Public Health Commons^™

What Older Adults Want From Their Health Care Providers, Hazel Williams-Roberts, Sylvia Abonyi, Julie Kryzanowski

Patient Experience Journal

Changing demographic trends and population needs have increased demand for chronic complex care and contributed to rising health care costs. The study sought to identify unmet health care needs of older adults and opportunities for service improvement in a high need suburban neighborhood of a prairie province. The insights provided by older adults informed the service design for a new model of integrated care in community settings. Narrative inquiry methodology was used to understand care experiences through stories. Stories of older adults’ health care journeys were elicited with semi-structured interviews. A paradigmatic approach to analysis was applied with holistic coding, …

Racial/Ethnic And Geographic Differences In Access To A Usual Source Of Care That Follows The Patient-Centered Medical Home Model: Analyses From The Medical Expenditure Panel Survey Data, Zo Ramamonjiarivelo, Delawnia Comer-Hagans, Shamly Austin, Karriem Watson, Alicia Kaye Matthews

Patient Experience Journal

This study examined racial and geographic differences in access to a usual source of care (USC) and it further explored these differences among individuals who had a USC that followed the patient-centered medical home (PCMH) model. Using cross-sectional data from the Household Component of the Medical Expenditure Panel Survey (2008-2013), our sample consisted of non-institutionalized US civilians ages 18-85 (n= 146,233; weighted n = 229,487,016). Our analysis included weighted descriptive statistics and weighted logistic regressions. Although 76% of the respondents had a USC, only 11% of them had a USC that followed the PCMH model. Among respondents who had a …

Barriers And Enablers Of Patient And Family Centred Care In An Australian Acute Care Hospital: Perspectives Of Health Managers, Bradley Lloyd, Mark Elkins, Lesley Innes

Patient Experience Journal

The aim of this study was to identify and explore organisational barriers to, and enablers of, patient and family centred care within an Australian acute care hospital from the perspective of that hospital’s management staff. A qualitative study, incorporating purposive sampling and semi-structured interviews was undertaken in a 215-bed metropolitan acute care public hospital in Sydney, Australia. Fifteen health managers from a broad range of professional groups, including Medicine, Nursing, Allied Health and non-clinical services were interviewed. Interview data were recorded, transcribed, and analysed for key themes using the Framework Approach. The key barriers to patient and family centred care …

Improving The Patient Experience Through Patient Portals: Insights From Experienced Portal Users, Cynthia J. Sieck, Jennifer L. Hefner, Ann Scheck Mcalearney

Patient Experience Journal

Background: Patient portals have become part of the ecosystem of care as both patients and providers use them for a range of activities both individually and collaboratively. As patients and providers gain greater experience using portals, their use and needs related to portals may evolve. Objective: This study aimed to learn from experienced patient portal users to improve our understanding of their perspectives on portal use for collaboration and engagement as well as explore how using a portal influenced their experiences with primary care providers. Methods: Qualitative study involving 29 semi-structured interviews with family medicine patients from a large Academic …

Transforming Care Through Bedside Leader Rounding: Use Of Handheld Technology Leads To Improvement In Perceived Patient Satisfaction, Alison Tothy, Sunitha K. Sastry, Mary K. Springman, Heather M. Limper, John Fahrenbach, Susan M. Murphy

Patient Experience Journal

When consistently executed, leader rounding has the ability to capture actionable information ensuring delivery of safe and effective patient care, identifying excellence among staff, and bringing opportunities for improvement. Our team set out to create an effective, standardized approach to targeted, daily, technology-driven leader rounding with the goal of integrating real-time patient feedback into the care experience. An application on handheld computer tablets was tailored and integrated with the hospital’s admission, discharge, and transfer (ADT) feed, allowing for streamlining of the rounding process by creation of workflow templates. Additionally, capabilities to receive and send alerts across disciplines were integrated in …

Can Specific Feedback Improve Patients’ Satisfaction With Hospitalist Physicians? A Feasibility Study Using A Validated Tool To Assess Inpatient Satisfaction, Sarah E. Richards, Rachel Thompson, Steven Paulmeyer, Ashvita Garg, Sarah Malik, Kristy Carlson, Elizabeth Lyden, Jason Shiffermiller

Patient Experience Journal

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a patient satisfaction survey utilized for hospital reimbursement calculations. It is not, however, considered a valid measure of individual physician performance. The object of this study was to determine if the “Tool to Assess Inpatient Satisfaction with Care from Hospitalists” (TAISCH) instrument could be leveraged to improve patient satisfaction. A pragmatic pre/post study was conducted with adult inpatients admitted to either teaching or non-teaching general internal medicine services at a large mid-western academic medical center. TAISCH surveys were administered to patients (n=192) who were able to identify their hospitalist …

Developing The First Pan-Canadian Acute Care Patient Experiences Survey, Salima Hadibhai, Jeanie Lacroix, Kira Leeb

Patient Experience Journal

The Canadian Institute for Health Information (CIHI) in partnership with stakeholders sought to develop the first pan-Canadian patient experiences survey for inpatient care (CPES-IC). The goal was to provide a national survey standard for comparative patient experience measures to facilitate benchmarking for quality improvement. A cognitive and pilot testing study design was performed using survey data from adult inpatient care settings. Participants included the inter-jurisdictional members (IJ), survey subject matter experts and CIHI (The Group). Cognitive testing of the survey took place in three Canadian jurisdictions in English and French languages. Thirty-nine individuals participated in one-on-one interviews. During pilot testing, …

Standardising The Collection Of Patient-Reported Experience Measures To Facilitate Benchmarking And Drive Service Improvement, Kathleen L. Withers, Sarah Puntoni, Susan O'Connell, Robert I. Palmer, Grace Carolan-Rees

Patient Experience Journal

Patient experience teams in NHS Wales’ Health Boards and Trusts are working across the country to collect patient experience feedback from members of the public who access health care services. Although this work is advanced in many areas, there is currently no way of benchmarking across organisations, reducing opportunities for shared learning. We aimed to work with patients and colleagues across Wales to agree a set of universal Patient Reported Experience Measures (PREMs) questions. Working with patient experience teams, patient groups and Welsh Government, the NHS Wales Patient Reported Outcome Measures (PROMs), Patient Reported Experience Measures (PREMs) and Effectiveness Programme …

First, Do No Harm: The Patient's Experience Of Avoidable Suffering As Harm, Ashley Bauer Mha

Patient Experience Journal

Although my entire career has been spent in Patient Experience, nothing I have learned from data, evidence-based practice, or experience-based correlations, has been near as impactful as what I learned from being a patient. This article discusses my own experiences as a patient. I ask readers to consider instances of avoidable suffering as sources of harm that negatively impact patient perceptions, erode trust in care providers and healthcare delivery systems, and create barriers to engaging patients in their care. Recognizing how avoidable suffering creates harm challenges traditional views of Patient Experience as hospitality-based “soft skills” and helps to establish patient …

Patient Partner Compensation In Research And Health Care: The Patient Perspective On Why And How, Dawn P. Richards, Isabel Jordan, Kimberly Strain, Zal Press

Patient Experience Journal

As patient and family engagement activity broadens across the continuum of care and expands around the world, the question of compensation for an increasingly competent advisory community continues to come up. The authors are 4 patients who are highly active in patient and public involvement initiatives internationally. Through our exclusive patient perspective, we provide insight into the reasoning and motivation that many patients are now awakening to as to why lived experience is a value that organizations need to recognize and support in concrete ways. We explore the core principles that an organization needs to consider and adopt when developing …

Elevating The Discourse On Experience In Healthcare’S Uncertain Times, Jason A. Wolf Phd, Cpxp

Patient Experience Journal

Over the last five years, we have been inspired by the breadth of contributions that have helped shape the experience landscape through PXJ as well as the reach that the conversation on patient experience has had. Both the authors and readers of PXJ reinforce that the conversation on patient experience and the human experience in healthcare is not one dominated by national intent or even policy. While for some motivation has come in some part from mandated action, for most tackling this idea in healthcare is it grounded in two core realities. The first, in healthcare at its core we …

What Conditions Enable Decentralization To Improve The Health System? Qualitative Analysis Of Perspectives On Decision Space After 25 Years Of Devolution In The Philippines, Harvy Joy Liwanag, Kaspar Wyss

Ateneo School of Medicine and Public Health Publications

Background

Decentralization is promoted as a strategy to improve health system performance by bringing decision-making closer to service delivery. Some studies have investigated if decentralization actually improves the health system. However, few have explored the conditions that enable it to be effective. To determine these conditions, we have analyzed the perspectives of decision-makers in the Philippines where devolution, one form of decentralization, was introduced 25 years ago.

Methods

Drawing from the “decision space” approach, we interviewed 27 decision-makers with an average of 23.6 years of working across different levels of the Philippine government health sector and representing various local settings. …

School‐Level Body Mass Index Shapes Children's Weight Trajectories, Ashley W. Kranjac

Sociology Faculty Articles and Research

BACKGROUND

Embedded within children's weight trajectories are complex environmental contexts that influence obesity risk. As such, the normative environment of body mass index (BMI) within schools may influence children's weight trajectories as they age from kindergarten to fifth grade.

METHODS

I use 5 waves of the ECLS‐K—Kindergarten Class 1998‐1999 data and a series of multilevel growth models to examine whether attending schools with higher overall BMI influences children's weight status over time.

RESULTS

Results show that, net of child, family, and school sociodemographic characteristics, children who attend schools with higher rates of obesity have increased weight compared to children who …

Access To Health Care Services For Adults In Maine [Policy Brief], Erika C. Ziller Phd, Barbara Leonard Mph, Amanda Burgess Mppm, Nathan Paluso Mph

Access / Insurance

This data brief by researchers at the Maine Health Access Foundation and the University of Southern Maine's Maine Rural Health Research Center found ongoing inequality in the ability of people in Maine to get quality health care. The report examines data from 2014-2016 and shows that Maine people, of all income groups, report difficulties in paying medical costs. Research has also found the ability to seek timely and appropriate health care is impacted by income levels, educational background, race and ethnicity.
This brief provides an update to the 2016 study (available in Digital Commons: https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1038&context=insurance)

For more information, please …

Initiative 427: Nebraska Medicaid Expansion, J. David Aiken

Cornhusker Economics

This article summarizes information regarding Initiative 427–the Medicaid expansion question on the November 6, 2018 ballot. It reprints the actual ballot language and the Nebraska Secretary of State’s summary of arguments for and against Initiative 427.

Background. Originally Medicaid covered the elderly, the disabled, children in low-income families, and low-income pregnant women. In 2010 Medicaid coverage was expanded by Congress to include the working poor. In 2012 the U.S. Supreme Court ruled that the provision of the Affordable Care Act (ACA) requiring states to expand Medicaid was unconstitutional. This made it a state option whether or not to expand Medicaid. …

Applying A Research Ethics Review Processes In Rural Practice-Based Research, Adam D. Baus, Tracy L. Hendershot, Martha Cook Carter, Laura K. Boone

Marshall Journal of Medicine

Introduction: Partnering with rural primary care in practice-based research allows researchers access to a vital segment of the health care sector and a window into some of the most vulnerable, high-risk, high-need patient populations. The readiness for rural primary care to fully embrace research partnerships, however, is often tempered by ethical questions in conducting research in close-knit settings. This research provides practices with a refined decision support tool for evaluating the fit of research opportunities for their unique practices.

Materials and Methods: A two-phase effort was conducted to glean insight from currently available literature on ethical considerations in practice-based research …

Identifikasi Faktor–Faktor Yang Berpengaruh Terhadap Medical Tourism Pada Rumah Sakit Di Indonesia, Ayu Nadya Kusumawati

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Medical tourism is an activity carried out by an individual to get a health service or medical care abroad. In the effort to develop the health system and competition and the impact of health globalization, it does not rule out the possibility that medical tourism raises intense competition among hospitals in providing quality services and superior service products provided by hospitals in attracting foreign patients to come get treatment. Objective of this research is to determined factors that affect hospital to be medical tourism’s aim. Methods in this research is literature review from international journals. The results is hospital needs …

Rumah Sakit Syariah Strategi Pemasaran Vs Syiar, Mala Hayati, Wahyu Sulistiadi

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The phenomenon of sharia awareness among the people of Indonesia, moves the economy in various aspects of people's lives, including the health service sector. The community begins to choose products that are not only quality from the medical side, but also get psychosocial safe services framed with Islamic values. Very open market opportunities to capture these symptoms. Sharia hospitals try to answer this challenge by packaging Islamic values into their service standards. Literature studies sourced from various scopus indexed international journals and google scholar. The concept of sharia hospitals that carry spiritual values is in line with the marketing 3.0 …

Variasi Biaya Sectio Caesaria Di Rumah Sakit Indonesia, Tetriadi Tetriadi, Atik Nurwahyuni

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Pricing / variation of costs is one of the strategic steps that must be taken because it refers to costs incurred, both marginal and total costs, including indirect costs (overhead costs). Cesarean section (SC) surgery is one of the most common actions performed in the operating room which also requires careful planning of service costs, so that the appropriate price setting for the hospital can do activities without reducing service quality. This paper aims to look at the different costs of SC in Indonesia based on the class / level of the hospital and hospital ownership, whether the hospital is …

Metode Pendekatan Top-Down Dan Bottom-Up: Strategi Marketing Penetapan Harga Di Pelayanan Kesehatan, Muchtar Muchtar, Wahyu Sulistiadi

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The marketing mix consists of product, price, place and promotion. Pricing in health services is an important mix that can be done through the top-down and bottom-up approach. The purpose of this paper is to review the differences between the top-down and bottom-up approaches to pricing health services. Method: This literature review is conducted in December 2018. Research related to the top-down and bottom-up approaches to pricing health services is sought by using valid keywords, including top down approaches, bottom-up approaches and costing through PubMed, Science Direct and EBSCO. Results & Discussion: A total of 10 papers were selected for …

The Impact Of Medical Tourism Industry For The Hospital Services And Marketing Activities: A Systematic Review, Nadya Aviliyani Taufik, Wahyu Sulistiadi

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The relationship between the health industry and tourism has produced what is called medical tourism which is one of the largest and fastest growing service industries in the world and is a profitable business for the destination country. To capture the many medical tourists it is necessary to recognize the vital factors that influence the decision of medical tourists to choose the destination country by implementing marketing strategies and good health services. Using Systematic Review with PRISMA method retrieved from online database such as PubMed, and Google Scholar using a keyword “Medical tourism” AND “hospital services” AND “marketing”. The end …

Hubungan Bauran Pemasaran (Marketing Mix) Dengan Loyalitas Pelanggan: Systematic Review, Leawaty Leawaty, Wahyu Sulistiadi

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Marketing activities in the business era are now an important factor for maintaining and developing a business. The higher the level of competition in the business, requires management to innovate in maintaining its customers. This activity is to create loyal customers. Customer loyalty is very important for the continuity of a business. To find out the marketing mix relationship with customer loyalty. Preferred Reporting Items for Systematic Reviews and Meta Analyzes (PRISMA) are evidence-based methods for conducting systematic reviews. Based on the results of the research at the Pulmo Clinic of Paru Batu Hospital, several conclusions can be obtained that …

Analisis Produk Layanan Rumah Sakit Dalam Lingkup Bauran Pemasaran, Rahmawati Rahmawati

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Hospitals as large service institutions, are required to be able to fulfill public health services well, this is due to a lot of competition and if they do not pay attention to these demands, it will be difficult to maintain their survival. Some breakthroughs in health services are a necessity especially to bridge the level of social differences in health services on the one hand to find the right form of funding efficiency for the community on the other hand. For this reason, the hospital must be able to develop a marketing strategy through an effective and efficient marketing mix …

Patient Barriers For Weight Management Among African American Women, Owen Bowie, Jennifer Kusch, George L. Morris Iii, Tracy Flood, Jessica Gill, Renee E. Walker, Ron A. Cisler, Jennifer T. Fink

Journal of Patient-Centered Research and Reviews

Purpose: The primary aim of this study was to assess the perceptions of local African American women who are overweight or obese using semi-structured focus groups to identify barriers to weight management and factors that support strategy success. The secondary aim of this study was to determine recommendations for patient-centered weight management interventions established specifically for African American women in the Milwaukee-area community.

Methods: Three semi-structured focus groups to explore barriers to weight management were performed among women patients. Participants (N = 41) were recruited via email, postal mail, and phone as available from an academic medical center in Milwaukee, …

Impact Of A Boot Camp Translation Intervention On Self-Management Support In Primary Care, Donald E. Nease Jr., Jeanette M. Daly, L. Miriam Dickinson, Douglas H. Fernald, David L. Hahn, Barcey T. Levy, Leann C. Michaels, Matthew J. Simpson, John M. Westfall, Lyle J. Fagnan

Journal of Patient-Centered Research and Reviews

Purpose: Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assist small to medium-sized primary care practices with care managers implement SMS tools.

Methods: INSTTEPP used a stepped-wedge design across 16 practices from 4 practice-based research networks over 12 months. Each network completed a 2-month boot camp translation for creating SMS tools with 16 participants (2 patients, a clinician, and a care manager …

Patient Self-Management: Tools And Barriers, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In his issue introduction, the editor-in-chief of the Journal of Patient-Centered Research and Reviews comments on the theme of patient self-management of chronic diseases and the related articles published therein. Illnesses such as cardiovascular disease, diabetes, epilepsy, arthritis, asthma, and obesity often require patients to administer their own medication daily or adhere to strict dietary restrictions. Progress is being made on the process of implementation and evaluation of patient self-management tools in primary care practices. Barriers to self-management tool implementations in clinics, as well as their use by individual patients, must be understood and addressed.

Implementing Community-Created Self-Management Support Tools In Primary Care Practices: Multimethod Analysis From The Insttepp Study, Douglas H. Fernald, Matthew J. Simpson, Donald E. Nease Jr., David L. Hahn, Amanda E. Hoffmann, Leann C. Michaels, Lyle J. Fagnan, Jeanette M. Daly, Barcey T. Levy

Journal of Patient-Centered Research and Reviews

Purpose: With one-half of Americans projected to be living with at least one chronic condition before 2020, enhancing patient self-management support (SMS) may improve health-related behaviors and clinical outcomes. Routine SMS implementation in primary care settings is difficult. Little is known about the practice conditions required for successful implementation of SMS tools.

Methods: Four primary care practice-based research networks (PBRNs) recruited 16 practices to participate in a boot camp translation process to adapt patient-centered SMS tools. Boot camp translation sessions were held over a 2-month period with 2 patients, a clinician, and a care manager from each practice. Qualitative case …

How To Translate Self-Management Support Tools Into Clinical Practice, Matthew J. Simpson, Jeanette M. Daly, Douglas H. Fernald, John M. Westfall, Leann C. Michaels, Barcey T. Levy, David L. Hahn, Lyle J. Fagnan, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaboration between clinicians and patients.

Methods: Translation of SMS tools derived from the library into primary care practices occurred utilizing boot camp translation in four different practice-based research networks (PBRNs). The typical model of boot camp translation was adapted for the purpose of the Implementing Networks’ Self-management Tools Through Engaging Patients and …

Adapting Boot Camp Translation Methods To Engage Clinician/Patient Research Teams Within Practice-Based Research Networks, Lyle J. Fagnan, Matthew J. Simpson, Jeanette M. Daly, Leann C. Michaels, David L. Hahn, Barcey T. Levy, Douglas H. Fernald, John M. Westfall, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based “best practices” models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support (SMS), require engaged practice teams that include patients. Models of engagement such as boot camp translation may be effective.

Methods: Four geographically dispersed practice-based research networks (PBRNs) from the Meta-LARC consortium engaged 16 practices to form SMS implementation teams involving a clinician, care manager, and 2 patients in each team. Our study adapted the boot camp …

Practice-Based Research Networks Ceding To A Single Institutional Review Board, Jeanette M. Daly, Tabria Weiner Harrod, Kate Judge, Leann C. Michaels, Barcey T. Levy, David L. Hahn, Lyle J. Fagnan, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Historically, a single research project involving numerous practice-based research networks (PBRNs) required multiple institutional review boards (IRBs) to be involved in approval of the project. However, to avoid redundancies, federal IRB regulations now allow cooperative research projects that involve more than one institution to use reasonable methods of cooperative IRB review and to cede authority for review and oversight of the project to a single lead IRB. Through ceding, a lead IRB has the authority for review and oversight of the project delegated by all participating sites’ IRBs and becomes the IRB of record for the ceded sites. In the …