Problem Solving and Decision Making in Public Health

Case Scenario A: Release of Information in the Healthcare Industry

Case studies and the case methods provide students with a well-organized approached to, and methodology for, problem solving and decision making. The project will give students an opportunity to identify important facts to solving the problem from assertions and opinions, and when necessary, make assumptions supported by the facts in the scenario. Apply relevant public health disciplines and methodology and take the role of a healthcare manager or a consultant when considering alternative solutions, offering recommendation, and planning implementation. Some of the questions to consider when analyzing the case scenario are:

1. What is the problem(s)? Analyze the case and identify the problem(s),
2. What are the facts presented in the case?
3. Are these enough, or do we need to gather additional information?
4. What are the assumptions supported by the facts in the scenario (if there is any)?
5. What are the Values? Examine the shared and competing values, obligations, and interests of the stakeholders (i.e., patients, health care professionals, administrators, society, and other advocates) involved in order to fully understand the complexity of the problem(s). when applicable
6. What are the alternatives available to solve the problem(s) in the scenario?
7. How are you going to implement these solutions
8. Justifies and support your choice?

1. Select one of the following Scenarios.

2. Analyze the case identify the problem(s) and answer all of the question related to the case, be sure to justify your decisions based on what you have learned from this course.

Sarah is a health information management (HIM) student completing a clinical practice rotation in an acute care hospital in her community. This week she is learning about the release-of-information process. At the breakfast table, Sarah’s mother asks her to find out what is wrong with Noor, their next-door neighbor. Noor has been admitted to the hospital twice in the last three months, and Sarah’s mother wants to know why. While processing the requests for release of information that afternoon, Sarah comes across one from Noor’s insurance company. Sarah learns that Noor was hospitalized due to physical abuse by her husband. Sarah has been in trouble with her mother recently. She knows that if she tells Mohammed S. Alnaif, Ph.D. her mother this information she will score “big points” she is very tempted to tell her mother the information she has learned.

Later that same day while responding to another request for information, Sarah realizes that the medical record she is reviewing belongs to Ali, her best friend’s fiancé. Sarah learns that Ali has a drug abuse problem and was recently diagnosed with HIV. Sarah will be the maid of honor at the wedding of Ali and Reem two months from now, and she knows that Reem does not know about Ali’s problems. Sarah becomes worried and wonders whether she should tell her best friend what she has learned, because Ali’s conditions could affect Reem’s health and the quality of her married life.

1. Does Sarah have the right to reveal this information to others? Please justify your answer based on what you know about public health and ethics.

2. In the situation regarding Sarah’s friend Reem and her fiancé Ali, would Sarah be more justified in revealing patient information than in the situation regarding the next-door neighbor? Why or why not? What if Reem was her sister?

3. Why are privacy and confidentiality so important to patients who receive care and to those who provide care? Does this contradict the mission of public health, when social interests and the interests of individuals come into conflict?Mohammed S. Alnaif, Ph.D.

Background

Childhood obesity is a serious problem in the United States. Nearly one-third (31.7%) of children in this country are overweight or obese. Childhood obesity rates across the nation have more than tripled since 1980, increasing from 5% to 17%. Obesity poses numerous challenges for childhood health. Excess weight impacts children’s mental and physical wellbeing and is associated with numerous conditions: breathing conditions such as asthma and sleep apnea, joint problems and musculoskeletal discomfort, risk factors for heart disease including high cholesterol and high blood pressure, and type 2 diabetes. In addition, obese children are more likely than normal weight children to become obese adults, leading to continued risk factors and disease.

Questions to Consider

Awareness of the magnitude and severity of childhood obesity has been increasing in recent years. By 2010, 80% of Americans recognized that childhood obesity is a significant and growing challenge.3 However; many parents still have difficulty determining whether or not their child is at a healthy weight. While nearly one-third of children and teens are overweight or obese, over 80% of parents think that their child is at a healthy weight. This problem is particularly pronounced for overweight parents. They are both more likely to have an at-risk or overweight child, and less likely to accurately assess their child’s weight--which limits their ability to take action to promote their child’s health. Cultural influences also may affect parents’ perceptions of children’s weight, reflecting differences in values or beliefs about body size among various ethnic groups. Health officials are particularly concerned that parents may lack the knowledge and skills necessary to help their children maintain a healthy weight. This may indicate a broader issue of health literacy in the population, described by the Institute of Medicine as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Limited health literacy has broad implications for health. It increases barriers to managing chronic illnesses, accessing care, and receiving preventative services. Furthermore, while limited health literacy affects Americans of all backgrounds, it disproportionately affects vulnerable populations, most notably, ethnic minorities, some of those disproportionately affected by childhood obesity, and those with lower socioeconomic status. To advance health literacy, the Institute of Medicine recommends collaboration with the population of interest through the four Es: Engage, Educate, Empower, and Enable. Collaborations to build the skills of health literacy can support population health across a wide range of conditions.

State health officials in State X have become particularly concerned about the impact of childhood obesity on their communities. The state’s adult obesity rates are average with respect to the rest of the country. However, the level of childhood obesity in the state far exceeds the national average, suggesting not only problems for the health of today’s children and teens, but also the future health of the broader population. One in five children in the state are obese, ranking it in the top five states for childhood obesity. Furthermore, obesity disproportionately affects minority populations in the state. While whites have an obesity rate of just over 25%, rates for Latinos and African-Americans are substantially higher, at 31% and 40%, respectively. Mohammed S. Alnaif, Ph.D.

The state health department has been asked to provide input on a health education campaign being developed by an alliance of health advocates. The campaign has two goals: first, to use social marketing to change social norms about healthy weight, the social desirability of physical activity, and making healthy food choices; and second, to improve health literacy, particularly in minority and lower socioeconomic populations.

The alliance is concerned that in today’s crowded media market, other media sources will overshadow health promotion messages. The alliance wants to ensure that the childhood obesity campaign not only captures the attention of the public, but also motivates individuals to change behavior. To do this, the alliance is considering launching a public awareness campaign focused around attention-grabbing advertisements that put a face to the health hazards associated with childhood obesity.

Advertisements will depict overweight and obese children from the community engaging in activities linked to obesity, such as consumption of less healthy foods (such as soda or other sugar sweetened beverages) and sedentary activities such as playing videogames and watching TV. A billboard, for example, might feature an overweight, sedentary child playing videogames, surrounded by “junk foods”, with the tagline: “Childhood obesity—a game no one wins.” An internet or TV video clip might offer testimonials from children about the ways obesity keeps them from enjoying life, such as being picked on by their peers or playing in games at recess or on sports teams.

The head of the alliance has contacted you, the local health director of the state’s largest city, for your thoughts about whether to conduct the health education campaign.

1. Who are the stakeholders that should be considered in deciding whether this health education campaign should be put into place? What are the values and perspectives of each of these stakeholders in this decision?

2. As a local health director, what are some of the advantages and disadvantages of the proposed social marketing strategy that you would consider in advising the alliance?

3. Should “shock messaging” be used to draw attention to health issues? What might be some of the unintended consequences of these messages?

4. What level of evidence of potential impact is necessary to justify the campaign?

5. What would be your recommendation to the alliance?