Health Services Administration Commons^™

Conception To Implementation: Quality Improvement In Behavioral Health Home Organizations, Elizabeth A. Miller

Muskie School Capstones and Dissertations

This capstone project developed quality improvement tools to be used by community mental health agencies participating in the Maine Behavioral Health Homes Initiative. Providing technical assistance, analysis of feedback, and developing recommendations were the foundation of this project with a central tenet to enhance the existing Quality Improvement Project Template created by MaineCare, Maine’s Medicaid Office. These recommendations suggest the Quality Improvement Project Template may be improved by providing an additional fillable quality improvement process outline, providing a list of example projects and focus areas for quality improvement projects, and providing tools to assist in implementation of quality improvement projects. …

Bridging The Location Gap: Physician Perspectives Of Physician-Pharmacist Collaboration In Patient Care (Bridge Phase Ii), Keri D. Hager, Donald Uden, Daniel M. Tomaszewski

Pharmacy Faculty Articles and Research

Background: To optimize patient outcomes, the patient-centred medical home model emphasizes comprehensive team-based care. Pharmacists are qualified to enhance appropriate medication use and help improve patient outcomes through provision of medication therapy management (MTM) services. To optimally provide MTM, pharmacists must effectively collaborate with physicians. This study explored factors that influence pharmacist-physician collaboration.

Methods and Findings: A convenience sample of five physicians participated in semi-structured interviews and the resulting data were analyzed using qualitative methods. Transcripts of the interviews were independently coded for themes by two researchers. Five themes emerged: trustworthiness, role specification, relationship initiation, effects on practice, …

Book Review: Being Mortal: Illness, Medicine And What Matters In The End, Sue Sutton

Patient Experience Journal

In her review of Being Mortal: Illness, Medicine and What Matters in the End written by Atul Gawande, MD, Sue Sutton shares both the insights of Dr. Gawande and their important perspectives for person-centered experience. She reinforces that in this day of increased focus on understanding patient’s expectations and patient-focused care, Dr. Gawande compels us to learn how to have the difficult conversations about what really matters. She closes the review with a compelling quote from the author, "I never expected that among the most meaningful experiences I’d have as a doctor— and, really, as a human being— would come …

Creating And Integrating A New Patient Experience Leadership Role: A Consultative Approach For Partnering With Executive And Clinical Leaders, Denise M. Kennedy

Patient Experience Journal

Many healthcare organizations are creating new leadership roles to add subject matter expertise and structure to their patient experience improvement efforts. The patient experience field is emerging, however, so there are many questions about this role’s function and how best to structure it in the organization for maximal effectiveness.

This article explores the benefits of a consultative approach for improving the patient experience. Previous research on management consulting and the integration of new roles in established organizations is briefly reviewed. Mayo Clinic Arizona’s (MCA) comprehensive, "7-prong" service model is revisited. Developed and implemented in 2008, the model is predicated on …

Health Information Technology: A Key Ingredient Of The Patient Experience, Matthew Werder

Patient Experience Journal

In this exploration to understand the linkages of health information technology (HIT) and patient experience, a comprehensive literature search was conducted using the key words, “information technology, HIT, patient experience, patient satisfaction, and technology”, on the MEDLINE, PubMed, and EMBASE databases resulting in over 1,000 citations. Eventually, 35 of the most relevant articles were reviewed and 11 identified as key references to include in beginning to explore the question, as the transformation of healthcare continues, how can technology enable a positive return on investment to a patients’ perception of their care in an organization and how can technology impact the …

Variations In The Patients’ Hospital Care Experience By States’ Strategy For Medicaid Expansion: 2009-2013, Edmund Becker, Kenton Johnston Phd, Jaeyong Bae, Jason M. Hockenberry Phd, Ariel C. Avgar, Sandra Liu, Ira Wilson, Arnold Milstein Md, Mph

Patient Experience Journal

Our investigation evaluates the extent of differences in the patient’s hospital experience due to variations among state strategies to adopt, or not adopt, their Medicaid plans to the 2010 ACA legislation. Using ten HCAHPS measures, we analyze patient hospital experience data for the 2009 - 2013 period for all 50 states and the District of Columbia grouped by those states that (1) did not expand, (2) expanded Medicaid through Section 1115 waivers, (3) expanders early, and (4) expanded Medicaid concurrent with the new ACA legislation.

Our findings reveal that those states that opted out of Medicaid expansion typically started with …

Cancer Patients’ Experiences Of Error And Consequences During Diagnosis And Treatment, Henriette Lipczak, Liv H. Dørflinger, Christine Enevoldsen, Mette M. Vinter, Jeanne L. Knudsen

Patient Experience Journal

The study objective was to investigate patient experienced error during diagnosis and treatment of cancer. The design included a nationwide patient survey on quality and safety in Danish cancer care. Responses regarding patient experienced error were separately analyzed, quantitative responses using descriptive statistics and qualitative responses using systematic text analysis. Study participants included 6,720 adult patients with a first time diagnosis of cancer registered between May 1st and August 31st 2010. The patients received a questionnaire concerning their experiences of care received by general practitioners, specialist practitioners and at the hospital. A response rate of 65% was achieved. 10 – …

Patient Complaints As Predictors Of Patient Safety Incidents, Helen L. Kroening, Bronwyn Kerr, James Bruce, Iain Yardley

Patient Experience Journal

Patients remain an underused resource in efforts to improve quality and safety in healthcare, despite evidence that they can provide valuable insights into the care they receive. This study aimed to establish whether high-level patient safety incidents (HLIs) were predictable from preceding complaints, enabling complaints to be used to prevent HLIs. For this study complaints received from November 2011 through June 2012 and HLI incident reports from April through September 2012 were examined. Complaints and HLIs were categorised according to location or specialty and the themes they included. Data were analysed to look for correlations between number of complaints and …

Weighting Patient Satisfaction Factors To Inform Health Care Providers Of The Patient Experience In The Age Of Social Media Consumer Sentiment, Blaine Parrish, Amita N. Vyas, Grace Douglass

Patient Experience Journal

The researchers explored the possibility that patients would go beyond simple ranking and could give weight to previously validated and reliable patient satisfaction factors, while also describing their online habits related to the patient experience and health seeking information in order to inform medical providers on what patients say matters most when evaluating satisfaction with their provider. One thousand one hundred and sixty-four adults completed a 13- item web-based quantitative survey, developed by public health researchers, to weight patient satisfaction factors and describe online health seeking habits of patients across the United States. Proportional weights for each of the patient …

Patient Satisfaction Reported By In-Visit And After-Visit Surveys, Rukiya Wongus, Nicholas H. Schluterman, Sharon Feinstein, Nihkolle Mcgirt, Deborah R. Greenberg, David B. Schwartz

Patient Experience Journal

Patient experience measurement has become a basic requirement for every healthcare provider organization. Yet, when the timing and mode of survey administration are considered, there is skepticism about the usefulness of ‘after- visit’ patient experience surveys to measure satisfaction and identify opportunities to improve service or health care quality. The aim of this observational study was to compare patient satisfaction among those who rated the patient experience at the conclusion of their outpatient appointment while still in the office, to that among those who rated the patient experience up to one month after their outpatient appointment via a mailed survey. …

Considering Shared Power And Responsibility: Diabetic Patients’ Experience With The Pcmh Care Model, Olena Mazurenko Md, Phd, Sheila Bock Phd, Catherine Prato, Margarita Bondarenko

Patient Experience Journal

The patient-centered medical home (PCMH), an innovative primary care model that fosters a stronger, more personal patient-doctor relationship than traditional health care models, should be particularly well suited for the treatment of chronic conditions such as diabetes that require ongoing management by both patients and providers. Despite growing research on the effectiveness of PCMHs in diabetes care, relatively little attention has been given to diabetic patients’ experiences. This qualitative study examines diabetic patients’ experiences at one PCMH setting, using in-depth interviews to understand patients’ perspectives of the shared power and responsibility between patient and provider in their diabetes care. Our …

The Children’S Hospital Of Philadelphia Family Partners Program: Promoting Child And Family-Centered Care In Pediatrics, Amy Kratchman, Ba, Darlene Barkman, Ma, Kathy Conaboy, Ba, Anna De La Motte, Msed, Rachel Biblow, Msw, Katherine Bevans, Phd

Patient Experience Journal

Involving Family Advisory Councils in decisions that impact pediatric healthcare demonstrates hospitals’ commitment to child- and family-centered care. Yet, reliance on advisors as the sole source of family input has several limitations: infrequent meetings impedes the council’s capacity to address emerging concerns in a timely manner; feedback obtained from a small number of highly-engaged family members may not represent the perspectives of “typical” patients and families; advisors provide feedback in a reactive manner and are generally not equitably involved in problem identification or the initial development of solutions. In recognition of the need to strengthen and advance family partnerships, the …

Patient Partnership In Quality Improvement Of Healthcare Services: Patients’ Inputs And Challenges Faced, Marie-Pascale Pomey, Hassiba Hihat, May Khalifa, Paule Lebel, André Néron, Vincent Dumez

Patient Experience Journal

This research focuses on the perception of patients who participated in Continuous Quality Improvement Committees (CIC) regarding their contribution, lessons learned, and challenges encountered. The committees are engaged in a care partnership approach where patients are recognized for their experiential knowledge and treated as full members of the clinical team. Based on patient interviews, we conclude that they bring a structured and thoughtful vision of their experience. They identify themselves as real partners in the care process and are grateful for the opportunity to improve the care provided to other patients by using their own experience and by bringing changes …

Meaningful And Effective Patient Engagement: What Matters Most To Stakeholders, Mandy Bellows, Katharina Kovacs Burns, Karen Jackson, Brae Surgeoner, Jennifer Gallivan

Patient Experience Journal

To determine what resources, preparation, and support are needed for patients, providers, and leaders to meaningfully and appropriately engage in patient-centred health system redesign, researchers sought to learn what really matters to these three stakeholder groups. A qualitative descriptive design was selected using purposive participant sampling, focusing on ‘who’, ‘what’ and ‘why’ questions pertaining to stakeholder perceptions about patient engagement in their specific context as patients, providers or leaders. Four project groups were selected; each group was responsible for a strategic initiative within Alberta Health Services and represented one of three different levels of the healthcare system (i.e. program, site …

The Power Of Patient Ownership: The Path From Engagement To Equity, Zal Press, Dawn Richards

Patient Experience Journal

Understanding patient engagement from the lens of a person who is suffering, who is in pain and anguish, who is wracked with fear of the impact of this pain on their body, their family, their career, and their mortality, is a complex undertaking. The authors provide an important patient perspective in acknowledging and highlighting efforts to shift the conversation on experience from one about patients and families to one with patients and families. They challenge us to consider the power that can be found in creating ownership for patients and suggest it may be the one true path to moving …

Reframing The Work On Patient Experience Improvement, Jocelyn Cornwell

Patient Experience Journal

In reframing the work on patient experience improvement Dr. Jocelyn Cornwell, chief executive of The Point of Care Foundation, challenges us to broaden our view on what is necessary to impact patient experience efforts. From a defined need to reduce avoidable suffering associated with health care delivery dysfunction, she suggests we extend the discussion in two ways: First, to include a concern for staff engagement, experience and well-being, and second, to position patient experience improvement as one type of quality improvement (QI) in healthcare, and urge practitioners to pay more attention to the lessons from QI in other domains. High …

Patient Experience Established: One Year Later, Geoffrey A. Silvera, Jason A. Wolf Phd

Patient Experience Journal

Scholars and administrators have long dedicated themselves to centering healthcare conversations and debates on the experiences of patients and their families. Patient experience advocates view these experiences as critical to evaluations of healthcare quality. There have been a great multitude of important contributions, yet, for decades, these calls for patient-centric care experiences and healthcare systems have been confined to the fringes of disparate health policy and reform debates. This bygone reality created a diaspora of scholars and administrators dedicated to understanding, evaluating, and improving the patient experience. This article begins to explore a coalescing around patient experience research efforts citing …

The Patient Experience Movement Moves On, Jason A. Wolf Phd

Patient Experience Journal

As we present Volume 2 of Patient Experience Journal (PXJ) we both recognize the contributions that helped launch this publication and acknowledge the work that helped build the foundation of the broader research exploration in the emerging field of patient experience. On this base of knowledge we have worked to establish a new home for expanding the exploration of new ideas and practices through this publication. The importance of building, supporting and sustaining an outlet for research in patient experience is grounded in the belief that positive patient experience is good for healthcare, it is good for the people who …

Health Policy & Management News, Georgia Southern University

Health Policy & Community Health: News & Publications (2011-2018)

• LHDs Approaches to Deal with the Aftermath of Recession

The Detrimental Pitfalls Of Provider Documentation, Rosalind Crook-Duckett

Applied Research Projects

Electronic Health Records hold many benefits and clearly is a cut above maintain-ing paper records. Although, over the years we have learned that there are potential drawbacks that come with having an electronic health record. This review on EHR’s, is what could be, considered detrimental pitfalls of provider documentation (copying and pasting) and how this may affect the safety and quality of the physician documentation and patient care.

Assessing Changes In Safety Net Providers Since The Passage Of The Affordable Care Act, Arlesia Mathis, Julia Burke, Gulzar H. Shah

Health Policy & Management: Faculty Presentations (2008-2022)

The passage of the Affordable Care Act presented opportunities and challenges for safety net providers. Significant investments in provider capacity promised much needed expansion of services; and in 2014, the law extended coverage to millions of previously uninsured Americans. However, safety net providers are concerned that changes to financing brought about by changes in the ACA may threaten their ability to provide services to millions more who still lack insurance. This is a preliminary study of changes occurring with maternal and child health services among safety-net providers.

Use Of Facebook By Local Health Departments: Activity And Focus Areas, Rakhi Trivedi, Gulzar H. Shah

Health Policy & Management: Faculty Presentations (2008-2022)

This presentation was given at the Keeneland Conference for Public Health Systems and Services Research.

Health Policy & Management News, Georgia Southern University

Health Policy & Community Health: News & Publications (2011-2018)

• Laying the Groundwork for Evidence-Based Public Health

Ulaanbaatar’S Ger District Issues: Changes And Attitudes, David Engel

Independent Study Project (ISP) Collection

Several of Ulaanbaatar’s current issues are directly related to Ulaanbaatar’s sprawling Ger District. The Ger District is home to approximately 736,000 residents, 61% of Ulaanbaatar’s population (Galimbyek, 2015). The significant growth in Ulaanbaatar is shown by its 52.8% of residents who were born outside of the city, the majority of migrants moving into the Ger District due to a lack of housing. (Chilkhaasuren & Baasankhuu, 2012). The development of Ulaanbaatar has not kept up with the rapid growth leading to inadequate infrastructure in much of the Ger District. In turn, inadequate infrastructure has lead to high pollution levels, negatively affecting …

Annual Report 2014, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2014 calendar year, and provides a snapshot of our audience and resources.

Providence Ed Guide Program - Analysis Of Program Impacts; The Center For Outcomes Research & Education (Core); Providence Health & Services, Bill J. Wright

Articles, Abstracts, and Reports

No abstract provided.

Deconstructing Unmade Examining The Capacity Of Ayurveda To Address India’S Mental Health Crisis, Cassie Sutten Coats

Independent Study Project (ISP) Collection

Though India does not have a credible, widespread system in place to recognize and focus on issues of mental health, especially in allopathic treatments, it is imperative to evaluate the existing practices and approaches in regards to mental health alongside the impact that these approaches may have on Indian society. In contrast to Westernized systems of medicine, the traditional Indian system of Ayurveda inherently addresses issues in mental health due to the holistic approach through mind-body medicine. This study evaluates the enormous potential that exists within Ayurvedic philosophy to provide adequate, culturally congruent, treatments and care in mental health, and …

Investigating Barriers To Early Cancer Detection For Rural Indian Women: A Qualitative Analysis Of Cancer Outreach In Dehradun, Uttarakhand, Blair Burnett

Independent Study Project (ISP) Collection

This study examines barriers to early detection for women’s specific cancers in rural India in and around Dehradun, Uttarakhand, within the framework of existing health outreach programs from tertiary hospitals in the state. The burden of cancer mortality within India is disproportionately affecting women living in rural populations considering the current health education and health care infrastructure in place. Barriers of knowledge, access to knowledge, economic condition, geography, and cultural norms are all examined within this study in the context of early cancer detection. National Indian health policy is currently framed to address the burden of cancer within India; however, …

Confronting Cultural Challenges For Migrant Healthcare In Switzerland, Rebecca Weiss

Independent Study Project (ISP) Collection

Switzerland is home to many migrants, and migration exacerbates health risks. In addition to physical health problems, migrants are more likely than Swiss nationals to face mental health challenges and cultural barriers, which complicate their experiences seeking healthcare. Similarly, clinicians encounter numerous challenges related to the special circumstances of migrant patients. As a response to the specific health needs of migrants, hospital networks and migrant support organizations promote the migrant health situation. However, these services are not ubiquitous in Switzerland, partly due to the partial freedoms of each canton to create its own health policy. This paper explores the barriers …

Levels And Predictors Of Lhds' Engagement In Community Health Assessment, 2002-2013, Gulzar H. Shah, Kay Lovelace, Daniel F. Linder

Health Policy & Management: Faculty Presentations (2008-2022)

This presentation was given at the Keeneland Conference for Public Health Systems and Services Research.