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• PHRG to Assist Peninsula Primary Care in Improving System of Care for Patients with
Chronic Medical Conditions
• Dr. Ronald Deprez Leads Session on Community-Based Chronic Care Services at APHA Annual
Meeting in Philadelphia
• PHRI to Assist in the Design, Implementation and Evaluation of a Mental Health Co-Location
Model for Primary Care Practice in Rural Maine
• PHRI to Evaluate Expanded Initiative to Improve Care for Chronic Obstructive Pulmonary
Disease (COPD) Patients in 25 Rural Primary Care Practices
• PHRI Continues its Work with NAMI Maine to Evaluate the Impact of Crisis Intervention Team(CIT) Training
in County Jails and Police Departments in Maine
• PHRG Working with Market Decisions to Assess the Health Insurance Needs of Vermont Residents
• PHRG launches it new Public Safety Division to provide planning, research, training and evaluation services to
Public Safety and Emergency Response Services Agencies
• The Governance Institute Publishes Specialty Service Models for Rural Hospitals by Dr. Deprez
• PHRG Working with the NE Maine Regional Resource Center on a Comprehensive Emergency Preparedness Plan
for the Region
• PHRG to Assist in the Development of a Chronic Care Technology Plan for Northern Maine
• PHRG Continues Its Work for The Central Peninsula General Hospital Service Area Board on a Chronic Care Services
Improvement Plan for the Kenai Alaska Region
• PHRG to Conduct Health Services Planning Study for Mayo Regional Hospital (MRH)
• PHRG Selected to Assess Chronic Care Services Needs in the Blue Hill, Maine Region
• PHRG Selected by the Governor’s Office of Health Policy and Finance to Provide and Analyze Baseline Indicators
for the State Health Plan
• PHRI to Evaluate Program to Assist Low-Income Pregnant Women in Quitting Smoking
• PHRG Develops a Web-Based Information System to Monitor Lung Health Status in Maine
• PHRG to Develop an Environmental Public Health Tracking System with the ME BOH & ALAM
• PHRG’s President Dr. Ronald Deprez Named to the Board of Directors of the American Health Planning Association
• More News in the Archive
PHRI to Assist Peninsula Primary Care in Improving System of Care for Patients with Chronic Medical Conditions
In 2004, PHRG conducted a Chronic Care Assessment and Planning Study (CCAPS) for Blue Hill Memorial Hospital (BHMH), illustrating the need for improved management of chronic care at the practice level and better patient and provider linkages to proven community-based health services. With assistance from PHRI, BHMH was awarded a grant by the Physicians’ Foundation for Health Systems Excellence (PFHSE) to implement a series of chronic disease prevention and management improvements in the community and at Peninsula Primary Care, the four practices affiliated with BHMH. PHRI will assist PPC in the design and evaluation of project initiatives, in particular with evidence based practice improvements and linking community resources for patient self-management. The Institute for Healthcare Improvement’s (IHI) Breakthrough Collaborative Process will serve as the format for educating providers and implementing physician office, and patient care management changes. Unlike most chronic care improvement initiatives, this project will address practices' strategies for multiple conditions including hyperlipidemia, hypertension, congestive heart failure, diabetes, chronic obstructive pulmonary disease, obesity, and major depression. The project will serve as a rural model for developing and sustaining changes. For more information contact Dr. Ronald Deprez.
At the 2005 Annual meeting of the American Public Health Association recently held in Philadelphia, PHRG’s president, Dr. Ronald Deprez, led a Session on Improving Community-based Chronic Care. The session presented methods for planning and implementing evidenced based chronic care improvements in the community, at practices and with patients. PHRG’s Chronic Care Services Improvement Roadmap, a series of rapid assessment tools for planning an implementing chronic care services, and based on WHO’s Innovative Care for Chronic Conditions (ICCC) format provided the structure for the session. Projects from several settings and countries illustrated the use of planning and implementing improvements in chronic care. Examples included the Veracruz Initiative for Diabetes Awareness (VIDA) project in Mexico, the Rural Maine Health Improvement Demonstration Project and chronic care improvement plans for Maine’s Blue Hill Peninsula and the Alaska’s Central Kenai Peninsula. (Please view the Chronic Care Service Improvement and Community-Based Chronic Care presentations for more information).
PHRI to assist in the Design, Implementation and Evaluation of a Mental Health Co-Location Model for Primary Care Practices in Rural Maine
PHRI is working with Eastern Maine Healthcare Systems’ (EMHS) Institute for Medical Improvement (IMI) and Acadia Hospital to develop and implement a pilot project to improve access to care at primary care settings for patients with behavioral health conditions. The pilot’s main objective is to develop and test a model that places a behavioral health specialist in primary care practice settings. The co-location pilot is designed to test the efficacy of integrating specialty behavioral health treatment into general medical care, as evidenced by improved treatment compliance and improved symptomatic and functional outcomes. PHRI will evaluate the implementation and impact of the Co-location Model on providers, practices and patients to determine if 1) management of patients with behavioral health disorders improves, 2) the use of best practice guidelines in patient care improves, 3) patient level barriers are reduced, 4) patient symptoms, functional status and satisfaction with behavioral health treatment improves, and 5) the confidence and skills of PCPs in diagnosing and treating patients with behavioral health conditions improves. For more information contact Denise Yob.
PHRI to Evaluate Expanded Initiative to Improve Care for Chronic Obstructive Pulmonary Disease (COPD) Patients in 25 Rural Primary Care Practices
In 2003, Eastern Maine Healthcare System (EMHS) received a federal grant through HRSA’s Outreach Grant program to implement the Rural Maine Health Demonstration Project. Evaluated by PHRI in 2004, this pilot project successfully identified sustainable strategies for applying evidence-based guidelines for Chronic Obstructive Pulmonary Disease (COPD) management in two primary care practices in rural Maine. With the support of Maine Health Access Foundation (MeHAF), EMHS’s Institute for Medical Improvement expanded the COPD collaborative to 25 additional eastern and northern Maine primary care practices over two years. PHRI will participate in the leadership of this collaborative, provide pulmonary medicine expertise to participating PCPs through Dr. Lee Ann Baggott, and evaluate the collaborative process and its impact on practice and patient level outcomes. As demonstrated in the pilot project, findings from evaluation activities are expected to provide tangible evidence of the effectiveness of this IHI style evidence based practice intervention. For more information contact Amy Kinner.
PHRI Continues its Work with NAMI Maine to Evaluate the Impact of Crisis Intervention Team (CIT) Training in County Jails and Police Departments in Maine
In 2004, PHRI was contracted by NAMI Maine to evaluate the impact of a first-of-its-kind pilot project that adapted the Memphis-based Crisis Intervention Team (CIT) model, an evidence based police response to community psychiatric crises, at Androscoggin County Jail. NAMI Maine has been awarded another Maine Health Access Foundation (MEHAF) grant to expand the adaptation of CIT to eight additional county jails and five police departments across Maine. Public Health Research Institute (PHRI) will conduct the evaluation of this 2-year expansion project. CIT is a pre-booking jail diversion program that has been shown to improve officer recognition of and response to people with mental illness, to reduce arrest rates, to reduce officer and community injuries as well as the use of restraint, to reduce emergency room admissions, and to improve community and officer satisfaction. Building on the experience at Androscoggin County Jail, PHRI will study the process of implementing CIT at multiple facilities and evaluate the impact of CIT on the characteristics of mental health-related crises in jails as well as the perspectives of officers, mental health providers and community stakeholders. For more information contact Richard Lumb or Brenna Byrne.
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PHRG Working with Market Decisions to Assess the Health Insurance Needs of Vermont Residents
PHRG is working with its survey research partner, Market Decisions, under contract with the State of Vermont to conduct and analyze a 4,000 household statewide study of access and affordability of health insurance among Vermont residents. The study is a project within the Vermont Division of Health Care Administration and will provide a better understanding the health insurance needs of residents and policy options available to improve access and affordability. PHRG will be developing three issue briefs based on the survey results. Additionally PHRG is assisting in developing the survey instrument and completing a comprehensive report of results and policy options. The statewide household survey will collect comprehensive data on health insurance plan characteristics, coverage and risks of loss of coverage, potential eligibility for coverage through state sponsored health insurance among the uninsured and prescription drug cost and burden among other topics. Issue briefs will address the status of health insurance coverage in Vermont, comparisons with past data, other state and national data, trends and policy recommendations.
PHRG Launches it New Public Safety Division to Provide Planning, Research, Training and Evaluation Services to Public Safety and Emergency Response Services Agencies
The Public Safety Division of the Public Health Resource Group
Mission: Providing Public Safety and Emergency Response Services to Public Sector Agencies
The mission of the Public Safety Division (PSD) at Public Health Resource Group (PHRG) is to assist public sector organizations and agencies to improve their readiness and response to public health and related emergencies. Through high quality consulting, training, research and practice the Public Safety Division of PHRG enhances the capabilities, leadership, service effectiveness, and preparedness of public sector agencies. The services provided through the PSD complement PHRG’s existing focus on planning, research, implementation and evaluation for public and private sector clients worldwide.
Goals:
Objectives:
Statement of Service:
PHRG’s Public Safety Division utilizes knowledgeable partners, leading practitioners and scholars in creating an environment for the development of sustainable change initiatives that can easily be monitored, evaluated and modified over time. PHRG will draw upon the broad variety of skills, knowledge and experience available from its staff and partners to address the specific preparedness needs of public safety, criminal justice and community agencies and groups. These include education, governance, health, training, data base technology and program planning, implementation and evaluation services.
Example of Services and Products:
The Northeast Institute for Leadership Development (NE-ILD), a component of PSD, was created to facilitate the efforts of public safety and public health agencies to improve their leadership capabilities as they carry out their critical roles of safeguarding Maine communities. The NE-ILD provides training, research, and public practice education and assistance to public sector organizations. NE-ILD enhances organization leadership capabilities and service delivery effectiveness.
NAMI Maine, in collaboration with the Androscoggin County Jail, St. Mary's Hospital, Common Ties/100 Pine Street Social Center, and Tri-County Mental Health Services, was awarded a Maine Health Access Foundation (MEHAF) grant to evaluate the adaptation of an evidence-based police response to community psychiatric crises to the Androscoggin County Jail. NAMI is contracting with Public Health Research Institute (PHRI), the research and evaluation component of PHRG to conduct the evaluation of this program. Crisis Intervention Team (CIT) is a pre-booking jail diversion program that has been shown to improve officer recognition of and response to people with mental illness, to reduce arrest rates, to reduce officer and community injuries as well as the use of restraint, to reduce emergency room admissions, and to improve community and officer satisfaction. Using a retrospective study that compares pre- and post-program data, PHRI will study the process of adapting this model to a jail setting and disseminate the results of the adaptation in Maine and across the nation. A research report will be published in a national peer reviewed journal to inform other jails considering implementing CIT in correctional settings.
Key Personnel: Richard C. Lumb, Ph.D., Ronald L. Breazeale, Ph.D., Gary Cattabriga.
The Governance Institute Publishes Specialty Service Models for Rural Hospitals by Dr. Deprez
The Governance Institute [website] has published a white paper, Specialty Service Models for Rural Hospitals, written by PHRG president Ronald Deprez, Ph.D.
Rural hospitals across the country deal with unique challenges in serving the special needs of their individual communities. Each situation is different, with different patients suffering from different illnesses, some chronic, some debilitating, some fatal if they don’t have access to timely treatment. How does a rural hospital deal with each unique situation, in a time when resources are scarce—even scarcer in rural areas—and specialists practice hundreds of miles away?
This special white paper for rural hospitals addresses the challenges and solutions to rural community access to quality specialty care, especially as it relates to the diagnosis, treatment, and management of chronic disease. Rural populations often experience disparities in health status compared to urban populations, in addition to having limited access to health insurance and limited access and availability to healthcare services, both general and specialty. Past efforts to improve access to healthcare in rural areas have focused on primary care in particular, with minimal policies and research on the provision of specialty services. With the growing population of individuals having chronic conditions, there is an increasing need for specialty services, especially in rural areas that are great distances from tertiary care centers where specialists tend to locate their practices.
- The Governance Institute
This paper may be purchased from The Governance Institute.
The Eastern Maine Regional Resource Center (RRC), located at Eastern Maine Medical Center (EMMC) and directed by Kathy Knight, RN, recently hired PHRG to work with its stakeholders to develop a comprehensive emergency preparedness plan for the region. Stakeholders include all agencies involved in emergency preparedness—first responders, hospitals, transporters, state and local emergency management personnel to name a few. PHRG is currently conducting the assessment against benchmarks and standards provided by HRSA, OSHA and CDC. Findings from this assessment will drive decisions to plan and purchase essential equipment and training to support emergency preparedness in the region.
In spring 2004, the Statewide Regional Resource Center Coordinating Committee developed a web-based survey tool to collect information from a wide range of healthcare facilities, including Ambulatory Surgical Centers, Emergency Medical Services, and hospitals. The tool focused on health system needs and planning gaps related to hospital bed capacity for both adults and children (routine and critical care); capacity for isolation and referral of patients with communicable infections; appropriate staffing to manage the short-or long-term surge of patients; appropriate staffing needed for functions related to the Strategic National Stockpile and the Maine Pharmaceutical Cache; personal protective equipment; capacity for trauma and burn care; capacity for mental health and substance abuse care; and redundant communications infrastructure (radio network).
PHRG will utilize these data and data from other sources to complete a detailed assessment of the current response capacity for all of the listed agencies and facilities within the region according to the Critical Benchmarks and Minimum Levels of Readiness published by HSRA, a list of prioritized health system infrastructure needs and gaps; and a list of planning activities to develop the comprehensive health system response plan. The comprehensive assessment will include redefining the Critical Benchmarks and assessing new Benchmarks at the sub-region level within the region. This project will not only help facilitate equal representation for decision making among stakeholders across the region, but will help inform future purchasing plans and distribution of goods based on the sub-regional capacity requirements.
Public Health Resource Group, Inc. (PHRG) will participate alongside many healthcare organizations, including The Aroostook Medical Center (TAMC), the Home Health Affinity Group of Eastern Maine Healthcare Systems (EMHS) and the EMHS Institute of Medical Improvement (IMI) to develop a chronic care technology plan for Northern Maine. The Chronic Care Technology Planning Project is being funded by a grant to TAMC from the Agency for Healthcare Research and Quality (AHRQ) Transforming Healthcare Quality Through Information Technology (THQIT) Planning Grant program. PHRG professionals will serve on the Leadership Steering Committee and the Technology Committee of this project. PHRG will also provide technical assistance to TAMC in the planning process, in particular defining technology solutions and requirements identified by the project’s Clinical Committee and evaluating technology applications to support improvements in chronic care management.
In 2001, PHRG completed a Comprehensive Community Health Needs Assessment for Eastern Maine Healthcare (EMH) that illustrated the need for widespread efforts to address severe chronic health conditions and expand critical access to comprehensive services in rural Maine. The resulting report, Health Planning Report for Northern, Eastern, and Central Maine, led to the development of the IMI, which bring physicians together to address the high rates of chronic disease in Maine. TAMC along with the IMI and the Home Health Affinity Group applied to the AHRQ’s THQIT grant program for funding to further the planning of technology solutions on this issue.
The Chronic Care Technology Planning Project will try to improve the health management of chronic care in Northern Maine through the identification and implementation of technologies that standardize the exchange of clinical information across the healthcare provider continuum. Past research has shown that patients diagnosed with chronic conditions need to access multiple providers and that communication across these providers is often delayed and inefficient. A final outcome of this project will be a well-defined and supported process to improve patient care coordination and facilitate availability of patient data when and where needed for the region’s primary care physicians, specialists, home health providers, nursing homes and hospitals. The plan will also identify technological templates of evidence-based primary care guidelines relevant to rural healthcare organizations.
In the of Spring 2004, the Kenai Peninsula Borough of Alaska retained the Public Health Resource Group (PHRG) to conduct a Community Health Needs Assessment as part of its strategic health planning process. That study established chronic care services as a fundamental need in the Central Kenai Peninsula, with a particular need for services to prevent and manage chronic diseases/conditions. In response to those findings, the CPGHSAB proposed the development of a cost effective care system for residents with chronic medical conditions. This will be accomplished in part by a chronic care health services plan prepared by PHRG.
The chronic care plan being developed by PHRG, based on the ICCC framework and building blocks, will identify clinical and non-clinical (community and patient level) service gaps to persons diagnosed or at risk of developing chronic medical conditions. This includes as assessment of community level services and physician practices in the region. PHRG will provide the necessary information to plan and implement integrated prevention and management services to improve health and support self-management of disease and symptoms, using its recently developed chronic care community and practice assessment tools. Project tasks include an analysis of health utilization and outcome data of the population; an inventory of services in the region that address prevention and management of chronic conditions and their linkage to primary care physicians; an assessment of physician practice capacity to provide evidence based treatment to patients diagnosed with chronic conditions; identification and prioritization of service delivery gaps at the community; identification of practice based quality improvement initiatives; and, identifying resources required to support effective patient self management. The plan will provide critical information for strategic service planning and implementation.
Mayo Regional Hospital (MRH), located in Dover-Foxcroft, Maine, recently retained Public Health Resource Group, Inc. (PHRG) to identify how the Hospital can improve the health services and programs it provides to its service area communities. PHRG will utilize components of its Community and Institutional Assessment Process (CIAP) to complete this study; however this effort will be tailored toward the project objectives, including:
PHRG will analyze population, demographic, utilization, and market data available for the region, and conduct a Community Household Health, Utilization, and Market Preference Survey through a randomized telephone sample, to obtain information relevant to project objectives. PHRG expects this work will produce the comprehensive health and market information critical for health program and marketing decisions by MRH.
PHRG will conduct an assessment of the level and quality of chronic care services and support infrastructure in the Blue Hill, Maine region. The focus will be on the patients served by the Blue Hill Memorial Hospital (BHMH) through its primary care practices on the peninsula.
The assessment tools developed for this project will be based on the Innovative Care for Chronic Conditions (ICCC) framework and building blocks. PHRG will provide information for the hospital, practices and the community to better plan and link resources for the care of persons with chronic conditions and will identify community primary care and prevention needs. Best practice interventions, better practice linkages to community support services, and higher quality patient care are expected outcomes from this assessment.
PHRG will augment this engagement work with an assessment the non-chronic disease components of the health care system in the Blue Hill service area. This will identify new information on health needs not covered by the previous two health needs assessments we have conducted with BHMH.
A comprehensive understanding of the health care issues and cost drivers for a population using scientific indicators gives health care providers and policy makers the necessary information for sound planning and cost-effective policy decisions. This can result in improved health of citizens; increases in care access, more efficient delivery systems and improved quality of care. PHRG has pioneered the development of population based planning tools for health system planning.
The Governor’s Office of Health Policy and Finance (GOHPF) recently selected PHRG to develop and analyze a baseline of credible, regionalized population and delivery system indicators on cost, quality, access and health status. PHRG will assess the indicators profile to identify priority health and system issues for each region; and identify gaps in indicators and data to support the development of critical measures required for state health planning. This will make it possible to conduct regional comparisons and to compare Maine’s health care system to other states and the US for best practice.
Public Health Research Institute (PHRI) was recently awarded a contract by Eastern Maine Healthcare to evaluate an innovative program to assist low-income pregnant women in quitting smoking. The program, being funded in part by the Maine Health Access Foundation and the Bingham Program, has two objectives — 1) to successfully provide tobacco treatment services for low-income pregnant women and 2) to demonstrate the effectiveness of this model using Public Health Service (PHS) tobacco treatment guidelines at primary care practices serving low-income pregnant patients. To be successful the intervention will be designed to accounts for patient and practice barriers to care and to effective smoking treatment. The demonstration will focus primarily on low-income pregnant women because of their increased risk of smoking during pregnancy. The intervention program will integrate the PHS evidence-based tobacco treatment guidelines into four primary care practices. The project will be conducted in three phases-identifying practice and patient barriers to access and successful outcomes; planning an office based and external intervention program; and demonstrating (and evaluating) the program at multiple primary care sites. Collaborators in this project include the Maine Network for Health, The Institute for Medical Improvement, the Center for Tobacco Independence (CTI), the American Lung Association of Maine (ALAM), Bangor Region Partners for Health, and Penquis CAP.
In cooperation with the American Lung Association of Maine (ALAM), PHRG has developed a web based information system on lung health in Maine. Named the Respiratory Health Indicators for Maine (RHIME), the system will permit users to evaluate the lung health status of area residents. Features of RHIME include the ability to produce a standard set of reports on lung health in a region and the ability to query the database to produce custom reports. Information from the system will be used for program planning, policy development and advocacy for ALAM, local health programs and the state. In addition this system will provide the basis for the development of the Maine Bureau of Health's (BOH) comprehensive environmental public health tracking system (see below).
The Maine Bureau of Health (BOH) was recently awarded cooperative agreement by Centers for Disease Control (CDC) to develop an environmental public health tracking system for the state of Maine. One of only 10 states to receive CDC funding for this initiative, the Maine BOH has engaged ALAM and PHRG to assist them in developing the tracking system for Maine. BOH is particularly interested in using the RHIME technology and architecture (see above) as the basis for the Maine tracking system. The tracking system will be used to assess health status and risk as it relates to the environment. It will permit the state to build core system surveillance in public health. The system will contain indicators for health (symptoms and disease), as well as potential environmental hazards and exposures. PHRG is proud to be a part of this effort since it dovetails so closely with our interest and work on disease surveillance.
Ronald D. Deprez, Ph.D., MPH, PHRG’s president was recently re-elected to the national board of directors of the American Health Planning Association (AHPA). Dean Montgomery, president of AHPA recently announced the election of Dr. Deprez to the board following AHPA’s annual meeting in December. President Montgomery welcomed Dr. Deprez on the board adding that he brings valuable health planning experience and leadership to the AHPA board. AHPA is a non-profit public interest organization committed to health policies and practices that promote access to health care at a reasonable cost. AHPA works to educate health policy makers and the public in the value and cost effectiveness of community-based health services planning and decision-making. Dr. Deprez looks forward to continuing his work on the AHPA board and in promoting comprehensive health services planning with evidence based measurement tools similar to what PHRG has been developing and using over the past 15 years.