bluuebunny/crossref_metadata_2025 huggingface dataset:
Change in the U.S. Health Care System: Effects on Physician Retirement and Implications for Health Care Managers
Authors: Bahrami Bahman , Elder John , Jacobson Sarah
Published: May 2024

Several authors tare postulated that managed care and other related changes in the U.S. health care system, perceived negatively by mature physicians. may contribute to their early retirement. This, in turn, may produce advene effects on the availability of medical care. The authors investigate this and other related issues through analysis of a unique data vet obtained from a survey of nearly four thousand physicians, that elicited responses to numerous factors potentially relevant to their retirement decisions. The empirical analysis reveals that while managed care is an important factor in the retirement decision of physicians, it does not necessarily lead to earlier retirement. Physicians rank other factors, related to financial and personal issues, as more important in their retirement decisions and the authors find that several of these factors significantly impact their expected retirement age. The results have several implications for health care managers relating to the retention or retirement of practicing physicians, successful planning, and seamless generation of income.
Interorganizational Networks: Using a Theoretical Model to Predict Effectiveness of Rural Health Care Delivery Networks
Authors: Schumaker Alice M.
Published: May 2024

Interorganizational health care delivery networks have potential for sustaining health services delivery in rural areas faced with economic and demographic challenges. Four Nebraska rural health care delivery networks (Albion-Ord, Blue River Valley. Rural Partners. Inc., and Western Nebraska) were compared to an interorganizational model based on theories of interorganizational relations, exchange, population ecology, and synthesized collaboration. It assumes that outcomes, including effectiveness, are influenced by external and internal factors that are operationalized through external control, technology, structure, and operational process variables.

Data were collected by a non-random, two-level cluster mail survey of network, members (45/59 = 76.3% response rate). All networks received technical assistance from the Nebraska Office of Rural Health. Networks have formal organization, strategic plans, and official coordinators. Hospital administrators hold most leadership positions; few doctors or citizens are involved.

Correlation and multiple regression analysis show partial fit between the research model and study networks. Effectiveness, measure by the gap between best possible and actual practice, increased with network connectivity (r=.36, p<.05), group methods of administrative decisionmaking (r=.52, p<.001) and sequential pattern of service delivery (r=.39, p<.05). Greater dependence on vertical funding corresponds to greater external control (r=.43, p<.01). The prediction that, as scope narrows, task intensity (r=.56, p<.001). duration (r=.41, p<.01), and task volume (r=.50, p<01) increase is upheld. Centrality and network size decrease together (r=.43, p<01) where there is little reliance on vertical sources of funds (r=.36, p<.05). The integrated interorganizational model demonstrates some efficacy for testing potential effectiveness of networks.
Hospital and Community Health: Going from Stakeholder Management to Stakeholder Collaboration
Authors: Olden Peter C.
Published: May 2024

Leaders of hospitals and other health service organizations often use stakeholder management capabilities to analyze, understand, and transact business with their stakeholders in order to achieve organizational goals. When these leaders and their organizations become involved in community health improvement, they have new and different types of stakeholders than for traditional medical care. In the community health domain, these leaders should modify their approach toward stakeholders so that they collaborate with stakeholders rather than try to manage them. Recommendations for how to do this include giving up some control, building trusting relationships, and emphasizing community goals.
A Stakeholder Approach to Community Health Management
Authors: Proenca E. Jose
Published: May 2024

Although community health management has become an important issue for health care organizations, there is little information on the roles that they and other community institutions ought to play in this area. This article develops a stakeholder approach to community health management, identifies the set of community health stakeholders, determines their salience to health care organizations, discusses the strategies they use to influence organizational involvement in community health management, and examines the responses of health care organizations. Implications for community institutions, health care managers, and researchers are discussed.
Health Care Disparities in Disadvantaged Medicare Beneficiaries: A National Project Review
Authors: Hebb John H. , Fitzgerald Dawn , Fan Weihong
Published: May 2024

The wealth of literature documenting differences in health care utilization by race and ethnicity underscores the need to develop a system to effectively measure health care related disparities. The Centers for Medicare & Medicaid Services has taken the first steps toward detailing the quality of care for fee-for-service (FFS) Medicare beneficiaries. Using data collected for the two-period 1997–1999 on a cross-section of beneficiaries from all states and territories of the U.S., quality was measured using a set of 24 indicators of care. The results of this effort were reported in the October 4, 2000 issue of the Journal of the American Medical Association. This article reports similar measures of quality but focuses specifically on disparities in the indicators among five disadvantaged Medicare beneficiary groups: African-American, American Indian/Alaska Natives, Asian/Pacific Islanders, Hispanics, and Medicare beneficiaries enrolled in Medicaid (dually enrolled). These indicators serve as a baseline for tracking quality improvement within disadvantaged populations and evaluating the success of efforts to reduce health care disparities at the national level.

The findings suggest that patterns of disparities exist in both the inpatient and outpatient settings for disadvantaged beneficiaries. Over the next decade, the composition of Medicare beneficiaries will become more diverse. This increasing diversity makes it imperative to identify and monitor the existence and extent of health care disparities. The consistent and ongoing evaluation of racial, ethnic, and socioeconomic disparities should provide an incentive to create effective preventive programs tailored to specific community needs.
The Dual Enrolled as a Disadvantaged Population: Developing Culturally Informed Interventions for Tennessee Medicare/Medicaid Women
Authors: Finerman Ruthbeth , Blanchard-Horan Christina , Jowers Stacy , Brittman Susan
Published: May 2024

The Centers for Medicare and Medicaid Services (CMS) have begun a major national initiative to reduce disparities in health care for the underserved through their contracts with state quality improvement organizations (QIOs). This initiative has translated into state-level projects that are, in many cases, investigating these populations to determine how best to address their health care deficiencies and improve the quality of their care. Tennessee's campaign, coordinated by the Center for Healthcare Quality (CHQ), the state's QIO, focused on the use of formative research to gain insights into diversity among the underserved in different settings across the state. Results aided the design of a series of site-appropriate interventions aimed at improving the utilization of mammography screening among Tennessee's Dual Enrolled: Medicare beneficiaries who are also enrolled in Medicare.
Reducing Disparities in Lipid Testing for African-Americans with Diabetes: Interim Report
Authors: Michalowski Kristin M. , Gold Jay A. , Morse Debra L. , Bluestein Joseph N.
Published: May 2024

Health care disparities exist throughout the United States. MetaStar, the Quality Improvement Organization (QIO) for Wisconsin, has developed a project designed to define, study, and reduce an identifiable health care disparity in Wisconsin. A disparity of 17% exists between the rate that African-American Medicare beneficiaries with diabetes and non-African-American Medicare beneficiaries receive lipid panel tests in Wisconsin. This article reviews the various methods that MetaStar has used to learn about this disparity, the African-American community, and the providers who serve this population. In addition, interventions developed from the information gathered through the learning activities are briefly described.
Reporting a Health Quality Improvement Project for Reducing the Disparity in Screening Mammograms among Senior African-American Women
Authors: Sobel Edward R. , Mannis Cindy
Published: May 2024

Despite intensive efforts by the established medical community to offer preventive health practices to minority populations, there remains a significant disparity in utilization of many of these services. Between African-American and Caucasian women there exists a significant disparity in the use of screening mammography. Under contract by the Centers for Medicare & Medicaid Services, Quality Improvement Organizations (QIOs) have been charged with reducing disparities in health care among identified minority populations within each state. Quality Insights of Delaware, the QIO for the state, has developed a project that utilizes a collaboration with African-American women and community resources in an effective outreach program to the targeted population.
Evaluating Emergency Medical Services: Cntrolling the Rising Cost of Saving Lives
Authors: Davis Jerry , Kuhns Roseann , Watson Douglas J.
Published: May 2024

A combination of recent changes in the way Emergency Medical Services are reimbursed by Medicare for ambulance services and escalating costs have prompted many EMS providers to seek new ways to meet the needs of the communities they serve in a more cost-effective manner. This article reports one such study of a county in the Southeastern United States with a population of over 100,000 distributed over an area of 600 square miles. The study used industrial techniques, including a combination of historical data analysis and time studies, to recommend ways to cut costs without adversely affecting either the emergency coverage or patient case provided. Based on usage data, reducing the number of service units during time of least demand was suggested. The time studies indicated that it might be possible to combine some jobs ( e.g. billing personnel and dispatchers), The usage data also showed that the existing geographical distribution of the units matched demand. The study demonstrated that industrial engineering techniques can be usefully employed in the evaluation of the efficiency and effectiveness of public services.
Responding to a Crisis: A Stakeholder Analysis of Community Health Organizations
Authors: Savage Grant T. , Dunkin Jeri W. , Ford David M.
Published: May 2024

On May 11, 2001, the Bureau of Primary Health Care notified West Alabama Health Services, doing business as Family HealthCare of Alabama, that it was terminating $6 million in grants due to non-compliance and amid allegations of financial mismanagement and fraud. West Alabama Health Services, a not-for-profit organization, operated 19 community health centers that provided preventive and primary care services for 17 counties in Alabama. This disruption of health services engendered considerable stakeholder debate. Within this context, the authors examine how a small, newly established rural health center and a well-established, federally qualified community health center responded to this crisis. The authors use a stakeholder analysis framework to highlight how key relationships with stakeholders may change with the perceived credibility of the organizational leaders and the legitimacy of their actions.
A Cohort Study of Former and Current Medicaid Recipients in two North Carolina Counties, 1996–1999
Authors: Brandon William P. , Chaudry Rosemary V. , Schoeps Nancy B. , Walsh Betsy J.
Published: May 2024

This article presents findings of a 1998–99 resurvey of Medicaid recipients (adults and children) who were first surveyed in 1996 in Mecklenburg and New Hanover Counties in North Carolina. It reports the insurance status and health care of former Medicaid recipients and compares them with those still on Medicaid in 1998–99 in respect to access to care and satisfaction. Just under half of those who had left Medicaid were without employer-sponsored health insurance (ESI) at the time of the second survey. Former Medicaid recipients without ESI rated their access to healthcare lower than those with Medicaid and former Medicaid recipients with ESI. Over 50% of target respondents in all groups were more positive than negative on access-related variables. But only those on Medicaid in Mecklenburg County had significant increases in satisfaction with health care between 1996 and 1998–99. Those in the control county who were oft Medicaid and those still receiving it and former recipients in Mecklenburg showed no significant change. The study has great policy relevance in light of recent national welfare reform.
Re-Engineering the Los Angeles County Public Health Care Safety Net: Recommendations from a Blue Ribbon Health Task Force
Authors: Rubino Louis , French William J.
Published: May 2024

Public hospitals throughout the United States are under increasing fiscal and political pressure to survive because of dynamic changes in healthcare delivery, an increasing uninsured population of patients and rapidly declining reimbursement. These safety net health care programs are also saddled with outdated and bureaucratic governmental policies and procedures which make it even more difficult to improve the quality of care and efficiency of the organization. As these pressures mount, some public hospital systems have attempted to be reinvented through the re-engineering process.

Los Angeles County, the second largest health system in the United States, has done relatively little to adjust to changing times. Los Angeles County Department of Health Services has been attempting to re-engineer for the past three years, but this has not averted the need for a second billion-dollar waiver in 2000 from the state and federal governments. A Blue Ribbon Health Task Force was appointed to examine the failure of re-engineering to restructure the Los Angeles public health delivery system. In this article, the group's findings and recommendations are reported. They cover three general areas: eliminating bureaucratic hurdles, improving healthcare planning and management of operations and setting priorities on critical investments in health services.
The Privatization of Human Services: Myths, Social Capital and Civil Society
Authors: Marten Lawrence L.
Published: May 2024

It is fashionable to point to privatization and the involvement of for-profits as the parties responsible for many, if not most, of the ills that plague the social welfare system today. This article takes a contrary point of view. Three arguments are made. First, private sector human service delivery and the use of for-profits in the United States predate privatization as a defined public policy. Second, the privatization of the human services is a world wide phenomenon that transcends politics and ideology. Third, the privatization of human services helps to promote civil society and generate social capital.
Health Seeking Behaviors of African Americans: Implications for Health Administration
Authors: Hewins-Maroney Barbara , Schumaker Alice , Williams Ethel
Published: May 2024

Disparities in health care and good health between African Americans and other populations while established in the literature are traditionally based on socioeconomic measures of race, income, age, and education (Bailey, 2000; Lillie-Blanton, Brodie, Rowland, Altman and McIntosh, 2000; Ren and Amick, 1996; Watson, 2001; Weinick, Zuvekas, and Cohen, 2000). This study broadens the scope by exploring how sociocultural (poverty, racism, prejudice, and discrimination) and psychosocial factors (perceived health status, the lack of personal efficacy in contributing to decisions about health care, feelings of helplessness, and the lack of trust in the health care providers) relate to health-seeking behaviors of African Americans (Bailey, 1991; Ren and Amick, 1996, Watson, 2001). Interviews were conducted with 111 African American adult patients at a community health center, focusing on health-seeking behaviors, and sociocultural and psychosocial factors. Results suggest that when these negative factors are removed, the health seeking behaviors of African Americans closely mirror the behaviors of the majority population. Subjects did not view themselves in poorer health, fail to seek medical attention when needed, or distrust their primary health care providers. In general, fears associated with health care were attributed to illness rather than health care providers, although a weak linkage was found between patient self-esteem and fear or dislike of future treatment by physicians (adj R2 = .362, S.E. = 15, F=21, sig. <.001). The study highlights the need for further study in two areas: cultural competency of health care providers, especially those from Asia and Africa who are often assigned to community health centers, and the impact of an accessible community health center on the health seeking behaviors and health status of predominately African American communities.
A Systems View of Health Promotion
Authors: Ureda John , Yates Steven
Published: May 2024

This article presents a systems view of health promotion and education. We offer an overview of systems theory, including the hierarchy of systems, the relationship between a system and its environment, and agent-host interactions. A host is any system that may face disruption from an environmental agent or perturbation from an adjacent system. A system is healthy to the extent it can prevent, parry, or dissipate the effects of disruptions and perturbations. Systems can collaborate and cooperate to enhance their capacity to respond adaptively to potential threats from agents. This offers new insights into the three levels of prevention, and into health promotion practice. Health promotion is any effort to influence host systems in ways that will enhance their capacity to prevent, resist, dissipate or respond adaptively to potential threats from their environment. We also offer an account of the balance between stability (or lack of) in the environment and the importance of flexibility enabling systems to adapt to change. We examine high-level wellness, a function of knowledge, learning, skills and stored-up resources that enhance adaptability, flexibility and timeliness in a system's response to anticipated and unanticipated potentially disruptive environmental agents. Finally we draw implications for health promotion and education practice. The health promoter / educator is a helpful agent seeking to influence systems at various levels in the hierarchy of systems in ways that will enhance their capacity to prevent, resist, dissipate or respond adaptively to potential disruptive agents in their environments.
Assessing Communications Effectiveness in Meeting Corporate Goals of Public Health Organizations
Authors: Brown Gordon D. , Bopp Kenneth D. , Boren Suzanne Austev
Published: May 2024

Much evaluation of health communications in public health is considered from a program perspective of smoking cessation, weight reduction, education on sexually transmitted diseases, etc. These studies have advanced the knowledge base of communications theory and evaluation and have contributed to program effectiveness. In program-based evaluation the communications process is structured as part of the program itself.

This article extends program-based communications evaluation to view communications from the perspective of the consumer and how effectively public health departments respond to consumer expectations. It develops a conceptual model for evaluating elements of communications such as its importance in defining mission and goals within the community, managing strategic constituencies, and enlisting individuals and groups as customers and co-producers of health. It gives a broader perspective on how communications in public heath organizations are managed and a basis for assessing whether they are being managed effectively.
Another Evolvement of the Cost and Risk Shifting Model: Consumer-Driven Health Plans
Authors: Saleh Shadi S , Levin Peter
Published: May 2024

The US health care system has changed dramatically over the past forty years or so. This paper analyzes its potential transformation into a consumer-driven health care system (with the newly enacted HSAs and the increased popularity of employer defined contributions). The emphasis in the first part is the evolution of the role of providers (mostly physicians) into bearers of financial risk and gatekeepers. The second part discusses the new consumer-driven health care proposals and its potential impact on the future of health care as it pertains to putting consumers under financial risk and gives them a perceived sense of control over health care decisions.
Health care Entrepreneurship: Financing Innovation
Authors: Grazier Kyle L. , Metzler Bridget
Published: May 2024

Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.
Entrepreneurship Management in Health Services: An Integrative Model
Authors: Guo Kristina L.
Published: May 2024

This research develops an integrated systems model of entrepreneurship management as a method for achieving health care organizational survival and growth. Specifically, it analyzes current health care environment challenges, identifies roles of managers and discusses organizational theories that are relevant to the health care environment, outlines the role of entrepreneurship in health care, and describes the entrepreneurial manager in the entrepreneurial management process to produce desirable organizational outcomes. The study concludes that as current health care environment continues to show intense competition, entrepreneurial managers are responsible for creating innovations, managing change, investing in resources, and recognizing opportunities in the environment to increase organizational viability.
Comparison of Job and Career Satisfaction between Women Physicians and Women Academicians at the American University of Beirut
Authors: Zgheib Nathalie , Zgheib Philippe W. , Usta Jinan
Published: May 2024

This study assesses the level of job and career satisfaction, work, social life and child care conflict of full time female academic physicians, and compares it with full time female non medical academicians at the American University of Beirut. The authors show that female physicians were significantly more satisfied with resources and income than non physicians. Both groups were satisfied with their job in general, yet less of the non medical academicians were satisfied with the career progress. Furthermore, despite the fact that both categories, if given the choice, would go again for the same major and the same career, yet less of the physicians would advise a friend to follow the same career. There is minimal conflict between social life and work; and being married and having children did not affect the satisfaction level except for the fact of feeling more torn between the demands of work and personal life. Several interpretations are exposed in order to explain the findings, as well as the implications of the study.
Police Response to Victims of Domestic and Non-Domestic Violence
Authors: Sun Ivan Y.
Published: May 2024

The research assesses whether police respond differently to victims of domestic and non-domestic interpersonal conflicts. Though many laws and policies have been introduced since the 1980s to enhance police responses to and protection of victims of domestic violence, very few studies have empirically examined police assistance or support toward victims of both domestic and non-domestic conflicts. Using data collected by a large-scale observational project, this research analyzes officer-initiated assistances and police responses to victim requests during conflict resolution. Findings show that police are more likely to provide assistances on their own initiative to victims of domestic violence than victims of non-domestic violence. Police, however, do not differ significantly in their responses to requests made by victims of domestic and non-domestic conflicts. Implications for policy and future research are discussed.
Sexual Abuse of Older Adults: Appropriate Responses for Health and Human Services Providers
Authors: Teitelman Jodi
Published: May 2024

Helpful and appropriate responses by health and human services providers to cases of suspected elder sexual abuse are often challenged by lack of awareness of how best to proceed. The purpose of this paper is to provide an introduction to the concept, scope and dynamics of elder sexual abuse and to offer suggestions for appropriate responses that are applicable across a wide range of health and social services. Definitions, demographic aspects and proposed causes of elder sexual abuse are discussed. Risk profiles for both community-dwelling older adults and those living in facilities are presented as a guide for professionals, followed by a discussion of physical and psychological signs of sexual abuse, and approaches for determining a client's capacity to consent to sexual activity Finally, recommendations for appropriate responses once it is determined that abuse is likely to have occurred, including meeting obligations as a mandated reporter and providing effective communication and support to victims, are provided.
Exploring Assumptions about Child Neglect in Relation to the Broader Field of Child Maltreatment
Authors: Polonko Karen A.
Published: May 2024

Research on child neglect is reviewed as it relates to common assumptions in the field, the broader context of research on child maltreatment and trends within the larger society. Overall, while child neglect is the type of maltreatment most frequently reported to and acted on by official agencies, its proportion of all maltreatment in the general population is comparatively smaller. The issue of “neglect of neglect” is placed within the larger framework of the low priority of research on child maltreatment in general. While research shows that all forms of child maltreatment are associated with devastating consequences for children, child physical neglect has the most profound effects on cognitive functioning and academic achievement, while child physical abuse has the most serious effects on aggression and subsequent violent behavior. Child emotional neglect, sexual and physical abuse have similarly grave effects on psychopathology, in contrast to child physical neglect which is associated with the least adverse consequences. These findings are discussed within the framework of research on the neurodevelopmental effects of child abuse and neglect. Research on the causes of child neglect, in particular as they relate to the perpetrators, points to a distressing “cycle of neglect.” Finally, suggestions for breaking this cycle and keeping our children safe are discussed.
Meaning in Motivation: Does Your Organization Need an Inner Life?
Authors: Morrison Eileen E. , Burke George C , Greene Lloyd
Published: May 2024

Leaders of health care organizations are increasingly interested in ways to attract, retain, and gain commitment from their employees. This interest is created in part because high turnover rates and the lack of commitment negatively affect the provision of care and the bottom line in their organizations. In a quality and cost conscious health care environment, health care managers need to find solutions for these difficult issues; solutions that are effective, efficient and sustainable. What can be done?

This article reviews, amplifies, and extends work that has been done in the area of “meaningfulness of work” in the context of employee retention and commitment. It begins with an exploration of the problems caused by lack of employee engagement and commitment including their impact on quality and costs. It then summarizes both the theoretical and applied research in the area of meaning and work. It also introduces the basic principles of Viktor Frankl's logotherapy (Frankl, 1998) as a foundation for encouraging the integration of meaning and work. The seminal work by Pattakos (2004) is used to demonstrate how Frankl's principles can be applied to healthcare work settings. Finally, the article provides suggestions for increasing employee commitment and engagement through identifying meaning and purpose in work.
How Well are We Doing Addressing Disability in America?
Authors: Bolin Jane Nelson
Published: May 2024

Despite laws like the Americans with Disabilities Act (ADA), (1992), and The Ticket to Work Act, (TTWA), (2001), working age adults who develop chronic disabling conditions often find themselves faced with a choice of leaving the labor market in order to qualify for public health insurance or continuing to work, often on a “hit and miss” basis, disqualifying them from employee health benefits. Federal and state policy makers continue to struggle to find solutions addressing the needs of working age adults with disabling conditions and illnesses. In this study we examine the work status of working age adults using two National Health Interview Surveys conducted a decade apart (1995 & 2005) to investigate and compare adults who have chronic, disabling conditions and self-reported rates of work. Specifically, this research investigates whether reported work activity among working age adults who report chronic health conditions has improved in the decade between 1995 and 2005. The effects of racial/ethnic differences, age, and region of residence on one's work status are also examined.
Still A Long Way to Go for the Lower Mississippi Delta
Authors: Gnuschke John E. , Hyland Stanley , Wallace Jeffrey , Hanson Ryan , Smith Stephen
Published: May 2024

It is difficult to separate the demographic, social, and economic changes that have occurred in the Delta. The complex fabric that forms the Delta cannot be broken into parts for simple analysis. Healthcare issues cannot be separated from economic issues, and neither of these issues can be separated from social, political, and other factors of race and power that form the fabric of the Delta. While this analysis disaggregates the data into separate and distinct sections, the reader should be aware of the complex interactions of the performance measures. The clear interaction of health and economic data cannot be overstated and neither can the relationships between education, productivity, employment, income, and social progress. Health is one aspect of investing in human capital and, like education, has its support in the basic mix of public and private goods. Social goods require social investments, and public safety, education, and health are frequent exceptions to the rules of the marketplace. In many areas of the Delta, the allocation of scarce federal and state financial resources to address the problems of the Delta has served to relieve some of the region's distress. The commitment to long-term intervention has, however, varied widely over time.
A Portrait of the Delta: Enduring Hope and Enduring Despair
Authors: Neaves Tonya T. , Feierabend Neal , Butts Charles Caleb , Weiskopf W. Lee
Published: May 2024

Place is an integral part of human identity. Not only does place define where people are, but it also helps determine who they are. The basic methods of answering questions concerning locational features often fail to detail the relationships between one feature and another. It has become increasingly important for researchers to define and gain a deeper understanding of such characteristics. The Mississippi Delta is a land with a rich, storied history and a slow-growing, agriculturally based economy. Over the past two decades, much attention has been focused on the Mississippi Delta with its slowed population growth, deteriorating economy, low education levels, and poor health outcomes. Understanding the relationship between location and relation is key to understanding the Mississippi Delta—a place rooted with a plantation legacy left reeling with postbellum socioeconomic challenges. Although the socio-cultural and political status of the Delta is tarnished with despair, the desire to remedy the situation remains hopeful.
Am I My Brother'S Keeper? A Proposal to Determine State Governments’ Affirmative Duty to Advance Public Health
Authors: Ryan Kevin W. , Card-Higginson Paula , Thompson Joseph W.
Published: May 2024

The authors of the other articles in this journal present a compelling case that not only is the economic well being of states in the Delta causally related to the health of those who live and work there, but also that attained improvements in the health of the population can directly result in improved economic conditions for Delta residents.
Hmos’ Consumer-Friendliness and Preventive Health Care Utilization: Exploratory Findings from the 2002 Medical Expenditure Panel Survey
Authors: Xiao Qian , Savage Grant T.
Published: May 2024

Research should move beyond the simple dichotomy between HMO and non-HMO care provision, and embrace the multidimensional aspects of HMOs. Doing so, we argue, helps address the issue of HMO performance. We used a consumer-centered approach to distinguish multiform HMOs and asked the questions, “Do HMOs differ in their consumer-friendly characteristics?” and if so, “Are these characteristics associated with different preventive health care utilization outcomes?” In this exploratory study, the consumer-friendly characteristics of both Medicaid HMOs and private HMOs were examined in relationship to consumers’ utilization of preventive care services. HMOs did differ in their consumer-friendly characteristics, and some of these characteristics were significantly associated with the utilization of preventive care services.
Does Providing Uninsured Adults with Free Or Low-Cost Primary Care Influence Their Use of Hospital Emergency Departments?
Authors: Zahradnik Anne G.
Published: May 2024

This study analyzes one component of the health care safety net to determine whether or not being enrolled in a free or low-cost primary care physician access program subsequently affects emergency room utilization by uninsured adults ages 18 through 64. The study is a quantitative analysis of more than 40,000 individual patient records. An Intensity of Use Indicator (IUI) was developed for tracking individual and group ED utilization trends. The IUI should prove useful to hospital and other not-for-profit organizations concerned with tracking cost effectiveness of programs for uninsured adults.
Organizational and Individual Perspectives on Caring in Hospitals
Authors: Graber David R.
Published: May 2024

Caring and humanism in hospitals exist on both the organizational and the individual levels. This paper identifies key organizations and foundations that have succeeded in promoting or fostering caring environments in hospitals. These include the Picker Institute, the Baptist Healing Trust, Sage Consulting, and the Caritas Consortium. Exemplary, caring clinicians in hospitals are also described. These clinicians developed positive relationships with patients and in interviews communicated a number of approaches to express caring to patients. Health and human services managers can take a number of steps to promote caring among their clinicians. However, they must implement a culture and a reward system that encourages humanism.
Health Literacy and English Language Comprehension among Elderly Inpatients at An Urban Safety-Net Hospital
Authors: Cordasco Kristina M. , Asch Steven M. , Franco Idalid , Mangione Carol M.
Published: May 2024

Objective

To evaluate the relationship between health literacy and age in chronically-ill inpatients at a safety-net hospital.

Setting and Participants

We recruited 399 English- and Spanish-speaking inpatients being evaluated or treated for Congestive Heart Failure or Coronary Artery Disease at a large, urban safety-net teaching hospital in Southern California.

Design

Participants were interviewed to ascertain education, English comprehension, and in-home language use. Health literacy was assessed using The Test of Functional Health Literacy in Adults (TOFHLA). We compared by age (aged 65 or more, 51 to 64 years of age, and less than age 50) levels of health literacy, educational attainment, English comprehension, and language use.

Results

Prevalence of inadequate health literacy significantly increased with increasing age (87.2% in ≥65, 48.9% for 51–64, and 26.3% in ≤50, p<0.001). The correlation between older age and lower health literacy persisted when controlling for educational achievement, race, ethnicity, gender, and immigration status. Additionally, older patients were more likely to have never learned to read (34.9% in ≥65, 6.5% for 51–64, and 1.5% in ≤50, p<0.001), no formal education (27.9% in ≥65, 9.0% for 51–64, and 0.8% in ≤50, p<0.001), have limited English comprehension (74.2% in ≥65, 43.5% for 51–64, and 35.8% in ≤50, p<0.001), and speak a non-English language at home (82.3% in ≥65, 70.2% for 51–64, and 62.2% in ≤50, p=0.015).

Conclusions

To prepare to meet the chronic disease needs of a growing older patient population, and ameliorate the negative health effects of associated low literacy, safety-net hospital leaders and providers need to prioritize the development and implementation of low-literacy educational materials, programs, and services.
Community Capacity for Cancer Prevention
Authors: Ransom Pamela E. , Wei Ying , Stellman Steven D.
Published: May 2024

We pilot-tested a street-level study of availability of physical resources to assess ethnic disparities in community capacity for cancer prevention in forty Brooklyn, NY, census tracts with high proportions of White, African American, or Jamaican immigrant populations. Interns with GIS maps made street-level inventories of food retailers, fast-food restaurants, and commercial exercise facilities. Availability was quantified as resources per capita or square mile. Median income-adjusted number of supermarkets, greengrocers and fast-food restaurants per square mile was significantly higher in Jamaican than in African American or White tracts. Bodegas per capita was greatest in African American tracts, with no significant differences among the population groups in availability of health food stores, or commercial exercise venues.
Social Support as A Predictor of Hiv Testing in At-Risk Populations: A Research Note
Authors: Grosso Ashley
Published: May 2024

This paper examines the relationship between social support and the probability of getting tested for human immunodeficiency virus (HIV) among at-risk adults in the United States. According to the literature, social support is one mechanism through which social capital is purported to work. Several studies have hypothesized that social capital influences public health, including HIV or Acquired Immune Deficiency Syndrome (AIDS) case rates and behaviors related to contracting HIV. In this analysis, I use social support as an individual level measure of social capital and examine its influence on a protective behavior, getting tested for HIV. The relationship of social capital and social support to behaviors related to HIV is relevant to the design and implementation of HIV prevention programs.
The Effect of Rurality and Gender on Stroke Awareness of Adults in West Virginia
Authors: Alkadry Mohamad G. , Tower Leslie E.
Published: May 2024

Rurality, characterized with limited access to emergency stroke care, adds another risk factor to victims of stroke. Although there is a growing literature on gender differences, very little is known about how these gender differences intersect with rurality. A random sample of 2,000 adults were invited to participate (n=1,114) in a mail survey in West Virginia. The population is split into four groups: urban men, urban women, rural men and rural women. The findings suggest that rural older women face higher risks of stroke than other groups. The study recommends that this group be targeted by campaigns to raise stroke awareness.
The Impact of the National Practitioner Data Bank on Licensing Actions by State Medical Licensing Boards
Authors: Jesilow Paul , Ohlander Julianne
Published: May 2024

The United States Congress mandated the establishment of the National Practitioner Data Bank in large part to decrease the likelihood that errant individuals might be able to avoid detection by licensing boards and practice medicine. We use a decade of longitudinal data (1985–94), for each of the 50 states, to evaluate the Bank's impact on state licensing board actions, during the four years following its 1990 birth. The results of a pooled, time-series analysis reveal that medical board restrictions on physicians’ practices increased substantially following the creation of the Data Bank. We conclude that the increase was likely due to the licensing boards taking actions against delinquent physicians who had previously slipped through cracks in the regulatory system or who had earlier received warnings or administrative fines.
Disproportionality at the “Front End” of the Child Welfare Services System: An Analysis of Rates of Referrals, “Hits,” “Misses,” and “False Alarms”
Authors: Mumpower Jeryl L.
Published: May 2024

Data from NIS-4, NCANDS, and the State of California were used to analyze the front end of the child welfare services system – the referral and substantiation components – in terms of the system's ability to diagnose or detect instances of child maltreatment. The analyses show that Blacks are disproportionately represented in rates of referral into the system. Moreover, the analyses demonstrate that the system is less accurate for Blacks than for other racial or ethnic groups. There is a higher rate of false positives (or “false alarms”) for Blacks than for other groups – that is, referrals leading to unsubstantiated findings. There is also a higher rate of false negatives (or “misses”) for Blacks than for other groups – that is, children for whom no referral was made but who are in fact neglected or abused. The rate of true positives (or “hits”) – children for whom a referral has been made and for whom that allegation has been substantiated – is generally higher for Blacks than for other groups, but this is attributable largely to the higher rate of referral for Blacks. In sum, the system demonstrates lower levels of accuracy for Blacks than for other groups. A model is proposed demonstrating that random error, as opposed to systematic bias, could produce a pattern of results much like that observed in the data.
Measuring Change in Disproportionality and Disparities: Three Diagnostic Tools
Authors: Richardson Brad , Derezotes Dennette
Published: May 2024

At present there are few examples of sustained reductions in disproportionate minority contact with the juvenile justice and child welfare systems. This article describes the use of three instruments that have been used to measure levels of racial and ethnic disproportionality and disparities: The Disproportionality Diagnostic Tool, Ecomap and Racial Equity Scorecard. Using a combination of community and public agency data, these tools measure and track change over time on racial and ethnic disproportionality and disparities. Study results indicated a reduction in racial and ethnic disproportionality and disparities and demonstrated the utility of all three instruments for targeting efforts and assessing improvements in child welfare over time.
21st Century Community Learning Centers—Improving the Academic Performance of At-Risk Students: A Bronx Tale
Authors: Dodd Arleen T. , Bowen Lizette M.
Published: May 2024

The authors of this article report on an intervention designed to improve the academic component of an extended after-school program. the agency involved in this intervention was a non-profit community action group (CAG) agency whose mission is to improve the socio-economic well-being of the residents of Upper Manhattan, the Bronx, and New York City. the agency has a staff of 200 that serve high school students. the intervention program was designed to (1) improve the working relationship between teachers, families, and students in the after-school program, (2) develop new and innovative ways to improve the academic curricula of the after-school program, and (3) provide continuous education to stakeholders to the after-school program. Improvements in student performance relating to attendance, academic work, discipline and social behaviors were reported. the intervention reported in this article has the potential of supporting learning and developmental outcomes over time.
Economic Impact of Public Sector Spending on Health Care
Authors: Hy Ronald John
Published: May 2024

Public sector spending on health care clearly has a positive economic impact on local communities. Not only does such spending provide residents with better health care, but it is widely recognized as an investment that returns continual dividends in the form of better jobs, higher incomes, and additional state and local tax revenues.

The results of a static input/output model shows that public sector spending on health care of approximately $46 billion (in 2009 dollars) in the state of Texas yields over 588,000 jobs, $74.2 billion in total output, $26.3 billion in personal income, $22 billion in employee compensation, and $1.8 billion in state and local taxes; it clearly has a considerable positive economic impact on local economies and their quest for economic development.