Understanding Entry-Level Health Care Employment in Chicago

Restructuring within the health care industry over the past ten years has sought to improve the quality and delivery of health care services while reducing employers' costs. However, coupled with the tight local and regional labor market, these organizational changes have introduced new challenges for employers trying to find workers who are adequately prepared to deliver quality health care services.Earlier this year, the Chicago Jobs Council received funding from the Richard H. Driehaus Foundation and BP Amoco to conduct research in the health care industry. This report summarizes the most recent industry and occupational data on Chicago's health care industry and provides a snapshot of the entry-level recruitment and retention needs of Chicago's health care employers, job training programs, and low-income job seekers. Based on our findings, the report also makes recommendations to employers, training providers, public agencies and workforce boards

State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity.

IntroductionFood insecurity, or uncertain access to food because of limited financial resources, is associated with higher health care expenditures. However, both food insecurity prevalence and health care spending vary widely in the United States. To inform public policy, we estimated state-level and county-level health care expenditures associated with food insecurity.MethodsWe used linked 2011-2013 National Health Interview Survey/Medical Expenditure Panel Survey data (NHIS/MEPS) data to estimate average health care costs associated with food insecurity, Map the Meal Gap data to estimate state-level and county-level food insecurity prevalence (current though 2016), and Dartmouth Atlas of Health Care data to account for local variation in health care prices and intensity of use. We used targeted maximum likelihood estimation to estimate health care costs associated with food insecurity, separately for adults and children, adjusting for sociodemographic characteristics.ResultsAmong NHIS/MEPS participants, 10,054 adults and 3,871 children met inclusion criteria. Model estimates indicated that food insecure adults had annual health care expenditures that were $1,834 (95$1,073-2,595, P < .001) higher than food secure adults. For children, estimates were 80 higher, but this finding was not significant (95% CI, -$171 to$329, P = .53). The median annual health care cost associated with food insecurity was $687,041,000 (25th percentile,$239,675,000; 75th percentile, $1,140,291,000). The median annual county-level health care cost associated with food insecurity was$4,433,000 (25th percentile, $1,774,000; 75th percentile,$11,267,000). Cost variability was related primarily to food insecurity prevalence.ConclusionsHealth care expenditures associated with food insecurity vary substantially across states and counties. Food insecurity policies may be important mechanisms to contain health care expenditures

A Pilot Study for Enhancing Postpartum Discharge Instructions for Incision Care: Assessment of Comprehension

Literacy and Health Care • 14.5% of United States is illiterate 1 • Reading level of most medical forms is 10th grade 2 Improving Outcomes with a Visual Aid • Cesarean Surgical Site Infection (SSI) rate is 5% 3 • A patient with a SSI can be 2 times as expensive 4 • Visual aids improve information recall 8 and confidence in wound care 5 Study Objectives 1. To evaluate the readability of the cesarean wound care discharge instructions relative to the patient population’s reading level 2. To conduct a pilot Randomized Control Trial (RCT) to evaluate the effectiveness of a visual aid on improving comprehension of the cesarean wound care instructionshttps://jdc.jefferson.edu/cwicposters/1034/thumbnail.jp

How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter?

Summarizes findings on U.S. patients' ability to manage their health and health care by income level, education, Medicaid status, and health status. Examines access to care by level of engagement among the chronically ill. Discusses policy implications

The Price-Quality Paradox in Healthcare

This data brief compares average state-level prices against quality measures for asthma, diabetes and hypertension care and finds that higher prices for medical services are not always indicative of higher quality of care

Children First! Child Care Assistance in Erie County

Child care subsidies are distributed in each county in New York by the county’s Department of Social Services. Due to a drop in state funding, Erie County has changed its eligibility level from 200% to 125% of the poverty line. The former level for eligibility should be reinstated because subsidized child care has social, financial and societal benefits

Is individual educational level related to end-of-life care use? : results from a nationwide retrospective cohort study in Belgium

Background: Educational level has repeatedly been identified as an important determinant of access to health care, but little is known about its influence on end-of-life care use. Objectives: To examine the relationship between individual educational attainment and end-of-life care use and to assess the importance of individual educational attainment in explaining differential end-of-life care use. Research Design: A retrospective cohort study via a nationwide sentinel network of general practitioners (GPs; SENTI-MELC Study) provided data on end-of-life care utilization. Multilevel analysis was used to model the association between educational level and health care use, adjusting for individual and contextual confounders based upon Andersen's behavioral model of health services use. Subjects: A Belgian nationwide representative sample of people who died not suddenly in 2005-2007. Results: In comparison to their less educated counterparts, higher educated people equally often had a palliative treatment goal but more often used multidisciplinary palliative care services (odds ratios [OR] for lower secondary education 1.28 [1.04-1.59] and for higher [secondary] education: 1.31 [1.02-1.68]), moved between care settings more frequently (OR: 1.68 [1.13-2.48] for lower secondary education and 1.51 [0.93-2.48] for higher [secondary] education) and had more contacts with the GP in the final 3 months of life. Conclusions: Less well-educated people appear to be disadvantaged in terms of access to specialist palliative care services, and GP contacts at the end of life, suggesting a need for empowerment of less well-educated terminally ill people regarding specialist palliative and general end-of-life care use

Access to HIV prevention and care for HIV-exposed and HIV-infected children : a qualitative study in rural and urban Mozambique

Background: Follow-up of HIV-exposed children for the delivery of prevention of mother-to-child transmission services and for early diagnosis and treatment of HIV infection is critical to their survival. Despite efforts, uptake of postnatal care for these children remains low in many sub-Saharan African countries. Methods: A qualitative study was conducted in three provinces in Mozambique to identify motivators and barriers to improve uptake of and retention in HIV prevention, care and treatment services for HIV-exposed and HIV-infected children. Participant recommendations were also gathered. Individual interviews (n = 79) and focus group discussions (n = 32) were conducted with parents/caregivers, grandmothers, community leaders and health care workers. Using a socioecological framework, the main themes identified were organized into multiple spheres of influence, specifically at the individual, interpersonal, institutional, community and policy levels. Results: Study participants reported factors such as seeking care outside of the conventional health system and disbelief in test results as barriers to use of HIV services. Other key barriers included fear of disclosure at the interpersonal level and poor patient flow and long waiting time at the institutional level. Key facilitators for accessing care included having hope for children's future, symptomatic illness in children, and the belief that health facilities were the appropriate places to get care. Conclusions: The results suggest that individual-level factors are critical drivers that influence the health-seeking behavior of caregivers of HIV-exposed and HIV-infected children in Mozambique. Noted strategies are to provide more information and awareness on the benefits of early pediatric testing and treatment with positive messages that incorporate success stories, to reach more pregnant women and mother-child pairs postpartum, and to provide counseling during tracing visits. Increasing uptake and retention may be achieved by improving patient flow at the institutional level at health facilities, by addressing concerns with family decision makers, and by working with community leaders to support the uptake of services for HIV-exposed children for essential preventive care

Predictors of spiritual care provision for patients with dementia at the end of life as perceived by physicians : a prospective study

Background: Spiritual caregiving is part of palliative care and may contribute to well being at the end of life. However, it is a neglected area in the care and treatment of patients with dementia. We aimed to examine predictors of the provision of spiritual end-of-life care in dementia as perceived by physicians coordinating the care. Methods: We used data of the Dutch End of Life in Dementia study (DEOLD; 2007-2011), in which data were collected prospectively in 28 Dutch long-term care facilities. We enrolled newly admitted residents with dementia who died during the course of data collection, their families, and physicians. The outcome of Generalized Estimating Equations (GEE) regression analyses was whether spiritual care was provided shortly before death as perceived by the on-staff elderly care physician who was responsible for end-of-life care (last sacraments or rites or other spiritual care provided by a spiritual counselor or staff). Potential predictors were indicators of high-quality, person-centered, and palliative care, demographics, and some other factors supported by the literature. Resident-level potential predictors such as satisfaction with the physician's communication were measured 8 weeks after admission (baseline, by families and physicians), physician-level factors such as the physician's religious background midway through the study, and facility-level factors such as a palliative care unit applied throughout data collection. Results: According to the physicians, spiritual end-of-life care was provided shortly before death to 20.8% (43/207) of the residents. Independent predictors of spiritual end-of-life care were: families' satisfaction with physicians' communication at baseline (OR 1.6, CI 1.0; 2.5 per point on 0-3 scale), and faith or spirituality very important to resident whether (OR 19, CI 5.6; 63) or not (OR 15, CI 5.1; 47) of importance to the physician. Further, female family caregiving was an independent predictor (OR 2.7, CI 1.1; 6.6). Conclusions: Palliative care indicators were not predictive of spiritual end-of-life care; palliative care in dementia may need better defining and implementation in practice. Physician-family communication upon admission may be important to optimize spiritual caregiving at the end of life