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Item Leveraging the power of partnerships: spreading the vision for a population health care delivery model in western Kenya(BMC, 2018-05-08) Mercer, Tim; Gardner, Adrian; Andama, Benjamin; Chesoli, Cleophas; Christoffersen-Deb, Astrid; Dick, Jonathan; Einterz, Robert; Gray, Nick; Kimaiyo, Sylvester; Kamano, Jemima; Maritim, Beryl; Morehead, Kirk; Pastakia, Sonak; Ruhl, Laura; Songok, Julia; Laktabai, Jeremiah; Medicine, School of MedicineBACKGROUND: The Academic Model Providing Access to Healthcare (AMPATH) has been a model academic partnership in global health for nearly three decades, leveraging the power of a public-sector academic medical center and the tripartite academic mission - service, education, and research - to the challenges of delivering health care in a low-income setting. Drawing our mandate from the health needs of the population, we have scaled up service delivery for HIV care, and over the last decade, expanded our focus on non-communicable chronic diseases, health system strengthening, and population health more broadly. Success of such a transformative endeavor requires new partnerships, as well as a unification of vision and alignment of strategy among all partners involved. Leveraging the Power of Partnerships and Spreading the Vision for Population Health. We describe how AMPATH built on its collective experience as an academic partnership to support the public-sector health care system, with a major focus on scaling up HIV care in western Kenya, to a system poised to take responsibility for the health of an entire population. We highlight global trends and local contextual factors that led to the genesis of this new vision, and then describe the key tenets of AMPATH's population health care delivery model: comprehensive, integrated, community-centered, and financially sustainable with a path to universal health coverage. Finally, we share how AMPATH partnered with strategic planning and change management experts from the private sector to use a novel approach called a 'Learning Map®' to collaboratively develop and share a vision of population health, and achieve strategic alignment with key stakeholders at all levels of the public-sector health system in western Kenya. CONCLUSION: We describe how AMPATH has leveraged the power of partnerships to move beyond the traditional disease-specific silos in global health to a model focused on health systems strengthening and population health. Furthermore, we highlight a novel, collaborative tool to communicate our vision and achieve strategic alignment among stakeholders at all levels of the health system. We hope this paper can serve as a roadmap for other global health partners to develop and share transformative visions for improving population health globally.Item Optogenetic Inhibition of the mPFC During Delay Discounting(2019-05) White, Shelby M.; Lapish, Christopher; Logrip, Marian; Czachowski, CristineImpulsivity, or the tendency to act prematurely without foresight, has been linked to a diverse range of pathological conditions. Foresight refers to the ability to envision future rewards and events (i.e. prospectively sample) and has been associated with decreased impulsivity. One form of impulsivity is measured by the ability to delay gratification and is often studied in the framework of Delay Discounting (DD). DD provides the means to study impulsivity in a number of pathological conditions. However, whether impulsivity precedes the development of pathological states or results from the pathological state itself is not fully understood. This necessitates an understanding of neurobiological mechanisms contributing to decision making in both non-impulsive as well as impulsive populations of individuals. Animal models allow invasive techniques to be used to dissect the neurocircuitry involved in decision making. Given that the decision-making process is an ongoing process rather than an isolated event, optogenetics provide the temporal and spatial specificity necessary for evaluating brain region specific contributions to decision making in DD. In the present study, optogenetics were used to assess the contribution of the medial Prefrontal Cortex (mPFC), a brain region involved in ‘goal-directed’ behavior, in the planning of future choices (i.e. prospective plans) and subsequent measures of impulsivity in an adjusting amount DD procedure. Optogenetic inhibition of mPFC was conducted in Wistar rats during different epochs of a DD task in order to assess how mPFC affects planning behavior in a population of rat not considered to be highly impulsive. Although no direct effects on planning behavior (e.g. consistency) were observed, inhibiting mPFC after a trial has been initiated and directly before a choice was made (Epoch 2) was observed to increase measures of impulsivity in comparison to days where no optogenetic manipulation occurred in a delay-specific manner. This suggests that mPFC differentially contributes to decision making at different delays. A pattern of associations between choice latency, impulsivity, and consistency began to emerge for inactivation occurring in Epoch 2, suggesting that mPFC contributes to some aspect of planning choices during this epoch. Moreover, these results indicate that mPFC is involved in decision making in Wistar Rats. Understanding the direct role that mPFC plays in promoting choices of delayed rewards provides a neurobiological target for treatment aimed at reducing impulsivity in the clinical population.Item Strategic use of health information exchange and market share, payer mix, and operating margins(Wolters Kluwer, 2022) Vest, Joshua R.; Freedman, Seth; Unruh, Mark Aaron; Bako, Abdulaziz T.; Simon, Kosali; Health Policy and Management, School of Public HealthBackground: Health information exchange (HIE) capabilities are tied to health care organizations' strategic and business goals. As a technology that connects information from different organizations, HIE may be a source of competitive advantage and a path to improvements in performance. Purpose: The aim of the study was to identify the impact of hospitals' use of HIE capabilities on outcomes that may be sensitive to changes in various contracting arrangements and referral patterns arising from improved connectivity. Methodology: Using a panel of community hospitals in nine states, we examined the association between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin (2010-2014). Regression models that controlled for the number of different data types shared intraorganizationally and other time-varying factors and included both hospital and time fixed effects were used for adjusted estimates of the relationships between changes in HIE capabilities and outcomes. Results: Increasing HIE capability was associated with a 13 percentage point increase in a hospital's discharges that were covered by commercial insurers or Medicare (i.e., payer mix). Conversely, increasing intraorganizational information sharing was associated with a 9.6 percentage point decrease in the percentage of discharges covered by commercial insurers or Medicare. Increasing HIE capability or intraorganizational information sharing was not associated with increased market share nor with operating margin. Conclusions: Improving information sharing with external organizations may be an approach to support strategic business goals. Practice implications: Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.