<p> The Bureau of Substance Abuse Treatment Recovery and Prevention, which oversees drug intervention services for Detroit residents, has found the city's illegal drug use among teens to mirror national rates. Illegal drug use is associated with addiction, major health problems, and stigma. Incorporating evidence-based screening during all teen health care visits would decrease missed opportunities to identify at-risk behaviors, the number of teens that do not receive intervention, and the stigma associated with screening. The purpose of this project was to develop evidence-based policy and practice guidelines for teen screening services for illegal drug use. The Plan-Do-Study-Act (PDSA) model was used to guide the project. An interdisciplinary team of direct service and administrative staff selected questions based on 6 key words&mdash;car, relax, alone, forget, friends, and trouble (CRAFFT)&mdash;to screen teens for illegal drug use. The interdisciplinary team also developed a teen screening policy along with practice guidelines for the screening policy, implementation plan, and project evaluation. A review of the literature provided support for the project methods. Two experts in the field of substance abuse provided content validity for the policy and practice guidelines, and concluded that the CRAFFT screening questions were valid for evidence-based screening for illegal drug use among teens, that the PDSA model was effective to guide the project, and that an interdisciplinary team approach was effective to address the issue. These findings may improve identification of at-risk teens, decrease missed screening opportunities, decrease stigma, and align the Bureau with current trends in substance abuse treatment.</p>

<p> Negative affect is widely recognized as a common precipitant of both subjective and objective sleep disturbances (Vandekerckhove &amp; Cluydts, 2010). Since repetitive thought forms such as rumination can sustain negative affect states, they may play a critical role in the etiology of sleep impairment. However, extant research suffers from a number of methodological shortcomings, including a lack of objective sleep assessment and 'first-night' effects. Further, this literature has yet to adequately address the treatment implications of the association between rumination and sleep. Mindfulness-based meditation has emerged as a favorable candidate for such an intervention in recent years (Carney &amp; Segal, 2005). Therefore, the present studies aimed to investigate the association between rumination and sleep outcomes using a multi-method approach to sleep assessment. The efficacy of mindfulness-based meditation in extinguishing rumination and improving sleep was also explored. </p><p> A sample of 42 university students who scored high on a trait-level measure of rumination participated in two, week-long studies. Participants provided informed consent, received an actiwatch, and were randomly assigned to either a mindfulness or distraction group before the studies began. During Study 1, participants in both groups completed brief, electronic questionnaires assessing daily levels of rumination just prior to bedtime. Immediately after waking, participants reported the duration and quality of sleep they experienced the previous night. Analyses revealed that daily rumination (z = 2.44; p &lt; .05) was significantly associated with actigraphy-based sleep-onset latency (SOL), but not with total sleep time (TST) or sleep efficiency (SE). Daily rumination was also significantly associated with self-reported SOL (z = 3.18; p &lt; .01) and SQ (z = 2.39; p &lt; .01), but not with TST. </p><p> During Study 2, participants in the mindfulness and distraction groups partook respectively in a mindfulness- or distraction-induction task immediately after the nightly questionnaires. A significant effect emerged between group membership and actigraphy-based SOL (z = - 2.13; p &lt; .05), diary-based TST (z = 2.38; p &lt; .05), and diary-based SQ (z = - 2.88; p &lt; .05), with the mindfulness group reporting better sleep outcomes. With respect to within-person effects over the course of the two studies, the mindfulness group exhibited shorter actigraphy-based SOL (z = - 2.30; p &lt; .05), higher actigraphy-based SE (z = 6.54; p &lt; .01), and higher diary-based SQ (z = - 2.22, p &lt; .05) during Study 2 than during Study 1. There were no significant differences in any sleep outcome between Studies 1 and 2 for the distraction group. </p><p> These data suggest that rumination is associated with both subjective and objective sleep impairment, and that mindfulness-based meditation can help attenuate this effect. Implications for current behavioral treatments for insomnia are discussed.</p>

<p> The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act or the ACA, introduced legislation that mandated all large employers to offer health insurance to their employees or a monetary penalty will be assessed. The mandate inherently impacted employers with older workers. This paper analyzed how California employers viewed their older workers specific to the ACA through qualitative interviews. Sample size of ten (<i>N </i>=10) participants in the study: eight employers and two professionals managing health insurance plans. Themes emerged from participant employers who viewed their older workers as valuable and like family, while the age of the older workers did not influence the participant employers during the decision making process to offer a health plan in light of the ACA's mandate. </p>

Length of hospital stay was analyzed in Ile-de-France, for 1147 patients with drug poisoning, diabetes mellitus, head trauma, varicoses veins, urinary calculus, gall-stone disease, or myocardial infarction. The explanatory variables (socio-demographic, hospital, and clinical characteristics) were different from one diagnosis to another; the percentage of variance explained laid between 13% and 26%, depending on the specific diagnosis. Results confirm that length of stay is more than a managerial indicator; it also contains clinical-epidemiological information. Results from multiple linear regression, logistic regression, and Cox model were compared for diabetes mellitus and myocardial infarction. From a managerial point of view, logistic regression provided operational information, whereas results from multiple linear regression, as an explanatory method, were disappointing. Cox model was less interesting since there is not censoring data in this study population. The use of administrative data for research is discussed.

Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2006. / "Title from dissertation home page (viewed July 16, 2007)." Source: Dissertation Abstracts International, Volume: 67-10, Section: A, page: 3907. Adviser: Pravin Trivedi.

<p> It has been estimated that by 2020 nearly one-third of all Americans (almost 160 million people) will have at least one chronic disease to manage and the cost of health care will consume over 20 percent of the GDP. The Obama Administration responded to this pending crisis by passing the Patient Protection and Affordable Care Act (PPACA) in 2010. This major legislation aims to instill patient-centered, accountable care into the health care delivery system. Specifically, the United States government is on a mission to reduce the utilization of expensive inpatient care, while increasing access to primary care for all Americans, thereby lowering the total cost of health care.</p><p> Primary care practices organized around the principles of the patient-centered medical home (PCMH) can better manage their patients, especially their patients with chronic conditions; and become accountable for their care. In 2008, the National Committee for Quality Assurance (NCQA) released practice-level recognition standards based on the seven Joint Principles of the PCMH, to aid doctors seeking to transform their practices into effective patient-centered delivery systems.</p><p> The results of several published studies have touted the successes (e.g., reduced emergency department visits, reduced hospitalizations) of the PCMH model at individual practice sites. These localized successes demonstrated that the principle tenets of the PCMH model&mdash;care coordination, team-based care, population management&mdash;helped lower utilization of more expensive health care services within the specific practice settings evaluated. However, there has been no study to determine if these core tenets are having a broader impact on the health care delivery system within a community.</p><p> One hypothesized outcome of a health care system centered on the PCMH care model is better care coordination and more effective, whole-person care management across the continuum of health care; resulting in a more efficient system that can prevent avoidable hospitalizations.</p><p> This dissertation proposal seeks to understand if the increasing numbers (density) of recognized PCMH practices in communities affect avoidable hospitalizations related to ambulatory care sensitive conditions (ACSC), as measured by the AHRQ Composite Prevention Quality Indicators (PQI). The research has two purposes: </p><p> 1. Establish constructs and hypotheses to measure the effect of the increasing numbers of NCQA-Recognized PCMH practices in communities (counties).</p><p> 2. Using an outcomes-based measurement approach, investigate the relationship between growing densities of NCQA-Recognized PCMH practice doctors among all primary care doctors (PCD) in a community and the associated impact on the utilization of inpatient care, specifically related to ACSCs, as measured by the AHRQ Composite PQIs.</p><p> The research is quasi-experimental in design and is based on a retrospective (2008&ndash;2011) analysis of existing data from the NCQA PCMH program, the AHRQ Composite PQI and the Centers for Medicare &amp; Medicaid Services (CMS) National Provider Identification (NPI) databases. Analysis will link NCQA-Recognized PCMH practices (independent variable), AHRQ Risk Adjusted Composite PQIs (dependent variable), and the CMS NPI (total PCDs) on Federal Information Processing Standard (FIPS) identifiers across 114 state and county-level geographical areas in Vermont and North Carolina. The research will inform the following hypotheses:</p><p> 1. Does the research literature support the measurement construct proposed in this study?</p><p> 2. Communities with concentrations of recognized PCMH practices among primary care practices will have lower risk-adjusted avoidable hospital admission rates.</p><p> 3. The use of technology and care coordination will have a greater predictive correlation on risk-adjusted avoidable hospital admission rates than other PCMH capabilities.</p>

<p>Objectives: First, to identify the core Electronic Health Records (EHR) functionalities available to physicians who work in private and public health care facilities in Trinidad and Tobago and the extent to which physicians are using each function. Second, to understand the rate of adoption of Electronic Health Records in private and public hospitals/clinics, and finally, to identify the barriers to adoption of Electronic Health Records in private and public hospitals/clinics in Trinidad and Tobago. Background: The two largest public hospitals in Trinidad and Tobago, Port of Spain General Hospital and San Fernando General Hospital, utilized paper medical records. In Trinidad and Tobago, there is little known about the EHR functions available and being used, adoption rates, and barriers to adoption of EHR in the private and public sectors. Method: Electronic Health Records (n = 130) questionnaires were sent to number of health care practices in the private and public facilities in the five regions of Trinidad and Tobago, in order to understand availability and use of EHR, adoption rates, and barriers to the use of EHR. Results: The most commonly available function for the private and public physicians was Health Information and Data with respective scores of 58% and 29%. Sixty-three percent of the private physicians who adopted EHR reported using the Result Management and Order Management functions. The public physicians who had adopted EHR reported they were not utilizing the Decision Support, Result Management, and Order Management functions. There was no statistical difference between private and public physicians for the available and used functions. A total of 53 private and 19 public physicians responded to the survey (55% response rate). Thirteen (25%) private physicians reported adopting EHR and 2(11%) public physician reported adoption of EHR. Private and public physicians cited start-up cost and technical limitations of systems as the barriers to their practices' adoption of EHR. Conclusion: Findings showed the same availability and use of core functionalities, as well as adoption rate among the private and public facilities, and slightly fewer barriers in the private practices. A larger sample is merited to understand if there is any statistically significant difference between the two groups.

<p> Employee burnout has been a toxic concern in today&rsquo;s American workforce. The prevalence of stress in the healthcare workplace is costing America billions of dollars and leading to medical errors, absenteeism, and turnover. Research indicates that human-animal bond provides physical, physiological, and psychological health benefits for professionals. This project will present the benefit of human-animal interactions (HAI) therapy in promoting the well-being in healthcare professionals. It will address services which will deliver to healthcare employees in the convenience of their workplace as well as educate the reader about the role animals play in humans&rsquo; lives. A combined minimal overhead cost and scientifically-proven health benefits of HAI, overall enhanced feelings of employee well-being and decreased animal abandonment are the strengths to this project. Finally, a discussion outlining the market, feasibility, legal and regulatory considerations and the proposal of financial analysis to deliver the project&rsquo;s value with specific services from the human-animal interactions program.</p><p>

<p> In spite of a decrease globally, the maternal mortality rate (MMR) in Nigeria and its Jigawa State has remained persistently high. Few efforts to address the MMR in Nigeria have been undertaken. The purpose of this study was to investigate the impact of Jigawa State&rsquo;s Free Maternal and Child Health Program (JSFMCHP), education, employment, and parity of pregnant women on health care utilization (the outcome variable), as measured by antenatal care (ANC) visits. Anderson&rsquo;s behavioral model served as the study&rsquo;s theoretical framework. The sample size included 400 antenatal records of pregnant women who were randomly selected from the state&rsquo;s Health Management and Information data collected between 2011 and 2015. Chi-square tests showed a significant association between those who did not participate in the JSFMCHP, education, employment, with ANC. There was no association between parity and the number of ANC visits. The odds ratio suggested that pregnant women who did not participate in the program were 5.53 times as likely to have 4 or more visits compared to those who participated. Furthermore, the recommended number (4 or more) of ANC visits was predicted by tertiary education and employment. This study&rsquo;s findings indicate the need for a reevaluation of JSFMCHP policy, with a focus on ensuring a minimum recommended number of ANC visits for all program participants. These results can influence positive social change if used by policy makers to strengthen policies that have a beneficial impact on maternal morbidity and mortality in Jigawa State, in particular, and Nigeria, in general.</p><p>

The economic study of incentives in firms has traditionally focused on one type of incentive—pecuniary—and one causal mechanism—the direct effect of incentives on effort. This dissertation uses three randomized field experiments to explore non-traditional incentives, and non-traditional incentive effects, in the setting of health care delivery. The first experiment (jointly authored with Nava Ashraf and Oriana Bandiera) addresses an under-appreciated phenomenon: incentives affect not only the effort of agents on the job, but also the selection of agents into the job. We collaborate with the Government of Zambia to experimentally vary the salience of career incentives in a newly created health worker position when recruiting agents nationally. We find that making career incentives salient at the recruitment stage attracts health workers who are more effective at delivering health services, with administrative data showing an improvement in institutional deliveries, child health visits, and immunization rates in the treatment areas. While career incentives attract agents who differ on observables (e.g., they have higher skills and career ambitions), 91% of the performance gap is due to unobservables. The results highlight the importance of incentive design at the recruitment stage for attracting high performers who cannot be identified on observables alone. The second and third experiments examine the use of non-pecuniary incentives in health care. The second experiment (jointly authored with Nava Ashraf and Oriana Bandiera) studies non-monetary awards. Awards may affect behavior through several mechanisms: by conferring employer recognition, by enhancing social visibility, and by facilitating social comparison. In a nationwide health worker training program in Zambia, we design a field experiment to unbundle these mechanisms. We find that employer recognition and social visibility increase performance, while social comparison reduces it, especially for low-ability trainees. These effects appear when treatments are announced and persist through training. The findings are consistent with a model of optimal expectations in which low-ability individuals exert low effort in order to avoid unfavorable information about their relative ability. The results highlight the importance of anticipating the distributional consequences of incentives in settings in which the performance of each worker affects social welfare. The third experiment turns from extrinsic incentives (such as career opportunities and non-monetary awards) to "intrinsic incentives"—that is, incentives that make work more intrinsically rewarding. In the context of a rural health worker program in India, I develop and test a novel, mobile phone-based self-tracking app designed to increase agents' intrinsic returns to effort. At nine months of follow-up, the self-tracking app leads to a 27% increase in performance as measured by the main job task (home visits). Moreover, the app is most effective when it leverages pre-existing intrinsic motivation: it produces a 46% increase in performance in the top tercile of intrinsically motivated workers, but no improvement in the bottom tercile. Evidence from survey and performance data indicates that the treatment effect is mediated primarily by making effort more intrinsically rewarding, and not by other mechanisms such as providing implicit extrinsic incentives. The results suggest the potential for wider use of intrinsic incentives that may increase performance at low cost, when agents are intrinsically motivated. / Health Policy