Health Services Administration Commons^™

Quality And Cost Of Diabetes Mellitus Care In Community Health Centers In The United States., Patrick Richard, Peter Shin, Tishra Beeson, Laura S. Burke, Susan F. Wood, Sara Rosenbaum

Health Policy and Management Faculty Publications

OBJECTIVE: To examine variations in the quality and cost of care provided to patients with diabetes mellitus by Community Health Centers (CHCs) compared to other primary care settings.

RESEARCH DESIGN AND METHODS: We used data from the 2005-2008 Medical Expenditure Panel Survey (N = 2,108). We used two dependent variables: quality of care and ambulatory care expenditures. Our primary independent variable was whether the respondent received care in a Community Health Centers (CHCs) or not. We estimated logistic regression models to determine the probability of quality of care, and used generalized linear models with log link and gamma distribution to …

The Impact Of Ciwa-Ar Tool On Healthcare Professionals, Laronda Tinsley

Applied Research Projects

Alcohol is one of the most abused substances worldwide. The regular consumption of alcohol can lead to dependency which depresses the central nervous system. Consequently, when a heavy drinker is no longer consuming alcohol, the central nervous system is no longer suppressed and may go into a hyperexcitable state known as alcohol withdrawal syndrome (AWS). Symptoms can vary from mild to life threatening. Patients who experience alcohol withdrawal symptoms often have a more complicated hospitalization, an extended length of stay, and increased utilization of intensive care and medical services. The Clinical Institute Withdrawal Assessment of Alcohol Scale-revised (CIWA-Ar) is a …

Measuring Quality Of Health Care In Type Ii Diabetes Mellitus Patients Using Certified Electronic Health Records, Tracey A. Hines

Applied Research Projects

Great strides have been made in health care over the past six years after the implementation of the policy known as meaningful use by the Center of Medicare and Medicaid Services. Health care subsidies and monetary incentive programs were created for eligible professionals and critical area hospitals to encourage the use of certified electronic health records in an effort to improve quality care of all acute and chronically ill patients, as well as provide routine examinations for healthy individuals.

Patients diagnosed with type II diabetes mellitus were studied using a certified electronic health record system for compliance in physician ordered …

Hospital Practices Related To Breastfeeding In Mississippi: A Socio-Ecological Approach, Amir Alakaam

Dissertations

Mississippi continues to have one of the lowest rates and the weakest support in respect to breastfeeding in the nation (Centers for Disease Control and Prevention, 2014a). Hospital practices supporting breastfeeding such as the Ten Steps to Successful Breastfeeding (TSSB) can dramatically increase breastfeeding rates and duration (Rosenberg, Stull, Adler, Kasehagen, & Crivelli-Kovach, 2008). The aim of this study was to explore breastfeeding practices in Mississippi hospitals based on two levels of the Socio-Ecological Model: the organizational level (phase I) examined the hospital practices based on the level of implementation of the TSSB; the individual level (phase II) examined knowledge …

Medicaid Discontinuity Among Adults With Cardiovascular Disease Or High Risk Conditions: Associations With Medication Adherence And Health Care Utilization, Kiraat Divyang Munshi

Theses and Dissertations (ETD)

BACKGROUND: Medicaid coverage among adults is often characterized by discontinuity – loss of Medicaid coverage, and churning, or entering and exiting Medicaid – over short durations. Little is known about the impact of having discontinuous Medicaid coverage on access to care, preventive care, pharmacotherapy, primary care, and hospitalizations, among non-elderly adults with cardiovascular disease (CVD) or high-risk conditions.

OBJECTIVES: This dissertation employed a three empirical research papers approach to pursue the following aims: (1) characterize the adult subpopulations with CVD or conditions placing them at high risk for CVD who lack continuous Medicaid coverage, and examine the characteristics associated with …

Universal Health Coverage Assessment Pakistan, Muhammad Ashar Malik

Community Health Sciences

No abstract provided.

Medicare Part B Premiums And Social Security Benefits, Sally Coberly

National Health Policy Forum

This paper describes the annual determination of beneficiaries' premiums for voluntary Medicare Part B coverage and a provision known as "hold harmless." The hold-harmless provision prevents a beneficiary's Social Security payments from being reduced as a result of an increase in the Part B premium. Because there was no cost-of-living increase for Social Security benefits for 2016, the hold-harmless provision will be in effect. This paper discusses what happens to premiums in 2016 for beneficiaries who are not held harmless—new beneficiaries, beneficiaries who do not participate in Social Security, those who are dually eligible for Medicare and Medicaid, and higher-income …

Assessment Of Quality Improvement In Ontario Public Health Units, Madelyn P. Law, J. Ross Graham, Erica Bridge

Frontiers in Public Health Services and Systems Research

Background: Quality Improvement (QI) approaches are used extensively in healthcare settings and increasingly in public health. However, the proliferation of QI in Canadian public health settings is unknown.

Purpose: The purpose of this study was to (a) assess the QI maturity in Ontario local public health units in Canada, and (b) to determine the relevance of the QI Maturity Tool in a Canadian setting

Methods: The QI Maturity Tool (Version 5) was used to conduct a cross-sectional assessment of the QI maturity of 36 local public health units in Ontario, Canada. After tool items were reviewed for relevance, individuals most …

Meaningful Use Of Health Information Technology: Proving Its Worth?, Lisa Sprague

National Health Policy Forum

Health policymakers in recent years have looked to the implementation of health information technology (IT)—electronic health records and the like—as a means to improve quality, reduce costs, and achieve better health outcomes across populations. But implementing health IT in a meaningful way must go beyond purchasing medical records software. The U.S. Department of Health and Human Services (HHS) devised a set of measures and incentives for hospitals and eligible medical professionals within Medicare or Medicaid to mark successive stages of effective IT implementation. This issue brief discusses the history of meaningful use, the measures used to evaluate effectiveness, and the …

Vision, Mission, And Values: From Concept To Execution At Mayo Clinic, Sandhya Pruthi, Dawn Marie R. Davis, Dawn L. Hucke, Francesca B. Ripple, Barbara S. Tatzel, James A. Dilling, Paula J. Santrach, Jeffrey W. Bolton, John H. Noseworthy

Patient Experience Journal

Mayo Clinic displays steadfast commitment to patient care, referral relations, and health care quality through institutional examples of unique, value-add endeavors that are under way with the Mayo Clinic Patient Experience Subcommittee and the Referring Physician Office. In this article, we share the Mayo Model of Care and patient stories that embody the 8 Mayo Clinic values of respect, compassion, integrity, healing, teamwork, excellence, innovation, and stewardship. The Mayo founders imparted to their staff the passion for patient care by encouraging a fair and just culture for its employees. This culture allows the creation, maintenance, and improvement of clinical care, …

A Single, Complete Touch: Population Health, The Health Contact Center, And The Patient Experience, Fran Horner, Susan Marks

Patient Experience Journal

As healthcare organizations turn to population health in order to more effectively manage the health and well-being of their patients, many need to ensure that these new strategies include a directive to improve the patient experience. Fortunately, healthcare systems can turn to an existing entity within its ranks, the health contact center, in order to execute a successful strategy and ensure that the individual patient never feels lost amongst the population crowd. Fran Horner from Singola Consulting and Susan Marks from Amati Health explore the ways in which population health and the health contact center work collaboratively to keep patient …

Randomized Clinical Trial Comparing Perioperative Care For Breast Cancer Patients At A Patient Hotel Versus A General Surgical Ward, Madleen Anna Camilla Huzell, Johan Frisack, Kristina Dalberg

Patient Experience Journal

Breast cancer is the most frequent cancer among women in Europe and the US. The aim of this study was to assess whether perioperative care, for breast cancer patients, provided at a patient hotel could be an alternative to the conventional care in an ordinary surgical ward. The study focuses solely on the patients’ experience of the provided care with a primary outcome that perioperative care at the patient hotel would be valued better than care in a general ward. Prospective, randomized single centre study. Between 2010 and 2012 a total of 151 patients < 80 years and without severe comorbidities were included in the trial, whereof 76 patients were randomised to the ward group and 75 patients to the hotel group. Five patients were excluded from each group. The validated IN2005-E questionnaire was used to evaluate the patients’ experiences of the care. The response rate was high with 65 patients answering the IN2005-E in each group. No difference could be found between the two groups regarding patient characteristics, type of surgery or tumour characteristics. The patients generally perceived the quality of the provided care as high. However, in the hotel group there was a better experience of care regarding issues such as coordination, privacy, some aspects of medical information, availability and the courtesy of the nurses. For selected patients, perioperative care at a patient hotel is an appreciated alternative to care at a surgical ward.

Patient Needs In Advanced Renal Cell Carcinoma: What Are Patients’ Priorities And How Well Are We Meeting Them?, Rick Harris, Kate Oake, Robert E. Hawkins, Robert J. Jones, Thomas Powles, David A. Montgomery

Patient Experience Journal

Treatment options and duration of therapy for patients with metastatic renal cell carcinoma (mRCC) have increased. Many patients now spend in excess of 2 years on active therapy. These patients’ needs, and the ability of health services to respond to them, are poorly understood. Ten patients living with mRCC for more than 2 years and treated with at least one targeted agent were selected at random from three hospitals in the United Kingdom (UK). One interviewer who was not involved in their care conducted in-depth interviews. Interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to identify issues of greatest …

The Comparative Impact Of Different Patient-Centered Medical Home Domains On Satisfaction Among Individuals Living With Type Ii Diabetes, Jon Mills, Allyson Hall, Rebecca Tanner, Jeffrey Harman, David L. Wood, Charles Lorbeer

Patient Experience Journal

Chronic illnesses like type 2 diabetes are costly and difficult to treat. Patient-centered medical homes (PCMH) have the potential to improve patient satisfaction in this population. However, which domains have the most impact on patient satisfaction has not been established. The aim of this study was to assess the relative strength of association between seven PCMH domains and two measures of satisfaction. Cross-sectional data were used in this observational study collected from a random sample of adults aged 18-89 with type 2 diabetes (n=1301) seen at 4 PCMHs. The Ambulatory Care Experiences Survey instrument was used to assess all measures. …

A Vision For Using Online Portals For Surveillance Of Patient-Centered Communication In Cancer Care, Hardeep Singh, Neeraj K. Arora, Kathleen M. Mazor, Richard L. Street Jr

Patient Experience Journal

The Veterans Health Administration (VHA) is charged with providing high-quality health care, not only in terms of technical competence but also with regard to patient-centered care experiences. Patient-centered coordination of care and communication are especially important in cancer care, as deficiencies in these areas have been implicated in many cases of delayed cancer diagnosis and treatment. Additionally, because cancer care facilities are concentrated within the VHA system, geographical and system-level barriers may present prominent obstacles to quality care. Systematic assessment of patient-centered communication (PCC) may help identify both individual veterans who are at risk of suboptimal care and opportunities for …

Impact Of Hospital Characteristics On Patients’ Experience Of Hospital Care: Evidence From 14 States, 2009-2011, Emily M. Johnston, Kenton J. Johnston, Jaeyong Bae, Jason M. Hockenberry, Ariel C. Avgar, Arnold Milstein Md, Mph, Sandra S. Liu, Ira Wilson, Edmund Becker

Patient Experience Journal

This paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in 10 hospital-reported patient experience-of-care scores by 29 characteristics classified as: patient characteristics, payer source, patient severity, hospital characteristics, hospital operations, and market characteristics. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores by hospital characteristics for 250 out of 290 HCAHPS-hospital characteristic combinations measured. We find fewer significant differences in changes in scores from 2009-2011 (135 out of …

Using A Process Improvement Tool To Improve Staff Skills & Enhance The Urgent Needs Patient Experience In A Women’S Health Center, Kenneth J. Feldman, Molly Lopez, Morris Gagliardi

Patient Experience Journal

NYC Health + Hospitals / Gouverneur serves more patients than any other diagnostic and treatment center in New York State. As part of the NYC Health + Hospitals public health care system, which serves 1.4 million patients and is the largest municipal health care delivery system in the United States, Gouverneur strives to serve the needs of both scheduled and unscheduled patients. Within Gouverneur, the Women’s Health department treats approximately 1,600 patients per month through approximately 2,100 visits. In September 2014, Gouverneur’s Women’s Health department launched a weeklong process improvement initiative known as a Rapid Improvement Event (RIE). Structured through …

Improving Process And Enhancing Parent And Therapist Satisfaction Through A Coordinated Intake Approach, Sharla Piecowye, Devona Gibson, Janis Carscadden, Kayla Ueland, Gregory Wells, Scott Oddie

Patient Experience Journal

Recent research indicates that, in Canada, approximately one in five children entering school are not meeting age appropriate milestones in physical, social, language, or cognitive development. Even where support services are available families often face barriers in accessing these. With the goals of improving access to programs, reducing barriers and increasing consistency and efficiency, a new Coordinated Intake Approach (CIA) was developed for families accessing Children’s Rehabilitation Services. It was expected that the CIA would result in 1) parents finding the intake process more satisfactory and easier to complete, 2) therapists feeling more supported and satisfied and 3) a decrease …

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 …

Instruments To Measure The Inpatient Hospital Experience: A Literature Review, Kelly J. Edwards, Kim Walker, Jed Duff

Patient Experience Journal

Healthcare professionals worldwide are increasingly broadening their focus to include the experiences of patients and their family members as a means of assessing quality patient centered care. This paper seeks to identify and discuss instruments specifically designed to measure the inpatient hospital experience. A literature search focusing on pre-identified instruments as per the Health Foundation’s Helping Measuring Patient Centered Care database of measurement instruments (de Silva, 2014) and additional health databases (CINAHL, ERIC, EBSCO, HaPI, MEDLINE, PubMed and Psych INFO) was undertaken. Thirteen relevant instruments and seventeen associated studies (regarding instrument development and or validation) were identified. These instruments provide …