Browsing by Subject "Health Policy"
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Item 2013 Indiana County Fact Sheets(2015-04) Nowak, Callie L.; Maxey, Hannah L.These fact sheets present detailed information on each of Indiana’s 92 counties. Information is provided on population and health system characteristics for each county which is critical to Indiana’s health system for planning and policy development. For each county, population characteristics such as age, race, economic indicators, health status, and education attainment were reported. Health system characteristics were also reported. Health workforce supply, healthcare facilities, and health professions shortages were used to estimate access to health care for each county. Data in each fact sheet provide stakeholders with information needed to improve the quality and accessibility of health care for Indiana residents through policy making, workforce development, and resource allocation. Additionally, fact sheets may be useful to local organizations seeking information for grant proposals or program implementation.Item Caring for Incarcerated Patients: Can it Ever be Equal?(Elsevier, 2021-11) Douglas, Anthony D.; Zaidi, Mohammad Y.; Maatman, Thomas K.; Choi, Jennifer N.; Meagher, Ashley D.; Surgery, School of MedicineBACKGROUND: Incarcerated patients represent one of the most vulnerable populations in the United States healthcare system. Studying disparities in care they receive, however, has been difficult due to a history of abuse at the hands of medical researchers rendering this population excluded from most current medical research. Due to incarceration, these patients are frequently maintained in shackles and under constant guard when receiving healthcare. There is a paucity of literature on the influence these measures exert on healthcare workers and the care they provide. Our study aimed to measure surgical trainee's perception of health inequities and disparities in incarcerated individuals undergoing surgical care. METHODS: An anonymous cross-sectional survey was administered at our single institution to all general surgery trainees assessing perceptions in delivering care to incarcerated patients within our hospital system. The survey consisted of 10 items, nine of which were yes or no responses, and 1 open-ended text question. Survey results were averaged, and percentages were reported. RESULTS: Of all current general surgery residents (n = 60), 40 (66%) completed the survey. Almost all respondents (n = 39, 97.5%) have cared for a patient that was incarcerated or in police custody. Most respondents (n = 25, 62.5%) have operated on an incarcerated patient with an armed guard present in the operating room. Similarly, most respondents (n = 26, 65%) have cared for a patient intubated and sedated that was shackled to a bed. The majority of respondents (n = 30, 75%) recalled incidents where a trauma patient was actively questioned by law enforcement during the primary/secondary survey during initial trauma evaluation. At the time of hospital discharge, a quarter (n = 10, 25%) of respondents reported being unable to prescribe all of the medications that a non-imprisoned patient would receive with the same condition. In addition, 18 (45%) respondents felt they were unable to arrange outpatient follow-up with physical or occupational therapy and/or the patient's primary/consulting physician due to patient's incarcerated status. Strikingly, half of respondents (n = 19, 47.5%) believed that the incarcerated patient received substandard care, and the majority of respondents (n = 28, 72%) agreed that the holding areas for incarcerated patients in the emergency room provide substandard patient care. CONCLUSIONS: The current status of caring for incarcerated patients within our system represents an urgent and needed area for quality improvement. Surgical trainees report difficulty caring for these patients, and they perceive these individuals receive substandard care. Though our cross-sectional study did not assess the origin of this disparity, the challenges trainees face in caring for incarcerated patients, from assessment to diagnosis and treatment, as well as in follow-up signals an area requiring further research and study.Item Contact Tracing, Intrastate and Interstate Quarantine, and Isolation(Public Health Law Watch, 2020-08) Silverman, Ross D.Contact tracing, quarantine and isolation are core communicable disease control measures used by public health departments as part of a comprehensive case ascertainment and management strategy. These are practices with historic roots enabled by state laws and policies, and have been used by other countries to slow and stop the spread of COVID-19. To date, their implementation as part of U.S. response efforts at the national, state, and local levels has been confounded by the scale of the COVID-19 outbreak; lack of a systemic infectious disease response; insufficient and fragmented funding streams; low levels of public accountability; and concerns about the impact of such efforts on individual privacy, liberty, and travel rights, as well as the financial and personal costs that may arise out of a positive diagnosis. Recommendations have been offered by expert groups on both the scaling up of contact tracing and ensuring ethical implementation of such measures. One state has passed legislation establishing an oversight framework for state contact tracing and associated data collection and use. Legal challenges to interstate quarantine rules have, thus far, been unsuccessful. Recommendations include: appropriating federal funding adequate to mount and sustain rapid, comprehensive, culturally-appropriate state and local testing, treatment, contact tracing, and supported quarantine and isolation service efforts; building contact tracing systems that cover social as well as health care supports for those affected; and, to bolster trust and participation in public health efforts, implement contact tracing-related health communication efforts targeted to reach the diverse array of communities affected by the epidemic.Item Data Report: 2012 Indiana Mental Health Professional Licensure Survey(2014-10) Sheff, Zachary T.; Maxey, Hannah L.; Barclay, Jonathan C.; Banti, SudhaItem Data Report: 2015 Indiana Nursing Licensure Survey(2016-06) Vaughn, S., Gano, L., Maxey, H.The mission of the Bowen Center for Health Workforce Research and Policy is to improve population health by contributing to informed health workforce policy through data management, community engagement, and original research. The Bowen Center has a rich history of collecting, analyzing, and disseminating health workforce data and research for the State of Indiana. These health workforce data are important to informing health workforce policy and planning efforts throughout Indiana. The nursing workforce represents the largest segment of the health workforce and works in a variety of settings to fulfill direct patient care, coordination of care, administrative and research roles.1 In fact, in 2015 Indiana had nearly 104,000 registered nurses (RNs) renew their professional license. Furthermore, as the number of medical students choosing to specialize in primary care decreases, the number of advanced practice nurses (APNs) has more than doubled over the past 20 years.2 Understanding the supply and distribution of the RN and APN workforce is critical to understand their capacity to meet healthcare needs and improve population health. The data presented in this report provides a snapshot of key demographic and practice characteristics for the RN workforce.Item Data Report: 2016 Indiana Physician Licensure Survey(2016-05) Vaughn, S., Gano, L., Maxey, H.The Bowen Center for Health Workforce Research and Policy, formerly called the Bowen Research Center, has a rich history of collecting, analyzing, and disseminating health workforce data and research for the State of Indiana. These health workforce data are important to informing health workforce policy and planning efforts through the State. Although the health workforce is comprised of a myriad of health professionals, the physician workforce may be regarded as the backbone of the healthcare system, which makes collecting and disseminating timely data on the supply and distribution of Indiana’s physician workforce critical to informing any health workforce policy or planning efforts. The 2016 Indiana Physician Licensure Survey Data Report presents key information and data collected from the physician re-licensure survey administered by the Indiana Professional Licensing Agency (IPLA) during physicians’ biennial license renewal. As of 2015, 26,536 physicians were licensed to practice in the State of Indiana. Of these, 10,057 physicians reported having an Indiana practice address. The majority of Indiana physicians reported having only one practice location in the state. Consistent with national trends, Indiana’s physicians are concentrated in populous, urban areas. In addition to understanding the geographic distribution of this workforce, practice characteristics are critical to determining capacity at the community level. A total of 6,285 (62%) physicians reported working 37 hours or more per week in direct patient care. Furthermore, roughly 52% of the physician workforce reported not offering a sliding fee scale. Also, 8.5% of Indiana physicians reported not accepting Medicaid. This report details important demographic and practice characteristics for the physician workforce. The report also examines these data for the primary care physician workforce and the psychiatric workforce. The 2015 Indiana Physician Licensure Survey Data Report presents a snapshot of data on the physician workforce in order to provide stakeholders with information needed to improve the quality and accessibility of health care for Indiana residents through policy making, workforce development, and resource allocation.Item High-Quality Nursing Home and Palliative Care-One and the Same(Elsevier, 2022) Ersek, Mary; Unroe, Kathleen T.; Carpenter, Joan G.; Cagle, John G.; Stephens, Caroline E.; Stevenson, David G.; Medicine, School of MedicineMany individuals receiving post-acute and long-term care services in nursing homes have unmet palliative and end-of-life care needs. Hospice has been the predominant approach to meeting these needs, although hospice services generally are available only to long-term care residents with a limited prognosis who choose to forego disease-modifying or curative therapies. Two additional approaches to meeting these needs are the provision of palliative care consultation through community- or hospital-based programs and facility-based palliative care services. However, access to this specialized care is limited, services are not clearly defined, and the empirical evidence of these approaches’ effectiveness is inadequate. In this paper, we review the existing evidence and challenges with each of these three approaches. We then describe a model for effective delivery of palliative and end-of-life care in nursing homes, one in which palliative and end-of-life care are seen as integral to high quality nursing home care. To achieve this vision, we make four recommendations: 1) Promote internal palliative and end-of-life care capacity through comprehensive training and support; 2) Ensure that state and federal payment policies and regulations do not create barriers to delivering high quality, person-centered palliative and end-of-life care; 3) Align nursing home quality measures to include palliative and end-of-life care-sensitive indicators; and 4) Support access to and integration of external palliative care services. These recommendations will require changes in the organization, delivery, and reimbursement of care. All nursing homes should provide high-quality palliative and end-of-life care, and this paper describes some key strategies to make this goal a reality.