Health Policy Commons^™

Integrating Health Services & Systems: What We Know, Think We Know, And Need To Learn, Glen P. Mays

Health Management and Policy Presentations

The delivery and financing systems for medical care, public health, and social and community services pursue many common goals and serve overlapping groups of families and communities. Unfortunately, in most American communities these systems interact in complex and often poorly understood ways through fragmented funding vehicles, information flows, governance and decision-making structures, institutional relationships, implementation rules and strategies, and professional and interpersonal connections. New research approaches are required to untangle these interactions and expose novel pathways of influence that can support equitable improvements in service delivery, resource use, health impact, and wellbeing. This presentation will summarize evidence from recent studies …

Measuring Multi-Sector Contributions To Public Health Delivery Systems & Population Health, Glen P. Mays

Health Management and Policy Presentations

The National Longitudinal Survey of Public Health Systems has followed a nationally-representative cohort of U.S. communities since 1998 to measure the scope of public health activities implemented in each community and the range of organizations and sectors that contribute to each activity. With 16 years of follow-up observations, this survey allows us to study the effects of demographic, economic, and policy shocks on public health delivery systems, and estimate the health effects attributable to delivery system change.

Measuring Comprehensive Public Health Delivery Systems And Their Contributions To Population Health, Glen P. Mays

Health Management and Policy Presentations

Delivery and financing systems for public health services vary widely across U.S. communities, raising questions about the comparative effectiveness and efficiency of alternative structures. We summarize recent approaches for measuring alternative system configurations and estimating their health and economic effects.

The Emerging Zika Pandemic: Enhancing Preparedness, Lawrence O. Gostin, Daniel Lucey

Georgetown Law Faculty Publications and Other Works

The Zika virus (ZIKV), a flavivirus related to yellow fever, dengue, West Nile, and Japanese encephalitis, originated in the Zika forest in Uganda and was discovered in a rhesus monkey in 1947. The disease now has “explosive” pandemic potential, with outbreaks in Africa, Southeast Asia, the Pacific Islands, and the Americas. Since Brazil reported Zika virus in May 2015, infections have occurred in at least 20 countries in the Americas. Puerto Rico reported the first locally transmitted infection in December 2015, but Zika is likely to spread to the United States. The Aedes species mosquito (an aggressive daytime biter) that …

Physician Assisted Dying: A Turning Point?, Lawrence O. Gostin, Anna E. Roberts

Georgetown Law Faculty Publications and Other Works

Physician Assisted Dying (PAD) has been lawful in some countries since the 1940s and in the United States since 1997. There is a body of social and scientific research that has focused on whether the practice has been misused and whether gaps exist in legislative safeguards. There are multiple concerns with physicians assisting patients to die: incompatibility with the physician’s role as a healer, devaluation of human life, coercion of vulnerable individuals (e.g., the poor and disabled), and the risk that PAD will be used beyond a narrow group of terminally ill individuals. Statutes in the United States have been …

Workforce Planning And Development In Times Of Delivery System Transformation, Patricia Pittman, Ellen Scully-Russ

Health Policy and Management Faculty Publications

Background

As implementation of the US Affordable Care Act (ACA) advances, many domestic health systems are considering major changes in how the healthcare workforce is organized. The purpose of this study is to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment.

Methods

Informed by the theory of loosely coupled systems (LCS), we use a case study design to examine how workforce changes are being managed in Kaiser Permanente and Montefiore Health System. We conducted site visits with in-depth interviews with 8 to 10 stakeholders in each organization.

Results

Both …

Disability Rights And Labor: Is This Conflict Really Necessary?, Samuel R. Bagenstos

Indiana Law Journal

In this Essay, I hope to do two things: First, I try to put the current labor-disability controversy into that broader context. Second, and perhaps more important, I take a position on how disability rights advocates should approach both the current contro-versy and labor-disability tensions more broadly. As to the narrow dispute over wage-and-hour protections for personal-assistance workers, I argue both that those workers have a compelling normative claim to full FLSA protection—a claim that disability rights advocates should recognize—and that supporting the claim of those workers is pragmatically in the best interests of the disability rights movement. As to …

The Disease Burden And The Extent Of Drug Therapy Problems In An Underserved Minority Population Receiving Medication Therapy Management At An Ambulatory Care Free Clinic, D. N. Ombengi, F. A. Ndemo, Ayman M. Noreddin, W. T. Harris

Pharmacy Faculty Articles and Research

Objective: To determine the common medical conditions, medications, and associated drug therapy problems in an underserved minority population receiving medication therapy management services at a large Community Free Clinic compared to the findings of the Minnesota Pharmaceutical Care Project.

Methods: Retrospective cohort study of a random sample of 60 minority patients referred for medication therapy management service at a Community Free Clinic from January 2012 to January 2014. Patient data including demographics, medication experience, past medical and medication history, medical conditions, active medications, allergies, immunization history and drug therapy was systematically evaluated to determine the most common conditions, …

Inter-Organizational Network Effects On The Implementation Of Public Health Services, Glen P. Mays

Health Management and Policy Presentations

Background: The Affordable Care Act created new incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing inter-organizational relationships and expanding implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities; (2) whether network changes attenuate or exacerbate disparities in public health implementation across communities; and (3) how network changes affect preventable mortality and resource use.

Methods: We follow a longitudinal cohort of …

Puerto Rico’S Community Health Centers In A Time Of Crisis, Peter Shin, Jessica Sharac, Marie Nina Luis, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2014, Puerto Rico’s twenty federally funded community health centers, operating in 71 sites located throughout the Commonwealth, served 330,736 patients, approximately one in ten Commonwealth residents. Compared to other Puerto Rico residents, health center patients are less likely to be insured. Despite considerable growth in Medicaid as a result of the supplemental funding provided under the Affordable Care Act, in 2014, 12.2% of health center patients remained uninsured.

Compared to health centers outside Puerto Rico, Puerto Rico’s health centers show a greater proportion of Medicaid patients served (69% compared to 46% outside Puerto Rico), a greater dependence on physician …

Hospital Practices Related To Breastfeeding In Mississippi: A Socio-Ecological Approach, Amir Alakaam

Dissertations

Mississippi continues to have one of the lowest rates and the weakest support in respect to breastfeeding in the nation (Centers for Disease Control and Prevention, 2014a). Hospital practices supporting breastfeeding such as the Ten Steps to Successful Breastfeeding (TSSB) can dramatically increase breastfeeding rates and duration (Rosenberg, Stull, Adler, Kasehagen, & Crivelli-Kovach, 2008). The aim of this study was to explore breastfeeding practices in Mississippi hospitals based on two levels of the Socio-Ecological Model: the organizational level (phase I) examined the hospital practices based on the level of implementation of the TSSB; the individual level (phase II) examined knowledge …

Vision, Mission, And Values: From Concept To Execution At Mayo Clinic, Sandhya Pruthi, Dawn Marie R. Davis, Dawn L. Hucke, Francesca B. Ripple, Barbara S. Tatzel, James A. Dilling, Paula J. Santrach, Jeffrey W. Bolton, John H. Noseworthy

Patient Experience Journal

Mayo Clinic displays steadfast commitment to patient care, referral relations, and health care quality through institutional examples of unique, value-add endeavors that are under way with the Mayo Clinic Patient Experience Subcommittee and the Referring Physician Office. In this article, we share the Mayo Model of Care and patient stories that embody the 8 Mayo Clinic values of respect, compassion, integrity, healing, teamwork, excellence, innovation, and stewardship. The Mayo founders imparted to their staff the passion for patient care by encouraging a fair and just culture for its employees. This culture allows the creation, maintenance, and improvement of clinical care, …

Randomized Clinical Trial Comparing Perioperative Care For Breast Cancer Patients At A Patient Hotel Versus A General Surgical Ward, Madleen Anna Camilla Huzell, Johan Frisack, Kristina Dalberg

Patient Experience Journal

Breast cancer is the most frequent cancer among women in Europe and the US. The aim of this study was to assess whether perioperative care, for breast cancer patients, provided at a patient hotel could be an alternative to the conventional care in an ordinary surgical ward. The study focuses solely on the patients’ experience of the provided care with a primary outcome that perioperative care at the patient hotel would be valued better than care in a general ward. Prospective, randomized single centre study. Between 2010 and 2012 a total of 151 patients < 80 years and without severe comorbidities were included in the trial, whereof 76 patients were randomised to the ward group and 75 patients to the hotel group. Five patients were excluded from each group. The validated IN2005-E questionnaire was used to evaluate the patients’ experiences of the care. The response rate was high with 65 patients answering the IN2005-E in each group. No difference could be found between the two groups regarding patient characteristics, type of surgery or tumour characteristics. The patients generally perceived the quality of the provided care as high. However, in the hotel group there was a better experience of care regarding issues such as coordination, privacy, some aspects of medical information, availability and the courtesy of the nurses. For selected patients, perioperative care at a patient hotel is an appreciated alternative to care at a surgical ward.

Patient Needs In Advanced Renal Cell Carcinoma: What Are Patients’ Priorities And How Well Are We Meeting Them?, Rick Harris, Kate Oake, Robert E. Hawkins, Robert J. Jones, Thomas Powles, David A. Montgomery

Patient Experience Journal

Treatment options and duration of therapy for patients with metastatic renal cell carcinoma (mRCC) have increased. Many patients now spend in excess of 2 years on active therapy. These patients’ needs, and the ability of health services to respond to them, are poorly understood. Ten patients living with mRCC for more than 2 years and treated with at least one targeted agent were selected at random from three hospitals in the United Kingdom (UK). One interviewer who was not involved in their care conducted in-depth interviews. Interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to identify issues of greatest …

The Comparative Impact Of Different Patient-Centered Medical Home Domains On Satisfaction Among Individuals Living With Type Ii Diabetes, Jon Mills, Allyson Hall, Rebecca Tanner, Jeffrey Harman, David L. Wood, Charles Lorbeer

Patient Experience Journal

Chronic illnesses like type 2 diabetes are costly and difficult to treat. Patient-centered medical homes (PCMH) have the potential to improve patient satisfaction in this population. However, which domains have the most impact on patient satisfaction has not been established. The aim of this study was to assess the relative strength of association between seven PCMH domains and two measures of satisfaction. Cross-sectional data were used in this observational study collected from a random sample of adults aged 18-89 with type 2 diabetes (n=1301) seen at 4 PCMHs. The Ambulatory Care Experiences Survey instrument was used to assess all measures. …

A Vision For Using Online Portals For Surveillance Of Patient-Centered Communication In Cancer Care, Hardeep Singh, Neeraj K. Arora, Kathleen M. Mazor, Richard L. Street Jr

Patient Experience Journal

The Veterans Health Administration (VHA) is charged with providing high-quality health care, not only in terms of technical competence but also with regard to patient-centered care experiences. Patient-centered coordination of care and communication are especially important in cancer care, as deficiencies in these areas have been implicated in many cases of delayed cancer diagnosis and treatment. Additionally, because cancer care facilities are concentrated within the VHA system, geographical and system-level barriers may present prominent obstacles to quality care. Systematic assessment of patient-centered communication (PCC) may help identify both individual veterans who are at risk of suboptimal care and opportunities for …

Impact Of Hospital Characteristics On Patients’ Experience Of Hospital Care: Evidence From 14 States, 2009-2011, Emily M. Johnston, Kenton J. Johnston, Jaeyong Bae, Jason M. Hockenberry, Ariel C. Avgar, Arnold Milstein Md, Mph, Sandra S. Liu, Ira Wilson, Edmund Becker

Patient Experience Journal

This paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in 10 hospital-reported patient experience-of-care scores by 29 characteristics classified as: patient characteristics, payer source, patient severity, hospital characteristics, hospital operations, and market characteristics. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores by hospital characteristics for 250 out of 290 HCAHPS-hospital characteristic combinations measured. We find fewer significant differences in changes in scores from 2009-2011 (135 out of …

Using A Process Improvement Tool To Improve Staff Skills & Enhance The Urgent Needs Patient Experience In A Women’S Health Center, Kenneth J. Feldman, Molly Lopez, Morris Gagliardi

Patient Experience Journal

NYC Health + Hospitals / Gouverneur serves more patients than any other diagnostic and treatment center in New York State. As part of the NYC Health + Hospitals public health care system, which serves 1.4 million patients and is the largest municipal health care delivery system in the United States, Gouverneur strives to serve the needs of both scheduled and unscheduled patients. Within Gouverneur, the Women’s Health department treats approximately 1,600 patients per month through approximately 2,100 visits. In September 2014, Gouverneur’s Women’s Health department launched a weeklong process improvement initiative known as a Rapid Improvement Event (RIE). Structured through …

Improving Process And Enhancing Parent And Therapist Satisfaction Through A Coordinated Intake Approach, Sharla Piecowye, Devona Gibson, Janis Carscadden, Kayla Ueland, Gregory Wells, Scott Oddie

Patient Experience Journal

Recent research indicates that, in Canada, approximately one in five children entering school are not meeting age appropriate milestones in physical, social, language, or cognitive development. Even where support services are available families often face barriers in accessing these. With the goals of improving access to programs, reducing barriers and increasing consistency and efficiency, a new Coordinated Intake Approach (CIA) was developed for families accessing Children’s Rehabilitation Services. It was expected that the CIA would result in 1) parents finding the intake process more satisfactory and easier to complete, 2) therapists feeling more supported and satisfied and 3) a decrease …

The Patient Patient: The Importance Of Knowing Your Navigator, Sarah M. Wheeler Phd, Julie E. Gilbert Phd, Melissa Kaan Mba, Eric Klonikowski, Claire Mb Holloway Md Phd Frcsc

Patient Experience Journal

In Ontario, Diagnostic Assessment Programs (DAPs) have been implemented to improve the quality of care patients receive during the diagnostic phase of the cancer journey. Patient navigators play a critical role in this model by coordinating care and providing information and support to patients and their families. The objectives of this study were 1) to determine whether patient navigation in DAPs is associated with a better patient experience and 2) to examine whether patient navigation in DAPs modifies the effect of wait times and patient volumes on patient experience. Data reflecting patients’ experience within the DAP were collected via survey …

Instruments To Measure The Inpatient Hospital Experience: A Literature Review, Kelly J. Edwards, Kim Walker, Jed Duff

Patient Experience Journal

Healthcare professionals worldwide are increasingly broadening their focus to include the experiences of patients and their family members as a means of assessing quality patient centered care. This paper seeks to identify and discuss instruments specifically designed to measure the inpatient hospital experience. A literature search focusing on pre-identified instruments as per the Health Foundation’s Helping Measuring Patient Centered Care database of measurement instruments (de Silva, 2014) and additional health databases (CINAHL, ERIC, EBSCO, HaPI, MEDLINE, PubMed and Psych INFO) was undertaken. Thirteen relevant instruments and seventeen associated studies (regarding instrument development and or validation) were identified. These instruments provide …

Managing Patient Expectations At Emergency Department Triage, Shital Shah, Anay Patel, Dino P. Rumoro, Samuel Hohmann, Francis Fullam

Patient Experience Journal

Emergency departments (ED) overcrowding, long wait, and uncomfortable waiting room conditions may lower perceived quality of the patient experience and satisfaction. This study investigates the relationship between patient satisfaction and communication of expected wait times, at the point of triage. A pre-post (11/4/ 2008 – 2/5/2009) group design with convenience sample (n=1,209) of all discharge adult ED patients was utilized for this study. A static expected wait time model (i.e., average wait time + one standard deviation) based on time of the day, day of the week and triage levels was employed to communicating expected wait time at triage while …

Bringing Patient Advisors To The Bedside: A Promising Avenue For Improving Partnership Between Patients And Their Care Team, Karine Vigneault, Johanne Higgins, Marie-Pascale Pomey, Josée Arsenault, Valérie Lahaie, Audrey-Maude Mercier, Olivier Fortin, Alain M. Danino

Patient Experience Journal

This paper presents an innovative model of care, which brings patients who have already been through a similar experience of illness (patient advisors) directly to the bedside of patients, where they are viewed as full-fledged members of the clinical team. As part of a pilot project, three patient advisors were recruited and met with patients who had sustained a traumatic amputation and were admitted to the only center of expertise in replantation of the upper limb in Canada. Several individual interviews and focus groups with patients and patient advisors have revealed very promising results. Indeed, patients have expressed …

Patient Leadership: Taking Patient Experience To The Next Level?, David Mcnally, Steve Sharples, Georgina Craig, Dr Anita Goraya, Frcgp

Patient Experience Journal

NHS England commissioned the project described in this article to explore how patients and carers can, acting as leaders, make a real difference in improving experience of care. The work was carried out on a collaborative basis, co-designing the scope of the research with patient leaders and commissioners. We gathered case examples across England that had involved patient leaders in using patient and carer feedback to improve experience of care. A Patient Leaders Expert Advisory Group selected four case examples that were visited to undertake a more detailed study and subsequently discussed and agreed the key learning points and conclusions. …

The Critical Role Of Family In Patient Experience, Brian Boyle

Patient Experience Journal

In this commentary Brian Boyle raises a simple, yet critical point about the value of family in the care experience. He offers, "When you are focusing on the goals for the patient's recovery, the doctors work with the nurses, specialists, and patient's family to decide on the appropriate care plan for the patient on both a short- and long-term basis. It is vital that this multi-disciplinary approach occurs during the formation of the care plan and is frequently updated as time goes on. The loved ones of a patient may not have a medical license or healthcare background, but their …

The State Of Patient Experience, Jason A. Wolf Phd

Patient Experience Journal

As the patient experience movement continues to flourish, there is greater alignment that experience encompasses all we do in healthcare – not simply a customer encounter, but how we engage people in mind, body and spirit, how we integrate the critical aspects of care from quality to safety to service and how we link the very complexities of our healthcare systems globally to provide for easy journeys for those receiving care. In sharing data from the latest study for The Beryl Institute on patient experience, the trends of this growing movement are seen as positive and a set of clear …

Irish Gms Cost Projections And Its Implications Between 2016 And 2026, Aisling Conway Lenihan, Noel Woods

Dept. of Management & Enterprise Publications

Introduction: Ireland had one of the highest pharmaceutical spends per capita in the EU in 2012. The General Medical Services (GMS) scheme is the largest community drug scheme in Ireland with approximately 40% of the population eligible for free drugs and appliances in 2012. The total cost of GMS prescriptions increased by 414% between 1998 and 2012. This paper projects Irish GMS cost from 2016 to 2026 and examines the implications of the estimated impact on GMS expenditure.

Method: Central Statistics Office (CSO) population projections (2013) and HSE-PCRS GMS population prescription data (2012) were used to develop four variables; population, …

Estimating Health & Economic Gains From Public Health Delivery System Transformation, Glen P. Mays

Health Management and Policy Presentations

Objectives: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health system change; and (2) the effects of these changes on preventable mortality and resource use. Methods: …

Kentucky’S Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays

Health Management and Policy Presentations

This session examines recent progress toward the 2012 Institute of Medicine recommendation to identify the components and costs of a "minimum package" of public health services and foundational capabilities to be available across the U.S. Research about the health and economic benefits of Foundational Public Health Services has begun to shape Kentucky's strategic plan for transforming the public health system.

Trends In Health Care Delivery Systems: Implications For Cancer Prevention And Control, Glen P. Mays

Health Management and Policy Presentations

The Affordable Care Act and larger economic forces are leading both health care providers and public health agencies to renegotiate their roles and responsibilities within the U.S. health system. This session reviews major changes occurring in both health care and public health delivery systems, with a focus on the implications for cancer prevention and control. The information infrastructure created by cancer registries and other health information systems are increasingly important for enabling greater coordination, alignment and accountability within the nation's changing delivery systems.