A project in Pennsylvania

Through collaboration, Mercy Health Partners (MHP) of Southwest Ohio, Cincinnati, and Catholic Social Services (CSS) of the Diocese of Scranton, PA, built a housing complex for low-income seniors and developed a variety of supportive services for residents. St. Catherine's Manor aims to meet elder adults' social and medical needs through offerings such as on-site health assessments, meal services, and transportation help. In order for the collaboration to be a success, MHP, CSS, and their partners had to trust one another. They also had to be clear and deliberate about their roles and responsibilities, thereby establishing expectations well in advance of the project. Their partnership was enhanced because they shared a common culture.     

A new role for the Church. Dioceses should do more in providing care for dependent and dying persons

In 1988, with the publication of Catholic Health Ministry: A New Vision for a New Century, the Commission on Catholic Health Care Ministry called on the Church to redefine its healing mission in society. Unfortunately, despite various efforts, the Church has not yet fully articulated a shared vision of Catholic healthcare, healing, and support. Healing human brokenness has always been the Church's work in the world, whether the brokenness be physical, emotional, intellectual, moral, or spiritual. The Church, having a broader definition of brokenness than that of the larger healthcare system, must sometimes act as a countercultural critic of that system. Two of the great challenges facing healthcare today are providing care for dependent persons (people with chronic illnesses and older people) and for dying persons. In both cases, much more coordination of the various actors is needed. The Church could ensure that this coordination is carried out. In each diocese, the bishop should organize a pastoral health and social service planning group to assess community needs and apply Church resources to them. Local Catholic healthcare providers and social service agencies should develop a corporate culture of healing and support. Parishes should accept the idea that healing and supporting frail people are integral parts of parish life.     

Partners in pediatric palliative care: a program to enhance collaboration between hospital and community palliative care services

The provision of high-quality palliative care services to dying children and their families often requires extensive collaboration between hospital-based and community-based care teams. This article describes the origins and development of the Partners in Pediatric Palliative Care program, which has provided pediatric-specific educational offerings and fostered joint endeavors between a palliative care service located in a tertiary care children's hospital and a wide range of hospice and home care agencies in 5 states. The Partners in Pediatric Palliative Care program is evaluated in terms of the favorable ratings that attendees have given the educational components, the relatively modest direct costs of mounting the regional meetings, and the expanded capacity to provide home-based palliative services to children and families who desire them. The Partners in Pediatric Palliative Care program provides another feasible means for hospitals and community agencies to work together to improve pediatric palliative care.     

The REACH Project: An Innovative Health Delivery Model for Medically Dependent Children

Rural Efforts to Assist Children at Home (REACH) is a service/demonstration and training project designed to provide specialized health care and case management services to medically dependent children in a 16-county area in central Florida REACH nurses, acting as Health Care Coordinators, provide instruction, consultation, coordination, and supervision of health care services in collaboration with tertiary care physicians and services at the University of Florida Health Center Patients include infants, children, and adolescents with a wide variety of chronic illnesses including leukemia, muscular dystrophy, pulmonary disorders, failure to thrive, and seizure disorders In addition to extensive work with families in the home, the REACH program incorporates a feedback system for its nurses, a progress-oriented record system, carefully designed agreements between tertiary care centers and community agencies, and an innovative training program for its nurses REACH intends to serve about 1000 children during its 3-year demonstration phase Success will be based on careful monitoring of costs, family functioning, and school attendance lf successful, the project will provide a model for the structured utilization of health and social services for families with medically dependent children.     

The REACH Project: An Innovative Health Delivery Model for Medically Dependent Children

Rural Efforts to Assist Children at Home (REACH) is a service/demonstration and training project designed to provide specialized health care and case management services to medically dependent children in a 16-county area in central Florida REACH nurses, acting as Health Care Coordinators, provide instruction, consultation, coordination, and supervision of health care services in collaboration with tertiary care physicians and services at the University of Florida Health Center Patients include infants, children, and adolescents with a wide variety of chronic illnesses including leukemia, muscular dystrophy, pulmonary disorders, failure to thrive, and seizure disorders In addition to extensive work with families in the home, the REACH program incorporates a feedback system for its nurses, a progress-oriented record system, carefully designed agreements between tertiary care centers and community agencies, and an innovative training program for its nurses REACH intends to serve about 1000 children during its 3-year demonstration phase Success will be based on careful monitoring of costs, family functioning, and school attendance lf successful, the project will provide a model for the structured utilization of health and social services for families with medically dependent children.     

Fragmented services, unmet needs: building collaboration between the mental health and domestic violence communities

The Domestic Violence and Mental Health Policy Initiative (DVMHPI) is an innovative project to address the unmet mental health needs of domestic violence survivors and their children and to develop models that integrate clinical and advocacy concerns. Overseeing a network of more than fifty community-based mental health, domestic violence, substance abuse, and social service agencies, as well as city and state officials, the DVMHPI promotes collaboration and provides training and technical assistance to improve the capacity of local service systems to address the traumatic effects of abuse. This report highlights the importance of generating funding streams that promote collaboration.     

Partnering for preparedness: the project public health ready experience

Effective partnerships between local and state public health agencies and schools of public health have tremendous potential to improve the health of communities nationwide. This article highlights successful collaboration between local public health agencies (LPHA), state health departments, and Academic Centers for Public Health Preparedness (ACPHP) in schools of public health developed through participation in Project Public Health Ready, a program to recognize LPHA emergency preparedness. The project's pilot phase illustrated that LPHAs, state health departments, and ACPHP can effectively work together to improve individual public health worker competency and organizational response capacity in local public health agencies nationwide.     

Affordable housing in Southern California

St. Joseph Health System (SJHS), Orange, CA, has been committed since the mid-1990s to acting as an advocate for the housing needs of low-income people. In 1997, for example, SJHS became a founder, with Mercy Housing and six other Catholic health care organizations, in creating the Strategic Health Care Partnership, an investment pool designed to bring affordable housing to the most vulnerable. In 1999, SJHS supported Mercy Housing's construction of an 81-unit development for very limited-income senior citizens in Orange County, CA. Two years later, SJHS supported Mercy Housing's creation of a 23-unit development in the county for homeless people with HIV/AIDS. In the same year, SJHS and other local groups formed the Kennedy Commission, a group devoted to improving housing in Orange County. Just last spring, the commission persuaded the city council of Anaheim, CA, to vote unanimously for an ordinance that would offer incentives to developers who set aside portions of their housing projects for low-income renters.     

Construction of the Brazilian Sanitary Surveillance System: arguments to debate

This paper analyzes the Brazilian Sanitary Surveillance System as an arrangement aimed at regulating and reducing health risks associated with consumption of products, use of health services and the environment. Historical, political and tax aspects were considered and their development compared with the National Health Surveillance System, which has received strong international cooperation. The comparison was based on the trajectory of their national systems and related federal agencies, as well as on criteria adopted for decentralization. The central category of analysis is federative coordination and was based on the framework of federalism and intergovernmental relations. The institutional context of health and sanitary surveillance presents strong political competition, instability in the project and probable reduction of the ability of federal coordination after the Pact for Health. The National Sanitary Surveillance System due to its nature of public good and high externality in its field of action requires federal coordination for increasing the regional and local cooperation, also because of the structural heterogeneity of Brazilian municipalities.     

Streetside support

Five years ago a small group of employees (health professionals and others) from Saint Joseph's Hospital, Atlanta, volunteered to prepare a meal for the homeless at one of the city's shelters. The experience led to a group decision to volunteer time to provide basic healthcare to the homeless. This soon led to the hospital-based Mercy Mobile Health Project, which, with community involvement, eventually became the Atlanta Community Health Program for the Homeless. Although the Saint Joseph's Mercy Care Corporation sponsors the program, a number of public and private agencies and professional groups are involved. All strive to expand efforts to address the problems of the homeless, to break the cycle of homelessness, and to provide continuing healthcare services where necessary. The number of clinic sites has more than doubled, while patient encounters have quadrupled.     

Rural connections. Iowa hospitals are establishing communications link to better serve rural areas

The Sisters of Mercy Health Corporation, with 14 hospitals in Iowa, and the Mercy Health Centers of Central Iowa, with 13 hospitals in the state, believe fiber-optic technology may provide solutions to the inadequacies inherent in the rural healthcare delivery system. Since 1989, Iowa has committed more than $100 million toward the development and installation of a statewide fiber-optic communication network. The Iowa Communication Network (ICN) was originally envisioned as a means of providing voice, data, and interactive video capabilities to state government agencies, libraries, schools, and colleges. Currently, only hospitals with medical education programs are authorized to use the network, but others are expected to be allowed to soon. Realizing the potential benefits telemedicine and the ICN posed, in June 1993 the Sisters of Mercy Health Corporation and the Mercy Health Centers of Central Iowa jointly established the Midwest Rural Telemedicine Consortium (MRTC) to enhance rural residents' access to primary healthcare through integrated communications systems. The MRTC is trying to secure federal funding to conduct a demonstration project in eight hospitals. The project's goal is to determine how the use of telemedicine applications, specifically fiber-optic applications, affects access, quality, and costs in providing specialty healthcare services to rural patients.     

End-of-life decisions: family views on advance directives

A cross-sectional survey was administered to family members of patients who died at 1 of the 5 Catholic institutions comprising Mercy Health Partners, a health care system in Ohio, to determine their opinions about patient and family participation in decisions about end-of-life care. Among 165 respondents, 118 (86%) of 138 agreed that the family was encouraged to join in decisions and 133 (91%) of 146 that their family member's health care choices were followed. Most agreed that nurses answered their questions (93%, 141/151) and that the doctor communicated well with family members (83%, 128/155). Seventy percent (107/152) indicated that their family member had at least 1 advance directive. There were no differences in whether health care choices were followed when patients with formal advance directives (92%, 92/100) were compared with patients without formal advance directives (88%, 35/40). A unique survey instrument can be used to measure family perceptions and opinions of participation in decisions about end-of-life care.     

Final report on public health practice linkages between schools of public health and state health agencies: 1992-1996.

Since 1988 there has been a call for enhanced linkages between schools of public health and public health agencies that has prompted schools of public health to develop public health practice initiatives. The University of Illinois at Chicago School of Public Health conducted surveys of schools of public health and of state public health agencies in 1992 to collect baseline data on practice initiatives undertaken by academe and governmental public health agencies to enhance collaboration; follow-up surveys were undertaken in 1993, 1994 and 1996. This article describes the trends and implications of this survey of practice linkages involving schools of public health and state health agencies.     

Factors Associated with Collaboration Among Agencies Serving Children with Complex Chronic Conditions

Our objective was to identify agency-level factors that increase collaborative relationships between agencies that serve children with complex chronic conditions (CCC). We hypothesized that an agency will collaborate with more partners in the network if the agency had a coordinator and participated in a community coalition. We surveyed representatives of 63 agencies that serve children with CCC in Forsyth County, North Carolina about their agencies’ collaborations with other agencies. We used social network analytical methods and exponential random graph analysis to identify factors associated with collaboration among agencies. The unit of analysis was the collaborative tie (n = 3,658) between agencies in the network. Agencies participating in a community coalition were 1.5 times more likely to report collaboration than agencies that did not participate in a coalition. Presence of a coordinator in an agency was not associated with the number of collaborative relationships. Agencies in existence for a longer duration (≥11 vs. ≤10 years; adjusted odds ratio (aOR): 2.1) and those with a higher proportion of CCC clientele (aOR: 2.1 and 1.6 for 11–30 % and ≥31 % compared to ≤10 %) had greater collaboration. Care coordination agencies and pediatric practices reported more collaborative relationships than subspecialty clinics, home-health agencies, durable medical equipment companies, educational programs and family-support services. Collaborative relationships between agencies that serve children with CCC are increased by coalition participation, longer existence and higher CCC clientele. Future studies should evaluate whether interventions to improve collaborations among agencies will improve clinical outcomes of children with CCC.     

Three faces of integrative coordination: a model of interorganizational relations in community-based health and human services.

OBJECTIVE. This study develops a theoretically justified, network-based model of integrative coordination in community-based health and human services, and it uses this model to measure and compare coordination in six elder service systems. DATA SOURCES AND STUDY SETTING. We collected data between 1989 and 1991 in six Alabama counties, including two major MSAs, two small MSAs, and two rural areas. STUDY DESIGN AND DATA COLLECTION/EXTRACTION METHODS. Our measurement of coordination is based on patterns of interorganizational relationships connecting the agencies constituting a community-based health and human services system. Within each site, we interviewed representatives from these agencies, asking them to indicate client referral, generalized support, and agenda-setting relationships they had developed with each of the other agencies in the system. Using network analysis procedures we then identified the network associated with each of these organizational functions (i.e., service delivery, administration, and planning) in each site, and we assessed levels of coordination in each network. PRINCIPAL FINDINGS. Our measure of integrative coordination is consistent with other indicators of coordination we derive from our data, suggesting its validity. In addition, levels of integrative coordination across sites for each organizational function are generally comparable. Comparisons across sites show integrative coordination to be consistently highest for service delivery networks and lowest for planning networks. CONCLUSIONS. Previous attempts to assess interorganizational coordination without regard to organizational function are subject to misinterpretation. The differing interorganizational dynamics involved in service delivery, administration, and planning appear to generate different patterns of interorganizational relationships, and different levels of coordination.     

Healthy bi-regional connection: The EU-LAC Health initiative has promoted equitable and collaborative health research and innovation

The European Union and Latin America and the Caribbean regions have enjoyed privileged relations since the first bi-regional Summit of Heads of State and Government, held in Rio de Janeiro, Brazil, in 1999, and the lunching of a Strategic Partnership. Health research stands as one of the major areas of research and development expenditure in both regions and has also been the focus of roughly 30% of all bilateral cooperation agreements and programmes.EU-LAC Health, a project funded by the European Union from 2011 to 2017, had the main objective to develop a consensus roadmap to enhance and coordinate the bi-regional collaboration between the European Union member states and Latin America and Caribbean countries in health research. From April 2013, EU-LAC Health has also supported the Working Group on Health created and designated by decision-makers at the highest political level to implement a bi-regional Join Initiative on Research and Innovation.This article collects and summarises the context, methodology (series of workshops, surveys and iterative deskwork by multiple bi-regional stakeholders) of this project, as well as the main outputs of (1) definition of a strategic roadmap, containing a scientific research agenda, to guide policy-makers in equitable and collaborative health research and innovation; (2) launching of the Joint Initiative on Health Research and Innovation, with the vision of being the reference body on the bi-regional health research and innovation collaboration; and (3) funding of 13 bi-regional health research and innovation projects.EU-LAC Health represents a successful example of bi-regional collaboration and the emerging networks and expertise gathered during the lifetime of the project have the potential to tackle common health challenges affecting the quality of life of citizens from the two regions and beyond. The project has also paved the way for more specific bi-regional initiatives such as a new initiative for bi-regional collaboration in personalised medicine that is being arranged by the partnership. Furthermore, it can inspire future initiatives for bi-regional research collaboration on other fields.     

Health charities, unethical research and organizational integrity

Organizations, particularly Catholic hospitals, schools and social service agencies, should re-examine their relationships to health and medical charities promoting unethical research such as human embryonic stem cell research and therapeutic cloning. Part 6 of the Ethical and Religious Directives provides a helpful framework for ethical analysis and action.     

How the National Prevention Council can overcome key challenges and improve Americans' health

The Affordable Care Act of 2010 established the first-ever National Prevention, Health Promotion, and Public Health Council out of recognition of the need for a major new national focus on disease prevention. Composed of cabinet-level officials from a range of federal agencies, the council has a clear policy mandate: to coordinate and lead prevention, wellness, and health promotion efforts across the entire federal government and the nation. In its first year, the council developed a comprehensive prevention strategy; but its full implementation is threatened by economic, political, bureaucratic, and institutional challenges. This article examines these challenges and makes recommendations for how to maximize the positive impact of the council through effective cross-agency collaboration aimed at improving Americans' health, including framing prevention as a bipartisan cost containment strategy; distancing the work of the council from the implementation of other aspects of the Affordable Care Act; using dollars from the Prevention and Public Health Fund to incentivize ongoing participation by nonhealth agencies; and providing technical assistance and analytic support to nonhealth agencies willing to broaden attention to the health impacts of their nonhealth policies.