No description available.

No description available.

The U.S. Department of Health and Human Services has declared the misuse of opioid prescription drugs as a public health emergency. The Affordable Care Act’s Medicaid expansion expanded the number of people with insurance and increased the demand for services related to substance abuse treatment. In the first part of this study, the researcher examines whether the Medicaid expansion reduced the likelihood of treatment delay. The second part of this study explores whether the length of stay for opioid use disorder treatment is significantly different in states that adopted Medicaid expansion versus states that did not. In both studies, the researcher analyzes administrative data from the Substance Abuse and Mental Health Services Administration to discover any treatment delays associated with the opioid treatments for the states that adopted the expansion versus the states that did not, and to determine whether there was a difference in the length of stay in the states that adopted the Medicaid versus the states that did not. A difference-in-difference approach is used in both studies to compare the states which adopted an optional Medicaid expansion to those non-adoption states. The evidence suggests that demand for opioid treatment services increased in expansion states as there is a decreased probability of obtaining treatment on the first day for initial requests for outpatient treatment. In addition, evidence suggests that Medicaid expansion increased the likelihood of staying longer in outpatient facilities, but not inpatient facilities. / Business Administration/Risk Management and Insurance

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23755号 / 医博第4801号 / 新制||医||1056(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 小濱 和貴, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

På Sveriges akutmottagningar ses att vistelsetiden ökar och att äldre över 65 år är de som står för nära hälften av alla akutbesök och mer än hälften av all sammanlagd vårdtid. Vistelsetiden inom sjukvården beskrivs med två begrepp, LOS som står för den totala vistelsetiden inom sjukhuset och ED LOS som beskriver vistelsetiden på akutmottagningen. Förlängd ED LOS och LOS drabbar äldre genom ökad förekomst av vårdskador och dödlighet. Skörhet är ett begrepp som används för att beskriva äldre som bedöms ha ökad risk att drabbas av sådana negativa konsekvenser. Sjuksköterskan på akutmottagningen har en nyckelfunktion inom patientsäkerhetsarbete och en viktig roll i att effektivisera patientflödet.  Syftet var att beskriva sjuksköterskeinitierade interventioner för sköra äldre på akutmottagning genom att undersöka vad som var gemensamt i interventionerna samt deras effekt på ED LOS och LOS.  En litteraturöversikt användes som metod. Datainsamlingen genomfördes via databassökningarna i PubMed och CINAHL. Femton vetenskapliga artiklar som beskrev sjuksköterskeinitierade interventioner som utfördes på akutmottagningar och som mätte ED LOS och LOS inkluderades i resultatet. Artiklarna kvalitetsgranskades och analyserades genom en integrerad analys.  I resultatet framkom tre huvudkategorier med sju tillhörande underkategorier som beskrev gemensamma fynd i interventionerna. Huvudkategorierna var kunskapens betydelse för interventionen, samverkan för den sköra äldre och identifiering, bedömning och behandling av sköra äldre. ED LOS och LOS presenterades i relation till huvudkategorier och underkategorier. ED LOS minskade i nio interventioner, ökade i två och hade ingen signifikant skillnad i två. LOS hade ingen signifikant skillnad i fem interventioner och minskade i tre.  Slutsatsen var att specialistsjuksköterskor har en viktig roll i att utveckla, implementera och leda interventioner för sköra äldre samt att samarbete mellan professioner och över organisationsgränser och införande av snabbspår var viktiga gemensamma faktorer i interventioner som minskade ED LOS och i viss mån LOS.

No description available.

No description available.

The cost and duration of cardiovascular care was studied for 4,804 episodes of hospitalization in patients between 45 and 64 years of age. Men were more likely than women to be treated in urban medical centers for shorter, more expensive hospital care; women were more likely to be treated in rural hospitals for longer, less expensive care. Cost of treatment per day was not dependent on the type of insurance, but Medicaid claims (which represent low income patients) were associated with greater lengths of stay.

Bridge engineers and managers in coastal areas and cold regions frequently specify the application of surface treatments on concrete bridge decks as barriers against chloride ingress. In consideration of concrete cover thickness and the presence of stay-in-place metal forms (SIPMFs), the objective of this research was to determine the latest timing of initial surface treatment applications on concrete bridge decks subjected to external chloride loading before chlorides accumulate in sufficient quantities to initiate corrosion during the service life of the deck. Chloride concentration data for this research were collected from 12 concrete bridge decks located within the I-215 corridor in Salt Lake City, Utah. Numerical modeling was utilized to generate a chloride loading function and to determine the diffusion coefficient of each deck. Based on average diffusion coefficients for decks with and without SIPMFs, chloride concentration profiles were computed through time for cover thicknesses of 2.0 in., 2.5 in., and 3.0 in. The results of the work show that the average diffusion coefficient for bridge decks with SIPMFs is approximately twice that of decks without SIPMFs and that, on average, each additional 0.5 in. of cover beyond 2.0 in. allows an extra 2 years for decks with SIPMFs and 5 years for decks without SIPMFs before a surface treatment must be placed to prevent excessive accumulation of chlorides. Although the data generated in this research are based on conditions typical of bridge decks in Utah, they clearly illustrate the effect of cover depth and the presence of SIPMFs. Given these research findings, engineers should carefully determine the appropriate timing for initial applications of surface treatments to concrete bridge decks in consideration of cover depth and the presence of SIPMFs. For maintenance of concrete bridge decks with properties similar to those tested in this study, engineers should follow the guidelines developed in this research to minimize the ingress of chlorides into the decks over time and therefore retard the onset of reinforcement corrosion; altogether separate guidelines may be needed for decks having substantially different properties. Surface treatments should be replaced as needed to ensure continuing protection of the concrete bridge deck against chloride ingress.

Motel life has existed in the United States for over 100 years. However, it was not until the HEARTH Act in 2009 changed the federal definition of homelessness that those who live in motels more or less permanently were considered homeless persons. This project utilizes qualitative, semi-structured interviews with 18 families with children who are living in motels to explore their experiences with motel life and social service providers, their housing identity, and identity management strategies. Findings show that most of the motel residents did not identify with the conventional definition or image of homelessness and instead negotiated the term to fit their situation. Although they did not initially self-identify as homeless, when discussing policy recommendations all participants adopted a homeless social-identity (i.e., they identified as members of the homeless social category). As members of the homeless community, the participants agreed that homeless families in the area needed more attention and assistance. Participants were aware that outsiders would view them as homeless and during their interviews several identity management strategies were used. Motel residents described a hierarchy of homelessness and placed themselves at the top of it, perceiving themselves to be better people than even other motel residents. The identity management strategies employed by the participants were meant to show how they were good people who were just stuck in a motel because of circumstances outside of their control and how they were deserving of assistance to help their families move out of the motel and obtain adequate, permanent housing.