NATIONAL HEALTH

 

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  2) its surrounding counties of Sarpy, Cass, Saunders, Dodge, and Washington Counties.  The two divisions will collaborate for certain functions of a  Community HEALTH Forum.

The Design Principles for Managing a Common-Pool Resource apply.  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:

1. Land Designations for each division by county
2. Participating Hospitals – 99 or less per Division
3. Hospital reporting —  number of hospital days by the respective division’s residents occupying a hospital bed at  0001 AM,  as totaled daily for an entire month per Division.

[  COMMENT:  Two special populations of citizens that could also be included.  First, there are  persons  who receive extended hospital-level healthcare during a prolonged stay in the Emergency Department, especially during the occurrence of a local disaster.  Second, there are persons who receive highly technical healthcare on an outpatient basis, such as an endoscopic gall bladder removal.  In the beginning, the pros and cons may be sufficient to exclude their contribution to the hospital utilization monitoring process.  ]

 

B.  Data  Output

1. 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
2. Rolling average for each Division: 3  year and  12  month

 

C.  Reporting  All reported data is deidentified.

1. 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 month;
2. 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
3. Arrangements developed prior to implementation include a means for shared monitoring among the reporting hospitals for the timeliness and apparent quality of the data received by the  ANALYSIS SITE
4. Submission of monthly data analysis to the respective HOSPITAL Medical Staff Office to the  person  designated by the respective Hospital’s Medical Staff President and delivered by return requested, Certified mail.

 

D.  ANALYSIS

1. 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
2. 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
3. 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

1.  Location of each Primary Healthcare clinic in Douglas and Sarpy counties
2.  Full-time equivalent providers: physicians, nurse practitioners, physician’s    assistants
3.  total PCP = MD total FTE  + ( NP total FTE + PA total FTE ) / 2

 

B. Reports

1.  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
2. Census tract set of both divisional county maps with PCP FTE, per 3 mile map, coverage per citizen in each census tract color coded
3. Reports produced annually in April by the ANALYSIS SITE according to the Multi-Hospital collaborative