Muskie School of Public Service

The Muskie School of Public Service and USM’s Department of Applied Medical Sciences (AMS) have received funding to evaluate a Maine Office of Child and Family Services project resulting from a federal Maternal, Infant, and Early Childhood Home Visiting Expansion grant.

Maine will use funding from the U.S. Department of Health and Human Services’ Health Resources and Services Administration to expand and enhance Maine Families, an evidence-based home visiting program designed to improve maternal and child health, reduce child maltreatment, and increase school readiness. The Muskie School and AMS have been funded at $1.69 million over four years for their evaluation. A mixed method approach will be used to evaluate whether program fidelity is maintained throughout the expansion, whether health and wellness outcomes are achieved, and whether successful collaboration improves service provision to high-risk families.

Brenda Joly, assistant research professor in the Muskie School’s public health program, will serve as co- evaluator. Other lead staff in the Muskie School include Barbara Poirier, manager of public health programs, and Diane Friese, research associate in the school’s Population Health and Health Policy research program.

Academy participants engage in workshop sessions on patient safety

On Monday, August 1, 115 health professionals gathered at the Muskie School of Public Service for the 2011 Patient Safety Academy, hosted by the Maine Critical Access Hospital Patient Safety Collaborative and supported by the Maine CDC Office of Rural Health and Primary Care. The day-long event included two presentations and a variety of workshop sessions offered by innovators and experts within the field.

In all, 27 hospitals from both urban and rural systems throughout the state were represented.  Participants included professionals from long-term care facilities, EMS, ambulatory care, primary care, state agencies, provider organizations, researchers, students, academics, and consumers.

Roger Swartz addresses positive deviance at the 2011 Patient Safety Academy

David Browning, co-director of the Patient Safety and Quality Initiatives at the Institute for Professionalism and Ethical Practice and author of Talking with Patients and Families About Medical Error, kicked off the day with “Disclosure and Apology with Patients and Families: What’s at Stake.” Later in the afternoon,  Roger Conrad Swartz, executive director of the Positive Deviance Initiative at Tufts University, challenged the audience to think outside of the box with “Positive Deviance: Innovation from the Inside Out.”

Ralph Gabarro and Lynne Gagno of Mayo Hospital served as workshop leaders

Workshop leaders included Lynne Gagnon, director of Patient Services, and Ralph Gabarro, CEO, both of Mayo Hospital; Peg Shore, HAI Prevention Coordinator for the state of Maine; Stephen Sears, Maine’s state epidemiologist; Elizabeth Hart, medical director at the Maine Hospice Council; Jennifer Hunt-MacLearn, director of Professional Development & Performance Excellence at Spring Harbor Hospital; and Davis Balestracci of Harmony Consulting, LLC.

Educational materials were provided throughout the day-long event

The Academy is an opportunity to advance the dialogue on patient safety on a broad level. Participants who attend each year bring educational materials, case studies, and best practices back to their own institutions and systems to improve patient safety throughout the state. “We know the only way to increase our level of expertise in the relatively new science of patient safety is to work and learn together,” said Judith Tupper, managing director of Population Health and Health Policy at the Muskie School’s Cutler Institute.

Click here to view additional photos from the 2011 Patient Safety Academy.

Erika Ziller, Senior Research Associate at the USM Muskie School’s Cutler Institute, recently received the Louis Gorin Award for Outstanding Achievement in Rural Health Care from the National Rural Health Association (NRHA). The award was presented on May 5 at the NHRA annual conference, which attracted over 900 rural health professionals and students to Austin, Texas.

This annual award honors the memory of Louis Gorin, a federal employee who for 25 years helped lead the design and authorization of health initiatives for rural America. Award recipients are selected based on their creativity, unselfishness, compassion, and cooperative attitude in seeking ways to make lasting contributions to rural health care. Their work extends beyond the local community and has a demonstrated effect on rural health at state and national levels, including contributions to rural health policy, legislation, health care, and health programs.

As the NHRA noted in its award announcement, Ziller has become a nationally recognized researcher for her work at Cutler, particularly with the Institute’s Maine Rural Health Research Center. In 2010, she produced several key policy briefs on the scope and consequences of rural un-insurance and under-insurance.

The USM Muskie School recently prepared two research and policy briefs for the Health Care Forum of the Policy Leaders Academy, a nonpartisan educational program for Maine Legislators.

Federal Health Care Reform: An Overview, authored by Andrew Coburn, Muskie Professor and Program Director of Population Health and Health Policy at the Cutler Institute. States will have significant choices and responsibilities in implementing the Patient Protection and Affordable Care Act. This policy brief summarizes the major components of the Act—health insurance coverage, delivery system improvements, and cost containment—and offers a concise description of other important provisions related to prevention and public health, workforce, and long term care.

Medicaid Managed Care: Background, Issues, and Options, authored by Julie Fralich, Program Director of Disability & Aging at the Cutler Institute. Medicaid managed care has become a leading model for the delivery and payment of health care services in state Medicaid programs across the U.S. Implementation of such programs requires thoughtful planning, active stakeholder engagement, and an effective administrative infrastructure to manage and operate in a value based purchasing environment. This policy brief provides an overview of the issues that states must consider in developing and implementing a Medicaid managed care program.

The Health Care Forum is sponsored in partnership with the USM Muskie School and the Margaret Chase Smith Policy Center at the University of Maine. The Policy Leaders Academy is a program of the Maine Development Foundation and is sponsored by the Maine Health Access Foundation.

Yahor Luhauskikh from Belarus, a graduate student in the Muskie School’s health policy and management program, was recently elected to the USM Graduate Student Government and will serve as its representative to the USM Faculty Senate.

Yahor, a fellow in the highly competitive U.S. State Dept.’s Muskie program, was a student leader in his home country, heading a student scientific club and organizing conferences of the Student Scientific Society at Belarus State Medical University.  In the future, Luhauskikh would like to teach at a medical university in Belarus where he plans to share his knowledge of international best practices in public health and to promote the modernization of health services.  Luhauskikh also wants to inspire other students to be active participants in university life.  He notes that after his experience at the University of Southern Maine, “I will have some ideas about how to make changes and help students get involved.”

The Edmund S. Muskie Graduate Fellowship Program confers fellowships for master’s degree-level study in the U.S. in the fields of business administration, economics, education, environmental policy and management, international affairs, journalism/mass communications, law, library and information science, public administration, public health and public policy for students and professionals from Eurasia. Candidates are recruited through a merit-based competition administered by the International Research & Exchanges Board (IREX). U.S. host campuses are also selected through a competition process and generally provide tuition waivers of fifty percent. Approximately 145 fellowships are awarded each academic year.

Read more about Yahor on the IREX blog.

A two-year grant from the federal Agency for Healthcare Research and Quality to develop and test patient safety practices will improve communication and information flow during transitions of patients and care between nursing facilities, emergency medical services and critical access hospitals.

Hands-off and care transition errors are among the most common and consequential errors in health care. Transfers between nursing homes and hospitals present significant challenges because they involve multiple settings, many different health care providers and exchange of patient care information.

“The quality of care during the transfer can be affected by missing or inaccurate information, which can then snowball into other problems,” said Judy Tupper, a project director at the Muskie School. “This is particularly important for Maine as an older, rural state. Rural elders are more likely to reside in nursing facilities and face more frequent transfers to the hospital.”

This grant will allow the Maine Critical Access Hospital Patient Safety Collaborative – a representative group of 14 small, rural hospitals – to partner with local Emergency Medical Services providers and nursing facilities in pilot activities.  The Muskie School will work with the local partnerships and state-wide stakeholder groups to develop and test interventions to improve communications, patient care and safety.

The ultimate goal will be to help nursing homes, emergency medical services and critical access hospitals improve the safety of patient transfers and increase wide-spread adoption of standardized, safe practices.

Practices that are determined to be successful in improving safety will be made available via the Collaborative’s web site: www.mainecahpatientsafety.net .

Study author Dr. Bill Thomas (photo credit: Tim Greenway)

Muskie researchers have published a revealing study in the September issue of Health Affairs, the nation’s leading health policy journal, that provides first-time comprehensive data on the effects defensive medicine–the practice by doctors and other health professionals to prescribe unnecessary tests and procedures to to reduce perceived threats of lawsuits. They found that national tort reform would likely lead to less than 1% decline in medical costs.

National tort reform and a resulting decline in malpractice insurance premiums would probably have little impact on costs in terms of reductions in defensive medicine, according to J. William Thomas, visiting professor at the USM Muskie School and his co-authors Erika Ziller and Deborah Thayer, also at the Muskie School.

“The practice is commonly assumed to increase health care costs,” said Thomas. “But, until now, we didn’t have consistent enough data to support that idea.” Their analysis shows that estimated savings from a 10 percent decline in malpractice premiums would translate into reductions in defensive medicine equal to less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.

In their published results, the authors wrote: “We conclude that defensive medicine practices exist and are widespread, but their impact on medical care costs is small.”

The USM team’s findings were published at the same time as a study by researchers at the Harvard School of Public Health, which pegged the total cost of malpractice at approximately $55.6 billion a year, or 2.4 percent of annual health care spending.

An interview with Dr. Thomas was published in Mainebiz on October 4, 2010.

A collaboration between the Muskie School and Maine DHHS has recently released a new web site with online resources for adults with developmental disabilities and their caregivers.

Part of the Maine Nutrition Network, this project helps caregivers guide the consumers they serve to take responsibility for their own health and make good choices for healthful eating and being physically active.

With increased knowledge and skills, the caregivers can improve their efforts to influence the food and physical activity choices of the people they serve.  Included on the web site are consumer guides, caregiver guides and resource notebooks.

Dr. David Hartley, who has studied mental health services in rural America for 16 years, was recently quoted in a Modern Healthcare magazine article about the unique issues contributing to higher suicide rates in rural areas.

According to Professor Hartley, “…the prevalence of depression or more serious disorders is pretty much the same in rural and urban areas. It’s not that they’re in greater need because of illness, but because they either don’t choose to seek services or the services aren’t there in the first place,” he adds. “There are vast areas in the West where there aren’t any.”

The article pointed out that the American Association of Suicidology shows that suicide rates are highest in states with highly rural areas: Alaska, Montana, New Mexico and Wyoming.

Dr. Hartley is the director of the Maine Rural Health Research Center at the USM Muskie School. Established in 1992, the Center informs health care policymaking and the delivery of rural health services through high quality, policy relevant research, policy analysis and technical assistance on rural health issues of regional and national significance.

On August 2, Dr. Carol Haraden of the Institute for Healthcare Improvement (Cambridge MA) addressed 150 health care providers from across Maine and New Hampshire for the first annual Patient Safety Academy hosted by the USM Muskie School and sponsored by the Maine CDC Office of Rural Health and Primary Care.

Dr. Haraden spoke about what is needed to make systemic change within the hospital setting and encouraged attendees to work together to start a movement for patient safety in the region. She urged Northern New England’s hospitals (many of which have fewer than 75 beds) to push for big improvements and to be at the leading edge in testing new ideas for improving patient safety.