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McGinty EE, Seewald NJ, Bandara S, Cerdá M, Daumit GL, Eisenberg MD, Griffin BA, Igusa T, Jackson JW, Kennedy-Hendricks A, Marsteller J, Miech EJ, Purtle J, Schmid I, Schuler MS, Yuan CT, Stuart EA. Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:96-108. [PMID: 36048400 PMCID: PMC11042861 DOI: 10.1007/s11121-022-01427-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
Policy implementation is a key component of scaling effective chronic disease prevention and management interventions. Policy can support scale-up by mandating or incentivizing intervention adoption, but enacting a policy is only the first step. Fully implementing a policy designed to facilitate implementation of health interventions often requires a range of accompanying implementation structures, like health IT systems, and implementation strategies, like training. Decision makers need to know what policies can support intervention adoption and how to implement those policies, but to date research on policy implementation is limited and innovative methodological approaches are needed. In December 2021, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness and the Johns Hopkins Center for Mental Health and Addiction Policy convened a forum of research experts to discuss approaches for studying policy implementation. In this report, we summarize the ideas that came out of the forum. First, we describe a motivating example focused on an Affordable Care Act Medicaid health home waiver policy used by some US states to support scale-up of an evidence-based integrated care model shown in clinical trials to improve cardiovascular care for people with serious mental illness. Second, we define key policy implementation components including structures, strategies, and outcomes. Third, we provide an overview of descriptive, predictive and associational, and causal approaches that can be used to study policy implementation. We conclude with discussion of priorities for methodological innovations in policy implementation research, with three key areas identified by forum experts: effect modification methods for making causal inferences about how policies' effects on outcomes vary based on implementation structures/strategies; causal mediation approaches for studying policy implementation mechanisms; and characterizing uncertainty in systems science models. We conclude with discussion of overarching methods considerations for studying policy implementation, including measurement of policy implementation, strategies for studying the role of context in policy implementation, and the importance of considering when establishing causality is the goal of policy implementation research.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nicholas J Seewald
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Matthew D Eisenberg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Tak Igusa
- Department of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward J Miech
- Indiana University School of Medicine, Indianapolis, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York City, New York, USA
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Christina T Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Albertson EM, Chuang E, O'Masta B, Miake-Lye I, Haley LA, Pourat N. Systematic Review of Care Coordination Interventions Linking Health and Social Services for High-Utilizing Patient Populations. Popul Health Manag 2022; 25:73-85. [PMID: 34134511 PMCID: PMC8861924 DOI: 10.1089/pop.2021.0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Recognizing that social factors influence patient health outcomes and utilization, health systems have developed interventions to address patients' social needs. Care coordination across the health care and social service sectors is a distinct and important strategy to address social determinants of health, but limited information exists about how care coordination operates in this context. To address this gap, the authors conducted a systematic review of peer-reviewed publications that document the coordination of health care and social services in the United States. After a structured elimination process, 25 publications of 19 programs were synthesized to identify patterns in care coordination implementation. Results indicate that patient needs assessment, in-person patient contact, and standardized care coordination protocols are common across programs that bridge health care and social services. Publications discussing these programs often provide limited detail on other key elements of care coordination, especially the nature of referrals and care coordinator caseload. Additional research is needed to document critical elements of program implementation and to evaluate program impacts.
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Affiliation(s)
- Elaine Michelle Albertson
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA.,University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,Address correspondence to: Elaine Michelle Albertson, MPH, Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, 650 Charles Young Drive S, Los Angeles, CA 90095, USA
| | - Emmeline Chuang
- University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,University of California Berkeley School of Social Welfare, Berkeley, California, USA
| | - Brenna O'Masta
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA
| | - Isomi Miake-Lye
- University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Leigh Ann Haley
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA
| | - Nadereh Pourat
- University of California Los Angeles Center for Health Policy Research, Health Economics and Evaluation Research Program, Los Angeles, California, USA.,University of California Los Angeles Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, California, USA
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Murphy KA, Daumit GL, Bandara SN, Stone EM, Kennedy-Hendricks A, Stuart EA, Pollack CE, McGinty EE. Association Between the Maryland Medicaid Behavioral Health Home Program and Cancer Screening in People With Serious Mental Illness. Psychiatr Serv 2020; 71:608-611. [PMID: 32019432 PMCID: PMC7266726 DOI: 10.1176/appi.ps.201900299] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study evaluated the association of the Maryland Medicaid behavioral health home (BHH) integrated care program with cancer screening. METHODS Using administrative claims data from October 2012 to September 2016, the authors measured cancer screening among 12,176 adults in Maryland's psychiatric rehabilitation program who were eligible for cervical (N=6,811), breast (N=1,658), and colorectal (N=3,430) cancer screening. Marginal structural modeling was used to examine the association between receipt of annual cancer screening and whether participants had ever enrolled in a BHH (enrolled: N=3,298, 27%; not enrolled: N=8,878, 73%). RESULTS Relative to nonenrollment, BHH enrollment was associated with increased screening for cervical and breast cancer but not for colorectal cancer. Predicted annual rates remained low, even in BHHs. CONCLUSIONS Despite estimates of improvements in cervical and breast cancer screening after BHH implementation, cancer screening rates remained suboptimal. Broader cancer screening interventions are needed to improve cancer screening for people with mental illness.
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Affiliation(s)
- Karly A Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit, Stone, Pollack); Department of Mental Health (Daumit, Stuart, McGinty), Department of Health Policy and Management (Daumit, Bandara, Kennedy-Hendricks, Stuart, Pollack, McGinty), and Center for Mental Health and Addiction Policy Research (Bandara, Kennedy-Hendricks, Stuart, McGinty), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit, Stone, Pollack); Department of Mental Health (Daumit, Stuart, McGinty), Department of Health Policy and Management (Daumit, Bandara, Kennedy-Hendricks, Stuart, Pollack, McGinty), and Center for Mental Health and Addiction Policy Research (Bandara, Kennedy-Hendricks, Stuart, McGinty), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Sachini N Bandara
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit, Stone, Pollack); Department of Mental Health (Daumit, Stuart, McGinty), Department of Health Policy and Management (Daumit, Bandara, Kennedy-Hendricks, Stuart, Pollack, McGinty), and Center for Mental Health and Addiction Policy Research (Bandara, Kennedy-Hendricks, Stuart, McGinty), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Elizabeth M Stone
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit, Stone, Pollack); Department of Mental Health (Daumit, Stuart, McGinty), Department of Health Policy and Management (Daumit, Bandara, Kennedy-Hendricks, Stuart, Pollack, McGinty), and Center for Mental Health and Addiction Policy Research (Bandara, Kennedy-Hendricks, Stuart, McGinty), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Alene Kennedy-Hendricks
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit, Stone, Pollack); Department of Mental Health (Daumit, Stuart, McGinty), Department of Health Policy and Management (Daumit, Bandara, Kennedy-Hendricks, Stuart, Pollack, McGinty), and Center for Mental Health and Addiction Policy Research (Bandara, Kennedy-Hendricks, Stuart, McGinty), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Elizabeth A Stuart
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit, Stone, Pollack); Department of Mental Health (Daumit, Stuart, McGinty), Department of Health Policy and Management (Daumit, Bandara, Kennedy-Hendricks, Stuart, Pollack, McGinty), and Center for Mental Health and Addiction Policy Research (Bandara, Kennedy-Hendricks, Stuart, McGinty), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Craig E Pollack
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit, Stone, Pollack); Department of Mental Health (Daumit, Stuart, McGinty), Department of Health Policy and Management (Daumit, Bandara, Kennedy-Hendricks, Stuart, Pollack, McGinty), and Center for Mental Health and Addiction Policy Research (Bandara, Kennedy-Hendricks, Stuart, McGinty), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Emma E McGinty
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit, Stone, Pollack); Department of Mental Health (Daumit, Stuart, McGinty), Department of Health Policy and Management (Daumit, Bandara, Kennedy-Hendricks, Stuart, Pollack, McGinty), and Center for Mental Health and Addiction Policy Research (Bandara, Kennedy-Hendricks, Stuart, McGinty), Johns Hopkins Bloomberg School of Public Health, Baltimore
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