Browsing by Subject "Health Policy"
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Item A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas(2007-05-01) Miller, Thaddeus L.; Scott McNabb; Peter Hilsenrath; Jotam PasipanodyaMiller, Thaddeus L. A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas. Doctor of Public Health (Health Management and Policy), May 2007, 232 pp., 29 tables, 2 illustrations, bibliography, 274 titles. Tuberculosis cost has been incompletely described as the cost arising from acute illness and treatment. The societal cost of tuberculosis arises from infection, suspicion of infection, acute and preventive responses, the sequalae of illness (including acute morbidity, drug induced hepatitis, mortality, and disability), and the compounding effects of transmission. This societal cost in unknown however the variable portion of this cost is equivalent to the savings made possible by averting tuberculosis, This study measured the societal cost of tuberculosis in Tarrant County, Texas, for the year 2002. Societal costs were estimated as the sum of known or estimated expenditures and health losses related to tuberculosis and discounted at 3%. Current and future costs will accrue to an estimated net $33.9 2002 USD million for the year 2002 in Tarrant County, Texas. An average of 1.4 QALYs net of 3% social discount were lost per incident case. The greatest burdens of tuberculosis, when analyzed by either cost or health quality, can be averted only by case prevention. Forty-three and 44% of societal cost was generate by secondary transmission and chronic impairment associated with pulmonary tuberculosis. Neither factor is routinely considered in discussions of tuberculosis cost. Acute treatment, hospitalization and direct medical care account for only 2.4% of societal cost. Any intervention that prevents one tuberculosis case will prevent at least a net $295,182 (2002 USD) and individual health quality losses averaging 1.4 net QALYs.Item A Critical Review of the One Hour and the Eight Hour Standards for Ozone with an Overview of the Proceedings that Led to the Implementation of The New Standard for Ozone(2004-05-01) Palla, Amruth A.Palla, Amruth R., A Critical Review of the One Hour and the Eight Hour Standards for Ozone with an Overview of the Proceedings that Led to the Implementation of The New Standard for Ozone; Master of Public Health (Environmental and Occupational Health), May 2004, 58 pp, 3 tables, 2 illustrations, 35 titles. With the increasing concern for human health and the recognition of the major role played by environment in the multi-factorial disease etiology, the various parameters established for maintaining the environmental constituents in the proportions desired for achieving a normal health status are taking an important position in the present day world. In 1997, during its review process the EPA found the exiting one-hour standards, for ozone to be insufficient to achieve the health friendly concentrations, and therefore proposed a new eight hour standard for this pollutant. The new standards proposed by the EPA were challenged by various other organizations and several proceedings have happened since then. The purpose of my thesis is to do a critical analysis of the advantages and the drawbacks of the two standards and to do an overview of the proceedings that have led to the implementation of the new standards.Item A Mixed Methods Approach to the Definition of Family Health Promotion Practices for Mexican Sonoran Mothers(2006-12-01) Montiel-Carbajal, Maria Martha; Sue LurieMontiel-Carbajal, Maria M., A Mixed Methods Approach to the Definition of Family Health Promotion Practices for Mexican Sonoran Mothers. Doctor of Public Health (Social and Behavioral Sciences), December 2006, 143 pp., 14 tables, 1 illustration, bibliography, 55 titles. The purpose of this research was to study the family health promotion practices of a sample of Mexican mothers living in the state of Sonora Mexico through a concurrent mixed method approach that included (1) a qualitative component with face to face and in-depth interviews, investigator observations, and analysis of content; (2) a quantitative component consisting of statistical analysis of data from selected selections of the National Survey for the Evaluation of Health Services 2002-2003. For the qualitative component 15 mothers, with mean age of 40 years, mean years of education of 10 years, living with their families were selected to form a purposive sample, and assigned to one of three groups: married working mothers, non-married working mothers, or married non-working mothers. The qualitative component was naturalistic and descriptive using semi-structured interviews with the mothers, and individual questionnaires to collect demographic and housing information. The quantitative component used the survey responses provided by the database of the National Survey for the Evaluation of Health Services 2002-2003, from 404 female adults age 18 and older, living in the urban zone of Sonora. The qualitative component showed that mothers conceptualize the health status of the family as a priority. The specific practices they use depend on the set of external resources and internal strengths of the family in order to overcome the physical, environmental, relational, or economic barriers they found to the promotion of health practices. The participants also reported being unsatisfied with the access and quality of the social health care system. The data from the quantitative component showed that Mexican Sonoran women living in the urban area reported having good health and felt satisfied with their health status; their satisfaction with the social health care system was fair. The group of non-married working mothers was detected to be more at risk for cardiovascular diseases due to a greater proportion of smokers and drinking paired with low amount of exercise. The results provided valuable information to formulate health promotion programs and future policies to be implemented with the target population.Item A Study of Disparities in the Receipt of Anti-Retroviral Drugs, Health Status, and Insurance Coverage Among a Sample of HIV-Positive Adults(2006-12-01) Wittenmyer, Brian F.; Kristine Lykens; Jeffrey Talbert; Tim StrawdermanWittenmyer, Brian F., A Study of Disparities in the Receipt of Anti-Retroviral Drugs, Health Status, and Insurance Coverage among a Sample of HIV-Positive Adults. Master of Public Health (Health Management and Policy), December 2006, 88 pp., 8 tables, references, 32 titles. Anti-retroviral medications (ARV) are effective at treating HIV/AIDS. Medicare, Medicaid, and ADAP are public programs that supply ARVs to needy patients in the U.S. Studies have documented dispartities in AIDS incidence/prevalence, insurance, and ARV-use. The study described demographic, clinical, and insurance characteristics of a sample of HIV+ persons. The study explored relationships between AIDS diagnosis, health status, and ARV-receipt and demographic, insurance, and clinical variables. Disparities in ARV-receipt, AIDS diagnosis, and health-status were found for gender, age, race, geographic region, and SES. Policy recommendations included: shortening the disability waiting-period for Medicare-eligibility, and relaxing Medicaid’s income-eligibility requirements.Item Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability(2006-12-01) Reese, Sharon E.; Kristine Lykens; Sue Lurie; Richard ScotchReese, Sharon E., Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability. Doctor of Public Health (Health Management and Policy), December, 2006, 79 pp., 7 tables, 51 references. This dissertation reports the results of research into the difficulties poverty level adults with disabilities have in accessing vital health and social services. Chapter one gives a background of the problem, a purpose of the research, the research question, limitations and constraints, and the importance of the study. Chapter two is a review of the literature concerning this population and access. Chapter three reviews the methodology used in the study, with chapters four and five presenting results, conclusions and recommendations. Qualitative methods using a focus group and individual interviews five major themes emerged: health issues, access or obtaining care, interactions with providers, obtaining medication, and transportation (table 6). A review of these themes and the particular responses of participants in these areas highlighted the need for policy change in the area of access to services for this special group. This dissertation also makes recommendations for policy changes and potential barriers to those changes.Item Advance Directives Planning Among Mexican-Americans in Dallas-Fort Worth(2005-05-01) Santiago, Carmen; Lurie, Sue; Gonzalez, Adela; Rene, AntonioSantiago, Carmen C., Advance Directives Planning Among Mexican-American in Dallas Fort Worth. Doctor of Public Health (Social and Behavioral Sciences), May 2005, 133 pp., bibliography, 33 titles. This qualitative study explored the knowledge base of advance directives planning among Mexican-Americans in the Dallas-Fort Worth area. In addition, the study explored areas that influenced their willingness to engage in advance directives and their preferences related to family collective decision-making. Two focus groups, representing two different populations were conducted. One focus group represented second generation Mexican-Americans, 65 years old and older, both men and women that were hospitalized or participated in home health care programs between January 2004 and January 2005. The second focus group consisted of Mexican-Americans, 18 years and older who were family members or caregivers of sick elders in the same time frame. Questions utilized to gather the knowledge and beliefs of the focus group participants, were based on a previous study by Dr. Morrison and Dr. Meir conducted in New York. Participant’s responses were analyzed using NVIVO software. Findings indicated a lack of knowledge of advance directives and confusion about state wills and living wills among Mexian-Americans in Dallas-Fort Worth. A majority of the focus group participants expressed a preference for their older children to make the decisions of their end of life care. This was due to a belief that their child is better educated and could make the right decision. Participants also revealed the importance of a family collective decision. This belief in family unity kept them from excluding members from the decision of end of life care. Another interesting finding from this study was a majority of the participants had already made funeral plans such as arranging for the lot to be buried in and funeral service pre-paid, but had not considered advance care directives. According to both groups of participants, arranging for their funeral service gave them a peace of mind and dignity since they had established where they will be interred. These findings suggested that the Mexican-American population needs to be informed about this legal process. Mexican-Americans need to be aware that the State provides ways to obtain this documentation at no cost. Health care providers should be involved in the education about advance directives and encourage their patients to learn more and consider obtaining one. Further research studying Mexican American knowledge and beliefs, at state level and a comparison among states should be explored. Keywords; advance directives, decision making, end of life, ethical issuesItem An Economic Analysis of Texas' Measles Vaccination Program: 1990-1996(2000-08-01) MacDonald, Tammy O.; Claudia S. CogginIn order to get the most benefit out of limited resources, public health departments must examine the costs and benefits of their activities to determine the most cost-effective method to allocate these scarce resources. The use of economic analysis can inform and help clarify upon which decisions are to be made. (CDC, 1996). The resources used to produce most goods and services in society are efficiently allocated through markets. However, markets can fail to efficiently provide goods and services that largely benefit individuals other than the consumer. The types of goods and services that public health departments provide often fall into that category. Cost-benefit analysis is one type of economic decision-making tool used when market forces are not in control Cost-benefit analysis (CBA) places a dollar value on the costs and benefits of each outcome so they can be compared. This type of economic analysis can then be taken one step further. An incremental or marginal analysis can determine changes in the relative costs and benefits’ resulting from increase or decreases in the amount of resources used in a program. Such an analysis should be part of the decision making process, so that scarce resources can be used efficiently. This paper examines not only the costs and benefits of the measles immunization program in Texas but also, the expansion of the program in the 1990’s. The most significant changes in Texas’ immunization program took place in 1994 as a result of the measles outbreak of 1989-1990. The years 1992, 1993, 1994 and 1996 were chosen for this analysis because of the difference in immunization rates, incidence rates and the level of State funding. This time period represents the most dramatic changes to these three areas. Since the measles vaccination was put into use in 1963, the number of measles cases in the United States has decreased dramatically. An average of 450 measles-associated deaths was reported each year between 1953 and 1963. (TDH, unpublished). Widespread use of the vaccine has led to a 95% reduction in measles compared with the pre-vaccine era. (TDH, unpublished). However, during 1989-1990, the number of measles cases and deaths rose sharply. During 1989, more than 18,000 cases and 41 deaths were reported. The largest number of reported cases since 1978 and the largest number of deaths in two decades in the U.S. (National Vaccine Advisory Committee, 1991). The major cause of the epidemic of 1989 and 1990 was a low vaccination rate among preschool children. (TDH, unpublished). The Centers for Disease Control and Prevention (CDC) estimates national measles vaccine coverage for 2-year-olds in 1985 was 61%, compared with 82% in 1991 and 1992. (CDC, 1994). The CDC has set a goal of 90% of 2-year-olds to be immunized against measles, mumps and rubella. Texas reported 11% of all measles cases in the U.S. between 1989 and 1990, although it only accounted for 7% of the total U.S. population (Schulte et al. 1996). This is likely due to the fact that immunization rates were low throughout the state. In 1989, only 66% of the children in Dallas and 58% in Houston were estimated to be immunized against polio, diphtheria, pertussis, tetanus, measles, mumps, and rubella by the age of two. Nationally, immunization rates were estimated to be 70% at the same time (Schulte et al., 1996). This paper will proceed as follows. Two benefit/cost studies will be outlined in the background section. These studies compare the total benefits and costs of current vaccination programs to no vaccination program. Then a history of Texas’ measles vaccination program will be discussed. It will explain how the measles outbreak of 1989-1990 brought about organizational and financial changes to the immunization program within the Texas Department of Health (TDH). In the method section, the disease costs and costs associated with a vaccination program are used to calculate a benefit/cost ratio. The changes in immunization rates and the associated marginal costs and benefits are then compared. The results of the CBA and marginal analysis indicate that the benefit to cost (B/C) ratios range from 17 to 30:1. After reaching an immunization rate of about 81%, marginal benefits become smaller and smaller while the cost of increasing the immunization rate rises. Finally, the results will be discussed and conclusions made as to the efficiency of Texas’ measles vaccination program. There is some evidence that the CDC’s goal to immunize 90% of 2-year-old children for measles may not the most efficient goal for Texas.Item An Evaluation of the Impact of Continuity of Care on Cost of Services in New and Renewing CHIP Enrollees(2001-01-01) Montague, Brian; Kristine Lykens; Muriel Marshall; Karan SinghObjective. To assess the impact of continuity of care as measured by enrollment history on the cost of services in Colorado’s state insurance program for children in low-income families, the Child Health Plan Plus. Design. A retrospective cohort study using data extracted from the eligibility/enrollment system and the claims payment system for inpatient and specialty services. All children enrolled in the program for at least 90 days and managed under the state managed-care network from its inception to April 1st of 2000 were included in the analysis (n-11841). Enrollees were separated into three enrollment groups: new members, renewing members, and members transition from a prior outpatient services group. The odds by enrollment groups: new members, renewing members, and members transition from a prior outpatient services program. The odds by enrollment group an average monthly claims greater than the 75th percentile amongst those with claims (n-2661) and the odds of presence of any claim in the full data set were compared means of a logistic regression model. In order to permit inferences regarding the total cost of care, all models included age group as a cofactor. Presence of chronic or congenital disease, ethnicity, primary language, urban residence, and the presence of multiple parents or caretakers were tested using univariate chi-square analysis and significant factors (p [less than] 0.1) were included as effects in the models. Results. All cofactors with the exception of ethnicity were significant in both models. Chronic disease status was associated with an increased risk of all claims. (OR=4.961, p [less than] 0.0001) and high claims (OR=9.639, p [less than] 0.0001). Renewal status was associated with a decreased risk of any claim (OR=0.921, p [less than] 0.0936) while rollover status was associated with both an increased risk of any claim (OR=1.157, p=0.0034) and a decreased risk of high claims (OR=0.731, p=0.0033). Residence in rural counties increased the risk of any claim (OR=0.0428, p [less than] 0.0001) and an increased risk of high claims (OR=1.472, p=0.0376). Conclusions. Enrollment history had a modest, though significant, effect on the presence of any claim and the specific presence of high claims. Rollover status was protective increasing utilization of the system overall but reducing the risk of high claims whereas renewal status only reduced the risk of utilization overall. The absence of multiple adults in the household showed a pattern consistent with episodic use of the system. Relative to urban residents, residents of rural counties were more likely to have used any service and less likely to have incurred high claims. This effect may be attributable to the transition of patients to HMO networks in urban counties. Linguistic or cultural barriers as reflected in primary language strongly decreased utilization, suggesting that these may be important barriers to address in outreach and member education.Item Are Patients Satisfied with Care in the Veterans Health Administration System?(2007-10-01) Budzi, Dorothy F.; Sue Lurie; Karan Singh; Jim StimpsonBudzi, Dorothy F., Are Patients Satisfied with Care in the Veterans Health Administration System? Doctor or Public Health (Social and Behavioral Sciences), October 2007, 152 pp, 9 tables, 66 figures, 107 reference, 45 titles. Over 5 million men and women of the U.S. armed forces receive care from the Veterans Affairs healthcare system. The Veterans Health Administration (VHA) is the largest healthcare system and the single largest employer of physician assistants (PAs) and nurse practitioners (NPs) in the United States. Research question: This study asks the question whether the utilization of PAs and NPs in the VHA is a satisfying experience for the patients. Methods: The study analyzed outpatient Survey of Healthcare Experiences of Patients (SHEP), a monthly survey that measures patient satisfaction with the VA healthcare system. Returned surveys of patients who completed their visits at VHA outpatient clinics, acute care centers, and primary care centers across the nation in 2002-2006 were analyzed to explain patients’ satisfaction with PAs, NPs, and physicians. Samplings: Of the 2,164,559 questionnaires that were mailed to patients, 1,601,828 were returned (response rate= 64%, P-value=.05, confidence interval=95%, margin of error +/-2.2). A difference of four or more points is statistically greater than could be caused by sampling error. Secondary data on primary care patient satisfaction scores per Veterans Integrated Network Service (VISN) and facility was analyzed, and compared with provider type ratio per VISN and per facility. Results: the study found that the utilization of non-physician clinicians such as PAs and NPs in the VHA system was a satisfying experience for patients. In certain VISNs, patient satisfaction scores increased by 5% when the number of non-physician clinicians (NPC) was increased compared to 1.8% when the number of physicians was increased. Physician to PA/NP ratio was 7:3, and majority of the primary care providers were male while most of the NPs were female. The dominant age group of the providers was 45-54 years of age. Considering veteran status, PA veteran and non-veteran were 50:50, NP veterans approximately 65%, NP non-veterans 45%, and physician veterans 20% to 80% non-veterans. The information gained from this research may permit the administrators to develop plans and adjustments that foster quality healthcare services.Item Are the Disaster Preparedness Plans in the Largest Cities in the States Adequate for Disabled & Elderly Populations?(2007-05-01) Hall, Stephanie K.Hall, Stephanie K, Are the Disaster Preparedness Plans in the Largest Cities in the Unites States Adequate for Disabled & Elderly Populations? Master of Public Health (Community Health), May 2007, 36 pp., 10 tables, 1 map, reference, 15 titles. This study seeks to compare urban disaster plans in the 25 largest U.S. cities. The focus of this study involves two populations that are often neglected or dealt with last: elderly and disabled. Therefore, the largest US cities should have a comprehensive disaster preparedness plan that includes evacuation & transportation; sheltering and health services; and legal considerations for both the disabled & elderly populations. The data reported in this study was gathered from each city Office of Emergency Management website. The data was analyzed to determine which cities have disaster preparedness plans that consider the disabled and again populations. Results indicate many cities are not prepared.Item Asthma Mortality and Toxic Release in Texas - An Ecological Study 1980-2001(2004-05-01) Maddipatla, Sreeram; Manuel BayonaMaddipatla, S., Asthma Mortality and Toxic Release in Texas - An Ecological Study 1980-2001. Master of Public Health (Environmental Health) April 2004, 97 pp., 4 tables, bibliography, 94 titles. There is a lack of literature examining how the spatiotemporal trend of asthma may have impacted different ethnic/racial compositions of Texans. The present study sought to evaluate the geographic-temporal variations in asthma mortality in Texans over a 22-year period, retrospectively, and examine whether the trend of environmental Toxic Release Inventory (TRI) concentrations and their spatiotemporal persistence might place an uneven burden on particular racial groups. The study concentrates on the time period between 1980-2001 and first evaluates geographic excess of asthma mortality in different racial groups at the county level and characterizes the excess burden by spatiotemporal variations. After this assessment, the impact of TRI on asthma mortality over this period of time is analyzed. Based on these two analyses, this would identify which racial/ethnic groups in which Texas regions might have been affected the most by regarding mortality over time, and suggested priority geographic areas for policy intervention. At the end of this study, it could be said that there might be an association between the TRI release and increased asthma mortality in the Black male population.Item Characteristics of Primary Care Physicians Serving in Texas Medically Underserved Areas(2006-08-01) Lancaster, Scott Bradley; Kristine Lykens; Russell Gamber; Jeffrey TalbertLancaster, Scott Bradley, Characteristics of Primary Care Physicians Serving in Texas Medically Underserved Areas, 2005. Master of Public Health (Health Management and Policy), May 2006, 63 pp., 13 tables, bibliography, 59 titles. Primary care physician demographics were examined to determine if subgroups differed in choice of practice location in urban and rural Medically Underserved Areas (MUAs) in Texas. Compared with the overall proportion of physicians practicing in rural MUAs (8.8%), subgroups that significantly differed were Dos (13.5%), males (10.6%), general practitioners (19.4%), family physicians (12.4%), and graduates of medical school prior to or during 1960 (18.8%) and from 1961-1970 (11.2%). Compared with the overall proportion of physicians practicing in urban MUAs (23.2%), subgroups that significantly differed were females (25%), Blacks (29.7%), and Latinos (38.7). Binary logistic regression showed that Asian ethnicity, general practice specialty, and graduate year of 1961-1970 predicted MUA practice location. The statistically significant differences observed underscore the importance of further study to examine potential differences between rural and urban MUAs. Public policy that provides incentives for more equitable physician distribution should be based on sound research.Item Disability-Adjusted Life Years Lost Due to Adult Pulmonary Tuberculosis in Tarrant County, 2005-2006: An Analysis of the Role of Post Tuberculosis Impairment(2008-05-01) Pasipanodya, Jotam Garaimunashe; Sejong Bae; Kristine Lykens; Peter HilsenrathPasipanodya, Jotam G. Disability-Adjusted Life Years lost due to adult pulmonary tuberculosis in Tarrant County, 2005-2006: An analysis of the role of post tuberculosis impairment. Doctor of Public Health (Health Management and Policy), May 2008. 145 pages, 18 tables, 11 illustrations, 135 references. Pulmonary impairment after tuberculosis treatment (PIAT) is not yet incorporated in assessing burden of tuberculosis. Previous global and national TB burden estimates therefore did not fully reflect the consequences of surviving tuberculosis disease. This study was conducted to assess burden of TB in Tarrant County, Texas, using Disability-Adjusted Life Years (DALY). DALY is a composite measure of premature mortality and disability that equates years of healthy life lost. DALY, stratified by gender and race were calculated for 118 adult TB subjects seen between July 2005 and October 2006. Years of Life Lost (YLL) were calculated from the difference between standard life expectancy and age at death from TB, summed across county population. Years Lived with Disability (YLD) were derived from age and gender-specific disease incidence weight-adjusted for impairment levels; using disability weights obtained from literature. Three percent discount rate per year was used. One hundred and eighteen subjects lost 444.25 DALY during the study period. Years of life lost to premature mortality (YLL) contributed 159.62 (36%) and years of life lived with disability (YLD) contributed majority of total DALY. Pulmonary impairment after tuberculosis (YLD PIAT) contributed 234.6 (53%), while YLD Acute contributed only 50.03 (11 %) of total DALYS. Contrary to previous estimates; disability contributes more than mortality to TB burden in areas with low TB adult and child mortality. PIA T contributes significantly to TB burden, but was previously unrecognized. These findings suggest that the greatest health savings will be achieved through strategies to prevent tuberculosis from developing rather than strategies to shorten treatment once it has developed.Item Epidemiological Modeling of a Bioterrorism Event in a Noncombat Environment(1999-07-01) Perkins, Christopher J.; Antonio Rene; Mains; Gilbert RamirezPerkins, Christopher J., Epidemiological Modeling of a Bioterrorism Event in a Noncombat Environment. Master of Public Health (Biomedical Sciences), July, 1999, 60 pp., 8 tables, 4 illustrations, references, 31 titles. The challenge to government, medical and public health officials is to advocate for American citizens the safest environment possible to live and work. A threat to the safety of all Americans has initiated preparations from national, state, and local jurisdictions in an attempt to counter the probability of biological terrorism. Bioterrorism is not only a threat to humans but also a threat to the nation’s water and food supplies. Epidemiological Modeling of a Bioterrorism Event demonstrates the importance in preparations to reduce the number of casualties and fatalities. Using Epidemiological Modeling of bioterrorism events will aid public health and medical personnel in the planning and initiation of appropriate public health actions and medical therapies should such events occur.Item Impact of Shared Decision Making Practices on Healthcare Utilization, Healthcare Expenditures, and Satisfaction with Care among Patients with Angina, Cancer, and Osteoarthritis/Joint Pain, Medical Expenditure Panel Survey 2007-2010(2014-05-01) Brown-Philpot, Lindsey; Nuha Lackan; Jose Pagán; Kristine A. LykensShared decision-making (SDM) within the healthcare environment is grounded in open communication between patients and their care providers. In SDM, clinical and comparative effectiveness information are synthesized with patient values and treatment goals in order to arrive at treatment plans. Researchers and policymakers hope that SDM will facilitate enhanced treatment compliance and quality of care delivery, while simultaneously controlling unnecessary healthcare utilization and costs. The specific aims of this study sought to determine whether six individual SDM practices had an impact on healthcare utilization, healthcare expenditures, and patient reported satisfaction with care among patients with three preference-sensitive health conditions: angina, cancer, and osteoarthritis/joint pain. Data from the Medical Expenditure Panel Survey were used to determine if six individual SDM practices were significant predictors of healthcare utilization, healthcare expenditures, and patient satisfaction with care. Results indicate that patients reporting that providers explained information in a manner that was easy to understand and showed respect for what patients had to say experienced lower incidence rate ratios of outpatient care utilization (IRR=0.9270, 95% CI 0.8616-0.9975; IRR=0.8900, 95% CI 0.8295-0.9549). Those reporting their providers showed respect for what they had to say also experienced lower outpatient care expenditures on average than those whose providers did not show respect for what they had to say ($2,964.69 vs. $2,619.27, difference=-$345.42, p=0.0400). Patients who reported that providers explained all treatment options experienced $87.97 per year more in emergency department expenditures and $1,198.07 per year more in inpatient hospital expenditures than those who reported their providers did not explain all of the treatment options when a medical decision was to be made (p=0.0252; p=0.0036). All six SDM practices were significant predictors of patient satisfaction with care. Provider communication practices have a significant impact on aspects of care utilization and expenditures among patients with angina, cancer, and osteoarthritis/joint pain. Patient-perceived experiences of SDM practices are significant predictors of patient satisfaction with care among patients with these conditions. Effective communication is imperative during medical decisions in order to help ensure the value and quality of healthcare delivery to patients with angina, cancer, and osteoarthritis/joint pain.Item Is an Enviormental Health Educational Intervention Sufficient to Change Behavior?: Perceptions from an Indigenous Lake Community in Guatemala(2006-12-01) Pezzia, Carla; Terrance Gratton; Sue Lurie; Norman TrieffPezzia, Carla. Is an environmental health educational intervention sufficient to change behavior?: Perceptions from an indigenous lake community in Guatemala. Master of Public Health (Environmental Health), December 2006, 46 pp., 6 tables, 1 illustration, references, 18 titles. Traditional environmental health practices focus on education and exposure prevention, but the division between the biophysico-chemical and social environment keeps them from always being sufficient; human ecology seeks to bridge this division. The second leading cause of mortality in Guatemala is gastrointestinal infections, and San Pedro, Guatemala, provides an opportunity to study these infections utilizing a human ecological approach. Morbidity data were collected from the local health center, observations noted systematically, and both residents and tourists were interviewed regarding their perceptions of the community’s environmental health. Results found that residents who had no contact with tourists stated that, for gastrointestinal infections due to refuse in the streets, education alone would not be sufficient to reduce this problem; most felt some type of government intervention would be necessary. It is recommended that public health specialists enjoy a human ecological approach and refer to the community when designing an appropriate intervention.Item Maternal Characteristics and Neighborhood Characteristics: How do they impact birth-weight and infant mortality?(2010-05-01) Roberson, Jerry L.; Kristine LykensRoberson, Jerry L., Maternal Characteristics and Neighborhood Characteristics: How Do They Impact Birth-Weight and Infant Mortality?. Doctorate of Public Health (Health Management and Policy), May 2010, 52 pp., 4 tables, 2 illustrations, bibliography, 63 titles. Infant mortality is a family tragedy and an index of community health and progress. Infant mortality (death in the first year) remains a serious problem in the US and locally (Kochanek, 2002). High rates of infant mortality suggest poor maternal health care, inadequate access to and utilization of health services, insufficient prenatal care, and other social, economic, and health related factors. Thus, the rate of infant mortality indicates the state of a population. The purpose of this study is to investigate the relationship between individual level characteristics and neighborhood characteristics on infant mortality. Four data sources were compiled to analyze secondary data regarding maternal characteristics, neighborhood characteristics and birth outcomes—birth-weight and infant death. The study population consisted of all live births in specified zip codes within Tarrant County. Neighborhood characteristics from the same areas were also studied. The findings from the study were that there is a significant relationship between some maternal characteristics and neighborhood characteristics on birth-weight; and that the significant relationships on infant mortality are primarily maternal characteristics. Future research should focus on the impact of social support for the pregnant mother.Item NorTex Fall 2013 Newsletter(2013-10-01)Item NorTex Fall 2014 Newsletter(2014-10-01)Item NorTex Fall 2015 Newsletter(2015-10-01)
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