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Grembowski, David

Works: 21 works in 46 publications in 1 language and 550 library holdings
Genres: Academic theses 
Roles: Author, Thesis advisor
Classifications: RA399.A1, 362.1
Publication Timeline
Publications about David Grembowski
Publications by David Grembowski
Most widely held works by David Grembowski
The practice of health program evaluation by David Grembowski( Book )
17 editions published between 2001 and 2016 in English and held by 475 libraries worldwide
As more and more money is spent developing programs and services to solve health problems, how can one know if a specific health program works or what it would take to improve it? Aimed at addressing this issue, this book provides readers with the methods to evaluate health programs and the expertise to navigate the political terrain so as to work more effectively with decision makers and other groups. To convey these principles, Grembowski uses the metaphor of evaluation being a three-act play with a variety of actors and interest groups, each having a role that involves entering and exiting the 'stage' at different points in the evaluation process
Who governs?, who plans? in King County's farmland retention decisionmaking process by David Grembowski( Book )
3 editions published between 1982 and 1983 in English and held by 5 libraries worldwide
Political polarization, anticipated health insurance uptake, and individual mandate : a view from the Washington State by Anirban Basu( Book )
5 editions published in 2014 in English and held by 4 libraries worldwide
The politicization of the Affordable Care Act (ACA) was extreme, with the popular moniker of "Obamacare" and 54 House attempts to repeal the law in the four years after passage. Our study set out to understand Washington state public's preferences about enrolling into ACA driven health insurance programs, the role that political polarization may play on the chances that the uninsured would enroll and the extent to which individual mandate may influence these choices. A representative mail survey among the registered voters of Washington State. We find that 27% have not ruled out purchasing insurance through the Exchange, but their ambiguity is most likely driven by conflicts between health care needs and financial worries on one hand and their political views on the other. Overall, compared to the insured population in 2013, uninsured are significantly more likely (OR = 2.0, 95%CI: 1.1, 3.4) to enroll through the Exchange even after all adjustments including medical needs and financial worries. This highlights that the individual mandate may have an independent effect on enrollment for the uninsured. However, the individual mandate effect is found to be negligible (OR: 1.1, 95%CI: 0.50, 2.8) for the uninsured who blamed the Democrats and/or President Obama for the 2013 governmental shutdown. Political polarization appears to have a trickle down affect at the individual choices even beyond medical needs and financial worries. Alternative strategies, for example bipartisan outreach, may be necessary to convince certain groups of eligible beneficiaries to consider enrollment through the Exchange
Managed care, physician referral and medical outcomes ( Book )
1 edition published in 2001 in English and held by 3 libraries worldwide
Health program evaluation by David Grembowski( Book )
1 edition published in 2001 in English and held by 2 libraries worldwide
Insurance effects on employer group dental expenditures by David Grembowski( Book )
3 editions published in 1983 in English and held by 2 libraries worldwide
Transition of care : evaluating the Harborview Medical Center Diabetes Recent Discharge Clinic by Glen Norine C Felias-Christensen( file )
1 edition published in 2012 in English and held by 2 libraries worldwide
Dental care demand : insurance effects and plan design by Douglas A Conrad( Book )
2 editions published in 1985 in English and held by 2 libraries worldwide
An evaluation of the Mongolian Red Cross Society's HIV/AIDS Response Program by Tia S Farrell( file )
1 edition published in 2012 in English and held by 2 libraries worldwide
Abstract: An Evaluation of the Mongolian Red Cross Society's HIV/AIDS Response Program Tia S. Farrell Chair of the Supervisory Committee: Professor David Grembowski Department of Health Sciences. Specific Aims: The aim of this program evaluation is to determine whether Mongolian Red Cross Society's HIV/AIDS Response Program (HARP) increased HIV/AIDS prevention knowledge among youth aged 15-24 in targeted secondary schools and universities in Ulaanbaatar, Mongolia by the conclusion of the program period (1 July, 2008 to 30 June, 2011). Setting: Although Mongolia presently has a low prevalence of HIV, with less than 0.01% of the population infected, it has been estimated that without concerted prevention efforts, between now and 2015 the country's HIV prevalence will double every two years (The Global Fund to Fight AIDS, Tuberculosis and Malaria, 2004). New HIV cases over the past two years have been mostly in youth and rates of transmission of STIs, already very high, continue to increase among youth in Mongolia. To date, most HIV prevention efforts in Mongolia have targeted most-at-risk populations; however, there is a great need for HIV awareness and prevention programs targeting the general population, specifically youth (Mongolian Red Cross Society, 2010). Methods: A post-intervention survey was conducted at project end, 1 July-1 August, 2011, among 712 youth in targeted secondary schools and universities in three districts of Ulaanbaatar, Mongolia to evaluate the impact of the project. The impact of the program was assessed by a post-intervention survey of prevention knowledge, by comparing groups that were exposed to the intervention to groups that were not exposed. Knowledge was assessed through analysis of survey questions about modes of transmission of HIV/AIDS, methods of prevention, and rejection of common misconceptions. Program contribution to target group knowledge levels was assessed through survey responses to the question, "Where do you receive information about HIV/AIDS?" Results: In answer to evaluation Question 1, "What is the difference in HIV/AIDS knowledge between those who were exposed to the HARP intervention and those who were not among youth aged 15-24 in targeted secondary schools and universities in Ulaanbaatar, Mongolia?" results showed a strong positive program effect on identifying all four important modes of transmission of HIV, a week positive program effect on identifying ways of preventing HIV, and a weak negative program effect on rejecting common misconceptions about HIV. The exposed group tended to answer correctly significantly more often than the non-exposed group on identifying important modes of transmission and prevention methods; however, the trend was the opposite when it came to identifying common misconceptions. It appears that the program increased knowledge among the exposed group in identifying modes of transmission and to some extent, prevention methods; but had a negative program effect when it came to rejecting misconceptions. Evaluation Question 2 was "To what extent is HARP the source of HIV/AIDS information among youth aged 15-24 in targeted schools and universities in Ulaanbaatar, Mongolia?" Sixteen percent of respondents directly credited Red Cross as a source of their knowledge about HIV/AIDS, and about 90% of respondents indicated sources of information of which Red Cross may be an indirect source. Conclusions: The impact of the Mongolian Red Cross Society's HIV/AIDS response program on HIV/AIDS knowledge among students in targeted secondary schools and universities in Ulaanbaatar, Mongolia ranged from strong positive program effects in some areas to weak negative program effects in other areas. The program appears to have increased knowledge in the exposed group in terms of correct identification of unsafe behaviors that increase risk of HIV acquisition, and to some extent in terms of identifying effective ways of preventing transmission. Why the exposed group incorrectly identified some safe behaviors as unsafe is unclear. Perhaps the intervention emphasized providing knowledge of unsafe behaviors, but did not explicitly explain that other behaviors were safe. Alternatively, Evaluation Question 1 or the format for soliciting or recording answers to Question 1 may have lacked clarity
Survey of non-dental providers' assessment and management of xerostomia in patients with mental health disorders by Nicole Murray( file )
1 edition published in 2012 in English and held by 2 libraries worldwide
Introduction: Approximately 26% American adults suffer from a diagnosable mental disorder, and 6% of the population suffers from a severe mental illness. Individuals with mental health disorders often have poor oral health, which may be exacerbated by rich diets, heavy tobacco use, and difficulty in accessing care. In addition, medications used to treat mental health disorders have side effects that can be detrimental to the tissues of the oral cavity. Xerostomia (dry mouth) is reported to affect one-fifth of patients taking antidepressants, with presence and severity of xerostomia positively correlated with the number of medications taken. It is unclear if possible xerogenic side effects are discussed with patients by healthcare providers prior to beginning treatment in the medical care setting. The purpose of this study is to survey prescribing healthcare providers to determine what non-dental providers know about xerostomia and to examine what information about potential side effects, if any, these practitioners provide patients before beginning pharmacological treatment for mental illnesses. Methods: Representative samples of health care providers in King County, Washington (125 primary care physicians, 50 nurse practitioners, and 75 psychiatrists) were mailed a 31-question survey. Participants were asked about their prescribing practices, knowledge about oral health side effects of medications, consideration of oral health side effects when prescribing psychotropic medications, and frequency of assessing patients' oral health. Responses were summarized in each area with regard to oral health knowledge and willingness to assess patients' oral health. <bold>Results</bold>: The response rate to this survey was 40%: 101 total responses, with 45 primary care physicians, 20 nurse practitioners, and 36 psychiatrists responding. The average age of responders was 56.7 years, with an average of 24.6 years within their profession. The majority of providers (90%) reported they evaluated oral health by "appearance of teeth," but what specifically is evaluated is unclear because far fewer providers reported assessing missing teeth, presence of plaque or calculus, looseness of teeth, or saliva consistency. Providers were less likely to assess the oral health of their patients being treated for a mental illness than those without. In addition, while 91.6% of providers reported that they have at least some patients who report xerostomia, knowledge of recommended treatments for dry mouth symptoms appears to be lacking. Discussion: This survey illustrates the complexities of treating patients and managing adverse medication side effects. While this survey identifies gaps in oral health treatment in the non-dental setting for patients with mental health conditions, future studies are needed about the specific barriers to providing adequate oral health recommendations to patients with mental illness, for this vulnerable population is in great need for holistic medical care, including dental care. Ultimately, improved provider management of oral needs would allow for not only an improvement of oral health (e.g. reduction in caries, periodontal disease) but also larger issues, such as improved quality of life and improved management of comorbid chronic conditions
Extending the hours of a pediatric emergency department's fast track clinic into night shift did not decrease the aggregate length of stay or the length of stay of high acuity patients on night shift by Erete S Bloom( file )
1 edition published in 2012 in English and held by 1 library worldwide
This study set out to see if extending the hours of the pediatric fast track clinic through the first half of night shift in a dedicated pediatric emergency department decreased the Length of Stay (LOS) of all the patients seen on night shift (termed aggregate LOS) and of the high acuity patients seen on night shift. This study was conducted in a pediatric hospital run by Multicare Health System in Tacoma, WA. The study was designed as a pre/post-intervention with a comparison to a similar time period the previous year. The intervention was the extension of the hours of Child Express clinic into night shift that started November 1, 2005. The pre/post intervention periods were from October 1 to October 31 and from November 1 to December 2, 2005, respectively, and for the same periods in the previous comparison year (2004). Linear regression was used to determine whether there were observable differences in mean length of stay adjusting for differential inpatient admit rates between pre and post assessment periods using a historical comparison control. Mean length of stay was found to be 2.1 hours in the post intervention (Child Express) period relative to 2.32 hours in the pre-intervention period. When compared to the 2.2 hours and 2.3 hours in the respective historical periods, the difference in differences was found to be .22 hours, or 7.2 minutes (95% CI 0.84, and 1.1, p = 0.37). Extending the hours of the fast track clinic into night shift was not associated with a difference in aggregate LOS or the LOS of high acuity patients on night shift. This is consistent with previous findings. Additional factors likely influence the throughput of a pediatric emergency department beyond simply reducing the volume of low acuity patients in the main emergency room
Evaluation of a quality improvement intervention for anesthetic management of acute ischemic stroke patients undergoing endovascular therapy by Jen-Ting Yang( file )
1 edition published in 2016 in English and held by 1 library worldwide
BACKGROUNDS: For acute ischemic stroke (AIS) cases receiving endovascular therapy (EVT), the use of general anesthesia (GA), physiological perturbations, and delays in the institution of EVT adversely impact the outcomes. In 2012, a quality improvement (QI) intervention utilizing PDSA (Plan-Do-Study-Act) model was implemented at Harborview Medical Center (HMC) aiming at minimizing delays for EVT, encouraging the use of monitored anesthesia care (as opposed to the routine use of general anesthesia) and avoiding physiologic perturbations under anesthesia, to improve neurological outcomes of the patients. The objective of this project is to evaluate the effectiveness of the QI intervention quantitatively. METHODS: This is a retrospective pre-post interventional study. The study period was separated into pre-intervention period (Jan 2008 to May 2012), QI intervention roll-out period (Jun 2012 to Nov 2012, the first six months of implementation), and post-intervention period (Dec 2012 to Aug 15th, 2015.) Patient characteristics, choice of anesthetic technique (general anesthesia or monitored anesthesia care), arterial line placement rate, timeliness indicators, intra-procedural physiological parameters, and clinical outcomes were collected and compared between pre-intervention and post-intervention phases. Multi-level generalized estimating equation models were used to estimate the clinical impacts. RESULTS: Data from 78 patients from pre-intervention phase and 43 patients from post-intervention phase were compared. The use of general anesthesia decreased from 97.4% to 72.1% (p<0.0005). The use of arterial catheter decreased from 75.6% to 39.5% (p<0.0005). The median anesthesia-ready time decreased from 14 to 12 minutes (p=0.007). The median door-to-puncture time decreased from 111 to 82 minutes (p=0.02). The prevalence of intra-procedural relative hypotension (non-invasive SBP below the recommended 140mmHg) decreased from 100% to 90.7% (p=0.006). No significant decreases in respiratory parameters were identified (EtCO2>40 mmHg, EtCO2<30 mmHg, SpO2<92%). The subjects in post-intervention phase had lower in-hospital all-cause mortality, (adjusted OR 0.67 [0.55-0.80]; p<0.0005), higher likelihood of favorable neurologic outcome (mRS≤2, adjusted OR 1.27 [0.42-3.8]; p=0.67) and favorable discharge disposition (adjusted OR 1.57 [0.88-2.8]; p=0.13), shorter hospital stay (adjusted IRR 0.79 [0.51-1.19]; p=0.25) and ICU stay (adjusted IRR 0.61 [0.51-1.19]; p=0.25). DISCUSSION: The QI intervention utilizing interdisciplinary “PDSA” model effectively changed physician decision-making for anesthesia technique choice and was significantly associated with less delay to treatment, less relative hypotension, and better survival
Jtpa Evaluation at the State and Local Level. Volume Viii: Mis Issues in Evaluating Jtpa by David Grembowski( Book )
1 edition published in 1986 in English and held by 1 library worldwide
This guide is intended to assist states and service delivery areas (SDAs) in addressing the new oversight responsibilities and opportunities stipulated by the Job Training Partnership Act (jtpa) with respect to management information system (mis) issues in evaluating jtpa programs. The first chapter discusses the general requirements of a jtpa mis to support evaluation (communications capability, data processing flexibility, skilled staff, statistical software, and a decentralized mis structure) and contains a supplemental data dictionary (containing participant master, service, and follow-up files and employer and subcontractor master files). The second chapter covers the following six steps in handling survey data: preparing a codebook, preparing data for entry, coding, entering data, using a computer to edit, and analyzing data. A supplement dealing with employer reports concludes the second chapter. The third chapter deals with the following aspects of using statistical software: file preparation for using statistical software, statistical software for microcomputers, and procedures for using statistical software. A supplemental demonstration of statistical software concludes the guide. (Mn)
A post-conflict assessment of breast cancer in Kuwait using mixed methods by Charles William Cange( file )
1 edition published in 2013 in English and held by 1 library worldwide
The Gulf War oil well fires lasted over eight months in 1991. The subsequent environmental contamination has had real, yet poorly documented impacts, on Kuwait health. The chemical fallout from the war makes it a unique case study of conflict, environmental degradation and health. The life course approach serves as the conceptual basis for this dissertation. By developing a modified ethnographic approach suitable for Kuwait, I was able to collect and procure qualitative and quantitative data in a site-specific, systematic manner. From the cancer registry data, we notice a significant shift in breast cancer rates which began around 1999, increases 7-10 additional cases/100,000, and continues until present. Leukemia and thyroid cancers are also increasing more rapidly than in other Arab countries not affected by the war. From the clinical case-control study, we identified an association between stress and the appearance of breast cancer in Kuwaiti women. Also, women who self-identified as trauma victims were more likely to have breast cancer than healthy women. From the qualitative study, we learn about the environmental health community's concerns around breast cancer. One woman stated that "it's like the flu ... every family has it." Since the late 1990s breast cancer has become a common occurrence in Kuwaiti households. Many of the participants felt that their voices had not been heard by the government. In fact, they felt that the government was actively downplaying the role of the residual Gulf War pollution on the development of cancer in Kuwait. It is suggested that the government carry out further monitoring and surveillance of leukemia and breast cancer in Kuwait in addition to executing a full clean-up of the Kuwaiti desert
Jtpa Evaluation at the State and Local Level. Volume Iii: A Guide for Process Evaluations by David Grembowski( Book )
1 edition published in 1986 in English and held by 1 library worldwide
This guide is intended to assist states and service delivery areas (SDAs) in addressing the new oversight responsibilities and opportunities stipulated by the Job Training Partnership Act (jtpa) with respect to process evaluation. The first chapter provides an overview of the jtpa organizational system. Discussed next is the relationship among environment, governance, and the performance control system. The next four chapters deal with how to examine JTPA's mission, work, coordination, and social components. The final chapter covers interpreting findings. Appendixes include a jtpa implementation strategy and an explanation of why service delivery areas (SDAs) subcontract. A supplement entitled "Some Process Issues at the State Level" examines approaches to and methods of process evaluation. Appendixes to the supplement include discussions of the statewide jtpa service delivery system and cost-effectiveness analysis in an employment and training program. (Mn)
An ecological perspective of crime and handgun purchase rates in the urban environment by David Grembowski( Archival Material )
1 edition published in 1975 in English and held by 1 library worldwide
Assessing variation in personal health service delivery and workplace smoking ban enforcement by local health departments by Jeremy W Snider( file )
1 edition published in 2016 in English and held by 1 library worldwide
Local Health Department (LHD) services play a crucial role in driving community health outcomes. However, LHDs face critical decisions, in times of budget and staffing shortfalls, around how essential public health services should be delivered. This dissertation describes variation in how LHDs are delivering services, and how other safety net providers, such as Federally-Qualified Health Centers (FQHCs), may be allowing LHDs to move their service portfolio away from clinical services and towards population-focused activities that they are uniquely suited to provide in their communities. This dissertation examines: 1) if higher volume of services provided by FQHCs was associated with discontinuation or absence of LHD clinical services; 2) if variation in FQHC and LHD service delivery was associated with differences in individual health access outcomes; and 3) whether variation in LHD enforcement of the Washington State Clean Indoor Air Act was associated with conditions which could be attributable to workplace smoking exposure. In the first paper of this dissertation, I found that LHDs are less likely to provide certain clinical services where FQHCs provide a greater volume of services, suggesting a substitution effect. However, there are clinical services, such as prenatal care, where the effect was not seen, that may complement a public health mission – and LHDs may be strategically placed to continue delivering these services. In the second paper, I observed a significantly higher likelihood of individuals reporting more positive health access outcomes where FQHC primary care service volumes were high, which suggests that intensive allocation of FQHC resources in a community is associated with improved health care access. In the third paper, I found that half of Washington State LHDs, mainly in rural jurisdictions, are not conducting state-mandated enforcement efforts. The presence of enforcement activities shows directional, but not statistically significant associations with lower WEA prevalence among individuals in a jurisdiction. As both inspection and violations exhibit similar effect magnitude, this suggests that responding to violations may be a cost-effective enforcement strategy. This dissertation examines how LHD service provision decisions are linked to partners in their community, and drive health and health care access. It offers guidance for LHDs in transforming their portfolio of activities so they can provide effective, population-focused services
Ill the practice of health program evaluation by David Grembowski( Book )
1 edition published in 2000 in English and held by 1 library worldwide
The Parctice of health program evaluaion by David Grembowski( Book )
1 edition published in 2001 in English and held by 1 library worldwide
Continuity of care in older adults with multiple chronic conditions by Lindsay L.Y White( file )
1 edition published in 2016 in English and held by 1 library worldwide
Nearly three out of four people over 65 years of age in the United States (U.S.), or greater than 35 million older adults, have two or more chronic conditions. People with multiple chronic conditions (MCCs) pose a significant challenge to the health care system because they are at greater risk for morbidity and mortality, utilize more health care services, and are vulnerable to poor quality care. Despite their considerable needs, this patient population is often excluded from clinical and health services research. Thus, the evidence base for best practices of care for this population is lacking, which contributes to poor outcomes of care. Continuity of care (COC) is an important process of care that prior studies have shown is associated with greater patient satisfaction, fewer emergency department (ED) visits and hospitalizations, a reduced risk of mortality, and lower costs of care in older adults. Studies specifically examining patients with MCCs have also demonstrated associations between higher COC and fewer duplicated medications, fewer ED visits and hospitalizations, and a lower risk of death. Thus, COC is a recommended component of high quality care for patients with MCCs. There are, however, a number of limitations to the current COC literature for older adults with MCCs. Although patients with MCCs would seem to be particularly vulnerable to care fragmentation, the association between morbidity burden and COC has not been explored. Also missing from the literature are studies exploring the relationships between COC and patient-reported measures of health status. Another shortcoming is the limited exploration of provider type in COC studies. Finally, differences in benefits conferred by continuity with an individual provider as compared with a medical practice are unclear. In this dissertation, I aim to fill the gaps in the COC literature by testing: 1) whether there is an association between morbidity burden and COC at the provider and practice-level among older adults who primarily saw a PCP and older adults who primarily saw a specialist for their medical care; 2) whether there is an association between provider and practice-level COC and functional status in a population of older adults with MCCs, and whether any observed associations were moderated by the type of provider the patient primarily saw for their health care visits; and 3) whether there is an association between provider and practice-level COC and health care expenditures in a population of older adults with MCCs, and whether any observed associations were moderated by the type of provider the patient primarily saw for their health care visits. In the first study of this dissertation, I found that multimorbidity is an independent risk factor for lower COC. The magnitude of the association was such that people with high levels of morbidity burden would be expected to experience a decrease in continuity that was clinically meaningful, and could impact their clinical outcomes. In the second study, I found that neither provider nor practice-level continuity was significantly associated with functional status decline. However, in subgroup analyses, I observed that specialty care continuity was significantly associated with a lower odds of functional status decline among patients seeing primarily a specialty care provider. Finally, in the third study, I found a significant association between higher continuity and lower expenditures that was irrespective of provider type and provider or practice levels. Results also suggested the lower costs may have arisen from lower rates of emergency department visits and hospitalizations among those with higher COC. Our findings lend further support for the value of COC, a process of care that should be encouraged, particularly among high morbidity patients who are at risk of greater care fragmentation. They also provide insight into the possible effects of delivery system reform efforts that emphasize COC. Our results suggest that COC may provide benefits in terms of costs and utilization, though not necessarily patient-reported health outcomes. They also suggest that emphases on different levels of continuity might not produce appreciable differences in terms of lowered costs, but differences may arise for patient-reported health outcomes. Finally, they indicate the importance of provider type considerations when thinking about care continuity
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Grembowski, David Emil
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