Strategic use of tobacco treatment specialists as an innovation for tobacco cessation health systems change within health care organizations.

Background: Tobacco screening interventions have demonstrated effectiveness at improving population health, yet many people who want to quit using tobacco lack access to professional assistance. One way to address this gap is to train members of the clinical team as tobacco treatment specialists (TTSs).

Purpose: The purpose of this study was to understand how TTSs have been used across a variety of health care organizations implementing health systems change for tobacco treatment and examine the sustainability of TTSs as a health systems change innovation for tobacco cessation.

Assessment of structured data elements for social risk factors.

Objectives: Computable social risk factor phenotypes derived from routinely collected structured electronic health record (EHR) or health information exchange (HIE) data may represent a feasible and robust approach to measuring social factors. This study convened an expert panel to identify and assess the quality of individual EHR and HIE structured data elements that could be used as components in future computable social risk factor phenotypes.

Study Design: Technical expert panel.

Public Health and Health Care Partnerships for Improved Tobacco Cessation.

Context: Tobacco use remains a leading cause of preventable death and disease. While most tobacco users are interested in quitting, few receive professional assistance.

Program: This state health department-led project leveraged partnerships to build capacity and support 9 health care organizations in implementing system-level initiatives to improve delivery of tobacco cessation.

Adoption of Health Information Technology Among US Nursing Facilities.

Objectives: Nursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption.

Design: Cross-sectional survey.

Concern about the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers.

Background: Prescription drug misuse and abuse has reached epidemic levels in the U.S., and stands as a leading cause of death.

The iatrogenic epidemic of prescription drug abuse: county-level determinants of opioid availability and abuse.

Background: Opioid use and abuse in the United States continues to expand at an alarming rate. In this study, we examine the county-level determinants of the availability and abuse of prescription opioids to better understand the socio-ecological context, and in particular the role of the healthcare delivery system, on the prescription drug abuse epidemic.

Methods: We use community-level information, data from Indiana's prescription drug monitoring program in 2011, and geospatial regression methods to identify county-level correlates of the availability and abuse of prescription opioids among Indiana's 92 counties.

Service utilization, expenditures, and success in a well-established system of care for young people with serious emotional disorders.

A major challenge in the implementation of systems of care is creating mechanisms to pay for services that are provided across social services systems and by multiple agencies. Using a managed care approach to coordinate service provision may be one way to effectively bridge the gap across agencies while also providing quality care. The authors explore the benefits of a managed care approach to service delivery within a well established system of care by describing the treatment planning process used by the system of care; describing the type and patterns of services provided to young people; and by describing the process used to bill for services.

The nature and impact of conflict within service coordination teams for children and adolescents with serious emotional and behavioral challenges.

While both theory and empirical research regarding work team performance suggests that conflict can play an important role in determining productivity and other outcomes, the impact of conflict on the effectiveness of service coordination teams is not well understood. In this study, the team records and charts of 189 young people maintained by service coordinators in a system of care initiative were analyzed to identify the number of intra-team conflicts, the participants involved in each conflict, the theme of each conflict and their relationship with the likelihood that young people were successful in meeting their treatment goals. Findings indicate that interpersonal concerns and concerns about team member follow-through were the most frequent types of conflict.

The Dawn Project: a model for responding to the needs of children with emotional and behavioral challenges and their families.

Systems of care represent a fundamental departure from traditional service provision by espousing genuine family-centered, culturally competent philosophies and blending the funding streams of multiple payers (e.g., education, mental health, child welfare).