Values and Evidence: Public input for hospital planning to improve community health

描述（由申请人提供）：人们普遍认为，美国人的健康状况比其他富裕国家差，健康状况和预期寿命方面存在不平等，影响着少数民族和社会经济上处于不利地位的人群，造成健康成绩不佳和不同结果的因素超出了医疗卫生服务系统的范围。要在人口健康方面取得有意义的成果，就需要提高公众的理解和扩大机构行动，从而支持社会和自然环境的变化。根据纽约州2013-2017年预防议程，并符合《平价医疗法案》中对非营利性医院的要求，纽约布鲁克林的迈蒙尼德医疗中心进行了一项全面的社区卫生需求评估（CHNA），旨在支持实施改善其服务的不同集水地区的健康状况的行动，同时努力减少种族、民族和社会经济健康差距。迈蒙尼德曾与纽约医学院（NYAM）合作开展中国健康调查，现在希望优先开展一套以证据为基础的项目，以改善其所服务的社区的人口健康。迈蒙尼德感兴趣的是使用一种审议方法，即公众成员将向机构提供知情和基于价值的建议，以尊重他们认为对改善社区健康具有最高效用的项目。为此，NYAM建议实施三个由24-28名参与者组成的公民小组，以反映Maimonides所服务人口的多样性。结果将总结在一份报告中，提交给迈蒙尼德的领导层，该报告将为方案优先事项提供知情的公众指导，并将在个人和机构层面对过程和结果进行评估。该研究的具体目的是：(1)实施多个公共审议会议，以响应城市医疗中心为多样化，主要是少数民族社区服务的决策责任；(2)评估审议过程对参与者对证据的知识和态度的影响，比较参与前和参与后；（三）评估审议会议的质量和效果；(4)检查机构对公民小组提出的建议的回应，包括建议的可接受性以及实施的障碍和促进因素。该提案的优势在于经验丰富的团队，以及Maimonides医疗中心的全部兴趣和参与，该机构需要做出关键的计划决定，以符合新的州和联邦要求，并满足其社区的需求。我们预计我们的发现将为迈蒙尼德的决策提供信息，并将提供经验教训，这些经验教训将被广泛传播，并可以被全国各地的非营利医院使用，这些医院有新的任务，可以有效地让社区参与医疗保健决策，促进和保护人口健康。

DESCRIPTION (provided by applicant): There is widespread agreement that the health of Americans is poorer than that of other wealthy nations, that there are inequalities in health status and life expectancy affecting minority and socioeconomically disadvantaged populations, and that factors creating both health underachievement and disparate outcomes lie outside of the reach of the medical health care delivery system. Meaningful gains in population health require better public understanding and expanded institutional actions, which support changes in the social and physical environment. In accordance with New York State's 2013-2017 Prevention Agenda and consonant with requirements for not-for-profit hospitals contained in the Affordable Care Act, the Maimonides Medical Center in Brooklyn, New York has undertaken a comprehensive community health needs assessment (CHNA) that is intended to support implementation of actions that improve the health of the diverse catchment area it serves while striving to reduce racial, ethnic, and socioeconomic health disparities. Maimonides has worked with The New York Academy of Medicine (NYAM) in conducting the CHNA and now wishes to prioritize a set of evidence-based programs directed at improving population health for implementation within the community it serves. Maimonides is interested in using a deliberative methodology whereby members of the public will offer informed and value-based advice to the institution with respect to programs they view as having the highest utility to improve the health of the community. In response to this, NYAM proposes to implement three citizen panels comprised of 24-28 participants that will reflect the diversity of the population served by Maimonides. The results will be summarized in a report to Maimonides leadership that will provide informed public guidance for programmatic priorities and will be evaluated for process and outcomes at the individual and institutional level. The specific aims of the study are to (1) implement multiple public deliberative sessions that are responsive to the decision-making responsibilities of an urban medical center serving a diverse, largely minority community; (2) Assess the impact of the deliberative process on participant knowledge and attitudes about evidence, comparing pre and post participation; (3) Assess the quality and effectiveness of the deliberative sessions; and (4) Examine the institutional response to recommendations made by citizen panels, including acceptability of recommendations and barriers and facilitators to implementation Strengths of this proposal are a highly experienced team, as well as the full interest and engagement of Maimonides Medical Center, an institution needing to make key programmatic decisions to comply with new state and federal requirements, and to meet the needs of its community. We anticipate that our findings will inform Maimonides decision making and will offer lessons that will be widely disseminated and can be used by non-profit hospitals across the country with new mandates to effectively engage their communities in health care decision making and to promote and protect population health.