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Luke RD, Balio CP, Foley CK, Soult AP. Implementation of a Trauma Bay Checklist Improves Antibiotic Prophylaxis Compliance in Open Extremity Fractures. Am Surg 2024:31348241244648. [PMID: 38584500 DOI: 10.1177/00031348241244648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Best practice guidelines from the ACS recommend that patients with open fractures receive antibiotics within 1-hour of presentation. Checklists are effective mechanisms for improving safety and compliance in surgical settings. The current study investigates implementation of a trauma bay checklist, referred to as MARTY, to improve administration of antibiotics in open extremity fractures at a level I trauma center. METHODS Retrospective pre-post design. Population consisted of trauma alerts from January to December 2021 (pre-MARTY) and 2022 (post-MARTY) with open fractures. Outcome measures included antibiotics administered within 1-hour of presentation and in the trauma bay. Bivariate and multivariate analyses were performed to estimate differences in both measures. RESULTS Our sample included 339 encounters, 174 pre-MARTY and 165 post-MARTY implementation. In the pre-MARTY period, 57.5% of encounters received antibiotics within 1-hour of presentation with 46.0% occurring in the trauma bay, in comparison to 65.5% and 54.5% in the post-MARTY period. In adjusted models, there were greater odds of antibiotic administration within 1-hour (OR = 1.654, P = .038) and prior to leaving the trauma bay (OR = 1.660, P = .041) than pre-MARTY. Encounters with higher-grade fractures were more likely to receive timely antibiotics (P<=.001). DISCUSSION Our study estimates improved compliance of antibiotic administration after implementation of MARTY after adjusting for encounter characteristics. Findings from this study demonstrate improved compliance, but this compliance is often still lacking in those with higher injury severity scores. Findings from this study may be used to inform approaches to further improve trauma care.
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Affiliation(s)
- Robert D Luke
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Casey P Balio
- Center for Rural Health Research & Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | | | - Alexa P Soult
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
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Balio CP, Mathis SM, Francisco MM, Meit M, Beatty KE. State Priorities and Needs: The Role of Block Grants. Public Health Rep 2023:333549231205338. [PMID: 37924249 DOI: 10.1177/00333549231205338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVES Block grant funding provides federal financial support to states, with increased flexibility as to how those funds can be allocated at the community level. At the state level, block grant amounts and distributions are often based on outdated formulas that consider population measures and funding environments at the time of their creation. We describe variation in state-level funding allocations for 5 federal block grant programs and the extent to which funding aligns with the current needs of state populations. METHODS We conducted an analysis in 2022 of state block grant allocations as a function of state-level characteristics for 2015-2019 for all 50 states. We provide descriptive statistics of state block grant allocations and multivariate regression models for each program. Models include base characteristics relevant across programs plus supplemental characteristics based on program-specific goals and state population needs. RESULTS Mean state block grant allocations per 1000 population by program ranged from $618 to $21 528 during 2015-2019. Characteristics associated with state allocations varied across block grants. For example, for every 1-percentage-point increase in the percentage of the population living in nonmetropolitan areas, Preventive Health and Health Services Block Grant funding was approximately $7 per 1000 population higher and Community Services Block Grant funding was approximately $40 per 1000 population higher. Few supplemental characteristics were associated with allocations. CONCLUSIONS Current block grant funding does not align with state characteristics and needs. Future research should consider how funds are used at the state level or allocated to local agencies or organizations and compare state block grant allocations with other types of funding mechanisms, such as categorical funding.
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Affiliation(s)
- Casey P Balio
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | - Stephanie M Mathis
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Margaret M Francisco
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Michael Meit
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | - Kate E Beatty
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
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Balio CP, Norwood C, McFarlane T, Rusyniak D, Blackburn J. Health Care and Behavioral Service Use by Medicaid-Enrolled Adults After Release From Incarceration. Psychiatr Serv 2023; 74:192-196. [PMID: 35855622 DOI: 10.1176/appi.ps.202200035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study explored the characteristics and health care utilization of adults released from state prisons and enrolled in Medicaid in Indiana, which has policies to facilitate timely enrollment. METHODS Medicaid claims and Department of Corrections data were used to examine demographic and incarceration characteristics and health care utilization patterns of adults (N=15,929) released from state prisons and enrolled in Medicaid within 120 days of release, between 2015 and 2018. RESULTS More than 80% of participants had at least one health encounter within 120 days of initiating coverage, and nearly 50% used the emergency department. Those enrolled in Medicaid within 30 days of release were more likely to have behavioral health needs and to utilize subacute behavioral health care than those who enrolled later. CONCLUSIONS Understanding these patterns of health care utilization is essential to operationalizing procedures and interventions to support the health care needs of adults involved in the criminal legal system.
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Affiliation(s)
- Casey P Balio
- Center for Rural Health Research and Department of Health Services Management and Policy, East Tennessee State University, Johnson City (Balio); Indiana Family and Social Services Administration, Indianapolis (Norwood, McFarlane, Rusyniak); Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis (Blackburn)
| | - Connor Norwood
- Center for Rural Health Research and Department of Health Services Management and Policy, East Tennessee State University, Johnson City (Balio); Indiana Family and Social Services Administration, Indianapolis (Norwood, McFarlane, Rusyniak); Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis (Blackburn)
| | - Tim McFarlane
- Center for Rural Health Research and Department of Health Services Management and Policy, East Tennessee State University, Johnson City (Balio); Indiana Family and Social Services Administration, Indianapolis (Norwood, McFarlane, Rusyniak); Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis (Blackburn)
| | - Dan Rusyniak
- Center for Rural Health Research and Department of Health Services Management and Policy, East Tennessee State University, Johnson City (Balio); Indiana Family and Social Services Administration, Indianapolis (Norwood, McFarlane, Rusyniak); Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis (Blackburn)
| | - Justin Blackburn
- Center for Rural Health Research and Department of Health Services Management and Policy, East Tennessee State University, Johnson City (Balio); Indiana Family and Social Services Administration, Indianapolis (Norwood, McFarlane, Rusyniak); Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis (Blackburn)
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Balio CP, Galler N, Meit M, Hale N, Beatty KE. Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize? J Public Health Manag Pract 2023; 29:S107-S115. [PMID: 36223506 PMCID: PMC10573113 DOI: 10.1097/phh.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study uses findings from the most recent iterations of the Public Health Workforce Interest and Needs Survey (PH WINS) to describe importance, skill level, and gaps of key public health competencies as well as characteristics associated with gaps. DESIGN Repeated cross-sectional analysis of the 2017 and 2021 PH WINS data. SETTING State and local health departments. PARTICIPANTS Nationally representative population of state and local governmental public health workers. MAIN OUTCOME MEASURES Gaps of key public health competencies related to data, evidence-based approaches, health equity and social justice, factors that affect public health, cross-sectoral partnerships, and community health assessments and improvement plans. Gaps reflect areas of high importance and low skill level. Differences in gaps among the traditional public health workforce and those hired specifically for COVID-19 response. RESULTS For most competency areas, more than 20% of the public health workforce perceived a gap. Gaps related to environmental factors that affect public health, social determinants of health and cross-sector partnerships, and community health assessments and improvement plans were the largest. Tenure in public health practice, highest level of education, and having formal public health training were associated with lower odds of gaps in most areas. In a secondary analysis of traditional public health workforce compared with those hired specifically for COVID-19 response, those hired for COVID-19 response reported significantly fewer gaps for all but one competency considered. CONCLUSIONS A substantial proportion of the public health workforce perceives gaps in competency areas that are of high importance to the evolving role of public health. As public health continues to adjust and modernize in response to the COVID-19 pandemic and other historic changes, understanding and addressing training needs of the workforce will be instrumental to public health's ability to respond to the needs of the public.
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Affiliation(s)
- Casey P. Balio
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Nicole Galler
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Michael Meit
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Nathan Hale
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Kate E. Beatty
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
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Feltner C, Wallace IF, Aymes S, Cook Middleton J, Hicks KL, Schwimmer M, Baker C, Balio CP, Moore D, Voisin CE, Jonas DE. Screening for Obstructive Sleep Apnea in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1951-1971. [PMID: 36378203 DOI: 10.1001/jama.2022.18357] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
IMPORTANCE Obstructive sleep apnea (OSA) is associated with adverse health outcomes. OBJECTIVE To review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force. DATA SOURCES PubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022. STUDY SELECTION English-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials. MAIN OUTCOMES AND MEASURES Test accuracy, excessive daytime sleepiness, sleep-related and general health-related quality of life (QOL), and harms. RESULTS Eighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score >10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, -2.33 [95% CI, -2.75 to -1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health-related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, -1.67 [95% CI, 2.09 to -1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg). CONCLUSIONS AND RELEVANCE The accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health-related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.
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Affiliation(s)
- Cynthia Feltner
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Ina F Wallace
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Shannon Aymes
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Jennifer Cook Middleton
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Kelli L Hicks
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Manny Schwimmer
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Claire Baker
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Casey P Balio
- Center for Rural Health Research, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Daniel Moore
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Christiane E Voisin
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
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Yeager VA, Balio CP, Chudgar RB, Hare Bork R, Beitsch LM. Estimating Public Health Workforce Efforts Toward Foundational Public Health Services. J Public Health Manag Pract 2022; 28:393-398. [PMID: 34939602 DOI: 10.1097/phh.0000000000001452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed. OBJECTIVE This study assessed the potential use of an FPHS calculator to assess health department workforce needs. DESIGN AND SETTING Qualitative interviews were conducted via Zoom in December 2020-January 2021. PARTICIPANTS Seventeen state and local public health leaders. MAIN OUTCOME MEASURES Qualitative insights into the potential use of an FPHS calculator. RESULTS Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed. CONCLUSIONS The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.
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Affiliation(s)
- Valerie A Yeager
- Department of Health Policy and Management, IU Fairbanks School of Public Health, Indianapolis, Indiana (Dr Yeager); Center for Rural Health Research, East Tennessee State University College of Public Health, Johnson City, Tennessee (Dr Balio); Public Health National Center Innovation, Public Health Accreditation Board, Alexandria, Virginia (Ms Chudgar); de Beaumont Foundation, Bethesda, Maryland (Dr Hare Bork); and Florida State University College of Medicine, Tallahassee, Florida (Dr Beitsch)
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Balio CP, Taylor HL, Robertson AS, Menachemi N. Faculty salaries in health administration: trends and correlates 2015-2021. J Health Adm Educ 2022; 39:7-21. [PMID: 36424952 PMCID: PMC9682474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this study, we provide updated information on salaries of academic health administration (HA) faculty members based on data collected in 2015, 2018, and 2021 and examine characteristics associated with earnings. We present mean inflation-adjusted salaries by demographic characteristics, education, experience, productivity, and job activities. We find that salaries of assistant, associate, and full professors have kept up with inflation and there have not been significant changes in salary by any characteristics over time. As in previous iterations of similar survey data, there remain differences in salary by both gender and race. Higher salaries were associated with having a 12-month contract, being tenured or tenure-track, having an administrative position, and being in a department whose focus is not primarily teaching. Findings from our study will be of interest to individuals on the HA job market, hiring committees, and doctoral students preparing for a position after graduation.
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Affiliation(s)
- Casey P. Balio
- East Tennessee State University College of Public Health, Center for Rural Health Research & Department of Health Services Management and Policy; 1276 Gilbreath Dr., Box 70300, Johnson City, TN 37614-1700
| | - Heather L. Taylor
- Indiana University Richard M. Fairbanks School of Public Health; 1050 Wishard Blvd., Indianapolis, IN, 46202
| | - Ashley S. Robertson
- Indiana University Richard M. Fairbanks School of Public Health; 1050 Wishard Blvd., Indianapolis, IN, 46202
| | - Nir Menachemi
- Indiana University Richard M. Fairbanks School of Public Health; 1050 Wishard Blvd., Indianapolis, IN, 46202
- Regenstrief Institute; 1101 W 10th St, Indianapolis, IN 46202
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Balio CP, Riley SR, Grammer D, Weathington C, Barclay C, Jonas DE. Barriers to recruiting primary care practices for implementation research during COVID-19: A qualitative study of practice coaches from the Stop Unhealthy (STUN) Alcohol Use Now trial. Implementation Research and Practice 2022; 3:26334895221094297. [PMID: 37091109 PMCID: PMC9924268 DOI: 10.1177/26334895221094297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The COVID-19 pandemic has brought widespread change to health care practice and research. With heightened stress in the general population, increased unhealthy alcohol use, and added pressures on primary care practices, comes the need to better understand how we can continue practice-based research and address public health priorities amid the ongoing pandemic. The current study considers barriers and facilitators to conducting such research, especially during the COVID-19 pandemic, within the context of recruiting practices for the STop UNhealthy (STUN) Alcohol Use Now trial. The STUN trial uses practice facilitation to implement screening and interventions for unhealthy alcohol use in primary care practices across the state of North Carolina. Methods: Semistructured interviews were conducted with a purposive sample of 15 practice coaches to discuss their recruitment experiences before and after recruitment was paused due to the pandemic. An inductive thematic analysis was used to identify themes and subthemes. Results: Pandemic-related barriers, including challenges in staffing, finances, and new COVID-19-related workflows, were most prominent. Competing priorities, such as quality improvement measures, North Carolina's implementation of Medicaid managed care, and organizational structures hampered recruitment efforts. Coaches also described barriers specific to the project and to the topic of alcohol. Several facilitators were identified, including the rising importance of behavioral health due to the pandemic, as well as existing relationships between practice coaches and practices. Conclusions: Difficulty managing competing priorities and obstacles within existing practice infrastructure inhibit the ability to participate in practice-based research and implementation of evidence-based practices. Lessons learned from this trial may inform strategies to recruit practices into research and to gain buy-in from practices in adopting evidence-based practices more generally. Plain Language Summary What is known: Unhealthy alcohol use is a significant public health issue, which has been exacerbated during the COVID-19 pandemic. Screening and brief intervention for unhealthy alcohol use is an evidence-based practice shown to help reduce drinking-related behaviors, yet it remains rare in practice. What this study adds: Using a qualitative approach, we identify barriers and facilitators to recruiting primary care practices into a funded trial that uses practice facilitation to address unhealthy alcohol use. We identify general insights as well as those specific to the COVID-19 pandemic. Barriers are primarily related to competing priorities, incentives, and lack of infrastructure. Facilitators are related to framing of the project and the anticipated level and type of resources needed to address unhealthy alcohol use especially as the pandemic wanes. Implications: Our findings provide information on barriers and facilitators to recruiting primary care practices for behavioral health projects and to implementing these activities. Using our findings, we provide a discussion of suggestions for conducting these types of projects in the future which may be of interest to researchers, practice managers, and providers.
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Affiliation(s)
- Casey P. Balio
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean R. Riley
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Debbie Grammer
- North Carolina Area Health Education Centers, CB 7165, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris Weathington
- North Carolina Area Health Education Centers, CB 7165, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colleen Barclay
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Daniel E. Jonas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Taylor H, Balio CP, Robertson AS, Menachemi N. Work-life balance among health administration faculty before and during the COVID-19 pandemic. J Health Adm Educ 2022; 39:127-142. [PMID: 36475090 PMCID: PMC9721113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This current study examines measures of work-life balance among health administration faculty prior to and during the COVID-19 pandemic. A repeated cross-sectional design is used to analyze data collected from a national survey in 2018 and 2021. Changes in six different outcome measures of work-life balance were examined using multivariable logistic regression, controlling for health administration faculty characteristics. Compared to 2018 respondents, faculty respondents in 2021 were more likely to report that family and personal matters were interfering with their ability to do their job (OR = 1.93, p=0.001). Females more frequently reported that their career had suffered because of personal issues/obligations (OR = 1.82, p=0.003) but were less likely to report having enough time to get their teaching (OR = 0.68, p=0.026). Respondents with children 18 years or younger reported higher rates of regularly having to miss a meeting or event at home (OR = 1.88, p<0.001) and an event at work (OR = 3.74, p<0.001). These faculty also more frequently reported that family or personal matters were interfering with their ability to do their job (OR = 3.04, p<0.001) and that their career suffered because of personal issues/obligations (OR = 2.09, p=0.001). Given the implications of work-life conflicts to organizational outcomes, academic leaders and university decision-makers should consider adopting strategies to mitigate the effects of these disruptions to the work-life equilibrium of academics.
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Affiliation(s)
- Heather Taylor
- Department of Health Policy and Management, Indiana University, Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis IN 46202
| | - Casey P. Balio
- East Tennessee State University College of Public Health, Center for Rural Health Research, Department of Health Services Management and Policy
| | | | - Nir Menachemi
- Fairbanks Endowed Chair and Professor of Health Policy and Management, Indiana University, Fairbanks School of Public Health, Scientist, Regenstrief Institute, Inc
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Balio CP, Blackburn J, Yeager VA, Simon KI, Menachemi N. Many States Were Able To Expand Medicaid Without Increasing Administrative Spending. Health Aff (Millwood) 2021; 40:1740-1748. [PMID: 34724415 DOI: 10.1377/hlthaff.2020.01695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.
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Affiliation(s)
- Casey P Balio
- Casey P. Balio is a research assistant professor at the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, in Johnson City, Tennessee. She was a doctoral candidate at the Indiana University Richard M. Fairbanks School of Public Health, in Indianapolis, Indiana, at the time this article was written
| | - Justin Blackburn
- Justin Blackburn is an associate professor in the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health
| | - Valerie A Yeager
- Valerie A. Yeager is an associate professor in the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health
| | - Kosali I Simon
- Kosali I. Simon is the Herman B. Wells Endowed Professor at the Paul H. O'Neill School of Public and Environmental Affairs and associate vice provost for health sciences, Indiana University, in Bloomington, Indiana
| | - Nir Menachemi
- Nir Menachemi is the Fairbanks Endowed Chair, a professor, and head of the Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, and a scientist at the Regenstrief Institute, in Indianapolis, Indiana
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Jonas DE, Crotty K, Yun JDY, Middleton JC, Feltner C, Taylor-Phillips S, Barclay C, Dotson A, Baker C, Balio CP, Voisin CE, Harris RP. Screening for Prediabetes and Type 2 Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 326:744-760. [PMID: 34427595 DOI: 10.1001/jama.2021.10403] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Type 2 diabetes is common and is a leading cause of morbidity and disability. OBJECTIVE To review the evidence on screening for prediabetes and diabetes to inform the US Preventive Services Task Force (USPSTF). DATA SOURCES PubMed/MEDLINE, Cochrane Library, and trial registries through September 2019; references; and experts; literature surveillance through May 21, 2021. STUDY SELECTION English-language controlled studies evaluating screening or interventions for prediabetes or diabetes that was screen detected or recently diagnosed. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings; meta-analyses conducted when at least 3 similar studies were available. MAIN OUTCOMES AND MEASURES Mortality, cardiovascular morbidity, diabetes-related morbidity, development of diabetes, quality of life, and harms. RESULTS The review included 89 publications (N = 68 882). Two randomized clinical trials (RCTs) (25 120 participants) found no significant difference between screening and control groups for all-cause or cause-specific mortality at 10 years. For harms (eg, anxiety or worry), the trials reported no significant differences between screening and control groups. For recently diagnosed (not screen-detected) diabetes, 5 RCTs (5138 participants) were included. In the UK Prospective Diabetes Study, health outcomes were improved with intensive glucose control with sulfonylureas or insulin. For example, for all-cause mortality the relative risk (RR) was 0.87 (95% CI, 0.79 to 0.96) over 20 years (10-year posttrial assessment). For overweight persons, intensive glucose control with metformin improved health outcomes at the 10-year follow-up (eg, all-cause mortality: RR, 0.64 [95% CI, 0.45 to 0.91]), and benefits were maintained longer term. Lifestyle interventions (most involving >360 minutes) for obese or overweight persons with prediabetes were associated with reductions in the incidence of diabetes (23 RCTs; pooled RR, 0.78 [95% CI, 0.69 to 0.88]). Lifestyle interventions were also associated with improved intermediate outcomes, such as reduced weight, body mass index, systolic blood pressure, and diastolic blood pressure (pooled weighted mean difference, -1.7 mm Hg [95% CI, -2.6 to -0.8] and -1.2 mm Hg [95% CI, -2.0 to -0.4], respectively). Metformin was associated with a significant reduction in diabetes incidence (pooled RR, 0.73 [95% CI, 0.64 to 0.83]) and reduction in weight and body mass index. CONCLUSIONS AND RELEVANCE Trials of screening for diabetes found no significant mortality benefit but had insufficient data to assess other health outcomes; evidence on harms of screening was limited. For persons with recently diagnosed (not screen-detected) diabetes, interventions improved health outcomes; for obese or overweight persons with prediabetes, interventions were associated with reduced incidence of diabetes and improvement in other intermediate outcomes.
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Affiliation(s)
- Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Karen Crotty
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill
- RTI International, Research Triangle Park, North Carolina
| | - Jonathan D Y Yun
- Thayer Internal Medicine, MaineGeneral Health, Waterville, Maine
| | - Jennifer Cook Middleton
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Cynthia Feltner
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Sian Taylor-Phillips
- Warwick Medical School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Colleen Barclay
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Andrea Dotson
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Claire Baker
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Casey P Balio
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Christiane E Voisin
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Russell P Harris
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Department of Medicine, University of North Carolina at Chapel Hill
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Balio CP, Wiley KK, Greene MS, Vest JR. Opioid-Related Emergency Department Encounters: Patient, Encounter, and Community Characteristics Associated With Repeated Encounters. Ann Emerg Med 2020; 75:568-575. [PMID: 31983498 PMCID: PMC10929732 DOI: 10.1016/j.annemergmed.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/21/2019] [Accepted: 12/03/2019] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE We describe the prevalence, trends, and factors associated with repeated emergency department (ED) encounters for opioid usage across multiple, independent hospital systems. METHODS A statewide regional health information exchange system provided ED encounters from 4 Indiana hospital systems for 2012 to 2017. In accordance with a series of International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 diagnosis codes for opioid abuse, adverse effects of opioids, opioid dependence and unspecified use, and opioid poisoning, we identified patients with an ED encounter associated with opioid usage (9,295 individuals; 12,642 encounters). Multivariate logistic regression models then described the patient, encounter, prescription history, and community characteristics associated with the odds of a patient's incurring a subsequent opioid-related ED encounter. RESULTS The prevalence of repeated nonfirst opioid-related ED encounters increased from 9.0% of all opioid encounters in 2012 to 34.3% in 2017. The number of previous opioid-related ED encounters, unique institutions at which the individual had had encounters, the encounter's being heroin-related, the individual's having a benzodiazepine prescription filled within 30 days before the encounter, and being either Medicaid insured or uninsured compared with private insurance were associated with significantly greater odds of having a subsequent encounter. CONCLUSION The ED is increasingly a site utilized as the setting for repeated opioid-related care. Characteristics of the individual, encounter, and community associated with repeated opioid-related encounters may inform real-time risk-prediction tools in the ED setting. Additionally, the number of institutions to which the individual has presented may suggest the utility of health information exchange data and usage in the ED setting.
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Affiliation(s)
- Casey P Balio
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN.
| | - Kevin K Wiley
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN
| | - Marion S Greene
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN
| | - Joshua R Vest
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN
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Abstract
Expanding eligibility for Medicaid was a central goal of the Affordable Care Act (ACA), which continues to be debated and discussed at the state and federal levels as further reforms are considered. In an effort to provide a synthesis of the available research, we systematically reviewed the peer-reviewed scientific literature on the effects of Medicaid expansion on the original goals of the ACA. After analyzing seventy-seven published studies, we found that expansion was associated with increases in coverage, service use, quality of care, and Medicaid spending. Furthermore, very few studies reported that Medicaid expansion was associated with negative consequences, such as increased wait times for appointments-and those studies tended to use study designs not suited for determining cause and effect. Thus, there is evidence to document improvements in several areas of health care delivery following the ACA Medicaid expansion. We outline areas for future research that can further reduce current knowledge gaps.
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Affiliation(s)
- Olena Mazurenko
- Olena Mazurenko is an assistant professor of health policy and management at Indiana University, in Indianapolis
| | - Casey P Balio
- Casey P. Balio is a doctoral student in health policy and management at Indiana University, in Indianapolis
| | - Rajender Agarwal
- Rajender Agarwal is director of the Center for Health Reform, in Dallas, Texas. At the time this work was done, he was a Business of Medicine MBA candidate at Indiana University's Kelley School of Business, in Indianapolis
| | - Aaron E Carroll
- Aaron E. Carroll is a professor of pediatrics at the Indiana University School of Medicine, in Indianapolis
| | - Nir Menachemi
- Nir Menachemi ( ) is a professor of health policy and management and chair of the Department of Health Policy and Management at Indiana University in Indianapolis
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