14 research outputs found
Health Professionals Training in the Era of the Patient Protection and Affordable Care Act (P.L. 111-148): Educating to Meet Workforce Demands
The 2010 Patient Protection and Affordable Care Act (P.L. 111-148) (PPACA) heralds new challenges for the education of health professionals and the development of a healthcare workforce primed to meet the influx of previously marginalized populations into healthcare systems. Changes in insurance coverage and mechanisms coupled with the focus on preventive care will require a healthcare workforce skilled in navigation, care coordination, ambulatory care models, and care for underserved populations. This dissertation is comprised of three studies that examine the current state of education for two professions impacted by the PPACA: social workers and physicians.
The first study, a systematic review of accredited MSW programs (n=200), was undertaken to investigate the level of health- related preparation provided by social work training program. Bivariate statistics and logistic regression models revealed that of the 200 programs, only 13 (6.5%) offer targeted health concentrations (HC). Controlling for university-level characteristics, university size (β=1.69, p \u3c .001) and presence of an MPH program (β=2.0, p\u3c.0001) were associated with having a HC.
The second study focused on education of medical students to meet PPACA stipulations of community-based training and graduates who go on to provide primary care. Using a grounded theory framework, 468 written assignments from a community-based experience were examined. Five domains emerged. Themes reflected a continuum of students\u27 abilities to understand the experiences and perspectives of community members and communicate their understanding.
The third manuscript examined resident experiences (N=22) in underserved communities through the lens of curricular requirements of community-based training. The assessment tool was found to have good reliability with Cronbach\u27s alpha coefficients for the scales in the assessment tool ranging from 0.88 to 0.95. Significant differences in pre- and post- educational intervention mean scores were found
A Monte Carlo simulation approach for estimating the health and economic impact of interventions provided at a student-run clinic
<div><p>Background</p><p>Student Run Clinics (SRCs) are a common aspect of medical education, present at more than half of US medical schools, and noted for providing care to communities that might otherwise lack access, including the uninsured and underinsured. To date, few studies have rigorously quantified the health and economic benefits of SRCs, and the present study remedies that.</p><p>Methods and findings</p><p>We used Monte Carlo simulations to estimate the health impact of common preventive health interventions applied to individuals in quality-adjusted life-years (QALYs). We then used those measurements to estimate the health and economic impact of United Community Clinic (UCC), a student-run clinic in Philadelphia, PA. We found that with an annual operating budget of 850,000 saved.</p><p>Conclusions</p><p>Using Monte Carlo simulation methods, the health and economic impact of SRCs can be reasonably estimated to demonstrate the utility of SRCs and justify their growing importance in the healthcare delivery landscape of the US.</p></div
Interventions with estimated coefficients of variation.
<p>Interventions with estimated coefficients of variation.</p
Annual health and economic impact of the preventive health interventions at UCC.
<p>Annual health and economic impact of the preventive health interventions at UCC.</p
Annual health and economic impact of potential preventive health interventions at UCC.
<p>Annual health and economic impact of potential preventive health interventions at UCC.</p
Kernel density estimation plots for QALYs/10<sup>3</sup>-interventions for 10<sup>6</sup> Monte Carlo simulations.
<p>Kernel density estimation plots for QALYs/10<sup>3</sup>-interventions for 10<sup>6</sup> Monte Carlo simulations.</p
QALYs/10<sup>3</sup>-interventions as calculated by Monte Carlo simulations.
<p>QALYs/10<sup>3</sup>-interventions as calculated by Monte Carlo simulations.</p
Perspectives and Practice in the Identification and Treatment of Opioid Use, Alcohol Use, and Depressive Disorders
How Nurse-Led Practices Perceive Implementation of the Patient-Centered Medical Home
Purpose The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. Methods Data were collected through in-depth interviews with providers and staff in nurse-led practices. Results These data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators. In addition, a number of barriers were identified to implementing the PCMH model. Overall, these practices creatively engaged in the transformation process by structuring themselves as a complex adaptive system and building upon the core principles of nurse-led care. Conclusion Since the core principles of nurse-led care map onto many of the same principles of the PCMH model, this study discusses the possibility that nurse-led practices may experience fewer barriers when transitioning into PCMHs