Selected Studies and Research

Presentations from AcademyHealth’s 2011 Annual Research Meeting

AcademyHealth’s Annual Research Meeting serves as forum for health services researchers, providers, decision makers, clinicians, graduate students, and research analysts to discuss health-policy implications and research methods and to: examine emerging research issues critical to the organization, financing, and management of health services; get updates on the latest research studies and current health policy issues; hear the research funding priorities of foundations and federal agencies; and explore the impact of health services research on improving access and quality of care.  At the 2011 meeting, held June 12-14 in Seattle, WA, CNA research analysts made the following presentations.

  • Increasing Colorectal Cancer Screening with the Population-Based SATIS-PHI/CRC Intervention: A Report from the CNA Health ACTION Partnership  (View on line • View pdf)
    Presented by: Dan Harris, PhD, CNA Health Research & Policy, at the session “Health Promotion and Chronic Disease Prevention Evaluating Approaches to Cancer Screening, Obesity treatment and Promoting Healthier Lifestyles” – June 12
    Prepared by: Dan Harris, PhD and Amanda Borsky, MPP, CNA Health Research & Policy; Brian Stello, MD, Melanie Johnson, MPA, and Nancy Gratz, MPA, Lehigh Valley Health Network; Mona Sarfaty, MD, Ronald Myers, PhD, Randa Sifri, MD, James Cocroft, MA, and Martha Kasper-Keintz,ScM, Thomas Jefferson University
     
  • A Population-Based Risk-Adjustment Model for Forecasting Psychological Health Provider Workforce Needs  (View on line • View pdf)
    Presented by Dan Harris, PhD, CNA Health Research & Policy, at the session “Current Health Workforce Measurement, Methods, & Models” – June 13
    Prepared by: Dan Harris, PhD and Linda M. Marr, MS, CNA Health Research & Policy
     
  • Poster Presentation:  Understanding the Contextual Factors Affecting a Public Health Intervention to Increase Colorectal Cancer Screening Using the Practical, Robust, Implementation and Sustainability Model (PRISM) – A report from the CNA Health ACTION Partnerhsip (View pdf)
    Prepared by: Amanda Borsky, MPP and Dan Harris, PhD, CNA Health Research & Policy; Brian Stello, MD, Melanie Johnson, MPA, and Nancy Gratz, MPA, Lehigh Valley Health Network; Mona Sarfaty, MD, Randa Sifri, MD, Ronald Myers, PhD, James Cocroft, MA, Martha Kasper-Keintz, ScM, and Valerie Pracilio, MPH, Thomas Jefferson University
     
  • Poster Presentation: Measuring the Impact of Alzheimer ’s disease and Related Dementias on Medicare Beneficiaries with Co-morbidities (View pdf)
    Presented and prepared by: Robert Levy, PhD and Shing Lai (Angie) Cheng, MPH, CNA Health Research & Policy
     

Implementing the System Approach to Tracking and Increasing Screening for Public Health Improvement of Colorectal Cancer (SATIS-PHI/CRC) in Primary Care Practices

Colorectal cancer (CRC) is the second leading cancer killer in the U.S. among cancers affecting both men and women. However, screening for CRC is sub-optimal even though evidence-based principles for successful screening programs exist. To address these gaps, the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ) asked us to conduct a study to determine whether an evidence-based, system-level intervention to improve CRC screening and follow-up among primary care patients could be successfully implemented in a range of primary care practices and be effective.

The System Approach to Tracking and Increasing Screening for Public Health Improvement of Colorectal Cancer (SATIS-PHI/CRC) is a six-step intervention conducted by a centralized organization on behalf of primary care practices. It is intended to assist these practices with providing guideline-based preven¬tive health care to patients who are at average risk for CRC and not up to date in their screen¬ing. It also helps educate both clinicians and patients about CRC screening.

We implemented SATIS-PHI/CRC in primary care practices affiliated with the Lehigh Valley Physician-Hospital Organization (LVPHO) and the Eastern Pennsylvania Inquiry Collaborative Network (EPICNet). Despite experiencing some hurdles, we successfully implemented SATIS-PHI/CRC and identified a set of lessons learned to inform future implementation. We also found that patients of primary care practices participating in SATIS-PHI/CRC had significantly greater odds of screening than patients of a group of comparison practices not participating in the intervention. Our experience with SATIS-PHI/CRC demonstrates that it can be implemented successfully with a wide range of primary care practices and increase guideline-recom¬mended CRC screening.

• For more information about the research study, its methodology, and its findings, see "Health Care Systems for Tracking Colorectal Cancer Screening Tests Final Report" (http://www.ahrq.gov/research/crcscreeningrpt/)

• For more information about how to implement the SATIS-PHI/CRC intervention in future settings, including the intervention materials, see the  Toolkit "Tracking and Improving Screening for Colorectal Cancer Intervention A Systems Approach" (http://www.ahrq.gov/research/crctoolkit/)
 

Navy-NGO Coordination for Health-Related HCA Missions: A Suggested Planning Framework

Humanitarian and civic assistance (HCA) missions are military missions that deliver medical, dental, and other services to underserved populations in developing countries. HCA missions are deliberately planned and conducted in non-crisis environments. The current National Security and National Defense Strategies identify HCA missions as an important part of our Nation's efforts to promote peace and stability throughout the world.

Emphasizing the importance of unity of effort among all actors in an area of operations, guidance from the Department of Defense (DOD) and the Office of the Chief of Naval Operations also identifies working with U.S. and foreign nongovernmental organizations (NGOs) as a key means to deliver HCA. The guidance acknowledges that NGOs have local knowledge and special expertise that can contribute to HCA missions.

There is limited doctrine, however, on how to work with NGOs in the HCA setting. As a result, there is currently no systematic framework for military-NGO coordination. The geographic combatant commanders (COCOMs) are left to determine when it is appropriate to include NGOs, how to identify the appropriate NGOs with which to work, and how to include them in the practical aspects of the mission.

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Lump Sum Alternatives to Current Veterans' Disability Compensation

The Veterans' Disability Benefits Commission asked CNA to study the issues involved in using a one-time lump sum payment, rather than lifetime monthly payments, to compensate service-disabled veterans.

The resulting report showed that a lump-sum program would require a complex design in order to produce the intended benefits—serving veterans better and reducing costs for the Department of Veterans Affairs (VA). CNA researchers also found that establishing the program could require significant initial costs, depending on the program design, and that it could take many years for the VA to achieve any savings.

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Analysis of the Use of Annuities to Shelter Assets in State Medicaid Programs

In this study for the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services, researchers from CNA and the University of Minnesota sought to answer two fundamental questions about the cost and prevalence of annuities in allowing individuals to qualify for Medicaid payments for nursing home care:

  • How widespread is the use of annuities in sheltering assets so that individuals can become eligible for Medicaid?
  • How much does annuity use cost the Medicaid program?

The study, which was subsequently published in the March/April 2006 issue of Health Affairs, found that in 2004, annuities cost Medicaid $197 million.

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Medical Surge Capacity and Capability (MSCC) Handbook

The Medical Surge Capacity and Capability (MSCC) Handbook was developed for the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services. The handbook describes a methodology for managing health and medical response to events resulting in large numbers of patients (surge capacity) and/or victims with unusual or highly specialized medical needs (surge capability). It also spotlights the role of management systems in developing and maintaining preparedness programs. Forming the basis of the MSCC Handbook are valid principles of emergency management and the Incident Command System (ICS). Medical and health systems may apply these principles to coordinate effectively with one another, and to integrate with response organizations that have established ICS and emergency management systems (fire service, law enforcement, etc.). The handbook promotes a common management system for all response organizations public and private that may be involved in major emergencies. In so doing, it helps guide the development of a health and medical response that is consistent with the new National Incident Management System (NIMS). CNA analysts Eric Trabert and Shayne Brannman collaborated with RADM Ann Knebel of HHS and Drs. Joseph Barbera and Anthony Macintyre of George Washington University to develop the handbook. View the full-text version of the handbook.

How Well Are We Keeping Watch? Current Applications in Syndromic Surveillance

CNA recently conducted a study to evaluate a selection of existing syndromic surveillance systems. The purpose of these systems is to identify health conditions that precede diagnosis and signal an increased probability of disease outbreak either due to a chemical or biological attack or to a naturally occurring outbreak of disease. Quickly detecting the outbreak via a computer-based surveillance system could help the public health and military health communities implement a timely response and save lives.

Understanding the impact of Increasing Obligated Service for Graduate Medical Education

Training medical specialists is very expensive. As a result the TRICARE Management Activity/Health Affairs asked CNA to help evaluate the feasibility of increasing the active duty obligation for graduate medical education to lower costs and improve its return on investment.

Medical Treatment Facility Refill Mail Service Initiative Pilot

Pharmaceutical refills by mail offer a cost-effective, value-added benefit for many people. The Department of Defense and the Veterans' Administration are in the process of evaluating the feasibility of jointly operating a consolidated mail outpatient pharmacy. In this analysis CNA examined the number of facilities needed to handle demand for the populations served by these two agencies, as well as economic and operational impacts of consolidation.

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Clinic Management, Productivity, and Cost

Medical systems are complex and serve many constituents. They are often made up of hospitals, clinics and other facilities that as a whole provide medical services to the communities they serve. These clinics and medical treatment facilities must manage the care of their beneficiaries as well as provide services in a cost-effective manner. CNA examined how successful primary care clinics, specifically Navy clinics, are at meeting their objectives. Some of the lessons learned from the analysis are potentially applicable to non-military clinics as well.

We looked at clinics that offer primary care, the usual point of entry into the military medical system, to determine best business practices, which clinics are successful, and what kinds of lessons can be learned and applied throughout the military medical system.

We explored several issues, including:

  • Understanding current clinic management practices
  • Developing measures of productivity that consider the unique constraints and missions faced by the study sponsor
  • Determining appropriate measures of health care costs in the direct care and purchased care systems
  • Examining the implications of other influences such as the incentives associated with the managed care contracts.

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Meeting current and expected future demand VA Mail Outpatient Pharmacy Program

The Department of Veterans Affairs asked CNA to conduct an economic assessment of the ability of the VA's Consolidated Mail Outpatient Pharmacy Program to meet current and expected future demand. As part of our analysis we reviewed and validated demand projections for the program, determined capacity and estimated when demand will exceed it, and determined a cost-effective investment plan for future expansion.

Modeling the Consequences of a Biological Attack: A Tool for Emergency Planners

CNA developed a model that helps medical planners develop first-order estimates of the effects of different intervention strategies in the event of a biological attack. In the event of such an attack the public health community needs to be able to quickly detect, confirm, and treat an exposed population. CNA helped develop the model and metrics to achieve this goal.

Health Professions' Retention-Accession Incentives Study Report to Congress

Health care personnel are expensive to educate and train. Retaining them is critical for any health care system. This study considers the impact of special pays and bonuses in helping recruit and retain qualified doctors, dentists, and other health care providers.

This is an especially important concern for the military, which asks its medical personnel to fulfill dual missions—providing medical support during combat and other military operations and maintaining the day-to-day health of about 1.5 million men and women who serve in the Army, Air Force, Navy, and Marine Corps. Given that medical personnel have skills that are in demand in the private sector, it is critical for the Department of Defense to understand how to attract and retain a sufficient number of qualified health professionals to meet the health care demands of the armed forces.

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