Browsing by Author "Norwood, Connor W."
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Item Administrative Challenges to the Integration of Oral Health With Primary Care(Lippincott Williams & Wilkins, 2016) Norwood, Connor W.; Maxey, Hannah L.; Randolph, Courtney; Gano, Laura; Kochhar, Komal; Department of Family Medicine, IU School of MedicineInadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.Item Data Report: 2013 Indiana Nursing Workforce(2015-02) Sheff, Zachary T.; Nowak, Callie L.; Maxey, Hannah L.; Norwood, Connor W.; Randolph, Courtney; Kelley, Tracie M.Indiana’s registered nurse workforce is comprised of health care providers working in a range of settings and specialties. Information on the supply and distribution of this workforce is critical to Indiana’s health system for planning and policy development. Supply data on Indiana’s registered nurse workforce are routinely collected in the form of surveys administered in conjunction with the biennial nursing license renewal process. During the 2013 re-licensure period, 99,545 registered nurses renewed their license in Indiana. After filtering out individuals who did not respond to the survey, did not hold an active or probationary license, and did not practice in Indiana, 53,135 registered nurses were included in the report for analysis. The survey had a 93.1 percent response rate. In 2013, the majority of registered nurses were white (92.8%) and female (93.8%). The mean age of registered nurses was 45.7 years of age. Advanced practice nurses (APNs) were slightly older with a mean age of 48.5 years old. Registered nurses were primarily employed in staff nurse positions. Hospitals were the most common work setting. In 2013, the majority of RNs held a Bachelor’s degree or higher (56.7%). This is the first time since data has been collected (1997) in which a greater proportion of RNs held a Bachelor’s or higher than did not. Marion County had the highest percent of RNs with a Bachelor’s degree or higher (65.1%). Since 1997 the total number of actively practicing Indiana RNs has increased from 38,721 to 53,135 in 2013. From 2005 to 2013 the number of RNs working in a nursing faculty position has increased from 733 to 1,114. There were 49,033.6 total RN FTEs and 2,723.8 APN FTEs in Indiana in 2013. Statewide, there was an average of 122 Indiana residents per RN FTE and 2,380 residents per APN FTE. Marion County had the highest number of RN and APN FTEs of any county.Item Dental safety net capacity: An innovative use of existing data to measure dentists’ clinical engagement in state Medicaid programs(Wiley, 2018) Maxey, Hannah L.; Norwood, Connor W.; Vaughn, Sierra X.; Wang, Yumin; Marsh, Stacie; Williams, John; Family Medicine, School of MedicineBackground The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists’ relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists’ willingness to participate in Indiana's Medicaid program. Methods We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists’ level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates. Results Though 75% of Medicaid‐enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists’ participation in state Medicaid programs. Conclusions In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self‐reported data and variations in Medicaid claims reporting.Item Fighting Prescription Drug Abuse Through State Policy: The Role of Nursing in Successful Implementation(Lippincott Williams & Wilkins, 2015-10) Norwood, Connor W.; Biviji-Sharma, Rizwana; Knotts, Adam; Omenka, Isaac; Stone, Cynthia; Purviance, Donna; Department of Family Medicine, IU School of MedicinePrescription drug abuse has become a top public health concern in the United States in recent years. Changes in prescribing practices and the way in which health providers manage pain resulted from national quality improvement efforts in the 1990s. Most efforts to reduce morbidity and mortality associated with the prescription drug abuse epidemic occur through policy initiatives at the state level. In 2011, Indiana ranked 17th in the United States and had only implemented a few intervention and prevention strategies. However, through a coordinated effort within the state, Indiana has expanded Good Samaritan laws and adopted rescue drug policies. Furthermore, the nursing workforce in Indiana has played a critical role in the successful implementation of these new policies. Nurses across the state have provided education and training to first responders and lay persons. They have also consulted with law enforcement agencies and other organizations looking to fully leverage the potential of these new state policies. Because of their versatility and clinical expertise, the nursing workforce has and will continue to play a critical role in the successful implementation of state policy initiatives aimed at fighting the prescription drug abuse epidemic.Item Indiana Housing & Community Development Authority: Policy Evaluation of Aging in Place(2014-08-28) Norwood, Connor W.; Omenka, Isaac O.Aging in place refers to making the living environment safe and adaptable for everyone to remain independent and thrive in their homes and community even as circumstances change. The primary target populations for aging in place strategies are seniors and persons with disabilities. The effort involves construction of buildings and communities that are accessible, and livable. Creation of these housing opportunities means Hoosiers can choose how and where they live: rent or own, urban or rural, close to school or close to work. The Indiana Housing and Community Development Authority (IHCDA) has been working on developing a working definition of “Aging in Place” (AiP) in order to enhance the aging in place strategic initiative to support seniors and persons with disabilities in Indiana. As a result an evaluation of the current initiative was completed to determine the needs of the target population and to enhance the strategic priority. The goal of the program evaluation is to determine if the working definition of AiP fully encompasses the needs of the community and target population. The evaluation design involves learning and improvement of the IHCDA AiP priority and intends to improve the process. The evaluation team conducted one focus group to collect more in-depth information on perceptions, insights, attitudes, experiences, and beliefs regarding AiP. Five major themes from the focus group were identified including family, accessibility, independence, community integration, and finances. The evaluation was also able to identify a unique perspective of the definition of “home” shared by the aging in place community. To establish a home a physical and psychological component must be met. Furthermore, independent senior living communities were identified as being in high demand. Based on the findings of the evaluation, three recommendations were developed to enhance the AiP priority at IHCDA. It is recommended that IHCDA amend the working definition to explicitly characterize the meaning of home based on the findings of this evaluation. IHCDA should also increase allocation of funds to independent senior living communities and should perform ongoing evaluations to ensure that current needs of the AiP community are being identified and met. Ongoing evaluation with the data collection tool developed in this evaluation will ensure that the AiP strategic priority at IHCDA is on the right path moving forward.Item Indiana Primary Health Care: Description, Distribution, Challenges, and Strategic Recommendation to Empowered Decision Making(2012-12) Maxey, Hannah L.; Malcolm, Amber; Norwood, Connor W.; Sheff, Zachary T.; Walters, Staci JoOver the past few years, and in light of the recent Supreme Court ruling on the Patient Protection and Affordable Care Act (ACA) and the result of the 2012 Presidential election, access to health care services has been in the forefront of health care discussions. Driving these discussions are rising chronic disease rates, skyrocketing health care costs, and the ever increasing number of individuals falling into that black hole known as the “uninsured” -- all of which are major burdens on Indiana’s health system. Regardless of ones perspective on health reform, the links between primary health care access, health outcomes, and health care costs are undeniable [1-3]. People with access to primary health care services live longer, healthier lives, and the overall cost of their health care are less than those without access to these services. Ensuring a strong primary health care system across the State of Indiana is crucial to ensuring the health of Hoosiers and improving the efficiency of Indiana’s health system. However, before our current system can be strengthened, it must be understood. This begs the following questions: what is primary care?; why is it important?; who provides these services?; and where are they located? The development and implementation of health policies and primary health care programs that would secure Hoosier health relies on the ability of the State of Indiana to make informed decisions.Item Indiana Primary Health Care: Description, Distribution, Challenges, and Strategic Recommendation to Empowered Decision Making(2012-12) Maxey, Hannah L.; Malcolm, Amber; Norwood, Connor W.; Sheff, Zachary; Walters, Staci JoItem Indiana’s Health Workforce: Description, Distribution, and Strategic Recommendation to Empowered Decision Making(2013-08-07) Maxey, Hannah L.; Norwood, Connor W.; Sheff, Zachary T.; Walters, StaciItem Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist's professional judgment(Elsevier B.V., 2015-06-06) Norwood, Connor W.; Wright, Eric R.Background Pharmacists have shared responsibility to investigate the validity of controlled substance prescriptions (CSPs) that raise concerns, or red flags, and subsequently exercise their right to refuse to dispense a CSP if its validity cannot be verified. Improving access to clinical practice tools, such as prescription drug monitoring programs (PDMPs), may increase availability of a patient's drug history, which is critical to making informed clinical decisions about dispensing CSPs. Objectives The purpose of this study was to examine how integration and consistent use of a PDMP in pharmacy practice impacts pharmacists' dispensing practices related to CSPs. Methods A cross-sectional study examined pharmacists' knowledge and use of Indiana's (US State) PDMP (INSPECT) and dispensing practices of CSPs. Three outcome measures were analyzed using multiple logistic regression so as to examine the relationship between PDMP use and pharmacists' controlled substance dispensing behaviors. Results Pharmacists were 6.4 times more likely to change their dispensing practice to dispense fewer CSPs if they reported that INSPECT provides increased access to patient information. Pharmacists who always use INSPECT refused an average of 25 CSPs annually compared to an average of 7 refusals for pharmacists not using INSPECT. Pharmacists using INSEPCT consistently (at every visit) were 3.3 times more likely to refuse to dispense more CSPs than pharmacists who report never using INSPECT. Conclusions Integration of PDMPs in pharmacy practice may improve a pharmacist's ability to make informed clinical decisions and exercise sound professional judgment. Providing clinical practice tools to both prescribers and pharmacists is important to preventing drug diversion and prescription drug abuse. Future research should focus on understanding the barriers and challenges to successful integration of PDMPs in pharmacy practice.Item Nurse practitioner patient care patterns and practice characteristics : understanding the role of state scope-of-practice policies(2017-05-09) Norwood, Connor W.; Harle, Christopher; Menachemi, Nir; Stone, Cynthia; Liu, ZiyueIntroduction: The U.S. is faced with a primary care (PC) workforce shortage; an estimated 43 percent of the population has unmet health care needs and 18.2 percent of the adult population lacks a usual source of care (USC) provider. The workforce shortage limits even those with a USC from receiving the full scope of recommended clinical services. One promising solution is reforming scope-of-practice (SOP) policies for PC nurse practitioners (NPs). Objectives: The primary objective of this dissertation was to assess the impact of NP SOP policy implementation on NP practice patterns and patient access to PC by evaluating NP time spent delivering patient care, NP role as USC providers, patient travel times, and appointment availability. Methods: The studies discussed in this dissertation leveraged cross-sectional data from the National Sample Survey of Nurse Practitioners (NSSNP), time-series data from the Medical Expenditure Panel Survey (MEPS), and the Nurse Practitioner Professional Practice Index (NPPPI) to quantify variations in state policy environments. We used generalized mixed effects models to examine relationships in the cross-sectional data analyses and two-way fixed effect models to evaluate longitudinal data. Results: Our analyses revealed several key findings: NP SOP policies do impact the percentage of time NPs spend providing direct patient care; the NP workforce role as USC providers has increased as SOP policies have changed; states with supportive reimbursement policies have more NPs working as USC providers; and states with fewer NP supervision requirements have shorter patient travel times to USC providers. Conclusion: The U.S. health care system must continue to evolve to address the growing demand for PC services. While strategies to increase the supply of PC providers may be an effective long-term solution, our findings suggest that NP SOP reform may be a viable and complementary strategy to increasing the capacity of the PC workforce, providing more immediate relief.