Jasmine Travers

Abstract

OBJECTIVE: During the Great Recession in America, African-Americans opted to forgo healthcare more than other racial/ethnic groups. It is not understood whether disparities in forgone care returned to pre-recession levels. Understanding healthcare utilization patterns is important for informing subsequent efforts to decrease healthcare disparities. Therefore, we examined changes in racial disparities in forgone care before, during, and after the Great Recession.DESIGN: Data were pooled from the 2006-2013 National Health Interview Survey. Forgone medical, mental, and prescription care due to affordability were assessed among African-Americans and Whites. Time periods were classified as: pre-recession (May 2006-November 2007), early recession (December 2007-November 2008), late recession (December 2008-May 2010) and post-recession (June 2010-December 2013). Multivariable logistic regressions of race, interacted with time periods, were used to identify disparities in forgone care controlling for other demographics, health insurance coverage, and having a usual place for medical care across time periods. Adjusted Wald tests were performed to identify significant changes in disparities across time periods.RESULTS: The sample consisted of 110,746 adults. African-Americans were more likely to forgo medical care during the post- recession compared to Whites (OR = 1.16, CI = 1.06, 1.26); changes in foregone medical care disparities were significant in that they increased in the post-recession period compared to the pre-recession (OR = 1.17, CI = 1.08, 1.28 and OR = 0.89, CI = 0.77, 1.04, respectively, adjusted Wald Test p-value < 0.01). No changes in disparities were seen in prescription and mental forgone care.CONCLUSION: A persistent increase in forgone medical care disparities existed among African-Americans compared to Whites post-Great Recession and may be a result of outstanding issues related to healthcare access, cost, and quality. While health insurance is an important component of access to care, it alone should not be expected to remove these disparities due to other financial constraints. Additional strategies are necessary to close remaining gaps in care widened by the Great Recession.

Abstract

While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P =.04) and had a lower percentage of Medicaid residents (P =.02) and higher certified nursing assistant and registered nurse staffing levels (P =.002 and.02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P =.001 and.01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.

Abstract

Health care-associated infections are a leading cause of morbidity and mortality in US nursing home residents. Ongoing training of nursing home staff is vital to the implementation of infection prevention and control processes. Our aim was to describe associations between methods, frequency, and timing of staff infection prevention and control training and infection-related quality measures. In this national survey of nursing homes, timing of staff infection prevention and control training was associated with reduced indwelling urinary catheter use.

Abstract

Background: Schools are a key setting for childhood obesity interventions, yet nurses are not often included in delivering these interventions. The objective of this systematic review and meta-analysis was to examine school-based interventions involving nurses in a role beyond anthropometric measurement for effect on change in body measures. Methods: We performed a systematic review and meta-analysis of these papers. Results: The literature search produced 2412 articles. Eleven met inclusion criteria for the systematic review (4 randomized controlled trail [RCT], 7 quasi-experimental) and 8 for the meta-analysis. None have been included in prior meta-analyses. Four studies restricted eligibility to overweight and/or obese children; 7 included all children regardless of body weight. Random effects meta-analytic models represent data from 6050 (body mass index [BMI]), 5863 (BMIz), and 416 (BMI percentile) children, respectively. Pooled analyses demonstrated statistically significant decreases in BMI (6 studies: -0.48 [95% CI -0.84, -0.12]; I2=91.2%, Q=68.1), BMIz (5 studies: -0.10 [95% CI: -0.15, -0.05]; I2=0, Q=2.3), and BMI percentile (3 studies: -0.41 [95% CI: -0.60, -0.21]; I2=0, Q=2.0). Conclusions: These findings are similar to those of other meta-analyses of school-based interventions and suggest that school nurses can play a key role in implementing sustainable, effective school-based obesity interventions.

Abstract

Influenza vaccination remains the cornerstone of influenza prevention, yet national goals for nursing home residents and staff vaccination have not been met. Few studies have examined associations between facility and resident characteristics; employee processes, such as staff vaccination policies; and resident influenza vaccination. In this national survey of nursing homes, employee processes were not associated with resident influenza vaccination; however, various facility and resident characteristics were.

Abstract

Background: Mobile technologies are a useful platform for the delivery of health behavior interventions. Yet little work has been done to create a rigorous and standardized process for the design of mobile health (mHealth) apps. This project sought to explore the use of the Information Systems Research (ISR) framework as guide for the design of mHealth apps. Methods: Our work was guided by the ISR framework which is comprised of 3 cycles: Relevance, Rigor and Design. In the Relevance cycle, we conducted 5 focus groups with 33 targeted end-users. In the Rigor cycle, we performed a review to identify technology-based interventions for meeting the health prevention needs of our target population. In the Design Cycle, we employed usability evaluation methods to iteratively develop and refine mock-ups for a mHealth app. Results: Through an iterative process, we identified barriers and facilitators to the use of mHealth technology for HIV prevention for high-risk MSM, developed 'use cases' and identified relevant functional content and features for inclusion in a design document to guide future app development. Findings from our work support the use of the ISR framework as a guide for designing future mHealth apps. Discussion: Results from this work provide detailed descriptions of the user-centered design and system development and have heuristic value for those venturing into the area of technology-based intervention work. Findings from this study support the use of the ISR framework as a guide for future mHealth app development. Conclusion: Use of the ISR framework is a potentially useful approach for the design of a mobile app that incorporates end-users' design preferences.

Abstract

A health-care workforce representative of our nation’s diversity is a health and research priority. Although racial and ethnic minorities represent 37% of Americans, they comprise only 16% of the nursing workforce. The purpose of this study was to examine the effect of state legislation on minority recruitment to nursing. Using data from the National Conference of State Legislatures, American Association of Colleges of Nursing, and U.S. census, we compared minority enrollment in baccalaureate nursing programs of states (Texas, Virginia, Michigan, California, Florida, Connecticut, and Arkansas) before and 3 years after enacting legislation with geographically adjacent states without legislation. Data were analyzed using descriptive and chi-square statistics. Following legislation, Arkansas (13.8%–24.5%), California (3.3%–5.4%), and Michigan (8.0%–10.0%) significantly increased enrollment of Blacks, and Florida (11.8%–15.4%) and Texas (11.2%–13.9%) significantly increased enrollment of Hispanic baccalaureate nursing students. States that tied legislation to funding, encouragement, and reimbursement had larger enrollment gains and greater minority representation.

Abstract

Background Isolation-based practices in nursing homes (NHs) differ from those in acute care. NHs must promote quality of life while preventing infection transmission. Practices used in NHs to reconcile these goals of care have not been characterised. Purpose To explore decision-making in isolation-based infection prevention and control practices in NHs. Methods A qualitative study was conducted with staff (eg, staff nurses, infection prevention directors and directors of nursing) employed in purposefully sampled US NHs. Semistructured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim and analysed using directed content analysis. The research team discussed emerging themes in weekly meetings to confirm consensus. Results We inferred from 73 interviews in 10 NHs that there was variation between NHs in practices regarding who was isolated, when isolation-based practices took place, how they were implemented, and how they were tailored for each resident. Interviewees' decision-making depended on staff perceptions of acceptable transmission risk and resident quality of life. NH resources also influenced decision-making, including availability of private rooms, extent to which staff can devote time to isolation-based practices and communication tools. A lack of understanding of key infection prevention and control concepts was also revealed. Conclusions and implications Current clinical guidelines are not specific enough to ensure consistent practice that meets care goals and resource constraints in NHs. However, new epidemiological research regarding effectiveness of varying isolation practices in this setting is needed to inform clinical practice. Further, additional infection prevention and control education for NH staff may be required.

Abstract

Mobile health (mHealth) technology can be a valuable tool in the management of chronic illnesses, including HIV. Qualitative research methods were used to identify the desired content and features of a mobile app for meeting and improving the healthcare needs of persons living with HIV (PLWH). We conducted six focus group sessions with 50 English-or Spanish-speaking PLWH in New York City. To inform data analysis and to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH, we integrated Fogg’s functional role triad for computing technology model with the self-determination theory to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH. Participants suggested several tools for meeting their healthcare needs, including: reminders/alerts, lab results tracking, and notes on health status. mHealth technology can function as a social actor by providing chat boxes/forums, testimonials of lived experiences, and personal outreach. Examples of media that can be used as a persuasive technology include games/virtual rewards, coding of health tasks, and simulations on how to connect with PLWH. Findings from these focus groups can be used to design a mobile app for PLWH that is targeted to meet their healthcare needs.

Abstract

Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices. The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective IPC for CNAs: 1) language/culture; 2) knowledge/training; 3) per-diem/part-time staff; 4) workload; and 5) accountability. Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time staff, increased staffing ratios, and inclusion/empowerment of CNAs. Understanding IPC barriers and strategies to overcome these barriers may better enable NHs to achieve infection reduction goals.