Health Services Research Commons^™

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 …

Disability Prevention Programs For Older People: Factors Associated With Medical And Nursing Care Costs, Takaaki Ikeda, Susumu Yanagawa, Kenichi Murakami, Toshiyuki Inoue, Takamasa Tsurumi

Kesmas

Penelitian ini bertujuan untuk mengklarifikasi faktor-faktor yang terkait dengan biaya medis dan perawatan lanjut usia (lansia) yang tinggal di panti sosial serta menyarankan program pencegahan disabilitas yang efektif. Total partisipan dalam penelitian ini adalah 83 orang (29 laki-laki dan 54 perempuan; usia rata-rata 81,2 ± 6,3 tahun) pada 1 November – 28 Desember 2014. Penelitian ini membandingkan biaya medis dan perawatan rata-rata per bulan dengan rata-rata nasional bagi yang berusia ≥ 65 tahun. Uji regresi logistik dilakukan untuk memeriksa keterkaitannya dengan biaya medis dan perawatan. Mereka yang pergi ke luar rumah ≥ 3 kali seminggu tiga kali lebih kecil kemungkinannya …

Pesticide Exposure, Behavior Of Farmer, And Activity Of Cholinesterase Enzyme In Blood Of Fertile Women Farmers, Deni Abdul Rahman, Zakianis Zakianis, Laila Fitria

Kesmas

Petani perempuan usia subur berisiko mengalami penurunan aktivitas kolinesterase akibat pajanan pestisida. Penelitian ini bertujuan untuk menganalisis hubungan antara pajanan pestisida dan perilaku pemajan terhadap aktivitas kolinesterase petani perempuan usia subur di Desa Kedunguter. Penelitian ini menggunakan desain potong lintang pada 94 petani perempuan usia subur tahun 2015. Pengumpulan data dilakukan secara observasi, wawancara, dan uji kolinesterase. Analisis data menggunakan uji kai kuadrat dan hasil analisis menunjukkan hubungan signifikan antara jenis pestisida, waktu kerja, penggunaan sarung tangan, perilaku mencuci tangan terhadap aktivitas kolinesterase petani perempuan usia subur. Hasil analisis pada penelitian ini menunjukkan bahwa variabel waktu kerja memiliki nilai odds …

The Use Of Earthworms And Household Organic Waste Composting Length Of Time, Abdul Khair, Lucky Herawati, Noraida Noraida, Munawar Raharja

Kesmas

Pengomposan dengan cacing tanah merupakan proses pembuatan kompos dengan melibatkan organisme makro cacing tanah. Kerja sama antara cacing tanah dengan mikroorganisme dapat memberi dampak pada proses penguraian yang dilakukan oleh mikroorganisme tersebut dibantu dengan keberadaan cacing tanah. Oleh karena bahan-bahan yang akan diurai oleh mikroorganisme telah diurai lebih dahulu oleh cacing, maka kerja mikroorganisme lebih efektif dan lebih cepat. Penelitian ini bertujuan untuk mengetahui pengaruh penggunaan cacing tanah terhadap lama waktu pengomposan sampah organik dari rumah tangga dengan menggunakan desain penelitian eksperimen. Objek penelitian adalah seluruh sampah organik dari rumah tangga yang diambil secara acak pada satu rumah tangga. Variabel …

Riwayat Berat Badan Lahir Dengan Kejadian Stunting Pada Anak Usia Bawah Dua Tahun, Atikah Rahayu, Fahrini Yulidasari, Andini Octaviana Putri, Fauzie Rahman

Kesmas

Kabupaten Hulu Sungai Utara masih dihadapkan dengan permasalahan gizi pada anak bawah dua tahun (baduta). Salah satu masalah gizi hingga saat ini adalah stunting. Anak dengan riwayat berat badan lahir rendah (BBLR) merupakan salah satu faktor yang potensial memengaruhi pertumbuhan anak. Penelitian ini bertujuan untuk mengkaji risiko riwayat berat badan lahir dengan kejadian stunting pada anak baduta. Desain penelitian adalah potong lintang. Populasi penelitian ini merupakan ibu-ibu yang memiliki anak baduta dan besar sampel sejumlah 117 terdiri dari anak baduta. Pelaksanaan penelitian dilakukan selama tiga bulan pada bulan September – November 2014. Kategori BBLR jika riwayat berat badan lahir < 2.500 gram. Analisis data bivariat menggunakan uji kai kuadrat dan data multivariat menggunakan uji regresi logistik. Hasil analisis bivariat menunjukkan bahwa terdapat hubungan yang signifikan antara riwayat status BBLR (nilai p = 0,015) dengan stunting pada anak baduta. Berdasarkan hasil analisis multivariat, diperoleh bahwa BBLR merupakan faktor risiko yang paling dominan berhubungan dengan kejadian stunting. Anak dengan BBLR memiliki risiko 5,87 kali untuk mengalami stunting. Riwayat BBLR memiliki peranan penting dalam kejadian stunting anak baduta di wilayah Puskesmas Sungai Karias, Hulu Sungai Utara. North Hulu Sungai District is still facing nutrition problems among children under two years old. One of nutrition problems up to now is stunting. Child with low birthweight (LBW) record is one of potential factors influencing the growth of a child. This study aimed to assess any risk of LBW records with stunting incidence among children under two years old. This study used cross-sectional design. The population was mothers having children under two years old and samples amounted to 117 consisted of children under two years old. This study was conducted within three months on September – November 2014. Category of LBW was if birth weight records < 2,500 gram. Bivariate data analysis used chi-square test and multivariate data analysis used logistic regression test. The result of bivariate analysis showed a significant relation between LBW status records (p value = 0.015) with stunting incidence among children under two years old. Based on the result of multivariate analysis, LBW was the most dominating risk factor related to stunting incidence. Children with LBW had 5.87 times risk of suffering from stunting. LBW records take an important role in stunting incidence among children under two years old around Sungai Karias Primary Health Care area in North Hulu Sungai.

Penemuan Kasus Infeksi Kusta Subklinis Pada Anak Melalui Deteksi Kadar Antibodi (Igm) Anti Pgl-1, Arif Sujagat, Fardhiasih Dwi Astuti, Eva Muslimawati Saputri, Annisa Sani, Agil Dwi Prasetya

Kesmas

]Kusta merupakan penyakit menular kronis yang disebabkan Mycobacterium leprae. Indonesia menempati peringkat ketiga penyumbang kasus kusta terbanyak di dunia pada tahun 2012 – 2014. Kota Surabaya merupakan daerah endemis kusta. Penelitian ini bertujuan untuk deteksi dini kusta subklinis berdasarkan pengukuran kadar antibodi (IgM) anti PGL-1 dan mengetahui faktor-faktor yang berhubungan dengan kusta subklinis pada anak di Kota Surabaya. Penelitian analitik menggunakan desain potong lintang pada bulan April - Mei 2015. Populasi dilakukan penelitian adalah keluarga yang memiliki anggota penderita kusta. Sampel dipilih dengan teknik simple random sampling dan sebanyak 30 kepala keluarga terpilih melalui rapid school and village survey pada …

Pre-Eklampsia Berat Dan Kematian Ibu, Nova Muhani, Besral Besral

Kesmas

Pre-eklampsia berat, salah satu penyebab utama kematian ibu di Indonesia dan di RSUD Dr. H. Abdul Moeloek Lampung, merupakan penyebab kematian ibu nomor satu (47,25%). Penelitian ini bertujuan untuk mengetahui hubungan prediktor pre-eklampsi berat (PEB) yang dinilai dari tekanan darah sistolik, tekanan darah diastolik, proteiunuria, eklampsia, sindrom hemolysis, elevated liver enzymes, low platelets count (HELLP) dengan kematian ibu di RSUD Dr. H. Abdul Moeloek. Penelitian ini menggunakan desain kasus kontrol dengan jumlah sampel 60 kasus dan 120 kontrol. Data diolah dari rekam medis rumah sakit selama periode lima tahun (2010 – 2014). Hasil penelitian ini memperlihatkan bahwa sindrom HELLP memiliki …

Peran Tenaga Kesehatan Dan Keluarga Dalam Kehamilan Usia Remaja, Mery Ramadani, Dien Gusta Anggraini Nursal, Livia Ramli

Kesmas

Sebanyak 10,3% kematian tidak langsung pada ibu disebabkan kehamilan usia remaja (< 20 tahun). Di Kabupaten Tanah Datar, masih terjadi peningkatan kehamilan usia remaja dalam tiga tahun terakhir. Penelitian ini bertujuan untuk mengetahui peran tenaga kesehatan, dukungan keluarga, dan pengetahuan remaja dengan kehamilan usia remaja di wilayah kerja Puskesmas Singgalang, Kabupaten Tanah Datar tahun 2014. Penelitian dilaksanakan pada bulan Mei – Juni 2014 menggunakan desain potong lintang. Populasi adalah seluruh remaja putri berusia < 20 tahun yang telah menikah berjumlah 215 orang. Sampel berjumlah 68 orang dan pengambilan sampel dilakukan secara proporsional di delapan jorong/desa. Data dikumpulkan melalui wawancara menggunakan kuesioner. Kemudian, analisis bivariat dilakukan dengan uji kai kuadrat dan analisis multivariat dengan uji regresi logistik ganda. Hasil penelitian mendapatkan sebanyak 55,9% responden hamil di usia remaja. Sebanyak 52,9% responden kurang merasakan peran dari tenaga kesehatan, 66,2% kurang mendapat dukungan keluarga, dan 58,8% memiliki pengetahuan rendah. Didapatkan hubungan peran tenaga kesehatan (nilai p = 0,032), dukungan keluarga (nilai p = 0,025), dan tingkat pengetahuan (nilai p = 0,002) dengan kehamilan usia remaja. Dapat disimpulkan bahwa tenaga kesehatan, keluarga dan tingkat pengetahuan berperan dalam kehamilan remaja. Tenaga kesehatan perlu memberikan penyuluhan mengenai risiko kehamilan remaja kepada remaja serta keluarga. Worth 10.3% of indirect maternal death is due to teenage pregnancy (< 20 years old). In Tanah Datar District, the increase of teenage pregnancy has occured in the last three years. This study aimed to determine health worker's role, family's support and teenagers' knowledge with teenage pregnancy in work area of Singgalang Primary Health Care, Tanah Datar District in 2014. This study was conducted on May – June 2014 using cross-sectional design. Population was 215 married teenage girls < 20 years old. A total of sample was 68 selected proportionally in eight villages. Data were collected through interview using questionnaire. Then bivariate analysis was conducted using chi-square test and multivariate analysis using multiple logistic regression test. Results of study found 55.9% of respondents were pregnant in teen age. Respondents worth 52.9% got less health worker’s role, 66.2% got less family’s support and 58.8% had low level of knowledge. There was a relation found between health worker’s role (p value = 0.032), family’s support (p value = 0.025) and knowledge level (p value = 0.002) with teenage pregnancy. In conclusion, health workers, family and knowledge level play a role in teenage pregnancy. Health workers need to provide counseling concerning teenage pregnancy risks for both teenagers and families.

Pengaruh Musik Keroncong Selama Pelaksanaan Kangaroo Mother Care Terhadap Respons Fisiologis Dan Lama Rawat Bayi Dengan Berat Badan Lahir Rendah, Anita Rahmawati, Endah Marianingsih Theresia, Yuliasti Eka Purnamaningrum

Kesmas

Kangaroo mother care (KMC) merupakan metode merawat bayi berat badan lahir rendah (BBLR). Beberapa intervensi perawatan di neonatal intensive care unit seperti pijat bayi, KMC, dan mendengarkan musik bermanfaat untuk pertumbuhan bayi berupa respons fisiologis BBLR dan mengurangi lama rawat. Penelitian ini bertujuan untuk mengetahui manfaat musik keroncong terhadap respons BBLR selama KMC dan lama rawat. Rancangan penelitian adalah quasi eksperimental dengan pretest dan posttest dengan desain grup kontrol. Pada Juli - September 2014 populasi penelitian adalah ibu dan bayi BBLR yang melaksanakan KMC. Pengambilan sampel dengan purposive sampling sebanyak 60 bayi. Kriteria inklusi bayi BBLR yang ditetapkan adalah berat …

Continuation Rates And Reasons For Discontinuation Of Intra-Uterine Device In Three Provinces Of Pakistan: Results Of A 24-Month Prospective Client Follow-Up, Waqas Hameed, Syed Khurram Azmat, Muhammad Ishaque, Wajahat Hussain, Erik Munroe, Ghulam Mustafa, Omar Farooq Khan, Ghazunfer Abbas, Safdar Ali, Qaiser Jamshaid Asghar

Community Health Sciences

Background: Long-acting reversible contraceptives, such as the intrauterine device (IUD), remain underutilised in Pakistan with high discontinuation rates. Based on a 24-month prospective client follow-up (nested within a larger quasi-experimental study), this paper presents the comparison of two intervention models, one using private mid-level providers branded as "Suraj" and the other using community midwives (CMWs) of Maternal Newborn and Child Health Programme, for method continuation among IUD users. Moreover, determinants of IUD continuation and the reasons for discontinuation, and switching behaviour were studied within each arm.
Methods: A total of 1,163 IUD users, 824 from Suraj and 339 from the …

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 …

Accounting For Indirect Costs In Public Health Cost Analyses, Melanie D. Whittington, Adam Atherly, Lisa Vanraemdonck

Frontiers in Public Health Services and Systems Research

Background. There is a gap in research regarding the resources needed to deliver public health activities, which inhibits informed decision making around investments in public health and the allocation of funds among activities. When conducting cost analyses in public health, it is important to include costs from all cost components, including personnel, non-personnel, and indirect costs. However, defining, identifying, and measuring indirect costs is challenging and can impede studies of this type. Purpose. The purpose of this pilot study is to create a catalog of the methodologies public health researchers have used to account for indirect costs. Methods. We surveyed …

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 …

Current Practice Of Neonatal Resuscitation Documentation In North America: A Multi-Center Retrospective Chart Review, Matthew S. Braga, Prakash Kabbur, Pradeep Alur, Michael H. Goodstein

Dartmouth Scholarship

To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation. Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant’s record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified.

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, …

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 …