COLUMBIA UNIVERSITY



COLUMBIA UNIVERSITY SCHOOL OF NURSING

M6920 HEALTH AND SOCIAL POLICY:

THE CONTEXT FOR PRACTICE AND RESEARCH

Prerequisites: None Term: Fall, 2001

Credits: 4 Time: Tuesday, 5-8 PM

Course Level: Required Location: PH 17-201

Faculty: Kristine M. Gebbie, DrPH, RN

Office: GB 250

Phone: 305-1794 FAX: 305-0722

E-mail: kmg24@columbia.edu

Teaching Assistant: Kris Qureshi, MS, RN

Office: GB 245

Phone: (212) 305 0540 Fax: (212) 305-0722

E-mail: kaq5@columbia.edu

Description:

This course examines contextual contributors to health status and relevant current U.S. social and health policies. Issues are explored with a particular emphasis on the impact they have on the current and future delivery of health care and on advanced practice nursing.

Objectives:

At the conclusion of this course the student will be able to:

1. Describe the determinants of health model as a way of relating social context to health outcomes;

2. Identify the key historical developments and socio-cultural-political forces that fostered the structure of the U.S. health system;

3. Identify population groups most at risk for adverse health outcomes due to historic and current social and public policies;

4. Describe current issues and trends in cost, access and quality in U.S. health care; and

5. Articulate the clinical and public policy responsibilities of nurses, especially advanced practice nurses, regarding the issues raised.

Methods:

Lecture, discussion 3 hours/week; observation activities av. 1hr/week.

Evaluation:

15% Current News Assignments (see attached description)

20% Community Policy Observation (See attached description)

40% Paper (See attached description)

20% Examination

5% Class Attendance and Participation

Required Texts:

Bodenheimer TS & Grumbach K. 1998 Understanding Health Policy: A Clinical Approach. Second edition. Norwalk, Conn.: Appleton and Lange.

Recommended Texts:

Aday, Lu Ann. 2001. At Risk in America, 2nd edition. San Francisco: Jossey Bass.

Amick, BC, Levine S, Tarlov AR, Walsh, DC. 1995. Society and Health New York: Oxford University Press.

Johnson HB & Broder DS 1996 The System: the American Way of Politics at the Breaking Point Boston: Little Brown.

Milio N. 2000. Public Health in the Market Ann Arbor, Michigan: University of Michigan Press.

Massing, Michael. 1998 The Fix New York: Simon and Schuster

Required Reading:

Bodenheimer T. 1999. The American Health Care System: Physicians and the Changing Medical Marketplace. NEJM 340:7 (584-8).

Cabana MD, Rand LS, Powe NR, Wu AW, Wilson MH, Abboud P-AC, Rubin HR. 1999 Why Don’t Physicians Follow Clinical Practice Guidelines? JAMA 282:15 (1458-63).

Calman, N. S. 2000. Out of the shadow. Health Affairs 19(1), 170-174.

Chassin M. 1998 Is Health Care Ready for Six Sigma Quality? The Milbank Quarterly 76:4 (565-91).

Conklin TJ, Lincoln T, Tuthill RW. 2000 Self-reported Health and Prior Health Behaviors of Newly Admitted Correctional Inmates. AJPH 90:12 (1939-41)

Corser, W. D. 2000. The contemporary nurse-physician relationship: Insights from scholars

outside the two professions. Nurs Outlook 48(6), 263-268.

Cubbin C, LeClerc FB, Smith GS. 2000. Socioeconomic Status and the Occurrence of Fatal and Nonfatal Injury in the United States. American Journal of Public Health 90:1 (70-7).

Davis K, Schoen C, Schoenbaum SC. 2000. A 2020 Vision for American Health Care Archives of Internal Medicine 160:22 (3357-3362).

DeClerq, Simmes D. 1997. The Politics of “Drive Through Deliveries”: Putting Early Post-partum Discharge on the Legislative Agenda. The Milbank Quarterly 75:2 (175-202).

Finucane TE 1999. How Gravely Ill Becomes Dying: a Key to End-of-life Care. JAMA 282:17(1670-2).

Freeman, H. P., & Payne, R. 2000. Racial injustice in health care [editorial; comment]. N Engl J Med 342(14), 1045-1047.

Friedman LH, Savage GT. 1998. Can Ethical Management and Managed Care Coexist? Health Care Management Review 23:2 (56-62).

Fullilove MT, Green L, Fullilove RE. 1999. Building Momentum: an Ethnographic Study of Inner-city Redevelopment. American Journal of Public Health 89:6(840-4).

Iglehart JK. 1999. The American Health Care System. NEJM 340:1 (70-6).

Letters to the Editor 2000. JAMA 283:19 (May 17, 2000) 2521-4.

Jones, C. P. 2000. Levels of racism: a theoretic framework and a gardener's tale. Am J Public

Health 90(8), 1212-1215.

LaDuke S. 2000. The Effects of Professional Discipline on Nurses. American Journal of Nursing 100:6 (26-33).

Lindeke LL, Chesney ML. 1999. Reimbursement Realities of Advanced Nursing Practice Nursing Outlook 47:6 (248-52).

Maantay J. 2001. Zoning, equity and public health. AJPH 91(7). 1033-1041.

Mayer ML, Clark SJ, Konrad TR, Freeman VA, Slifkin RT. 1999. The Role of State Policies and Programs in Buffering the Effects of Poverty on Children’s Immunization Receipt. American Journal of Public Health 89:2 (164-70).

McGinnis JM, Foege WH. 1993. Actual causes of death in the United States. JAMA 270:2207.

Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D.,

Friedewald, W. T., Siu, A. L., & Shelanski, M. L. 2000. Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial [see comments]. JAMA, 283(1), 59-68.

Oppenheimer GM. 2001 Paradigm lost: race, ethnicity and the search for a new population taxonomy. AJPH 91(7) 1049-1055.

Romm, J. J., & Ervin, C. A. 1996. How energy policies affect public health. Public Health Rep

111(5), 390-399.

Sox, H. C. 2000) Independent primary care practice by nurse practitioners [editorial; comment]

JAMA, 283(1), 106-108.

Stewart AL. Grumbach K. Osmond DH. Vranizan K. Komaromy M. Bindman AB. 1997.

Primary care and patient perceptions of access to care. Journal of Family Practice. 44:2(177-85).

Thomas SB. 2001. The color line: race matters in the elimination of health disparities. AJPH 91(7) 1046-8.

Willis DP 2001. Them and us: the politics of population taxonomy. AJPH 91(7) 148-1049

Useful Web Sites

|World Health Organization | |

|Pan American Health Organization | |

| | |

|US Dept. of Health & Human Services | |

| Agency for Healthcare Research & Quality | |

| Centers for Disease Control & Prevention | |

| Centers for Medicare & M'caid Services | |

| Health Resources & Services Admin. | |

| Substance Abuse & MH Services Admin. | |

|US. Dept. of Labor | |

|US Bureau of the Census | |

|Federal Statistics (FedStats) | |

|US Congress | |

| | |

|New York State Department of Health | |

|New York City Department of Health | |

|New York City Community Boards | |

| | |

|American Nurses Association | |

|New York State Nurses Association | |

|American Public Health Association | |

|Annie E. Casey Foundation | |

|Commonwealth Fund | |

|Kaiser Family Foundation | |

|Robert Wood Johnson Foundation | |

|Center for Studying Health System Change | |

| | |

|Health Rights Hotline (consumer advocacy) | |

Many of these sites also include links to other sources of useful information

Topic Outline

|DATE |TOPIC |READINGS |

|Sept. 4 |Introduction and Course Expectations | |

| |Outline of significant perspectives on health and social policy | |

|Sept. 11 |Determinants of health model |Aday, McGinnis, Calman, Cubbin , Romm, Freeman;|

|NA 1 due |Significant vulnerable populations in the US |Maantay |

| | | |

|Sept. 18 |Public health and population focus |Bodenheimer Ch. 11; HP2010; Fullilove; Thomas; |

| |Healthy People 2010 |Oppenheimer |

|Sept. 25 |Making a difference in the system: the case of NY State DOCS. Guest |Conklin |

|NA 2 due |speaker: Lester Wright, MD, MPH, Associate Commissioner and Chief | |

| |Medical Officer, New York State Department of Corrections Services | |

|October 2 Vulnerable |Structure and history of US health system |Bodenheimer Ch 1, 10 |

|Pop Due |Introduction to policy framework |Jones, Massing, Mayer |

|October 9 |Making and changing health policy |Johnson & Broder; Bodenheimer Ch. 13; DeClerq |

|NA 3 due |Media and politics | |

|October 16 |Organizing systems for care |Bodenhiemer, Ch 6, 7; LH Friedman |

|Pol Question Due | | |

|October 23 |No class: comparable time for assignments | |

|October 30 |Health workforce issues |Bodenheimer (NEJM); Corser Lindeke, Mundinger, |

|NA 4 due | |Sox, JAMA letters |

|Nov. 6 |No class/Election Day | |

|Nov. 13 |Access to care |Bodenheimer, Ch. 3; Stewart |

|Nov. 20 |Cost of care and payment for care |Bodenheimer, Ch. 2, 4, 5, 9; Iglehart |

| | | |

|Nov. 27 |Quality of Care; Guide to Clinical Preventive Services and Guide to |Bodenheimer, Ch. 12, Cabana, Chassin, LaDuke |

|Obs. Due |Community Preventive Services | |

|Dec. 4 |Making a difference in the system: directions for the future |Bodenheimer Ch. 17 |

|Paper due | |Davis, Finucane, Milio |

|Dec. 10 |Exam distributed | |

|Dec. 12 |Exam due | |

Current News Assignments

The four short current news assignments are each worth 4 points, a maximum of 1 point each for the following areas:

- a timely general press article relevant to nursing practice and a vulnerable population;

- identification of the policy area to which it relates and the related political forces;

- identification of the anticipated impact; and

- coherent, organized discussion of the issues.

You are to use the issues or information from a general press article (newspaper, news magazine) as a part of the assignment.

You are to tie the issue to advanced nursing practice AND to a vulnerable population.

The purpose is to learn to identify the policy issues and political forces which are involved in or raised by the article--what is the policy goal, who are the intended beneficiaries, what players are expected to have a role, what are the costs--and that you understand these issues as a part of the context for your advanced nursing practice.

Your paper should be approximately one typewritten page (double-spaced, 10 or 12 pt. type).

DO NOT use up more than 1/4 of your space on a ‘book report’ of the article; focus on your analysis and commentary. Attach copy of the article you are discussing; if I need to review it, I can read the original.

Assignments due on September 11, September 25, October 9 and October 30.

Please do not put any assignments into any holder, folder, binder; staple pages together.

Community Policy Observation Assignment

Attend at least one meeting of a social- or health-related policy making body relevant to the vulnerable population that is your focus during this course. This could be a city council, local board of health, legislative committee, neighborhood board or board of a not-for-profit agency. You are encouraged to attend two consecutive meetings of the same board, if possible.

The purpose of the assignment is to see the dynamics of policy-making: the information available to policy-makers, the context of the issues, the interaction and the politics. The group does not need to be taking action on an item specifically related to your topic or specifically labeled 'health'. Reminder: a policy-making meeting is not an educational program or an issue rally designed to “sell” a policy already identified.

If you have any question about the appropriateness of a meeting to this assignment, please consult with me or with Ms. Qureshi.

Your observations should be written up in approximately 5 pages, and should describe:

a. the role and authority of the body (how are they chosen/to whom accountable);

b. the relevance of the body to the vulnerable population of interest;

c. the health policy issue(s) under discussion; and

d. the outcome(s) of the meeting.

Grading criteria:

Role/authority clearly identified 5

Populations affected identified 3

Issue(s) clearly stated 5

Outcome(s) identified 5

Readability 2

The policy observation paper is due November 27.

Please do not put any assignments into any holder, folder, binder; staple pages together.

Policy Action Paper

The format of this paper is similar to that you might use to provide decision makers in an organization with alternatives and an action recommendation on a policy question. The question you choose to describe and answer may be about cost, access, quality, scope of services, or some combination of these as they affect a vulnerable population. This is not a theoretical, clinical or advocacy paper or literature review paper, though it may be about a clinical topic, and does involve using current professional literature and lays the basis for advocacy.

You should write the paper as if you have been asked by some the policy-making body or individual to recommend a solution to a policy question.

The introductory sections of your paper should identify the population of interest, the organization for which you are making the recommendation and the policy question you will be discussing.

Identify no less than 3 alternative policy actions, including the strengths and weaknesses of each. The strength or weakness of an option often is related to its relative political feasibility.

Identify key interest groups that should be involved in answering this policy question and how they will become involved.

Recommend one of the described alternatives, and state why you believe it to be the best choice.

Provide a bibliography of no less than 6 current (published within 5 years), peer-reviewed journal articles relevant to your issue. For current health statistics relevant to your population of interest only, official agency web sites may be used as references, but they do not substitute for peer-reviewed literature.

Maximum length of the paper is 15 pages of text plus bibliography (10 point type minimum). The paper and references should be in APA format.

Grading criteria:

Description of vulnerable population coherent, accurate 3

Policy maker identified and question clearly stated 3

Alternatives identified 5

Strengths/weaknesses of each alternative identified 8

Interest groups identified and role described 5

Recommendation made 2

Rationale for recommendation clear 6

Bibliography 5

Readability 3

Description of Vulnerable Population due October 2. Identify the composition of this population AND the source of or reason for the vulnerability. This should be approximately 2 pages, and will become part of the introduction of your final paper.

Organization and policy question due October 16. In no more than one paragraph, identify the policy-making body or individual to whom your recommended solution will be presented, and the policy question that you will be addressing in your paper. This will become a part of the introduction to your final paper. Hint: If you write a question that can be answered “yes” or “no”, you have not asked a policy question.

Final Paper due December 4.

Please do not put any assignments into any holder, folder, binder; staple pages together.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download