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Core Competencies For Clinical Supervisors, David Kalman, Stephanie Rodrigues

Stephanie Rodrigues

This chapter provides useful strategies that will help guide clinical supervisors who oversee and support the work of MISSION-VET Case Managers and Peer Support Specialists. It includes an overview of the MISSION-VET supervisor’s role and a description of each team member’s primary area of responsibility within the MISSION-VET program. The remainder of the chapter describes key strategies that MISSION-VET supervisors will need in order to establish productive working relationships with MISSION Case Managers and Peer Support Specialists. These strategies, which are designed to foster a strong supervisory alliance and assure that services are being delivered with fidelity to the MISSION-VET …

Physician Incentives: Managed Care And Ethics, Douglas A. Mains, Alberto Coustasse, Kristine Lykens

Alberto Coustasse, DrPH, MD, MBA, MPH

The authors review the principle features of the managed care system in an effort to understand the ethical assumptions inherent in managed care. The interrelationships among physician incentives, responsibilities of patients and the physician-patient relationship are examined in light of the ethical concerns identified in the managed care system. The managed care system creates ethical tensions for those who influence the allocation of scare resources. Managed care's administrative controls have increasingly changed the doctor-patient relationship to the businessperson-consumer relationship. Managed care goals of quality and access demand that physicians be both patient advocate and organizational advocate, even though these roles …

Judy Savageau And Terri Anderson On Strategies For Strategic Planning To Improve Evaluation, Judith A. Savageau, Teresa Anderson

Judith A. Savageau

Blog post to AEA365, a blog sponsored by the American Evaluation Association (AEA) dedicated to highlighting Hot Tips, Cool Tricks, Rad Resources, and Lessons Learned for evaluators. The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. Evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness.

Michelle Landry And Judy Savageau On No Need To Reinvent The Wheel: Project Management Tools For Your Evaluation Projects, Michelle R. Landry, Judith A. Savageau

Judith A. Savageau

Blog post to AEA365, a blog sponsored by the American Evaluation Association (AEA) dedicated to highlighting Hot Tips, Cool Tricks, Rad Resources, and Lessons Learned for evaluators. The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. Evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness.

Dissemination Of Evidence-Based Atypical Antipsychotic Information To Nursing Homes, Celeste A. Lemay, Jennifer Tjia, Kathleen M. Mazor, Terry S. Field, Abir O. Kanaan, Jennifer L. Donovan, Jerry H. Gurwitz

Jennifer Tjia

Background: Accumulating evidence demonstrates minimal benefit and increased risk of off-label use of atypical antipsychotic medications for dementia-related behaviors. Optimal strategy for disseminating evidence-based guides to nursing home (NH) stakeholders is unclear. Our objective is to describe the impact of differing dissemination efforts in Connecticut NHs.

Methods: Forty-three Connecticut NHs were randomized to one of 3 arms receiving incrementally intensive dissemination strategies of the Agency for Healthcare Research and Quality Comparative Effectiveness Review Summary Guide on the off-label use of atypical antipsychotic drugs, which was included in a toolkit informed by a needs assessment of NHs. All NHs received the …

Reducing Rehospitalizations Through Automated Alerts To Primary Care Providers And Staff When Older Patients Are Discharged From The Hospital: A Randomized Trial, Jerry H. Gurwitz, Terry S. Field, Jessica Ogarek, Jennifer Tjia, Sarah L. Cutrona, Leslie R. Harrold, Jennifer L. Donovan, Abir O. Kanaan, Shawn J. Gagne, Peggy Preusse, Lawrence D. Garber

Jennifer Tjia

Background: Inadequate continuity of care places older patients at very high risk during transitions from the hospital to ambulatory setting.

Methods: We conducted a randomized controlled trial of an HIT-based transitional care intervention in patients aged 65 and older discharged from hospital to home. All patients were senior plan members of a Massachusetts-based health plan, and cared for by a multispecialty medical group using the EpicCare Ambulatory Medical Record. In addition to notifying providers about the patient’s recent transition, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and …

Diabetes Care Trends In The Ma Patient Centered Medical Home Initiative (Ma Pcmhi) At Mid-Point, Sai Cherala, Judith Steinberg, Stephen Baker

Sai Cherala

Background: The MA PCMHI is a multi-payer demonstration involving 45 primary care practices. Thirty-one (31) practices receive additional financial support; all receive technical assistance.

Objectives: To assess data trends in diabetes quality measures from participating adult practices.

Study Design: Quality improvement study utilizing practices’ self-reported data on clinical quality measures. Diabetes measures included blood pressure, LDL cholesterol and hemoglobin A1C control and depression screening.

Methods: Monthly quality data from 38 practices reported June 2011 (baseline) through November 2012 were evaluated. Using a general linear mixed model Analysis of Variance (ANOVA), an overall comparison across time and pair-wise comparisons between times …

Rates Of Insurance For Injured Patients Before And After Health Care Reform In Massachusetts: Another Case Of Double Jeopardy?, Heena P. Santry, Courtney E. Collins, Jason T. Wiseman, Julie M. Flahive, Charles M. Psoinos, Zeling Chau, Shimul A. Shah, Catarina I. Kiefe

Catarina I. Kiefe

Background: As a result of healthcare reform (HCR), insurance rates among Massachusetts (MA) residents increased from 86.6% (2006) to 94.4% (2010) and conferred a 7.6% higher probability of being insured compared to neighboring states. The effect of an individual mandate on insurance rates among trauma patients is unknown.

Methods: This was retrospective analysis of adult (18-64yrs) trauma patients from MA and surrounding states (NH, RI, CT, NY, VT) treated at our level 1 trauma center in central MA before (2004-2005) and after (2009-2010) MA-HCR. We estimated changes in insurance rates across time-periods and state-residence.

Results: Before MA-HCR, 76.7% (1647/2,148) of …

Reducing Rehospitalizations Through Automated Alerts To Primary Care Providers And Staff When Older Patients Are Discharged From The Hospital: A Randomized Trial, Jerry H. Gurwitz, Terry S. Field, Jessica Ogarek, Jennifer Tjia, Sarah L. Cutrona, Leslie R. Harrold, Jennifer L. Donovan, Abir O. Kanaan, Shawn J. Gagne, Peggy Preusse, Lawrence D. Garber

Abir O. Kanaan

Background: Inadequate continuity of care places older patients at very high risk during transitions from the hospital to ambulatory setting.

Methods: We conducted a randomized controlled trial of an HIT-based transitional care intervention in patients aged 65 and older discharged from hospital to home. All patients were senior plan members of a Massachusetts-based health plan, and cared for by a multispecialty medical group using the EpicCare Ambulatory Medical Record. In addition to notifying providers about the patient’s recent transition, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and …

Disparities In Access To Healthcare: The Case Of A Drug And Alcohol Abuse Detoxification Treatment Program Among Minority Groups In A Texas Hospital, Alberto Coustasse, Karan P. Singh, Fernando M. Trevino

Alberto Coustasse, DrPH, MD, MBA, MPH

The authors analyzed ethnic/racial disparities in healthcare access and length of stay from a defined population of individuals seeking medical detoxification services at a hospital in Texas. Results indicated Blacks were more likely to be insured compared with Whites, mostly by public insurance, but this did not hold for Hispanics, who were about three times more likely to be uninsured compared with Blacks. In addition, the authors observed lower median of length of stay in the Medicaid category among Hispanics. These results can be explained by aggressive case management, sociocultural barriers, or discriminatory practices, both intentional and unintentional.

The Case Of South African And Chilean Health Systems: Comparison Of Financial, Economic And Health Indicators, Alberto Coustasse, Peter Hilsenrath, Patricio Silva Rojas

Alberto Coustasse, DrPH, MD, MBA, MPH

The purpose of this study is to identify similarities and differences between healthcare systems of South Africa and Chile. The World Health Report 2000, the Human Development Index, and financial indicators were used for comparison. Chile showed better performance than South Africa in most of the measures used. Significant progress has been made in South Africa, bringing better education, healthcare and housing to the deprived black majority. However, the HIV/AIDS epidemic, weighs heavily on health indicators. Chile decentralized its health services and implemented economic reforms during the 1980's and has had steady improvement in its healthcare indicators. Finally, these counties …

Studies To Reduce Unnecessary Medication Use In Frail Older Adults: A Systematic Review, Jennifer Tjia, Sarah Velten, Carole Parsons, Sruthi Valluri, Becky Briesacher

Jennifer Tjia

BACKGROUND: Overuse of unnecessary medications in frail older adults with limited life expectancy remains an understudied challenge.

OBJECTIVE: To identify intervention studies that reduced use of unnecessary medications in frail older adults. A secondary goal was to identify and review studies focusing on patients approaching end of life. We examined criteria for identifying unnecessary medications, intervention processes for medication reduction, and intervention effectiveness.

METHODS: A systematic review of English articles using MEDLINE, EMBASE, and International Pharmaceutical Abstracts from January 1966 to September 2012. Additional studies were identified by searching bibliographies. Search terms included prescription drugs, drug utilization, hospice or palliative …

Emergency Preparedness And Public Health: The Lessons Of Hurricane Sandy, Tia Powell, Dan Hanfling, Lawrence O. Gostin

Dan Hanfling, M.D.

When Hurricane Sandy hit downtown Manhattan, three neighboring hospitals each made different decisions about when to evacuate. Across the metro region, more than five hospitals and over 20 nursing and assisted living facilities were evacuated, making this the central public health challenge of this calamitous event. It is a familiar story—a super storm comes ashore, infrastructure is overwhelmed, and healthcare facilities evacuate patients, with major delays in returning to normal functioning. Afterwards, policy makers evaluate lessons learned for the next disaster, but similar missteps are often repeated. Although not identical, it is instructive to compare Hurricane Katrina with the still …

Centre Volume And Resource Consumption In Liver Transplantation, Christopher Macomber, Joshua Shaw, Heena Santry, Reza Saidi, Nicolas Jabbour, Jennifer Tseng, Adel Bozorgzadeh, Shimul Shah

Joshua J Shaw

BACKGROUND: Using SRTR/UNOS data, it has previously been shown that increased liver transplant centre volume improves graft and patient survival. In the current era of health care reform and pay for performance, the effects of centre volume on quality, utilization and cost are unknown.

METHODS: Using the UHC database (2009-2010), 63 liver transplant centres were identified that were organized into tertiles based on annual centre case volume and stratified by severity of illness (SOI). Utilization endpoints included hospital and intensive care unit (ICU) length of stay (LOS), cost and in-hospital mortality.

RESULTS: In all, 5130 transplants were identified. Mortality was …

Big Things Come In Bundled Packages: Implications Of Bundled Payment Systems In Health Care Reimbursement Reform, Dennis Delisle, Mhsa, Pmp

Dennis Delisle, Sc.D, FACHE

No abstract provided.