Supervisors: Dr. Claudia Campbell (ScD dissertation committee chair), Dr. Richard Culbertson (ScD advisor), Dr. John Lefante (ScD advisor), Dr. Paloma Toledo (ScD advisor), Dr. John Arras (MA advisor), Dr. James Childress (MA research supervisor), Dr. Judith Feder (MPP advisor), Dr. Harriet Komisar (MPP research supervisor), and Dr. Robert G Williams (BA advisor)
"Withholding relevant medical information from patients without their knowledge or conse... more "Withholding relevant medical information from patients without their knowledge or consent, in an attempt to minimize potential physical or psychological harms, has been called “therapeutic privilege.” This practice creates a conflict between physicians’ concurrent obligations to act beneficently and to respect patients’ autonomy. Whenever possible, physicians should minimize the withholding of medical information by accommodating patients’ preferences."
Achieving health care equity and eliminating health care disparities are a top goal of hospitals ... more Achieving health care equity and eliminating health care disparities are a top goal of hospitals and health systems. Health care equity has become an important discussion nationally as policymakers aim to improve quality of care while lowering costs through a variety of changes to existing incentives. Recognizing that there are areas for improvement is a first step, but it must be followed by actionable strategies to make sustainable improvements.
"Policymakers, payers and health care leaders agree that the current fee-for-service pay... more "Policymakers, payers and health care leaders agree that the current fee-for-service pay structure is creating unsustainable growth in U.S. health care costs. As a result, many are touting the accountable care organization as a way to bend the health care cost curve and encourage care coordination. An ACO accepts responsibility for the cost and quality of the care its providers deliver to a specific population of enrolled patients. ACOs also coordinate care among multiple providers, and in doing so they can address some of the shortcomings associated with the fee-for-service payment system. But the success of the ACO model resides in fostering clinical excellence and continual improvement. These goals may be accomplished best by incentivizng hospitals, physicians, post-acute care facilities and other providers to coordinate care while collecting and analyzing data on costs and outcomes."
In dealing with outbreaks of communicable diseases, the medical profession should work with publi... more In dealing with outbreaks of communicable diseases, the medical profession should work with public health authorities to promote the use of interventions that achieve desired public health outcomes with minimal infringement upon individual liberties. This article endeavors to help physicians manage their dual responsibilities to their patients and to their communities when participating in appropriate quarantine and isolation measures. In implementing such measures, individual physicians should take necessary actions to promote patients' well-being. In addition, the medical profession and individual physicians share responsibility for taking appropriate precautionary measures to protect the health of individuals caring for patients with communicable diseases.
Disaster Medicine and Public Health Preparedness, 2007
ABSTRACTThe recent shootings at Virginia Polytechnic Institute and State University (Virginia Tec... more ABSTRACTThe recent shootings at Virginia Polytechnic Institute and State University (Virginia Tech) suggest that an increased reliance upon the medical community to support public health violence prevention efforts may be warranted. As physicians are called upon to support these efforts, they must effectively balance their obligations to promote public safety with their traditional obligations to promote the best interests of their individual patients. To meet these concurrent ethical obligations, physicians' participation in public health violence prevention should seek to improve public safety without compromising the care of patients or exposing individuals to undue harm. Physicians should, therefore, report to the appropriate authorities those patients who are at risk of committing violent acts toward the public, but should only disclose the minimal amount of information that is necessary to protect the public. Moreover, physicians should also recommend the separation of vio...
Disaster medicine and public health preparedness, 2008
Large-scale catastrophic events typically result in a scarcity of essential medical resources and... more Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can en...
"Overall, hospitals embracing the ACO model appeared to be more progressive in terms of ... more "Overall, hospitals embracing the ACO model appeared to be more progressive in terms of care coordination and transition activities, as well as the achievement of meaningful use criteria, relative to non-ACO institutions. This suggests that the accountable care model may well improve upon the traditional fee-for-service model by better incentivizing the enhanced care of patients. These findings may warrant further studies to determine if such improved care methods serve to functionally reduce the overall cost of medical care provision."
Patients belonging to racial and ethnic minority populations continue to receive lesser-quality h... more Patients belonging to racial and ethnic minority populations continue to receive lesser-quality healthcare relative to other patients, even when controlling for relevant demographic variables. Such disparities represent a significant challenge for physicians who are ethically committed to serving all patients equally, irrespective of personal characteristics. Accordingly, this report explores the ethical obligations of individual physicians and the medical profession as they pertain to racial and ethnic disparities in healthcare. To address these disparities, the AMA Council on Ethical and Judicial Affairs recommends that physicians customize the provision of medial care to meet the needs and preferences of individual patients. Moreover, physicians must learn to recognize racial and ethnic healthcare disparities and critically examine their own practices to ensure that inappropriate considerations do not affect clinical judgment. Physicians can also work to eliminate racial and ethn...
... The Council on Ethical and Judicial Affairs at the time this report was written included Robe... more ... The Council on Ethical and Judicial Affairs at the time this report was written included Robert Sade, MD (Chair); Mark A. Levine, MD (Vice-Chair); Regina Benjamin, MD, MBA; Sharon Douglas, MD; Hillary Fairbrother, MD, MPH; H. Rex Greene, MD; William Martinez, MS; John ...
Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Fo... more Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) Employer Health Benefits Survey found. In 2013 single coverage premiums rose 5 percent to $5,884, and family coverage premiums rose 4 percent to $16,351. The percentage of firms offering health benefits (57 percent) was similar to that in 2012, as was the percentage of workers at offering firms who were covered by their firm’s health benefits (62 percent). The share of workers with a deductible for single coverage increased significantly from 2012, as did the share of workers in small firms with annual deductibles of $1,000 or more. Most firms (77 percent), including nearly all large employers, continued to offer wellness programs, but relatively few used incentives to encourage employees to participate. More than half of large employers offering health risk appraisals to workers offered financial incentives for completing the appraisal.
"Overall, hospitals embracing the ACO model appeared to be more progressive in terms of care coor... more "Overall, hospitals embracing the ACO model appeared to be more progressive in terms of care coordination and transition activities, as well as the achievement of meaningful use criteria, relative to non-ACO institutions. This suggests that the accountable care model may well improve upon the traditional fee-for-service
model by better incentivizing the enhanced care of patients. These findings may warrant further studies to determine if such improved care methods serve to functionally reduce the
overall cost of medical care provision."
OBJECTIVES: The Centers for Disease Control and Prevention recommends HIV screening in U.S. healt... more OBJECTIVES: The Centers for Disease Control and Prevention recommends HIV screening in U.S. health-care settings unless providers document a yield of undiagnosed HIV infections of <1 per 1,000 population. However, implementation of this guidance has not been widespread and little is known of the characteristics of hospitals with screening practices in place. We assessed how screening practices vary with hospital characteristics.
METHODS: We used a national hospital survey of HIV testing practices, linked to HIV prevalence for the county, parish, borough, or city where the hospital was located, to assess HIV screening of some or all patients by hospitals. We used multivariate logistic regression analysis to assess the association between screening practices and hospital characteristics that were significantly associated with screening in bivariate analyses.
RESULTS: Of 376 hospitals in areas of prevalence ≥0.1%, only 25 (6.6%) reported screening all patients for HIV and 131 (34.8%) reported screening some or all patients. Among 638 hospitals included, screening some or all patients was significantly (p<0.05) more common at teaching hospitals, hospitals with higher numbers of annual admissions, and hospitals with a high proportion of Medicaid admissions. In multivariable analysis, screening some or all patients was independently associated with admitting more than 15% of Medicaid patients and receiving resources or reimbursement for screening tests.
CONCLUSION: We found that few hospitals surveyed reported screening some or all patients, and failure to screen is common across all types of hospitals in all regions of the country. Expanded reimbursement for screening may increase compliance with the recommendations."
With the generous support of The Commonwealth Fund, the Health Research & Educational Trust perfo... more With the generous support of The Commonwealth Fund, the Health Research & Educational Trust performed a national survey of all hospitals in 2011 to assess the current state of hospital readiness in the development of accountable care organizations (ACOs).
"Policymakers, payers and health care leaders agree that the current fee-for-service pay structur... more "Policymakers, payers and health care leaders agree that the current fee-for-service pay structure is creating unsustainable growth in U.S. health care costs. As a result, many are
touting the accountable care organization as a way to bend the health care cost curve and encourage care coordination.
An ACO accepts responsibility for the cost and quality of the care its providers deliver to a specific population of enrolled patients. ACOs also coordinate care among multiple providers, and in
doing so they can address some of the shortcomings associated with the fee-for-service payment system.
But the success of the ACO model resides in fostering clinical excellence and continual improvement. These goals may be accomplished best by incentivizng hospitals, physicians, post-acute care facilities and other providers to coordinate care while collecting and analyzing data on costs and outcomes."
&quot;Withholding relevant medical information from patients without their knowledge or conse... more &quot;Withholding relevant medical information from patients without their knowledge or consent, in an attempt to minimize potential physical or psychological harms, has been called “therapeutic privilege.” This practice creates a conflict between physicians’ concurrent obligations to act beneficently and to respect patients’ autonomy. Whenever possible, physicians should minimize the withholding of medical information by accommodating patients’ preferences.&quot;
Achieving health care equity and eliminating health care disparities are a top goal of hospitals ... more Achieving health care equity and eliminating health care disparities are a top goal of hospitals and health systems. Health care equity has become an important discussion nationally as policymakers aim to improve quality of care while lowering costs through a variety of changes to existing incentives. Recognizing that there are areas for improvement is a first step, but it must be followed by actionable strategies to make sustainable improvements.
&quot;Policymakers, payers and health care leaders agree that the current fee-for-service pay... more &quot;Policymakers, payers and health care leaders agree that the current fee-for-service pay structure is creating unsustainable growth in U.S. health care costs. As a result, many are touting the accountable care organization as a way to bend the health care cost curve and encourage care coordination. An ACO accepts responsibility for the cost and quality of the care its providers deliver to a specific population of enrolled patients. ACOs also coordinate care among multiple providers, and in doing so they can address some of the shortcomings associated with the fee-for-service payment system. But the success of the ACO model resides in fostering clinical excellence and continual improvement. These goals may be accomplished best by incentivizng hospitals, physicians, post-acute care facilities and other providers to coordinate care while collecting and analyzing data on costs and outcomes.&quot;
In dealing with outbreaks of communicable diseases, the medical profession should work with publi... more In dealing with outbreaks of communicable diseases, the medical profession should work with public health authorities to promote the use of interventions that achieve desired public health outcomes with minimal infringement upon individual liberties. This article endeavors to help physicians manage their dual responsibilities to their patients and to their communities when participating in appropriate quarantine and isolation measures. In implementing such measures, individual physicians should take necessary actions to promote patients' well-being. In addition, the medical profession and individual physicians share responsibility for taking appropriate precautionary measures to protect the health of individuals caring for patients with communicable diseases.
Disaster Medicine and Public Health Preparedness, 2007
ABSTRACTThe recent shootings at Virginia Polytechnic Institute and State University (Virginia Tec... more ABSTRACTThe recent shootings at Virginia Polytechnic Institute and State University (Virginia Tech) suggest that an increased reliance upon the medical community to support public health violence prevention efforts may be warranted. As physicians are called upon to support these efforts, they must effectively balance their obligations to promote public safety with their traditional obligations to promote the best interests of their individual patients. To meet these concurrent ethical obligations, physicians' participation in public health violence prevention should seek to improve public safety without compromising the care of patients or exposing individuals to undue harm. Physicians should, therefore, report to the appropriate authorities those patients who are at risk of committing violent acts toward the public, but should only disclose the minimal amount of information that is necessary to protect the public. Moreover, physicians should also recommend the separation of vio...
Disaster medicine and public health preparedness, 2008
Large-scale catastrophic events typically result in a scarcity of essential medical resources and... more Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can en...
&quot;Overall, hospitals embracing the ACO model appeared to be more progressive in terms of ... more &quot;Overall, hospitals embracing the ACO model appeared to be more progressive in terms of care coordination and transition activities, as well as the achievement of meaningful use criteria, relative to non-ACO institutions. This suggests that the accountable care model may well improve upon the traditional fee-for-service model by better incentivizing the enhanced care of patients. These findings may warrant further studies to determine if such improved care methods serve to functionally reduce the overall cost of medical care provision.&quot;
Patients belonging to racial and ethnic minority populations continue to receive lesser-quality h... more Patients belonging to racial and ethnic minority populations continue to receive lesser-quality healthcare relative to other patients, even when controlling for relevant demographic variables. Such disparities represent a significant challenge for physicians who are ethically committed to serving all patients equally, irrespective of personal characteristics. Accordingly, this report explores the ethical obligations of individual physicians and the medical profession as they pertain to racial and ethnic disparities in healthcare. To address these disparities, the AMA Council on Ethical and Judicial Affairs recommends that physicians customize the provision of medial care to meet the needs and preferences of individual patients. Moreover, physicians must learn to recognize racial and ethnic healthcare disparities and critically examine their own practices to ensure that inappropriate considerations do not affect clinical judgment. Physicians can also work to eliminate racial and ethn...
... The Council on Ethical and Judicial Affairs at the time this report was written included Robe... more ... The Council on Ethical and Judicial Affairs at the time this report was written included Robert Sade, MD (Chair); Mark A. Levine, MD (Vice-Chair); Regina Benjamin, MD, MBA; Sharon Douglas, MD; Hillary Fairbrother, MD, MPH; H. Rex Greene, MD; William Martinez, MS; John ...
Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Fo... more Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) Employer Health Benefits Survey found. In 2013 single coverage premiums rose 5 percent to $5,884, and family coverage premiums rose 4 percent to $16,351. The percentage of firms offering health benefits (57 percent) was similar to that in 2012, as was the percentage of workers at offering firms who were covered by their firm’s health benefits (62 percent). The share of workers with a deductible for single coverage increased significantly from 2012, as did the share of workers in small firms with annual deductibles of $1,000 or more. Most firms (77 percent), including nearly all large employers, continued to offer wellness programs, but relatively few used incentives to encourage employees to participate. More than half of large employers offering health risk appraisals to workers offered financial incentives for completing the appraisal.
"Overall, hospitals embracing the ACO model appeared to be more progressive in terms of care coor... more "Overall, hospitals embracing the ACO model appeared to be more progressive in terms of care coordination and transition activities, as well as the achievement of meaningful use criteria, relative to non-ACO institutions. This suggests that the accountable care model may well improve upon the traditional fee-for-service
model by better incentivizing the enhanced care of patients. These findings may warrant further studies to determine if such improved care methods serve to functionally reduce the
overall cost of medical care provision."
OBJECTIVES: The Centers for Disease Control and Prevention recommends HIV screening in U.S. healt... more OBJECTIVES: The Centers for Disease Control and Prevention recommends HIV screening in U.S. health-care settings unless providers document a yield of undiagnosed HIV infections of <1 per 1,000 population. However, implementation of this guidance has not been widespread and little is known of the characteristics of hospitals with screening practices in place. We assessed how screening practices vary with hospital characteristics.
METHODS: We used a national hospital survey of HIV testing practices, linked to HIV prevalence for the county, parish, borough, or city where the hospital was located, to assess HIV screening of some or all patients by hospitals. We used multivariate logistic regression analysis to assess the association between screening practices and hospital characteristics that were significantly associated with screening in bivariate analyses.
RESULTS: Of 376 hospitals in areas of prevalence ≥0.1%, only 25 (6.6%) reported screening all patients for HIV and 131 (34.8%) reported screening some or all patients. Among 638 hospitals included, screening some or all patients was significantly (p<0.05) more common at teaching hospitals, hospitals with higher numbers of annual admissions, and hospitals with a high proportion of Medicaid admissions. In multivariable analysis, screening some or all patients was independently associated with admitting more than 15% of Medicaid patients and receiving resources or reimbursement for screening tests.
CONCLUSION: We found that few hospitals surveyed reported screening some or all patients, and failure to screen is common across all types of hospitals in all regions of the country. Expanded reimbursement for screening may increase compliance with the recommendations."
With the generous support of The Commonwealth Fund, the Health Research & Educational Trust perfo... more With the generous support of The Commonwealth Fund, the Health Research & Educational Trust performed a national survey of all hospitals in 2011 to assess the current state of hospital readiness in the development of accountable care organizations (ACOs).
"Policymakers, payers and health care leaders agree that the current fee-for-service pay structur... more "Policymakers, payers and health care leaders agree that the current fee-for-service pay structure is creating unsustainable growth in U.S. health care costs. As a result, many are
touting the accountable care organization as a way to bend the health care cost curve and encourage care coordination.
An ACO accepts responsibility for the cost and quality of the care its providers deliver to a specific population of enrolled patients. ACOs also coordinate care among multiple providers, and in
doing so they can address some of the shortcomings associated with the fee-for-service payment system.
But the success of the ACO model resides in fostering clinical excellence and continual improvement. These goals may be accomplished best by incentivizng hospitals, physicians, post-acute care facilities and other providers to coordinate care while collecting and analyzing data on costs and outcomes."
Cultural competency in health care describes the ability of systems to provide care to patients w... more Cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs. A culturally competent health care system is one that acknowledges the importance of culture, incorporates the assessment of cross-cultural relations, recognizes the potential impact of cultural differences, expands cultural knowledge, and adapts services to meet culturally unique needs. Ultimately, cultural competency is recognized as an essential means of reducing racial and ethnic disparities in health care. This guide explores the concept of cultural competency and builds the case for the enhancement of cultural competency in health care.
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Papers by Nathan (Andy) Bostick
model by better incentivizing the enhanced care of patients. These findings may warrant further studies to determine if such improved care methods serve to functionally reduce the
overall cost of medical care provision."
METHODS: We used a national hospital survey of HIV testing practices, linked to HIV prevalence for the county, parish, borough, or city where the hospital was located, to assess HIV screening of some or all patients by hospitals. We used multivariate logistic regression analysis to assess the association between screening practices and hospital characteristics that were significantly associated with screening in bivariate analyses.
RESULTS: Of 376 hospitals in areas of prevalence ≥0.1%, only 25 (6.6%) reported screening all patients for HIV and 131 (34.8%) reported screening some or all patients. Among 638 hospitals included, screening some or all patients was significantly (p<0.05) more common at teaching hospitals, hospitals with higher numbers of annual admissions, and hospitals with a high proportion of Medicaid admissions. In multivariable analysis, screening some or all patients was independently associated with admitting more than 15% of Medicaid patients and receiving resources or reimbursement for screening tests.
CONCLUSION: We found that few hospitals surveyed reported screening some or all patients, and failure to screen is common across all types of hospitals in all regions of the country. Expanded reimbursement for screening may increase compliance with the recommendations."
touting the accountable care organization as a way to bend the health care cost curve and encourage care coordination.
An ACO accepts responsibility for the cost and quality of the care its providers deliver to a specific population of enrolled patients. ACOs also coordinate care among multiple providers, and in
doing so they can address some of the shortcomings associated with the fee-for-service payment system.
But the success of the ACO model resides in fostering clinical excellence and continual improvement. These goals may be accomplished best by incentivizng hospitals, physicians, post-acute care facilities and other providers to coordinate care while collecting and analyzing data on costs and outcomes."
model by better incentivizing the enhanced care of patients. These findings may warrant further studies to determine if such improved care methods serve to functionally reduce the
overall cost of medical care provision."
METHODS: We used a national hospital survey of HIV testing practices, linked to HIV prevalence for the county, parish, borough, or city where the hospital was located, to assess HIV screening of some or all patients by hospitals. We used multivariate logistic regression analysis to assess the association between screening practices and hospital characteristics that were significantly associated with screening in bivariate analyses.
RESULTS: Of 376 hospitals in areas of prevalence ≥0.1%, only 25 (6.6%) reported screening all patients for HIV and 131 (34.8%) reported screening some or all patients. Among 638 hospitals included, screening some or all patients was significantly (p<0.05) more common at teaching hospitals, hospitals with higher numbers of annual admissions, and hospitals with a high proportion of Medicaid admissions. In multivariable analysis, screening some or all patients was independently associated with admitting more than 15% of Medicaid patients and receiving resources or reimbursement for screening tests.
CONCLUSION: We found that few hospitals surveyed reported screening some or all patients, and failure to screen is common across all types of hospitals in all regions of the country. Expanded reimbursement for screening may increase compliance with the recommendations."
touting the accountable care organization as a way to bend the health care cost curve and encourage care coordination.
An ACO accepts responsibility for the cost and quality of the care its providers deliver to a specific population of enrolled patients. ACOs also coordinate care among multiple providers, and in
doing so they can address some of the shortcomings associated with the fee-for-service payment system.
But the success of the ACO model resides in fostering clinical excellence and continual improvement. These goals may be accomplished best by incentivizng hospitals, physicians, post-acute care facilities and other providers to coordinate care while collecting and analyzing data on costs and outcomes."