HU Credits: 2

Degree/Cycle: 2nd degree (Master)

Responsible Department: Public Health - International Prog.

Semester: 1st Semester

Teaching Languages: English

Campus: Ein Karem

Course/Module Coordinator: Dr Adam Rose

Coordinator Email: chinitz@cc.huji.ac.il

Coordinator Office Hours: Mondays

Teaching Staff:
Prof Adam Rose

Course/Module description:
The course is an introduction to the major concepts of health services delivery and health services research. This will include an introduction to several of the most important conceptual models that are used to understand health services delivery.

Course/Module aims:
At the conclusion of the course, students will understand and be able to explain foundational concepts of how health services delivery is organized, the goals of the health system, and how to measure the achievement of these goals. By the end of the course, students should be familiar with the most important issues and current topics in health services delivery and health services research, and should have a basis to further explore these issues as needed.

Learning outcomes - On successful completion of this module, students should be able to:
At the conclusion of the course, students will understand and be able to explain foundational concepts of how health services delivery is organized, the goals of the health system, and how to measure the achievement of these goals. By the end of the course, students should be familiar with the most important issues and current topics in health services delivery and health services research, and should have a basis to further explore these issues as needed.

Attendance requirements(%):
100

Teaching arrangement and method of instruction: Lectures and discussions

Course/Module Content:
1.Overview of Health Services Delivery and Introduction to Health Services Research
2.Determinants of Healthcare Utilization and Access to Care
3.Financing – How We Pay for Healthcare
4.Health Care Professionals
5.Healthcare Settings: Primary Care
6.Healthcare Settings: Hospitals
7.Vulnerable Populations and Health Disparities
8.Quality of Care Measurement – Part 1
9.Quality of Care Measurement – Part 2
10.Implementation Science
11. Student Presentations – Part 1
12. Student Presentations – Part 2
13.Emerging Topics in Health Services Delivery

Required Reading:

1https://en.wikipedia.org/wiki/Social_ecological_model#Bronfenbrenner's_ecological_framework_for_human_development

2White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med. 1961;265:885-92.

3West J, Mehrotra A. The Future Ecology of Care. Ann Intern Med. 2016;164(8):560-561. doi:10.7326/M15-1978


4https://www.ahrq.gov/talkingquality/measures/six-domains.html

5McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635-2645. doi:10.1056/NEJMsa022615
https://www.nejm.org/doi/full/10.1056/NEJMsa022615

6Brooks R, Vaiana, M. Using the Knowledge Base of Health Services Research to Redefine Health Care Systems. J Gen Intern Med 30(10):1547–56.

7Andersen R. Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 1995;36:1-10

8Graves, John & Hatfield, Laura & Blot, William & Keating, Nancy & McWilliams, J. (2020). Medicaid Expansion Slowed Rates Of Health Decline For Low-Income Adults In Southern States: An analysis of the impact of Medicaid expansion on the self-reported health of low-income older nonelderly adults living in the South. Health Affairs. 39. 67-76. 10.1377/hlthaff.2019.00929.

9Ansari, Z., Laditka, J. N., & Laditka, S. B. (2006). Access to health care and hospitalization for ambulatory care sensitive conditions. Medical Care Research and Review, 63(6), 719-741

10 https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum

11Stone D. Moral hazard. Journal of Health Politics, Policy, and Law 2011;36:887-896.

12Ubel PA. Physicians, thou shalt ration: the necessary role of bedside rationing in controlling healthcare costs. Healthc Pap. 2001;2(2):10-21. doi:10.12927/hcpap.2002.17453
https://www.longwoods.com/content/17453//physicians-thou-shalt-ration-the-necessary-role-of-bedside-rationing-in-controlling-healthcare-cos

13https://www.rand.org/pubs/research_briefs/RB9174.html

14Trivedi A, Rakowski W, Ayanian J. Effect of cost sharing on screening mammography in Medicare health plans. New England Journal of Medicine 2008;358:375-383.

15https://en.wikipedia.org/wiki/Flexner_Report

16Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P. A. C., & Rubin, H. R. (1999). Why don't physicians follow clinical practice guidelines?: A framework for improvement. JAMA, 282(15), 1458-1465.

17Aiken, LH; Clarke, SP; et al. (Oct 2002). "Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction".

18Hall P, Weaver L. Interdisciplinary education and teamwork: a long and winding road. Med Educ. 2001 Sep;35(9):867-75.

19Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–1779.

20Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502.

21Stange KC, Nutting PA, Miller WL et al. Defining and measuring the patient centered medical home. Journal of General Internal Medicine. 2010; 25 (6):601-612.

22Maeng DD, Khan N, Tomcavage J, Graf TR, Davis DE, Steele GD. Reduced acute inpatient care was largest savings component of Geisinger Health System’s Patient-Centered Medical home. Health Affairs. 2015; 34 (4). (2015):636-644.

23Fetter, R. B. (1991). Diagnosis related groups: understanding hospital performance. Interfaces, 21(1), 6-26.

24Krumholz HM, Merrill AR, Schone EM, et al. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes. 2009;2(5):407-413. doi:10.1161/CIRCOUTCOMES.109.883256

25Wasfy JH, Hidrue MK, Ngo J, et al. Association of an Acute Myocardial Infarction Readmission-Reduction Program With Mortality and Readmission. Circ Cardiovasc Qual Outcomes. 2020;13(5):e006043. doi:10.1161/CIRCOUTCOMES.119.006043

26Jack, B. W., Chetty, V. K., Anthony, D., Greenwald, J. L., Sanchez, G. M., Johnson, A. E., ... & Culpepper, L. (2009). A Reengineered Hospital Discharge Program to Decrease Rehospitalization: A Randomized Trial. Annals of internal medicine, 150(3), 178-187.

27Rathore SS, Krumholz HM. Differences, disparities, and biases: clarifying racial variations in health care use. Ann Intern Med. 2004;141(8):635-638. doi:10.7326/0003-4819-141-8-200410190-00011

28Kilbourne AM, Switzer G, Hyman K, Crowley-Matoka M, Fine MJ. Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health. 2006;96(12):2113-2121. doi:10.2105/AJPH.2005.077628

29Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: The Public Health Disparities Geocoding Project. Am J Public Health. 2005;95(2):312-323. doi:10.2105/AJPH.2003.032482

30Paasche Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31(Suppl 1):S19-S26

31https://en.wikipedia.org/wiki/W._Edwards_Deming
32https://en.wikipedia.org/wiki/Total_quality_management

33Donabedian A. The Quality of Care: How Can it Be Assessed? JAMA 1988;260:1743-8.

34Ayanian, J.Z. and Markel, H., 2016. Donabedian's Lasting Framework for Health Care Quality. The New England journal of medicine, 375(3), pp.205-207.

35Brook RH, McGlynn EA, Cleary PD. Quality of health care. Part 2: measuring quality of care. N Engl J Med. 1996;335(13):966-970. doi:10.1056/NEJM199609263351311

36Wennberg J, Gittelsohn A. Small area variations in health care delivery. Science 1973;182:1102-1108.

37Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138(4):273-287. doi:10.7326/0003-4819-138-4-200302180-00006

38Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4):288-298. doi:10.7326/0003-4819-138-4-200302180-00007

39https://en.wikipedia.org/wiki/Diffusion_of_innovations

40Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):32. Published 2015 Sep 16. doi:10.1186/s40359-015-0089-9
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573926/

41Stetler, C.B., Damschroder, L.J., Helfrich, C.D. et al. A Guide for applying a revised version of the PARIHS framework for implementation. Implementation Sci 6, 99 (2011). https://doi.org/10.1186/1748-5908-6-99

42Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009; 4:50.

43Kellermann AL, Jones SS. What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Affairs. 2013; 32 (1): 63-68.

44Budrionis A, Bellika JG. The Learning Healthcare System: Where are we now? A systematic review. J Biomed Inform. 2016;64:87-92. doi:10.1016/j.jbi.2016.09.018

45Rajkomar A, Dean J, Kohane I. Machine Learning in Medicine. N Engl J Med. 2019;380(14):1347-1358. doi:10.1056/NEJMra1814259

46Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med. 2015;372:793-

Additional Reading Material:
n/a

Course/Module evaluation:
End of year written/oral examination 30 %
Presentation 15 %
Participation in Tutorials 10 %
Project work 0 %
Assignments 0 %
Reports 0 %
Research project 15 %
Quizzes 30 %
Other 0 %

Additional information:
None