Advance Health Research Articles

Integrating Well-Being Information and the Multidimensional Adaptive Prediction Process to Estimate Individual-Level Future Health Care Expenditure Levels

Decades of research exist focusing on the utility of self-reported health risk and status data in health care cost predictive models. However, in many of these studies a limited number of self-reported measures were considered. Compounding this issue, prior research evaluated models specified with a single covariate vector and distribution. In this study, the authors incorporate well-being data into the Multidimensional Adaptive Prediction Process (MAPP) and then use a simulation analysis to highlight the value of these findings for future cost mitigation. Data were collected on employees and dependents of a nationally based employer over 36 months beginning in January 2010. The first 2 years of data (2010, 2011) were utilized in model development and selection; 51239 and 54085 members were included in 2010 and 2011, respectively. The final results were based on prospective prediction of 2012 cost levels using 2011 data. The well-being-augmented MAPP results showed a 5.7% and 13% improvement in accurate cost capture relative to a reference modeling approach and the first study of MAPP, respectively. The simulation analysis results demonstrated that reduced well-being risk across a population can help mitigate the expected upward cost trend. This research advances health care cost predictive modeling by incorporating well-being information within MAPP and then leveraging the results in a simulation analysis of well-being improvement.

Continuing Education for Mentors and a Mentoring Program for RN-to-BSN Students.

Mentoring programs have been used effectively with graduate and undergraduate nursing students and newly licensed nurses. There are few publications about mentoring for the RN enrolled in a bachelor of science in nursing (RN-to-BSN) program. To address low graduation rates in the public RN-to-BSN nursing programs, the Montana Center to Advance Health Through Nursing designed a mentoring program to help these nurses achieve their BSN. This voluntary program was initiated at an RN-to-BSN program in a 4-year college with six RN students who were paired with a mentor. An interactive, continuing education workshop on mentoring also was developed to prepare experienced nurses for their role as a mentor. This workshop was held nine times across Montana, with a total of 156 attendees. Workshop evaluations were consistently positive. Participants identified time and personality issues as barriers to successful mentoring and recommended expansion of the workshop to a distance-learning format so more nurses could attend. J Contin Educ Nurs. 2016;47(6):272-277.

2015 International Society for Disease Surveillance Conference Harnessing Data to Advance Health Equity

2015 International Society for Disease Surveillance Conference Harnessing Data to Advance Health Equity

Civil Rights Laws as Tools to Advance Health in the Twenty-First Century.

To improve health in the twenty-first century, to promote both access to and quality of health care services and delivery, and to address significant health disparities, legal and policy approaches, specifically those focused on civil rights, could be used more intentionally and strategically. This review describes how civil rights laws, and their implementation and enforcement, help to encourage health in the United States, and it provides examples for peers around the world. The review uses a broad lens to define health for both classes of individuals and their communities--places where people live, learn, work, and play. Suggestions are offered for improving health and equity broadly, especially within societal groups and marginalized populations. These recommendations include multisectorial approaches that focus on the social determinants of health.

Policy Approaches to Advancing Health Equity.

Public health policy approaches have demonstrated measurable improvements in population health. Yet, "one-size-fits-all" approaches do not necessarily impact all populations equally and, in some cases, can widen existing disparities. It has been argued that interventions, including policy interventions, can have the greatest impact when they target the social determinants of health. The intent of this article was to describe how selected current policies and policy areas that have a health equity orientation are being used with the aim of reducing health disparities and to illustrate contemporary approaches that can be applied broadly to a variety of program areas to advance health equity. Applying a health equity lens to a Health in All Policies approach is described as a means to develop policies across sectors with the explicit goal of improving health for all while reducing health inequities. Health equity impact assessment is described as a tool that can be effective in prospectively building health equity into policy planning. The discussion suggests that eliminating health inequities will benefit from a deliberate focus on health equity by public health agencies working with other sectors that impact health outcomes.

The Importance of Advance Health Planning.

The Importance of Advance Health Planning.

Community Engaged Leadership to Advance Health Equity and Build Healthier Communities.

Health is a human right. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential. Addressing the multi-faceted health needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive strategies to reduce risk factors and buttress protective factors to promote greater well-being among individuals, families, and communities. With growing diversity concerning various ethnicities and nationalities; and with significant changes in the constellation of multiple of risk factors that can influence health outcomes, it is imperative that we delineate strategic efforts that encourage better access to primary care, focused community-based programs, multi-disciplinary clinical and translational research methodologies, and health policy advocacy initiatives that may improve individuals’ longevity and quality of life.

Health disparities in advance care planning at a safety-net hospital.

125 Background: Advance health care directives (AHCDs) are recommended by ASCO as a strategy to improve compliance with patient wishes at the end-of-life, thereby facilitating appropriate use of health care resources. We already know too few cancer patients complete AHCDs, but we know less about barriers to their completion. This study assessed the frequency with which AHCDs were completed in different ethnic groups and whether hospice enrollment varied by ethnicity. Methods: Retrospective analysis conducted at Hennepin County Medical Center in Minneapolis, MN with review of the cancer registry data from 2008 to 2013. Data were collected for deceased patients with stage III-IV cancer from the time of diagnosis through death. Demographics, AHCD, hospital deaths, enrollment in hospice, and individual patient data were analyzed using logistic regression, adjusting for both race and language as covariates. Results: From 2008 to 2013, there were 273 patients diagnosed with stage III-IV cancer and followed through death. Fourteen percent of patients were non-English speaking. Thirty-one percent were African American (AA), 4% were Hispanic, and 4% were Asian. Only 21% of patients completed an AHCD during their care, and none were Asian or Hispanic. English speakers were almost five times more likely than non-English speakers to have an AHCD (OR = 4.66, 95% CI = (1.06, 20.46), p = 0.04). Fifty-one percent of English-speaking patients enrolled in hospice compared to 39% of non-English-speaking patients (p = 0.08). Sixty percent of patients with an AHCD enrolled in hospice compared to 46% of those patients without an AHCD (p = 0.10). Forty-three percent of patients with an AHCD died in the hospital, 33% of whom died in an intensive care unit (ICU), versus 46% without an AHCD, 49% of whom died in an ICU. Of patients with advanced cancer, 46% died in the hospital and 21% died in the intensive care unit (ICU). Conclusions: Non-English-speaking patients are far less likely to have an AHCD than English speakers. Some ethnicities in our study had no patients with an AHCD. Since completing an AHCD may increase hospice enrollment and decrease ICU deaths, strategies to promote advance care planning are urgently needed, particularly with non-English speaking patients.

Abstract A40: Promoting colorectal cancer education: A partnership facilitated program evaluation examining generalizability across diverse populations

Abstract Background: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths among men and women with over 96,000 new cases and 50,000 individuals expected to die from the disease in 2014. Cancer mortality rates, however, are higher among certain ethnic populations including Hispanics and American Indians/Alaska Natives (AI/AN). Through education and screening, CRC can be successfully detected early and treated before it progresses to advanced stages. The purpose of this study was to evaluate the effectiveness of a partnership-facilitated colorectal cancer education program across different ethnic populations in two U.S. regions. Pre/post design was used to measure changes in CRC knowledge as well as behavioral intentions to obtain screening and share CRC information obtained with others. Methods: The National Cancer Institute's National Outreach Network (NON) Community Health Educators (CHE) at New Mexico State University (NMSU) and at the Fred Hutchinson Cancer Research Center (FHCRC), a Comprehensive Partnership to Advance Health Equity (CPACHE) program, collaborated to develop an assessment tool that would evaluate the Inflatable Colon (IC) as a CRC educational tool across diverse ethnic populations. Instrument: NON CHE developed a pre/post-test assessment questionnaire based on literature reviews; questions asked about CRC knowledge, intention to obtain screening, and intention to disseminate CRC information. Procedure: In New Mexico, individuals at an educational institution were recruited to participate in this study, whereas participants in Eastern Washington were recruited at community health events. All study participants received the pre-test prior to touring the IC and the post-test after completing the IC tour. Results: A total of 1,286 individuals from Southern New Mexico and Eastern Washington participated in this study, 60% were males. We conducted a repeated measures analysis of covariance, including study site, age, education, insurance, regular doctor, and history of CRC as covariates. Analyses found a significant interaction by race/ethnicity and time, F (2, 1181) = 3.29, p = .04. After adjusting for covariates, there were significant differences in CRC knowledge across race/ethnicity, F (2, 1188) = 2.94, p = .05. Hispanic participants had a significantly greater change in knowledge relative to non-Hispanic whites (NHW). There was also a non-significant trend concerning AI/AN participants and NHW. Hispanic and AI/AN participants had greater change in intentions to obtain a CRC screening in the future relative to NHW. Subsequent post-hoc comparisons revealed that, relative to NHWs, Hispanics reported being more likely to intend to discuss CRC with their parents, p = .02, and grandparents, p = 0.003. AI/AN participants were also less likely to report to intend to discuss CRC with their parents, p = .04. Conclusion: This study examined the generalizability of a partnership-facilitated CRC educational program and assessment tool across different US populations and its effectiveness in increasing CRC knowledge as well as behavioral intention to obtain CRC screening and disseminate CRC information. This study suggests that the IC is an effective educational tool for increasing cancer knowledge and behavioral intentions among diverse ethnic populations. Complementing the IC intervention with access to free CRC screening, such as the FOBT kits, has the potential to address the CRC mortality disparities through the promotion of screening among certain ethnic populations and among those at a higher risk for CRC. Citation Format: Janeth I. Sanchez, Katherine Briant, Yamile Molina, Noah Espinoza, Nathan Marchello, Rebecca Palacios, Beti Thompson, Mary O'Connell. Promoting colorectal cancer education: A partnership facilitated program evaluation examining generalizability across diverse populations. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A40.

Connected Care Quotient (CCQ) and the Future of Nursing.

It is nearly five years since the Institute of Medicine released its seminal report, Future of Nursing: Leading Change, Advancing Health. report made several far-reaching recommendations for nursing as follows:* Remove scope-of-practice barriers.* Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.* Implement nurse residency programs.* Increase the proportion of nurses with baccalaureate degrees to 80 percent by 2020.* Double the number of nurses with doctorates by 2020.* Ensure that nurses engage in lifelong learning.* Prepare and enable nurses to lead change to advance health.* Build an infrastructure for the collection and analysis of interprofessional health care workforce data.To evaluate progress, resolve issues outlined in the report, and assess the impact of the AARP and Robert Wood Johnson Foundation's (RWJF) Future of Nursing: Campaign for Action, the Committee for the Evaluation of the Impact of the Institute of Medicine Report held a series of meetings this spring and summer. According to the project description (www8.nationalacademies.org/cp/projectview.aspx- ?key=49704), The workshops...invite[d] stakeholders representing nursing, medicine, health systems, consumer groups, business and policy makers at the state and national levels to provide testimony...on the following broad topics: practice, education, and leadership; with diversity, interprofessional collaboration, and needed data as cross-cutting issues. (See the Figure for the names of committee members.)Dr. Marsha Howell Adams, president of the NLN, participated in the first workshop on May 28. This workshop had two sessions. first focused on assessing data and information about the progress of the Campaign for Action. second involved three stakeholder groups (Education and Training, Delivery of Care - Policy and Regulatory, and Delivery of Care - Health Care Organizations and Providers). goal was to gain insight into the efforts, successes, and barriers to implementing the recommendations. (Recordings and slides for these presentations are available online at http://iom.nationalacademies.org/ Activities/Workforce/FutureofNursingImpact/2015-MAY-28.aspx.)The second workshop, held July 27-28, included a variety of sessions: Day 1, Toward a More Highly Educated Nursing Workforce, Models of Academic Progression, Nursing Education and Workforce Data, Toward Establishing Nurse Residency Programs, and Recruiting and Retaining a Diverse Nursing Workforce; Day 2, Impact of Health Care System Changes on the Culture of Care Delivery and Roundtable on Culture Change in the Health Professions and Health Care Delivery. (The agenda, recordings, and slides are online at http://iom.nationalacademies. org/Activities/Workforce/FutureofNursingImpact/2015- JUL-27.aspx.)I had the privilege of speaking on the second day in a panel discussion on the culture of care delivery moderated by Richard A. Berman, a professor at the Institute for Advanced Discovery & Innovation, University of South Florida, our taskmaster in terms of timing. (See the Figure for all panel participants.) When I received the letter with the invitation to participate, I had heart palpitations: OMG, they want me to speak!Our 75-minute session began with a brief introduction by Berman, followed by individual remarks by each of the panelists (six minutes, slides optional), and then 40 minutes of Q&A with the IOM committee. Berman asked us to focus on the changes we have seen in the health care delivery system and in the skills or roles of nurses in health care delivery. committee sent specific questions on a number of topics - how technology has affected the nursing profession in terms of patient care and team-based care, leadership in team-based care, the impact of value-based payment on primary care and the health system, and cultural and organizational conflicts that need monitoring and management - and we could anticipate questions on topics including interprofessional practice and leadership in the health arena. …

Promoting hygienic hand disinfection as an ongoing task: results of a cluster-randomized controlled trial to (re-)raise compliance of physicians and nurses based on psychological tailoring in a tertiary intensive care setting

Insufficient use of psychological theory is one reason that conclusive evidence regarding hand hygiene promotion is scarce. In addition, compliance has been shown to be lower among physicians than among nurses. The PSYGIENE-project set out to draw on theoretical advances (Health Action Process Approach-HAPA) to optimise education and feedback interventions.

Implications of English-speaking status for end-of-life care in advanced cancer.

e20511 Background: Advance health care directives (AHCD) are recommended by ASCO as a strategy to improve compliance with patient wishes at the end-of-life, and thereby ensure appropriate use of he...

Advocacy

Lynn S. Muller, RN, BA-HCM, CCM, JD, is a nurse attorney and managing partner of Muller & Muller. She is a CCM with extensive nursing and case management experience. Her practice includes family law, wills, trusts and estates, defense of health care professionals before the state licensing boards, as well as transactional and consulting work for practitioners and health care companies on such issues as regulatory investigation and compliance. Lynn is an adjunct professor in the Doctor of Nursing Program at Saint Peters University, where she teaches Legal and Ethical Parameters of Advance Practice Nursing and Health Policy and Politics. She is the author of numerous articles in professional journals and is the author of the legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and the second edition of CMSA Core Curriculum for Case Management. She is a former commissioner of CCMC, past president of the NJ Chapter of CMSA. Address correspondence to Lynn S. Muller, Esq., Muller & Muller, 15 West Main Street, Suite C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics they would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected].

Missed policy opportunities to advance health equity by recording demographic data in electronic health records.

The science of eliminating health disparities is complex and dependent on demographic data. The Health Information Technology for Economic and Clinical Health Act (HITECH) encourages the adoption of electronic health records and requires basic demographic data collection; however, current data generated are insufficient to address known health disparities in vulnerable populations, including individuals from diverse racial and ethnic backgrounds, with disabilities, and with diverse sexual identities. We conducted an administrative history of HITECH and identified gaps between the policy objective and required measure. We identified 20 opportunities for change and 5 changes, 2 of which required the collection of less data. Until health care demographic data collection requirements are consistent with public health requirements, the national goal of eliminating health disparities cannot be realized.

Mentorship in Developing Transformational Leaders to Advance Health Policy: Creating a Culture of Health

Historically, mentoring in nursing has focused primarily on either moving novice nurses to a more advanced level of expertise in the clinical setting, assisting advanced practice nurses to reach professional excellence, or mentoring students and junior faculty researchers to expand evidence-based practice in nursing for colleges of nursing and nursing science. These efforts have achieved success at the individual and organizational level; however, nursing has yet to achieve a culture of mentorship within the profession.1–4 Nowhere is this gap more pronounced than in mentorship of future nurse leaders with the specific intent to develop the knowledge, skills, and political savvy to advance health policy and create better systems of care. The nursing profession is the largest segment of the nation's healthcare workforce, yet nurses remain grossly underrepresented in major leadership positions within the healthcare system and within those organizations empowered to develop and implement health policy.5,6 In order to ensure that nurses are ready to assume these leadership roles, leadership development and mentoring programs need to be made available for nurses at all levels.

Vaccinations: eliminating preventable illness.

Jayne Skehan, RN, BSN, MSN, is Director of Pediatric Cardiology at Morgan Stanley Children's Hospital at New York Presbyterian Hospital in New York City. In addition to this role, she is a per diem Administrator at Mount Sinai Medical Center in Harlem. Ms. Skehan received her Bachelor of Science in Nursing Degree from the College of New Rochelle, New York, and her Master of Science in Nursing degree from Mercy College, Dobbs Ferry, New York. Jayme has experience in emergency cardiology and operating room management. She is currently a DNP doctoral candidate at Saint Peter's University in Englewood Cliffs, New Jersey. When Jayme is not doing school work, she is a community advocate, donating her time to youth programs, and is Vice President of Daytop Village Alumni Program. Her goal is to teach nursing upon completion of her doctoral degree. Jayme can be contacted at: [email protected]. Lynn S. Muller, RN, BA-HCM, CCM, JD, is a nurse attorney and managing partner of Muller & Muller. She is a CCM with extensive nursing and case management experience. Her practice includes family law, wills, trusts and estates, defense of health care professionals before the state licensing boards, as well as transactional and consulting work for practitioners and health care companies on such issues as regulatory investigation and compliance. Lynn is an adjunct professor in the Doctor of Nursing Program at Saint Peters University, where she teaches Legal and Ethical Parameters of Advance Practice Nursing and Health Policy and Politics. She is the author of numerous articles in professional journals and is the author of the legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and the 2nd edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner of CCMC, past president of the NJ Chapter of CMSA, and a former public defender, judge, and councilwoman. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Muller & Muller, 15 West Main Street, Suite C, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like answered here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics they would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at: [email protected].

Advance Directives Education

Despite increasing age, most older Americans do not have Advance Health Care Directives (AHCDs) while healthcare providers report limited knowledge for teaching about AHCDs. This article offers a history of AHCDs, explores one method for assessing AHCD knowledge using the Knowledge-Attitudinal-Experimental Survey on Advance Directives (KAESAD), and utilizes adult learning theory to develop an AHCD educational in-service for nurses. AHCD information and resources are provided.

A case management briefing on domestic violence.

Lynn S. Muller, RN, BA-HCM, CCM, JD, is a nurse attorney and managing partner of Muller & Muller. She is a CCM with extensive nursing and case management experience. Her practice includes family law, wills, trusts and estates, defense of health care professionals before the state licensing boards, as well as transactional and consulting work for practitioners and health care companies on such issues as regulatory investigation and compliance. Lynn is an adjunct professor in the Doctor of Nursing Program at Saint Peters University, where she teaches Legal and Ethical Parameters of Advance Practice Nursing and Health Policy and Politics. She is the author of numerous articles in professional journals and is the author of the legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and the second edition of CMSA Core Curriculum for Case Management. She is a former commissioner of CCMC, past president of the NJ Chapter of CMSA, and a former public defender, judge, and councilwoman. Address correspondence to Lynn S. Muller, RN, BA-HCM, CCM, JD, Esq., Muller & Muller, 15 West Main Street, Suite C, PO Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can only be given by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like answered here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics they would like to see addressed in this department. Questions and other inquiries are accepted by e-mail at:[email protected].

Doctors' Decisions When Faced With Contradictory Patient Advance Directives and Health Care Proxy Opinion: A Randomized Vignette-Based Study

ContextSometimes a written advance directive contradicts the opinion of a health care proxy. How this affects doctors' decision making is unknown. ObjectivesTo quantify the influence of contradictory instructions on doctors' decisions. MethodsAll the generalists and internists in French-speaking Switzerland were mailed the questionnaire. Respondents (43.5%) evaluated three vignettes that described medical decisions for incapacitated patients. Each vignette was produced in four versions: one with an advance directive, one with a proxy opinion, one with both, and one with neither (control). In the first vignette, the directive and proxy agreed on the recommendation to forgo a medical intervention; in the second, the advance directive opposed, but the proxy favored the intervention; and in the third, the roles were reversed. Each doctor received one version of each vignette, attributed at random. The outcome variables were the doctor's decision to forgo the medical intervention and the rating of the decision as difficult. ResultsWritten advance directives and proxy opinions significantly influenced doctors' decision making. When both were available and concordant, they reinforced each other (odds ratio [OR] of forgoing intervention 35.7, P < 0.001 compared with no instruction). When the directive and proxy disagreed, the resulting effect was to forgo the intervention (ORs 2.1 and 2.2 for the two discordant vignettes, both P < 0.001). Discordance between instructions was associated with increased odds of doctors rating the decision as difficult (both ORs 2.0, P ≤ 0.001). ConclusionContradictions between advance directives and proxy opinions result in a weak preference for abstention from treatment and increase the difficulty of the decision.

The Future of Nursing

The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, challenges the nursing profession to take a key role in redesigning the health care system. Intended to shape the future of nursing in the United States, the IOM report has implications for nursing worldwide. While individual states and nursing organizations are developing initiatives to implement the IOM recommendations in the United States, there must be a concomitant effort to examine the ripple effect on global health and the nursing community. This article addresses four IOM recommendations that are directly relevant to internationally educated nurses who practice across borders: nurse residency programs, lifelong learning, leading change to advance health, and interprofessional health care workforce data. The article discusses the IOM recommendations through a global perspective and offers policy implications for legislators, health care organizations and nurse educators, regulators and administrators.