Topic Areas:
Policy Level Intervention
Community Level Intervention
Program and Institutional Level Intervention
Provider Level Intervention
Client Level Intervention
Age-Friendly NYC
View completed Research/Programs
Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Medical Care Reauthorization Policy Study
Despite the high health care needs of people living with HIV/AIDS, medical care expenditures comprise a relatively low proportion of overall Ryan White expenditures. The primary objective of this study was to determine how and why Ryan White CARE Act grantees allocate funds to medical services. The Division of Health Policy (DHP) analyzed the relationship between healthcare spending and characteristics of local healthcare environments. We found that resource allocations for Title I in the 54 hardest-hit cities and, to a lesser extent, the states’ Title II service allocations are relatively impervious to local healthcare financing conditions. These findings are one factor influencing the 2006 reauthorization of the CARE Act.
This study was funded by the HRSA HIV/AIDS Bureau through a subcontract with Betah Associates.
Assessment of HIV-Related Service Gaps and Unmet Needs of Asians and Pacific Islanders in the New York Eligible Metropolitan Area
In New York City, the number of new Asian and Pacific Islander (A&PI) AIDS cases diagnosed annually as well as the estimated number of A&PIs living with HIV/AIDS has been rising. Yet, little is known about the specific needs and service barriers of this population. The Division of Health Policy is conducting a multi-method study that examines the prevalence, needs, and barriers to care for NYC A&PIs with HIV/AIDS, as well as A&PIs at risk for HIV. Information from this study will contribute to our knowledge of how to provide support and care for A&PIs living with HIV and will be used by the New York City and Westchester County Title I Planning Council to plan for services.
Access to Health Insurance and Health Care for Children in Immigrant Families: Experiences of Haitian, Russian and Latin American Parents in New York City
With funding from the Foundation for Child Development, DHP directed a qualitative study of the experiences of parents who are immigrants from Latin American, Haiti, and the former Soviet Union in using health insurance and health care. Analysis of in-depth interviews with 75 immigrant parents indicate that they face significant language barriers at local hospitals, and that they utilized different strategies to address these language barriers, including: relying on bilingual children as interpreters, bringing friends and family with them during hospital visits, and requesting informal and voluntary assistance from other patients or hospital staff. The study also highlighted the difficulties immigrant parents face in accessing and maintaining public insurance, and findings from this study should be used to inform policies and programs for immigrant families in need of health care coverage.
Level and Cost of Disruption in Health Care
Churning has long been recognized as a problem in Medicaid, but recent studies have emphasized and given enhanced visibility to the problem. For example, recent studies have shown that as many as 50% of children fail to re-certify on time and are dropped from insurance rolls. The purpose of this project was to determine both the level of churning and the cost to enroll children in Medicaid and Medicaid managed care. A case studies method was used to analyze secondary data on churning in four states over a three year period for all children in Medicaid in three age groups. Key findings reinforce the high level and consequent disruption in care of churning.
Enhanced Enrollment
Access to and use of health care, even among those with health insurance, is less than optimal among some populations. Working with the New York City Department of Health and Mental Hygiene, DHP evaluated their pilot project aimed at increasing access to and use of health care by newly insured individuals. The project sought to do this through the addition of a new health education component to the current enrollment process in health insurance programs in selected sites. Differences were assessed between a control group and the intervention group in access and utilization six months after enrollment in health insurance and found that all participants in our study, in both the comparison and intervention groups, reported substantial reduction in their health concerns, greater use of preventive care and less use of the emergency department. These results show that insurance, along with routine services at enrollment which stress the importance of preventive care and awareness of what health coverage can offer, had a dramatic effect on health care access, use and satisfaction. Adding a 15 minute, personalized consumer health education component at enrollment can be a low cost way to help vulnerable clients to maximize the insurance benefits that they are receiving and increase preventive care utilization.
Asian Immigrant Community Institutions in NYC and HIV
At the community and organizational levels, social norms guide community members' social understanding of HIV and shape social practices and organizational ideology, policies and procedures. Community social norms also shape individuals' perception of risk and their willingness to engage in protective behaviors. The aim of this study was to assess the role of community institutions in encouraging or impeding HIV prevention activities within Chinese and Indian immigrant communities in New York City. The study focused particularly on the role these institutions play in promoting or challenging community social norms that impact HIV prevention. Interviews conducted with leaders and members of these community institutions revealed that, although they are eager to be of service to their communities and sometimes have an interest in getting involved in HIV-related activities, they also have misconceptions about HIV transmission and carry stigmatizing attitudes about HIV that inhibit their participation. We hope that the findings from this NICHD-funded study will be used to improve the ways health intervention strategies take into account how immigrant communities are organized (e.g., religious institutions).
Impact of Mental Health Services in NY after WTC Disaster
The purpose of this NIMH-funded study was to assess community mental health service utilization, access to care, and treatment outcomes in New York City after the World Trade Center disaster. This was the first study specifically designed to evaluate these outcomes after a major disaster. Study findings, published in numerous medical journals, suggested that despite the availability of mental health services in New York City post-disaster, relatively few persons used these services. Furthermore, members of minority groups were even less likely to use these services. However, those that received brief worksite counseling sessions after the disaster had much better mental health outcomes. Results from this study will help community planners prepare appropriate community mental health services in post-disaster situations.
Disaster Research Education and Mentoring (DREM) Project
Disaster research is a relatively new and growing field. This is a NIMH disaster-training grant in collaboration with the Medical University of South Carolina and The New York Academy of Medicine to train professionals in disaster research. The specific goal of the Disaster Research Education and Mentoring (DREM) Project is to create disaster research capacity in the US through disaster research and mentoring activities. Recently, DREM investigators were involved in assisting local investigators in the Gulf States begin their research projects following Hurricane Katrina.
Mt. Sinai School of Medicine – National Children’s Study Vanguard Centers
Despite the increasing focus on environmental health issues, little is known about specific environmental factors and their impact on the health of children. This is a landmark children’s environmental health study funded by the NICHD designed to follow 100,000 US children from preconception until early adulthood. Dr. Boscarino from DHP serves as a consultant on this project and will assist with design and analysis of the initial focus groups for this study at the Queens Vanguard site.
PROGRAM AND INSTITUTIONAL LEVEL INTERVENTION
Integrated Buprenorphine and HIV Care Evaluation and Support Center
The twin epidemics of HIV and drug use continue to adversely affect the health and mortality of large numbers of drug users infected with HIV. Programs which integrate HIV care and drug treatment have the potential to improve both substance use and health outcomes in patients struggling with addiction. The Drug Addiction Treatment Act of 2000 and the approval of buprenorphine (a new opiate agonist treatment) for the office-based treatment of opioid addiction provide a new opportunity to integrate addiction treatment and medical care for people with HIV. However, little is known about implementing such programs in HIV care settings; their cost; what effect they have on the health and substance use of people living with HIV/AIDS; or what broader impact they have on providers, institutions, and local systems. The Health Resources and Services Administration (HRSA) funded a five-year initiative to develop and evaluate ten model programs that integrate HIV primary care and buprenorphine treatment for opioid dependence, as well as a national evaluation and technical assistance center headed by Ruth Finkelstein. Data from this study will be used to inform program design and service delivery of integrated care programs.
For more information, visit the Center's website at http://www.bhives.org, or contact the Center at bhives@nyam.org.
Understanding Why Nurses Leave the Bedside: Does Informal Caregiving Impact Formal Caregiving?
With the aging of the baby boomer cohort, increasing numbers of people must balance both work and home care needs of elderly parents. A qualitative study of hospital-based Registered Nurses (RNs) and Nursing Assistants (NAs) aged 45 and over, this study was designed to explore how aging nurses balance their work and home responsibilities and whether these competing demands contribute to the large number of nurses leaving the workforce. We found that respondents were involved in a wide spectrum of caregiving activities and were at the nexus of the health care and family systems. Respondents noted that without official workplace policies and practices that support elder caregivers, many experienced RNs and NAs are compelled to leave hospitals to more flexible workplaces in community-based and ambulatory sites. Several institutional and public policy initiatives will help retain nurse/caregivers, such as programs to support caregivers with referral services, advice regarding financial and other employee benefits, and psycho-social support services; increased use of the federal Family and Medical Leave Act among elder caregivers; and possible tax deductions for family caregivers.
Strategies for Increasing Retention of Nurses in New York City
Policy initiatives dealing with historic and chronic nursing shortages have predominantly focused upon attracting new recruits into the profession rather than on retaining as many RNs in the workforce as possible. Little tangible information exists on who remains and who leaves the nursing workforce. This project analyzes trends in the New York City nursing workforce and focuses on retention, exit from the profession, turnover, and mobility between types of clinical settings through a secondary analysis of national data. The cross-sectional analysis will explore the employment and demographic characteristics of the Registered Nurse population in NYC, identify correlates and predictors of retention and attrition from hospital nursing and from the nursing profession, examine policy and practice issues related to nurse retention and identify strategies for increasing nurse retention in New York City.
Enabling Services
Enabling services, the services that community health centers provide to improve access to care, are largely non-reimbursable, but are essential for delivering appropriate care for their ethnically and culturally diverse patient population. The purpose of this project was to develop strategies at Asian American Pacific Islander (AAPI) health centers for collecting data on enabling services that is currently unavailable in order to better understand the utilization and need for services. We found a significant number of health center patients use enabling services for access to care, and the most common services are eligibility assistance and interpretation. Enabling service users are more likely to be older, AAPI, and publicly insured or uninsured. Health center management has been able to use these data to better manage their enabling services, effectively utilize their resources, and appeal for increased funding.
Feasibility Evaluation of Cornell University’s “Evaluation of a Patient Centered Electronic Medical Record”
Investigators from Cornell University are conducting an evaluation of a patient-centered electronic medical record at two free-standing HIV clinics in New York City with the goals of enhancing shared decision-making between physicians and patients and improving quality of care and patient outcomes. Cornell University has contracted with the DHP to conduct a study to assess the perceptions and experiences of both patients and staff in using the patient-centered electronic medical record. Results from this study will help program planners to better understand the feasibility of integrating patient-centered electronic medical records meaningfully into care within HIV care clinics.
Gay Men’s Health Crisis Strategic Planning
The Division of Health Policy was hired by the Gay Men’s Health Crisis (GMHC) Board of Directors to direct the assembly of data to inform their long term strategic planning process. Data collection included design, implementation and analysis of a series of focus groups and interviews of clients, volunteers, staff, Board members and other stakeholders, and leaders. These findings combined with an overview of current epidemiology and HIV/AIDS funding informed our analysis of the agency’s current location within the HIV/AIDS epidemic and framed suggestions for the Board’s strategic planning process.
Medication Information for Immigrant New Yorkers: Research and Intervention for New York City Pharmacists
Comprehension of health-related information by patients and their families is essential for effective health care delivery and optimal health outcomes. A full understanding of prescription medication information is particularly critical, given the complexity of medication instructions, the serious implications of medication-taking errors, and patient responsibility for medication adherence and recognition of adverse effects. To the extent that prescription medication information, including labels and leaflets, are provided in English only, individuals with limited English proficiency (LEP) are unlikely to have access to the information they need to appropriately manage their medications. This project, funded by the Altman Foundation, focuses on the comprehensibility of instructions received with prescription medications. Working with a community advisory board composed of pharmacy educators, pharmacists, health care providers, advocates, and educators, we are (1) conducting an assessment of New York City pharmacy capacity for and provision of translated and low literacy medication labels and informational leaflets; (2) examining consumer receipt and perceived need for translated or low literacy medication information; (3) and identifying and assessing resources, programs, and effective practices for providing multilingual and low literacy medication information. Findings from these activities will be disseminated to NYC pharmacists, health care providers, and immigrant service organizations and used to develop plans for pilot-testing selected interventions in pharmacies serving New York’s immigrant and LEP populations.
Evaluation of a Physician Training and Clinical Support Center for Buprenorphine Prescribers
Because buprenorphine may be prescribed for the treatment of opioid addiction by any physician in an office-based setting, it has tremendous potential to both expand treatment capacity and to create new options for people unable or unwilling to seek treatment through traditional methadone programs. However, thus far, few physicians have elected to be trained and certified to prescribe buprenorphine. The Division of Health Policy has received funding from the American Society of Addiction Medicine to evaluate their new buprenorphine physician training and clinical support center, which is supported through the Center for Substance Abuse Treatment. This unique program is designed to support physicians who would like to prescribe buprenorphine for the treatment of opioid addiction but lack clinical expertise and/or training. Interested physicians will be assigned to a mentor physician, who is an experienced prescriber and who can provide ongoing support via email and phone. DHP will evaluate this mentor program in order to determine what level of support physicians require to prescribe buprenorphine as well as participants' satisfaction with the program. The evaluation will also track the extent to which prescribing practices change over time. We hope that this program will both expand the number of physicians prescribing buprenorphine and provide a model for programs to support prescribing physicians.
For more information, visit the PCSS website at http://www.pcssmentor.org.
Disparities in Referrals for Hospice Care
In collaboration with the Visiting Nurse Service of New York, this Aetna-funded project examines the barriers in referrals to and utilization of hospice care among Hispanics and African Americans in NYC. Survey findings from home health care clients and their caregivers who are eligible for hospice care but who have not chosen the service, reveal that cultural attitudes towards death and spirituality, as well as misinformation about the differences between hospice and home care, act as barriers to use of hospice services. In addition, home health nurses do not feel they are culturally competent to raise these issues with their clients. Using these findings, the VNSNY is implementing an educational intervention to provide home health nurses with culturally sensitive information for raising the issue of hospice care with their clients and thereby increase referrals and utilization of hospice services among Hispanics and African Americans.
Development of a Child Psychiatric Consultation Service (CPCS) model for New York State
The mental health task force of the New York Forum for Child Health identified untreated mental health problems as adversely affecting the health of children in New York State. Upon investigation, it became clear that, although pediatricians are the de facto mental health service for most children in need of such care, very few pediatricians have the training, support or referral resources they need to deal effectively with these issues. Furthermore, New York State lacks enough mental health specialists to manage the tremendous need among the 2 million publicly-insured children in the state. The CPCS model supports pediatricians by offering them consults with experts in child psychiatry.
Mt. Sinai School of Medicine – Reaching Children Initiative Post-9/11 through Primary Care
The need for child mental health services is great, and primary care physicians are playing an increasingly important role in identifying and responding to the psychiatric needs of children. This is a health workforce intervention study funded by the American Red Cross Liberty Fund in collaboration with Mt. Sinai School of Medicine. The purpose of this project is to assess the training of child healthcare professionals in the tri-state area related to providing mental services in primary care by comparing the practice patterns of several hundred pediatricians who received training related to mental health issues in primary care to several hundred who did not receive this training. Results from this study will be used to determine how effective this training is in changing physician practice patterns.
Evaluation of an Online Health Education Curriculum Resource Center
Funded through the National Library of Medicine, this joint project of The Division of Health Policy, The Division of Information Management, and The Office of School Health Programs provides teachers with online access to quality health education curricula and lesson plans that have been reviewed and rated by a panel of experts. DHP will conduct a pilot test of the web-based resource center with a national sample of elementary, middle, and high school teachers to assess utility, ease of access, and satisfaction with the website and its content. The goal of the project is to improve health education instruction for elementary, middle, and high school children by creating easy access for teachers to high quality health education materials.
Outcome Evaluation of 23 Minority AIDS Initiative Programs
The Division of Health Policy has continued leading an ongoing evaluation of HIV programs at hospitals, community-based health centers, and social service organizations that are designed to help African Americans and other people of color with HIV to access the care system and stay more consistently connected to it. These programs, which are located in New York City and Westchester County, are funded through the Congressional Minority AIDS Initiative (MAI), which was created to address the disparities in access to health care and health outcomes experienced by people of color with HIV. The evaluation study relies on an assessment of functional health status and other health-related measures before and following program participation to define barriers and to identify characteristics of programs successful in linking people to care. Analyses are currently focusing on what kinds of programs are most effective in different kinds of settings. Analysis indicates that different types of programs (hospital-based, community health center-based, or social service organization-based) have different levels of success in recruiting and retaining the neediest clients. These analyses are being used to inform the planning process of the New York and Westchester County Ryan white Title I Planning Council.
Evaluation of Use and Treatment of Crystal Methamphetamine Among Gay and Bisexual Men
Crystal methamphetamine use appears to be increasing rapidly among NYC’s gay and bisexual men. Crystal use has been associated with increased incidence of HIV and a number of other health and psychiatric problems, but few evaluated intervention programs for the treatment of crystal addiction exist, particularly those addressing the unique concerns of gay/bisexual men few treatment options for crystal addiction exist. DHP has partnered with Callen-Lorde Community Health Center (CLCHC) to evaluate the feasibility of a medication-assisted detox and therapy intervention designed to reduce harm and promote the cessation of methamphetamine use. We hope that this evaluation will provide important insight into better ways to treat crystal addiction and reduce the risk of HIV associated with crystal use in this population.
This work is funded by the New York State Department of Health AIDS Institute.
Conceptions of Health and Wellbeing among Gay/Bisexual Men Living in NYC
Although attention has been given to the HIV prevention and care needs of gay and bisexual men, relatively little has been done to address their other health concerns. Callen-Lorde Community Health Center received funding to design a health awareness campaign for gay and bisexual men and contracted with DHP to conduct a series of focus groups with 80 men who have sex with men to explore their conceptions of health, wellbeing, and barriers to care. The major findings of the study included: (1) conceptions of health were holistic; (2) health concerns were largely rooted in stress and fatigue caused, in large part, by social forces such as homophobia and racism; (3) traditional healthcare was viewed with a large measure of skepticism and mistrust; (4) participants felt a strong sense of personal responsibility and a need to ‘take control of’ their own health’; (5) participants’ internal barriers to seeking care centered on low self esteem which they attributed variously to homophobia, racism, and ageism; and (6) participants faced a number of external barriers to care. These results can be used to insure that health messages targeted to gay and bisexual men address their issues and concerns.
Assessing the Use and Usefulness of an Electronic Referral System
Difficulty obtaining useful information to meet specific health and social services needs is one of the barriers preventing people from getting the help they need. The Greater New York Hospital Association has developed an electronic health and social services referral system known as HITE. A team at NYAM is evaluating the use and usefulness of this system to consumers in need of such assistance (recruited in homeless shelters and other social services agencies) and to the front line staff serving these same people.
