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1.
Global Health ; 16(1): 34, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295622

RESUMO

BACKGROUND: Leadership and management training has become increasingly important in the education of health care professionals. Previous research has shown the benefits that a network provides to its members, such as access to resources and information, but ideas for creating these networks vary. This study used social network analysis to explore the interactions among Central American Healthcare Initiative (CAHI) Fellowship alumni and learn more about information sharing, mentoring, and project development activities among alumni. The CAHI Fellowship provides leadership and management training for multidisciplinary healthcare professionals to reduce health inequities in the region. Access to a network was previously reported as one of the top benefits of the program. RESULTS: Information shared from the work of 100 CAHI fellows from six countries, especially within the same country, was analyzed. Mentoring relationships clustered around professions and project types, and networks of joint projects clustered by country. Mentorship, which CAHI management promoted, and joint project networks, in which members voluntarily engaged, had similar inclusiveness ratios. CONCLUSION: Social networks are strategic tools for health care leadership development programs to increase their impact by promoting interactions among participants. These programs can amplify intergenerational and intercountry ties by organizing events, provide opportunities for alumni to meet, assign mentors, and support collaborative action groups. Collaborative networks have great value to potentiate health professionals' leadership and management capabilities in a resource-constrained setting, such as the Global South.

2.
Popul Health Manag ; 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31808734

RESUMO

The US opioid epidemic is national in scope, but many local solutions have been shown to have efficacy. Many nonprofit hospitals have the resources and infrastructure to lead these community-based efforts, but there is evidence that some organizations are not adopting opioid services as part of their community benefit requirements to assess and address critical community health needs. This paper assesses why hospitals do not address opioid abuse after completing a community health needs assessment. For a 20% random sample of nonprofit hospitals, a unique data set was constructed of hospital efforts to address opioid abuse using the most recent publicly available community health needs assessments and implementation strategies adopted by hospitals (calendar years 2015, 2016, 2017, or 2018). Multinomial logistic regression was used to assess the relationship between 5 different reasons hospitals cited for not addressing opioid abuse and both hospital and community characteristics. Results indicate that opioid abuse was not addressed by 32% (143) of hospitals in their formal implementation strategies. State community benefit laws, county overdose level, county poverty rate, hospital region, and hospital system membership all were significantly related to the reasons hospitals cited for not addressing opioid abuse as part of their community health engagement. Hospitals in communities with significant substance abuse needs and few institutional resources may need support to address opioid misuse and adopt treatment and harm reduction initiatives. Policies that support hospital-public health partnerships may be especially important to assist hospitals to address nonmedical or behavioral health needs in their communities.

3.
Med Care Res Rev ; : 1077558719880090, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31583961

RESUMO

The U.S. epidemic of opioid abuse calls for broad collaboration between a wide range of health care institutions and the various levels of government. Through the community benefit programs they provide, nonprofit hospitals are well positioned to be key partners in local efforts. Although substance abuse appears on approximately 90% of the most recent community health needs assessments completed by hospitals, many hospitals are not addressing substance abuse in their programmatic efforts. Given wide state variation in policies to combat opioid abuse, we assess whether state leadership to address the opioid crisis influences hospital decisions to invest in substance abuse programs. Our findings suggest that several key state policies are related to hospital investments in substance abuse initiatives. To capitalize on the community benefit responsibilities of local hospitals, policies that provide specific direction for and engagement with local hospitals may increase cooperation and investments to address substance abuse.

4.
J Prim Care Community Health ; 10: 2150132719863611, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31387443

RESUMO

Objectives: To assess the strategies that nonprofit hospitals are adopting to address opioid abuse after requirements for community engagement expanded in the Affordable Care Act. Methods: We constructed a dataset of implementation activities for a 20% random sample of nonprofit hospitals in the United States. Using logistic regression, we assessed the extent to which strategies adopted are new, existing, or primarily partnerships. Using negative binomial regression, we assessed the total number of strategies adopted. We controlled for hospital and community characteristics as well as state policies related to opioid abuse. Results: Most strategies adopted by hospitals were new and clinical in nature and the most common number of strategies adopted was one. Hospitals in the Northeast were more likely to adopt a higher number of strategies and to partner with community-based organizations. Hospitals that partner with community-based organizations were more likely to adopt strategies that engage in harm reduction, targeted risk education, or focus on addressing social determinants of health. Conclusions: Community, institutional, and state policy characteristics predict hospital involvement in addressing opioid abuse. These findings underscore several opportunities to support hospital-led interventions to address opioid abuse.

6.
Health Equity ; 3(1): 280-286, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236527

RESUMO

Purpose: Hispanic women are less likely to be screened for breast cancer than non-Hispanic women, which contributes to the disproportionate prevalence of advanced-stage breast cancer in this population group. Patient navigation may be a promising approach to help women overcome the complexity of accessing multiple health care services related to breast cancer screening and treatment. The goal of this study is to assess patient perception and cost-effectiveness of a multilevel, community-based patient navigation program to improve breast cancer screening among Hispanic women in South Texas. Methods: We used mixed methods-including focus groups of program participants and a microsimulation model of breast cancer-to evaluate the effectiveness and cost-effectiveness of the program on the target population. Program data from 2013 to 2016 were collected and used to conduct the analyses. Results: Focus groups showed that the patient navigation program improved patient knowledge, attitudes, and behaviors regarding breast health and increased the mammography screening rate from 60% to 80%. Cost-effectiveness analysis showed that the program could increase life expectancy by 0.71 years and yield an incremental cost-effectiveness ratio of $3120 per quality-adjusted life year compared to no intervention. Conclusion: The 3-year multilevel, community-based patient navigation program effectively increased mammography screening uptake and adherence and improved knowledge and behaviors on breast health among program participants. Future research is needed to translate and disseminate the program to other socioeconomic and demographic groups to test its robustness and design.

7.
J Prim Care Community Health ; 10: 2150132719829311, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30767604

RESUMO

OBJECTIVE: Nearly one-third of adults in New York City (NYC) have high blood pressure and many social, economic, and behavioral factors may influence nonadherence to antihypertensive medication. The objective of this study is to identify profiles of adults who are not taking antihypertensive medications despite being advised to do so. METHODS: We used a machine learning-based population segmentation approach to identify population profiles related to nonadherence to antihypertensive medication. We used data from the 2016 NYC Community Health Survey to identify and segment adults into subgroups according to their level of nonadherence to antihypertensive medications. RESULTS: We found that more than 10% of adults in NYC were not taking antihypertensive medications despite being advised to do so by their health care providers. We identified age, neighborhood poverty, diabetes, household income, health insurance coverage, and race/ethnicity as important characteristics that can be used to predict nonadherence behaviors as well as used to segment adults with hypertension into 10 subgroups. CONCLUSIONS: Identifying segments of adults who do not adhere to hypertensive medications has practical implications as this knowledge can be used to develop targeted interventions to address this population health management challenge and reduce health disparities.

8.
Telemed J E Health ; 25(10): 952-959, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30372366

RESUMO

Background: The documented efficacy and promise of telemedicine in diabetes management does not necessarily mean that it can be easily translated into clinical practice. An important barrier concerns patient activation and engagement with telemedicine technology. Objective: To assess the importance of patient activation and engagement with remote patient monitoring technology in diabetes management among patients with type 2 diabetes. Methods: Ordinary least squares and logistic regression analyses were used to examine how patient activation and engagement with remote patient monitoring technology were related to changes in hemoglobin A1c (HbA1c) for 1,354 patients with type 2 diabetes monitored remotely for 3 months between 2015 and 2017. Results: Patients with more frequent and regular participation in remote monitoring had lower HbA1c levels at the end of the program. Compared to patients who uploaded their biometric data every 2 days or less frequently, patients who maintained an average frequency of one upload per day were less likely to have a postmonitoring HbA1c > 9% after adjusting for selected covariates on baseline demographics and health conditions. Conclusions: Higher levels of patient activation and engagement with remote patient monitoring technology were associated with better glycemic control outcomes. Developing targeted interventions for different groups of patients to promote their activation and engagement levels would be important to improve the effectiveness of remote patient monitoring in diabetes management.

9.
Prev Med ; 111: 110-114, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29525577

RESUMO

China has the largest population of adults with hypertension in the world. Recent clinical trials have shown that intensive hypertension control can help patients achieve lower blood pressure and reduce the incidence of major cardiovascular disease (CVD) events, but this level of hypertension control also incurs additional costs to patients and society and may result in a substantial increase in adverse events. The objective of this study is to assess the cost-effectiveness of intensive hypertension control to inform health policymakers and health care delivery systems in China in their decision-making regarding hypertension treatment strategies. We developed a Markov based simulation model of hypertension to assess the impact of intensive and standard hypertension control strategies for the Chinese population who are diagnosed with hypertension. Model parameters were estimated based on the best available data and the literature. We projected that intensive hypertension control would avert about 2.2 million coronary heart disease events and 4.4 million stroke events for all hypertensive patients in China in 10 years compared to standard hypertension control. The incremental cost-effectiveness ratio (ICER) for intensive hypertension control was estimated at 7876 CNY per quality-adjusted life year (QALY) compared to standard hypertension control. Intensive hypertension control would be more cost-effective than standard hypertension control in China. Our findings indicated that China should consider expanding intensive hypertension control among hypertensive patients given its great potential in preventing CVD.


Assuntos
Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Custos de Cuidados de Saúde , Hipertensão/tratamento farmacológico , Pessoal Administrativo , Adulto , Idoso , China , Humanos , Pessoa de Meia-Idade , Modelos Estatísticos , Anos de Vida Ajustados por Qualidade de Vida
10.
Am J Mens Health ; 12(4): 981-988, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29540130

RESUMO

The National Diabetes Prevention Program (NDPP) has been effectively translated to various community and clinical settings; however, regardless of setting, enrollment among men and lower-income populations is low. This study presents participant perspectives on Power Up for Health, a novel NDPP pilot adaption for men residing in low-income communities in New York City. We conducted nine interviews and one focus group with seven participants after the program ended. Interview and focus group participants had positive perceptions of the program and described the all-male aspect of the program and its reliance on male coaches as major strengths. Men felt the all-male adaptation allowed for more open, in-depth conversations on eating habits, weight loss, body image, and masculinity. Participants also reported increased knowledge and changes to their dietary and physical activity habits. Recommendations for improving the program included making the sessions more interactive by, for example, adding exercise or healthy cooking demonstrations. Overall, findings from the pilot suggest this NDPP adaptation was acceptable to men and facilitated behavior change and unique discussions that would likely not have occurred in a mixed-gender NDPP implementation.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde/organização & administração , Cooperação do Paciente/estatística & dados numéricos , Prevenção Primária/organização & administração , Adaptação Psicológica , Adulto , Atitude Frente a Saúde , Imagem Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 2/psicologia , Grupos Focais , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Projetos Piloto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
11.
Popul Health Manag ; 21(5): 387-394, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29583057

RESUMO

The objective of this study was to evaluate changes in clinical outcomes for patients with type 2 diabetes (T2D) after a 3-month remote patient monitoring (RPM) program, and examine the relationship between hemoglobin A1c (HbA1c) outcomes and participant characteristics. The study sample included 955 patients with T2D who were admitted to an urban Midwestern medical center for any reason from 2014 to 2017, and used RPM for 3 months after discharge. Clinical outcomes included HbA1c, weight, body mass index (BMI), and patient activation scores. Logistic regression was used to estimate the likelihood of having a postintervention HbA1c <9% by patient characteristics, among those who had baseline HbA1c >9%. Most patients experienced decreases in HbA1c (67%) and BMI (58%), and increases in patient activation scores (67%) (P < 0.001 in all 3 cases) at the end of RPM. Logistic regression analyses revealed that among patients who had HbA1c >9% at baseline, men (odds ratio [OR] = 3.72; 95% confidence interval [CI], 1.43-9.64), those who had increased patient activation scores after intervention (OR = 1.05; 95% CI, 1.01-1.09), those who had higher baseline patient activation scores, and those who had a greater number of biometric data uploads during the intervention (OR = 1.02; 95% CI, 1.00-1.04) were more likely to have reduced their HbA1c to <9% at the end of RPM. RPM for postdischarge patients with T2D might be a promising approach for HbA1c control with increased patient engagement. Future studies with study designs that include a control group should provide more robust evidence.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Prev Med ; 106: 73-78, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28987339

RESUMO

Most residents in New York City (NYC) do not consume sufficient fruits and vegetables every day. Difficulties with access and high prices of fruits and vegetables in some neighborhoods contribute to different consumption patterns across NYC neighborhoods. We developed an agent-based model (ABM) to predict dietary behaviors of individuals at the borough and neighborhood levels. Model parameters were estimated from the 2014 NYC Community Health Survey, United States Census data, and the literature. We simulated six hypothetical interventions designed to improve access and reduce the price of fruits and vegetables. We found that all interventions would lead to increases in fruit and vegetable consumption but the results vary substantially across boroughs and neighborhoods. For example, a 10% increase in the number of fruit/vegetable vendors combined with a 10% decrease in the prices of fruits and vegetables would lead to a median increase of 2.28% (range: 0.65%-4.92%) in the consumption of fruits and vegetables, depending on neighborhood. We also found that the impact of increasing the number of vendors on fruit/vegetable consumption is more pronounced in unhealthier local food environments while the impact of reducing prices on fruits/vegetable consumption is more pronounced in neighborhoods with low levels of education. An agent-based model of dietary behaviors that takes into account neighborhood context has the potential to inform how fruit/vegetable access and pricing strategies may specifically work in tandem to increase the consumption of fruits and vegetables at the local level.


Assuntos
Comércio/estatística & dados numéricos , Frutas , Características de Residência/estatística & dados numéricos , Análise de Sistemas , Verduras , Censos , Comportamento Alimentar , Feminino , Humanos , Masculino , Cidade de Nova Iorque , Inquéritos e Questionários
13.
Am J Prev Med ; 53(6S2): S220-S227, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29153124

RESUMO

INTRODUCTION: High sodium intake is a major risk factor for hypertension, but evidence is limited on which interventions are effective in reducing sodium consumption. This study examined the associations between frequent use of nutrition labels and daily sodium intake and the consumption of high-sodium foods in the U.S. METHODS: Using the 2007-2008 and 2009-2010 Flexible Consumer Behavior Survey, this study compared sodium intake measured from the 24-hour dietary recalls, availability of salty snacks at home, and frequencies of eating frozen meals/pizzas between frequent (i.e., always or most of the time) and infrequent nutrition label users. Also, the study examined the association between nutrition label use and sodium-related dietary behaviors across different demographic and socioeconomic groups. Data were analyzed in 2016. RESULTS: Frequent users of nutrition labels consumed 92.79 mg less sodium per day (95% CI= -160.21, -25.37), were less likely to always or most of the time have salty snacks available at home (OR=0.86, 95% CI=0.76, 0.97), but were just as likely to eat frozen meals or pizzas (incidence rate ratio=0.96, 95% CI=0.84, 1.08) compared with infrequent label users. The associations between nutrition label use and sodium intake differed considerably across age, gender, and socioeconomic groups. CONCLUSIONS: Frequent use of nutrition labels appears to be associated with lower consumption of sodium and high-sodium foods in the U.S. Given this small reduction, interventions such as enhancing nutrition label use could be less effective if implemented without other strategies.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Comportamento Alimentar , Rotulagem de Alimentos , Hipertensão/prevenção & controle , Sódio na Dieta/efeitos adversos , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Lanches , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
14.
Public Health Rep ; 132(5): 549-555, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28813636

RESUMO

OBJECTIVES: Because of state and federal health care reform, local health departments play an increasingly prominent role leading and coordinating disease prevention programs in the United States. This case study shows how a local health department working in chronic disease prevention and management can use systems science and evidence-based decision making to inform program selection, implementation, and assessment; enhance engagement with local health systems and organizations; and possibly optimize health care delivery and population health. METHODS: The authors built a systems-science agent-based simulation model of diabetes progression for the San Antonio Metropolitan Health District, a local health department, to simulate health and cost outcomes for the population of San Antonio for a 20-year period (2015-2034) using 2 scenarios: 1 in which hemoglobin A1c (HbA1c) values for a population were similar to the current distribution of values in San Antonio, and the other with a hypothetical 1-percentage-point reduction in HbA1c values. RESULTS: They projected that a 1-percentage-point reduction in HbA1c would lead to a decrease in the 20-year prevalence of end-stage renal disease from 1.7% to 0.9%, lower extremity amputation from 4.6% to 2.9%, blindness from 15.1% to 10.7%, myocardial infarction from 23.8% to 17.9%, and stroke from 9.8% to 7.2%. They estimated annual direct medical cost savings (in 2015 US dollars) from reducing HbA1c by 1 percentage point ranging from $6842 (myocardial infarction) to $39 800 (end-stage renal disease) for each averted case of diabetes complications. CONCLUSIONS: Local health departments could benefit from the use of systems science and evidence-based decision making to estimate public health program effectiveness and costs, calculate return on investment, and develop a business case for adopting programs.


Assuntos
Análise Custo-Benefício , Gerenciamento Clínico , Saúde Pública/métodos , Análise de Sistemas , Sistema de Vigilância de Fator de Risco Comportamental , Doença Crônica/economia , Complicações do Diabetes/economia , Diabetes Mellitus/economia , Humanos , Modelos Estatísticos , Estudos de Casos Organizacionais , Texas
15.
Am J Manag Care ; 23(7): 429-434, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28817782

RESUMO

OBJECTIVES: To assess the cost-effectiveness of a community-based patient navigation program to improve cervical cancer screening among Hispanic women 18 or older in San Antonio, Texas. STUDY DESIGN: We used a microsimulation model of cervical cancer to project the long-term cost-effectiveness of a community-based patient navigation program compared with current practice. METHODS: We used program data from 2012 to 2015 and published data from the existing literature as model input. Taking a societal perspective, we estimated the lifetime costs, life expectancy, and quality-adjusted life-years and conducted 2-way sensitivity analyses to account for parameter uncertainty. RESULTS: The patient navigation program resulted in a per-capita gain of 0.2 years of life expectancy. The program was highly cost-effective relative to no intervention (incremental cost-effectiveness ratio of $748). The program costs would have to increase up to 10 times from $311 for it not to be cost-effective. CONCLUSIONS: The 3-year community-based patient navigation program effectively increased cervical cancer screening uptake and adherence and improved the cost-effectiveness of the screening program for Hispanic women 18 years or older in San Antonio, Texas. Future research is needed to translate and disseminate the patient navigation program to other socioeconomic and demographic groups to test its robustness and design.


Assuntos
Detecção Precoce de Câncer/economia , Hispano-Americanos , Navegação de Pacientes/economia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Adolescente , Adulto , Serviços de Saúde Comunitária/organização & administração , Análise Custo-Benefício , Feminino , Humanos , Expectativa de Vida , Pessoa de Meia-Idade , Modelos Econométricos , Estadiamento de Neoplasias , Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/etnologia , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
16.
Health Aff (Millwood) ; 36(6): 1048-1056, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28583963

RESUMO

In the United States, steps to advance health equity often take place at the state and local levels rather than the national level. Using publicly available data sources, we developed a scorecard for all fifty states and the District of Columbia that measures indicators of the use of five evidence-based policies to address domains related to health equity. The indicators are the cigarette excise tax rate, a state's Medicaid expansion status and the size of its coverage gap, percentage of four-year olds enrolled in state-funded pre-kindergarten, minimum wage level, and the presence of state-funded housing subsidy programs and homelessness prevention and rapid rehousing programs. We found that states varied significantly in their implementation of the selected policies and concluded that a variety of approaches to encourage policy changes at the state level will be needed to create healthier and more equitable communities. We describe promising, feasible state-level approaches for states to "do something, do more, do better" when they take action on the five selected policies that can promote health equity.


Assuntos
Equidade em Saúde/tendências , Medicaid/economia , Política Pública , District of Columbia , Humanos , Renda , Impostos/estatística & dados numéricos , Estados Unidos
17.
Prev Med ; 99: 77-79, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28189807

RESUMO

Excessive sodium intake is linked to an increased risk for hypertension and cardiovascular disease. Although health care providers and other health professionals frequently provide counseling on healthful levels of sodium consumption, many people who consume sodium in excess of recommend levels still do not watch or reduce their sodium intake. In this study, we used a population segmentation approach to identify profiles of adults who are not watching or reducing their sodium intake despite been advised to do so. We analyzed sodium intake data in 125,764 respondents sampled in 15 states, the District of Columbia and Puerto Rico through the Behavioral Risk Factor Surveillance System to identify and segment adults into subgroups according to differences in sodium intake behaviors. We found that about 16% of adults did not watch or reduce their sodium intake despite been told to do so by a health professional. This proportion varied substantially across the 25 different population subgroups identified. For example, about 44% of adults 18 to 44years of age who live in West Virginia were not reducing their sodium intake whereas only about 7.2% of black adults 65years of age and older with diabetes were not reducing their sodium intake. Population segmentation identifies subpopulations most likely to benefit from targeted and intensive public health and clinical interventions. In the case of sodium consumption, population segmentation can guide public health practitioners and policymakers to design programs and interventions that change sodium intake in people who are resistant to behavior change.


Assuntos
Aconselhamento Diretivo/métodos , Comportamentos Relacionados com a Saúde , Vigilância da População/métodos , Sódio/administração & dosagem , Pessoal Administrativo , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Hipertensão/prevenção & controle , Masculino , Pessoa de Meia-Idade , Sódio/efeitos adversos
18.
Matern Child Health J ; 21(3): 432-438, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28132168

RESUMO

Purpose This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women. Description A large health care system, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for women identified as high-risk. The program includes a social work/care management component and a payment system redesign with a cost-sharing arrangement between the health system and the Medicaid managed care plan to cover the cost of staff, clinician education, performance feedback, and clinic/clinician financial incentives. The goal is to enroll 510 high-risk postpartum mothers. Assessment The primary outcome of interest is a timely postpartum visit in accordance with NCQA healthcare effectiveness data and information set guidelines. Secondary outcomes include care process measures for women with specific high-risk conditions, emergency room visits, postpartum readmissions, depression screens, and health care costs. Conclusion Our evidence-based program focuses on an important area of maternal health, targets racial/ethnic disparities in postpartum care, utilizes an innovative payment reform strategy, and brings together insurers, researchers, clinicians, and policy experts to work together to foster health and wellness for postpartum women and reduce disparities.


Assuntos
Disparidades em Assistência à Saúde/normas , Programas de Assistência Gerenciada/economia , Cuidado Pós-Natal/normas , Gravidez de Alto Risco , Sistema de Pagamento Prospectivo/tendências , Adolescente , Adulto , Feminino , Gastos em Saúde/normas , Humanos , Mortalidade Materna , Cuidado Pós-Natal/economia , Gravidez , Complicações na Gravidez/economia , Complicações na Gravidez/prevenção & controle , Estados Unidos , Populações Vulneráveis
19.
Popul Health Manag ; 20(5): 342-347, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28106511

RESUMO

Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO® (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.


Assuntos
Serviços de Saúde para Idosos/normas , Serviços de Saúde Mental/normas , Tutoria/métodos , Médicos de Atenção Primária/educação , Telecomunicações , Idoso , Idoso de 80 Anos ou mais , Educação a Distância , Humanos , New York
20.
Diabetes Res Clin Pract ; 116: 136-48, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27321329

RESUMO

AIMS: To assess the overall effect of telemedicine on diabetes management and to identify features of telemedicine interventions that are associated with better diabetes management outcomes. METHODS: Hedges's g was estimated as the summary measure of mean difference in HbA1c between patients with diabetes who went through telemedicine care and those who went through conventional, non-telemedicine care using a random-effects model. Q statistics were calculated to assess if the effect of telemedicine on diabetes management differs by types of diabetes, age groups of patients, duration of intervention, and primary telemedicine approaches used. RESULTS: The analysis included 55 randomized controlled trials with a total of 9258 patients with diabetes, out of which 4607 were randomized to telemedicine groups and 4651 to conventional, non-telemedicine care groups. The results favored telemedicine over conventional care (Hedges's g=-0.48, p<0.001) in diabetes management. The beneficial effect of telemedicine were more pronounced among patients with type 2 diabetes (Hedges's g=-0.63, p<0.001) than among those with type 1 diabetes (Hedges's g=-0.27, p=0.027) (Q=4.25, p=0.04). CONCLUSIONS: Compared to conventional care, telemedicine is more effective in improving treatment outcomes for diabetes patients, especially for those with type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Telemedicina/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
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