Agency Characteristics Research Articles

Health Information Technology Adoption at U.S. Home Health Care Agencies: Results from a Multi-Methods Study.

Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR; (2) Benefits of EHR; (3) Benefits of other HIT; (4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR; an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.

Policy Implementation of System Online Single Submission Risk Based Approach in Banda Aceh

This study aims to analyze barriers factor the policy implementation of Online Single Submission Risk-Based Approach (OSS RBA) in BandaAceh. This study uses a qualitative descriptive approach by collecting data through observation, interviews, and documentation. This study uses Van Meter and Van Horn model (1975). Factors supporting the implementation of OSS BRA are standardization of licencing requirements, human resources, characteristics of implementers agencies and dispositions of implementers, economic, social and political conditions. While the barriers factors are the readiness of the technology resources OSS RBA which still often errors and it’s not yet fully integrated with other application. Then, the factor of inter-organizational communication and outreach activities to business actors are still limited. This study recommended to increase the socialization of applying system OSS RBA to business actors in Banda Aceh.

Alcohol-impaired driving enforcement priorities and strategies in a nationwide sample of U.S. law enforcement agencies

Objective Excessive alcohol consumption leads to a range of public health problems and social and financial burdens. Traffic crashes resulting from alcohol-involved driving are a major contributor to the overall health consequences of alcohol. Various laws and enforcement strategies aim to prevent alcohol-involved driving. The extent to which law enforcement agencies prioritize enforcement of alcohol-impaired driving laws can help to reduce alcohol-impaired driving. Among law enforcement agencies in the US, we examined prioritization of alcohol-impaired driving enforcement and how it is associated with use of specific enforcement strategies, as well as agency and community characteristics. Methods We conducted a survey of a national sample of 1,024 US police and sheriff agencies in 2019. We assessed prioritization of alcohol-impaired driving enforcement, use of specific enforcement strategies (saturation patrols, sobriety checkpoints, open container law enforcement, training field officers to identify driving impairment), and agency and jurisdiction characteristics. We assessed how priority of enforcement (high vs. low) was associated with use of specific strategies, and agency and jurisdiction characteristics using regression models that accounted for agencies nesting within states. Results A majority of agencies (68%) placed a high priority on alcohol-impaired driving enforcement. Almost all agencies (93%) reported performing at least one alcohol-impaired driving enforcement strategy and the most common strategy used was saturation patrols. Agencies that prioritized alcohol-impaired driving enforcement were more likely to use sobriety checkpoints and saturation patrols, conduct enforcement of open container laws and train field officers in identifying driving impairment (p < 0.05). They were also more likely to have an officer assigned primarily to alcohol enforcement, have an alcohol division, and serve jurisdictions that had fewer Black residents (p < 0.05). Conclusions Many law enforcement agencies utilize strategies to address alcohol-impaired driving, however, some strategies are underutilized and an opportunity exists for agencies to incorporate additional strategies to help prevent alcohol-impaired driving. Agencies that made alcohol-impaired driving enforcement a priority were more likely to conduct related enforcement strategies. Encouraging police and sheriff agencies to prioritize alcohol-impaired driving enforcement may be an effective approach for preventing alcohol-related harms.

The influence of conservation agency resources on officer entry and training requirements

The current inquiry examines the influence that agency characteristics (e.g. hunting and fishing license sales, total revenue) have on the minimum entry and training standards established by those agencies (e.g. minimum education, academy type, physical standards). Open source data were collected from each state's conservation agency through an extensive internet search and directly contacting agencies. Findings indicated a significant relationship between the number of fishing license and hunting license holders and both the minimum education standards set by the agency and their academy modality ( p ≤ .05). Conversely, no significant relationships were found between revenue from license sales and any entry or training requirements. In addition, neither the number of license holders nor revenue was shown to be statistically significant among minimum physical standards for entry-level work as a conservation officer. Thus, the number of license holders appears to be more influential over the minimum education requirements and academy type versus generated revenue. This indicates that demand placed on natural resource organizations may have a greater effect than the revenue they generate.

The Role of Dementia and Residential Service Agency Characteristics in the Care Experiences of Maryland Medicaid Home and Community-Based Service Participants and Family and Unpaid Caregivers.

In Maryland, residential service agencies deliver Medicaid Home and Community-Based Services (HCBS) to older adults with disabilities through direct care workers (e.g., personal care aides). Leveraging survey data from residential service agency administrators, linked to interRAI Home Care assessments for 1144 participants, we describe agency characteristics, and participant and family caregiver experiences by participant dementia status. Most (61.7%) participants experienced low social engagement, and roughly 10.0% experienced a hospitalization or emergency room visit within 90days. Few (14.4%) participants were served by agencies requiring dementia-specific direct care worker training, and most were served by agencies offering supplemental services, or in which direct care workers helped with health information technology (81.2% and 72.8%, respectively). Few caregivers reported negative care experiences. Participants with dementia and those served by agencies with training and support more often reported negative care experiences. Findings lay the foundation for future longitudinal and embedded interventions within Medicaid HCBS.

Strategies Used by Local Law Enforcement Agencies to Prevent Overservice of Alcohol in the United States.

Overservice of alcohol, defined as commercial provision of alcohol to an individual who is obviously intoxicated, is illegal in most states and contributes to motor vehicle crashes and violence. Law enforcement agencies use various strategies that aim to reduce overservice at licensed alcohol establishments (e.g., bars, restaurants). Place of Last Drink (POLD) data collection is an emerging overservice enforcement strategy. POLD identifies patterns of overservice, which can provide support for targeted interventions to prevent overservice at offending establishments. We describe the prevalence of POLD and other overservice enforcement strategies and associations with agency characteristics, which has important implications for public health and safety. We conducted a national survey of 1024 municipal (e.g., town, city) and county law enforcement agencies in 2019 (response rate = 73%). We assessed the use of overservice enforcement strategies conducted by the agencies over the past year. We examined associations of each type of overservice enforcement strategy with agency and jurisdiction characteristics using regression models. 27% of responding agencies reported conducting overservice enforcement and 7% conducted POLD data collection specifically. Municipal (vs. county) agencies and agencies with an officer assigned primarily to alcohol enforcement activities were significantly more likely to conduct overservice enforcement generally but not POLD data collection specifically. Overservice enforcement in general, and POLD data collection specifically, are not widely conducted. Prevention of overservice has the potential to reduce harms related to excessive alcohol consumption. Increased evaluation of overservice enforcement strategies should be prioritized.

How Do Medicaid Agencies Improve Substance Use Treatment Benefits? Lessons from Three States' 1115 Waiver Experiences.

In 2015, the Centers for Medicare and Medicaid Services (CMS) urged state Medicaid programs to use 1115 waiver demonstrations to expand substance use treatment benefits. We analyzed four critical points in states' decision-making processes before expanding benefits. We conducted qualitative cross-case comparison of three states that were early adopters of the 1115 waiver request. We conducted 44 interviews with key informants from CMS, Medicaid, and other state agencies, providers, and managed care organizations. Policy makers expanded substance use treatment in response to "fragmented" care systems and unsustainable funding streams. Medicaid staff had mixed preferences for implementing new benefits via 1115 waivers or state plan amendments. The 1115 waiver process enabled states to provide coverage for residential benefits, but state plan amendments made other services permanent parts of the benefit. Medicaid agencies relied on interorganizational networks to identify evidence-based practices. Medicaid staff secured legislative support for reform by focusing on program integrity concerns and downstream effects of substance use rather than Medicaid beneficiaries' needs. Decision-making processes were influenced by Medicaid agency characteristics and interorganizational partnerships, not federal executive branch influence. Lessons from early-adopter states provide a road map for other state Medicaid agencies considering similar reform.

Geographic variation in Medicare home health expenditures.

To quantify geographic variation in home health expenditures per Medicare home health beneficiary and investigate factors associated with this variation. Retrospective study design analyzing US counties in which at least 1 home health agency served 11 or more beneficiaries in 2016. Several sources of 2016 national public data were used. The key variable is county-level Medicare home health expenditures per home health beneficiary. Counties were grouped into quintiles based on per-beneficiary expenditures. Analyses included calculation of coefficients of variation, computation of the ratio of 90th percentile to 10th percentile in expenditures, and linear regression predicting expenditure. The control variables included characteristics of patients, agencies, and communities. Significant variation in home health expenditures was identified across county quintiles, with a 90th-to-10th-percentile expenditure ratio of 2.5. The percentage of for-profit agencies in the lowest quintile was 15.7 compared with 81.7 in the highest quintile of spending. Unadjusted spending differed by $3864 (95% CI, $3793-$3936), compared with $3611 (95% CI, $3514-$3708) in the adjusted model, between counties in spending quintiles 1 and 5. Although state fixed effects explained nearly 20% of the variation in home health expenditures, 42% of the variation remained unexplained. Home health care exhibits considerable unwarranted variation in per-patient expenditures across counties, signifying inefficiency and waste. Given the expected growth in home health demand, strategies to reduce unwarranted geographic variation are needed.

Implementation Model of Regional Spatial Planning Policy in Realizing Sustainable City Development in Banjar City

The main problems in this study are directed at the model of the implementation of the Regional Spatial Planning policy in practice has not run effectively in realizing sustainable urban development in Banjar City. The research method used by researchers is descriptive analysis, while the type of approach used in this study is qualitative. Descriptive analysis method aims to describe complex social reality by applying concepts that have been developed in social science / public administration. Whereas the qualitative approach was chosen with the consideration that this approach is expected to obtain true data and be able to examine research problems in depth so that the expected results can be obtained. The results of the study can be stated that there are factors that lead to the implementation of the Regional Spatial Plan (RTRW) policy in realizing sustainable city development in Banjar City can run effectively, namely Policy standards and objectives, Resources and incentives, The quality of inter-organizational relationship , The characteristics of implementation agencies, the economic, social and political environment and the 'dispositon' or response of the implementers. However, based on the results of the research, these factors have not been entirely effective. The factors that have not been implemented effectively are the Policy standards and objectives and the "dispositon" or response of the implementers. Therefore there are still problems faced with regard to the Regional Spatial Planning (RTRW) policy, so that it has not been able to provide the best way to regulate, make the best use of spatial planning in the region by considering the level of needs, especially the development sector in urban areas. Disamaping also the results of the study suggest that there is a model in implementing the Regional Spatial Plan policy in realizing sustainable city development in Banjar City, namely synthesis / hybrid models by elaborating the interests of the Central Government, Provincial and Community Participation. This means that the RTRW policy both in planning and in its implementation elaborates by involving the Central Government, West Java Province and the participation of the Banjar City community. Although the policy is decentralized, the central and provincial governments still have a stake in controlling and overseeing the policies of the regional layout plan in realizing sustainable urban development in Banjar City.

Services Responding to Domestic Violence Survivors’ Needs: A Study of Pennsylvania Providers’ Perspective

This research examined domestic violence services and programs provided in rural and urban Pennsylvania. It identified the potential gaps in services and assessed programs adequacies from the perspective of program leaders. The study examined the needs and characteristics of both agencies and their clients. In addition, barriers to effective delivery of domestic violence services in Pennsylvania was examined.&#x0D; A Structured questionnaire was used as a primary method of data collection and explored answers for research question on the challenges and opportunities Domestic Violence agencies’ leaderships experiences in providing services. Sampling frame included 60 service providers from Pennsylvania, of which 45 agencies serving the survivors of Domestic Violence participated. Funding for this research was provided by a University grant and the partnership with Pennsylvania Coalition Against Domestic Violence provided technical assistance and access to agencies. The agency leaders who agreed to participate were contacted and both in person and telephonic interviews were conducted. The interview lasted for about 45 -60 minutes.&#x0D; The study found that there is a wide consensus among leaders that transportation and transitional housing services are inadequate in their program service areas while services like crisis hotline, general advocacy and case management are exceptional.&#x0D; Over 50% of the agencies did not comment on the adequacies of the services such as Job Coaching, Immigrations services, Divorce/Custody representation, and Criminal Court representation.&#x0D; The results have several policy implications regarding federal and state government programs, specifically considerations to fund transportation, transitional housing and legal advocacy services.

Variation in Benzodiazepine and Antipsychotic Prescribing Among Hospice Agencies.

Benzodiazepines and antipsychotics are routinely prescribed for symptom management in hospice. There is minimal evidence to guide prescribing in this population, and little is known about how prescribing varies across hospice agencies. Examine patient- and hospice agency-level characteristics associated with incident prescribing of benzodiazepines and antipsychotics in hospice. Retrospective cohort study of a 20% sample of Medicare beneficiaries newly enrolled in hospice. Medicare hospice beneficiaries ≥ 65 years old between 2014 and 2016, restricted to those without benzodiazepine (N = 169,688) or antipsychotic (N = 190,441) prescription fills in the 6 months before hospice enrollment. The primary outcome was incident (i.e., new) prescribing of a benzodiazepine or antipsychotic. A series of multilevel Cox regression models with random intercepts for hospice agency were fit to examine the association of incident benzodiazepine and antipsychotic prescribing with patient and hospice agency characteristics. A total of 91,728 (54.1%) and 58,175 (30.5%) hospice beneficiaries were newly prescribed an incident benzodiazepine or antipsychotic. The prescribing rate of the hospice agency was the strongest predictor of incident prescribing: Compared to patients in bottom-quartile benzodiazepine-prescribing agencies, those in top-quartile agencies were 10.7 times more likely to be prescribed an incident benzodiazepine (adjusted hazard ratio [AHR] 10.7, 95% CI 10.1-11.3). For incident antipsychotic prescribing, patients in top-quartile agencies were 51.7 times more likely to receive an antipsychotic (AHR 51.7, 95% CI 44.3-60.4) compared to those in the bottom quartile. Results remained consistent accounting for comfort kit prescribing. The pattern of benzodiazepine or antipsychotic prescribing of a hospice agency strongly predicts whether a hospice enrollee is prescribed these medications, exceeding every other patient-level factor. While the appropriate level of prescribing in hospice is unclear, this variation may reflect a strong local prescribing culture across individual hospice agencies.

The Extent of Using E-Integrated Marketing Communication and its Effect on Algerian Tourism: Case Study on Algerian Tourism Agencies

This study sought to investigate the usage profile of Electronic Integrated Marketing Communication (E-IMC) and its impact on the Performance of the Algerian tourism sector. To accomplish so, the study examines the extent to which E-IMC has been used, as well as the level of awareness, internal and external hurdles, problems, and benefits of employing it in the context of touristic marketing performance. In addition, the study had to include the characteristics of touristic agencies in terms of type, job sector, number of employees, and export experience. A mixed-method approach was utilized to study these research concerns. Following a detailed literature analysis, a speculative model of tourist market performance was developed. A questionnaire was created and given to 111 tourism agencies as part of the study. A total of 39 questioners were collected, resulting in a 35% response rate.

The implementation of the screening tool for autism in toddlers in Part C early intervention programs: An 18-month follow-up.

The early detection of autism spectrum disorder can lead to access to autism spectrum disorder-specific services that have been shown to have a large impact on a child's overall development. Although a stable diagnosis of autism spectrum disorder can be made by age 2 years, most children are not diagnosed until much later. To address this issue, this study examined the effectiveness of training Part C Early Intervention providers to use an interactive autism spectrum disorder screening tool, the Screening Tool for Autism in Toddlers. Sixty-nine providers attended a 1-day training workshop on the use of the Screening Tool for Autism in Toddlers. After the workshop, providers reported increased knowledge about recognizing the early signs of autism spectrum disorder, and about 45% of the providers reported using the Screening Tool for Autism in Toddlers with families in their caseloads 18 months after the training. These results suggest that the Screening Tool for Autism in Toddlers is feasible for use within Early Intervention settings. In addition, they suggest that specific providers might serve as a screening "point-person," rather than expecting the Screening Tool for Autism in Toddlers to be used by all providers. Future research should aim to identify specific characteristics of agencies or providers that might be best suited for using the Screening Tool for Autism in Toddlers.

Can transportation network companies replace the bus? An evaluation of shared mobility operating costs

ABSTRACT Municipal governments struggle with providing accessible mobility for constituents without overburdening them with service costs. While transit offers many advantages, the cost of providing services can be prohibitive. Transportation Network Companies (TNCs) are a mobility alternative. This research answers the following question: Can TNCs be economically feasible as a replacement for bus? U.S. Federal Transit Administration (FTA) National Transit Database (NTD) data was evaluated finding that while TNCs could replace transit in some instances (23% of cases for an exclusive TNC option; 45% of cases for shared TNCs) most of the time bus will be more cost effective. Three agency characteristics were identified to anticipate TNC cost effectiveness: ridership, service area density, and average bus operating speeds. Overall, while TNCs are unlikely to be able to replace transit completely in most cases, their flexibility allows public entities to be more creative when making mobility policy and operational decisions.

The COVID-19 Pandemic and Probation in Chile: Remote Supervision and Regional Differences

The COVID-19 pandemic forced Chilean probation officers to adopt remote supervision technologies to maintain contact with their clients. Considering remote contact was scarcely used by Chilean probation officers before the pandemic, this change demands studying the impact of the pandemic remote supervision on the contact between officers and clients. To address this problem, we surveyed probation officers (n = 326) exploring the impact of COVID-19 on clients, officers, and the use of remote supervision across six Chilean macro-geographical regions representing the entire country: Extreme North, North, Santiago (Metropolitan Region), Middle South, South, and Extreme South. The survey includes demographics on probation officers at the national level, presenting data about their workload and agency for the first time. The results suggest that probation officers drastically changed how they contact their clients, shifting from primarily in-person communication to remote contact including videoconferencing, calls, and text messages. Our findings indicate that clients were heavily impacted by the pandemic in different psychosocial aspects and had low rates of access to technology. Finally, the macro-geographical analysis reveals how demographics, agency characteristics, technology access, and COVID-19 impact vary throughout the country. We conclude by discussing the relevance of the geographical and socioeconomic context before implementing remote supervision as community supervision core practice.

Directing young dropouts via SMS: evidence from a field experiment

Abstract Although short message services (SMS) are constantly used to transmit information, little is known about the use of SMS by public institutions to direct people. This paper presents a field experiment in France about the effectiveness of SMS in directing disadvantaged people toward public services. Two types of treatment SMS were provided: one type had its content written in a formal style; the second type SMS style was much informal. All the SMS were individualized and included specific information about the agencies. Results indicate that the SMS had no significant effect on enrollment. There is also no apparent heterogeneous effect according to individual, agency, or location characteristics. In line with other academic evidence, these findings suggest that SMS have very limited effectiveness in directing this population toward public services.

Actual status of educational programs at home visiting nurse agencies and related agency characteristics

Actual status of educational programs at home visiting nurse agencies and related agency characteristics

Women in Power? Examining Gender and Promotion in Policing Through an Organizational Perspective

Women bring important strengths to the field of policing, such as communication skills, the ability to lead teams, as well as the ability to coach and nurture subordinates. Despite these contributions, the rate of women entering policing has stagnated in recent years, and the percentage of women in supervisory, command, and leadership positions remains low. To explain this, we use an organizational structure perspective to explore how characteristics of police agencies (e.g., department size, officer demographics, and formalization) may influence the promotion of women to leadership positions. We make suggestions regarding hiring and retention and provide recommendations for further research.

Home Health Agencies With More Socially Vulnerable Patients Have Poorer Experience of Care Ratings.

Examine the relationships between dual eligibility and race/ethnicity characteristics of Medicare-Certified Home Health Agencies (CHHAs) and experience of care ratings. Analysis of 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs. CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings for all three domains (e.g., for care delivery, quartile 4 vs. 1: odds ratio [OR] = 0.622, p < .001); CHHAs with higher concentrations of racial/ethnic minorities generally were less likely to have high experience of care ratings in care delivery (e.g., Black: quartile 4 vs. 1: OR = 0.418, p<0.001), communication (e.g., Black: quartile 4 vs. 1: OR = 0.316, p<0.001), and specific care issues (e.g., Hispanic: quartile 4 vs. 1: OR = 0.397, p < .001). CHHAs with greater concentrations of dual-eligible patients and racial/ethnic minorities were more likely to have poor experience of care ratings.

Receipt of Hospice Aide Visits Among Medicare Beneficiaries Receiving Home Hospice Care

ContextHospice aides provide essential direct care to hospice patients, yet there is minimal research examining hospice aide visits. Objectivesdescribe the prevalence and frequency of hospice aide visits, and 2) evaluate patient, community, and hospice characteristics associated with these visits. MethodsLongitudinal cohort study of Medicare Current Beneficiary Survey (MCBS) participants who died between 2010-2018 and received routine hospice care in the 6 months prior to death (n = 674). We characterized prevalence and frequency of hospice aide visits over time and used generalized linear modelling to identify factors associated with visits. Results64% of hospice enrollees received hospice aide visits and average visit frequency (1.3 per week) remained stable throughout enrollment. The only patient characteristic associated with receipt of hospice aide visits was primary hospice diagnosis (respiratory diagnosis vs. dementia: OR 0.372, P = 0.040). Those living in community-based residential housing and those cared for by hospices with aides employed as staff were more likely to receive any hospice aide visits (OR 2.331, P = 0.047 and OR 4.612, P = 0.002, respectively.) ConclusionHospice aide visits are a common component of hospice care, but visit frequency does not increase as death approaches. Receipt of hospice aide visits was primarily associated with community and hospice agency (rather than patient) characteristics. Future work is needed to ensure that hospice aides are integrated in the hospice interdisciplinary team and that access to hospice aide visits is meaningfully driven by patient and family needs, rather than the practice norms and business models of individual hospice agencies.