Berkeley Franz

Changing medical relationships after the ACA: Transforming perspectives for population health

American health care has undergone significant organizational change in recent decades. But what is the state of core medical relationships in the wake of these changes? Throughout ACA-era health care reform, the doctor–patient relationship was targeted as a particularly important focus for improving communication and health outcomes. Recent developments however have shifted the focus from individual-level outcomes to the wellbeing of populations. This, we argue, requires a fundamental rethinking of health care reform as an opportunity to renegotiate relationships. For example, the move to population medicine requires that the very concept of a patient be resituated and the scope of relevant relationships expanded. Medical relationships in this era of health care are likely to include partnerships between various types of clinicians and the communities in which patients reside, as well as a host of new actors, from social workers and navigators to scribes and community health workers. To address the upstream determinants of population health, providers must be increasingly willing and trained to collaborate with community stakeholders to address both medical and non-medical issues. These community-based partnerships are critical to providing health care that is both relevant and appropriate for addressing problems, and sustainable. Approaching health care reform, and the focus on population health, as a fundamental reworking of relationships provides scholars with a sharper theoretical lens for understanding 21st century American health care.

The impact of the Affordable Care Act on hospital-led community health evaluation in the U.S. Appalachian Ohio region

In recent years, policy developments in the United States have dramatically changed how nonprofit hospitals interact with surrounding communities. However, despite the importance of these changes encoded in Internal Revenue Service regulations, little is known about how these requirements have affected how nonprofit hospitals are approaching community health evaluation. We present qualitative findings from interviews with hospital employees and consultants overseeing preliminary rounds of community health needs assessments, as required by the Affordable Care Act. The sample comes from the Appalachian region of Ohio, an area targeted because of significant health challenges. Our findings suggest that the Affordable Care Act has led hospitals to formalize their processes, focus on developing an evidence base, cultivate local partnerships, and reflect on the role of the hospital in public health.

Evangelical Protestants and the ACA: An Opening for Community-Based Primary Care?

Evangelical Protestants make up the largest religious subgroup in the United States, and previous research has shown that Evangelical churches are disproportionately active in community engagement and efforts toward social change. Although Evangelical Protestant perspectives have been considered with regard to persistent socioeconomic stratification and racial discrimination, less focus has been given to how churches interpret poor health outcomes within the United States. In particular, this research addresses how enduring health disparities are understood within the larger discussion of healthcare reform. Due to the similarity of approaches favored by participants in this study and community-based philosophy, a suggestion is made for future health policy dialogue. Although Evangelical Protestants have been most likely to reject all aspects of the Affordable Care Act, in many ways the findings of this study suggest the potential for successful future health policy collaboration. In particular, community-based primary care might appeal to Evangelicals and health professionals in the ongoing effort to improve population health and the quality of healthcare in the United States.

Group Maturity in a Community-Based Project

Community-based projects have become popular as a method to address various community problems. Specifically important is that community members take an active role in these interventions resulting in sustainable social change. Although considerable literature exists on the dynamics of small group interaction, this article addresses how group processes differ in community-based projects. Instead of constructing a static model for group interaction, this discussion focuses on experiences from a recent community-based health project on the island of Grenada. Because community-based projects are directed by a diverse group of community members, maturity is described as a process of negotiation rather than consensus.

Electronic Medical Records and the Technological Imperative: The Retrieval of Dialogue in Community-Based Primary Care

Electronic medical records are regarded as an important tool in primary health-care settings. Because these records are thought to standardize medical information, facilitate provider communication, and improve office efficiency, many practices are transitioning to these systems. However, much of the concern with improving the practice of record keeping has related to technological innovations and human-computer interaction. Drawing on the philosophical reflection raised in Jacques Ellul’s work, this article questions the technological imperative that may be supporting medical record keeping. Furthermore, given the growing emphasis on community-based care, this article discusses important non-technological aspects of electronic medical records that might bring the use of these records in line with participatory primary-care medicine.

What should churches do? Evangelical perspectives on church involvement in an era of community health

Abstract Health disparities in the US pose a significant challenge to scholars, providers, and community activists. An ongoing transition to population health shifts the focus away from individual health outcomes to the prevention of disease and the wellbeing of communities. This approach, however, requires developing partnerships with communities to enact appropriate interventions. In this article, Evangelical churches, an important community institution in the US, are considered potential stakeholders in future health initiatives. We present qualitative findings from 29 Christian Evangelical Protestants, on how Evangelicals themselves view their role in caring for the health of their communities. Our findings suggest a need for: better understanding of the boundaries between (a) domains that require elite expertise, (b) domains in which non-elites such as pastors and parishioners can play a role, and (c) domains in which elites within churches might play an important role through volunteer efforts.

Evangelical theology, health care, and the third way

ABSTRACT In the context of American health care, considerable attention has been paid to health disparities based on both race and socioeconomic status. Scholars of public health and other social scientists agree that these inequities are enduring and tied to important social factors. Recently, community-based interventions have become popular to address population health and improve health outcomes. These projects that occur in the third sector are thought to be successful because of the full participation of community members who are familiar with local problems and prepared to design appropriate solutions. In many ways, community-based philosophy is consistent with the commitment to voluntarism found in Evangelical theology and religious practice. We, therefore, offer a framework for future collaboration and health policy dialogue in the third sector between community-based activists and American Evangelicals.

Reconsidering the role of language in medicine

BackgroundDespite an expansive literature on communication in medicine, the role of language is dealt with mostly indirectly. Recently, narrative medicine has emerged as a strategy to improve doctor-patient communication and integrate patient perspectives. However, even in this field which is predicated on language use, scholars have not specifically reflected on how language functions in medicine.MethodsIn this theoretical paper, the authors consider how different models of language use, which have been proposed in the philosophical literature, might be applied to communication in medicine. In particular, the authors contrast the traditional, indexical thesis of language with new models that focus on interpretation instead of standardization.ResultsThe authors demonstrate how paying close attention to the role of language in medicine provides a philosophical foundation for supporting recent changes in doctor-patient communication. In particular, interpretive models are at the foundation of new approaches such as narrative medicine, that emphasize listening to patient stories, rather than merely collecting information.ConclusionUltimately, debates regarding the role of language which have largely resided in non-medical literatures, have important implications for describing communication in medicine. In particular, interpretive models of language use provide an important rationale for facilitating a more robust dialogue between doctors and patients.

Automatic Medicine? Technology and the Future of Primary Health Care

How do emerging medical technologies stand to impact primary care services? Drawing from theoretical literature on the effects of technology on human interaction, we explore three developments in medical technology. The goal of this analysis is to assess how each technology may contribute to the goals of improved population health outcomes, while revealing the politics of technology at work in American health care. Primary care, in contrast to the ubiquitous use of technology in medical specialty care, is of particular interest because of the focus on preventing illness and improving wellness on the level of populations, rather than individual patients. We assess the extent to which technology promotes the aims of primary care to engage patients in a collaborative relationship and improve population health outcomes.

Health Committees as a Community-Based Strategy

Among the many truisms of community-based health care is that communities must be intimately involved in the conceptualization of problems, devising of solutions, and the execution and implementation of programs. While community members across the United States organize and collaborate on a number of levels, this activity is often ad hoc in response to specific and often fleeting concerns about pressing issues, such as environmental hazards, crime, or neighborhood blight. Deep investments in community-based health require something more along the line of permanent, enduring institutions. To be successful, such institutions must possess consistency, formal rules, continuous support, and participation, in addition to a shared mission.