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Bardach SH, Perry AN, Cavanaugh ET, Mulley AG. Reflections on 3 Years of Innovation: Recognizing the Need for Innovation Beyond the Clinical Care Pathway. Am J Med Qual 2024; 39:55-58. [PMID: 38403968 DOI: 10.1097/jmq.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The Susan and Richard Levy Healthcare Delivery Incubator is designed to bring about rapid, sustainable, scalable, and transformational health care redesign. All 10 projects in the initial 3 cohorts of teams embraced the Incubator process-forming diverse teams and following a design-thinking informed curriculum-and each successfully implemented improvements or innovations by the end of their project. The purpose of this article is to identify the key features of teams' work that may help account for projects' success. For the 10 projects completed, findings from debrief interviews and staff observations were examined to identify processes key to project's success. Analysis highlighted cross-project learnings that indicate nonclinical aspects of care delivery that play a critical role in project innovation success. Innovating health care delivery requires considering social and political determinants of health. The Incubator's process and structures enable teams to identify and respond to a broad range of health determinants.
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Affiliation(s)
- Shoshana H Bardach
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Amanda N Perry
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | | | - Albert G Mulley
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
- Regional Strategy and Operations, Dartmouth Health, Lebanon, NH
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Windle A, Javanparast S, Freeman T, Baum F. Evaluating local primary health care actions to address health inequities: analysis of Australia's Primary Health Networks. Int J Equity Health 2023; 22:243. [PMID: 37990326 PMCID: PMC10664268 DOI: 10.1186/s12939-023-02053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Meso-level, regional primary health care organisations such as Australia's Primary Health Networks (PHNs) are well placed to address health inequities through comprehensive primary health care approaches. This study aimed to examine the equity actions of PHNs and identify factors that hinder or enable the equity-orientation of PHNs' activities. METHODS Analysis of all 31 PHNs' public planning documents. Case studies with a sample of five PHNs, drawing on 29 original interviews with key stakeholders, secondary analysis of 38 prior interviews, and analysis of 30 internal planning guidance documents. This study employed an existing framework to examine equity actions. RESULTS PHNs displayed clear intentions and goals for health equity and collected considerable evidence of health inequities. However, their planned activities were largely restricted to individualistic clinical and behavioural approaches, with little to facilitate access to other health and social services, or act on the broader social determinants of health. PHNs' equity-oriented planning was enabled by organisational values for equity, evidence of local health inequities, and engagement with local stakeholders. Equity-oriented planning was hindered by federal government constraints and lack of equity-oriented prompts in the planning process. CONCLUSIONS PHNs' equity actions were limited. To optimise regional planning for health equity, primary health care organisations need autonomy and scope to act on the 'upstream' factors that contribute to local health issues. They also need sufficient time and resources for robust, systematic planning processes that incorporate mechanisms such as procedure guides and tools/templates, to capitalise on their local evidence to address health inequities. Organisations should engage meaningfully with local communities and service providers, to ensure approaches are equity sensitive and appropriately targeted.
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Affiliation(s)
- Alice Windle
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia.
| | - Sara Javanparast
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Toby Freeman
- Stretton Health Equity, School of Social Sciences, Faculty of Arts, Business, Law and Economics, The University of Adelaide, Adelaide, South Australia
| | - Fran Baum
- Stretton Health Equity, School of Social Sciences, Faculty of Arts, Business, Law and Economics, The University of Adelaide, Adelaide, South Australia
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Crowley R, Mathew S, Hilden D. Modernizing the United States' Public Health Infrastructure: A Position Paper From the American College of Physicians. Ann Intern Med 2023; 176:1089-1091. [PMID: 37459617 DOI: 10.7326/m23-0670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
The United States' public health sector plays a crucial role in preventing illness and promoting health. Public health drove massive gains in life expectancy during the 20th century by supporting vaccination campaigns, promoting motor vehicle safety, and preventing and treating tobacco use. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians (ACP) updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. ACP calls for effective coordination of public health activities, robust and stable year-to-year funding of public health services, a renewed and well-supported public health workforce, action to address health-related dis- and misinformation, modernized public health data systems, and greater coordination between public health and medical sectors.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C.)
| | - Suja Mathew
- Atlantic Health System, Morristown, New Jersey (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
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Allen LN, Barkley S, De Maeseneer J, van Weel C, Kluge H, de Wit N, Greenhalgh T. Unfulfilled potential of primary care in Europe. BMJ 2018; 363:k4469. [PMID: 30355571 DOI: 10.1136/bmj.k4469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Luke N Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Chris van Weel
- Radboud Institute of Health Sciences, Department of Primary and Community Care, Radboud University, Nijmegen, Netherlands
- Department of Health Services Research and Policy, Australian National University, Canberra, Australia
| | - Hans Kluge
- Division of Health Systems and Public Health, WHO Europe, Copenhagen, Denmark
| | - Niek de Wit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Association between the General Practitioner Workforce Crisis and Premature Mortality in Hungary: Cross-Sectional Evaluation of Health Insurance Data from 2006 to 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071388. [PMID: 30004449 PMCID: PMC6068803 DOI: 10.3390/ijerph15071388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/26/2018] [Accepted: 06/30/2018] [Indexed: 11/28/2022]
Abstract
The workforce crisis of primary care is reflected in the increasing number of general medical practices (GMP) with vacant general practitioner (GP) positions, and the GPs’ ageing. Our study aimed to describe the association between this crisis and premature mortality. Age-sex-standardized mortality for 18–64 years old adults was calculated for all Hungarian GMPs annually in the period from 2006 to 2014. The relationship of premature mortality with GPs’ age and vacant GP positions was evaluated by standardized linear regression controlled for list size, urbanization, geographical location, clients’ education, and type of the GMP. The clients’ education was the strongest protective factor (beta = −0175; p < 0.001), followed by urban residence (beta = −0.149; p < 0.001), and bigger list size (beta1601–2000 = −0.054; p < 0.001; beta2001−X = −0.096; p < 0.001). The geographical localization also significantly influenced the risk. Although GMPs with a GP aged older than 65 years (beta = 0; p = 0.995) did not affect the risk, GP vacancy was associated with higher risk (beta = 0.010; p = 0.033), although the corresponding number of attributable cases was 23.54 over 9 years. The vacant GP position is associated with a significant but hardly detectable increased risk of premature mortality without considerable public health importance. Nevertheless, employment of GPs aged more than 65 does not impose premature mortality risk elevation.
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Martin LT, Plough A, Carman KG, Leviton L, Bogdan O, Miller CE. Strengthening Integration Of Health Services And Systems. Health Aff (Millwood) 2018; 35:1976-1981. [PMID: 27834236 DOI: 10.1377/hlthaff.2016.0605] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
New care delivery models that hold providers more accountable for coordinated, high-quality care and the overall health of their patients have appeared in the US health care system, spurred by recent legislation such as the Affordable Care Act. These models support the integration of health care systems, but maximizing health and well-being for all individuals will require a broader conceptualization of health and more explicit connections between diverse partners. Integration of health services and systems constitutes the fourth Action Area in the Robert Wood Johnson Foundation's Culture of Health Action Framework, which is the subject of this article. This Action Area conceives of a strengthened health care system as one in which medical care, public health, and social services interact to produce a more effective, equitable, higher-value whole that maximizes the production of health and well-being for all individuals. Three critical drivers help define and advance this Action Area and identify gaps and needs that must be addressed to move forward. These drivers are access, balance and integration, and consumer experience and quality. This article discusses each driver and summarizes practice gaps that, if addressed, will help move the nation toward a stronger and more integrated health system.
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Affiliation(s)
- Laurie T Martin
- Laurie T. Martin is a senior policy researcher at the RAND Corporation in Arlington, Virginia
| | - Alonzo Plough
- Alonzo Plough is vice president, Research-Evaluation-Learning, and chief science officer at the Robert Wood Johnson Foundation, in Princeton, New Jersey
| | - Katherine G Carman
- Katherine G. Carman is an economist at the RAND Corporation in Santa Monica, California
| | - Laura Leviton
- Laura Leviton is a senior adviser for evaluation at the Robert Wood Johnson Foundation
| | - Olena Bogdan
- Olena Bogdan is an assistant policy analyst at the RAND Corporation in Santa Monica
| | - Carolyn E Miller
- Carolyn E. Miller is a senior program officer in the Research-Evaluation-Learning unit at the Robert Wood Johnson Foundation
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Factors Driving Local Health Departments' Partnerships With Other Organizations in Maternal and Child Health, Communicable Disease Prevention, and Chronic Disease Control. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 22:E21-8. [PMID: 26480282 DOI: 10.1097/phh.0000000000000353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe levels of partnership between local health departments (LHDs) and other community organizations in maternal and child health (MCH), communicable disease prevention, and chronic disease control and to assess LHD organizational characteristics and community factors that contribute to partnerships. DATA SOURCES Data were drawn from the National Association of County & City Health Officials' 2013 National Profile Study (Profile Study) and the Area Health Resources File. LHDs that received module 1 of the Profile Study were asked to describe the level of partnership in MCH, communicable disease prevention, and chronic disease control. Levels of partnership included "not involved," "networking," "coordinating," "cooperating," and "collaborating," with "collaborating" as the highest level of partnership. Covariates included both LHD organizational and community factors. Data analyses were conducted using Stata 13 SVY procedures to account for the Profile Study's survey design. RESULTS About 82%, 92%, and 80% of LHDs partnered with other organizations in MCH, communicable disease prevention, and chronic disease control programs, respectively. LHDs having a public health physician on staff were more likely to partner in chronic disease control programs (adjusted odds ratio [AOR] = 2.33; 95% confidence interval [CI], 1.03-5.25). Larger per capita expenditure was also associated with partnerships in MCH (AOR = 2.43; 95% CI, 1.22-4.86) and chronic disease prevention programs (AOR = 1.76; 95% CI, 1.09-2.86). Completion of a community health assessment was associated with partnership in MCH (AOR = 7.26; 95% CI, 2.90-18.18), and chronic disease prevention (AOR = 5.10; 95% CI, 2.28-11.39). CONCLUSION About 1 in 5 LHDs did not have any partnerships in chronic disease control. LHD partnerships should be promoted to improve care coordination and utilization of limited health care resources. Factors that might promote LHDs' partnerships include having a public health physician on staff, higher per capita expenditure, and completion of a community health assessment. Community context likely influences types and levels of partnerships. A better understanding of these contextual factors may lead to more complete and effective LHD partnerships.
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Greer SL, Vasev N, Wismar M. Fences and ambulances: Governance for intersectoral action on health. Health Policy 2017; 121:1101-1104. [DOI: 10.1016/j.healthpol.2017.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Describing the continuum of collaboration among local health departments with hospitals around the community health assessments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 20:617-25. [PMID: 24402432 DOI: 10.1097/phh.0000000000000030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospitals and local health departments (LHDs) are under policy requirements from the Affordable Care Act and accreditation standards through the Public Health Accreditation Board. Tax exempt hospitals must perform a community health needs assessment (CHNA), similar to the community health assessment (CHA) required for LHDs. These efforts have led to a renewed interest in hospitals and LHDs working together to achieve common goals. PURPOSE The purpose of this study is to gain a better understanding of levels of joint action leading toward collaboration between LHDs and hospitals and describe collaboration around CHAs. METHODS Local health departments were selected on the basis of reporting collaboration (n = 26) or unsure about collaboration (n = 29) with local hospitals. Local health departments were surveyed regarding their relationship with local hospitals. For LHDs currently collaborating with a hospital, a collaboration continuum scale was calculated. Appropriate nonparametric tests, chi-squares, and Spearman's rank correlations were conducted to determine differences between groups. RESULTS A total of 44 LHDs responded to the survey (80.0%). Currently collaborating LHDs were more likely to be interested in accreditation and to refer to their CHA 5 or more times a year compared to the unsure LHDs. In the analysis, a collaboration continuum was created and is positively correlated with aspects of the CHA and CHA process. CONCLUSIONS This study is the first attempt to quantify the level of collaboration between LHDs and hospitals around CHAs. Better understanding of the levels of joint action required may assist LHDs in making informed decisions regarding deployment of resources on the path to accreditation.
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Kringos DS, van den Broeke JR, van der Lee APM, Plochg T, Stronks K. How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study. BMC Public Health 2016; 16:545. [PMID: 27402143 PMCID: PMC4940836 DOI: 10.1186/s12889-016-3246-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 06/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach. Methods We compared expected (based on consumption patterns of a health insurers’ total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest) and 2 (Kanaleneiland) over the period 2006–2011, when an integrated care approach was increasingly provided in the intervention district. Standardized insurance claims data were used to indicate use of GP care and hospital care. Results Our findings revealed that the utilization of total GP care increased more in the intervention district than in the control districts. And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards. In addition, we observed a change in type of GP care use in the intervention district in particular: the number of regular consultations, long consultations, GP home visits and evening, night and weekend consultations were increasingly higher than expected. The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations. Conclusions Utilization patterns for general practice and hospital care of people living in deprived districts may change when primary care professionals work in a more coherent and coordinated manner by applying a more ‘comprehensive’ integrated care approach. Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3246-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dionne S Kringos
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands.
| | - Jennifer R van den Broeke
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands
| | | | - Thomas Plochg
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands
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Strand MA, Tellers J, Patterson A, Ross A, Palombi L. The achievement of public health services in pharmacy practice: A literature review. Res Social Adm Pharm 2015. [PMID: 26215337 DOI: 10.1016/j.sapharm.2015.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is known that pharmacists are currently contributing to public health; however, the extent of this contribution as reported in the literature has not been examined. Investigating the ways that pharmacists are currently participating in public health is critical for the profession of pharmacy, pharmacy educators, and the public health community. OBJECTIVES The purpose of this study was to determine the reported contributions of pharmacy to each of the ten essential services of public health, and which of the five core competencies of public health were most frequently utilized in those contributions. METHODS A PubMed search was used to extract references that included both the words pharmacy and services in the title or abstract, and the words public health in any part of the document. A total of 247 references were extracted and categorized into the essential services and core competencies. RESULTS The essential services Inform, Educate, and Empower, and Link to/Provide Care were more frequently represented in the literature, and the core competency of Health Policy and Administration was most frequently utilized. CONCLUSION To further contribute to and integrate their contributions within population health, pharmacists must consider ways to strategically contribute to the essential services of public health and seek to increase competency in public health.
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Affiliation(s)
- Mark A Strand
- Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, ND, USA; School of Pharmacy, College of Health Professions, North Dakota State University, Fargo, ND, USA.
| | - Jackie Tellers
- Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, ND, USA
| | - Alan Patterson
- Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, ND, USA
| | - Alex Ross
- Pharmacy Practice Department, College of Health Professions, North Dakota State University, Fargo, ND, USA
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Beatty KE, Wilson KD, Ciecior A, Stringer L. Collaboration among Missouri nonprofit hospitals and local health departments: content analysis of community health needs assessments. Am J Public Health 2015; 105 Suppl 2:S337-44. [PMID: 25689184 DOI: 10.2105/ajph.2014.302488] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital's community health needs assessments (CHNAs). METHODS In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n = 34) CHNAs, and identified hospitals based on previously reported collaboration with LHDs. We coded the content according to the level of joint action. A comparison sample (n = 50) of Missouri nonprofit hospitals provided the basic comparative information on hospital characteristics. RESULTS Among the hospitals identified by LHDs, 20.6% were "networking," 20.6% were "coordinating," 38.2% were "cooperating," and 2.9% were "collaborating." Almost 18% of study hospitals had no identifiable level of joint action with LHDs based on their CHNAs. In addition, comparison hospitals were more often part of a larger system (74%) compared with study hospitals (52.9%). CONCLUSIONS The results of our study helped develop a better understanding of levels of joint action from a hospital perspective. Our results might assist hospitals and LHDs in making more informed decisions about efficient deployment of resources for assessment processes and implementation plans.
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Affiliation(s)
- Kate E Beatty
- Kate E. Beatty is with the Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City. Kristin D. Wilson is with the Health Management and Policy Masters in Public Health Program, Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St. Louis, MO. Amanda Ciecior is with the Department of Vermont Health Access, Vermont Agency of Human Services, Winooski. Lisa Stringer is with the Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St. Louis
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Answering the call for integrating population health: insights from health system executives. Adv Health Care Manag 2015. [PMID: 25626202 DOI: 10.1108/s1474-823120140000016009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
PURPOSE The Affordable Care Act is transforming health care practice nationwide through emphasis on population health and prevention. Health care organizations are increasingly required to address population health needs. However, they may be ill equipped to answer that call. DESIGN/METHODOLOGY/APPROACH This study identified ways that health care organizations might better integrate public and population health efforts to better respond to this new emphasis on population health. Employing semi-structured key informant interviews, barriers to and facilitators of integration were explored and implications for health care and public health leaders were developed. FINDINGS - Participants (n = 17)--including senior hospital executives, group practice administrators, and health department officials--dentified strategies for health care and public health leaders to more effectively integrate in order to achieve better performance and popula-ion health gains. These strategies and their implications are discussed. OORIGINALITY/VALUE:The results of this study provide important value to health care administrators leading efforts to integrate population and public health.
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Werner JJ, Stange KC. Praxis-based research networks: An emerging paradigm for research that is rigorous, relevant, and inclusive. J Am Board Fam Med 2014; 27:730-5. [PMID: 25381067 PMCID: PMC4822826 DOI: 10.3122/jabfm.2014.06.140034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Practice-based research networks (PBRNs) have developed a grounded approach to conducting practice-relevant and translational research in community practice settings. Seismic shifts in the health care landscape are shaping PBRNs that work across organizational and institutional margins to address complex problems. Praxis-based research networks combine PBRN knowledge generation with multistakeholder learning, experimentation, and application of practical knowledge. The catalytic processes in praxis-based research networks are cycles of action and reflection based on experience, observation, conceptualization, and experimentation by network members and partners. To facilitate co-learning and solution-building, these networks have a flexible architecture that allows pragmatic inclusion of stakeholders based on the demands of the problem and the needs of the network. Praxis-based research networks represent an evolving trend that combines the core values of PBRNs with new opportunities for relevance, rigor, and broad participation.
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Affiliation(s)
- James J Werner
- From the Department of Family Medicine and Community Health (JJW, KCS), the Mandel School of Applied Social Sciences (JJW), and the Departments of Epidemiology and Biostatistics, Oncology, and Sociology (KCS), Case Western Reserve University, Cleveland, OH.
| | - Kurt C Stange
- From the Department of Family Medicine and Community Health (JJW, KCS), the Mandel School of Applied Social Sciences (JJW), and the Departments of Epidemiology and Biostatistics, Oncology, and Sociology (KCS), Case Western Reserve University, Cleveland, OH
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Ventres W, Page T. Bring global health and global medicine home. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:907-908. [PMID: 23799430 DOI: 10.1097/acm.0b013e3182952940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Levesque JF, Breton M, Senn N, Levesque P, Bergeron P, Roy DA. The Interaction of Public Health and Primary Care: Functional Roles and Organizational Models that Bridge Individual and Population Perspectives. Public Health Rev 2013. [DOI: 10.1007/bf03391699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Academic general internal medicine: a mission for the future. J Gen Intern Med 2013; 28:845-51. [PMID: 23321931 PMCID: PMC3663942 DOI: 10.1007/s11606-013-2334-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 11/07/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
After five decades of growth that has included advances in medical education and health care delivery, value cohesion, and integration of diversity, we propose an overarching mission for academic general internal medicine to lead excellence, change, and innovation in clinical care, education, and research. General internal medicine aims to achieve health care delivery that is comprehensive, technologically advanced and individualized; instills trust within a culture of respect; is efficient in the use of time, people, and resources; is organized and financed to achieve optimal health outcomes; maximizes equity; and continually learns and adapts. This mission of health care transformation has implications for the clinical, educational, and research activities of divisions of general internal medicine over the next several decades.
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Teaching Population Health: A Competency Map Approach to Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:626-37. [PMID: 23524919 PMCID: PMC3636155 DOI: 10.1097/acm.0b013e31828acf27] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A 2012 Institute of Medicine report is the latest in the growing number of calls to incorporate a population health approach in health professionals’ training. Over the last decade, Duke University, particularly its Department of Community and Family Medicine, has been heavily involved with community partners in Durham, North Carolina to improve the local community’s health. Based on these initiatives, a group of interprofessional faculty began tackling the need to fill the curriculum gap to train future health professionals in public health practice, community engagement, critical thinking, and team skills to improve population health effectively in Durham and elsewhere. The Department of Community and Family Medicine has spent years in care delivery redesign and curriculum experimentation, design, and evaluation to distinguish the skills trainees and faculty need for population health improvement and to integrate them into educational programs. These clinical and educational experiences have led to a set of competencies that form an organizational framework for curricular planning and training. This framework delineates which learning objectives are appropriate and necessary for each learning level, from novice through expert, across multiple disciplines and domains. The resulting competency map has guided Duke’s efforts to develop, implement, and assess training in population health for learners and faculty. In this article, the authors describe the competency map development process as well as examples of its application and evaluation at Duke and limitations to its use with the hope that other institutions will apply it in different settings.
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Scutchfield FD, Michener JL, Thacker SB. Scutchfield et al. Respond. Am J Public Health 2012. [DOI: 10.2105/ajph.2012.301012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- F. Douglas Scutchfield
- F. Douglas Scutchfield is with the Colleges of Public Health and Medicine, University of Kentucky, Lexington. J. Lloyd Michener is with the Department of Community and Family Medicine, Duke University Medical Center, Durham, NC. Stephen B. Thacker is with Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
| | - J. Lloyd Michener
- F. Douglas Scutchfield is with the Colleges of Public Health and Medicine, University of Kentucky, Lexington. J. Lloyd Michener is with the Department of Community and Family Medicine, Duke University Medical Center, Durham, NC. Stephen B. Thacker is with Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
| | - Stephen B. Thacker
- F. Douglas Scutchfield is with the Colleges of Public Health and Medicine, University of Kentucky, Lexington. J. Lloyd Michener is with the Department of Community and Family Medicine, Duke University Medical Center, Durham, NC. Stephen B. Thacker is with Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
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Koh HK, Tavenner M. Connecting care through the clinic and community for a healthier America. Am J Public Health 2012; 102 Suppl 3:S305-7. [PMID: 22690961 DOI: 10.2105/ajph.2012.300760] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Plochg T, van den Broeke JR, Kringos DS, Stronks K. Integrating primary care and public health. Am J Public Health 2012; 102:e1; author reply e1-2. [PMID: 22897598 DOI: 10.2105/ajph.2012.300977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Koo D, Felix K, Dankwa-Mullan I, Miller T, Waalen J. A call for action on primary care and public health integration. Am J Public Health 2012; 102 Suppl 3:S307-9. [PMID: 22690962 PMCID: PMC3478083 DOI: 10.2105/ajph.2012.300824] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2012] [Indexed: 11/04/2022]
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