Browsing by Subject "Delivery of Health Care"
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Item Changes in Healthcare Utilization and Charges Among Supportive Housing Residents Enrolled in a Health Coaching Program(2019-05) Chhetri, Shlesma; Spence-Almaguer, Emily; Walters, Scott T.; Stockbridge, Erica L.; Aryal, SubhashThe effectiveness of self-management programs on healthcare use outcomes is an active area of research with inconsistent results. This study was the first to evaluate changes in healthcare utilization (including hospital encounters, inpatient visits, outpatient visits, and emergency visits) and charged amounts among supportive housing residents enrolled in a health coaching program. We utilized retrospective longitudinal medical claims data and a qualitative examination of participants' perceptions of the program's influence on their healthcare use. Zero-inflated negative binomial model and log-gamma models were used to assess change in count variables and charged amounts respectively. Although participants reported a positive impact of the program on their overall quality of life through improved health self-management strategies, the analysis of claims data showed no significant change in healthcare use and charged amounts in all analyses spanning 12 months prior to 24 months post enrollment. These findings may potentially demonstrate the success of health coaching programs in stabilizing healthcare utilization among individuals who otherwise might have increased their healthcare use over time. During interviews and focus groups, participants also shared personal and systems level challenges that influenced their healthcare use. The inclusion of a control group in future analyses would help measure the actual impact of health coaching on healthcare utilization measures among supportive housing residents with high health needs.Item Implementation-effectiveness trial of systematic family health history based risk assessment and impact on clinical disease prevention and surveillance activities(BioMed Central Ltd., 2022-12-07) Wu, R. Ryanne; Myers, Rachel A.; Neuner, Joan; McCarty, Catherine; Haller, Irina V.; Harry, Melissa; Fulda, Kimberly G.; Dimmock, David; Rakhra-Burris, Tejinder; Buchanan, Adam; Ginsburg, Geoffrey S.; Orlando, Lori A.BACKGROUND: Systematically assessing disease risk can improve population health by identifying those eligible for enhanced prevention/screening strategies. This study aims to determine the clinical impact of a systematic risk assessment in diverse primary care populations. METHODS: Hybrid implementation-effectiveness trial of a family health history-based health risk assessment (HRA) tied to risk-based guideline recommendations enrolling from 2014-2017 with 12 months of post-intervention survey data and 24 months of electronic medical record (EMR) data capture. SETTING: 19 primary care clinics at four geographically and culturally diverse U.S. healthcare systems. PARTICIPANTS: any English or Spanish-speaking adult with an upcoming appointment at an enrolling clinic. METHODS: A personal and family health history based HRA with integrated guideline-based clinical decision support (CDS) was completed by each participant prior to their appointment. Risk reports were provided to patients and providers to discuss at their clinical encounter. OUTCOMES: provider and patient discussion and provider uptake (i.e. ordering) and patient uptake (i.e. recommendation completion) of CDS recommendations. MEASURES: patient and provider surveys and EMR data. RESULTS: One thousand eight hundred twenty nine participants (mean age 56.2 [SD13.9], 69.6% female) completed the HRA and had EMR data available for analysis. 762 (41.6%) received a recommendation (29.7% for genetic counseling (GC); 15.2% for enhanced breast/colon cancer screening). Those with recommendations frequently discussed disease risk with their provider (8.7%-38.2% varied by recommendation, p-valuesItem The human toll and humanitarian crisis of the Russia-Ukraine war: the first 162 days(BMJ Publishing Group Ltd., 2022-09-28) Haque, Ubydul; Naeem, Amna; Wang, Shanshan; Espinoza, Juan; Holovanova, Irina; Gutor, Taras; Bazyka, Dimitry; Galindo, Rebeca; Sharma, Sadikshya; Kaidashev, Igor P.; Chumachenko, Dmytro; Linnikov, Syvatoslav; Annan, Esther; Lubinda, Jailos; Korol, Natalya; Bazyka, Kostyantyn; Zhyvotovska, Liliia; Zimenkovsky, Andriy; Nguyen, Uyen-Sa D.T.BACKGROUND: We examined the human toll and subsequent humanitarian crisis resulting from the Russian invasion of Ukraine, which began on 24 February 2022. METHOD: We extracted and analysed data resulting from Russian military attacks on Ukrainians between 24 February and 4 August 2022. The data tracked direct deaths and injuries, damage to healthcare infrastructure and the impact on health, the destruction of residences, infrastructure, communication systems, and utility services - all of which disrupted the lives of Ukrainians. RESULTS: As of 4 August 2022, 5552 civilians were killed outright and 8513 injured in Ukraine as a result of Russian attacks. Local officials estimate as many as 24 328 people were also killed in mass atrocities, with Mariupol being the largest (n=22 000) such example. Aside from wide swaths of homes, schools, roads, and bridges destroyed, hospitals and health facilities from 21 cities across Ukraine came under attack. The disruption to water, gas, electricity, and internet services also extended to affect supplies of medications and other supplies owing to destroyed facilities or production that ceased due to the war. The data also show that Ukraine saw an increase in cases of HIV/AIDS, tuberculosis, and Coronavirus (COVID-19). CONCLUSIONS: The 2022 Russia-Ukraine War not only resulted in deaths and injuries but also impacted the lives and safety of Ukrainians through destruction of healthcare facilities and disrupted delivery of healthcare and supplies. The war is an ongoing humanitarian crisis given the continuing destruction of infrastructure and services that directly impact the well-being of human lives. The devastation, trauma and human cost of war will impact generations of Ukrainians to come.