In order to better understand variations of health behaviors between US-born and foreign-born elderly Asian Americans (65+) in the United States, the research aims to explore relationships among health outcomes, healthcare utilization, and sociodemographic characteristics. Data from the National Health Interview Survey 1998-2012 is used to construct structural equation models for the US born group and for the foreign born group. The results found that there is a reciprocal relationship between health outcomes and healthcare utilization in both groups. Use of healthcare services can positively affect health outcomes, while better health outcomes reduce the need for healthcare utilization. In addition, some sociodemographic characteristics, such as age, sex, and marital status have a direct effect on health outcomes, but some others, such as education, family size and combined family income, have an indirect effect on health outcomes via healthcare utilization. The region of residency has both direct and indirect effects on health outcomes. Regarding the effects of predictors on health outcomes, US-born elderly Asians usually receive more health advantages from using institutional health services than foreign-born elderly Asians. Practitioners, social gerontologists, and policy makers should be cautious about assuming that there is a positive impact of increased healthcare utilization on health outcomes in elderly Asian Americans.

Dans l’ensemble de la thèse, nous avons appliqué des techniques de ‘mesure des variations spatiales’ pour l'étude des variations géographiques de taux d'hospitalisation en France. La thèse est composée de 4 études :Étude 1 : « Variation géographique des recours aux procédures chirurgicales en France en 2008-2010 et comparaison avec les États-Unis et la Grande-Bretagne ».Étude 2 : « Variation géographique des admissions pour les prothèses du genou, de la hanche et la fracture de la hanche en France : existence d’une demande induite dans le secteur des hôpitaux à but lucratif et dans les hôpitaux public et privés à but non-lucratif »Étude 3 : « Caractéristiques et tendances des admissions non urgentes à but lucratif et sans but lucratif hôpitaux en France en 2009 et 2010 ». Étude 4 : « Taux d'admission pour des ’hospitalisations évitables par le système ambulatoire’ (ACSC) en France en 2009-2010 : tendances, variation géographique, coûts et comparaison internationale ». / For all of this work, we applied ‘small-area variation’ techniques to the study of geographic variations in hospitalization rates in France. We conducted four studies:Study 1: Geographic variation in rates of common surgical procedures in France in 2008-2010 and comparison to the US and BritainStudy 2: Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for profit hospitalsStudy 3: Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010Study 4: Rates of admission for ambulatory care sensitive conditions in France in 2009-2010: trends, geographic variation, costs, and an international comparison

Alzheimer's disease (AD) is associated with substantial healthcare utilization costs, resulting in a public health priority. In this study, the relationship between the demographic characteristics of age, gender, and type of health insurance; the presence of comorbidities of older Puerto Rican residents diagnosed with AD; and their healthcare utilization patterns (i.e., medical office and emergency room visits and hospital admissions) was examined using Andersen's behavioral model. Data from the 2013 Puerto Rico Health Study was used in this retrospective cohort design study. All AD cases aged -?¥ 60 years were extracted using systematic random sampling. One-way ANOVA-WELCH, Mann-Whitney U test, and negative binomial regressions determined if there was a relationship between independent and dependent variables. Results indicated a statistically significant relationship between age, gender, health insurance type, and presence of comorbidities factors and healthcare utilization patterns among older Puerto Ricans with AD. From the results, opportunities were identified for further research and changes in professional practices in order to initiate discussions and action plans to improve services coordination for older Puerto Ricans with AD. Findings might impact social change by inspiring modifications to the public health infrastructure. These modifications may lead to enhanced disease management support, promoted social justice, and increased resources to improve healthcare access and quality of care, and overall enhancement of health outcomes, for Puerto Ricans living with AD.

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Aim: To determine if a significant relationship exists between a) nurse-driven interventions to foster collaborative psychiatric and oncology care and b) higher rates of cancer treatment adherence and lower healthcare utilization rates in patients with serious mental illness (SMI) and cancer. Background: It is not uncommon for patients with SMI to suffer from treatment noncompliance and present in the acute care setting, such as the emergency department. Patients with cancer and SMI pose a unique challenge to nurses and providers due to the psychological effect of a cancer diagnosis as well as side effects experienced from psychotropic medications and oncology treatments alike. As a result, these patients are less likely to maintain cancer treatment regimens and present with advances stages of cancer in the acute care setting. Methods: An extensive electronic literature search in the CINAHL Plus and APA PsycINFO databases was completed and included the keywords: cancer, neoplasms, carcinoma, serious mental illness, chronic mental illness, mental disorders, mental disorders, chronic, psychiatric illness, psychiatric disability, cognitive behavioral therap*, intervention*, mindful*, and mental health. Inclusion criteria included: published in the years 2012-2022. The available literature was carefully examined for interventions performed with SMI and cancer for ultimate results to be finalized as a written report. Significance: The results of this research can optimize healthcare and prognosis for the population of mental health patients with cancer and also reduce costs to the healthcare system. Conclusion: The 10 studies reviewed indicated that collaborative psychiatric-oncology care with specific Registered Nurse (RN)-led interventions, such as medication management programs and behavioral counseling, was associated with increased rates of cancer treatment adherence and lower rates of healthcare utilization. Conclusions were based on data collected in cohort studies, randomized control trials, pre- and post-intervention assessments, and clinic data from quality improvement projects. More research is needed to explore the implementation of collaborative care practices.

Background: Despite implementation efforts, most anxious youth do not receive evidence-based treatment. Dissemination initiatives can increase consumer knowledge of evidence-based treatments. Opinion leaders (OLs) have been used in public health campaigns, but this strategy has not been examined for the dissemination of mental health treatments. This study uses the theory of planned behavior to test the dissemination strategies of (1) involving an OL and (2) using an educational presentation to increase caregiver demand for CBT for youth anxiety. Methods: Participants (N=262; 92% Female; 69% White, 82% non-Hispanic) were caregivers who registered for a virtual presentation on youth anxiety and how to seek treatment. Caregivers were cluster-randomized by school (N=25) to the OL condition (presented by a clinical researcher and local caregiver OL) or the researcher-only condition (presented by two clinical researchers). Presentations occurred from May 2021-May 2022. Measures were completed pre- and post-presentation, and at three-month follow-up. Results: One hundred and nine participants attended the presentations. Relative to the researcher co-presenter, participants rated the OL as significantly more relatable, familiar, similar, and understanding of their community, but significantly less credible. Across conditions, there was a significant increase in participants’ (a) knowledge of, (b) subjective norms related to, and (c) intention to seek CBT for youth anxiety, but no change in stigma or attitudes about CBT. Presentation conditions did not differ in change on these measures, or on rates of seeking youth anxiety CBT at three-month follow-up. Conclusion: Although involvement of a caregiver OL did not increase caregiver demand for EBT for youth anxiety, the overall outreach presentation was an effective dissemination strategy. Involving OLs may not be necessary for all consumer audiences, but may be beneficial for individuals with higher levels of stigma or scientific skepticism than participants in this study. / Psychology

BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.

BACKGROUND: The field of health literacy research has been focused recently on developing more accurate measurement tools and understanding the relationship between health literacy and health outcomes. Individuals with lower levels of health literacy have worse health outcomes, including hospitalization rates, compared to those with adequate health literacy. This relationship has yet to be examined in the cancer patient population, although significant relationships between health literacy and cancer knowledge, screening behavior and quality of life have been found. This study is the first to examine the relationship between health literacy and hospitalization rates in a cancer patient population, and the first to examine the relationship between health literacy and health outcomes using the recently developed Cancer Health Literacy Tests (CHLT-30, CHLT-6). METHOD: These secondary data analyses matched data collected during the larger Cancer Health Literacy Study (CHLS) to hospital data from electronic medical records. This study examined the data of 778 CHLS participants interviewed within the first five years of their cancer diagnosis. The outcomes of interest were the number of inpatient hospital admissions, the total number of days spent hospitalized, and the number of 30-day hospital readmissions. Multivariate multiple negative binomial regression modeling was done to identify predictors of the three hospitalization outcomes. RESULTS: The CHLT-30 was found to significantly predict number of inpatient admissions when controlling for confounding variables, total days hospitalized, and number of readmissions. The CHLT-6 significantly predicted total days spent hospitalized when controlling for number of inpatient admissions, number of 30-day readmissions, treatment, race, stage, number of comorbidities, dying, and education level, with those with limited health literacy spending more days in the hospital as compared to those with adequate health literacy. CONCLUSION: This study produced mixed results regarding the significance of health literacy in predicting hospitalization rates in a cancer patient population. However, this study provides evidence that health literacy may be a mediator in this relationship and further work should be done to test a full or partial mediation model.

This research examines the viability of a need-based approach that models the age-trajectories of healthcare utilization. We propose a fundamentally different way of treating age in modeling healthcare use. Rather than treating age as a need indicator, we refocus modeling efforts to predicting the age-trajectories of healthcare use. Using inpatient hospital utilization data from the Discharge Abstract Database, first, we model the age-trajectories of the rate of hospital use employing a common functional form. Second, we assess variation in these age-trajectories using growth curve modeling. Third, we explain variation in these age-trajectories using census variables. Our analysis shows that the regional variation in the age-trajectories of the rate of inpatient hospital use is sufficient to justify this method, and could be partially explained using census variables. This indicates that modeling age-trajectories of healthcare use is advantageous, and the current need-based approach may benefit from this new modeling strategy.

This research examined the health care related issues of the American seniors retiring in Mexico. Data for this study were collected through in-person questionnaire surveys and case studies. Findings of this study indicate that US seniors retiring in Mexico are predominantly non-Hispanic whites, married, and more likely to be college graduates. This study challenges the general perception that US seniors move to foreign countries is "amenity-led." The case studies clearly show that many US seniors move there because they are afraid that with reduced income and increased health care needs they would not be able to maintain the same lifestyle after retirement in the US. Climate and the slower pace of life are two other big attractions for seniors' to move to Mexico. A major finding of this study is age, gender, education, use of Medicare for medical care coverage, and chronic medical condition are significant predictors of US seniors' health behavior and health outcomes in Mexico. The policy implications of the findings have been discussed.