Publications by authors named "Gail Jensen"

75 Publications

Do we need a signature pedagogy for interprofessional education?

J Interprof Care 2021 Sep-Oct;35(5):649-653. Epub 2021 Jun 14.

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http://dx.doi.org/10.1080/13561820.2021.1918071DOI Listing
November 2021

Severity, Irritability, Nature, Stage, and Stability (SINSS): A clinical perspective.

J Man Manip Ther 2021 10 17;29(5):297-309. Epub 2021 May 17.

Creighton University, Graduate School and College of Professional Studies, Omaha, NE, USA.

Clinical reasoning errors in health-care can be mitigated with the use of systematic strategies and tools. One of these strategies is the SINSS construct, an acronym for Severity, Irritability, Nature, Stage, and Stability. The construct of SINSS appears in several textbooks and peer-reviewed articles. However, it has been inconsistently defined and applied in clinical practice. In this clinical perspective, the terms of the SINSS construct are defined in detail and their application to clinical practice is discussed. Current research showing the application of SINSS as a whole in clinical practice and educational settings is also presented. Recommendations for future application of SINSS are provided to advance the study of clinical reasoning and help minimize diagnostic, prognostic, and interventional clinical errors. The systematic use of SINSS allows the clinician to gain a thorough understanding of the patient's condition and symptoms, which can lead to a well-tolerated and appropriately tailored physical examination and intervention. Additionally, the proper use of this construct can result in more optimal patient outcomes, as well as provide a structure for the mentor and learner in helping uncover errors in the learner's clinical reasoning process.
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http://dx.doi.org/10.1080/10669817.2021.1919284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491699PMC
October 2021

Norwegian physiotherapy teachers' experience from working in a partnership project in Sudan - A case study approach.

Physiother Theory Pract 2021 Apr 19:1-11. Epub 2021 Apr 19.

Faculty of Health Sciences, Ahfad University for Women, Omdurman, Sudan.

Professionals working abroad as part of a partnership program is a central act of internationalization among higher education institutions. Little research has been carried out on this topic. The goal of this study was, therefore, to explore, describe and discuss the workplace learning factors - especially cultural factors - influencing Norwegian physiotherapy teachers, working in an international partnership project at a women's university in Sudan. The study had a qualitative case-study design, intended to provide an in-depth understanding of workplace learning processes. We used a multifaceted approach which included individual interviews and document analyses. We identified individual, social and institutional factors that influenced workplace learning. Culture is decisive at all levels, and knowledge, skills and attitudes are culturally situated. The Norwegian teachers' learning was found to be dependent on both internal and external factors and the pre- and post-project periods.  This study shows that a workplace perspective on the experience of Norwegian physiotherapy teachers gives us a better understanding of the important factors, associated with such a project. Working abroad not only requires preparation on the part of the sending and host institution but also from the person working abroad (prior to, during and after the stay abroad) if workplace learning is to occur.
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http://dx.doi.org/10.1080/09593985.2021.1901325DOI Listing
April 2021

Gains in insurance coverage following the affordable care act and change in preventive services use among non-elderly US immigrants.

Prev Med 2021 07 7;148:106546. Epub 2021 Apr 7.

Wayne State University, Institute of Gerontology, USA; Wayne State University, Department of Economics, USA; University of New Mexico, Department of Sociology, USA; University of California San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, USA; Wayne State University, Department of Healthcare Sciences, USA. Electronic address:

Immigrants have lower and disproportionate use of preventive care. We use longitudinal panel data to examine how the 2014 full implementation of the ACA mandates affected change in preventive services (PS) use among immigrants that gained insurance. We used data on Foreign-Born (FB) and US-Born (USB) adults, ages 26-64 years, from the 2013/16 Medical Expenditures Panel Survey longitudinal files to examine within-person change in yearly utilization of age/sex specific United States Preventive Services Task Force (USPSTF) recommended services. We included five primary care (e.g., influenza immunization), three behavioral (e.g., diet), and seven cancer screening (e.g., mammography) measures. We used generalized estimating equations and difference-in-differences tests to assess the effects of insurance gain on: (1) change in PS utilization, and (2) reduction in utilization disparities between USB and FB adults, adjusting for predisposing, health enabling, and health needs factors. Our results showed that newly-insured FB adults substantially increased their use of all primary care checks, and exercise and diet advice. We also found improvements in use of endoscopies, two modalities of colon cancer screening, and prostate cancer screening, but not in receipt of mammography and clinical breast exams. Newly-insured FB PS use remained lower than use among continuously-insured USB adults, but some of the differences were explained by adjustment to enabling and health needs factors. Briefly, health insurance gains among immigrants translated into substantial improvements in use of recommended PS. Still, notable disparities persist among the newly-insured FB, and more so among the 1 in 5 that remain continuously uninsured.
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http://dx.doi.org/10.1016/j.ypmed.2021.106546DOI Listing
July 2021

Residency Education: Is It Now or Never?

Phys Ther 2021 04;101(4)

Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA.

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http://dx.doi.org/10.1093/ptj/pzaa225DOI Listing
April 2021

Medicaid managed care and preventable emergency department visits in the United States.

PLoS One 2020 29;15(10):e0240603. Epub 2020 Oct 29.

Institute of Gerontology, Wayne State University, Detroit, MI, United States of America.

Objectives: In the United States the percentage of Medicaid enrollees in some form of Medicaid managed care has increased more than seven-fold since 1990, e.g., up from 11% in 1991 to 82% in 2017. Yet little is known about whether and how this major change in Medicaid insurance affects how recipients use hospital emergency rooms. This study compares the performance of Medicaid health maintenance organizations (HMOs) and fee-for-service (FFS) Medicaid regarding the occurrence of potentially preventable emergency department (ED) use.

Methods: Using data from the 2003-2015 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the non-institutionalized US population, we estimated multivariable logistic regression models to examine the relationship between Medicaid HMO status and potentially preventable ED use. To accommodate the composition of the Medicaid population, we conducted separate repeated cross-sectional analyses for recipients insured through both Medicaid and Medicare (dual eligibles) and for those insured through Medicaid only (non-duals). We explicitly addressed the possibility of selection bias into HMOs in our models using propensity score weighting.

Results: We found that the type of Medicaid held by a recipient, i.e., whether an HMO or FFS coverage, was unrelated to the probability that an ED visit was potentially preventable. This finding emerged both among dual eligibles and among non-duals, and it occurred irrespective of the adopted analytical strategy.

Conclusions: Within the U.S. Medicaid program, Medicaid HMO and FFS enrollees are indistinguishable in terms of the occurrence of potentially preventable ED use. Policymakers should consider this finding when evaluating the pros and cons of adopting Medicaid managed care.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240603PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595391PMC
December 2020

Racial/Ethnic Differences in Mortality in Late Midlife: Have They Narrowed in Recent Years?

J Gerontol B Psychol Sci Soc Sci 2021 08;76(7):1475-1487

Institute of Gerontology and Division of Health Sciences, Wayne State University, Detroit, Michigan.

Objectives: To examine whether racial/ethnic differences in mortality rates have changed in recent years among adults in late midlife, and if so, how.

Methods: We analyze Health and Retirement Study data on non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks), and English- and Spanish-speaking Hispanics (Hispanic-English and Hispanic-Spanish), aged 50-64 from 2 periods: 1998-2004 (Period 1, n = 8,920) and 2004-2010 (Period 2, n = 7,224). Using survey-generalized linear regression techniques, we model death-by-end-of-period as a function of race/ethnicity and sequentially adjust for a series of period-specific baseline risk factors including demographics, health status, health insurance, health behaviors, and social networks. Regression decomposition techniques are used to assess the contribution of these factors to observed racial/ethnic differences in mortality rates.

Results: The odds ratio for death (ORD) was not statistically different for Blacks (vs. Whites) in Period 1 but was 33% higher in Period 2 (OR = 1.33; 95% confidence interval [CI] = 1.05-1.69). The adjusted ORD among Hispanic-English (vs. Whites) was not statistically different in both periods. The adjusted ORD among Hispanic-Spanish (vs. Whites) was lower (ORD = 0.36; 95% CI = 0.22-0.59) in Period 1 but indistinguishable in Period 2. In Period 1, 50.1% of the disparity in mortality rates among Blacks was explained by baseline health status, 53.1% was explained by financial factors. In Period 2, 55.8% of the disparity in mortality rates was explained by health status, 40.0% by financial factors, and 16.2% by health insurance status.

Discussion: Mortality rates among Blacks and Hispanic-Spanish have risen since the mid-1990s. Hispanic-Spanish may be losing their advantageous lower risk of mortality, long known as the "Hispanic Paradox."
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http://dx.doi.org/10.1093/geronb/gbaa175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8521734PMC
August 2021

Changes in Insurance Coverage and Healthcare Use Among Immigrants and US-Born Adults Following the Affordable Care Act.

J Racial Ethn Health Disparities 2021 04 3;8(2):363-374. Epub 2020 Jul 3.

Department of Neurosciences, University of California San Diego, San Diego, USA.

Objectives: Immigrants to the USA have disparate access to health insurance coverage and healthcare services. We evaluate the effects of gaining insurance following the January 2014 Affordable Care Act's (ACA) key provisions implementation on health services use among foreign- (FB) and US-born (USB) adults.

Methods: Longitudinal data from two panels (2013/2014 and 2014/2015) of the Medical Expenditure Panel Survey on FB and USB adults, ages 26-64 (unweighted n = 15,232), and difference-in-differences analysis using generalized estimating equations were used to estimate the effects of insurance gain. The primary outcomes were five measures of healthcare utilization including yearly routine care appointment, annual number of physician office visits, annual number of prescription medications filled or refilled, use of the emergency department (ED) during the year, and having an inpatient hospital stay during the year.

Results: Immigrants were more likely to gain health insurance between 2013 and 2015 relative to USB adults (6.3% vs. 4.4%) but remained much more likely to be continuously uninsured by 2015 (20.8% vs. 6.4%). Controlling for sociodemographic and health characteristics, FB and USB adults who gained insurance increased their use of health services, including routine care (absolute change Δ = 15.7%; p < 0.001 and Δ = 11.7%; p < 0.001), office-based doctor visits (Δ = 1.3; p < 0.001 and Δ = 0.6; p < 0.001), prescribed medications (Δ = 2.5; p < 0.001 and Δ = 1.6; p = 0.016), and inpatient hospitalizations (Δ = 3.6%; p = 0.017 and Δ = 3%; p < 0.001). ED use increased only among the FB (Δ = 4.8%; p < 0.001). Gaining insurance eliminated the differences in health services use for all considered outcomes among the FB relative to the continuously insured USB.

Conclusions: US immigrants had notable gains in health insurance after the ACA provisions took full effect, but major disparities in coverage persist. If insurance continues to expand among immigrants, then the gains may reduce longstanding disparities in health services use and enhance primary and preventive healthcare.
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http://dx.doi.org/10.1007/s40615-020-00790-yDOI Listing
April 2021

Effects of the Affordable Care Act's enhancement of Medicare benefits on preventive services utilization among older adults in the U.S.

Prev Med 2020 09 27;138:106148. Epub 2020 May 27.

Institute of Gerontology, Wayne State University, 87 East Ferry Street, Detroit, MI 48202, USA; Department of Healthcare Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA. Electronic address:

Since 2011, the Affordable Care Act (ACA) requires the provision of certain recommended clinical preventive services without cost-sharing for individuals in Medicare. We re-visited the effects of the ACA on preventive services utilization under Medicare, using data from the Medical Expenditure Panel Survey (MEPS) and examined the ACA's longer-term effects on preventive services utilization among Medicare beneficiaries. We analyzed nationally representative data on non-institutionalized Medicare beneficiaries (n = 27,124) from the 2006-2010 and 2012-2016 Medical Expenditure Panel Survey. Preventive services of interest were cholesterol test, blood pressure test, flu shot, endoscopy, blood stool test, clinical breast exam, mammography and prostate exam. We estimated propensity score weighted difference-in-difference (DID) models to test for differences in preventive services utilization based on Medicare insurance status. Nationwide, among beneficiaries with traditional Medicare only, who stood to gain the most from eliminating cost-sharing for preventive services, the percentage of women receiving clinical breast exams rose post-reform (Δ = 8.1%; p < 0.015) as compared to Medicare beneficiaries with supplemental private coverage, while at the same time the percentage receiving other preventive services did not change post-reform (all p > 0.05). Based on this analysis of MEPS data spanning 2006-2016, the ACA's enhancement of Medicare coverage had only modest effects on the percentage of beneficiaries receiving a range of preventive services. Medicare beneficiaries should be better informed of the availability of these services and encouraged by their physicians to avail the no cost-sharing incentive of these reforms.
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http://dx.doi.org/10.1016/j.ypmed.2020.106148DOI Listing
September 2020

Can Reading Tolstoy Make Us Better Physical Therapists? The Role of the Health Humanities in Physical Therapy.

Phys Ther 2020 06;100(6):885-889

Department of Ethics School of Medicine, Massachusetts General Hospital Institute of Health Professions, Charlestown, Massachusetts; and Department of Physical Therapy School of Pharmacy and Health Professions, Creighton University.

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http://dx.doi.org/10.1093/ptj/pzaa027DOI Listing
June 2020

Motivations to Pursue Physical Therapy Residency Training: A Q-Methodology Study of Stakeholder Perspectives.

Phys Ther 2020 01;100(1):57-72

Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University.

Background: Residency training is recognized as a valuable form of professional development and pathway to specialization. Currently residency is voluntary for physical therapists, with less than 12% of DPT students choosing to apply upon graduation. Motivations that drive the decision to pursue residency are currently unknown as is the extent of similarity and difference in perspective among various stakeholders.

Objective: The purpose of this study was to identify the dominant perspectives on motivations to pursue residency held by various stakeholders.

Design: This study was conducted using Q Methodology, which incorporates aspects of quantitative and qualitative techniques into the examination of human subjectivity.

Methods: Program directors, faculty, and current residents from all accredited physical therapy residency programs were invited to complete a forced-choice sorting activity where potential motivations for residency were sorted by perceived level of importance. Principal component analysis was used to identify dominant perspectives, which were interpreted based on emergent themes in the cluster of motivations identified as most important.

Results: Four dominant perspectives were identified: (1) desire to provide better patient care, (2) preparation for specialty practice, (3) fast track to expert practice, and (4) career advancement. These perspectives provided context and utility to 2 broad meta-motivations: improved clinical reasoning and receiving mentoring. Both within- and between-group differences among stakeholders were identified. However, subsets from each role-group population were found to share similar perspectives.

Limitations: Results from this study may not apply to potential residents in all specialty areas, and the implications of having a particular perspective are unknown.

Conclusions: Identification of the dominant perspective on motivations for pursuing residency may aid in promoting participation, program development, matching residents to programs and mentors, and future research.
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http://dx.doi.org/10.1093/ptj/pzz142DOI Listing
January 2020

Is enrollment in a Medicaid health maintenance organization associated with less preventable hospitalizations?

Prev Med Rep 2019 Dec 26;16:100964. Epub 2019 Jul 26.

Institute of Gerontology, Wayne State University, 87 East Ferry Street, Detroit, MI 48202, USA.

Introduction: The objective of this study is to compare the performance of Medicaid health maintenance organizations (HMOs) and fee-for-service (FFS) Medicaid regarding the prevalence of potentially preventable hospitalizations, a recognized measure of outpatient care quality.

Methods: This study used nationally representative data on non-institutionalized Medicaid recipients, ages 18-64, from the 2003-2012 Medical Expenditure Panel Survey. Separate analyses are conducted for recipients insured through both Medicaid and Medicare ("dual eligibles") and recipients whose only health insurance is Medicaid ("non-duals"). In each group the occurrence of potentially preventable hospitalizations is measured, and then survey-weighted multivariable logistic regression models are fit to quantify the relationship between Medicaid HMO status and the occurrence of such stays. The possibility of selection bias into HMOs is considered and explicitly addressed in model estimation using propensity score methods.

Results: Adjusting for covariates and confounders dual eligible enrolled in Medicaid managed care are more likely to have a potentially preventable hospitalization relative to those covered under FFS Medicaid (survey weighted logit model OR = 1.72, 95% CI = 0.98-3.03; propensity score weighted logit model OR = 1.87, 95% CI = 1.06-3.28). In contrast, the odds ratios did not differ among non-duals in Medicaid HMOs versus FFS Medicaid.

Conclusion: These findings suggest that, at least for dual eligibles, the quality of outpatient care in Medicaid HMOs may be worse than under FFS Medicaid. Better and more streamlined clinical preventive approaches for this high risk and vulnerable population might be required in Medicaid HMOs.
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http://dx.doi.org/10.1016/j.pmedr.2019.100964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700448PMC
December 2019

Futility in Rehabilitation.

PM R 2019 04 1;11(4):420-428. Epub 2019 Apr 1.

Northwestern University Feinberg School of Medicine and Shirley Ryan AbilityLab, Chicago, IL.

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http://dx.doi.org/10.1002/pmrj.12152DOI Listing
April 2019

Trajectories of Aging Among U.S. Older Adults: Mixed Evidence for a Hispanic Paradox.

J Gerontol B Psychol Sci Soc Sci 2020 02;75(3):601-612

Department of Neurosciences, University of California, San Diego.

Objectives: A well-documented paradox is that Hispanics tend to live longer than non-Hispanic Whites (NHW), despite structural disadvantages. We evaluate whether the "Hispanic paradox" extends to more comprehensive longitudinal aging classifications and examine how lifecourse factors relate to these groupings.

Methods: We used biennial data (1998-2014) on adults aged 65 years and older at baseline from the Health and Retirement Study. We use joint latent class discrete time and growth curve modeling to identify trajectories of aging, and multinomial logit models to determine whether U.S.-born (USB-H) and Foreign-born (FB-H) Hispanics experience healthier styles of aging than non-Hispanic Whites (NHW), and test how lifecycle factors influence this relationship.

Results: We identify four trajectory classes including, "cognitive unhealthy," "high morbidity," "nonaccelerated", and "healthy." Compared to NHWs, both USB-H and FB-H have higher relative risk ratios (RRR) of "cognitive unhealthy" and "high morbidity" classifications, relative to "nonaccelerated." These patterns persist upon controlling for lifecourse factors. Both Hispanic groups, however, also have higher RRRs for "healthy" classification (vs "nonaccelerated") upon adjusting for adult achievements and health behaviors.

Discussion: Controlling for lifefcourse factors USB-H and FB-H have equal or higher likelihood for "high morbidity" and "cognitive unhealthy" classifications, respectively, relative to NHWs. Yet, both groups are equally likely of being in the "healthy" group compared to NHWs. These segregations into healthy and unhealthy groups require more research and could contribute to explaining the paradoxical patterns produced when population heterogeneity is not taken into account.
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http://dx.doi.org/10.1093/geronb/gby057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357956PMC
February 2020

Clinical narratives in residency education: Exploration of the learning process.

Physiother Theory Pract 2019 Dec 15;35(12):1202-1217. Epub 2018 May 15.

Department of Physical Therapy, Creighton University, School of Pharmacy and Health Professions, Omaha, NE, USA.

: Post-professional residency educational programs aim to advance the knowledge and skills of therapists in a clinical specialty area, however, little is known about the process, outcomes, or effectiveness of residency education. : The purpose of this study was to use narrative as a teaching and learning tool to gain insight into the progressive development of the residents' learning process. : Qualitative methods including a retrospective analysis of residents' narratives were used to explore the professional development and thought process of residents. : Six physical therapy residents wrote reflective narratives across 4 time placements during their one-year residency. Qualitative content analysis was used to analyze the data for types of reflection across time frames and to construct themes based on meaning statements. : Four main themes evolved from the residents' clinical narratives: 1) developing clinical reasoning skills; 2) developing professional formation and identity; 3) moral agency; and 4) emerging characteristics of expertise : In this study, clinical narratives served as a pedagogical tool to enhance aspects of clinical expertise. The utilization of clinical narrative may be used as one tool to help to create reflective practitioners with improved skills foundational to clinical practice.
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http://dx.doi.org/10.1080/09593985.2018.1472686DOI Listing
December 2019

The active engagement model of applied ethics as a structure for ethical reflection in the context of course-based service learning.

Physiother Theory Pract 2018 Jan 30;34(1):1-12. Epub 2017 Aug 30.

c Department of Medical Education , University of Melbourne , Victoria , Australia.

Purpose: The purpose of this case report is to explore the active engagement model as a tool to illuminate the ethical reflections of student physical therapists in the context of service learning in a developing country.

Methods: The study participants were a convenience sample of six students. The study design is a case report using a phenomenological perspective. Data were collected from students' narrative writing and semi-structured interviews. The steps of the active engagement model provided the structural framework for student responses. The analysis process included open coding, selective coding, and member checking.

Results: Results showed the emergence of two main themes: 1) gathering rich detail and 2) developing independent moral identity. Students' descriptions of their relationships were detailed and included explanations about the complexities of the sociocultural context. Independent and deliberate agency was evident by the students' preparedness to be collaborative, to raise ethical questions, to identify ethically important aspects of their practice and to describe their professional roles. The students noted that the use of the model increased their engagement in the ethical decision-making process and their recognition of ethical questions.

Conclusions: This case report illustrates attributes of the active engagement model which have implications for teaching ethical reflection: scaffolding for ethical reflection, use of narrative for reflection, reflection in action, and illumination of relevant themes. Each of these attributes leads to the development of meaningful ethical reflection. The attributes of this model shown by this case report have potential applications to teaching ethical reflection.
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http://dx.doi.org/10.1080/09593985.2017.1368759DOI Listing
January 2018

Healthy Aging After Age 65: A Life-Span Health Production Function Approach.

Res Aging 2018 06 14;40(5):480-507. Epub 2017 Jun 14.

2 Institute of Gerontology, Wayne State University, Detroit, MI, USA.

This article examines the determinants of healthy aging using Grossman's framework of a health production function. Healthy aging, sometimes described as successful aging, is produced using a variety of inputs, determined in early life, young adulthood, midlife, and later life. A healthy aging production function is estimated using nationally representative data from the 2010 and 2012 Health and Retirement Study on 7,355 noninstitutionalized seniors. Using a simultaneous equation mediation model, we quantify how childhood factors contribute to healthy aging, both directly and indirectly through their effects on mediating adult outcomes. We find that favorable childhood conditions significantly improve healthy aging scores, both directly and indirectly, mediated through education, income, and wealth. We also find that good health habits have positive effects on healthy aging that are larger in magnitude than the effects of childhood factors. Our findings suggest that exercising, maintaining proper weight, and not smoking are likely to translate into healthier aging.
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http://dx.doi.org/10.1177/0164027517713312DOI Listing
June 2018

National Study of Excellence and Innovation in Physical Therapist Education: Part 2-A Call to Reform.

Phys Ther 2017 Sep;97(9):875-888

Program in Physical Therapy, School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant, Michigan.

This perspective shares recommendations that draw from (1) the National Study of Excellence and Innovation in Physical Therapist Education research findings and a conceptual model of excellence in physical therapist education, (2) the Carnegie Foundation's Preparation for the Professions Program (PPP), and (3) research in the learning sciences. The 30 recommendations are linked to the dimensions described in the conceptual model for excellence in physical therapist education: Culture of Excellence, Praxis of Learning, and Organizational Structures and Resources. This perspective proposes a transformative call for reform framed across 3 core categories: (1) creating a culture of excellence, leadership, and partnership, (2) advancing the learning sciences and understanding and enacting the social contract, and (3) implementing organizational imperatives. Similar to the Carnegie studies, this perspective identifies action items (9) that should be initiated immediately in a strategic and systematic way by the major organizational stakeholders in physical therapist education. These recommendations and action items provide a transformative agenda for physical therapist education, and thus the profession, in meeting the changing needs of society through higher levels of excellence.
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http://dx.doi.org/10.1093/ptj/pzx062DOI Listing
September 2017

National Study of Excellence and Innovation in Physical Therapist Education: Part 1-Design, Method, and Results.

Phys Ther 2017 Sep;97(9):857-874

Physical Therapy Division, Duke University, Durham, North Carolina.

Background: The Carnegie Foundation for the Advancement of Teaching commissioned the Preparation for the Professions Program, a qualitative study of professional education in 5 professions: medicine, nursing, law, engineering, and clergy. These studies identified curricular structures, instructional practices, assessment approaches, and environmental characteristics that support the preparation of professionals and led to educational reforms. The physical therapy profession has not had any in-depth, national investigation of physical therapist education since the Catherine Worthingham studies conducted more than 50 years ago.

Objectives: This research was a Carnegie-type study, investigating elements of excellence and innovation in academic and clinical physical therapist education in the United States.

Design: Five physical therapist education researchers from across the United States used a qualitative multiple-case study design.

Methods: Six academic and 5 clinical programs were selected for the study. The academic institutions and clinical agencies studied were diverse in size, institutional setting, geography, and role in residency education. Qualitative case studies were generated from review of artifacts, field observations, and interviews (individual and focus group), and they provided the data for the study.

Results: A conceptual framework grounded in 3 major dimensions was generated, with 8 supporting elements: (1) culture of excellence (shared beliefs and values, leadership and vision, drive for excellence, and partnerships), (2) praxis of learning (signature pedagogy, practice-based learning, creating adaptive learners, and professional formation), and (3) organizational structures and resources.

Conclusion: Building on the work of the Carnegie Foundation's Preparation for the Professions Program, a conceptual model was developed, representing the dimensions and elements of excellence in physical therapist education that is centered on the foundational importance of a nexus of linked and highly valued aims of being learner centered and patient centered in all learning environments, both academic and clinical.
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http://dx.doi.org/10.1093/ptj/pzx061DOI Listing
September 2017

Effects of Medicare Coverage of a "Welcome-to-Medicare" Visit on Use of Preventive Services among New Medicare Enrollees.

J Aging Res 2017 4;2017:2074810. Epub 2017 May 4.

Eugene Applebaum College of Pharmacy and Health Sciences and Institute of Gerontology, Wayne State University, 259 Mack Ave., Detroit, MI 48201, USA.

In January 2005, Medicare began covering a one-time initial preventive physical examination (IPPE), also called a "Welcome-to-Medicare" visit, during a beneficiary's first 6 months under Part B. This paper examines the effects of offering Medicare IPPE coverage on the use of mammograms, breast self-exams, Pap smears, prostate cancer screenings, cholesterol screenings, and flu vaccines among beneficiaries new to Part B. We adopt a difference-in-difference estimator and estimate a set of multivariate logit models to quantify the effects of introducing Medicare IPPE coverage on the use of preventive services. Models are estimated separately for men and women. Data for the analysis come from the 1996-2008 Health and Retirement Study. Among both men and women, having coverage for a one-time IPPE under Medicare had no effects on the utilization of any of the preventive services listed above. In this study, we find that offering coverage for a one-time IPPE under Medicare was insufficient to spur greater use of preventive services among new Medicare beneficiaries. These findings are important and suggest that policy-makers may need to consider other approaches to increase the use of recommended preventive services.
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http://dx.doi.org/10.1155/2017/2074810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435974PMC
May 2017

Systematic Clinical Reasoning in Physical Therapy (SCRIPT): Tool for the Purposeful Practice of Clinical Reasoning in Orthopedic Manual Physical Therapy.

Phys Ther 2017 01;97(1):61-70

Background And Purpose: Clinical reasoning is essential to physical therapist practice. Solid clinical reasoning processes may lead to greater understanding of the patient condition, early diagnostic hypothesis development, and well-tolerated examination and intervention strategies, as well as mitigate the risk of diagnostic error. However, the complex and often subconscious nature of clinical reasoning can impede the development of this skill. Protracted tools have been published to help guide self-reflection on clinical reasoning but might not be feasible in typical clinical settings.

Case Description: This case illustrates how the Systematic Clinical Reasoning in Physical Therapy (SCRIPT) tool can be used to guide the clinical reasoning process and prompt a physical therapist to search the literature to answer a clinical question and facilitate formal mentorship sessions in postprofessional physical therapist training programs.

Outcomes: The SCRIPT tool enabled the mentee to generate appropriate hypotheses, plan the examination, query the literature to answer a clinical question, establish a physical therapist diagnosis, and design an effective treatment plan. The SCRIPT tool also facilitated the mentee's clinical reasoning and provided the mentor insight into the mentee's clinical reasoning. The reliability and validity of the SCRIPT tool have not been formally studied.

Discussion: Clinical mentorship is a cornerstone of postprofessional training programs and intended to develop advanced clinical reasoning skills. However, clinical reasoning is often subconscious and, therefore, a challenging skill to develop. The use of a tool such as the SCRIPT may facilitate developing clinical reasoning skills by providing a systematic approach to data gathering and making clinical judgments to bring clinical reasoning to the conscious level, facilitate self-reflection, and make a mentored physical therapist's thought processes explicit to his or her clinical mentor.
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http://dx.doi.org/10.2522/ptj.20150482DOI Listing
January 2017

Patient Centered Medical Home Care Among Near-Old and Older Race/Ethnic Minorities in the US: Findings from the Medical Expenditures Panel Survey.

J Immigr Minor Health 2017 12;19(6):1271-1280

Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, USA.

Access to Patient Centered Medical Home (PCMH) care has not been explored among older racial/ethnic minorities. We used data on adults 55-years and older from the Medical Expenditure Panel Survey (2008-2013). We account for five features of PCMH experiences and focus on respondents self-identifying as Non-Latino White, Black, and Latino. We used regression models to examine associations between PCMH care and its domains and race/ethnicity and decomposition techniques to assess contribution to differences by predisposing, enabling and health need factors. We found low overall access and significant racial/ethnic variations in experiences of PCMH. Our results indicated strong deficiencies in access to a personal primary care physician provided healthcare. Factors contributing to differences in reported PCMH experiences relative to Whites differed by racial/ethnic grouping. Policy initiatives aimed at addressing accessibility to personal physician directed healthcare could potentially reduce racial/ethnic differences while increasing national access to PCMH care.
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http://dx.doi.org/10.1007/s10903-016-0491-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5714276PMC
December 2017

Health Shocks and Initiation of Use of Preventive Services Among Older Adults.

J Appl Gerontol 2018 07 22;37(7):856-880. Epub 2016 Jul 22.

1 Wayne State University, Detroit, MI, USA.

This article examines whether adverse changes to health or functioning serve as an impetus to begin using preventive services among older individuals with a history of non-use. Using data from the 1998-2008 Health and Retirement Study, the use of mammograms, pap smears, prostate cancer screenings, cholesterol checks, and flu shots is examined among 2,975 self-reported non-users of such services. Older women who experience a health shock are 1.86, 1.50, 1.79, and 1.46 times more likely to begin getting mammograms, pap smears, cholesterol checks, and flu shots, respectively. Older men who experience a health shock are 2.24, 2.72, and 1.64 times more likely to begin getting prostate cancer screenings, cholesterol checks, and flu shots, respectively. All of these results are statistically significant. Thus, older adults often improve their health behaviors after experiencing an adverse health event.
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http://dx.doi.org/10.1177/0733464816657474DOI Listing
July 2018

Education Research in Physical Therapy: Visions of the Possible.

Phys Ther 2016 Dec 16;96(12):1874-1884. Epub 2016 Jun 16.

B. Greenfield, PT, PhD, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia.

Education research has been labeled the "hardest science" of all, given the challenges of teaching and learning in an environment encompassing a mixture of social interactions, events, and problems coupled with a persistent belief that education depends more on common sense than on disciplined knowledge and skill. The American Educational Research Association specifies that education research-as a scientific field of study-examines teaching and learning processes that shape educational outcomes across settings and that a learning process takes place throughout a person's life. The complexity of learning and learning environments requires not only a diverse array of research methods but also a community of education researchers committed to exploring critical questions in the education of physical therapists. Although basic science research and clinical research in physical therapy have continued to expand through growth in the numbers of funded physical therapist researchers, the profession still lacks a robust and vibrant community of education researchers. In this perspective article, the American Council of Academic Physical Therapy Task Force on Education Research proposes a compelling rationale for building a much-needed foundation for education research in physical therapy, including a set of recommendations for immediate action.
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http://dx.doi.org/10.2522/ptj.20160159DOI Listing
December 2016

Physical Therapy Residency and Fellowship Education: Reflections on the Past, Present, and Future.

Phys Ther 2016 07 17;96(7):949-60. Epub 2015 Dec 17.

M.J. Rapport, PT, DPT, PhD, FAPTA, Physical Therapy Program, School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, Colorado.

The physical therapy profession continues to respond to the complex and changing landscape of health care to meet the needs of patients and the demands of patient care. Consistent with this evolution is the rapid development and expansion of residency and fellowship postprofessional programs. With the interested number of applicants exceeding the number of residency and fellowship slots available, a "critical period" in the educational process is emerging. The purposes of this perspective article are: (1) to analyze the state of residency and fellowship education within the profession, (2) to identify best practice elements from other health professions that are applicable to physical therapy residency and fellowship education, and (3) to propose a working framework grounded in common domains of competence to be used as a platform for dialogue, consistency, and quality across all residency and fellowship programs. Seven domains of competence are proposed to theoretically ground residency and fellowship programs and facilitate a more consistent approach to curricular development and assessment. Although the recent proliferation of residency and fellowship programs attempts to meet the demand of physical therapists seeking advanced educational opportunities, it is imperative that these programs are consistently delivering high-quality education with a common focus on delivering health care in the context of societal needs.
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http://dx.doi.org/10.2522/ptj.20150473DOI Listing
July 2016

Impact of Medicare Age Eligibility on Health Spending among U.S. and Foreign-Born Adults.

Health Serv Res 2016 06 20;51(3):846-71. Epub 2015 Oct 20.

Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.

Objective: Examine differences in health care expenditures between foreign-born and U.S.-born adults in late mid-life, and how these differences change after age 65, when Medicare is near-universal.

Data: Medical Expenditures Panel Survey data (2000-2010) on adults ages 55-75 years (n = 46,132) to examine annual total and payer-specific expenditures.

Study Design: We use (1) propensity score matching to generate quasi-experimental samples with equivalent health needs and health care preferences, (2) generalized linear modeling to estimate group differences in expenditures, and (3) bootstrapping methods to obtain variance estimates for significance testing.

Principal Findings: Among adults ages 55-64, the foreign-born spend $3,314 (p < .001) less on health care, even when they have equivalent health needs and health care preferences. This difference is due mainly to lower spending through private insurance. After age 65, differences in total spending disappear but not differences in payer-specific spending. The foreign-born continue to spend significantly less through private insurance and begin to spend significantly more through Medicare and Medicaid.

Conclusion: Foreign-born adults in late mid-life spend significantly less on health care than U.S.-born adults. After age 65, with near-universal Medicare coverage, differences in total spending disappear between the groups, although differences in spending by payer persist.
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http://dx.doi.org/10.1111/1475-6773.12402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874820PMC
June 2016
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