Research Methods: Policy Analysis

Maine Pediatric and Family Practice Survey Chartbook

Abstract: 

In February 2010, Maine and Vermont were awarded a five-year demonstration grant from the Centers for Medicare and Medicaid Services to improve care quality for children who are insured by Medicaid and the Children’s Health Insurance Program (CHIP). In Maine, Improving Health Outcomes for Children (IHOC) is a public/private collaboration of health systems, pediatric and family practices, associations, state programs and consumers that is intended to 1) select and promote a set of child health quality measures; 2) build a health in­formation technology infrastructure to support the reporting and use of quality information; and 3) transform the delivery of health services for children using a patient centered medical home model.

As part of the IHOC initiative, the University of Southern Maine surveyed pediatric and family practices about how they use data, clinical guidelines and office systems to monitor and improve children’s healthcare quality. The purpose of the survey is to provide baseline information about quality improvement activities in primary care practices serving children in Maine. Survey data was used to inform IHOC activities and to monitor changes over time. The web-based survey was conducted in the winter of 2011-2012 and sent to practice man­agers at a sample of 168 practice sites, of which 64% responded. Responding practices represent more than one-quarter of family practices and nearly two thirds of all pediatric practices in the state. Together these prac­tices served more than half (57%) of all children insured by MaineCare, or nearly 68,000 MaineCare children. Respondents represent a broad distribution of practices across regions of the state and practice size and own­ership, and include nearly two-thirds of practices participating in IHOC’s First STEPS learning collaborative.

This report summarizes the results of the initial survey and assesses quality improvement activities in pediatric and family practices at baseline. In 2014, a follow-up survey will be conducted to assess how quality improve­ment has changed in child-serving practices statewide over time and within specific types of practices (e.g. those participating in First STEPS).

Key issues from the baseline survey results include the following:

  • Medical Home Recognition and Practice-Level Quality Improvement
  • Data Systems Used to Track and Monitor Care
  • Use of Electronic Health Records for Quality Improvement
  • Awareness and Use of Financial Incentives and Data for Quality Improvement from Payers

A follow-up survey was fielded during the final year of the initiative in 2014.The practice survey was designed to assess changes in knowledge and awareness of: child health quality measures; evidence-based clinical guidelines; recommended preventive screening tools; office systems and procedures; and the degree to which Maine practices use standardized protocols to monitor and improve children’s healthcare quality. Results of that survey can be viewed or downloaded here: Child Health Quality in Maine: Practice Survey Report 2011-2014

Publication Type: 
Report
Publish Date: 
January 29, 2011
URL: 
http://www.maine.gov/dhhs/oms/pdfs_doc/children_IHOC/Provider%20Survey%20final.pdf

Developing Program Performance Measures for Rural Emergency Medical Services

Abstract: 

 Prehospital Emergency Care

Developing Program Performance Measures for Rural Emergency Medical Services

Authors: John Gale, MS; Andrew Coburn, PhD; Karen Pearson, MLIS, MA; Zach Croll, BA; George Shaler, MPH

University of Southern Maine, Muskie School of Public Service

Background: The development of measures to monitor and evaluate the performance and quality of emergency medical services (EMS) systems has been a focus of attention for many years. The Medicare Rural Hospital Flexibility Program (Flex Program), established by Congress in 1997, provides grants to states to implement initiatives to strengthen rural healthcare delivery systems, including better integration of EMS into those systems of care.

Objective: Building on national efforts to develop EMS performance measures, we sought to identify measures relevant to the rural communities and hospitals supported by the Flex Program. The measures are intended for use in monitoring rural EMS performance at the community level as well as for use by State Flex Programs and the Federal Office of Rural Health Policy (FORHP) to demonstrate the impact of the Flex Program.

Methods: To evaluate the performance of EMS in rural communities, we conducted a literature search, reviewed research on performance measures conducted by key EMS organizations, and recruited a panel of EMS experts to identify and rate rurally-relevant EMS performance measures as well as emergent protocols for episodes of trauma, ST Elevation Myocardial Infarction (STEMI), and stroke. The rated measures were assessed for inclusion in the final measure set.

Results: The Expert Panel identified 17 program performance measures to support EMS services in rural communities. These measures monitor the capacity of local agencies to collect and report quality and financial data, use the data to improve agency performance, and train rural EMS employees in emergent protocols for all age groups.

Conclusion: The system of care approach on which this rural EMS measures set is based can support the FORHP's goal of better focusing State Flex Program activity to improve program impact on the performance of rural EMS services in the areas of financial viability, quality improvement, and local/regional health system performance. [Journal abstract provided by authors]

Suggested citation:

Gale, J., Coburn, A., Pearson, K., Croll, Z., & Shaler, G. (2016). Developing program performance measures for rural emergency medical services. Prehospital Emergency Care, 1-9. doi: 10.1080/10903127.2016.1218978

FMI: John Gale

Publication Type: 
Journal Article
Publish Date: 
September 9, 2016
URL: 
http://dx.doi.org/10.1080/10903127.2016.1218978

Understanding the Business Case for Telemental Health in Rural Communities

Abstract: 

Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment. [Journal Abstract]

Suggested Citation: Lambert, D., Gale, J., Hartley, D., Croll, Z., & Hansen, A. (2015). Understanding the business case for telemental health in rural communities. Journal of Behavioral Health Services and Research. doi: 10.1007/s11414-015-9490-7 [epub ahead of print].

FMI: John Gale

Publication Type: 
Journal Article
Publish Date: 
December 22, 2015

Exploring the Business Case for Children's Telebehavioral Health

Abstract: 

This brief, authored by John Gale, M.S. and David Lambert, Ph.D. from the University of Southern Maine's Muskie School of Public Service, Maine Rural Health Research Center, explores terminology, reimbursement and business issues, and provides examples from the field in the development of telebehavioral health services. In the first section, the authors place children’s telebehavioral health within the context and demands of today’s rural healthcare system, where the majority of children’s telebehavioral health services are delivered. They then describe three examples of the use of telebehavioral health to serve children, adolescents, and families in rural communities. The brief concludes by exploring the business case for telebehavioral health including the issues and challenges of service delivery, coordination, and financing. This brief is informed by a national study of telemental health (serving children, adults, and older persons) in rural health systems conducted by the authors and updated to reflect the latest information on three case examples.

For more information, please contact John Gale at john.gale@maine.edu

Suggested citation: Gale J, Lambert D. Exploring the Business Case for Children's Telebehavioral Health. Washington, DC: The Technical Assistance Network for Children's Behavioral Health, The Institute for Innovation & Implementation; March, 2015. Brief.

Publication Type: 
Research and Policy Brief
Publish Date: 
March 2, 2015

Gender-Responsive Policy Development in Corrections: What We Know and Roadmaps for Change

Abstract: 

Erica King, research staff at the Muskie School, co-authored this policy bulletin for the US Department of Justice National Institute of Corrections with Jillian Foley, a recent Muskie School graduate.

Lack of gender-informed policy creates challenges for correctional practitioners. When there is a gap between training that is evidence-based and gender-informed and what is written in policy, staff may find themselves hindered in their attempts to work toward establishing a gender-responsive environment. This policy bulletin, released in February 2015 and based on survey data and focus groups with women, is an initial step to determine the existence of gender-informed policy within correctional agencies. The findings of this bulletin provide an overview of the current state of gender-responsive policies for women and define a focus for future research, training and technical assistance in the effort to create a more effective, and efficient correctional approach for women offenders.

Suggested Citation: King E, Foley J. Gender-Responsive Policy Development in Corrections: What We Know and Roadmaps for Change. Washington, DC: U.S. Department of Justice, National Institute of Corrections; October, 2014.

Publication Type: 
Research and Policy Brief
Publish Date: 
October 1, 2014
Author: 
URL: 
https://s3.amazonaws.com/static.nicic.gov/Library/029747.pdf

Early Lessons Learned in Implementing MaineCare Health Homes

Abstract: 

This Issue Brief, authored by researchers at the University of Southern Maine's Muskie School, highlights key lessons learned from the first year of implementation of the MaineCare Health Homes Initiative.

Key Findings:

  • MaineCare's Health Homes Initiative has expanded Maine's capacity for chronic care management in primary care practices and community care teams (CCTs);
  • CCTs provide valuable additional support to patients of Health Homes, including home visits and social supports in the community;
  • Flexibility in program design allowed for wide variation of service delivery models within CCTs;
  • Three percent of Health Home members were referred to CCTs by the end of the first year, but overall practice referral rates varied by CCT--from 1% to 7% of Health Home members within their associated practices.

To view or download the full study, click here

To view or download the Issue Brief on enrollment in the first year of MaineCare Health Homes implementation, click here

Suggested Citation: Fox K, Gray C, Rosingana K. Early Lessons Learned in Implementing MaineCare Health Homes. Portland, ME: University of Southern Maine, Muskie School of Public Service; September, 2014.

Publication Type: 
Research and Policy Brief
Publish Date: 
September 30, 2014
URL: 
http://muskie.usm.maine.edu/Publications/PHHP/MaineCare-HealthHomes-Implementation.pdf

MaineCare Health Homes Enrollment in the First Year of Implementation

Abstract: 

This Issue Brief, authored by researchers at the University of Southern Maine's Muskie School, highlights enrollment trends and characteristics of MaineCare's Health Homes initiative during the first year of implementation.

Key Findings:

  • MaineCare initially estimated 42,000 members were Health Home eligible; 48,000 members were enrolled by December 2013;
  • Health Homes practices increased referrals to Community Care Team (CCT) services over the course of the first year of the initiative, increasing from 60 members enrolled in CCTs in January 2013 to 1,392 in Decmber (3% of Health Home members);
  • Health Home members had an average of three chronic conditions.  Two out of the five most common conditions were behavioral health related.

To view or download the full study click here

To view or download the Issue Brief on implementation in the first year of MaineCare's Health Home Initiative click here

Suggested Citation: Fox K, Gray C, Rosingana K. MaineCare Health Homes Enrollment in the First Year of Implementation. Portland, ME: University of Southern Maine, Muskie School of Public Service; September, 2014.

Publication Type: 
Research and Policy Brief
Publish Date: 
September 30, 2014
URL: 
http://muskie.usm.maine.edu/Publications/PHHP/MaineCare-HealthHomes-Enrollment.pdf

Rural and Remote Food Environments and Obesity

Abstract: 

Researchers at the Maine Rural Health Research Center Rural have published a review in the January 2015 issue of Current Obesity Reports describing the rural community, home, and individual food environments and what is known about their roles in healthy eating.

Abstract: Rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities.

Suggested Citation: Lenardson, J. D., Hansen, A. Y., & Hartley, D. (2015). Rural and remote food environments and obesity. Current Obesity Reports. doi: 10.1007/s13679-014-0136-5

Publication Type: 
Journal Article
Publish Date: 
January 30, 2015
URL: 
http://link.springer.com/article/10.1007%2Fs13679-014-0136-5#page-1

Rural Health Clinic Readiness for PCMH Recognition

Abstract: 

The patient-centered medical home (PCMH) model reaffirms traditional primary care values including continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access, and positions providers to participate in accountable care and other financing and delivery system models. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). Researchers at the Maine Rural Health Research Center (University of Southern Maine) present findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discuss the implications of the findings for efforts to support RHC capacity development.

Key Findings

  • Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition.
  • RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record.
  • RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams.
  • RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition.

For more information on this study, please contact John Gale.

Suggested Citations:

(Working Paper) Gale JA, Croll Z, Hartley D. Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; January, 2015. Working Paper No. 57.

(Policy Brief) Gale J, Croll Z, Hartley D.Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; January, 2015. Research & Policy Brief PB-57.

 

Publication Type: 
Working Paper
Publish Date: 
January 30, 2015
URL: 
http://muskie.usm.maine.edu/Publications/rural/RHC-Readiness-for-PCMH-Recognition-Working-Paper

Adults with Intellectual Disability or Autism Spectrum Disorder. Executive Summary

Abstract: 

Adults with intellectual disability or autism spectrum disorder (ID/ASD) have a variety needs for long term services supports to enable them to live as independently as possible. In Maine, the Office of Aging and Disability Services/Developmental Services provides a wide array of services to adults with ID/ASD, the majority of which are funded through MaineCare. This Chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; an analysis of the utilization and cost of services for adults with ID/ASD who were on the waitlists for home and community based waivers services in SFY 2013; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

This Chartbook is unique in its detailing of the service and costs of adults with intellectual disability or austim spectrum disorder (ID/ASD) in Maine. The Chartbook focuses on adults with ID/ASD who are eligible only for MaineCare (Maine's Medicaid system) or who are dually eligible for MaineCare and Medicare.

The Executive Summary provides key findings in the areas of:

  • Historical Trends
  • Claims Analysis of Dually Eligible and MainCare-only Eligible Adults with ID/ASD in 2010
  • MaineCare Claims Analysis of Members on the HCBS Waitlists, SFY 2013
  • Quality Measures, SFY 2010
  • Supports Intensity Scale, 2013
  • ID/ASD Providers in Maine Compared to the Nation, 2005-2010

Click here for the Executive Summary.

Click here for the Executive Summary with Charts. 

Click here for the full Chartbook.

Suggested Citations: Snow KI, Bratesman S, Bowe T, Fralich J. Adults with Intellectual Disability or Autism Spectrum Disorder: Population and Service Use Trends in Maine, 2014 Edition. (Executive Summary). Portland, ME: University of Southern Maine, Muskie School of Public Service;2014.

Snow KI, Bratesman S, Bowe T, Fralich J. Adults with Intellectual Disability or Autism Spectrum Disorder: Population and Service Use Trends in Maine, 2014 Edition. (Chartbook). Portland, ME: University of Southern Maine, Muskie School of Public Service;2014.

Prepared for the Office of Aging and Disability Services, Maine Department of Health and Human Services by the Muskie School of Public Service, University of Southern Maine.

Publication Type: 
Report
Publish Date: 
December 1, 2014
URL: 
http://muskie.usm.maine.edu/Publications/DA/Exec-Sum-Charts-Adults-with-Intellectual-Disability-or-Autism-Maine-2014.pdf

Pages

Subscribe to RSS - Research Methods: Policy Analysis