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PubMed2003

Entry-level competencies needed by BSNs in acute health care agencies in Tennessee in the next 10 years.

This study focused on the identification of entry-level competencies needed by bachelor of science in nursing (BSN) graduates who will begin working in acute health care agencies in Tennessee within 10 years. The purpose of this study was to increase awareness of the competencies needed by graduates of BSN programs in Tennessee to meet the demands of acute health care agencies, considering current and anticipated changes in the healthcare delivery system. The opinions of nurse educators, nurse administrators, recent BSN graduates, and experienced BSN graduates were solicited to assess congruency of perceptions. This study found there was a statistically significant difference in the perceptions of nurses in acute health care agencies and faculty in BSN programs about the importance of entry-level competencies needed by BSN graduates.

Adult↗
PubMed2006

Status of PharmD/PhD programs in colleges of pharmacy: the University of Tennessee dual PharmD/PhD program.

OBJECTIVES: To describe the University of Tennessee PharmD/PhD program and assess the prevalence and characteristics of PharmD/PhD programs in the United States. METHODS: Survey instruments were mailed in May 2004 to UT dual-degree program participants and deans of US colleges and schools of pharmacy. RESULTS: University of Tennessee PharmD/PhD students completed more than 30 hours of graduate credit before obtaining their PharmD and 72.2% agreed or strongly agreed that the program met their professional goals. More than 40% of US pharmacy colleges and schools have or plan to have PharmD/PhD programs. A wide variation exists in the level of integration, PhD concentrations offered, entrance requirements, and student benefits. Most schools with PharmD/PhD programs had few students enrolled in the program, but attrition rates were low (<20%) for 69% of the schools. CONCLUSIONS: Dual-degree programs attract and retain pharmacy students in research programs and 47.6% of graduates entered academia and industry.

Curriculum↗
PubMed1987

Commitment patients in a private psychiatric hospital: a pilot program in Tennessee.

This paper surveys the epidemiological characteristics of the first 100 patients committed to a new private psychiatric hospital in Upper East Tennessee, under a pilot program of the Tennessee Department of Mental Health and Mental Retardation. The number of psychiatric commitments in the region has increased since the opening of a local hospital required, by contract, to accept them. While all commitments were because of a psychiatric diagnosis, many patients might have been treated as outpatients had their illness not been complicated by substance abuse. Greater integration of all levels of psychiatric care would make it possible for such patients to receive care in settings more appropriate to their condition before they experience a crisis requiring inpatient commitment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1999

Hypertrophic pyloric stenosis in infants following pertussis prophylaxis with erythromycin--Knoxville, Tennessee, 1999.

In February 1999, pertussis was diagnosed in six neonates born at hospital A in Knoxville, Tennessee. Because a health-care worker at hospital A was most likely the source of exposure, the local health department recommended on February 25, 1999, that erythromycin be prescribed as postexposure prophylaxis for the approximately 200 infants born at hospital A during February 1-24, 1999. In March 1999, local pediatric surgeons noticed an increased number of cases of infantile hypertrophic pyloric stenosis (IHPS) in the area, with seven cases occurring during a 2-week period. All seven IHPS cases were in infants born in hospital A during February who were given erythromycin orally for prophylaxis following possible exposure to pertussis, although none had pertussis diagnosed. The Tennessee Department of Health and CDC investigated the cluster of IHPS cases and its possible association with use of erythromycin. This report summarizes the results of the investigation, which suggest a causal role of erythromycin in this cluster of IHPS cases.

Anti-Bacterial Agents↗
PubMed2000

Principal-agent theory: a framework for improving health care reform in Tennessee.

Using a framework based on principal-agent theory, this study examines problems faced by managed care organizations (MCOs) and major health care providers under the state of Tennessee's current capitation-based managed care programs called TennCare. Based on agency theory, the study proposes a framework to show how an effective collaborative relationship can be forged between the state of Tennessee and participating MCOs which takes into account the major concerns of third-party health care providers. The proposed framework further enhances realization of the state's key health care reform goals which are to control the rising costs of health care delivery and to expand health care coverage to uninsured and underinsured Tennesseans.

Capitation Fee↗
PubMed2000

Salaries and benefits of dental hygienists in Tennessee.

Salaries and benefits are a major concern for dental hygienists and their employers. In 1998, the University of Tennessee Dental Hygiene Department conducted a survey of dental hygienists licensed to practice in Tennessee. Objectives included (1) to determine the current salary range and benefits of practicing dental hygienists, (2) to determine the factors which influence salaries and benefits, and (3) to compare the salaries and benefits of dental hygienists across the state. Results revealed an average compensation of $175.00 per day. While most full-time dental hygienists receive paid vacation, only 33 percent receive health care benefits. There were various factors influencing salaries and benefits, including the method of compensation, region of the state in which one practices, years of experience, and ethnic background.

Adult↗
PubMed2002

TennCare--Medicaid managed care in Tennessee in jeopardy.

TennCare, the statewide Medicaid managed care system implemented in Tennessee on January 1, 1994, sought to reduce state and federal healthcare expenditures while enhancing access to and quality of care. TennCare currently covers 1.32 million enrollees (25% of the citizens of Tennessee), including more than 520,248 citizens previously not covered by health insurance. It is one of the largest Medicaid managed care enterprises in the nation and the only program to cover uninsurables regardless of income. Utilization of preventive and primary care services has increased, and selected measures of quality of care have improved. Program costs from 1994 through 1998 rose at a rate below that of overall US Medicaid costs during the same period, resulting in modest savings. However, managed care plans, hospitals, and individual providers continue to report substantial fiscal losses, and managed care organizations--including the 3 largest plans in the program--have closed, been placed under receivership, or threatened to withdraw from the market. Furthermore, safety net hospitals, academic medical centers, and community mental health programs have fared financial cutbacks that have limited their ability to serve the remaining uninsured as well as the insured. Because of these fiscal difficulties, the TennCare program is now in significant jeopardy despite its important clinical successes. Major structural and fiscal changes will be required if the program is to continue to enhance services and remain financially viable. This report focuses on TennCare's successes and failures to offer lessons for Medicaid managed care programs nationwide.

Academic Medical Centers↗
PubMed2002

Human rabies--Tennessee, 2002.

On August 31,2002, a boy aged 13 years residing in Franklin County, Tennessee, died from rabies encephalitis caused by a rabies virus variant associated with silver-haired and eastern pipistrelle bats. This report summarizes the investigation by the Tennessee Department of Health (TDH). Persons should avoid direct contact with bats, other wildlife, and stray or ill domestic animals; however, if direct contact with bats has occurred, exposed persons should see their health-care provider, and the exposure should be reported to local public health officials.

Adolescent↗
PubMed2003

Benchmarking information needs and use in the Tennessee public health community.

OBJECTIVE: The objective is to provide insight to understanding public health officials' needs and promote access to data repositories and communication tools. METHODS: Survey questions were identified by a focus group with members drawn from the fields of librarianship, public health, and informatics. The resulting comprehensive information needs survey, organized in five distinct broad categories, was distributed to 775 Tennessee public health workers from ninety-five counties in 1999 as part of the National Library of Medicine-funded Partners in Information Access contract. RESULTS: The assessment pooled responses from 571 public health workers (73% return rate) representing seventy-two of ninety-five counties (53.4% urban and 46.6% rural) about their information-seeking behaviors, frequency of resources used, computer skills, and level of Internet access. Sixty-four percent of urban and 43% of rural respondents had email access at work and more than 50% of both urban and rural respondents had email at home (N = 289). Approximately 70% of urban and 78% of rural public health officials never or seldom used or needed the Centers for Disease Control (CDC) Website. Frequency data pooled from eleven job categories representing a subgroup of 232 health care professionals showed 72% never or seldom used or needed MEDLINE. Electronic resources used daily or weekly were email, Internet search engines, internal databases and mailing lists, and the Tennessee Department of Health Website. CONCLUSIONS: While, due to the small sample size, data cannot be generalized to the larger population, a clear trend of significant barriers to computer and Internet access can be identified across the public health community. This contributes to an overall limited use of existing electronic resources that inhibits evidence-based practice.

Attitude to Computers↗
PubMed2004

The changing epidemiology of HIV/AIDS in Tennessee.

BACKGROUND: We describe the changing epidemiology of HIV/AIDS in Tennessee to identify opportunities for improved response to the epidemic. METHODS: Health department records of all new cases of HIV/AIDS in Tennessee from January 1992 through December 2001 were examined. Cases were defined according to CDC criteria and classified as HIV or AIDS based on diagnosis in the initial report. RESULTS: During the ten-year study period, 14,278 new cases were reported; 67% were HIV and 33% were AIDS. Incidence in males was three times higher than females. The rate among blacks was seven times higher than whites. From 1992-1996, 17% of cases had a primary risk factor of heterosexual contact, increasing to 26% in 1997-2001 (P<0.01). The proportion of new cases with a diagnosis of AIDS was higher in non-metropolitan than metropolitan areas (35% vs. 21%, P<0.01). CONCLUSIONS: Intervention efforts should include targeting to blacks, females, heterosexual exposure, and persons in non-urban communities.

Acquired Immunodeficiency Syndrome↗
PubMed2003

The dual enrolled as a disadvantaged population: developing culturally informed interventions for Tennessee Medicare/Medicaid women.

The Centers for Medicare and Medicaid Services (CMS) have begun a major national initiative to reduce disparities in health care for the underserved through their contracts with state quality improvement organizations (QIOs). This initiative has translated into state-level projects that are, in many cases, investigating these populations to determine how best to address their health care deficiencies and improve the quality of their care. Tennessee's campaign, coordinated by the Center for Healthcare Quality (CHQ), the state's QIO, focused on the use of formative research to gain insights into diversity among the underserved in different settings across the state. Results aided the design of a series of site-appropriate interventions aimed at improving the utilization of mammography screening among Tennessee's Dual Enrolled: Medicare beneficiaries who are also enrolled in Medicare.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2005

The University of Tennessee's accelerated family medicine residency program 1992-2002: an 11-year report.

BACKGROUND AND OBJECTIVES: In 1992, with the approval of the American Board of Family Medicine (ABFM) (formerly known as the American Board of Family Practice), we established an accelerated residency program (ARP) involving five residency programs at the University of Tennessee (UT). An accredited resident can complete medical school and residency in a combined total of 6 years. This paper is a report of our experience with the ARP. Our objective was to determine if accelerated residents performed as well as or better than non-accelerated residents. METHODS: Students are selected for the ARP on the basis of academic achievement, life experience, interviews, and commitment to family medicine. For the accelerated residents, we tracked outcomes measures, including medical school grade point average (GPA), US Medical Licensing Examination (USMLE) scores, ABFM In-training Examination scores, and board certification status. RESULTS: From 1992 to 2002, 47 students entered the ARP at five UT residency programs. Five students did not complete the program. The average entering GPA was 3.17, and the average USMLE Step I score was 207. The accelerated residents, on average, performed better on ABFM In-training Examinations in the first and third years of residency than the non-accelerated residents did. Accelerated residents have a 100% ABFM certification rate. A total of 76% practice in Tennessee, and 65% began practice in a rural county. CONCLUSIONS: The UT ARP has been an effective means for allowing medical students to complete their family medicine training in 6 years. Accelerated residents have performed as well as or better than non-accelerated residents on standardized testing.

Academic Medical Centers↗
PubMed1991

A successful decade of regionalized perinatal care in Tennessee: the neonatal experience.

We hypothesized that successful implementation of regionalized perinatal care would result in early identification and antenatal referral of high-risk neonates, and also improved stabilization before and during transport of those transferred postnatally. We conducted a retrospective study of demographic characteristics and transport outcome in two defined groups of neonates transported to regional perinatal centers in Tennessee, one group (n = 218) from the first year of regionalization (1975), and a second group (n = 261) from the 12th year (1986). The percentage of outborn infants decreased, from 50% of all admissions in 1975 to 22% in 1986 (P = .005). Likewise, the percentage of low-birthweight neonates transported after birth decreased, from 59% of all transports to 32% (P = .002). The frequency of stabilization measures performed before and during transport increased between study years (intravenous line placement: 12% to 58%, P = .0001; assisted ventilation: 10% to 33%, P = .001). The incidence of complications during transport decreased between study years (cyanosis: 25% to 8%, P = .0001; hypothermia: 30% to 3%, P = .0001; acidemia: 33% to 13%, P = .011). Both transport-related mortality and neonatal mortality decreased between study years (2.8% to 0.8%, P = .043; 17% to 7%, P = .0001, respectively). We conclude that regionalization during its first decade has been successful in improving perinatal care in Tennessee as indicated by favorable changes in referral patterns and improved outcome of transported neonates.

Humans↗
PubMed1989

Dietary fluoride supplements for Tennessee's children: the role of the physician.

1. All children should receive some form of systemic fluoride and appropriate forms of topical fluoride. 2. If a child is not receiving optimally fluoridated water, the physician or dentist should prescribe a dietary fluoride supplement as tablets or drops. 3. The correct dosage must be determined, based on patient age and fluoride content of the patient's drinking water. 4. Special attention is necessary concerning fluoride intake for children breast-feeding or consuming infant formula. 5. To arrive at the correct fluoride dose, these steps should be followed: (A) Whenever you do not have specific knowledge of water fluoride content, have a sample of the main drinking water source (usually home water) analyzed for the fluoride content before prescribing a fluoride supplement. (B) When the fluoride content of the water has been determined, the fluoride level and the child's age should be matched on Table 1 to arrive at the correct supplement dose. 6. The Fluoridation Program of the Tennessee Division of Water Supply can provide lists of communities and schools in Tennessee that are optimally fluoridated.

Child↗
PubMedDate not supplied

Validation of maternally reported birth weights among 46,637 Tennessee WIC program participants.

To assess the accuracy of maternally reported birth weights, we compared birth weights reported by mothers in the Tennessee Women, Infants, and Children Supplemental Feeding Program (WIC) from 1975 to 1984 with the birth weights recorded on the corresponding Tennessee birth certificate file. Differences in birth weights between these two sources were compared for the total group and were also stratified by sociodemographic and medical variables that might influence the accuracy of birth weight recall. An accurate birth weight was defined as one reported within 1 ounce of the birth certificate birth weight. We also calculated the proportion of birth weights that would be incorrectly classified as low or normal by maternal reporting. A total of 72,245 WIC records were matched with their corresponding birth certificates. Of these, 46,637 had WIC birth weights recorded within the specified birth weight range. Eighty-nine percent of birth weights were reported within 1 ounce of birth certificate birth weights. Lower accuracy of birth weight reporting was associated with the infant's low birth weight, preterm delivery, and low Apgar scores, and with the mother's grand multiparity, less than a high school education, black race, single marital status, and young age. Only 1.1 percent of birth weights would have been incorrectly classified into low or normal birth weight categories based on maternal reporting. Overall, our results suggest that maternally reported birth weights are sufficiently accurate for research and programmatic purposes when birth certificate information is not readily available.

Birth Certificates↗
PubMed1988

Current and future delegation of pharmacy activities to technicians in Tennessee.

Pharmacists in charge of community and institutional pharmacies in Tennessee were surveyed to identify which activities they currently delegate to technicians and which activities they might consider delegating in the future. Survey questionnaires were mailed to all pharmacists-in-charge registered with the board of pharmacy. Respondents were asked to indicate which of 38 listed pharmacy activities were currently delegated to technicians and which currently undelegated activities would be delegated in the future if legal and policy barriers were removed and if technician training programs were available. Respondents also ranked six types of technician training programs in order of preference and were asked whether they thought technicians should receive official recognition through certification or licensure. A total of 947 questionnaires were returned, for a response rate of 62%. Of the 24 activities that were delegated by significantly different numbers of pharmacists in community and institutional settings, 23 were delegated more frequently by institutional pharmacists. Activities related to drug therapy were delegated least frequently by either group, although community pharmacists delegated the task of recommending nonprescription drugs more often than did institutional pharmacists. If barriers were removed and training programs were available, more pharmacists would delegate activities to technicians than currently do. Most respondents preferred a formal, in-house training program for technicians; more than 65% of pharmacists favored certification of technicians. Pharmacists in Tennessee currently delegate a number of activities to technicians, and more pharmacists would do so if barriers toward technician use were removed and if more trained technicians were available.

Pharmacies↗
PubMed1985

Linking clinical dietetic practice with educational development in Tennessee.

Does the setting for health care delivery affect the development of competence in clinical dietetics? A survey was conducted to compare clinical dietetic practice in hospitals and in public health agencies in Tennessee. It was found that the nature of practitioners--their demographic characteristics, credentials, and roles in practice--could not be differentiated. There was, however, a difference between groups when the high-priority counseling performance situations (problem-solving encounters) were compared, suggesting that there is a difference in competence needed for clinical dietetic practice. A Delphi probe was conducted among educators and practitioners in Tennessee to identify anticipated priorities among clients' needs and problems in future counseling intervention without regard to the setting for health care delivery. In clinical education, selecting a general set of performance situations representative of practice in a variety of settings enables practitioners to develop breadth of competence. Future practitioners need to be able to modify and create roles to address societal needs and expectations in systems not yet envisioned. The articulation of dietetic and public health nutrition education programs that have a common purpose is a step in that direction.

Adult↗
PubMed1984

The use and efficacy of child restraint devices. The Tennessee experience, 1982 and 1983.

The Tennessee Child Passenger Protection Act, mandating the use of child restraint devices for children younger than 4 years, took effect in 1978. In the years 1978 through 1983, eighty-one children younger than 4 years died in Tennessee traffic accidents; only two were in child restraint devices. During this period, as child restraint device use rose from 8% to more than 30%, the number of deaths among children younger than 4 years declined more than 50%. Analysis of supplemental accident reports filed in investigations of motor vehicle accidents involving children younger than 4 years during 1982 and 1983 showed that child restraint devices are highly effective in preventing death and in preventing or reducing injury. Children not in child restraint devices were 11 times more likely to die in an accident than children in child restraint devices. Children traveling in the arms of an adult were exposed to a risk of injury or death comparable to that of children left entirely unrestrained.

Accident Prevention↗