Health Services Administration Commons^™

Leaving Home Care: Decision Making, Risk Scenarios & Services Gaps In The Home Care System, Jacey J. Vaughan, Nina M. Silverstein

Nina Silverstein

Home and community-based services (HCBS) enable older and disabled adults to age-in-place in their homes and communities by helping them function independently for as long as possible (Grabowski et al., 2010; Wong & Silverstein, 2011). Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home (e.g., Walker, 2010; Fox-Grage, Coleman, & Freiman, 2006). Medicaid is a major source of funding for long-term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional care (National Conference of State Legislatures & AARP, 2009), and older adults and their …

Current Research Projects Of The Public Health Pbrn Program, Glen P. Mays

Glen Mays

The Robert Wood Johnson Foundation’s Public Health Practice-Based Research Networks Program supports research on the organization, financing, and delivery of public health services using the infrastructure of practice-based networks (PBRNs). A Public Health PBRN brings multiple public health agencies into collaboration with an academic research partner to design and conduct studies in real-world practice settings. The program supports research through several different mechanisms, including (1) large-scale Research Implementation Awards (RIAs) conducted by established networks; (2) Quick-Strike Research Fund (QSRF) awards that support short-term, time-sensitive studies on emerging issues; and (3) supplemental Research Acceleration and Capacity Expansion (RACE) awards designed to …

Driving Qi With Research: Findings From Public Health Pbrns, Glen Mays

Glen Mays

Public health agencies are increasingly experimenting with quality improvement (QI) strategies designed to enhance the effectiveness and efficiency of their efforts. Does QI work in public health, and if so for whom and under what circumstances? What QI strategies work best for which types of public health process failures, and at what cost? Research underway through the Public Health Practice-Based Research Networks (PBRN) Program is examining these types of questions to build an evidence base for public health QI.

Prevalence Of Colorectal Cancer Screening Among A Multimorbid Rural Appalachian Population, Steven T. Fleming, Nancy E. Schoenberg, Yelena N. Tarasenko, Kevin A. Pearce

Yelena N. Tarasenko

Objectives: The purpose of this study was to determine the relation among multiple morbidities and the prevalence of colorectal cancer (CRC) screening among older adult Appalachian residents of Kentucky. This is the first known study to address multiple morbidities exclusively with a health-disparities population.

Methods: This was a cross-sectional study of 1153 subjects, aged 50 to 76 years, from Appalachian Kentucky.

Results: White race, post-high school education, and perception of having more than enough income on which to survive were associated with higher rates of any guideline concordant CRC screening. Statistically significant trends in the outcome of …

Overview Of The Public Health Pbrn Program, Glen Mays

Glen Mays

The Public Health Practice-Based Research Networks Program is a national program of the Robert Wood Johnson Foundation that supports the development of research networks for studying the comparative effectiveness, efficiency and equity of public health strategies deployed in real-world practice settings. A practice-based research network (PBRN) brings multiple public health agencies together with research partners to design and implement studies of population-based strategies that prevent disease and injury and promote health. Participating practitioners and researchers collaborate to identify pressing research questions of interest, design rigorous and relevant studies, execute research effectively, and translate findings rapidly into practice. As such, PBRNs …

The Science Of Public Health Delivery: Evidence, Uncertainties & Research Needs, Glen Mays

Glen Mays

Policy initiatives to reform the nation's health system increasingly recognize the need to incorporate public health and prevention strategies. The nation's delivery system for public health, however, varies widely across states and communities in its structure, authority, and capabilities. This session examines research from the growing field of public health services and systems research to identify directions for improving public health delivery.

Estimating The Value Of Public Health Services & Systems: Evidence, Uncertainties, And Research Needs, Glen Mays

Glen Mays

The Affordable Care Act authorized the largest expansion in federal funding for public health services and delivery systems in decades. These provisions, designed to support programs and services that promote health and prevent disease and injury on a population-wide basis, remain controversial because of uncertainties regarding their effectiveness in improving health and constraining medical cost growth. This session examines a series of recent studies to shed light on the health and economic value of spending on public health.

Disparities Research In Public Health Pbrns, Glen Mays

Glen Mays

Public health agencies are well positioned within the health system to play key roles in addressing oral health issues on a population-wide basis, However, current evidence reveals wide geographic variation in the delivery of public health interventions for oral health promotion. This session explores the factors contributing to this variation, and it highlights studies underway through the Public Health Practice-Based Research Networks (PBRNs) to produce more and better evidence about public health delivery and impact.

Key Findings From A Council On Linkages Survey Of Public Health Workers, Vincent Francisco, Jeffery A. Jones, Robin Pendley

Jeffery A Jones

The US governmental public health workforce is dwindling while the need for additional workers is increasing. In an historic effort to address this issue, in March 2010 the Council on Linkages Between Academia and Public Health Practice (Council on Linkages) surveyed over 70,000 public health workers across the US to determine how, when, and why they entered the governmental public health workforce and reasons they have remained in the workforce. Key survey findings were released in the spring of 2011 and have informed the development by the Council on Linkages of evidence-assisted recruitment and retention strategies for the US public …

Leading Improvement Through Inquiry: Practice-Based Research Networks In Public Health, Glen Mays

Glen Mays

The field of public health has surged in public visibility and attention in recent years due to its potential to mitigate leading risks to human health and wellbeing. Advances in prevention research provide an expanding toolbox of programs, policies, and interventions to reduce health risks. As these advances occur, uncertainties loom large regarding how best to deliver efficacious public health strategies to the populations at greatest risk. The nation's local, state, and federal public health agencies—together with their peers and partners in the private and public sectors—represent a vast yet diffuse delivery system of actors charged, to greater or lesser …

Spatial Cluster Of Female Breast Cancer In Missouri, Faustine Williams, Jeanette Jackson-Thompson, David O'Brien, Stephen C. Jeanetta, Chris Barnett

Faustine Williams

Seniors Count Follow-Up Study, Nina M. Silverstein, Heather Connors, May Jawad

Nina Silverstein

Seniors Count is an ongoing outreach initiative under the direction of Boston Mayor Thomas M. Menino with the leadership and support of Joyce Williams, Boston's Commissioner on Affairs of the Elderly. The program's purpose is to "identify and reach out to those members of the city's elderly population who live in private housing arrangements and help provide them with the information and services they [may] need" (Boston Commission on Affairs of the Elderly, 2002). Since the program's inception in 1999, it has reached over 5,500 community-dwelling elders in the City of Boston (Boston Commission on Affairs of the Elderly, 2002). …

Using Pbrn Research To Inform Policy And Practice, Glen Mays

Glen Mays

This brief provides examples of how findings from RWJF-supported research projects underway through the public health PBRNs and the larger field of PHSSR are being used to inform public health practice and policy.

Public Health Pbrn Network Analysis Survey Instrument, Glen Mays

Glen Mays

This survey instrument was used to collect data on research activities patterns of interaction within public health practice-based research networks (PBRNs).

Building A Sustainable Pbrn: Securing Ongoing Funding, Glen Mays

Glen Mays

Practice-based research networks require a diversified mix of funding to sustain their activities in research production and translation.

The Role Of Social Support In Multiple Morbidity Self-Management Among Rural Residents, Shoshana Bardach, Yelena N. Tarasenko, Nancy E. Schoenberg

Yelena N. Tarasenko

Social support generally is considered a valuable asset that may compensate for health service deficiencies among rural populations. Employing a mixed methods approach, we explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions. Participants generally felt support was available, though emotional/ informational support was perceived as less available than other types of support. Participants did not rely heavily on informal support to help them manage their multiple morbidities, preferring to call on their doctor and their own resources. We discuss implications of these findings for meeting this vulnerable population’s self-management needs.

Working Off The Record: Physicians' And Nurses' Transformations Of Electronic Patient Record-Based Patient Information, Lara Varpio, Catherine Schryer, Pascale Lehoux, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Electronic patient records (EPRs) are increasingly being used in health care, but little is known about how EPR-based patient information is used in daily care activities, nor about its potential influence on novice training.

METHOD: Seventy-two physicians and nurses participated in an eight-month study on a single pediatric ward. Eighty hours of nonparticipant observations and 20 interviews were conducted. Data were analyzed using constructivist grounded theory and visual rhetoric.

RESULTS: Three main features of participant interactions with EPR-based information were identified: (1) EPR-based information was routinely transformed into paper documents; (2) these transformations were organized by profession-specific guiding principles; …

Community-Based Coalitions: Influencing Policy & Practice, Florida Covering Kids & Families

Florida Covering Kids & Families

Simple approaches to outreach can increase enrollment in CHIP. The Robert Wood Johnson Foundation (2010) found community-based coalitions can be simple yet effective methods to communicate needed policy and practice changes to those “charged with implementing insurance coverage”. Community-based coalitions are able to bring to light enrollment and retention barriers increasing the awareness of stakeholders and hopefully, help to create effective solutions.

Quality Improvement Quick Strike Research Projects In Public Health Pbrns, Glen P. Mays

Glen Mays

The Quality Improvement Quick Strike (QIQS) research program provides research networks participating in the Robert Wood Johnson Foundation’s Public Health PBRN Program with supplemental funding and technical assistance to conduct rapid turn-around, time-sensitive research studies that produce evidence about the effectiveness and impact of quality improvement (QI) strategies, public reporting initiatives, and accreditation activities in public health settings. Specifically, the program supports research studies that investigate the effectiveness, cost-effectiveness and/or impact of three related types strategies designed to drive quality in public health practice: (1) QI tools and processes implemented in public health settings; (2) accreditation programs and performance standards …

The Emergency Department As A Potential Intervention Recruitment Venue Among Vulnerable Rural Residents, Yelena N. Tarasenko, Nancy E. Schoenberg, Keisa L. Bennett

Yelena N. Tarasenko

Meeting the health care needs of rural residents is complicated by their substantial medical burdens that frequently outstrip patient and community resources. Nowhere is this more evident than in central Appalachia. Preventive procedures are often sacrificed as patients and providers attend to more pressing medical issues. We report the results of a pilot study designed to explore the need for and appropriateness of a potential intervention placed in an emergency department (ED), with the eventual goal of using the ED to link traditionally underserved patients to preventive services. We used a convenience sample of 49 ED patients to explore their …

Cognitive Processes In Object-Oriented Requirements Engineering Practice: Analogical Reasoning And Mental Modelling, Linda Dawson

Associate Professor Linda Dawson

This paper presents a background in cognitive processes such as problem solving and analogical reasoning for considering modeling from an object-oriented perspective within the domain of requirements engineering. The paper then describes a research project and the findings from a set of four cases which examine professional practice from perspective of cognitive modeling for object-oriented requirements engineering. In these studies, it was found that the analysts routinely built models in their minds and refined them before committing them to paper or communicating these models to others. The studies also showed that objectoriented analysts depend on analogical reasoning where they use …

Technological Iatrogenesis: The Manifestation Of Inadequate Organizational Planning And The Integration Of Health Information Technology., Patrick Albert Palmieri

Patrick Albert Palmieri

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern. Recognizing the technology–organizational misalignments that result from HIT adoption is …