bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare Managers’ Perceptions of Professional Development and Organizational Support
Authors: Gumus Gulcin , Borkowski Nancy , Deckard Gloria J. , Martel Karen J.
Published: May 2024

Purpose

This article explores the participation of healthcare managers in professional development (PD) activities, the reasons for seeking PD and the perceived support of their organizations in terms of reward and recognition.

Methodology

An exploratory survey was emailed to current and past members of three professional associations who share similar missions “to provide educational and networking opportunities” for their members in the southern region of Florida.

Findings

Findings suggest that healthcare managers and healthcare organizations both support and value personal and professional development. Certification by professional organizations appears to be a key credential for upward mobility.

Research limitations

This study serves as an initial attempt to account for the factors that explain differences in pursuing professional development activities. Given the exploratory nature of the study and low response rates, the findings provide direction for further research rather than conclusive judgments.

Practical implications

Continuous learning by managers and organizations should allow the healthcare industry to position itself for future challenges.

Originality

Across all settings, positions, age groups, and perceived organizational support, individuals seek professional certification suggesting recognition of the professional value associated with these certifications. the value attributed to certification and PD by healthcare managers is further demonstrated by our finding that individuals engage in these activities even in the absence of employer reimbursement.
Adoption of An Algorithm and Client Pathway for the Aged and Disabled: Training Implications for the Health and Human Service Sectors
Authors: Hewitt Anne M. , Polansky Patricia A. , Day Nancy , Field Nancy , Moore Alice
Published: May 2024

Objectives

This paper reports on a state agency's training activities undertaken to totally redesign a long-term-care (LTC) delivery system as part of the national Aging and Disability Resource Center (ADRC) initiative.

Method

Through the development of an ADRC algorithm and the implementation of a corresponding client pathway, NJ DACS, a division of aging, aligned 14 separate core functions necessary for lifespan services. a Training Academy facilitated the adoption of five new health service delivery products and processes by state and county health and human services personnel.

Results

Intensive training activities resulted in the algorithm and client pathway framework being successfully disseminated in all 21 counties within a short timeframe. Barriers to training were reduced and acceptance of new protocols and processes were facilitated leading to rapid adoption. Implications for training of health and human service personnel are presented. Full adoption of the complete ADRC model across the state was directly linked to agency software integration.

Conclusions

Promoting standardized service delivery for the aging population through the use of an algorithm and parallel client pathway is feasible as a training model for health care service delivery.
Health Services Utilization, Satisfaction, and Attachment to a Regular Source of Care among Participants in An Urban Health Provider Alliance
Authors: Tataw David B. , Bazargan-Hejazi S. , James F W.
Published: May 2024

This study examines the effect of a provider alliance on service utilization, satisfaction , self efficacy, and attachment to a regular source of care for participating low income urban children and their families. the use of Physician Assistants and community health workers to expand community outreach, primary care services, pediatric sub-specialty care, and service coordination within and between care settings improved health services utilization, satisfaction with health services, parental self efficacy in navigating the health care system for their children, and service convenience for an at-risk population. Also, the use of Physician Assistants to provide pediatric sub-specialty services did not have a negative effect on parental satisfaction with a child's care. Parents were slightly more satisfied with services received from a Physician Assistant in comparison with the physician sub- specialists in cardiology and nephrology clinics.
Reducing Healthcare Disparities in the Military through Cultural Competence
Authors: Harris G.L.A.
Published: May 2024

Healthcare disparities are fast encroaching upon equal access healthcare systems like the military. While this growth has been attributed to the same antecedents as those found in the general civilian population, four additional assumptions are posited as contributing factors to healthcare disparities that are peculiar to the military. Research on certain segments of the veteran population in the Veterans Administration (VA) is profiled as the most analogous healthcare system to that of the military's and a meta-analysis of studies on similar populations in the military are also examined. Like the general civilian population, cultural competence is viewed as an imperative component of healthcare delivery to help to narrow the healthcare disparities gap between majority (men and whites) and minority (women and nonwhites) populations in the military.
Reducing Health Disparities: Medical Advice Received for Minorities with Diabetes
Authors: Vaccaro Joan A. , Huffman Fatma G.
Published: May 2024

Objective

to examine the relationships among reported medical advice, diabetes education, health insurance and health behavior of individuals with diabetes by race/ethnicity and gender.

Method

Secondary analysis of data (N = 654) for adults ages ≥ 21 years with diabetes acquired through the National Health and Nutrition Examination Survey (NHANES) for the years 2007–2008 comparing Black, non-Hispanics (BNH) and Mexican-Americans (MA) with White, non-Hispanics (WNH). the NHANES survey design is a stratified, multistage probability sample of the civilian non-institutionalized U.S. population. Sample weights were applied in accordance with NHANES specifications using the complex sample module of IBM SPSS version 18.

Results

The findings revealed statistical significant differences in reported medical advice given. BNH [OR = 1.83 (1.16, 2.88), p = 0.013] were more likely than WNH to report being told to reduce fat or calories. Similarly, BNH [OR = 2.84 (1.45, 5.59), p = 0.005] were more likely than WNH to report that they were told to increase their physical activity. Mexican-Americans were less likely to self-monitor their blood glucose than WNH [OR = 2.70 (1.66, 4.38), p < 0.001]. There were differences by race/ethnicity for reporting receiving recent diabetes education. Black, non-Hispanics were twice as likely to report receiving diabetes education than WNH [OR = 2.29 (1.36, 3.85), p = 0.004]. Having recent diabetes education increased the likelihood of performing several diabetes self-management behaviors independent of race.

Conclusions

There were significant differences in reported medical advice received for diabetes care by race/ethnicity. the results suggest ethnic variations in patient-provider communication and may be a consequence of their health beliefs, patient-provider communication as well as length of visit and access to healthcare. These findings clearly demonstrate the need for government sponsored programs, with a patient-centered approach, augmenting usual medical care for diabetes. Moreover, the results suggest that public policy is needed to require the provision of diabetes education at least every two years by public health insurance programs and recommend this provision for all private insurance companies.
Inter-Organizational Relationships of Health Partnerships: Characteristics of the Fulton County Sparc Program
Authors: Sullivan Brenda A.
Published: May 2024

Local governments have long used partnerships and collaborations with the nonprofit and private sectors to improve services, support innovation, and save cost. Nowhere is this more evident than in the public health and human services sectors. This case study follows up on an earlier report on the attributes of a collaborative public/ private-nonprofit health partnership; Fulton County, Georgia's Sickness Prevention Achieved Through Regional Collaboration program, (SPARC). Fulton County has been able to sustain its SPARC partnership despite the demise of similar efforts within the region. This study examines the characteristics of the Fulton County SPARC partnership that may have contributed to its endurance. a series of interviews and surveys were administered to Fulton County SPARC partners in 2009 and 2011 to capture operational characteristics of the partnership and the degree to which partners interacted among themselves. Results indicate that despite changes thought to strengthen the partnership, the developmental stages of partnerships and collaborations are shown to be non-linear; therefore, movement from one stage to the other is not guaranteed thus warranting leaders’ regular attention to both individual and organizational commitment to collaboration dynamics.
Experience and Education of Home Health Administrators and Nursing Home Administrators and the Relationship to Establishment Ownership
Authors: Decker Frederic H. , Decker Sandra L.
Published: May 2024

Administrators in long-term care may have an important influence on quality of care. Limited prior research has described the characteristics of nursing home administrators. Despite growing emphasis on home health care as an alternative to nursing homes, almost no research has described the characteristics of administrators of home health agencies. Using the 2004 National Nursing Home Survey and the 2007 National Home and Hospice Care Survey, we describe the career experience of administrators, and examine the relationship between experience and education of administrators both within and across the nursing home and home health sectors. We also explore the characteristics of nursing homes and home health agencies, including establishment ownership (e.g., nonchain not-for-profit), that are associated with being able to attract administrators with the most experience. We find that home health administrators have, on average, less experience than nursing home administrators. Among home health agencies, administrators with the least experience also tend to have less education. in nursing homes, administrators with less experience tend to have more education. Results from multivariate analysis suggest that chain for-profits may be the least able to attract experienced administrators. More research on the effects of different levels of experience and education among administrators is needed.
Antenarratives to Inform Health Care Research: Exploring Workplace Illness Disclosure for People with Multiple Sclerosis (Ms)
Authors: Vickers Margaret H.
Published: May 2024

I share Boje's (2001) concept of antenarratives as a useful means of presenting qualitative health care research, especially their capacity to share illness-related stories which may be fragmented, non-linear, sometimes incoherent, and often speculative. I do this to offer insights to health care professionals that might maximize the health care outcomes for those they serve. An Australian based qualitative research project explored the lived experience of what life is really like for a person with Multiple Sclerosis (MS). Rather than presenting a traditional, narrative based, coherent and saturated theme, I present antenarratives that vivify the lived experience of illness disclosure. Antenarratives have the capacity to share key elements of experience in ways that can edify health care practitioners concerned with offering support that consists of more than prescriptive solutions and certain advice.
Management Challenges at the Intersection of Public Policy Environments and Strategic Decision Making in Public Hospitals
Authors: Longest Beaufort B.
Published: May 2024

Hospitals in the United States are heavily impacted by public policies that affect them. for example, Medicare and Medicaid programs account for more than half the revenue in most of the nation's almost 5,000 community hospitals, including the almost 1,100 public hospitals controlled by state and local governments (American Hospital Association, 2012). the public hospitals are especially closely aligned with and controlled by governmental entities compared with hospitals with other kinds of sponsorship. This article addresses the management challenges at the intersection of the strategic management of public hospitals and their public policy environments.

Public hospitals are complicated entities designed not only to provide health services but also in many cases to play key roles in health-related research and education and to play important general economic development roles in their communities. the multi-faceted strategic decision making in these organizations is as heavily affected by their public policy environments as by their business, demographic, technological or other external environments. Effectively managing the intersection of their public policy environments and their strategic management is indeed vital for contemporary public hospitals.

This article is intended to clarify certain aspects of this intersection through a description and model of the strategic activity in public hospitals and the connection between this activity and their external environments. Specific attention is focused on the concept of public policy environments and their features. Attention is also given to how managers can assess public policy environments and incorporate the results into strategic activities.
Risk of Exposure to Second Hand Smoke for Adolescents in Las Vegas Casinos: An Evaluation of the Nevada Clean Indoor Air Act
Authors: Cochran Christopher , Henriques Dominic , York Nancy , Lee Kiyoung
Published: May 2024

Since the Surgeon General's groundbreaking report of 1964, “Smoking and Health,” the medical and scientific communities have uncovered the devastating effects of tobacco smoke on health. in reaction to these findings, local and state governments have enacted a variety of clean air acts to prevent unnecessary exposure to this known carcinogen. the Nevada Clean Indoor Air Act (NCIAA), a non-comprehensive smoke-free law, permits smoking in designated areas of casinos, bars, and taverns. With many Las Vegas casinos catering to all ages, this study was designed to evaluate the efficacy of NCIAA in protecting children from second hand smoke exposure. Using a device that measures ambient air particle matter concentrations, this study sampled the air quality in 15 casino gaming areas and corresponding non-smoking, children-friendly areas. the results indicate that current policy fails to preserve indoor air quality in these children-friendly areas. Furthermore, this research suggests the adoption of a more comprehensive, 100% smoke-free policy as the only effective remedy.
Assessment of Pandemic Preparedness in a Socially Vulnerable Community in South Texas
Authors: Kiltz Linda , Fonseca Diana , Rodriguez Christina , Munoz Paola
Published: May 2024

The purpose of this research was to obtain information about general and pandemic preparedness efforts of residents within San Patricio County in South Texas, as well as to identify the most effective means of communicating the risks posed by pandemic influenza. the population of San Patricio County is socially vulnerable to a variety of disasters, including influenza pandemics due to the unique demographic profile of the county as well as its location on the Gulf Coast. the goals of this study were to help with pandemic planning efforts and to provide recommendations that could serve as a foundation for building more resilient communities within San Patricio County. Clearly the various governmental levels must work together to assist communities prepare for pandemic preparedness but broad, inclusive community participation is also necessary to strengthen community resilience.
Faith-Based Partnerships and Foster Parent Satisfaction
Authors: Howell-Moroney Michael
Published: May 2024

Throughout the last several decades, there has been a chronic shortage of foster and adoptive families in the United States. Recruiting families to begin the licensure process to become foster and adoptive parents is already a difficult undertaking. But research shows that a very large proportion of families drop out of the licensure process early on due to frustration or a lack of support. This paper studies two faith-based partnerships that have arisen to create new capacity in the child welfare system. These programs recruit prospective families from churches and then provide training and ongoing support to those families throughout the licensure process. Using survey data collected from program participants, respondent perceptions of the licensure process are compared to a nationally representative sample of foster parents from the National Foster Care Adoptions Attitude Survey. Statistical results demonstrate that participants with the faith-based programs reported much higher levels of satisfaction with the process than the national sample. These findings provide evidence that these faith-based partnerships may provide an important additional source of capacity for an overburdened child welfare system.
Physical Symptoms, Chronic and Life-Threatening Illness Trajectories among Minority and Aging Populations
Authors: Lyons Beverly P. , Levine Helisse
Published: May 2024

The purpose of this study is to determine the relationship across race/ethnicity relative to reported subjective physical symptoms and clinically assessed medical conditions among the aging minority population using the Health and Retirement Study data for years 1998–2000. Poisson and negative binomial regressions were used to estimate three count dependent variables: physical symptom, chronic, and life-threatening medical conditions. Results indicate that while Black respondents were 18% more likely to report physical symptoms when compared to White respondents (B = .171, p < .01, e.171 = 1.18) and 1.06 times more likely to report life-threatening medical conditions (B = .058, p < .01, e.058 = 1.06), when SES variables were added being Black was no longer significantly associated with physical symptoms and chronic conditions. However, being Black did remain statistically significant and positively associated with life-threatening conditions, even after controlling for SES.

Results bear statistical and clinical significance, given that we are examining racial and ethnic groups. First, Blacks are at higher risk for premature death for a variety of reasons; this has implications on financial expenditures and on the quality of life. Second, growth among the Hispanic population is outpacing both White and Black populations. Policy initiatives, including geriatric health education, partnerships with community and grass-roots leaders will promote awareness.
Home-Based Caregivers in Africa: Alliance Building, Advocacy and Policy Environments
Authors: Ransom Pamela E. , Asaki Becca
Published: May 2024

Home-based caregiving in Africa was examined in the context of the work of the Home-Based Care Alliance, first launched in 2005 to provide support and advocacy for approximately 30,000 caregivers. a review of ten countries in Africa shows that caregivers were either not included, or only selectively included in government programs. With respect to caregiver advocacy, additional resources, recognition and increased involvement in decision-making were the primary identified concerns. Increased health systems capacity for AIDS management, new regulation, innovative collaborations, decentralization, task-shifting, and caregiver burnout are among the trends identified in the broader policy environment impacting caregivers.
Who Pays? How Reimbursement Impacts the Emergency Department
Authors: Downey Lavonne , Zun Leslie S. , Burke Trena , Jefferson Tangula
Published: May 2024

Background

Nationwide from 1996 to 2004, the overall proportion of Emergency Department (ED) reimbursement ratios for outpatient ED visits decreased from 57% to 42%. the continued falling of ED reimbursement ratios, which is the share of ED charges that are ultimately paid, is an indicator of the financial pressures facing the ED. Once the healthcare reforms are put in place what will the impact be on reimbursement rates of overburdened and underfunded emergency departments.

Purpose

The purpose of this study is to examine if there is a declining disparity in payment rates for ED care based on payment sources in a safety net ED provider. Findings of this study could indicate how the healthcare reforms might impact these types of ED reimbursement ratios in the upcoming years.

Methods

This was a retrospective study that examined randomly selected charts of all ED visits charts from May 2002 to May 2008 at a level one adult and pediatric emergency trauma center with 45,000 annual visits. This study was IRB approved.

Results

A regression model was used to predict if there was a relationship between amount received and types of insurance payers within the ED. a significant relationship was found between types of insurance (payers) as the independent variable, and the dependent variables of charges ( p = .00), payments ( p = .00), amount of adjustments (p = .00), and balance remaining after 90 days (p = .00).

Conclusions

Who pays for the ED services does impact the ED's bottom line. the privately funded patients will provide an ED with a higher reimbursement ratio per year as compared to those patients who are publicly or self pay. This explains why EDs that provide care for 40% or more publicly or self pay patients have seen a decline in reimbursement ratios. Healthcare reform has the potential to change and possibly improve safety net ED rate of reimbursement depending on how private, public and self pay patients pay for ED services.
Framing the Same Sex Marriage Decisions: The Context and the Possibilities
Authors: Swan Wallace
Published: May 2024

The efforts to accomplish the implementation of marriage for same-sex couples have had considerable success in the past few years. a minority of states are now able to offer this option as a result of either court action or legislative efforts. This movement will continue to be successful in the very near future, and may eventually result in the offering of marriage to all couples in all states. However, the culture of the states which oppose marriage for same-sex couples will continue to be problematic. in at least four groupings of states (southern states, rust-belt states, central plains states and mountain/western states) the differing cultures will ensure that lesbian, gay, bisexual and transgender people continue to be treated unequally in many ways other than marriage. the irony of a same-sex couple finally being able to receive marital rights while simultaneously being discriminated against in housing, education, and employment cannot be overlooked…
Sexual Orientation and Mental Health: Incremental Progression Or Radical Change?
Authors: Wyatt-Nichol Heather
Published: May 2024

This manuscript provides a critical historic analysis of the status of sexual orientation nondiscrimination within the context of the mental health profession. the declassification and reclassification of homosexuality in the Diagnostic and Statistical Manual of Mental Disorders is addressed. While the DSM reclassifications represent a slow shift toward the acceptance of homosexuality within the fields of psychiatry and psychology, the APA of the present represents a radical shift from the past.
Second Parent Adoption: Same-Sex and the Best Interest of the Child
Authors: Maxwell Mark Edward , Kelsey Gary
Published: May 2024

The best interest of the child is the federal mandate, but it is just an ideal for same-sex parents with children adopted from North Carolina's foster care system. a same-sex couple can jointly foster in North Carolina, but once an adoption decree is issued, one parent becomes a legal stranger. a second parent adoption would allow a non-married spouse to adopt their partner's child. Little was known about the experiences of the hidden population in North Carolina. the framework for the study is Procedural Justice. the qualitative phenomenological study affirmed prior research and filled a gap in literature with regard to the understanding the families legal challenges. the study successfully described the families lived experiences and could potentially inform public policy makers, social workers, the hidden population and educators.
The Importance and Value of Professional Membership of Nursing Home Administrators
Authors: Castle Nicholas , Olson Douglas M. , Hyer Kathryn , Sheridan John , Ferguson-Rome Jamie , Wolf David , Burke Robert
Published: May 2024

This study examines the association between nursing home administrators (NHAs) professional membership, certification, and fellow status with quality indicators in nursing homes. Membership, certification, and fellow information (representing increasing levels of participation) originated from the American College of Health Care Administrators (ACHCA). ACHCA is a professional association which represents long-term care administrators. the Quality Measures reported on the Nursing Home Compare web-site, and facility information from the On-line Survey Certification of Automated Records (OSCAR) were used. the period of interest was 2010 and a total of 19 quality indicators were examined. Data were analyzed through multivariate analyses using negative binomial regression. the results indicate NHAs who are members of ACHCA are associated with better quality in 6 of the 19 quality indicators examined; ACHCA certified member fellows are associated with better quality in 7 of the 19 quality indicators examined; ACHCA fellows are associated with better quality in 10 of the 19 quality indicators examined; and, ACHCA members (excluding certified, certified fellows, and fellows) are associated with better quality in 13 of the 19 quality indicators examined. These findings support the value of professional membership, as well as voluntary certification or fellow credentialing of NHAs with respect to quality improvement.
Payer Source for Single, Elderly Women in Nursing Homes
Authors: Nakagawa Sage , O'Lawrence Henry
Published: May 2024

This study seeks to determine the payer source for single, elderly women in nursing homes by using secondary data from the 2004 National Nursing Home Survey was extracted and analyzed for the aforementioned hypotheses. By determining the payer source for single, elderly women, the next generation of women can prepare for high nursing home costs by saving earlier or investing in long-term care insurance. The analyses indicated self-pay and Medicaid was the primary sources for elderly women in nursing homes. Marital status did not have an impact on the payer source for elderly women. Single women did not have different payer sources than married elderly women. However, the study did not focus on payer sources for single, elderly women in nursing homes, but the demographic population as a whole.
Fee-Scheduleincreasesincanada: Implication for Service Volumes among Family and Specialist Physicians
Authors: Ariste Ruolz
Published: May 2024

Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004–2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors.
Earnings Management in U.S. Hospitals
Authors: Dong Gang Nathan
Published: May 2024

Objective

This paper examines the hospital management practices of manipulating financial earnings within the bounds of generally accepted accounting principles (GAAP).

Study Design

We conduct regression analyses that relate earnings management to hospital characteristics to assess the economic determinants of hospital earnings management behavior.

Method and Data

From the CMS Cost Reports we collected hospital financial data of all U.S. hospitals that request reimbursement from the federal government for treating Medicare patients, and regress discretionary accruals on hospital size, profitability, asset liquidity, operating efficiency, labor cost, and ownership.

Results

Hospitals with higher profit margin, current ratio, working capital, days of patient receivables outstanding and total wage are associated with more earnings management, whereas those with larger size and higher debt level, asset turnover, days cash on hand, fixed asset age are associated with lower level of earnings manipulation. Additionally, managers of non-profit hospitals are more likely to undertake some form of window-dressing by manipulating accounting accruals without changing business models or pricing strategies than their public hospital counterparts.

Conclusions

We provide direct evidence of the use of discretionary accruals to manage financial earnings among U.S. hospitals and the finding has profound policy implications in terms of assessing the pervasiveness of accounting manipulation and the overall integrity of financial reporting in this very special public and quasi-public service sector.
Effect of Gni on Infant Mortality Rate in Low Income, Lower Middle Income, Upper Middle Income and High Income Countries
Authors: Jalal Sabeena , Khan Najib Ullah , Younis Mustafa Z.
Published: May 2024

Global disparities in health form a complex issue adversely affecting much of the world's population. What has been found is that national income and other general socio-economic factors are strong determinants of population health (Houweling, 2005 & Schell, 2007). In countries where resources are less, people are much less healthy than people living in rich countries. In wealthier countries that have made immense progress in health indicators, the resulting change in age structure and morbidity and mortality patterns portends even greater financial demands on the health sector.

This study noted the trends in several health indicators versus economic indicators and related it to low income, lower middle income, upper middle income and high income countries.

We noted that there is improvement in all health indicators along with an increasing GNI per Capita and GDP. In low income regions though, the rate of improvement is slower as opposed to high income countries. However, there is progress, which is leading to an increase in aging population.
Is Accreditation Sufficient? A Case Study and Argument for Transparency When Government Regulatory Authority is Delegated
Authors: Wickersham Mary Eleanor , Basey Stephanie
Published: May 2024

In Georgia and across the United States, there is a fundamental and perhaps dangerous disconnect between findings of regulatory authorities and private accreditation agencies when both are charged with aspects of oversight of quality of care in opioid treatment programs. Though accreditation plays an important role in the social norming aspect of quality improvement of many health care organizations, the proprietary nature of information gathered by accrediting bodies and the lack of communication among government regulators limits the effectiveness of the current quality assurance effort. This research uses publically available data from opioid treatment programs in the State of Georgia as a case example to examine the “regulatory fog” that obscures the ability of consumers and even state and federal governments to effectively assess quality and performance of opioid treatment programs. The authors conclude that delegation to accrediting organizations of the governments’ regulatory responsibility should entail expanded public reporting and a lead agency for coordination of findings among the various regulators.
Evaluating A Consistent Care Program for A Hospital Emergency Department to Reduce Frequent Visits
Authors: Gerhold Marilyn , Selfridge Sallie , Copper Joan
Published: May 2024

Patients utilizing Emergency Departments (EDs) frequently have become an increasing concern to hospitals across the nation as it creates inconsistent care for patients and increased care costs for patients, hospitals, and insurers. Over a period of 4 years, a Midwest regional hospital identified an upward trend in these visits to the ED and implemented a case management intervention that included individualized care planning and a social work case manager for 103 patients. During the first year of the program, ED visits for this patient population were reduced by 68% and ED charges decreased by $1.1 million. This manuscript has implications for EDs, behavioral health units, out-patient services, and medical homes.
Creating A Culture of Health in Rural Arkansas
Authors: Day Cynthia R. , Ashcraft Pamela F. , Scott Patricia
Published: May 2024

Residents of Yell County have high rates of childhood and adult overweight/obesity, physical inactivity, teen births, and children in poverty. A recent community health needs assessment performed by John Ed Chambers Memorial Hospital (JECMH) identified an unprecedented opportunity to improve the health and the quality of life for residents of this small west central Arkansas county. In order to effect change, JECMH sought to go outside the confines of traditional hospital based responses and utilize the Culture of Health (COH) Action Framework to engage the community in developing an action plan. The COH Action Framework include four focus areas: Action Area 1, Making Health a Shared Value; Action Area 2, Fostering Cross-sector Collaboration to Improve Well-being; Action Area 3, Creating Healthier, More Equitable Communities; and Action Area 4, Strengthening Integration of Health Services and Systems.

Three outcomes specific to Healthy People 2020 are proposed for the residents of Yell County. Over the next 10 years, reduce the proportion of adults who are obese in Yell County from 35% to 31%; reduce the proportion of adults that participate in no leisure time activities from 37% to 33%; and increase access to locations for physical activity from 41% to 44%.

The aim of this article is to demonstrate how a rural community hospital can utilize the COH Action Framework to conduct a community health needs assessment and engage the community in developing a long-term action plan. The methods of data collection include a combination of community opinion surveys and key informant interviews.

This article illustrates how moving beyond the traditional patient/healthcare organization relationship can lead to healthier communities.
Examining the Impact of Federal Employee Wellness Programs and Employee Resilience in the Federal Workplace
Authors: Pink-Harper Stephanie A. , Rauhaus Beth
Published: May 2024

The term “family-friendly” has been broadened to “employee-friendly” to encompass employees who may not benefit from traditional familial benefits. This change in terminology, focusing on employees in a general sense, has not necessarily resulted in policies that are beneficial to a dynamic, diverse public service. As demographics and lifestyles of federal government employees change, human resource policies will need to adapt to meet the needs of this population. This research explores the impact that employee-friendly policies (i.e. family, health, and socio-economic) have on the employee, and the workplace environment. This project attempts to bridge the gap between the theory- driven creation of employee-friendly policies and the practice of beneficial policies that employees will take advantage of. Results suggest that as demographics of the public service change, the need for human resource practices to be modified becomes even more apparent to achieve an appropriate work-life balance. In order to address these challenges, this work offers policy recommendations for increased levels of job satisfaction, which focus on benefits useful in improving federal public servants’ wellness.
Institutional Design of the Aca Health Insurance Exchanges: Factors Affecting Policy Implementation in State Administration
Authors: Noh Shihyun , Janousek Christian L.
Published: May 2024

In state implementation of the Affordable Care Act (ACA) health insurance exchanges, sixteen states decided to create and administer their own exchanges, determining the institutional location of the exchanges. This institutional design of implementing organizations affects aspects of state policy implementation of the health exchanges, reflecting the intentions of state officials to exert control over the administration of operations and other decisions such as funding sources. This research examines whether state decisions regarding agency assignment of the ACA health exchanges were associated with political, economic, and historical-cultural explanations. This study provides evidence that, in the decision of the location of health insurance exchanges, state officials were influenced by the factors of state budget shortfalls and state histories of creating independent agencies, but not by divided government, compound divided government and state personnel capacity.
Chronic Medical Conditions in Criminal Justice Involved Populations
Authors: Harzke Amy J. , Pruitt Sandi L.
Published: May 2024

Nationally representative data collected by the Bureau of Justice Statistics (BJS) have shown increasing and elevated prevalence of a number of non-infectious chronic medical conditions in criminal justice populations relative to the non-institutionalized population. Prevalence of these conditions, including hypertension and arthritis, are especially high among elderly and female prisoners and jail inmates. State- and site-specific prevalence estimates, however, have revealed patterns that are somewhat inconsistent with BJS national data. We summarize the extant literature regarding prevalence of chronic medical conditions in U.S. prison and jail settings, determinants of these conditions across the phases of criminal justice involvement, and potential opportunities for reducing and managing the burden of chronic medical conditions in criminal justice populations. We provide research and policy recommendations for improving measurement of the burden of chronic medical conditions in criminal justice populations, provision of healthcare in correctional settings, and post-release continuity of care and community reentry.
Avoidable Emergency Department Visits: Differences between Texas and Washington Medicaid Enrollees
Authors: Mandal Bidisha
Published: May 2024

Administrative claims data from 2012 are used from Texas and Washington State to understand state differences in the likelihood of non-urgent emergency department utilization prior to the implementation of the Affordable Care Act. Texas is currently the largest state that has opted to not expand Medicaid. Washington State has expanded Medicaid, and it had more generous pre-expansion Medicaid income eligibility criterion compared to Texas. I find that emergency department use for non-urgent reasons was higher in Texas compared to the state of Washington in 2012. Additionally, in Texas, there was a disproportionately high demand for obstetric services that are typically provided in outpatient settings. Non-urgent emergency department demand was associated with disruption in Medicaid coverage in both states. In Texas, especially, Medicaid coverage disruption and rural area residency were associated with higher likelihood of emergency department use for emergent but primary care treatable reasons.
The Role of Support Administration: A Study on Critical Incidents
Authors: Testoni Ines , Pompele Sara , Venturini Daniele , Zanca Gloria , Maccarini Andrea Maria
Published: May 2024

This qualitative study examines evidence of practice for “support administration” (SAd) in Italy. Using the framework of the critical incident technique, the textual analysis surveyed the experience of three lawyers, to highlight the difficulties of this role from the psychological and social areas. The reports of 48 cases, collected thanks to the interaction with three Italian lawyers who work as support administrators (SAds) in Verona (Italy), were processed through thematic analysis, which evidenced specific problems inherent to beneficiaries, their relatives and professionals. The discussion on the role of SA and a comparison with other forms of legal protection of vulnerable people in Europe is presented. Some hypotheses on the strategies which could improve the efficacy of this professional intervention are discussed.
Is it important for tourists to say, “This is my destination?”
Authors: Kucukergin Fulden Nuray , Kiliclar Arzu
Published: May 2024

This study aims to investigate the relationships among tourist motivations, destination psychological ownership (DPO), tourist satisfaction, on-the-spot behavior, braggart word-of-mouth (WOM), and revisit intention. Although the available research examines the antecedents and outcomes of DPO, this study integrates tourist motivations and DPO into the same model by considering the theory of psychological ownership. The model was tested using partial least squares-structural equation modeling. The results show that the effect of some of the elements related to tourist motivation and DPO on tourist satisfaction are significant. Moreover, DPO positively affects braggart WOM and revisit intention, whereas tourist satisfaction has a significant effect on on-the-spot behavior and revisit intention.
Evaluation of commercial facemasks to reduce the radioactive dose of radon daughters
Authors: Gutiérrez-Álvarez Isidoro , González Santiago Celaya , Merino Ismael Fuente , Quindós Luis Santiago , Fernández Carlos Saínz
Published: May 2024

Commercial facemasks have become a common tool during the COVID-19 pandemic. They are cheap, simple to use and some are capable of filtering out most particles in the air, protecting the user. These qualities are usually employed in relation to hurtful viruses or contaminants, but they could also be used to prevent the radioactive dose due to radon, which is the second leading cause of lung cancer worldwide. For that reason, the main goal of this study is to verify if facemasks could prevent radon decay products from entering the potential user’s lungs. Since these decay products are the main source of radioactive dose, several commercial facemasks were tested by exposing them to radon and then measuring the presence of radon daughters by gamma spectroscopy. Reusable facemasks made from materials such as cotton, polyester or neoprene appeared to be inefficient with only 40% filtering efficiency, Polypropylene woven masks being the only exception, with 80% efficiency. Surgical masks presented filtering efficiencies between 90 and 98%. FFP3 and FFP2 proved to be the most reliable, almost completely filtering out radon daughters with filtering efficiencies up to 98%. Results prove that the use of FFP3 and FFP2 facemasks could be a useful tool to reduce the radioactive dose due to radon in places where other techniques cannot be used or are not advisable.
The effect of body mass index on stroke prognosis: A systematic review and meta-analysis of 32 cohort studies with 330,353 patients
Authors: Qin Jiangxia , Zhang Tong , Chen Yajing , Wei Xiaoqin , Yang Yiyi , Yuan Yue , Guo Jiali , Han Lin , Ma Yuxia
Published: May 2024

Background:

Many studies have explored the impact of body mass index (BMI) on stroke prognosis, yet findings remain inconsistent.

Aims:

The aims of this study were to conduct a systematic review and meta-analyses to summarize the existing evidence on BMI and stroke outcomes.

Methods:

PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, Wanfang Database, and VIP Database were systematically searched from inception to 1 January 2023. Cohort studies were included if they reported on a population of patients with stroke, evaluated BMI on stroke outcomes (mortality/recurrence/score of modified Rankin scale (mRs)), and reported original data. Data extraction and quality assessment were independently undertaken by two reviewers. Stata 16.0 software was used for meta-analysis.

Results:

Thirty-two studies involving 330,353 patients (5 Chinese language articles) were included in the analysis. The proportion of underweight, overweight, and obese patients was 1.85%, 18.2%, and 15.6%, respectively. Compared with normal weight, being underweight was associated with an increased risk of mortality (relative risk (RR) = 1.78, 95% confidence interval (CI) = 1.60–1.96), poor functional outcomes defined as modified Rankin scale ⩾ 3 (RR = 1.33, 95% CI = 1.22–1.45), and stroke recurrence (RR = 1.19, 95% CI = 1.04–1.37). Being overweight but not obese was associated with reduced mortality (RR = 0.81, 95% CI = 0.74–0.89) and better functional outcomes (RR = 0.92, 95% CI = 0.89–0.96), but did not alter the risk of stroke recurrence (RR = 1.03, 95% CI = 0.90–1.17). Obesity was associated with lower risk of mortality (RR = 0.76, 95% CI = 0.72–0.81) and better functional outcomes (RR = 0.89, 95% CI = 0.84–0.94).

Conclusions:

Our findings indicate that in patients with stroke, being underweight is associated with an increased risk of mortality, poor functional outcomes, and stroke recurrence. In contrast, being overweight but not obese, or being obese, was associated with a decreased risk of mortality and better functional outcomes. This is consistent with the obesity paradox in stroke, whereby obesity increases stroke risk in the general population but is associated with improved outcome in patients suffering stroke.