Health Services Research Commons^™

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 …

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 …

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).

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 …

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 …

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 …

Analysis Of Out-Of-Pocket Expenditures Of Oral Oncologics For Tennessee Recipients Of Medicare Part D, Eve Carolyn Elias

Theses and Dissertations (ETD)

Background: There are few studies that examine patients' costs of oral oncology drugs from Medicare Part D plan providers. These drugs can impose a financial burden to beneficiaries, and, due to their cost, place beneficiaries in the coverage gap in a short period of time. In addition to examining costs, there is little published concerning the potential impact of drug utilization management techniques on access to these drugs in Medicare Part D plans. This study examined the roles of prior authorization, step-therapy, and placement of drugs in higher formulary tiers on patients' out-of-pocket costs, and access to therapy.

Methods …

The Influence Of Patient-Reported Provider Availability Factors On Nonurgent Emergency Department Use, Cheryl Anne Dewood

Theses and Dissertations (ETD)

Purpose. The purpose of this study was to examine the influence of patient‑perceived provider availability on nonurgent emergency department use (NUEDU). The study population consisted of a nationally‑representative population of non‑elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).

Methods. Data were obtained from a nationally‑representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient­‑perceived provider …

Adoption Of Electronic Health Records By Admitting Physicians: A Heuristic Model, John Sharon Hudson

Health Services Research Dissertations

Background: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption.

Purpose: This study uses constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of an EHR by admitting physicians from three of ten hospitals in a highly integrated health system in Virginia. Functions evaluated: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical …

The Hospitalist: Better Value In Inpatient Care?, Lisa Sprague

National Health Policy Forum

From perhaps a few hundred practitioners in 1996 to an estimated 30,000 today, the discipline called hospital medicine has shown remarkably rapid growth. It represents a fundamental separation of the inpatient and outpatient components of internal and family medicine. The split has implications for the quality and efficiency of care delivery, the outlook for the physician workforce, and the development of new models such as accountable care organizations (ACOs).

Medicare's Bundling Pilot: Including Post-Acute Care Services, Laura A. Dummit

National Health Policy Forum

Fee-for-service Medicare, in which a separate payment is made for each service, rewards health care providers for delivering more services, but not necessarily coordinating those services over time or across settings. To help address these concerns, the Patient Protection and Affordable Care Act of 2010 requires Medicare to experiment with making a bundled payment for a hospitalization plus post-acute care, that is, the recuperative or rehabilitative care following a hospital discharge. This bundled payment approach is intended to promote more efficient care across the acute/post-acute episode because the entity that receives the payment has financial incentives to keep episode costs …

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 …

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 …