Department of Public Health Maccabi Healthcare Services The Maccabi Institute for Health Services...

Department of Public Health

Maccabi Healthcare ServicesMaccabi Healthcare Services

The Maccabi Institute for The Maccabi Institute for Health Services ResearchHealth Services Research Department of Public HealthDepartment of Public Health

In the In the

School of Public HealthSchool of Public Health

Tel Aviv UniversityTel Aviv University

January 2007January 2007


Israel's leading and most advanced Israel's leading and most advanced

healthcare organization aims tohealthcare organization aims to achieveachieve

Total HealthTotal Health for its members, providingfor its members, providing

integrative andintegrative and personally- tailoredpersonally- tailored health health

care to each and every member, and care to each and every member, and

encouragesencourages excellenceexcellence in the quality of in the quality of

medical care, knowledge andmedical care, knowledge and serviceservice..

Maccabi’s VisionMaccabi’s Vision


1,700,000 members (24% Market Share)

3,560 physicians (independent contract and salaried)

797 nurses

429 physical therapists

97 social workers

168 dieticians

197 occupational therapists

177 speech therapists

207 psychologists

5 regions with 152 branches and clinics

Income budget (capitation) $1.28 Billion

Total income $1.65 Billion

Maccabi Statistics - 2007Maccabi Statistics - 2007


Pharmacy &

Pharmacology

Director General

Real Estate and Logistics Division

Operations and Hospital

Relations Section

Medical Section

Legal Department

Internal AuditorOmbudsma

n

Media Relations & Public Affairs

Marketing

Human Resources Division

Central Services

Information

Technology Division

Quality Promotion

Medical Technology

Assistant to Director General

Insurance

Division

Supplementary Healthcare Services

Finance & Planning Division

Secondary Healthcare Division

Primary Healthcare Division

Maccabi Institute for

Health Services Research

Purchasing Division

North Region

SharonRegion

CenterRegion

Shfela & Jerusalem

Region

Negev Region


ObjectiveObjective

The Institute provides

an organizational framework

for encouraging and supporting

health services research

which is aimed at

promoting community health

for Maccabi members

and for the health sector at large


Purpose and GoalsPurpose and Goals

Promoting research activities at Maccabi

This is accomplished by: 1.Encouraging research in relevant areas

according to priorities set by the Institute’s Steering Committee and Advisory Board.

2. Developing and expanding research potential via collaborative activities with researchers from academic institutions and/or external research organizations.

3. Providing the necessary means to implement research projects.


The Maccabi Institute for The Maccabi Institute for Health Services ResearchHealth Services Research

DirectorSteering

Committee

Institute Director

Dr. Rachelle Kaye

Research Fund

Department of

Public Health

Maccabi Research

Committee

Advisory Board

Department of Research and Evaluation

MedicalSection


Director Dr. Rachelle Kaye

Prof Joshua Shemer

Prof Manfred Green

Mentors andAdvisors

Clinical Appointments

EpidemiologyDr. Gabriel HodickDr. Nurit Friedman

Preventive MedMrs. Leora Valinsky

Dr. Shelley Sternberg

Environmental Health

Dr. Shlomo Moshe

― Dr. Ayalla Blau― Dr. Anthony Heymann― Dr. Yossi Lomnicky― Dr. Yoram Sandhaus― Dr. Yoav Yechezkeli― Dr. Yosef Cohen― Dr. Rachel Miron― Dr. Miki Nobel― Dr. Barbara Silverman― Dr. Galit Fusman― Dr. Ehud Kokia― Dr. Yitzchak Katzir― Dr. Meir Raz― Dr. Eduardo Scejter― Dr. Varda Shalev― Prof. Yair Shapiro

The Department of Public HealthThe Department of Public Health


Department of Public HealthDepartment of Public Health The goal is to integrate academic activity with

implementation in healthcare facilities.

Department activities focus on: Research, lecturing, mentoring and collaboration with academic institutions.

Members of the Department form a bridge between academia and the community.

Department members are full time employees, they each hold a half time position in the School of Public Health and half time position at a senior post in Maccabi.

16 Clinical appointees are on the staff, each one holds a quarter time position.

16 more Clinical appointments will be added in the future (4 positions).


Research InfrastructureResearch Infrastructure

Members

Physicians and other care givers

Integrated administrative Data Base

Facilities (e.g. mega lab)

Knowledge and research capability

Connections with academic intuitions


MaccabiMaccabi offers an ideal framework offers an ideal framework for health services researchfor health services research

Defined and stable population.

Integrated health care system dedicated to finding solutions to unknown problems.

Full access to health status and treatment to all members.

System is characterized by mutual dynamic interaction between health care and research.


Information SystemInformation SystemMaccabi’s fully computerized health system Maccabi’s fully computerized health system

includes includes ID numbers and demographic information for each member.

Physician visits including diagnoses and treatments.

Medications prescriptions and purchases at Maccabi pharmacies.

Diagnostic procedures and results: laboratory, pathology.

Visits to expert consultation clinics and para- medical centers.

Visits to out patient hospital clinics.

Hospitalization.

Visits and treatment by supportive and para medical services.


Integrated Information Integrated Information SystemSystem

Information SourcesInformation Sources

Clin

icExtr

an

et

Internet

Intra

ne

t

Members Members Members Members

Medical Control

Admin Control

Payment Control

Reimburse-ment Control

Doc. Clinic

Doc. Clinic

Pharmacy

Specialist

Consultant

Paramedic

Diagnostic Center

Firewall

Backup Computer

Main Computer

IDC

Mgmt. of Insured People

IDC

Mgmt. of the Fund

IDC

Mgmt. of Service Provider

s

Drug consumpt

ion control

Labs control

Tele radiology

Web Services

CMRERP


Office visits

pathology

imaging

Laboratoryresults

medications

treatments

diagnostics

hospitals

ElectronicElectronic HealthHealth

RecordRecord


Information : Type and ScopeInformation : Type and Scope

Administrative and medical data bases on over 2 million people collected over a 16 year time span.

Integrated data base includes clinical, financial and demographic data.

Medical data includes information from all physicians and other care givers, clinics, laboratories and etc.

Recently the centralized electronic health record (EHR) program , further improved data by Physicians.

Data Base is easily accessible to researchers.


Heymann AD, Tarashansky I, Kokia E, Chodick G. The use of organizational data for the evaluation of mass prevention programs. Prev Med. 2004 Dec;39(6):1143-7.

Heymann AD, Shapiro Y, Chodick G, Shalev V, Kokia E, Kramer E, Shemer J. Reduced hospitalizations and death associated with influenza vaccination among patients with and without diabetes. Diabetes Care. 2004 Nov;27(11):2581-4.

Heymann AD, Hoch I, Valinsky L, Shalev V, Silber H, Kokia E. Mandatory Computer Field for Blood Pressure Measurement Improves Screening. Family Practice 2005; 22(2):168-9.

Heymann A, Hodick G, Halkin H, Shalev V , Kokia E, Shemer J. The implementation of country-wide managed care for diabetes using medical informatics in a large Preferred Provider Organization. Diabetes research and clinical practice. 2006; 71:290-8.

Lerman Y, Chodick G, Tepper S, Livni g, Ashkenazi S. Seroepidemiology of varicella-zoster virus antibodies among health-care workers and day-care-centre workers. Epidemiol Infect. 2004 Dec;132(6):1135-8.

Publications in Professional Publications in Professional JournalsJournals


Heymann AD, Chodick G, Reichman B, Kokia E, Laufer J. Influence of school closure on the incidence of viral respiratory diseases among children and on health care utilization. Pediatr Infect Dis J. 2004 Jul;23(7):675-7.

Hoch I, Heymann AD, Kurman I, Valinsky LJ, Chodick G, Shalev V. Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics. J Am Med Inform Assoc. 2003 Nov-Dec;10(6):541-6.

Epub 2003 Aug 4.

Huerta M, Chodick G, Balicer RD, Davidovitch N, Grotto I. Reliability of self-reported smoking history and age at initial tobacco use. Prev Med. 2005 Aug;41(2):646-50 .

Kaye R. Long Term Care – The Next Revolution? Accepted for publication in proceedings from The Third International Jerusalem Conference on Health Policy, Dec 2006.

Moshe S. Levin M. occupational aspects of low back pain. Harefua 2005:144;492-496 .



Chodick G, Heymann AD, Wood F, Kokia E. The direct medical cost of diabetes in Israel. Eur J Health Econ. 2005 Feb 3.

Shalev V, Chodick G, Bialik M, Heymann AD. Predictors of mortality in people with diabetes in a population based five years follow-up. Journal of Clinical Epidemiology accepted 3.06.

Shapiro J, Cohen AD, David M, Chodik G, Viner A, Kremer E, Heymann AD The association between Psoriasis, Diabetes Mellitus and Atherosclerosis in Israel.Journal of the American Academy of Dermatology accepted 8.06

Shmuely H, Samra Z, Ashkenazi S, Dinari G, Chodick G, Yahav J. Association of Helicobacter pylori infection with Shigella gastroenteritis in young children. Am J Gastroenterol. 2004 Oct;99(10):2041-5 .

Sikron R, Wilf-Miron R, Israeli A. Adolescent pregnancy in Israel: a methodology for rate estimation and analysis of characteristics and trends. Harefuah. 2003 Feb;142(2):131-6, 158, 157. Review. Hebrew.



Sample Research GrantsSample Research GrantsResearch SubjectFunding OrganizationGrant (NIS)

A study to examine the differences between different primary physician’s specialty on patient’s health and health utilization

The Israel National Institute for Health Policy and Health Services Research

98,000

Implementing Clinical Guidelines in Primary Care Medicine in Israel: Changing Physicians’ Behavior.


200,000

What are the factors the encourage and obstruct the delivery of preventive care to the elderly in primary care


100,000

Financial Thinking for Physicians and Healthcare Consumers


500,000

The Content of Pediatric Practice in the Community and Training for the Task.


500,000

Complementary Health Insurance in Europe and the West: Dilemmas and Directions


65,000


Teaching ExperienceTeaching Experience

Dr. Ayala Blau, Lecturer, Wolfson School of Nursing, School of Nursing, Tel Hashomer HospitalDr. Anthony Heymann- Lecturer, Tel Aviv University, Faculty of Medicine, Department of Family MedicineLeora Valinsky – Lecturer, School of Nursing and Public Health, Edith Cowan University, Perth, Western Australia, School of Medicine, Univ Of Western AustraliaDr. Gabriel Chodick- Lecturer, Department of Epidemiology, Tel Aviv UniversityDr. Sandhaus-Lecturer, Tel Aviv University, School of Medicine, pediatricsDr. Shlomo Moshe- Lecturer, Tel Aviv University, School of MedicineDr. Joseph Cohen-Lecturer, Technion, School of Medicine, Wolfson Hospital, diabetesDr. Miki Nobel- Lecturer, Tel Aviv University, School of Medicine, surgeryDr. Galit Fussman- Lecturer, Tel Aviv University, School of Medicine, family medicineDr. Ehud Kokia- Lecturer, Ben Gurion University, health administrationDr. Rachelle Kaye- Lecturer, University of Denver, Guest Lecturer, School of Public Health, Hadassah University Hospital, lecturer, Kiryat Ono College, Health Insurance and long term care

Dr. Shelley Sternberg – Lecturer, University of Toronto, Assistant Prof, Department of Medicine, University of ChicagoProf. Yair Shapiro-Prof, Ben Gurion University, Tel Aviv University, faculty of health sciences, Judea & Samria College, department of physiology and pharmacology, School of Public Health.


Types of Support and Mentoring Types of Support and Mentoring for Studentsfor Students

Research planning and Methodology.

Data Extraction.

Data Analysis consultation.

Reporting Consultation.


Examples of projects supported Examples of projects supported by the by the

Department of Public HealthDepartment of Public Health

BA Students: Degree in Health AdministrationBA Students: Degree in Health Administrationat the Ben-Gurion University and Emek- Jezrael at the Ben-Gurion University and Emek- Jezrael

CollegeCollege Intervention Program by Nurses in Patients to Improve

Mammography.

Performance Measurement to Gauge Improvement of Mammography Screening.

Effectiveness of Group Therapy Sessions on Health and Compliance in Diabetic Patients.

Predictors of Beta blocker Use for Post MI Patients in a Preferred Provider Organization.



LONG TERM CARE – THE NEXT REVOLUTION?__________________________________________________________

Rachelle Kaye, PhDMaccabi Healthcare Services, Israel

_____________________________________________________________________

The issue of Long Term Care, particularly for the dependent elderly, has been of increasing concern in all of the countries of the Western world, and is even beginning to demand attention in developing countries. One of the obvious reasons for this growing concern is demography. Life expectancy is increasing and is expected to continue increasing, particularly in the elderly population. From 1960 to 2000, the life expectancy of males aged 65 in OECD countries increased by almost 3 years – an increase of 22%, while the life expectancy of women aged 65 increased by almost 5 years – an increase of more than 30%.[1] As a result of increasing life expectancy as well as the trend in decreasing birth rates, the share of older people in the population has increased dramatically and the prediction is that it will continue to increase. In 1960 the OECD average for the share of persons aged 65 and over was 8.7% of the population. In 2000 it had increased to 13.8% and the projection for 2040 is 25.6%. It should be noted that the average share of persons aged 65+ for Western Europe in 2000 was even higher than the OECD average – about 15%. The increase in the share of persons over 80 in the population is no less dramatic. In 1960 it was 1.3%, in 2000 it was 3.1% and the projection for 2040 is almost 8% - similar to the average for the over 65s in 1960.[2]

Accepted for publication in The Proceedings of the Third International Jerusalem Conference on Health Policy.







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