Putting change into practice
The Dartmouth Institute's founding class of online Master of Public Health students returned to Hanover, Dec. 12-15, 2016, for their second residential period in the program. Not only did they get a chance to meet more faculty and dive deep into data analysis with stata and biostatistics, they also shared initial work begun on their practicum projects. Designed to give students an opportunity to make an immediate impact on health and health care, the practicum projects enable students to put into practice what they're learning about how to develop solutions to some of the most intractable problems in health care and to overcome the institutional inertia and complexity that often stand in the way of change.
Through a combination of capstone and internship work, students develop and refine their practicum projects throughout the two-year program. The practicums can range from a quality improvement project in a medical care setting to a policy project. See what some of our students are working on below.
How Can Community-Based Policies Improve Chronic Disease Management?
By Emily Haas
Why I Chose It: I just finished up a project with the World Health Organization, Regional Office in Europe. I helped to organize a high-level conference focused on improving equity and social outcomes for children and adolescents. You can have a perfect health system and a perfect model for treating patients within a clinical setting, but if the community infrastructure, support, and coordination isn’t there, the overall health and well-being of our society cannot improve.Thus, it's important to consider population health in a more holistic way.
Public Health Impact: This inspired me to focus my practicum work on expanded care models and look at ways that communities, governments, and municipalities can work together to support chronic disease management. I plan to compile a policy review that governments can use as a tool for creating and implementing public health policies in their own communities. Whether that’s introducing health promotion in schools, building more parks and green spaces where people can walk, or building a community center that’s accessible to people with chronic disease, my plan is to evaluate existing policies and identify what could be most useful to create a comprehensive framework.
Quality Improvement Initiative to Reduce Antibiotic Overuse in Washington State Nursing Homes
By Amit Desai
Why I Chose It: I have been interested in the way physicians prescribe antibiotics for a long time. I am currently working with the Washington State Department of Health to determine ways that nursing homes can monitor antibiotic use on a daily basis and change prescribing behavior. I’m part of 25-member steering committee that includes physicians, nurses, and QI specialists who are looking at this problem in Washington State.
Public Health Impact: Specifically, I’m interested in figuring out how to engage physicians to have better prescribing habits and making them aware of existing evidence-based guidelines. I also want to help educate family members on the harms of overprescribing, including the increase of antibiotic resistance and the unneeded transfers to hospital settings where many of these patients are uncomfortable and face a lot of adverse effects. To some extent, these nursing homes do not have the infrastructures needed for successfully monitoring prescribing practices. The State Department of Health is conducting this project to help them establish practices and assessments that are sustainable in the long run.
Understanding Value-Based Payment Models in Obstetrics and Gynecology
By Karen George
Why I Chose It: I’ve been a practicing OB-GYN for almost 25 years. In recent years—seeing an increase in substance abuse issues, obesity, and other public health concerns among my patients—I was starting to feel I didn’t really have a medical solution to these problems. I felt I needed to step away from the work I was doing and develop new skills to take care of patients at a population level.
Public Health Impact: In January, I’ll begin working in Washington, DC, as a health economics and policy intern at The American Congress of Obstetricians and Gynecologists (ACOG). The bulk of my work will be looking at alternative payment models in OB-GYN, and at what quality measures are important and meaningful to women and to the people taking care of them. I hope to focus on ways to create better coordination of care for women, so that we can start to address some of the pressing public health concerns that we don’t traditionally have time to focus on.
Optimizing Shared Decision Making in Lung Cancer Screening
By Paul Hill
Why I Chose It: I wanted to focus on a project that blends some of The Dartmouth Institute research hallmarks, such as shared decision making and co-production, into my work as a chief radiology resident at Dartmouth-Hitchcock Medical Center. There was a unique opportunity in CT lung cancer screening, now that Centers for Medicare & Medicaid Services (CMS) legislation mandates shared decision making in order to be eligible. Screening is often a difficult concept for patients to comprehend because there is a lot of information to absorb to fully understand the benefits, risks, and next steps. I wanted to see how our institution was doing and determine what’s most relevant to patients when making this decision.
Public Health Impact: A number of decision aids have been developed to support shared decision making. I’m investigating how they can be better used before, during, and/or after the clinic visit to guide patients and providers in working together to choose a health pathway that is most appropriate for the patient. I’ve begun surveying patients about their experiences and looking back at their conversations. My goal is to determine what an ideal shared decision making model would look like.
Evaluation of the Comprehensive Soldier Fitness Course at the Wisconsin Army National Guard
Why I Chose It: Having been a leader in the military for the past 10 years, I have seen how soldiers’ careers can be negatively impacted if they fail to meet the Army’s health and fitness standards. As a medical company commander, the majority of my unit are combat medics. In the austere conditions we work in, you might be dodging bullets and carrying bodies off the battlefield. You have to physically fit enough to get to the patient, no matter where they are. Otherwise, you can’t be an effective medic.
Public Health Impact: The Wisconsin Army National Guard has a fitness course that is designed to be a rehabilitative initiative for soldiers who are not in compliance with the Army’s health and fitness requirements. It’s a win-win situation. It’s good for the National Guard because we retain a qualified soldier, and it’s good for that soldier because they can then continue their military career. I want to evaluate what is most effective in the course and figure out where to make improvements, so that our soldiers get the most out of it—not only for themselves, but also for their families and their fellow soldiers.