Public Health Nursing
Message from the Chair
Greetings, Public Health Nursing Section!
I was fascinated by the community and media interest in the County Health Rankings that were recently released by the Robert Wood Johnson Foundation. Were you? No one wanted to be on the bottom of that list, and officials were often forced to explain their county’s ranking to their constituents. For better or worse, public health (often a well-kept secret) was in the spotlight, and people noticed.
Do you think most citizens would agree that everyone in the United States, regardless of where they live, should be able to count on the same set of public health activities? You will likely say “yes” but then point out how every state and every health department is different, the old cliché that “if you have seen one health department, you have seen one health department.” However, over the past decade the public health system has evolved. Public health core functions and essential services are universally accepted. They can be measured, and if they can be measured they can be compared against agreed upon standards. Imagine a future where accreditation assures a reasonable set of public health activities that everyone can count on, no matter which state they live in or where they live within their state. Soon accreditation will be a reality for state and local health departments. In 2007, the Public Health Accreditation Board (PHAB) was formed, and since then has been conducting Beta Test site visits with state, local and tribal health departments. Accreditation will provide a basis for ongoing measurement, accountability and quality of public health services and document that public dollars are being well used.
I had the privilege of serving as one of the PHAB Beta Test site visitors to a local health department. It was a fascinating experience and answered the question that had been in the back of my mind since the first draft of the accreditation standards were released – could the functions and activities of a health department be objectively measured? My answer was a resounding ‘YES’. The accreditation coordinator at the site that I visited was a public health nurse. Her organization and depth of knowledge about the health department’s infrastructure, workforce and programs was amazing. She utilized her public health nursing skills and expertise to address components ranging from clinical lab requirements to Advisory Board orientation.
What is the role for public health nurse leaders in the accreditation process? Accreditation is not new to most nurses. In fact, many of us are very familiar with accreditation processes! Many nurses have experience preparing for Joint Commission hospital accreditation or Medicare surveys. Most public health nursing educators have experience in preparing for Commission on Collegiate Nursing Education (CCNE) accreditation. Our nursing background gives us unique perspectives, knowledge and experience that we can offer to the public health accreditation process.
This is a great opportunity for PHNs to provide leadership and vision at the vanguard of the accreditation initiative. Is your state or local health department considering applying for accreditation? Or, perhaps already preparing for accreditation? If you are not already part of the process, become involved and encourage others to get involved. National accreditation requires a community health assessment, a community health improvement plan, and a strategic plan for the health department. Public health nurses play an important role in these activities in many health departments. If you are a PHN faculty, have you incorporated the accreditation standards into your curriculum? This is especially important for graduate PHN programs. These new accreditation standards, measures, and processes represent a new chapter in public health. It is up to us to determine what that chapter will say about public health nursing.
Congratulations Newly Elected PHN Section Leaders!
Our new PHN Section officers
Susan Coleman is incoming chair, and Jo Anne Bennett is incoming secretary. I know that the Section will benefit from their leadership, expertise and energy.
Congratulations to our newly elected officers! Our new chair-elect is David Reyes, and our new secretary-elect is Alexandra Garcia.
New Section Councilors
Ø Joanna Holsten
Ø Donna Westawski
These individuals will join Section Councilors Ingrid Brudenell, Diane Downing, Carol Graham, Luba Ivanov, and Jeanne Matthews.
New Governing Councilors
Ø Debra Gay Anderson
Ø Colleen Hughes
Ø Beth Lamanna
Ø Mary McLaughlin
These individuals will join current Governing Councilors Carol Allen, Rachel Kauffman, and Cynthia Stone.
Thank you to all who have given of their time to advance public health nursing: our Section Councilors, Governing Councilors, officers, committee chairs/ members and those deployed to APHA committees.
It has been a privilege and pleasure to serve as your Chair. See you in Denver!
Linda Olson Keller
One is not born into the world to do everything but to do something.
~ Henry David Thoreau, poet, writer, philosopher
Return to Top
Public Health Accreditation
In August 2005, a feasibility study, Exploring Accreditation, was conducted by a 25-member Steering Committee composed of representatives from public health practitioners from local, state, tribal and federal levels. Two questions guided the study: Is it desirable to develop a national voluntary public health accreditation program for the country? And, is it feasible to initiate such a program? The Exploring Accreditation report issued one year later not only affirmed the responses to the questions but also suggesting a model by which national public health accreditation could be developed. Subsequently, in 2007 the Public Health Accreditation Board (PHAB)
was incorporated. The three years following the release of this report have been spent in developing and testing the components of accreditation for public health departments. The initial application period is expected to open in the summer of 2011 when the full program is launched. Elements of the accreditation
program developed by PHAB
include an application process, which includes demonstration of a completed community health assessment, a community health improvement plan, and an agency strategic plan. The applicant health department then progresses through a self-assessment process, which is reviewed by a team of peer site visitors. Accreditation status is ultimately decided by the PHAB Board of Directors
and is granted for a five-year period. Creating PHAB, a new and independent entity to oversee the accreditation process, promotes impartiality and ensures avoidance of real or perceived conflicts of interest.
The goal of national public health accreditation is to protect and improve the health of the public by advancing the quality and performance of all health departments in the country — local, state, territorial and tribal. Accreditation will drive public health departments to continuously improve the quality, efficiency and effectiveness of their services and help make all our communities healthier places to live, work, learn and play. For public health departments, accreditation means demonstrated accountability and improved quality. Nationally, public health accreditation means that people across the country can expect the same quality of public health programs and services no matter where they live. Accreditation is expected to strengthen public health departments and the services they provide, which will contribute to improved health outcomes in communities. Local public health departments already participating in state-based accreditation programs report a variety of benefits, including:
· Performance feedback and quality improvement. The accreditation process provides valuable feedback to health departments about their strengths and areas for improvement, laying the foundation for improved protection, promotion and preservation of their community’s health.
· Accountability and credibility. Accreditation is also a way for health departments to show how effectively they are allocating often-scarce state and local resources. Achieving accreditation demonstrates accountability to elected officials and communities, resulting in increased credibility for public health departments.
· Staff morale and visibility. The recognition of excellence that comes with meeting accreditation standards has positively affected staff morale and enhanced the visibility of the health departments in their communities, enabling them to compete successfully for additional resources and contributing to increased staff recruitment and retention.
Based on the Ten Essential Public Health Services framework, the accreditation standards were developed by a nationwide work group through review and use of 15 sets of state and national standards, including the National Association of City & County Health Officials (NACCHO’s) Operational Definition (including metrics), National Public Health Performance Standards Program (NPHPSP) for state and local health departments, Project Public Health Ready, and results of the Association of State & Territorial Health Officials' (ASTHO’s) State Public Health Survey. The first version of Proposed PHAB Standards was reviewed through an alpha test with two state agencies and six local health departments. The revised standards were reviewed through an extensive, formal vetting process that resulted in more than 3,700 comments throughout the country. Additional changes are expected upon completion of the field beta test in 30 selected sites.
Part A includes standards for administrative capacity and governance. This section addresses functions of the health department such as human resources, information technology, planning, governing, and other similar administrative functions. The remaining standards and measures focus on core public health functions (as defined by the 10 Essential Services) and exclude areas such as Medicaid, mental health, substance abuse, primary care and human service programs. However, when core public health functions are provided by more than one agency, the agencies will come together for the purposes of an accreditation survey (e.g., environmental public health functions are located in a different agency than communicable disease functions). A separate set of documents with language specific for tribal public health departments will be developed prior to the launch of the program.
While the majority of the standards and measures are the same for state and local agencies, the measures often address similar topics but have slight differences in wording. For example, the standard and some measures for health improvement plans are specific to local or state due to the distinction of community health improvement plans (CHIPs) at the local level and state health improvement plans (SHIPs) at the state level. Throughout the standards development process, the wide variation in state and local structures was acknowledged and the intent is that the standards be broadly applicable to differing structures, sizes and complexities of agencies.
There is every reason to believe that high performing health departments who keep abreast of the latest in public health science and best practices will positively affect the health of the community they serve. There is a growing body of evidence developed by public health systems researchers that suggest that those linkages can be made. The addition of a national data base that provides information on the characteristics of those high performing public health systems and the types of quality improvement projects that they focused on to decrease infant mortality, improve epidemiological surveillance, strengthen health education for multi-cultural neighborhoods, foster improved communication of health laws and regulations, and other similar projects will only add to the body of knowledge needed to move the governmental public health into the 21st century in terms of its impact on the health status of its citizens.
Kaye Bender, PhD, RN, FAAN
President/CEO, Public Health Accreditation Board
Click here for References
Return to Top
Together We're Better: System Collaboration for PH Accreditation
“It’s always better when we’re together.”
These words are more than just lyrics from a popular song; they also reflect the value and benefit of public health system partners working together for system improvements through collaboration. Public health accreditation provides a prime opportunity for system collaboration that makes us better together.
In Kansas, public health system partners from local and state health departments are coming together to prepare their agencies for accreditation, and to build a stronger statewide public health system in the process. The Kansas Public Health Accreditation Pilot brings together state and local partners to jointly examine their current performance and to share model practices, programs, and policies that will support each agency’s attainment of national standards and accreditation. The Kansas Health Foundation has funded this pilot for a one-year period.
The Kansas Public Health Accreditation Pilot targets the following objectives:
- To identify the organizational capacity and resources necessary to attain accreditation.
- To clarify state and local agency roles in national public health standards.
- To clarify roles of partner organizations in national public health standards.
- To support and inform the development of the national standards and accreditation process through PHAB.
- To increase system readiness for national public health accreditation in Kansas.
The pilot partners include six local health departments of varying sizes and the state health department. The group meets once monthly to review the PHAB standards and measures, one to two domains per meeting. In addition to review of standards and measures, the group collects and shares examples of documentation that illustrates agency performance of each of the measures. The documentation is collected and cataloged through a group electronic workstation hosted by the KU Community Toolbox, an academic partnership with Kansas University. This collaborative review of standards and measures, along with collection of evidence from system partners, provides a forum for sharing of best practices, including ongoing quality improvement activities.
The lessons learned through the pilot will be shared with statewide public health partners through existing communication channels, including regional public health meetings, newsletters and conferences. Upon completion of the pilot, resources to support accreditation preparation for all agencies statewide will be offered through multiple avenues, including open access to the Community Toolbox workstation. The pilot experience will also provide useful input to guide the development of ongoing public health workforce development programs that support accreditation, targeting both the current and future public health workforce.
For additional information about the Kansas Accreditation Pilot, please contact Shirley Orr at email@example.com.
Shirley Orr, MHS, ARNP, NEA-BC
Director, Local Health
RWJ Executive Nurse Fellow
KDHE Office of Local and Rural Health
Return to Top
QI in Public Health: Picasso vs. da Vinci
Like most local public health directors, I take great pride in the accomplishments of our local agency. Our particular health department serves tens of thousands of clients each year, both in a clinic and community setting. Program audits, internal reviews, and laboratory inspections assure us that we are performing at the highest standards. However, an ongoing desire to excel leaves no room for complacency. With that in mind, last year we had the opportunity to answer the question: “how are we doing as a local public health agency compared to national standards?” “Are we meeting those standards?” And, if we are not, are we prepared to make the necessary changes? In other words, “are we truly committed to be the local public health agency our residents and our community partners deserve?”
In search of this answer, we voluntarily applied to be a part of the Public Health Accreditation Board (PHAB) beta test. As I am sure most in public health know this beta test is aimed at establishing national accreditation standards. Sure, we have our 10 essential public health functions that broadly guide our practice, but we do not have a national system to independently evaluate our performance against those functions. The PHAB beta test provided us with more than an opportunity to provide input into an emerging accreditation system. It also provided us with an opportunity to do a comprehensive self-assessment and answer our own questions of where we stand as a local public health agency. For our local health department, this beta test, and eventually full accreditation, is likely the single best opportunity for a true, comprehensive, and effective self-assessment of our agency using national standards. Of course, critical self-assessment is never easy, and as should be expected, the process shines a great deal of light on areas that have been well preserved in the dark.
Prior to applying as a beta test site, the staff and I discussed our position and performance concerning accreditation. One of the areas we felt most comfortable with was quality improvement. After all, we vigorously strive to ensure quality in service delivery. As already mentioned, we excel at our grant audits, program audits, and laboratory audits. Every clinic record goes through an extensive process to ensure it accurately reflects professional nursing and program standards. We obviously have it together when it comes to quality improvement…right? Hold that thought…
Once accepted as a beta test site, we delved deeply into the specific PHAB domains, standards, and measures, eager to demonstrate our compliance. As we worked through this self-assessment, specifically Domain 9, “evaluate and continuously improve processes, programs, and interventions”, a picture started to emerge. Unfortunately, this picture was more Picasso than Da Vinci. Sure, there were some masterful elements in place, but in an odd arrangement that compelled us to search for the pattern instead of standing back and appreciating the result. Regardless, we still had our excellent program and audit results, and in some areas, we were even incorporating some of the principles of Quality Improvement (QI). The truth is however, we lacked the methodical approach necessary for effective QI. Our positive results were due to diligent effort and stringent processes more than effective and efficient QI. ‘Plan, Do, Check, Act’, a standard QI approach, was not so much a part of our culture as ‘check, fix, check, fix’! Our process was not completely ineffective. After all, we were getting what we perceived to be very positive results. What we lacked was efficiency, and the broader understanding of the principles of QI, which would allow us to grow a culture of quality. Instead of finding root causes and focusing on lasting change in that area, we found mistakes and corrected them. Instead of applying QI principles in all areas of our operation, we maintained a vigilant endeavor of ‘error and correction,’ and even that was limited primarily to a clinical setting.
Because of the PHAB beta test, we have embarked on a new program of QI. We have begun the process of training staff in the tried and true techniques of the process. We are moving from ‘check, fix, check, fix’ to ‘plan, do, check, act’. Additionally, we recognize the value of this approach in all our programs, not just the direct care aspect. Health education, community engagement, consumer health, and preparedness are all excellent forums for QI. As such, quality improvement will now be a centralized theme in improving all our efforts, and should eventually permeate our local public health culture.
Ultimately, this beta test has turned out to be an incredibly enlightening experience. As I have said to others, sometimes, the light is warm and welcoming, and at other times, it is bright and intrusive! Regardless of any deficiencies that have ultimately been revealed through the PHAB beta test, we do not look at them as failures. Instead, we look at these deficiencies and the knowledge gained, as an opportunity to excel as a local public health agency, enhancing our capacity as a community partner for health, worthy of the trust of our citizens.
Keith Reed, RN, MPH, CPH
Comanche County Health Department
Return to Top
Annual Meeting Highlights
From Nov. 6-10, 2010, join us in Denver for the APHA 138th Annual Meeting and Exposition. More than 1,000 cutting edge scientific sessions will be presented by public health researchers, academicians, policy-makers and practitioners on the most current public health issues facing the nation today. For more information about the Annual Meeting, visit www.apha.org/meetings.
The theme for this year’s meeting is “Social Justice: A Public Health Imperative.” We hope to see many of you at the Annual Meeting. Our PHN Section Business meetings are open to everyone. If you have never attended a business meeting, please join us! It is one of the best ways to get involved.
Colorado Convention Center
All Business Meeting and scientific sessions will take place at the Convention Center except the PHN Emerging Leaders Speed Networking for PHN in the 21 Century special session which will take place at the Hyatt Regency hotel.
Our section will have a strong presence at the meeting. View the sessions sponsored by our section by visiting the interactive Online Program. Search the program using keyword, author name or date. Don’t forget to stop by our new booth in the Section and SPIG pavilion (booth 1384) in the Public Health Expo next to Everything APHA.
E-mail notifications including presentation dates and times have been sent to all presenters. If you are a presenter and have not received this e-mail, or if you have a question about your scheduled time/date, please contact Huey-Shys Chen at firstname.lastname@example.org.
Please note that all scheduled presentation dates and times are final and cannot be changed. You can view the online program at the following website: http://apha.confex.com/apha/137am/webprogram/PHN.html.
The PHN Section is organizing several special events including the PHN Emerging Leaders Speed Networking, the Annual PHN Awards Luncheon. In addition there will be three round table sessions, four poster sessions, and 29 scientific sessions on a variety of subjects of interest to public health researchers, and practitioners.
Here are a few highlights:
PHN Section Business Meetings:
Sunday, Nov. 7: 8-9:30 a.m. & 10-11:30 a.m.
Monday, Nov. 8: 6:30-8 a.m.
Tuesday, Nov. 9: 6:30 – 8 a.m.
Wednesday, Nov. 10: 6:30 – 8 a.m.
Quad Council of Public Health Nursing’s Learning Institute
Sunday, Nov. 7, 4:00 – 5:30 p.m.
The Quad Council Learning Institute will host the “PHN Challenges of Practicing Social Justice in a Market Justice World” presented by Linda Olson Keller, DNP, CPH, APHN-BC, FAAN, on Sunday, Nov. 6, 4:00 to 5:30 p.m. (note the time correction). The session will address the professional and personal challenges of advocating for social justice in today’s environment and conclude with roundtable discussions on strategies to advance the role of public health nurses as social activists. Please remember to register for this free Learning Institute when you register for the APHA Annual Meeting.
RWJ Recommendations for Public Health Nursing
Monday, Nov. 8, 6:30 – 8:00 pm
Susan Hassmiller, PhD, RN, FAAN, Robert Wood Johnson Foundation Senior Adviser for Nursing and the Director of the Robert Wood Johnson Foundation’s Initiative on the Future of Nursing at the Institute of Medicine, will present an overview of the report’s recommendations for public health nursing. She will present the Future of Nursing recommendations related to public health nursing and engage the audience in a discussion of their implications. This is followed by the "Speed Networking" event.
PHN Emerging Leaders Speed Networking for PHN in the 21st Century
This will be a great time to network with scholars, nurses, and other public health practitioners. We will recognize all of the students who presented at the conference, and the PHN Section New Investigator Award will l be given at the same event.
PHN SECTION AWARDS LUNCHEON
Tuesday, Nov. 9, 12:30 – 2:00 p.m.
Plan to attend the PHN Section’s Annual Awards Luncheon that will recognize and honor exemplary service to Public Health Nursing. This is a ticketed event, purchased when you register for the Annual Meeting. If you plan on attending and did not purchase a ticket, you must go back to the Annual Meeting registration site to purchase a ticket.
We look forward to seeing you in Denver!
Huey-Shys Chen, PhD, RN, PHN Section Program Co-Chair
Cecilia Venzon, MSN, RN , PHN Section Program Co-Chair
Return to Top
NFP National Service Office Invitation
APHA 2010 Annual Meeting
Nurse-Family Partnership Event
Nov. 9, 2010 3:00-5:00 p.m.
Elevating a Different Kind of Public Health Nursing
Federal Program Provides Historic Funding
You can read in the history books about the days when health care professionals made home visits. Or, like Gail Ricks, a registered nurse from North Carolina, you can experience it first hand.
As a nurse home visitor with Nurse-Family Partnership™, Gail spent years on the back roads of central North Carolina meeting low-income clients in their homes. Nurse-Family Partnership serves first-time mothers who are living in poverty through a series of nurse home visits that span two years.
As Gail quickly learned, the nurse is a source of support and information that covered the gamut of topics and concerns a new mother might anticipate. “During the two years I spent with each mother, I witnessed changes that were life altering,” says Gail.
Today, Nurse-Family Partnership serves more than 22,000 young families in 32 states – and is poised to grow as a result of the historic Maternal, Infant, and Early Childhood Home Visitation Program, which Congress enacted in 2010. The federal program, which is rolling out this year, provides $1.5 billion in funding over five years for states to implement or expand evidence-based home visitation programs such as Nurse-Family Partnership.
Three long-term randomized, controlled trials conducted in urban and rural areas, and with diverse populations, show impressive replicated results that support the program’s goals of improved pregnancy outcomes, child health and development, and economic self-sufficiency for the family.
“It was necessary for me to understand the mothers' dream for themselves,” says Gail. “It was this experience that separates Nurse-Family Partnership from other programs designed to improve outcomes for low income, under educated, and under-served new mothers. I felt as if I were teaching these young women to fish.” Look for more information about the Nurse-Family Partnership at www.nursefamilypartnership.org.
Nurse-Family Partnership’s National Service Office – its headquarters – is in Denver, where the APHA's 138th Annual Meeting will be held this year. On Nov. 9, Nurse Family Partnership’s leadership and nursing team will host a reception at their headquarters for APHA attendees who are interested in learning more about this different kind of nursing as well as the new federal program designed to help grow programs like NFP and elevate the role of the public health nurse in preventive home visitation. Attendees will find it easy to reach the Nurse-Family Partnership’s National Service Office (NFPNSO) by using the free shuttle buses between the Denver Convention Center and the Warwick Hotel, 1779 Grant Street; the NFPNSO is a short one-block walk from the hotel.
Space for the event is limited to 60 participants; to reserve your space RSVP to email@example.com.
Nurse-Family Partnership National Service Office
1900 Grant Street, 10th Floor
Denver, CO 80203
Return to Top
Research Committee Report
Capacity Building Remains Key Focus for Research Committee
Once again, the Research Committee will feature a session at the Annual Meeting aimed at an essential component of research competence, the process of scientific critique. Shawn Kneipp, PhD, ARNP will spearhead this year’s session, along with Carolyn Blue, RN, PhD, CHES, and Betty Bekemeier, PhD, MPH, RN.
PHN research, while unique in its own right, takes place within the larger scientific community and within a deeply rooted history of scientific tradition. Reviews of studies and research programs are not mechanical processes. Perspectives from the philosophy of science and past research inform current endeavors to advance the scientific knowledge base of PHN practice. Evidence is accumulated and breakthroughs are recognized through critique, debate, and consensus. To ensure a strong contingent of future scientists doing PHN-related work, we must be able to share insights and participate in the give and take of honest critique.
Thanks to All Reviewers!
The following members of the Research Committee served as the New Investigator Award Selection Committee for this year’s PHN Section New Investigator Award: Carolyn Blue, Kelly Buettner-Schmidt, Veronica Culhane, May Dobal, Joyce Katherine Edmonds, Juanita Graham, Shawn Kneipp, Lynette Landry, Catherine Levonian, Susan Levtak, Emily Litt, Rita Lourie, Barbara Polivka, and Feleta Wilson. Karen D’Alonzo served as chair of the New Investigator Award Selection Committee.
The review for the New Investigator Award is a two-step process: Abstract submitters who are eligible for the award are asked to submit an additional detailed summary of their study, which is then reviewed blindly by at least three reviewers. The three top-scoring reports are then reviewed by the entire Selection Committee. The recipient of the PHN Section New Investigator Award will be announced at the Annual Meeting in Denver.
From Consensus Agenda to Action
The Agency for Healthcare Research and Quality (AHRQ) and the University of Illinois (Chicago) School of Public Health will host an invitational conference in October to identify and prioritize a research agenda for public health nursing specific to population-focused outcomes regarding the quality and safety of public health nursing practice. Participants will include nurse leaders, public health systems researchers, and other key stakeholders.
The APHA meeting in Denver will provide a timely opportunity for disseminating findings from the conference to the PHN research community. An interactive roundtable session will focus on translating the identified priorities to strategic action steps that can move the agenda. To fill in identified evidence gaps, funding and educational initiatives as well as research collaborations need to be considered. Michele Issel, PhD, RN (UIC), primary organizer of the October AHRQ conference, will lead the Denver session. We hope that this session will spark momentum and action.
Return to Top
Ruth Knollmueller Recognized by ANA
Ruth N. Knollmueller RN, PhD, received the Pearl McIver Award
for significant contribution to public health nursing at the American Nurses Association (ANA) meeting in Washington, D.C., in June 2010. To view the full ANA press release, click here
Return to Top
Community Guide Updates
One easy way to keep up to date on the work of the Task Force on Community Preventive Services, and what’s happening at The Community Guide, is to sign up for e-mail updates through the website at www.thecommunityguide.org . For example, in just the last month, e-mails on the following new reviews were received:
· Using technology supports (such as computers, pagers, phones) as part of multi-component coaching and counseling programs for reducing and maintaining weight are recommended (sufficient evidence).
· Dram shop liability laws are recommended as being effective in preventing and reducing alcohol related illness (strong evidence).
· Overservice law enforcement initiatives as a means to reduce excessive alcohol consumption and alcohol related harms could not be recommended because of insufficient evidence (too few studies).
Coming soon are new Task Force recommendations regarding immunization information systems, community-based interventions to increase vaccination rates, use of client incentives and client reminders for cancer screening, communication campaigns that distribute and promote the use of specific health related products, and collaborative care for management of depressive disorders.
Researchers: Focus on gaps
While The Community Guide is primarily an online resource to help public health practitioners and communities identify evidence-based interventions for community health improvement, it is also a valuable tool for identifying gaps in knowledge. Public health nurse researchers and graduate students interested in conducting research to help build evidence for practice should look to this site for ideas for research questions. Public health nurses in practice could work with research colleagues to identify the gaps in evidence most relevant for their practice decisions. Imagine the potential for coordinated research efforts to address those gaps in evidence that are relevant to making decisions about public health nursing interventions and processes.
Fellowship opportunities (ORISE)
Much of the “leg-work” of the systematic reviews conducted by the Task Force on Community Preventive Services is done by CDC staff and by interns and fellows from the Oak Ridge Institute for Science and Education (ORISE) program. This program administers a variety of internship, scholarship, fellowship and research experiences for students at every level of education and for faculty. Public health nursing students and faculty can search for learning opportunities through the ORISE online catalog, found at this website: http://orise.orau.gov/science-education/internships-scholarships-fellowships/default.aspx
The PHN Section, through membership in The Quad Council of Public Health Nursing Organizations, is privileged to have an organization liaison position with the Task Force. The roles of the liaisons are to: 1) apprise the Task Force of their organizational member’s views, priorities, current issues and projects relevant to the work of the Task Force, and 2) share information from the Task Force and Community Guide within their organization’s and among their members/constituencies. In order to do this job well, liaisons need to hear from the people we represent. Please feel free to contact the liaisons with questions about The Community Guide and recommendations for the Task Force or Community Guide staff.
Contact your Quad Council liaisons:
Susan Zahner, DrPH, RN
Betty Daniels, MN, RN
Return to Top
New Healthcare Cost & Utilization Project Reports Released
Three new Healthcare Cost and Utilization Project (HCUP)
reports from the HCUP Statistical Brief
series have recently been electronically released.
One in Four Patients Experienced Revolving-Door Hospitalizations
Roughly one-quarter of all hospital patients were readmitted for the same conditions that prompted their initial hospitalization over a two-year period, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ).
According to the Federal agency's analysis of data on 15 million patients in 12 States in 2006 and 2007, more than a third of those who had hardening of the arteries (called coronary atherosclerosis) were readmitted at least once to the hospital during the period. Multiple readmissions were also seen for 30 percent of patients with uncomplicated diabetes, 28 percent with high blood pressure, and 21 percent with asthma.
AHRQ also found that:
· Among Medicare patients, 42 percent experienced multiple hospital admissions and 38 percent multiple emergency department visits. For Medicaid patients, 23 percent experienced multiple hospital admissions and 50 percent went to the emergency department more than once.
· About 22 percent of uninsured patients had multiple hospital readmissions, and 38 percent had multiple hospital emergency department visits but were not admitted.
· Privately insured patients were the least likely to require multiple hospital readmissions (19 percent) or make multiple visits to the emergency department (29 percent).
While some patients may be readmitted because of the severity and complexity of their underlying condition, research shows that many repeat admissions can be avoided if patients have better outpatient care. Readmissions can also drive up health care costs.
These findings are based on data described in Hospital Readmissions and Multiple Emergency Department Visits, in Selected States, 2006-2007. The report uses statistics from the HCUP State Inpatient Databases (SID) and HCUP State Emergency Department Databases (SEDD) for 12 States: Arizona, California, Florida, Hawaii, Massachusetts, Missouri, Nebraska, New Hampshire, New York, South Carolina, Tennessee and Utah.
Cost of Hospital Treatment for Blood Infection Surges, Especially for Uninsured Patients
According to another recent report from AHRQ, hospital costs for treating patients with the blood infection septicemia surged 174 percent between 2001 and 2007, making it the condition with highest-rising treatment costs during that period.
Although just 3 percent of $12.3 billion in 2007 was spent treating blood infections in uninsured patients, they accounted for the highest average increase of 228 percent. By comparison, the average cost to hospitals of treating blood infections in Medicaid patients jumped by 192 percent, in Medicare patients by 172 percent, and in privately insured patients by 152.5 percent.
In addition, the federal agency found that other conditions with rapidly increasing cost by payer included:
· Medicare — Intestinal infection: 205 percent; acute kidney failure: 154 percent.
· Uninsured — Acute kidney failure: 179 percent; respiratory failure: 154 percent.
· Medicaid — Acute kidney failure: 160 percent; leukemia and other white blood cell disease: 127 percent.
· Privately insured — Osteoarthritis: 120 percent; acute kidney failure: 119 percent.
These findings are based on data described in Diagnostic Groups with Rapidly Increasing Costs, by Payer, 2001-2007. The report uses statistics from the 2007 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.
Mental Disorders and/or Substance Abuse Related to One of Every Eight Emergency Department Cases
Nearly 12 million visits made to U.S. hospital emergency departments in 2007 involved people with a mental disorder, substance abuse problem, or both, according to another recent report from AHRQ. This accounts for one in eight of the 95 million visits to emergency departments by adults that year.
Of these visits, about two-thirds involved patients with a mental disorder, one-quarter was for patients with a substance abuse problem, and the remainder involved patients with both a mental disorder and substance abuse diagnosis.
The analysis also found that for the 12 million emergency department visits involving mental health and/or substance abuse:
· Depression and other mood disorders accounted for 43 percent of the visits, while 26 percent were for anxiety disorders and 23 percent involved alcohol-related problems.
· Mental health and/or substance abuse-related visits were 2.5 times more likely to result in hospital admission than visits not involving mental disorders and/or substance abuse. Nearly 41 percent of mental disorder and/or substance abuse-related visits resulted in hospitalization.
· Medicare was billed for 30 percent of all mental health and/or substance abuse emergency department visits; private insurance was billed for 26 percent; the uninsured for 21 percent; and Medicaid for 20 percent.
These findings are based on data described in Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007. The report uses statistics from the 2007 Nationwide Emergency Department Sample, an AHRQ database that is nationally representative of emergency department visits in all non-federal hospitals. The Nationwide Emergency Department Sample contains 26 million records from emergency department visits from approximately 1,000 community hospitals nationwide, approximating a 20 percent stratified sample of all U.S. hospital emergency departments.
Return to Top
Omaha System International Conference Announced
The Omaha System International Conference: A Key to Practice, Documentation, and Information Management will be held in Eagan, MN, from April 7-9, 2011. It is presented by Martin Associates, and hosted by San Jose State University School of Nursing. Poster abstracts/awards nominations are due Jan. 31, 2011. For additional information, visit www.omahasystem.org/conference.htm or send an e-mail to LuAnn Rice at firstname.lastname@example.org.
Judith Riemer, RN, PHN, CNS, MS
Return to Top
Join the PHN Section Today!
Return to Top
Public Health Nursing Newsletter Archives