Dental safety net capacity: An innovative use of existing data to measure dentists’ clinical engagement in state Medicaid programs

Background The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists’ relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists’ willingness to participate in Indiana's Medicaid program. Methods We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists’ level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates. Results Though 75% of Medicaid‐enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists’ participation in state Medicaid programs. Conclusions In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self‐reported data and variations in Medicaid claims reporting

2018 Telemedicine In Indiana Report

Telemedicine: What is it? Telemedicine is a 21st Century approach to delivering health care and addressing health workforce shortages. It involves the remote diagnosis and treatment of patients by means of telecommunications technology (video, picture, voice, etc.). It has been defined as “the practice of medicine using technology to deliver care at a distance. It occurs using telecommunications infrastructure between a patient (at an origination or spoke site) and a physician or other practitioner licensed to practice medicine (at a distant or hub site).” Telemedicine in Indiana: In Indiana, physicians who offer telemedicine services are held to the same standards as a physician providing in-person health care services. In addition to holding a medical license, Indiana has a certification for telemedicine providers, administered by the Indiana Professional Licensing Agency (IPLA); however, physicians who predominately practice within Indiana are not required to file this certification . There are currently 226 physicians reported to hold this telemedicine certification . As of the 2017 medical license renewal period, 1,394 of Indiana’s licensed physicians (808 excluding those that reported radiology as their specialty) reported delivering care through telemedicine services. The purpose of this report is to describe characteristics of Indiana physicians that self-reported being engaged in providing telemedicine services in order to inform current and future related efforts. The data presented here are a subset from the 2017 Physician Licensure Survey Data Report

Indiana Addiction Counselors: A Review and Recommendations for a Workforce at the Frontline of the Opioid Epidemic

The following recommendations for Indiana’s Addiction Counselor Workforce were generated as a result of findings within this report, including: review and analysis of licensure data, state statute & rules, a literature review on occupational regulation, stakeholder engagement, and national environmental scan. Recommendations represent the synthesis of the information presented throughout the report. To provide public comment on this document, please email comment to the Bowen Center at [email protected]. Public comment will be uploaded to this homepage and Bowen Staff may publish responses to commentary

2018 Oral Health Data Report

Determining the supply and distribution of Indiana’s oral health workforce is crucial to understanding the capacity available to meet oral healthcare needs of Indiana citizens. Such data can also be used to inform initiatives aimed at increasing diversity, cultural competency, quality of care, and dental care access in underserved communities . Data presented in this report provide a snapshot of key demographic and practice characteristics for the oral health workforce in Indiana. The 2018 Indiana Oral Health Licensure Survey Data Report presents key information derived from data collected from the dentist and dental hygienist re-licensure survey administered by the Indiana Professional Licensing Agency (IPLA) during the license renewal period. In 2018, 4,001 dentists and 4,996 dental hygienists renewed their professional licenses. Of those who renewed their license, 2,697 dentists (67.4%) and 3,521 dental hygienists (70.4%) reported actively practicing and had a valid Indiana license address and were included in this report. Marion County encompasses the largest reported oral health workforce full-time equivalents (FTEs): 376.7 FTE for dentists and 235.2 FTE for dental hygienists. Based on the survey samples, there are significantly fewer oral health professionals available to serve Indiana citizens in rural, less populous counties such as LaGrange, Crawford and Jennings Counties. Additionally, a relatively low proportion of dentists reported offering services to low-income persons (i.e. accepting Medicaid). This report details, 2018 Indiana Oral Health Licensure Survey Data Report, presents a snapshot of data on the dentist and dental hygienist professions to provide stakeholders with information needed to improve the quality and accessibility of oral health care for Indiana residents through policymaking, workforce development, and resource allocation. Additional analyses and reports may be made available upon submission of a technical assistance request at http://family.medicine.iu.edu/hws

Assessing public behavioral health services data: a mixed method analysis

Background Measuring behavioral health treatment accessibility requires timely, comprehensive and accurate data collection. Existing public sources of data have inconsistent metrics, delayed times to publication and do not measure all factors related to accessibility. This study seeks to capture this additional information and determine its importance for informing accessibility and care coordination. Methods The 2018 National Survey for Substance Abuse and Treatment Services (N-SSATS) data were used to identify behavioral health facilities in Indiana and gather baseline information. A telephone survey was administered to facilities with questions parallel to the N-SSATS and additional questions regarding capacity and patient intake. Quantitative analysis includes chi-square tests. A standard qualitative analysis was used for theming answers to open-ended questions. Results About 20% of behavioral health facilities responded to the study survey, and non-response bias was identified by geographic region. Among respondents, statistically significant differences were found in several questions asked in both the study survey and N-SSATS. Data gathered from the additional questions revealed many facilities to have wait times to intake longer than 2 weeks, inconsistency in intake assessment tools used, limited capacity for walk-ins and numerous requirements for engaging in treatment. Conclusion Despite the low response rate to this study survey, results demonstrate that multiple factors not currently captured in public data sources can influence coordination of care. The questions included in this study survey could serve as a framework for routinely gathering these data and can facilitate efforts for successful coordination of care and clinical decision-making

Scratching the Surface of Psychiatric Services Distribution and Public Health: an Indiana Assessment

Mental illness is a leading cause of disability with many public health implications. Previous studies have demonstrated a national shortage of psychiatrists, particularly in rural areas. An analysis of how this workforce distribution relates to population demographics and public/behavioral health is lacking in the literature. This study encompassed a statewide assessment of the Indiana psychiatric workforce as it relates to population characteristics and public/behavioral health. This study’s findings demonstrate a profoundly low psychiatry workforce in rural counties of Indiana. The low psychiatry workforce capacity in rural counties is so disparate that the demographic and public/behavioral health characteristics differ from the State averages in the same manner as counties without a psychiatrist at all. The psychiatric workforce distribution did not differ significantly on the basis of poverty prevalence. The potential utility of indicators of population health was also evaluated and revealed that social factors such as poverty and Medicaid prevalence may be superior to more traditional measures

X-ray Emission Spectroscopy at X-ray Free Electron Lasers: Limits to Observation of the Classical Spectroscopic Response for Electronic Structure Analysis

X-ray free electron lasers (XFELs) provide ultrashort intense X-ray pulses suitable to probe electron dynamics but can also induce a multitude of nonlinear excitation processes. These affect spectroscopic measurements and interpretation, particularly for upcoming brighter XFELs. Here we identify and discuss the limits to observing classical spectroscopy, where only one photon is absorbed per atom for a Mn2+ in a light element (O, C, H) environment. X-ray emission spectroscopy (XES) with different incident photon energies, pulse intensities, and pulse durations is presented. A rate equation model based on sequential ionization and relaxation events is used to calculate populations of multiply ionized states during a single pulse and to explain the observed X-ray induced spectral lines shifts. This model provides easy estimation of spectral shifts, which is essential for experimental designs at XFELs and illustrates that shorter X-ray pulses will not overcome sequential ionization but can reduce electron cascade effects

Dengue viruses – an overview

Dengue viruses (DENVs) cause the most common arthropod-borne viral disease in man with 50–100 million infections per year. Because of the lack of a vaccine and antiviral drugs, the sole measure of control is limiting the Aedes mosquito vectors. DENV infection can be asymptomatic or a self-limited, acute febrile disease ranging in severity. The classical form of dengue fever (DF) is characterized by high fever, headache, stomach ache, rash, myalgia, and arthralgia. Severe dengue, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) are accompanied by thrombocytopenia, vascular leakage, and hypotension. DSS, which can be fatal, is characterized by systemic shock. Despite intensive research, the underlying mechanisms causing severe dengue is still not well understood partly due to the lack of appropriate animal models of infection and disease. However, even though it is clear that both viral and host factors play important roles in the course of infection, a fundamental knowledge gap still remains to be filled regarding host cell tropism, crucial host immune response mechanisms, and viral markers for virulence