Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare & Medicaid Services' Health Care Innovation Awards Program.

OBJECTIVE: To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs. DATA SOURCES: Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations. STUDY DESIGN: NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews. DATA COLLECTION/EXTRACTION METHODS: We used qualitative thematic coding for data from 21 programs actively engaging physicians as part of HCIA interventions. PRINCIPAL FINDINGS: Establishing physician champions and ensuring an innovation-values fit between physicians and programs, including the strategies programs employed, facilitated engagement. Among engagement practices identified in this study, tailoring team working styles to meet physician preferences and conducting physician outreach and education were the most common successful approaches. CONCLUSIONS: We describe engagement strategies derived from a diverse range of programs. Successful programs considered physicians' values and engagement as components of process and policy, rather than viewing them as exogenous factors affecting innovation adoption. These types of approaches enabled programs to accelerate acceptance of innovations within organizations.

The use of and satisfaction with the Emergency Severity Index.

INTRODUCTION: The Emergency Severity Index (ESI) is a 5-level emergency department triage algorithm designed to facilitate the sorting and streaming of patients. The purpose of this study was to assess the use of the ESI in emergency departments, including satisfaction with the ESI, usefulness of the ESI compared with other triage algorithms, and lessons learned from implementation. METHODS: A self-administered questionnaire was sent to 935 people who requested the ESI training materials from the Agency for Healthcare Research and Quality (AHRQ) at the U.S. Department of Health and Human Services and who volunteered to participate in a study about the ESI. The response rate for the survey was 42% (n = 392). Telephone interviews were conducted with an additional 19 ED professionals. Descriptive statistics and qualitative content analysis were used in the data analysis. RESULTS: Three hundred twenty-two survey respondents (82%) reported that they use the ESI in their emergency department. Satisfaction with the ESI triage algorithm is high. ESI users indicated that the ESI is more accurate than other triage algorithms and that its strengths are simplicity of use and the ability to reduce the subjectivity of triage. DISCUSSION: The majority of ED professionals who reported using the ESI were very satisfied with the tool. Users found that it was more accurate than other triage algorithms and reduced the subjectivity of the triage process. Both survey and interview findings indicated that few emergency departments have formally assessed the impact of the ESI on ED operations.

News on tobacco and public attitudes toward smokefree air policies in the United States.

OBJECTIVES: Smoking bans are a central component of comprehensive tobacco control programs, and an increasing number of states and localities have adopted them. Public support is critical as efforts continue to extend protection from secondhand smoke to all. We examine the relationship between state print news coverage of tobacco and public sentiment towards smoking bans. METHODS: We utilize two data sources: the February 2002 Current Population Survey Tobacco Use Supplement, and articles from 2 months in a database comprised of content-analyzed newspaper articles on tobacco from all daily U.S. newspapers. We control for demographic and state-level tobacco covariates, and use logistic regression to identify associations between news coverage and attitudes towards policy initiatives by smoking status. RESULTS: We find no association between tone of news coverage and any outcome measure and little evidence of a relationship between the volume of overall tobacco news and attitudes towards smoking bans. Our data suggest that people exposed to more news on secondhand smoke issues are less likely to support restaurant smoking bans. Higher volume of secondhand smoke news is also predictive of lower support for bar bans among recent quitters. Support for hospital bans is, however, largely independent of news coverage. CONCLUSIONS: We suggest two alternate explanations for our findings. First, for certain people, greater news volume on secondhand smoke may lead to lower support for bans. Alternatively, secondhand smoke may be more newsworthy in states where bans are more controversial.

Survivors on Cancer: the portrayal of survivors in print news.

INTRODUCTION: This study examines the types of news stories that include comments by everyday cancer survivors and the messages or information these individuals provide. Even though these non-celebrity survivors increasingly serve on the front lines of cancer prevention and advocacy efforts and often engage with media, the role they play in the media discourse on cancer has not been a focus of research. METHODS: We conducted a thematic content analysis of print news articles of non-celebrity cancer survivors in 15 leading national daily newspapers for four consecutive months starting in June 2005 to identify the issues or events that included a survivor perspective and the messages or information conveyed by the everyday survivors. RESULTS: Journalists included survivor commentary primarily when covering cancer fundraising events and when focusing on individual survivorship stories. In overall news coverage involving survivors, breast and prostate cancers received the greatest attention, followed by blood and lung cancers. Survivors spoke mainly about the diagnosis experience and life post-cancer. Our analysis of survivors' comments revealed that discussions of the diagnosis experience often convey fear and a lack of confidence in cancer screening practices, while cancer is portrayed as a positive life event. DISCUSSIONS/CONCLUSIONS: While evidence of a positive and hopeful portrayal of survivorship is an encouraging finding for continued efforts to decrease stigma associated with a cancer diagnosis and for the public understanding of the disease, it is important to consider potential negative implications of an idealized and restricted media discourse on survivorship. IMPLICATIONS FOR CANCER SURVIVORS: The increasing size and capacity of the survivor community offers opportunities for the cancer advocacy community to consider how news media portrayal of cancer and survivorship may contribute in both positive and potentially detrimental ways to public understanding of this disease, its survivors and life after cancer.

Health services research as a source of legislative analysis and input: the role of the California Health Benefits Review Program.

This article examines the role of the California Health Benefits Review Program (CHBRP) as a source of information in state health policy making. It explains why the California benefits review process relies heavily on university-based researchers and employs a broad set of criteria for review, which set it apart from similar programs in other states. It then analyzes the politics of health insurance mandates and how independent research and analysis might alter the perceived benefits and costs of health insurance mandates and thus political outcomes. It considers how research and analysis is typically used by policy makers, and illustrates how participants inside and outside of state government have used the reports prepared by CHBRP as both guidance in policy design and as political ammunition. Although there is consensus that the review process has reduced the number of mandate bills that are passed out of the legislature, both supporters and opponents favor the new process and generally believe the reports strengthen their case in legislative debates over health insurance mandates. The role of the CHBRP is narrowly defined by statute at the present time, but the program may well face pressure to evolve from its current academic orientation into a more interactive, advisory role for legislators in the future.