360 results
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2. Culturally Congruent Health Care of COVID-19 in Minorities in the United States: A Clinical Practice Paper From the National Coalition of Ethnic Minority Nurse Associations.
- Author
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Cuellar, Norma G., Aquino, Elizabeth, Dawson, Martha A., Garcia-Dia, Mary Joy, Im, Eun-Ok, Jurado, Leo-Felix M., Lee, Young Shin, Littlejohn, Sandy, Tom-Orme, Lillian, and Toney, Debra A.
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NURSES' associations , *BLACK people , *COALITIONS , *ETHNOPSYCHOLOGY , *HEALTH services accessibility , *HEALTH status indicators , *HISPANIC Americans , *NATIVE Americans , *MEDICAL care , *PSYCHOLOGY of Minorities , *RACE , *CULTURAL competence , *HEALTH & social status , *COVID-19 - Abstract
Introduction: Race and ethnicity along with social determinants of health have been identified as risk factors for COVID-19. The purpose of this clinical paper is to provide an overview of the National Coalition of Ethnic Minority Nurse Associations (NCEMNA), present COVID-19 epidemiological data on five racial–ethnic groups, identify culturally congruent health care strategies for each group, and provide directions for practice and research. Method : NCEMNA collaborated to provide a clinical paper that addresses information about COVID-19 and culturally congruent health care in five racial–ethnic groups. Results : Every organization presented common themes across the different groups and unique perspectives that each group is faced with during this challenge. Discussion : This article provides an introduction to the issues that minority groups are facing. It is imperative that data are collected to determine the extent of the impact of COVID-19 in diverse communities in the country. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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3. White paper on designing a risk evaluation and mitigation strategies (REMS) system to optimize the balance of patient access, medication safety, and impact on the health care system.
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HEALTH risk assessment ,HEALTH services accessibility ,MEDICAL care ,PATIENT education ,PHARMACISTS ,QUALITY control - Abstract
Objective: To convene a group of expert stakeholders to develop recommendations for standardizing systems for the implementation of risk evaluation and mitigation strategies (REMS). Data sources: On July 15, 2009, the American Pharmacists Association convened an expert panel of stakeholders to explore standardized solutions to REMS development and implementation. Meeting participants included pharmacists from various practice settings, physicians, researchers, patient advocates, and a nursing delegate, and the meeting was observed by a U.S. Food and Drug Administration representative. The stakeholders' recommendations were combined with themes arising from discussion of their experiences with existing REMS, and a review of the literature on REMS and risk management was performed by the author. Summary: A systematic, standardized REMS process that balances the need to control the risks of medications with the need to minimize the impact on patient access is required. A standardized REMS system could address various aspects of development and implementation, including the creation of specific REMS "levels," centralized systems for data management and program structure, public education, individualized patient education, provider education, access to medications, pilot testing, outcomes monitoring, and quality of care. Conclusion: Several strategies to streamline the development and implementation of a REMS system are feasible. Incorporating such strategies is necessary to manage the rapidly growing number of individual and diverse REMS programs that patients and health care providers must navigate. Furthermore, a standardized REMS system could be used to improve quality of care and support patient education and empowerment. [ABSTRACT FROM AUTHOR]
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- 2009
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4. White paper addresses VBP opportunities, challenges for BH providers.
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Canady, Valerie A.
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VALUE-based healthcare ,ASSOCIATIONS, institutions, etc. ,COST control ,HEALTH services accessibility ,MEDICAID ,MEDICAL care ,HEALTH policy ,MENTAL health ,POLICY sciences ,QUALITY assurance ,PATIENT Protection & Affordable Care Act ,ELECTRONIC health records ,MEDICAL laws - Abstract
Health care payments continue to evolve and shift away from fee‐for‐service payment systems that typically reward volume and move to value‐based payment (VBP) models that incentivize high‐quality, cost‐effective care. While this is happening more for physical health services, there's more uncertainty about the role of behavioral health. A new white paper aims to tackle that question with information about existing models that have been implemented along with recommendations for federal and state policymakers. [ABSTRACT FROM AUTHOR]
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- 2019
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5. Health Care for Our Nation's Veterans: A Policy Paper From the American College of Physicians.
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Crowley, Ryan, Atiq, Omar, Hilden, David, Cooney, Thomas G., Beachy, Micah, Brislen, Heather, Curry, William, Dhingra, Menaka, Engel, Lee, Henry, Tracey L., Hollon, Matthew, Mathew, Suja, Shoushtari, Christiana, Southworth, Molly, Tan, Michael, and Health and Public Policy Committee of the American College of Physicians*
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INTEGRATED health care delivery ,MEDICAL care ,HEALTH facilities ,MEDICAL personnel ,TRAINING of medical residents ,HEALTH policy ,HEALTH services accessibility ,PRIVATE sector ,MEDICAL care research ,HOLISTIC medicine ,PRIMARY health care ,MENTAL health services administration ,HEALTH care teams ,POLICY sciences ,MEDICAL education ,TELEMEDICINE ,MEDICAL societies - Abstract
The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development. [ABSTRACT FROM AUTHOR]
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- 2021
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6. The Impact of Cultural Humility in Prehospital Healthcare Delivery and Education a Position Paper from the National Association of EMS Educators (NAEMSE): Adopted by the NAEMSE Board of Directors on 7/15/2019.
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Khalsa, Sahaj, Barnes, Leaugeay, Audet, Robert, Sweeney, Michele, Leggio, William, Linder, Lawrence, MacArthur, Jane, Flint, Diane C., Cottell, Dwayne, and Epstein, Jonathan L.
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EMERGENCY medical services ,EMERGENCY medicine ,HEALTH services accessibility ,HEALTH status indicators ,LABOR supply ,MEDICAL care ,CULTURAL pluralism ,CULTURAL awareness ,CULTURAL competence - Abstract
EMS personnel in the U.S. continue to be overwhelmingly Caucasian and male, with 75% being male and 85% identifying as nonminority. While the population of the United States becomes more diverse in ethnicity, religion, and race, the EMS workforce remains largely homogenous and does not reflect the diversity of the population it serves. Given the growing diversity across the country, EMS personnel will increasingly be responding to calls for service involving patients with different cultural backgrounds than their own. This growing gap between providers and the population they serve may exacerbate already existing disparities in care. [ABSTRACT FROM AUTHOR]
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- 2020
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7. Policy recommendations to guide the use of telemedicine in primary care settings: an American College of Physicians position paper.
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Daniel, Hilary, Sulmasy, Lois Snyder, and Health and Public Policy Committee of the American College of Physicians
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TELEMEDICINE ,PRIMARY care ,PERIODIC health examinations ,PHYSICIAN-patient relations ,GUIDELINES ,MEDICAL care cost control ,HEALTH services accessibility ,MEDICAL care ,HEALTH policy ,PRIMARY health care ,HEALTH insurance reimbursement ,ECONOMICS - Abstract
Telemedicine-the use of technology to deliver care at a distance-is rapidly growing and can potentially expand access for patients, enhance patient-physician collaboration, improve health outcomes, and reduce medical costs. However, the potential benefits of telemedicine must be measured against the risks and challenges associated with its use, including the absence of the physical examination, variation in state practice and licensing regulations, and issues surrounding the establishment of the patient-physician relationship. This paper offers policy recommendations for the practice and use of telemedicine in primary care and reimbursement policies associated with telemedicine use. The positions put forward by the American College of Physicians highlight a meaningful approach to telemedicine policies and regulations that will have lasting positive effects for patients and physicians. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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8. Dental hygiene and direct access to care: Past and present.
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Gadbury‐Amyot, Cynthia C., Simmer‐Beck, Melanie L., Lynch, Ann, and Rowley, Lisa J.
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PSYCHOLOGY of dentists ,ORAL hygiene ,HEALTH services accessibility ,ORAL health ,DENTAL care ,CURRICULUM ,MEDICAL care ,OCCUPATIONS ,HEALTH insurance reimbursement ,MEDICAL practice ,MEDICAID - Abstract
The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider–patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be 'deployed' outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future‐ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care. [ABSTRACT FROM AUTHOR]
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- 2023
- Full Text
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9. Nursing in deathworlds: Necropolitics of the life, dying and death of an unhoused person in the United States healthcare industrial complex.
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Jenkins, Danisha, Chechel, Laura, and Jenkins, Brian
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PALLIATIVE care nursing ,HEALTH care industry ,TERMINAL care ,HEALTH services accessibility ,TERMINALLY ill ,PRACTICAL politics ,EXTRACORPOREAL membrane oxygenation ,MEDICAL care ,SOCIOECONOMIC factors ,PSYCHOSOCIAL factors ,CRITICAL care medicine ,HOMELESS persons ,DEATH - Abstract
This paper begins with the lived accounts of emergency and critical care medical interventions in which an unhoused person is brought to the emergency department in cardiac arrest. The case is a dramatised representation of the extent to which biopolitical forces via reduction to bare life through biopolitical and necropolitical operations are prominent influences in nursing and medical care. This paper draws on the scholarship of Michel Foucault, Giorgio Agamben, and Achille Mbembe to offer a theoretical analysis of the power dynamics that influence the health care and death care of patients who are caught in the auspices of a neoliberal capitalist healthcare apparatus. This paper offers analysis of the overt displays of biopower over those individuals cast aside as generally unworthy of access to healthcare in a postcolonial capitalist system, in addition to the ways in which humans are reduced to 'bare life' in their dying days. We analyse this case study through Agamben's description of thanatopolitics, a 'regime of death', and the technologies that accompany the dying process, particularly in that of the homo sacer. Additionally, this paper illustrates the ways in which necropolitics and biopower are integral to understanding how the most advanced and expensive medical interventions make visible the political values of the healthcare system and how nurses and healthcare functions in these deathworlds. The purpose of this paper is to develop a greater understanding of biopolitical and necropolitical operations in acute and critical care environments, and to offer guidance to nurses in these spaces as they work to uphold ethical duties in a system that increasingly dehumanises. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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10. Dementia care navigation: A systematic review on different service types and their prevalence.
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Giebel, Clarissa, Reilly, Siobhan, Gabbay, Mark, Dickinson, Julie, Tetlow, Hilary, Hogan, Hayley, Griffiths, Alys, and Cooper, Claudia
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TREATMENT of dementia ,ONLINE information services ,SOCIAL support ,HEALTH services accessibility ,SYSTEMATIC reviews ,PATIENT-centered care ,MEDICAL care ,COMPARATIVE studies ,DISEASE prevalence ,RESEARCH funding ,MEDLINE - Abstract
Background: Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts. Methods: The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non‐clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst. Results: We included 14 papers reporting on six studies. All services were US‐based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well‐being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages. Conclusions: DCN services have the potential to effectively provide non‐clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required. Key points: Evidence on the impact of Dementia Care Navigators (DCNs) is limited but shows promising benefits for people living with dementia and their carers.More research needs to be conducted in countries other than the US, where all evidence was reported, and with similar outcome measures to allow comparison.DCNs are a highly useful professional group without medical training, who can navigate people living with dementia and their carers to support and provide support themselves. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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11. Public Health Challenges and Barriers to Health Care Access for Asylum Seekers at the U.S.-Mexico Border in Matamoros, Mexico.
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Reynolds, Christopher W.
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IMMIGRATION law ,UNITED States emigration & immigration ,HEALTH policy ,HEALTH education ,HEALTH services accessibility ,INTERNATIONAL relations ,HUMANITARIANISM ,HOSPITAL emergency services ,NUTRITION ,RESEARCH methodology ,PUBLIC health ,SANITATION ,MEDICAL care ,INTERVIEWING ,MENTAL health ,CONTINUUM of care ,QUALITATIVE research ,SOCIOECONOMIC factors ,REFUGEES ,EMPLOYMENT ,SEX crimes ,STATISTICAL sampling - Abstract
The Migrant Protection Protocols (MPP) and border closure to asylum seekers during the COVID-19 pandemic created a humanitarian crisis at the U.S.-Mexico border. This paper outlines the public health challenges and health care access barriers for asylum seekers living in a tent encampment in Matamoros, Mexico resulting from these policies. Thirty participants, including asylum seekers (n=20) and health care professionals (n=10) in the Matamoros asylum camp, were interviewed. Public health challenges included environmental exposures and inadequate infrastructure; poor sanitation and disease control; and limited safety, nutrition, education, and employment. Health care access barriers included lack of continuity of care and emergency services, resource insufficiencies, and interpersonal barriers. Policy responses to address these challenges include outlawing MPP and other immigration policies that infringe on human rights, collaborating with international partners, and implementing more creative and community-based approaches to asylum processing. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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12. Organisational systems' approaches to improving cultural competence in healthcare: a systematic scoping review of the literature.
- Author
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McCalman, Janya, Jongen, Crystal, and Bainbridge, Roxanne
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ETHNIC groups ,HEALTH services accessibility ,HEALTH status indicators ,HEALTH systems agencies ,INDIGENOUS peoples ,MEDICAL care ,MINORITIES ,SYSTEMATIC reviews ,HEALTH care industry ,HEALTH of indigenous peoples ,CULTURAL competence - Abstract
Introduction: Healthcare organisations serve clients from diverse Indigenous and other ethnic and racial groups on a daily basis, and require appropriate client-centred systems and services for provision of optimal healthcare. Despite advocacy for systems-level approaches to cultural competence, the primary focus in the literature remains on competency strategies aimed at health promotion initiatives, workforce development and student education. This paper aims to bridge the gap in available evidence about systems approaches to cultural competence by systematically mapping key concepts, types of evidence, and gaps in research. Methods: A literature search was completed as part of a larger systematic search of evaluations and measures of cultural competence interventions in health care in Canada, the United States, Australia and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched from 2002 to 2015. Overall, 109 studies were found, with 15 evaluating systems-level interventions or describing measurements. Thematic analysis was used to identify key implementation principles, intervention strategies and outcomes reported. Results: Twelve intervention and three measurement studies met our inclusion criteria. Key principles for implementing systems approaches were: user engagement, organisational readiness, and delivery across multiple sites. Two key types of intervention strategies to embed cultural competence within health systems were: audit and quality improvement approaches and service-level policies or strategies. Outcomes were found for organisational systems, the client/practitioner encounter, health, and at national policy level. Discussion and implications: We could not determine the overall effectiveness of systems-level interventions to reform health systems because interventions were context-specific, there were too few comparative studies and studies did not use the same outcome measures. However, examined together, the intervention and measurement principles, strategies and outcomes provide a preliminary framework for implementation and evaluation of systems-level interventions to improve cultural competence. Identified gaps in the literature included a need for cost and effectiveness studies of systems approaches and explication of the effects of cultural competence on client experience. Further research is needed to explore the extent to which cultural competence improves health outcomes and reduces ethnic and racially-based healthcare disparities. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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13. Vital Directions for Health and Health Care: Priorities From a National Academy of Medicine Initiative.
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Dzau, Victor J., McGinnis, J. Michael, Hamburg, Margaret A., Henney, Jane E., Leavitt, Michael O., Parker, Ruth M., Sandy, Lewis G., Schaeffer, Leonard D., Steele Jr., Glenn D., Thompson, Pamela, Zerhouni, Elias, Steele, Glenn D Jr, McClellan, Mark B., Burke, Sheila P., Coye, Molly J., Diaz, Angela, Daschle, Thomas A., Frist, William H., Gaines, Martha, and Kumanyika, Shiriki
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PATIENT Protection & Affordable Care Act ,MEDICAL care costs ,HEALTH equity ,HEALTH & welfare funds ,HEALTH insurance ,MEDICAL education ,COMPARATIVE studies ,HEALTH facilities ,HEALTH planning ,HEALTH services accessibility ,HEALTH status indicators ,LABOR incentives ,RESEARCH methodology ,MEDICAL care ,MEDICAL cooperation ,MEDICAL research ,PAY for performance ,POWER (Social sciences) ,RESEARCH ,EVIDENCE-based medicine ,EVALUATION research - Abstract
Importance: Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.Objectives: To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity.Evidence Review: Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings.Findings: The US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress.Conclusions and Relevance: The action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress. [ABSTRACT FROM AUTHOR]- Published
- 2017
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14. American Geriatrics Society Policy Priorities for New Administration and 115th Congress.
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Lundebjerg, Nancy E., Hollmann, Peter, and Malone, Michael L.
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GERIATRICS ,PRESIDENTIAL administrations ,OLDER people ,GOVERNMENT programs ,HEALTH policy ,HEALTH care reform ,HEALTH ,TWENTY-first century ,GOVERNMENT policy ,HISTORY ,MEDICARE ,MEDICAID ,CELEBRITIES ,ECONOMIC impact ,HEALTH services accessibility ,LABOR supply ,VETERANS ,MEDICAL care ,MEDICAL personnel ,MEDICAL societies ,NONPROFIT organizations ,PATIENTS ,POLICY sciences ,PREVENTIVE health services ,PUBLIC administration ,QUALITY of life ,PATIENT Protection & Affordable Care Act ,HUMAN services programs - Abstract
This paper is a statement of the American Geriatrics Society's (AGS) core policy priorities and the Society's positions on federal programs and policies that support older Americans as articulated to the new administration. Among the AGS priorities discussed in this paper are health reform, Medicare, and Medicaid. The AGS is committed to leveraging its expertise to inform regulatory and legislative policy proposals. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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15. Supporting older military veterans in the rural US.
- Author
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Hicken, Bret and Parry, Kimber
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AMERICAN veterans ,ELDER care ,AGING ,HEALTH services accessibility ,MEDICAL care ,RURAL conditions ,PSYCHOLOGY of veterans ,VETERANS' hospitals ,GOVERNMENT programs ,SOCIAL support ,MILITARY service ,HUMAN services programs - Abstract
Purpose The purpose of this paper is to provide an overview of rural older veterans in the USA and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans.Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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16. Challenges to care coordination posed by the use of multiple health IT applications.
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Carayon, Pascale, Alyousef, Bashar, Hoonakker, Peter, Hundt, Ann Schoofs, Cartmill, Randi, Tomcavage, Janet, Hassol, Andrea, Chaundy, Kimberly, Larson, Sharon, Younkin, Jim, and Walker, James
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CHRONIC disease treatment ,HEART failure treatment ,OBSTRUCTIVE lung disease treatment ,ASSOCIATIONS, institutions, etc. ,HEALTH care teams ,HEALTH services accessibility ,INFORMATION technology ,INTERVIEWING ,LONGITUDINAL method ,MEDICAL care ,SCIENTIFIC observation ,RESEARCH funding ,RURAL conditions ,TECHNOLOGY ,TEAMS in the workplace ,QUALITATIVE research ,PRODUCT design ,DATA analysis ,UNOBTRUSIVE measures - Abstract
Coordinating care for hospitalized patients requires the use of multiple sources of information. Using a macroergonomic framework (i.e. the work system model), we conducted interviews and observations of care managers involved in care coordination across transitions of care. When information is distributed across multiple health IT applications, care managers experience a range of challenges, including organizational barriers, technology design problems, skills and knowledge issues, and task performance demands (i.e. issues related to individual information processing and management and sharing of information). These challenges can be used as a checklist to evaluate the proposed IT infrastructure that will allow the integration of multiple health IT applications and, therefore, support coordination across transitions of care. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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17. Some conjectures about access to US health care for disposed people.
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Kover, Arthur J.
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HEALTH services accessibility ,HEALTH insurance ,MEDICAL care ,UNEMPLOYED people ,HEALTH - Abstract
This paper hypothesizes the extent of access to health care by disposed people, particularly in the US. The disposed are people 'thrown away' as used-up commodities. This paper briefly examines the theoretical idea of disposability. It then presents the basic results of new research showing that a sample of Americans sees that people in several different occupations are equally liable to be disposed. The section that follows proposes that the access these disposed people have to the US health-care system is minimal overall and is not likely to improve. Because this total grouping has not previously been studied as a whole, these hypothetical findings are partly based on subsets of the disposed: the poor; those without health insurance; and the unemployed. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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18. Access to Care for Methadone Maintenance Patients in the United States.
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Hettema, Jennifer E. and Sorensen, James L.
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DRUG abuse treatment ,METHADONE treatment programs ,DRUG addiction complications ,TREATMENT of drug addiction ,SUBSTANCE abuse treatment facilities ,MEDICAL care ,HEALTH services accessibility ,SUBSTANCE abuse treatment ,GOVERNMENT policy - Abstract
This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more intensive interventions, such as residential care. Many publically-funded residential treatment programs explicitly decline to admit MMT patients, contending that methadone raises both clinical and administrative problems in treatment. Although advocates within the field believe that this issue is a violation of the American’s with Disabilities Act (ADA) in the United States, no lawsuits have been brought forth, and there is no legal precedent or public policy to inform the debate. The present paper provides an overview of this problem and discusses factors that may contribute to the problem, including an abstinence-oriented philosophy and treatment program operational concerns. The paper also draws parallels between methadone and other medical conditions and analyzes the problem in the context of disabilities encompassed in the ADA. Finally, recommendations on strategies for increasing access to residential care for MMT patients are provided. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
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19. Stepped Care as an Implementation and Service Delivery Model for Cognitive Behavioral Therapy for Psychosis.
- Author
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Kopelovich, Sarah L., Strachan, Eric, Sivec, Harry, and Kreider, Valerie
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PSYCHOSES ,BEHAVIOR therapy ,COGNITIVE therapy ,HEALTH care teams ,HEALTH services accessibility ,MATHEMATICAL models ,MEDICAL care ,THEORY ,THERAPEUTICS - Abstract
Cognitive behavioral therapy for schizophrenia spectrum disorders is an evidence-based treatment that is recommended by United States schizophrenia treatment guidelines. Based on recent estimates, only 0.3% of individuals with a primary psychotic disorder are able to access this treatment in the United States. Stepped care interventions have shown promise as an applied treatment delivery model in other settings and for other psychotherapeutic interventions. The current paper describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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20. A Human Rights Framework for Advancing the Standard of Medical Care for Incarcerated People in the United States in the Time of COVID-19.
- Author
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SALONER, BRENDAN, EBER, GABRIEL B., SUFRIN, CAROLYN B., BEYRER, CHRIS, and RUBENSTEIN, LEONARD S.
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MEDICAL quality control ,HUMAN rights ,PRISON psychology ,HEALTH services accessibility ,MEDICAL care ,MEDICAL care of prisoners ,MEDICAID ,COVID-19 pandemic - Abstract
The COVID-19 pandemic has underscored the lack of resources and oversight that hinders medical care for incarcerated people in the United States. The US Supreme Court has held that "deliberate indifference" to "serious medical needs" violates the Constitution. But this legal standard does not assure the consistent provision of health care services. This leads the United States to fall behind European nations that define universal standards of care grounded in principles of human rights and the ideal of equivalence that incarcerated and non-incarcerated people are entitled to the same health care. In this paper, we review a diverse legal and policy literature and undertake a conceptual analysis of policy issues related to the standard of care in correctional health; we then describe a framework for moving incrementally closer toward a universal standard. The expansion of Medicaid funding and benefits to corrections facilities, alongside a system of comprehensive and enforceable external oversight, would meaningfully raise the standard of care. Although these changes on their own will not resolve all of the thorny health problems posed by mass incarceration, they present a tangible opportunity to move closer to the human rights ideal. [ABSTRACT FROM AUTHOR]
- Published
- 2022
21. Seeking care across the US-Mexico border: The experiences of Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress.
- Author
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Ortiz, Gabriela, Rodriguez, Sophia, Pozar, María, Moran, Ashley, and Cheney, Ann
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HISPANIC Americans , *HEALTH services accessibility , *QUALITATIVE research , *FOCUS groups , *SOCIAL determinants of health , *MEDICAL care , *INTERVIEWING , *RESPIRATORY diseases , *ASTHMA in children , *DECISION making , *DESCRIPTIVE statistics , *TOXINS , *ENVIRONMENTAL justice , *ENVIRONMENTAL exposure , *PSYCHOLOGY of caregivers , *CAREGIVER attitudes , *PSYCHOLOGICAL vulnerability - Abstract
Many Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions. This study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information. A total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health. This study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services. • Municipal unincorporation contributes to health disparities among Latinx families in US-Mexico borderlands. • Latinx children in colonias are disproportionately exposed to environmental toxins. • Geography acts as a structural determinant of health for Latinx families in colonias. • A binational approach to health services should be prioritized for families in the borderlands. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
22. Primary Care in Cuba: Considerations for the U.S.
- Author
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Bhardwaj, Nakul and Skinner, Daniel
- Subjects
COMMUNITY health services ,HEALTH care reform ,HEALTH services accessibility ,HEALTH services administration ,MEDICAL care ,MEDICAL education ,MEDICAL practice ,PRIMARY health care ,GRADUATE education - Abstract
Abstract In 2017, we traveled to Cuba to learn about the nation's approach to health care. Despite being a developing nation, Cuba boasts health care indicators that are comparable to those of the United States and other developed nations. Emphasizing prevention and proactive care, the Cuban health care system provides lessons to inform future U.S. health care reform efforts in order to contain medical costs while providing quality care. Visiting with Cuban health care professionals over the course of eight days, and interviewing American physicians who were trained in Cuba but practice in the U.S. this paper provides an overview of key differences in primary health care in Cuba and primary care practice in the U.S. Our work has three main themes: how Cuban medicine approaches primary health care, the importance of medical curriculum in establishing these priorities, and the prioritization of the clinical encounter over technologically-advanced interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
23. Financing uterus transplants: The United States context.
- Author
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Blake, Valarie K.
- Subjects
TRANSPLANTATION of organs, tissues, etc. ,UTERUS ,ENDOWMENTS ,HEALTH services accessibility ,INFERTILITY ,MEDICAL care ,ECONOMICS - Abstract
The first baby has successfully been born by uterus transplantation (UTx) in the United States and the procedure is swiftly becoming a viable clinical option for patients with uterine factor infertility (UFI). This raises a practical ethical question: should health insurers finance UTx and what issues should they consider in coming to this decision? The article lays forth some of the factors that shape the decision over whether to finance UTx in the United States, including what procedures must be covered, whether UTx is more like organ transplantation or infertility treatment (which are treated differently in the United States), and the benefits and alternatives of the procedure. Then, the article explores arguments around why UTx should be financed, or at least considered along with other important medical needs. The paper argues that UTx ought to be considered along with other competing claims for healthcare services. In countries that generously cover other infertility services, it may logically follow that medical services that enable gestation should be insured when the healthcare system covers services to conceive. In the United States, however, many groups have long suffered inadequate access to medical care, in the context of infertility and more broadly. U.S. healthcare may need to be made more widely equitable, before covering UTx is seen as financially or politically possible. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
24. Achieving Universal Coverage through Medicare Part E(veryone).
- Subjects
HEALTH services accessibility ,MEDICAL care ,HEALTH care reform ,HEALTH insurance - Abstract
The article highlights key points in a discussion paper about the access of Americans to affordable health care coverage, released by the Hamilton Project, Gerard Anderson and Hugh Waters. The paper is guided by the principle that a practical and feasible reform for universal coverage should minimize disruptions and costs. The proposal also extends Medicare to all Americans who do not have other public or private insurance.
- Published
- 2007
25. Program Director Reports of COVID-19 Lockdown-Driven Service Changes in Community-Based STI Clinics and Syringe Services Programs in the Southeastern U.S.
- Author
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Hatch, Mary A., Laschober, Tanja C., Ertl, Melissa M., Paschen-Wolff, Margaret M., Norman, Gaia, Wright, Lynette, and Tross, Susan
- Subjects
HIV infection risk factors ,SUBSTANCE abuse ,COMMUNITY health services ,RISK assessment ,SEXUALLY transmitted diseases ,HEALTH services accessibility ,EXECUTIVES ,NEEDLE exchange programs ,QUALITATIVE research ,STATISTICAL significance ,RESEARCH funding ,EVALUATION of human services programs ,MEDICAL care ,QUANTITATIVE research ,DESCRIPTIVE statistics ,STAY-at-home orders ,TELEMEDICINE ,THEMATIC analysis ,ATTITUDES of medical personnel ,DATA analysis software ,COVID-19 pandemic ,DISEASE complications - Abstract
The COVID-19 pandemic strained the U.S. health care system, posing logistical challenges for community-based programs. This study surveyed 11 program directors in sexually transmitted infection (STI) clinics and syringe services programs (SSPs) that served people who use substances and are at risk for HIV in five southeastern U.S. states. Brief survey questions asked about programs' use of in-person and telehealth services. Results indicated widespread reduction of in-person services and concomitant adoption of telehealth services. In STI clinics, telehealth replaced in-person visits for all but urgent treatment of active symptoms. In SSPs, in-person contact continued or increased from pre-pandemic volumes. In both programs, the most salient telehealth use barrier was limited device or internet access and limited technological ease. Services were sustained through innovative adaptations. This snapshot of response to the early COVID-19 lockdown phase offers actionable guidance about service preparedness for future public health catastrophes in community-based programs serving vulnerable populations. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
26. Confronting Barriers to Equitable Care: A Qualitative Analysis of Factors That Inform People with Mobility Disabilities' Decisions to Self-Advocate in the Context of Healthcare.
- Author
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VanPuymbrouck, Laura and Magasi, Susan
- Subjects
HEALTH services accessibility ,PATIENT selection ,QUALITATIVE research ,SELF-efficacy ,DATA analysis ,INTERVIEWING ,LEGISLATION ,PRIMARY health care ,HUMAN research subjects ,MEDICAL care ,DECISION making ,JUDGMENT sampling ,DESCRIPTIVE statistics ,REFLEXIVITY ,THEMATIC analysis ,RESEARCH methodology ,ACQUISITION of data ,HEALTH equity ,SELF advocacy ,PUBLIC health ,PHENOMENOLOGY ,DISCRIMINATION against people with disabilities ,PEOPLE with disabilities ,PHYSICAL mobility - Abstract
Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants' experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of "recognizing the normalization of disability discrimination and disability stigma" which necessitates the development of "agency in self-advocacy." This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
27. Health Care Usage and Health Status of Immigrant Children: The Effects of Nativity versus Citizenship.
- Author
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García-Pérez, Mónica
- Subjects
CHILDREN'S health ,CHILDREN of immigrants ,UNITED States citizenship ,MEDICAL care ,HEALTH of Hispanic Americans ,HEALTH services accessibility ,HEALTH of Asian Americans ,HEALTH of African Americans - Abstract
This paper addresses the relationship between child access to and use of health services, perceived health, and parental nativity. Parental region of birth is identified to include the underlying cultural differences across immigrant groups. We found that children of immigrant families, regardless of their immigration status, have lower odds to visit the doctor at least once a year and lack of usual place of care. Conversely, this group has better outcomes with regard to their perceived health. Results hold when parental region of birth is included. Overall, non-citizen children of Latino American, Asian and African families have the worse outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
28. Complex care and contradictions of choice in the safety net.
- Author
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Van Natta, Meredith, Burke, Nancy J., Yen, Irene H., Rubin, Sara, Fleming, Mark D., Thompson‐Lastad, Ariana, and Shim, Janet K.
- Subjects
COST effectiveness ,HEALTH services accessibility ,HOSPITAL emergency services ,LONGITUDINAL method ,MEDICAL care ,MEDICAL care use ,MEDICAL care costs ,METROPOLITAN areas ,PATIENTS ,PATIENT safety ,HEALTH self-care ,ETHNOLOGY research ,SOCIOECONOMIC factors - Abstract
Abstract: This article explores the complicated and often‐contradictory notions of choice at play in complex care management (CCM) programmes in the US healthcare safety net. Drawing from longitudinal data collected over two years of ethnographic fieldwork at urban safety‐net clinics, our study examines the CCM goal of transforming frequent emergency department (ED) utilisers into ‘active’ patients who will reduce their service utilisation and thereby contribute to a more rational, cost‐effective healthcare system. By considering our data alongside philosopher Annemarie Mol's (2008) conceptualisation of the competing logics of choice and care, we argue that these premises often undermine CCM teams' efforts to support patients and provide the care they need – not only to prevent medical crises, but to overcome socio‐economic barriers as well. We assert that while safety‐net CCM programmes are held accountable for the degree to which their patients successfully transform into self‐managing, cost‐effective actors, much of the care CCM staff provide in fact involves attempts to intervene on structural obstacles that impinge on patient choice. CCM programmes thus struggle between an economic imperative to get patients to make better health choices and a moral imperative to provide care in the face of systemic societal neglect. (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA). [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
29. Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders.
- Author
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Kim, Giyeon, Dautovich, Natalie, Ford, Katy-Lauren, Jimenez, Daniel, Cook, Benjamin, Allman, Richard, Parmelee, Patricia, Jimenez, Daniel E, and Allman, Richard M
- Subjects
PATHOLOGICAL psychology ,MEDICAL care ,MENTAL health ,LOGISTIC regression analysis ,HEALTH equity ,MENTAL illness treatment ,STATISTICS on Black people ,STATISTICS on minorities ,STATISTICS on Hispanic Americans ,ASIANS ,HEALTH services accessibility ,HEALTH status indicators ,PSYCHOLOGY of Hispanic Americans ,MENTAL health services ,MENTAL illness ,PSYCHOLOGY of Minorities ,POPULATION geography ,RESEARCH funding ,SURVEYS ,WHITE people ,PSYCHOLOGY of Black people ,SOCIOECONOMIC factors ,PSYCHOLOGY - Abstract
Purpose: The main purpose of this paper is to examine geographic variation in unmet need for mental health care among racially/ethnically diverse adults with psychiatric disorders in the US.Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES; 2001-2003), adults with any past year psychiatric disorder diagnosis (n = 3211) from diverse racial/ethnic backgrounds were selected for analyses. Using weighted data, descriptive analyses and logistic regression analyses were conducted.Results: Two-thirds of the total sample had unmet mental health care need, which differed significantly by race/ethnicity (p < .001). Logistic regression analyses show regional variation of the effect of race/ethnicity in unmet need: after adjusting for covariates, Latinos in the South, Blacks and Latinos in the Midwest, and Latinos and Asians in the West had higher unmet need than non-Hispanic Whites, whereas no significant racial/ethnic effects were found in the Northeast.Conclusions: Findings suggest that geographic region plays an important role in the sufficient use of mental health services among racial/ethnic minorities. Further research should elucidate reasons for geographic disparities in mental health care among racial/ethnic minority adults to reduce disparities. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
30. Transforming clinical practice to eliminate racial-ethnic disparities in healthcare.
- Author
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Washington, Donna L., Bowles, Jacqueline, Saha, Somnath, Horowitz, Carol R., Moody-Ayers, Sandra, Brown, Arleen F., Stone, Valerie E., Cooper, Lisa A., and Writing group for the Society of General Internal Medicine, Disparities in Health Task Force
- Subjects
CLINICAL medicine ,MEDICAL care ,GENERAL practitioners ,MEDICAL practice ,MEDICAL personnel ,ETHNIC relations ,MEDICAL informatics ,MEDICAL care standards ,ATTITUDE (Psychology) ,COMPARATIVE studies ,ETHNIC groups ,HEALTH services accessibility ,HEALTH status indicators ,RESEARCH methodology ,MEDICAL quality control ,MEDICAL cooperation ,HEALTH policy ,MINORITIES ,CULTURAL pluralism ,PRIMARY health care ,RESEARCH ,RESEARCH funding ,SOCIAL classes ,EVALUATION research - Abstract
Racial-ethnic minorities receive lower quality and intensity of health care compared with whites across a wide range of preventive, diagnostic, and therapeutic services and disease entities. These disparities in health care contribute to continuing racial-ethnic disparities in the burden of illness and death. Several national medical organizations and the Institute of Medicine have issued position papers and recommendations for the elimination of health care disparities. However, physicians in practice are often at a loss for how to translate these principles and recommendations into specific interventions in their own clinical practices. This paper serves as a blueprint for translating principles for the elimination of racial-ethnic disparities in health care into specific actions that are relevant for individual clinical practices. We describe what is known about reducing racial-ethnic disparities in clinical practice and make recommendations for how clinician leaders can apply this evidence to transform their own practices. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
31. The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review.
- Author
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Twersky, Sylvia E., Jefferson, Rebeca, Garcia-Ortiz, Lisbet, Williams, Erin, and Pina, Carol
- Subjects
EVALUATION of medical care ,ONLINE information services ,IMMIGRANTS ,HEALTH services accessibility ,COMMUNICATION barriers ,SYSTEMATIC reviews ,MEDICAL care ,LANGUAGE & languages ,MEDICAL care costs ,MENTAL health ,SOCIOECONOMIC disparities in health ,GOVERNMENT policy ,HOSPITAL care ,LITERATURE reviews ,MEDLINE ,ECONOMICS - Abstract
A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
32. Over-the-Counter Hearing Aids Challenge the Core Values of Traditional Audiology.
- Author
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Menon, Katherine N., Hoon-Starr, Michelle, Shilton, Katie, and Hoovera, Eric C.
- Subjects
TREATMENT of hearing disorders ,HEALTH services accessibility ,AUDIOLOGY ,GOVERNMENT regulation ,MOTIVATION (Psychology) ,HEARING aids ,MEDICAL care ,PATIENT satisfaction ,QUALITATIVE research ,COMPARATIVE studies ,MEDICAL equipment safety measures ,PRODUCT design ,SELF-efficacy ,RESEARCH funding ,DESCRIPTIVE statistics ,CONTENT analysis ,BIOETHICS - Abstract
Purpose: Regulatory changes in the United States introduced over-the-counter (OTC) hearing aids with the goal of increasing the accessibility and affordability of hearing health care. It is critical to understand the values inherent to hearing health care systems to evaluate their effectiveness in serving people with hearing difficulty. In this study, we evaluated the relative importance of values across service delivery models and the extent to which the introduction of OTC hearing aids represents a values shift relative to traditional audiology. Method: We performed a qualitative content analysis of two document categories: critique documents that motivated the creation of OTC hearing aids and regulatory documents that defined OTC hearing aids. Team members coded portions of text for the values they expressed. In total, 29,235 words were coded across 72 pages in four documents. Rank-order analyses were performed to determine the prioritization of values within each category of documents and subsequently compare values between OTC and traditional audiology documents analyzed in a previous study. Results: Critique and regulatory documents both prioritized values related to reducing barriers to hearing aid access and use, but the lack of a significant correlation in the rank order of values in these documents was evidence of inconsistency between the motivation and implementation of OTC hearing aids. Differences in the rank order of values in the OTC documents compared to traditional audiology were consistent with a values shift. Conclusions: The introduction of OTC as a solution to low hearing aid use represents a values shift, challenging the values of traditional audiology. This research demonstrates a need to establish the values of hearing health care service delivery through a consensus of stakeholders, including individuals from diverse backgrounds underserved by the traditional model. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
33. Quantifying and explaining accessibility with application to the 2009 H1N1 vaccination campaign.
- Author
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Heier Stamm, Jessica, Serban, Nicoleta, Swann, Julie, Wortley, Pascale, and Heier Stamm, Jessica L
- Subjects
PUBLIC health ,HEALTH services accessibility ,MEDICAL care ,INFLUENZA A virus, H1N1 subtype ,VACCINATION ,THERAPEUTICS - Abstract
Accessibility and equity across populations are important measures in public health. This paper is specifically concerned with potential spatial accessibility, or the opportunity to receive care as moderated by geographic factors, and with horizontal equity, or fairness across populations regardless of need. Both accessibility and equity were goals of the 2009 vaccination campaign for the novel H1N1a influenza virus, including during the period when demand for vaccine exceeded supply. Distribution system design can influence equity and accessibility at the local level. We develop a general methodology that integrates optimization, game theory, and spatial statistics to measure potential spatial accessibility across a network, where we quantify spatial accessibility by travel distance and scarcity. We estimate and make inference on local (census-tract level) associations between accessibility and geographic, socioeconomic, and health care infrastructure factors to identify potential inequities in vaccine accessibility during the 2009 H1N1 vaccination campaign in the U.S. We find that there were inequities in access to vaccine at the local level and that these were associated with factors including population density and health care infrastructure. Our methodology for measuring and explaining accessibility leads to policy recommendations for federal, state, and local public health officials. The spatial-specific results inform the development of equitable distribution plans for future public health efforts. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
34. Health Status Indices and Access to Medical Care.
- Author
-
Andersen, Ronald
- Subjects
MEDICAL care ,HEALTH status indicators ,HEALTH surveys ,PUBLIC health ,HEALTH ,PHYSICIANS ,HEALTH services accessibility ,MEDICAL care of poor people - Abstract
This paper examines the uses of some health status indices in measuring equity of access to medical care. Empirical examples are provided using data from national surveys of the U.S. population conducted from 1964 through 1976. A simple indicator, mean number of physician visits, suggests that between 1963 and 1976 the poor improved their position relative to the rest of the population and, indeed, currently enjoy the highest level of access. However, a second measure, the use-disability ratio indicates that the poor may still receive less care relative to their need. A third measure, the symptoms-response ratio suggests how norms of appropriate behavior might be incorporated into an access measure. [ABSTRACT FROM AUTHOR]
- Published
- 1978
- Full Text
- View/download PDF
35. PATIENT ENGAGEMENT AND MEANINGFUL USE: ASSESSING THE IMPACT OF THE EHR INCENTIVE PROGRAM ON CULTURAL COMPETENCE IN HEALTHCARE.
- Author
-
Watters, Amy, Bergstrom, Amy, and Sandefer, Ryan
- Subjects
- *
MEANINGFUL Use (Incentive program) , *COLLEGE teachers , *ETHNIC groups , *GOAL (Psychology) , *HEALTH services accessibility , *HEALTH status indicators , *MEDICAL care , *MEDICAL education , *MINORITIES , *CULTURAL pluralism , *PATIENT participation , *ACCESS to information , *HEALTH equity , *CULTURAL competence - Abstract
This paper examines the importance and increasing need for health care practitioners to develop cultural competence in an effort to engage patients in their care to minimize the health disparities that are found in predominately ethnic minority populations. Although Meaningful Use requires data collection related to race and ethnicity, there is no evidence to support that the data is being used to engage patients in a culturally competent way. Lessons learned from the field of education regarding strategies used to develop cultural competence in the teaching profession can be applied in the health care field. This paper argues that cultural competence and patient engagement are clearly linked. [ABSTRACT FROM AUTHOR]
- Published
- 2016
36. How should health service organizations respond to diversity? A content analysis of six approaches.
- Author
-
Seeleman, Conny, Essink-Bot, Marie-Louise, Stronks, Karien, and Ingleby, David
- Subjects
MEDICAL care ,DIVERSITY in organizations ,CONTENT analysis ,CULTURAL competence ,OPERATIONAL definitions ,CLASSIFICATION ,COMPARATIVE studies ,HEALTH outcome assessment ,MEDICAL care standards ,HEALTH insurance statistics ,ASSOCIATIONS, institutions, etc. ,CLINICAL competence ,CORPORATE culture ,DECISION making ,ETHNIC groups ,HEALTH services accessibility ,HEALTH status indicators ,MANAGEMENT ,RESEARCH methodology ,MEDICAL needs assessment ,MEDICAL quality control ,MEDICAL cooperation ,MEDICAL personnel ,CULTURAL pluralism ,QUESTIONNAIRES ,RESEARCH ,PATIENT participation ,PATIENTS' rights ,EVALUATION research - Abstract
Background: Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches?Methods: We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches.Results: We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender.Conclusions: Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2015
- Full Text
- View/download PDF
37. The sun never sets . . . but shadows still remain.
- Author
-
Sekscenski, Edward
- Subjects
TELEMEDICINE ,MEDICAL care ,HEALTH ,HEALTH services accessibility - Abstract
The article discusses the place of telemedicine in medical care in the U.S. Telemedicine has the potential to ease some of the imbalances in the distribution of health resources. There are several examples where telemedicine has proved to be effective in providing additional access to persons in both rural areas and inner-city settings. Indeed, some of these models of service delivery may prove to be more promising than traditional methods in extending health services.
- Published
- 1999
- Full Text
- View/download PDF
38. U.S. Rural Hospital Care Quality and the Effects of Hospital Closures on the Health Status of Rural Vulnerable Populations: An Integrative Literature Review.
- Author
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Stansberry, Tracey T., Roberson, Patricia N. E., and Myers, Carole R.
- Subjects
RURAL hospitals ,MEDICAL quality control ,CINAHL database ,ONLINE information services ,EVALUATION of medical care ,HEALTH services accessibility ,HOSPITAL closures ,RURAL conditions ,PSYCHOLOGICAL vulnerability ,SYSTEMATIC reviews ,HEALTH status indicators ,MEDICAL care ,MEDLINE ,RURAL population - Abstract
Introduction. Hospital and emergency department closures are emblematic of America's changing healthcare delivery system, which often places rural vulnerable communities at further risk for poor health outcomes. Employing the Vulnerable Populations Conceptual Model (VPCM), we aimed to synthesize the existing research addressing care quality in these facilities and the impacts of their closures on affected communities and health status. Materials and Methods. We conducted a modified integrative literature review (outlined by Whittemore and Knafl), comparing and contrasting articles via an organizational matrix. We identified articles through three databases and ancestral searches. We included English-written, peer-reviewed articles published from 2010 forward. We excluded international and nonresearch articles that focused on the closure of specific departments (other than emergency departments). Our final sample included 26 primary research studies (24 quantitative and two qualitative). We scored the articles according to their scientific rigor and data relevance, then deductively coded them according to the VPCM constructs. Results. We identified two overarching themes from the literature: (1) association of rural hospital care and patient health outcomes and (2) access to hospital care-effects of closures and openings on rural vulnerable populations. Subthemes reflected access to care and other resources, relative risks associated with time-sensitive health events, and health outcomes. Discussion and Conclusion. We found that rural hospitals provide access to essential health services and emergency care in these vulnerable, underserved communities. Their loss may increase adverse outcomes in affected communities and the overall health system. However, our review was limited by the retrospective, nonexperimental nature of most included articles, and more data quantifying these effects and the impact of confounding factors are needed. Multidisciplinary stakeholders must jointly address declining access to hospital and emergency care by sustainably addressing social determinants of health, quality assurance, innovative healthcare delivery systems, and rural hospital funding. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
39. Human-centered Design to Address Ageism and Ableism in Rural America.
- Author
-
Cantor, Sara
- Subjects
HEALTH services accessibility ,DIFFUSION of innovations ,NATURAL foods ,MEDICAL care ,FOOD security ,PATIENT-centered care ,RURAL health services ,TRANSPORTATION ,AGEISM ,RURAL conditions ,AGING ,RURAL population ,CONSUMER activism ,MEDICAL needs assessment ,HEALTH promotion ,PEOPLE with disabilities - Abstract
Despite the abundance of older people--many with disabilities--living in them, rural communities in the United States are not prepared to care for elders' needs. Elders and people with disabilities in rural communities face structural barriers to vital resources like healthy food, medical care, and transportation. This article explores how a human-centered design (HCD) process can circumvent entrenched ageism and ableism to yield creative solutions that positively impact everyone in a community, using the successful roll-out of a healthy food initiative in Wilkesboro, NC, as a case study. [ABSTRACT FROM AUTHOR]
- Published
- 2023
40. Expanding the Lifestyle Medicine Inpatient Consultation Services at Loma Linda University Health: A Transformative Tool for Chronic Diseases Management in Tertiary Care Settings.
- Author
-
Annam, Rachel, Florian, Rosemarie, Johnson, Sara, Mondala, Melisa, Wilson, April, and Rea, Brenda
- Subjects
PREVENTION of chronic diseases ,CHRONIC disease treatment ,LIFESTYLES ,MEDICINE ,HOSPITALS ,INSURANCE companies ,HOSPITAL patients ,ACADEMIC medical centers ,HEALTH services accessibility ,TERTIARY care ,MEDICAL care ,DISEASES ,MEDICAL care costs ,COMPARATIVE studies ,MEDICAL referrals ,HEALTH behavior ,QUALITY of life ,DESCRIPTIVE statistics ,DISEASE management ,LONGITUDINAL method ,HEALTH promotion - Abstract
Lifestyle Medicine (LM) is an emerging field dedicated to the prevention, management, and reversal of chronic diseases by promoting healthy lifestyle choices. LM utilizes six pillars targeting the root causes of diseases to promote health, improve clinical outcomes and significantly enhance overall quality of life. They include plant-based nutrition, physical activity, sleep health, tobacco cessation/managing risky alcohol use, and spiritual/emotional well-being. LM holds great promise as an evidence-based solution for the rising rates of chronic diseases and healthcare costs in the United States. Loma Linda University Health (LLUH), a pioneer of LM, has successfully implemented a phased expansion of its novel LM inpatient consultation services to positively impact the trajectory of morbidity and mortality among patients with chronic conditions and/risk factors admitted to the hospital. This was achieved by boosting awareness, hiring LM-trained providers to meet growing demand, and making consultations accessible hospital-wide. The service has been very well received and saw a 50-fold increase in consultations between 2016 and 2022. It is also reimbursed by all major insurers. LLUH's experience shows that establishing and growing an inpatient LM consultation service is a viable clinical and cost-effective chronic care model that can be utilized in a tertiary care setting. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
41. Access and Utilization of Free Health Care Service: Findings from Community-Based Research.
- Author
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Thomas, Byron, Pizmony-Levy, Oren, Wininger, Bryce, and Shaddox, Abagail
- Subjects
MEDICAL care ,PUBLIC welfare policy ,HEALTH services accessibility ,SOCIAL networks ,CLINICS - Abstract
With a limited welfare policy, the United States addresses the pressing issue of access to health care by supplementing care of the uninsured with volunteer health organizations. This paper presents a community-based research conducted with the Volunteers in Medicine (VIM) clinic in Bloomington, Indiana. The main objective of this research is to examine and evaluate the issue of access to health care in a unique context where a free health care clinic is available. Consistent with other research in this field, our findings show an association between several socio-demographic characteristics and usage of the VIM clinic. Findings also point to the importance of social capital and social networks. Based on these findings, we argue that the establishment of free health clinics like the VIM, are an example of first-order change - a response to a social problem within an existing framework. In this case it is the development of free health care clinics following the template of conventional health care clinics. However, this change does not address the underlying processes that shape actual access and usage. Hence, we highlight the need for second-order change that will include re-thinking the concept of the clinic to include more innovative strategies for patient recruitment. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]
- Published
- 2009
42. Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health.
- Author
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Butkus, Renee, Rapp, Katherine, Cooney, Thomas G., and Engel, Lee S.
- Subjects
ELECTRONIC cigarettes ,MEDICAL care ,CHARACTER ,HEALTH services accessibility ,SUBSTANCE-induced disorders - Abstract
The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S. health system goes beyond ensuring coverage, efficient delivery systems, and affordability. Reductions in non-financial barriers to care and improvements in social determinants of health are also necessary. This ACP position paper calls for ending discrimination based on personal characteristics; correcting work force shortages, including the under supply of primary care physicians; and understanding and ameliorating social determinants of health. The ACP calls for in creased efforts to address urgent public health threats, including injuries and deaths from firearms; environmental hazards; climate change; maternal mortality; substance use disorders; and the health risks associated with nicotine, tobacco use, and electronic nicotine delivery systems in order to achieve ACP's vision for a better U.S. health care system. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
43. Undocumented Patients in the Emergency Department: Challenges and Opportunities.
- Author
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Samra, Shamsher, Taira, Breena R., Pinheiro, Erika, Trotzky-Sirr, Rebecca, and Schneberk, Todd
- Subjects
MEDICAL care ,CONCEPTUAL structures ,DOCUMENTATION ,CURRICULUM ,EMERGENCY medicine ,EMERGENCY physicians ,HEALTH services accessibility ,HOSPITAL emergency services ,MEDICAL care use ,PATIENTS ,PATIENT safety ,OCCUPATIONAL roles ,PSYCHOSOCIAL factors ,HEALTH & social status ,PSYCHOLOGY - Abstract
In the United States, undocumented residents face unique barriers to healthcare access that render them disproportionately dependent on the emergency department (ED) for care. Consequently, ED providers are integral to the health of this vulnerable population. Yet special considerations, both clinical and social, generally fall outside the purview of the emergency medicine curriculum. This paper serves as a primer on caring for undocumented patients in the ED, includes a conceptual framework for immigration as a social determinant of health, reviews unique clinical considerations, and finally suggests a blueprint for immigration-informed emergency care. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
44. Healthy People 2020: Developing the potential of mobile and digital communication tools to touch the life of every American.
- Author
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Manderscheid, Ron and Wukitsch, Kimber
- Subjects
HEALTH promotion ,PUBLIC health ,COMMUNICATION ,CAUSES of death ,HEALTH services accessibility ,HEALTH status indicators ,INTERNET ,MEDICAL care ,HEALTH policy ,PORTABLE computers ,SOCIAL networks ,USER interfaces ,WIRELESS communications ,SOCIAL media ,CLOUD computing - Abstract
The U.S. Department of Health and Human Services implemented the Healthy People initiative to set national health objectives for four different decades since 1979. This national effort has promoted a shared vision for improving the health of all Americans in a very fragmented health care delivery system. The current Healthy People 2020 initiative being implemented by the Department's Office of Disease Prevention and Health Promotion differs from previous efforts in several important ways. This paper explores one of these changes: implementation of a new communication strategy based in modern information technology. This strategy conceptualized a Healthy People 2020 online space that would be a user-focused, 'one-stop shop' for public health and health care professionals, policymakers, and community members to learn about the objectives, plan interventions, and implement strategies to reach the 2020 objectives. The communication strategy incorporated new digital media, including building a following on LinkedIn and Twitter. At present, membership in the Healthy People LinkedIn group is more than 7700 people, and the Healthy People Twitter account (@gohealthypeople) has nearly 50 000 followers. In addition to the growth in number of users, the success of the communication strategy is also confirmed by the consistently high customer satisfaction rankings the site receives from the American Customer Satisfaction Index E-government Satisfaction Index. New developments in digital communication technology have the potential to advance three principal functions originally conceptualized for Healthy People 2020 online: benchmarking, advocacy, and connecting with others. Several exciting digital tools can be used to implement each of these key Healthy People 2020 functions, including mobile Web site optimization, smartphone/tablet apps, social media, and cloud computing. Ultimately, HHS can conduct research with Healthy People target audiences and stakeholders to inform the types of digital tools that will be most helpful to Healthy People 2020 users. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
45. Note from the Editor.
- Author
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Brennan, Virginia M.
- Subjects
ASSOCIATIONS, institutions, etc. ,CARDIOVASCULAR diseases risk factors ,HEALTH care teams ,HEALTH services accessibility ,HEALTH status indicators ,HISPANIC Americans ,IMMIGRANTS ,NATIVE Americans ,MEDICAL care ,HEALTH policy ,MENTAL health ,SERIAL publications ,REPRODUCTIVE health ,MEDICALLY underserved persons ,PATIENT Protection & Affordable Care Act - Published
- 2019
- Full Text
- View/download PDF
46. Healthcare Policy in the United States: A Primer for Medical Family Therapists.
- Author
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Edwards, Todd, Patterson, JoEllen, Vakili, Susanna, and Scherger, Joseph
- Subjects
HEALTH policy ,FAMILY psychotherapy ,HEALTH care reform ,HEALTH services accessibility ,INTEGRATED health care delivery ,MEDICAL care ,MEDICAL quality control ,MENTAL health services ,PATIENT safety ,PSYCHOTHERAPISTS ,QUALITY assurance ,PATIENT-centered care - Abstract
As family therapists increasingly practice in healthcare settings, they need to be aware of forthcoming changes in healthcare policy and the impact of these changes on their clinical work and the lives of their clients. In this paper, we provide a primer on healthcare policy for family therapists, which describes current and proposed changes in healthcare that will potentially revolutionize healthcare delivery for families. We describe three key initiatives: (1) Triple Aim; (2) the Accountable Care Organization; and (3) the Patient Centered Medical Home. We conclude with a discussion about future directions and healthcare policies that include families. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
47. Defining core issues in utilizing information technology to improve access: evaluation and research agenda.
- Author
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Jackson, George, Krein, Sarah, Alverson, Dale, Darkins, Adam, Gunnar, William, Harada, Nancy, Helfrich, Christian, Houston, Thomas, Klobucar, Thomas, Nazi, Kim, Poropatich, Ronald, Ralston, James, Bosworth, Hayden, Jackson, George L, Krein, Sarah L, Alverson, Dale C, Darkins, Adam W, Harada, Nancy D, Helfrich, Christian D, and Houston, Thomas K
- Subjects
INFORMATION technology ,HEALTH services accessibility ,MEDICAL quality control ,MEDICAL records ,MEDICAL care - Abstract
The Department of Veterans Affairs (VA) has been at the vanguard of information technology (IT) and use of comprehensive electronic health records. Despite the widespread use of health IT in the VA, there are still a variety of key questions that need to be answered in order to maximize the utility of IT to improve patient access to quality services. This paper summarizes the potential of IT to enhance healthcare access, key gaps in current evidence linking IT and access, and methodologic challenges for related research. We also highlight four key issues to be addressed when implementing and evaluating the impact of IT interventions on improving access to quality care: 1) Understanding broader needs/perceptions of the Veteran population and their caregivers regarding use of IT to access healthcare services and related information. 2) Understanding individual provider/clinician needs/perceptions regarding use of IT for patient access to healthcare. 3) System/Organizational issues within the VA and other organizations related to the use of IT to improve access. 4) IT integration and information flow with non-VA entities. While the VA is used as an example, the issues are salient for healthcare systems that are beginning to take advantage of IT solutions. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
48. Educating Advanced Practice Nurses in Using Social Media in Rural Health Care.
- Author
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Rutledge, Carolyn M., Renaud, Michelle, Shepherd, Laurel, Bordelon, Michele, Haney, Tina, Gregory, Donna, and Ayers, Paula
- Subjects
MEDICAL technology ,SOCIAL media ,RURAL health ,NURSING ,DOCTORAL degree ,MEDICAL care ,EDUCATION of nurse practitioners ,RURAL health services ,CAREGIVERS ,HEALTH services accessibility ,INFORMATION technology ,ONLINE information services ,PATIENT education ,SCALE analysis (Psychology) ,SIMULATED patients ,SOCIAL networks ,SURVEYS ,TELEMEDICINE ,ADULT education workshops ,GRADUATE nursing education ,DOCTORAL programs ,SOCIAL support ,SOCIAL learning theory ,COURSE evaluation (Education) ,EDUCATIONAL outcomes - Abstract
Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
49. Categorization, Designation, and Regionalization of Emergency Care: Definitions, a Conceptual Framework, and Future Challenges.
- Author
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Kocher, Keith E., Sklar, David P., Mehrotra, Abhishek, Tayal, Vivek S., Gausche-Hill, Marianne, and Riner, R. Myles
- Subjects
CONCEPTUAL structures ,EMERGENCY medical services ,EMERGENCY medicine ,EMERGENCY physicians ,HEALTH care rationing ,HEALTH services accessibility ,HOSPITAL emergency services ,MEDICAL care ,MEDICAL care research ,MEDICAL referrals ,ACCREDITATION - Abstract
This article reflects the proceedings of a breakout session, 'Beyond ED Categorization-Matching Networks to Patient Needs,' at the 2010 Academic Emergency Medicine consensus conference, 'Beyond Regionalization: Integrated Networks of Emergency Care.' It is based on concepts and areas of priority identified and developed by the authors and participants at the conference. The paper first describes definitions fundamental to understanding the categorization, designation, and regionalization of emergency care and then considers a conceptual framework for this process. It also provides a justification for a categorization system being integrated into a regionalized emergency care system. Finally, it discusses potential challenges and barriers to the adoption of a categorization and designation system for emergency care and the opportunities for researchers to study the many issues associated with the implementation of such a system. ACADEMIC EMERGENCY MEDICINE 2010; 17:1306-1311 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
50. Does Access to Care Still Affect Health Care Utilization by Immigrants? Testing of an Empirical Explanatory Model of Health Care Utilization by Korean American Immigrants with High Blood Pressure.
- Author
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Song H, Han H, Lee J, Kim J, Kim KB, Ryu JP, and Kim M
- Subjects
MEDICAL care use ,HEALTH services accessibility ,MEDICAL care of immigrants ,HEALTH of Korean Americans ,PATIENTS ,HYPERTENSION ,NEEDS assessment ,IMMIGRANTS ,STATISTICAL correlation ,GOODNESS-of-fit tests ,MATHEMATICAL models ,MEDICAL care ,PATH analysis (Statistics) ,SCALE analysis (Psychology) ,THEORY ,DESCRIPTIVE statistics - Abstract
Despite well-known benefits of health care utilization for the effective management of chronic diseases, the underlying mechanism of understanding health care utilization in ethnic minority population has not been systematically explored. The purpose of this paper is to examine the predictive ability of a health care utilization model by analyzing the interplay between predisposing, enabling, and need factors. The sample consisted of hypertensive Korean American immigrants (KAIs) 40–64 years of age who participated in a self-help intervention for high blood pressure care (SHIP-HBP). Using structured questionnaires, data were collected from 445 KAIs at baseline and analyzed with path analysis. Insurance status and relevant medical history were not just strong direct effects but also carried the most total effect on the health care utilization of these patients. Life priorities, years of residence in the US and perceived income level exerted indirect effects through the participants’ insurance status. Our statistical analysis indicated a good fit for the proposed model ( x
2 = 28.4, P = 0.29; NFI = 0.91; CFI = 0.99; RMSEA = 0.02). Overall, the model explained 18% of the variance in health care utilization of hypertensive KAIs. These findings strongly support a need to improve access to health care for KAIs by introducing a variety of community resources and building sustainable community infrastructures. [ABSTRACT FROM AUTHOR]- Published
- 2010
- Full Text
- View/download PDF
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