Health Services Research Commons^™

Referral Patterns Of Neonatal Healthcare Professionals For Cleft Lip And Palate Patients, Alyssa Morrow

Annual Research Symposium

Cleft Lip and Palate patients are some of the most vulnerable and complex orthodontic patients. They face a myriad of health challenges including psychological, nutritional, auditory, speech, airway, skeletal, and dental. Ideal comprehensive treatment for CLP patients is provided via multidisciplinary teams of healthcare providers. However, there is currently limited access to proper multidisciplinary care for CLP patients in the US, partly due to lack of education regarding available resources. For the most effective treatment and optimal outcomes, it is essential that coordinated care starts at birth and that parental education begins as soon as CLP is detected in utero. …

Quantifying Community-Based Pharmacy Student Operational And Clinical Rotation (Ippe) Activities., Kenneth Kunke, Phillip Lawrence, C. Leiana Oswald, Erin Johanson, Michelle Hon

Annual Research Symposium

The purpose of this study is to identify and describe trends in the quantity and proportion of operational and clinical activities performed by students on introductory (IPPE) rotations.

Comments Re: Draft Guidance Considering Exercise Of March-In Rights - Docket No.: 230831-0207, Fred D. Ledley, Edward Zhou

CISI Publication

This comment focuses on criterion #3 of the march-in provisions of the Bayh Dole Act, which pertains to “…action is necessary to meet requirements for public use specified by Federal regulations and such requirements are not reasonably satisfied by the contractor, assignee, or licensees.” We recognize that the term “public use” in Bayh Dole refers not only to commercialization or availability of products representing practical applications of the inventions made with federal funding and licensed to industry under the terms of the Act, but also use of these inventions to achieve a series of socioeconomic goals (i.e., access to and …

Patient Satisfaction With A Coach-Guided, Technology-Based Mental Health Treatment: Qualitative Interview Study And Theme Analysis, Ashley Helm Smith, Hilary Touchett, Patricia Chen, Terri Fletcher, Jennifer Arney, Julianna Hogan, Miryam Wassef, Marylene Cloitre, Jan A Lindsay

Faculty, Staff and Students Publications

Background: Technology-based mental health interventions address barriers rural veterans face in accessing care, including provider scarcity and distance from the hospital or clinic. webSTAIR is a 10-module, web-based treatment based on Skills Training in Affective and Interpersonal Regulation, designed to treat posttraumatic stress disorder and depression in individuals exposed to trauma. Previous work has demonstrated that webSTAIR is acceptable to participants and effective at reducing symptoms of posttraumatic stress disorder and depression when delivered synchronously or asynchronously (over 5 or 10 sessions).

Objective: This study explored factors that lead to greater patient satisfaction with webSTAIR, a web-based, coach-guided intervention.

Methods: …

Chronic Respiratory Symptoms Following Deployment-Related Occupational And Environmental Exposures Among Us Veterans, Eric Garshick, Carrie A Redlich, Anna Korpak, Andrew K Timmons, Nicholas L Smith, Karen Nakayama, Coleen P Baird, Paul Ciminera, Farrah Kheradmand, Vincent S Fan, Jaime E Hart, Petros Koutrakis, Ware Kuschner, Octavian Ioachimescu, Michael Jerrett, Phillipe R Montgrain, Susan P Proctor, Emily S Wan, Christine H Wendt, Cherry Wongtrakool, Paul D Blanc

Faculty, Staff and Students Publications

Objectives: Characterise inhalational exposures during deployment to Afghanistan and Southwest Asia and associations with postdeployment respiratory symptoms.

Methods: Participants (n=1960) in this cross-sectional study of US Veterans (Veterans Affairs Cooperative Study 'Service and Health Among Deployed Veterans') completed an interviewer-administered questionnaire regarding 32 deployment exposures, grouped a priori into six categories: burn pit smoke; other combustion sources; engine exhaust; mechanical and desert dusts; toxicants; and military job-related vapours gas, dusts or fumes (VGDF). Responses were scored ordinally (0, 1, 2) according to exposure frequency. Factor analysis supported item reduction and category consolidation yielding 28 exposure items in 5 categories. Generalised …

Herpes Zoster And Risk Of Incident Parkinson's Disease In Us Veterans: A Matched Cohort Study, Louis Tunnicliffe, Rimona S Weil, Judith Breuer, Maria C Rodriguez-Barradas, Liam Smeeth, Christopher T Rentsch, Charlotte Warren-Gash

Faculty, Staff and Students Publications

Background: Although some systemic infections are associated with Parkinson's disease (PD), the relationship between herpes zoster (HZ) and PD is unclear.

Objective: The objective is to investigate whether HZ is associated with incident PD risk in a matched cohort study using data from the US Department of Veterans Affairs.

Methods: We compared the risk of PD between individuals with incident HZ matched to up to five individuals without a history of HZ using Cox proportional hazards regression. In sensitivity analyses, we excluded early outcomes.

Results: Among 198,099 individuals with HZ and 976,660 matched individuals without HZ (median age 67.0 years …

Collaboration And Growth In A Large Research Cooperative: A Network Analytic Approach, Lori J Ducharme, Kayo Fujimoto, Jacky Kuo, Jonathan Stewart, Bruce Taylor, John Schneider

Faculty, Staff and Student Publications

Research networks encourage team science and facilitate collaboration within and across research teams. While many analyses have examined the output of these collaborative networks (e.g., authorship networks, publications, grant applications), less attention has been paid to the formative phases of these initiatives. This article presents analyses of a whole-network survey of investigators participating in a new research initiative, and examines the development of collaborative ties over the network's first year. In particular, we examine the influence of research center affiliation, seniority, and prior network experience on the number and structure of collaborative ties, including participants' bridging and broker roles. Such …

Fibroblast Heterogeneity In Pulmonary Fibrosis: A New Target For Therapeutics Development?, Konstantin Tsoyi, Ivan O Rosas

Faculty, Staff and Students Publications

No abstract provided.

The Human Vaginal Microbiota: From Clinical Medicine To Models To Mechanisms, Samantha Ottinger, Clare M Robertson, Holly Branthoover, Kathryn A Patras

Faculty, Staff and Students Publications

The composition of the vaginal microbiota is linked to numerous reproductive health problems, including increased susceptibility to infection, pregnancy complications, and impaired vaginal tissue repair; however, the mechanisms contributing to these adverse outcomes are not yet fully defined. In this review, we highlight recent clinical advancements associating vaginal microbiome composition and function with health outcomes. Subsequently, we provide a summary of emerging models employed to identify microbe-microbe interactions contributing to vaginal health, including metagenomic sequencing, multi-omics approaches, and advances in vaginal microbiota cultivation. Last, we review new in vitro, ex vivo, and in vivo models, such as organoids and humanized …

Correlates Of Risk For Disinhibited Behaviors In The Million Veteran Program Cohort, Peter B Barr, Tim B Bigdeli, Jacquelyn L Meyers, Roseann E Peterson, Sandra Sanchez-Roige, Travis T Mallard, Danielle M Dick, K Paige Harden, Anna Wilkinson, David P Graham, David A Nielsen, Alan C Swann, Rachele K Lipsky, Thomas R Kosten, Mihaela Aslan, Philip D Harvey, Nathan A Kimbrel, Jean C Beckham

Faculty, Staff and Students Publications

Importance: Many psychiatric outcomes share a common etiologic pathway reflecting behavioral disinhibition, generally referred to as externalizing (EXT) disorders. Recent genome-wide association studies (GWASs) have demonstrated the overlap between EXT disorders and important aspects of veterans' health, such as suicide-related behaviors and substance use disorders (SUDs).

Objective: To explore correlates of risk for EXT disorders within the Veterans Health Administration (VA) Million Veteran Program (MVP).

Design, setting, and participants: A series of phenome-wide association studies (PheWASs) of polygenic risk scores (PGSs) for EXT disorders was conducted using electronic health records. First, ancestry-specific PheWASs of EXT PGSs were conducted in the …

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 = …

The Pridx Framework To Engage Payers In Reducing Diagnostic Errors In Healthcare, Kisha J Ali, Christine A Goeschel, Derek M Delia, Leah M Blackall, Hardeep Singh

Faculty, Staff and Students Publications

Objectives: No framework currently exists to guide how payers and providers can collaboratively develop and implement incentives to improve diagnostic safety. We conducted a literature review and interviews with subject matter experts to develop a multi-component 'Payer Relationships for Improving Diagnoses (PRIDx)' framework, that could be used to engage payers in diagnostic safety efforts.

Content: The PRIDx framework, 1) conceptualizes diagnostic safety links to care provision, 2) illustrates ways to promote payer and provider engagement in the design and adoption of accountability mechanisms, and 3) explicates the use of data analytics. Certain approaches suggested by PRIDx were refined by subject …

Improving Veteran Engagement With Virtual Care Technologies: A Veterans Health Administration State Of The Art Conference Research Agenda, Taona P Haderlein, Jenice Guzman-Clark, Navid S Dardashti, Nicholas Mcmahon, Elizabeth L Duran, Jolie N Haun, Stephanie A Robinson, Amanda C Blok, Sarah L Cutrona, Jan A Lindsay, Christina M Armstrong, Kim M Nazi, Stephanie L Shimada, Nancy R Wilck, Erin Reilly, Eric Kuhn, Timothy P Hogan

Faculty, Staff and Students Publications

Although the availability of virtual care technologies in the Veterans Health Administration (VHA) continues to expand, ensuring engagement with these technologies among Veterans remains a challenge. VHA Health Services Research & Development convened a Virtual Care State of The Art (SOTA) conference in May 2022 to create a research agenda for improving virtual care access, engagement, and outcomes. This article reports findings from the Virtual Care SOTA engagement workgroup, which comprised fourteen VHA subject matter experts representing VHA clinical care, research, administration, and operations. Workgroup members reviewed current evidence on factors and strategies that may affect Veteran engagement with virtual …

Development And Validation Of A Risk Model For Hospital-Acquired Venous Thrombosis: The Medical Inpatients Thrombosis And Hemostasis Study, Neil A Zakai, Katherine Wilkinson, Andrew D Sparks, Ryan T Packer, Insu Koh, Nicholas S Roetker, Allen B Repp, Ryan Thomas, Chris E Holmes, Mary Cushman, Timothy B Plante, Hanny Al-Samkari, Allyson M Pishko, William A Wood, Camila Masias, Radhika Gangaraju, Ang Li, David Garcia, Kerri L Wiggins, Jordan K Schaefer, Craig Hooper, Nicholas L Smith, Leslie A Mcclure

Faculty, Staff and Students Publications

Background: Regulatory organizations recommend assessing hospital-acquired (HA) venous thromboembolism (VTE) risk for medical inpatients.

Objectives: To develop and validate a risk assessment model (RAM) for HA-VTE in medical inpatients using objective and assessable risk factors knowable at admission.

Methods: The development cohort included people admitted to medical services at the University of Vermont Medical Center (Burlington, Vermont) between 2010 and 2019, and the validation cohorts included people admitted to Hennepin County Medical Center (Minneapolis, Minnesota), University of Michigan Medical Center (Ann Arbor, Michigan), and Harris Health Systems (Houston, Texas). Individuals with VTE at admission, aged < 18 years, and admitted for < 1 midnight were excluded. We used a Bayesian penalized regression technique to select candidate HA-VTE risk factors for final inclusion in the RAM.

Results: The development cohort included …

The Brain Drain Of The Egyptian Physicians: A Look From Both Sides, Hebatalla Ahmed Mohamed Ismail

Theses and Dissertations

The brain drain of well-educated and trained workers is a problem that faces many nations. The pandemic revealed the importance of being ready with all resources, especially the healthcare workers. In Egypt, according to records of the Egyptian medical syndicate, half of the registered physicians in the syndicate are working abroad. In this study, we aimed to understand the relationship between individual satisfaction regarding work or family, his capability factors, and his intention to leave the country to work in another one. A quantitative approach was used by a self-administered online questionnaire. The results showed that 66.4% of physicians who …

The Differences In Code Status Conversation Approaches Reported By Emergency Medicine And Palliative Care Clinicians: A Mixed-Method Study, Kei Ouchi, Thidathit Prachanukool, Emily L Aaronson, Joshua R Lakin, Masaya Higuchi, Shan W Liu, Maura Kennedy, Anna C Revette, Anita N Chary, Jenson Kaithamattam, Brandon Lee, Thanh H Neville, Mohammad A Hasdianda, Rebecca Sudore, Mara A Schonberg, James A Tulsky, Susan D Block

Faculty, Staff and Students Publications

BACKGROUND: During acute health deterioration, emergency medicine and palliative care clinicians routinely discuss code status (e.g., shared decision making about mechanical ventilation) with seriously ill patients. Little is known about their approaches. We sought to elucidate how code status conversations are conducted by emergency medicine and palliative care clinicians and why their approaches are different.

METHODS: We conducted a sequential-explanatory, mixed-method study in three large academic medical centers in the Northeastern United States. Attending physicians and advanced practice providers working in emergency medicine and palliative care were eligible. Among the survey respondents, we purposefully sampled the participants for follow-up interviews. …

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 …

Recommendations From People Who Use Drugs In Philadelphia, Pa About Structuring Point-Of-Care Drug Checking, Megan K. Reed, Elias Borne, Tracy Esteves Camacho, Morgan Kelly, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

Background

Adulterants, such as fentanyl and xylazine, among others, are present in a high percentage of the illicit drug supply, increasing the risk for overdose and other adverse health events among people who use drugs (PWUD). Point-of-care drug checking identifes components of a drug sample and delivers results consumers. To successfully meet the diverse needs of PWUD, more information is needed about the utility of drug checking, motivations for using services contextualized in broader comments on the drug supply, hypothesized actions to be taken after receiving drug checking results, and the ideal structure of a program.

Methods

In December 2021, …

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 …

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 …