Browsing by Subject "access to care"

Now showing 1 - 4 of 4
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    Patient-Centered Appointment Scheduling Using Agent-Based Simulation
    (2014-11) Turkcan, Ayten; Toscos, Tammy; Doebbeling, Bradley N.; Department of BioHealth Informatics, School of Informatics and Computing
    Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling.
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    Time Required for Planned and Unplanned Episodes of Care in Septic Two-Stage Revision Hip and Knee Arthroplasty
    (Elsevier, 2022-04) Hulsman, Luci A.; Ziemba-Davis, Mary; Hicks, Shelly A.; Meneghini, R. Michael; Buller, Leonard T.; Orthopaedic Surgery, School of Medicine
    Background Septic revision total hip (rTHA) and knee (rTKA) arthroplasty requires more effort but is reimbursed less than primary procedures per minute of intraoperative time. This study quantified planned and unplanned work performed by the surgical team for septic 2-stage revision surgeries during the entire episode-of-care “reimbursement window” and compared that time to allowable reimbursement amounts. Methods Between October 2010 and December 2020 all unilateral septic 2-stage rTHA and rTKA procedures performed by a single surgeon at a single institution were retrospectively reviewed. Time dedicated to planned work was calculated over each episode of care, from surgery scheduling to 90 days postoperatively. Impromptu patient inquiries and treatments after discharge, but within the episode of care, involving the surgeon/surgeon team constituted unplanned work. Planned and unplanned work minutes were summed and divided by the number of patients reviewed to obtain average minutes of work per patient. Results Sixty-eight hips and 64 knees were included. For 2-stage rTHA and rTKA the average time per patient for planned care was 1728 and 1716 minutes and for unplanned care was 339 and 237 minutes. Compared to the Centers for Medicare and Medicaid Services’ allowable reimbursement times, an additional 799 and 887 minutes of uncompensated time was required to care for 2-stage rTHA and rTKA patients. Conclusion Two-stage revision procedures are substantially more complex than primary procedures. Financially disincentivizing surgeons to care for these patients reduces access to care when high-quality care is most needed. These findings support increasing the allowable times for 2-stage septic revision cases.
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    Willingness and Ability of Dental Healthcare Workers to Work During the COVID-19 Pandemic
    (Elsevier, 2021) Scully, Allison C.; Joshi, Ajay P.; Rector, Julia M.; Eckert, George J.; Pediatric Dentistry, School of Dentistry
    Background The 2019 novel coronavirus pandemic continues to disrupt dental practice in the United States. Dental health care workers (DHCWs) play an integral role in societal health, yet little is known about their willingness and ability to work during a pandemic.background Methods DHCWs completed a survey distributed on dental specific Facebook groups for an eight-week period (May 2020-June 2020) about their willingness and ability to work during the COVID-19 pandemic, barriers to working, and willingness to take a COVID-19 vaccine. Results 459 surveys were returned. Only 53% of dentists, 33% of hygienists, 29% of assistants and 48% of non-clinical staff would be able to work a normal shift during the pandemic, while even fewer (50%, 18%, 17%, 38% respectively) would be willing to work a normal shift. Barriers included caring for family, a second job and personal obligations and were faced by assistants and hygienists. Dentists were more likely than hygienists (p<0.001), assistants (p<0.001) and non-clinical staff (p=0.014) to take a COVID-19 vaccine.results Conclusions DHCWs have a decreased ability and willingness to report to work during a pandemic, with dentists being significantly more able and willing to work than hygienists and assistants. Dentists are more likely than staff to take a COVID-19 vaccine.
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    “Women Never Use Drugs Alone” Assessing Stigma & Access to Care among Women who use Drugs.
    (2019-07) Essex, Amanda; Lawrence, Carrie; Turner, Brooklyne
    Increased rates of opioid misuse among pregnant women has become a significant public health issue in Indiana. Nation-wide the rate of opioid use among pregnant women has quadrupled since 2005, and Indiana is following the same trend. As this issue grows it becomes increasingly important to understand the unique needs of this vulnerable population. Mothers who use illicit drugs during pregnancy often have fewer prenatal care visits than non-using mothers. The issue of prenatal care access is intensified among women of color who systematically experience greater health disparities and inequities. Without access to adequate prenatal care both mothers and their children risk various health consequences. In Indiana, a state that is ranked among the 10 worst states for infant and maternal mortality, addressing stigma and factors that contribute to prenatal care barriers is critical. This qualitative study sought to assess the current role of stigma and identify other barriers to health and healthcare services among women of childbearing age in Indiana who use or have used illicit drugs and identify ways to improve their experiences with and access to these services.