• Characterizing discrepancies in school recovery after disasters

      Shah, Hazel; Georgia State University (Georgia Public Health Association, 2019-01-30)
      Background: Academic institutions provide consistency and routine to children. When disasters damage schools, students often suffer in a variety of ways, and racial minority students are often impacted disproportionately. However, minimal research exists exploring these discrepancies. This presentation examines racial disparities in school systems affected by Hurricane Ike (2008). Methods: This study, funded by the National Science Foundation, uses publicly available Texas Education Agency data from approximately 600 schools affected by Hurricane Ike. Schools were included in the study based on two criteria: if they were declared “disaster areas” by FEMA and if they were closed for at least 10 school days after Hurricane Ike. Results: Descriptive analyses were conducted comparing school characteristics and pass rates for all students in grades 3-11 on the Texas Assessment of Knowledge and Skills (TAKS) standardized test during pre- and post-hurricane school years (i.e., 2003 – 2011). Mean pass rates on the TAKS varied greatly by race/ethnicity and other factors. Of African American students, 60.7% (SD=17.4) passed the TAKS in 2004 compared to 69.9% in 2011 (SD=15.0); 68.0% (SD=15.7) of Hispanic students passed in 2004 as opposed to 76.23% (SD=12.2) in 2011; 78.8% (SD=14.8) of White students passed in 2004 versus 83.1% in 2011. Further analyses will explore various other determinants influencing academic performance. Conclusions: Preliminary findings show discrepancies at baseline in academic outcomes between racial/ethnic groups. These discrepancies persisted post-hurricane, though all groups saw an increase in pass-rates. Further research utilizing advanced statistical approaches and geographic information system (GIS) analysis could yield insights on variation of academic performance between schools and school districts, as well as physical exposure and risk factors. These insights can inform strategies for improving schools’ academic trajectories after disasters and optimizing community recovery as a whole.
    • Surveillance, Epidemiology, and End Results (SEER) data for monitoring cancer trends

      Yoo, Wonsuk; Coughlin, Steven S; Augusta University (Georgia Public Health Association, 2019)
      Background: Monitoring cancer trends allows evaluation of the effectiveness of cancer screening or detection methods and determination of priorities in cancer control programs. Government officials and policy makers also use information on cancer trends to allocate resources for cancer research and prevention. Although data from the Surveillance, Epidemiology, and End results (SEER)-affiliated cancer registry are accessible to the public, there is a shortage of published research describing cancer incidence rates for White, Black, and other residents in Georgia. The objective of this research is to provide an overview of how to use SEER data through analysis of the incidence rate for cervical cancer. Methods: Cervical cancer cases (ICD-O-3/WHO 2008 =’Cervix Uteri’, corresponding to C530-C539) were obtained from the SEER18 database. It includes the largest geographic coverage compared to SEER 9 and SEER 13 data. The incidence and incidence rates for cervical cancer were obtained, stratified by year (2000-2012), sex, race/ethnic groups, and region (Georgia and US). Age-adjusted incidence and incidence rates (to the 2000 US standard population) were calculated using SEER*Stat software, which is available, free of charge, on the SEER Web site: http://seer.cancer.gov. Results: Age-adjusted incidences and incidence rates in Georgia and the US from SEER 18 data were created by SEER*Stat. The incidence rates were stratified by age variable (5-year category), sex, race/ethnicity, and other socio-demographic variables. Annual percent changes (APC) and 95% CI were also obtained to characterize trends in cancer rates over time. The trends for age-adjusted incidence rates for regions (Georgia and the US) and race (white, black, others) were compared using APC. Furthermore, age-specific incidence and incidence rates for cervical cancer for Georgia and US for recent five years (2008-2012) were reported. Conclusions: The Surveillance, Epidemiology, and End results (SEER) program provides cancer researchers a convenient and intuitive system for viewing individual cancer records and producing statistics useful in studying the impact of cancer on a population.
    • A multi-county health district’s journey to accreditation: The challenges and benefits

      Echols, Tara; Gwinnett, Newton and Rockdale County Health Departments (Georgia Public Health Association, 2017)
      Background: In September 2011, the Gwinnett, Newton, and Rockdale Health Departments began to discuss accreditation. We regarded accreditation as a way to highlight our strengths and identify areas for quality and performance improvement as well as an opportunity to improve our capacity for greater accountability, increased efficiency and improved process flow. We further viewed it as a means to successfully carry out our mission, and effectively deliver the core functions and ten essential public health services. Methods:With financial backing from Healthcare Georgia Foundation and technical assistance from Georgia Southern University, the Gwinnett, Newton and Rockdale County Health Departments began its pursuit of accreditation by assessing department processes, policies, and procedures for alignment to the Public Health Accreditation Board (PHAB) standards. This resulted in identified areas for improvement and needed policy and procedure development. The Model for Improvement was actively used throughout our pursuit of accreditation, and we viewed the process as several inter- related plan, do, check, act (PDCA) cycles. After being advised on several options, we changed our application from multi-jurisdictional to a local health district based on guidance from PHAB for all the health districts in Georgia. Domain leads were assigned; these later developed into domain teams comprised of individuals with expertise in various relevant areas. The teams met on a regular basis to review domain documentation and to discuss the ‘story’ it tells about our department. We prepared for the site visit by conducting a mock site visit using local PHAB site visitors. This experience was extremely helpful in calming the participant staff and identifying areas that we could improve. Results: After several iterations of guidance from PHAB on how we should apply we applied as a local public health district. With feedback from our mock site visit we were able to prepare for and successfully complete our site visit with no request to reopen any measures. We received a stellar site visit report with 93% of the measures scored ‘fully demonstrated’ and 7% scored ‘largely demonstrated’. Our department was accredited on August 17, 2016 as the 3rd accredited health district in the State of Georgia. Conclusions: The process of pursuing accreditation has been a challenge on various fronts; from indecision about how we should apply, to uncertainty about interpretation of the standards, to hesitance about choosing county-specific or departmental documentation. However, the culture of quality and solidified community partnerships that resulted from this process are invaluable.
    • Dental College of Georgia teams up with Richmond County Health Department to help underserved patients

      Wilson, Lyn Nancy; Peacock, Mark; Cutler, Christopher; De Stefano, Jamie; Augusta University, Richmond County Board of Public Health (Georgia Public Health Association, 2017)
      Background: The Central Savannah River Area remains, for many of the poor, a dental health care shortage area. Each year, from December to March, fourth-year dental students perform outreach with faculty to search the community for unmet dental needs, including dental caries and periodontal disease, the treatment of which is required for the Central Regional Dental Testing Service (CRDTS) Exam, the dental licensing examination. Methods: Fourth year students at the Augusta University Dental College of Georgia recruit patients for free dental pre-screenings at health fairs, community centers, the Barnyard Flea Market, and the dental school. Persons with periodontitis are invited for further screenings at the dental school where they receive a free dental examination and dental radiographs. Many of these patients present with other dental needs requiring restorations, root canals, and extractions, conditions that potentially could disqualify them from receiving periodontal therapy during CRDTS. Through a collaborative effort with the Richmond County Health Department Dental Clinic, these patients receive the treatment for their acute dental needs, while also qualifying them for the periodontics portion of the exam. Results: Regardless of their qualification status for boards, the program provides referrals for patients to the Dental College of Georgia or the Richmond County Health Department, gives patients a chance to be informed about their oral health status, and gives qualifying patients the potential to receive discounted or even free dental work. The efforts of the senior dental students represent an oral public health service effective in achieving improvements in periodontal outcomes within our community. Conclusions: This program not only benefits the future dentists of Georgia by helping provide licensing board requirements, it also introduces dental students to a more diverse population and provides exposure to public health outreach. In addition, this program offers a valuable service to underserved populations who would otherwise have limited or no access to dental care.
    • Leveraging partnerships in order to increase notifiable disease reporting

      Dekalb County Board of Health (Georgia Public Health Association, 2017)
      Background: Notifiable disease reporting, although required by law, does not always occur. For this reason, it is crucial for local public health agencies to leverage new partnerships for reporting of notifiable diseases. Schools represent sites within communities that experience relatively high numbers of cases of notifiable disease and clusters of illness. By leveraging partnerships with schools, an increase in disease reporting can occur within communities. Methods: DeKalb County Board of Health has developed an infectious disease protocol for the two major school systems in the county and one large private school: DeKalb County School District, City Schools of Decatur and the Waldorf School of Atlanta. This protocol was developed to outline each party’s responsibilities regarding disease reporting, surveillance and infection control within the schools. This protocol template was then used to develop an infectious disease protocol in partnership with two county school districts and a university within the North Central Health District and in a private school system in the DeKalb Health District. Results: Through education of notifiable disease reporting, the health district developed and implemented two protocols and has three pending protocols with schools. This has improved the relationships between the health district and the school systems through better communication and surveillance within the schools. Conclusions: Response to public health situations requires coordination across multiple sectors and effective use of existing resources within communities. It is essential for local public health agencies to build innovative partnerships that can then form the foundations for an increase in notifiable disease reporting and disease surveillance.
    • Implementation of the SafeCare model in Georgia for preventing child maltreatment

      Whitaker, Daniel; Glasheen, Theresa; Georgia State University (Georgia Public Health Association, 2017)
      Background: The SafeCare model is a behaviorally-based parenting model used in the prevention of child maltreatment. SafeCare targets three proximal risk factors for child neglect and abuse: parent-child interactions, home safety, and child health. SafeCare is one of only a few evidence-based practices for preventing child neglect, the dominant problem in child welfare, accounting for over 75% of child maltreatment cases. SafeCare has been broadly implemented in several states in the US, including Georgia, and is disseminated by the National SafeCare Training and Research Center (NSTRC) at Georgia State University. The presentation will (1) describe SafeCare and associated data, (2) describe the SafeCare implementation. Methods: SafeCare has been implemented in Georgia since 2008 using a rigorous implementation model, which includes on-going quality assurance of SafeCare providers and skill acquisition evaluation in families. Providers of child welfare services have been trained to deliver SafeCare and have been coached by trainers from NSTRC. Evaluation data are regularly collected which include provider fidelity via observed sessions, family outcomes relating to completion of SafeCare, and skill acquisitions (i.e., changes in parenting behaviors, reductions in home hazards, and increases in knowledge and behaviors regarding child health care). Results: Recent evaluation data (2013-2015) indicate 115 families have been referred to a SafeCare provider and 100 families completed at least one session. Thirty-eight (38%) have completed the program in its entirety. Provider fidelity data collected monthly indicate high program fidelity (mean of 91% of desired behaviors performed). Family behavior data indicate excellent skill acquisition among families completing each SafeCare model. Parenting skills increased by 104%; home hazards were reduced by 85%, and child health care skills increased by 34%. Conclusions: The SafeCare model is an effective parenting program for reducing child maltreatment, and has been implemented successfully in Georgia. Broader impact of SafeCare will require increased implementation of the model to increase reach.
    • Injection drug use and hepatitis C: Interventions in behavioral health settings

      Sutton, Marie; Imagine Hope INC (Georgia Public Health Association, 2017)
      Background: Georgia is experiencing a crisis of injection drug use and hepatitis C virus (HCV) infection. From 2002 to 2014, the statewide drug overdose mortality rate increased, with nearly every county experiencing a significant increase in drug overdose mortality. Especially concerning is the rising HCV infection rate in people younger than 30, many of whom inject drugs. HCV incidence in young people increased over 200% in Georgia from 2006 to 2012. CDC officials have suggested “…Georgia is experiencing an expanding epidemic of heroin use that is driving an increase in injection drug use, putting many more at risk for the spread of HIV and HCV infection.” Methods: Now in its second year, Imagine Hope is a Georgia-wide project that includes 20 agencies (8 methadone clinics, 12 abstinence based agencies) serving substance-using populations. It offers free routine HCV testing and linkage to care. Nearly all individuals served inject drugs. The agencies have implemented a novel combination of embedding routine HCV testing into services; tandem testing for HCV and HIV; linking individuals to HCV care and treatment; and providing access to two support groups. Results: Over 18 months, 6,136 consumers received HCV antibody testing. Of those, 677 (11%) were HCV antibody positive (Ab+), with 83% of them born outside the baby-boomer cohort. To confirm HCV status, clinics conducted RNA tests, completing 464 such tests that yielded 381 (82.1%) confirmed cases of HCV. Currently, the project has linked 102 (36.8%) confirmed HCV+ clients to care and treatment services, with 12 (11.8%) clients experiencing total remission. Conclusions: Among intravenous drug users, HCV prevalence is high, while infection awareness is low. Navigators and support groups enhance linkage. Connecting a population of mostly uninsured behavioral health clients to care is feasible. Providing HCV RNA confirmatory testing in the behavioral health setting greatly enhances the linkage to care process.
    • Tailoring a hybrid program for reducing health and education disparities in Georgia communities: Outcomes of listening sessions

      Ejikeme, Chinwe; Georgia Department of Public Health (Georgia Public Health Association, 2017)
      Background: Minorities in Georgia experience increased rates of chronic disease and poor health and education outcomes. In the general population in 2013, about 35% of adolescents were either overweight or obese and approximately 13% of children 2-4 years old were obese, with minorities accounting for higher rates. In 2010, 23% of students from low-income families, comprising a higher proportion of minorities, scored at or above proficient level for reading at the end of third grade. Targeting children 0-5 years, Georgia Department of Public Health developed an integrated curriculum to train Early Childcare Educators (ECEs) to increase their knowledge and skills to model food, activity and language nutrition in their classrooms and to coach families. We conducted listening sessions to understand attitudes and knowledge around nutrition in 3 communities with significant racial and ethnic populations. Methods: Listening sessions with ECEs and families were conducted separately in each community. Participants engaged in guided one-hour discussions around food, activity and language nutrition and completed a post-listening session survey to assess their nutrition practices with the children in their care or homes. Results: 70 ECEs and families participated in the sessions and post session surveys. With an over 80% satisfaction rate with sessions, results showed that although baseline understanding of and challenges to modelling nutrition differed in different communities, many strategies used to support nutrition were common across communities. Participants also demonstrated a need for support in increasing access to resources to improve nutrition. Conclusions: This study suggested that multiple issues hinder optimal engagement of children 0-5 years in improved nutrition. Addressing the factors specific to targeted communities is essential to reducing disparities. Thus, integrating these findings in the development of the curriculum and training strategy has the potential to produce more knowledgeable and skilled ECEs as coaches for improving nutrition.
    • Social networks as predictors of colorectal cancer screening in African Americans

      Alema-Mensah, Ernest; Smith, Selina; Claridy, Mechelle D; Ede, Victor; Ansa, Benjamin E.; Blumenthal, Daniel S.; Morehouse School of Medicine, Augusta University (Georgia Public Health Association, 2017)
      Background: Early detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to health-promoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening. Methods: In a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen. Results: Small group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12-1.31; p=0.0017) than the comparison group. In the second component of the SNI score - -the number of people talked to over a two week period -- the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963-14.6266; p=0.0004). Conclusions: The findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans.
    • The association between dental coverage and self-reported health in older adults

      Yang, Frances M; Kao, Solon T; Lundeen, Joran S; Augusta University (Georgia Public Health Association, 2017)
      Background: For the older population of the United States, lack of dental insurance coverage is a substantial health problem. The purpose of the present study was to examine the longitudinal relationship between dental coverage and self-reported health among older adults. Methods: The Health and Retirement Study (HRS), a nationally representative biennial cohort study of community-dwelling individuals, includes 19,595 adults (aged 50 and older) living in the United States. For the 2010, 2012, and 2014 waves, the independent variable of dental coverage and the outcome of self-reported health were examined. Results: At each time point, dental coverage for older adults had a positive association with self-reported health (parameter estimate, β=0.340, standard error (SE)=0.039, p<0.0001), controlling for sociodemographic variables of age, sex, race/ethnicity, education, and the status of edentulism. There were no significant longitudinal effects for dental coverage associated with self-reported health. Conclusions: At each time point, the results show a positive association between having dental coverage and better self-reported health of older adults. This is relevant, because, in the United States, there is an increasing population of older people.
    • Dental students develop program addressing geriatric oral health at local nursing home

      Wilson, Nancy Lyn; Ciarrocca, Katharine; Chana, Monica; Augusta University, Georgia War Veterans Nursing Home (Georgia Public Health Association, 2017)
      Background: The elderly, especially those who reside in institutions and have a minority or low-income background, often have unmet oral health needs. As life expectancy increases, so will the need for oral health providers skilled in addressing the unique challenges presented by geriatric patients. Methods: Dentists for Della is a student organization at the Dental College of Georgia that aims to improve the oral health status of residents at the Georgia War Veterans Nursing Home (GWVNH) in Augusta, Georgia. The students conduct fundraising activities so that third and fourth year students can provide needed dental treatment at no cost to the residents. Students also regularly rotate at GWVNH in order to provide tooth brushing help, denture cleanings, and head and neck examinations, including oral cancer screenings. Results: Dentists for Della has funded approximately $40,000 worth of dental work since 2013. The program also provides an educational experience valued by students: the ability to interact with patients as early as their first semester of dental school. Conclusions: Dentists for Della is a vital program which not only provides educational opportunities in institutional public health dentistry and geriatrics for dental students, it also provides a much needed safety net for Georgia veterans with no ability to access other means of dental care
    • Characteristics of reported symptoms among confirmed and suspect cases of Zika virus in Georgia, 2016

      Thompson, Ashton; Georgia Department of Public Health (Georgia Public Health Association, 2017)
      Background: In May 2015, Zika virus was detected in Brazil. The virus has since spread through several countries in the Americas. Knowledge of the major symptoms of Zika virus infection was based on historic data from two previous outbreaks in the Pacific Islands. Currently-known Zika-specific symptoms include rash, conjunctivitis, arthralgia, and fever. Epidemiologists at the Georgia Department of Public Health (GDPH) began surveillance for travel-related Zika virus infections in January 2016. Surveillance data from GDPH contributes to better characterization of the current Zika clinical picture and more efficient triage of suspect cases for laboratory testing and prevention measures. Methods: For each patient approved for Zika testing, GDPH epidemiologists created an entry in the Zika Active Monitoring System (ZAMS) within the State Electronic Notifiable Disease Surveillance System (SendSS). Patients are categorized as “asymptomatic” or “symptomatic” and reported symptoms are noted. For symptomatic patients, clinical data are compared to determine differences in the distribution of symptoms in Zika negative and positive patients. Results: GDPH has approved testing for 383 symptomatic suspect Zika patients as of October 19, 2016; 88 (23%) were confirmed Zika infections. Among symptomatic positive patients, the most common Zika-specific symptom was maculopapular rash (95%); other common symptoms were headache and myalgia (27%). Among symptomatic Zika-negative patients, the most common Zika specific symptom was fever (62%), and the most common non-Zika specific symptom was headache (19%). Conclusions: Maculopapular rash is the most suggestive symptom of a true Zika virus infection, with 95% of symptomatic Zika positive patients in Georgia exhibiting the symptom. These data can be taken into consideration when updating the testing criteria for Zika virus. GDPH currently does not approve a patient for testing based on fever or non-Zika specific symptoms alone, and that guideline is reaffirmed by these results.
    • Chronic disease prevention as an adaptive leadership problem

      O'Connor, Jean; Georgia Department of Public Health (Georgia Public Health Association, 2017)
    • Letter to the Editor in response to “STD services delivery arrangements in Georgia county health departments”

      Moore, Kathryn; Terry, Latasha; Allen, Michelle (Georgia Public Health Association, 2017)
    • Physician attitudes toward the ethics of pre-exposure prophylaxis (PrEP): Cost, safety, and resource allocation

      Grippo, Jessica; Smallwood, Stacy; Pincura, Katherine; Wright, Tamara; Masa, WIlliam (Georgia Public Health Association, 2017)
      Background: In the United States, human immunodeficiency virus (HIV) remains a substantial public health issue. There is evidence that the use of antiretroviral medications such as pre-exposure prophylaxis (PrEP) can be a safe and effective primary prevention strategy to reduce new cases of HIV infection. Provider practice behavior as it relates to prescribing PrEP and the potential impact on specific vulnerable populations needs increased attention. Few studies have evaluated the attitudes of physicians towards ethical issues related to prescribing PrEP. Methods: The purpose of the present literature review was to evaluate provider attitudes toward the ethics of prescribing PrEP for individuals at risk of acquiring HIV infection. Searches of the PubMed and Cochrane databases were conducted. Three reviewers independently assessed the relevance of articles and discarded those not directly related to the attitudes of physicians toward ethics of the cost, safety, and resource allocation of PrEP. A total of twenty-one articles were included in the review. Results: Provider attitudes and perceptions focused on three areas: resource allocation, cost, and safety or effectiveness of PrEP. Providers who were hesitant in prescribing PrEP were concerned with the availability of resources, patient adherence, risk of drug resistance, and toxicity. In the studies reviewed, few providers had prescribed PrEP; however, prescribing practices trended upward with time and awareness. Conclusions: Realization of the benefits of PrEP will require a utilitarian ethical approach to identifying the populations that will benefit most, monitoring for adverse effects, addressing costs, and educating and training providers to prescribe PrEP responsibly. Ensuring that PrEP fulfills its potential as part of a combination regimen for HIV prevention requires identification of additional evidence, education, support services, and resources that are needed, as well as the regulatory framework and cost scenarios for access to PrEP.
    • Randomness and inference in medical and public health research

      Hayat, Matthew J; Knapp, Thomas; Georgia State University, Ohio State University (Georgia Public Health Association, 2017)
      Background: The purpose of this study was to provide a basis for describing the types of randomness used and statistical inferences reported in the medical and public health research literature. Methods: A study was conducted to quantify the types of research designs and analyses used and reported in medical and public health research studies. A stratified random sample of 198 articles from three top-tier medical and public health journals was reviewed, and the presence or absence of random assignment, random sampling, p-values, and confidence intervals, as well as type of research design, were quantified. Results: Random sampling was used in 58 (29.3%) and random assignment in 21 (10.6%) articles. Most (n=125; 63.1%) research studies did not report random assignment or random sampling; however, statistical inference was applied in more than 90%. Conclusions: Results revealed a concerning overuse of statistical inference. Incorrectly applying statistical inference when not warranted has potentially damaging medical and public health consequences. Researchers should carefully consider the appropriateness of using statistical inference in medical and public health research.
    • A clinical trial to increase the identification, genetic counseling referral and genetic testing of women at risk for hereditary breast and/or ovarian cancer

      Bellcross, Cecelia; Stanislaw, Christine; Hermstad, April (Georgia Public Health Association, 2017)
      Background: Approximately 1/300 individuals in the general population are at risk for hereditary breast and ovarian cancer due to an inherited mutation in the BRCA1/BRCA2 genes. BRCA mutations are associated with dramatically increased risks for breast cancer, especially at younger ages, in addition to ovarian cancer. Enhanced screening and risk reduction strategies can significantly reduce associated morbidity and mortality. The United States Preventive Services Task Force (USPSTF) recommends identifying women at-risk for BRCA mutations for receipt of genetic counseling and if appropriate, testing. The Breast Cancer Genetics Referral Screening Tool (B-RST) is a validated screen endorsed by USPSTF to facilitate this process. This implementation study seeks to evaluate the most effective means of follow-up for screen-positive women to maximize the number who are referred to, and receive, cancer genetic counseling (CGC) services. Methods: B-RST (v3.0) was used in three Emory Healthcare breast-imaging centers. Screen-positive women were randomized into three methods of follow-up (patient initiated, physician notification, or staff phone call). Primary outcomes were to compare the number of screen positive individuals who were referred for, scheduled, and completed a CGC appointment among the three groups. Results: Of 3,419 women approached, 63% participated and 579 (27%) screened positive. Appointments were scheduled by 7% of Group 1 participants, 17% of Group 2 individuals, and 11% of Group 3 (p<0.001). Scheduling challenges included physician non-response to notification and unsuccessful direct contact. Of those scheduled, 73% completed the CGC appointment. Conclusions: Genomic medicine is receiving increased attention in the public health arena. Screening with B-RST 3.0 in mammography settings can improve identification of individuals at-risk for BRCA mutations and facilitate referral to CGC services. Despite B-RST’s ability to easily and accurately identify individuals appropriate for CGC, additional strategies are needed to facilitate completion of CGC in routine clinical practice.
    • Triple-negative breast cancer in Georgia: Burden, disparities, and connections to Georgia’s Breast Cancer Genomics Project

      Berzen, Alissa; Bayakly, Rana (Georgia Public Health Association, 2017)
      Background: Triple negative breast cancer (TNBC) is typically aggressive and unresponsive to traditional cancer treatment, and disproportionately affects young and Black women. Approximately 60%-80% of breast cancers in women with the breast cancer gene (BRCA) mutation are TNBC, and children of a parent with a BRCA mutation have a 50% chance of inheriting it. Current guidelines recommend women diagnosed with TNBC receive genetic testing and counseling. Georgia’s Breast and Cervical Cancer Program (BCCP) routinely screens clients for increased risk of genetic mutation via an online screening tool. Methods: Using data from the Georgia Comprehensive Cancer Registry (GCCR) for 2010-2013, we calculated TNBC percentages/rates, diagnosis stage, and case fatality rate based on vital status. By using TNBC data as a proxy for BRCA gene mutation prevalence, we assessed the burden of TNBC and racial/age disparities to inform Georgia’s genomics efforts. Results: The percentage of invasive breast cancers, versus in-situ, was the same for Georgia Black and White women; however, Black women had almost double the percentage of TNBC as compared to White women. Black women under 40 had a 20% higher breast cancer incidence rate than similarly aged White women, but had almost double the TNBC rate. Georgia TNBC cases were about twice as likely as non-TNBC cases to be deceased, and Black TNBC cases had higher fatality rates than White cases (almost twice as high in women under 40). Conclusions: Georgia’s genomics program began screening in 2012, and participating counties offer screening to all women’s health clients. Awareness of hormone receptor status (and furthermore, possible presence of genetic mutation) for women diagnosed with breast cancer can guide the proper course of treatment. Additionally, family members of women diagnosed with TNBC in Georgia may take advantage of the screening for risk of genetic mutation through the genomics program prior to a cancer diagnosis, and receive counseling where appropriate.
    • Operational and financial performance of Georgia’s Critical Access Hospitals

      Kimsey, Linda; Apentenge, Bettya; Mase, William; Opoku, Samuel; Hanna, Mark; Boakye, Kwabena; Carhuff, Lisa; Owens, Charles; Peden, Angela; Tedders, Stuart; et al. (Georgia Public Health Association, 2017)
      Background: Georgia’s Critical Access Hospitals (CAHs) face increasingly complex threats to financial sustainability, as demonstrated by the disproportionally high number of closures in comparison to other states in the nation. Methods: Financial performance measures (including profitability, revenue, liquidity, debt, utilization, and productivity), site visits, key personnel interviews, and a revenue cycle management assessment were used to assess the strategic landscape of CAHs in Georgia, analyze financial and operational performance, and provide recommendations. Results: For CAHs in Georgia, financial and operating performance indicators, interviews, and assessments depict a challenging operating environment, but opportunities for improvement exist through implementation of a Lean Six Sigma program and improved benchmarking processes. Conclusions: Georgia’s CAHs operate in a challenging environment, but operational improvement strategies (such as a Lean Six Sigma program) and benchmarking directed towards business processes, including revenue cycle management, provide opportunities for sustainability in the future.
    • Medicaid savings continue in the year after end of participation in the program, Money Follows the Person

      Landers, Glenn; Fuller, Kristi; Zhou, Mei; Georgia State University (Georgia Public Health Association, 2017)
      Background: The aim of this analysis was to compare Georgia’s Medicaid expenditures for participants in the Money Follows the Person (MFP) six months before, 12 months during, and 12 months after MFP participation. Methods: Differences in Medicaid expenditures for three populations of MFP participants (individuals with developmental disabilities, individuals with physical disabilities, and older adults) were compared by use of repeated measures t-tests. Results: Per-member per-month Medicaid expenditures were lower across the three populations when comparing six months prior to transition from an institution to 12 months after leaving the MFP program. Conclusions: The incorporation of features from programs such as MFP into existing state Medicaid long-term services and supports may assist in reducing the growth of future expenditures.