Browsing by Subject "health disparities"
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Item Beyond Health Care: Why We Get Sick and What To Do About It(2017-10-06) Williams, David; Malcolm, Jan; Noor, Sahra; Jacobs, Lawrence RItem Caring for our Caregivers: an Evaluation of the Minnesota Safe Patient Handling Act(2020-05) Rosebush, ChristinaBackground Minnesota is one of 12 states to pass safe patient handling legislation aimed at reducing high rates of musculoskeletal disorders (MSDs) in health care workers.1 MSD rates are 2- and 3- times higher in U.S. hospitals and nursing homes, respectively, compared to the private sector average.2 Further, MSDs comprise almost half of all reportable injuries in these settings.2 State safe patient handling (SPH) laws generally require health care facilities to implement multicomponent safe patient handling programs. Studies of multicomponent programs in large health care systems show substantial reductions in reportable injuries and workers’ compensation claims, but few evaluations of statewide mandates have been conducted. The 2007 Minnesota Safe Patient Handling (MN SPH) Act requires each health care facility to obtain adequate assistive lifting equipment and create a written safe patient handling plan and committee. The effectiveness of the law in nursing homes is of particular interest due to the frequency of patient handling tasks, challenging physical environment, and unique workforce comprised largely of certified nursing assistants (CNAs). To evaluate the MN SPH Act and better protect Minnesota nursing home workers, studies are needed to characterize patient handling injuries by occupation, assess temporal trends in injuries following enactment of the MN SPH Act, and compare Minnesota’s experience to states without SPH legislation. Objective The overall objectives of this research are to provide a profile of patient handling injuries in Minnesota nursing home workers and to evaluate the effectiveness of the MN SPH Act in reducing workers’ compensation claims. Results will be used to inform future safe patient handling policymaking and to identify groups of Minnesota workers and types of facilities in need of additional state outreach and support. Manuscript 1: Aim: Compare workers’ compensation indemnity claim rates and severity among occupational groups in Minnesota nursing homes. Methods: Negative binomial and linear regression models with generalized estimating equations were used with 2005-2016 data from the statewide workers’ compensation database to model the effect of occupation on type of workers’ compensation indemnity claim. Minnesota Nursing Home Report Card data were used to calculate claim rates by occupation. Results: Claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers in CNAs, licensed practical nurses (LPNs), and registered nurses (RNs), respectively. CNAs were more likely to experience musculoskeletal and patient handling injuries than RNs. However, their claims were less likely to result in temporary total disability or permanent partial disability benefits and more likely to result in stipulation settlements. Manuscript 2: Aim: Compare pre- and post-MN SPH Act trends in patient handling injury claim rates among Minnesota nursing homes and assess whether temporal trends are modified by facility-level staffing and retention. Methods: Negative binomial regression models with generalized estimating equations were used with 2005-2016 statewide workers’ compensation data matched to Centers for Medicare and Medicaid Services data to evaluate the impacts of time, staffing, and retention on patient handling injuries. Results: Compared to 3 pre-law years, the patient handling indemnity claim rate declined by 38% in years 7-9 following enactment of the MN SPH Act. Claims for all other injuries and illnesses declined by 20%. The association between time and patient handling claims was not modified by staffing or retention. However, across time, nursing homes with annual staff retention ≥75% (vs. <65%) had a 17% lower patient handling injury claim rate. Manuscript 3: Aim: Compare injury trends in Minnesota nursing homes, hospitals, and outpatient facilities to Wisconsin, a state without safe patient handling legislation. Methods: Mixed effects negative binomial regression models were used with 2005-2017 workers’ compensation data from a single large insurer. The effects of the MN SPH Act were evaluated by assessing the interaction between state and time period on workers’ compensation claim outcomes. Results: In both Minnesota and Wisconsin, patient handling injuries comprised the largest proportion of claims in nursing homes (54% and 45%, respectively) and smallest proportion in outpatient facilities (6% for both states). The change in mean annual facility-level patient handling claims from pre-law (2005-2007) to second post-implementation (2014-2017) did not differ between states. Further, changes in patient handling claims over time did not differ by healthcare setting. Conclusion Temporal trends in workers’ compensation indemnity claims suggest that the MN SPH Act may have successfully reduced patient handling injuries in Minnesota nursing homes. However, among health care facilities enrolled with a single large insurer, the change in indemnity and medical only workers’ compensation claims from pre-law to post-implementation did not differ between Minnesota and Wisconsin, a state without SPH legislation. Due to data limitations, including a small Wisconsin sample size, more research comparing Minnesota to states without legislation is needed. In Minnesota, state support of the law should target nursing homes with elevated claim rates, including those that have low staff retention, are non-profit, not affiliated with a hospital, or outside the Twin Cities metropolitan area. Further, additional support is needed to prevent and accommodate patient handling injuries among nursing home CNAs, an occupation with high patient handling and MSD injury rates and adverse workers’ compensation claim outcomes.Item Emergency Department Use by Asian American Children(2015-05) Zook, HeatherThe purpose of this study was to compare emergency department (ED) utilization and treatment patterns of Asian American children with children from other racial/ethnic groups. A cross-sectional design was used to examine all visits by children under 18 years to two urban pediatric EDs between June 2011 and May 2012. Demographic, socioeconomic, and clinical data were extracted from the patients' electronic medical records. A logistic regression model was used to assess the patients' odds of high ED utilization (at least 4 ED visits in the study period), controlling for potential confounders. The overall sample consisted of 86,922 ED visits, and over 4% were made by Asian American children. Asian Americans' ED usage and treatment patterns reflected those of Whites and not of other minority racial/ethnic groups in areas such as elopements, visit frequency, time and day of visit, time to exam, length of stay, tests ordered, inpatient admissions, and triage scores. Among all racial/ethnic groups, Asian Americans had the largest percentage of patients living in the lowest income level (45%). After adjusting for demographic, socioeconomic, and clinical covariates, Asian American children were the least likely to have high ED utilization. White patients were 2.57 (95% confidence interval 1.89 - 3.51) times more likely to have high ED utilization than Asian Americans, with all other groups having even higher odds. In conclusion, despite similar ED behaviors as Whites, Asian American children were significantly less likely to use the pediatric ED than all other racial/ethnic groups.Item Holistic Healthcare: Recognizing traditional practices of the American Indian community(2022-12) Phan, Tia MyThe American Indian community has had traditional healing practices, herbs, and medicines to cure their people long before Western medicine dominated the landscape. This holistic approach to healthcare including these traditional practices and medicines were not included in what we see offered at Western clinics nor are they covered by health insurance companies in the United States. The purpose of this work was to personally observe to understand the marriage of traditional healing and spiritual care in a Western clinic setting. In order to increase the number of people being served in this holistic manner, I name a few recommendations including: adding traditional healing and/or spiritual care service components to other clinics and perhaps hospitals; creating a formal referral network for physicians, nurse practitioners, nurses, and other healthcare providers to use; creating a database of available traditional healing and spiritual care services in a geographic area for community members and organizations to use; and expanding the post-event participant surveys to collect more identifiable information and potential barriers to service their participants face to better serve the community.Item Reaching Southeast Asian Families with a Healthy Nutrition Message(University of Minnesota Extension, 2013-10) Keo, Phalla; Sherman, ShelleyMinnesota ranks high among states for the health and education of its people, but some of the largest disparities in the nation also exist here. Minority communities, such as the Southeast Asian community, show disproportionately greater rates of obesity, heart disease, cancer, diabetes, high blood pressure and other nutritionally related diseases. Extension’s Simply Good Eating (SGE) nutrition education program collaborated with a California program to adapt and pilot a curriculum titled Building Healthy Families, developed for the Hmong community. Building Healthy Families sparked the interest of local partner agencies. The curriculum was adapted in 2012, has the potential to bridge a gap and fill a need in these communities due to similar values and challenges. The adaptations have the twin goals of increasing healthy behaviors and reducing the risk of chronic diseases and obesity in these groups.Item Rethinking How to Create a Health Disparity Tutorial(Medical Library Association, 2011-05) McGuire, Lisa AThis poster describes the creation of an online tutorial on how to research a health disparity topic. Contents include: defining health disparities, introduction to the MEDLINE database and the PubMed interface, and identification of medical subject headings that are useful in researching health disparities in the published journal literature.Item Structural racism and its role in propagating racial health inequities through systems of higher education and public health surveillance(2022-07) Thyden, NaomiHealth inequities by race are ubiquitous and persistent in the U.S., and structural racism is understood to be the cause. However, there has been relatively little research on structural racism as an exposure. This dissertation will describe three ways to conceptualize and measure structural racism with the end goal of intervening to reduce health inequities. First, it will examine structural racism in surveillance data. The Sudden Unexpected Infant Death (SUID) Case Registry is a public health surveillance system created to prevent SUIDs. This study assesses the quality of data collection by rurality and by race to examine bias within the surveillance system. Second, it will discuss exposure distributions and structural racism. Research about causes of racial health inequities often favor using an interaction term with race rather than also considering unequal distributions of exposures by race. This study provides the first estimates for Hispanic Americans, Asian Americans, and Native Americans on an understudied exposure – death of a sibling or a parent – and its effect on attaining a Bachelor’s degree. Third, it will delve into education policy and structural racism. Historically Black Colleges or Universities (HBCUs) were founded on anti-racism while predominantly white institutions (PWIs) were often founded on white supremacy. This contrast provides an opportunity to study effects of structural racism on the health of Black students who attended college in the U.S. This study measures the long-term effect of attending an HBCU on depressive symptoms among Black people compared to Black people who attended PWIs.