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Group 8 - Public Health Posters, 39-45 - Biomedical Posters, 15 & 76 - Anatomy Poster, 74
No full textThe eighth group of the presentation breakout consists of Public Health Posters 39-45, Biomedical Posters 15 & 76, and Anatomy Poster 74
Oral cancer screening prevalence in low-income adults before and after the ACA
No full textBackground: Detecting oral cancer early is associated with higher probability of survival, reduced treatment costs, and improved quality of life. Unfortunately, \u3c30% of oral cancers are detected early. Recent health insurance expansions from the Affordable Care Act (ACA) could improve outcomes by increasing access to screening. However, due to the differences in screening practices by physicians and dentists, the impact of expanded access to insurance on oral cancer screenings remains unknown. Methods: Self-reported oral cancer screening data were obtained from The National Health and Nutrition Examination Survey (NHANES) for years 2011–2017. NHANES questionnaires ask respondents if they have received an oral cancer screen from a physician or dentist in the past year. Along with adjusting for demographic characteristics, this study accounts for unobserved heterogeneity by comparing “Differences-in-Differences” estimates of low-income adults (\u3c200 % FPL) with high-income adults, before and after the ACA (2014), for adults most exposed
Primitive reflex retention and attention among preschool children
No full textPrimitive reflexes are a critical part of early development but eventually integrate to give rise to volitional and cortically directed movements and higher-level cognitive skills. Failure to integrate these reflexes in a developmentally appropriate stage has shown correlation with developmental delays which affect occupational participation. Retention of reflexes may be linked to academic difficulties, including attention deficits in the classroom. The purpose of this study was to explore prevalence of primitive reflex activity among 4- to 6-year-old children and to understand the relationship between primitive reflex activity and attention. A total of 27 preschool students were screened for 7 primitive reflexes as well as attention utilizing the SNAP-IV. Overall, 100% of the students had at least 1 retained reflex, with STNR being the most common (81.4%). Males demonstrated more reflex activity than females for 6 of the 7 tested reflexes. A significant difference was found between males and females for scores within the inattention subtest of the SNAP-IV, with males scoring higher for inattention. Correlational analyses indicated a statistically significant relationship among males between ATNR activity and opposition/defiance as well as retention of Moro and inattention. Though ongoing research is indicated, the findings of this study support prior research which indicates a need for early screening of primitive reflexes as client factors which could impact occupational performance
Occupational Therapy and the IMPACT Act: Part 2. A Systematic Review of Evidence for Functional Status, Medication Reconciliation, and Skin Integrity Interventions
No full textImportance: Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs. Objective: In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity. Data Sources: We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings: We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers
How did the COVID-19 Pandemic impact self-reported cancer screening rates in 12 Midwestern states?
No full textObjective: In the early months of the COVID-19 pandemic, the U.S. healthcare system reallocated resources to emergency response and mitigation. This reallocation impacted essential healthcare services, including cancer screenings.
Methods: To examine how the pandemic impacted cancer screenings at the population-level, this study analyzes 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the change in the proportion of eligible adults reporting a recent cancer screen (mammogram, pap smear, colon/sigmoidoscopy, blood stool test). All analyses accounted for response rates and sampling weights, then explored differences by gender and rurality across 12 Midwestern states.
Results: We found that the proportion of adult women completing a mammogram declined across all states (-0.9% to -18.1%). The change in colon/sigmoidoscopies, pap smears, and blood stool tests were mixed, ranging from a 9.7% decline in pap smears to a 7.1% increase in blood stool tests. Declines varied considerably between states and within states by gender or metro/urban/rural status.
Conclusions: The COVID-19 pandemic led to delayed breast, cervical, and colorectal cancer detection services. Policymakers should aim to advance cancer control efforts by implementing targeted screening initiatives
Impact of Medicaid dental coverage expansion on self-reported tooth loss in low-income adults
No full textBackground: Low-income adults delay oral health care due to cost more than any other health care service. These delays lead to caries, periodontal disease, and tooth loss. Expanding Medicaid dental coverage has increased dental visits, but the potential impact on previously unmet oral health needs is not well understood. Methods: In this analysis, the authors estimated the association between Medicaid dental expansion and tooth loss. Data on self-reported tooth loss among adults below 138% federal poverty guideline were obtained from the Behavioral Risk Factor Surveillance System. A difference-in-differences regression was estimated. Additional analyses stratified according to age and separated extensive and limited dental benefits. Results: Expanding Medicaid dental coverage is associated with increased probability of total tooth loss of 1 percentage point in the total sample, representing a 20% relative increase from the pre-expansion rate. This increase was concentrated in states offering extensive dental benefits and was largest (2.5-percentage-point greater likelihood) among adults aged 55 through 64 years for whom both extensive and limited dental benefits were associated with total tooth loss. Conclusions: Medicaid expansion with extensive dental benefits was associated with increased total tooth loss among low-income adults. This finding suggests that greater access to oral health care addressed previously unmet oral health needs for this population. Practical Implications: As public dental coverage continues to expand, dental care professionals may find themselves treating a greater number of patients with substantial, previously unmet, oral health needs. Additional research to understand the long-term effects of Medicaid dental insurance for adults on their oral health is needed
Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions
No full textIMPORTANCE: Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. OBJECTIVE: In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. DATA SOURCES: We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS: We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act
Federalism and the Value of Institutional Experience During a National Disaster: Identifying Determinants of Rapid Emergency Medicaid Waiver Adoption During the Covid-19 Pandemic
No full textSection 1135 emergency waivers were designed as tools for policy-makers to rapidly increase health system capacity during a disaster. Granting regulatory, administrative, or payment-model flexibilities during the covid-19 pandemic, states may be better equipped for an influx of hospitalizations. One month passed before every state adopted a covid-19 waiver and no research investigated why states adopted waivers sooner than others. This study utilizes a Parametric (Gamma) Time-to-Event design to construct a Contextual, Institutional, Political, External, and a combined Integrated model to identify determinants of speedy waiver request. States with Section 1135 precedent in previous disasters submitted requests to CMS more quickly than states without prior experience. In the Integrated Model, four indicators were significantly associated with a shorter time to request: history of a previous waiver (0.7248, p \u3c0.01), state health expenditures (0.9994, p \u3c0.001), a democratic governor (0.6794, p \u3c0.05), and a new 1135 Waiver request in the region (0.8424, p \u3c0.001). Within the U.S. federalist system, states with greater institutional experience and fiscal capacity appeared to act most quickly to expand health system flexibility during the peak of the pandemic’s uncertainty. Such state variation in ability to respond rapidly to an emergency may confound attempts for equity in this pandemic and beyond
Waiving Medicaid Regulations During a Public Health Crisis: Identifying Heterogeneous Effects of Suspending Pre-Admission Screening Requirements on COVID-19 Deaths
No full textBackground: During the COVID-19 Public Health Emergency, states were authorized to waive Pre-Admission Screening Resident Review (PASRR), a federal regulation requiring all individuals be evaluated before admission into a federally qualified nursing facility. We suspect states waived PASRR to reallocate resources from admission towards infection control and outbreak mitigation. However, by waiving PASRR and fast-tracking admissions, vulnerable elders may have been exposed to COVID-19 and unexpectedly placed at substantial risk for increased morbidity. Methodology: We reviewed all COVID-19 Medicaid emergency waiver requests to identify states waiving PASRR. We then analyzed daily, state-level COVID-19 deaths with a panel regression model, controlling for state and time fixed effects, and daily case rates. Finally, we expanded the model to identify heterogeneous effects shaped by market and administrative oversight factors. Results: Suspending PASRR led to significant declines in state COVID-19 deaths (–2.3 deaths per 100,000 population, p \u3c 0.001). However, the effect waiving PASRR varied by excess nursing bed capacity (7.3 deaths per 100,000 population, p = 0.024) and historical PASRR deficiencies (0.9 deaths per 100,000, p = 0.009). Implications: Within the first month of the COVID-19 emergency invocation, nearly all states suspended PASRR, which our estimates suggest averted 7,600 deaths nationwide. However, we found that greater pre-emergency bed availability and less administrative oversight may have reduced the effectiveness of a PASRR waiver. While future research should aim to understand the mechanisms for such heterogeneity, immediate concerns relate to the variation, both between and within states, for adhering to a critical regulation protecting older adults
Telehealth Interventions within the Scope of Occupational Therapy Practice: A Systematic Review
No full textImportance: With the increasing use of telehealth, it is imperative to synthesize the existing evidence to examine the effectiveness of telehealth interventions and inform practitioners and reimbursement entities. Objective: To examine the effectiveness of telehealth occupational therapy interventions across the lifespan, delivered either independently or as part of an interdisciplinary team. Data Sources: MEDLINE, CINAHL, SAGE, PsycInfo, Cochrane Database of Systematic Reviews, OTseeker, and OT Search and hand searches of systematic reviews, relevant journals, and known occupational therapy telehealth research. Study Selection and Data Collection: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we screened and appraised articles that included an occupational therapy intervention delivered via telehealth and that were peer reviewed, written in English, published between 2009 and 2019, and Levels 1b to 3b evidence. Findings: Twenty full-text articles (8 Level 1b, 9 Level 2b, and 3 Level 3b) met the inclusion criteria. Strong strength of evidence supports the use of telehealth approaches for occupational therapy interventions for people with neurological and pain conditions. Moderate strength of evidence supports the use of telehealth interventions to support education outcomes. Low strength of evidence was found for other outcomes for children with developmental disorders and additional conditions. Conclusions and Relevance: There is evidence to support that occupational therapy interventions delivered via telehealth are similarly effective as those delivered face-to-face, especially for neurological and pain conditions. What This Article Adds: The findings include an updated synthesis of telehealth occupational therapy interventions provided separately and with interdisciplinary health care teams. They expand occupational therapy’s scope of practice to include interventions provided across the lifespan for rehabilitation and habilitation needs and include effectiveness by conditions