Health Policy Commons^™

Exploring The Process, Models, And Outcomes Of Hospital-Public Health Partnerships, Danielle M. Varda, Jessica H. Retrum, Carrie Chapman

Frontiers in Public Health Services and Systems Research

Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) requirement that hospitals conduct community health needs assessments, taking into greater consideration the public health of their respective communities. This has led to growing strategies to develop partnerships between hospitals and public health (PH) as a way to meet these needs¹. Meantime, there is a need for data on Hospital-PH partnerships, due to the growing emphasis that these types of partnerships get implemented in practice. In this paper we analyze a secondary data set to explore how hospitals and public health …

A Case Study Of Cross-Jurisdiction Resource Sharing: The Merger Of Two Tuberculosis Clinics In East Tennessee., Anne Kershenbaum, Margaret A. Knight, Martha L. Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Cross-jurisdiction resource sharing is considered a possible means to improve efficiency and effectiveness of public health service delivery. A merger of the Tuberculosis (TB) clinics of a rural and a metropolitan jurisdiction in East Tennessee provided an opportunity to study service provision changes in real time. A mixed methods approach was used, including quantitative data on latent TB treatment outcomes and qualitative data from staff interviews, as well as documentation of changes in staffing time in TB services. Results showed a mix of efficiency changes, indicating probable increased pressure on key service providers after the merger, in addition to expected …

What “Community Building” Activities Are Nonprofit Hospitals Reporting As Community Benefit?, Erik Bakken, David Kindig, Jo Ivey Boufford

Frontiers in Public Health Services and Systems Research

In 2008, the Internal Revenue Service (IRS) revised and standardized the reporting policy for community benefit expenses for nonprofit hospitals. These expenses are required for tax exemption. At that time, the IRS designated some categories of activities as non-eligible as a community benefit, but still mandated their reporting on hospitals’ Form 990, the annual tax filing for nonprofit organizations. One such category was community building, which encompasses a broad range of nonmedical determinants of health and an important potential source of population health revenue. This is the first study to analyze community-building dollars at any level, examining New York State’s …

Book Review: Questioning Protocol, Barbara Lewis Mba

Patient Experience Journal

In her review of Questioning Protocol by Randi Redmond Oster, Barbara Lewis shares how this new and award winning book takes the reader on Randi Oster's harrowing journey of navigating the healthcare system while helping her teenage son’s battle with Crohn’s disease. Seventeen chapters build a chronological story of success, frustration and failure in dealing with modern medicine and a healthcare industry that may appear foreign to the outsider.

Book Review: The Language Of Caring Guide For Physicians: Communication Essentials For Patient-Centered Care (2nd Edition), Chet Wyman Md

Patient Experience Journal

In thie book review for Wendy Leebov and Carla Rotering’s The Language of Caring Guide for Physicians: Communication Essentials for Patient-Centered Care (2nd edition), the author/reviewer conveys his perspective on the essential value of this publication. He offers his recommendation of this book for anyone who wants to improve their own communication skills and also for physician leaders responsible for initiatives to engage physicians and improve service quality, patient outcomes, and CAHPS scores for a department or organization, noting it is an essential read in today’s healthcare environment.

Learning What High Quality Compassionate Care Means For Cancer Patients And Translating That Into Practice, Fiona Mckenzie, Katherine Joel, Charlotte Williams, Kathy Pritchard-Jones Professor

Patient Experience Journal

In 2010, UCLPartners, a partnership of health care providers and universities in North Central London, began a collaboration with local commissioners that aimed to think about cancer care and diagnosis differently. Understanding that a good patient experience can only be delivered by putting patients first and working together along their journey from symptoms to recovery, we brought clinical leaders together with patients to think about how to improve outcomes for patients, outside institutional barriers. From the very beginning this new network, an integrated cancer system, focused on understanding what mattered most to patients and organising how it worked and how …

Exploring The Impact Of An Interprofessional Care Protocol On The Patient Experience And Outcomes For Seniors With Diabetes, Linda J. Mast Phd, Facmpe, Ateequr Rahman Phd, Diane Bridges Phd, Neil L. Horsley Dpm

Patient Experience Journal

Contemporary healthcare has placed intensified focus on the patient experience. Ultimately the patient experience is influenced by relationships with healthcare providers. In order to make a positive impact on patient outcomes and quality of care, the patient experience must be positive. Interprofessional collaboration is recognized as a key aspect of a culture that fosters patient-centered care and a positive patient experience. This quasi-experimental study explores the impact of interprofessional collaboration to develop a preventive services care protocol for seniors with diabetes. Patients were studied over six months using pre-test and post-test measures. Both quantitative data from clinical outcomes and qualitative …

Are We Providing Patient-Centered Care? Preferences About Paracentesis And Thoracentesis Procedures, Jeffrey H. Barsuk, Sarah E. Kozmic, Jordan Scher, Joe Feinglass, Aimee Hoyer, Diane B. Wayne

Patient Experience Journal

Procedures performed at the bedside are as safe and less expensive than Interventional Radiology (IR) procedures. Patient preferences regarding location are rarely taken into account. Therefore, in this study we compared patient satisfaction with bedside and IR paracentesis and thoracentesis procedures, and identified reasons for patient location preferences. We performed a cross-sectional survey of medical inpatients undergoing paracentesis or thoracentesis procedures at a tertiary care academic medical center. The survey had eight domains: overall experience, pain control, expertise, courtesy, bedside manner of the physician, time required, explanation of risks/benefits, comfort and privacy. Patients were also asked about their preference for …

Using A Data-Driven Organizational Improvement Model To Engage An Interdisciplinary Team In Transforming A Public Women’S Health Clinic, Kenneth J. Feldman, Molly Lopez, Morris Gagliardi

Patient Experience Journal

Gouverneur Health is the largest diagnostic and treatment center in New York State, and part of the New York City Health and Hospitals Corporation (HHC), a public benefit corporation with $6.7 billion in annual revenues. HHC is the largest municipal healthcare system in the United States serving 1.4 million patients, including more than 475,000 uninsured city residents.[1] Within Gouverneur, the Women’s Health department is committed to providing high quality services that improve patients' health and wellbeing, yet patient experience, flow, clinic access and education are in need of process improvements. To enhance patient experience and identify strategies replicable for other …

Feasibility Of Using Emergency Department Patient Experience Surveys As A Proxy For Equity Of Care, Helen Chiu, Nadia Batara, Robert Stenstrom, Lianne Carley, Catherine Jones, Lena Cuthbertson, Eric Grafstein

Patient Experience Journal

Collecting and examining equity data can help inform quality improvement initiatives but is a relatively new practice in health care. The overall goal of this study was to assess different methods of administering patient experience surveys as a feasible starting point in measuring equity in an urban Emergency Department (ED) that serves a diverse patient population. Socio-demographic characteristics of patients visiting an ED were compared with those of patients who responded to provincial patient experience surveys routinely administered by mail. Patient experience survey data were collected over an 11-week period in an urban ED using different survey administration methods (face-to-face …

The Relationships Between Hcahps Communication And Discharge Satisfaction Items And Hospital Readmissions, Fadi Hachem, Jeff Canar, Francis Fullam Ma, Andrew S. Gallan Phd, Samuel Hohmann, Catherine Johnson

Patient Experience Journal

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become a key metric used by organizations and patients to evaluate patient experience. Readmissions also continue to be a metric used to evaluate performance because of the added cost to both healthcare systems and patients. Both measures are also seen in programs such as Value Based Purchasing that have an effect on hospital reimbursements. Previous studies have demonstrated a relationship between patient perceptions and quality of care, and have found patients to be reliable evaluators of their care. While good communication and positive provider relationships have been related …

Evaluation Of An Advisory Committee As A Model For Patient Engagement, Cynthia Kendell, Robin Urquhart, Jill Petrella, Sarah Macdonald, Meg Mccallum

Patient Experience Journal

Patient engagement (PE) is not well defined and little guidance is available to those attempting to employ PE in decision-making relevant to health system improvement. After completing a 2-year PE project, overseen by an Advisory Committee, our objectives were: 1) to evaluate how effectively the project team engaged the Advisory Committee, 2) to examine how Advisory Committee members perceived PE and their role in PE, and 3) to identify barriers and facilitators to PE in order to improve future efforts. Five members of the Advisory Committee completed semi-structured interviews post-project about their experiences. Thematic analysis identified four themes: the approach, …

Improving The Patient Experience Through Nurse Leader Rounds, Judy C. Morton, Jodi Brekhus, Megan Reynolds, Anna Kay Dykes

Patient Experience Journal

While providing exceptional care experiences to patients is a priority for many organizations, creating and sustaining measureable success in this area remains a challenge for many. This article examines the impact of implementing nurse leader rounds on patient perception of care in the hospitals and emergency departments of a large healthcare system. Nurse leader rounds were implemented as a system-wide improvement practice at Providence Health & Services in 2012. Analysis of Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results indicates that implementation of nurse leader rounds is associated with statistically significant improvement in patient …

Creating And Sustaining A Culture Of Accountability For Patient Experience, Denise M. Kennedy Mba, Roshanak Didehban Mhs, Fache, John P. Fasolino Md

Patient Experience Journal

Improving the quality of the patient experience has become an imperative for healthcare organizations. Value-based payment models include patient perception data, and a negative experience can impact an organization’s finances. Sustainable improvement requires more than quick-fix cosmetic enhancements, ‘flavor-of-the-month’ service trainings, or bonuses for front-line staff. Organizations must actually improve the patient experience. Doing so requires a culture of accountability and a systematic framework for collecting and acting on patient perception data.

This article revisits Mayo Clinic Arizona's (MCA) "7-prong" model for improving service quality: (1) multiple data sources to drive improvement; (2) accountability; (3) service consultation and improvement tools; …

Beyond Credentialing In Physician Selection: Application Of An Instrument That Measures Behavioral Aptitude, Edgar Staren Md, Phd, Mba, Susan Hirt Ph.D., Doug Rath M.A.

Patient Experience Journal

This article explores the idea that the assessment of candidates for the role of physician caregiver can be enhanced by evaluating their inter-personal and behavioral aptitude as well as their clinical skills. The objective of this work was to determine whether results of a structured interview correlate to performance ratings for physicians. Two data sets were collected: a structured aptitude assessment for physicians (the Physician Interview) and job performance data for physicians. Analysis of performance data allowed categorization of the physicians into three groups: top performers, contrast performers, and neither. The two data sets were then analyzed to assess the …

Hindsight Is 20/20: Lessons Learned After Implementing Experience Based Design, Kate Bak, Laura Macdougall, Esther Green, Lesley Moody, Genevieve Obarski, Lori Hale, Susan Boyko, Deborah Devitt

Patient Experience Journal

Experience Based Design (EBD) uses patient and staff experiences to identify quality improvement opportunities in healthcare settings. An EBD Collaborative was established to share successes and challenges related to the EBD projects. This paper summarizes the various lessons learned. A document analysis was conducted that examined meeting minutes and audio recordings, email communications, newsletters, project updates, project spotlights and evaluation surveys and interviews. A total of ten key themes were identified. While EBD teams encountered challenges, overall the experience led to successful quality improvement initiatives. In particular, staff gained new insights from the patients’ perspective, which enhanced their understanding of …

The Patient Experience Movement Moment, William Lehrman Phd, Geoffrey Silvera Mha, Jason A. Wolf Phd

Patient Experience Journal

For years, the patient experience movement has continued to gain momentum. From a novel concept, there is an emerging consensus that the patient experience is a fundamental aspect of provider quality; one that complements established clinical process and outcome measures but is neither subsumed nor secondary to them. An increasing volume of research as encouraged by publications such as Patient Experience Journal show this to be true. As the expectation of a high-quality patient experience becomes the norm, these developments have brought us to what we call the patient experience movement moment and there is little doubt that the patient …

Customer Service Vs. Patient Care, Kathy Torpie

Patient Experience Journal

In a competitive market where financial resources are limited, many of the popular approaches to improving the patient experience involve large capital investments in such things as hotel style amenities and expensive technology. The author argues that marketing based on a model of the patient as a traditional ‘customer’ is ill conceived and contributes unnecessarily to the high cost of healthcare while lacking a true understanding of, or an appropriate response to, the most basic needs of hospitalized patients that lead to patient satisfaction.

Experience Framework

This article is associated with the Patient, Family & Community Engagement lens of The …

To Serve Patients Is Our Greatest Privilege, David T. Feinberg Md, Mba

Patient Experience Journal

In his guest editorial, Dr. David Feinberg of UCLA Health System reminds us of the power of patient voice and the lessons we should be open to learning from those we serve every day. He offers, "It is a blessing for us to work in an environment where we have the opportunity every day to touch someone’s life so deeply. We must never lose sight of that. It is our responsibility to not just treat our patients, but also to embrace them."

A Gathering Place For Patient Experience Research: The Power Of Community, Jason A. Wolf Phd

Patient Experience Journal

In introducing Issue 2, we explore the power of community and its implications in shaping not only the purpose and intent of Patient Experience Journal, but of the patient experience movement itself. Community defined in this moment is simple, yet significant, the key being unity around common interest and its focus on ownership and participation. The idea of community bears great weight and has provided strong guidance and purpose for the work of experience excellence. It supports the goal of elevating the conversation, helps align the voices engaged and provides the space for listening, learning and impact.

Experience Framework …

The Population Genetic Structure Of Biomphalaria Choanomphala In Lake Victoria, East Africa: Implications For Schistosomiasis Transmission, Claire J. Standley, Sara L. Goodacre, Christopher M. Wade, J. Russell Stothard

Health Policy and Management Faculty Publications

Background

The freshwater snail Biomphalaria acts as the intermediate host of Schistosoma mansoni, a globally important human parasite. Understanding the population structure of intermediate host species can elucidate transmission dynamics and assist in developing appropriate control methods.

Methods

We examined levels of population genetic structure and diversity in 29 populations of Biomphalaria choanomphala collected around the shoreline of Lake Victoria in Uganda, Kenya and Tanzania, where S. mansoni is hyper-endemic. Molecular markers were utilized to estimate the degree to which snail populations are genetically differentiated from one another.

Results

High levels of snail genetic diversity were found coupled with …

Frontiers In Phssr Is On The Move, F. Douglas Scutchfield

Frontiers in Public Health Services and Systems Research

Recently, Dr. Jenine Harris and her colleagues examined the use of journals by state chronic disease prevention staff to stay up-to-date on public health evidence. We, at Frontiers in PHSSR, are pleased to be included among the journals listed in the survey. Online open-access journals are shifting the paradigm of scientific publication, allowing free and rapid exchange of information. Another illustration of Frontier’s increasing utility is a forthcoming issue of the American Journal of Public Health (AJPH). We are pleased that AJPH has agreed to publish selected abstracts from Frontiers in PHSSR in their regular issue with links to …

Editorial Comment: Understanding Cost Variation In Std Service Delivery As State And Federal Agencies Reduce Funding, Michael A. Preston, William W. Greenfield, Sharla A. Smith

Frontiers in Public Health Services and Systems Research

As health reform gains momentum, many changes have been seen in the way health services are delivered and financed. In an attempt to address the uncertainties and understand the costs of delivering STD prevention services, the authors examined the cost of STDs in a highly centralized public health agency system (PHAS). This commentary covers several implications that arise from this study.

Understanding Cost Variations In Std Service Delivery As State And Federal Agencies Reduce Funding, William C. Livingood, Lori Bilello, Bonita Sorensen

Frontiers in Public Health Services and Systems Research

Sexually transmitted diseases (STD) continue to be a major health problem in the U.S. Despite the persistence of STDs and the critical role of the public health sector in controlling these diseases, STD services continue to be reduced. A linear regression was performed using county demographic and cost variables. Many of these variables in county public health agencies and the populations they serve were not significantly correlated with cost of service. However, the availability of local tax funding for county health departments (CHDs), which varies extensively across counties within the state, is statistically linked to higher STD expenditure per case. …

The Role Of Leadership In Creating A Strategic Climate For Evidence-Based Practice Implementation And Sustainment In Systems And Organizations, Gregory A. Aarons, Mark G. Ehrhart, Lauren R. Farahnak, Marisa Sklar

Frontiers in Public Health Services and Systems Research

There is a growing impetus to effectively implement evidence-based practices (EBPs) in health and allied health settings in order to improve the public health impact of such practices. To support implementation and sustainment of EBPs, it is important to consider that health care is delivered within the outer context of public health systems and the inner context of health care organizations and work groups (3). This article identifies two relevant types of leadership for implementation and recommends steps that leaders can take in developing a strategic climate for EBP implementation and sustainment within the outer and inner contexts of health …

Editorial Comment: What Influences The Use Of Administrative Evidence-Based Practices In Local Health Departments?, Christopher M. Maylahn

Frontiers in Public Health Services and Systems Research

In 2012, Frontiers published an article by Allen et al. about identifying administrative and management practices that make up an evidence-based local health department.¹ They recommended that local health departments (LHDs) consider using such practices to implement sustained evidence-based policies, programs, and interventions. Strategies that should be given ‘high priority’ for implementation were highlighted. My accompanying editorial² acknowledged the value of this practical advice to LHDs in optimizing their performance and achieving desired health outcomes.

What Influences The Use Of Administrative Evidence-Based Practices In Local Health Departments?, Kathleen Duggan, Peg Allen, Ross Brownson, Paul C. Erwin, Robert Fields, Rodrigo S. Reis, Carson Smith, Katherine Stamatakis

Frontiers in Public Health Services and Systems Research

Evidence based public health (EBPH) in local health departments (LHDs) is a process that involves translating the best available scientific evidence into practice. However, EBPH and implementation of evidence based programs and policies in LHDs are not widespread. This report outlines the patterns and predictors of the use of administrative evidence based practices (A-EBPs) in a national sample of LHD directors. LHDs can improve performance, prepare for accreditation and ultimately improve community health by utilizing an administrative evidence based process.

The Impact Of State Mandated Healthcare-Associated Infection Reporting On Infection Prevention And Control Departments In Acute Care Hospitals: Results From A National Survey, Carolyn T. A. Herzig, Monika Pogorzelska-Maziarz, Julie Reagan, Elaine Larson, Patricia W. Stone

Health Policy and Management Faculty Presentations

Background: In addition to federally mandated reporting, most US states have adopted legislation requiring hospitals to submit healthcare-associated infection (HAI) data. Evidence that state HAI laws have increased patient safety and reduced HAI rates is inconsistent, however, and resources needed to comply are considerable. We evaluated the impact of state HAI laws on infection prevention and control departments (IPCD).

Methods: Web-based survey of a national sample of hospital IPCD was conducted in Fall 2011; all non-VA hospitals enrolled in the National Healthcare Safety Network were eligible to participate. States with HAI laws effective prior to Fall 2011 were identified using …

Children's Use Of Dental Care In Medicaid: Federal Fiscal Years 2000-2012, Erika Steinmetz, Brian K. Bruen, Leighton C. Ku

Health Policy and Management Faculty Publications

This report presents with national and state-specific analyses about dental services received by children ages 1 to 20 under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit in federal fiscal years (FFY) 2000-2012. These analyses are based on data reported by state Medicaid agencies using Form CMS-416 (Form 416); all data reflect updates received by CMS as of April 3, 2014. This report focuses on the number of children who received any dental service, any preventive dental service (e.g., dental cleaning or application of dental sealants) and any dental treatment service (e.g., filling a cavity). The national trend …

Access To Comprehensive Perinatal Services Among Pregnant Women Enrolled In Both Medi-Cal And Covered California: Aligning And Integrating Care, Sara J. Rosenbaum, Carla Hurt, Mark Dorley, Sara Rothenberg, Nancy Lopez

Health Policy and Management Faculty Publications

Medi-Cal-enrolled women who are pregnant are entitled to coverage for enriched pregnancy-related care under Medi-Cal’s Comprehensive Perinatal Services Program (CPSP), a national landmark in the care and management of pregnant women with elevated health risks due to their low economic status. This entitlement applies to all pregnant women enrolled in Medi-Cal, including women who also are enrolled in subsidized health plans purchased through Covered California. The task that jointly faces Medi-Cal and Covered California is how best to align these two sources of pregnancy care financing in order to achieve a central goal of SB 857 – ensuring that dually …