Viewing health care delivery as science: challenges, benefits, and policy implications.
Ontology highlight
ABSTRACT:
SUBMITTER: Pronovost PJ
PROVIDER: S-EPMC2965889 | biostudies-other | 2010 Oct
REPOSITORIES: biostudies-other
Publications
Viewing health care delivery as science: challenges, benefits, and policy implications.
Pronovost Peter J PJ Goeschel Christine A CA
Health services research 20100802 5 Pt 2
The need for health services research is likely to rise rapidly as the population ages, health care costs soar, and therapeutic and diagnostic choices proliferate. Building an effective and efficient health care delivery system is a national priority. Yet the national health care quality report concludes that we lack the ability to monitor progress toward even basic quality and patient safety goals effectively. The gap between the need to improve and our ability to do so exists in part because w ...[more]
Similar Datasets
Project description:BackgroundMedication therapy management (MTM) program evaluations have revealed mixed outcomes, with some studies finding favorable outcomes and others finding no differences between patients who received MTM versus those who did not. One possible reason for outcomes variability is differences in delivery of MTM programs. The Chronic Care Model (CCM) provides a framework for how health care organizations can improve care for the chronically ill through 6 elements: organization of health care, delivery system design, clinical information systems, decision support, self-management, and linkages to community resources.ObjectiveTo apply the CCM to understand variation in MTM delivery and formulate policy recommendations.MethodsThis study used a mixed-methods descriptive analysis of MTM delivery. Investigators conducted visits to a purposeful sample of MTM practices to observe MTM and interview participants. The pharmacists and staff of these practices completed a modified Assessment of Chronic Illness Care (ACIC). Pairs of investigators analyzed interview transcripts to identify themes. Demographics and ACIC scores were summarized using descriptive statistics. After analysis, investigators discussed overarching themes and policy implications organized by CCM elements.ResultsSeven practices participated, and 87 participants were interviewed. Based on ACIC scores, MTM patient volume, and payer mix, practices were categorized as Early Maturity Level or Later Maturity Level. From the model, organization of health care themes included whether MTM was the practice's core competence, belief/confidence in the MTM process, lack of formal rewards, and the influence of organizational goals and external environment. Delivery system design themes pertained to the extent that MTM processes were formalized. Clinical information systems themes were the extent to which systems were influenced by payers, efficiency strategies, and the accuracy and availability of information. In considering clinical decision support themes, alert design limitations and variation in user approaches to alerts based on experience were noted. We observed strong support for patient self-management; when present, barriers were attributed to the patient, MTM provider, or payer. Referral to community resources was minimal. Numerous policy implications were identified.ConclusionsOur research identified numerous ways by which MTM delivery varies, particularly by MTM practice maturity level. These findings provide evidence for several policy changes that could be considered to optimize MTM delivery, encourage alignment with the CCM, and promote practice maturation.DisclosuresThis research and a portion of Snyder's salary were supported by grant number K08HS022119 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Snyder reports consulting fees from Westat for an evaluation of the CMS Enhanced MTM program. The other authors have nothing to disclose. Portions of this research have been presented as abstracts at the following conferences: (a) 2017 Academy Health Annual Research Meeting; June 25-27, 2017; New Orleans, LA; (b) 2015 American Society of Health-System Pharmacists Clinical Midyear Meeting; December 4-8, 2015; New Orleans, LA; and
| S-EPMC7543051 | biostudies-literature
Project description:Mental illness is common among forced migrant populations, and ongoing mental illness can hinder refugees' ability to negotiate the asylum process. This editorial rehearses the challenges of undertaking research among forced migrant populations, exploring how they could be addressed in future research, and outlines differences between forced migrant groups. It points to the growing body of evidence that can be called on in advocating for systemic change in government policy and mental health services, with significant support for a sensitive and objective inquisitorial approach to gathering evidence in support of asylum claims.
| S-EPMC7488309 | biostudies-literature
Project description: Not available
| S-EPMC7385499 | biostudies-literature
Project description:This article analyzes the concept of "grand challenges" as part of a shift in how scientists and policymakers frame and communicate their respective agendas. The history of the grand challenges discourse helps to understand how identity work in science and science policy has been transformed in recent decades. Furthermore, the question is raised whether this discourse is only an indicator, or also a factor in this transformation. Building on conceptual history and historical semantics, the two parts of the article reconstruct two discursive shifts. First, the observation that in scientific communication references to "problems" are increasingly substituted by references to "challenges" indicates a broader cultural trend of how attitudes towards what is problematic have shifted in the last decades. Second, as the grand challenges discourse is rooted in the sphere of sports and competition, it introduces a specific new set of societal values and practices into the spheres of science and technology. The article concludes that this process can be characterized as the sportification of science, which contributes to self-mobilization and, ultimately, to self-optimization of the participating scientists, engineers, and policymakers.
| S-EPMC5948272 | biostudies-literature
Project description:Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health (a broad term referring to mental health, substance use, and health behavior) care in the United States. Advances in knowledge regarding effective treatment and services coupled with incentives for innovation in health and behavioral health care delivery systems make this a unique time for mobilizing our science to enhance the success of health and behavioral health care redesign. To optimize the potential of our current health care environment, a team was formed composed of leaders from the Societies of Clinical Child & Adolescent Psychology, Pediatric Psychology, and Child and Family Policy and Practice (Divisions 53, 54, and 37 of the American Psychological Association). This team was charged with reviewing the scientific and policy literature with a focus on five major issues: (a) improving access to care and reducing health disparities, (b) integrating behavioral health care within primary care, (c) preventive services, (d) enhancing quality and outcomes of care, and (e) training and workforce development. The products of that work are summarized here, including recommendations for future research, clinical, training, and policy directions. We conclude that the current emphasis on accountable care and evaluation of the outcomes of care offer numerous opportunities for psychologists to integrate science and practice for the benefit of our children, families, and nation. The dramatic changes that are occurring in psychological and behavioral health care services and payment systems also require evolution in our practice and training models.
| S-EPMC5546314 | biostudies-other
Project description:Undergraduate college "science partners" provided content knowledge and a supportive atmosphere for K-5 teachers in a university-school professional development partnership program in science instruction. The Elementary Science Education Partners program, a Local Systemic Change initiative supported by the National Science Foundation, was composed of four major elements: 1) a cadre of mentor teachers trained to provide district-wide teacher professional development; 2) a recruitment and training effort to place college students in classrooms as science partners in semester-long partnerships with teachers; 3) a teacher empowerment effort termed "participatory reform"; and 4) an inquiry-based curriculum with a kit distribution and refurbishment center. The main goals of the program were to provide college science students with an intensive teaching experience and to enhance teachers' skills in inquiry-based science instruction. Here, we describe some of the program's successes and challenges, focusing primarily on the impact on the classroom teachers and their science partners. Qualitative analyses of data collected from participants indicate that 1) teachers expressed greater self-confidence about teaching science than before the program and they spent more class time on the subject; and 2) the college students modified deficit-model negative assumptions about the children's science learning abilities to express more mature, positive views.
| S-EPMC2736027 | biostudies-literature
Project description:A common feature of many citizen science projects is the collection of data by unpaid contributors with the expectation that the data will be used in research. Here we report a teaching strategy that combined citizen science with inquiry-based learning to offer first year university students an authentic research experience. A six-year partnership with the Australian phenology citizen science program ClimateWatch has enabled biology students from the University of Western Australia to contribute phenological data on plants and animals, and to conduct the first research on unvalidated species datasets contributed by public and university participants. Students wrote scientific articles on their findings, peer-reviewed each other's work and the best articles were published online in a student journal. Surveys of more than 1500 students showed that their environmental engagement increased significantly after participating in data collection and data analysis. However, only 31% of students agreed with the statement that "data collected by citizen scientists are reliable" at the end of the project, whereas the rate of agreement was initially 79%. This change in perception was likely due to students discovering erroneous records when they mapped data points and analysed submitted photographs. A positive consequence was that students subsequently reported being more careful to avoid errors in their own data collection, and making greater efforts to contribute records that were useful for future scientific research. Evaluation of our project has shown that by embedding a research process within citizen science participation, university students are given cause to improve their contributions to environmental datasets. If true for citizen scientists in general, enabling participants as well as scientists to analyse data could enhance data quality, and so address a key constraint of broad-scale citizen science programs.
| S-EPMC5665417 | biostudies-literature
Project description:The movement towards open science is a consequence of seemingly pervasive failures to replicate previous research. This transition comes with great benefits but also significant challenges that are likely to affect those who carry out the research, usually early career researchers (ECRs). Here, we describe key benefits, including reputational gains, increased chances of publication, and a broader increase in the reliability of research. The increased chances of publication are supported by exploratory analyses indicating null findings are substantially more likely to be published via open registered reports in comparison to more conventional methods. These benefits are balanced by challenges that we have encountered and that involve increased costs in terms of flexibility, time, and issues with the current incentive structure, all of which seem to affect ECRs acutely. Although there are major obstacles to the early adoption of open science, overall open science practices should benefit both the ECR and improve the quality of research. We review 3 benefits and 3 challenges and provide suggestions from the perspective of ECRs for moving towards open science practices, which we believe scientists and institutions at all levels would do well to consider.
| S-EPMC6513108 | biostudies-literature
Project description:BackgroundAround the world, millions of people are impoverished due to health care spending. The highest catastrophic health expenditures are found in countries in transition. Our study analyzes the extent of financial protection by estimating the incidence of catastrophic health care expenditure in Myanmar and its association with sociodemographic factors.MethodsWe performed a secondary analysis of data from the household surveys conducted by the Livelihoods and Food Security Trust Fund (LIFT) in 2013 and 2015 in Myanmar. To estimate the magnitude of catastrophic health care expenditure, we applied the definition of catastrophic payment proposed by the World Health Organization (WHO); a household's out-of-pocket payment for health care is considered catastrophic if it exceeds 40% of the household capacity to pay. We also examined the changes in catastrophic payments at three different threshold levels (20, 30, 40%) with one equation allowing for a negative capacity to pay (modified WHO approach) and another equation with adjusted negative capacity to pay (standard WHO approach).ResultsIn 2013, the incidence of catastrophic expenditure was 21, 13, 7% (standard WHO approach) and 48, 43, 41% (modified WHO approach) at the 20, 30, 40% threshold level respectively, while in 2015, these estimates were 18, 8, 6% (standard WHO approach) and 47, 41, 39% (modified WHO approach) respectively. Geographical location, gender of the household head, total number of household members, number of children under 5, and number of disabled persons in the household were statistically significantly associated with catastrophic health care expenditures in both studied years 2013 and 2015. Education of household head was statistically significantly associated with catastrophic health expenditure in 2013. We found that the incidence of catastrophic expenditures varied by the approach used to estimate expenditures.ConclusionsAlthough the level of catastrophic health care expenditure varies depending on the approach and threshold used, the problem of catastrophic expenditures in Myanmar cannot be denied. The government of Myanmar needs to scale up the current Social Security Scheme (SSS) or establish a new financial protection mechanism for the population. Vulnerable groups, such as households with a household head with a low-level of education, households with children under the age of 5 years or disabled persons, and low-income households should be prioritized by policymakers to improve access to essential health care.
| S-EPMC6664746 | biostudies-literature
Project description:Despite the central place held by bioinformatics in modern life sciences and related areas, it has only recently been integrated to a limited extent into high-school teaching and learning programs. Here we describe the assessment of a learning environment entitled 'Bioinformatics in the Service of Biotechnology'. Students' learning outcomes and attitudes toward the bioinformatics learning environment were measured by analyzing their answers to questions embedded within the activities, questionnaires, interviews and observations. Students' difficulties and knowledge acquisition were characterized based on four categories: the required domain-specific knowledge (declarative, procedural, strategic or situational), the scientific field that each question stems from (biology, bioinformatics or their combination), the associated cognitive-process dimension (remember, understand, apply, analyze, evaluate, create) and the type of question (open-ended or multiple choice). Analysis of students' cognitive outcomes revealed learning gains in bioinformatics and related scientific fields, as well as appropriation of the bioinformatics approach as part of the students' scientific 'toolbox'. For students, questions stemming from the 'old world' biology field and requiring declarative or strategic knowledge were harder to deal with. This stands in contrast to their teachers' prediction. Analysis of students' affective outcomes revealed positive attitudes toward bioinformatics and the learning environment, as well as their perception of the teacher's role. Insights from this analysis yielded implications and recommendations for curriculum design, classroom enactment, teacher education and research. For example, we recommend teaching bioinformatics in an integrative and comprehensive manner, through an inquiry process, and linking it to the wider science curriculum.
| S-EPMC5221422 | biostudies-literature