Browsing by Subject "Health Services"
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Item Early childhood Child and Adolescent Needs and Strengths (CANS): Indiana multi-system comprehensive Glossary, v 2.2(2015-08) Walton, Betty A.; Moynihan, Stephanie N.; Cornett, StaceyThe early childhood or Birth to Five CANS assessment tool is developmentally appropriate for infants, toddlers and preschoolers. Similar to the Comprehensive Child and Adolescent Needs and Strengths (CANS, Lyons, 2009) 5 to 17 tool, the early childhood version considers basic life dimensions or domains (social/emotional needs, risk factors, risk behaviors, daily life functioning, child strengths, acculturation and caregiver strengths and needs).Item The impact of design on research teams in health services: A case study of the significance of the design artifact for interdisciplinary research and the generation of theoretical and applied lines of inquiry(John Benjamins, 2017-01-01) Sanematsu, Helen; Cripe, Larry D.; Herron School of Art and DesignThe development of patient communication tools in health services research often requires the skills of a designer who will give the tool its final, usable form. However, research teams frequently overlook the demands of implementation and focus instead on the delivery of content to the patient. In the study considered here, shared decision making in cancer treatment research was initiated by an interdisciplinary team without the participation of a designer. Once a designer began working on the team, the benefits she brought to the production of the designed artifact were evident. Design improved the team’s effectiveness through better communication, and allowed for further studies based on application and theory. Researchers responded positively to design and saw the potential for its application to a range of health research.Item Improving the Mental Health Functioning of Youth in Rural Communities(2013-07-03) Moore, Matthew A.; Walton, Betty A.Disparities in mental health outcomes for youth are often found between rural and urban areas. As part of an overarching question about under what circumstances and for whom, the wraparound process is beneficial (Suter & Bruns, 2009), this study specifically examined whether high fidelity to the wraparound model helped bridge the gap between outcomes in urban and rural areas for youth with complex behavioral health challenges. Youth participating in Indiana’s Community Alternatives to Psychiatric Residential Treatment Facilities Medicaid demonstration grant between 2008 and 2011 (n = 811) resided in urban (n = 615) or rural (n = 196) communities. Logistic regression examined treatment and contextual predictors of improvement in the mental health functioning of youth. High fidelity to the wraparound model and higher levels of initial behavioral health symptoms predicted improvement in mental health outcomes, with a small, but significant effect size (R2 = .129). Geography, demographic characteristics, initial risk behaviors, nor functional needs were significant predictors of change. Effectively implementing the wraparound process is a feasible strategy to reduce disparities in behavioral health outcomes for youth with complex needs in rural communities.Item Mapping the rules: conceptual and logical relationships in a system for pediatric clinical decision support(2013-10-07) Ralston, Rick K.; Odell, Jere D.; Whipple, Elizabeth C.; Liu, Gilbert C.The Child Health Improvement through Computer Automation (CHICA) system uses evidence-based guidelines and information collected in the clinic and stored in an electronic medical record (EMR) to inform physician and patient decision making. CHICA helps physicians to identify and select relevant screenings and also provides personalized, just-in-time information for patients. This system relies on a database of Medical Logic Modules (MLMS) written in the Arden Rules syntax. These MLMs store observations (StorObs) during the clinical encounter which trigger potential screenings and preventive health interventions for discussion with the patient or for follow up at the next visit. This poster shows how informationists worked with the CHICA team to describe the MLMs using standard vocabularies, including Medical Subject Headings (MeSH) and Logical Observation Identifiers Names and Codes (LOINC). After assigning keywords to the database of MLMs, the informationists used visualization tools to generate maps. These maps show how rules are related by logic (shared StorObs) and by concept (shared vocabulary). The CHICA team will use these maps to identify gaps in the clinical decision support database and (if needed) to develop rules which bridge related but currently isolated concepts.Item Paracentesis is Associated with Reduced Mortality in Patients Hospitalized with Cirrhosis and Ascites(Elsevier B.V., 2014-03) Orman, Eric S.; Hayashi, Paul H.; Bataller, Ramon; Barritt, A. Sidney IV; Department of Medicine, IU School of MedicineDiagnostic paracentesis is recommended for patients with cirrhosis admitted to the hospital for ascites or encephalopathy. However, it is not known if clinicians in the United States adhere to this recommendation; a relationship between paracentesis and clinical outcome has not been reported. We analyzed a US database to determine the frequency of paracentesis and its association with mortality. Methods The 2009 Nationwide Inpatient Sample (which contains data from approximately 8 million hospital discharges each year) was used to identify patients with cirrhosis and ascites admitted with a primary diagnosis of ascites or encephalopathy. In-hospital mortality, length of stay, and hospital charges were compared for those who did and did not undergo paracentesis. Outcomes were compared for those who received an early paracentesis (within 1 day of admission) and those who received one later. Results Of 17,711 eligible admissions, only 61% underwent paracentesis. In-hospital mortality was reduced by 24% among patients who underwent paracentesis (6.5% vs 8.5%, adjusted odds ratio [OR], 0.55; 95% confidence interval [CI], 0.41–0.74). Most paracenteses (66%) occurred ≤1 day after admission. In-hospital mortality was lower among patients who received early paracentesis than those who received it later (5.7% vs 8.1%; P=.049), although this difference was not significant after adjustment for confounders (OR, 1.26; 95% CI, 0.78–2.02). Among patients who underwent paracentesis, the mean hospital stay was 14% longer, and hospital charges were 29% greater than for patients that did not receive the procedure. Conclusions Paracentesis is underused for patients admitted to the hospital with ascites; the procedure is associated with increased short-term survival. These data support practice guidelines derived from expert opinion. Studies are needed to identify barriers to guideline adherence.Item Transforming Indiana’s Behavioral Health System for Children and Their Families(2006-08) Walton, Betty A.State (Boggs, 2005) and federal (New Freedom Commission on Mental Health, 2003; SAMSHA, 2005) policy calls for the transformation of mental health care to achieve the promise of recovery so that individuals are able to live, work, learn, and participate fully in their community. Access to effective treatments and support services are necessary to realize this promise (NFCMH, 2003). Transformation is by definition more than reform; it “represents the bold vision to change the very form and function of the mental health service delivery system to better meet the needs of individuals and families it was designed to serve .... it will be a complex process that proceeds in a non-linear fashion and that requires collaboration, innovation, sustained commitment, and a willingness to learn from mistakes” (SAMHSA, section 5, 2005). Why is transformation needed? What does transformation mean for the behavioral health system for children, youth and their families in Indiana?