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Jack Amory
Health 4200
19 July 2015
Dr. Crandall
Public Health Determinants and Trends
1) Social Determinants in Health
Modern public health has recognized a variety of social determinants of
health. Pick one, from one of the three categories, of these social
determinants of health and reflect on how it (they) may have influenced the
type, variety, and/or need for the health or medical services delivered at
your internship site.
Access to Medical Care: Presence of services delivery systems based on
principles of equity of access
For many Americans, the cost of necessary healthcare services is
prohibitively expensive. Individuals oftentimes feel forced to put up with
suffering from a particular ailment because they are unable to cover the cost
of returning to good health. Oftentimes these individuals enter the system
only once their problem requires emergency medical care. Since emergent
care is the most costly type of delivery, these trends end up putting an
enormous financial burden on the healthcare system. Upstate Cardiology
recognizes the importance of seeking wellness through primary health care
measures, and will go through great lengths to ensure that patients get the
care they need regardless of their ability to pay.
Many of the patients seen at Upstate Cardiology are elderly,
overweight, and have a low socioeconomic status. The combination of these
factors leads to patients with highly complex cardiovascular issues who may
not have the coverage or resources to pay for their care. Upstate Cardiology,
however, holds moral ethics in higher regard than financial gain from those
who are indigent. During my internship experience there were multiple
occasions where a patient was admitted to Upstate for a diagnostic screening
after being denied care from other clinics. The savings that the clinic has
generated for the system by providing these preventative diagnostics and
checkups are huge, but that is not why the practice does it. Whether through
insurance, a payment plan, reduced rates, or even charity care, Upstate
Cardiology always put the needs of the patient before themselves because
they believe access to these services should be equitable for all walks of life. I
was proud to be part of an organization that holds these values and look to
carry these lessons forward in my future career.
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2) Organizational Behavior and Governance
Our health care system is an interface of multiple structures for the
organization, financing, management, delivery and evaluation of a wide
variety of health related services. Based on classwork and your experience in
your internship, (a) identify a structure, role or function that you believe is
crucial to the services (availability, quality, cost effectiveness, etc.) provided
at your internship site. (b) How is that structure, role or function facilitated
by, (or impeded by) things like organizational culture, organizational
functioning, policy, or law? (c) If you could change the law policy, or
organizational practices to make the system more effective/efficient what
would you change? (d) Explain why.
Delivering effective, quality driven care is the most important part of
the service experience when caring for a patient. This holds especially true
when managing chronic illnesses such as blood pressure issues, arrhythmia,
and other cardiovascular problems that Upstate Cardiology treats. If the care
the practice gives is not effective in treatment and delivered with the utmost
quality, then the patient may choose a different provider or stop treatment
altogether. Thus, Upstate Cardiology takes great care to facilitate effective
quality deliverance through its organizational culture within the practice.
The organizational culture of Upstate Cardiology is wholeheartedly
patient focused. The practice’s objective is to be cardiovascular practice of
choice, and thus their attention towards quality starts from the ground up.
This process begins at the front office, the first point of contact with the
patient. They are greeted with a smile and guided through the check in
process when needed. Furthermore, Upstate prides itself in the fact that it
accepts walk in patients, significantly increasing access to their services. Each
clinical staff member is highly educated, jovial, and patient with the
individuals who are in need of their services. Mr. Ron Eskew, the practice
administrator, even makes daily rounds throughout the office to ensure that
both patients are being treated to the high standards that Upstate Cardiology
has set for itself. I am proud to have contributed towards Upstate’s mission of
quality by developing a new quality survey. This survey follows standards set
by the Agency for Healthcare Research and Quality, and is mailed out after a
patient’s visit to accurately assess how well the practice provided top-notch
care. The reason the practice is able to provide this level of care at the high
volumes it does boils down to each staff member taking an active roll in
producing the best possible outcomes for their clients.
In order to promote quality to a higher standard, however, there
needs to be a change in how EMRs are handled. Oftentimes physicians and
nurses are relegated to their computer screens during consultations so that
they can get all of their notes into the system. While it is very beneficial on an
informational level to have this, it severely detracts from one’s ability to
connect with the patient. A theoretical proposal that I would implement
would be to require physicians to only use the EMR system for important
informational retrieval during the consultation. The process of inputting new
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data into the system would be relegated to a time where they are not in
direct contact with their clients. This would aim to shift some of the focus on
healthcare back towards the human element that is increasingly being lost in
today’s technology push. While small, this change could prove to go a long
way towards increasing perceived quality.
3) Concentration- Specific Question
Health Administration Concentration: Based on your internship experience,
what one cost-effective policy intervention would you suggest to improve
systems, processes or health outcomes in the setting where you worked?
Why do you think this would produce better health at a reasonable cost?
Heart disease is the number one leading cause of death in the United
States, taking hundreds of thousands of lives each year. Based on my work in
the medical records office, conversation with staff, and general observations,
an overwhelming majority of the patients admitted to Upstate Cardiology are
overweight, lack dietary and exercise discipline, and smoke. These are all
behavioral factors that have a direct effect on heart health. In order to
reverse this trend, I suggest that a policy intervention should be put into
effect that seeks to promote healthy eating habits, regular exercise, and
smoking education. Fortunately, this policy can be very low cost. To begin, I
would recommend that Bon Secours St. Francis Healthcare System, hospital
system Upstate Cardiology is affiliated with, begin to endorse healthy living
tips at all of their practices. Flyers could be posted throughout each practice
and be made available to those who wanted one. Furthermore, all providers
within the system could be given an educational seminar on the topic so that
they are informed and prepared to pass the information along to all of their
patients. Hosting a number of events throughout the year for children that
exposed them to healthy lifestyle habits in a fun, low pressure way would be
another relatively low cost method that engages the younger generation and
provides good publicity for the practice and system as a whole. I believe that
these would provide positive outcomes at a reasonable cost because
education is the first line of defense against unhealthy habits. If you are
informed and aware of the hazards that await from risky health behavior,
individuals are much less likely to engage in them. If individuals do not
smoke, eat more consciously, and engage in physical activity more regularly,
there will be less incidences of heart disease. The cost savings from having to
provide financial assistance and charity care down the line would ostensibly
cover what it costs to print fliers, educate providers, and host a number of
field day events for children.
