Health Policy Training: A Review of the Literature

Pregnancy and breastfeeding in mental health policy: a narrative review

OBJECTIVES

Mental health difficulties are often exacerbated during the perinatal period. Policy and guidelines are increasingly being used to enhance the quality of healthcare. We conducted a literature review of published research relating to pregnancy and breastfeeding in mental health policy.

METHODS

Relevant terms were searched in Medline, CINAHL, APA PsycINFO and EMBASE for articles published in English from 1970 until 2020. Only papers that referenced policy, guidance, legislation or standards were included. While a systematic approach was used, the nature of the results necessitated a narrative review.

RESULTS

Initially, 262 papers were identified, 44 met the inclusion criteria. Reproductive health is given sparse consideration in research relating to mental health policy. Despite this, some key areas emerged. These included: the need for proactive preconception psychoeducation, proactive screening of mothers of infants and young children for perinatal mental health issues, enhanced prescribing practice for women of child-bearing age, enhanced monitoring during pregnancy, development of safe modification of coercive practices should they need to be employed in emergency circumstances and targeted measures to reduce substance misuse. Themes that arose relating to breastfeeding and bonding are also described.

CONCLUSIONS

Female reproductive health is often ignored in research relating to mental health policy, guidelines and standards. These tools need to be harnessed to promote good healthcare. Reproductive health should be included in the care plan of all mental health patients. These topics need to be integrated into existing relevant policies and not isolated to a separate policy.

National Health Policy Leadership Program for General Internists

INTRODUCTION

Early or mid-career physicians have few opportunities to participate in career development programs in health policy and advocacy with experiential and mentored training that can be incorporated into their busy lives.

AIM

The Society of General Internal Medicine (SGIM) created the Leadership in Health Policy (LEAHP) program, a year-long career development program, to prepare participants with a sufficient depth of knowledge, skills, attitudes, and behaviors to continue to build mastery and effectiveness as leaders, advocates, and educators in health policy. We sought to evaluate the program's impact on participants' self-efficacy in the core skills targeted in the curriculum.

SETTING/PARTICIPANTS

Fifty-five junior faculty and trainees across three scholar cohorts from 2017 to 2021.

PROGRAM DESCRIPTION

Activities included workshops and exercises at an annual meeting, one-on-one mentorship, monthly webinars and journal clubs, interaction with policy makers, and completion of capstone projects.

PROGRAM EVALUATION

Self-administered, electronic surveys conducted before and following the year-long program showed a significant improvement in mean self-efficacy scores for the total score and for each of the six domains in general knowledge, teaching, research, and advocacy in health policy. Compared to the baseline scores, after the program the total mean score increased from 3.1 to 4.1, an increase of 1.1 points on a 5-point Likert scale (95% CI: 0.9-1.3; Cohen's D: 1.7), with 61.4% of respondents increasing their mean score by at least 1 point. Responses to open-ended questions indicated that the program met scholars' stated needs to improve their knowledge base in health policy and advocacy skills.

DISCUSSION

The LEAHP program provides an opportunity for mentored, experiential training in health policy and advocacy, can build the knowledge and amplify the scale of physicians engaged in health policy, and help move physicians from individual patient advocacy in the clinic to that of populations.

Engaging Leadership Competencies Through Population Health Policy Advocacy: A Review of the Evidence

The purpose of this article is to identify the gaps in prelicensure nursing curriculum regarding the teaching and learning of policy advocacy and the necessary nursing leadership competencies that are significant in addressing social determinants of health at an upstream, policy level and to discuss how current prelicensure nursing curricula integrates and applies concepts of population health, policy advocacy, and nursing leadership competencies. The authors performed a conceptual review of the literature, analyzing the current, evidence-based scholarship on the topic in an effort to categorize and describe relevant concepts and outline a relationship between them, by combining the concept terms nursing leadership, policy advocacy, population health policy, nursing education, and social determinants of health. The conceptual review identified gaps in nursing education regarding the preparation of nursing graduates for leadership engagement at the policy level, which presents opportunities for future research and exploration. This article shares the thematic gaps, major findings, and recommendations that resulted. Continued effort should be invested into the development of more robust discussions and curriculum related to population health advocacy and the impact on population health in baccalaureate nursing educational programming.

Mortality and Quality of Life with Chronic Kidney Disease: A Five-Year Cohort Study with a Sample Initially Receiving Peritoneal Dialysis

The quality of life, morbidity and mortality of people receiving renal replacement therapy is affected both by the renal disease itself and its treatment. The therapy that best improves renal function and quality of life is transplantation. Objectives: To study the quality of life, morbidity and mortality of people receiving renal replacement therapy over a five-year period. Design: A longitudinal multicentre study of a cohort of people with chronic kidney disease. Methods: Patients from the Girona health area receiving peritoneal dialysis were studied, gathering data on sociodemographic and clinical variables through an ad hoc questionnaire, quality of life using the SF-36 questionnaire, and social support with the MOS scale. Results: Mortality was 47.2%. Physical functioning was the variable that worsened most in comparison with the first measurement (p = 0.035). Those receiving peritoneal dialysis (p = 0.068) and transplant recipients (p = 0.083) had a better general health perception. The social functioning of transplant recipients improved (p = 0.008). Conclusions: People with chronic kidney disease had a high level of mortality. The dimension of physical functioning worsens over the years. Haemodialysis is the therapy that most negatively effects general health perception. Kidney transplantation has a positive effect on the dimensions of energy/vitality, social functioning and general health perception.

Association between public health nurses' involvement in local healthcare planning and the corresponding off-the-job training

OBJECTIVE

This study investigated the association between receiving off-the-job training and the involvement of public health nurses in local healthcare planning.

DESIGN

A nationwide, cross-sectional study design.

METHODS

We sent self-report questionnaires to 2,185 public health nurses with experience in developing local healthcare plans in Japan since 2013 and collected information related to three main categories: demographic data, involvement in local healthcare planning and strategies for healthcare planning.

RESULTS

We received 1,281 responses (return rate of 58.6%), of which 231 did not meet the inclusion criteria. Thus, we analysed 1,050 valid responses. Among the 1,050 respondents, 496 (47.2%) had received off-the-job training in healthcare planning. A subsequent logistic regression analysis revealed that the following factors were associated with this achievement: holding a managerial position, receiving healthcare planning education at the undergraduate level, having mentors regarding the promotion of it, partially conducting cross-sectional coordination and conducting groupwork with community-dwelling residents.

Feasibility of an educational program for public health nurses to promote local healthcare planning: protocol for a pilot randomized controlled trial

BACKGROUND

Promoting of local healthcare planning is crucial for assisting public health nurses in improving community health inequities. However, there is no effective educational program for developing relevant skills and knowledge among these nurses. Therefore, this study aims to assess the feasibility of a newly developed web-based self-learning program to promote the involvement of public health nurses in the local healthcare planning process.

METHODS

A pilot randomized control trial randomly allocated eligible public health nurses to intervention and control wait-list groups [1:1]. The former will be exposed to six web-based learning modules from July to October 2021. After collecting post-test data, the wait-list group will be exposed to the same modules to ensure learning equity. The primary outcome will be evaluated by implementing a validated and standardized scale designed to measure public health policy competencies at the baseline and post-intervention, while secondary outcome will be measured on an action scale to demonstrate the necessity of healthcare activities. The third outcome will be the knowledge and skills related to local healthcare planning by public health nurses. The participants will provide feedback through free descriptions on the trial feasibility and a web-based self-learning program to identify improvement points for continual refinement.

DISCUSSION

The results will provide suggestions in preparation for a future definitive randomized controlled trial. This will provide preliminary data for an intervention aimed at improving relevant competencies among public health nurses who are tasked with resolving health inequities in their respective communities through local health planning.

TRIAL REGISTRATION

The protocol for this study was registered with the University Hospital Medical Information Network Clinical Trials Registry and approved by the International Committee of Medical Journal Editors (No. UMIN000043628 , March 23, 2021).

An exclusive health policy education: Original insights from KSA

Objectives

Health policy education is increasingly understood to be an important aspect in preparing future health professionals to become active policy leaders. However, current research on health policy education is limited and has been performed predominantly in Western contexts. The aim of this study was to explore and analyze the state of health policy education in KSA.

Methods

A qualitative document analysis was performed on the course materials of health policy courses offered in Saudi universities. The inductive and interpretive analysis revealed four themes that were finalized after iterative engagement with data and interpretation. The study's credibility was enhanced through negative case analysis and rival explanations.

Results

The results indicated that health policy education was delivered exclusively to specific programs. Whereas health policy courses had specific objectives, the programs’ specialization or the Saudi context influenced the foci of these courses. The varying foci in health policy courses were accompanied by content reflecting the policy process and a discussion of various health policy domains.

Conclusion

The results underscore the importance of building momentum in health policy education and the crucial roles of academic, health and policy leaders. The holistic approach of this study comprehensively indicates the national status of health policy education and situates the ongoing conversation regarding health policy education in a global context.

Self-reported competences of public health nurses for developing needs-oriented local healthcare plans: A nationwide cross-sectional survey

AIM

To identify self-reported competencies of public health nurses for reflecting community healthcare needs in local healthcare plans.

DESIGN

We conducted a nationwide cross-sectional survey in Japan from October 7-November 30, 2019.

METHODS

We sent 2,185 self-reported questionnaires to public health nurses in Japan who had developed a local healthcare plan since 2013. Self-reported questionnaires included questions regarding demographic data and the reflection of community healthcare needs in local healthcare plans, and the involvement in local healthcare planning.

RESULTS

We analysed 1,042 questionnaires: 651 (62.5%) were from public health nurses who reported that they elicited and shared community views to be reflected for purposes of local healthcare planning (the reflecting group), and 391 (37.5%) of the remaining public health nurses who reported that they did not do so (the non-reflecting group). The logistic regression analysis revealed that public health nurses in the reflecting group were more likely to be in a managerial position, have colleagues who played an active role in healthcare planning, conduct a questionnaire survey, engage in group work, participate in a municipal healthcare planning committee with community-dwelling people, and identify the opinions of the professional organizations.

CONCLUSIONS

Identifying community healthcare needs through collaboration with community-dwelling people and professional organizations should be essential competencies for public health nurses (the reflecting group) in developing needs-oriented local healthcare plans.

IMPACT

Identification of their related competencies for developing a needs-oriented local healthcare plan as an upstream strategy to mitigate the prevalence of health inequities in each community.

Text Mining and Quantitative Research of Medical Service Policy: Sichuan Province as an Example

Medical service policy plays a prominent role in the development of a “Healthy China.” This paper constructs a three-dimensional framework for text mining of medical service policy using the elements of policy instruments, policy strength, and types of medical service activity. Taking Sichuan Province as an example, 221 medical service policy documents, issued by the government and related departments, are selected as the research sample; the policy instruments, policy strength, and medical service activity types are analyzed using ROST and Nvivo 11.0 software. It is concluded that the government needs to optimize the structure of policy instruments, to appropriately reduce the use of environmental policy instruments in particular, while increasing the use of demand-based policy instruments. It is necessary to strengthen the interaction between the various sub-policy instruments, and to increase the use of financial services, fiscal taxes, overseas communications, and strategic measures. An increase in the implementation of government policy assists the acceleration of the policy landing, the further improvement of the supervision system, and the safeguard mechanism of the three medicine policy linkage, which can improve the sustainability of the medical service policy, and further resolve the difficulty and expense of seeing a doctor.

Improving health policy competency through collaboration and enhanced curriculum delivery

Health policy is a key criterion for the academic preparation of nurse practitioners. To meet this criterion, faculty frequently utilize standard passive learning assignments that leave students feeling ill prepared to create and advocate for health policy upon graduation. To meet this need, faculty at two independent schools of nursing created curriculum to enhance health policy education for nurse practitioners. Using a variety of techniques based on real-world experience, nurse practitioner students gained increased retention of knowledge and increased activation in the health policy arena upon graduation. This finding supports that active learning increases retention and utilization in the area of health policy.

Interprofessional Education: Reaching Health Professionals With an Interactive Professional Virtual/Online Event on Advocacy and Policy

Competencies in health policy and advocacy should be developed by all health professionals to effectively advance their professions but also effectively collaborate in interprofessional teams to improve public health. However, the COVID-19 epidemic presents a challenge to reaching students of health professions through face-to-face offerings. To meet this need, the University of South Florida College of Public Health developed asynchronous and synchronous online health policy and advocacy modules delivered to an interprofessional group of students pursuing health careers. After learning policy and advocacy material individually through a self-paced online curriculum, faculty gathered the students for a synchronous online event where they formed collaborative groups. In interprofessional teams, students prepared and presented advocacy briefs that were critiqued by the faculty. Post-event evaluation results showed that most students strongly agreed that the interprofessional event was very effective, and they all would recommend the program to other students. Universities and colleges educating students of health professions can take advantage of the technologies employed to keep students safe in the COVID-19 pandemic and still reach students effectively with interprofessional health policy and advocacy content.

Emerging roles for research intensive PhD prepared nurses: Beyond faculty positions

Research-intensive PhD programs need to prepare nurse scientists to bridge the chasms between research, and practice and policy in an increasingly complex healthcare system. In practice, nurse scientists are critical to building capacity for research, promoting excellence in patient-centered care, and achieving or exceeding national quality benchmarks. Moreover, they provide methodological expertise and insight to address pressing clinical questions. PhD-prepared nurses also leverage their research expertise and practice knowledge to transform health policy in roles as organizational executives and leaders, advocates, and communicators. Re-envisioning nursing PhD curricula is required to ensure that PhD students are capable of not only conducting rigorous and impactful science, but launching careers across sectors of healthcare. Here, we summarize viewpoints of a special session from the October 2019 PhD Summit "Re-Envisioning PhD Programs of the Future" sponsored by the University of Pennsylvania School of Nursing and literature to invigorate thinking about ways to promote career transitions into nontraditional vital positions for nurse scientists. Advancing the health of patients and communities depends on preparing the next generation of nurse scientist to pursue career trajectories outside of traditional academic institutions.

The Related Factors of Nurses' Participation and Perceived Benefits and Barriers in Health Policy Making

BACKGROUND

Nurses play a critical role in providing good health services.

PURPOSE

The aim of this study was to examine the factors related to the participation of nurses in the provision of health services and the perceived benefits and barriers to their participation in health policy making.

METHODS

A cross-sectional descriptive study was conducted in several hospitals affiliated with the Iran University of Medical Sciences during the first half of 2018 on a sample size of 220 people. A standard, self-management questionnaire was used to collect the data, and SPSS 21.0 software was used for data analysis. None of the demographic characteristics were found to be significantly associated with nurse participation in or the perceived barriers and benefits to health policy making.

RESULTS

The results of this study show that the participants were involved only moderately in health policy making. "Providing written reports on problems or receiving consultation from a related official" was the performance item most frequently cited by the participants in terms of involvement, whereas "Disappointment in work procedures" was the most frequently cited barrier item affecting involvement.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Despite the importance of the nursing role in health polices, this study indicates that nurses participate at only a moderate level in health policy-making activities. Providing more information to nurses regarding health policies, enhancing nurses' image of their job and their perceptions about the importance of their participation in the health policy, increasing partnerships with nurses at the upper levels of health services management, and supporting nursing professional organizations in the field of health policy are potential strategies for encouraging greater nursing participation in health policy making.

Capacitación de recursos humanos en salud materna en Bolivia, Colombia, Ecuador, Guatemala, Haití, Honduras, Nicaragua y Perú: descripción de la experiencia

Introducción: América Latina y el Caribe han disminuido la mortalidad materna; sin embargo, aún poseen países con altas tasas, lo que refleja inequidades en el acceso a servicios de salud. La capacitación de recurso humano competente en atención primaria es una de las principales estrategias para abordar la problemática. Objetivo: Describir la experiencia de planificación, implementación y evaluación de un programa de capacitaciones en salud materna en países de la región (Bolivia, Colombia, Ecuador, Guatemala, Honduras, Nicaragua, Haití y Perú). Metodología: Entre 2016 y 2019, el Departamento de Sistemas y Servicios de Salud y la Unidad de Recursos Humanos de la Organización Panamericana de la Salud, junto a centros colaboradores, universidades y al Centro Latinoamericano de Perinatología y Salud de la Mujer, realizaron un levantamiento de necesidades de capacitación, desarrollaron plan de formación e implementaron capacitaciones para personal profesional y no profesional en salud materna. Resultados: Las necesidades de capacitación detectadas fueron liderazgo en salud, cuidados prenatales, parto, posparto, emergencias obstétricas y planificación familiar. Estas se consideraron en capacitaciones presenciales y virtuales, con 71 entrenadores de 7 países, quienes a su vez las reprodujeron para más de 4000 personas. Las evaluaciones fueron muy positivas y se espera determinar el impacto en salud en futuros proyectos. Conclusiones: Es fundamental la detección de necesidades y el trabajo colaborativo para realizar capacitaciones acordes en los países de la región, que permita contar con recurso humano motivado y competente para aumentar el acceso y la cobertura en la atención en salud materna de calidad.

Curriculum Mapping and Needs Assessment to Inform the Training of Health Policy Leaders

Purpose

To identify synergies and gaps in knowledge, skills, and attributes identified by health policy leaders and create a summary measure of congruence with the Health Policy Leadership Fellowship Program curriculum.

Methods

We mapped the Health Policy Leadership Fellowship Program curriculum to the most highly ranked knowledge, skills, and attributes identified through the Health Policy Leaders' Training Needs Assessment survey.

Results

Overall, the Health Policy curricular elements had the highest percentage of congruence with the needs assessment Knowledge elements (>60%). The lowest levels of congruence (<30%) occurred most frequently within the Attribute elements.

Conclusions

Mapping an existing program's content and elements to needs perceptions from professionals practicing in the field may help to both inform and evaluate an existing program's ability to attract and meet the needs of target learners. While needs assessments have traditionally been used to help develop programs, this study also demonstrates their application as a process evaluation tool when mapped to existing programs' curricular elements.

Leveraging Science to Advance Health Equity: A Regional Health Policy Research Center's Approach

Advancing health equity and reducing disparities through evidence-based policy research requires the expertise, insights, and active participation of various policy stakeholders - particularly those representing vulnerable populations who may be disproportionately affected by such policies. Unfortunately, there are few sustainable settings for these diverse stakeholders to convene, share their knowledge, develop and execute research in a collaborative fashion, and effectively translate evidence-based findings. The development of a health policy-focused center supports the collaborative structure needed to present a unified, multi-disciplinary approach toward informing health policy. The Transdisciplinary Collaborative Center for Health Disparities Research (TCC) at Morehouse School of Medicine (U54MD008173) was funded in 2012 by the National Institute on Minority Health and Health Disparities (NIMHD) as an innovative approach for conducting health policy research and disseminating evidence-based science to diverse stakeholders. This article provides an overview of the research projects, pilot project programs, infrastructure cores, communications, and strategic dissemination activities supported by the TCC.

Health Policy Training for Health Equity Leaders

Health professional training programs increasingly recognize the importance of health policy training. Despite integration of this training into health professional education, there have been limited published studies about health policy training and few studies that meaningfully measure and evaluate learner outcomes. The Satcher Health Leadership Institute at Morehouse School of Medicine developed a multidisciplinary, post-doctoral, health policy fellowship program in 2009, uniquely focused at the intersections of health policy, health equity, and leadership development. The program curriculum was intentionally designed with desired learner outcomes, aligning training and learner experiences with these outcomes, and meaningfully capturing and measuring outcomes in program evaluation. We present our training approach as well as results from an alumni survey assessing learner outcomes one to five years post fellowship completion. To our knowledge, this is the first study that evaluates the longitudinal impact of health policy training on the career trajectories of program graduates. We believe this offers a number of opportunities for replication and translation across health professional training programs.

Applying a Health Equity Lens to Evaluate and Inform Policy

Health disparities have persisted despite decades of efforts to eliminate them at the national, regional, state and local levels. Policies have been a driving force in creating and exacerbating health disparities, but they can also play a major role in eliminating disparities. Research evidence and input from affected community-level stakeholders are critical components of evidence-based health policy that will advance health equity. The Transdisciplinary Collaborative Center (TCC) for Health Disparities Research at Morehouse School of Medicine consists of five subprojects focused on studying and informing health equity policy related to maternal-child health, mental health, health information technology, diabetes, and leadership/workforce development. This article describes a "health equity lens" as defined, operationalized and applied by the TCC to inform health policy development, implementation, and analysis. Prioritizing health equity in laws and organizational policies provides an upstream foundation for ensuring that the laws are implemented at the midstream and downstream levels to advance health equity.

Trends of case-fatality rate by acute coronary syndrome in Portugal: Impact of a fast track to the coronary unit

INTRODUCTION

Efforts were made to improve management of coronary disease as the fast-track system to the Coronary Unit. We aim to analyse case-fatality rates by acute coronary syndrome in Portugal from 2000 to 2016, mainly the impact of the fast-track system and the proportion of patients that activate the fast-track system.

METHODS

We analysed monthly acute coronary syndrome case-fatality before and after the implementation of the fast-track system in 2007. Impact of the system was assessed through regression models for interrupted time-series. We calculated annual proportion of fast-track system admissions.

RESULTS

After 2007 case-fatality by acute coronary syndrome decreased (β=-1.27, p-value < 0.01). The estimates obtained for ST Elevation Myocardial Infarction suggest a reduction of nearly 86 monthly deaths prevented after 2007. The highest percentage of patients admitted through the fast-track system was 35%.

CONCLUSIONS

Our results suggest fast-track system may have contributed to a decline in acute coronary syndrome case-fatality. However, more than half of patients were not admitted through the system. This should encourage health authorities to make efforts to ensure compliance.

Medical student involvement in health policy roles

OBJECTIVES

A teaching curriculum in health policy may be well established in medical school; however, an emphasis on applying taught principles via participation in health policy roles is less defined. We undertook a study to explore medical student participation in health policy roles.

DESIGN AND SETTING

An anonymous online survey via convenience sampling was conducted in the UK.

PARTICIPANTS

A total of 112 students from six medical schools participated in the study.

OUTCOME MEASURES

The outcome measures were as follows: medical students' beliefs about their current knowledge of health policy and their desire to learn more; their current, past and future involvement in a health policy role, and perceived barriers to involvement.

RESULTS

Forty-seven percent of participants reported previous teaching on health policy, with the majority scoring themselves 2 out of 5 for knowledge about the topic (38%). Seventy-seven percent of participants expressed a desire to be taught health policy while 73% agreed with compulsory teaching. Ninety-six percent of participants reported no current or previous activity in a health policy role, with 61% willing to undertake a role in the future. The three main barriers to student involvement were: a lack of knowledge about health policy (57%), an unawareness of opportunities available (56%), and a lack of time (43%).

CONCLUSION

In addition to already established teaching programs within medical school, implementation of community-based experiences could improve knowledge of health policy, while providing an opportunity for students to gain experience in health policy committee roles.

Systems-Based Training in Graduate Medical Education for Service Learning in the State Legislature in the United States: Pilot Study

BACKGROUND

There is a dearth of advocacy training in graduate medical education in the United States. To address this void, the Legislative Education and Advocacy Development (LEAD) course was developed as an interprofessional experience, partnering a cohort of pediatrics residents, fourth-year medical students, and public health students to be trained in evidence-informed health policy making.

OBJECTIVE

The objective of our study was to evaluate the usefulness and acceptability of a service-based legislative advocacy course.

METHODS

We conducted a pilot study using a single-arm pre-post study design with 10 participants in the LEAD course. The course's didactic portion taught learners how to define policy problems, research the background of the situation, brainstorm solutions, determine evaluation criteria, develop communication strategies, and formulate policy recommendations for state legislators. Learners worked in teams to create and present policy briefs addressing issues submitted by participating Illinois State legislators. We compared knowledge and attitudes of learners from pre- and postcourse surveys. We obtained qualitative feedback from legislators and pediatric residency directors.

RESULTS

Self-reported understanding of the health care system increased (mean score from 4 to 3.3, P=.01), with answers scored from 1=highly agree to 5=completely disagree. Mean knowledge-based scores improved (6.8/15 to 12.0/15 correct). Pediatric residency program directors and state legislators provided positive feedback about the LEAD course.

CONCLUSIONS

Promising results were demonstrated for the LEAD approach to incorporate advocacy training into graduate medical education.

Understanding health policy leaders' training needs

PURPOSE

We assessed the training needs of health policy leaders and practitioners across career stages; identified areas of core content for health policy training programs; and, identified training modalities for health policy leaders.

METHODS

We convened a focus group of health policy leaders at varying career stages to inform the development of the Health Policy Leaders' Training Needs Assessment tool. We piloted and distributed the tool electronically. We used descriptive statistics and thematic coding for analysis.

RESULTS

Seventy participants varying in age and stage of career completed the tool. "Cost implications of health policies" ranked highest for personal knowledge development and "intersection of policy and politics" ranked highest for health policy leaders in general. "Effective communication skills" ranked as the highest skill element and "integrity" as the highest attribute element. Format for training varied based on age and career stage.

CONCLUSIONS

This study highlighted the training needs of health policy leaders personally as well as their perceptions of the needs for training health policy leaders in general. The findings are applicable for current health policy leadership training programs as well as those in development.

A Staged Approach to Educating Nurses in Health Policy

Nurse leaders and health-care experts agree that nurses have a responsibility to address the health problems facing the nation by participating in health policy development. However, nurses have not fully realized their potential when it comes to engaging in health policy advocacy and leadership. Nurse leaders, professional nursing organizations, accrediting bodies, and the Institute of Medicine have all identified the need to educate nurses in heath policy. Valuable recommendations for content and learning activities in health policy have been made. We argue that nursing education in health policy and the many recommendations offered have been broad and overly ambitious. This article presents a proposal for a staged approach to educating nurses. This approach would tailor content to the role of the nurse at each level of nursing education. The focus of health policy content would progress from the organizational level to local, state, and finally national level health policies. The goal of this approach is to better prepare all levels of nursing students to participate in shaping effective health policies.

Geospatial Information System Analysis of Healthcare Need and Telemedicine Delivery in California

BACKGROUND

Geospatial Information Systems (GIS) superimpose data on geographical maps to provide visual representations of data by region. Few studies have used GIS data to investigate if telemedicine services are preferentially provided to communities of greatest need.

INTRODUCTION

This study compared the healthcare needs of communities with and without telemedicine services from a university-based telemedicine program.

METHODS

Originating sites for all telemedicine consultations between July 1996 and December 2013 were geocoded using ArcGIS software. ZIP Code Tabulation Areas (ZCTAs) were extracted from the 2010 U.S. Census Bureau's Topologically Integrated Geographic Encoding and Referencing file and assigned a community needs index (CNI) score to reflect the ZCTA community's healthcare needs based on evidence-based barriers to healthcare access. CNI scores were compared across communities with and without active telemedicine services.

RESULTS

One hundred ninety-four originating telemedicine clinic sites in California were evaluated. The mean CNI score for ZCTAs with at least one telemedicine clinic was significantly higher (3.32 ± 0.84) than those without a telemedicine site (2.95 ± 0.99) and higher than the mean ZCTAs for all of California (2.99 ± 1.01). Of the 194 telemedicine clinics, 71.4% were located in communities with above average need and 33.2% were located in communities with very high needs.

DISCUSSION

Originating sites receiving telemedicine services from a university-based telemedicine program were located in regions with significantly higher community healthcare needs. Leveraging a geospatial information system to understand community healthcare needs provides an opportunity for payers, hospitals, and patients to be strategic in the allocation of telemedicine services.