- Madison, Wisconsin, United States
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Objective: To determine the costs associated with conducting concurrent utilization review, a utilization management strategy widely used by the managed care industry. Study design: A production process model focusing on resource... more
Objective: To determine the costs associated with conducting concurrent utilization review, a utilization management strategy widely used by the managed care industry. Study design: A production process model focusing on resource utilization. Subjects: The 29 clinical services of a 500-bed academic health center were aggregated into 9 clinical groups. A random sample of at least 15 reviews per group was studied. Methods: Time sampling and cost analysis methods were used to determine the cost to the hospital of conducting utilization review. Component activities of the process were identified and analyzed to determine differences among clinical services and among the component tasks of the utilization review process. Results: In 12 months, 13 126 reviews were completed in an average of 15 minutes 41 seconds. Across clinical groups, the average total time of each review ranged from 11 minutes 18 seconds (medical group) to 19 minutes 4 seconds (pediatrics group). Significant differences existed among clinical service groups for the activity of preparing for conducting the review, with the pediatrics group spending more time than the cardiology and oncology groups. The total cost of the process was nearly dollar 166 000 annually. The average cost per review was dollar 11, the average cost per patient-day denied was dollar 478, and the average cost per patient denial was dollar 1592. Conclusions: These figures are conservative in that they do not include the payer component of the costs, which could be as high as the hospital provider cost. Given a denial rate of < 2% and the high cost of the process, it may be beneficial to investigate alternative processes for conducting utilization review.
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Research Interests: Psychology, Communication, Risk Taking, Suicide prevention, Adolescent, and 14 moreMedicine, Crisis Intervention, Humans, Social connectedness, Child, Female, Male, Elementary School, Interpersonal Relations, Suicidal Ideation, Attempted Suicide, Psychiatric Mental Health Nursing, Psychology and Cognitive Sciences, and Medical and Health Sciences
Much of the negative perception of managed care focuses on fear of denials of certification for reimbursement. This study examined more than 50,000 concurrent utilization reviews completed over a four-year period (1998-2001) at a large... more
Much of the negative perception of managed care focuses on fear of denials of certification for reimbursement. This study examined more than 50,000 concurrent utilization reviews completed over a four-year period (1998-2001) at a large teaching hospital. The results showed a denial rate of less than 1.5% of all patients reviewed, higher denial rates among certain clinical services, higher rates of reviews among certain services only partially explained by volume of admissions, and a lack of patient criteria to receive care in the inpatient setting as the most frequent reason given for denial.
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Research Interests: Genetics, Biology, Neurophysiology, Epigenetics, Medicine, and 12 moreMethylation, Animals, Male, DNA methylation, Globus Pallidus, Single Nucleotide Polymorphism, Dopamine Transporter, Macaca Mulatta, Radiopharmaceuticals, Impulsive behavior, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Cognitive Science, Computer Science, Cognition, Cognitive Neuroscience, and 15 moreMedicine, Primates, Impulsivity, Low Dose, Impulse response, Animals, Male, Dissociative disorders, Macaca Mulatta, Mechanism of action, Methylphenidate, Neurosciences, Impulsive behavior, Attention deficit hyperactivity disorder, and photic stimulation
Research Interests: Psychology, Clinical Psychology, Nursing, Anxiety Disorders, Psychometrics, and 15 moreMeasurement and Evaluation, Cystic Fibrosis, Medicine, Anxiety, Humans, Female, Male, Parents, Adult, Reproducibility of Results, Chi Square Distribution, ANXIETY, Congenital Hypothyroidism, Personality Inventory, and Reliability and validity
ABSTRACTThis study compared the asymmetry of different features of brain electrical activity during the performance of a verbal task (word finding) and a spatial task (dot localization) that had been carefully matched on psychometric... more
ABSTRACTThis study compared the asymmetry of different features of brain electrical activity during the performance of a verbal task (word finding) and a spatial task (dot localization) that had been carefully matched on psychometric properties and accompanying motor activity. Nineteen right‐handed subjects were tested. EEG was recorded from F3, F4, C3, C4, P3, and P4, referred to both Cz and computer‐derived averaged‐ears references, and Fourier transformed. Power in the delta, theta, alpha, and beta bands was computed. There were significant Task X Hemisphere effects in all bands for Cz‐referenced data and for the alpha and beta bands for ears‐referenced data. The effects were always either greater power suppression in the hemisphere putatively most engaged in task processing or greater power in the opposite hemisphere. Correlations between EEG and task performance indicated that Cz‐referenced parietal alpha asymmetry accounted for the most variance in verbal task performance. Power within individual hemispheres or across hemispheres was unrelated to task performance. The findings indicate robust differences in asymmetrical brain physiology that are produced by well‐matched verbal and spatial cognitive tasks.
Research Interests: Psychology, Cognitive Psychology, Psychophysiology, Audiology, Cognition, and 15 moreAttention, Electroencephalography, Medicine, Biological Sciences, Problem Solving, Humans, Cerebral Cortex, Lateralization, Female, Arousal, Adult, Cognitive Tasks, Psychomotor Performance, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Psychology, Health Psychology, Education, Decision Making, Health, and 15 moreMedicine, Social Influence, Humans, Negative Affect, Female, Patient Compliance, Psychosocial, Mammography, Aged, Middle Aged, Analysis of Variance, The Transtheoretical Model, Breast Neoplasms, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Public health workforce trends demonstrate threats to a vital national resource. The current shortage of public health nurses is due to a variety of factors. One route to addressing the public health nursing shortage is to increase the... more
Public health workforce trends demonstrate threats to a vital national resource. The current shortage of public health nurses is due to a variety of factors. One route to addressing the public health nursing shortage is to increase the level of interest in public health as a career option for nurses. The main objective of this study was to examine the relationship of nursing education program and field experience characteristics on the level of interest in a public health career among student nurses. Cross-sectional, online surveys of undergraduate student nurses were conducted over 6 semesters to assess the relationship of field practicum characteristics and level of interest in a public health career. Undergraduate student nurses (N = 882) enrolled in traditional baccalaureate nursing programs (n = 18) and online associate to baccalaureate degree completion programs (n = 2) in one US state participated in the survey after completing the required community or public health coursework and field experiences. Level of interest in a career in public health was measured using a 4-point Likert-type scale anchored by &amp;amp;quot;no interest&amp;amp;quot; and &amp;amp;quot;very strong interest.&amp;amp;quot; Overall, 46% of respondents expressed either moderate or strong interest in a future career in public health. Having had a field experience in a local health department was the only type of experience associated with stronger interest in a public health career. Enrollment in baccalaureate completion programs was associated with higher interest, and enrollment in programs located in a region of the state where students were significantly less likely to have field experiences in local health departments was associated with lower interest. Career interests for nurses are developed in part through field experiences while in nursing school. Interest in public health careers may be nurtured through field experiences in local health departments.
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Research Interests: Psychology, Electrophysiology, Audiology, Cognition, Laterality, and 15 moreElectroencephalography, Medicine, Biological Sciences, Biological Psychiatry, Humans, Female, Male, Depressive Disorder, Electroencephalogram, Adult, Frontal Lobe, Functional Laterality, Psychomotor Performance, Psychology and Cognitive Sciences, and Medical and Health Sciences
Several different models postulate that depression is associated with decreased approach-related behavior. Relatively little has been done to date to specifically investigate this issue. In the present study, a signal-detection analysis... more
Several different models postulate that depression is associated with decreased approach-related behavior. Relatively little has been done to date to specifically investigate this issue. In the present study, a signal-detection analysis was used to examine the response biases of dysphoric and nondysphoric female undergraduates during 3 payoff conditions: neutral, reward, and punishment. As predicted, the dysphoric subjects had a smaller change in bias from the neutral to the reward condition compared with the nondysphoric group. The 2 groups did not differ during the neutral and punishment conditions. These findings are consistent with the hypothesis that the left frontal hypoactivation observed in depression reflects a deficit in approach-related behavior.
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Research Interests: Psychology and Medicine
Identifying the most efficient and theoretically appropriate methods to assess patient anxiety in fast-paced medical environments may be beneficial for clinical purposes as well as for research. The purpose of this study was to examine... more
Identifying the most efficient and theoretically appropriate methods to assess patient anxiety in fast-paced medical environments may be beneficial for clinical purposes as well as for research. The purpose of this study was to examine the reliability and validity of two previously published six-item versions of the State form of the State-Trait Anxiety Inventory (STAI) and to identify the version that would be most appropriate to use with a sample of parents who had infants with normal or abnormal newborn screens. In the current study, confirmatory factor analyses were conducted to evaluate the fit of the two six-item forms with STAI data collected at three time points from 288 parents of 150 infants. Study groups of parents were based upon infant newborn screens and subsequent diagnostic testing to include cystic fibrosis (CF; n = 26), congenital hypothyroidism (CH; n = 39), CF Carriers (CF–C; n = 45), and healthy infants (H; n = 40). The results showed the version containing item...
Research Interests: Psychology, Nursing, Anxiety Disorders, Psychometrics, Measurement and Evaluation, and 15 moreCystic Fibrosis, Medicine, Anxiety, Humans, Female, Male, Parents, Adult, Reproducibility of Results, Chi Square Distribution, ANXIETY, Congenital Hypothyroidism, State Trait Anxiety Inventory, Personality Inventory, and Reliability and validity
Research Interests: Program Evaluation, Psychology, Communication, Health Promotion, Adolescent, and 15 moreMedicine, Multivariate Analysis, Problem Solving, Humans, Child, Female, Male, Mental health services, Parents, Adult, Hostility, Psychiatric Mental Health Nursing, attitude to health, Conflict Psychology, and Medical and Health Sciences
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Much of the negative perception of managed care focuses on fear of denials of certification for reimbursement. This study examined more than 50,000 concurrent utilization reviews completed over a four-year period (1998-2001) at a large... more
Much of the negative perception of managed care focuses on fear of denials of certification for reimbursement. This study examined more than 50,000 concurrent utilization reviews completed over a four-year period (1998-2001) at a large teaching hospital. The results showed a denial rate of less than 1.5% of all patients reviewed, higher denial rates among certain clinical services, higher rates of reviews among certain services only partially explained by volume of admissions, and a lack of patient criteria to receive care in the inpatient setting as the most frequent reason given for denial.
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Impulsivity, the predisposition to act without regard for negative consequences, is a characteristic of several psychiatric disorders and is thought to result in part from genetic variation in the untranslated region of the dopamine... more
Impulsivity, the predisposition to act without regard for negative consequences, is a characteristic of several psychiatric disorders and is thought to result in part from genetic variation in the untranslated region of the dopamine transporter (DAT) gene. As the exact link between genetic mutations and impulsivity has not been established, we used oculomotor behavior to characterize rhesus monkeys as impulsive or calm and genetic/epigenetic analysis and positron emission tomography (PET) to correlate phenotype to DAT genotype, DAT gene methylation, and DAT availability. We found three single nucleotide polymorphisms (SNPs) in the 3'-UTR of the DAT gene, one of which provided a potential site for methylation in the impulsive group. Bisulfite analysis showed that the DNA of the impulsive but not the calm subjects was methylated at one SNP. Because genetic/epigenetic modifications could lead to differences in protein expression, we measured DAT availability using [(18)F]2β-carbome...
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Recommendations for improving public health workforce competency led to an academic-practice partnership project conducted to improve competency for providing essential public health services among public health nurses. To measure... more
Recommendations for improving public health workforce competency led to an academic-practice partnership project conducted to improve competency for providing essential public health services among public health nurses. To measure competency for public health practice at baseline, identify factors associated with higher competency, document change in competency over 4 years, and assess differential effects associated with project participation. Perceived competency was assessed using a validated instrument administered through online surveys at baseline (2007) and 4-year follow-up (2011). Analysis was completed in 2014. Overall means and SDs were calculated for each domain in the competency scale. Differences in means by role were tested using multivariate analysis of variance. Factors associated with higher competency were identified using regression analysis. Mean comparisons between baseline and follow-up were tested using paired samples t test and ANCOVA was used to test differe...
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This study used a retrospective comparison of 2 naturally occurring groups, first to examine how exclusive versus partial breastfeeding relates to duration of breastfeeding and, second, to determine if factors such as age and body mass... more
This study used a retrospective comparison of 2 naturally occurring groups, first to examine how exclusive versus partial breastfeeding relates to duration of breastfeeding and, second, to determine if factors such as age and body mass index are associated with exclusive versus partial breastfeeding duration. These factors were hypothesized to influence the amount of breastfeeding in a sample of 42 low-income mothers enrolled in the Supplemental Nutrition Program for Women, Infants, and Children of a predominately rural, Midwestern county. This study examined de-identified data from a state database spanning a calendar year. Breastfeeding behavior, age, and body mass index measurements for mothers giving birth within the first 6 months of that year were analyzed. Exclusive breastfeeding mothers breastfed longer, were of older age, and had lower body mass indexes than partial breastfeeding mothers. These findings further describe characteristics of low-income breastfeeding women. Und...
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Nurses have a critical role in family development of competencies for giving care to very low birth-weight infants, However, current information-based methods of preparation may be inadequate for competency development. This article... more
Nurses have a critical role in family development of competencies for giving care to very low birth-weight infants, However, current information-based methods of preparation may be inadequate for competency development. This article describes a continuing education program designed to strengthen nurses' support of families in developing caregiving competencies through processes of guided participation. Program effectiveness was explored with: (1) a survey of participant and non-participant nurse satisfaction with family work and with organizational resources and practices; (2) a description of relationship and caregiving competencies for mothers who had and had not received guided participation; and (3) a review of mothers' reports of their experience either with or without guided participation. Organizational arrangements and mechanisms for establishing guided participation practice within an agency, including ongoing reflective supervision sessions, peer collaboration, and...
Research Interests: Program Evaluation, Nursing, Job Satisfaction, Infant Toddler Care, Humans, and 15 moreWisconsin, Female, Education Systems, The, Mothers, Nursing Education and Research in Nursing, Public Health Nursing, Newborn Infant, Educational Models, Mentors, Clinical Competence, Nursing staff, attitude to health, Infant Care, and Inservice training
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Much of the negative perception of managed care focuses on fear of denials of certification for reimbursement. This study examined more than 50,000 concurrent utilization reviews completed over a four-year period (1998-2001) at a large... more
Much of the negative perception of managed care focuses on fear of denials of certification for reimbursement. This study examined more than 50,000 concurrent utilization reviews completed over a four-year period (1998-2001) at a large teaching hospital. The results showed a denial rate of less than 1.5% of all patients reviewed, higher denial rates among certain clinical services, higher rates of reviews among certain services only partially explained by volume of admissions, and a lack of patient criteria to receive care in the inpatient setting as the most frequent reason given for denial.