23 research outputs found
Barriers to Utilizing Medicaid Smoking Cessation Benefits
Introduction. Smoking is the number one preventable cause of deathin the United States. Under the Affordable Care Act, Kansas Medicaidcovers all seven FDA-approved smoking cessation therapies.However, it is estimated only 3% of Kansas Medicaid smokers usetreatment compared to the national estimate of 10%. The objectiveis to determine systemic barriers in place that prevent optimal utilizationof Medicaid smoking cessation benefits among KU MedicalCenter Internal Medicine patients.
Methods. For this quality improvement project, a population of 169Kansas Medicaid smokers was identified who had been seen at the KUInternal Medicine Clinic from January 1, 2015 - February 16, 2016.Phone surveys were completed with 62 individuals about smokingstatus, interest in using smoking cessation treatment options, andawareness of Medicaid coverage of treatment.
Results. Of the 62 respondents, 24 (39%) were prescribed pharmacotherapyand 41 (66%) were interested in using smoking cessationtreatment. There were eight who had quit smoking. Of the remaining54 smokers, 31 (57%) were unaware that Medicaid would coverpharmacotherapy. Of 24 participants who received a prescription forpharmacotherapy, 13 (54%) were able to fill the prescription at no costusing the Medicaid benefit.
Conclusion. The majority of respondents were interested in usingsmoking cessation treatment, yet three main barriers existed to usingMedicaid smoking cessation benefits: physicians not prescribingtreatment to patients, patients not aware of Medicaid coverage, andinadequate pharmacy filling. Improved physician and patient awarenessof Medicaid coverage will facilitate more patients receivingsmoking cessation therapy and ultimately quitting smoking.KS J Med 2017;10(4):88-91
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A Framework for Making Sustainable Cleanup Decisions Using the KONVERGENCE Model
The effects of closure decisions for used nuclear facilities can extend centuries into the future. Yet, the longevity of decisions made over the past half century has been poor. Our goal is an improved decision framework for decommissioning, stewardship, and waste management. This paper describes our overall framework. Companion papers describe the underlying philosophy of the KONVERGENCE Model for Sustainable Decisions1 and implications for a class of intractable decision problems.2 Where knowledge, values, and resources converge (the K, V, and R in KONVERGENCE), you will find a sustainable decision – a decision that works over time. Our approach clarifies what is needed to make and keep decisions over relevant time periods. The process guides participants through establishing the real problem, understanding the universes of knowledge, values, resources, and generating alternatives. We explore three classes of alternatives – reusable (e.g. greenfield), closed (e.g. entombed structures), and adaptable. After testing for konvergence of alternatives among knowledge, values, resources, we offer suggestions to diagnose divergence, to reduce divergence by refining alternatives to address identified weaknesses, and to plan to keep konvergence over the life of the decision. We believe that decisions made via this method will better stand the test of time – because it will be either acceptable to keep them unchanged or possible to adapt them as knowledge, values, and resources change
Somewhere in the night there must be someone for me, [first line of chorus]
Performers: June Haver, George Montgomery, Vivian Blaine, Celeste Holm, Vera-Ellen, Frank LatimorePiano, Voice and Chord
This isn\u27t sometimes, this is always. This isn\u27t maybe, [first line of chorus]
Performers: June Haver, George Montgomery, Vivian Blaine, Celeste Holm, Vera-Ellen, Frank LatimorePiano, Voice and Chord
Enhancing the uptake of systematic reviews of effects: what is the best format for health care managers and policy-makers? A mixed-methods study
Abstract Background Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. Methods A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs. Results Two hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1–7) and content (Mdn = 4; IQR = 3; range = 1–7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]). Conclusions HCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial