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and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and behavioral health integration. These models rely on interdisciplinary provider teams... more
and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and behavioral health integration. These models rely on interdisciplinary provider teams to coordinate patient care; health information and other technologies to assure, monitor, and assess quality; and payment and financial incentives such as bundling, pay-for-performance, and gain-sharing to encourage value-based health care. In this paper, we review evidence about integrated care delivery, payment methods, and financial incentives to improve value in health care purchasing, and address how these approaches can be used to advance health system change. National health care reform legislation enact-ed inMarch 2010 as the Patient Protection and Affordable Care Act (ACA) opened the door to significant changes in health care organiza-tion, delivery, and financing. The ACA introduces a variety of financial and other
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Diabetes is a chronic condition that results in the body's inability to either produce or respond to insulin. Abnormal insulin production and sensitivity lead to improper blood glucose levels and energy storage required for... more
Diabetes is a chronic condition that results in the body's inability to either produce or respond to insulin. Abnormal insulin production and sensitivity lead to improper blood glucose levels and energy storage required for homeostatic organ maintenance. Over 151 million people worldwide, including 7% of the US and 5% of Canadian populations have been diagnosed with diabetes, and the prevalence varies greatly by race and ethnicity. However, since the end of World War II, the people with the greatest risk include First Nations people, including Canada's aboriginal, Inuit and Native Indian populations with up to a 5-fold greater prevalence than the general population. Prevalence can vary from 8% to 48% among the sexes and tribes. Understanding the prevalence and causes of this epidemic is immediately needed as diabetes precedes various other endocrine and cardiovascular diseases. Here we review the current understanding of diabetes risk in Canada's First Nations people in ...
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BACKGROUND The Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) Initiative funded grantees in 45 states, the District of Columbia and Puerto Rico to implement and expand delivery of CDSMP to older... more
BACKGROUND The Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) Initiative funded grantees in 45 states, the District of Columbia and Puerto Rico to implement and expand delivery of CDSMP to older adults. We examine whether there are differences in the enrollment and completion rates of members of racial and ethnic minority groups and what sites have done to enhance their delivery of the CDSMP to such groups. METHOD This study used a multi-method approach including: site visits to 6 states, telephone interviews with the 47 program grantees and delivery sites, review of program reports, and analysis of administrative data on participants, completers, workshops and leaders. RESULTS Grantees served 89,861 participants, including 56.3% who self-identified as White, 17.3% as Black, 5.0% as other/multi-racial, 3.2% as Asian/Asian Americans, 1.4% as American Indian/Alaskans, .8% as Native Hawaiian/Pacific Islanders, and 16.0% individuals of unknown ra...
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Bilal B. Ayach, MSc, PhD; Holly Korda, MA, PhD Diabetes is a chronic condition that results in the body’s inability to either produce or respond to insulin. Abnormal insulin production and sensitivity lead to improper blood glucose levels... more
Bilal B. Ayach, MSc, PhD; Holly Korda, MA, PhD Diabetes is a chronic condition that results in the body’s inability to either produce or respond to insulin. Abnormal insulin production and sensitivity lead to improper blood glucose levels and energy storage required for homeostatic organ maintenance. Over 151 million people worldwide, including 7% of the US and 5% of Canadian populations have been diagnosed with diabetes, and the prevalence varies greatly by race and ethnicity. However, since the end of World War II, the people with the greatest risk include First Nations people, including Canada’s aboriginal, Inuit and Native Indian populations with up to a 5-fold greater prevalence than the general population. Prevalence can vary from 8% to 48% among the sexes and tribes. Understanding the prevalence and causes of this epidemic is immediately needed as diabetes precedes various other endocrine and cardiovascular diseases. Here we review the current understanding of diabetes risk i...
This report presents evidence about "what works" in value-based purchasing strategies emphasized in national healthcare reform legislation,... more
This report presents evidence about "what works" in value-based purchasing strategies emphasized in national healthcare reform legislation, with a focus on service delivery integration, payment, and value-based insurance design. We review key findings to address the question: What is the evidence that a value-based strategy will improve health outcomes or reduce healthcare costs? This report is a review of peer-reviewed and field-based research associated with several value-based strategies purchasers can use to increase value in their healthcare market decision making: Accountable Care Organizations, Patient Centered Medical Homes, bundled payment methods and incentives, and value-based insurance designs. Environmental scans and evidence reviews of value-based purchasing were conducted to inform this report. Many value-based approaches are new to the healthcare arena, and evidence of performance in improving health outcomes or reducing healthcare costs is limited but increasing as experience with these approaches grows. Purchasers should be aware that evidence is contingent on market environment and study assumptions in considering specific strategies, and be cautious implementing them. The need for a new measurement paradigm for cost and quality that reaches across the care continuum is evident.
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Fidelity of implementation in replicating evidence-based health promotion interventions, to ensure implementation as designed and proven through research, is crucial if evidence-based community and population health interventions are to... more
Fidelity of implementation in replicating evidence-based health promotion interventions, to ensure implementation as designed and proven through research, is crucial if evidence-based community and population health interventions are to achieve promised results but can be difficult to attain in practice. This article highlights major challenges, considerations, and strategies associated with fidelity as public health care practitioners implement evidence-based interventions and bring them to scale in the field. There is need for sharing information about "what works" in implementing these interventions with fidelity, as well sharing information about implementation challenges and improvements to intervention design. Fidelity is important if practitioners are to obtain results and outcomes planned by intervention developers and is an essential value proposition for evidence-based public health practice and population health improvement.
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The Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) Initiative funded grantees in 45 states, the District of Columbia and Puerto Rico to implement and expand delivery of CDSMP to older adults. We... more
The Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) Initiative funded grantees in 45 states, the District of Columbia and Puerto Rico to implement and expand delivery of CDSMP to older adults. We examine whether there are differences in the enrollment and completion rates of members of racial and ethnic minority groups and what sites have done to enhance their delivery of the CDSMP to such groups. This study used a multi-method approach including: site visits to 6 states, telephone interviews with the 47 program grantees and delivery sites, review of program reports, and analysis of administrative data on participants, completers, workshops and leaders. Grantees served 89,861 participants, including 56.3% who self-identified as White, 17.3% as Black, 5.0% as other/multi-racial, 3.2% as Asian/Asian Americans, 1.4% as American Indian/Alaskans, .8% as Native Hawaiian/Pacific Islanders, and 16.0% individuals of unknown race. Overall, completion rates averaged 74.5%, with Native Hawaiian/Pacific Islanders completing workshops at a higher rate (90.6%) than other groups. Completion rates for participants aged > or = 75 were higher than for younger participants. Senior centers, health care organizations, and residential facilities served 63.1% of the participants. Grantees have successfully delivered CDSMP to racially and ethnically diverse participants in a range of settings. As the Administration for Community Living/Administration on Aging (ACL/AoA) grantees have demonstrated, CDSMP can be brought to scale by community organizations, partnerships and networks to reach diverse populations in diverse settings. The program can be a significant tool for addressing health disparities and empowering racial/ethnic minorities to take charge, promote better health and self-management of chronic conditions.
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ABSTRACT
Sustainable systems are essential to ensure ongoing distribution and delivery of community-based programs, but how to effectively ensure continuation of grant funded community-based programs after funding ends remains a common challenge... more
Sustainable systems are essential to ensure ongoing distribution and delivery of community-based programs, but how to effectively ensure continuation of grant funded community-based programs after funding ends remains a common challenge for program developers and funders. This session presents successful sustainability strategies used by grantees of the Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) initiative, that awarded two-year grants totaling $27 million to 45 states, the District of Columbia, and Puerto Rico to provide CDSMP to older adults in 2010. These strategies are based on findings of a multi-method national process evaluation of CDSMP implementation funded by the Administration for Community Living, based on site visits, surveys, key informant interviews, and grantee reports. Sustainable systems shared common features: (1) champions who integrated CDSMP into statewide strategic planning, actively support implementation through t...
We analyze the completion patterns in the Chronic Disease Self-Management Program (CDSMP), an evidence-based health promotion program funded through the Communities Putting Prevention to Work: Chronic Disease Self-Management Program by... more
We analyze the completion patterns in the Chronic Disease Self-Management Program (CDSMP), an evidence-based health promotion program funded through the Communities Putting Prevention to Work: Chronic Disease Self-Management Program by the Administration for Community Living (ACL) in collaboration with the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS). CDSMP is a community-based program that helps participants self-manage their chronic conditions on their own to improve the quality of life and reduce utilization of more expansive types of health care. Using administrative data, we find that (1) participants with depression are much less likely to complete the program, but the opposite is true for participants with hypertension and osteoporosis; (2) participants are much more likely to complete in small classes (i.e., less than 6 participants); (3) completion rates are the lowest at residential facilities and highest at faith-...
Claims data are an important source of data for public health surveillance but have not been widely used in the United States because of concern with personally identifiable health information and other issues. We describe the development... more
Claims data are an important source of data for public health surveillance but have not been widely used in the United States because of concern with personally identifiable health information and other issues. We describe the development and availability of a new set of public use files created using de-identified health care claims for fee-for-service Medicare beneficiaries, including individuals 65 years and older and individuals with disabilities younger than 65 years, and their application as tools for public health surveillance. We provide an overview of these files and their attributes; a review of beneficiary de-identification procedures and implications for analysis; a summary of advantages and limitations for use of the public use files for surveillance, alone and in combination with other data sources; and discussion and examples of their application for public health surveillance using examples that address chronic conditions monitoring, hospital readmissions, and preval...
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The Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) Initiative funded grantees in 45 states, the District of Columbia and Puerto Rico to implement and expand delivery of CDSMP to older adults. We... more
The Communities Putting Prevention to Work: Chronic Disease Self-Management Program (CDSMP) Initiative funded grantees in 45 states, the District of Columbia and Puerto Rico to implement and expand delivery of CDSMP to older adults. We examine whether there are differences in the enrollment and completion rates of members of racial and ethnic minority groups and what sites have done to enhance their delivery of the CDSMP to such groups. This study used a multi-method approach including: site visits to 6 states, telephone interviews with the 47 program grantees and delivery sites, review of program reports, and analysis of administrative data on participants, completers, workshops and leaders. Grantees served 89,861 participants, including 56.3% who self-identified as White, 17.3% as Black, 5.0% as other/multi-racial, 3.2% as Asian/Asian Americans, 1.4% as American Indian/Alaskans, .8% as Native Hawaiian/Pacific Islanders, and 16.0% individuals of unknown race. Overall, completion ra...
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This report presents evidence about "what works" in value-based purchasing strategies emphasized in national healthcare reform legislation, with a focus on service delivery integration, payment, and value-based insurance design.... more
This report presents evidence about "what works" in value-based purchasing strategies emphasized in national healthcare reform legislation, with a focus on service delivery integration, payment, and value-based insurance design. We review key findings to address the question: What is the evidence that a value-based strategy will improve health outcomes or reduce healthcare costs? This report is a review of peer-reviewed and field-based research associated with several value-based strategies purchasers can use to increase value in their healthcare market decision making: Accountable Care Organizations, Patient Centered Medical Homes, bundled payment methods and incentives, and value-based insurance designs. Environmental scans and evidence reviews of value-based purchasing were conducted to inform this report. Many value-based approaches are new to the healthcare arena, and evidence of performance in improving health outcomes or reducing healthcare costs is limited but incr...
Research Interests:
Diabetes is a chronic condition that results in the body's inability to either produce or respond to insulin. Abnormal insulin production and sensitivity lead to improper blood glucose levels and energy storage required for... more
Diabetes is a chronic condition that results in the body's inability to either produce or respond to insulin. Abnormal insulin production and sensitivity lead to improper blood glucose levels and energy storage required for homeostatic organ maintenance. Over 151 million people worldwide, including 7% of the US and 5% of Canadian populations have been diagnosed with diabetes, and the prevalence varies greatly by race and ethnicity. However, since the end of World War II, the people with the greatest risk include First Nations people, including Canada's aboriginal, Inuit and Native Indian populations with up to a 5-fold greater prevalence than the general population. Prevalence can vary from 8% to 48% among the sexes and tribes. Understanding the prevalence and causes of this epidemic is immediately needed as diabetes precedes various other endocrine and cardiovascular diseases. Here we review the current understanding of diabetes risk in Canada's First Nations people in ...
Research Interests:
When some participants in a hypertension screening program reported a previous diagnosis or treatment of low blood pressure a similar program was established at two shopping centres in Montreal to identify and characterize subjects... more
When some participants in a hypertension screening program reported a previous diagnosis or treatment of low blood pressure a similar program was established at two shopping centres in Montreal to identify and characterize subjects labelled as having low blood pressure. Of the 1019 subjects screened (434 men and 585 women) 275 (27.0%) reported a previous diagnosis of low blood pressure and 278 (27.3%) a previous diagnosis of hypertension. Low blood pressure was significantly more likely to be diagnosed in women than in men. Of the 181 subjects reporting a diagnosis of low blood pressure in the absence of other diagnoses, 69 had received treatment for this condition; fewer than 10 years of education had been completed by 46.4% of the treated subjects and 34.8% of those not treated, compared with 20.0% of the subjects in whom no diagnosis had been made. Assuming that these findings do not reflect an idiosyncrasy of the community or of the population studied, the public and personal he...
As part of an organ sharing network's outreach, African American adults were interviewed to assess their awareness of the network's efforts and willingness to donate their organs after death. To describe (1) the proportion who... more
As part of an organ sharing network's outreach, African American adults were interviewed to assess their awareness of the network's efforts and willingness to donate their organs after death. To describe (1) the proportion who expressed their intentions to be an organ donor, (2) the means they had used, and (3) sociodemographic characteristics of the participants who used a particular means. A repeated, cross-sectional, random-digit dialing telephone interview was conducted from July 2005 (start of wave 1) to April 2006 (end of wave 3). Each interview averaged 7 minutes and consisted of 60 items. Trained interviewers placed telephone calls to the residences of African Americans who resided in 1 of 4 New Jersey locales: East Orange/Orange, Irvington, Jersey City/Newark, and Trenton. One thousand five hundred sixty-seven African Americans, aged 18 to 95 years. Five Yes/No items were used to determine if participants had declared their intention to be an organ donor via driver&...
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Hospital readmissions are the focus of many recent efforts to improve quality and reduce spending under the Affordable Care Act (ACA). We examined variations in Medicare readmission rates by hospital characteristics (e.g., type, size,... more
Hospital readmissions are the focus of many recent efforts to improve quality and reduce spending under the Affordable Care Act (ACA). We examined variations in Medicare readmission rates by hospital characteristics (e.g., type, size, utilization) and Medicare patient mix (i.e., share of dual eligible beneficiaries, share of patients under 65 years of age, health status). Using 2010 data from 3,543 short-stay Medicare-certified hospitals, readmission rates were higher for hospitals that served a greater share of patients who were dual-eligible and less healthy; and larger hospitals and hospitals with higher occupancy rates even after controlling for patient mix.
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National health reform includes an emphasis on integrated service delivery models including Accountable Care Organizations and Patient-Centered Medical Homes. These value-based models of care delivery may offer opportunities for nursing... more
National health reform includes an emphasis on integrated service delivery models including Accountable Care Organizations and Patient-Centered Medical Homes. These value-based models of care delivery may offer opportunities for nursing to advance its patient care and profession. This paper presents four pillars of health care delivery reform-team-based care; cross-team communication, coordination and collaboration; infrastructure and technology; and aligned payment incentives -intended to improve quality of care while reducing cost increases. Opportunities and challenges for nursing are discussed in this context.
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To describe the various means that African American adults had used to express their intention to become an organ donor, as well as to determine whether there were characteristics that distinguished those individuals who had expressed... more
To describe the various means that African American adults had used to express their intention to become an organ donor, as well as to determine whether there were characteristics that distinguished those individuals who had expressed their intention from those individuals who had not. Participants were 1 567 African American adults who resided in four urban areas in New Jersey. From July 2005 to April 2006, university survey center interviewers conducted 7-minute, random-digit-dial telephone interviews. Approximately 3.2 percent reported that they had donated an organ; 3.4 percent reported being an organ recipient; 11.4 percent reported that a family member had donated an organ or tissue; and 12 percent reported that a family member was a recipient. Forty-six percent reported that they had indicated their willingness to be an organ donor when they applied for a driver's license; 37 percent had done so by discussing their wishes with family members. Fewer had signed an organ donor card (21%) or had signed up with an organ donor registry (16%). A multiple logistic regression model revealed a negative association between the respondent's age and whether the respondent had expressed an intention to be a donor, and a positive association between having known a family member who had received or donated an organ and the respondent's intention. Neither gender nor marital status was associated with the intention to donate. As the driver's license was the means favored by African Americans for declaring their intentions to be organ donors, motor vehicle registries appear to hold the greatest promise for documenting and communicating this intention.
Research Interests: Public Health, Intention, Multivariate Analysis, Humans, Female, and 14 moreMale, New Jersey, African Americans, Family Relations, Aged, Middle Aged, Adult, Public health systems and services research, Urban Population, Licensure, Logistic Models, Automobile driving, Interviews as topic, and Tissue and organ procurement
Fidelity of implementation in replicating evidence-based health promotion interventions, to ensure implementation as designed and proven through research, is crucial if evidence-based community and population health interventions are to... more
Fidelity of implementation in replicating evidence-based health promotion interventions, to ensure implementation as designed and proven through research, is crucial if evidence-based community and population health interventions are to achieve promised results but can be difficult to attain in practice. This article highlights major challenges, considerations, and strategies associated with fidelity as public health care practitioners implement evidence-based interventions and bring them to scale in the field. There is need for sharing information about "what works" in implementing these interventions with fidelity, as well sharing information about implementation challenges and improvements to intervention design. Fidelity is important if practitioners are to obtain results and outcomes planned by intervention developers and is an essential value proposition for evidence-based public health practice and population health improvement.
Research Interests:
The Patient Protection and Affordable Care Act encourages use of payment methods and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and... more
The Patient Protection and Affordable Care Act encourages use of payment methods and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and behavioral health integration. These models rely on interdisciplinary provider teams to coordinate patient care; health information and other technologies to assure, monitor, and assess quality; and payment and financial incentives such as bundling, pay-for-performance, and gain-sharing to encourage value-based health care. In this paper, we review evidence about integrated care delivery, payment methods, and financial incentives to improve value in health care purchasing, and address how these approaches can be used to advance health system change.
Research Interests:
Rapid and innovative advances in participative Internet communications, referred to as "social media," offer opportunities for modifying health behavior. Social media let users choose to be either anonymous or... more
Rapid and innovative advances in participative Internet communications, referred to as "social media," offer opportunities for modifying health behavior. Social media let users choose to be either anonymous or identified. People of all demographics are adopting these technologies whether on their computers or through mobile devices, and they are increasingly using these social media for health-related issues. Although social media have considerable potential as tools for health promotion and education, these media, like traditional health promotion media, require careful application and may not always achieve their desired outcomes. This article summarizes current evidence and understanding of using social media for health promotion. More important, it discusses the need for evaluating the effectiveness of various forms of social media and incorporating outcomes research and theory in the design of health promotion programs for social media.
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Research Interests: Information Systems, Health Behavior, Health Informatics, Cell Phones, Library and Information Studies, and 12 moreCrisis Intervention, Humans, Iraq War, Text Messaging, Feasibility Studies, Veterans, Mental health services, Organizational Innovation, Remote Consultation, Pilot Projects, Post Disaster Planning, and Patient discharge
The Chronic Disease Self-Management Program and the Diabetes Self-Management Program offer evidence-based self-management for persons with diabetes. We examined participation and completion rates for older adults in the Communities... more
The Chronic Disease Self-Management Program and the Diabetes Self-Management Program offer evidence-based self-management for persons with diabetes. We examined participation and completion rates for older adults in the Communities Putting Prevention to Work initiative and found that completion is more likely (1) in Diabetes Self-Management Program for individuals with diabetes; (2) for Chronic Disease Self-Management Program and Diabetes Self-Management Program with introductory class zero; and (3) in small classes. We also found that participants reporting depression were less likely to complete either workshop. Future research is needed to examine workshop availability and selection, health and behavioral outcomes, and participant/completer experience.
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Current research indicates that health care contributes no more than 50% toward broad health outcomes. The rest comes from non-medical determinants, including the social environment, the physical environment, and individual behaviors that... more
Current research indicates that health care contributes no more than 50% toward broad health outcomes. The rest comes from non-medical determinants, including the social environment, the physical environment, and individual behaviors that fosteror diminish ...
Utilization review practices, innovations and trends for the 21 states using diagnosis-related groups for Medicaid during 1992 are described. According to this descriptive survey, Medicaid inpatient utilization review programs vary widely... more
Utilization review practices, innovations and trends for the 21 states using diagnosis-related groups for Medicaid during 1992 are described. According to this descriptive survey, Medicaid inpatient utilization review programs vary widely in authority, approach and focus, reflecting state payment system incentives, health and hospital system characteristics, and provider practice norms. More than half of the states with Medicaid diagnosis-related group systems contract with a Medicare Peer Review Organization. State programs are developing complementary clinical and data analytic approaches, advised by multidisciplinary utilization review committees, and are moving from random review to strategies that focus on specific types of admissions/procedures, and shift as provider practices and utilization patterns change. Utilization review strategies also support payment incentives and system features, e.g., by targeting outliers, readmissions and transfers, and short stays. Overall, programs are becoming more flexible, targeted, and interactive. Trends and suggestions for refining utilization review programs for diagnosis-related group systems are presented.
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Competition and a rapidly changing market place have dramatically altered the dynamics of primary health care delivery in urban areas across the US, focusing new attention on access to care for the indigent. Public and private sector... more
Competition and a rapidly changing market place have dramatically altered the dynamics of primary health care delivery in urban areas across the US, focusing new attention on access to care for the indigent. Public and private sector policymakers in Boston, Massachusetts, addressed these issues by examining the health status, payer coverage and availability of providers of primary health care for individuals at risk. Strategies were targeted in the areas of health insurance, reimbursement, and provider organisations to improve access to services at the state and local level.