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Metropolitan Government of Nashville-Davidson (balance), TN, United States

Woodward J.,10 James Robertson Parkway | Rice E.,Austin Peay State University
Nursing Clinics of North America | Year: 2015

Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. © 2015 Elsevier Inc. Source


Epstein R.A.,Vanderbilt University | Feix J.,10 James Robertson Parkway | Arbogast P.G.,Vanderbilt University | Beckjord S.H.,993 Brodhead Road | Bobo W.V.,Vanderbilt University
BMC Health Services Research | Year: 2012

Background: The purpose of the current study was to evaluate the impact of a July 2008 Tennessee Court of Appeals opinion that shifted financial responsibility for juvenile court ordered psychiatric evaluations from the State to the County. Methods. We used de-identified administrative data from the Tennessee Department of Mental Health and mid-year population estimates from the U.S. Census Bureau from July 1, 2006 to June 30, 2010, and an interrupted time series design with segmented regression analysis to quantify the impact of the implementation of the Court opinion. Results: In the study period, there were 2,176 referrals for juvenile court ordered psychiatric evaluations in Tennessee; of these, 74.1% were inpatient evaluations. The Court opinion was associated with a decrease of 9.4 (95%C.I. = 7.9-10.8) inpatient and increase of 1.2 (95%C.I. = 0.4-2.1) outpatient evaluations per 100,000 Tennessee youth aged 12 to 19years per month. Conclusions: The Court opinion that shifted financial responsibility for juvenile court ordered psychiatric evaluations from the State to the County was associated with a sudden and significant decrease in inpatient psychiatric evaluations, and more modest increase in outpatient evaluations. © 2012 Epstein et al.; licensee BioMed Central Ltd. Source


Marder E.P.,10 James Robertson Parkway | Marder E.P.,Centers for Disease Control and Prevention | Garman K.N.,10 James Robertson Parkway | Ingram L.A.,10 James Robertson Parkway | Dunn J.R.,10 James Robertson Parkway
Foodborne Pathogens and Disease | Year: 2014

Shiga toxin-producing Escherichia coli O157:H7 (STEC O157) is the most commonly identified serotype of STEC in the United States. An estimated 63,000 STEC O157 infections occur annually. Infection typically results in diarrhea, bloody stool, abdominal cramps, and, in some cases, hemolytic uremic syndrome. Recent outbreaks of STEC O157 have increasingly been associated with consumption of leafy greens such as lettuce and spinach. We investigated an outbreak of STEC O157 associated with the consumption of bagged salad with cases clustered in various institutional settings. A case-control study was conducted among cases from selected schools with controls matched by school and grade. Seventeen cases from three U.S. states were identified. The median age of cases was 23 years (range: 3-88) and 13 (76%) were female. Six cases were hospitalized and two died. Onset dates ranged from April 29 to May 12, 2012. The matched case-control analysis identified a single significant food service exposure: consumption of lettuce provided by a school cafeteria (median odds ratio=9.4, 95% confidence interval: 1.4-∞, p=0.0469). The implicated bagged salad product was traced back to a single production facility. Implicated growing areas were scheduled for heightened inspection for the upcoming growing season. A combination of analytical epidemiologic studies among subclusters of cases, surveillance, and traceback implicated bagged salad in this outbreak investigation. © Copyright 2014, Mary Ann Liebert, Inc. 2014. Source

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