15 results on '"Scott T. Shimotsu"'
Search Results
2. Low back pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort study
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David Elton, Thomas M. Kosloff, Meng Zhang, Protima Advani, Yinglong Guo, Scott T. Shimotsu, Sean Sy, and Ari Feuer
- Abstract
BackgroundLow back pain (LBP) is prevalent, management benefits from high-quality clinical practice guidelines, and yet LBP is a common source of low value care. The purpose of this retrospective cohort study was to examine the association between the type of initial contact health care provider (HCP), service utilization, and total episode cost for the management of LBP.MethodsEpisode of care was used to analyze a US national sample of LBP episodes completed in 2017-2019. A combined surgical and non-surgical (pooled) sample and a non-surgical sample were separately analyzed. The primary independent variable was the type of the initial contact HCP. Dependent measures included rate and timing of use of 14 types of health care services and total episode cost. The association between initial contact HCP, total episode cost and rate of prescription opioid and NSAID use was tested using a mixed effects model.ResultsThe study included 616,766 continuously insured individuals aged 18 years and older with 756,631 episodes of LBP involving 386,795 HCPs and incurring $1,010,495,291 in expenditures. A primary care or specialist HCP was initially contacted in 62.0% of episodes, with these episodes associated with early use of low-value services such as imaging, pharmacologic, and interventional services. A non-prescribing HCP was initially contacted in 32.5% of episodes with these episodes associated with early use of guideline recommended first line services.Each type of HCP emphasized different initial services with little indication of a stepped approach to managing LBP. Following adjustment for covariates chiropractors were associated with the lowest total episode cost. As an observational study of associations, numerous confounders may have impacted results.ConclusionsAn individual with LBP has different experiences based on the type of HCP initially contacted. Initial contact with primary care or specialist HCPs is associated with second- and third-line services provided before first line services, with little indication of a guideline recommended stepped approach to managing LBP. Increasing the likelihood of guideline- concordant, high-value care for LBP may require systemic changes to the health care delivery system. In the absence of red flags these changes may include increasing the proportion of individuals receiving early non-pharmacological treatment, either through improving direct access to non-prescribing HCPs or increasing timely referrals from primary care and specialist health care providers.
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- 2022
3. COVID-19 Infection Control Measures in Long-Term Care Facility, Pennsylvania, USA
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Ethan M. Berke, Scott T Shimotsu, Ariel R L Johnson, and Daniel O Griffin
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Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Epidemiology ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030231 tropical medicine ,lcsh:Medicine ,Disease ,medicine.disease_cause ,Residential Facilities ,long-term care facilities ,lcsh:Infectious and parasitic diseases ,COVID-19 Infection Control Measures in Long-Term Care Facility, Pennsylvania, USA ,03 medical and health sciences ,respiratory infections ,0302 clinical medicine ,Research Letter ,Medicine ,Infection control ,Humans ,lcsh:RC109-216 ,viruses ,030212 general & internal medicine ,Coronavirus ,Aged ,Infection Control ,business.industry ,SARS-CoV-2 ,lcsh:R ,COVID-19 ,Middle Aged ,Pennsylvania ,testing ,United States ,zoonoses ,Long-term care ,Infectious Diseases ,coronavirus disease ,Population Surveillance ,Emergency medicine ,Female ,business ,Coronavirus Infections ,severe acute respiratory syndrome coronavirus 2 - Abstract
Residents of long-term care facilities are at risk for coronavirus disease. We report a surveillance exercise at such a facility in Pennsylvania, USA. After introduction of a testing strategy and other measures, this facility had a 17-fold lower coronavirus disease case rate compared with those of neighboring facilities.
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- 2020
4. Associations between psychiatric morbidity and COVID-19 vaccine hesitancy: An analysis of electronic health records and patient survey
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Mara Eyllon, Alexander P. Dang, J. Ben Barnes, John Buresh, Gabrielle D. Peloquin, Annika C. Hogan, Scott T. Shimotsu, Susan R. Sama, and Samuel S. Nordberg
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Depressive Disorder, Major ,COVID-19 Vaccines ,SARS-CoV-2 ,COVID-19 ,Psychiatric illness ,Article ,Psychiatry and Mental health ,Cross-Sectional Studies ,Prevalence ,vaccine hesitancy ,Electronic Health Records ,Humans ,Vaccination Hesitancy ,Biological Psychiatry - Abstract
Psychiatric illness confers significant risk for severe COVID-19 morbidity and mortality; identifying psychiatric risk factors for vaccine hesitancy is critical to mitigating risk in this population. This study examined the prevalence of vaccine hesitancy among those with psychiatric illness and the associations between psychiatric morbidity and vaccine hesitancy. Data came from electronic health records and a patient survey obtained from 14,365 patients at a group medical practice between February and May, 2021. Logistic regression was used to calculate odds for vaccine hesitancy adjusted for sociodemographic characteristics and physical comorbidity. Of 14,365 participants 1,761 (12.3%) participants reported vaccine hesitancy. Vaccine hesitancy was significantly more prevalent among participants with substance use (29.6%), attention deficit and hyperactivity (23.3%), posttraumatic stress (23.1%), bipolar (18.0%), generalized anxiety (16.5%), major depressive (16.1%), other anxiety (15.5%), and tobacco use disorders (18.6%), and those previously infected with COVID-19 (19.8%) compared to participants without these disorders. After adjusting for sociodemographic characteristics and physical comorbidities, substance use disorders and tobacco use were significantly associated with increased odds for vaccine hesitancy and bipolar disorder was significantly inversely associated with vaccine hesitancy. Interventions to improve uptake in these populations may be warranted.
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- 2022
5. Medicaid expansion and mental health: A Minnesota case study
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Laura Guzman-Corrales, Katherine Diaz Vickery, Dana Soderlund, Scott T. Shimotsu, Mark Linzer, Ross Owen, and Pam Clifford
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Adult ,Male ,Mental Health Services ,Gerontology ,Minnesota ,Population ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Patient Protection and Affordable Care Act ,medicine ,Humans ,030212 general & internal medicine ,education ,Applied Psychology ,Retrospective Studies ,education.field_of_study ,Medicaid ,business.industry ,Mental Disorders ,030503 health policy & services ,Middle Aged ,Mental illness ,medicine.disease ,Mental health ,United States ,Integrated care ,Psychiatry and Mental health ,Housing ,Female ,0305 other medical science ,business ,Psychosocial - Abstract
INTRODUCTION The health status and psychosocial needs of the Medicaid expansion population have been estimated but not measured. This population includes childless adults predicted to have high rates of mental illness, especially among the homeless. Given limitations in access to mental health services, it is unclear how prepared the U.S. health care system is to care for the needs of the expansion population. METHOD Using enrollment and claims data from the Minnesota Department of Human Services, this study presents prevalence rates of mental illness diagnoses and measures of unstable housing in Minnesota's childless-adult early Medicaid expansion population. Rates are compared with prior predictions of serious psychological distress and mental illness constructed from the National Survey on Drug Use and Health (NSDUH) using χ2 and t tests. RESULTS Diagnoses of mental illness in Minnesota's childless-adult early Medicaid expansion population were more than 15% higher than prevalence measures of mental illness/distress for the current Medicaid population. Diagnosis rates fell within confidence intervals of estimates of mental illness for Minnesota's Medicaid expansion population. Almost 1 in 3 enrollees had a marker of unstable housing; of this group, half had mental illness and/or distress. DISCUSSION Findings support predictions of the high burden of mental illness and unstable housing among the Medicaid expansion population. Minnesota offers lessons to other regions working to care for such populations: (a) the use of flexible financing structures to build integrated care systems and (b) passage of legislation to allow data sharing among mental health, social services, and medical care.
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- 2016
6. Diabetes Outcome and Process Measures Among Patients Who Require Language Interpreter Services in Minnesota Primary Care Practices
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Chun Fan, Scott T. Shimotsu, Mark L. Wieland, Deborah H. Boehm, Laura Guzman-Corrales, Jane W. Njeru, and Debra J. Jacobson
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Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Health (social science) ,Adolescent ,Minnesota ,Population ,Emigrants and Immigrants ,Blood Pressure ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Sex Factors ,Diabetes management ,Diabetes mellitus ,Health care ,medicine ,Humans ,030212 general & internal medicine ,education ,Aged ,Language ,Retrospective Studies ,Glycated Hemoglobin ,education.field_of_study ,030505 public health ,Primary Health Care ,business.industry ,Communication Barriers ,Process Assessment, Health Care ,Public Health, Environmental and Occupational Health ,Age Factors ,Retrospective cohort study ,Odds ratio ,Guideline ,Cholesterol, LDL ,Middle Aged ,Translating ,medicine.disease ,Diabetes Mellitus, Type 2 ,Limited English proficiency ,Emergency medicine ,Female ,0305 other medical science ,business - Abstract
Immigrants and refugees are less likely to meet diabetes management goals than the general US population. Those with limited English proficiency (LEP) and who need interpreter services (IS) for health care encounters, maybe at higher risk for encountering barriers to optimal diabetes management, and while most receive diabetes care in primary care settings, little is known about the association between IS need and diabetes outcomes. This study aims to determine adherence with diabetes process and outcomes measures among LEP patients in primary care settings, and is a retrospective cohort study of patients with type II diabetes at two large primary care networks in Minnesota from January 1, 2012 through December 31, 2013. Diabetes outcome measure goals were defined as hemoglobin A1C
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- 2017
7. The Relationships among Socioeconomic Status, Fruit and Vegetable Intake, and Alcohol Consumption
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Jean L. Forster, Leslie A. Lytle, Rhonda J Jones-Webb, Richard F. MacLehose, Scott T. Shimotsu, and Toben F. Nelson
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Adult ,Male ,Multivariate statistics ,Health (social science) ,Multivariate analysis ,Adolescent ,Alcohol Drinking ,Cross-sectional study ,Minnesota ,Binge drinking ,Diet Surveys ,Binge Drinking ,Young Adult ,symbols.namesake ,Environmental health ,Vegetables ,Humans ,Medicine ,Poisson Distribution ,Poisson regression ,Socioeconomic status ,Aged ,Consumption (economics) ,business.industry ,Public Health, Environmental and Occupational Health ,Middle Aged ,Diet ,Cross-Sectional Studies ,Socioeconomic Factors ,Fruit ,Multivariate Analysis ,Income ,Linear Models ,symbols ,Educational Status ,Household income ,Female ,business - Abstract
Purpose. We examined the relationships among fruit and vegetable intake, alcohol consumption, and socioeconomic status (SES). We hypothesized that fruit and vegetable consumption would be inversely associated with alcohol consumption and the relationship would differ by SES. Design. A cross-sectional analysis. Setting. Large, urban Midwestern county. Subjects. A unique, racially/ethnically diverse sample of 9959 adults (response rate: 66.3%). Measures. Fruit and vegetable intake was measured using two items that assessed servings per day. Alcohol consumption was measured in terms of volume of alcohol consumed and binge drinking. Individual measures of SES included education and household income. Analysis. Weighted multivariate linear and Poisson regression were used to estimate effects. Results. The relationship between fruit and vegetable intake and alcohol consumption varied by SES. Those with lower household incomes who consumed five or more servings of fruits and vegetables per day were less likely to engage in binge drinking relative to those consuming zero to one servings of fruits and vegetables per day (risk ratio = .66; 95% confidence interval: .46, .95). No association was observed for higher–household-income individuals. Conclusion. We observed an inverse relationship between fruit and vegetable consumption and alcohol intake in those with lower household incomes but not in those with higher household incomes. Results suggest that the relationship between diet and alcohol consumption may be more relevant in populations with more restricted economic choices. Results are, however, based on cross-sectional data.
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- 2012
8. Adopting Local Alcohol Policies: A Case Study of Community Efforts to Regulate Malt Liquor Sales
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Scott T. Shimotsu, Rhonda J Jones-Webb, Peter J. Hannan, Patricia McKee, Traci L. Toomey, and Toben F. Nelson
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Health (social science) ,Alcohol Drinking ,Concept Formation ,Malt liquor ,Public policy ,Poison control ,Public Policy ,Context (language use) ,Qualitative property ,Health Promotion ,food ,Residence Characteristics ,Humans ,Mass Media ,Marketing ,Enforcement ,Qualitative Research ,Retrospective Studies ,Mass media ,Geography ,food.beer_style ,business.industry ,Alcoholic Beverages ,Commerce ,Public Health, Environmental and Occupational Health ,United States ,Government Regulation ,business ,Qualitative research - Abstract
Purpose. To learn how the local context may affect a city's ability to regulate alcohol products such as high–alcohol-content malt liquor, a beverage associated with heavy drinking and a spectrum of nuisance crimes in urban areas. Approach. An exploratory, qualitative case study comparing cities that adopted policies to restrict malt liquor sales with cities that considered, but did not adopt policies. Setting. Nine large U.S. cities in seven states. Participants. City legislators and staff, alcohol enforcement personnel, police, neighborhood groups, business associations, alcohol retailers, and industry representatives. Method. Qualitative data were obtained from key informant interviews (n = 56) and media articles (n = 360). The data were coded and categorized. Similarities and differences in major themes among and across Adopted and Considered cities were identified. Results. Cities faced multiple barriers in addressing malt liquor–related problems, including a lack of enforcement tools, alcohol industry opposition, and a lack of public and political will for alcohol control. Compared to cities that did not adopt malt liquor sales restrictions, cities that adopted restrictions appeared to have a stronger public mandate for a policy and were less influenced by alcohol industry opposition and lack of legislative authority for alcohol control. Strategies common to successful policymaking efforts are discussed. Conclusion. Understanding the local context may be a critical step in winning support for local alcohol control policies.
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- 2012
9. Increased Likelihood of Missed Appointments ('No Shows') for Racial/Ethnic Minorities in a Safety Net Health System
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Anne Roehrl, Nancy A. Garrett, Katherine Diaz Vickery, Laura Guzman-Corrales, Maribet McCarty, Mark Linzer, and Scott T. Shimotsu
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Adult ,medicine.medical_specialty ,Cross-sectional study ,Safety net ,education ,Psychological intervention ,Ethnic group ,lcsh:Computer applications to medicine. Medical informatics ,Vulnerable Populations ,03 medical and health sciences ,Race (biology) ,Appointments and Schedules ,0302 clinical medicine ,Risk Factors ,Ethnicity ,Research Letter ,Medicine ,Humans ,030212 general & internal medicine ,Community and Home Care ,Primary Health Care ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Patient Acceptance of Health Care ,Mental illness ,medicine.disease ,Health equity ,Country of origin ,United States ,Cross-Sectional Studies ,Family medicine ,lcsh:R858-859.7 ,0305 other medical science ,business - Abstract
Missed appointments have been linked to adverse outcomes known to affect racial/ethnic minorities. However, the association of missed appointments with race/ethnicity has not been determined. We sought to determine the relationships between race/ethnicity and missed appointments by performing a cross-sectional study of 161 350 patients in a safety net health system. Several race/ethnicity categories were significantly associated with missed appointment rates, including Hispanic/Latino patients, American Indian/Alaskan Native patients, and Black/African American patients, as compared with White non-Hispanic patients. Other significant predictors included Mexico as country of origin, medical complexity, and major mental illness. We recommend additional research to determine which interventions best reduce missed appointments for minority populations in order to improve the care of vulnerable patients.
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- 2015
10. Practice Application
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Simone A. French, Scott T. Shimotsu, Anne Faricy Gerlach, and Melanie Wall
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Nutrition and Dietetics ,Food Science - Published
- 2009
11. Capturing the spectrum of household food and beverage purchasing behavior: a review
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Scott T. Shimotsu, Simone A. French, Melanie M. Wall, and Anne Faricy Gerlach
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education.field_of_study ,Nutrition and Dietetics ,digestive, oral, and skin physiology ,Population ,Health Behavior ,Commerce ,Food purchasing ,Feeding Behavior ,Healthful food ,Nutrition Surveys ,Choice Behavior ,Purchasing ,Article ,Diet ,Food Supply ,Food Preferences ,Food choice ,Humans ,Business ,Marketing ,education ,Food Science - Abstract
The household setting may be the most important level at which to understand the food choices of individuals and how healthful food choices can be promoted. However, there are few available measures of the food purchase behaviors of households and little consensus on the best way to measure it. This review explores the currently available measures of household food purchasing behavior. Three main measures are described, evaluated, and compared: home food inventories, food and beverage purchase records and receipts, and Universal Product Code bar code scanning. The development of coding, aggregation, and analytical methods for these measures of household food purchasing behavior is described. Currently, annotated receipts and records are the most comprehensive, detailed measure of household food purchasing behavior, and are feasible for population-based samples. Universal Product Code scanning is not recommended due to its cost and complexity. Research directions to improve household food purchasing behavior measures are discussed.
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- 2007
12. Neighborhood socioeconomic characteristics, the retail environment, and alcohol consumption: A multilevel analysis
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Leslie A. Lytle, Toben F. Nelson, Rhonda J Jones-Webb, Richard F. MacLehose, Jean L. Forster, and Scott T. Shimotsu
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Adult ,Male ,Alcohol Drinking ,Minnesota ,Binge drinking ,Poison control ,Toxicology ,Social Environment ,Residence Characteristics ,Environmental health ,Injury prevention ,Humans ,Pharmacology (medical) ,Socioeconomic status ,Pharmacology ,Median income ,Alcoholic Beverages ,Multilevel model ,Commerce ,food and beverages ,Human factors and ergonomics ,Census ,Middle Aged ,Health Surveys ,Psychiatry and Mental health ,Geography ,Cross-Sectional Studies ,Socioeconomic Factors ,Multilevel Analysis ,Female ,Self Report - Abstract
The neighborhoods where people live can influence their drinking behavior. We hypothesized that living in a neighborhood with lower median income, higher alcohol outlet density, and only liquor stores and no grocery stores would be associated with higher alcohol consumption after adjusting for individual demographic and lifestyle factors.We used two self-report measures to assess alcohol consumption in a sample of 9959 adults living in a large Midwestern county: volume of alcohol consumed (count) and binge drinking (5 or more drinks vs.5 drinks). We measured census tract median annual household income based on U.S. Census data. Alcohol outlet density was measured using the number of liquor stores divided by the census tract roadway miles. The mix of liquor and food stores in census tracts was assessed using a categorical variable based on the number of liquor and number of food stores using data from InfoUSA. Weighted hierarchical linear and Poisson regression were used to test our study hypothesis.Retail mix was associated with binge drinking. Individuals living in census tracts with only liquor stores had a 46% higher risk of binge drinking than individuals living in census tracts with food stores only after controlling for demographic and lifestyle factors.Census tract characteristics such as retail mix may partly explain variability in drinking behavior. Future research should explore the mix of stores, not just the over-concentration of liquor stores in census tracts.
13. Worksite environment physical activity and healthy food choices: measurement of the worksite food and physical activity environment at four metropolitan bus garages
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Simone A. French, Peter J. Hannan, Anne Faricy Gerlach, and Scott T. Shimotsu
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Nutrition and Dietetics ,business.industry ,lcsh:Public aspects of medicine ,Research ,Physical activity ,Medicine (miscellaneous) ,lcsh:RA1-1270 ,030209 endocrinology & metabolism ,Physical Therapy, Sports Therapy and Rehabilitation ,Metropolitan area ,Work environment ,lcsh:Nutritional diseases. Deficiency diseases ,03 medical and health sciences ,0302 clinical medicine ,Healthy food ,Weight gain prevention ,Environmental health ,Weight management ,Medicine ,Environmental intervention ,Transit bus ,030212 general & internal medicine ,business ,lcsh:RC620-627 - Abstract
Background The present research describes a measure of the worksite environment for food, physical activity and weight management. The worksite environment measure (WEM instrument) was developed for the Route H Study, a worksite environmental intervention for weight gain prevention in four metro transit bus garages in Minneapolis-St. Paul. Methods Two trained raters visited each of the four bus garages and independently completed the WEM. Food, physical activity and weight management-related items were observed and recorded on a structured form. Inter-rater reliability was computed at the item level using a simple percentage agreement. Results The WEM showed high inter-rater reliability for the number and presence of food-related items. All garages had vending machines, microwaves and refrigerators. Assessment of the physical activity environment yielded similar reliability for the number and presence/absence of fitness items. Each garage had a fitness room (average of 4.3 items of fitness equipment). All garages had at least one stationary bike and treadmill. Three garages had at least one weighing scale available. There were no designated walking areas inside or outside. There were on average < 1 food stores or restaurants within sight of each garage. Few vending machine food and beverage items met criteria for healthful choices (15% of the vending machine foods; 26% of the vending machine beverages). The garage environment was perceived to be not supportive of healthy food choices, physical activity and weight management; 52% reported that it was hard to get fruits and vegetables in the garages, and 62% agreed that it was hard to be physically active in the garages. Conclusion The WEM is a reliable measure of the worksite nutrition, physical activity, and weight management environment that can be used to assess changes in the work environment.
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14. Annotated receipts capture household food purchases from a broad range of sources
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Ericka M. Welsh, Melanie M. Wall, Scott T. Shimotsu, Nathan R. Mitchell, and Simone A. French
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2. Zero hunger ,0303 health sciences ,Nutrition and Dietetics ,030309 nutrition & dietetics ,business.industry ,Dietary intake ,Research ,lcsh:Public aspects of medicine ,digestive, oral, and skin physiology ,Food consumption ,Behavioural sciences ,Medicine (miscellaneous) ,Physical Therapy, Sports Therapy and Rehabilitation ,lcsh:RA1-1270 ,Food purchasing ,Agricultural economics ,03 medical and health sciences ,lcsh:Nutritional diseases. Deficiency diseases ,0302 clinical medicine ,Medicine ,030212 general & internal medicine ,business ,lcsh:RC620-627 ,Consumer behaviour ,health care economics and organizations - Abstract
Background Accurate measurement of household food purchase behavior (HFPB) is important for understanding its association with household characteristics, individual dietary intake and neighborhood food retail outlets. However, little research has been done to develop measures of HFPB. The main objective of this paper is to describe the development of a measure of HFPB using annotated food purchase receipts. Methods Households collected and annotated food purchase receipts for a four-week period as part of the baseline assessment of a household nutrition intervention. Receipts were collected from all food sources, including grocery stores and restaurants. Households (n = 90) were recruited from the community as part of an obesity prevention intervention conducted in 2007–2008 in Minneapolis, Minnesota, USA. Household primary shoppers were trained to follow a standardized receipt collection and annotation protocol. Annotated receipts were mailed weekly to research staff. Staff coded the receipt data and entered it into a database. Total food dollars, proportion of food dollars, and ounces of food purchased were examined for different food sources and food categories. Descriptive statistics and correlations are presented. Results A total of 2,483 receipts were returned by 90 households. Home sources comprised 45% of receipts and eating-out sources 55%. Eating-out entrees were proportionally the largest single food category based on counts (16.6%) and dollars ($106 per month). Two-week expenditures were highly correlated (r = 0.83) with four-week expenditures. Conclusion Receipt data provided important quantitative information about HFPB from a wide range of sources and food categories. Two weeks may be adequate to reliably characterize HFPB using annotated receipts.
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15. Hennepin Health: a safety-net accountable care organization for the expanded Medicaid population.
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Sandberg SF, Erikson C, Owen R, Vickery KD, Shimotsu ST, Linzer M, Garrett NA, Johnsrud KA, Soderlund DM, and DeCubellis J
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- Health Services Accessibility, Humans, Minnesota, Organizational Case Studies, United States, Accountable Care Organizations organization & administration, Community-Institutional Relations, Cooperative Behavior, Medicaid, Safety-net Providers organization & administration
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Health care payment and delivery models that challenge providers to be accountable for outcomes have fueled interest in community-level partnerships that address the behavioral, social, and economic determinants of health. We describe how Hennepin Health--a county-based safety-net accountable care organization in Minnesota--has forged such a partnership to redesign the health care workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care for an expanded community of Medicaid beneficiaries. Early outcomes suggest that the program has had an impact in shifting care from hospitals to outpatient settings. For example, emergency department visits decreased 9.1 percent between 2012 and 2013, while outpatient visits increased 3.3 percent. An increasing percentage of patients have received diabetes, vascular, and asthma care at optimal levels. At the same time, Hennepin Health has realized savings and reinvested them in future improvements. Hennepin Health offers lessons for counties, states, and public hospitals grappling with the problem of how to make the best use of public funds in serving expanded Medicaid populations and other communities with high needs., (Project HOPE—The People-to-People Health Foundation, Inc.)
- Published
- 2014
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