Across the United States, reducing readmissions has been a concern of most hospitals, some of which have been at risk for having a higher than expected, 30-day readmission ratio for a particular physical health condition. A recent review conducted by Ms. Ivy Benjenk and Prof. Jie Chen from School of Public Health, University of Maryland has shown that care coordination between hospital and community after the discharge, which includes mental health therapy and community mental health services and educations, can significantly reduce the 30-day readmission rate (1). An integrated mental health care system, therefore, is necessary to promote care coordination and improve population health. Journal of Hospital Management and Health Policy (JHMHP) is pleased to interview Prof. Chen in regard to this recent work and her research in health care delivery system and policy (Figure 1).
Jie Chen currently serves as the Associate Professor of Health Services and Administration at the School of Public Health, University of Maryland, College Park, USA. Prof. Chen’s research fields include health care disparities, health care delivery system and policy, behavioral health, and economic evaluation. Her work uses a multidisciplinary perspective and involves collaboration with clinical leaders, community partners, and organizational decision makers. Her research on behavioral health focuses on the integration of health care organizations to promote behavioral health of vulnerable populations.
Prof. Chen has conducted research on patient-centered medical homes, including using mixed methods to design personalized activation and empowerment strategies to engage patients and reduce health disparities (PI of the Pilot Project, 5R24HS022135-02). She is leading a project (PI, R21MH106813-01) to investigate the impact of public health-integrated health care on health care access among people with mental illness and co-existing conditions.
Based on the encouraging finding of the National Institute of Mental Health (NIMH) project, Prof. Chen and her team further developed Project System-level Multidisciplinary Integration for popuLation health and Equity (SMILE) (1R01MD011523-01, Chen PI) to systematically examine care coordination practices between hospitals and communities, and evaluate their impact on hospital use for people with mental illness. An additional field of her research involves economic evaluation, including cost-effectiveness and cost-benefit analysis of community intervention and state/federal policies. She has more than 15 years of research experience developing, refining, and applying analytical methods to evaluate the impact of health policy and the health care delivery system on population health outcomes. Prof. Chen has been working closely with local health departments, hospitals, and community partners to design, develop, and evaluate care coordination interventions.
I am leading a project (PI, R21MH106813-01) to investigate the impact of public health-integrated health care on health care access among people with mental illness and co-existing conditions. Based on the encouraging finding of the NIMH project, we further developed project SMILE (1R01MD011523-01, Chen PI) to systematically examine care coordination practices between hospitals and communities, and evaluate their impact on hospital use for people with mental illness. Our recent research suggests that care coordination is the most useful among the elderly African American and Latino populations with multiple chronic conditions and cognitive limitations. Such evidence motivates us to pursue this exciting study to comprehensively examine the impact of care coordination for people with a diagnosis of Alzheimer’s disease and related dementia (1R56AG062315-01, Chen PI).
Let me introduce project SMILE today. The objective of the project SMILE is to examine the current state of the extent and variation in integrated care coordination between hospitals, communities, and public health agencies (hospital-community-public health) among African American and Latino patients with mental illness and how these coordination practices impact racial and ethnic disparities in health. Our primary hypothesis is that integrating hospital-community-public health can reduce racial and ethnic disparities in health care access, quality, and costs among people with mental illness. This hypothesis is based on our preliminary studies that demonstrate that public health integration can improve patient engagement, and reduce racial and ethnic disparities in preventable hospitalization for people with mental illness. The rationale for the proposed research is that once it is known what specific coordination practices and policies are most successful for different patient populations, integration of mental and physical health care delivery systems can be designed in a more cost-effective way to target the social determinants of health and overcome the barriers from stigma and limited health care access. The resulting integration is expected to align health care delivery with public health and thereby improve population health and eliminate disparities among the mentally ill population.
We expect to identify barriers and challenges in adopting and applying hospital care coordination that may be unobserved in the existing data sets or omitted in the literature, and aid in both the interpretation of quantitative findings and in the development of actionable solutions. Our results combining perspectives from providers and patient representatives (e.g., the end user of care coordination practices) are expected to reflect patients’ and their caregivers’ preferences and enhance the knowledge needed to personalize care coordination. Key informants (expert stakeholders of patient advocates, physicians, hospital administrators, and public health agencies) have been engaged to identify barriers and challenges to adopt and apply care coordination, assist with the interpretation of the findings, indicate whether the results reflect their personal experiences, and translate and disseminate the results among patient groups, local hospitals, and public health agencies.
Improving hospital care coordination is essential to meet the growing demands for mental health care access, while controlling costs and improving quality of service delivery. The proposed project offers an unprecedented opportunity to generate substantial amounts of new evidence and insights about the impact of the hospital care coordination practices on the effective treatment and community benefit activities for racial and ethnic minority populations with mental illness. Evidence will help us to achieve our long-term goal to determine best practice approaches to structuring and sustaining the hospital-community-public health integration to promote population health and reduce health disparities.
We would like to express our sincerest gratitude to Prof. Jie Chen for sharing her insights and opinions with us.
Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Hospital Management and Health Policy for the series “Meet the Professor”. The article did not undergo external peer review.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jhmhp.2019.01.02). The series “Meet the Professor” was commissioned by the editorial office without any funding or sponsorship. Brad Li reports that he is a full-time employee of AME publishing company (publisher of the journal). The author has no other conflicts of interest to declare.
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- Benjenk I, Chen J. Effective mental health interventions to reduce hospital readmission rates: a systematic review. J Hosp Manag Health Policy 2018;2:45. [Crossref] [PubMed]
(Science Editor: Brad Li, JHMHP, email@example.com)
Cite this article as: Li B. Jie Chen: promote population health and reduce health disparities through care coordination. J Hosp Manag Health Policy 2019;3:3.