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2011 LEADS Scholarly Projects

OUr LEADS Scholars


 

 Accordion

 

 Autism Society of Colorado - "Dispelling Myths and Clarifying Discrepancies Between Existing Systems of Care"

Nicholas Berlin 
Faculty Mentor:  Cathy Battaglia         Organization Mentor:   Rich Jones
 
8-week Project Goals: 
To identify the current discrepancies and misconceptions in the Colorado school systems and medical community regarding the systems of care in place for individuals with Autism Spectrum Disorders (ASD). 
 
Identify methods to dispel these myths and disseminate facts to educate the local community.
 
Very Brief Background or Rationale of Project:
                   "9 Common Misconceptions of Partens of AD individauls"
The goal of this document is to clarify existing misconceptions that parents may have regarding access to educational and medical services for their children. Please read over this document and revisit it from time to time. The issues addressed in this document may prove crucial to your child’s care and your relationship with providers and educators.
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 Bell Policy Center - "​​Looking Forward"

Alexi Kimballl and Laura Scrimgeour
LEADS Faculty Mentor:  Dan Matlock       Organization Mentor:  Rich Jones

8-week Project Goals:  
Research what home and community-based services relating to long-term care exist in the state. what challenges limit patient access and what providers can offer, and what the sources of funding are for the clinics/organizations that provide these services.

Research current Medicaid fund distribution and programs in other states to key informants and identify questions about some of the shortages in our state that might be areas to shift funding to cut health care costs.

Very Brief Background or Rationale of Project:
While the elderly and persons with disabilities make up less than 25% of Colorado’s Medicaid (MCD) recipients, they consume about 69% of the MCD funds (based on data from 2007).  About 17.5% of the state budget is for MCD costs. Reducing costs associated with the elderly and persons with disabilities would open up funds to many other needed areas in the state budget. Assisted living, nursing homes, and hospital stays are very costly. One way to lower these costs would be to increase the use of home and community-based services. With the use of these services, it is easier for the elderly and persons with disabilities to continue to live independently and in their own home. However, there is likely a shortage of these services in many areas, particularly in rural settings. Our plan is to investigate the shortage of these services, both in locations and in funding, so that if the state decided to provide funding for home and community-based services as a means to cut down on nursing home and other more costly long term care options, there would be data on where these are most needed
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 CAHEP - "Assessment of medication Adherence in the Colorado Alliance for Health Equity and PracticeAssessment of medication Adherence in the Colorado Alliance for Health Equity and Practice"

Akua Fordjour
LEADS Faculty Mentor:  Rita Lee          Organization Mentor:  Jamal Moloo

8-week Project Goals: 
Caregivers, patients and the health care system in the United States contribute to the lack of medication adherence.  On average, it has been estimated that this wide gap in health care costs $100 billion a year and contributes to about 33-69% of annual hospitalizations, poor quality of life and even death (Osterberg L and Blaschke L. Mitka)

Identify which environmental factors or how attitudes towards healthcare providers or the system affects non adherence at the CAHEP clinic. 

Determine if identified causative factors of non-adherence are common to both insured and underinsured/uninsured patients.

Implement an interventional approach to tackle the problem of non-adherence at the CAHEP clinic


Very Brief Background or Rationale of Project:

Non-adherence simply refers to not being able to abide to a set of rules.  In healthcare, the term has been broadly defined to include patient’s non-adherence to medication, a provider’s advice or not making it to medical appointments (Holzemer WL).  Non-adherence in healthcare can be complicated by a myriad of factors including, lack of a clear communication between caregivers and patients, inability of patients to afford their medications coupled with health insurance access and costs, and the absence of follow-up care.  Patients with chronic diseases take only about half of the prescribed medications (Haynes RB, DeMatteo MR).  Clearly, the complex nature of this problem suggests that it cannot be tackled with a single specific interventional approach. 

Data suggests that both patient behavior and changes in structure of the existing health care system can help improve adherence in the health care system.  Studies looking at specific diseases or different subtypes of population groups suggest that with targeted intervention, the problem of non-adherence can be minimized by tailoring interventions to specific diseases or to the needs of specific communities.  Studies by Kalichman SC and Grebler T showed that poverty and hunger as opposed to depression, stigma or substance abuse correlate with improvement of medication adherence in HIV/AIDs patients.  Also, studies have shown that in depression in diabetic patients contribute to a lack of adherence to their medication regimen (Lin E.).  Further, a study in an elderly population showed that proper self monitoring of medications is better in patients who aged properly and lived a more organized and balanced ( referring to better physical activity and  good nutrition) lifestyle (Swanlund, SL).  On the other hand, Mitka M believe that identifying difficulties with the health care system rather than the patient will be more effect than modifying patient behavior to improve medication adherence.  Nevertheless, more findings suggest that health disparities and socioeconomic challenges contribute to the lack of medication compliance in low income and underserved communities.  Thus, for this study, the patient population will likely benefit more from assessing patient behavior in decision making. 

 

 

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 CCHI- General Summaries: descriptions and information regarding projects listed in the Health Benefits Exchange project matrix

Kinsey Roth and Zachary Tenbeath
Faculty Mentor: Mark Earnest, MD       Organization Mentor:  Lorez Meinhold

8-week Project Goals:|
Compiling a comprehensive matrix of advocacy groups and government agencies within the state working on projects related to the Health Insurance Exchange.  The matrix identifies funding sources, areas of overlap, and gaps in forming the exchange, which will help Colorado be more efficient in pursuing the development of its’ exchange which must

Brief Backgound or Project Rationale (limit 200 word)
General Principal: determine the preparedness of each group or individual to take advantage of or move forward with building up and completing the Colorado Health Benefit Exchange.     Currently, there are dozens of advocate agencies within the state working on some project or another related to the exchange.  There are also the state agencies themselves who are either working on projects or providing funding for the previously mentioned projects.  So many people trying to do so much good is admirable but no one else knows what  anyone else is doing, how they’re getting funding, if there are overlaps of effort, or if there are gaps in forming this exchange.  The survey and matrix tool which we will develop will help to resolve this confusion and help Colorado be more efficient as we pursue the development of our own exchange which must prove to be functional by 2013.  

 

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 CCMU - Assessing the Workforce Capacity for Colorado’s Medicaid Expansion to Adults without Dependent Children (AwDC) under Colorado HB09-1293

Sara Scannell
Faculty MentorJemery Long    Organition Mentor:  Gretchen Hammer

8-week Project Goals:
Weeks 1 & 2: Research gathering and literature review regarding: history/success of Medicaid expansions in other states; networking with other organizations/providers interested in AwDC expansion; creating interview tool for bulk of summer work; understanding the current knowledge about healthcare needs of AwDC.

Weeks 3, 4, 5, 6, 7: Key informant interviews with providers to qualitatively assess capacity/workforce ability to meet access to care required by expanded Medicaid population under HB09-1293 creation of new eligibility category for AwDC.
Weeks 7, 8: Wrap-up key informant interviews; summarize findings; prepare presentation for Connect Campaign meeting on August 4, 2011.eeks 7, 8: Wrap-up key informant interviews; summarize findings; prepare presentation for Connect Campaign meeting on August 4, 2011.
Brief Background or Project Rationale:
In 2009 the Colorado state legislature passed a bill to expand Medicaid coverage starting in 2011, including to a previously ineligible population: adults without dependent children (AwDC). According to data published by the Colorado Health Institute, approximately 158,000 adults in Colorado will become newly eligible under this new AwDC Medicaid category, most of whom are located in the Front Range. Research predicts that these adults will access medical care at rates higher than current Medicaid enrollees. Consequently, the question of capacity needs to be assessed. In other words, what is the current capacity of health care providers to see these new enrollees? I will spend my summer interviewing providers in order to qualitatively assess their perceptions on how this Medicaid expansion will be successful and what barriers may limit new enrollees from accessing care.
 
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 CASBHC - CREATING AN “OBESITY TOOLKIT” FOR USE IN SCHOOL-BASED HEALTH CENTERS

​Rachel Skakina and Kasey Topp
Faculty Mentor:  Steve Federico    Organization Mentor:  Debbie Costin

8-week Project Goals:
What are best practice guidelines for providers in school-based health clinics when approaching obesity in their patients?

Brief Background or Project Rationale:
Childhood obesity is a growing problem across the country, and Colorado is not immune to the issue. While no one knows how to solve the obesity epidemic, it is clearly an issue that must be confronted. Many children here receive their primary healthcare in school-based health centers. However, providers at health centers do not always know the best way to approach obesity in their patients. We will develop a “toolkit” for such providers that clearly lays out current best practice guidelines and that provides recommendations and ideas for other programs that could be implemented.

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 Denver Health - ​"Teenage Pregnancy Prevention Programs: A Needs Assessment"

Gail McSpadden
LEADS Faculty Mentor:  Jeremy Long, MD, MPH  Organization Mentor:  Irene Aguilar, MD, State Senator

8-week Project Goals

 
1.      Literature review of teenage pregnancy prevention programs in Colorado, comparing rates of teenage pregnancy, types of programs, and usage of state funds with other states.
2.      Consolidate a list of teenage prevention programs in Colorado and consolidate Dr. Aguilar’s contacts of people involved these programs in Colorado.
3.      Develop an interview script.
4.      Interview key-informants (at least 15) involved in prevention programs.
5.      Perform a qualitative assessment of data gathered from the interviews.
6.      Work on research poster.
 
  1. Brief Background or Project Rationale (limit 200 words) 
Teen pregnancy is a significant public health concern in the United States. Our country has the highest teen pregnancy and birth rates of the industrial nations (The National Campaign to Prevent Teen Pregnancy, 2006). Teen pregnancy is a health risk for the mothers and their children. Young mothers are less likely to seek and receive adequate prenatal care increasing their risk of pregnancy complications and increasing their child’s risk of developmental disabilities and in general adverse health outcomes. Teen pregnancy is also a burden on state Medicaid programs that provide healthcare support for pregnant teens.
 
 
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 Denver Health -" Payment Reform for Patient-Centered Medical Homes in Colorado (Senator Irene Aguilar’s office)"

​David Roth
Faculty Mentor: Jeremy Long     Organization Mentor: Irlene Arguilar

8-week Project Goals:  

  • Research the theoretical pros and cons for implementing payment reform to help create patient-centered medical homes in Colorado
  • Research examples of patient centered medical homes that have been implemented elsewhere, whether through legislation or as individual experiments
  • Research examples of increasing payment up-front for preventive services, and whether these payment increases saved money in the long run
  • Create a white paper for Senator Aguilar, detailing the main points regarding payment reform for patient centered medical homes 
  • Produce a white paper on Payment Reform for Patient Centered Medical Homes in Colorado
Brief Background or Project Rationale (limit 200 words)
Payment Reform for Patient Centered Medical Homes has become a hot topic is medicine and in politics because the model created by increasing up-front payments and re-arranging incentives to promote health instead of procedures has been thought to be a potential way to save money and improve health outcomes simultaneously.  While there has not been definitive examples to draw on yet, there is substantial piecemeal, theoretical, and experimental examples to demonstrate the potential for Patient Centered Medical Homes. 
 

 

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 Laboratory to Combat Human Trafficking - A Community Needs Assessment Evaluation of Service Provider Understanding of Human Trafficking and its Presence as a Major Public Health Dilemma in Colorado

Sarah Hendrickson
Faculty Mentor:  Cathy Battaglia      Organzation Mentor:  Amanda Finger

8-week Project Goals:

·        Review of Human Trafficking in CO, the United States, and internationally
·        Medically focused literature review on healthcare provider knowledge of human trafficking
·        Data analysis of CAN survey results from 5 CO communities (Fort Collins, Colorado Springs, Denver, Englewood, Boulder)
·        Qualitative Assessment
·        Quantitative Assessment
·        Key Informant Interviews regarding the history of human trafficking in each community
·        Development of a secondary survey tool focused for healthcare providers
·        Develop working plan for the delivery of CAN survey to University physicians
·        Engage in training and education activities w/ LCHT
·        Develop training program for at-risk youth department at Children’s Hospital Kempe Center

Brief Background Or Project Rationale:

·        Human trafficking and human slavery are prominent social problems – that are significantly under recognized and under reported.
·        Total annual revenue for trafficking in persons is estimated to be between 5 and 9 billion dollars. It is currently the second largest black market, behind drugs.
·         Over the past decade: “People trafficking has reached epidemic proportions with a global annual market of about $42.5 billion.”
·        2.5 million people from 127 different countries are being trafficked around the world (UN estimate)
·        US State Department: 600,000 – 820,000 individuals are trafficked across international borders annually
·        80% women
·        45,000 – 50,000 to the United States Annually
·        Up to 50% are minors
·        Trafficking in women and children is now recognized as a global public health issue, as well as a violation of human rights” (BMJ)

 

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 Medicaid - Adding value to Medicaid primary care reimbursement

Jessica Lee
Faculty Mentor: Rita Lee    Organization Mentor:  Judy Zerzon

8-week Project Goals:

  • identify options from other states' experiences and the literature to add value-based incentives to primary care payment 
  • identify measures to evaluate the new payments' effects on outcomes and spending
  • coordinate with related state initiatives, e.g. health homes for patients with chronic condition

Brief Backgound or Project Rationale (limit 200 word)

 

While recent state legislation has extended Medicaid coverage and designated funds to primary care efforts, Colorado Medicaid reimburses physicians approximately eighty percent of their costs. These underpayments do not promote access to quality health services for the vulnerable population Medicaid serves. The reconciliation act for the Patient Protection and Affordable Care Act requires states to pay 100 percent of Medicare’s payment rate for primary care services provided by family medicine, general internal medicine, or pediatric medicine practitioners in 2013 and 2014. During those 2 years, the federal government will fund the difference between each state’s primary care Medicaid payment and the Medicare payment. As there is no additional federal funding specified for subsequent years, presumably states would have to carry their traditional share of funding beginning in 2015.
 
My project entails developing options to reengineer Medicaid primary care payments to promote quality outcomes and value. Colorado Medicaid is currently 85% fee-for-service and would like to move towards alternative payment models. This additional federal funding provides an opportunity to change how Colorado Medicaid pays providers besides fee-for-service, ie bundled payments, an additional per member per month payment to support care coordination activities, and incentive payments for quality or improving health outcomes.
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