Marcia M Ward

Marcia M Ward
University of Iowa | UI · College of Public Health

PhD

About

205
Publications
29,290
Reads
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5,606
Citations
Additional affiliations
September 1973 - August 1978
The Ohio State University
Position
  • Research Assistant
August 1978 - August 1997
SRI International
Position
  • Senior Research Consultant
August 1997 - present
University of Iowa
Position
  • Professor (Full)
Education
September 1973 - June 1981
The Ohio State University
Field of study
  • Clinical Psychology

Publications

Publications (205)
Article
Background: As the COVID-19 public health emergency (PHE) altered delivery of health care, alternate forms of health care delivery were adopted. The usage of telehealth expanded during the PHE to reduce exposure to COVID-19, which provides the opportunity to understand how expanded telehealth access affected costs of care. The objective of this wor...
Article
Full-text available
The purpose of this descriptive analysis is to compare patient and encounter characteristics in rural patients who received telehealth versus in-person behavioral health treatment. This study, including over 11,000 rural patients and nearly 35,000 patient encounters, used a non-randomized prospective research design involving two active usual-care...
Article
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 t...
Preprint
Objective: Sepsis is a leading cause of hospitalization and death in the United States, and rural patients are at particularly high risk. Telehealth has been proposed as one strategy to narrow rural-urban disparities. The objective of this study was to understand why staff use provider-to-provider telehealth in rural emergency departments (tele-ED)...
Article
Introduction The COVID-19 public health emergency led to an unprecedented rapid increase in telehealth use, but the role of telehealth in reducing disparities in access to care has been questioned. The objective of this study was to conduct a systematic review to summarize the available evidence on how telehealth during the COVID-19 pandemic was as...
Article
Background: Chronic health diseases such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM) affect 6 in 10 Americans and contribute to 90% of the $4.1 trillion health care expenditures. The objective of this study was to measure the effect of clinical video telehealth (CVT) on health care uti...
Article
Our objective was to evaluate clinical effectiveness and utilization associated with telehealth for clinical management of mental health and SUD and to identify emerging patterns for underrepresented groups stratified by race/ethnicity, gender, age, rural status, insurance, sexual minorities, and social vulnerability that would suggest health inequ...
Article
The COVID-19 public health emergency (PHE) necessitated a profound change in the delivery of healthcare services. With a highly infectious virus, telehealth use was expanded to reduce the risk of transmission and improve access to care. The sudden uptake in telehealth provided a natural experiment to assess not only the acceptability of this techno...
Article
The objective of this paper was to summarize the available evidence on how telehealth access and utilization changed for minority groups during the COVID-19 public health emergency. We planned to complete this objective by conducting a systematic review, with a focus on health equity. Our secondary objective was to understand which dimensions of mi...
Article
Our objective was to evaluate clinical effectiveness and utilization associated with telehealth for clinical management of mental health and SUD and to identify emerging patterns for underrepresented groups stratified by race/ethnicity, gender, age, rural status, insurance, sexual minorities, and social vulnerability that would suggest health inequ...
Article
The objective of this paper was to summarize the available evidence on how telehealth access and utilization changed for minority groups during the COVID-19 public health emergency. We planned to complete this objective by conducting a systematic review, with a focus on health equity. Our secondary objective was to understand which dimensions of mi...
Article
The COVID-19 public health emergency (PHE) necessitated a profound change in the delivery of healthcare services. With a highly infectious virus, telehealth use was expanded to reduce the risk of transmission and improve access to care. The sudden uptake in telehealth provided a natural experiment to assess not only the acceptability of this techno...
Article
The objective of this paper was to summarize the available evidence on how telehealth access and utilization changed for minority groups during the COVID-19 public health emergency. We planned to complete this objective by conducting a systematic review, with a focus on health equity. Our secondary objective was to understand which dimensions of mi...
Article
Our objective was to evaluate clinical effectiveness and utilization associated with telehealth for clinical management of mental health and SUD and to identify emerging patterns for underrepresented groups stratified by race/ethnicity, gender, age, rural status, insurance, sexual minorities, and social vulnerability that would suggest health inequ...
Article
Our objective was to evaluate clinical effectiveness and utilization associated with telehealth for clinical management of mental health and SUD and to identify emerging patterns for underrepresented groups stratified by race/ethnicity, gender, age, rural status, insurance, sexual minorities, and social vulnerability that would suggest health inequ...
Article
The COVID-19 public health emergency (PHE) necessitated a profound change in the delivery of healthcare services. With a highly infectious virus, telehealth use was expanded to reduce the risk of transmission and improve access to care. The sudden uptake in telehealth provided a natural experiment to assess not only the acceptability of this techno...
Article
The objective of this paper was to summarize the available evidence on how telehealth access and utilization changed for minority groups during the COVID-19 public health emergency. We planned to complete this objective by conducting a systematic review, with a focus on health equity. Our secondary objective was to understand which dimensions of mi...
Article
The COVID-19 public health emergency (PHE) necessitated a profound change in the delivery of healthcare services. With a highly infectious virus, telehealth use was expanded to reduce the risk of transmission and improve access to care. The sudden uptake in telehealth provided a natural experiment to assess not only the acceptability of this techno...
Article
Background Telehealth has been proposed as one strategy to improve the quality of time‐sensitive sepsis care in rural emergency departments (EDs). The purpose of this study was to measure the association between telehealth‐supplemented ED (tele‐ED) care, healthcare costs, and clinical outcomes among patients with sepsis in rural EDs. Methods Cohor...
Article
Home health care has a significant role in the care of Medicare beneficiaries. Certificate of Need (CON) laws for home health agencies limit their number in affected states. This study’s objective was to evaluate the association of CON laws with the availability and service utilization of urban and rural home health agencies in CON states and non-C...
Article
Background: Treatment crossovers occur when one mode of treatment is begun and then a different mode of treatment is utilized. Treatment crossovers are frequently examined in randomized controlled trials, but have been rarely noted or quantitatively evaluated in usual care treatment studies. The purpose of this analysis is to examine the extent of...
Article
Full-text available
Background The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that wer...
Preprint
Purpose Provider-to-provider emergency department telehealth (tele-ED) has been proposed to improve rural sepsis care. The objective of this study was to measure the association between sepsis documentation and tele-ED use, treatment guideline adherence, and mortality. Materials and Methods This analysis was a multicenter (n=23) cohort study of se...
Article
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....
Article
Background The high prevalence of chronic diseases, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM), accounts for a large burden of cost and poor health outcomes in US hospitals, and home telehealth (HT) monitoring has been proposed to improve outcomes.Objective To measure the assoc...
Article
Background: Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care...
Article
Full-text available
Background: A mental health crisis can create challenges for individuals, families, and communities. This multifaceted issue often involves different professionals from law enforcement and health care systems, which may lead to siloed and suboptimal care. The virtual crisis care (VCC) program was developed to provide rural law enforcement with acc...
Preprint
BACKGROUND The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that wer...
Article
Introduction: Telepsychiatry consultation for rural providers may help address local staffing needs while ensuring timely and appropriate care from behavioral health experts. The purpose of this study was to assess the implementation of a telepsychiatry consultation service within medical and psychiatry inpatient units of hospitals serving predomin...
Article
Full-text available
Background This study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementat...
Article
Telehealth can expand and enhance access to school-based health care, but its use has been relatively limited. Recognizing that school-based health care is still not reaching many students, the Health Resources and Services Administration (HRSA) funded the School Based Telehealth Network Grant Program to expand telehealth in rural school-based sett...
Article
Purpose: Access to adequate dental services is limited for children in rural communities in the United States.The purpose of this paper was to describe how two school-based teledentistry programs increased access to oral health services for children and adolescents living in rural areas.Methods: The School-Based Telehealth Network Grant Program (SB...
Article
Background: School-based health services, particularly those available to underserved and rural communities, remain in high demand. Advancements in telehealth services present clinical resources otherwise typically unavailable to students from rural communities. Methods: Data were collected during 4 semesters on all students receiving primary care...
Preprint
BACKGROUND A mental health crisis can create challenges for individuals, families, and communities. This multifaceted issue often involves different professionals from law enforcement and health care systems, which may lead to siloed and suboptimal care. The virtual crisis care (VCC) program was developed to provide rural law enforcement with acces...
Article
Full-text available
Background Telehealth studies have highlighted the positive benefits of having the service in rural areas. However, there is evidence of limited adoption and utilization. Our objective was to evaluate this gap by exploring U.S. healthcare systems’ experience in implementing telehealth services in rural hospital emergency departments (TeleED) and by...
Preprint
Full-text available
Background This study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementat...
Preprint
Objective To test the hypothesis that provider-to-provider tele-emergency department (tele-ED) care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments (EDs). Methods Multicenter (n=23), propensity-matched, cohort study using medical records of sepsis pat...
Article
Background Due to limited community resources for mental health and long travel distances, emergency departments (EDs) serve as the safety net for many rural residents facing crisis mental health care. In 2019, The Leona M. and Harry B. Helmsley Charitable Trust funded a project to establish and implement an ED-based telepsychiatry service for pati...
Article
Aim: Sepsis is a top contributor to in-hospital mortality and, healthcare expenditures and telehealth have been shown to improve short-term sepsis care in rural hospitals. This study will evaluate the effect of provider-to-provider video telehealth in rural emergency departments (EDs) on healthcare costs and long-term outcomes for sepsis patients....
Article
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 r...
Article
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...
Article
Implementation processes are often long and complex, requiring sustained facilitation efforts. Drawing on organizational and implementation literature, we examined the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME) and team continuity (CONTINUITY) on sustainment of internal f...
Article
Sepsis is a life-threatening infection that affects over 1.7 million Americans annually. Low-volume rural hospitals have worse sepsis outcomes, and emergency department (ED)-based telemedicine (tele-ED) has been one promising strategy for improving rural sepsis care. The objective of this study is to evaluate the impact of tele-ED consultation on s...
Article
Full-text available
Background The Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy (FORHP) funded the Evidence-Based Tele-Emergency Network Grant Program (EB TNGP) to serve the dual purpose of providing telehealth services in rural emergency departments (teleED) and systematically collecting data to inform the telehealth evid...
Article
Background Patients with rectal cancer treated at specialized or high-volume hospitals have better outcomes, but a minority of these patients are treated there. Physician recommendations are important considerations for patients with rectal cancer when making treatment decisions, yet little is known about the factors that affect these physician ref...
Article
Objective: This analysis identified the rate of transfers and averted transfers and their associated costs across multiple emergency department telemedicine (teleED) networks. Methods: This study is a prospective cohort analysis in six teleED networks operating in 65 hospitals in 11 states across the United States. Each submitted uniform data on a...
Article
Background: The low volume and the intermittent nature of serious emergencies presenting to rural emergency departments (EDs) make it difficult to plan and deliver pertinent professional training. Telemedicine provides multiple avenues for training rural ED clinicians. This study examines how telemedicine contributes to professional training in rur...
Technical Report
Key Findings • Candidate measures were identified through an extensive published and grey literature review and search of key organizations’ existing measures. • The resulting inventory was subjected to three rounds of scoring by the research team, external experts, and grantees. • The final set of 9 measures were operationalized into 26 data eleme...
Article
Background Timely diagnosis of pediatric sepsis remains elusive. We estimated the risk of potentially missed pediatric sepsis in US emergency departments (EDs) and determined factors associated with its occurrence. Methods In a retrospective study of linked inpatient and ED records from four states using administrative data (excluding 40% with mis...
Article
Introduction: Acute myocardial infarction (AMI) is a time-sensitive condition. Meeting guideline-recommended time metrics for these patients can be challenging in rural emergency departments (EDs). Telemedicine has been shown to improve the quality and timeliness of emergency care in rural areas. The objective of this study was to evaluate the impa...
Article
Introduction: Sepsis is a life-threatening emergency. Together, early recognition and intervention decreases mortality. Protocol-based resuscitation in the emergency department (ED) has improved survival in sepsis patients, but guideline-adherent care is less common in low-volume EDs. This study examined the association between provider-to-provide...
Article
Introduction: Challenges accessing behavioural health services in rural and underserved areas are compounded by severe shortages of behavioural health specialists, and difficulties placing patients. Tele-emergency (tele-ED) behavioural health is a promising solution for enhancing access to specialists and assisting in patient placement. This paper...
Article
Introduction: Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (a) identify the impact of telemedicine on emergency department (ED) stroke care, (b) identify if telemedicine impact vari...
Article
Objective: To determine factors associated with rectal cancer surgery performed at high-volume hospitals (HVHs) and by high-volume surgeons (HVSs), including the roles of rurality and diagnostic colonoscopy provider characteristics. Summary of background data: Although higher-volume hospitals/surgeons often achieve superior surgical outcomes, ma...
Article
Objective The purpose of this study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt. Methods Retrospective propensity-matched cohort study of patients treated for suicidal attempt and ideatio...
Article
Purpose To study the relationship between the availability and activation of emergency department‐based telemedicine (teleED) and patient disposition in Critical Access Hospitals (CAHs). Methods A non randomized stepped wedge design examined 133,396 ED visits in 15 CAHs that subscribe to a single teleED provider. Data were available for at least 1...
Article
Full-text available
Introduction: Tele-emergency models have been utilized for decades, with growing evidence of their effectiveness. Due to the variety of tele-emergency department (tele-ED) models used in practice, however, it is challenging to build standardized metrics for ongoing evaluation. This study describes two tele-ED programs, one specialized and one gene...
Article
Full-text available
Background Cancer survival rates in adolescents and young adults (AYAs) have shown slow improvements in comparison with other age groups, and this may be due to lower participation in clinical trials. Little evidence has been provided regarding how nonmetropolitan residence may influence clinical trial enrollment for AYAs with cancer. This study so...
Article
There is a chronic shortage of physicians to cover emergency departments (EDs) in critical access hospitals. A 2013 memorandum from the Centers for Medicare and Medicaid Services clarified that a telemedicine physician could fulfill the regulatory requirements for physician backup when advanced practice providers were at telemedicine-equipped criti...
Article
Background Current literature suggests surgeons who perform large volumes of rectal cancer resections achieve superior outcomes, but only about half of rectal cancer resections are performed by high-volume surgeons in comprehensive hospitals. Little is known about the considerations of patients with rectal cancer when deciding where to receive surg...
Article
Aims: To examine how the process of change prescribed in Kotter's change model applies in implementing team huddles, and to assess the impact of the execution of early change phases on change success in later phases. Background: Kotter's model can help to guide hospital leaders to implement change and potentially to improve success rates. Howeve...
Article
Background: Implementation models, frameworks, and theories recognize the importance of activities that facilitate implementation success. However, little is known about internal facilitation activities that hospital personnel engage in during implementation efforts. Purpose: The aim of the study was to examine internal facilitation activities a...
Article
Background: Meeting time goals for patients with time-sensitive conditions can be challenging in rural emergency departments (EDs), and adopting policies is critical. ED-based telemedicine has been proposed to improve quality and timeliness of care in rural EDs. Introduction: The objective of this study was to test the hypothesis that diagnostic...
Article
835 Background: Current literature suggests surgeons and hospitals that perform large volumes of rectal cancer care achieve superior outcomes, but only about half of rectal cancer resections are performed by high-volume surgeons in comprehensive hospitals. Little is known about considerations of patients with rectal cancer when deciding where to re...
Article
808 Background: Hospitals that perform high volumes of rectal cancer resections achieve superior rates of sphincter preservation and survival compared to those that do not, but many rectal cancer resections are still performed in low-volume centers. We aimed to determine the patient, provider and pathway characteristics associated with receipt of s...
Article
Background: Emergency department (ED)-based telemedicine has been implemented in many rural hospitals to provide specialty care and expertise to patients with critical time-sensitive conditions. Introduction: The purpose of this study was to measure the impact of ED-based telemedicine on timeliness of care in participating rural hospitals. Mate...
Article
Background: Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes. Objectives: This study was conducted to describe the effect of telemedicine on management and clinical outcomes for trauma patients in North Dakota. Methods: Cohort study of adult (age ≥18 ye...
Article
Full-text available
Introduction Tele-emergency can address several challenges facing emergency departments in rural areas. The purpose of this paper is to (a) examine the rates of avoided transfers in rural emergency departments that adopted tele-emergency applications; and (b) estimate the costs and benefits of using tele-emergency to avoid transfers. Methods Analy...
Article
Background: To enhance the quality of emergency department (ED) care, some rural hospitals have adopted the use of telemedicine (tele-ED). Without a common set of metrics, it is difficult to quantify the impact of this technology. Introduction: To address this limitation, the Health Resources and Services Administration funded the identification...
Article
Background: A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are re...
Article
Full-text available
Facilitating team development is challenging, yet critical for ongoing improvement across healthcare settings. The purpose of this exemplary case study is to examine the role of nurse leaders in facilitating the development of a high-performing Change Team in implementing a patient safety initiative (TeamSTEPPs) using the Tuckman Model of Group Dev...
Article
Full-text available
Implementation of handoff as part of TeamSTEPPS initiatives for improving shift-change communication is examined via qualitative analysis of on-site interviews and process observations in 8 critical access hospitals. Comparing implementation attributes and handoff performance across hospitals shows that the purpose of implementation did not differe...
Article
Objectives Traumatic injury is a leading cause of death in the United States, and rural populations are at increased risk of injury and death. Rural residents have limited access to trauma care, and telemedicine has been proposed as one strategy to improve the provision of trauma care locally. The objective of this study was to describe patient‐lev...
Article
Objective: To identify factors associated with rural sepsis patients' bypassing rural emergency departments to seek emergency care in larger hospitals, and to measure the association between rural hospital bypass and sepsis survival. Design: Observational cohort study. Setting: Emergency departments of a rural Midwestern state. Patients: All...
Article
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 od...
Article
Small and rural hospitals face special challenges to implement and sustain organization-wide quality improvement (QI) initiatives due to limited resources and infrastructures. We studied the implementation of TeamSTEPPS, a national QI initiative, in 14 critical access hospitals. Drawing on QI and organization development theories, we propose five s...
Article
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 Database...
Article
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...
Article
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 el...
Article
In this policy brief we describe the types and volume of major surgical services provided in the inpatient and outpatient settings of Critical Access Hospitals (CAHs) in 2011. Major surgical services are those procedures that require use of an operating room (OR), regardless of whether the procedure was inpatient or outpatient. Key Findings (1) CAH...
Article
Tele-emergency is an expanding telehealth service that provides real-time audio/visual consultation delivered by an emergency medicine team to a remote, often rural, emergency department (ED). Financial analyses of tele-emergency in the literature are limited. This article expands the tele-emergency literature to describe the business case for tele...
Article
Full-text available
Implementation of TeamSTEPPS for improving patient safety is examined via descriptive qualitative analysis of semistructured interviews with 21 informants at 12 hospitals. Implementation approaches fit 3 strategies: top-down, bottom-up, and combination. The top-down approach failed to develop enough commitment to spread implementation. The bottom-u...
Article
Tele-emergency provides audio/visual communication between a central emergency care centre (tele-emergency hub) and a distant emergency department (remote ED) for real-time emergency care consultation. The purpose of this mixed methods study is to examine how often tele-emergency is activated in usual practice and in what circumstances it is used....
Article
Purpose: Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is being widely promoted in healthcare settings to train staff in evidence-based approaches that promote patient safety. It involves a comprehensive curriculum that spells out key principles and actionable tools for a culture change toward patient-safety-focu...
Article
Telemedicine (also known as telehealth) is a means to increase access to care, one of the foundations of the Triple Aim. However, the expansion of telemedicine services in the United States has been relatively slow. We previously examined the extent of uptake of hospital based telemedicine using the 2013 HIMSS (Healthcare Information and Management...
Article
Introduction: Telemedicine is designed to increase access to specialist care, especially in settings distant from tertiary-care centers. One of the more established telemedicine applications in hospitals is the tele-intensive care unit (tele-ICU). Perceptions of tele-ICU users are not well studied. Thus, we undertook a study focused on assessing s...