Selected Studies and Research

Presentations from CNA Health Research & Policy Navy Medicine Symposium, June 7-8, 2012

On June 7 and 8, 2012, CNA hosted top military and civilian healthcare executives in the Navy to chart the course of the future of military healthcare for the U.S. Navy, Marine Corps and their families in a two-day workshop led by Navy Surgeon General Vice Adm. Matthew L. Nathan. The following study was prepated by CNA analyst, Dr. Eric Christensen, for presentation at this workshop.

• Patient-centered Medical Home/Medical Home Port Evaluation
  (with emphasis on chronic conditions, particularly diabetes)  View ppt
  Presented by Eric Christensen, Ph.D., managing director, CNA Health Research & Policy
  
• Read the release “Navy Surgeon General Hosts Workshop to Explore Future of Military Healthcare”

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/)

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.Full Document

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.

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.

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.