c o m m u n i t y b y c o m m u n i t y
community HEALTH forum
METROPOLITAN OMAHA Nebraska
INTRODUCTION
“Unfortunately, many analysts –
in academia, special-interest groups, governments, and the press –
still presume that common-pool problems are all social dilemmas in which
the participants themselves cannot avoid producing sub-optimal results,
and in some cases disastrous results.”
^
“There is no reason to believe that bureaucrats and politicians,
no matter how well-meaning,
are better at solving problems than the people on the spot,
who have the strongest incentive to get the solution right.”
^
“Without monitoring, there can be no credible commitment;
without credible commitment,
there is no reason to propose new rules.”
Elinor Ostrom ( 1933 – 2012 )
The OMAHA METROPOLITAN AREA will constitute two divisions: 1) Douglas county and its surrounding communities of 2) Sarpy, Cass, Saunders, Dodge and Washington Counties. Both will share a combined Community HEALTH Forum.
The Design Principles for Managing a Common-Pool Resource applies. Proposed and validated during her long academic career, Professor Ostrom received a Nobel Prize award in Economics for her research in 2009. See David Sloan Wilson et al. Generalizing the core design principles for the efficacy of groups. J Econ Behav Organ. (2013), http://dx.doi.org/10.1016/j.jebo.2012.12.010
I. HOSPITAL INPATIENT UTILIZATION — Start early 2021
A. Data input
1. Monthly population estimate for both Divisions with a 12 months population data-set estimated annually in December for the next calendar year:
- Land Designations for each division by county
- Participating Hospitals – 99 or less per Division
- Hospital reporting — reporting number of hospital days by the respective division residents occupying a hospital bed at 0001 AM, as totaled daily for an entire month per Division.
B. Data Output
- Column Total of “resident days per 1000 population per year equivalent” for each division reported from all hospitals with notation of percent of hospitals contributing with timely data
- Rolling average for each Division: 3 year and 12 month
C. Reporting [ NOTE: All data is deidentified. ]
- Hospital utilization by each Division’s citizens reported between the first non-holiday, week-day after the 4th day of the month and the 7th day following initial reporting day of that montht;
- Data collected per joint agreement of each participating hospital’s Medical Staff who maintains its own collecting and submitting process to an agreed upon ANALYSIS SITE representative
- Arrangements developed prior to implementation includes a means for shared monitoring among the reporting hospitals for the timeliness and apparent quality of the data received by the ANALYSIS SITE
- Submission of monthly data analysis to the respective HOSPITAL Medical Staff Office
D. ANALYSIS
- Identify an ad hoc group to finalize a Cooperative Medical Staff Agreement and the process to account for the preservation and quality of the data reporting process by the ANALYSIS SITE
- Meet with each of the hospital Medical Staff Executive Committees to begin a trial, intially limited to two years, of a monthly report of a very limited set of deidentified, monthly hospital use of hospital beds by citizens living in the Omaha Metropolitan Area community
- ANALYSIS SITE – prepare a summary and proposal for next phase annually in January according to the Multi-Hospital Collaborative
III. EQUITABLY AVAILABLE PRIMARY HEALTHCARE — Start mid-2021
A. Input Data
- Location of each Primary Healthcare clinic in Douglas and Sarpy counties
- Full-time equivalent providers: physicians, nurse practitioners, physician’s assistants
- total PCP = MD total FTE + ( NP total FTE + PA total FTE ) / 2
B. Reports
- Topographical mapping for each PCP clinic: 1/2 mile diameter (green) Set and 3 mile diameter (red) set; each with Color density layering for over-lapping circles, especially for close proximity layering
- Census tract set of both divisional county maps with PCP FTE, per 3 mile map, coverage per citizen in each census tract color coded
- Reports produced annually in April by the ANALYSIS SITE according to the Multi-Hospital collaborative
