Browsing by Author "Stone, Cynthia L."

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Developing a Model Curriculum for a University Course in Health Impact Assessment in the United States
    (Taylor & Francis, 2014-10-29) Pollack, Keshia M.; Dannenberg, Andrew L.; Botchwey, Nisha D.; Stone, Cynthia L.; Seto, Edmund
    As Health Impact Assessment (HIA) become increasingly common in the U.S. there is growing demand for instruction beyond sho1i courses and online training. As of October 2013, there are graduate level courses that include instruction on HIA in at least 17 universities in the U.S., including 4 courses that focus explicitly on HIA. Instructors of these four courses collaborated to develop a model curriculum for teaching HIA that draws on a framework for experiential learning and on a theoretical model of curriculum formulation. This article includes an in-depth analysis of these courses and presents a model curriculum for HIA instruction during an academic quaiier or semester course in a University. This model curriculum may help faculty develop a graduate level HIA course at their institution, as well as inform public health and community design professionals interested in building capacity to conduct HIAs, and students considering taking an HIA course. International instructors could also learn from the U.S. experience, and apply the model curriculum to their setting and educational structure.
  • Thumbnail Image
    Item
    First Do No Harm - The Indiana Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain
    (State of Indiana, 2013) Bell-Sharp, Kim; Gregory, Eigner; Brooks, Tracy L.; Elliott, Alicia; Cragen, Debbie; Ersin, Ozlem H.; Croasdell, Lori; Fernandes, Taya; Duwve, Joan; Fielding, Stephen M.; Gentry, Mark E.; Greene, Marion S.; King, Timothy E.; Kelley, Kristen; Konchalski, Jan; Kuzma, Abigail; LaHood, Amy; MacKie, Palmer J.; McMahan, Deborah; Mowry, James B.; Park, Esther J.; Pontones, Pam; Ring, Barry S.; Robinson, Natalie; Roth, Daniel C.; Rumsey, Todd C.; Schreier, Eric M.; Stone, Cynthia L.; Straub, Tom; Welch, Peggy; Sybesma, J. Michelle; Symmes, Shelly; Whitworth, Michael; Vaught, Cynthia; Weitlauf, Sharon L.; Weaver, Tamara; Zachodni, Carla
    "First Do No Harm: The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain" was developed by the Indiana Prescription Drug Abuse Prevention Task Force’s Education Committee under the leadership of Dr. Deborah McMahan. This provider toolkit, based on expert opinion and recognized standards of care, was developed over many months with the input of healthcare providers representing multiple specialties and all corners of the state. First Do No Harm provides options for the safe and responsible treatment of chronic pain, including prescriptions for opioids when indicated, with the ultimate goals of patient safety and functional improvement. It was developed as an interactive compendium to the new Medical Licensing Board rule addressing Opioid Prescribing for Chronic, Non-terminal Pain to give healthcare providers tools they can use to comply with the rule.
  • Thumbnail Image
    Item
    The legal and ethical implications of the Indiana surrogate decision making impact on physicians and patient care in Indiana hospitals
    (2015) Comer, Amber R.; Silverman, Ross David; Torke, Alexia Mary; Eberl, Jason; Gaffney, Margaret M.; Stone, Cynthia L.
    Background: When a patient is incapacitated and unable to make health care decisions, a surrogate decision maker must be designated to make decisions about the patient’s care in his or her place. Studies show that fewer than 20% of patients in hospitals present with a designated health care representative form. Therefore, the overwhelming majority of surrogates in hospitals are identified via default state statutes. Little is known about the implications of state default surrogate decision making statutes on physicians and patient care in clinical practice. Methods: An evaluation of state surrogate decision making statutes was conducted in order to determine variability among state laws. Additionally, a statewide, quantitative, descriptive, cross-sectional survey of a random sample of 405 physicians working in Indiana hospitals was conducted to determine: 1) physicians’ knowledge of Indiana’s surrogate decision making law; 2) physicians’ approaches to hypothetical cases they might encounter in hospital practice; and 3) any delay in patient care physicians experience as a result of state surrogate decision making laws. Results: There is very little consistency among states regarding who may serve as a surrogate decision maker. In Indiana, less than half of the surveyed physicians (47.90%) were able to correctly identify legally allowable surrogates. When presented with clinica vignettes, nearly all physicians (84.90%) report that they would allow a grandchild to act as a surrogate decision maker, even though grandchildren are not legal surrogates under the law. Additionally, more than half of physicians (53.8%) experienced a delay in patient care due to the inability to identify a legal surrogate. Conclusions: The narrow construction of state laws can leave patients in situations where they either have no qualified surrogate under the law or where they have multiple surrogates. If there are multiple surrogates with competing interests a consensus may not be reached on the patient’s medical care. These situations result in a delay of patient care. The results of this study show that the Indiana Surrogate Decision Making law is flawed as it does not reflect the composition of Indiana families and leads to delays in patient care.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Physician understanding and application of surrogate decision-making laws in clinical practice
    (Taylor & Francis, 2016) Comer, Amber Rose; Gaffney, Margaret; Stone, Cynthia L.; Torke, Alexia; Department of Health Sciences, School of Health and Rehabilitation Sciences
    Background: Although state surrogate laws are the most common way surrogate decision makers are identified, no studies have been conducted to determine physician understanding of these laws or how these laws are utilized during clinical practice. The purpose of this study is to better understand how surrogate decision-making laws function in practice. Methods: A cross-sectional survey of 412 physicians working in Indiana hospitals was conducted between November 2014 and January 2015 to determine physicians' knowledge of Indiana's surrogate decision-making law and physicians' approaches to hypothetical cases using the law in clinical practice. Results: Fewer than half of physicians (48%) were able to correctly identify all legally allowable surrogate decision makers. Of those physicians who knew the law, nearly all of them (98%) indicated that they would violate the law during clinical practice by allowing nonlegal surrogates such as grandchildren to make medical decisions. Conclusions: A majority of physicians endorse relying on surrogates who have strong ties to the patient but are not legally allowable in Indiana. It is possible that these decisions reflect sound ethical reasoning even though they are illegal. Due to the narrow construction of some state surrogate decision laws, physicians may be placed in the position where they must either choose to follow medical ethical principles or the law. To alleviate these issues, state surrogate decision laws need to be amended to include a broader list of surrogates, such as extended family and close friends.