Swanee Shore : A Dreamy Southern Waltz Song

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To Examine the Rate of Establishing a Primary Care Home in Uninsured Unassigned Patients Referred from the Emergency Department

Background: Currently, over 45 million people in the United States are uninsured. Many among the uninsured population are not established with a primary care provider and therefore utilize the Emergency Department (ED) for non-emergency concerns. Investigators have examined the impact a primary care referral has on subsequent ED utilization. At University of New Mexico Hospital (UNMH), Murnik et al asked if scheduling follow-up visits for uninsured patients using the ED to a primary care clinic would decrease subsequent ED utilization. The follow-up visits were scheduled using the Community Access Program for Central New Mexico (CAP-NM) a HIPAA compliant web-based system developed to share medical information from UNMH-ED and a consortium of six safety net community primary care clinics. Murnik et al results showed a 31% reduction of ED visits in referred patients compared to the control group. However, the number of clinic follow up visits for referred patients not was determined. Purpose: To determine the number of visits made to a primary care home by uninsured, unassigned patients referred from the emergency department. Methods: CAP-NM data base included 484 patients given a referral to primary care clinic between January 27, 2005 and November 30, 2005. The establishment of a primary care home\u27 was defined as at least two visits within a two-year period. Referral counts were limited to those made from the UNMH Emergency Ward to one of the First Choice Community Healthcare clinics. Results: There were 203/484 (42%) of referred patients that made one or more First Choice visit in the two years following the CAP referral. Of the 203, 103 (50%) had one visit; 35 (17%) had two visits; 27 (13%) had three visits; 12 (6%) had 4 visits; 11 (5%) had 5 visits; 3 (1%) had 6 visits; 4 (2%) had 7 visits; 2 (1%) had 8 visits; 4 (2%) had 9 visits; 1 (0.5%) had 10 visits; 1 (0.5%) had 11 visits; and 1 (0.5%) had 13 visits. Therefore, there were 101 out of the 484 (21%) who had two or more visits, meeting the criteria of having established a \u27medical home.\u27 Conclusions: This study of the First Choice Community Healthcare Clinic shows that referral of uninsured patients from the emergency department to a primary care home results in only one fifth of patients establishing a medical home. Further research is needed to determine effective interventions to increase patients\u27 establishing such a home.\u2

Planning and Implementing a Public Health Certificate (PHC) for All Medical Students at the University of New Mexico

Context The University of New Mexico School of Medicine (UNM SOM) will require that all medical students graduate with a Public Health Certificate (PHC). Strategies to overcome identified barriers to implementation of the Certificate have been identified. Objectives - To illustrate the process involved in implementing the PHC - To share the planning and implementation outcomes Setting - Southwestern, U.S. Institution of Higher Education (IHE), the UNM SOM in collaboration with one other IHE, community agencies and organizations interventions - Assess and modify institutional policies and resources that may hinder implementation of the PHC - Identify where PHC curriculum elements can be integrated into existing courses and training venues - Develop evaluation measures to measure outcomes Main Outcomes Integration of the PHC in the medical school curriculum; inter and intra collaboration of the various programs, divisions, and departments; graduate all medical students with a PHC; assess what works and what needs improvement in the process Conclusions - The process of creating a required PHC for all medical students is very rewarding, yet challenging. Extensive planning, flexibility, creativity, collaboration, and resources are essential to make the PHC a realit

Effect of high up front charges on access to surgery for poor patients at a public hospital in New Mexico

BACKGROUND: A public hospital in New Mexico required collection of 50% of estimated costs prior to elective surgeries for self-pay patients. This study assesses the impact of this policy on access to elective surgical procedures. METHODS: Chi-square tests determined if there was a statistically significant difference between the number of self-pay and insured patient cancellations for financial reasons. A multivariate binomial regression model was used to calculate risk ratios and confidence limits for effects of race/ethnicity, and insurance status, controlling for gender, on these cancellations. RESULTS: Of the 667 cancellations, there were 99 self-pay and 568 insured patients. Cancellations for financial reasons occurred in 55.6% of self-pay and 9.3% of insured patients (p < 0.0001). Inability to pay 50% up front accounted for 76.4% of self-pay patient cancellations for financial reasons. Self-pay, non-Hispanic whites and minority race/ethnicities were 8.76 and 8.61 times more likely to cancel for financial reasons, respectively, than insured non-Hispanic whites. CONCLUSION: Self-pay patients, regardless of race/ethnicity, have elective surgical procedures cancelled for financial reasons significantly more often than insured patients. The hospital's 50% up-front payment policy represents a significant financial barrier to accessing elective surgical procedures for self-pay patients

Fuel cell and system for supplying electrolyte thereto with wick feed

An electrolyte distribution and supply system for use with a fuel cell having a means for drawing electrolyte therein is formed by a set of containers of electrolyte joined to respective fuel cells in a stack of such cells. The electrolyte is separately stored so as to provide for electrical isolation between electrolytes of the individual cells of the stack. Individual storage compartments are coupled by tubes containing wicking fibers, the ends of the respective tubes terminating on the means for drawing electrolyte in each of the respective fuel cells. Each tube is heat shrunk to tightly bind the fibers therein

Changed Response Preference for Stimuli Previously Paired with High or Low Hunger Drive

Psycholog

The impact of a sliding schedule down payment policy on self-pay patients\u27 access to elective surgery

Purpose: Previous research investigating a 50% down payment policy for elective surgeries demonstrated that a substantial number of self pay patients failed to receive recommended surgery due to the down payment cost. The current study analyzes the effect of a new, more liberal sliding scale down payment policy implemented at this same public hospital and assesses the impact on health care access for self pay patients. Methods: Data was collected from the admissions office and the pre-operative assessment office where elective surgery cancellation reasons were recorded. Chi-square tests were used to determine the statistical significance between data sets. Results: 448 recorded cancellations were documented over an 8 month period. Of those records, 6.9% (n=31) were self pay patients and 93% (n=417) had insurance. Of the 31 self pay patients, 51.6% (n=16) had cancelled stating financial reasons, while 4.8% (n=20) of the insured canceled for financial reasons (p\u3c0.0001). In comparison to the previous study performed by Kaufman and Chavez, the results revealed a 50% decrease in the number of self pay patients failing to receive recommended surgery. Of those self pay patients who did not receive surgery, there was no significant difference in the rate of canceling for financial reasons (p=0.18). Conclusions: Despite gender or race, self-pay patients cancel elective surgeries at a rate significantly greater than insured patients. The more liberal sliding scale down payment policy appears effective in reducing the overall number of self pay patients who decline elective surgery for financial reasons. Self pay patients are still facing financial barriers to health care access despite the sliding scale payment policy

Measuring Creativity for Innovation Management

Identifying the extent and nature of the creativity of new products is a key for innovation management. The revised Creative Solution Diagnosis Scale (CSDS) is a 27-item scale based on a theoretical model of functional creativity, consisting of five main criteria: Relevance &amp; Effectiveness, Problematization, Propulsion, Elegance and Genesis. The CSDS offers potential for differentiated assessments of product creativity as part of the larger process of innovation. Non-expert judges rated a series of mousetrap designs using a 30-item version of the CSDS. Confirmatory factor analysis revealed a simple structure that corresponded closely to the a priori theoretical model of functional creativity. The untrained judges were able to use the scale with a high degree of reliability and internal consistency. The scale offers a tool for managing innovation, especially for stimulating creativity and diagnosing the creativity of products