Marcia M Ward
Dados Biográficos
| ID | 4890762 |
|---|---|
| NOME | Marcia M Ward |
| PRENOMES | Marcia M |
| SOBRENOME | Ward |
| ASSINATURA | WARD M M |
| AFILIAÇÕES | University of Iowa |
| ORCID | 0000-0003-1948-1302 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 28 |
| TOTAL DE CITAÇÕES | 60 |
| TOTAL COMO AUTOR | 28 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1983 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2025 |
| ÍNDICE H | 2 |
Provider‐to‐provider telemedicine for sepsis is used less frequently in communities with high social vulnerability
PURPOSE: Sepsis disproportionately affects patients in rural and socially vulnerable communities. A promising strategy to address this disparity is provider-to-provider emergency department (ED)-based telehealth consultation (tele-ED). The objective of this study was to determine if county-level social vulnerability index (SVI) was associated with tele-ED use for sepsis and, if so, which SVI elements were most strongly associated. METHODS: We use…
Change in Drug Use Disorders Identification Test – Consumption (Dudit-C) with Telehealth Treatment Compared to in-Person Treatment
Background and Objectives: There is little published evidence for the effectiveness of telehealth in the treatment of substance use disorders. Methods: We analyzed Drug Use Disorders Identification Test – Consumption (DUDIT-C) scores from 360 patients who completed the measure as part of outpatient behavioral health treatment at rural clinic sites. Some patients received in-person care, while others received telehealth. Results were analyzed usin…
Describing Changes in Telebehavioral Health Utilization and Services Delivery in Rural School Settings in Pre‐ and Early Stages of the Covid ‐19 Public Health Emergency
BACKGROUND: Receiving treatment for behavioral health disorders remains problematic due to profound provider shortages. Telebehavioral health services are effective for providing quality care, but research literature on these services in schools is limited. METHODS: Data were collected during Fall 2019 and Spring 2020 semesters on all students receiving telebehavioral health services from 15 school-based telehealth programs across the U.S. RESULT…
Implementation of Telehealth Services in Rural Schools
BACKGROUND: In rural areas with health professional workforce shortages, telehealth offers an opportunity to address service gaps and meet the health needs of students. Few studies have examined telehealth implementation in rural schools. This study explores facilitators and barriers to the implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initia…
Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals
The role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments
Rural Bypass of Critical Access Hospitals in Iowa
PURPOSE: Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. METHODS: Discharge data from the 2011 State Inpatient Databases and State Ambulat…
Surgical Patient Safety Outcomes in Critical Access Hospitals
PURPOSE: The aim of the study was to examine whether Critical Access Hospitals (CAHs), the predominant type of hospital in small and isolated rural areas, perform better than, the same as, or worse than Prospective Payment System (PPS) hospitals on measures of quality. METHODS: The Healthcare Cost and Utilization Project State Inpatient Databases and American Hospital Association annual survey data were used for analyses. A total of 35,674 discha…
Rural Bypass for Elective Surgeries
PURPOSE: Rural bypass of Critical Access Hospitals (CAHs) for elective inpatient and outpatient surgical procedures has not been studied. Residents choosing to have their elective surgeries elsewhere, when the local CAH provides those surgical services, erode their rural hospital's financial base. The purpose of this research is to describe the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distributi…
Is Travel Time to Colonoscopy Associated With Late‐Stage Colorectal Cancer Among Medicare Beneficiaries in Iowa
BACKGROUND: Colorectal cancer (CRC) screening has been shown to decrease the incidence of late-stage colorectal cancer, yet a substantial proportion of Americans do not receive screening. Those in rural areas may face barriers to colonoscopy services based on travel time, and previous studies have demonstrated lower screening among rural residents. Our purpose was to assess factors associated with late-stage CRC, and specifically to determine if …
Emrs and Clinical Is Implementation in Hospitals
Purpose: Present an overview of clinical information systems (IS) in hospitals and analyze the level of electronic medical records (EMR) implementation in relation to clinical IS capabilities and organizational characteristics. Methods: We developed a survey instrument measuring clinical IS implementation and classified clinical IS across 5 EMR levels. The survey was administered to hospitals in a state with a large number of rural hospitals (84%…
Patient Safety Outcomes in Small Urban and Small Rural Hospitals
PURPOSE: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes. METHODS: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was restricted to hospitals with fewer than 100 beds. Out of 292 hospitals in the sample, 185 were rural hospita…
Creating a Shared Formulary in 7 Critical Access Hospitals
PURPOSE: This paper reports a case study of 7 Critical Access Hospitals' (CAH) and 1 rural referral hospital's successful collaboration to develop a shared formulary. METHODS: Study methods included document reviews, interviews with key informants, and use of descriptive statistics. FINDINGS: Through a systematic review and decision process, CAH formularies ranging in size from 667 to 1,351 items were compared, rationalized, and consolidated resu…
Factors Associated with Iowa Rural Hospitals' Decision to Convert to Critical Access Hospital Status
Context: The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost‐based. Some subsequent CAH‐related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. Purpose: To examine factors related to hospitals' decisions to convert and time to CAH conversion. Methods: Ei…
Converting to Critical Access Status
To improve rural access to care, the Balanced Budget Act of 1997 allowed eligible rural hospitals to convert to critical access hospitals (CAHs), which changed their Medicare payment from a prospective payment system (PPS) to a cost-based system. The objective of this paper is to examine the effects of CAH conversion on rural hospital operating revenues, operating expenses, and operating margins using an eight-year panel of 89 rural hospitals in …
Do Postoperative Complications Vary by Hospital Teaching Status
OBJECTIVE: The purpose of this paper is to assess postoperative patient safety outcomes across teaching and nonteaching hospitals and to examine the relation of hospital and patient factors to patient safety outcomes. RESEARCH DESIGN AND METHODS: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. Patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality (…
Development of a Measure of Clinical Information Systems Expectations and Experiences
BACKGROUND/OBJECTIVES: The purpose of this study is to describe the development and initial psychometric properties of a measure of expectations and experiences regarding the impact of clinical information systems on work process and outcomes. RESEARCH DESIGN: Basic item analysis, confirmatory factor analysis, cross-validation factor analyses, and reliability analysis were used to assess the psychometric properties of the scale. SUBJECTS: The ini…
The Limited Effect of Screening for Depressive Symptoms With the PHQ-9 in Rural Family Practices
CONTEXT: Previous studies have found that routine screening for depression does not improve patient outcome unless it is combined with case management. However, these studies were conducted before the widespread use of SSRIs or in settings other than traditional primary care. PURPOSE: This study investigated whether screening for depressive symptoms improves outcomes for depressed patients seen in rural fee-for-service primary care offices. METHO…
What Would Be the Effect of Referral to High‐Volume Hospitals in a Largely Rural State
Context: Volume of certain surgical procedures has been linked to patient outcomes. The Leapfrog Group and others have recommended evidence‐based referral using specific volume thresholds for nonemergent cases. The literature is limited on the effect of such referral on hospitals, especially in rural areas. Purpose: To examine the impact of evidence‐based referral by volume standard for 5 hospital procedures (abdominal aortic artery repair, coron…
Intensive Care Unit Utilization and Interhospital Transfers As Potential Indicators of Rural Hospital Quality
Context: Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease‐specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care processes. Purpose: To evaluate the applicability of intensive care unit (ICU) utilization …
Physician Process and Patient Outcome Measures for Diabetes Care
BACKGROUND: Optimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes. PURPOSE: To explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient popu…
Medical Checkups
Objectives. This study determined which predisposing, enabling, need, behavioral, and disease factors predict the use of medical checkups. Methods. The Behavioral Risk Factor Surveillance System was used to obtain state estimates in Iowa. Results. A decreased likelihood of recent checkups was noted for persons aged 25 to 44, men, and those who faced cost barriers. An increased likelihood of recent checkups was associated with married people, high…
Benchmarking Veterans Affairs Medical Centers in the Delivery of Preventive Health Services
OBJECTIVE: To identify consistent provision of clinical preventive services, we sought to benchmark all acute care Veterans Affairs Medical Centers (VAMCs) against each other nationally on the basis of multiple evidence-based, performance measures to identify facilities performing consistently higher and lower than expected. METHODS: The 1998 Veterans Health Survey assessed the self-reported delivery of evidence-based clinical preventive services…
Why Rural Residents Migrate for Family Physician Care
Several studies have examined why rural residents bypass local hospitals, but few have explored why they migrate for physician care. In this study, data from a random mail survey of households in rural Iowa counties were used to determine how consumers' attitudes about their local health system, health beliefs, health insurance coverage and other personal characteristics influenced their selection of local vs. nonlocal family physicians (family p…
Because They're My Parents
Catherine H. Stein, Virginia A. Wemmerus, Marcia Ward, Michelle E. Gaines, Andrew L. Freeberg, Thomas C. Jewell, "Because They're My Parents": An Intergenerational Study of Felt Obligation and Parental Caregiving, Journal of Marriage and Family, Vol. 60, No. 3 (Aug., 1998), pp. 611-622
The power of a place
Presented the structure and implementation of a university-based practicum course on social relationships for people with serious mental illness and college undergraduates. Grounded in an ecological view of social settings, cooperative learning models of education and mutual help principles, the practicum was designed to create a collaborative classroom setting where undergraduates and people with serious mental illness could both develop and enh…
Because They're My Parents
Catherine H. Stein, Virginia A. Wemmerus, Marcia Ward, Michelle E. Gaines, Andrew L. Freeberg, Thomas C. Jewell, "Because They're My Parents": An Intergenerational Study of Felt Obligation and Parental Caregiving, Journal of Marriage and Family, Vol. 60, No. 3 (Aug., 1998), pp. 611-622
Mine, Yours and Ours
The present study examined different ways that a sample of 49 working- and middle-class married couples structured their shared and separate relationships with family and friends. The research focused on the married couple as the unit of analysis, and used information from both members of the dyad to construct descriptions of couples' conjoint networks. Couples were empirically classified according to network structural variables considered simul…
The power of a place
Presented the structure and implementation of a university-based practicum course on social relationships for people with serious mental illness and college undergraduates. Grounded in an ecological view of social settings, cooperative learning models of education and mutual help principles, the practicum was designed to create a collaborative classroom setting where undergraduates and people with serious mental illness could both develop and enh…
Epinephrine and Norepinephrine Responses in Continuously Collected Human Plasma to a Series of Stressors
The present study employed continuous blood withdrawal to examine epinephrine and norepinephrine responses to a cognitive stressor (mental arithmetic), active physical stressors (handgrip and knee bends), passive painful stressors (venipuncture and cold pressor), and a medical procedure that was considered nonstressful (blood pressure measurements). The data were analyzed by analysis of variance (ANOVA) and by time series analysis. The ANOVA indi…
Relaxation training for essential hypertension at the worksite
This industry-based randomized study compared the effects of behavioral treatment (BT) and blood pressure monitoring (BPM) on blood pressure (BP) change in 158 unmedicated persons with mild hypertension (diastolic blood pressure 90 to 104 mm Hg). Participants recruited by a three-stage screening were randomly assigned to BT or BPM groups and stratified by entry diastolic blood pressure (DBP), age, and sex. BT participants received relaxation trai…
The power of a place
Presented the structure and implementation of a university-based practicum course on social relationships for people with serious mental illness and college undergraduates. Grounded in an ecological view of social settings, cooperative learning models of education and mutual help principles, the practicum was designed to create a collaborative classroom setting where undergraduates and people with serious mental illness could both develop and enh…
Mine, Yours and Ours
The present study examined different ways that a sample of 49 working- and middle-class married couples structured their shared and separate relationships with family and friends. The research focused on the married couple as the unit of analysis, and used information from both members of the dyad to construct descriptions of couples' conjoint networks. Couples were empirically classified according to network structural variables considered simul…
Because They're My Parents
Catherine H. Stein, Virginia A. Wemmerus, Marcia Ward, Michelle E. Gaines, Andrew L. Freeberg, Thomas C. Jewell, "Because They're My Parents": An Intergenerational Study of Felt Obligation and Parental Caregiving, Journal of Marriage and Family, Vol. 60, No. 3 (Aug., 1998), pp. 611-622
Why Rural Residents Migrate for Family Physician Care
Several studies have examined why rural residents bypass local hospitals, but few have explored why they migrate for physician care. In this study, data from a random mail survey of households in rural Iowa counties were used to determine how consumers' attitudes about their local health system, health beliefs, health insurance coverage and other personal characteristics influenced their selection of local vs. nonlocal family physicians (family p…
Medical Checkups
Objectives. This study determined which predisposing, enabling, need, behavioral, and disease factors predict the use of medical checkups. Methods. The Behavioral Risk Factor Surveillance System was used to obtain state estimates in Iowa. Results. A decreased likelihood of recent checkups was noted for persons aged 25 to 44, men, and those who faced cost barriers. An increased likelihood of recent checkups was associated with married people, high…
Benchmarking Veterans Affairs Medical Centers in the Delivery of Preventive Health Services
OBJECTIVE: To identify consistent provision of clinical preventive services, we sought to benchmark all acute care Veterans Affairs Medical Centers (VAMCs) against each other nationally on the basis of multiple evidence-based, performance measures to identify facilities performing consistently higher and lower than expected. METHODS: The 1998 Veterans Health Survey assessed the self-reported delivery of evidence-based clinical preventive services…
What Would Be the Effect of Referral to High‐Volume Hospitals in a Largely Rural State
Context: Volume of certain surgical procedures has been linked to patient outcomes. The Leapfrog Group and others have recommended evidence‐based referral using specific volume thresholds for nonemergent cases. The literature is limited on the effect of such referral on hospitals, especially in rural areas. Purpose: To examine the impact of evidence‐based referral by volume standard for 5 hospital procedures (abdominal aortic artery repair, coron…
Intensive Care Unit Utilization and Interhospital Transfers As Potential Indicators of Rural Hospital Quality
Context: Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease‐specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care processes. Purpose: To evaluate the applicability of intensive care unit (ICU) utilization …
Physician Process and Patient Outcome Measures for Diabetes Care
BACKGROUND: Optimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes. PURPOSE: To explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient popu…
The Limited Effect of Screening for Depressive Symptoms With the PHQ-9 in Rural Family Practices
CONTEXT: Previous studies have found that routine screening for depression does not improve patient outcome unless it is combined with case management. However, these studies were conducted before the widespread use of SSRIs or in settings other than traditional primary care. PURPOSE: This study investigated whether screening for depressive symptoms improves outcomes for depressed patients seen in rural fee-for-service primary care offices. METHO…
Development of a Measure of Clinical Information Systems Expectations and Experiences
BACKGROUND/OBJECTIVES: The purpose of this study is to describe the development and initial psychometric properties of a measure of expectations and experiences regarding the impact of clinical information systems on work process and outcomes. RESEARCH DESIGN: Basic item analysis, confirmatory factor analysis, cross-validation factor analyses, and reliability analysis were used to assess the psychometric properties of the scale. SUBJECTS: The ini…
Do Postoperative Complications Vary by Hospital Teaching Status
OBJECTIVE: The purpose of this paper is to assess postoperative patient safety outcomes across teaching and nonteaching hospitals and to examine the relation of hospital and patient factors to patient safety outcomes. RESEARCH DESIGN AND METHODS: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. Patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality (…
Factors Associated with Iowa Rural Hospitals' Decision to Convert to Critical Access Hospital Status
Context: The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost‐based. Some subsequent CAH‐related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. Purpose: To examine factors related to hospitals' decisions to convert and time to CAH conversion. Methods: Ei…
Converting to Critical Access Status
To improve rural access to care, the Balanced Budget Act of 1997 allowed eligible rural hospitals to convert to critical access hospitals (CAHs), which changed their Medicare payment from a prospective payment system (PPS) to a cost-based system. The objective of this paper is to examine the effects of CAH conversion on rural hospital operating revenues, operating expenses, and operating margins using an eight-year panel of 89 rural hospitals in …
Patient Safety Outcomes in Small Urban and Small Rural Hospitals
PURPOSE: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes. METHODS: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was restricted to hospitals with fewer than 100 beds. Out of 292 hospitals in the sample, 185 were rural hospita…
Creating a Shared Formulary in 7 Critical Access Hospitals
PURPOSE: This paper reports a case study of 7 Critical Access Hospitals' (CAH) and 1 rural referral hospital's successful collaboration to develop a shared formulary. METHODS: Study methods included document reviews, interviews with key informants, and use of descriptive statistics. FINDINGS: Through a systematic review and decision process, CAH formularies ranging in size from 667 to 1,351 items were compared, rationalized, and consolidated resu…
Emrs and Clinical Is Implementation in Hospitals
Purpose: Present an overview of clinical information systems (IS) in hospitals and analyze the level of electronic medical records (EMR) implementation in relation to clinical IS capabilities and organizational characteristics. Methods: We developed a survey instrument measuring clinical IS implementation and classified clinical IS across 5 EMR levels. The survey was administered to hospitals in a state with a large number of rural hospitals (84%…
Is Travel Time to Colonoscopy Associated With Late‐Stage Colorectal Cancer Among Medicare Beneficiaries in Iowa
BACKGROUND: Colorectal cancer (CRC) screening has been shown to decrease the incidence of late-stage colorectal cancer, yet a substantial proportion of Americans do not receive screening. Those in rural areas may face barriers to colonoscopy services based on travel time, and previous studies have demonstrated lower screening among rural residents. Our purpose was to assess factors associated with late-stage CRC, and specifically to determine if …
Surgical Patient Safety Outcomes in Critical Access Hospitals
PURPOSE: The aim of the study was to examine whether Critical Access Hospitals (CAHs), the predominant type of hospital in small and isolated rural areas, perform better than, the same as, or worse than Prospective Payment System (PPS) hospitals on measures of quality. METHODS: The Healthcare Cost and Utilization Project State Inpatient Databases and American Hospital Association annual survey data were used for analyses. A total of 35,674 discha…
Rural Bypass for Elective Surgeries
PURPOSE: Rural bypass of Critical Access Hospitals (CAHs) for elective inpatient and outpatient surgical procedures has not been studied. Residents choosing to have their elective surgeries elsewhere, when the local CAH provides those surgical services, erode their rural hospital's financial base. The purpose of this research is to describe the elective surgical bypass rate, the procedures most commonly bypassed by rural residents, the distributi…
Rural Bypass of Critical Access Hospitals in Iowa
PURPOSE: Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. METHODS: Discharge data from the 2011 State Inpatient Databases and State Ambulat…
Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals
The role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments
Describing Changes in Telebehavioral Health Utilization and Services Delivery in Rural School Settings in Pre‐ and Early Stages of the Covid ‐19 Public Health Emergency
BACKGROUND: Receiving treatment for behavioral health disorders remains problematic due to profound provider shortages. Telebehavioral health services are effective for providing quality care, but research literature on these services in schools is limited. METHODS: Data were collected during Fall 2019 and Spring 2020 semesters on all students receiving telebehavioral health services from 15 school-based telehealth programs across the U.S. RESULT…
Medicine (25 obras) · Family medicine (13 obras) · Health care (12 obras) · Internal Medicine (12 obras) · Nursing (11 obras) · Emergency Medicine (7 obras) · Psychology (7 obras) · Environmental health (6 obras) · Telemedicine and Telehealth Implementation (6 obras) · Business (5 obras)