Nonprofit Health Research Articles

Carissa Gilman: Taking the Reins During Uncertain Times

This isn’t how Carissa Gilman thought her year as President of the CSE would start. But here we are, almost half a year into a global pandemic that has pushed everything into a constant state of flux and uncertainty. As a scientific publishing veteran, having worked for both authors and editors, and now as Managing Editor of the American Cancer Society’s journal Cancer, she’s seen many changes to the publishing landscape, so I thought it would be a good time to talk with her about her experiences, CSE in particular. In early July, I spoke with Carissa about her life in publishing, her love of horses and dogs, and the challenges and opportunities ahead for CSE and scientific publishing. Science Editor: How did you get involved in science editing and production? Carissa Gilman: I got my degree in English, and when I got out of college, I was just looking for any job where I could use my degree that was not teaching. I was looking in the newspaper (that’s how long ago it was) for any job that I thought applied. There was an editorial assistant position and I just saw the word “editorial” and zeroed in on it. It was at a nonprofit health services research organization, so I started my career in scholarly publishing as an author’s editor. I helped researchers prepare and submit their papers to journals and, like a lot of nonprofits, it had some funding issues: I saw the writing on the wall […]

Transitioning an Infection Prevention and Control Program to a New Outpatient Hospital-Based Cancer Center

Background In order to create a more patient-centric, multidisciplinary approach to cancer care, a large non-profit health system moved cancer treatment services from across the system to a newly renovated office complex consisting of over 400,000 square feet and 100 acres. The move brought together clinical operations from both the acute care and outpatient care settings. In mid-2019, the new hospital-based outpatient cancer institute was opened. Unifying infection prevention and control (IPC) practices across the newly formed clinical setting created a challenging environment for implementing an effective IPC program. Methods The combination and integration of different clinical areas from across the system highlighted inconsistency in IPC practices. To identify the IPC needs throughout the cancer center clinical practices, a comprehensive assessment was performed. A current state matrix helped identify several gaps in infection control knowledge and practices. The deficiencies with the highest risk to patients were addressed first with focus on high- and low-level disinfection, sterile processing, safe infection practices, standard and transmission-based precautions and hand hygiene. Results With the assistance of front-line staff and evidence-based, best practice guidance, new processes and procedures were developed and rolled out facility wide. To support and unify IPC practices, staff attended educational sessions where the special concerns for preventing infections in the cancer patient populations were discussed. Conclusions Even though infection control principles are the same across care settings, the new environment and targeted patient population required a tailored approach in order to maintain consistent IPC practices. Furthermore, understanding the special needs of oncology patient care, building strong relationships with clinical leadership and maintaining visibility throughout the facility have been critical in providing and maintaining an effective program. In order to create a more patient-centric, multidisciplinary approach to cancer care, a large non-profit health system moved cancer treatment services from across the system to a newly renovated office complex consisting of over 400,000 square feet and 100 acres. The move brought together clinical operations from both the acute care and outpatient care settings. In mid-2019, the new hospital-based outpatient cancer institute was opened. Unifying infection prevention and control (IPC) practices across the newly formed clinical setting created a challenging environment for implementing an effective IPC program. The combination and integration of different clinical areas from across the system highlighted inconsistency in IPC practices. To identify the IPC needs throughout the cancer center clinical practices, a comprehensive assessment was performed. A current state matrix helped identify several gaps in infection control knowledge and practices. The deficiencies with the highest risk to patients were addressed first with focus on high- and low-level disinfection, sterile processing, safe infection practices, standard and transmission-based precautions and hand hygiene. With the assistance of front-line staff and evidence-based, best practice guidance, new processes and procedures were developed and rolled out facility wide. To support and unify IPC practices, staff attended educational sessions where the special concerns for preventing infections in the cancer patient populations were discussed. Even though infection control principles are the same across care settings, the new environment and targeted patient population required a tailored approach in order to maintain consistent IPC practices. Furthermore, understanding the special needs of oncology patient care, building strong relationships with clinical leadership and maintaining visibility throughout the facility have been critical in providing and maintaining an effective program.

What Is the Financial Impact of Orthopaedic Sequelae of Intravenous Drug Use on Urban Tertiary-care Centers?

What Is the Financial Impact of Orthopaedic Sequelae of Intravenous Drug Use on Urban Tertiary-care Centers?

From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases

BackgroundDifferent forms of public/private mix have become a central mode of the privatization of healthcare, in both financing and provision. The present article compares the processes of these public/private amalgams in healthcare in Spain and Israel in order to better understand current developments in the privatization of healthcare.Main textWhile in both Spain and Israel combinations between the public and the private sectors have become the main forms of privatization, the concrete institutional forms differ. In Spain, these institutional forms maintain relatively clear boundaries between the private and the public sectors. In Israel, the main forms of public/private mix have blurred such boundaries: nonprofit health funds sell private insurance; public nonprofit health funds own private for-profit hospitals; and public hospitals sell private services.ConclusionsComparison of the processes of privatization of healthcare in Spain and Israel shows their variegated characters. It reveals the active role played by national and regional state apparatuses as initiators and supporters of healthcare reforms that have adopted different forms of public/private mix. While in Israel, until recently, these processes have been perceived as mainly technical, in Spain they have created deep political rifts within both the medical community and the public. The present article contains lessons each country can learn from the other, to be adapted in each one’s local context: The failure of the Alzira model in Spain warns us of the problems of for-profit HMOs and the Israeli private private/public mix shows the risk of eroding trust in the public system, thus reinforcing market failures and inefficient medical systems.

Why Did the ACA Co-Op Program Fail? Lessons for the Health Reform Debate

The ACA created a new type of nonprofit health insurance entity, the "Consumer Operated and Oriented Plan" ("co-op"). Most of the newly created co-ops soon lost money, and only 4 of the original 23 remain. We interviewed key stakeholders and conducted in-depth case studies of 3 of these co-ops. We discovered that politicians and regulators made it unlikely the program could succeed, that most of the co-ops did not have the management capacity to overcome these political obstacles, and that even those with good managers lacked the needed fiscal resilience. We also considered lessons suggested for those proposing a newly created "public option." The main one is that a successful public option requires a supportive political environment, strong management, and significant fiscal capacity, none of which comes easily. A better route may be a quasi-public option in which the government subcontracts the operation of its newly created plan to a private firm. Although it is uncertain whether federal regulators have the capacity to hold such private for-profit firms accountable, pragmatism suggests that a combination of public-sector regulation and private-sector implementation may be the most direct path toward a US version of affordable universal coverage.

Abstract C123: The San Francisco Cancer Initiative: Addressing disparities in colorectal cancer screening in community health centers

Abstract Background: Despite being among the wealthiest cities in the United States, San Francisco continues to suffer from disparities in colorectal cancer (CRC) screening and diagnostic follow up among low-income and ethnically diverse residents served by community health centers (CHCs). The San Francisco Cancer (SF CAN) Initiative, a collaborative effort to reduce cancer in San Francisco, is dedicated to decreasing these and other cancer-related disparities. Purpose: To describe the approach and preliminary outcomes of the SF CAN’s CRC Task Force. Methods: Using principles of community engagement and implementation science, we developed a logic model to address CRC screening disparities. As inputs, the logic model features a partnership with the San Francisco Community Clinic Consortium (SFCCC) and its partner nonprofit community health centers. The goal is to increase screening with fecal immunochemical testing (FIT) and when needed, follow up colonoscopy, for its patient population. Continuous program evaluation utilizes the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Results: The SFCCC has created a quarterly reporting system to track CRC screening rates and facilitate collaborative goal setting for its partner CHCs. Six SFCCC clinical sites serving 18,815 adults aged 50-75 have used SF CAN’s technical assistance and Quality Improvement Stipends (QIS) to engage in an analysis of barriers and facilitators to screening and implement multi-level evidence-based interventions tailored to their identified specific needs. Barriers include low literacy, language, economic, and social obstacles to CRC screening such as lack of transportation or reliable access to housing or a private bathroom. The Task Force has assisted with staff training, patient education materials, and strategies for FIT distribution and collection. We have helped several sites switch from multi-sample FIT kits to evidence-based, user-friendly single sample FIT, and encouraged the development of tracking and navigation systems for abnormal FIT. In the first six months of QIS program, 5,199 patients were provided with FIT, and 3,932 (75.6%) successfully completed it. In addition, a first-ever review of 298 patients with abnormal FIT at these sites revealed that only 144 (48%) completed colonoscopy within 6 months, a finding that may lead to new initiatives to improve patient navigation. Additional SFCCC clinical sites will join the QIS program in the coming year. Conclusion: The SF CAN CRC Task Force has provided a model of academic and community partnership through which interventions to address CRC screening disparities in medically underserved communities can be implemented. Citation Format: Robert Hiatt, Carly Rachocki, Michael B. Potter, Ma Somsouk, David Ofman. The San Francisco Cancer Initiative: Addressing disparities in colorectal cancer screening in community health centers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C123.

Individual, Team, and Organizational Factors Influencing Worker Satisfaction: Program Evaluation Findings for Nonprofit Mental Health Providers

PurposeThe purpose of this quantitative study was to evaluate the influences of self-care, support, and organizational factors (program locations, injury rates, intensity of services) on the job satisfaction of 154 nonprofit residential mental health workers.MethodsHierarchical multiple linear regression was utilized in order to determine which group of variables explained the most variation in the outcome variable.ResultsBased upon the results of the three models of hierarchical linear regression, the hypothesis that higher self-care ratings are related to higher levels of job satisfaction and higher staff team support ratings are related to higher overall worker satisfaction scores was supported.ConclusionAgencies, supervisors, and professionals can utilize these findings to inform policies and practices aimed at increasing worker satisfaction.

4309 Ascertaining the Medical Needs of Galveston County

4309 Ascertaining the Medical Needs of Galveston County

Availability and prices of medicines for non-communicable diseases at health facilities and retail drug outlets in Kenya: a cross-sectional survey in eight counties

ObjectivesThe objective of this study was to determine the availability and prices of medicines for non-communicable diseases (NCDs) in health facilities and private for-profit drug outlets in Kenya.DesignCross-sectional study.MethodsAll public...

Proper Disposal of Prescription Opioids in Southwest Virginia: Assessment of Patient, Physician, and Medical Student Beliefs and Practices.

Southwestern Virginia demonstrates the highest regional mortality rate from prescription opioid overdoses. Nationally, 65% of patients misusing opioid medications received them from friends and family, underscoring the need for effective disposal of unused narcotics. (1) To understand patient, provider, and medical student beliefs and misconceptions regarding proper methods of opioid disposal; (2) to characterize discrepancies that exist between patient self-reported habits and medical student/provider perceptions of opioid usage, disposal, and diversion. Descriptive, cross-sectional, observational study. Large, nonprofit health care organization and allopathic medical school in Southwestern Virginia. All ambulatory patients 18 years or older presenting for elective consultation at health system orthopedics department; all institutionally employed physicians with active system e-mail addresses; and all current students at the associated medical school. Patients: The number who had received information regarding proper methods of opioid disposal, intended disposal method, methods of disposal considered appropriate, comfort level with opioid disposal, and demographic data. Physicians and Medical Students: The number who had received instruction regarding proper methods of opioid disposal, acceptable means of opioid disposal, most appropriate disposal method, disposal method most likely to be employed by patients, practice profile/prescribing data, and medical school year. In total, 64% of patients (n = 255/750) had never received instruction from a physician regarding opioid disposal; 56% of physicians (n = 212/732) and 78% (n = 80/171) of medical students indicated that they never received formal instruction regarding methods of disposal. The majority of physicians believed that their patients are most likely to use in-home methods of disposal or store prescription medications for future use; 61% of patients indicated a preference for accessible disposal facilities. The discrepancy between patient and physician responses highlights a lack of communication regarding disposal of unused opioid medications and is a target for future intervention.

Addressing Health Care Disparities: A Radical Perspective and Proposal.

This paper begins by rethinking the sociological theory that social conditions are fundamental causes of health disparities and that controlling disease ironically increases or creates them. While usually true, the radical proposal of non-profit health care and pharmaceutical development could ameliorate health disparities if a nation like Canada or a region like the EU looked to radically different but successful models such as the Drugs for Neglected Diseases initiative. It uses what could be called entrepreneurial collaboration for public health markets and inverts intellectual property to public health IP to maximize health gain instead of profits.

Virtual clinic to assist patients with urgent psychiatric care

As Maryland braces for a surge of COVID‐19 cases, the country's largest private provider of nonprofit mental health and substance use services has launched a virtual crisis walk‐in clinic to avail the state's residents with an online mental assessment by a provider and connection to the most appropriate follow‐up care. Officials say the goal is to decrease emergency room visits for psychiatric patients during this time.

Understanding Reporting of Type II Workplace Violence Among Home Health Care Nurses.

Background: Home health care nurses (HHNs) work alone in patients' homes. They experience high rates of Type II (client/patient-on-worker) workplace violence (WPV); however, little is known about the extent and factors of their reporting. Methods: A convenience sample of employees aged 18 years and older and working as an HHN or management staff were recruited from a U.S. nonprofit home health care agency. To describe the extent of reporting of WPV events, an HHN survey was conducted. To identify the barriers and facilitators to reporting, two HHN focus groups were conducted, and management key informant interviews were employed. Findings: We recruited 18 HHNs and five management staff into the study. Almost all HHNs reported to management the most serious forms of violence they experienced, and that HHNs reported WPV when they perceived that reporting was beneficial (alerting other nurses and management) and supported by management staff. However, they were unwilling to report when it was perceived as disadvantageous (reliving the trauma), discouraged (by a norm that experiencing violence is a part of the job), unachievable (unstandardized reporting process), and ambiguous (uncertain of what is reportable). Management staff perceived a lack of standardized reporting processes as a barrier when responding to HHNs' reporting. Conclusion/Application to Practice: High reporting was related to strong support from management. Policies and procedures should clearly define WPV, the threshold for reporting, how to report, and how management will respond to the reports.

Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit.

Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit.

What Shapes National Responses to EU Public Procurement Policy? The Case of Health and Social Services in Norway, Germany and England

This article investigates responses to EU public procurement directives in Norway, England and Germany, with a particular focus on health and social services. We used a comparative national patterns approach to analyse parliamentary debates, consultative statements, the media and interviews with stakeholders.
 The literature contains prominent arguments suggesting that health and social service governance regimes are converging on the liberal model. Some authors argue that with its focus on policies which create markets, the EU is a driving force with an increasing relevance for market-based governance practices. However, the role of EU legislation is unclear as procurement regimes in relation to the governance of health and social services constitute a highly ambiguous terrain. Our study enabled us to show that the form of the debate is highly dependent on path-dependent mechanisms and the degree of openness of the national political system that provides channels for interests to be articulated. Indeed, the Norwegian case study serves as an excellent example of why marketisation has not advanced to the degree predicted in the literature: an inclusive and open political system and a strong non-profit health and service sector meant that the non-profit groups managed to turn the debate in their favour.

Behind closed doors: What happens when pharmacies close?

Behind closed doors: What happens when pharmacies close?

Augmenting usual care SSRIs with cognitive behavioral therapy for insomnia to improve depression outcomes in youth: Design of a randomized controlled efficacy-effectiveness trial

ImportanceExtant treatments for youth depression are only modestly effective. Alternative approaches are needed to improve health outcomes. A novel approach to improve depression outcomes is suggested by epidemiological studies finding that insomnia often predates and may contribute to depression risk. We test whether treating insomnia among youth starting a new course of SSRI antidepressants improves depression outcomes. This paper describes our study design. Design2-arm randomized controlled efficacy-effectiveness trial. SettingA large non-profit health maintenance organization. Participants165 adolescents aged 12–19 with research-confirmed depression and insomnia diagnoses, starting a new episode of selective serotonin reuptake inhibitor (SSRI) antidepressant treatment prescribed by their usual care provider. InterventionsTwo sleep interventions, each 6–7 sessions, both overlaying “treatment as usual” (TAU) SSRIs: a sleep hygiene (SH) attention control condition, and cognitive-behavioral therapy for insomnia (CBTI). Conclusions and relevanceIf CBT-I improved sleep is shown to improve depression-related outcomes, this may provide an additional, easily tolerated intervention for an important public health target.Trial Registration: clinicaltrials.gov, NCT02290496, https://clinicaltrials.gov/ct2/show/NCT02290496.

Prevalence of mutations in a diverse cohort of 3162 women tested via the same multigene cancer panel in a managed care health plan.

Advances in gene sequencing of mutations related to hereditary cancers have enabled expansion of this testing to patients cared for in community clinics. Our goal was to report on the prevalence of pathogenic/likely pathogenic variants (PV/LPV) and the distribution of mutations by cancer history in a diverse cohort. We evaluated 3162 women in a large non-profit health plan who were referred for cancer genetic counseling and tested them via the same multigene cancer panel. We examined the pathogenic variant/likely pathogenic variant (PV/LPV) prevalence for 20 genes by clinical factors, demographics, and personal or family cancer history. We calculated adjusted odds ratios for the association between race/ethnicity and mutation results. The majority of women (65.4%) were referred post-breast or ovarian cancer diagnosis. The overall prevalence of any PV/LPV result was 11.7%. Overall, nearly 5.4% had BRCA1/2 mutations, while 6.3% had at least one mutation in non-BRCA genes. In the subset with any PV/LPV result, 55.0% of the total mutations were in non-BRCA genes. The distribution of mutations was similar in those with or without a personal cancer history. Latina women were somewhat less likely to have mutations in non-BRCA genes implicated with breast cancer (OR = 0.55, 95% CI 0.36-0.87). Given that 55.0% of the PV/LPV results were in genes other than BRCA1/2, regardless personal or family cancer history, the study suggests that multigene cancer panel testing may be appropriate for detecting germline mutations in a high-risk cohort in a managed care or public health setting.

Structuring Sustainable Universal Health Care in South Africa.

Intervening in debates around universal health care in South Africa, this article draws on class-based analytical tools from social medicine, political economy, and historical sociology. It is argued there are 3 keys to achieving sustainable universal health care in South Africa: addressing the socioeconomic roots of ill health; establishing a fully public, nonprofit health care system; and adequate investment in undervalued female workers who are the backbone of public health care. Each key is discussed with accompanying recommendations, using evidence from South Africa and other countries. Principal constraints are also identified through an analysis demonstrating the links between inequality, health care financing, and the monopoly structure of the South African health care industry.

Rural and minority populations face barriers in accessing school‐based support

High school students, particularly those of color or living in rural communities, report difficulty in gaining access to basic mental health services, according to a report released last month. Among the promising interventions suggested in the report to address this problem, authors cite closer partnerships between local school districts and area nonprofit mental health providers.