Exploring the Process, Models, and Outcomes of Hospital-Public Health Partnerships

Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) requirement that hospitals conduct community health needs assessments, taking into greater consideration the public health of their respective communities. This has led to growing strategies to develop partnerships between hospitals and public health (PH) as a way to meet these needs1. Meantime, there is a need for data on Hospital-PH partnerships, due to the growing emphasis that these types of partnerships get implemented in practice. In this paper we analyze a secondary data set to explore how hospitals and public health have engaged in partnerships prior to the ACA. We asked “How amenable have hospitals and public health agencies been to forming partnerships?” We found that while Hospitals traditionally have fewer partners, contribute fewer resources, and report fewer outcomes, they tend to report high perceptions of value and more frequent, complex partnerships. The impact of these results are important to efforts to build an evidenced-based foundation by which hospital and public health personnel can develop skills to manage these complex relationships

New Perspectives on the “Silo Effect” – Initial Comparisons of Network Structures across Public Health Collaboratives

Objectives: We explored to what extent "silos" (preferential partnering) persist in interorganizational boundaries despite advances in working across boundaries. We focused on organizational homophily and resulting silo effects within networks that might both facilitate and impede success in public health collaboratives (PHCs). Methods: We analyzed data from 162 PHCs with a series of exponential random graph models to determine the influence of uniform and differential homophily among organizations and to identify the propensity for partnerships with similar organizations. Results: The results demonstrated a low presence (8%) of uniform homophily among networks, whereas a greater number (30%) of PHCs contained varying levels of differential homophily by 1 or more types of organization. We noted that the higher frequency among law enforcement, nonprofits, and public health organizations demonstrated a partner preference with similar organizations. Conclusions: Although we identified only a modest occurrence of partner preference in PHCs, overall success in efforts to work across boundaries might be problematic when public health members (often leaders of PHCs) exhibit the tendency to form silos

Factors Affecting BSW Students' Choices in Initial Field Placement: A Racial/Ethnic Comparison

Field placement experiences have long been viewed as a critical component of social work training. However, little research has focused on choice of initial undergraduate field placement experience and on factors affecting this choice, particularly as they relate to race or ethnicity. This study addressed this research gap in initial field placements for students seeking an undergraduate degree. Data from a survey of 220 students, collected through six semesters from their initial field placement course, are analyzed. Results suggest that students of color differ significantly from their White counterparts not only in choice of field placement but also in certain aspects of the decision process related to this choice. Implications for social work field education are discussed.</jats:p

Patterns in PARTNERing across Public Health Collaboratives

Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162), to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG) models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships

Understanding Social Isolation Among Urban Aging Adults: Informing Occupation-Based Approaches

Socially isolated aging adults are at risk of poor health and well-being. Occupational therapy can help address this issue; however, information is needed to guide such work. National surveys characterize social isolation in populations of aging adults but fail to provide meaningful information at a community level. The objective of this study is to describe multiple dimensions of social isolation and related factors among aging adults in diverse urban neighborhoods. Community-based participatory research involving a door-to-door survey of adults 50 years and older was used. Participants ( N = 161) reported social isolation in terms of small social networks (24%) and wanting more social engagement (43%). Participants aged 50 to 64 years reported the highest levels of isolation in most dimensions. Low income, poor health, lack of transportation, and infrequent information access appeared linked to social isolation. Occupational therapists can address social isolation in similar urban communities through policy and practice that facilitate social engagement and network building. </jats:p

Abstract 124: Patient-Identified Factors Related to Heart Failure Readmissions

Background : Readmission following hospitalization for heart failure (HF) has received increasing attention yet relatively little is known about its root causes. The purpose of our study was to systematically investigate the experiences of patients to gain a better understanding of factors related to readmission. Although prior studies have relied on administrative databases, retrospective chart review, and single-question surveys, ours involves systematic, in-depth primary data collection. Methods : Qualitative semi-structured interviews, paired with chart reviews, were conducted on 28 patients readmitted within 6 months of index hospitalization for HF. Interview questions focused on reasons for readmission and other readmission-related topics and suggestions for improving care. Combinations of both inductive and deductive qualitative approaches were used to code and interpret data. Results : Patient median age was 61, 29% were African American, Latino, or Native American, 50% were married, 32% had preserved ejection fraction, with multimorbidity common. Adherence to self-care behaviors (diet, fluid, medications) was high for most patients. Depression and anxiety, comorbidities, access to care, and economic hardship were identified as significant difficulties for many patients in managing HF. Patient perspectives on the causes of readmission coalesced into 4 common themes: 1) symptom focused (rather than diagnoses based), 2) readmission was unavoidable, often due to the inexorable progression of HF, 3) self-blaming for behaviors related to self care, and 4) health care system failures, including premature discharge from index hospitalization. Interestingly, patient perspectives about reasons for readmission were multi-dimensional in nature, with any single reason rarely given. Patient interviews and provider documentation in charts, while not conflicting, generally did not offer similar causes of readmission in the majority of cases. Conclusions : Our study provides the first systematic qualitative assessment of patient perspectives on HF readmission. Contrary to previous research, we found that patient experiences highlighted a variety of contributing factors for readmission which made it difficult to categorize a readmission as preventable. These findings highlight the importance of considering the patient perspective in designing policies and interventions aimed at reducing unnecessary HF readmissions. </jats:p

Perspectives of LGBTQ Older Adults on Aging in Place: A Qualitative Investigation

This qualitative study conducted by a community-research partnership used multiple types of data collection to examine variables relevant for LGBTQ older adults who wished to age in place in their urban Denver neighborhood. Focus groups, interviews, and a town hall meeting were used to identify barriers and supports to aging in place. Participants (N = 73) identified primarily as lesbian or gay, aged 50–69, and lived with a partner. Ageism, heterosexism, and cisgenderism emerged as cross-cutting themes that negatively impact access to health care, housing, social support, home assistance, and legal services. Resilience from weathering a lifetime of discrimination was identified as a strength to handle aging challenges. Recommendations for establishing an aging in place model included establishing welcoming communities and resource centers and increasing cultural competence of service providers. This study provides a unique contribution to understanding the psychosocial, medical, and legal barriers for successfully aging in place