Management Approach for Population Health Outcomes and Economic Improvement: Appointing Health Services Early Careerists to Rural Communities for Leadership Development.

Securing health services administrators to manage health care organizations in rural areas and small town communities presents unique challenges; however, potential benefits abound for residents in terms of improving population health outcomes from a community-based approach and stimulating the local economy. The influx of community-based approaches to revitalize small towns and rural communities is evident in the literature. Small towns and rural areas lack advanced health care practices, which results in poor health outcomes; economic development as a result of a poorly prepared workforce; and community connection to the vast array of knowledge, activities, and other supports as a result of poor physical and virtual connectivity. An approach that prompts new health management graduates to practice where they have an opportunity to cultivate the residents, the community at large, and themselves is an optimal management method in improving rural areas. This framework places emphasis on students completing a health services administration curriculum training program and beginning their careers in underserved areas to positively impact rural communities by playing a role in revitalizing the local economy and improving population health.

Health services use and prescription access among uninsured patients managing chronic diseases.

Effective chronic condition management is dependent upon prescription medication access and compliance. Impacted access results in increased pain, worsening of the condition and association of additional health-related problems. Prescription medication costs constitute a significant burden for patients who are uninsured and managing chronic conditions. This burden links to the likelihood of medication non-compliance. The purpose of this research was to test the ability of the Andersen Behavioral Model of Health Services Use to examine health behaviors among adult uninsured patients managing physician-diagnosed chronic conditions. To enhance its chronic disease management model for uninsured patients diagnosed with chronic conditions requiring prescription regimens, a local community health center added a pharmaceutical access component to its health care delivery model. The Andersen Behavioral Model of Health Services Use was employed to gain insight on how the predictors of predisposing, enabling and need factors impact the change in clinical outcomes and the number of non-urgent triage telephone encounters, physician visits, and emergency department visits of each uninsured patient diagnosed with a chronic condition requiring prescription medication treatment and receiving care at this facility. Individual health behavior patterns are based on predisposition to care, factors that impede or enable the use of care and overall need for care. In this study, there was a statistically significant relationship between population characteristics and health behavior; between health behavior and outcomes; and between population characteristics and outcomes.

Analysis of Opioid Poisoning in Medically Underserved Rural Areas: An Evaluation of International Statistical Classification of Diseases Codes from the State of South Dakota.

Background: Rural hospitals and patient population tend to be medically underserved. The states with more rural population dispensed the most opioids per person in the last 10 years. We aimed to explore if rurality contributed to the likelihood of higher opioid adversity and how it affected substance-use rehabilitation in federally designated Medically Underserved Areas (MUAs). Methods: We analyzed data dispensed by the South Dakota Department of Health (DOH) on opioid-led poisoning International Classification of Disease (ICD) codes that were active within the state in the last decade. After locating MUA rural and partially rural counties, we cross profiled the counties to the state datasets. Assessments were conducted using the PROC SURVEY methods in SAS version 9.3 (SAS Institute) and checked for multicollinearity with the Belsley-Kuh-Welsch technique. Finally, we used the American Hospital Association (AHA) database for analyzing substance use rehabilitation availability on per hospital basis. Results: The chi-square statistic for comparing opioid codes against non-opioid codes distributed among three categories, rural, non-rural, and partially rural was significant at the limit of p <0.05. 81.134% of opioid-led poisoning codes were activated in a rural county. Only four hospitals had substance-use rehabilitation, three of which were in a non-rural area. More people from the teenage and early-adulthood years (10-19) were prone to opioid usage. Conclusions: Rural counties in South Dakota were more likely to dispense opioid care and not have access to rehabilitation. We also found that as the opioid dispensing rate at hospitals within a state decreased as the state had less rural counties. Introducing public programs to train more physicians and cutting down cost of non-opioid based care may lower opioid distribution and increase rehabilitation options in rural hospitals.

Emergency department use for nontraumatic dental conditions among children and adolescents: NEDS 2014-2015.

OBJECTIVES: Despite great efforts to improve paediatric dental care access in the last two decades, the use of emergency departments (ED) for dental conditions among children that are more appropriately addressed in dental offices remains a public health concern in the United States. We examined factors associated with ED visits for nontraumatic dental conditions or NTDCs and ED visits for any other reason among children and adolescents. METHODS: A retrospective secondary data analysis of ED visits was conducted using the 2014-2015 Nationwide Emergency Department Sample (NEDS) data. NTDCs were further categorized as diseases of hard tissue (eg dental caries), pulp/periapical (eg root canal infections), gingival/periodontal (eg conditions that affect the supporting tissues) and other. We included patient/socioeconomic characteristics, disposition, time of visit, and the Grouped Charlson Comorbidity Index (GRPCI) in our analysis. Bivariate associations were tested using chi-squared test (α = 0.05). RESULTS: There were 70 616 194 ED visits in 2014-15, with 465 353 (0.7%) visits for NTDCs. Statistically significant differences were observed for all patient characteristics tested, except for gender when comparing children visiting the ED for NTDCs and children visiting for any other reason. Medicaid was the expected payer for nearly 60% of all ED visits, and the uninsured shared a larger proportion of NTDC visits (19.4%) than other visits (8.8%). Late adolescents (aged 18-21) accounted for over 50% of NTDC visits but only one-fifth of all other types of ED visits. Late adolescents (18-21 years old) who were uninsured had a significantly higher proportion of NTDC visits. Of all NTDC visits, 19.1% were related to hard tissue disease, 25.3% pulp/periapical, 7.9% periodontal disease, and the remaining were grouped as other dental diseases. CONCLUSIONS: The ED use for NTDCs is more common among late adolescents, Medicaid and uninsured groups. Examining and implementing new approaches that improve access to routine dental care for these groups may help in reducing inefficient ED use related to NTDCs.

Risk Factors of Fall-Related Emergency Department Visits by Fall Location of Older Adults in the US.

INTRODUCTION: Prior evidence indicates that predictors of older adult falls vary by indoor-outdoor location of the falls. While a subset of United States' studies reports this finding using primary data from a single geographic area, other secondary analyses of falls across the country do not distinguish between the two fall locations. Consequently, evidence at the national level on risk factors specific to indoor vs outdoor falls is lacking. METHODS: Using the 2017 Nationwide Emergency Department Sample (NEDS) data, we conducted a multivariable analysis of fall-related emergency department (ED) visits disaggregated by indoor vs outdoor fall locations of adults 65 years and older (N = 6,720,937) in the US. RESULTS: Results are compatible with findings from previous primary studies. While women (relative risk [RR] = 1.43, 95% confidence interval [CI], 1.42-1.44) were more likely to report indoor falls, men were more likely to present with an outdoor fall. Visits for indoor falls were highest among those 85 years and older (RR = 2.35, 95% CI, 2.33-2.37) with outdoor fall visits highest among those 84 years and younger. Additionally, the probabilities associated with an indoor fall in the presence of chronic conditions were consistently much higher when compared to an outdoor fall. We also found that residence in metropolitan areas increased the likelihood of an indoor elderly fall compared to higher outdoor fall visits from seniors in non-core rural areas, but both indoor and outdoor fall visits were higher among older adults in higher income ZIP codes. CONCLUSION: Our findings highlight the contrasting risk profile for elderly ED patients who report indoor vs outdoor falls when compared to the elderly reporting no falls. In conjunction, we highlight implications from three perspectives: a population health standpoint for EDs working with their primary care and community care colleagues; an ED administrative vantage point; and from an individual emergency clinician's point of view.

Novel interventions for HIV self-management in African American women: a systematic review of mHealth interventions.

The purpose of this systematic review was to assess the quality of interventions using mobile health (mHealth) technology being developed for and trialed with HIV-infected African American (AA) women. We aimed to assess rigor and to ascertain if these interventions have been expanded to include the broad domain of self-management. After an extensive search using the PRISMA approach and reviewing 450 records (411 published studies and 39 ongoing trials at clinicaltrials.gov), we found little completed research that tested mHealth HIV self-management interventions for AA women. At clinicaltrials.gov, we found several mHealth HIV intervention studies designed for women in general, forecasting a promising future. However, most studies were exploratory in nature and focused on a single narrow outcome, such as medication adherence. Given that cultural adaptation is the key to successfully implementing any effective self-management intervention, culturally relevant, gender-specific mHealth interventions focusing on HIV-infected AA women are warranted for the future.