Health Policy

Hospitals

Hospitals
in A.R. Kovner and S. Jonas (eds.) Health Care Delivery in the United States, New York, Springer, 7th edition, pp 145-72.

Kovner, A.R.
01/01/2002

How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care and access to care? These core questions regarding our health policy are answered in this text.

Lessons Learned from 22 Years of Testing the Quality Cost Model of Advanced Practice Nursing (APN) Transitional Care

Lessons Learned from 22 Years of Testing the Quality Cost Model of Advanced Practice Nursing (APN) Transitional Care
Journal of Nursing Scholarship, Vol. 34, No. 4, pp. 369-75.

Brooten, D., Naylor, M., Finkler, S., et al.
01/01/2002

To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research. ORGANIZING CONSTRUCT: The Quality Cost Model of APN Transitional Care. METHODS: Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care. FINDINGS: APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group. CONCLUSIONS: To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost.

Managers, Teachers, Researchers: Sharing Experience in Health Care

Managers, Teachers, Researchers: Sharing Experience in Health Care
Health Care Management Review, 27 (4), pp. 68-75.

Kovner, A.R.
01/01/2002

The author observes that academic training is an asset for any managerial position in the health sector. As with medicine and nursing, health care management should be more evidence-based. The author argues that top managers in health care generally lack adequate internal support to rigorously evaluate strategic interventions or consultant recommendations and to learn from industrywide best practices.

Outcomes in Young Adulthood for Very-Low-Birth-Weight-Infants

Outcomes in Young Adulthood for Very-Low-Birth-Weight-Infants
(Letter) New England Journal of Medicine. 2002, Vol. 347(2), pp. 141.

Conley, D. & Bennett, N.
01/01/2002

To the Editor: Hack et al. (Jan. 17 issue)1 report that 20-year-olds who had very low birth weight have a lower rate of risk-taking behavior than their normal-birth-weight peers, and the authors describe this finding as "reassuring." McCormick and Richardson, in their editorial,2 suggest that the avoidance of risk-taking behavior indicates a special "resilience" in very-low-birth-weight children and their families. I disagree.

Setting an Agenda for Local Action: The Limits of Expert Opinion and Community Voice

Setting an Agenda for Local Action: The Limits of Expert Opinion and Community Voice
Policy Studies Journal (2002 - Vol. 30, No. 3), pp. 362-278.

Silver, D., Weitzman, B.C. & Brecher, C.
01/01/2002

Many social programs, funded by government or philanthropy, begin with efforts to improve local conditions with strategic planning. Mandated by funders, these processes aim to include the views of community residents and those with technical expertise. Program leaders are left to reconcile public and expert opinions in determining how to shape their programs. The experience of the Robert Wood Johnson Foundation's Urban Health Initiative suggests that although consultation with experts and the public failed to reveal a clear assessment of the community's problems or their solutions, it did assist in engaging diverse groups. Despite this engagement, however, core leaders wielded substantial power in selecting the agenda.

South Bronx Environmental Health and Policy Study, Public Health and Environmental Policy Analysis: Final Report for Phase I

South Bronx Environmental Health and Policy Study, Public Health and Environmental Policy Analysis: Final Report for Phase I
New York, NY: New York University, Wagner Graduate School of Public Service, Institute for Civil Infrastructure Systems,

Zimmerman, R., Restrepo, C., Hirschstein, C., Holguín-Veras, J., Lara, J. & Klebenov, D..
01/01/2002

The quality of the environment in communities with large minority populations has been a growing concern particularly with respect to public health given the potential for greater
exposure among minorities and the lower availability of health services to address such exposures. A public health and environmental policy analysis is being conducted by the Institute for Civil Infrastructure Systems (ICIS) at New York University's Wagner Graduate School of Public Service (NYU-Wagner) to address some of these issues in the South Bronx. The Wagner School study is part of a larger project funded by the U.S. EPA about environmental issues in the
South Bronx, NY that aims to provide relationships among air quality, transportation, waste transfer activity, and demographic characteristics in the South Bronx.

Safety Net Research in Emergency Medicine: The Unraveling Safety Net

Safety Net Research in Emergency Medicine: The Unraveling Safety Net
Academic Emergency Medicine, November 2001, 8(11): 1024-1029.

Gordon, J.A., Billings, J., Asplin, B.R. & Rhodes, K.V.
11/01/2001

A primary goal of the Academic Emergency Medicine Consensus Conference, "The Unraveling Safety Net: Research Opportunities and Priorities," was to explore a formal research agenda for safety net research in emergency medicine. This paper represents the thoughts of active health services researchers regarding the structure and direction of such work, including some examples from their own research. The current system for safety net care is described, and the emergency department is conceptualized as a window on safety net patients and systems, uniquely positioned to help study and coordinate integrated processes of care.

The Development of the Diabetes Problem Solving Measure for Adolescents (DPSMA)

The Development of the Diabetes Problem Solving Measure for Adolescents (DPSMA)
The Diabetes Educator, 27(6): 1-18.

Cook, S., Aikens, J.E., Berry, C. & McNabb, W.L.
11/01/2001

PURPOSE

This paper describes the development and psychometric properties of the Diabetes Problem-Solving Measure for Adolescents (DPSMA).

METHODS

The DPSMA is a structured, interview-based questionnaire that examines how adolescents with type 1 diabetes solve diabetes-related self-management problems. Seventeen diabetes-related self-management problem vignettes were derived from a survey of adolescents and their parents. The vignettes were reviewed and finalized by a multidisciplinary team of diabetes experts. A sample of 43 adolescents, 13 to 17 years old, with type 1 diabetes, was used to establish the psychometric properties of the instrument.

RESULTS

The scale demonstrated acceptable internal consistency and interrater reliability. Predicted relationships with scores on concurrently administered measures of adherence, diabetes quality of life, and metabolic control provided support for construct validity.

CONCLUSIONS

The results suggest that the DPSMA has acceptable internal consistency, interrater reliability, and construct validity. It may be a useful tool to help healthcare providers understand the diabetes-related problem-solving abilities of their adolescent patients.

Healthcare in a Land Called PeoplePower: Nothing About Me Without Me

Healthcare in a Land Called PeoplePower: Nothing About Me Without Me
Health Expectations, Vol. 4., September 2001, Page 144

Delbanco, T., Berwick, D.M., Boufford, J.I., Edgman-Levitan, Ollenschlager, G., Plamping, D. & Rockefeller, R.G.
09/01/2001

In a 5-day retreat at a Salzburg Seminar attended by 64 individuals from 29 countries, teams of health professionals, patient advocates, artists, reporters and social scientists adopted the guiding principle of 'nothing about me without me' and created the country of PeoplePower. Designed to shift health care from 'biomedicine' to 'infomedicine', patients and health workers throughout PeoplePower join in informed, shared decision-making and governance. Drawing, where possible, on computer-based guidance and communication technologies, patients and clinicians contribute actively to the patient record, transcripts of clinical encounters are shared, and patient education occurs primarily in the home, school and community-based organizations. Patients and clinicians jointly develop individual 'quality contracts', serving as building blocks for quality measurement and improvement systems that aggregate data, while reflecting unique attributes of individual patients and clinicians. Patients donate process and outcome data to national data banks that fuel epidemiological research and evidence-based improvement systems. In PeoplePower hospitals, constant patient and employee feedback informs quality improvement work teams of patients and health professionals. Volunteers work actively in all units, patient rooms are information centres that transform their shape and decor as needs and individual preferences dictate, and arts and humanities programmes nourish the spirit. In the community, from the earliest school days the citizenry works with health professionals to adopt responsible health behaviours. Communities join in selecting and educating health professionals and barter systems improve access to care. Finally, lay individuals partner with professionals on all local, regional and national governmental and private health agencies.

A Randomized Trial of Nurse Specialist Home Care for Women with High Risk Pregnancies: Outcomes and Costs

A Randomized Trial of Nurse Specialist Home Care for Women with High Risk Pregnancies: Outcomes and Costs
American Journal of Managed Care, Volume 7, Number 8, August

Brooten, D., Youngblut, J., Brown L., Finkler, S. et. al.
08/01/2001

OBJECTIVE: To examine prenatal, maternal, and infant outcomes and costs through 1 year after delivery using a model of prenatal care for women at high risk of delivering low-birthweight infants in which half of the prenatal care was provided in women’s homes by nurse specialists with master’s degrees. STUDY DESIGN: Randomized clinical trial. PATIENTS AND METHODS: A sample of 173 women (and 194 infants) with high-risk pregnancies (gestational or pregestational diabetes mellitus, chronic hypertension, preterm labor, or high risk of preterm labor) were randomly assigned to the intervention group (85 women and 94 infants) or the control group (88 women and 100 infants). Control women received usual prenatal care. Intervention women received half of their prenatal care in their homes, with teaching, counseling, telephone outreach, daily telephone availability, and a postpartum home visit by nurse specialists with physician backup. RESULTS:For the full sample, mean maternal age was 27 years; 85.5% of women were single mothers, 36.4% had less than a high school education, 93.6% were African American, and 93.6% had public health insurance, with no differences between groups on these variables. The intervention group had lower fetal/infant mortality vs the control group (2 vs 9), 11 fewer preterm infants, more twin pregnancies carried to term (77.7% vs 33.3%), fewer prenatal hospitalizations (41 vs 49), fewer infant rehospitalizations (18 vs 24), and a savings of more than 750 total hospital days and $2,880,000. CONCLUSION: This model of care provides a reasoned solution to improving pregnancy and infant outcomes while reducing healthcare costs.

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