PERS 2002 Fall 2024 Mid-term Exam PDF

Welcome! PERS 2002: Mid-term Exam Review Fall 2024 Heather D. Martin, PhD, MSBA Next week – Synchronous, online Mid- term Exam Online - take exam wherever you like Synchronous - Tuesday, at 12:45pm – 2:25pm (regular class time) On a laptop or PC, no Chrome Books or tablets...

Welcome! PERS 2002: Mid-term Exam Review Fall 2024 Heather D. Martin, PhD, MSBA Next week – Synchronous, online Mid- term Exam Online - take exam wherever you like Synchronous - Tuesday, at 12:45pm – 2:25pm (regular class time) On a laptop or PC, no Chrome Books or tablets (for technical reasons) Must have a camera Must download Lockdown Browser before starting exam (link on exam, but try to download beforehand) https://cetloe.gsu.edu/tool/respondus-lockdown-browser-monitor/ 2 Team Norms Document Mimics team in real workplace Always put your group number or team name in the title, and team member names Work with team members before going overhead to management Promote healthy communication If an issue, discuss to see what is going on Support each other Step up and fill gaps when needed When you have exhausted methods to try to work it out yourself, seek help 3 Writing AI Prompt Tips (Researched by Stephen Durso) AI Prompt generation is the most important, yet also one of the most potentially complicated, aspects of using AI. A good prompt usually results in a good answer, and a bad prompt, a lower quality response. AI cannot read your mind, or even really infer much. It doesn't generally go beyond its input when doing a task. It does what you tell it to, not more, not less. This is why explicitly stated and purposeful prompts are important. Who/What/Where/When/Why. For instance, a good prompt would be "Write an analytical essay regarding racial prejudices within the Union during the Civil War, from the perspective of a freedman who escaped slavery in the South." This would be a much more compelling and interesting essay, with a more specific focus and deeper insights into this period of US History. Provide background information. Context is KEY! Give the AI context on what you are doing or looking for. You can talk to is as if it is a person, giving it details about your objective and how you want to accomplish it. AI works better when it can "frame" its responses in a way that is relevant to your objective. Build the conversation. Instead of giving completely new prompts if you don't like the original response, tell the AI what you do or don't like and ask it to refine its response accordingly. This yields a more thorough and iterative process that gives you more control over the responses Experiment. Try different things. Be explicit on what you are trying to accomplish, and you may even have to be "firm" with an AI sometimes. Correct the prompt if your results are not what you are looking for. 4 Activity Who: Patient (demographics = gender, age, etc.) Height and build Skin tone Facial features Clothing Etc. What: image Where: specific location in country When: time frame Why: to help me understand their perspective as a patient 5 Patient-centered Care Patient-centered care (person-centered care) Integrated health care services delivered in a setting and manner that is responsive to individuals and their goals, values and preferences, in a system that supports good provider–patient communication and empowers individuals receiving care and providers to make effective care plans together (shared-decision making) (Centers for Medicare & Medicaid Services). Health care providers work collaboratively with patients (and sometimes family members or other caregivers) and other health care providers to do what is best for the patients’ health and well-being (Centers for Medicare & Medicaid Services). An individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements (Catalyst 2017). Providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial (Catalyst 2017). Care is collaborative, coordinated, and accessible. The right care is provided at the right time and the right place (Catalyst 2017). Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected (Catalyst 2017). Information is shared fully and in a timely manner so that patients and their family members can make informed decisions (Catalyst 2017). 6 Examples of Patient-centered Care (Catalyst 2017) Doctor’s office Care focuses more on the patient’s problem than on his or her diagnosis. Patients have trusted, personal relationships with their doctors in patient-focused care models. Requires providers to offer services or referral to services such as peer support programs, social workers, financial counselors, mental and emotional health providers, transportation and daily living assistance, and in some communities, language and literacy education. Technology-based tools to help patients take ownership of their health care outside of the doctor’s office. 24/7 online portals to schedule appointments, check testing results, ask questions, pay bills, track data from wearables Hospital More flexibility in visiting hours and who can visit Family members/care givers invited during rounding/shift changes to be part of a care team, discussions, decisions (and kept more informed on patient’s progress when not visiting) Designed with a more home-like environment Personalized medicine (precision medicine) Treatments and therapies are customized to the patient’s needs Genetics, metabolism, biomarkers, immune system, environment, and other items 7 Impact of Patient-centered Care (Catalyst 2017) Improved satisfaction scores among patients and their families Enhanced reputation of providers among health care consumers Better morale and productivity among clinicians and ancillary staff Improved resource allocation Reduced expenses and increased financial margins throughout the continuum of care 8 Shift to Patient-centered Care (Catalyst 2017) Shift in the way practices and healthcare organizations are designed, managed, and reimbursed Every member of the organization plays a part; no longer provider only decisions Patient, family members, and practitioners are part of a team Requiresengagement and feedback from all team members toward improvement to meet team goals to optimize patient-centered care 9 Interprofessional Healthcare An interprofessional healthcare team is comprised of team members from two or more different professions (e.g., nurses and physicians, physicians and community health workers, social workers and psychologists, pharmacists and respiratory therapists) who learn with, from, and about each other to enable effective collaboration and improve health outcomes (Accredidation Council for Continuing Medical Education 2023). (Physicians 2023) 10 Interprofessional Healthcare Factors that may influence team success (Bosch and Mansell 2015) : Accountability Communication Leadership (collaborative) Discipline Coordination Clear purpose and strategy in place 11 Interprofessional Healthcare (Bosch and Mansell 2015) Benefits may include: Improve patient outcomes such as reducing preventable adverse drug reactions Decrease morbidity (illness or disease) and mortality (death) rates Optimize medication doses Reduce providers’ workload Increase providers’ job satisfaction 12 Group Activity: Pick one health challenge your patient is facing in their country Each team member pick a role: Patient Physician Nurse Pharmacist Counselor Physical therapist Etc. What are some challenges you may face when trying to work together to treat your patient? How would you handle those challenges? Whatare some benefits that your patient would receive from this interprofessional approach? Why? 13 Care Continuum Continuum of care Conceptinvolving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care (Evashwick 1989). (Surendran 2023) 14 Care Continuum (Surendran 2023) 15 Care Continuum Why might this be difficult in the U.S.? Today, the complex U.S. healthcare organization has emerged as a highly sophisticated but fragmented collection of service providers (Evashwick 1989). Much energy and resources into rebuilding the comprehensiveness and continuity that represent high-quality care (Evashwick 1989). 16 Care Continuum Basic Components (organizational standpoint) Internal and external care coordination (Evashwick 1989), (Regis College 2023) Staff schedules - Physicians, nursing professionals, specialists, and other providers working in an inpatient setting should ensure that the appropriate personnel are available to provide each type of care a patient needs Care transitions - Providers should have access to a patient’s medical history and know what services they’ve received as they progress through each phase of treatment Strengthening communication - Open communication between medical providers. This communication should include access to patient records and data, to help providers from different facilities and systems stay up to date on a patient’s medical history. Care transitions - Providers should have access to a patient’s medical history and know what services they’ve received as they progress through each phase of treatment Outside treatments - Providers also need information about past care that a patient received from medical and nonmedical professionals in other facilities or health care networks Collecting data - Collecting various types of data from patients at every step of the continuum of care to help providers stay abreast of patients’ changing needs and concerns R Standardizing records - Making data collection uniform makes it easier to compare and review, which can aid in identifying care gaps for specific populations or at certain facilities and improve care across the life span of all patients R Establish success metrics - Providers should establish how they’ll determine success in the services they offer throughout the continuum of care. These success metrics should inform goal setting to help health systems and hospitals determine the effectiveness of care initiatives and the work that supports them. Case-based financing (Evashwick 1989), (Regis College 2023) Equality in payments across health-care providers for services of the same kind (fee-for-service) Move toward a value-based (fee for outcome) model, where payments to health care providers are dependent on patient outcomes Patient billing - Nonmedical professionals need to have clear records of financing and provider networks to ensure accurate billing. Integrated information systems (Evashwick 1989) (Regis College 2023) Interoperability (patient data sharing) within internal systems Interoperability across organizations Education Train healthcare practitioners how to manage transitions of care (Lapkin, Levett-Jones et al. 2013) Interprofessional training Improve education between different types of healthcare professionals Seamless transfer of patient medical history and care May lead to improved patient outcomes 17 Impact of Care Continuum Benefits to patients (Regis College 2023) Greater convenience - offering various services in one location or through a single, easy- to-access network. Seamless transitions - offering medical care that adapts to address a patient’s many needs makes it easier to navigate the changes that come with life’s transitions. Informed decision-making - sharing information to coordinate care helps providers educate patients about their conditions and the many types of treatment they’re receiving. Less expense- keeping abreast of the treatments a patient has received can lead to fewer duplications and unnecessary procedures, reducing patient expenses. Personalized care - understanding a patient’s history can help health care professionals tailor care to that patient’s individual concerns. Enhanced safety - having an awareness of a patient’s medical background can help providers avoid prescribing medications and treatments that could be dangerous based on preexisting conditions. 18 Impact of Care Continuum Benefits to providers (Regis College 2023) Greater efficiency - Avoiding duplicate procedures and unnecessary hospital readmissions can save time and money, as well as improve patient satisfaction. Better reputation - Providing care that puts the changing needs of patients first promotes positive experiences and outcomes. Improved morale - Helping patients achieve positive health outcomes can lead to a more fulfilling experience and greater job satisfaction for medical professionals. Increased insurance reimbursements - the cornerstone of value-based care models, which reimburse according to patient outcomes. 19 References Accreditation Council for Continuing Medical Education (2023). "What is an “interprofessional team,” as described in the Engages Teams Criterion?". Retrieved September 4, 2023, from https://www.accme.org/faq/what-interprofessional-team-described-engages-teams-criterion. Bosch, B. and H. Mansell (2015). "Interprofessional collaboration in health care: Lessons to be learned from competitive sports." Canadian Pharmacists Journal/Revue des Pharmaciens du Canada 148(4): 176- 179. Catalyst, N. (2017). "What Is Patient-Centered Care?". Retrieved September 4, 2023, from https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559. Centers for Medicare & Medicaid Services. "Person-Centered Care." Retrieved September 4, 2023, from https://innovation.cms.gov/key-concept/person-centered-care. Evashwick, C. (1989). "Creating the continuum of care." Health matrix 7(1): 30-39. Lapkin, S., et al. (2013). "A systematic review of the effectiveness of interprofessional education in health professional programs." Nurse education today 33(2): 90-102. Physicians, A. C. o. (2023). "COVID-19 Recovery: Team-Based Care Toolkit." Retrieved September 4, 2023, from https://www.acponline.org/practice-resources/covid-19-practice-management-resources/covid- 19-recovery-team-based-care-toolkit. Regis College (2023). "What Is the Continuum of Care?". Retrieved September 4, 2023, from https://online.regiscollege.edu/blog/what-is-the-continuum-of-care/#:~:text=Patient%20health%20outcomes %20can%20also,of%20improvement%20during%20that%20time. Surendran, B. (2023). Use of Data Analytics to Improve Continuum of Care, Kaiser Permanente. 20 Country Comparisons and Cultural Competence Diverse/Sensitive Topics Please recognize and respect that we each come from a unique background with different histories, cultures, experiences, and ideas In this diverse environment, you have a right to express your opinions, but so do others, so your opinions may be challenged Sometimes we have to be comfortable with the uncomfortable Sometimes we have to agree to disagree You are welcome to leave the room, take a walk if needed But above all …. we should learn from each other! Instructor has the right to take classroom discussion back to learning objectives, because we have limited time, and you need to finish this class and ultimately graduate! 22 Country Comparisons in Healthcare Whyis it important to make country comparisons? Assess performance and benchmarks Learn effective methods Prompt improvement Why is defining what we compare important? Inconsistent or inaccurately measured or defined data can lead to invalid conclusions Reduce unnecessary variations in comparisons Improve the validity of comparisons How do we make valid country comparisons? Accurate, consistent data collection and metric definitions Difficult Lack of standardization of healthcare metrics across countries Making comparisons with large amounts of aggregate data can make it difficult to identify causes of healthcare issues and how best to address them 23 U.S. Healthcare Outcomes Americans are more likely to die younger and from avoidable causes (compared higher income countries) Decreasing life-expectancy in the U.S. (obesity, heart disease, other co-morbidities) Lowest life expectance at birth Highest maternal and infant mortality rate Among highest suicide rates Only country that doesn’t have universal health coverage See physicians less often Lowest rate of practicing physicians and hospital beds per 1,000 people Among the highest screening rates for breast and colorectal cancer Among the highest rates for flu vaccination (except COVID-19 vaccine) 24  U.S. life expectancy at birth is three years lower than the OECD average. Years expected to live, 1980–2021* 2021 data (or latest 86 available year)*: AUS: 83.2* CAN: 81.7* 82 FRA: 82.5 GER: 80.9 JPN: 84.7* 78 KOR: 83.5* NETH: 81.5 NZ: 82.3* 74 NOR: 83.2 SWE: 83.2 SWIZ: 84.0 70 UK: 80.4* US: 77.0* 66 OECD average: 62 80.4 Note: * 2020 data. Total population at birth. OECD average reflects the average of 38 OECD member countries, including ones not shown here. Because of methodological differences, JPN and UK data points are estimates. Data: OECD Health Statistics 2022. Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes (Commonwealth Fund, Jan. 2023). https://doi.org/10.26099/8ejy-yc74 26  Avoidable deaths per 100,000 population in the U.S. are higher than the OECD average. Avoidable deaths per 100,000 population (standardized rates), 2000–2020* 2020 data (or latest 400 available year)*: AUS: 144 350 CAN: 171* FRA: 164* GER: 195 300 JPN: 137* KOR: 147* 250 NETH: 161 NZ: 179* 200 NOR: 156* SWE: 150* SWIZ: 150 130* UK: 194* 100 US: 336 50 OECD 0 average: 225 Notes: Rates reflect age-standardized rates. Avoidable mortality includes deaths which are preventable and treatable. * 2019 data for CAN, JPN, KOR, and UK; 2018 data for SWE and SWIZ; 2016 data for FRA, NZ, and NOR. Data: OECD Health Statistics 2022. Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes (Commonwealth Fund, Jan. 2023). https://doi.org/10.26099/8ejy-yc74 The U.S. has the highest rate of infant and maternal deaths. Infant mortality, deaths per 1,000 live births Maternal mortality, deaths per 100,000 live births 23.8 5.4 4.5 4.3 OECD average: 4.1 3.6 3.6 3.8 13.6 3.1 3.2 3.2 11.8 2.4 2.5 OECD average: 9.8 8.4 1.8 7.6 1.6 7.0 7.0 6.5 3.6 3.7 2.7 2.0 1.2 R N E R ER S IZ RA K H Z N S S R R E O JP S W KO AU S W F U ET N CA U H N JP G E NO K IZ RA AN OR Z S N G N ET AU U SW SW F C K N U N Notes: Infant mortality rates reflect no minimum threshold or gestation period or birthweight. Infant mortality 2021 data for FRA and SWIZ; 2020 data for AUS, CAN, GER, JPN, KOR, NETH, NOR, SWE, UK, and US; 2018 data for NZ. Maternal mortality 2020 data for AUS, CAN, GER, JPN, KOR, NETH, NOR, SWE, and US; 2019 data for SWIZ; 2018 data for NZ, 2017 data for UK; 2015 data for FRA. OECD average reflects the average of 38 OECD member countries. Data: OECD Health Statistics 2022. Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes (Commonwealth Fund, Jan. 2023). https://doi.org/10.26099/8ejy-yc74  Rates of suicide were highest in the U.S., Japan, and South Korea. Intentional self-harm deaths per 100,000 population (standardized rates) 24.1 14.1 14.6 OECD average: 11.1 11.1 11.8 12.1 12.3 12.4 10.0 10.5 12.4 9.7 8.4 UK GER NETH CAN SWIZ NOR NZ FRA SWE AUS US JPN KOR Notes: Rates reflect age-standardized rates. Intentional self-harm death rates 2020 data for AUS, GER, KOR, NETH, UK, and US; 2019 data for CAN, JPN, and SWIZ; 2018 data for SWE; 2017 data for FRA; 2016 data for NZ and NOR. OECD average reflects the average of 38 OECD member countries, including ones not shown here. Data: OECD Health Statistics 2022. Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes (Commonwealth Fund, Jan. 2023). https://doi.org/10.26099/8ejy-yc74  The U.S. obesity rate is nearly double the OECD average. Percent of total population that is obese 42.8 34.3 30.4 OECD average: 25.0 28.0 23.6 24.3 15.6 14.4 13.0 13.4 11.3 7.4 4.6 JPN KOR SWIZ NOR NETH SWE FRA GER CAN UK AUS NZ US Notes: Obese defined as body-mass index of 30 kg/m² or more. Data reflect rates based on measurements of height and weight, except NETH, NOR, SWE, SWIZ, for which data are self-reported. (Self-reported rates tend to be lower than measured rates.) 2021 data for NZ; 2020 data for KOR, NETH, and SWE; 2019 data for CAN, JPN, NOR, UK, and US; 2017 data for AUS, FRA, and SWIZ; 2012 data for GER. OECD average reflects the average of 23 OECD member countries, including ones not shown here, which provide data on obesity rates. Data: OECD Health Statistics 2022. Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes (Commonwealth Fund, Jan. 2023). https://doi.org/10.26099/8ejy-yc74 The U.S. has among the lowest rates of physician visits and practicing physicians. Physician consultations in all settings per capita Practicing physicians per 1,000 population 14.7 12.4 9.5 8.4 OECD average: 5.7 6.6 5.2 6.1 4.3 4.5 4.5 5.0 OECD average: 3.7 4.3 3.8 3.9 4.0 3.8 3.9 3.5 3.2 3.2 2.5 2.6 2.6 2.8 2.2 Notes: Data for UK not available. 2021 data for AUS and NOR; 2020 data for FRA, GER, KOR, NETH, and SWE; 2019 data for CAN and JPN; 2017 for NZ and SWIZ; 2011 data for Notes: 2021 data for CAN, GER, NZ, NOR, SWIZ, and UK; 2020 data for AUS, FRA, JPN, US. OECD average reflects the average of 37 OECD member countries, including ones not KOR, and NETH; 2019 data for SWE and US. OECD average reflects the average of 31 shown here. OECD member countries, including ones not shown here. Data: OECD Health Statistics 2022. Data: OECD Health Statistics 2022. Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes (Commonwealth Fund, Jan. 2023). https://doi.org/10.26099/8ejy-yc74  Hospital stays are shortest in the Netherlands and the U.S. The U.S. has among the lowest number of hospital beds. Average length of stay for inpatient care (days) Number of total hospital beds per 1,000 population 12.6 12.7 19.1 7.8 5.7 9.1 OECD average: 4.3 OECD average: 7.3 8.7 4.5 8.2 8.2 3.8 6.3 6.6 3.4 5.2 5.3 5.4 2.8 2.9 4.5 4.8 2.6 2.7 2.3 2.1 S R S E Z K IZ A U O AU N U AN ER FR R N SW C SW G KO Notes: Data reflect average length of stay for inpatient care for all hospitals. 2021 data for NOR; 2020 data for CAN, FRA, GER, KOR, NETH, SWE, and SWIZ. 2019 data for AUS and NZ; 2018 data for UK; 2010 data for US. Data for JPN not Notes: 2021 data for NZ and UK; 2020 data for CAN, FRA, GER, JPN, KOR, NETH, NOR, SWE, and SWIZ; 2019 data for available. OECD average reflects the average of 36 OECD member countries, including ones not shown here, where data are US; 2016 data for AUS. OECD average reflects the average of 38 OECD member countries, including ones not shown here, available. with available data. Data: OECD Health Statistics 2022. Data: OECD Health Statistics 2022. Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes (Commonwealth Fund, Jan. 2023). https://doi.org/10.26099/8ejy-yc74 U.S. Healthcare Spending Highest health care spending (per person and as a share of GDP) Why? Growth of economy since 1980’s (growing about 2.5% over past 20 years) Cost of healthcare services growing faster than the cost of other goods and services (growing about 3.2% per year over past 20 years) Aging population Hospital consolidations lead to lack of price competition The introduction of new, innovative healthcare technology can lead to better, more expensive procedures and products. (R&D) No unified health system to negotiate prescription drug prices Over testing Lack of health care price transparency 33  The U.S. is a world outlier when it comes to health care spending. Percent of GDP spent on health, 1980–2021* 2021 data (or latest 20.0 available year)*: AUS: 10.6%* 18.0 CAN: 11.7% 16.0 FRA: 12.4% GER: 12.8% 14.0 JPN: 11.1%* KOR: 8.8% 12.0 NETH: 11.2% NZ: 9.7%* 10.0 NOR: 10.1% SWE: 11.4% 8.0 SWIZ: 11.8%* 6.0 UK: 11.9% US: 17.8% 4.0 2.0 OECD average: 0.0 9.6% Notes: * 2020 data. Current expenditures on health for all functions by all providers for all financing schemes. Data points reflect share of gross domestic product. Based on System of Health Accounts methodology, with some differences between country methodologies. GDP = gross domestic product. OECD average reflects the average of 38 OECD member countries, including ones not shown here. Data: OECD Health Statistics 2022. Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes (Commonwealth Fund, Jan. 2023). https://doi.org/10.26099/8ejy-yc74 Summary of Healthcare in the U.S. Not doing very well life-expectancy maternal and infant mortality rates suicide rates substance use disorder overdose rates no universal health coverage shortage of primary care and OBGYN practitioners among other types of healthcare practitioners employees (SUD and mental health) expensive Doing better health insurance coverage rate at all time high since Affordable Care Act (Medicaid, CHIPS, Medicare) R&D in medical technologies, treatments, and pharmaceuticals diagnosis screenings rates like breast and colorectal cancer vaccination rates telehealth (SUD and mental health) policy changes to shift to more outcomes based, not fee-for-service based policy changes to promote transparency in healthcare – change consumer demand 35 Cultural Competence Cultural competence – no consistent definition across healthcare A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable that system, agency, or profession to work effectively in cross-cultural situations – broad definition Cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes.- CDC Expand that definition into healthcare institutions and systems, the policies that govern those systems, and the people that work in those systems Focuson behaviors, attitudes, and policies that enable effective healthcare in cross-cultural situations Required to meet the needs of culturally, ethnically, and racially diverse patient groups Acknowledgement and responses to sociocultural differences at health system, organizational, and individual health practitioner levels are required 36 37 How can lack of cultural competency hurt patients? Peopleof racial and ethnic underrepresented groups receive lower quality of healthcare on average than people not classified into those same groups Even when controlling for access-related factors like patients’ insurance status and income People with infectious diseases such as HIV and in underrepresented groups People who are women or Black are less likely to receive HIV treatment when controlled for gender, age, education, and insurance coverage People of underrepresented groups are less likely to participate in clinical trials Bias studies’ outcomes Less opportunity for people in those groups to receive possible positive benefits People with HIV and substance use disorders are less likely to receive HIV treatment compared to people with HIV (no substance use disorders) 38 Cultural Competency and Health Equity Lack of knowledge of and action to account for different cultural contexts in a healthcare setting can be associated with and further harm health equity 39 40 Cultural Competency and Health Equity Lack of knowledge of and action to account for different cultural contexts in a healthcare setting can be associated with and further harm health equity On average, Black, Hispanic, and American Indian and Alaskan Native (AIAN) people fared worse than White people across the majority of examined measures of health and health care and social determinants of health. – 2023 study NonelderlyAIAN (21%) and Hispanic (19%) people were more than twice as likely as their White counterparts (7%) to be uninsured as of 2021 Among adults with any mental illness, Black (39%), Hispanic (36%), and Asian (25%) adults were less likely than White (52%) adults to receive mental health services as of 2021. Roughly,six in ten Hispanic (62%), Black (58%), and AIAN (59%) adults went without a flu vaccine in the 2021-2022 season, compared to less than half of White adults (46%). Atbirth, AIAN and Black people had a shorter life expectancy (65.2 and 70.8 years, respectively) compared to White people (76.4) as of 2021, and AIAN, Hispanic, and41 Black people experienced larger declines in life expectancy than White people Cultural Competency and Health Equity Lack of knowledge of and action to account for different cultural contexts in a healthcare setting can be associated with and further harm health equity Blackinfants were more than two times as likely to die as White infants (10.4 vs. 4.4 per 1,000), and AIAN infants were nearly twice as likely to die as White infants (7.7 vs. 4.4 per 1,000) as of 2021. Black and AIAN women also had the highest rates of pregnancy-related mortality. Black(13%) and Hispanic (11%) children were over twice as likely to be food insecure than White children (4%) as of 2021. 42 43 44 45 46  Principles of Cultural Competence In a healthcare organization Broad definition of culture Value patients’ cultures and cultural beliefs Recognize the need and complexity of language interpretation Facilitate learning between providers and communities Involve the community in defining and addressing service needs Collaborate with other agencies to broaden cultural perspectives Professionalize staff hiring and training around cultural competence Institutionalize cultural competence Cultural competence training Improving access to care for all cultural contexts Building knowledge about the local Community Recruit and Retain diverse employees Understanding current state of organization's cultural competence (and individual current state) Providing resources Knowledge is not enough; operating effectively in different cultural contexts Learning new patterns of behavior of underrepresented groups (special needs and life contexts) Health promotion and education to improve cultural competence Demonstrated by: Healthcare organizations, administrators, policy makers, intervention programs, practitioners, employees, researchers 47 Measuring Cultural Competence Improvement Evaluate success against the drivers interventions aim to address Patient satisfaction Healthcare adherence Health outcomes Patient attendance and compliance 48 Special populations in healthcare Elderly Children/adolescents People who live in rural areas People of low income People with mental health challenges People with substance use disorder People who have experienced trauma Socialdeterminants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. Others 49 Health Equity, Data Bias and AI 50 Complete Asynchronous Individual Exercise! Review the readings: RWJF Blog on Bias in Data Yale Medicine’s Guidelines for Reducing Bias in Healthcare AI Mathematica’s Article on Addressing Bias in Policy Research Review how to write good AI prompts from a health equity perspective How to Write Good AI Prompts: Prompt Engineering Mitigate biases such as demographic, geographic, socioeconomic and other biases Be prepared to answer why there is healthcare data bias and how can we mitigate it! 51 Health Policy 52 How does a bill become a law? 53 Public policy is … “Authoritativedecisions made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others (Longest Jr)“ Intended to serve the interests of the public 54 What is health? …”stateof complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organization 2023)” Isthis a thorough definition? Almost always something negatively impacting our physical, mental, or social- well-being Doesn’t necessarily mean we are often in a state of bad health Social How do we know if this has been accomplished? l Can this be measured? Not without defining n ta complete well-being e M Health is “the ability to adapt and self- Physical manage social, physical, and emotional (mental) challenges” Goal of health policy 55 Determinants of Health 56 How does health policy impact us? PublicPolicy  Determinants of Health  Individual adapt and manage health  Individual social function 57 Health Policy Policy instruments Regulation Government management Education/information/persuasion Taxing/spending Market mechanisms Federal Government Constitutional authority to tax and spend Categorical and block grant programs Regulate interstate commerce Information dissemination (e.g. guidelines) Influence states through these tools 58 What are tensions that drive debates in health policy? 59 What are tensions that drive debates in health policy? Is access to good/affordable health care a human right? How do you allocate healthcare resources? E.g. supplies, practitioners, funding Should government play a larger or smaller role in healthcare? Whyshould public policy around health care be different than from other goods/services? Reproductive and abortion rights? 60 Health policy change Agenda setting Policy change is difficult – many policy agendas, different perspectives, different priorities Need a policy window – Are the stars aligned? This window often opens out of severe need e.g. telehealth during COVID-19 pandemic, state harm reduction during opioid crisis (Many theories around how policies change happens; below is just one theory) (Kingdon 1993) 61 Categories of health policies Allocative Provide net benefit (resources) to some distinct group or class of individuals Medical fees restrictions Subsidies to medical schools to train practitioners Public funding for medical research Medicare and Medicaid programs Regulatory policy Influence the actions, behaviors, decisions of individuals and corporations Market entry restrictions Rate or price settings Quality controls Market preserving/enhancing controls Social regulation 62 How would you characterize our health care delivery system? 63 How would you characterize our health care delivery system? ? 64 How would you characterize our health care delivery system? Different financing streams Different types of hospitals Differnet ambulatory (outpatient) providers Lack of coordination across the health care continuum No central health care or public health agency Largest population without healthcare coverage 65 Why are we different from other developed countries? No systematic policy approach to health care delivery and financing Large array of delivery settings Multiple and complex financial arrangements Relatively limited use of information technology “Performance of the health care system varies considerably. It may be exemplary, but often is not, and millions of Americans fail to receive effective care…… The health care system as currently structured does not, as a whole, make the best use of its resources…….. Many types of medical errors result in the subsequent need for additional health care services to treat patients who have been harmed. A highly fragmented delivery system that largely lacks even rudimentary clinical information capabilities results in poorly designed care processes characterized by unnecessary duplication of services and long waiting times and delays. And there is substantial evidence documenting overuse of many services—services for which the potential risk of harm outweigh the potential benefits (Baker 2001).” 66 U.S. Health Policy – Attempt to improve current state CMS National Quality Strategy Buildson previous efforts to improve quality across the health care system, incorporates lessons learned from the COVID-19 Public Health Emergency (PHE), and addresses the urgent need for transformative action to advance towards a more equitable, safe, and outcomes-based health care system for all individuals (Centers for Medicare & Medicaid Services 2023). TheCenters for Medicare & Medicaid Services (CMS) is responsible for implementing laws passed by Congress related to: Medicare and Medicaid the Children’s Health Insurance Program (CHIP) To implement these programs, CMS issues various forms of guidance to explain how laws will be implemented and what states and others need to do to comply In addition to regulations, CMS issues sub-regulatory guidance to address policy issues as well as operational updates and technical clarifications of existing guidance 67 U.S. Health Policy 68 U.S. Health Policy – data privacy HIPAA Enforcement (U.S. Department of Health and Human Services 2023) Enforced by the U.S. Department of Health and Human Services (law enforcement agency) Privacy and Security Rules – enforcement began on April, 2003 for most HIPAA covered entities 69 U.S. Health Policy - ACA Affordable Care Act (ACA) – possible solution Need - problems Nearly 50 million uninsured people prior to 2011 (about 16% of US population) Trust issues with health insurance Individual health insurance mostly unobtainable or affordable Employers concerned about their costs Economists began to consider that doing nothing would crush the US economy Timely political support – political circumstances Obama elected (2008 – beginning of great recession) 60 Democratic senators unexpectedly elected Understanding that health care was a critical aspect of the economy and needed to be addressed 70 ACA: Legislative History July 2009: Speaker of the House Nancy Pelosi and a group of Democrats from the House of Representatives reveal their plan for overhauling the health-care system. It’s called H.R. 3962, the Affordable Health Care for America Act. August 25, 2009: Massachusetts senator Ted Kennedy, a leading supporter of health-care reform, dies and puts the Senate Democrats’ 60-seat supermajority required to pass a piece of legislation at risk. September 24, 2009: Democrat Paul Kirk is appointed interim senator from Massachusetts, which temporarily restores the Democrats’ filibuster-proof 60th vote. November 7, 2009: In the House of Representatives, 219 Democrats and one Republican vote for the Affordable Health Care for America Act, and 39 Democrats and 176 Republicans vote against it. December 24, 2009: In the Senate, 60 Democrats vote for the Senate’s version of the bill, called America’s Healthy Future Act, whose lead author is senator Max Baucus of California. Thirty-nine Republicans vote against the bill, and one Republican senator, Jim Bunning, does not vote. January 2010: In the Senate, Scott Brown, a Republican, wins the special election in Massachusetts to finish out the remaining term of US senator Ted Kennedy, a Democrat. Brown campaigned heavily against the health-care law and won an upset victory in a state that consistently votes in favor of the Democratic party. March 11, 2010: Now lacking the 60th vote needed to pass the bill, Senate Democrats decide to use budget reconciliation in order to get to one bill approved by the House and the Senate. The use of budget reconciliation only requires 51 Senators to vote in favor of the bill in order for it to go to the president’s desk for signature. March 21, 2010: The Senate’s version of the health-care plan is approved by the House in a 219-212 vote. All Republicans and 34 Democrats vote against the plan. March 23, 2010: President Obama signs the Affordable Care Act into law. 71 ACA Made affordable health insurance available to more people (marketplace) Expanded Medicaid program (for states that participate) Removed pre-existing conditions to qualify for health insurance Health insurance for young adults that are dependents up to age 26 Many others 72 Conclusion Healthpolicy is related to individual health by creating and enforcing laws that allow us to manage and adapt to mental, physical, and social stressors Health policy change is difficult – Are the stars aligned? Problems, possible solutions, political circumstances TheU.S. faces many healthcare quality challenges due to a fragmented system with no systematic policy approach ACA was most impactful healthcare reform the U.S. has seen in decades 73 Wrap-Up Reminders 74 Questions 75 References Longest Jr, B. B. "Health Policymaking in the U.S.". Kingdon, J. W. (1993). "How do issues get on public policy agendas." Sociology and the public agenda 8(1): 40-53. World Health Organization (2023). "Constitution." from https://www.who.int/about/governance/constitution. Braveman, P., et al. (2011). "Annu Rev Public Health." Baker, A. (2001). Crossing the quality chasm: a new health system for the 21st century, British Medical Journal Publishing Group. 323: 1192. Centers for Medicare & Medicaid Services (2023). "CMS Quality Strategy." from https://www.cms.gov/medicare/quality/meaningful-measures-initiative/cms-quality-strategy#:~:text=The%20CMS%20National %20Quality%20Strategy%20builds%20on%20previous%20efforts%20to,and%20outcomes%2Dbased%20health%20care. U.S. Department of Health and Human Services (2023). "HIPAA Enforcement." from https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/index.html. 76