación es comprender los factores que impactaron en la priorización de la inclusión cultural en el sistema público de salud (FONASA), utilizando el parto aymara en Arica como un estudio de caso. Esta investigación toma forma en un diseño de investigación cualitativa y exploratoria utilizando 5 entrevistas y 5 observaciones, así como las …

Medicina Tradicional En La Urbe: El Funcionamiento Del Sistema De Salud Mapuche En Santiago, Mariko Yatsuhashi

Independent Study Project (ISP) Collection

En Santiago, Chile, una ciudad con más de 5 millones de personas, el pueblo originario Mapuche ha logrado la reconstrucción de su sistema tradicional de salud para servir la comunidad urbana de la comunidad mapuche. Hoy en día, la mayoría de gente mapuche viven en ambientes urbanos debido a una migración masiva desde su territorio ancestral en el sur, que creó una población distinta de gente mapuche llamada warriache, o gente de la ciudad. Después de una expansión nacional de los derechos básicos de pueblos originarios en los años ‘90, el pueblo originario Mapuche, junto con otros pueblos originarios, podía …

Doj Withdraws Healthcare Antitrust Protections, Lance Plunkett Jd, Llm

The New York State Dental Journal

DOJ has withdrawn longstanding antitrust guidance that provided safe harbors for specific conduct in the healthcare marketplace.

International Society For Prenatal Diagnosis 2022 Debate 3-Fetal Genome Sequencing Should Be Offered To All Pregnant Patients, Ignatia B Van Den Veyver, Yuval Yaron, Zandra C Deans

Center for Medical Ethics and Health Policy Staff Publications

Prenatal trio exome sequencing (ES) has become integrated into the care for pregnant women when the fetus has structural anomalies. Details regarding optimizing indications for prenatal exome sequencing, its detection rates with different categories of fetal anomalies, and principles of interpretation of pathogenicity of sequence variants are still under investigation. However, there is now growing consensus about its benefits for finding the cause of fetal structural anomalies. What is not established, is whether exome or genome sequencing (GS) has a place in the care of all pregnant women. This report is a summary of the debate on this topic at …

Development And Pilot Testing Of Internet-Delivered, Family-Based Cognitive Behavioral Therapy For Anxiety And Obsessive-Compulsive Disorders In Autistic Youth, Andrew G Guzick, Sophie C Schneider, Amanda B Perozo Garcia, Minjee Kook, Rebecca L Greenberg, David Riddle, Morgan Mcneel, Servando Rodriguez-Barajas, Michelle Yang, Blake Upshaw, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Cognitive behavioral therapy adapted for autistic youth with anxiety and/or OCD has a strong evidence base, but few have access. A 12-week family-based, Internet-delivered cognitive behavioral therapy (iCBT) program for 7-15 year-old autistic youth with anxiety and/or OCD was developed as a potential method to address this problem. Quantitative and qualitative feedback from stakeholders (parents, youth, clinicians) was gathered on an initial draft of content before conducting a pilot trial. This feedback suggested high quality, engagement, usability, and informativeness of the material. Suggestions were incorporated into the treatment program that was tested in a pilot trial. Eight families were randomized …