Catholic Health Systems Research Articles

The Catholic Church and Its Hospitals

In this conversation from a recent episode of SoundPractice, the discussion focuses on Patricia Gabow’s book *The Catholic Church and Its Hospitals: A Marriage Made in Heaven?*. We delve into the role of bishops and Ethical and Religious Directives (ERDs) in shaping policies within the Catholic health system. We reveal surprising statistics about the reach and influence of Catholic healthcare and discuss the implications for patient care and physician understanding, especially regarding reproductive and end-of-life care. Gabow’s book also addresses considerations for the Catholic health system’s return to mission fidelity.

How Do Church Rules Influence Care in Catholic Health Systems? Find Out Here

How Do Church Rules Influence Care in Catholic Health Systems? Find Out Here

Medical group governance for better organisational integration

Today, three of four US physicians are employed by hospitals, health systems or corporations. Forward-thinking healthcare leaders are looking for ways to leverage the intellectual capital of their employed and affiliated physicians and tighten physician–hospital integration as a means to improve care management and coordination, improve access and quality and reduce costs. Structured medical group governance is one such approach taken by healthcare leaders to enable meaningful and intentional physician–hospital joint decision making and better integration. Governance enables providers to unify and speak with one collective voice, influence the business side of clinical matters, build a unified brand and culture within the organisation and set policy or standards needed to be adopted at scale, to name just a few. Since 2019, Providence Health, a national not-for-profit Catholic Health System providing services across seven states with nearly 9,000 employed or affiliated physicians, has developed a multi-tiered medical group governance structure to coalesce on strategic direction and the major decisions that influence the clinical practice. This paper describes Providence Health’s journey in designing and maturing its medical group governance structure. In this case study, the authors describe the why, the what and the how of medical group governance and provide lessons learned and specific examples of the impact Providence Medical Group boards have had on clinician integration, engagement and alignment across the system.

Spiritual Support Staff Influence Stress Among Hospital-Based Health Care Personnel: A Cross-Sectional Study.

Stress negatively affects well-being, relating to poor physical, emotional, and occupational outcomes for health care personnel. Health care professionals faced extreme stressors in the context of the COVID-19 pandemic, making occupational stress relief a top priority for hospital administrators. Many health systems employ specially trained spiritual support staff as one strategy to alleviate work-related stressors. It is unclear whether health care personnels' perceptions of the availability of spiritual care staff influence self-reported stress. The purpose of this study was to explore relationships between perceived stress and perceptions of availability of spiritual support among acute care health care personnel. This study analyzed cross-sectional, survey-based data collected between February and April 2022 from 1352 interdisciplinary health care staff working in a large, nonprofit Catholic health system in the Western United States. Bivariate tests and multivariate linear regression models were conducted to test for factors influencing perceived stress. Results support that high stress was prevalent in the sample. Perceived availability of spiritual support staff in the hospital and seeking coworker and professional support for work-related stress all independently influence stress in this population when controlling for confounders. Stress of health care personnel may be influenced by the perceived availability of specially trained spiritual support staff. Hospital administrators should advocate for spiritual support staff availability in all health care settings as one strategy to mitigate occupational stress that health care professionals may experience through providing high-stakes patient care. Further research is warranted to uncover targeted spirituality-related strategies to reduce stress and preserve well-being of health care personnel.

A Faith Community Nursing Intervention for Informal Caregiver-Older Adult Dyads.

The purpose of this study was to test the impact of embedding trained Faith Community Nurse (FCN) interventionists in a Catholic Health System affiliated primary care practice as liaisons of care in the homes of older adult clients (OACs) and their informal caregiver (IC). Specific aims were to examine if a FCN intervention improved IC and OAC health, well-being, knowledge and understanding of chronic disease management, self-advocacy, and self-care. A non-random quasi-experimental design was used. Most ICs were spouses or adult children (M age = 66) who lived with the older adult (M age = 79). The ICs' scores significantly increased after the intervention on the Preparedness for Caregiving Scale (p = .002), Spirituality as Life, Meaning, and purpose (p = .026), and Rosenberg Self Esteem Scale (p = .005). Future research is needed examining the FCN intervention with larger sample sizes in more diverse communities and acute care settings.

Feasibility of a Reinforcement Learning-Enabled Digital Health Intervention to Promote Mammograms: Retrospective, Single-Arm, Observational Study.

Preventive screenings such as mammograms promote health and detect disease. However, mammogram attendance lags clinical guidelines, with roughly one-quarter of women not completing their recommended mammograms. A scalable digital health intervention leveraging behavioral science and reinforcement learning and delivered via email was implemented in a US health system to promote uptake of recommended mammograms among patients who were 1 or more years overdue for the screening (ie, 2 or more years from last mammogram). The aim of this study was to establish the feasibility of a reinforcement learning-enabled mammography digital health intervention delivered via email. The research aims included understanding the intervention's reach and ability to elicit behavioral outcomes of scheduling and attending mammograms, as well as understanding reach and behavioral outcomes for women of different ages, races, educational attainment levels, and household incomes. The digital health intervention was implemented in a large Catholic health system in the Midwestern United States and targeted the system's existing patients who had not received a recommended mammogram in 2 or more years. From August 2020 to July 2022, 139,164 eligible women received behavioral science-based email messages assembled and delivered by a reinforcement learning model to encourage clinically recommended mammograms. Target outcome behaviors included scheduling and ultimately attending the mammogram appointment. In total, 139,164 women received at least one intervention email during the study period, and 81.52% engaged with at least one email. Deliverability of emails exceeded 98%. Among message recipients, 24.99% scheduled mammograms and 22.02% attended mammograms (88.08% attendance rate among women who scheduled appointments). Results indicate no practical differences in the frequency at which people engage with the intervention or take action following a message based on their age, race, educational attainment, or household income, suggesting the intervention may equitably drive mammography across diverse populations. The reinforcement learning-enabled email intervention is feasible to implement in a health system to engage patients who are overdue for their mammograms to schedule and attend a recommended screening. In this feasibility study, the intervention was associated with scheduling and attending mammograms for patients who were significantly overdue for recommended screening. Moreover, the intervention showed proportionate reach across demographic subpopulations. This suggests that the intervention may be effective at engaging patients of many different backgrounds who are overdue for screening. Future research will establish the effectiveness of this type of intervention compared to typical health system outreach to patients who have not had recommended screenings as well as identify ways to enhance its reach and impact.

Abstract TP34: Cerebrovascular Nursing Voice Is Critical, Information-Technology Listened, And Posterior Stroke Signs And Care Documentation Improved

Introduction: The impact of EMR workflow template on the capture of signs of posterior circulation stroke is not well understood. The previous Stroke Unit’s EMR-workflow template at Catholic Health System had no protocol in gauging stroke clinician input in EMR-workflow sheet. In November 2020, a new EMR workflow template with protocol in gauging stroke clinician input in EMR-workflow sheet replaced the old one. We conducted a pilot study to determine the ability of the new EMR stroke template capturing signs of posterior stroke. In parallel, elbow support education and training using the new-EMR template was provided to stroke clinicians. Methods: We conducted a retrospective chart review and a comparative analysis of patients with a CT/MRI diagnosis of posterior circulation strokes captured with the old-EMR (stroke nurses not involved in design) vs the new-EMR (stroke nurses involved) to see what EMR captured vision and balance problems. From the old EMR, we randomly selected 24 charts from June 2020 to October 2020. From the new EMR, we randomly selected 24 charts from December 2020 to April 2021 (We allowed elbow support and a learning curve of 4 weeks for the new EMR) at our comprehensive stroke center. An audit pass or fail based was assigned on the ability of the EMRs to capture vision and balance symptoms prior and after patient received stroke care. Age, sex, visual and balance symptoms of patients were documented. Data was stored in Excel and analysis was performed with Statistical Package for the Social Sciences (SPSS) version 23 for descriptive and inferential statistics. Result: Approximately 56.3% (n=27) were male. Patients’ ages ranged between 18-95 years with the mean age of 66.5 years (95% CI [61.9, 71.1]).Old-EMR stroke template captured visual 62.5% (n=15) and balance 4.2% (n=1) symptoms out of 24 charts reviewed. New-EMR template captured vision 91.6% (n=22) and balance 75% (n=18) as posterior stroke symptoms out of 24 chart reviewed. New EMR stroke template differed from old by audit pass rate (75% vs 4.2%, p < 0.00001). Conclusion: This study might suggest a relationship between nursing inputs in stroke EMR workflow design and improve documentation. We propose to carry out our study on a larger number of patients to further understand the relationships.

Data Ethics in Catholic Health Systems

The Catholic moral tradition has a rich foundation that applies broadly to encompass all areas of human experience. Yet, there is comparatively little in Catholic thought on the ethics of the collection and use of data, especially in healthcare. We provide here a brief overview of terminology, concepts, and applications of data in the context of healthcare, summarize relevant theological principles and themes (including the Vatican’s Rome Call for AI Ethics), and offer key questions for ethicists and data managers to consider as they analyze ethical implications pertinent to data governance and data management.

A comprehensive approach to addressing the opioid epidemic in a large health system.

To describe the implementation of a comprehensive program to address the opioid epidemic in a large health system and to assess the effect of the program on opioid prescribing. Mercy Health is a nonprofit, Catholic health system that employs over 1,400 providers and operates 23 hospitals in Ohio and Kentucky, 2 states that have experienced large numbers of overdoses. As a good community partner, the health system developed a comprehensive plan to address the opioid crisis. A system-wide Opioid Steering Committee was established to implement and manage the program. The committee was chaired by a senior pharmacy executive and supported by 4 subcommittees: the data analytics, education development, outreach and assessment, and electronic health record (EHR) subcommittees. The 4 subcommittees developed and implemented several initiatives, including forming a database with prescribing data by specialty and geographical location, implementing a standardized screening approach in the emergency department, challenging hospitals to create partnerships with local schools, and creating EHR enhancements to change opioid prescribing habits. When normalized for patient volume, the prescribed opioid burden was reduced from 65.3 to 35.2 morphine milligram equivalents per unique patient from 2016 to 2019 (a 46% absolute reduction). During this same time the number of acute prescription orders with a morphine equivalent dose greater than 30 was reduced by 52% (from 37,793 to 17,822 prescriptions per year). Mercy Health's comprehensive approach to the opioid epidemic has successfully impacted opioid prescribing habits, screening practices, and community outreach.

Integrating Ethics Services in a Catholic Health System in Oregon

Integrating Ethics Services in a Catholic Health System in Oregon

The relationship between Quebec Task Force Classification and outcome in patients with low back pain treated through mechanical diagnosis and therapy

Objective: To determine the correlation between the Quebec Task Force Classification (QTFC) system and outcome in patients with non-specific low back pain (LBP).Methods: Forty-nine patients who were treated in outpatient physical therapy clinics of Catholic Health System (CHS) of Western New York (WNY) were classified according to the QTFC at the initial examination by physical therapists (PTs) with training in Mechanical Diagnosis and Therapy (MDT). The patient’s perceived level of function was assessed with the Focus On Therapeutic Outcomes (FOTO) tool at the initial examination, 2 weeks following the initiation of physical therapy and again at discharge.Results: A linear regression model between acuity and change in FOTO score was performed and demonstrated statistical significance (P<0·05) as the more favorable outcome was found with the more acute patients. Spearman correlations between change in FOTO score and QTFC, duration of treatment and acuity of condition, and number of visits and change in FOTO score were not found to be statistically significant.Conclusions: The patients treated in this study demonstrated functional improvement in an average of eight visits, indicating efficacious care. Future research is needed to determine prioritized intervention strategies for designated LBP classifications.

Culturally Competent Care

In 1900, 88% of the U.S. population was composed of white people. Minorities, including African Americans and Hispanics, lived in certain parts of the country but were barely found in others. We had, in other words, a fairly homogeneous nation. More than 100 years later, the demographic landscape of the nation is dramatically different. According to the 2010 Census, the percentage of white people is now approximately 72%. Of the 300 million people who live in the United States, more than 100 million are classified as minority, including, among other groups, African American, Hispanic or Latino, Native American, Asian, and Middle Eastern (U.S. Census Bureau, 2010). Decade after decade, immigrants have made possible our nation's rich diversity. THE CURRENT STATE OF HEALTHCARE DISPARITIES In the healthcare setting, these demographics have very real and personal implications. Data show that medical outcomes are routinely better for whites than for minority populations, especially with respect to certain disease conditions, such as heart disease, cancer, HIV, and diabetes. For instance, African American women and men ages 45-74 years had the largest death rates from heart disease and stroke in 2006 compared to men and women of other racial and ethnic groups (Office of Minority Health, 2011). These health disparities speak to differences among population groups in the incidence, prevalence, and outcomes of health conditions. Healthcare disparities, meanwhile, refer to the inferior quality of and accessibility to healthcare experienced by minority groups (MLibrary, 2013). Agency for Healthcare Research and Quality (AHRQ, 2011) states in its report on healthcare disparities that All Americans should have equal access to high-quality care. Instead, we find that racial and ethnic minorities and poor people often face more barriers to care and receive poorer quality of care when they can get it. Specifically, AHRQ found that blacks received worse care than whites for 41% of quality measures studied (e.g., pneumonia, surgery, influenza, heart failure). Asians received worse care for 30% of measures, and Hispanics for 39% of measures. Poor people of all racial/ethnic categories, meanwhile, received worse care for 47% of measures. THE CHALLENGE AND OPPORTUNITY These facts are intolerable. For Catholic healthcare, disparities present a challenge and an opportunity--a challenge to reduce, or eliminate altogether, healthcare inequality and an opportunity to provide consistently high-quality care regardless of the patient's ethnic background. mission of Catholic healthcare is profound but simple: to treat with dignity and compassion every person who is in our care. This means preventing or healing illness but also being sensitive to the cultural preferences and needs of our patients. Addressing healthcare disparities is core to our mission--every person is created in God's image, and we must respect and understand the differences in how patients perceive their caregivers, the system, and medicine and recovery in general. As noted by Thies (2010, pp. 11-12), The very mission of Catholic healthcare draws us to emphasize the importance of culturally competent and linguistically appropriate care as we bring together people of diverse backgrounds and answer God's call. Many Catholic health systems and hospitals actively work on programs and outreach strategies to reduce or eliminate healthcare disparities in their communities. This vital work includes cultural competency efforts to align the unique needs and perspectives of our patients with caregivers' communication processes and treatment regimens. In 2007, for example, Providence Center for Health Care Ethics, in Portland, Oregon, developed a competency curriculum for physicians that covers three key areas: disclosing a serious diagnosis and prognosis to people from different cultures, discussing code status, and introducing transition to hospice. …

Implementing Enterprise-Wide Electronic Fetal Monitoring Certification for All Perinatal Clinicians

The Trinity Health Perinatal Patient Safety Initiative was launched in March 2009 to improve safety for mothers and infants. Trinity Health is a large Catholic health system with 25 hospitals that provides obstetric services, with annual births ranging from 50 to 8,500. The total number of deliveries for Trinity Health in 2010 was 38,656, which is approximately 1% of the nation's deliveries. Nationally, one of the most frequent allegations in perinatal malpractice claims is delayed diagnosis of an indeterminate/abnormal fetal heart rate tracing.

Implementing a System-Wide Perinatal Patient Safety Initiative

Trinity Health is the fourth largest Catholic health system in the United States with 19 Ministry Organizations encompassing 47 hospitals, 379 outpatient clinics and numerous long-term, home health, hospice and other facilities in eight states. There are 26 hospitals that provide obstetric services with annual births ranging from 50 to 8,400. In 2008, Trinity Health Executive Team launched the Perinatal Patient Safety Initiative (PPSI) to standardize high-risk obstetric processes to improve safety and the quality of care provided to mothers and babies at each of the Ministry Organizations.

Catholic hospital services for vulnerable populations

Catholic hospitals and health systems comprise a substantial segment of nonprofit, mission-driven, health care services, with accountability to institutional pressures of the Roman Catholic Church as well as economic pressures for solvency. Values are the way in which the organization expresses its faith-based institutional identity, which may used to select services that represent those values. The purpose of this study was to identify whether Catholic health systems' explicit values of justice or compassion (and derivatives of those words, known to have similar meaning) were associated with a greater number of system member hospitals' services aimed at vulnerable populations. Using information from Web sites of 41 Catholic health systems in 2007 and data describing their 452 hospitals from the American Hospital Association Annual Survey, the relationship of health system values with hospital services for vulnerable populations was examined while controlling for organizational, market, and demand variables. Although Catholic hospitals as a whole are more likely to provide services to vulnerable populations than to other ownership types, the results show that among Catholic hospitals, values of justice or compassion are not associated with more services (defined in this study) that reflect those values. System hospitals likely to have more services that represent the values of justice and compassion are larger, have a higher Medicaid payer mix, are located in less dense urban areas, and are members of geographically dispersed systems. Hospitals select services that may represent symbolic system values, but community need and financial means are stronger determinants. To bolster community benefit to justify tax exempt status, Catholic hospitals and systems may benefit from further defining, analyzing, and reporting the impact of access to relatively unprofitable services for previously underserved vulnerable populations.

Ann Hendrich, RN, MS, FAAN

Ann Hendrich, RN, MS, FAAN

Intrasectoral variation in mission and values

Catholic health systems represent a unique sector of nonprofit health care delivery organizations because they must be accountable to institutional pressures of the Roman Catholic Church, in addition to responsiveness to market pressures. Mission statements and values are purported to be the driving force of Catholic institutional identity. Central to the understanding of the Catholic health care delivery sector is the exploration of variation in mission and values statements across the homogeneous field of organizations. The purposes of this study were to identify expressed organizational identity variation-in terms of keywords in mission statements and values-of Catholic health systems in the United States by applying a methodology that integrates text and social network analytical techniques. Data were obtained from the Web site of The Catholic Health Association of the United States and the Web sites of 50 Catholic health systems in 2007. Catholic health system mission statements and values were assessed using a cross-sectional study design. Text analysis and social network techniques were employed to identify the most central words in the texts and linkages among mission statement components and values. This study identifies the components of a common mission statement and the most shared and unique values for a Catholic health system. Even with tremendous similarity, there is also evidence of intrasectoral variation between Catholic health system keywords in mission statements and values. Management implications include the consideration of word relationships developing and constructing mission and values statements to form the framework for strategic vision and management decision making, to assess potential partnership arrangements based on expressed mission statements and values, and to use in executing due diligence in mergers and partnerships.

Medically Assisted Nutrition and Hydration: A Contribution to the Dialogue

The Address to Participants the International Congress on Life-Sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas, promulgated March of this year by Pope John Paul II, has become a source of considerable controversy, partly due to the theological and clinical complexity of this issue, and partly because of how has been portrayed the popular media. (1) In light of this controversy, many Catholics, as well as Catholic health systems, are re-examining the half-millennium-old tradition of Catholic moral teaching regarding the obligation to use particular means of sustaining human life. (2) In this essay, we seek to foster that effort. In light of that tradition, and particularly the discussion of the principles of proportionate and disproportionate means, we will propose a way of interpreting the recent papal address that has not received significant attention. The Duty to Sustain Life Perhaps the most fundamental tenet of the Roman Catholic moral tradition is that life is a precious gift from God. (3) This conviction is the basis for a duty to protect and preserve our lives, but that duty does not imply an obligation to use every and all means available to sustain our lives at all costs. (4) Catholic moral teaching holds that the ultimate end of human life lies with God and that life on earth is itself only a penultimate good. As Pope Pius XII notes, Life, health, all temporal activities are fact subordinated to spiritual ends. (5) Reaffirming this insight, Pope John Paul II wrote Evangelium Vitae that it is precisely [our] supernatural calling which highlights the relative character of each individual's earthly life. After all, life on earth is not an 'ultimate' but a 'penultimate' reality. (6) Thomas Shannon and James Waiters have recently pointed out that the resulting duty to sustain life has traditionally been understood the Roman Catholic moral tradition as teleological. (7) In the context of the Catholic moral tradition, is not synonymous with consequentialist. Rather, as we understand it, the teleological framework found within the Catholic tradition recognizes the moral relevance both of rules of right conduct and of consequences. (8) In other words, the Catholic moral tradition has always recognized some negative obligations of a fundamentally deontological nature, including of course the obligation never to directly intend the destruction of innocent human life. It is our view, however, that these deontological obligations do not preclude the use of the principles of proportionate and disproportionate means as teleological guides for discerning whether discontinuing a particular life-sustaining treatment would constitute the directly intended destruction of innocent human life. As defined by the Ethical and Religious Directives for Catholic Health Care Services (ERDs), a proportionate means is one that individuals are obligated to use to preserve life insofar as, the judgment of the patient, the means question offer a reasonable hope of benefit and do not entail excessive burdens. (9) One is not obligated to use any means of sustaining life that, one's own judgment, either do not offer a reasonable hope of benefit or entail excessive--that is, disproportionate--burdens. The Catechism of the Catholic Church affirms this when says, Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; is the refusal of 'over-zealous' treatment. Here one does not will to cause death; one's inability to impede is merely accepted. (10) It is important to note here that neither the ERDs nor the Catechism specify which procedures, diagnostics, or therapies constitute proportionate or disproportionate means. In fact, the ERDs explicitly emphasize that those determinations are to be made in the judgment of the patient. …

The role of a mission leader within a large Catholic health system

This reflective narrative is intended as a "Letter to the Editor" of sorts, to highlight my personal and professional growth in the role of mission leader for a large academic health centre in South Western Ontario, Canada. This story takes the reader through my lived experience, my beliefs and views of the role of mission leader, against a backdrop of the work of Mary Kathryn Grant, a pioneer in this area of mission and leadership.