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Enhancing professional identity in a multidisciplinary Healthcare Systems and Policy course
No full textDrawing upon theory and prior research this article describes a comprehensive framework to enhance professional identity formation through the development of a health professions course involving multiple disciplines
2020 Research Symposium Program
No full textThe program for the 2020 annual Research Symposium which took place on December 3, 2020
Expanding the Capacity of Rural Cancer Care With Teleoncology
No full textBackground: In the United States, 6 of the 25 leading causes of death stem from site-specific cancers, resulting in over 1.7 million deaths annually. Yet, this burden is not evenly distributed. While the incidence of cancer is significantly higher in urban areas, rural regions face higher rates of cancer mortality. Identifying the factors contributing rural cancer disparities can facilitate more effective and feasible policy solutions.’
Problem Definition: Rural Americans are geographically isolated from high-quality cancer services and face systemic barriers to NCI designated comprehensive cancer centers. Given this disparity, rural Americans have failed to fully realize the benefits of expanded federal investment in improved cancer care. Efforts to increase the supply of rural oncologists have yielded mixed results. Rather, this policy review identifies an opportunity to expand the capacity of America’s oncologists through provider-to-provider telehealth models.
Methods: Federal and state statutes were scanned for telehealth legislation. CMS guidance relating to telehealth capacity building were also reviewed. The tabulated political venues and policy activity were reported by branch and level of government. Policy recommendations were then made by the focusing on states implementing provider-to-provider teleoncology models in rural regions.
Policy Report: In 2016, Congress passed the Project ECHO Act which aimed to evaluate all provider-to-provider telehealth capacity building models. However, the 2019 Project ECHO Act, which aimed to build upon the initial pilot, failed to progress through the Senate. Most provider-to-provider teleoncology activity occurred at the state-level through Medicaid Waivers.
Conclusion: Neighboring states can build upon the success of these innovative healthcare delivery models by expanding the diffusion of Medicaid waiver demonstrations which authorize reimbursement for provider-to-provider teleoncology in rural areas
A systematic review on the health of African immigrants in the United States: synthesizing recommendations for future research
No full textPurpose
The purpose of this paper is to conduct a systematic review of published literature studying the health of African immigrants in the USA and to develop a formal set of recommendations for future researchers aiming to improve the health outcomes in this population. Design/methodology/approach
A comprehensive search was initiated on PubMed, Cochrane, ERIC, DOAJ, Prospero and Scopus databases. Final inclusion criteria were: systematic reviews, studying African Immigrants in the USA, measuring a clinical health outcome, since 1999. Articles were screened in four stages by title, abstract, full-text of the review and full-text of the primary studies within each review. Data was abstracted by identifying general information, study population, outcome measurements, conclusions and recommendations of each review. Findings
In the initial search, 519 potential reviews were identified. After removing duplicates, 473 articles were excluded by screening the title or abstract. After a full-text review of each article and primary study within each article, nine reviews were included in the final synthesis. Reviews covered Female Genital Cutting and Pregnancy Outcomes, Caesarean Births, Gestational Diabetes, Cancer, HIV/AIDS, Body-weight and Acculturation. Among the primary reports included in the final synthesis, less than 50 per cent studied African immigrants in the USA. African Americans living in the USA made up only 11 per cent of the pooled study sample. Research limitations/implications
Immigrants from Africa are one of the fastest-growing populations in the USA. This group has been underrepresented in health research, leading to a poor understanding of the group’s health outcomes. Health researchers must adopt recommendations and prioritize studies that meet the health needs of Africans during this time of demographic transition. Originality/value
Systematic reviews represent a bedrock of medical evidence and signify a solid understanding of accepted knowledge in the field. Systematic reviews, however, do not necessarily constitute the end of discovery. Researchers can use existing systematic reviews to critique previous studies or initiate future research. There remain significant research gaps analyzing the health outcomes, behaviors and treatment of subgroups of African immigrants living in the USA. Future research should shift toward the growing needs of the population, leveraging the strengths and diversity of African immigrants now living in the USA
Teaching Quality of Life and Well-Being in Public Health
No full textIn this chapter, authors explore interrelated and multidimensional factors that influence health, well-being, and quality of life. Teaching well-being in public health requires thoughtful planning and pedagogy that moves beyond traditional didactic instruction. Using the social ecological model of health as an organizing framework, authors describe an innovative and integrated approach to teaching that aims to create quality learning experiences. Through applying Fink’s taxonomy of significant learning to public health education across health science disciplines, instructors can guide the process of active learning through incorporating each phase of the taxonomy: learning how to learn, foundational knowledge, application, integration, caring, and human dimension constructs. Creating significant learning experiences involves engaging students in multiple ways and incorporating strategies and activities that encourage lasting change in the life of the learner. In this chapter authors discuss active learning, technology utilization, reflective dialogue, and rich discussion as methods of teaching health, quality of life, and well-being within each level of the social ecological model of health: intrapersonal, interpersonal, institutional, community, and public policy. Learners explore factors related to quality of life and well-being as authors describe how influences of context, social determinants of health, contextual factors, culture, and engagement in meaningful activities relate to health. Assignment descriptions and case examples are timely and serve to equip students to meet the demands placed upon health professionals in our modern, globally connected society. Sustainable improvements in health often include a series of complementary interventions that target multiple levels of the social ecological model. The chapter culminates with examples of direct and indirect learning experiences, in which course objectives align with Fink’s taxonomy of significant learning and related activities target each level of the social ecological model. These examples illustrate the importance of engaging health science students in innovative and interprofessional learning experiences as a way to promote and sustain health, quality of life, and well-being
Telepharmacy Rules and Statutes: A 3-Year Update for all 50 States
No full textMotivated by the persistent decline of independently owned retail pharmacies in rural communities, this policy brief updates previous research surveying the legislative and administrative activity authorizing community-based telepharmacy. After investigating all administrative rules and legislative statutes governing each state\u27s pharmacy practice, states were comparatively analyzed for the following telepharmacy regulatory features: geographic restrictions, permitted providers, staffing requirements, and inter-state accessibility. Compared to the growth between 2010 and 2016, recent telepharmacy diffusion has been modest. As of January 31, 2020, telepharmacy was authorized in 21 states. Ten states regulate telepharmacy through legislation, while 11 state Board of Pharmacists regulate telepharmacy by administrative code. While the growth in states authorizing telepharmacy has slowed, regulatory activity within states permitting telepharmacy has increased. Among states authorizing telepharmacy, 15 states impose a geographic restriction on licensed telepharmacies, 20 states place restrictions on permitted providers, and 16 states regulate inter-state accessibility of telepharmacy practice. As more states implement and adapt telepharmacy programs, identifying the telepharmacy regulatory variation will assist policymakers developing a portfolio of solutions in states confronting continued rural pharmacy closures
Breast density notification with adjunctive digital breast tomosynthesis (DBT): A cost-effectiveness analysis.
No full textBackground: Dense breasts increase a woman\u27s risk of developing cancer while also raising the likelihood of a missed diagnosis from traditional mammography screening. Digital Breast Tomosynthesis (DBT) has been shown to identify positive breast cancer more accurately in women with dense breasts, but no study has estimated the cost-effectiveness of this screening mode under a notification requirement.
Methods: Taking the perspective of a healthcare system, we estimated the incremental cost-effectiveness ratio (ICER) of providing DBT as an alternative to mammography for 40-year old women. Model parameters reflecting risk of breast cancer, detection rates, and costs were estimated from recent meta analyses, Tufts’ CEA registry, and Medicare Fee Schedules. We used probabilistic Markov Models to estimate the ICER under uncertainty, and a time-variant model in which breast density and cancer risk change over time. Additionally, a heterogeneity analysis included all women between the ages of 40-65, while also using 1st and 2nd degree family history to calculate cancer risk.
Results: In the probabilistic model, adjunctive DBT has a cost differential of 319,491/QALY) compared to mammography. This result was most sensitive to the probability of a missed diagnosis for women with dense breasts. At a willing-ness to pay of 174,218, but adjunctive DBT became even more cost-effective after expanding the population and including family history of cancer (ICER_All Ages = 153,388).
Conclusions: Breast density notification laws which provide additional screening via DBT are not cost-effective at a willingness to pay of $50,000. Policymakers, however, should note that many modern cancer therapeutics also exceed this threshold. As an adjunctive screening technique, DBT would result in fewer deaths and increase quality of life, but the effect is minimal and carries a high cost. Including breast density within greater risk stratification protocols, however, may prove highly cost-effective, especially for older women with a family history of cancer
Evaluating the Effect of Medicaid Expansion on Black/White Breast Cancer Mortality Disparities: A Difference-in-Difference Analysis
No full textPurpose Medicaid expansion was designed to increase access to health care. Evidence is mixed, but theory and empirical data suggest that lower cost of care through greater access to insurance increases health care utilization and possibly improves the health of poor and sick populations. However, this major health policy has yet to be thoroughly investigated for its effect on health disparities. The current study is motivated by one of today’s most stark inequalities: the disparity in breast cancer mortality rates between Black and White women. Methods This analysis used a difference-in-difference fixed effects regression model to evaluate the impact of Medicaid expansion on the disparity between Black and White breast cancer mortality rates. State-level breast cancer mortality data were obtained from the Centers for Disease Control and Prevention. Each state’s Medicaid expansion status was provided by a Kaiser Family Foundation white paper. Two tests were conducted, one compared all expanding states with all nonexpanding states, and the second compared all expanding states with nonexpanding states that voted to expand—but did not by 2014. The difference-in-difference regression models considered the year 2014 a washout period and compared 2012 and 2013 (pretreatment) with 2015 and 2016 (posttreatment). Results Medicaid expansion did not lower the disparity in breast cancer mortality. In contrast to expectations, the Black/White mortality ratio increased in states expanding Medicaid for all Medicaid-eligible age groups, with significant effects in younger age groups (P = .01 to .15). Conclusion These results suggest that states cannot solely rely on access to insurance to alleviate disparities in cancer or other chronic conditions. More exploration of the impacts of low-quality health systems is warranted
Can health system engagement facilitate greater utilization of genetic tests to predict cancer risk? A health disparities exploration of national survey data
No full textFunding: Susan G. Komen ® GTDR16376189
Objective: To estimate the effect health system engagement on a woman’s awareness of and decision to complete a genetic test to predict cancer risk.
Background: Young African American women face a higher risk of breast cancer mortality than white women. To mitigate this disparity, clinicians have developed predictive risk assessment and stratified screening protocols based on genetic tests. However, African American women have historically been under represented in genetic test utilization. If the trend of low genetic test participation continues, potential health gains from precision medicine will be limited or unrealized, further expanding the Black/White breast cancer mortality disparity.
Significance: While previous investigators have made numerous attempts to better understand the Black/White disparity in genetic testing, this study directly analyzes racial disparities in genetic test exposure and utilization through health system engagement using the latest population-level survey dataset.
Methods: Data was obtained from the nationally representative, cross-sectional National Health Interview Surveys for years 2000, 2005, 2010, and 2015.
Outcomes included: 1) awareness of a genetic test; 2) genetic test utilization, conditional on awareness; 3) discussing a genetic test with a medical provider; and 4) unconditional genetic test utilization. Weighted odds ratios were calculated by a series of multivariate logistic regression models. Independent variables included various socioeconomic and demographic indicators, as well as health system factors.
Results: White women with a usual place of medical care held significantly higher odds of genetic test awareness and of discussing a genetic test with a medical provider (OR = 2.16, p \u3c .001; OR = 5.34, p \u3c .05). Conversely, a usual place of medical care was not found to heighten awareness or facilitate greater discussion with a medical provider for African American women. Consistent with this trend, only among white women did a consistent place of medical care yield a positive effect on genetic test utilization (OR = 2.53, p \u3c .001). No such protective factor existed for black women at a significant level.
Conclusion: There still exists a stark disparity in genetic test awareness and utilization between black and white women. But this study identified another disparity, that white women were more likely to discuss genetic tests with a medical provider than black women. These results support the idea that health system engagement promotes greater awareness of genetic tests to predict cancer risk. However, the limited impact a usual place of medical care had on actual utilization warrants further exploration into the drivers of genetic test decision making both across and within racial groups. The continued commitment to addressing cancer disparities requires not only policy-makers and oncologists, but explicit engagement from genetic counselors and providers across the care continuum
Guidelines for Occupational Therapy Interventions Based on Meaningful and Psychologically Rewarding Occupations
No full textThe purpose of this paper is to describe a newly developed set of guidelines for use of meaningful and psychologically rewarding occupations as therapeutic media in occupational therapy interventions for better therapy outcomes among occupational therapy service users. We begin with a report of the results from meta-analyses indicating that participation in and/or interventions based on meaningful and psychologically rewarding occupations have a positive effect on perceived health and well-being. Using these findings from meta-analysis as a foundation, we present step-by-step guidelines regarding how to evaluate a service user in order to identify personally meaningful and psychologically rewarding occupations; assess the occupational performance issues that are a priority for the service user; plan and implement evidence-based and theory-based interventions that are centered on personally meaningful and psychologically rewarding occupations; and evaluate therapeutic outcomes. Finally, we provide a case example to illustrate application of the intervention guidelines. We recommend that the guidelines be tested through clinical trials in order to determine their clinical effectiveness in typical occupational therapy practice settings