Hannah L. Maxey

State policy environment and the dental safety net: a case study of professional practice environments’ effect on dental service availability in Federally Qualified Health Centers

OBJECTIVES To determine whether and to what extent the state policy environment for the dental hygiene workforce affects the availability of dental services at Federally Qualified Health Centers (FQHCs). METHODS We examined data drawn from the Uniform Data System on 1,135 unique FQHC grantees receiving community health center funding from the U.S. Health Center program between 2004 and 2012. The Dental Hygiene Professional Practice Index was used to quantify variations in state policy environment. We then examined the influence of state policy environment on the availability of dental care through generalized linear mixed-effects models. RESULTS Approximately 80% of FQHCs reported delivering dental services. We consistently observed that FQHCs with favorable levels of state support had the highest proportion of FQHCs that delivered dental services, even more so than FQHCs with extremely high support. FQHCs located in the most restrictive states had 0.28 the odds of delivering dental services as did those located in the most supportive states. CONCLUSIONS The state policy environment for the dental hygiene workforce is likely associated with the availability of dental services at FQHCs. The greatest proportion of FQHCs delivering dental services was found in states with policy provisions supporting professional independence in public health settings. Nevertheless, additional research is needed to understand the specific mechanism by which these policies affect FQHCs.

Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

Frequency of Pediatric Emergencies in Ambulatory Practices

Through verification of EMS data, we objectively characterize the frequency and etiology of pediatric emergencies in ambulatory practices in a metropolitan area. BrightcoveDefaultPlayer10.1542/6138649665001PEDS-VA_2017-3082 Video Abstract BACKGROUND: Management of pediatric emergencies is challenging for ambulatory providers because these rare events require preparation and planning tailored to the expected emergencies. The current recommendations for pediatric emergencies in ambulatory settings are based on 20-year-old survey data. We aimed to objectively identify the frequency and etiology of pediatric emergencies in ambulatory practices. METHODS: We examined pediatric emergency medical services (EMS) runs originating from ambulatory practices in the greater Indianapolis metropolitan area between January 1, 2012, and December 31, 2014. Probabilistic matching of pickup location addresses and practice location data from the Indiana Professional Licensing Agency were used to identify EMS runs from ambulatory settings. A manual review of EMS records was conducted to validate the matching, categorize illnesses types, and categorize interventions performed by EMS. Demographic data related to both patients who required treatment and practices where these events occurred were also described. RESULTS: Of the 38 841 pediatric EMS transports that occurred during the 3-year period, 332 (0.85%) originated from ambulatory practices at a rate of 42 per 100 000 children per year. The most common illness types were respiratory distress, psychiatric and/or behavioral emergencies, and seizures. Supplemental oxygen and albuterol were the most common intervention, with few critical care level interventions. Community measures of low socioeconomic status were associated with increased number of pediatric emergencies in ambulatory settings. CONCLUSIONS: Pediatric emergencies in ambulatory settings are most likely due to respiratory distress, psychiatric and/or behavioral emergencies, or seizures. They usually require only basic interventions. EMS data are a valuable tool for identifying emergencies in ambulatory settings when validated with external data.

Scratching the Surface of Psychiatric Services Distribution and Public Health: an Indiana Assessment

Mental illness is a leading cause of disability with many public health implications. Previous studies have demonstrated a national shortage of psychiatrists, particularly in rural areas. An analysis of how this workforce distribution relates to population demographics and public/behavioral health is lacking in the literature. This study encompassed a statewide assessment of the Indiana psychiatric workforce as it relates to population characteristics and public/behavioral health. This study’s findings demonstrate a profoundly low psychiatry workforce in rural counties of Indiana. The low psychiatry workforce capacity in rural counties is so disparate that the demographic and public/behavioral health characteristics differ from the State averages in the same manner as counties without a psychiatrist at all. The psychiatric workforce distribution did not differ significantly on the basis of poverty prevalence. The potential utility of indicators of population health was also evaluated and revealed that social factors such as poverty and Medicaid prevalence may be superior to more traditional measures.

The U.S. Health System

The complexity of the health system continues to grow and can be characterized by more to know, do, manage, and watch for more people than at any point in history. Population health and health outcomes in the United States have been largely impacted by poorly organized and uncoordinated health care delivery. As the U.S. health system aims to improve quality, increase access, and reduce cost, the role of clinical informatics has become increasingly important. This chapter sets the foundation for understanding the importance of clinical information’s and the flow of information within the various domains of the health system as well as between these health system domains.

Policy Report: 2012 Indiana Mental Health Workforce

Assuring that mental health services are available and accessible for all Hoosiers that need them is important to reduce related morbidity and mortality and improve mental health. At the community-level, the availability of mental health services is largely based upon the supply and distribution of the workforce that delivers mental health services. Indiana’s licensed mental health workforce is comprised of psychiatrists, psychologists, psychiatric nurses, and a number of mental health professionals. A number of important issues emerge from recent data on the supply and distribution of this workforce. These issues, described throughout the document and outlined below, have been organized for the purpose of informing the agenda for mental health workforce policy in the State of Indiana. These issues emerged in objective consideration of workforce data and do not take into account perspectives of any one profession or stakeholder group.