One strategy for aging in place is an emerging idea known as aging in community, in which older adults depend on a community support group or program for assistance. This can consist of situations like older adults or family and friends living in the same house or close by each other in communities where they can easily assist each other.

To find out just how well the aging-in-community strategy is working, a Â鶹ӳ»­´«Ã½ health management and informatics researcher examined three aging-in-community programs in Florida. Her study, which is among the first to examine some key variables for these programs, was recently published in the journal Gerontology and Geriatric Medicine.

“Given the fast approaching ‘super-aged society’ in the U.S., there is a critical need to identify and assess the impact of aging-in-community programs aimed at helping older adults remain independent at home while also having a sense of belonging to their community,â€� says Su-I Hou, professor and interim chair of Â鶹ӳ»­´«Ã½â€™s and author of the study.

Hou examined two important factors for successful aging in community – people’s perceived ability to live independently and their perceived neighborhood social cohesiveness – in three types of aging-in-community programs in Central Florida.

These were two village programs, Thriving-in-Place, in Celebration, and Neighbors Network, in Winter Park; the Seniors First Meals on Wheels Program in Orlando, which is a county neighborhood lunch program; and a university-based lifelong learning program, .

In a village program, older residents band together to help each other out with drives to the doctor, help with errands and to vet any outside services or assistance.

Countywide neighborhood lunch programs provide meals and nutritional services to older adults in a group setting.

The university-based lifelong learning program provides education for older adults and ways to connect with other people and engage in campus services and programs.

The researcher found that for the nearly 300 total older people she surveyed in the aging-in-community programs, the higher a person’s education level was, the less likely they were to perceive themselves as having the ability to live independently.

She also found that people who were married had greater perceptions of social cohesiveness, or that they lived in a neighborhood where people helped each other out.

When comparing the three programs, study data showed that older adults participating in the neighborhood lunch program perceived a higher level of confidence that they can live independently at their own home, yet a lower level of neighborhood social cohesiveness, compared with older adults participating in the village or lifelong learning programs.

“The findings suggest ‘remain independent at home’ and ‘having a sense of belonging to their community’ may impact older adults with different characteristics or community-support systems differently,� Hou says. “It calls attention to examine how these key factors operate in different programs promoting aging in community, as well as a need to promote confidence in living independently at home among higher-educated older adults, and to facilitate a sense of belonging to their own community for single, older adults.�

Hou received her doctorate in health promotion and health education from the University of Texas Health Science Center at Houston. She joined Â鶹ӳ»­´«Ã½â€™s Department of Health Management and Informatics, part of Â鶹ӳ»­´«Ã½â€™s College of Community Innovation and Education, in 2015.

But often those electronic records are incomplete, which isn’t good for patients and means doctors often have to file multiple times with insurance companies to get paid. That’s lost time and revenue.

A professor at the Â鶹ӳ»­´«Ã½ has developed a computer model that allows healthcare facilities to determine how complete their patients’ electronic records are in real time. Once doctors or their front office staff can spot the issues, they can address them. That would translate into more complete information so doctors can make better decisions about patient care. Also, this technology should translate into better reimbursement rates.

“Our method doesn’t spot what is missing in each individual electronic record,â€� says health management and informatics Associate Professor Varadraj Gurupur, who was assisted in this pursuit by Ayan Nasir, a doctoral student with the Â鶹ӳ»­´«Ã½ School of Medicine. “But it gives each record a rating of how complete it is based on what’s missing. For example, if a work phone number is missing, that’s one score. But if blood test records are missing, that’s a higher score because that data is more important in the treatment of the patient. I think this is a valuable tool for patient care, but also for rural clinics that really need to be sure to get reimbursed for their services.â€�

These rural clinics often struggle, Gurupur says. Cash flow is always an issue and can make the difference between staying open and closing. That often leaves residents who live in these areas hours away from the next closest medical care facility.

The usefulness of this technology and possible commercialization opportunities were investigated with the financial support of the National Science Foundation I-Corps grant, and the university has now received a patent. That means it is available to license and that healthcare offices and hospitals can begin using it.

Gurupur, who is a computer scientist by training, recognized the need for the technology after working in a hospital administration office doing data processing while he earned his master’s degree in computer and information sciences at the University of Alabama at Birmingham. Because he knew computers, he was soon finding ways to connect systems and he started to spot gaps.

He joined Â鶹ӳ»­´«Ã½ in 2014. Thanks to the I-Corps grant he obtained in 2019 he was able to conduct a national survey, which looked at the challenges with standardizing electronic health records. He and his team members spent seven weeks traveling and interviewing healthcare professionals at conferences to discuss the challenges and discovered his idea could potentially make a difference for patients and doctors.

Gurupur has multiple degrees including a doctorate in computer engineering from the University of Alabama at Birmingham. Before joining Â鶹ӳ»­´«Ã½ he was an assistant professor at Louisiana Tech University and Texas A&M University – Commerce. He also had industry experience having worked in multiple computer-related positions at the Alzheimer’s Disease Center in Birmingham and the UAB Hospital. Aside from teaching and conducting research at Â鶹ӳ»­´«Ã½, Gurupur currently works as a walk-in researcher at Veterans Affairs in Orlando.

The Â鶹ӳ»­´«Ã½ and the Orlando VA Healthcare System will explore why that’s the case in a new study that could aid in finding ways to improve therapy delivery during the modern era of pandemics.

The nine-month project will be funded by a more than $25,000 grant from the Veterans Health Administration Office of Research and Development.

“A large proportion of veterans deal with mental health issues, but often psychotherapy fails to improve their symptoms because for this treatment to be most effective, the patient must adhere to the full schedule, typically involving 10 to 12 sessions,â€� says Christian King, an assistant professor in Â鶹ӳ»­´«Ã½â€™s and the project’s co-investigator.

“We wanted to understand why some veterans complete their treatments while others do not,� he says. “Then COVID-19 happened and all sessions that were previously in-person were moved to videoconference or telephone. So the need to understand how to keep veterans engaged in therapy became more urgent because the switch to remote modality created new hurdles.�

The project will mine the electronic medical records of VA to understand how the pandemic affected patients’ treatment for PTSD and depression during the 2020 fiscal year.

In addition to King, the research team includes assistant professor Andriy Koval and associate professor Varadraj Gurupur, both with Â鶹ӳ»­´«Ã½â€™s Department of Health Management and Informatics; Dr. Diana Mendez, the project’s principal investigator, with the Orlando VA Healthcare System; Dr. Teresa Carper with Orlando VA Healthcare System; and Dr. Adam Golden with Orlando VA Healthcare System and Â鶹ӳ»­´«Ã½â€™s College of Medicine.

“We hope that our study will help improve the treatment of PTSD and depression for veterans,� King says.

King received his doctorate in public policy in a joint program from Georgia State University and the Georgia Institute of Technology, and his master’s in statistics and economics and his bachelor’s in economics and French literature from Hunter College, City University of New York. King joined Â鶹ӳ»­´«Ã½â€™s Department of Health Management and Informatics, part of Â鶹ӳ»­´«Ã½â€™s College of Community Innovation and Education, in 2018.

These unintended consequences include keeping women from getting the treatment they need and failing to reduce the number of babies addicted to drugs.

The study, which was published Monday in the journal Health Affairs, compared the effects of punitive polices in states that implemented them and those that didn’t.

The findings are increasingly important as instances of opioid use disorder at delivery continue to rise.

“Opioid use during pregnancy can harm both the mother and baby, and rates of opioid use disorder at delivery increased over 300 percent between 1999 and 2014,â€� says Danielle Atkins, an assistant professor in Â鶹ӳ»­´«Ã½â€™s College of Community Innovation and Education and study co-author.

“States have taken various approaches to address prenatal substance use, including policies that consider prenatal substance use as equivalent to child abuse or neglect,� Atkins says. “In our study, we did not find evidence that having a punitive prenatal-substance-use policy reduced rates of babies born with withdrawal symptoms or maternal narcotic exposure at birth.�

“We found evidence, however, that punitive policies reduce substance use treatment admissions among pregnant women and that a smaller share of pregnant women are referred to treatment by health care providers in states with punitive policies,� she says.

For the study, Atkins and co-author Christine Piette Durrance, an associate professor in the Department of Public Policy at the University of North Carolina at Chapel Hill, used data from the Healthcare Cost and Utilization Project’s State Inpatient Databases, which has records for 95 percent of hospital discharges from 37 states.

From that data, they counted the number of babies born with withdrawal symptoms and affected by maternal narcotics exposure from 2000 to 2014.

They also used data from the Treatment Episode Data Set – Admissions, a national data system of annual admissions to substance abuse treatment facilities, to identify the number of pregnant women admitted to treatment by state and year.

For prenatal-substance-use policies implemented in different states, they used information from the Guttmacher Institute, State Policies in Brief, Substance Abuse During Pregnancy, bi-annual reports.

When they compared the proportion of pregnant women admitted to treatment before punitive policies were enacted to after, and with states that had those policies and those that didn’t, they found that treatment admissions for pregnant women dropped by 29 percent and referrals to treatment by health care professionals decreased by 18 percent when punitive laws were put in place.

Furthermore, punitive policies were not statistically significantly related to the number of babies born with withdrawal symptoms or exposed to narcotics.

“These results provide population-based evidence of the effect of punitive prenatal-substance-use policies on birth outcomes and substance use treatment admissions,� Atkins says. “Although proponents of punitive prenatal-substance-use policies often cite improved birth outcomes for infants as one policy aim, our results do not support this.�

She says alternatives to punitive laws include improved access to medication-assisted treatment with methadone or buprenorphine, along with prenatal care and behavioral health counseling.

Atkins also noted the complex nature of prenatal substance abuse, such as whether prenatal opioid exposure was the result of a medically used prescription, and barriers to treatment, such as cost, availability and stigma.

Atkins received her doctorate in public administration and policy with a specialization in health policy and Master of Public Administration from the University of Georgia and bachelor’s degree in psychology from the University of Tennessee, Knoxville. She joined Â鶹ӳ»­´«Ã½â€™s , part of Â鶹ӳ»­´«Ã½â€™s College of Community Innovation and Education, in 2016.

The study, published in Journal of Aging and Health, combined GIS, clinical data from hospitals in Texas, and other geospatial data to paint a more comprehensive picture than is typically shown about how assets are distributed relative to need. Samuel Towne, an assistant professor of Health Management and Informatics at the Â鶹ӳ»­´«Ã½, led the study.

The approach is an example of combing big data with other tools that can give practitioners information to improve the delivery of products or services. In this case, the results could help agencies keep older adults who are more prone to falls safer by providing prevention education in the right places.

The study looked at one particular resource — an evidence-based fall prevention program — to identify whether it was reaching areas with highest needs, which can be defined in many ways. The study authors looked at a variety of factors including areas with a high rate of fall-related hospitalizations among older adults.

The researchers believe state government agencies can build upon this model to explore these and other areas of interest through asset mapping relative to need.

“This study has the potential to serve as a model for both continued evaluation within and across states and to provide critical and actionable information to stakeholders associated with program planning for older adults both locally and statewide,� Towne says.

The collaboration among academia, individuals affiliated with hospital systems, and aging services providers which facilitate many critical evidence-based programs to older adults in the community made the research possible.

Other members of the research team include: Matthew Lee Smith, Minjie Xu, Yajuan Li and Marcia G. Ory of Texas A&M University, Sungmin Lee from the University of Connecticut, Sushma Sharma from the Dallas-Fort Worth Hospital Council Foundation, Don Smith from the United Way of Tarrant County and Yasmin Fucci from Florida Department of Health Bureau of Vital Statistics.

Towne joined Â鶹ӳ»­´«Ã½ in 2018 and is part of the university’s Disability, Aging, and Technology Faculty Cluster. He has multiple degrees including a doctorate in health services policy and management from the University of South Carolina. He also holds affiliations with Texas A&M University.

A research team led by the Â鶹ӳ»­´«Ã½ has evaluated how the use of physical therapy to treat acute low back pain ― and the timing of when treatment begins ― impact the use and costs of health care.

The researchers found that patients who started physical therapy within three days of receiving an acute low back pain diagnosis were less likely to use advanced imaging, specialist care and opioids than those who started physical therapy later.

The team’s findings were published online today in Physical Therapy Journal, the American Physical Therapy Association’s publication.

“Low back pain is the cause of significant pain, disability and loss of productivity,â€� said Xinliang Liu, who led the study as an assistant professor in the Department of Health Management and Informatics at Â鶹ӳ»­´«Ã½. “Decisions about treatment have important implications for the health care industry.â€�

Only a small percentage of patients with acute back pain are referred for physical therapy, according to Liu. And patients with physical therapy begin treatment at different times.

“There is no consensus about when to refer patients for physical therapy,â€� said William Hanney, a research team member and assistant professor of physical therapy at Â鶹ӳ»­´«Ã½. “The timing of physical therapy initiation remains controversial.â€�

The researchers addressed this controversy by examining insurance claims records for 46,914 patients in New York who had a new onset of acute low back pain from 2009 to 2014. They followed each patient’s records over one year starting with the date of diagnosis.

Among patients who had physical therapy, those who started treatment within three days of being evaluated (“immediate� treatment) were less likely to seek out more costly advanced imaging and specialist care than those who started physical therapy later.

Patients with immediate treatment, about 27 percent, were the least likely to have emergency room visits. Nearly 33 percent of patients who had no physical therapy used emergency room services.

Patients with immediate treatment also were the least likely to fill a prescription for opioid medication (44 percent), followed by patients receiving no physical therapy (48 percent), patients receiving therapy 4-14 days later (54 percent) or 15-28 days later (61 percent).

The authors estimate that immediate referral to physical therapy for acute low back pain potentially could lead to a cost savings of more than $7 billion a year in the United States.

“The impact of improving treatment of this condition is huge for all stakeholders ― patients, providers, public and private payers and employers,� said Carolyn Watts, the Richard M. Bracken chair and chairman for the Department of Health Administration at Virginia Commonwealth University, and a health services expert not associated with the study.

“This study represents the kind of research [that] policy and other decision makers need to create incentives to achieve the results,� she said.

Other members of the research team are Michael Masaracchio from Long Island University, Morey Kolber from Nova Southeastern University, Mei Zhao from the University of North Florida, Aaron Spaulding from the Mayo Clinic, and Meghan Gabriel from Â鶹ӳ»­´«Ã½. The study was funded by a grant from the New York Physical Therapy Association.

After close to two decades of working for Orlando Health, Shannon Elswick has joined the HMI faculty as a lecturer and an executive in residence. In this new role, Elswick will not only teach the future leaders of the health care industry; he will develop strategic partnerships between the department and the local health care community.

Elswick’s relationship with the HMI department originally began before he retired from Orlando Health a few years ago, when he started teaching as an adjunct instructor. Although he was serving as the senior vice president of acute care services for Leading Edge Healthcare in Orlando, he was interested in finding an opportunity to further leverage his knowledge and years of experience. So when he heard about the open executive in residence position, he jumped at the opportunity.

“I feel very fortunate to have been given the chance to join this team and offer what I can to enhance this terrific program,” Elswick said in an email. “I go to work now with talented and creative individuals who are focused on the opportunities we have to enrich the educational experiences for our students.”

As the department’s executive in residence, Elswick will develop programs and enhance partnership connections between the department and local businesses and health care providers. He said that the goal of building these connections is to create meaningful fellowship and leadership opportunities for students.

The other goal of Elswick’s work is to help students “learn how to learn.” This semester, he teaches Issues and Trends for the Master of Science in Health Services Administration as well as Financial Accounting for Health Care Managers for the Executive Master of Science in Health Services Administration. He said that his teaching style tends to focus on building students’ oral and written communication skills with written assignments and classroom discussions as opposed to giving typical exams based on lectures.

“When going through the text, we are talking more about how the content relates to the world of health care leadership,” Elswick said. “In other words, I want our students to learn ‘what’ but, more importantly, understand ‘why.'”

While learning in the classroom is important, Elswick also encourages students to dive headfirst into the field, where they will gain essential hands-on experience.

“First, if they have never worked in health care, I encourage them to do anything they can to get behind the curtain. A part-time job, at any level, or even volunteering will provide some experiential learning and allow them to speak with some knowledge when they land their first interview.”

He also encourages students to connect with the HMI faculty and advisors when they need help with professional development, such as polishing a resume or preparing for a job interview.

When he’s not in the classroom, you can find him serving on a society board – but this board doesn’t have anything to do with health care. Elswick is the immediate past president of the Barbershop Harmony Society Board as well as the co-director and performance coach for Sisters of Sound, the Clermont Chapter of Harmony Incorporated. He is also a member of a barbershop quartet, a barbershop chorus and an a capella quartet.

Although music is an integral and rewarding part of Elswick’s life, working with students is now just as satisfying.

“I get incredibly energized when I get to work with the students who are hungry for knowledge,” he said. “There is a kind of feedback loop where the more they want to get the more I want to be able to give. This kind of relationship is a kind of luxury most senior executives in the field do not have time to fully explore.”

Providers, patients and insurers are teaming up with innovators and entrepreneurs to develop new mobile technologies that deliver virtual health care anytime and anyplace. This emerging mode of health care delivery is known as Mobile Health or mHealth.

mHealth has the potential to reinvent health care, according to Donna Malvey, associate professor of health management and informatics at Â鶹ӳ»­´«Ã½.

“From service delivery to patient care to reimbursement systems to global outsourcing of clinical and financial services, all will be impacted,� she said.

Malvey is one to know, having just completed a new book, mHealth: Transforming Healthcare, published by Springer. The book is based on extensive research by her and co-author Donna Slovensky at the University of Alabama, Birmingham.

In mHealth, Malvey and Slovensky report on advancements and trends in mobile health technologies. They also offer insight on how the technologies are revising and reshaping health care delivery systems in the United States and globally.

“mHealth will greatly simplify things for the consumer,� Malvey shared. “It will change the way consumers search for health information and communicate with providers and insurers. It is believed to be essential to reducing health care costs, while enhancing access to care and improving health quality and outcomes.�

Shifts in relationships among doctors and patients are already under way. For example, doctors who normally see high-risk diabetic patients a few hours a year can use mHealth to provide more frequent care through virtual office visits and remote monitoring.

Malvey and her co-author also explore issues associated with health technologies. Industry regulations and information privacy and security issues may discourage or at least slow down mHealth innovation, according to the authors.

“Even though mHealth promises to simplify processes and reduce costs, there are no proven business models and there is a dearth of research and evidence,� Malvey said. “We don’t know if consumers want mHealth technologies or if it is only vendor hype.�

Malvey and Slovensky’s new book explains what is necessary for long-term viability of mHealth as a health care delivery medium.

Market factors such as the availability of inexpensive technology, partnership opportunities across industry segments and the growing interest of investors in digital health technologies create a supportive environment for advancement of mHealth products, Malvey explained.

“Ultimately, the success of mHealth will depend on its acceptance and use by consumers and its ability to reduce health care costs and lead to improved health outcomes,� she said.

mHealth: Transforming Healthcare is available online at .

The 467-page book, titled United States of America Health Systems in Transition, includes “everything you want to know� about the U.S. health care system, according to the observatory, a multi-national organization within the European branch of WHO.

“The book covers areas often missing from other texts such as dental care, mental health care, public health and complementary medicine,� explained Unruh, a professor in the Department of Health Management and Informatics. “It’s also unique in focusing on health care in transition, so it includes information about the Affordable Care Act or ‘Obamacare.’�

A final plus is that it is now available online for free (bit.ly/1e1TPEh), she said.

Unruh’s co-authors are Thomas Rice, Fielding School of Public Health, University of California, Los Angeles; Pauline Rosenau, School of Public Health, Health Science Center, University of Texas, Houston; and Andrew J. Barnes, Virginia Commonwealth University School of Medicine.

Unruh wrote two chapters, “Physical and human resources� and “Provision of services,� as well as parts of other chapters, and she reviewed and edited all of the chapters.

United States of America Health Systems in Transition is one in a series of dozens of country-based books on health systems published by the observatory. This is the organization’s first book about the U.S. health system.

The HiT series uses a uniform format to describe health systems worldwide and provides a basis for comparison of the U.S. health system in an international perspective, reported the observatory.

Unruh thinks the publication will be useful as a textbook for classes on the U.S. health care system or on comparative health care systems, and as a reference for anyone interested in learning more about the delivery of U.S. health care.