Health Services Research 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 …

The Aging Services Network: Serving A Vulnerable And Growing Elderly Population In Tough Economic Times, Carol O'Shaughnessy

National Health Policy Forum

In 1965, Congress enacted the Older Americans Act, establishing a federal agency and state agencies to address the social services needs of the aging population. The mission of the Older Americans Act is broad: to help older people maintain maximum independence in their homes and communities and to promote a continuum of care for the vulnerable elderly. In successive amendments, the Act created area agencies on aging and a host of social support programs. The "aging services network," broadly described, refers to the agencies, programs, and activities that are sponsored by the Older Americans Act. The Act’s funding for services …

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

Health Management and Policy Presentations

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.

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.

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 …

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

Gerontology Institute Publications

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 …

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.

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

Health Management and Policy Presentations

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.

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

Health Management and Policy Presentations

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 P. Mays

Health Management and Policy Presentations

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.

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.

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 …

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).

Using Public Health Pbrn Research To Inform Policy & Practice, Public Health Practice-Based Research Networks

Health Management and Policy Reports

The Public Health Practice-Based Research Networks Program is a national program of the Robert Wood Johnson Foundation that supports research networks dedicated to producing new scientific knowledge on how best to organize, finance, and deliver public health strategies in realworld practice settings. This body of scientific inquiry, known as Public Health Services and Systems Research (PHSSR), is a rapidly developing area of scholarship within the larger fields of public health research and health services research. A public health practice-based research network (PBRN) brings multiple public health organizations into collaboration with an academic research center for the purposes of designing and …

Individual And Small-Group Market Health Insurance Rate Review And Disclosure: State And Federal Roles After Ppaca, Kathryn Linehan

National Health Policy Forum

Oversight of private insurance, including health insurance, is primarily a state responsibility. Each state establishes its own laws and regulations regarding insurer activities, including premium increases for the insurance products within its purview. The authority that state regulators have to review and deny requests for premium changes varies from state to state, as do the amount of resources available to state insurance departments for reviewing premium changes. In some markets where insurers have proposed or implemented steep increases, such changes have received considerable attention from the press, state regulators, and policymakers. The Patient Protection and Affordable Care Act (PPACA) requires …

High Burden Of Prevalent And Recently Acquired Hiv Among Female Sex Workers And Female Hiv Voluntary Testing Center Clients In Kigali, Rwanda, Sarah L. Braunstein, Chantal M. Ingabire, Eveline Geubbels, Joseph Vyankandondera, Marie-Michele Umulisa, Elysee Gahiro, Mireille Uwineza, Coosje J. Tuijn, Denis Nash, Janneke H. H. M. Va De Wijgert

Publications and Research

Methods: We conducted a cross-sectional survey of 800 FSW and 1,250 female VCT clients in Rwanda, which included interviewing and testing for HIV-1/2, HSV-2 and pregnancy, and BED-CEIA and Avidity Index (AI) to identify recent infections among HIV-infected women.

Results: Prevalence of HIV-1, HSV-2, and pregnancy were 24% (95% CI: 21.0–27.0), 59.8% (56.4–63.2), and 7.6% (5.8–9.5) among FSW, and 12.8% (10.9–14.6), 43.2% (40.4–46.0), and 11.4% (9.7–13.3) among VCT clients, respectively. Thirty-five percent of FSW and 25% of VCT clients had never been HIV tested. Per national guidelines, 33% of newly HIV-diagnosed FSW and 36% of VCT clients were already eligible …

Building A Sustainable Public Health Pbrn: Tips For Securing Ongoing Research Funding, Public Health Practice-Based Research Networks

Health Management and Policy Reports

Diversify your network’s research funding base. The Public Health PBRN Program funding made available by the Robert Wood Johnson Foundation provides start-up resources and initial research support for networks, but networks will require larger and more sustainable sources of funding for public health research as they progress. The most ample sources can be found in federal funding agencies that operate competitive extramural research programs, include CDC, NIH, AHRQ, HRSA, USDA, and NSF. Public health research funding is also available from state and foundation sources, and even corporate sources (e.g. Pfizer’s Public Health Research Fellowship Program). For sustainability, networks should look …

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.

Aligning Graduate Medical Education With Public Policy, Rob Cunningham

National Health Policy Forum

In late May–early June 2011, the Forum sponsored a site visit to Denver, Colorado, to observe innovative efforts to improve the health of Coloradans and reduce the cost of health care. The three-day agenda was designed to convey the breadth and interconnectedness of the efforts underway in Denver and to highlight both successes and challenges. The exploration concentrated on how three themes of national interest are unfolding in Denver: building and sustaining a robust and effective safety net in an evolving health care market; improving the health of people and their communities to prevent and reduce the need for health …

Public Health Pbrns: Generating Evidence For Policy & Practice, Public Health Practice-Based Research Networks Program

Health Management and Policy Reports

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 Community Action Framework In Practice: An Illustration Based On The Ready By 21 Coalition Of Austin/Travis County, Raphael Travis Jr., Tamara Leech

Department of Public Health Scholarship and Creative Works

The field of positive youth development has expanded focus from articulating and measuring desired manifestations of positive well-being to assembling the environmental conditions known to promote these desired outcomes. Evidence of the effectiveness of community-level efforts promoting positive youth development is still emerging, in particular theory-driven examples of community-driven youth development. This study examined the Community Action Framework, one theory-based community youth development model, through the experiences of the Ready by 21 Austin/Travis County coalition (RB21). The coalition connects youth-serving organizations and also regional coalitions, while promoting the positive development of area youth. Participant observation, interviewing, and archival strategies were …

Access To Essential Medicines: In Pakistan Identifying Policy Research And Concerns, Shehla Zaidi, Noureen Nishtar

Community Health Sciences

The fundamental importance of ensuring access to medicines, particularly for the poor, is reflected in MDG 8 however remains poor in many low and middle income countries (LMICs). Country specific evidence on access to medicines is weak in LMICs and research has rarely been from an integrated health systems perspective. This study used an evidence based approach to identify key priority concerns and emerging research questions related to access to medicines in Pakistan. WHO’s Access to Medicine Framework was used as the conceptual basis for data collection on rational usage, affordability, financing and health systems. Methods involved a systematic desk …

Principal Component Analysis Of Dietary And Lifestyle Patterns In Relation To Risk Of Subtypes Of Esophageal And Gastric Cancer, Stephanie A. Navarro Silvera, Susan T. Mayne, Harvey A. Risch, Marilie D. Gammon, Thomas Vaughan, Wong-Ho Chow, Joel A. Dubin, Robert Dubrow, Janet Schoenberg, Janet L. Stanford, A. Brian West, Heidrun Rotterdam, William J. Blot

Department of Public Health Scholarship and Creative Works

Purpose

To carry out pattern analyses of dietary and lifestyle factors in relation to risk of esophageal and gastric cancers.

Methods

We evaluated risk factors for esophageal adenocarcinoma (EA), esophageal squamous cell carcinoma (ESCC), gastric cardia adenocarcinoma (GCA), and other gastric cancers (OGA) using data from a population-based case-control study conducted in Connecticut, New Jersey, and western Washington state. Dietary/lifestyle patterns were created using principal component analysis (PCA). The impact of the resultant scores on cancer risk was estimated through logistic regression.

Results

PCA identified six patterns: meat/nitrite, fruit/vegetable, smoking/alcohol, legume/meat alternate, GERD/BMI, and fish/vitamin C. Risk of each …

Disclosure Of Medical Error, Kiran Shaikh, Sharifa Bashir Lalani

School of Nursing & Midwifery

With the advancement of medical sciences, lives are being prolonged and practice of medicine is considered an art and no longer as science. ‘To Err is Human Report’ has been released and gives data of medical errors in United States which opened people’s eyes but there is grieving need that health professional in Pakistan also report the medical errors. Medical errors are common, costly, and often preventable. This could only happen when health professional are trained and made aware to report the errors. Evidences shows that full and honest disclosure of error and restitution are factors that may lead to …

Rocky Mountain Highs And Lows: Efforts To Improve Health And Reduce Costs In Denver, Michele J. Orza, Jessamyn Taylor

National Health Policy Forum

In late May–early June 2011, the Forum sponsored a site visit to Denver, Colorado, to observe innovative efforts to improve the health of Coloradans and reduce the cost of health care. The three-day agenda was designed to convey the breadth and interconnectedness of the efforts underway in Denver and to highlight both successes and challenges. The exploration concentrated on how three themes of national interest are unfolding in Denver: building and sustaining a robust and effective safety net in an evolving health care market; improving the health of people and their communities to prevent and reduce the need for health …

Home, But Not Alone: Evidence-Based Maternal, Infant, And Early Childhood Home Visitation, Eileen Salinsky

National Health Policy Forum

Home visitation services for young and expectant families have the potential to improve child and parent outcomes in a broad variety of ways, but the effectiveness of home visits may depend on the nature, frequency, and duration of these services. The Patient Protection and Affordable Care Act of 2010 (PPACA) created a new federal funding stream to promote the development and implementation of evidence-based home visiting programs. This issue brief provides an overview of the newly established Maternal, Infant, and Early Childhood Home Visiting program, describes existing approaches to home visitation, and discusses the implications of federal funding for state …