Health Services Research Commons^™

The Early Steps Project: Occupational Therapy In A Pediatric Primary Care Setting, Anne H. Zachry, J. Flick, P. Richey

Faculty Presentations

The purpose of this study is expand on the Early STEPs project goal of identifying early developmental delays in infants and young children in a health disparate population and to collect preliminary data to lay the groundwork for a future NIH grant proposal. Individuals with less education have poor health and shorter life expectancies than well-educated individuals, and research reveals that poverty is directly related to limited education. An innovative approach is needed to overcome barriers, improve health literacy, and educate parents on effective parenting strategies for this population. Technology may be the part of the solution to this issue. …

A Multi-Level Assessment Of Healthcare Facilities Readiness, Willingness, And Ability To Adopt And Sustain Telehealth Services, Jamie Larson

Theses & Dissertations

Telehealth technologies are becoming more pervasive throughout the healthcare system as a way to provide services to patients that would otherwise have difficulty with access. Currently, little is known about the current state of telehealth use within clinics and hospital in the US. Most studies evaluating telehealth programs are feasibility or small patient outcome studies from one location. Utilizing a hybrid framework combining the levels of complex socio-technical systems with the theory of ready, willing and able. The theory of ready, willing, and able is founded on the basis that these three preconditions need to be met for a change …

Disparities In Pulmonary Fibrosis Care In The United States: An Analysis From The Nationwide Inpatient Sample, Adam W. Gaffney, Steffie Woolhander, David Himmelstein, Danny Mccormick

Publications and Research

Background: Idiopathic pulmonary fibrosis is a disease with high morbidity and mortality. Care for these patients, including lung transplantation, may provide significant benefits, but is resource-intensive and expensive. Disadvantaged patients with IPF may hence be at risk for receiving inferior care.

Methods: We analyzed data from the Nationwide Inpatient Sample, a database consisting of all hospitalizations from a 20% sample of US hospitals. We identified adults hospitalized with IPF between 1998 and 2011 using ICD-9 codes. We assessed the effect of insurance coverage and socioeconomic status (SES) on lung transplantation, a treatment that may improve survival. We also examined the …

Medication Exposure Patterns In Primary Care Patients Prescribed Pharmacogenetically Actionable Opioids, Mitchell R. Knisely, Janet S. Carpenter, Marion E. Broome, Ann M. Holmes, Diane Von Ah, Todd Skaar, Claire Burke Draucker

The Qualitative Report

Current approaches to assessing medication exposure fail to capture the complexity of the phenomenon and the context in which it occurs. This study’s purpose was to develop a typology of subgroups of patients who share common patterns of medication exposure. To create the typology, we used an exemplar sample of 30 patients in a large public healthcare system who had been prescribed the pharmacogenetically actionable opioids codeine or tramadol. Data related to medication exposure were drawn from large data repositories. Using a person-oriented qualitative approach, eight subgroups of patients who shared common patterns of medication exposure were identified. The subgroups …

Implementing A Pre-Exposure Prophylaxis Intervention For Safer Conception Among Hiv Serodiscordant Couples: Recommendations For Health Care Providers, Mari-Lynn Drainoni, Dea L. Biancarelli, Ashley A. Leech, Meg Sullivan, Angela R. Bazzi

Journal of Health Disparities Research and Practice

Couples in HIV serodiscordant relationships frequently desire children. Although partners who are virally suppressed pose almost no risk of transmitting HIV to their partners, partners who are inconsistently on therapy may transmit HIV to their partners when attempting to conceive. Pre-exposure prophylaxis (PrEP) is an available safer conception strategy for these couples but is not consistently offered. We sought to better understand barriers to PrEP implementation for couples seeking conception and patient perceptions on what providers could do to encourage use. We conducted in-depth, qualitative interviews with 11 participants representing six couples taking PrEP for safer conception in a safety-net …

Generalized Spatiotemporal Modeling And Causal Inference For Assessing Treatment Effects For Multiple Groups For Ordinal Outcome., Soutik Ghosal

Electronic Theses and Dissertations

This dissertation consists of three projects and can be categorized in two broad research areas: generalized spatiotemporal modeling and causal inference based on observational data. In the first project, I introduce a Bayesian hierarchical mixed effect hurdle model with a nested random effect structure to model the count for primary care providers and understand their spatial and temporal variation. This study further enables us to identify the health professional shortage areas and the possible impacting factors. In the second project, I have unified popular parametric and nonparametric propensity score-based methods to assess the treatment effect of multiple groups for ordinal …

Uams Summer Health Literacy Study, Merritt Osment

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Health Literacy is a barrier to self-care; patients often lack the skills to understand complicated instructions that deal with medications, wound care, follow up schedules, and preventative care. Patients who undergo hip and knee replacements are often older adults, a population that normally struggles with various aspects of health literacy. Patient education materials are a common means of communicating with these individuals. However, if the patient does not understand the materials that they are given, they are more likely to experience negative side effects after their operation. Purpose: The purpose of this study is to compare the health literacy …

The Effect Of Lowering Public Insurance Income Limits On Hospitalizations For Low-Income Children., Jessica L. Bettenhausen, Matt Hall, Jeffrey D. Colvin, Henry T. Puls, Paul J. Chung

Manuscripts, Articles, Book Chapters and Other Papers

Background and objectives: Thirty million children are currently covered by public insurance; however, the future funding and structure of public insurance are uncertain. Our objective was to determine the number, estimated costs, and demographic characteristics of hospitalizations that would become ineligible for public insurance reimbursement under 3 federal poverty level (FPL) eligibility scenarios.

Methods: In this retrospective cohort study using the 2014 State Inpatient Databases, we included all pediatric (age

Results: In 775 460 publicly reimbursed hospitalizations in 14 states, reductions in eligibility limits to 300%, 200%, or 100% of the FPL would have resulted in large numbers of newly …

Failure-To-Rescue Simulations As A Risk Management Strategy For Registered Nurses, Trena K. Seago

Graduate Theses, Dissertations, and Capstones

In the hospital setting, prevention of failure-to-rescue (FTR) events is an important aspect of patient safety. The use of patient simulation as a strategy to educate nurses on the prevention of these events offers two modes of learning: 1) experiential learning through simulation and 2) reflection through debriefing. The act of practicing to recognize a deteriorating patient through experiential learning and reflection may help increase nurses’ self-efficacy in recognizing a similar situation in their future practice. This quasi-experimental, one-group, pretest-posttest pilot study investigated the use of patient simulation among registered nurses (RNs) in the hospital setting as an anticipatory educational …

A Characterization Of The Medical-Legal Partnership (Mlp) Of Nebraska Medicine, Jordan Pieper

Capstone Experience: Master of Public Health

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project through the partnership it has formed working with Nebraska Medicine and Iowa Legal Aid. Traditionally, health and disease have always been viewed exclusively as "healthcare" issues. But with healthcare consistently growing towards holistic approaches to help patients, we now know there are deeper, structural conditions of society that can act as strong driving forces of a person's poor daily living conditions that can negatively impact health. The importance of a Medical-Legal Partnership is that it considers a patient's social determinants of health (SDHs). The goal …

Health Information Technology And Language Barriers In Pre-Admission Clinics, Sandra M. Coffey

Applied Research Projects

LEP or Limited English Proficiency patients across the United States are at higher risk for decreased quality of care because of their inability to communicate effectively with healthcare providers. Interpreters are not offered in a consistent manner due to many variables such as cost, availability of qualified interpreters, the time spent with patients due to an increased work-overload and clinician lack of knowledge into technologies available to use. Healthcare information technology such as video and telephone interpretation can bridge the gap between patients and medical personnel when a language barrier is present. At the pre-admission clinic, the Nursing personnel interviews …

A Markov Approach For Increasing Precision In The Assessment Of Data-Intensive Behavioral Interventions, Vincent Berardi, Ricardo Carretero-González, John Belletierre, Marc A. Adams, Suzanne C. Hughes, Melbourne Hovell

Psychology Faculty Articles and Research

Health interventions using real-time sensing technology are characterized by intensive longitudinal data, which has the potential to enable nuanced evaluations of individuals’ responses to treatment. Existing analytic tools were not developed to capitalize on this opportunity as they typically focus on first-order findings such as changes in the level and/or slope of outcome variables over different intervention phases. This paper introduces an exploratory, Markov-based empirical transition method that offers a more comprehensive assessment of behavioral responses when intensive longitudinal data are available. The procedure projects a univariate time-series into discrete states and empirically determines the probability of transitioning from one …

An Analysis On The Policy Implementation Of Antibacterial Resistance Control At The Hospital, Nani Indriana, Wiku Bakti B. Adisasmito

Journal of Indonesian Health Policy and Administration

In order to control Antibacterial Resistance at the hospital in Indonesia, the Government of Indonesia established an Antibiotics Resistance Control Committee and issued a Regulation from the Ministry of Health, regulation no 8/2015 on an antibiotics resistance control program at the hospital. This is an investigation on the Antibacterial Resistance Control Program (ARCP) at the Hospital, which compares its implementation at a government hospital and a private hospital, Persahabatan Central General Hospital (CGH) and Bogor Indonesian Red Cross Hospital (BIRCH). This was a descriptive study with a qualitative analysis obtained through indepth interviews and documentary research. We discovered that the …

An Analysis Of The Healthcare Center System As A Gatekeeper In 2018, Septiana Maharanti, Puput I Oktamiant

Journal of Indonesian Health Policy and Administration

In managed care, primary healthcarecare facilities acts as the gatekeepers, and its success is judged from the number of visits. In the year 2016, the Healthcare Centers in Tangerang was unable to meet the targets set by BPJS healthcare, ideally the visit rate should reach >150‰ and the referral ratio <10%. However, the visit rate only reachd 41‰ and the referral ratio was 29%. In addition, most healthcare centers the nonspecialised referral ratio was above 5%. The purpose of this research is to analyze the healthcare service system as the gatekeepers in managed care. This research is a descriptive analytical study with a qualitative approach. The data was collected through in-depth interviews, examination of documents and observations. Research conducted at healthcare centers and clinics Pedurenan Pabuaran Tumpeng from May-June 2018. From this research we discovered that the low contact lrate was caused be the low first contact levels, continuity, and comprehensiveness. The registering process was also complicated. We also discovered that the lack of human resources also influences the low contact rate.

An Analysis Of The Health Centers Readiness For Accreditation In Brebes District In 2018, Deny Ardi Lourina, Dumilah Ayuningtyas

Journal of Indonesian Health Policy and Administration

The accreditation of health centers is an endeavor by the Ministry of Health to improve the quality and performance of health centers regulated by Permenkes No. 4/2015. Of the 38 health centers in Brebes, only 10 has been accredited. We wish to discover how prepared are the health centers to be accredited based on the resources available and pre-accreditation survey. Data was obtained through in-depth interviews and documentary research. Results indicated that there was sufficient funds, facilities and equipment for the accreditation. However, the assessment scores for human resources sufficiency and documentary completeness was low.

Multiracial Patient Experiences With Racial Microaggressions In Health Care Settings, Cyndy R. Snyder, Prince Z. Wang, Anjali R. Truitt

Journal of Patient-Centered Research and Reviews

Purpose: Illuminating patients’ experiences of microaggressions in health care settings can help practitioners develop care that is more culturally responsive. While much of the literature on health care disparities focuses on minority groups generally, we sought to identify and to describe the ways in which racial microaggressions manifest for multiracial individuals and families specifically.

Methods: Using a combination of interviews and focus groups, we conducted 15 interviews and 3 focus groups. Eligible participants self-identified as more than one race and/or they self-identified as part of an interracial family, and they and/or someone they considered to be part of their family …

Improving Health And Well-Being: Connecting Research And Practice. The 24th Annual Conference Of The Health Care Systems Research Network, Karen L. Margolis, Nico Pronk, Jane E. Duncan, Sarah M. Greene

Journal of Patient-Centered Research and Reviews

The 24th annual conference of the Health Care Systems Research Network (HCSRN, formerly the HMO Research Network), held April 11–13, 2018, in Minneapolis, Minnesota, attracted 357 attendees. The HCSRN is a consortium of 18 community-based research organizations embedded in or affiliated with large health care delivery systems. Its annual research conference, held since 1994, is a unique venue that brings diverse stakeholders (eg, research teams, clinicians, patients, funders) together to explore a range of health research topics and scientific findings, with a unifying goal of connecting applied research to real-world care delivery for the betterment of individual and community health. …

Racial Disparity Among Women Diagnosed With Invasive Breast Cancer In A Large Integrated Health System, Maharaj Singh, Santhi D. Konduri, George C. Bobustuc, Amin B. Kassam, Richard A. Rovin

Journal of Patient-Centered Research and Reviews

Purpose: Reasons for the well-described disparity in outcomes between African American (AA) and non-Hispanic white (NHW) women with invasive breast cancer are unclear, making it difficult to identify solutions. This study examined the effects of demographics, biomarkers, tumor characteristics, cancer stage, morphology, and treatment variables on overall and cancer-free survival in these patient populations.

Methods: We retrospectively reviewed data for 6231 patients diagnosed with invasive breast cancer throughout an integrated health system from January 2006 through March 2015. Included for analysis were 5023 NHW and 413 AA women. All category and continuous variables in the study were described in the …

Mobile Health Technology Knowledge And Practices Among Patients Of Safety-Net Health Systems In Washington State And Washington, Dc, Sharon S. Laing, Muhammad Alsayid, Carlota Ocampo, Stacey Baugh

Journal of Patient-Centered Research and Reviews

Purpose: Mobile health technology (mHealth) can reduce health disparities, but research on the health behaviors of low-income patients is needed. This study evaluates mHealth knowledge and practices of low-resource safety-net patients.

Methods: We administered a 47-item questionnaire to 164 low-income patients accessing services at community health centers in the state of Washington and Washington, DC. Predictor variables included demographic factors: age, race, ethnicity, income. Outcome variables were smartphone knowledge (smartphones as a wellness tool), medical app knowledge (availability of medical-based apps), smartphone practices (ever used smartphones for wellness), health apps practices (ever used health-based apps), and medical apps practices (ever …

An Analysis On Non-Specialist Outpatient Referrals At Beji And Depok Jaya Health Centers In 2018, Tasya Caesarena Pertiwi, Masyitoh Basabih

Journal of Indonesian Health Policy and Administration

The Health Social Security Agency (BPJS kesehatan) is one of the government’s efforts to provide quality healthcare for the people. To guarantee its quality and maintain efficiency, a tiered referral system is used. However, there were many problems in its implementation. One of the ways to investigate is to evaluate the non-specialist outpatient referrals (RRNS). Therefore, in March-July 2018, this research was performed in order to analyze whether the system was implemented at Beji and Depok Jaya Health Center. The method used was the qualitative research method, with primary data from in-depth interviews and secondary data from documents. It was …