User:Anmontoya/sandbox

Area article: https://en.wikipedia.org/wiki/Alameda_Health_System (Alameda Health System)
or

https://en.wikipedia.org/wiki/Highland_Hospital_(Oakland,_California) (Highland Hospital)

Both pages could be expanded to include specifics on the finances of each sector -- how much money the health system as well as how much highland hospital specifically is granted vs. spending.

https://en.wikipedia.org/wiki/The_Waiting_Room_(2012_film) (The Waiting Room)

The Waiting Room is a documentary made at highland hospital made to reflect the needs of the Oakland community and maybe I can expand this page to include the actual content of the documentary and highlight key points of the documentary that relate to the statistically proven needs of the hospital and the patient population.

Sector article: https://en.wikipedia.org/wiki/Safety_net_hospital
Safety Net Hospital

The article describes the typical financial situation of funding and sustainability of safety net hospitals as well as brief mention about the typical type of patient in a safety net hospital.

I believe that there could be expansion on the article in two sections:

1. A deeper discussion/presentation about the statistics of safety net hospital patients: present actual numbers of average incomes, average number of medicaid recipients, how severe/not sever the need is of individuals, etc.

2. The article details estimated projections for how Obamacare was going to affect the number of people covered and how many people were meant to still be uninsured. The numbers presented are a bit outdated and now that Obamacare has been in place for several years, there is more data that details how many people were actually helped and how many are still uninsured.

Area sources:
GATES-WILLIAMS, JAN; SCHEAR, STEVEN; TERVALON, MELANIE (1988). "HEALTH CARE ADMINISTRATION AND THE COUNTY HOSPITAL: COMMUNITY ACTIVISM AS A CATALYST FOR CHANGE". Journal of Health and Human Resources Administration. 10 (3): 297–310. doi:10.2307/25780326

Guralnik, J M; Kaplan, G A (1989-06-01). "Predictors of healthy aging: prospective evidence from the Alameda County study.". American Journal of Public Health. 79 (6): 703–708. ISSN 0090-0036. doi:10.2105/AJPH.79.6.703.

Seeman, Teresa E.; Guralnik, Jack M.; Kaplan, George A.; Knudsen, Lisa; Cohen, Richard. "The Health Consequences of Multiple Morbidity in the Elderly". Journal of Aging and Health. 1 (1): 50–66. doi:10.1177/089826438900100104.

Sector sources:
Sommers, M.D., Ph.D., Benjamin D. (2015). "Health Care Reform's Unfinished Work — Remaining Barriers to Coverage and Access". The New England Journal of Medicine. 373: 2395–2397.

Oberlander, Ph.D., Jonathan (2012). "The Future of Obamacare". New England Journal of Medicine. 367 (23): 2165–2167. ISSN 0028-4793. PMID 23171062. doi:10.1056/nejmp1213674.

Anderson, Ron; Cunningham, Peter; Hofmann, Paul; Lerner, Wayne; Seitz, Kevin; McPherson, Bruce (2009). "Protecting the Hospital Safety Net". Inquiry. 46(1): 7–16. doi:10.2307/29773398.

Scholarly sources and summaries - updated
Area Wikipedia page: Alameda Health System

Area sources:
==== SOURCE: Alameda County Medical Center (February 18, 2011). "ALAMEDA COUNTY MEDICAL CENTER DELIVERY SYSTEM REFORM INCENTIVE POOL PROPOSAL FOR THE CALIFORNIA SECTION 1115 WAIVER DEMONSTRATION YEARS SIX - TEN" (PDF). Retrieved 10/10/17. http://www.dhcs.ca.gov/Documents/1_ACMC%20DSRIP%20Proposal.pdf pg. 3-8 ==== This is a document that was put forth by the Alameda Health system in order to describe their proposal for improvements in the upcoming years. In this document there is a lot of background information about the history of the hospital and the process of moving from "disease-focused model of episodic care" to a "to a model of coordinated, pro-active care that helps patients manage their own conditions" - which that along with other detailed information could make detailed additions to the history portion of the Highland Hospital (Oakland, CA) page.

Additionally, this report also includes information about the patient demographics such as race/ethnicity as well as education levels, what federal services they use (Medical/Medicare, etc.), income levels, etc. This information could help fill gaps in the history portion of the website or it could also serve to create a new sub heading titled "patient demographics" or "demographics". etc.

SOURCE: Integrated delivery system
Would want to link this term that is used at the beginning of the page to further clarify what this means - linking internally to another wikipedia page.

==== SOURCE: Kongstvedt, Peter Reid (2001). The Managed Health Care Handbook. Jones & Bartlett Learning. ISBN 9780834217263. ==== This is a scholarly source that works to define what an integrated health care delivery system is as well as the foundations of the such and what the model of an integrated health system aims to do. The article goes on to discuss the various different forms of integrated health care systems. I could (in addition to linking the above internal wikipedia page) reference this external source to provide more detail to the specific line on the Alameda Health System wikipedia page that refers to the health system as an "integrated pubic health care system".

==== SOURCE:  https://www.acgov.org/health/documents/ballot_measureA.pdf ==== (for some reason couldn't get it to list out but citation included when you click on [1].

These sources discuss the Measure A of Alameda County (the first source if the PDF of the official ordinance of Measure A) - Measure A briefly mentioned in the Wikipedia page but I would want to expand on it. Measure A is designed and implemented to provide additional financial support for many of the medical departments of the alameda health system (emergency medical, hospital inpatient, outpatient, public health, mental health and substance abuse services) and is meant to primarily serve indigent, low-income, and uninsured adults, children, families, seniors and other residents of Alameda County that are traditionally seen as very vulnerable populations and those that are usually at proportionately high rates coming to AHS facilities (as reflected by the first source). I could use this source to expand on Measure A and again on the history of Alameda Health System. Furthermore, the Wikipedia page states that its more to recover from a financial crisis and transfer of power (Alameda county to AHS) that these funds are being allocated to pay debt -- need further research to see intentions behind implementation of Measure A.

SOURCE: "Administration, Indigent Health & Cross-Jurisdictional Programs - Health Care Services Agency - Alameda County's Official Website". www.acgov.org. Retrieved 2017-10-12.
https://www.acgov.org/health/

This website as a whole provides detailed information on the various resources and services that the Alameda Heath System provides to their patients in all sectors of medicine and health. Particularly under the tab titled "Administration, Indigent Health & Cross-Jurisdictional Programs", there is more information on how the Alameda Health System specifically works with the vulnerable populations in the Bay Area with regards to their health. This tab provides further information on measure A as well as more sources/specifics to the list of sources provided in the area. I would want to use this information (and the specifics of certain programs offered) to potentially integrate a section on the Alameda Health System page to what services they offer and what populations are targeted through these programs (giving further insight to the specific needs of the Bay Area Highland General Hospital population and the the response from these health institutions).

Sector Wikipedia page: Safety net hospitals

Sector sources:
==== SOURCE: Sommers, M.D., Ph.D., Benjamin D. (2015). "Health Care Reform's Unfinished Work — Remaining Barriers to Coverage and Access". The New England Journal of Medicine. 373: 2395–2397. ==== This article details the various amounts of work left to do and the large gaps that are still in place after the implementation of the Patient Protection and Affordable Care Act. The article pays attention to how many Americans, on estimate, will still be left without health care; the increase in individuals that will receive coverage will alleviate health systems (especially safety net hospitals) from some financial burden that they currently must absorb because of the number of uninsured individuals BUT the article also details the financial burden that will still be in place after Obamacare is in full swing. I would like to use this information to expand and cite the paragraph under "Obamacare Cuts and Safety Net Hospitals" and what the expert opinions predicted.

==== SOURCE: Oberlander, Ph.D., Jonathan (2012). "The Future of Obamacare". New England Journal of Medicine. 367 (23): 2165–2167. ISSN 0028-4793. PMID 23171062. doi:10.1056/nejmp1213674. ==== I plan to use this article to add to my Sector page (Safety Net Hospitals) under the heading of "Obamacare Cuts and Safety Net Hospitals". Particularly, I tend to use data from the article to speak to more in depth to the number of individuals that will remain uninsured (I already linked and updated the number of how many people in the article itself). There is also a section of the paper that speaks to the political climate focused on whether the ACA was likely to pass and to last (and is compared to the political climate of Massachusetts and the implementation of their health program) -- I then intend to add information about how this political climate ultimately lead to the support of trump in terms of supporting his repeal of Obamacare and his rise to power; I then intend to link the page to the Trump Care wikipedia site which details the new plan.

==== SOURCE: "Obamacare repeal could leave 32 million uninsured and double premiums, report finds - ProQuest". search.proquest.com. Retrieved 2017-10-19 ==== This is a second scholarly source that speaks to the number of individuals that were left uninsured. This article echos the same sentiments that is addressed in the article sited directly above (Oberlander et. al). I could again further use this information to contribute to the AHS (Alameda Health System Article) in the same way as stated in the previous article.

==== SOURCE: Oberlander, Jonathan (2017-01-05). "The End of Obamacare". New England Journal of Medicine. 376(1): 1–3. ISSN 0028-4793. PMID 27959711. doi:10.1056/NEJMp1614438. ==== The article (published in 2017) presents a current perspective on Obamacare and it's impending end (whereas the two aforementioned articles speak to a stance on Obamacare from the perspective on the matter circa 2012 and 2016 which was the time periods right before full implementation and full implementation but before the threat of a repeal from Trump, respectively). This article thus speaks to the difficulties that may in attempting to repeal Obamacare (politically and logistically speaking) and also alludes to the difficulty and anxiety that certain stakeholders (such as hospitals and safety net hospitals) are currently facing because of the uncertainty of the direction that this matter will go towards. I plan to use this article to speak to the current uncertainty and the predictions for the ways in which experts think both patients and health care institutions will be affected.

==== SOURCE: "H.R. 1628, Better Care Reconciliation Act of 2017". Congressional Budget Office. June 26, 2017. Archived from the original on July 1, 2017. ==== This article reports what changes would take place if Obamacare was to repealed and Trumps health care efforts "Better Care reconciliation Act or 2017" was implemented in full; the article quantifies the number of people and assets that would be impacted and saved, speaking from a national budget and hospital administrative point of view. I intend to use this article to speak to how the repeal of Obamacare and the aforementioned increase of the uninsured population will cause a big strain on safety net hospitals in general but also simultaneously decreasing patient care and increasing the overall burden of sickness. I want to make the facts available and present the point of view objectively of course, from the safety net perspective.

Proposed edit 1:
The first sentence of the page describes Alameda Health System as a "integrated public health care system" -- I would link this text to the internal wikipedia page (Integrated delivery system) and I would also site a second source that details integrated health systems in order to further detail the type of system that it is; source:

Proposed edit 2:
I want to add a third subheading to the page (directly under the Locations section titled "Patient demographics")

I aim to include graphs from the Alameda County Pool Proposal that detail the population demographics of the Alameda Health System patient population and then underscore the images with text summaries.

Refer to pg. 4 table (titled Patient Race/Ethnicity ACMC FY 2010 Inpatient Discharges) and

Refer to pg.5 table (titled Patient Demographic Pilot Study Results, 2009)

• Almost a quarter (22%) used the Emergency Room as their primary source of health care.

• Almost half (47%) rated their own health status as poor or fair.

• 56% reported income below the federal poverty level, and another 21% had income between 101% and 200% of the FPL.

• Thirty-eight percent did not graduate from high school, and only 11% had a degree from a four year college or higher.

Paragraph text that I would add: The data indicates both the racial/ethnic racial composition as well as the demographics of the patients that attend highland hospital. From the data, we can see that the majority of patients are African American and Latino, respectively. Additionally, about 40% of the patient population is a recipient of either Medicare or Medicaid.

Proposed edit 3:
I want to create a second sub-heading that describes the purpose of Measure A in Alameda and how it impacts the Alameda Health System

Section title: Measure A and it's impacts on Alameda Health System

Paragraph text: Measure A is designed and implemented to provide additional financial support for many of the medical departments of the alameda health system (emergency medical, hospital inpatient, outpatient, public health, mental health and substance abuse services) and is meant to primarily serve indigent, low-income, and uninsured adults, children, families, seniors and other residents of Alameda County that are traditionally seen as very vulnerable populations and those that are usually at proportionately high rates coming to AHS facilities (as reflected by the first source).

____________________________________________________________________________________________________________________________________________________

Proposed edit 1:
Adding to the section titled "Obamacare cuts and safety net hospitals"

I intend to add a sub-heading on this page directly after the heading title "Obamacare cuts and safety net hospitals"

Sub-heading: "Prospects for safety net hospitals under the Trump Administration"

Paragraphs:

Donald Trump was elected into the U.S. presidency in 2017, many of his campaign platforms revolving around making changes to the existing health care system in the United States, particular advocating for the repeal of the Patient Protection and Affordable Care Act (Obamacare). Republicans currently also hold the majority in the House and the Senate; experts say that this majority increases the chances that President Trump will be able to repeal Obamacare, or at least parts of the Act. A few of the efforts made towards passing Obamacare and amendments to the function of Obamacare post the passing of the main body of the law, was done so through executive orders; Trump has the power to reverse those executive orders. Tump, however, has publicly expressed that there are several stipulations of Obamacare that he would like to keep for his proposed health care system (American Health Care Act of 2017), such as the stipulations that do not allow for discrimination of patients with preexisting conditions by insurance companies and the ability for individuals to be able to stay on their parents insurance plans until the age of 26. Elimination of mandates for individuals and larger employers to offer insurance coverage or pay penalties and eliminating the Cadillac tax on high-cost private plans are a few of the stipulations/changes that Trump advocates for in his proposed health act.

Paul Ryan, Speaker of the House, advocates for many large-scale tax cuts which would serve to reduce the federal funds that financially supports federal programs such as Medicare and Medicaid, in an effort to decrease the federal deficit that America faces. These potential federal cuts and proposed increased enrollment criteria for federal welfare programs will make it more difficult for Americans to be able to participate and receive aid from federal programs (especially with less money allocated to these programs) and will create an inevitable cost shift on patients; Hypothetically speaking, less money allocated to federal programs and the simultaneous repeals to Obamacare will lead to less patients receiving financial help and qualifying for insurance programs, which means they will have to pay more money out of pocket. It is estimated that there will be 15 million (or more) less individuals insured with "Trumpcare" than with Obamacare. This will directly impact safety net hospitals because that means the number of patients without insurance will increase at safety net hospitals but in turn, safety net hospitals will also be suffering a decrease in financial support from the federal government and will not be able to absorb as many costs for these patients (decreasing the number of patients that can receive help). The aforementioned proposed acts will place financial burdens and operational constraints on both patients and safety net hospitals.

Edits for final contributions on safety net hospital page: Drafting
A safety net hospital is a healthcare entity/organization that has a legal obligation to provide healthcare for individuals regardless of their insurance status and regardless of their ability to pay. Because of this legal mandate to serve all populations, safety net hospitals typically serve a proportionately higher number of uninsured, Medicaid, Medicare, low-income (and other vulnerable) individuals than their private hospital counterpart. Safety net hospitals are not defined by their ownership terms; they can be either publicly or privately owned. The missions of safety net hospitals are rather, to focus and emphasize their devotion to providing the best possible care for those who are barred from health care due to the various possible adverse circumstances. These circumstances mostly revolve around problems with financial payments, insurance plans, or health. As per America’s Health Care Safety Net: Intact But Endangered , safety nets are known for maintaining an open-door policy for their services.

Some safety net hospitals even offer high-cost services like burn, trauma, and neonatal treatments. Some also provide training for medical professionals. The Health and Hospital Corporation in NYC, Cook County Health and Hospital System in Chicago, and Parkland Health & Hospital System in Dallas are three of the country’s largest safety net hospitals.

Definitions from articles:

‘those organizations and programs, in both the public and private sectors, with a legal obligation or a commitment to provide direct health care services to uninsured and underinsured populations.’’

"safety-net providers as those that by legal mandate or stated mission offer care to all patients regardless of ability to pay, and thus have a substantial portion of uninsured, Medicaid, and other vulnerable patients"

Additional sources found:
7. Source gives information on the typical demographics of emergency department hospitals and also details how the demographics of emergency rooms has become an issue (to cite in safety net hospital page)

This source details how policy is having an impact on funding for safety net hospitals and how the issue of constantly decreasing funding places constraints on these institutions (safety net hospital page)

This source describes how safety net hospitals tend to perform at lower levels than non safety net hospitals and tend to rank worse overall in patient experience but details how these institutions are hoping to advocate for policy that could improve these patient experience scores (safety net hospital page)

Another two sources that details how safety net hospitals are ranked lower on patient care quality and experience than non safety net hospitals (safety net hospital page)

This source details how safety net hospitals must rely on payments from SDH in order to compensate for the high volumes of patients in safety net hospitals that have Medicare and Medicaid (and details how this fact makes it difficult for safety net hospitals to be financially sustained). - for safety net hospital page

The Waiting Room (2012 film) - internally link this page that details the demographics and the difficulties that highland hospital of Alameda Health System experiences, particularly their financial burdens and the patient care -- add to the AHS page

This source speaks to a cohort study done with patients from Oakland, CA (Alameda Country) -- speaks to the high mortality rates experienced by these individuals which when viewed under multivariate analysis, shows that environment sometimes has more health effects than individual behaviors more often than not (gives insight to patient population demographics) - for AHS page

The article details how when compared to a non safety net hospital, safety net hospitals do not tend to perform as well in patient experience. I plan to use this information to add citations to the patient care section on the safety net hospital page.

This article detailed the prospects of the number of estimated uninsured individuals under Obamacare. I used this article to cite text already existing on the safety net hospital page.

This article detailed the prospects of the number of estimated uninsured individuals under Obamacare. I used this article to cite text already existing on the safety net hospital page.

This article goes into depth on the demographics of the patient population that is typical of a safety net hospital. The article delves into the issues that patients who are uninsured, low income, working poor and disqualified for public assistance, etc. struggle with, especially those with life threatening diseases. The article also massively highlights how those who seem to suffer the most are uninsured ethnic minorities. - intend to use in intro paragraph of safety net hospital.

This article provides insight on the "financial health" of safety net institutions and why they should be "protected" in order to insure their survival. I plan to use this article to discuss the financial atmosphere of safety net hospitals and issues that they face in financing in the safety net hospital page under the section titled "financing a safety net hospital"

This article details the nature of safety net hospitals; the typical patient population demographics, private versus public nature, and a brief history of the private versus public discourse on vulnerable populations in the transition from public to private. I plan to use this in the introduction of the safety net hospital paragraph.

Safety Net Hospital (Sector):

 * Total of 16 sources added (previously no source citations to support this page)
 * Restructuring of sentences in introduction paragraph
 * Added 2 sentences (replaced 2)
 * Addition of 3 sources here (two of which Prof. Clare shared with me!)
 * Addition of citation to support already existing text
 * Many edits to "Financing of Safety Net Hospitals" section
 * Change of section from "Financial behavior of safety net hospitals" to "Financing a safety net hospital"
 * Addition of 4 sources in this section
 * Added 6 sentences --- a lot of grammatical pruning to existing text
 * Addition of "Prospects for safety net hospitals under the Trump Administration"
 * Addition of paragraph (6 sentences)
 * Addition of 4 sources to support my text
 * Addition of a sentence under the "Patient Experience in Safety Net Hospitals"
 * Addition of 4 sources to support existing and additional text
 * Minor edits to section headings for uniformity purposes

Alameda Health System (Area):

 * Total of 5 sources added (not including internal wikipedia links)


 * Added 2 internal wikipedia links to the introduction sentence (both to integrated health systems)
 * Added an additional sentence and citation for the Measure A description under the history section
 * Creation of the "Patient Demographics" section
 * Creation of 4 pie charts
 * Addition of all text listed (3 sentences)
 * Addition of 1 source from which the information for pie charts was included
 * Addition of two internal wikipedia links to the "See Also" section
 * "The Waiting Room" internal link
 * Highland General Hospital internal link