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Item Achieving an Optimal Childhood Vaccine Policy(American Medical Association, 2017-09-01) Opel, Douglas J.; Schwartz, Jason L.; Omer, Saad B.; Silverman, Ross D.; Duchin, Jeff; Kodish, Eric; Diekema, Douglas S.; Marcuse, Edgar K.; Orenstein, Walt; Health Policy and Management, School of Public HealthPolicies to remove parents' ability to opt-out from school immunization requirements on the basis of religious or personal beliefs (ie, nonmedical exemptions) may be a useful strategy to increase immunization rates and prevent outbreaks of vaccine-preventable disease. However, there is uncertainty about the effectiveness of this strategy and the range of possible outcomes. We advocate for a more deliberative process through which a broad range of outcomes is scrutinized and the balance of values underlying the policy decision to eliminate nonmedical exemptions is clearly articulated. We identify 3 outcomes that require particular consideration before policies to eliminate nonmedical exemptions are implemented widely and outline a process for making the values underlying such policies more explicit.Item Adoption of Best Practices in Behavioral Health Crisis Care by Mental Health Treatment Facilities(APA, 2023-09-01) Burns, Ashlyn; Menachemi, Nir; Yeager, Valerie A.; Vest, Joshua R.; Mazurenko, Olena; Health Policy and Management, School of Public HealthObjective: The authors aimed to examine adoption of behavioral health crisis care (BHCC) services included in the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) best practices guidelines. Methods: Secondary data from SAMHSA’s Behavioral Health Treatment Services Locator in 2022 were used. BHCC best practices were measured on a summated scale capturing whether a mental health treatment facility (N=9,385) adopted BHCC best practices, including provision of these services to all age groups: emergency psychiatric walk-in services, crisis intervention teams, onsite stabilization, mobile or offsite crisis responses, suicide prevention, and peer support. Descriptive statistics were used to examine organizational characteristics (such as facility operation, type, geographic area, license, and payment methods) of mental health treatment facilities nationwide, and a map was created to show locations of best practices BHCC facilities. Logistic regressions were performed to identify facilities’ organizational characteristics associated with adopting BHCC best practices. Results: Only 6.0% (N=564) of mental health treatment facilities fully adopted BHCC best practices. Suicide prevention was the most common BHCC service, offered by 69.8% (N=6,554) of the facilities. A mobile or offsite crisis response service was the least common, adopted by 22.4% (N=2,101). Higher odds of adopting BHCC best practices were significantly associated with public ownership (adjusted OR [AOR]=1.95), accepting self-pay (AOR=3.18), accepting Medicare (AOR=2.68), and receiving any grant funding (AOR=2.45). Conclusions: Despite SAMHSA guidelines recommending comprehensive BHCC services, a fraction of facilities have fully adopted BHCC best practices. Efforts are needed to facilitate widespread uptake of BHCC best practices nationwide.Item Adoption of Health Information Technology Among US Nursing Facilities(Elsevier, 2018-12-19) Vest, Joshua R.; Jung, Hye-Young; Wiley, Kevin; Kooreman, Harold; Pettit, Lorren; Unruh, Mark A.; Health Policy and Management, School of Public HealthObjectives: Nursing facilities have lagged behind in the adoption interoperable health information technology (i.e. technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption. Design: Cross-sectional survey. Setting & participants: We surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations’ health information technology usage and characteristics. Measurements: Using questions adopted from existing instruments, the survey measured nursing home’s EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for eight determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources and slack resources. A series of regression models estimated the association between potential determinants and technology adoption. Results: 84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39; 95%CI = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%). Conclusions/Implications: An organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policymakers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities.Item Alpha test results for a Housing First eLearning strategy: the value of multiple qualitative methods for intervention design(BMC, 2017-10-31) Ahonen, Emily Q.; Watson, Dennis P.; Adams, Erin L.; McGuire, Alan; Health Policy and Management, School of Public HealthBackground Detailed descriptions of implementation strategies are lacking, and there is a corresponding dearth of information regarding methods employed in implementation strategy development. This paper describes methods and findings related to the alpha testing of eLearning modules developed as part of the Housing First Technical Assistance and Training (HFTAT) program’s development. Alpha testing is an approach for improving the quality of a product prior to beta (i.e., real world) testing with potential applications for intervention development. Methods Ten participants in two cities tested the modules. We collected data through (1) a structured log where participants were asked to record their experiences as they worked through the modules; (2) a brief online questionnaire delivered at the end of each module; and (3) focus groups. Results The alpha test provided useful data related to the acceptability and feasibility of eLearning as an implementation strategy, as well as identifying a number of technical issues and bugs. Each of the qualitative methods used provided unique and valuable information. In particular, logs were the most useful for identifying technical issues, and focus groups provided high quality data regarding how the intervention could best be used as an implementation strategy. Conclusions Alpha testing was a valuable step in intervention development, providing us an understanding of issues that would have been more difficult to address at a later stage of the study. As a result, we were able to improve the modules prior to pilot testing of the entire HFTAT. Researchers wishing to alpha test interventions prior to piloting should balance the unique benefits of different data collection approaches with the need to minimize burdens for themselves and participants. Electronic supplementary material The online version of this article (10.1186/s40814-017-0187-y) contains supplementary material, which is available to authorized users.Item Am I Broken?: A mixed-method analysis of an ethnotheatrical performance about women’s experiences with infertility and friendship(Taylor & Francis, 2024) Binion, Kelsey E.; Brann, Maria; Longtin, Krista J.; Health Policy and Management, School of Public HealthBackground This study evaluated an ethnotheatrical performance about infertility to bring awareness to the health condition and its impact on friendships. Methods After each performance (N = 2), attendees participated in a talkback session to express thoughts and ask questions about the production; then, they completed a survey describing their overall experience. Analyses included descriptive statistics for Likert questions and a thematic analysis for open-ended responses. Results Eighty-six percent of attendees found the performance informative about the challenges infertility imposes on everyday life, and more than 60% gained new information and advice on how to talk about infertility. The thematic analysis revealed three themes: learn about the complexities of infertility experiences, develop empathy towards individuals with infertility, and respond appropriately to individuals coping with infertility. Conclusion The performance offered a safe environment for attendees to learn, understand, and process infertility’s complex nature. Creating awareness influenced participants’ perceptions and communicative behaviors.Item Analgesic Management of Pain in Elite Athletes: A Systematic Review(Wolters Kluwer, 2018-09) Harle, Christopher A.; Danielson, Elizabeth C.; Derman, Wayne; Stuart, Mark; Dvorak, Jiri; Smith, Lisa; Hainline, Brian; Health Policy and Management, School of Public HealthObjective: To identify the prevalence, frequency of use, and effects of analgesic pain management strategies used in elite athletes. Design: Systematic literature review. Data Sources: Six databases: Ovid/Medline, SPORTDiscus, CINAHL, Embase, Cochrane Library, and Scopus. Eligibility Criteria for Selecting Studies: Empirical studies involving elite athletes and focused on the use or effects of medications used for pain or painful injury. Studies involving recreational sportspeople or those that undertake general exercise were excluded. Main Results: Of 70 articles found, the majority examined the frequency with which elite athletes use pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, and opioids. A smaller set of studies assessed the effect of medications on outcomes such as pain, function, and adverse effects. Oral NSAIDs are reported to be the most common medication, being used in some international sporting events by over 50% of athletes. Studies examining the effects of pain medications on elite athletes typically involved small samples and lacked control groups against which treated athletes were compared. Conclusions: Existing empirical research does not provide a sufficient body of evidence to guide athletes and healthcare professionals in making analgesic medication treatment decisions. Based on the relatively robust evidence regarding the widespread use of NSAIDs, clinicians and policymakers should carefully assess their current recommendations for NSAID use and adhere to a more unified consensus-based strategy for multidisciplinary pain management in elite athletes. In the future, we hope to see more rigorous, prospective studies of various pain management strategies in elite athletes, thus enabling a shift from consensus-based recommendations to evidence-based recommendations.Item Analysis of Joint External Evaluations in the WHO Eastern Mediterranean Region(2018) Samhouri, Dalia; Ijaz, Kashef; Rashidian, Arash; Chungong, Stella; Flahault, Antoine; Babich, Suzanne M.; Mahjour, Jaouad; Health Policy and Management, School of Public HealthBACKGROUND: Joint External Evaluation (JEE) was developed as a new model of peer-to-peer expert external evaluations of IHR capacities using standardized approaches. AIMS: This study aimed to consolidate findings of these assessments in the Eastern Mediterranean Region and assess their significance. METHODS: Analysis of the data were conducted for 14 countries completing JEE in the Region. Mean JEE score for each of the 19 technical areas and for the overall technical areas were calculated. Bivariate and multivariate analyses were done to assess correlations with key health, socio-economic and health system indicators. RESULTS: Mean JEE scores varied substantially across technical areas. The cumulative mean JEE (mean of indicator scores related to that technical area) was 3 (range: 1-4). Antimicrobial resistance, Biosecurity and Biosafety indicators obtained the lowest scores. Medical countermeasures, personnel deployment and linking public health with security capacities had the highest cumulative mean score of 4 (range: 2-5). JEE scores correlated with most of the key indicators examined. Countries with better health financing system, health service coverage and health status generally had higher JEE scores. Adolescent fertility rate, neonatal mortality ratio and net primary school enrollment ratio were primary factors within a country's overall JEE score. CONCLUSIONS: An integrated multisectoral approach, including well-planned cross-cutting health financing system and coverage, are critical to address the key gaps identified by JEEs in order to ensure regional and global health security.Item An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy(SAGE Publications, 2019-12-10) Danielson, Elizabeth C.; Mazurenko, Olena; Andraka-Christou, Barbara T.; DiIulio, Julie; Downs, Sarah M.; Hurley, Robert W.; Harle, Christopher A.; Health Policy and Management, School of Public HealthBackground. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis (n = 10), spondylosis (n = 6), and low back pain (n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits.Item Application for Public Health Accreditation Among US Local Health Departments in 2013 to 2019: Impact of Service and Activity Mix(American Public Health Association, 2021) Leider, Jonathon P.; Kronstadt, Jessica; Yeager, Valerie A.; Hall, Kellie; Saari, Chelsey K.; Alford, Aaron; Tremmel Freeman, Lori; Kuehnert, Paul; Health Policy and Management, School of Public HealthObjectives: To examine correlates of applying for accreditation among small local health departments (LHDs) in the United States through 2019. Methods: We used administrative data from the Public Health Accreditation Board (PHAB) and 2013, 2016, and 2019 Profile data from the National Association of County and City Health Officials to examine correlates of applying for PHAB accreditation. We fit a latent class analysis (LCA) to characterize LHDs by service mix and size. We made bivariate comparisons using the t test and Pearson χ2. Results: By the end of 2019, 126 small LHDs had applied for accreditation (8%). When we compared reasons for not pursuing accreditation, we observed a difference by size for perceptions that standards exceeded LHD capacity (47% for small vs 22% for midsized [P < .001] and 0% for large [P < .001]). Conclusions: Greater funding support, considering differing standards by LHD size, and recognition that service mix might affect practicality of accreditation are all relevant considerations in attempting to increase uptake of accreditation for small LHDs. Public Health Implications: Overall, small LHDs represented about 60% of all LHDs that had not yet applied to PHAB.Item Assessing the capacity of social determinants of health data to augment predictive models identifying patients in need of wraparound social services(Oxford Press, 2018-01) Kasthurirathne, Suranga N.; Vest, Joshua R.; Menachemi, Nir; Halverson, Paul K.; Grannis, Shaun J.; Health Policy and Management, School of Public HealthIntroduction A growing variety of diverse data sources is emerging to better inform health care delivery and health outcomes. We sought to evaluate the capacity for clinical, socioeconomic, and public health data sources to predict the need for various social service referrals among patients at a safety-net hospital. Materials and Methods We integrated patient clinical data and community-level data representing patients’ social determinants of health (SDH) obtained from multiple sources to build random forest decision models to predict the need for any, mental health, dietitian, social work, or other SDH service referrals. To assess the impact of SDH on improving performance, we built separate decision models using clinical and SDH determinants and clinical data only. Results Decision models predicting the need for any, mental health, and dietitian referrals yielded sensitivity, specificity, and accuracy measures ranging between 60% and 75%. Specificity and accuracy scores for social work and other SDH services ranged between 67% and 77%, while sensitivity scores were between 50% and 63%. Area under the receiver operating characteristic curve values for the decision models ranged between 70% and 78%. Models for predicting the need for any services reported positive predictive values between 65% and 73%. Positive predictive values for predicting individual outcomes were below 40%. Discussion The need for various social service referrals can be predicted with considerable accuracy using a wide range of readily available clinical and community data that measure socioeconomic and public health conditions. While the use of SDH did not result in significant performance improvements, our approach represents a novel and important application of risk predictive modeling.