Publications by authors named "Jodie C Gary"

14 Publications

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The effect of expanded insurance coverage under the Affordable Care Act on emergency department utilization in New York.

Am J Emerg Med 2021 Apr 30;48:183-190. Epub 2021 Apr 30.

Population Informatics Lab, Texas A&M University, College Station, TX, USA; Texas A&M University, School of Public Health, Department of Health Policy & Management, College Station, TX, USA.

Background: One of the proposed benefits of expanding insurance coverage under the Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for non-urgent visits related to lack of health insurance coverage and access to primary care providers. The objective of this study was to estimate the effect of the 2014 ACA implementation on ED use in New York.

Methods: We used the Healthcare Cost and Utilization Project State Emergency Department and State Inpatient Databases for all outpatient and all inpatient visits for patients admitted through an ED from 2011 to 2016. We focused on in-state residents aged 18 to 64, who were covered under Medicaid, private insurance, or were uninsured prior to the 2014 expansion. We estimated the effect of the expanded insurance coverage on average monthly ED visits volumes and visits per 1000 residents (rates) using interrupted time-series regression analyses.

Results: After ACA implementation, overall average monthly ED visits increased by around 3.0%, both in volume (9362; 95% Confidence Intervals [CI]: 1681-17,522) and in rates (0.80, 95% CI:0.12-1.49). Medicaid covered ED visits volume increased by 23,972 visits (95% CI: 16,240 -31,704) while ED visits by the uninsured declined by 13,297 (95% CI:-15,856 - -10,737), and by 1453 (95% CI:-4027-1121) for the privately insured. Medicaid ED visits rates per 1000 residents increased by 0.77 (95% CI:-1.96-3.51) and by 2.18 (95% CI:-0.55-4.92) for those remaining uninsured, while private insurance visits rates decreased by 0.48 (95% CI:-0.79 - -0.18). We observed increases in primary-care treatable ED visits and in visits related to mental health and alcohol disorders, substance use, diabetes, and hypertension. All estimated changes in monthly ED visits after the expansion were statistically significant, except for ED visit rates among Medicaid beneficiaries.

Conclusion: Net ED visits by adults 18 to 64 years of age increased in New York after the implementation of the ACA. Large increases in ED use by Medicaid beneficiaries were partially offset by reductions among the uninsured and those with private coverage. Our results suggest that efforts to expand health insurance coverage only will be unlikely to reverse the increase in ED use.
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http://dx.doi.org/10.1016/j.ajem.2021.04.076DOI Listing
April 2021

Emergency Department Utilization by Adolescents Experiencing Homelessness in Massachusetts.

Med Care 2021 Apr;59(Suppl 2):S187-S194

Population Informatics Lab, Texas A&M University, College Station.

Background: Adolescents who experience homelessness rely heavily on emergency departments (EDs) for their health care.

Objectives: This study estimates the relationship between homelessness and ED use and identifies the sociodemographic, clinical, visit-level, and contextual factors associated with multiple ED visits among adolescents experiencing homelessness in Massachusetts.

Research Design: We used the Healthcare Cost and Utilization Project State Emergency Department Databases on all outpatient ED visits in Massachusetts from 2011 to 2016. We included all adolescents who were 11-21 years old. We estimated the association between homelessness and ED utilization and investigated predictors of multiple ED visits among adolescents who experience homelessness using multivariate logistic and negative binomial regressions.

Results: Our study included 1,196,036 adolescents, of whom about 0.8% experienced homelessness and this subset of adolescents accounted for 2.2% of all ED visits. Compared with those with stable housing, adolescents who were homeless were mostly covered through Medicaid (P<0.001), diagnosed with 1 or more comorbidities (P<0.001), and visited the ED at least once for reasons related to mental health; substance and alcohol use; pregnancy; respiratory distress; urinary and sexually transmitted infections; and skin and subcutaneous tissue diseases (P<0.001). Homeless experience was associated with multiple ED visits (incidence rate ratio=1.18; 95% confidence intervals, 1.16-1.19) and frequent ED use (4 or more ED visits) (adjusted odds ratio=2.21; 95% confidence interval, 2.06-2.37). Factors related to clinical complexity and Medicaid compared with lack of coverage were also significant predictors of elevated ED utilization within the cohort experiencing homelessness.

Conclusions: Adolescents who experience homelessness exhibit higher ED use compared with those with stable housing, particularly those with aggravated comorbidities and chronic conditions. Health policy interventions to integrate health care, housing, and social services are essential to transition adolescents experiencing homelessness to more appropriate community-based care.
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http://dx.doi.org/10.1097/MLR.0000000000001436DOI Listing
April 2021

Frequent emergency department use in the paediatric population: A systematic literature review.

J Eval Clin Pract 2021 Feb 5;27(1):193-203. Epub 2020 Mar 5.

Medical Sciences Library, Texas A&M University, College Station, Texas, USA.

Objective: We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States.

Methods: We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors.

Results: Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use.

Conclusions: Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost-saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.
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http://dx.doi.org/10.1111/jep.13382DOI Listing
February 2021

TeamSTEPPS Training for Nursing Students Using Pop Culture Media.

Authors:
Jodie C Gary

Nurse Educ 2020 Jan/Feb;45(1):5-6

Author Affiliations: Assistant Professor, College of Nursing, Texas A&M University, Bryan.

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http://dx.doi.org/10.1097/NNE.0000000000000663DOI Listing
April 2020

Meeting Texas Nursing Workforce Needs Through Recruitment and Retention Initiatives.

Nurs Educ Perspect 2019 Nov/Dec;40(6):355-357

About the Authors Jodie C. Gary, PhD, RN, is an assistant professor, College of Nursing, Texas A&M University, Bryan, Texas. Kevin Gosselin, PhD, is director of academics and biostatistics, HonorHealth, Scottsdale, Arizona, and an adjunct professor at A.T. Still University in Mesa, Arizona. Abigail Mulcahy, MPH, is a doctoral student, College of Public Health, Oregon State University, Corvallis, Oregon. Debra Wise Matthews, PhD, RN, is an assistant professor and -associate dean for academic affairs, College of Nursing, Texas A&M University. This work was supported in part by a grant from the Texas Higher Education Coordinating Board. The opinions and conclusions expressed in this document are those of the authors and do not necessarily represent the opinions or policy of the Texas Higher Education Coordinating Board. For more information, contact Dr. Gary at

Evidence demonstrates health inequities can be ameliorated by a workforce whose diversity reflects the population served. The diversity of the Texas nursing workforce, however, is not reflective of the Texas population. This article reports on a project to recruit and retain minority nurses in Texas. The project goals were to improve enrollment for minority students, specifically Hispanic students, in an online South Texas baccalaureate nursing program (traditional BSN, second-degree BSN, and RN to BSN); facilitate student success; and promote student satisfaction. These goals were successfully achieved at one academic institution.
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http://dx.doi.org/10.1097/01.NEP.0000000000000452DOI Listing
November 2019

Direct Observation of Medication Errors in Critical Care Setting: A Systematic Review.

Crit Care Nurs Q 2018 Jan/Mar;41(1):76-92

Medical Sciences Library (Ms Foster) and College of Architecture (Ms Sooryanarayana), Texas A&M University, College Station; and College of Nursing, Texas A&M University Health Science Center, Bryan (Dr Gary).

Medication errors continue to be an issue for the critically ill and are costly to both patients and health care facilities. This article reviews published research about these errors and reports results of observational studies. The types of errors, incidence, and root causes have been considered along with adverse consequences. The implications for bedside practice as a result of this review are fairly straightforward. Medication errors are happening at an alarming rate in the critical care environment, and these errors are preventable. It is imperative that all personnel respect and follow established guidelines and procedural safeguards to ensure flawless drug delivery to patients.
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http://dx.doi.org/10.1097/CNQ.0000000000000188DOI Listing
February 2018

Health science center faculty attitudes towards interprofessional education and teamwork.

J Interprof Care 2018 Mar 12;32(2):231-234. Epub 2017 Oct 12.

a Texas A&M University Health Science Center , College of Nursing , Bryan , USA.

The attitudes of faculty towards interprofessional education (IPE) and teamwork impact the education of health professions education (HPE) students. This paper reports on a study evaluating attitudes from health professions educators towards IPE and teamwork at one academic health science center (HSC) where modest IPE initiatives have commenced. Drawing from the results of a previous investigation, this study was conducted to examine current attitudes of the faculty responsible for the training of future healthcare professionals. Survey data were collected to evaluate attitudes from HSC faculty, dentistry, nursing, medicine, pharmacy and public health. In general, positive HSC faculty attitudes towards interprofessional learning, education, and teamwork were significantly predicted by those affiliated with the component of nursing. Faculty development aimed at changing attitudes and increasing understanding of IPE and teamwork are critical. Results of this study serve as an underpinning to leverage strengths and evaluate weakness in initiating IPE.
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http://dx.doi.org/10.1080/13561820.2017.1376626DOI Listing
March 2018

Reverse Engineering: Strategy to Teach Evidence-Based Practice to Online RN-to-BSN Students.

Nurse Educ 2016 Mar-Apr;41(2):83-5

Author Affiliations: Assistant Professor and RN-to-BSN Program Coordinator (Dr Gary), College of Nursing, Texas A&M University Health Science Center; and Associate Professor and Dean (Dr Hudson), School of Nursing and Health Professions, Langston University, Langston, Oklahoma.

This article describes an innovative approach to introducing RN-to-BSN students to nursing research and evidence-based practice (EBP). Reverse engineering updates an existing EBP project to better emphasize the role of research and evidence to practicing RNs enrolled in an RN-to-BSN program. Reverse engineering of a nursing practice guideline offers a method for teaching an appreciation of research and supporting nursing practice with best evidence.
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http://dx.doi.org/10.1097/NNE.0000000000000203DOI Listing
August 2016

Embracing a quixotic vision for nursing.

Authors:
Jodie C Gary

Nursing 2014 Jun;44(6):48-9

Jodie C. Gary is an assistant professor at the College of Nursing, Texas A & M Health Science Center in Bryan, Tex.

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http://dx.doi.org/10.1097/01.NURSE.0000446630.78337.5aDOI Listing
June 2014

The wicked question answered: positive deviance delivers patient-centered care.

Authors:
Jodie C Gary

Dimens Crit Care Nurs 2014 May-Jun;33(3):142-50

Jodie C. Gary, PhD, RN, has more than 20 years of healthcare experience, including field emergency medical management (from emergency dispatch to paramedic), clinical and laboratory research experience, and hospital-based primary care nursing including supervisory positions in telemetry and critical care. Her primary research is aimed at bedside nursing practice and the delivery of patient-centered care within the framework of Complexity Science. Currently, she is a faculty member for the Texas A&M University Health Science Center College of Nursing. She teaches adult health/medical-surgical and research didactic contact as well as in clinical content in the acute care setting.

Background: How nurses respond when faced with the dilemma of providing patient-centered care in the absence of patient-centered practice guidelines remains relatively unreported. Standards may not be available to guide nurses or may not be realistic for implementation at the point of care. Nurses may be forced to react creatively to meet the needs of their patients.

Objectives: The purpose was to understand nursing care when standard practice guidelines did not meet patient-specific care needs and to develop various viewpoints related to the use of positive deviance in providing patient-centered care.

Methods: Complexity theory and the framework of a wicked question were used to guide a 3-round online national Delphi study from November 2011 to February 2012. The panel was accessed through the American Association of Critical Care Nurses to expose the care provided when standard practice guidelines were lacking.

Results: Findings support the presence of positive deviance and expose care provided by nurses when standard practice guidelines lacked the ability to provide patient-centered care. Dominant themes of positive deviance are recommended as priorities for future research.

Discussion: Better guidelines are needed that work for nurses, instead of against them, that would not force a nurse into actions that are not patient centered. Guidelines should guide practice and assist in allowing nurses to provide care that is centered on the best needs of the patient in the specific care situation.
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http://dx.doi.org/10.1097/DCC.0000000000000038DOI Listing
July 2015

Author's reply: To PMID 23851287.

Authors:
Jodie C Gary

Am J Nurs 2013 Dec;113(12):13

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December 2013

Exploring the concept and use of positive deviance in nursing.

Authors:
Jodie C Gary

Am J Nurs 2013 Aug;113(8):26-34; quiz 46, 35

College of Nursing, Texas A&M Health Science Center, Bryan, TX, USA.

Overview: Positive deviance involves an intentional act of breaking the rules in order to serve the greater good. For nurses, the rightness or wrongness of such actions will be judged by other people who are in charge of rules enforcement; but the decision to engage in positive deviance lies solely with the nurse. There is no uniform or consistent definition of positive deviance. This article uses the Walker and Avant method of concept analysis to explore and identify the essence of the term positive deviance in the nursing practice environment, provide a better understanding of the concept, and clarify its meaning for the nursing profession. In turn this led to an operational definition: positive deviance is intentional and honorable behavior that departs or differs from an established norm; contains elements of innovation, creativity, adaptability, or a combination thereof; and involves risk for the nurse. The concept of positive deviance is useful, offering nurses a basis for decision making when the normal, expected actions collide with the nurse's view of the right thing to do.
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http://dx.doi.org/10.1097/01.NAJ.0000432960.95762.5fDOI Listing
August 2013