Papers by suzanne cashman
Quality management in health care, 1993
2015 APHA Annual Meeting & Expo (Oct. 31 - Nov. 4, 2015), Nov 2, 2015
Public Health Reports, Mar 1, 2000
American Journal of Preventive Medicine, Nov 1, 1997
American Journal of Preventive Medicine, 1992
Background: Refugees resettling in the US historically follow a trajectory of declining health as... more Background: Refugees resettling in the US historically follow a trajectory of declining health as they adopt American diet and physical activity. Methods: This participatory research study explored health beliefs and behaviors of refugees from Burma currently resettling in New England. Community members and researchers adapted a healthy living bilingual educational flipchart, which was piloted in two workshops with a total of 20 adult men and women. An interpreter translated the audio taped discussions which were transcribed and analyzed using standard qualitative methods. Conclusions/ Discussion: Refugee camps constrain food and physical activity related health behaviors. Refugees rely on traditional healing practices but are familiar with western public health care and preventive education. In camps, close living quarters encouraged social interaction and group play. Physical activity was built into daily life as transportation, occupation and food gathering method. Exercise was a byproduct of a busy day, walking to work or school, collecting bamboo in the woods. New arrivals are often housebound and isolated; they seek simple maps that assist in locating resources in their new communities. Asking about sleep appears to open the conversation about emotional and mental health problems. Refugees want specific information about healthy foods and better understanding of how to determine need for exercise. They also seek consistent information on prevention of health problems common in the US coupled with assistance preserving their traditional beliefs. Discussion: Post-settlement in the US, retaining good health is challenging. Flipcharts and neighborhood map drawing provide avenues for open discussion leading to areas for Prevention Research Centers to partner for health.
Journal of Nursing Scholarship, Dec 1, 2004
Evaluate the effectiveness of body mass index (BMI) tables placed in exam rooms as an interventio... more Evaluate the effectiveness of body mass index (BMI) tables placed in exam rooms as an intervention to encourage providers to calculate and record BMI scores in patients' medical records. Design: In a prospective cohort design, medical record data for 276 adult patients at a federally funded community health center in New England were examined from August 2000 to August 2002 following the intervention. Methods: Prominent, multicolored, laminated BMI tables were posted in the exam rooms of one of the study site's three primary health care teams. Medical record data collected included documentation of BMI calculation in medical records, documentation of an obesity diagnosis, and inclusion of heights and current weights. Frequency distributions were calculated; chi-square tests were used to identify associations. Findings: In contrast to the comparison teams, patients on the intervention team were more likely to have BMI recorded in the medical record. A statistically significant increase in the diagnosis of obesity was observed throughout the health center after the intervention. Conclusions: Posting BMI tables in exam rooms contributed to increased BMI documentation in patients' medical records.
The Journal of ambulatory care management, 2005
Healthcare safety net providers are under increasing pressure to meet the physical and mental hea... more Healthcare safety net providers are under increasing pressure to meet the physical and mental health-as well as the range of social service-needs of traditionally vulnerable and hardto-reach populations. The extent to which health center patients are less well and in poorer health than is the rest of society, thus requiring greater depth and breadth of service, has not generally been the focus of systematic assessment. This case study uses the 12-Item Short-Form Health Survey (SF-12) and selected years of healthy life questions from the National Health Interview Survey to assess the self-perceived health status of patients at one Section 330 community health center in central Massachusetts. Five hundred thirteen patients completed all questions on the SF-12; 619 completed each of the years of healthy life questions. Respondents' physical and mental component summary scores were significantly lower than national norms for all age groups (P < .001). Respondents were also significantly more likely than the civilian noninstitutionalized population to be unable to perform major activities (P < .0001) and to be in fair or poor health (P < .0001). Analyses give an indication of the magnitude of difference in self-perceived health status between this poor, vulnerable population and the citizenry at large and suggest implications for policy related to safety net healthcare facilities.
Ambulatory Pediatrics, Jul 1, 2008
Objective.-To determine whether the medical-legal advocacy screening questionnaire (MASQ), a simp... more Objective.-To determine whether the medical-legal advocacy screening questionnaire (MASQ), a simple 10-item questionnaire, is able to screen families in a primary care setting for possible referral to legal services more effectively than the clinical interview alone. Methods.-Family Advocates of Central Massachusetts (FACM) is a medical-legal collaboration that assists low-income families with legal issues that affect child health. A convenience sample of parents seen at each of 5 medical practices associated with FACM was recruited to complete the MASQ prior to a routine child health care visit. Physicians blinded to the result assessed family need for referral to FACM after their usual clinical encounter. The sensitivity and specificity of both the MASQ and provider assessment were calculated. Results.-Two hundred fifty-five parents from 5 practices participated in the study. The MASQ identified 85 patients in need of legal services. Prior to reviewing the MASQ, the primary care providers identified 35 families in need of referral to the FACM. After completion of both the MASQ and the medical encounter, 37 families agreed to referral. The MASQ had sensitivity of 0.81 and specificity of 0.75 in predicting program referral. Provider assessment had sensitivity of 0.65 and specificity of 0.95 of predicting program referral. Conclusions.-Routine use of the MASQ would likely identify more patients in pediatric practices who would accept referral to legal assistance than reliance on provider impression alone after a routine clinical encounter.
Journal of the American Board of Family Medicine, 2003
Background: Obesity is at epidemic proportions. This study examined the extent to which obesity i... more Background: Obesity is at epidemic proportions. This study examined the extent to which obesity is being diagnosed at a community health center residency-training site. Results were examined by provider type. Characteristics of patients with obesity diagnosed by primary care providers were compared with characteristics of patients determined to be obese by body mass index (BMI) calculation exclusively. Methods: A cross-sectional design was used. Medical records of 465 adult patients were audited. Data collected included diagnosis of obesity, height and weight, demographics, and comorbidity. Results: Of the 465 patients' charts audited, 83 contained a provider diagnosis of obesity, and 74 additional patients were determined to be obese by BMI calculation exclusively. Significant underdiagnosis occurred among all provider types (P ؍ .036). Patients with a diagnosis of obesity had significantly higher BMI scores (38.4 vs 34.4, P ؍ .002). Obesity was more likely to be diagnosed in female than in male patients (P ؍ .001). Differences related to age, insurance coverage, and comorbidity were not significant. Conclusions: Obesity was found to be an underdiagnosed condition among all provider types. As evidenced by significantly higher BMI scores for provider-diagnosed obesity, the data suggest that the obesity diagnosis is made by appearance. The importance of teaching and modeling the use of BMI to diagnose obesity is underscored. (J Am Board Fam Pract 2003;16:14-21.) Recent data have indicated that obesity is at epidemic proportions in this country and in other countries around the world. 1,2 In the United States, the prevalence of obesity (body mass index [BMI] Ͼ 30) has increased more than 50% during the last 20 years, from 14.5% to 22.5% of the adult population. 3,4 Currently, approximately 50% of the United States population is overweight or obese, with low-income persons, particularly women and people of color, having the highest prevalence rates. 5 Obesity has been implicated in a variety of longterm, chronic health problems, including diabetes, 6 hypertension, coronary artery disease, stroke, 7 hyperlipidemia, and osteoarthritis. 4 Among women,
The Journal of ambulatory care management, Apr 1, 2008
Community health centers face the need for safe, accessible, and affordable exercise for low-inco... more Community health centers face the need for safe, accessible, and affordable exercise for low-income patients to implement self-management strategies. This study reports on one federally qualified health center's experience developing a partnership with a local YWCA to offer open access to patients for physical activity. Over a 24-month period, 1060 adult patients made at least 1 visit to the YWCA, logging a total of 14,276 visits. Among the exercisers, 112 had diabetes and made 3225 visits. Frequent users (≥24 visits), had an HbA lc reduction of 1% (P = .02). Community health centers can collaborate with local exercise facilities to ensure that patients have opportunities to pursue healthier lifestyles. Key words: community health center, chronic care model, diabetes, physical activity, underserved populations I NCREASED PHYSICAL ACTIVITY has beneficial effects on health and lowers the risk of chronic diseases such as hypertension, diabetes, cardiovascular disease, and depression (Kahn et al., 2002). For the last decade, US prevention and treatment recommendations for these diseases have called
American Journal of Public Health, Nov 1, 2012
Objectives. Our community health center attempted to meet public health goals for encouraging exe... more Objectives. Our community health center attempted to meet public health goals for encouraging exercise in adult patients vulnerable to obesity, diabetes, hypertension, and other chronic diseases by partnering with a local YMCA.Methods. During routine office visits, providers referred individual patients to the YMCA at no cost to the patient. After 2 years, the YMCA instituted a $10 per month patient copay for new and previously engaged health center patients.Results. The copay policy change led to discontinuation of participation at the YMCA by 80% of patients. Patients who persisted at the YMCA increased their visits by 50%; however, more men than women became frequent users after institution of the copay. New users after the copay were also more likely to be younger men. Thus the copay skewed the population toward a younger group of men who exercised more frequently. Instituting a fee appeared to discourage more tentative users, specifically women and older patients who may be less physically active.Conclusions. Free access to exercise facilities (rather than self-paid memberships) may be a more appropriate approach for clinicians to begin engaging inexperienced or uncertain patients in regular fitness activities to improve health.
Journal of Health Care for the Poor and Underserved, 2004
This study examined factors associated with the use of three free clinics located in Central Mass... more This study examined factors associated with the use of three free clinics located in Central Massachusetts. A total of 248 patients completed a questionnaire during the 2month study period. Descriptive results showed a majority of free clinic patients are lowincome, uninsured, and female. Many patients (62%) do not have a usual source of care, nor do they know where to go if the clinic is not open (61%). Most (82%) report using free clinics because they lack insurance. Patients who had been using the free clinics longer than 1 year are more likely to use the clinic because of inadequate insurance (p = 0.002) and as a way to obtain prescription drugs (p < 0.001). Although they serve an important need, free clinics cannot provide comprehensive, continuous care. Efforts to provide health care to the medically underserved must take these findings into consideration if they are to be successful.
Journal of Rural Health, Sep 1, 2006
American Journal of Preventive Medicine, Dec 1, 2004
The Clinical Prevention and Population Health Curriculum Framework is the initial product of the ... more The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual-and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.
American Journal of Preventive Medicine, Sep 1, 2008
In 2003, the Institute of Medicine (IOM) described public health as "an essential part of the tra... more In 2003, the Institute of Medicine (IOM) described public health as "an essential part of the training of citizens," a body of knowledge needed to achieve a public health literate citizenry. To achieve that end, the IOM recommended that "all undergraduates should have access to education in public health." Service-learning, a type of experiential learning, is an effective and appropriate vehicle for teaching public health and developing public health literacy. While relatively new to public health, service-learning has its historical roots in undergraduate education and has been shown to enhance students' understanding of course relevance, change student and faculty attitudes, encourage support for community initiatives, and increase student and faculty volunteerism. Grounded in collaborative relationships, service-learning grows from authentic partnerships between communities and educational institutions. Through emphasizing reciprocal learning and reflective practice, service-learning helps students develop skills needed to be effective in working with communities and ultimately achieve social change. With public health's enduring focus on social justice, introducing undergraduate students to public health through the vehicle of service-learning as part of introductory public health core courses or public health electives will help ensure that our young people are able to contribute to developing healthy communities, thus achieving the IOM's vision.
Academic Medicine, Mar 9, 2023
Academic Medicine, Feb 1, 1994
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Papers by suzanne cashman