Funding Community Health Worker Programs and Services in Minnesota: Looking to the Future

This report is a supplement to the 2006 report "Advancing Community Health Worker Practice and Utilization: The Focus on Funding"

Advancing Community Health Worker Practice and Utilization: The Focus on Financing

There is a growing interest in the use of community health workers in various roles in the US health care system. These workers go by various titles and names -- including promotora and community health advisor -- but all assist members of the communities they serve. As the role of these workers becomes more accepted and desirable in the overall system of care, they face the challenges of moving from being an exceptional add-on to the system to being more a part of the mainstream. Issues such as educational preparation, formal credentialing, licensure and compensation are all part of this process. In particular, various organizations are interested in but challenged by the need for sustainable financing of the CHW position. It is time to explore and develop viable financing arrangements that go beyond short-term grants.To address these concerns, this research was undertaken to study sustainable financing mechanisms for community health workers. The focus is on existing and emerging funding, reimbursement and payment policies for community health workers. The study seeks to identify promising examples and models of payment programs for community health workers generally in the United States. To the authors' knowledge, this is the first national project with this exclusive focus.The audiences for this report include community health workers, directors of programs that employ or work with community health workers, and administrators of public and private coverage programs such as health plans, insurance companies and state Medicaid programs seeking options for improving health care access and quality at the same or lower costs. Businesses, non-profit organizations and consumers exploring the possibilities of using the services community health workers could provide might also be interested in the findings

Social protection programs and employment: The case of Mexico’s “Seguro Popular” program

Mexico created Seguro Popular in 2002 with the goal of providing free or subsidized health insurance coverage to 47 million uninsured people by the year 2013. Only individuals lacking the social security protections granted to all formal sector workers and their families are eligible. Hence, one unintended consequence of the program could be an increase in the size of the informal sector. The introduction of the Seguro Popular program was conducted in stages, across municipalities and time. We exploit this variation and implement a differences-in-differences approach in order to identify the causal effect of the program in formal employment outcomes. We analyze the effect of Seguro Popular using 33 large and relatively rich cities from labor force surveys conducted from 2001 to 2004. In order to measure the effect for poorer municipalities, we also use the individual-level Oportunidades dataset that covers 136 municipalities from 2002 to 2004. We find little evidence of any correlation between Seguro Popular and the decision of workers to be employed in the formal or informal sector. One possible explanation of our findings is the low enrollment of the Seguro Popular program during the period we study. We provide suggestive evidence from the 33 cities that the result holds for the 2005 to 2006 period as well. We conclude that the recent increase in informal employment in Mexico is due to other causes.Mexico, informality, employment

P4‐564: Short‐Term Outcomes Of A Randomized Controlled Trial Of Amyloid Pet Results Disclosure In Mild Cognitive Impairment

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152786/1/alzjjalz201908111.pd

Systems view of adipogenesis via novel omics-driven and tissue-specific activity scoring of network functional modules

The investigation of the complex processes involved in cellular differentiation must be based on unbiased, high throughput data processing methods to identify relevant biological pathways. A number of bioinformatics tools are available that can generate lists of pathways ranked by statistical significance (i.e. by p-value), while ideally it would be desirable to functionally score the pathways relative to each other or to other interacting parts of the system or process. We describe a new computational method (Network Activity Score Finder - NASFinder) to identify tissue-specific, omicsdetermined sub-networks and the connections with their upstream regulator receptors to obtain a systems view of the differentiation of human adipocytes. Adipogenesis of human SBGS pre-adipocyte cells in vitro was monitored with a transcriptomic data set comprising six time points (0, 6, 48, 96, 192, 384 hours). To elucidate the mechanisms of adipogenesis, NASFinder was used to perform time-point analysis by comparing each time point against the control (0 h) and time-lapse analysis by comparing each time point with the previous one. NASFinder identified the coordinated activity of seemingly unrelated processes between each comparison, providing the first systems view of adipogenesis in culture. NASFinder has been implemented into a web-based, freely available resource associated with novel, easy to read visualization of omics data sets and network modules

Itegrated Test and Evaluation of a 4-Bed Molecular Sieve (4BMS) Carbon Dioxide Removtal System (CDRA), Mechanical Compressor Engineering Development Unit (EDU), and Sabitier Engineering Development Unit (EDU)

Currently on the International Space Station s (ISS) U.S. Segment, carbon dioxide (CO2) scrubbed from the cabin by a 4-Bed Molecular Sieve (4BMS) Carbon Dioxide Removal Assembly (CDRA) is vented overboard as a waste product. Likewise, the product hydrogen (H2) that will be generated by the Oxygen Generation Assembly (OGA) planned for installation will also be vented. A flight experiment has been proposed that will take the waste CO2 removed from the cabin, and via the catalytic Sabatier process, reduce it with waste H2 to generate water and methane. The water produced may provide cost and logistics savings for ISS by reducing the amount of water periodically re-supplied to orbit. To make this concept viable, a mechanical piston compressor and accumulator were developed for collecting and storing the CO2 from the CDRA. The compressor, accumulator and Sabatier system would be packaged together as one unit and referred to as the Carbon Dioxide Reduction Assembly (CRA). Testing was required to evaluate the performance of a 4BMS CDRA, compressor, accumulator, and Sabatier performance along with their operating rules when integrated together. This had been numerically modeled and simulated; however, testing was necessary to verify the results from the engineering analyses. Testing also allowed a better understanding of the practical inefficiencies and control issues involved in a fully integrated system versus the theoretical ideals in the model. This paper presents and discusses the results of an integrated engineering development unit test

Methodology, selection, and integration of fracture healing assessments in mice

Long bone fractures are one of the most common and costly medical conditions encountered after trauma. Characterization of the biology of fracture healing and development of potential medical interventions generally involves animal models of fracture healing using varying genetic or treatment groups, then analyzing relative repair success via the synthesis of diverse assessment methodologies. Murine models are some of the most widely used given their low cost, wide variety of genetic variants, and rapid breeding and maturation. This review addresses key concerns regarding fracture repair investigations in mice and may serve as a guide in conducting and interpreting such studies. Specifically, this review details the procedures, highlights relevant parameters, and discusses special considerations for the selection and integration of the major modalities used for quantifying fracture repair in such studies, including X-ray, microcomputed tomography, histomorphometric, biomechanical, gene expression and biomarker analyses

A randomized controlled trial of amyloid positron emission tomography results disclosure in mild cognitive impairment

IntroductionRecent studies suggest that Alzheimer’s disease (AD) biomarker disclosure has no discernable psychological impact on cognitively healthy persons. Far less is known about how such results affect symptomatic individuals and their caregivers.MethodsRandomized controlled trial of 82 mild cognitive impairment (MCI) patient and caregiver dyads (total n = 164) to determine the effect of receiving amyloid positron emission tomography results on understanding of, and perceived efficacy to cope with, MCI over 52 weeks of follow‐up.ResultsGains in the primary outcomes were not consistently observed. Amyloid negative patients reported greater perceived ambiguity regarding MCI at follow‐up, while moderate and sustained emotional distress was observed in patients, and to a lesser extent, caregivers, of those who were amyloid positive. There was no corresponding increase in depressive symptoms.DiscussionThese findings point to the possibility that both MCI patients and caregivers may need emotional support after the disclosure of amyloid scan results.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163444/2/alz12129_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163444/1/alz12129.pd

LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie