Search

Presents a study which assessed whether insurance coverage is associated with the differences in hospital resource allocation among sick newborns in California in 1987. Measures of hospital resource allocation to sick newborns and difference by insurance status; Differences in total charges according to insurance status among sick newborns; Severity of medical problems among sick newborns in the state.

Objectives To explore how older adults in the community with a limited life expectancy make healthcare decisions and the processes used when they are not in an acute crisis. Design Grounded theory. Setting Medical programs and geriatrics clinics at the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center. Participants Community-dwelling adults aged 67 to 98 with a life expectancy of less than 1 year (N = 20). Measurements In-depth semistructured interviews in participants' homes. Constant comparative analysis was used to develop codes and identify themes. Results Participants generally delegated decisions to others, expressing their wishes by describing desired end-of-life outcomes and highlighting meaningful aspects of their lives. They did this in the belief that the delegate would make appropriate decisions on their behalf. In this way, participants were able to achieve a sense of control without being in control of decisions. Four themes emerged from the analysis that reflect the various approaches participants used to articulate their goals and maintain a sense of control: direct communication, third-party analogies, adaptive denial, and engaged avoidance. Conclusion These findings challenge the prevailing view of personal autonomy. These older adults suggest a path to decision-making that focuses on priorities and goals, allowing them to take a more-passive approach to decision-making while still maintaining a sense of control. [ABSTRACT FROM AUTHOR]

An index of relative need for health resources was developed to assist the California Rural Indian Health Board in allocating limited funds to rural California Indian health projects. The index was constructed by determining the relative weight of each project according to the following criteria: the current population served, the total population in the service area, the population density of the service area, the proportion of the population that lives within 30 minutes of the health facility, the distance of the health facility from the nearest urban area, and weather. A multi-step process was then used to determine weights to assign to each of the individual criteria. [ABSTRACT FROM AUTHOR]

The article discusses issues related to the use of data to plan and fund HIV/AIDS care services for underserved populations under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. To consolidate all programs funded under the CARE Act, the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA) was formed in August 1997. The CARE Act became law on August 15, 1990, to improve the quality and availability of care for people with HIV/AIDS and their families. It was amended and reauthorized in May 1996 and again in November 2000. HRSA has improved the availability of service data to CARE Act programs by developing the CARE Act Data Report, which is used by all service programs of the CARE Act. But, the CARE Act planning is complicated by the kinds and quality of the data it must consider. Qualitative data are a rich source for describing what the epidemiologic data cannot. Priority setting and resource allocation is mandated in the CARE Act as a planning step in which information compiled from other planning work, particularly needs assessments, is used to determine how to prioritize needs.

People experiencing homelessness (PEH) have been disproportionately affected by COVID-19, yet their vaccination coverage is lower than is that of the general population. We implemented a COVID-19 vaccination program that used evidence-based and culturally tailored approaches to promote vaccine uptake and equity for PEH in Los Angeles County, California. From February 2021 through February 2022, 33 977 doses of vaccine were administered at 2658 clinics, and 9275 PEH were fully vaccinated. This program may serve as a model for future service delivery in vulnerable populations. (Am J Public Health. 2023;113(2):170–174. https://doi.org/10.2105/AJPH.2022.307147) [ABSTRACT FROM AUTHOR]

Objective: To examine the feasibility of a self-guided, Web-based program for universal prevention of anxiety and depression in university students. Participants: University students (n = 651) enrolled in the tested program (March, 2016). Methods: The program delivered eight weeks of mental health skills (e.g., behavioral activation, mindfulness). Data was collected online through an entry survey, weekly check-in surveys, and a post-program feedback survey. Results: Campus-wide recruitment emails were the most encountered recruitment strategy (82%). In terms of adherence, the program was initiated by 73% of students and fully completed by 11% of students. There was some evidence of program acceptability (e.g., 71% of students endorsed the program as "useful"). Common qualitative themes further suggested acceptability for some aspects of the program while also highlighting others for revision. Conclusion: Findings support further development of the online program and recommendations are made for improving the platform before future testing. [ABSTRACT FROM AUTHOR]

Aims: To identify and describe profiles of nursing resources and compare nurse and patient outcomes among the identified nursing resource profiles. Background: Research linking nurse education, staffing, and the work environment treats these nursing resources as separate variables. Individual hospitals exhibit distinct profiles of these resources. Methods: This cross‐sectional secondary analysis used 2006 data from 692 hospitals in four states. Latent class mixture modelling was used to identify resource profiles. Regression models estimated the associations among the profiles and outcomes. Results: Three profiles were identified (better, mixed and poor) according to their nursing resource levels. Hospitals with poor profiles were disproportionately mid‐sized, for‐profit, and had lower technology capability. Nurse job outcomes, patient mortality and care experiences were significantly improved in hospitals with better resource profiles. Conclusions: Hospitals exhibit distinct profiles of nursing resources that reflect investments into nursing. Nurse and patient outcomes and patients' experiences are improved in hospitals with better nursing resource profiles. This finding is consistent with the literature that has examined these resources independently. Implications for Nursing Management: Nurse managers can identify their nursing resource profile and the associated outcomes. Our results show the advantages of improving one's hospital nursing resource profile, motivating managers to make an informed decision regarding investments in nursing resources. [ABSTRACT FROM AUTHOR]

Purpose: In the face of growing demand for care and tightening resource constraints, hospitals need to ensure access to care that is affordable and effective. Yet, the multiplicity of objectives is a key challenge in this industry. An understanding of the interrelationships (tradeoffs) between the multiple outcome objectives of care (throughput, experiential and financial performance) and returns to operational inputs (diversification of care) is fundamental to improving access to care that is effective and affordable. This study serves to address this need. Design/methodology/approach: The empirical analysis in the study builds on an output-oriented distance function model and uses a longitudinal panel dataset from 153 hospitals in California. Findings: This study results point to key insights related to output–output tradeoffs along the production frontier. Specifically, the authors find that higher throughput rates may lead to significantly lower levels of experiential quality, and net revenue from operations, accounting for the clinical quality of care. Similarly, the authors' findings highlight the resource intensity and operational challenges of improving experiential quality of care. In regards to input–output relationships, this study finds diversification of care is associated with increased throughput, improvements in service satisfaction and a corresponding increase in the net revenue from operations. Originality/value: Highlighting the tradeoffs along the production frontier among the various outcomes of interest (throughput, experiential quality and net revenue from operations), and highlighting the link between diversification of care and care delivery outcomes at the hospital level are key contributions of this study. An understanding of the tradeoffs and returns in healthcare delivery serves to inform policy-making with key managerial implications in the delivery of care. [ABSTRACT FROM AUTHOR]

Historically, California supplemented federal funding of HIV prevention and testing so that Californians with HIV could become aware of their infection and obtain lifesaving treatment. However, budget deficits in 2009 led the state to eliminate its supplemental funding for HIV prevention. We analyzed the impact of California's HIV resource allocation change between state fiscal years 2009 and 2011. We found that the number of HIV tests declined 19 percent, from 66,629 to 53,760, in local health jurisdictions with high HIV burden. In low-burden jurisdictions, the number of HIV tests declined 90 percent, from 20,302 to 2,116. New diagnoses fell from 2,434 in 2009 to 2,235 in 2011 (calendar years) in high-burden jurisdictions and from 346 to 327 in low-burden ones. California's budget crunch prompted state and local programs to redirect remaining HIV funds from risk reduction education to testing activities. Thus, the impact of the budget cuts on HIV tests and new HIV diagnoses was smaller than might have been expected given the size of the cuts. As California's fiscal outlook improves, we recommend that the state restore supplemental funding for HIV prevention and testing. [ABSTRACT FROM AUTHOR]

CBT is considered the first-line treatment for anxiety disorders, particularly when it involves gradual confrontation with feared stimuli (i.e., exposure); however, delivery of CBT for anxiety disorders in real-world community clinics is lacking. This study utilized surveys we developed with key stakeholder feedback (patient, provider, and administrator) to assess patient and provider/administrator perceptions of the barriers to delivering (or receiving) CBT for anxiety disorders. Providers/administrators from two counties in California (N = 106) indicated lack of training/competency as primary barriers. Patients in one large county (N = 42) reported their own symptoms most often impacted treatment receipt. Both groups endorsed acceptability of exposure but indicated that its use in treatment provided/received had been limited. Implications and recommendations are discussed. [ABSTRACT FROM AUTHOR]

Frequent emergency department (ED) use often serves as a marker for poor access to non-ED ambulatory care. Policy makers and providers hoped that by expanding coverage, the Affordable Care Act (ACA) would curtail frequent ED use. We used data from California's Office of Statewide Health Planning and Development to compare the characteristics of frequent ED users among nonelderly adults in California before and after implementation of several major coverage expansion provisions in the ACA. Frequent users--patients with four or more annual ED visits--accounted for 7.9 percent of ED patients before and 8.5 percent after those provisions were implemented, and they were responsible for 30.7 percent of all visits before and 31.6 percent after. However, after controlling for patient-level characteristics, we found that the odds of being a frequent ED user were significantly lower post ACA for Medicaid-insured patients. Uninsured patients were also less likely to be frequent users post ACA, while privately insured patients experienced little change. The largest predictors of frequent ED use included having a diagnosis of a mental health condition or a substance use disorder. Interventions to address frequent ED use must involve Medicaid managed care plans, given that more than two-thirds of frequent ED users post ACA have Medicaid as their primary coverage source. [ABSTRACT FROM AUTHOR]

Routine HIV screening, linkage, and retention in health care are nodes of the HIV continuum of care and goals of the National HIV/AIDS Strategy. However, up to 80% of youth are unaware of their HIV status, 29% are linked to and less than 50% are engaged in HIV health care, and fewer maintain viral suppression. To fill these gaps and to address the national call to establish a seamless system for quality HIV health care, the authors describe the processes by which the SMILE Program, with ATN-affiliated Connect-to-Protect® (C2P) community coalitions, addressed structural barriers that prevented HIV testing, linkage, and engagement in HIV health care among youth. [ABSTRACT FROM PUBLISHER]

Risk assessment differs from other medical interventions in that the welfare of the patient is not the immediate object of the intervention. However, improving the risk assessment process may reduce the chance of risk assessment itself being unjust. We explore the ethical arguments in relation to risk assessment as a medical intervention, drawing analogies, where applicable, with ethical arguments raised by general medical investigations. The article concludes by supporting the structured professional judgement approach as a method of risk assessment that is most consistent with the respect for principles of medical ethics. Recommendations are made for the future direction of risk assessment indicated by ethical theory. [ABSTRACT FROM AUTHOR]

Objectives. To examine changes in HIV-positive patient enrollment in a large health care delivery system before and after key Affordable Care Act (ACA) provisions went into effect in 2014. Methods. Analyses compared HIV-positive patients newly enrolled in Kaiser Permanente Northern California between January and June 2012 (n = 339) to those newly enrolled between January and June 2014 through the California insurance exchange or via other mechanisms (n = 549). Results. After the ACA, the HIV-positive patient enrollment increased. These new enrollees were more likely to be male (93.6% vs 89.1%; P = .01), to be enrolled in high-deductible benefit plans (≥ $1000; 18.8% vs 5.5%; P = .01), and to have better HIV viral control (HIV RNA levels below limits of quantification 79.5% vs 73.6%; P = .05) compared with pre-ACA new enrollees. Among post-ACA new enrollees, there were more patients in the lowest and highest age groups. Post-ACA exchange enrollees (22%) were more likely to be male and to have high-deductible plans than those enrolled through other mechanisms. Conclusions. More men, higher deductibles, and better HIV viral control characterize newly enrolled HIV-positive patients after the ACA in California.Public health implications. Evolving characteristics of HIV-positive enrollees may affect HIV policy, patient care needs, and service utilization. [ABSTRACT FROM AUTHOR]

The Fall Prevention Center of Excellence (Center), a consortium of federal, state, and private organizations, was established in 2005 to guide the implementation of a statewide initiative to prevent falls among older Californians. The process began with the convening of a representative group of recognized leaders in California's health and human services in 2003. This group engaged in a 2-day strategic planning process that culminated in the development of the California Blueprint for Fall Prevention. The overarching goal of the Blueprint is to build a statewide infrastructure for fall prevention services and programs that will serve as a model for the rest of the country. The specific goals of the Center are to establish fall prevention as a key public health priority in California; create, test, and evaluate effective and sustainable fall prevention programs; and build a comprehensive and sustainable fall prevention system in California. To accomplish these goals, the Center is currently engaged in developing and disseminating fall prevention tools and informational resources directed at the needs of both consumer and professional audiences; linking organizations involved in fall prevention while increasing awareness of fall prevention as an important public health issue; and helping communities build their capacity to effectively address falls in older adults through the delivery of integrated fall prevention services and “best practice” programs. [ABSTRACT FROM AUTHOR]

Examines the creation of incentives for consumers and providers to make economical choices on health care purchasing in California. Development of economical delivery systems; Adoption of managed competition; Aggregations of employees and concentrations in insurance markets.

This article reports on the decrease in obstetric services due to changes in Medicaid reimbursement rates in California. The usual Medicaid reimbursement for all physician fees has been reduced to 47% from 75%. This low reimbursement rate coupled with higher malpractice insurance costs and the increased malpractice risk of Medicaid patients makes the Medicaid obstetric patient a most unappealing potential client. The result is that many women on Medicaid in California cannot find physicians willing to provide prenatal care and delivery services.