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Texas Medical Center Health Policy Institute Unveils Results of Inaugural Collaborative Research Grants

HOUSTON, April 5, 2017 /PRNewswire/ -- The Texas Medical Center (TMC) Health Policy Institute last night revealed the results of the four research projects in its inaugural Grant Program in Collaborative Health Policy Research, which awards a total of $750,000 each year to selected projects in an ongoing effort to promote collaboration and partnerships across the TMC's 59 member institutions.

The principal investigators from the four projects presented their research findings to a large crowd of students, clinicians, researchers and others interested in health policy, and then engaged in a lively discussion with a panel of top leaders from TMC institutions: Eric Boerwinkle, Ph.D., Dean, UTHealth School of Public Health; Marc Boom, M.D., M.B.A., President and CEO, Houston Methodist Hospital System; and Paul Klotman, M.D., President, CEO and Executive Dean, Baylor College of Medicine; moderated by the Health Policy Institute's Director Arthur (Tim) Garson, Jr., M.D., MPH and Associate Director Stephen H. Linder, Ph.D.

"One of the major goals of the Health Policy Institute is to foster collaboration across TMC member institutions, and this grant program is a wonderful example of that," said Arthur "Tim" Garson, M.D., director of the TMC Health Policy Institute. "We are proud to have funded four research projects on topics that could not be more fitting given the current state of health policy in the United States. As the nation waits for health care decisions to be made at the national level, some of TMC's leading researchers joined together to study health issues that are relevant to so many people in Houston, the state and the entire United States."

To qualify for the grant, each 12-month research initiative was required to include new, significant collaboration among investigators from two or more TMC member institutions, with the goal of applying their findings to directly impact public policy at the state or federal level in the near term. The principal investigators awarded the grants hail from four different institutions, with a total of 10 member organizations collaborating.

"The intent of these grants is not only to bring together researchers across the TMC to collaborate on policy-relevant research, but also to support projects that can have an impact on health policy," said Stephen Linder, Ph.D., associate director of the TMC Health Policy Institute. "Accordingly, over time, we expect the grant program to build capacity for policy research within the TMC and to produce insights and evidence for better public policy."   

The researchers studied four distinct and timely topics with direct implications for health policy, including preventing hospital readmissions, freestanding emergency departments, mobile health clinics and health care access for refugee children:

The TEXAS Project: Transitions Explored and Studied: Leveraging Data to Prevent Readmissions in the TMC

Robert A. Phillips, M.D., Ph.D., F.A.C.C., Executive Vice President, Chief Medical Officer & Chief Quality Officer at Houston Methodist collaborated with researchers from MD Anderson Cancer Center, Texas A&M University Health Science Center, UTHealth and Baylor College of Medicine to better understand the impact and costs of programs to reduce hospital readmissions, as well as the drivers of these readmissions. The TEXAS Project identified the most common tools to reduce readmissions, including team-based collaboration, calling patients after their discharge, providing education to patients, scheduling a follow-up appointment for patients, and conducting home visits. Additionally, it determined the cost of conducting two of the most common programs, telephone follow-up and medication reconciliation, at the participating institutions. 

  • The most important outcome of the project was the collaboration between MD Anderson Cancer Center and Houston Methodist in order to address this ever-important issue and improve the quality of care these institutions provide in the Texas Medical Center. 
  • Moving forward, this project has the potential to inform how clinicians prevent readmissions across institutions.

Tracking Implications of Freestanding Emergency Departments for Texans
Vivian Ho, Ph.D., Baker Institute Chair in Health Economics, Rice University, and Professor of Medicine, Baylor College of Medicine, was joined by researchers from UTHealth School of Public Health, Baylor College of Medicine and the Michael E. Debakey Veterans Affairs Medical Center to study freestanding emergency departments (EDs), facilities that are structurally separate and distinct from a hospital where individuals can seek emergency care. Freestanding emergency departments are often located in suburban strip malls and frequently mistaken for retail clinics or urgent care centers by uninformed customers. Researchers analyzed more than 16 million insurance claims processed by Blue Cross Blue Shield of Texas to track growth in use and prices at freestanding EDs relative to hospital-based EDs and urgent care centers between 2012 and 2015.

  • More patients utilized hospital-based EDs and urgent care centers, but the growth rate of patients visiting freestanding emergency departments was much higher over the four-year period.
  • Prices at freestanding emergency departments and hospital-based EDs were comparable, while prices at urgent care centers were much lower. There was substantial overlap in the diagnoses of patients and procedures performed in emergency departments relative to urgent care centers. On average, prices of visits with the same diagnosis were 10 times higher in EDs versus urgent care centers, which can result in sticker shock for patients who are responsible for covering out-of-pocket costs after the deductible was met.
  • Researchers also found that freestanding emergency departments tended to locate in areas where residents had higher rates of private health insurance coverage, and freestanding emergency departments did not locate in markets with high wait times for hospital ED care. Nor were they helpful in lowering wait times for hospital-based ED care between 2012 and 2015 relative to markets with no freestanding emergency departments entry.

Increasing Healthcare Access to At-Risk-Populations: Research-based Policies for Mobile Health Clinics
Rigoberto I. Delgado, Ph.D., M.B.A., Assistant Professor at UTHealth School of Public Health, Department of Healthcare Management, Policy and Community Health collaborated with researchers from University of Houston, Texas Children's Hospital, MD Anderson Cancer Center and the University of Texas Medical Branch to study mobile clinics, which play an important role in providing health care to at-risk populations in both urban and rural areas. Currently, more than 1,500 mobile clinics operate in the U.S. and handle over five million visits per year. In Texas, mobile clinic programs have grown organically over time, and it is important to develop approaches to encourage a systematic expansion of this essential delivery model.

  • The researchers used sophisticated mathematical models, combined with complex geographic population health data, to recommend optimized routing for three mobile programs in Harris, Fort Bend and Galveston counties.
  • Their models, for example, will allow the Mobile Clinic Program at Texas Children's Hospital to vaccinate 6,000 more children every year, a 60 percent increase in capacity.
  • The project's success allowed the researchers to secure grant funding from the National Science Foundation to expand the project to include five more mobile clinic programs.

Policies, Practices and Structures Impacting the Health and Care Access of Refugee Children
Kenneth D. Smith, Ph.D., Director, University of Texas Medical Branch's Center to Eliminate Health Disparities, was joined by researchers from Baylor College of Medicine, Texas Children's Hospital and University of Houston-Clearlake to assess U.S. laws, policies, regulations and organizational practices as they relate to children crossing the U.S. border originating from Mexico, Honduras, Guatemala and El Salvador. The researchers interviewed experts, agency heads and refugee families in order to identify specific conditions, factors and upstream determinants that contribute to increasing or decreasing health risks during the migration journey; barriers to quality health and health care services experienced by migrant children and their families; and effective strategies to reduce health risks and eliminate barriers to health care among child migrants.

  • The team recommends the end of family detention, including revoking state licensure of existing facilities.
  • They also recommend ensuring adequate screening and treatment for physical and mental health—particularly for trauma, which has long-term health impacts on children—including expanding medical coverage for unaccompanied child migrants released to the community who are likely to receive immigration relief.
  • The research team convened a Cross-Sector Advisory Board on Child Refugee Health, which continues to provide support to this work. It anticipates educating policy makers about policies to address child migrant health through a potential task force on asylum-seeking children. The task force would be established under HB 278, which was recently introduced by Texas State Rep. Donna Howard.

About the TMC Health Policy Institute
The TMC Health Policy Institute was established to inform, define and lead health policy with the goal of developing the most effective solutions to improve the health of diverse populations around the globe. By driving innovative, evidence-based health policy initiatives across the Texas Medical Center's 59 member institutions, the TMC Health Policy Institute addresses fundamental health policy issues important to Houston, the state and the nation, including public health advocacy, health care delivery models, health care funding, patient quality outcomes, patient safety and health ethics. The TMC Health Policy Institute annual Consumer Health Report survey by Nielsen highlights changing perspectives on some of the most pressing health issues facing the American public, such as the expansion of Medicaid, emergency room usage, obesity and quality of patient care. Learn more at tmc.edu/health-policy.

About TMC
What was sparked with the founding of a single hospital in Houston in 1925 has come to be the Texas Medical Center (TMC) today. Home to 59 member institutions, including 21 hospitals, 13 support organizations, nine academic and research institutions, six nursing programs, four public health organizations, three medical schools, four universities, two pharmacy schools and a dental school, TMC operates the world's largest medical city with 10 million patients and family encounters with doctors, nurses and staff at TMC every year. TMC is dedicated to reinventing life sciences to improve the health and wellness of Houston, and the world. Learn more at tmc.edu.

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