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Jackson GL, Fix GM, White BS, Cutrona SL, Reardon CM, Damschroder LJ, Burns M, DeLaughter K, Opra Widerquist MA, Arasim M, Lindquist J, Gifford AL, King HA, Kaitz J, Jasuja GK, Hogan TP, Lopez JCF, Henderson B, Fitzgerald BA, Goetschius A, Hagan D, McCoy C, Seelig A, Nevedal A. Diffusion of excellence: evaluating a system to identify, replicate, and spread promising innovative practices across the Veterans health administration. FRONTIERS IN HEALTH SERVICES 2024; 3:1223277. [PMID: 38420338 PMCID: PMC10900518 DOI: 10.3389/frhs.2023.1223277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/20/2023] [Indexed: 03/02/2024]
Abstract
Introduction The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program provides a system to identify, replicate, and spread promising practices across the largest integrated healthcare system in the United States. DoE identifies innovations that have been successfully implemented in the VHA through a Shark Tank style competition. VHA facility and regional directors bid resources needed to replicate promising practices. Winning facilities/regions receive external facilitation to aid in replication/implementation over the course of a year. DoE staff then support diffusion of successful practices across the nationwide VHA. Methods Organized around the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, we summarize results of an ongoing long-term mixed-methods implementation evaluation of DoE. Data sources include: Shark Tank application and bid details, tracking practice adoptions through a Diffusion Marketplace, characteristics of VHA facilities, focus groups with Shark Tank bidders, structured observations of DoE events, surveys of DoE program participants, and semi-structured interviews of national VHA program office leaders, VHA healthcare system/facility executives, practice developers, implementation teams and facilitators. Results In the first eight Shark Tanks (2016-2022), 3,280 Shark Tank applications were submitted; 88 were designated DoE Promising Practices (i.e., practices receive facilitated replication). DoE has effectively spread practices across the VHA, with 1,440 documented instances of adoption/replication of practices across the VHA. This includes 180 adoptions/replications in facilities located in rural areas. Leadership decisions to adopt innovations are often based on big picture considerations such as constituency support and linkage to organizational goals. DoE Promising Practices that have the greatest national spread have been successfully replicated at new sites during the facilitated replication process, have close partnerships with VHA national program offices, and tend to be less expensive to implement. Two indicators of sustainment indicate that 56 of the 88 Promising Practices are still being diffused across the VHA; 56% of facilities originally replicating the practices have sustained them, even up to 6 years after the first Shark Tank. Conclusion DoE has developed a sustainable process for the identification, replication, and spread of promising practices as part of a learning health system committed to providing equitable access to high quality care.
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Affiliation(s)
- George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Advancing Implementation and Improvement Science Program, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gemmae M. Fix
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Brandolyn S. White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Caitlin M. Reardon
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Laura J. Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Madison Burns
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | | | - Maria Arasim
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Jennifer Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Heather A. King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Division of General Internal Medicine, Duke University, Durham, NC, United States
| | - Jenesse Kaitz
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | - Guneet K. Jasuja
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Timothy P. Hogan
- Advancing Implementation and Improvement Science Program, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | - Jaifred Christian F. Lopez
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Blake Henderson
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Blaine A. Fitzgerald
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Amber Goetschius
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Danielle Hagan
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Carl McCoy
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Alex Seelig
- Agile Six Applications, Inc., San Diego, CA, United States
| | - Andrea Nevedal
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
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2
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Berman AN, Ginder C, Wang XS, Borden L, Hidrue MK, Searl Como JM, Daly D, Sun YP, Curry WT, Del Carmen M, Morrow DA, Scirica B, Choudhry NK, Januzzi JL, Wasfy JH. A pragmatic clinical trial assessing the effect of a targeted notification and clinical support pathway on the diagnostic evaluation and treatment of individuals with left ventricular hypertrophy (NOTIFY-LVH). Am Heart J 2023; 265:40-49. [PMID: 37454754 DOI: 10.1016/j.ahj.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Electronic health records contain vast amounts of cardiovascular data, including potential clues suggesting unrecognized conditions. One important example is the identification of left ventricular hypertrophy (LVH) on echocardiography. If the underlying causes are untreated, individuals are at increased risk of developing clinically significant pathology. As the most common cause of LVH, hypertension accounts for more cardiovascular deaths than any other modifiable risk factor. Contemporary healthcare systems have suboptimal mechanisms for detecting and effectively implementing hypertension treatment before downstream consequences develop. Thus, there is an urgent need to validate alternative intervention strategies for individuals with preexisting-but potentially unrecognized-LVH. METHODS Through a randomized pragmatic trial within a large integrated healthcare system, we will study the impact of a centralized clinical support pathway on the diagnosis and treatment of hypertension and other LVH-associated diseases in individuals with echocardiographic evidence of concentric LVH. Approximately 600 individuals who are not treated for hypertension and who do not have a known cardiomyopathy will be randomized. The intervention will be directed by population health coordinators who will notify longitudinal clinicians and offer to assist with the diagnostic evaluation of LVH. Our hypothesis is that an intervention that alerts clinicians to the presence of LVH will increase the detection and treatment of hypertension and the diagnosis of alternative causes of thickened myocardium. The primary outcome is the initiation of an antihypertensive medication. Secondary outcomes include new hypertension diagnoses and new cardiomyopathy diagnoses. The trial began in March 2023 and outcomes will be assessed 12 months from the start of follow-up. CONCLUSION The NOTIFY-LVH trial will assess the efficacy of a centralized intervention to improve the detection and treatment of hypertension and LVH-associated diseases. Additionally, it will serve as a proof-of-concept for how to effectively utilize previously collected electronic health data to improve the recognition and management of a broad range of chronic cardiovascular conditions. TRIAL REGISTRATION NCT05713916.
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Affiliation(s)
- Adam N Berman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Massachusetts General Physicians Organization, Boston, MA
| | - Curtis Ginder
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Xianghong S Wang
- Division of Performance Analysis and Improvement, Massachusetts General Physicians Organization, Boston, MA
| | - Linnea Borden
- Massachusetts General Physicians Organization, Boston, MA
| | - Michael K Hidrue
- Division of Performance Analysis and Improvement, Massachusetts General Physicians Organization, Boston, MA
| | | | - Danielle Daly
- Massachusetts General Physicians Organization, Boston, MA
| | - Yee-Ping Sun
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William T Curry
- Massachusetts General Physicians Organization, Boston, MA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marcela Del Carmen
- Massachusetts General Physicians Organization, Boston, MA; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David A Morrow
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin Scirica
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Niteesh K Choudhry
- Department of Medicine, Center for Healthcare Delivery Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA
| | - Jason H Wasfy
- Massachusetts General Physicians Organization, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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3
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Edelman A, Taylor J, Ovseiko PV, Larkins S, Topp SM. The population health role of academic health centres: a multiple-case exploratory study in Australia and England. Health Policy 2022; 126:1051-1061. [PMID: 36031466 DOI: 10.1016/j.healthpol.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Academic health centres (AHCs) are organisations that aim to mobilise knowledge into practice by improving the responsiveness of health systems to emerging evidence. This study aims to explore the population health role of AHCs in Australia and England, where AHCs represent novel organisational forms. METHODS A multiple-case study design using qualitative methods was used to explore population health goals and activities in four discrete AHCs in both countries during 2017 and 2018. Data from 85 interviews with AHC leaders, clinicians and researchers, direct observation, and documentation were analysed within and across the cases. RESULTS Comparison across cases produced four cross-case themes: health care rather than population health; incremental rather than major health system change; different conceptions of "translation" and "innovation"; and unclear pathways to impact. The ability of the AHCs to define and enact a population health role was hindered during the study period by gaps in knowledge mobilisation strategies at a health system and policy level, the biomedical orientation of government designation schemes for AHCs in Australia and England, and competing expectations of the sovereign partner organisations in AHCs against a backdrop of limited operational resources. DISCUSSION The study identifies several institutional elements that are likely to be needed for AHCs in Australia and England to deliver on both internal and external expectations of their population health role.
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Affiliation(s)
- Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Pavel V Ovseiko
- Radcliffe Department of Medicine, Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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4
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Sud A, Buchman DZ, Furlan AD, Selby P, Spithoff SM, Upshur REG. Chronic Pain and Opioid Prescribing: Three Ways for Navigating Complexity at the Clinical‒Population Health Interface. Am J Public Health 2022; 112:S56-S65. [PMID: 35143271 PMCID: PMC8842204 DOI: 10.2105/ajph.2021.306500] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/04/2022]
Abstract
Clinically focused interventions for people living with pain, such as health professional education, clinical decision support systems, prescription drug monitoring programs, and multidisciplinary care to support opioid tapering, have all been promoted as important solutions to the North American opioid crisis. Yet none have so far delivered substantive beneficial opioid-related population health outcomes. In fact, while total opioid prescribing has leveled off or reduced in many jurisdictions, population-level harms from opioids have continued to increase dramatically. We attribute this failure partly to a poor recognition of the epistemic and ethical complexities at the interface of clinical and population health. We draw on a framework of knowledge networks in wicked problems to identify 3 strategies to help navigate these complexities: (1) designing and evaluating clinically focused interventions as complex interventions, (2) reformulating evidence to make population health dynamics apparent, and (3) appealing to the inseparability of facts and values to support decision-making in uncertainty. We advocate that applying these strategies will better equip clinically focused interventions as complements to structural and public health interventions to achieve the desired beneficial population health effects. (Am J Public Health. 2022;112(S1):S56-S65. https://doi.org/10.2105/AJPH.2021.306500).
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Affiliation(s)
- Abhimanyu Sud
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Daniel Z Buchman
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Andrea D Furlan
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Peter Selby
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Sheryl M Spithoff
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Ross E G Upshur
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
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Cofer J, Hurst AN, Winter T, Moreno M, Cinciripini PM, Walsh MT, Tektiridis J, Hawk E. A Comprehensive Program to Reduce Tobacco-related Cancers Through Actions by a National Cancer Institute-designated Cancer Center. Cancer Control 2022; 29:10732748221138713. [DOI: 10.1177/10732748221138713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tobacco use accounts for 30% of all cancer-related deaths worldwide and 20% in the US, despite effective, evidence-based interventions for reducing tobacco use and tobacco-related cancers and deaths. In 2012, to reduce the burden of tobacco-related cancer and associated population-level risks across Texas, The University of Texas MD Anderson Cancer Center initiated the EndTobacco® program to promote statewide cancer control activities. We created evidence-based initiatives, established selection criteria, and implemented actions involving policy, education, and tobacco treatment services. As a result, EndTobacco has supported, educated, and convened local and state coalitions in policymaking; provided tobacco treatment education to health professionals; implemented Texas’ only certified tobacco treatment training program; and led an initiative to enhance the tobacco-free culture of the state’s publicly funded university system. Supported by commitments from MD Anderson, we developed and implemented evidence-based actions for tobacco control tailored to the center’s mission, values, expertise, resources, and partnerships. By 2021, the adult smoking rate in Texas dropped from 19.2% (2014) to 13.2%. Contributors to this drop include state tobacco control policies, programs and services from multiple agencies and associations, and EndTobacco activities that complement the statewide effort to prevent youth smoking initiation and increase quit attempts among youth and adults.
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Affiliation(s)
- Jennifer Cofer
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alex N. Hurst
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tiffany Winter
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Moreno
- Governmental Relations, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul M. Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael T Walsh
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer Tektiridis
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ernest Hawk
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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Tierney WM, Auzenne D, Cook L, Jones BL, Mackert M, Paydarfar D, Ding X, Woods JM, Kahlon M. Importance of Community Impact as the Fourth Academic Mission: A Qualitative Study. Popul Health Manag 2021; 24:610-615. [PMID: 33709790 DOI: 10.1089/pop.2021.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Most US medical schools have 3 primary missions: education, research, and clinical service. Recently there have been calls for a fourth primary mission focused on improving health in their surrounding communities. To date, few medical schools have done so. To identify factors supporting and challenges to establishing a sustainable community impact mission, the authors conducted semi-structured key informant interviews with the dean, associate deans, departments chairs, and institute and center directors at a new US medical school that established a fourth "community impact" mission at its conception. Interviewees believed that it was appropriate for a community-focused tax-supported medical school to embrace community impact as a fourth mission to enhance community health outside of its hospitals and clinics. Many also felt that community impact should be an overriding framework for activities in the 3 primary missions. Achieving community impact would require creating a "learning health community" via partnerships with community organizations and linking faculty effort and funding to specific and valid measures of community health improvement. Sustainable funding would require core school funds and a broad portfolio of extramural funding. Faculty promotions with community impact as a focus would need explicit, achievable, and unique milestones. Interviewees made specific suggestions on the support and structure needed to launch and sustain this fourth mission. Establishing a fourth mission of community impact can extend medical schools' influence beyond typical health care venues to enhance the health of their communities and their residents. Doing so requires rethinking organizational structures, support, and measures of success.
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Affiliation(s)
- William M Tierney
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.,Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - David Auzenne
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Lori Cook
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Barbara L Jones
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA.,Department of Health Social Work, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Michael Mackert
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA.,Stan Richards School of Advertising & Public Relations, Moody College of Communication, University of Texas at Austin, Austin, Texas, USA
| | - David Paydarfar
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Xiao Ding
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Joy Melody Woods
- Stan Richards School of Advertising & Public Relations, Moody College of Communication, University of Texas at Austin, Austin, Texas, USA
| | - Maninder Kahlon
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
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7
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Boulware LE, Harris GB, Harewood P, Johnson FF, Maxson P, Bhavsar N, Blackwelder SS, Poley SS, Arnold K, Akindele B, Ferranti J, Lyn M. Democratizing health system data to impact social and environmental health contexts: a novel collaborative community data-sharing model. J Public Health (Oxf) 2020; 42:784-792. [PMID: 31915811 DOI: 10.1093/pubmed/fdz171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Community health data are infrequently viewed in the context of social and environmental health determinants. We developed a novel data-sharing model to democratize health system data and to facilitate community and population health improvement. METHODS Durham County, the City of Durham in North Carolina, Durham health systems and other stakeholders have developed a data-sharing model to inform local community health efforts. Aggregated health system data obtained through clinical encounters are shared publicly, providing data on the prevalence of health conditions of interest to the community. RESULTS A community-owned web platform called the Durham Neighborhood Compass provides aggregate health data (e.g. on diabetes, heart disease, stroke and other conditions of interest) in the context of neighborhood social (e.g. income distribution, education level, demographics) and environmental (e.g. housing prices, crime rates, travel routes, school quality, grocery store proximity) contexts. Health data are aggregated annually to help community stakeholders track changes in health and health contexts over time. CONCLUSIONS The Durham Neighborhood Compass is among the first collaborative public efforts to democratize health system data in the context of social and environmental health determinants. This model could be adapted elsewhere to support local community and population health improvement initiatives.
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Affiliation(s)
- L E Boulware
- Center for Community and Population Health Improvement, Duke University Clinical and Translational Science Institute, Durham, NC 27701, USA.,Division of General Internal Medicine, Department of Medicine Duke University School of Medicine, Durham, NC 27701, USA
| | - G B Harris
- Durham County Department of Public Health, Durham, NC 27701, USA
| | - P Harewood
- Lincoln Community Health Center, Durham, NC 27707, USA
| | - F F Johnson
- Center for Community and Population Health Improvement, Duke University Clinical and Translational Science Institute, Durham, NC 27701, USA.,Division of Community Health, Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC 27701, USA
| | - P Maxson
- Center for Community and Population Health Improvement, Duke University Clinical and Translational Science Institute, Durham, NC 27701, USA
| | - N Bhavsar
- Center for Community and Population Health Improvement, Duke University Clinical and Translational Science Institute, Durham, NC 27701, USA.,Division of General Internal Medicine, Department of Medicine Duke University School of Medicine, Durham, NC 27701, USA
| | - S S Blackwelder
- Duke Health Technology Solutions, Duke Health, Durham, NC 27707, USA
| | - S S Poley
- Duke Health Technology Solutions, Duke Health, Durham, NC 27707, USA
| | - K Arnold
- Duke Health Technology Solutions, Duke Health, Durham, NC 27707, USA
| | - B Akindele
- Duke Health Technology Solutions, Duke Health, Durham, NC 27707, USA
| | - J Ferranti
- Duke Health Technology Solutions, Duke Health, Durham, NC 27707, USA
| | - M Lyn
- Center for Community and Population Health Improvement, Duke University Clinical and Translational Science Institute, Durham, NC 27701, USA.,Division of Community Health, Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC 27701, USA
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8
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Park S, Hamadi H, Apatu E, Spaulding AC. Hospital Partnerships in Population Health Initiatives. Popul Health Manag 2020; 23:226-233. [DOI: 10.1089/pop.2019.0074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Sinyoung Park
- Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
| | - Hanadi Hamadi
- Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
| | - Emma Apatu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Aaron C. Spaulding
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic Robert D. and Patricia E. Kern, Center for the Science of Health Care Delivery, Jacksonville, Florida, USA
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Barrett NJ, Ingraham KL, Bethea K, Hwa-Lin P, Chirinos M, Fish LJ, Randolph S, Zhang P, Le P, Harvey D, Godbee RL, Patierno SR. Project PLACE: Enhancing community and academic partnerships to describe and address health disparities. Adv Cancer Res 2020; 146:167-188. [PMID: 32241388 DOI: 10.1016/bs.acr.2020.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Achieving cancer health equity is a national imperative. Cancer is the second leading cause of death in the United States and in North Carolina (NC), where the disease disproportionately impacts traditionally underrepresented race and ethnic groups, those who live in rural communities, the impoverished, and medically disenfranchised and/or health-disparate populations at high-risk for cancer. These populations have worse cancer outcomes and are less likely to be participants in clinical research and trials. It is critical for cancer centers and other academic health centers to understand the factors that contribute to poor cancer outcomes, the extent to which they impact the cancer burden, and develop effective interventions to address them. Key to this process is engaging diverse stakeholders in the development and execution of community and population health assessments, and the subsequent programs and interventions designed to address the need across the catchment area. This chapter describes the processes and lessons learned of the Duke Cancer Institute's (DCI) long standing community partnerships that led to Project PLACE (Population Level Approaches to Cancer Elimination), a National Cancer Institute (NCI)-funded community health assessment reaching 2315 respondents in 7 months, resulting in a community partnered research agenda to advance cancer equity within the DCI catchment area. We illustrate the application of a community partnered health assessment and offer examples of strategic opportunities, successes, lessons learned, and implications for practice.
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Affiliation(s)
- Nadine J Barrett
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States; Department of Family Medicine and Community Health, Duke School of Medicine, Durham, NC, United States; Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States.
| | - Kearston L Ingraham
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kenisha Bethea
- Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States
| | - Pao Hwa-Lin
- Chinese Christian Church, Raleigh, NC, United States; Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | | | - Laura J Fish
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | | | - Ping Zhang
- Chinese American Friendly Association, Raleigh, NC, United States
| | - Peter Le
- St. Joseph's Primary Care, Raleigh, NC, United States
| | - Demetrius Harvey
- Black Men's Health Initiative, Wilson, NC, United States; Alumni Chapter of Kappa Alpha Psi Fraternity, Inc., Smithfield, NC, United States
| | | | - Steven R Patierno
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
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10
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Hebert CA, Trudeau SA, Sprinkle W, Moo LR, McConnell ES. Directed content analysis of Veterans Affairs policy documents: A strategy to guide implementation of a dementia home safety toolkit for Veterans to promote ageing in place. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:182-194. [PMID: 31523881 DOI: 10.1111/hsc.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 06/10/2023]
Abstract
Older adults' preference to age in place, coupled with an increasing prevalence of dementia, creates an imperative to address home safety risks that occur due to cognitive impairment. Providing caregivers with home safety items and education can facilitate ageing in place for older adults living with dementia. In 2015-2017, we examined barriers and facilitators within 17 policy documents and dementia guidelines of the United States (US) Veterans Health Administration pertinent to implementation of a home safety toolkit (HST) for Veterans living with dementia. The documents were issued from 2000 to 2015. Directed qualitative content analysis of these documents guided by themes from stakeholder interviews revealed two key implementation barriers: a focus on physical rather than cognitive risks when determining medical necessity for home equipment, and a focus on rehabilitation and treatment rather than prevention. Mandates for person-centred care planning, including comprehensive assessment, interdisciplinary collaboration, staff education and a focus on population health in primary care facilitate HST implementation. Content analysis can identify policy-level barriers that slow innovation and facilitators that can increase access to care that support ageing in place.
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Affiliation(s)
| | - Scott A Trudeau
- American Occupational Therapy Association, Inc., Bethesda, Maryland
- NE Geriatric Research Education and Clinical Center, Bedford, Massachusetts
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts
| | | | - Lauren R Moo
- New England GRECC, ENRM VAMC, Bedford, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Eleanor S McConnell
- Durham VA Geriatric Research, Education and Clinical Center (GRECC), Durham, North Carolina
- Duke University School of Nursing, Durham, North Carolina
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11
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Halvorson SAC, Tanski M, Milligan L, Yackel T. Transitioning From Volume to Value: Lessons Learned From the Dissolution of a Population Health Partnership. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1305-1309. [PMID: 31460920 DOI: 10.1097/acm.0000000000002614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 2017, the authors published an article describing the experiences of Oregon Health & Science University (OHSU) as it adapted to new challenges of changing payment models, the imperative to manage the health of populations, and the desire to compete for statewide contracts. The authors described Propel Health, a multi-institution partnership created in 2013 to deliver the tools, methods, and support necessary for population health management. In the ensuing two years there were considerable changes to the structure and mission of Propel Health, ultimately resulting in its dissolution in January 2018. Using the organizational framework from the original publication, this article shares a number of lessons learned with other academic medical centers as they make the journey toward value-based care and population health management. Examples of lessons learned include ensuring that clinical and administrative leadership are aligned and that shared partnership goals are not eclipsed by local strategic needs. The potential for shared data remains a powerful motivation to partner; however, technology integration can be costly and complex. Once data are available, the ability to respond quickly is a key competency. Understanding individual sites' needs and capabilities is critical before embarking on shared clinical programs. Best practices from industry-specific experts should be employed. Lastly, it is essential for partners to determine how shared gains/losses will be attributed, and how aggressively risk should be required. Next steps for OHSU, including new, local partnerships, are shared.
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Affiliation(s)
- Stephanie A C Halvorson
- S.A.C. Halvorson is associate professor of medicine and chief, Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon. M. Tanski is associate professor of medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon. L. Milligan is chief medical information officer, Information Technology Services, Asante Health System, Medford, Oregon. T. Yackel is professor of medicine, Virginia Commonwealth University, Richmond, Virginia
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12
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Shahzad M, Upshur R, Donnelly P, Bharmal A, Wei X, Feng P, Brown AD. A population-based approach to integrated healthcare delivery: a scoping review of clinical care and public health collaboration. BMC Public Health 2019; 19:708. [PMID: 31174501 PMCID: PMC6556001 DOI: 10.1186/s12889-019-7002-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background A population-based approach to healthcare goes beyond the traditional biomedical model and addresses the importance of cross-sectoral collaboration in promoting health of communities. By establishing partnerships across primary care (PC) and public health (PH) sectors in particular, healthcare organizations can address local health needs of populations and improve health outcomes. The purpose of this study was to map a series of interventions from the empirical literature that facilitate PC-PH collaboration and develop a resource for healthcare organizations to self-evaluate their clinical practices and identify opportunities for collaboration with PH. Methods A scoping review was designed and studies from relevant peer-reviewed literature and reports between 1990 and 2017 were included if they met the following criteria: empirical study methodology (quantitative, qualitative, or mixed methods), based in US, Canada, Western Europe, Australia or New Zealand, describing an intervention involving PC-PH collaboration, and reporting on structures, processes, outcomes or markers of a PC-PH collaboration intervention. Results Out of 2962 reviewed articles, 45 studies with interventions leading to collaboration were classified into the following four synergy groups developed by Lasker’s Committee on Medicine and Public Health: Coordinating healthcare services (n = 13); Applying a population perspective to clinical practice (n = 21); Identifying and addressing community health problems (n = 19), and Strengthening health promotion and health protection (n = 21). Furthermore, select empirical examples of interventions and their key features were highlighted to illustrate various approaches to implementing collaboration interventions in the field. Conclusions The findings of our review can be utilized by a range of organizations in healthcare settings across the included countries. Furthermore, we developed a self-evaluation tool that can serve as a resource for clinical practices to identify opportunities for cross-sectoral collaboration and develop a range of interventions to address unmet health needs in communities; however, the generalizability of the findings depends on the evaluations conducted in individual studies in our review. From a health equity perspective, our findings also highlight interventions from the empirical literature that address inequities in care by targeting underserved, high-risk populations groups. Further research is needed to develop outcome measures for successful collaboration and determine which interventions are sustainable in the long term. Electronic supplementary material The online version of this article (10.1186/s12889-019-7002-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad Shahzad
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Peter Donnelly
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Canada
| | - Aamir Bharmal
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, Canada.,Fraser Health Authority, Surrey, British Columbia, Canada
| | - Xiaolin Wei
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, Canada
| | - Patrick Feng
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adalsteinn D Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada
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Swarthout M, Bishop MA. Population health management: Review of concepts and definitions. Am J Health Syst Pharm 2019; 74:1405-1411. [PMID: 28887342 DOI: 10.2146/ajhp170025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The terms population health, population health improvement, and population health management are discussed. SUMMARY A key concept in defining population health activities is clearly delineating the population(s) of focus. The Institute for Healthcare Improvement's (IHI's) Triple Aim Initiative uses the term population health management to describe the work by healthcare organizations to improve outcomes for individual patients to maximize population health. The National Academy of Medicine favors the term population health improvement and uses this term to describe work to identify and improve aspects of or contributors to population health, expanding the focus beyond traditional healthcare delivery systems. As organizations like IHI and the National Academy of Medicine continue to focus on population health, the terms and definitions used to describe these activities will continue to evolve. CONCLUSION The use of consistent, clear definitions for population health activities is critical to the practice of pharmacy and healthcare delivery.
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Affiliation(s)
- Meghan Swarthout
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD .,Johns Hopkins Outpatient Pharmacy, Baltimore, MD.
| | - Martin A Bishop
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD
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14
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Smitherman HC, Baker RS, Wilson MR. Socially Accountable Academic Health Centers: Pursuing a Quadripartite Mission. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:176-181. [PMID: 30303815 DOI: 10.1097/acm.0000000000002486] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States' overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. AHCs' tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or differences in a population's SDOH.AHCs enjoy broad public support and have an opportunity-and an obligation-to lead in improving the nation's health. This Perspective proposes a new framework for AHCs to expand on their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process, yielding defined outcomes.
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Affiliation(s)
- Herbert C Smitherman
- H.C. Smitherman Jr is vice dean of diversity and community affairs, Wayne State University School of Medicine, Detroit, Michigan. R.S. Baker is vice dean of medical education, Wayne State University School of Medicine, Detroit, Michigan. M.R. Wilson is president, Wayne State University, Detroit, Michigan
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15
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Duan-Porter W, Martinson BC, Greer N, Taylor BC, Ullman K, McKenzie L, Rosebush C, MacDonald R, Falde S, Wilt TJ. Evidence Review-Social Determinants of Health for Veterans. J Gen Intern Med 2018; 33:1785-1795. [PMID: 30030735 PMCID: PMC6153229 DOI: 10.1007/s11606-018-4566-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/07/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Veterans Health Administration (VHA) is committed to providing high-quality care and addressing health disparities for vulnerable Veterans. To meet these goals, VA policymakers need guidance on how to address social determinants in operations planning and day-to-day clinical care for Veterans. METHOD MEDLINE (OVID), CINAHL, PsycINFO, and Sociological Abstracts were searched from inception to January 2017. Additional articles were suggested by peer reviewers and/or found through search of work associated with US and VA cohorts. Eligible articles compared Veterans vs non-Veterans, and/or Veterans engaged with those not engaged in VA healthcare. Our evidence maps summarized study characteristics, social determinant(s) addressed, and whether health behaviors, health services utilization, and/or health outcomes were examined. Qualitative syntheses and quality assessment were performed for articles on rurality, trauma exposure, and sexual orientation. RESULTS We screened 7242 citations and found 131 eligible articles-99 compared Veterans vs non-Veterans, and 40 included engaged vs non-engaged Veterans. Most articles were cross-sectional and addressed socioeconomic factors (e.g., education and income). Fewer articles addressed rurality (N = 20), trauma exposure (N = 17), or sexual orientation (N = 2); none examined gender identity. We found no differences in rural residence between Veterans and non-Veterans, nor between engaged and non-engaged Veterans (moderate strength evidence). There was insufficient evidence for role of rurality in health behaviors, health services utilization, or health outcomes. Trauma exposures, including from events preceding military service, were more prevalent for Veterans vs non-Veterans and for engaged vs non-engaged Veterans (low-strength evidence); exposures were associated with smoking (low-strength evidence). DISCUSSION Little published literature exists on some emerging social determinants. We found no differences in rural residence between our groups of interest, but trauma exposure was higher in Veterans (vs non-Veterans) and engaged (vs non-engaged). We recommend consistent measures for social determinants, clear conceptual frameworks, and analytic strategies that account for the complex relationships between social determinants and health.
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Affiliation(s)
- Wei Duan-Porter
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA.
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA.
| | - Brian C Martinson
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- HealthPartners Institute, Bloomington, MN, USA
- School of Public Health, University of Minnesota, Twin Cities Campus, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Twin Cities Campus, Minneapolis, MN, USA
| | - Kristen Ullman
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Lauren McKenzie
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Christina Rosebush
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
| | - Samuel Falde
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System HSR&D, One Veterans Dr, Minneapolis, MN, 55417, USA
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
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16
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Knoer SJ, Swarthout MD, Sokn E, Vakharia N, Pfeiffenberger T, Greskovic GA, Kelley LR, Thompson A, Achey TS, Calabrese SV. The Cleveland Clinic Pharmacy Population Health Management Summit. Am J Health Syst Pharm 2018; 75:1421-1429. [PMID: 30190296 DOI: 10.2146/ajhp180081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Meghan D Swarthout
- Ambulatory and Care Transitions, The Johns Hopkins Hospital, Baltimore, MD
| | - Erick Sokn
- Transitions of Care, Cleveland Clinic, Cleveland, OH
| | | | | | - Gerard A Greskovic
- Ambulatory Clinical Pharmacy Programs, Geisinger Health System, Danville, PA
| | | | - Amy Thompson
- Innovations and Partnerships, University of Michigan, Ann Arbor, MI
| | - Thomas S Achey
- Inpatient Pharmacy Services, Duke University Hospital, Durham, NC
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17
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Tierney WM. Use of Stakeholder Focus Groups to Define the Mission and Scope of a new Department of Population Health. J Gen Intern Med 2018; 33:1069-1076. [PMID: 29633122 PMCID: PMC6025682 DOI: 10.1007/s11606-018-4403-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The focus and funding of US healthcare is evolving from volume to value-based, and healthcare leaders, managers, payers, and researchers are increasingly focusing on managing populations of patients. Simultaneously, there is increasing interest in getting "upstream" from disease management to promote health and prevent disease. Hence, the term "population health" has both clinical and community-based connotations relevant to the tripartite mission of US medical schools. OBJECTIVE To seek broad input for the strategic development of the Department of Population Health in a new medical school at a tier 1 research university. DESIGN Focus groups with facilitated consensus development. PARTICIPANTS Eighty-one persons representing the Dell Medical School and other schools at the University of Texas at Austin, city/county government, community nonprofit organizations, and faculty from other local university schools along with selected national academic leaders. APPROACH Focus groups with subsequent consensus development of emphases identified premeeting by participants by e-mail exchanges. KEY RESULTS The resulting departmental strategic plan included scope of work, desired characteristics of leaders, and early impact activities in seven areas of interest: community engagement and health equity, primary care and value-based health, occupational and environment medicine, medical education, health services and community-based research, health informatics and data analysis, and global health. CONCLUSIONS Medical schools should have a primary focus in population, most effectively at the departmental level. Engaging relevant academic and community stakeholders is an effective model for developing this emerging discipline in US medical schools.
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Affiliation(s)
- William M Tierney
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
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18
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Mercer T, Gardner A, Andama B, Chesoli C, Christoffersen-Deb A, Dick J, Einterz R, Gray N, Kimaiyo S, Kamano J, Maritim B, Morehead K, Pastakia S, Ruhl L, Songok J, Laktabai J. Leveraging the power of partnerships: spreading the vision for a population health care delivery model in western Kenya. Global Health 2018; 14:44. [PMID: 29739421 PMCID: PMC5941561 DOI: 10.1186/s12992-018-0366-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Academic Model Providing Access to Healthcare (AMPATH) has been a model academic partnership in global health for nearly three decades, leveraging the power of a public-sector academic medical center and the tripartite academic mission - service, education, and research - to the challenges of delivering health care in a low-income setting. Drawing our mandate from the health needs of the population, we have scaled up service delivery for HIV care, and over the last decade, expanded our focus on non-communicable chronic diseases, health system strengthening, and population health more broadly. Success of such a transformative endeavor requires new partnerships, as well as a unification of vision and alignment of strategy among all partners involved. Leveraging the Power of Partnerships and Spreading the Vision for Population Health. We describe how AMPATH built on its collective experience as an academic partnership to support the public-sector health care system, with a major focus on scaling up HIV care in western Kenya, to a system poised to take responsibility for the health of an entire population. We highlight global trends and local contextual factors that led to the genesis of this new vision, and then describe the key tenets of AMPATH's population health care delivery model: comprehensive, integrated, community-centered, and financially sustainable with a path to universal health coverage. Finally, we share how AMPATH partnered with strategic planning and change management experts from the private sector to use a novel approach called a 'Learning Map®' to collaboratively develop and share a vision of population health, and achieve strategic alignment with key stakeholders at all levels of the public-sector health system in western Kenya. CONCLUSION We describe how AMPATH has leveraged the power of partnerships to move beyond the traditional disease-specific silos in global health to a model focused on health systems strengthening and population health. Furthermore, we highlight a novel, collaborative tool to communicate our vision and achieve strategic alignment among stakeholders at all levels of the health system. We hope this paper can serve as a roadmap for other global health partners to develop and share transformative visions for improving population health globally.
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Affiliation(s)
- Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, 1701 Trinity St, Austin, TX, 78712, USA.
| | - Adrian Gardner
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA.,Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Cleophas Chesoli
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Astrid Christoffersen-Deb
- Department of Obstetrics and Gynaecology, University of Toronto Faculty of Medicine, 123 Edward Street, Suite 1200, Toronto, ON, M5G1E2, Canada.,Department of Reproductive Health, Moi University School of Medicine, Eldoret, Kenya
| | - Jonathan Dick
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA.,Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Robert Einterz
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Nick Gray
- Dow AgroSciences, 9330 Zionsville Rd, Indianapolis, IN, 46268, USA
| | - Sylvester Kimaiyo
- Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Jemima Kamano
- Department of Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Beryl Maritim
- Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
| | - Kirk Morehead
- Dow AgroSciences, 9330 Zionsville Rd, Indianapolis, IN, 46268, USA
| | - Sonak Pastakia
- Purdue University College of Pharmacy, 575 Stadium Mall Dr, West Lafayette, IN, 47907, USA.,Department of Pharmacology, Moi University School of Medicine, Eldoret, Kenya
| | - Laura Ruhl
- Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Dr, Indianapolis, IN, 46202, USA.,Department of Child Health and Paediatrics, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Julia Songok
- Department of Child Health and Paediatrics, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
| | - Jeremiah Laktabai
- Department of Family Medicine, Moi University School of Medicine, PO Box 4606 30100, Eldoret, Kenya
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Pratt R, Gyllstrom B, Gearin K, Lange C, Hahn D, Baldwin LM, VanRaemdonck L, Nease D, Zahner S. Identifying Barriers to Collaboration Between Primary Care and Public Health: Experiences at the Local Level. Public Health Rep 2018; 133:311-317. [PMID: 29614236 DOI: 10.1177/0033354918764391] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration between primary care and public health at the local level in 4 states. METHODS The study team, which comprised 12 representatives of Practice-Based Research Networks (networks of practitioners interested in conducting research in practice-based settings), identified 40 key informants from the public health and primary care fields in Colorado, Minnesota, Washington State, and Wisconsin. The key informants participated in standardized, semistructured telephone interviews with 8 study team members in 2014 and 2015. Interviews were audio recorded and transcribed verbatim. We analyzed key themes and subthemes by drawing on grounded theory. RESULTS Primary care and public health participants identified similar barriers to collaboration. Barriers at the institutional level included the challenges of the primary care environment, in which providers feel overwhelmed and resources are tight; the need for systems change; a lack of partnership; and geographic challenges. Barriers to collaboration included mutual awareness, communication, data sharing, capacity, lack of resources, and prioritization of resources. CONCLUSIONS Some barriers to collaboration (eg, changes to health care billing, demands on provider time) require systems change to overcome, whereas others (eg, a lack of shared priorities and mutual awareness) could be addressed through educational approaches, without adding resources or making a systemic change. Overcoming these common barriers may lead to more effective collaboration.
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Affiliation(s)
- Rebekah Pratt
- 1 Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Beth Gyllstrom
- 2 Center for Public Health Practice, Minnesota Department of Health, Saint Paul, MN, USA
| | - Kim Gearin
- 2 Center for Public Health Practice, Minnesota Department of Health, Saint Paul, MN, USA
| | - Carol Lange
- 1 Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - David Hahn
- 3 Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura-Mae Baldwin
- 4 Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Lisa VanRaemdonck
- 5 School of Public Affairs, University of Colorado Denver, Denver, CO, USA
| | - Don Nease
- 6 Department of Family Medicine, University of Colorado Denver, Denver, CO, USA
| | - Susan Zahner
- 7 School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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Edelman A, Taylor J, Ovseiko PV, Topp SM. The role of academic health centres in improving health equity: a systematic review. J Health Organ Manag 2018; 32:279-297. [PMID: 29624138 DOI: 10.1108/jhom-09-2017-0255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Academic health centres (AHCs) are organisations that pursue a "tripartite" mission to deliver high-quality care to patients, undertake clinical and laboratory research, and train future health professionals. The last decade has seen a global spread of AHC models and a growing interest in the role of AHCs in addressing health system equity. The purpose of this paper is to synthesise and critically appraise the evidence on the role of AHCs in improving health equity. Design/methodology/approach Peer-reviewed and grey literature published in English between 2000 and 2016 were searched. Articles that identified AHCs as the primary unit of analysis and that also addressed health equity concepts in relation to the AHC's activity or role were included. Findings In total, 103 publications met the inclusion criteria of which 80 per cent were expert opinion. Eight descriptive themes were identified through which health equity concepts in relation to AHCs were characterised, described and operationalised: population health, addressing health disparities, social determinants of health, community engagement, global health, health system reform, value-based and accountable financing models, and role clarification/recalibration. There was consensus that AHCs can and should address health disparities, but there is a lack of empirical evidence to show that AHCs have a capacity to contribute to health equity goals or are demonstrating this contribution. Originality/value This review highlights the relevance of health equity concepts in discussions about the role and missions of AHCs. Future research should improve the quality of the evidence base by empirically examining health equity strategies and interventions of AHCs in multiple countries and contexts.
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Affiliation(s)
- Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University , Townsville, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University , Townsville, Australia
| | - Pavel V Ovseiko
- Radcliffe Department of Medicine, Medical Sciences Division, John Radcliffe Hospital, University of Oxford , Oxford, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University , Townsville, Australia
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21
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Morey MC, Lee CC, Castle S, Valencia WM, Katzel L, Giffuni J, Kopp T, Cammarata H, McDonald M, Oursler KA, Wamsley T, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Parker DC. Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program. J Am Geriatr Soc 2018; 66:1009-1016. [PMID: 29430642 DOI: 10.1111/jgs.15276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Exercise provides a wide range of health-promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long-lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long-standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow-up, improvements in well-being, and a 10-year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8-foot up and go 8.7 ± 6.7 seconds, 30-second chair stands 10.7 ± 5.1, 6-minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow-up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1-year outcomes. We suggest that such programs be considered essential elements of healthcare systems.
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Affiliation(s)
- Miriam C Morey
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cathy C Lee
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, California
| | - Steven Castle
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, California
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, Miami Healthcare System, Miami, Florida.,University of Miami, Miller School of Medicine, Miami, Florida
| | - Leslie Katzel
- Geriatric Research, Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland.,School of Medicine, University of Maryland, Baltimore, Maryland
| | - Jamie Giffuni
- Geriatric Research, Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland
| | - Teresa Kopp
- Veterans Affairs Medical Center, Canandaigua, New York
| | | | - Michelle McDonald
- Geriatric Rehabilitation and Clinical Center, Veterans Affairs Pacific Health Care System, Honolulu, Hawaii
| | - Kris A Oursler
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Timothy Wamsley
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Chani Jain
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Janet P Bettger
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Megan Pearson
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| | - Kenneth M Manning
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| | - Orna Intrator
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Peter Veazie
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Richard Sloane
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jiejin Li
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Daniel C Parker
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
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22
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Sanborn MD. Population health management and the pharmacist’s role. Am J Health Syst Pharm 2017; 74:1400-1401. [DOI: 10.2146/ajhp170157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Michael D. Sanborn
- Baylor Scott & White All Saints Medical Center–Fort Worth Fort Worth, TX
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23
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Stoutenberg M, Shaya GE, Feldman DI, Carroll JK. Practical Strategies for Assessing Patient Physical Activity Levels in Primary Care. Mayo Clin Proc Innov Qual Outcomes 2017; 1:8-15. [PMID: 30225397 PMCID: PMC6134906 DOI: 10.1016/j.mayocpiqo.2017.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Mark Stoutenberg
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Gabriel E Shaya
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - David I Feldman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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24
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Utley-Smith Q. An online education approach to population health in a global society. Public Health Nurs 2017; 34:388-394. [DOI: 10.1111/phn.12332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Halvorson SAC, Tanski ME, Yackel TR. Transitioning From Volume to Value: One Academic Medical Center's Approach to Improving Population Health. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:666-670. [PMID: 28441676 DOI: 10.1097/acm.0000000000001536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM The U.S. health care system is undergoing a major transformation. Clinical delivery systems are now being paid according to the value of the care they provide, in accordance with the Triple Aim, which incorporates improving the quality and cost of care and the patient experience. Increasingly, financial risk is being transferred from insurers to clinical delivery systems that become responsible for both episode-based clinical care and the longitudinal care of patients. Thus, these delivery systems need to develop strategies to manage the health of populations. Academic medical centers (AMCs) serve a unique role in many markets yet may be ill prepared for this transformation. APPROACH In 2013, Oregon Health & Science University (OHSU) partnered with a large health insurer and six other hospitals across the state to form Propel Health, a collaborative partnership designed to deliver the tools, methods, and support necessary for population health management. OHSU also developed new internal structures and transformed its business model to embrace this value-based care model. OUTCOMES Each Propel Health partner included the employees and dependents enrolled in its employee medical plan, for approximately 55,000 covered individuals initially. By 2017, Propel Health is expected to cover 110,000 individuals. Other outcomes to measure in the future include the quality and cost of care provided under this partnership. NEXT STEPS Anticipated challenges to overcome include insufficient primary care networks, conflicting incentives, local competition, and the magnitude of the transformation. Still, the time is right for AMCs to commit to improving the health of populations.
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Affiliation(s)
- Stephanie A C Halvorson
- S.A.C. Halvorson is clinical associate professor of medicine, Department of Medicine, and medical director for clinical integration, Oregon Health & Science University, Portland, Oregon.M.E. Tanski is assistant professor of medicine, Department of Emergency Medicine, and medical director for clinical integration, Oregon Health & Science University, Portland, Oregon.T.R. Yackel is clinical professor of medicine, Department of Medical Informatics and Clinical Epidemiology, and chief clinical integration officer, Oregon Health & Science University Partners, Portland, Oregon
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Wrathall J, Belnap T. Reducing Health Care Costs Through Patient Targeting: Risk Adjustment Modeling to Predict Patients Remaining High Cost. EGEMS 2017; 5:4. [PMID: 29881748 PMCID: PMC5983005 DOI: 10.13063/2327-9214.1279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Context: The transition to population health management has changed the healthcare landscape to identify high risk, high cost patients. Various measures of patient risk have attempted to identify likely candidates for care management programs. Pre-screening patients for outreach has often required several years of data. Intermountain Healthcare relied on cost-ranking algorithms which had limited predictive ability. A new risk-adjusted algorithm shows improvements in predicting patients’ future cost status to facilitate identifying patient eligibility for care management. Case Description: A retrospective cohort study design was used to evaluate high-cost patient status for two of the next three years. Modeling was developed using logistic regression and tested against other decision tree methods. Key variables included those readily available in electronic health records supplemented by additional clinical data and estimates of socio-economic status. Findings: The risk-adjusted modeling correctly identified 79.0% of patients ranking among the top 15% of costs in one of the next three years. In addition, it correctly estimated 48.1% of the patients in the top 15% cost group in two of the next three years. This method identified patients with higher medical costs and more comorbid conditions than previous cost-ranking methods. Major Themes: This approach improves the predictive accuracy of identifying high cost patients in the future and increases the sensitivity of identifying at-risk patients. It also shortened data requirements to identify eligibility criteria for case management interventions. Conclusion: Risk-adjustment modeling may improve management programs’ interface with patients thus decreasing costs. This method may be generalized to other healthcare settings.
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27
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Jackson GL, Roumie CL, Rakley SM, Kravetz JD, Kirshner MA, Del Monte PS, Bowen ME, Oddone EZ, Weiner BJ, Shaw RJ, Bosworth HB. Linkage between theory-based measurement of organizational readiness for change and lessons learned conducting quality improvement-focused research. Learn Health Syst 2017; 1:e10013. [PMID: 31245556 PMCID: PMC6516710 DOI: 10.1002/lrh2.10013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/28/2016] [Accepted: 08/18/2016] [Indexed: 11/21/2022] Open
Abstract
Organizations have different levels of readiness to implement change in the patient care process. The Hypertension Telemedicine Nurse Implementation Project for Veterans (HTN-IMPROVE) is an example of an innovation that seeks to enhance delivery of care for patients with hypertension. We describe the link between organizational readiness for change (ORC), assessed as the project began, and barriers and facilitators occurring during the process of implementing a primary care innovation. Each of 3 Veterans Affairs medical centers provided a half-time nurse and implemented a nurse-delivered, telephone-based self-management support program for patients with uncontrolled hypertension. As the program was starting, we assessed the ORC and factors associated with ORC. On the basis of consensus of medical center and research partners, we enumerated implementation process barriers and facilitators. The primary ORC barrier was unclear long-term commitment of nursing to provide continued resources to the program. Three related barriers included the need to address: (1) competing organizational demands, (2) differing mechanisms to integrate new interventions into existing workload, and (3) methods for referring patients to disease and self-management support programs. Prior to full implementation, however, stakeholders identified a high level of commitment to conduct nurse-delivered interventions fully using their skills. There was also a significant commitment from the core implementation team and a desire to improve patient outcomes. These facilitators were observed during the implementation of HTN-IMPROVE. As demonstrated by the link between barriers to and facilitators of implementation anticipated though the evaluation of ORC and what was actually observed during the process of implementation, this project demonstrates the practical utility of assessing ORC prior to embarking on the implementation of significant new clinical innovations.
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Affiliation(s)
- George L. Jackson
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
- Division of General Internal MedicineDuke UniversityDurhamNC
| | - Christianne L. Roumie
- VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Health Services Research & DevelopmentVA Tennessee Valley Healthcare SystemNashvilleTN
- Department of MedicineVanderbilt UniversityNashvilleTN
| | - Susan M. Rakley
- Division of General Internal MedicineDuke UniversityDurhamNC
- Durham VA Medical CenterDurhamNC
| | - Jeffrey D. Kravetz
- VA Connecticut Healthcare SystemWest HavenCT
- School of MedicineYale UniversityNew HavenCT
| | - Miriam A. Kirshner
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
| | | | - Michael E. Bowen
- Departments of Internal Medicine, Clinical Sciences, and PediatricsUniversity of Texas Southwestern Medical CenterDallasTX
| | - Eugene Z. Oddone
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
- Division of General Internal MedicineDuke UniversityDurhamNC
| | - Bryan J. Weiner
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNC
| | - Ryan J. Shaw
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
- School of NursingDuke UniversityDurhamNC
| | - Hayden B. Bosworth
- Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamNC
- Division of General Internal MedicineDuke UniversityDurhamNC
- School of NursingDuke UniversityDurhamNC
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNC
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28
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Maher D, Ford N, Gilmore I. Practical steps in promoting synergies between clinical medicine and public health. Clin Med (Lond) 2017; 17:100-102. [PMID: 28365615 PMCID: PMC6297615 DOI: 10.7861/clinmedicine.17-2-100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Dermot Maher
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Ian Gilmore
- Royal Liverpool University Hospitals and honorary professor, Department of Medicine, University of Liverpool, UK
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29
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Affiliation(s)
- Ramachandran S Vasan
- From National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.S.V., E.J.B.); Evans Department of Medicine, Whitaker Cardiovascular Institute (R.S.V., E.J.B.) and Preventive Medicine and Cardiology Sections, Department of Medicine (R.S.V., E.J.B.), Boston University School of Medicine, MA; and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V., E.J.B.).
| | - Emelia J Benjamin
- From National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.S.V., E.J.B.); Evans Department of Medicine, Whitaker Cardiovascular Institute (R.S.V., E.J.B.) and Preventive Medicine and Cardiology Sections, Department of Medicine (R.S.V., E.J.B.), Boston University School of Medicine, MA; and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V., E.J.B.)
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