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Angus L, Dall A, Ghosal R. Catalyzing alignment and systems transformation through cross-sector partnerships: Findings from the California Accountable Communities for Health Initiative. Health Serv Res 2024; 59 Suppl 1:e14236. [PMID: 37749901 PMCID: PMC10796288 DOI: 10.1111/1475-6773.14236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES To describe the impact of Accountable Communities of Health (ACHs) on organizational and community partnerships and explore how ACHs contribute to systems change. DATA SOURCES AND STUDY SETTING The California Accountable Communities of Health Initiative (CACHI) was a 5-year, $17 M investment in community health transformation in 13 ACH sites. Data sources include two surveys, key informant interviews, small group conversations, and ACH meeting observations and document review. STUDY DESIGN This was a mixed-methods, observational study. Surveys conducted in 2021 and 2022 focused on ACH progress in building organizational and community partnerships and ACH impact on partners and systems, respectively. Interviews and small group conversations were conducted toward the end of the CACHI grant period and designed to complement the surveys. DATA COLLECTION Survey respondents included ACH backbone agency staff and partner organization representatives (n = 141 in 2021 and 88 in 2022). Semistructured individual interviews and group conversations were conducted with 40 ACH backbone staff and partners. Documents were collected via grant reporting and directly from ACH staff. Data were analyzed descriptively and thematically. PRINCIPAL FINDINGS ACHs appear to have supported organizational partnerships and collaboration. Seventy-six percent of survey respondents reported that their ACH had strengthened organizations' ability to work together and 65% reported developing new or deepened connections. While ACH participants reported a better understanding of community needs and priorities, progress on community relationships, and greater attention to equity and racial justice, many saw room for improvement on meaningful community engagement. Systems changes and precursors of systems change observed across ACH sites included strengthened partnerships, enhanced knowledge, increased capacity, more collaborative ways of working, and new funding streams. CONCLUSIONS The ACH model is effective at strengthening organizational partnerships and catalyzing other systems changes and precursors including enhanced knowledge, increased capacity, more collaborative ways of working, and new funding.
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Affiliation(s)
- Lisa Angus
- Providence Center for Outcomes Research and Education (CORE)PortlandOregonUSA
| | | | - Ritu Ghosal
- Providence Center for Outcomes Research and Education (CORE)PortlandOregonUSA
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Palmer T, Jennings HM, Shannon G, Salustri F, Grewal G, Chelagat W, Sarker M, Pelletier N, Haghparast-Bidgoli H, Skordis J. Improving access to diabetes care for children: An evaluation of the changing diabetes in children project in Kenya and Bangladesh. Pediatr Diabetes 2022; 23:19-32. [PMID: 34713540 DOI: 10.1111/pedi.13277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The changing diabetes in children (CDiC) project is a public-private partnership implemented by Novo Nordisk, to improve access to diabetes care for children with type 1 diabetes. This paper outlines the findings from an evaluation of CDiC in Bangladesh and Kenya, assessing whether CDiC has achieved its objectives in each of six core program components. RESEARCH DESIGN AND METHODS The Rapid Assessment Protocol for Insulin Access (RAPIA) framework was used to analyze the path of insulin provision and the healthcare infrastructure in place for diagnosis and treatment of diabetes. The RAPIA facilitates a mixed-methods approach to multiple levels of data collection and systems analysis. Information is collected through questionnaires, in-depth interviews and focus group discussions, site visits, and document reviews, engaging a wide range of stakeholders (N = 127). All transcripts were analyzed thematically. RESULTS The CDiC scheme provides a stable supply of free insulin to children in implementing facilities in Kenya and Bangladesh, and offers a comprehensive package of pediatric diabetes care. However, some elements of the CDiC program were not functioning as originally intended. Transitions away from donor funding and toward government ownership are a particular concern, as patients may incur additional treatment costs, while services offered may be reduced. Additionally, despite subsidized treatment costs, indirect costs remain a substantial barrier to care. CONCLUSION Public-private partnerships such as the CDiC program can improve access to life-saving medicines. However, our analysis found several limitations, including concerns over the sustainability of the project in both countries. Any program reliant on external funding and delivered in a high-turnover staffing environment will be vulnerable to sustainability concerns.
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Affiliation(s)
- Tom Palmer
- Institute for Global Health, University College London, London, UK
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Mithun Sarker
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Nicole Pelletier
- Institute for Global Health, University College London, London, UK
| | | | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
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Affiliation(s)
| | | | - José Esparza
- University of Maryland, Baltimore, Maryland, USA
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Kim W, Jung TY, Roth S, Um W, Kim C. Management of the COVID-19 Pandemic in the Republic of Korea from the Perspective of Governance and Public-Private Partnership. Yonsei Med J 2021; 62:777-791. [PMID: 34427063 PMCID: PMC8382722 DOI: 10.3349/ymj.2021.62.9.777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/27/2022] Open
Abstract
The government of the Republic of Korea (ROK) has established relevant laws and a master plan for infectious disease control and prevention based on their experiences with past epidemics. In addition, the Ministry of Health and Welfare has designed a standard manual for risk management that involves pan-governmental crisis management systems. This national infectious disease management system is constantly being supplemented and developed in face of infectious disease-related crises. In this study, we set out to present directions for infectious disease prevention and flow of management and governance between central and local governments to ensure systematic quarantine activities in the ROK. During the coronavirus disease 2019 (COVID-19) pandemic, public-private partnerships have been established to collect, provide, process, and disseminate information for effective quarantine. This has enabled the development and rapid approval of test kits, the tracking of cases, and the allocation of appropriate resources for patient treatment. Additionally, the Infectious Disease Control Agency has actively utilized information and communication technology platforms to disclose information necessary in real-time for COVID-19 quarantine and management. Overall, these efforts have played an important role in epidemiological investigations, patient management, and quarantine in the early stages of the COVID-19 pandemic.
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Affiliation(s)
- Woojin Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Yong Jung
- Graduate School of International Studies, Yonsei University, Seoul, Korea
| | - Susann Roth
- Sustainable Development and Climate Change Department, Asian Development Bank, Metro Manila, Philippines
| | - Woochong Um
- Office of the President, Asian Development Bank, Metro Manila, Philippines
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Human Complexity and Systems Science, Yonsei University, Incheon, Korea.
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Inaba M, Naito H, Muramatsu T, Yamada T, Sakata T, Nakao A. Hospital Evacuation Assistance from Public and Private Resources: Lessons Learned from the 2018 Western Japan Floods. Acta Med Okayama 2021; 74:359-364. [PMID: 32843768 DOI: 10.18926/amo/60375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
During major flooding in June/July 2018, the Mabi Memorial Hospital in Kurashiki, Okayama, Japan was flooded and patients were stranded in the hospital. Peace Winds Japan, a non-governmental organization, collaborated with the Japanese Disaster Medical Assistance Team and Self-Defense Force Public to transport 8 critical patients from the hospital by helicopter. Ultimately, 54 patients and hospital staff members were safely evacuated. The evacuation was accomplished without any casualties, despite the severe conditions. Public and private organizations can work together and continue to seek ways to collaborate and cooperate in disaster settings.
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Affiliation(s)
- Mototaka Inaba
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, .,Peace Winds Japan, Jinseki, Hiroshima 720-1622, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | | | - Taihei Yamada
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Taizo Sakata
- Peace Winds Japan, Jinseki, Hiroshima 720-1622, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Hogg-Graham R, Edwards K, L Ely T, Mochizuki M, Varda D. Exploring the capacity of community-based organisations to absorb health system patient referrals for unmet social needs. Health Soc Care Community 2021; 29:487-495. [PMID: 32716100 DOI: 10.1111/hsc.13109] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/11/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Abstract
This study examines the perspectives, resources, role and services provided by community-based organisations (CBOs) in response to the integration of health and social services to address individual unmet social needs, as well as the impact on organisational carrying capacity related to the ability to receive referrals from health system partners. Mixed methods combining qualitative interviews with 24 organisations and Social Network Analysis with 75 organisations were completed in 2018 in two communities (Denton, TX and Sarasota, FL) with robust examples of health and social systems alignment. Findings suggest that while community organisations are embedded in robust cross-sector networks, the potential increase in referrals from clinical settings is not something they are fully aware of, or prepared for, as evidenced by inadequate funding models, misalignment between capacity and capability, and a lack of coordination on screening and referral activities. Misalignment between clinical and CBO understanding of demand, needs and capacity present a potential risk in building strategies that integrate health and social services to address unmet social need. Failing to build a strong cross-sector screening and referral infrastructure that considers CBO capacity from the start could undermine the goal of improving population health through the integration of clinical and social care.
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Affiliation(s)
| | | | - Todd L Ely
- School of Public Affairs, University of Colorado Denver, Denver, CO, USA
| | - Malinda Mochizuki
- School of Public Affairs, University of Colorado Denver, Denver, CO, USA
| | - Danielle Varda
- School of Public Affairs, University of Colorado Denver, Denver, CO, USA
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Davalbhakta S, Sharma S, Gupta S, Agarwal V, Pandey G, Misra DP, Naik BN, Goel A, Gupta L, Agarwal V. Private Health Sector in India-Ready and Willing, Yet Underutilized in the Covid-19 Pandemic: A Cross-Sectional Study. Front Public Health 2020; 8:571419. [PMID: 33194971 PMCID: PMC7643808 DOI: 10.3389/fpubh.2020.571419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The private medical sector is a resource that must be estimated for efficient inclusion into public healthcare during pandemics. Methods: A survey was conducted among private healthcare workers to ascertain their views on the potential resources that can be accessed from the private sector and methods to do the same. Results: There were 213 respondents, 80% of them being doctors. Nearly half (47.4%) felt that the contribution from the private medical sector has been suboptimal. Areas suggested for improved contributions by the private sector related to patient care (71.8%) and provision of equipment (62.4%), with fewer expectations (39.9%) on the research front. Another area of deemed support was maintaining continuity of care for non-COVID patients using virtual consultation services (77.4%), tele-consultation being the preferred option (60%). 58.2% felt that the Government had not involved the private sector adequately; and 45.1% felt they should be part of policy-making. Conclusion: A streamlined pathway to facilitate the private sector to join hands with the public sector for a national cause is the need of the hour. Through our study, we have identified gaps in the current contribution by the private sector and identified areas in which they could contribute, by their own admission.
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Affiliation(s)
- Samira Davalbhakta
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Supriya Sharma
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Shefali Gupta
- Department of Microbiology, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mulana, India
| | | | - Gaurav Pandey
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Bijaya Nanda Naik
- Department of Community Medicine, NAMO Medical Education and Research Institute, Silvassa, India
| | - Ashish Goel
- Department of Medicine, University College of Medical Sciences, New Delhi, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Khokhar MA, Ali MM, Liaqat S, Moin A, Sarwar HA, Sarwar MZ. A review of access to cancer facilities in Punjab, Pakistan. Cancer Rep (Hoboken) 2020; 3:e1245. [PMID: 32671984 PMCID: PMC7941486 DOI: 10.1002/cnr2.1245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Punjab is the most populous province of Pakistan, with only 12 countries in the world succeeding it in terms of population. AIMS This review article has the objective of providing novel statistics regarding available cancer therapeutics in Punjab across four different sectors-including government, semi-private, trust and private sectors. METHODS AND RESULTS Keywords such as "cancer treatment," "facilities," "Pakistan," were used to search Pubmed Database. 36 results were generated: after sifting based on a personal reference list as well as for relevance, 16 articles were finally reviewed. Novel statistics regarding current state of access to cancer facilities were drawn from personal references as well as from studies conducted in other LMICs. There is a gross deficit of oncological services in Punjab, with the ratio of medical oncologists to population being 0.027 per 100, 000, and every oncologist checking 1300-1500 patients annually. Only 21.4% of the population has access to radiotherapy facilities. Major problems include lack of healthcare professional awareness; poor infrastructure including drug access, radiotherapy, and cancer pain management facilities; lack of planning; and lack of educational and research programs. CONCLUSIONS Improving education & training, developing infrastructure based on public-private-partnership models, building cancer registries and organizing national cancer screening programs, as well as encouraging basic health education and research in oncology, are measures that can ensure Punjab's healthcare delivery system becomes capable of handling increasing incident burden of cancer.
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Affiliation(s)
| | | | - Samrin Liaqat
- Department of OncologyKing Edward Medical UniversityLahorePakistan
| | - Arif Moin
- Multan Institute of Nuclear Medicine and RadiologyMultanPakistan
| | - Hafiz Abubakar Sarwar
- Department of Medical OncologyShaukat Khanum Memorial Hospital and Cancer Research CenterLahorePakistan
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Affiliation(s)
- Raymond C Harris
- Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and
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Bonventre JV, Hurst FP, West M, Wu I, Roy-Chaudhury P, Sheldon M. A Technology Roadmap for Innovative Approaches to Kidney Replacement Therapies: A Catalyst for Change. Clin J Am Soc Nephrol 2019; 14:1539-1547. [PMID: 31562182 PMCID: PMC6777588 DOI: 10.2215/cjn.02570319] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The number of patients dialyzed for ESKD exceeds 500,000 in the United States and more than 2.6 million people worldwide, with the expectation that the worldwide number will double by 2030. The human cost of health and societal financial cost of ESKD is substantial. Dialytic therapy is associated with an unacceptably high morbidity and mortality rate and poor quality of life. Although innovation in many areas of science has been transformative, there has been little innovation in dialysis or alternatives for kidney replacement therapy (KRT) since its introduction approximately 70 years ago. Advances in kidney biology, stem cells and kidney cell differentiation protocols, biomaterials, sensors, nano/microtechnology, sorbents and engineering, and interdisciplinary approaches and collaborations can lead to disruptive innovation. The Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and the US Food and Drug Administration, has convened a multidisciplinary group to create a technology roadmap for innovative approaches to KRT to address patients' needs. The Roadmap is a living document. It identifies the design criteria that must be considered to replace the myriad functions of the kidney, as well as scientific, technical, regulatory, and payor milestones required to commercialize and provide patient access to KRT alternatives. Various embodiments of potential solutions are discussed, but the Roadmap is agnostic to any particular solution set. System enablers are identified, including vascular access, biomaterial development, biologic and immunologic modulation, function, and safety monitoring. Important Roadmap supporting activities include regulatory alignment and innovative financial incentives and payment pathways. The Roadmap provides estimated timelines for replacement of specific kidney functions so that approaches can be conceptualized in ways that are actionable and attract talented innovators from multiple disciplines. The Roadmap has been used to guide the selection of KidneyX prizes for innovation in KRT.
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Affiliation(s)
- Joseph V Bonventre
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; .,Harvard Stem Cell Institute, Cambridge, Massachusetts
| | | | | | - Iwen Wu
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Prabir Roy-Chaudhury
- Division of Nephrology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; and.,Department of Medicine, WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina
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Abstract
BACKGROUND The World Health Organization (WHO) 2017 Global Conference in Montevideo, Uruguay, was dedicated to promoting successful cases and best practices in fighting and preventing noncommunicable disease (NCDs). The global effort undertaken by WHO aims to reduce road traffic deaths in order to meet goal number 3.4 of the sustainable development goals. OBJECTIVES To describe two Brazilian road safety prevention programs, presented at the WHO 2017 Global Conference: São Paulo Traffic Safety Movement (Movimento Paulista de Segurança no Trânsito) and Safe Life Program of Brasília (Programa Brasília Vida Segura), along with their governance structures, models and results. DESIGN AND SETTING This was a descriptive case study conducted in São Paulo and Brasilia from 2015 to 2018. These programs aimed to reduce the number of deaths caused by road accidents to 8.3 deaths per 100,000 inhabitants in São Paulo by 2020 and in Brasília by 2016; and to reduce harmful use of alcohol by 10% by 2020. METHODS These two initiatives were designed, managed and operated to bring together government and civil society, i.e. industry, academia, non-governmental organizations (NGOs), etc., around the common goal of saving lives. They were collaborative and guided by sharing of best practices, learning and information, thereby making it possible to attain more and better results. Their format enables reproduction in cities across all Brazilian regions. RESULTS The results attest to the efficacy of the programs implemented in these two cities. In Brasília, the initiative helped reduce the number of traffic-related deaths by 35% (2017). In the same year in the state of São Paulo, 7,600 deaths were avoided. CONCLUSION Both programs are innovative public policies that deal with health issues caused by the external agents that ultimately account for the rapid increase in days lost to disability. Prevention of external causes of deaths and injuries, such as traffic violence, strongly correlates with changes in habits and actions, especially excessive consumption of alcohol, and with NCDs in Brazil.
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Affiliation(s)
- Leandro Piquet Carneiro
- MSc, PhD. Economist and Professor, International Relations Institute, Universidade de São Paulo (USP), São Paulo (SP), Brazil.
| | - Linamara Rizzo Battistella
- MD, PhD. Professor, Department of Legal Medicine, Medical Ethics and Social and Labor Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.
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Anglin G, Tu HA, Liao K, Sessums L, Taylor EF. Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative. Milbank Q 2017; 95:602-633. [PMID: 28895218 DOI: 10.1111/1468-0009.12280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations. CONTEXT With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation. However, sustaining engagement and achieving coordination among payers can be challenging. The Comprehensive Primary Care (CPC) initiative is one of the largest multipayer initiatives ever tested. Drawing on the experience of the CPC initiative, this paper examines the factors that influence the effectiveness of multipayer collaboration. METHODS This paper draws largely on semistructured interviews with CPC-participating payers and payer conveners that facilitated CPC discussions and on observation of payer meetings. We coded and analyzed these qualitative data to describe collaborative dynamics and outcomes and assess the factors influencing them. FINDINGS We found that several factors appeared to increase the likelihood of successful payer collaboration: contracting with effective, neutral payer conveners; leveraging the support of payer champions, and seeking input on decisions from practice representatives. The presence of these factors helped some CPC regions overcome significant initial barriers to achieve common goals. We also found that leadership from the Centers for Medicare & Medicaid Services (CMS) was key to achieving broad payer engagement in CPC, but CMS's dual role as initiative convener and participating payer at times made collaboration challenging. CMS was able to build trust with other payers by clarifying which parts of CPC could be adapted to regional contexts, deferring to other payers for these decisions, and increasing opportunities for payers to meet with CMS representatives. CONCLUSIONS CPC demonstrates that when certain facilitating factors are present, payers can overcome competitive market dynamics and competing institutional priorities to align financial incentives, quality measurement, and data feedback to support practice transformation. Lessons from this large-scale, multipayer initiative may be helpful for other multipayer efforts getting under way.
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Affiliation(s)
| | - H A Tu
- Mathematica Policy Research, Inc
| | - Kristie Liao
- John F. Kennedy School of Government, Harvard University
| | - Laura Sessums
- Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
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Erickson KJ, Monsen KA, Attleson IS, Radosevich DM, Oftedahl G, Neely C, Thorson DR. Translation of obesity practice guidelines: measurement and evaluation. Public Health Nurs 2014; 32:222-31. [PMID: 25424421 DOI: 10.1111/phn.12169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE(S) A public health nurse (PHN) in the Midwestern United States (U.S.) led a collaborative system-level intervention to translate the Institute of Clinical Systems Improvement (ICSI) Adult Obesity Guideline into interprofessional practice. This study (1) evaluated the extent of guideline translation across organizations and (2) assessed the Omaha System as a method for translating system-level interventions and measuring outcomes. DESIGN AND SAMPLE This retrospective, mixed methods study was conducted with a purposeful sample of one administrator (n = 10) and two to three clinicians (n = 29) from each organization (n = 10). MEASURES Omaha System Problem Rating Scale for Outcomes Knowledge, Behavior, and Status (KBS). KBS ratings gathered from semi-structured interviews and Omaha System documentation were analyzed using standard descriptive and inferential statistics and triangulated findings with participant quotes. RESULTS KBS ratings and participant quotes revealed intervention effectiveness in creating sustained system-level changes. Self-reported and observed KBS ratings demonstrated improvement across organizations. There was moderate to substantial agreement regarding benchmark attainment within organizations. On average, self-reported improvement exceeded observer improvement. CONCLUSIONS System-level PHN practice facilitator interventions successfully translated clinical obesity guidelines into interprofessional use in health care organizations. The Omaha System Problem Rating Scale for Outcomes reliably measured system-level outcomes.
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Affiliation(s)
- Kristin J Erickson
- Health Initiatives and Evaluation, Otter Tail County Public Health and PartnerSHIP 4 Health, Fergus Falls, Minnesota
| | - Karen A Monsen
- School of Nursing Affiliate Faculty, Institute for Health Informatics, University of Minnesota School of Nursing, Minneapolis, Minnesota
| | - Ingrid S Attleson
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - David M Radosevich
- Clinical Outcomes Research Center, University of Minnesota, Minneapolis, Minnesota
| | - Gary Oftedahl
- Institute for Clinical Systems Improvement, Bloomington, Minnesota
| | - Claire Neely
- Institute for Clinical Systems Improvement, Bloomington, Minnesota
| | - Diane R Thorson
- Public Health Department, Otter Tail County, Fergus Falls, Minnesota
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Whittaker MA, Dean AJ, Chancellor A. Advocating for malaria elimination - learning from the successes of other infectious disease elimination programmes. Malar J 2014; 13:221. [PMID: 24902848 PMCID: PMC4057589 DOI: 10.1186/1475-2875-13-221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/01/2014] [Indexed: 11/10/2022] Open
Abstract
Malaria elimination is back on the agenda, but it remains challenging for countries to make the transition from effective control to elimination. Many other infectious diseases have been targeted by globally-coordinated elimination advocacy campaigns, and advocacy has been considered an essential component of the success of other disease elimination programmes. What can the malaria community learn from these successes? A review of infectious disease elimination programmes to identify successful elements of advocacy for disease elimination was undertaken. Key elements are: (i) a global elimination plan, supported by international health bodies; (ii) thorough costings and tools to support the business case; (iii) an approach that is positioned within a development framework; (iv) core elimination advocacy messages; (v) provision of advocacy tools for partners (vi) extensive and effective community engagement; and (vii) strong partnerships. These features provide insights into 'what works' in global elimination advocacy. Advocacy is a powerful tool to support the long-term political and financial commitment necessary for malaria elimination. The global malaria community needs to work together, to ensure that the early steps towards the end goal of malaria elimination are taken.
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Affiliation(s)
- Maxine A Whittaker
- School of Population Health, The University of Queensland, Herston, Australia
| | - Angela J Dean
- School of Population Health, The University of Queensland, Herston, Australia
| | - Arna Chancellor
- School of Population Health, The University of Queensland, Herston, Australia
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Abstract
PURPOSE We explored participants' accounts of weight loss interventions to illuminate the reasons behind the greater weight loss observed among those attending a commercial program compared with those receiving standard care in a recent large-scale trial. We further wanted to examine how participants' general explanatory model of being overweight related to the 2 different interventions. METHODS Our study was based on thematic analysis of semistructured telephone interviews with a purposeful sample of 16 female participants from the UK center of a randomized controlled trial of weight loss in primary care. RESULTS The commercial provider delivered weight management in a nonmedical context, which mirrors how participants regard being overweight. Participants felt they needed support and motivation rather than education, and valued the ease of access and frequent contact the commercial provider offered. Some participants preferred individual level support with their primary care clinician, and all were positive about the opportunity to access support through the primary care setting. CONCLUSIONS Primary care referral to a commercial weight loss program for people who do not require specific clinical care appears to be in accord with their general explanatory model about being overweight, offering motivation and support to lose weight outside a strictly medical context. This approach may not be effective or acceptable for everyone, however, and there are likely to be considerable variations in the explanatory models held. Findings support the argument that a range of evidence-based options for weight management should be available in primary care.
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Affiliation(s)
- Amy L Ahern
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom.
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