trust . cooperation . reciprocity
R E S O U R C E A G R E E M E N T
INTRODUCTION
A community by community-driven strategy for healthcare reform will likely require new connections within their communities. As a means to formalize any new connections, this new strategy will begin with a commitment to clarify its Goals and reciprocal obligations. A written document or AGREEMENT will be an important attribute of this project. Once Attested, an agreement can serve as a means to periodically institute an improvement in its stated purpose and the achievement of its goals. And, most importantly, a written agreement serves as a basis for improving its benefit to each of its participants, especially its accuracy and release to their community.
A model AGREEMENT based on a strategy to begin a process of collecting hospital utilization data from among a community’s hospitals provides an opportunity to monthly evaluate the number of hospital days used per 1000 citizens, who live within a specified area of the community. The data would be collected monthly. Specifically, an effort to promote a community-wide commitment to better HEALTH will benefit from a succinct measure of its improved Unstable HEALTH throughout the community.
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A PRELIMINARY AGREEMENT PROPOSAL
BY AND BETWEEN EACH HOSPITAL’S MEDICAL STAFF
OF THE METROPOLITAN OMAHA AREA
TO SHARE CERTAIN PATIENT, DE-IDENTIFIED DATA
FOR THE PURPOSE
OF IMPROVING THE HEALTH OF THEIR COMMUNITY’S RESIDENT PERSONS
– – – P R E A M B L E – – –
The prospect of arranging a reporting process for the total number of hospital days used each month by any of a community’s resident persons would quickly encounter many issues. Solving these issues starts with a proposal that protects the information with a means to prevent their harmful use. Since the information does not require any specific personal data, it is considered de-identified. But, the data from an individual hospital could be used for unpredictable purposes, especially if inaccurately assembled and publicly disclosed. The process of collating the data and determining a community’s over-all hospital utilization rate would require an almost complete level of hospital participation to be usable as a basis for improving a community’s HEALTH .
This PRELIMINARY AGREEMENT reflects an intent to collect data from all the hospitals within the Metropolitan Omaha area. It proposes to begin under the combined auspices of each Hospital’s Medical Staff for a 2 year Trial Interval. Every three months before the end of the Trial Interval, an evaluation of the initial data would be reviewed with each Medical Staff Executive Committee. At the end of the 2 year trial, the final quarterly evaluation schedule would consider either its termination or a further evaluation of its usefulness and any requirements for its future use and economic support. The data would not be released for general publication, either during OR at the end of the two-year demonstration project without the specific advice and consent of all the contributing hospitals.
The collection of this data anticipates the possible formation of a Community HEALTH Forum for the Metropolitan Omaha Area to promote the resiliency of the community’s Survival Commons. This would eventually involve either a currently established Omaha institution or an independently formed institution to promote a Community HEALTH Plan for Metropolitan Omaha without duplicating any institutions that already contribute to each resident person’s healthcare.
The Metropolitan Omaha Area would refer to the combined Douglas, Sarpy, Cass, Saunders, Dodge, and Washington counties. The population of these six counties was 853,000 in 2019. For this data analysis, the total hospital days required for healthcare by any resident would be reported monthly for the resident persons of either 1) Douglas county or 2) the combined Sarpy, Cass, Saunders, Dodge, and Washington counties. The monthly data would be collated according to each hospitalized person’s zip code within 1) Douglas and 2) the other counties. Persons hospitalized but not primarily living in the Metropolitan Omaha Area would not be included.
Collated together, the final use of the data would ONLY be used to determine the hospital-use days per/1000 citizens, monthly, for the two geographic regions and to use graphic means to identify community trends identified by the data. The individual hospital data would not be available for any other use unless authorized by the Executive Committee of the participating Hospitals’ combined Medical Staffs.
The relevant economic concepts surrounding the management of a common-pool resource apply. Most importantly, the Design Principles for the use of collective action to manage a common-pool resource emphasize the importance of decentralized governance, as in community by community. For this AGREEMENT, the common-pool resource is the use of resources within the national economy for our own community’s healthcare. The PREAMBLE above cites Nobel Prize winner Elinor Ostrom, Ph.D. along with many other colleagues for the studies that underlie these Design Principles.
Given the pivotal role for mediating the overall cost of healthcare, the use of a hospital bed also represents 1) the level of a community’s social capital to mitigate the adverse effects of a resident person’s social adversities, if any, and 2) the effectiveness of a person’s healthcare to achieve Stable HEALTH. Combined with the community’s Survival Commons and each person’s healthcare would either prevent a hospital stay OR, when required, reduces its length of stay. In addition, the resilience of a community’s social capital contributes to a decreasing need for hospital utilization. The connection to our community’s social cohesion, alone, drives the initiating basis for this AGREEMENT.
– – – T A S K S – – –
A. Accept a common set of DEFINITIONS as a basis for the joint collaborative use of certain specified data for the Survival Commons of Metropolitan Omaha;
[ see A T T A C H M E N T I: DEFINITIONS ];
B. Consider an Investigation Review Board (IRB) consultation by 2 separate Hospital Systems associated with the participating Hospitals to assure the absence of any Human Rights violations;
C. Configure a “Data Management Council” of 3-5 Members for 2 years, assembling every 1-6 months:
1. to initiate monthly hospital bed-days data collection by resident persons divided into 2 regions based on their primary address, if any, located at an address defined by the Douglas County and the other 5 Counties,
2. to use national census data to compile monthly hospital bed-days per 1,000 citizens by two regions,
3. to distribute the utilization report to each of the participating Hospitals according to the person designated by its Medical Staff Executive Committee and delivered to its Medical Staff office,
and
4. to begin community release of monthly data beginning with the 7th month of data collection;
D. Maintain all data reports at one location selected by the Data Management Council including the destruction of individual hospital data reports within three months of their receipt by that Medical Staff office or other location;
E. Prepare two evolving long-term plans by the Data Management Council to either:
1. terminate the data collection at any time and, if appropriate,
2. prepare a replacement AGREEMENT including any needs for:
a. an automated, secure computer-generated reporting process along with a means for its financial support,
b. a plan for establishing a community-wide connection by the Hospital institutions to augment the community’s Social Capital asset for the resilience of the community’s Survival Commons,
c. any possible plan for further, limited hospital de-identified data reporting,
d. the possible development of this data monitor for the other 4 population regions across Nebraska (with respective Home Offices located in Lincoln, Norfolk, York, and Ogallala),
and
e. the future governance to assure the stability and precision of the reporting process;
AND
F. Terminate this AGREEMENT after 24 months or less of Data Collection with or without any continuation by a replacement AGREEMENT.
– – – A T T E S T A T I O N – – –
- Bergan Mercy / Creighton University Medical Center *
- Boys Town National Research Hospital
- Children’s Hospital & Medical Center *
- Douglas County Mental Health Center
- Ehrling Berquist USAF Hospital
- Fremont Area Hospital
- Immanuel Medical Center * [ including Mental Health ]
- Immanuel Medical Center – Rehabilitation
- Lakeside Hospital *
- Lasting Hope Recovery Center
- Madonna Rehabilitation Hospitals-Omaha
- Methodist Hospital *
- Methodist Women’s Hospital *
- Midlands Hospital *
- Midwest Surgical Hospital
- Nebraska Medical Center – Bellevue *
- Nebraska Medical Center – UNMC *
- Nebraska Orthopedic Hospital
- Nebraska Spine Hospital
- Omaha VA Hospital
- Region 6 Behavioral Health Center
- Select Specialty Hospital
[ Signature Blocks to be added as each Hospital enters the initial Collaboration group. ]
NOTE: The use of the ” * ” hospital designation indicates the initial 11 hospitals’ involvement at the beginning of the two-year project.
– – – A T T A C H M E N T ONE : D E F I N I T I O N S – – –
1. Foundational
a. Caring relationship
b. Collective Action
c. HEALTH
d. Survival Commons
e. Institution
f. Social Capital
2. Data
a. Hospital Day – all citizens residing in a hospital bed at 0001 on a calendar day
b. Reported Utilization – the total of hospital days for all days of a calendar month for any person with a home address in:
i. Location A — Douglas County ( possibly divided in half at 72nd Steet)
ii. Location B — Sarpy, Cass, Saunders, Dodge, and Washington Counties