Jessica H. Retrum

Patient-Identified Factors Related to Heart Failure Readmissions

Background—Although readmission after hospitalization for heart failure has received increasing attention, little is known about its root causes. Prior investigations have relied on administrative databases, chart review, and single-question surveys. Methods and Results—We performed semistructured 30- to 60-minute interviews of patients (n=28) readmitted within 6 months of index heart failure admission. Established qualitative approaches were used to analyze and to interpret data. Interview findings were the primary focus of the study, but patient information and provider comments from chart data were also consulted. Patient median age was 61 years; 29% were nonwhite; 50% were married; 32% had preserved ejection fraction; and median time from discharge to readmission was 31 days. Reasons for readmission were multifactorial and not easily categorized into mutually exclusive reasons. Five themes emerged as reasons cited for hospital readmission: distressing symptoms, unavoidable progression of illness, influence of psychosocial factors, good but imperfect self-care adherence, and health system failures. Conclusions—Our study provides the first systematic qualitative assessment of patient perspectives concerning heart failure readmission. Contrary to prior literature and distinct from what we found documented in the medical record, patient experiences were highly heterogeneous, not easily categorized as preventable or not preventable, and not easily attributed to a single cause. These findings suggest that future interventions designed to reduce heart failure readmissions should be multifaceted, should be systemic in nature, and should integrate patient input.

Patient and caregiver congruence: the importance of dyads in heart failure care.

Background:Informal (family) caregivers are integrally involved in chronic heart failure (HF) care. Few studies have examined HF patients and their informal caregiver as a unit in a relationship, or a dyad. Dyad congruence, or consistency in perspective, is relevant to numerous aspects of living with HF and HF care. Incongruence or lack of communication could impair disease management and advance care planning. Objectives:The purpose of this qualitative study was to examine for congruence and incongruence between HF patients and their informal (family) caregivers. Secondary analyses examined the relationship of congruence to emotional distress and whether dyad relationship characteristics (eg, parent-child vs spouse) were associated with congruence. Methods:Thirty-four interviews consisting of HF patients and their current informal caregiver (N = 17 dyads) were conducted. Each dyad member was asked similar questions about managing HF symptoms, psychosocial care, and planning for the future. Interviews were transcribed and analyzed using the general inductive approach. Results:Congruence, incongruence, and lack of communication between patients and caregivers were identified in areas such as managing illness, perceived care needs, perspectives about the future of HF, and end-of-life issues. Seven dyads were generally congruent, 4 were incongruent, and 6 demonstrated a combination of congruence and incongruence. Much of the tension and distress among dyads related to conflicting views about how emotions should be dealt with or expressed. Dyad relationship (parent-child vs spouse) was not clearly associated with congruence, although the relationship did appear to be related to perceived caregiving roles. Conclusions:Several areas of HF clinical and research relevance, including self-care, advance care planning, and communication, were affected by congruence. Further research is needed to define how congruence is related to other relationship characteristics, such as relationship quality, how congruence can best be measured quantitatively, and to what degree modifying congruence will lead to improved HF patient and caregiver outcomes.

Implications of Network Structure on Public Health Collaboratives

Interorganizational collaboration is an essential function of public health agencies. These partnerships form social networks that involve diverse types of partners and varying levels of interaction. Such collaborations are widely accepted and encouraged, yet very little comparative research exists on how public health partnerships develop and evolve, specifically in terms of how subsequent network structures are linked to outcomes. A systems science approach, that is, one that considers the interdependencies and nested features of networks, provides the appropriate methods to examine the complex nature of these networks. Applying Mays and Scutchfields’s categorization of “structural signatures” (breadth, density, and centralization), this research examines how network structure influences the outcomes of public health collaboratives. Secondary data from the Program to Analyze, Record, and Track Networks to Enhance Relationships (www.partnertool.net) data set are analyzed. This data set consists of dyadic (N = 12,355), organizational (N = 2,486), and whole network (N = 99) data from public health collaborations around the United States. Network data are used to calculate structural signatures and weighted least squares regression is used to examine how network structures can predict selected intermediary outcomes (resource contributions, overall value and trust rankings, and outcomes) in public health collaboratives. Our findings suggest that network structure may have an influence on collaborative-related outcomes. The structural signature that had the most significant relationship to outcomes was density, with higher density indicating more positive outcomes. Also significant was the finding that more breadth creates new challenges such as difficulty in reaching consensus and creating ties with other members. However, assumptions that these structural components lead to improved outcomes for public health collaboratives may be slightly premature. Implications of these findings for research and practice are discussed.

Collaborative Performance as a Function of Network Members’ Perceptions of Success

Abstract: Interorganizational networks are a common collaborative approach to tackle complex issues such as public health, national security, education, and poverty. While there is a consensus that networks are a viable approach to these issues, it is unclear what factors lead to effective collaborative performance. One issue for assessing performance is the lack of sufficient evaluation/assessment methods and, subsequently, of empirical data. Applying a conceptual model based in the literature, this study examines characteristics of network members and their perceptions of success in order to ascertain the degree to which members’ agreement on outcomes varies among networks and the characteristics of members of networks that report greater levels of success or of disagreement about success. This study contributes to the collaborative performance literature by analyzing an unprecedentedly large N (n = 98) dataset of interorganizational (whole) networks to test empirically the conceptual model. The results show that higher trust and greater resource contributions predicted higher levels of perceived success among members of a network. A second model, with disagreement about success as the dependent variable, more resources, and higher amounts of diversity, predicted higher levels of disagreement about success. We conclude that the literature on interorganizational networks overemphasizes the benefits of network diversity, and that diversity may, in fact, hinder perceptions of success.

An exploratory analysis of network characteristics and quality of interactions among public health collaboratives

While the benefits of collaboration have become widely accepted and the practice of collaboration is growing within the public health system, a paucity of research exists that examines factors and mechanisms related to effective collaboration between public health and their partner organizations. The purpose of this paper is to address this gap by exploring the structural and organizational characteristics of public health collaboratives. Design and Methods. Using both social network analysis and traditional statistical methods, we conduct an exploratory secondary data analysis of 11 public health collaboratives chosen from across the United States. All collaboratives are part of the PARTNER (www.partnertool.net) database. We analyze data to identify relational patterns by exploring the structure (the way that organizations connect and exchange relationships), in relation to perceptions of value and trust, explanations for varying reports of success, and factors related to outcomes. We describe the characteristics of the collaboratives, types of resource contributions, outcomes of the collaboratives, perceptions of success, and reasons for success. We found high variation and significant differences within and between these collaboratives including perceptions of success. There were significant relationships among various factors such as resource contributions, reasons cited for success, and trust and value perceived by organizations. We find that although the unique structure of each collaborative makes it challenging to identify a specific set of factors to determine when a collaborative will be successful, the organizational characteristics and interorganizational dynamics do appear to impact outcomes. We recommend a quality improvement process that suggests matching assessment to goals and developing action steps for performance improvement. Acknowledgements the authors would like to thank the Robert Wood Johnson Foundation’s Public Health Program for funding for this research.

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.

The Influence of Teaching Methodology on Student Social Interaction

In this paper, we explore the effects of various teaching methodologies on the social interactions reported by university students in the School of Public Affairs at the University of Colorado Denver. Specifically, we will answer the question: How do different teaching methodologies affect the formation of network ties among students in a university classroom? We implement a novel research design, in which we operationalize the impact of alternative teaching methodologies on social interactions, specifically the number and quality of dyadic relationships between students in university classrooms. We find that online classes tend to have fewer, but more frequent interactions among students, more diversity among interactions, and greater likelihood that students perceive other students as influential to their learning. In primarily lecture classes, students reported fewer connections, but similar to online students’ interactions, the interactions were frequent and influential. We conclude that teaching in an online environment has its own strengths in terms of student relationships; that working in groups offers fewer positive relational outcomes than expected; that the experience of the lecturer has a surprising influence on relationships among students; and that student types affect relationships in fairly predictable ways.

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

ABSTRACT 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.

Lessons learned from community-based participatory research: establishing a partnership to support lesbian, gay, bisexual and transgender ageing in place

Background Due to a history of oppression and lack of culturally competent services, lesbian, gay, bisexual and transgender (LGBT) seniors experience barriers to accessing social services. Tailoring an evidence-based ageing in place intervention to address the unique needs of LGBT seniors may decrease the isolation often faced by this population. Objective To describe practices used in the formation of a community-based participatory research (CBPR), partnership involving social workers, health services providers, researchers and community members who engaged to establish a LGBT ageing in place model called Seniors Using Supports To Age In Neighborhoods (SUSTAIN). Methods A case study approach was employed to describe the partnership development process by reflecting on past meeting minutes, progress reports and interviews with SUSTAINs partners. Results Key partnering practices utilized by SUSTAIN included (i) development of a shared commitment and vision; (ii) identifying partners with intersecting spheres of influence in multiple communities of identity (ageing services, LGBT, health research); (iii) attending to power dynamics (e.g. equitable sharing of funds); and (iv) building community capacity through reciprocal learning. Although the partnership dissolved after 4 years, it served as a successful catalyst to establish community programming to support ageing in place for LGBT seniors. Conclusion Multi-sector stakeholder involvement with capacity to connect communities and use frameworks that formalize equity was key to establishing a high-trust CBPR partnership. However, lack of focus on external forces impacting each partner (e.g. individual organizational strategic planning, community funding agency perspectives) ultimately led to dissolution of the SUSTAIN partnership even though implementation of community programming was realized.

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.