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Utilizing Transgender Patient Health Care Experiences To Address Future Physicians' Gaps In Knowledge

Description: This poster describes a project to create a free, open-access, web-based curriculum designed to educate medical students and residents on how to give compassionate care to disadvantaged populations who are in great need of consistent, stigma-free, and socially informed health care.
Date: February 2, 2018
Creator: Moore, Antoinette & Keralis, Spencer D. C.
Partner: UNT Libraries

Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act

Description: This report summarizes legislative actions taken to repeal, defund, delay, or otherwise amend the Affordable Care Act (ACA) since it was signed into law. The report is divided into two sections. The first section focuses on authorizing legislation, and the second section discusses appropriations bills.
Date: March 2, 2015
Creator: Redhead, C. S. & Kinzer, Janet
Partner: UNT Libraries Government Documents Department

Influencing Self-Reported Health Among Rural Low-Income Women Through Health Care and Social Service Utilization: A Structural Equation Model

Description: Article discussing a structural equation model and influencing self-reported health among rural low-income women through health care and social service utilization.
Date: November 2, 2012
Creator: Bice-Wigington, Tiffany & Huddleston-Casas, Catherine A.
Partner: UNT College of Public Affairs and Community Service

Veterans' Health Care: Oversight of Tissue Product Safety

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Data from the Veteran's Health Administration (VHA), within the Department of Veterans Affairs (VA), do not show evidence of VHA receiving contaminated tissue products, although, it is difficult to link adverse events in recipients to such products. VA's National Center for Patient Safety (NCPS), which began operation in 1999, has not issued any patient safety alerts—mandates for action to address actual or potential threats to life or health—or advisories—guidance to address issues such as equipment design and product failure—related to tissue products potentially received by VA medical centers (VAMC) in the last 10 years. NCPS issues patient safety alerts and advisories for recalls that require specific clinical actions to ensure patient safety. Since NCPS began issuing and recording data on recalls in November 2008, NCPS has notified VAMCs of 13 recalls for tissue products from vendors from which VHA could have received affected products—none of these recalls have resulted in patient safety alerts or advisories. For 6 of the recalls, 27 VAMCs reported to NCPS that they had identified and removed the recalled products from their inventories. For the other 7 recalls, none of the VAMCs had the affected tissue products in their inventories. The 13 recalls were not issued for known tissue product contamination. Instead, most were initiated because of the possibility of contamination, such as compromise of product sterility and incomplete donor records. Further, VHA officials told us that their analysis of VHA data found no evidence of reported adverse events among VHA patients that were caused by contaminated tissue products. According to officials from the Food and Drug Administration (FDA), post-surgical infections often occur, even in the absence of tissue use, and it is often not possible to definitively attribute such infections to a tissue ...
Date: April 2, 2014
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicaid: Transfers of Assets by Elderly Individuals to Obtain Long-Term Care Coverage

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2004, the Medicaid program financed about $93 billion for long-term care services. To qualify for Medicaid, individuals' assets (income and resources) must be below certain limits. Because long-term care services can be costly, those who pay privately may quickly deplete their assets and become eligible for Medicaid. In some cases, individuals might transfer assets to spouses or other family members to become financially eligible for Medicaid. Those who transfer assets for less than fair market value may be subject to a penalty period that can delay their eligibility for Medicaid. GAO was asked to provide data on transfers of assets. GAO reviewed (1) the level of assets held and transferred by the elderly, (2) methods used to transfer assets that may result in penalties, (3) how states determined financial eligibility for Medicaid long-term care, and (4) guidance the Centers for Medicare & Medicaid Services (CMS) has provided states regarding the treatment of asset transfers. GAO analyzed data on levels of assets and cash transfers made by the elderly from the 2002 Health and Retirement Study (HRS), a national panel survey; analyzed states' Medicaid applications; and interviewed officials from nine states about their eligibility determination processes."
Date: September 2, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Defense Health Care: TRICARE Multiyear Surveys Indicate Problems with Access to Care for Nonenrolled Beneficiaries

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In its analysis of the 2008-2011 beneficiary survey data, GAO found that nearly one in three nonenrolled beneficiaries experienced problems finding a civilian provider who would accept TRICARE and that nonenrolled beneficiaries' access to civilian primary care and specialty care providers differed by type of location. Specifically, a higher percentage of nonenrolled beneficiaries in Prime Service Areas (PSA), which are areas with civilian provider networks, experienced problems finding a civilian primary care or specialty care provider compared to those in non-Prime Service Areas (non-PSA), which do not have civilian provider networks. GAO found that the top reasons reported by nonenrolled beneficiaries for why they experienced access problems--regardless of type of provider--were that the providers were either not accepting TRICARE payments or new TRICARE patients. Additionally, GAO's comparison of the Department of Defense's (DOD) beneficiary survey data to related data from a Department of Health and Human Services survey showed that nonenrolled beneficiaries' satisfaction ratings for primary and specialty care providers were consistently lower than those of Medicare fee-for-service beneficiaries."
Date: April 2, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Social Security Administration: More Effort Needed to Assess Consistency of Disability Decisions

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Each year, about 2.5 million people file claims with the Social Security Administration (SSA) for disability benefits. If the claim is denied at the initial level, the claimant may appeal to the hearings level. The hearings level has allowed more than half of all appealed claims, an allowance rate that has raised concerns about the consistency of decisions made at the two levels. To help ensure consistency, SSA began a "process unification" initiative in 1994 and recently announced a new proposal to strengthen its disability programs. This report examines (1) the status of SSA's process unification initiative, (2) SSA's assessments of possible inconsistencies in decisions between adjudication levels, and (3) whether SSA's new proposal incorporates changes to improve consistency in decisions between adjudication levels."
Date: July 2, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Global HIV/AIDS: A More Country-Based Approach Could Improve Allocation of PEPFAR Funding

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The President's Emergency Plan for AIDS Relief (PEPFAR) provides assistance for combating HIV/AIDS in 15 focus countries and elsewhere, with global targets for prevention, treatment, and care. The U.S. Leadership Against HIV/AIDS, TB and Malaria Act of 2003, which authorizes the $15 billion program, contains directives to guide the Office of the U.S. Global AIDS Coordinator's (OGAC) allocation of this funding. The act expires in September 2008. The President announced his intention to ask Congress to authorize $30 billion for these efforts for the next 5 years. In 2007, the Institute of Medicine (IOM) recommended eliminating the directives. GAO was asked to describe (1) the views of HIV/AIDS experts on these directives, (2) an alternative approach to allocating funds, and (3) potential challenges related to this approach. GAO interviewed 22 experts, surveyed PEPFAR officials in the 15 focus countries, and reviewed pertinent documentation."
Date: April 2, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Indian Health Service: Millions of Dollars in Property and Equipment Continue to Be Lost or Stolen

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In 2008, GAO issued a report and testimony revealing gross mismanagement of property at the Indian Health Service (IHS). GAO found that 5,000 items with an acquisition value of $15.8 million were reported lost or stolen for fiscal years 2004 through 2007. GAO attributed the property mismanagement and waste to weak internal controls. GAO made 10 recommendations to IHS. IHS ultimately agreed to implement all 10 recommendations. Given the extent and seriousness of the property management problems at IHS, GAO was asked to determine (1) whether property loss, property theft, and wasteful spending continue at IHS; and (2) to what extent IHS made progress in implementing GAO's prior recommendations. GAO analyzed IHS property records from fiscal year 2008 through January 2009, conducted a full physical inventory at IHS headquarters, and performed a probability sample of information technology equipment inventory at six IHS field locations. GAO also examined IHS policies, analyzed documents, and conducted interviews with IHS officials."
Date: June 2, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare: HCFA to Strengthen Medicare Provider Enrollment Significantly, but Implementation Behind Schedule

Description: Correspondence issued by the General Accounting Office with an abstract that begins "One of the first defenses against improper Medicare billings is the screening of applications from providers seeking to participate in the program. The Health Care Financing Administration (HCFA) operates and manages the Medicare program and, with help from insurance companies, reviews provider applications to determine whether providers meet Medicare requirements and if there is a reason to suspect that providers' future Medicare billings would be improper. GAO found that HCFA's current provider enrollment process does not completely ensure that dishonest and unqualified providers are prevented from obtaining Medicare billing privileges. GAO suggests consolidating provider enrollment tasks with fewer contractors to strengthen HCFA's ability to oversee these contractors and enhance the efficiency of the enrollment process. HCFA is implementing several changes to its provider enrollment processes that may make it more difficult for dishonest providers to enroll in Medicare; however, delays in implementing these initiatives will also postpone their benefits."
Date: November 2, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medicare: Identifying Third-Party Billing Companies Submitting Claims

Description: Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO described how the Health Care Financing Administration (HCFA) and its contractors monitor third-party billing companies' involvement in the submission of claims to Medicare."
Date: June 2, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Workplace Safety and Health: Multiple Challenges Lengthen OSHA's Standard Setting

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Between 1981 and 2010, the time it took the Department of Labor’s Occupational Safety and Health Administration (OSHA) to develop and issue safety and health standards ranged widely, from 15 months to 19 years, and averaged more than 7 years. Experts and agency officials cited increased procedural requirements, shifting priorities, and a rigorous standard of judicial review as contributing to lengthy time frames for developing and issuing standards. For example, they said that a shift in OSHA’s priorities toward one standard took attention away from several other standards that previously had been a priority."
Date: April 2, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Community-Based Clinics Improve Primary Care Access

Description: A statement of record issued by the General Accounting Office with an abstract that begins "This testimony discusses the Veterans Health Administration's (VHA) efforts to improve veterans' access to health care through its Community-Based Outpatient Clinics Initiative. Overall, through its clinics, VHA is steadily making primary care more available within reasonable proximity of patients who have used VHA's system in the past. However, the uneven distribution of patients living more than 30 miles from a VHA primary care facility suggests that access inequities across networks may exist. Also, the improvements likely to result from VHA's planned clinics indicate that achieving equity of access may be difficult. In addition, GAO's assessment suggests that new clinics may have contributed to, but are not primarily responsible for, the marked rise in the number of higher-income patients who have sought health care through VHA in recent years. Although the clinics have undoubtedly attracted some new patients to VHA, GAO's analysis suggests that new patients would have sought care at other VHA facilities in the absence of the clinics. Enhanced benefits and access improvements afforded by eligibility reform may have attracted more new patients, including those with higher incomes."
Date: May 2, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

DOD and VA Health Care: Medication Needs during Transitions May Not Be Managed for All Servicemembers

Description: A letter report issued by the Government Accountability Office with an abstract that begins "About 1 in 12 (approximately 94,000) servicemembers discharged from military service and Reservists and National Guard members demobilized in fiscal years 2009 through 2011 had a psychiatric or pain medication, and almost half of these servicemembers subsequently received care from the Department of Veterans Affairs (VA) within 9 months. The percentage of servicemembers discharged or demobilized with psychiatric or pain medications increased slightly across the 3 fiscal years, from about 7 percent in fiscal year 2009 to about 9 percent in fiscal year 2011. The most common psychiatric medications for servicemembers discharged or demobilized from fiscal years 2009 through 2011 included antidepressants, while the most common pain medications included nonsteroidal anti-inflammatories, such as prescription-strength ibuprofen, and an opioid--oxycodone acetaminophen. Although not all discharged or demobilized servicemembers receive care from VA, GAO found that almost half of servicemembers with psychiatric or pain medications in fiscal years 2009 through 2011 subsequently received care from VA within 9 months."
Date: November 2, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Important Steps Taken to Enhance Veterans' Care by Aligning Inpatient Services with Projected Needs

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) operates one of the nation's largest health care systems. In 1999, GAO reported on VA's aged, obsolete capital assets, noting that better management of these assets could significantly reduce VA's operating costs. GAO further noted that VA could reinvest the savings to enhance veterans' health care services. In response, VA initiated its Capital Asset Realignment for Enhanced Services (CARES) process. Through CARES, VA identified what health care services it should provide and in which locations through 2022. The CARES process included assessing alternative ways to align inpatient services by closing or adding services at existing VA medical facilities or establishing new facilities. In May 2004, VA published its CARES decisions, but did not provide a national comprehensive summary of all its decisions about the alignment of inpatient services. GAO was asked to provide additional information about the inpatient service assessments and decisions made by VA. To provide a national, comprehensive summary, GAO summarized the locations where VA (1) identified a need to evaluate alternative ways to align inpatient health care service to improve quality, efficiency, or access and (2) made decisions to realign inpatient services or leave inpatient services as aligned, or deferred decisions pending further study."
Date: March 2, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Defense Health Care: Access to Civilian Providers under TRICARE Standard and Extra

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) provides health care through its TRICARE program, which is managed by the TRICARE Management Activity (TMA). TRICARE offers three basic options. Beneficiaries who choose TRICARE Prime, an option that uses civilian provider networks, must enroll. TRICARE beneficiaries who do not enroll in this option may obtain care from nonnetwork providers under TRICARE Standard or from network providers under TRICARE Extra. The National Defense Authorization Act for Fiscal Year 2008 directed GAO to evaluate various aspects of beneficiaries' access to care under the TRICARE Standard and Extra options. This report examines (1) impediments to TRICARE Standard and Extra beneficiaries' access to civilian health care and mental health care providers and TMA's actions to address the impediments; (2) TMA's efforts to monitor access to civilian providers for TRICARE Standard and Extra beneficiaries; (3) how TMA informs network and nonnetwork civilian providers about TRICARE Standard and Extra; and (4) how TMA informs TRICARE Standard and Extra beneficiaries about their options. To address these objectives, GAO reviewed and analyzed TMA and TRICARE contractor data and documents. GAO also interviewed TMA officials, including those in its regional offices, as well as its contractors."
Date: June 2, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Chronic Fatigue Syndrome: CDC and NIH Research Activities Are Diverse, but Agency Coordination Is Limited

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the chronic fatigue syndrome (CFS) research activities administered by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), focusing on: (1) the CFS activities that CDC and NIH have supported; (2) the funds and resources CDC and NIH have devoted to CFS research; and (3) how CDC and NIH coordinate research and involve patient organizations and external researchers in developing their CFS research programs."
Date: June 2, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medicare: Program Remains at High Risk Because of Continuing Management Challenges

Description: Testimony issued by the Government Accountability Office with an abstract that begins "In the February 2011 High-Risk Series update, GAO continued designation of Medicare as a high-risk program because its complexity and susceptibility to improper payments, combined with its size, have led to serious management challenges. In 2010, Medicare covered 47 million people and had estimated outlays of $509 billion. The Centers for Medicare & Medicaid Services (CMS) has estimated fiscal year 2010 improper payments for Medicare fee-for-service and Medicare Advantage of almost $48 billion. This statement focuses on the nature of the risk in the program, progress made, and specific actions needed. It is based on GAO work developed by using a variety of methodologies--including analyses of Medicare claims, review of policies, interviews, and site visits--and information from CMS on the status of actions to address GAO recommendations."
Date: March 2, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicaid: Concerns Remain about Sufficiency of Data for Oversight of Children's Dental Services

Description: Testimony issued by the Government Accountability Office with an abstract that begins "The 31 million children enrolled in Medicaid are particularly vulnerable to tooth decay, which, if untreated, may lead to more serious health conditions and, on rare occasion, result in death. Congress established a comprehensive health benefit for children enrolled in Medicaid to cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which include dental services. The Centers for Medicare & Medicaid Services (CMS) is responsible for oversight of these services. States are responsible for administering their state Medicaid programs in accordance with federal requirements, including requirements to report certain data on the provision of EPSDT services. GAO was asked to address the data that CMS requires states to submit on the provision of EPSDT dental services and the extent to which these data are sufficient for CMS oversight of the provision of these services. This testimony is based on reports GAO issued from 2000 through 2003. GAO updated relevant portions of its earlier work through interviews conducted in April 2007 with officials from CMS; state Medicaid programs in California, Illinois, Minnesota, New York, and Washington (states contacted for GAO's 2001 study or referred to GAO by another official); and national health associations. GAO also reviewed relevant literature provided by officials from CMS and other organizations."
Date: May 2, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Nursing Home Reform: Continued Attention Is Needed to Improve Quality of Care in Small but Significant Share of Homes

Description: Testimony issued by the Government Accountability Office with an abstract that begins "With the Omnibus Budget Reconciliation Act of 1987 (OBRA '87), Congress responded to growing concerns about the quality of care that nursing home residents received by requiring reforms in the federal certification and oversight of nursing homes. These reforms included revising care requirements that homes must meet to participate in the Medicare or Medicaid programs, modifying the survey process for certifying a home's compliance with federal standards, and introducing additional sanctions and decertification procedures for noncompliant homes. GAO's testimony addresses its work in evaluating the quality of nursing home care and the enforcement and oversight functions intended to ensure high-quality care, the progress made in each of these areas since the passage of OBRA '87, and the challenges that remain. GAO's testimony is based on its prior work; analysis of data from the Centers for Medicare & Medicaid Services' (CMS) On-Line Survey, Certification, and Reporting system (OSCAR), which compiles the results of state nursing home surveys; and evaluation of federal comparative surveys for selected states (2005-2007). Federal comparative surveys are conducted at nursing homes recently surveyed by each state to assess the adequacy of the state's surveys."
Date: May 2, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Women's Health: NIH Has Increased Its Efforts to Include Women in Research

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the National Institutes of Health's (NIH) efforts to include women in clinical research, focusing on: (1) the extent to which women are being included in clinical research that NIH funds; (2) the activities and accomplishments of the NIH Office of Research on Women's Health (ORWH) in promoting women's health research at NIH; and (3) how much funding NIH has allocated to research on health issues that affect women."
Date: May 2, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Toxic Chemicals: Long-Term Coordinated Strategy Needed to Measure Exposures in Humans

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO reviewed efforts to collect environmental health data, focusing on the: (1) extent to which states, the Department of Health and Human Services (HHS), and the Environmental Protection Agency (EPA) collect human exposure data on potentially harmful chemicals, including data to identify at-risk populations; and (2) main barriers hindering further progress in such efforts."
Date: May 2, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Federal Employees Health Benefits Program: Differences in Health Care Prices Across Metropolitan Areas Linked to Competition and Other Factors

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Differences in utilization of health care services across the country have been well documented, but less has been reported on geographic variation in price. As health care spending is the product of utilization and price, information on health care prices and factors contributing to price differences provides an additional perspective on drivers of health care spending. In an August 2005 report, GAO examined claims data on enrollees of preferred provider organizations (PPO) participating in the Federal Employees Health Benefits Program (FEHBP) and found substantial price variation across metropolitan areas, after adjusting prices to account for area differences in the cost of providing services and in the types of services provided. This statement is based on GAO's August 2005 report entitled Federal Employees Health Benefits Program: Competition and Other Factors Linked to Wide Variation in Health Care Prices (GAO-05-856). It focuses on (1) factors that underlie area differences in price and (2) the contribution of price to geographic differences in spending on health care."
Date: December 2, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Adequacy of Resident Supervision Is Not Assured, but Plans Could Improve Oversight

Description: A letter report issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) provides graduate medical education (GME) to as many as one-third of U.S. resident physicians, but oversight responsibilities spread across VA's organizational components and multiple affiliated hospitals and medical schools could allow supervision problems to go undetected or uncorrected. GAO was asked to examine VA's procedures for (1) monitoring VA medical centers' adherence to VA's requirements for resident supervision, (2) using evaluations of supervision by GME accrediting bodies and residents, and (3) using information about resident supervision drawn from VA's programs for monitoring the quality and outcomes of patient care."
Date: July 2, 2003
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department