Health Policy

Application of Global Positioning System Methods for the Study of Obesity and Hypertension Risk Among Low-Income Housing Residents in New York City: A Spatial Feasibility Study.

Application of Global Positioning System Methods for the Study of Obesity and Hypertension Risk Among Low-Income Housing Residents in New York City: A Spatial Feasibility Study.
Duncan DT, Regan SD, Shelley D, Day K, Ruff RR, Al-Bayan M, Elbel B. Application of Global Positioning System Methods for the Study of Obesity and Hypertension Risk Among Low-Income Housing Residents in New York City: A Spatial Feasibility Study. Geospatial Health. 2014; 9(1): 57-70.

Duncan DT, Regan SD, Shelley D, Day K, Ruff RR, Al-Bayan M, Elbel B.
11/10/2014

The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users
AIDS & Behavior, Sep 2014. DOI: 10.1007/s10461-014-0890-0

Mizuno, Y., D.W. Purcell, A.R. Knowlton, J.D. Wilkinson, M.N. Gourevitch, and K.R. Knight
09/24/2014

Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n = 1,052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p < 0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons.

Comparison of rehospitalization rates in France and the United States

Comparison of rehospitalization rates in France and the United States
Gusmano, MK, et al. Journal of Health Services Research & Policy; 20(1): 18-25.

Gusmano, MK. Rodwin, VG. Weisz, D. Cottenet, J. and Quantin, C.
09/24/2014

Objective: To compare rates of 30-day all-cause rehospitalization in France and the US among patients aged 65 years and older and explain any difference between the countries.

Methods: To calculate rehospitalization rates in France, we use an individual identifying variable in the national hospital administrative dataset to track unique individuals aged 65 years or more hospitalized in France in 2010. To calculate the proportion of rehospitalized patients (65þ) who received outpatient visits between the time of initial discharge and rehospitalization, we linked the hospital database with a database that includes all medical and surgical admissions. We used step by step regression models to predict rehospitalization.

Results: Rates of rehospitalization in France (14.7%) are lower than among Medicare beneficiaries in the US (20%). We find that age, sex, patient morbidity and the ownership status of the hospital are all correlated with rehospitalization in France.

Conclusions: Lower rates of rehospitalization in France appear to be due to a combination of better access to primary care, better health among the older French population, longer lengths of stay in French hospitals and the fact that French nursing homes do not face the same financial incentive to rehospitalize residents.

Presenting Quality Data to Vulnerable Groups: Charts, Summaries or Behavioral Economic Nudges?

Presenting Quality Data to Vulnerable Groups: Charts, Summaries or Behavioral Economic Nudges?
Elbel B, Schlesinger M. Responsive Consumerism: Empowerment in Markets for Health Plans. The Milbank Quarterly. 2009; 87(3): 633-682.

Elbel B, Gillespie C, Raven MC.
09/10/2014

OBJECTIVES:

Despite the increased focus on health care consumers' active choice, not enough is known about how to best facilitate the choice process. We sought to assess methods of improving this process for vulnerable consumers in the United States by testing alternatives that emphasize insights from behavioral economics, or 'nudges'.

METHODS:

We performed a hypothetical choice experiment where subjects were randomized to one of five experimental conditions and asked to choose a health center (location where they would receive all their care). The conditions presented the same information about health centers in different ways, including graphically as a chart, via written summary and using behavioral economics, 'nudging' consumers toward particular choices. We hypothesized that these 'nudges' might help simplify the choice process. Our primary outcomes focused on the health center chosen and whether consumers were willing to accept 'nudges'.

RESULTS:

We found that consumer choice was influenced by the method of presentation and the majority of consumers accepted the health center they were 'nudged' towards.

CONCLUSIONS:

Consumers were accepting of choices grounded in insights from behavioral economics and further consideration should be given to their role in patient choice.

Same Strategy Different Industry? Corporate Influence on Public Policy.

Same Strategy Different Industry? Corporate Influence on Public Policy.
Shelley D, Ogedegbe G, Elbel B. Same Strategy Different Industry? Corporate Influence on Public Policy. American Journal of Public Health. 2014; 104(4): e9-e11.

Shelley D, Ogedegbe G, Elbel B.
09/10/2014

In March 2013 a state judge invalidated New York City's proposal to ban sales of sugar-sweetened beverages larger than 16 ounces; the case is under appeal. This setback was attributable in part to opposition from the beverage industry and racial/ethnic minority organizations they support. We provide lessons from similar tobacco industry efforts to block policies that reduced smoking prevalence. We offer recommendations that draw on the tobacco control movement's success in thwarting industry influence and promoting public health policies that hold promise to improve population health.

Connecting the Dots: Interprofessional Health Education and Delivery System Redesign at the Veterans Health Administration

Connecting the Dots: Interprofessional Health Education and Delivery System Redesign at the Veterans Health Administration
Academic Medicine, Vol. 89, no. 8, pp. 1113-1116. DOI: 10.1097/ACM.0000000000000312

Gilman, S.C., D. Chokshi, J.L. Bowen, K.W. Rugen, and M. Cox
08/01/2014

Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

Using Comparative Analysis to Address Health System Caricatures

Using Comparative Analysis to Address Health System Caricatures
International Journal of Health Services; 44(3): 547–559. doi: http://dx.doi.org/10.2190/HS.44.3.g

Gusmano, MK. Rodwin, VG. and Weisz, D.
07/29/2014

To learn from health care systems abroad, we must move beyond simplistic characterizations and compare different systems with respect to salient performance measures. Despite findings from recent cross-national studies suggesting that many health care systems outperform the United States, claims by U.S. public officials often fail to acknowledge the actual accomplishments of health care systems abroad. We document significant variation among the United States and France, Germany, and England, which provide universal coverage, albeit in different ways. As previously documented, the United States has the highest rate of mortality amenable to health care. We extend this work by adding two indicators: (a) access to timely and effective primary care as measured by hospital discharges for avoidable hospital conditions; and (b) use of specialty services as indicated by coronary revascularization (bypass surgery and angioplasty), adjusted for the burden of coronary artery disease. Our findings indicate that: (a) the United States suffers the gravest consequences of financial barriers to primary care; (b) in all four countries, older people (65+) receive fewer revascularizations than their younger counterparts once we account for disease burden; and (c) in France, patients receive the most revascularizations, after adjusting for the burden of disease.

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