Biomedical subjects

Pamela L Davidson

Publications and source records attributed to Pamela L Davidson.

7 recordsLinked to original sources

PubMed2005

Role of community risk factors and resources on breast carcinoma stage at diagnosis.

BACKGROUND: The current study investigated the individual and community determinants of breast carcinoma stage at diagnosis (BCSAD) using multiple data sources merged with cancer registry data. The literature review yielded 5 studies that analyzed cancer registry data merged with community-level variables (1995-2004). METHODS: Community variables constructed for the current study reflected social and economic risk factors, physician supply, and health maintenance organization penetration. Multivariate logistic regression was used to identify the significant predictors of increasingly progressive BCSAD. RESULTS: Disparities remained for black and Hispanic females in California, who were least likely to be diagnosed early compared with their white counterparts. Younger (< 40 years) and middle-aged (40-64 years) females were less likely to be diagnosed with early BCSAD, compared with older females (> or = 65 years). Utilizing services at hospitals serving a lower volume of patients with breast carcinoma was associated with later BCSAD. After controlling for individual-level factors, community-level variables constructed at the census block group and county level were tested. If a woman resided in a neighborhood with greater percentages of female-headed households, persons living below the poverty level, less educated people, and more recent immigrants, then her chances of being diagnosed at an earlier stage were diminished. If, conversely, she resided in a neighborhood with greater percentages of females > or = 65 years (a proxy for Medicare coverage), her access to medical care and the probability of earlier BCSAD increased. County-level insurance rates and residing in counties where greater percentages of women ever had a mammogram were associated with in situ and early-stage diagnosis. Similarly, the supply of primary care physicians and radiologists was associated positively with earlier BCSAD. CONCLUSIONS: Results confirmed community-level predictors of socioeconomic and delivery system context matter, although the individual-level predictors showed a stronger effect. Nevertheless, analysis of community variables is promising for guiding and evaluating the effects of health policy and developing community and delivery system interventions for earlier detection and treatment of breast carcinoma.

Adult↗

PubMed2005

Pipeline, profession, and practice program: evaluating change in dental education.

This article describes the conceptual and analytical framework that will be used to assess the effectiveness of the Pipeline, Profession, and Practice: Community-Based Dental Education Program. The evaluation will use a mixed method qualitative and quantitative data collection, analysis, and triangulation. Baseline measures are reported using data from the 2003 ADEA survey of dental school seniors. Baseline measures show the dental schools are confronting a major recruitment challenge that will require short and long pipeline efforts to attract and retain underrepresented and low-income (URM/LI) persons. Gaps were found between the perceptions of URM and non-URM students in the adequacy of the curricula. The majority of all seniors described the current extramural clinical rotations as positive experiences, but URMs were more likely to report the experience improved their ability to care for diverse groups.

Community Dentistry↗

PubMed2004

A framework for evaluating safety-net and other community-level factors on access for low-income populations.

The framework presented in this article extends the Andersen behavioral model of health services utilization research to examine the effects of contextual determinants of access. A conceptual framework is suggested for selecting and constructing contextual (or community-level) variables representing the social, economic, structural, and public policy environment that influence low-income people's use of medical care. Contextual variables capture the characteristics of the population that disproportionately relies on the health care safety net, the public policy support for low-income and safety-net populations, and the structure of the health care market and safety-net services within that market. Until recently, the literature in this area has been largely qualitative and descriptive and few multivariate studies comprehensively investigated the contextual determinants of access. The comprehensive and systematic approach suggested by the framework will enable researchers to strengthen the external validity of results by accounting for the influence of a consistent set of contextual factors across locations and populations. A subsequent article in this issue of Inquiry applies the framework to examine access to ambulatory care for low-income adults, both insured and uninsured.

Ambulatory Care↗

PubMed2004

Effects of community factors on access to ambulatory care for lower-income adults in large urban communities.

This study examines the effects of community-level and individual-level factors on access to ambulatory care for lower-income adults in 54 urban metropolitan statistical areas in the United States. Drawing on a conceptual behavioral and structural framework of access, the authors developed multivariate models for insured and uninsured lower-income adults to assess the adjusted effects of community- and individual-level factors on two indicators of access: having a usual source of care, and having at least one physician visit in the past year. Several community factors influenced access, but they did so differently for insured and uninsured adults and for the two measures of access used. The findings of this sttudy confirm that public policies and community environment have measurable and substantial impacts on access to care, and that expanded public resources, such as Medicaid payments and safety-net clinics, can lead to measurable improvements in access for vulnerable populations residing in large urban areas.

Adult↗

PubMed2002

A framework for evaluating and continuously improving the NCHL transformational leadership initiative. National Center for Healthcare Leadership.

The National Center for Healthcare Leadership transformational leadership project is a broad and ambitious initiative that seeks to bring to the table top leaders from industry and academe. Their charge is to accomplish nothing short of resetting the course for health management education and practice in the coming decades. Four councils were recruited to launch the four major interventions: (1) recruitment and diversity, (2) core competencies, (3) the advanced learning institute, and (4) accreditation and certification. After describing intervention goals, we provide examples of baseline measures for tracking educational and performance outcomes longitudinally. We believe this transformation is only beginning, and it will take many years or decades. The transformation will be most successful if it is guided by data and systematic evaluation.

Accreditation↗

PubMed2002

Toward an understanding of competency identification and assessment in health care management.

Given the revolutionary changes occurring in the health care industry, there is increasing agreement that academicians and practitioners must collaborate to identify and prioritize major educational outcomes for health care management. Several competency initiatives have been undertaken or completed in health care and health care management in the last 5 to 7 years. Health care leaders who have undertaken such endeavors reveal that the task is most formidable. This article provides: (1) a summary of progress in competency identification for health management, (2) an historical overview on competency-based education and assessment, (3) a glossary of terms used in discussions on competency-based education and training, and (4) an outline of the challenges and benefits associated with competency modeling.

Competency-Based Education↗

PubMed2002

Access to medical care for low-income persons: how do communities make a difference?

This paper considers the impact of community-level variables over and above the effects of individual characteristics on healthcare access of low-income children and adults residing in large metropolitan statistical areas (MSAs). Further, we rank MSAs' performance in promoting healthcare access for their low-income populations. The individual-level data come from the 1995 and 1996 National Health Interview Survey (NHIS). The community-level variables are derived from multiple public-use data sources. The outcome variable is whether low-income individuals received a physician visit in the past twelve months. The proportion receiving a visit by MSA varied from 63% to 99% for children and from 62% to 83% for adults. Access was better for individuals with health insurance and a regular source of care and for those living in communities with more federally-funded health centers. Children residing in MSA.

Adolescent↗