Browsing by Author "Holmes, Ann"

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    Factors and Outcomes Associated with Dental Care Use Among Medicaid-Enrolled Adults
    (2021-12) Taylor, Heather Lynn; Blackburn, Justin; Menachemi, Nir; Holmes, Ann; Schleyer, Titus; Sen, Bisakha
    Poor oral health is associated with pain, decreased chewing function, negative social perceptions, and reduced quality of life. Low-income adults disproportionally have worse oral health and use dental services at lower rates than higher-income adults. This disparity is associated with individual demographic and socioeconomic factors, cost and coverage barriers, as well as the supply and location of dental providers. Although the full causal pathway remains elusive, evidence suggests an association with poor oral health and an exacerbation of chronic diseases symptoms. Thus, adequate provision of dental care has important population health implications. Despite this importance, dental care use among low-income adults is particularly underexplored. Furthermore, existing research lacks robust methodological designs to mitigate bias from unobserved confounders. Dental coverage for low-income adults through Medicaid is emerging as a way to provide services to this population. However, given state budget constraints, comprehensive public dental benefits are uncommon or at risk of being cut. Therefore, it is important to quantify the individual and economic value of dental care use among adult Medicaid enrollees. This dissertation examines factors and outcomes associated with dental care use among Medicaid-enrolled adults in Indiana. This dissertation includes three studies 1) a pooled cross-sectional analysis that measures the association of individual and community level factors with dental care use, 2) a repeated measures study with individual fixed effects to examine whether receipt of preventive dental care is associated with fewer subsequent non-preventive dental visits and lower total annual dental expenditures, and 3) an empirical study that utilizes an instrumental variable estimation method to examine the effect of preventive dental visits on medical and pharmacy expenditures. Overall, this dissertation attempts to understand the correlates of dental care use, the effectiveness of preventive dental care, and the association between preventive dental care and medical expenditures.
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    Living kidney donor follow-up in a statewide health information exchange: health services utilization, health outcomes and policy implications
    (2016-05-24) Henderson, Macey Leigh; Stone, Cynthia L.; Dixon, Brian; Harle, Chris; Menachemi, Nir; Holmes, Ann; Fry-Revere, Sigrid
    Living donors have contributed about 6,000 kidneys per year in the past 10 years, but more than 100,000 individuals are still waiting for a kidney transplant. Living kidney donors undergo a major surgical procedure without direct medical benefit to themselves, but comprehensive follow-up information on living donors’ health is unfortunately limited. Expert recommendations suggest capturing clinical information beyond traditional sources to improve surveillance of co-morbid conditions from living kidney donors. Currently the United Network for Organ Sharing is responsible for collecting and reporting follow-up data for all living donors from U.S. transplant centers. Under policy implemented in February of 2013, transplant centers must submit follow-up date for two years after donation, but current processes often yield to incomplete and untimely reporting. This dissertation uses a statewide Health Information Exchange as a new clinical data source to 1) retrospectively identify a cohort of living kidney donors, 2) understand their follow-up care patterns, and 3) observe selected clinical outcomes including hypertension, diabetes and post-donation renal function.
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    Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study
    (Oxford University Press, 2022-12-20) Blackburn, Justin; Mills, Carol; Tran, Yvette; Yeager, Valerie; Unroe, Kathleen; Holmes, Ann; Health Policy and Management, School of Public Health
    Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive, require dedicated clinical staff, and nursing homes are chronically understaffed. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project was one of seven sites selected by CMS as "enhanced care & coordination providers" and was implemented from 2012 to 2020. A virtual program based on the principles of OPTIMISTIC was developed in the spring of 2020 with the goal of expanding the reach of the program’s services. This qualitative study explores the perceptions and experiences of the nurses that piloted a virtual care support project in 11 nursing homes in a midwestern state, and identified the nurses’ perceived facilitators of, and barriers to, the effectiveness of delivering a novel virtual care support program. A key finding from this analysis is that relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of implementation of virtual care support programs within nursing homes, from the perspective of the nurses delivering the services. The experiences and recommendations of the program nurses provide insights into crucial elements important to the implementation of similar virtual care support models, and the role of telehealth in bridging healthcare workforce gaps.
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    Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study
    (Sage, 2023-03-22) Mills, Carol A.; Tran, Yvette; Yeager, Valerie A.; Unroe, Kathleen T.; Holmes, Ann; Blackburn, Justin; Health Policy and Management, School of Public Health
    Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive and require dedicated clinical staff, although nursing homes are chronically understaffed. The OPTIMISTIC project was one of seven programs selected by CMS as “enhanced care & coordination providers” and was implemented from 2012 to 2020. This qualitative study explores the perceptions of the nurses that piloted a virtual care support project developed to expand the program’s reach through telehealth, and specifically considered how nurses perceived the effectiveness of this program. Relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of the implementation of virtual care support programs within nursing homes.
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    Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study
    (Sage, 2023-03-22) Mills, Carol A.; Tran, Yvette; Yeager, Valerie A.; Unroe, Kathleen T.; Holmes, Ann; Blackburn, Justin; Health Policy and Management, School of Public Health
    Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive and require dedicated clinical staff, although nursing homes are chronically understaffed. The OPTIMISTIC project was one of seven programs selected by CMS as “enhanced care & coordination providers” and was implemented from 2012 to 2020. This qualitative study explores the perceptions of the nurses that piloted a virtual care support project developed to expand the program’s reach through telehealth, and specifically considered how nurses perceived the effectiveness of this program. Relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of the implementation of virtual care support programs within nursing homes.
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    The impact of rural general hospital closures on communities-A systematic review of the literature
    (Wiley, 2023-11-20) Mills, Carol A.; Yeager, Valerie A.; Unroe, Kathleen T.; Holmes, Ann; Blackburn, Justin; Health Policy and Management, School of Public Health
    Purpose: To compile the literature on the effects of rural hospital closures on the community and summarize the evidence, specifically the health and economic impacts, and identify gaps for future research. Methods: A systematic review of the relevant peer-reviewed literature, published from January 2005 through December 2021, included in the EMBASE, CINAHL, PubMed, EconLit, and Business Source Complete databases, as well as "gray" literature published during the same time period. A total of 21 articles were identified for inclusion. Findings: Over 90% of the included studies were published in the last 8 years, with nearly three-fourths published in the last 4 years. The most common outcomes studied were economic outcomes and employment (76%), emergent, and non-emergent transportation, which includes transport miles and travel time (42.8%), access to and supply of health care providers (38%), and quality of patient outcomes (19%). Eighty-nine percent of the studies that examined economic impacts found unfavorable results, including decreased income, population, and community economic growth, and increased poverty. Between 11 and 15.7 additional minutes were required to transport patients to the nearest emergency facility after closures. A lack of consistency in measures and definition of rurality challenges comparability across studies. Conclusions: The comprehensive impact of rural hospital closures on communities has not been well studied. Research shows predominantly negative economic outcomes as well as increased time and distance required to access health care services. Additional research and consistency in the outcome measures and definition of rurality is needed to characterize the downstream impact of rural hospital closures.
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    The Relationship Between Dental Provider Density and Receipt of Dental Care Among Medicaid-enrolled Adults
    (Johns Hopkins University, 2024) Taylor, Heather L.; Menachemi, Nir; Holmes, Ann; Sen, Bisakha; Schleyer, Titus; Blackburn, Justin; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: We sought to measure the association of dental provider density and receipt of dental care among Medicaid-enrolled adults. Methods: We used four years of Indiana Medicaid claims and enrollment data (2015 to 2018) and the Area Health Resources File to examine the relationship between any dental visit (ADV) or any preventive dental visit (PDV) and three county-level measures of dental provider density (the total number of Medicaid-participating dentists, a binary indicator of a federally qualified health center (FQHC) with a Medicaid-participating dentist, and the overall county dentist-to-population ratio). Results: The likelihood of ADV or PDV increased with greater density of Medicaid-participating dentists as well as dentists accepting Medicaid working at an FQHC within the county. The overall dentist-to-population ratio was not associated with dental care use among the adult Medicaid population. Conclusion: Dentist participation in Medicaid program may be a modifiable barrier to Medicaid-enrolled adults' receipt of dental care.