Browsing by Subject "healthcare"

Now showing 1 - 20 of 20
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    Addressing Institutional Racism in Healthcare: A Case Study
    (2020-10) Banks, Barbra
    The extent of health inequities plaguing our nation is well-documented, with Black Americans continuing to experience the largest gaps (U.S. Department of Health and Human Services, 2014). Healthcare organizations cannot achieve racial health equity until they are willing to address institutional racism. With the magnitude of health inequities, particularly racial inequities, healthcare organizations addressing institutional racism as a part of their health equity efforts becomes even more critical. This case study offers an in-depth description of a Midwestern urban hospital birth center’s year-long equity education program, posing the question, “How does a large, urban hospital address institutional racism as a part of their health equity strategy?” Results show three outcomes of the department’s intervention to address racial health inequity and institutional racism: 1) the central features of the intervention’s framework and approach proved instrumental in individual development and change, 2) through double- and triple-loop learning, the department effectively addressed and began to dismantle institutional racism, and 3) the convergence of events leading to the intervention offered a “ripe” time for the creation, planning, and execution of the equity education program. Implications from this study contribute to healthcare, workplace diversity and inclusion, and human resource development scholarship and practice.
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    Case Study: Developing, Implementing, and Evaluating a One-Day Leadership Conference to Foster Women’s Leadership in Healthcare
    (University of Minnesota, College of Pharmacy, 2014) Fierke, Kerry K.; Kading, Margarette L.
    Despite women increasingly entering the healthcare field, they still face barriers to advancing in leadership ranks within healthcare. To address the need for leadership development among women in healthcare, the Center for Leading Healthcare Change (CLHC) at the University of Minnesota College of Pharmacy piloted a one-day conference in November 2012 entitled “Women Impacting Healthcare: Decide to Make a Difference.” This conference utilized an interactive agenda: each speaker’s presentation was followed by hands-on leadership activities during which attendees developed their own personal leadership visions. Specific leadership activities were designed to build upon one another and help design a leadership pathway. All activities were consistent as they included personal reflection and interaction with others. Attendees were asked to complete two evaluations, one immediately at the conclusion of the conference, and another two-weeks post. The conference committee achieved the goal of delivering the conference objectives. As the Women Impacting Healthcare committee continues to look for ways to develop leaders in healthcare, the focus of future conferences will also evolve to include the needs of women currently in leadership roles, as well as ways women can grow into leadership roles.
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    A Data Quality Framework for the Secondary Use of Electronic Health Information
    (2016-04) Johnson, Steven
    Electronic health record (EHR) systems are designed to replace paper charts and facilitate the delivery of care. Since EHR data is now readily available in electronic form, it is increasingly used for other purposes. This is expected to improve health outcomes for patients; however, the benefits will only be realized if the data that is captured in the EHR is of sufficient quality to support these secondary uses. This research demonstrated that a healthcare data quality framework can be developed that produces metrics that characterize underlying EHR data quality and it can be used to quantify the impact of data quality issues on the correctness of the intended use of the data. The framework described in this research defined a Data Quality (DQ) Ontology and implemented an assessment method. The DQ Ontology was developed by mining the healthcare data quality literature for important terms used to discuss data quality concepts and these terms were harmonized into an ontology. Four high-level data quality dimensions (CorrectnessMeasure, ConsistencyMeasure, CompletenessMeasure and CurrencyMeasure) categorized 19 lower level Measures. The ontology serves as an unambiguous vocabulary and allows more precision when discussing healthcare data quality. The DQ Ontology is expressed with sufficient rigor that it can be used for logical inference and computation. The data quality framework was used to characterize data quality of an EHR for 10 data quality Measures. The results demonstrate that data quality can be quantified and Metrics can track data quality trends over time and for specific domain concepts. The DQ framework produces scalar quantities which can be computed on individual domain concepts and can be meaningfully aggregated at different levels of an information model. The data quality assessment process was also used to quantify the impact of data quality issues on a task. The EHR data was systematically degraded and a measure of the impact on the correctness of CMS178 eMeasure (Urinary Catheter Removal after Surgery) was computed. This information can help healthcare organizations prioritize data quality improvement efforts to focus on the areas that are most important and determine if the data can support its intended use.
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    Digitizing Difference: Fraudulence, Gender Non-Conformity, and Data
    (2019-03) Mackenzie, Lars
    This dissertation explores how fraudulence shapes contemporary trans life. It examines the impacts of software design, law, and policy on trans and gender non-conforming people, arguing that social expectations about the stability of sex, gender, and identity systematically devalue the lives of trans and gender non-conforming people with particularly harmful impacts in the financial and healthcare sectors. Further, it demonstrates that incongruent or gender non-conforming data wields significant and dangerous power in an era of data-driven decision-making and present alternative approaches towards challenging these paradigms.
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    Duluth Bethel Program Evaluation
    (University of Minnesota Duluth, 2019) Haynes, Monica; Chiodi Grensing, Gina; Dauner, Kim; Brand, Nathan; Olafson, Tommy; Badger, Megan; Hockert, Matthew
    The Duluth Bethel (Bethel) is a private non-profit 501c(3) organization that provides community corrections and inpatient and outpatient chemical dependency services to individuals in Duluth and the surrounding region. Roughly half of the individuals served by Bethel in a given year receive treatment for chemical dependency through the Port Rehabilitation program, while the rest participate in one of the facility’s Community Corrections programs (either the Work Release or Female Offender Programs). This project outlines an evaluation strategy for Bethel and assesses the costs and outcomes of the organization’s primary programs. The team utilized data for four years, 2015-2018. The analysis has four primary goals. First was the development of an agency-wide logic model that includes program resources and inputs; actions and outputs; and short-term, medium-term, and long-term outcomes on both clients and the community. Second, data currently being collected by Bethel on its programs and clients as well as any important measures not currently being collected were summarized. Third, common client scenarios (or pathways) for Bethel’s clients were identified, and the costs and outcomes of Bethel’s programs were compared with the most likely alternatives for clients (e.g. jail, prison, treatment). And fourth, a list of recommendations for the organization, based on the study results, existing literature, and feedback from staff and subject-matter experts was developed.
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    Dumping the “Anti-Dumping” Law: Why EMTALA Is (Largely) Unconstitutional and Why It Matters
    (Minnesota Journal of Law, Science and Technology, 2014-02-20) Morreim, E.H.
    EMTALA—the Emergency Medical Treatment and Active Labor Act requiring hospital emergency departments to screen and stabilize emergency patients, regardless of ability to pay— has played a pivotal and peculiar role in American health care, as the only assured access to care for millions of people. Curiously, although EMTALA imposes enormous costs on hospitals, neither the Supreme Court nor any circuit courts have addressed its constitutionality. This Article argues that, particularly in the paradigm case of an indigent patient at a for-profit hospital, EMTALA violates the Fifth Amendment’s Takings Clause: the government takes property for public use without just compensation. All the elements of a taking are readily established: property, taking, and public use. Here, the property is not the hospital as such—this is not a case of land use regulation. Rather, the hospital is the “person” from whom property is taken, including: [1] personal property such as costly pharmaceuticals, medical devices, and paid staff time; and [2] physical invasion of spaces such as the emergency room, operating suites, and intensive care beds. Such destruction or transfer of personal property and invasion of physical spaces constitute per se takings. Regulatory takings analysis, ordinarily invoked for regulating real property, is inapplicable. These takings’ public use is to ensure immediate emergency care, regardless of ability to pay. All three elements of a taking are thus satisfied. As this Article further argues, EMTALA’s broad economic coercion of hospitals cannot be justified as simply a condition of participation in Medicare. In the end, the problem is not that EMTALA mandates takings, but rather that it fails to provide adequately for just compensation. For-profit hospitals often receive no compensation whatever. Even not-for-profit hospitals can quickly cross the threshold from “compensated” (e.g., via tax exemption) into uncompensated care. Where compensation is insufficient, EMTALA’s takings are unconstitutional. The substantial constitutional impairment of EMTALA could trigger an interesting predicament. Historically, EMTALA has been a “fig leaf” obscuring the nation’s less-than-universal access to care. After all, the uninsured can always go to the emergency room. Going forward, EMTALA may be an “enabler,” encouraging healthy people to forego insurance until they become ill. The Affordable Care Act (ACA) permits anyone, even those with preexisting conditions, to buy insurance at the same cost as anyone else and, although it mandates that everyone be insured, the “tax” for noncompliance is modest and not strongly enforceable. Refusal to buy insurance until after one is ill may thus be attractive because, after all, the emergency room cannot demand advance assurance of payment. If the cost of insurance thereby spirals out of control because too few healthy people buy it, the Fifth Amendment’s Takings Clause could actually salvage the ACA’s mandate. Although this Article neither endorses nor disparages the idea, the individual mandate could be re-cast as a constitutionally proper act of eminent domain: the “property” being taken is the citizen’s money; the “just compensation” is a health insurance policy; and the “public use” is to save private health insurance as Congress’ chosen avenue for broadening access to care. Perhaps most interestingly, the mandate as an exercise of eminent domain need not satisfy the Commerce Clause. Per a long line of Supreme Court rulings, acts of eminent domain need only satisfy the rational basis test.
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    Financing Long Term Care: Dilemmas and Decisions Facing the Elderly, Family Members, and Society.
    (Center for Urban and Regional Affairs, University of Minnesota, 1996) Stum, Marlene; Brouwer, Estelle
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    The Future of Medicaid Expansion
    (2014-08-05) Jacobs, Lawrence R.
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    India's National Population Policy (2000): An Evaluation
    (Hubert H. Humphrey Institute of Public Affairs, 2009-05-14) Agrawal, Sandhya
    This paper examines the quality of India’s family planning practice under the National Population Policy (2000) or NPP-2000. The intent of NPP-2000 is to eliminate unmet contraceptive needs by providing high quality reproductive healthcare. In particular, the NPP-2000 aims to address flaws in healthcare infrastructure and to achieve a total fertility rate of 2.1 births per woman by 2010. Unfortunately, the implementation difficulties of past years persist in the era of NPP-2000. Indian families are subject to poorly-trained healthcare personnel and insufficient medical supplies, among other setbacks. Using interviews with family planning professionals and data from quantitative and qualitative studies, the following analysis exposes widespread variation in the quality of family planning practice. Additionally, the author proposes strategies to address unmet contraceptive needs in northern states and among disadvantaged populations.
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    International Students’ Experiences and Concerns During the Pandemic
    (SERU Consortium, University of California - Berkeley and University of Minnesota., 2020-07) Chirikov, Igor; Soria, Krista M.
    In contrast to domestic students, international students at research universities are more satisfied with their academic experiences and institutional support during the pandemic, according to the recent Student Experience in the Research University (SERU) Consortium survey of 22,519 undergraduate students and 7,690 graduate and professional students at five public research universities. International students’ primary concerns are not with universities themselves but with health, safety and immigration issues.
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    Into the Fields: A Report on Migrant and Seasonal Farmworkers in Minnesota.
    (University Migrant Project, Center for Urban and Regional Affairs, University of Minnesota., 1995) Casillo-Morales, Lupe; Pergament, Shannon; Durkin, Debrah
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    Mistake-Proofing Medicine: Legal Considerations and Healthcare Quality Implications
    (2013-02-12) Grout, John R.; Hill, John W.; Langvardt, Arlen W.
    In 1999, the Institute of Medicine estimated that approximately 98,000 deaths resulted annually from medical errors. This shocking number does not appear to have lessened during the intervening years. Mistake-proofing techniques similar to those that have proven useful in the product liability context hold great promise for reducing the number of medical errors. However, the adoption of such techniques in healthcare settings is more limited than expected. This article examines potentially useful mistake-proofing techniques, explores the largely unsound reasons why healthcare professionals have been slow to adopt such techniques, and explores the implications of mistake-proofing adoption (or lack thereof) for malpractice litigation and liability. Along the way, this article considers the undesirable effects of misperceptions on the part of healthcare professionals regarding their risks of being held liable in a malpractice case. This article also proposes ways of encouraging greater adoption of mistake-proofing techniques and other error-reduction practices in healthcare contexts.
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    On house calls, healthcare, and hope: one student’s perspective
    (University of Minnesota, College of Pharmacy, 2014) Shelquist, Ryan; Greene, Elisa
    Healthcare providers spend years studying pathophysiology and therapeutics, often neglecting to consider the whole picture of influences on a person’s health. House calls are a beneficial tool in that they provide the opportunity for trainees to experience these concepts firsthand, often opening student eyes to suffering, poverty, and unexpectedly, hope. Exposure to this broader perspective may empower health care providers to see beyond the limitations of disease and medication, into deeper issues that affect patient health.
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    Out-Of-Pocket Health Care Spending: Effects Of Partner Spending On Own Spending
    (2018-05) Adeniyi, Titilope
    Background. Delayed or foregone medical care because of cost is an ever-present possibility for most households and a current concern for many households in the United States. A small body of literature exists concerning the relationship between household out-of-pocket spending and household-member delayed or foregone health care and none of this literature focuses primarily on older adults. This research seeks to answer the following question: Among older adults, how does the existence of a pre-existing medical condition(s) in one’s partner effect one’s own out-of-pocket health care spending in the period following a recent medical condition diagnosis? Methods. This research used data from the Health and Retirement Study (HRS). The HRS surveys United States non-institutionalized residents at least 50 years of age and their partners every two years. The analytic sample was comprised of 2,325 observations for 524 households from the 2002 to 2012 survey waves. This research utilized a 2-part fixed-effects difference-in-differences model. The outcomes of interest were individual total and prescription out-of-pocket health care spending. Results. In contrast to unadjusted models, after adjusting for a number of individual and household characteristics, there was no significant difference in the change in total and prescription out-of-pocket spending behavior after a medical condition diagnosis when comparing individuals with and without a partner with a pre-existing medical condition. Conclusion. While most of the difference-in-differences results were not significant in the unadjusted, adjusted, and sensitivity analyses for both total and prescription out-of-pocket spending, all but a handful of these results were positive. Positive effect values are counter to the result that was expected. The positive sign indicates a tendency for individuals who have partners with a pre-existing condition to have a greater change in out-of-pocket spending than individuals without a partner with a pre-existing condition. A possible explanation for this finding could relate to increased health care literacy in households that have a partner with a pre-existing condition.
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    Well-Being of Parents and Children in the Minnesota Family Investment Program in Hennepin County, Minnesota, 1998-2002.
    (2003) Hollister, David; Martin, Mary; Toft, Jessica; Yeo, Ji-in; Kim, Youngmin