Author: Tom Stanoch

Jennifer Pelletier: Researching a collaborative, policy-driven approach to preventing obesity

Girl-With-LunchThe pressure is on to create nationwide policy changes and practices that will lower the obesity rate, reduce the related fiscal stress on the U.S. healthcare system, and-most importantly-boost the general wellbeing of the American population.

At the University of Minnesota School of Public Health’s Division of Epidemiology & Community Health, doctoral student Jennifer Pelletier is researching how multiple organizations are working together to combat obesity in the U.S.

Pelletier was recently profiled by the University of Minnesota Graduate School.

Gun Violence and Mental Health: Too Much Has Slipped Through the Cracks

Recently, the Minnesota community was rocked by an absolute tragedy. I do not wish to add to the wounds of the family so I will not use any quotes or names. After battling anxiety and depression for what is believed to be months, a Lake Minnetonka man took the lives of his wife, son, two daughters, and then turned the gun on himself. The bereaved family buried their lost relatives a few weeks ago and what stuck out to me were the words spoken about the family. A loving family who worked hard to get where they were … The American Dream. It saddens me that we as a community have yet again been affected by gun violence.

In just the last few months, we have witnessed the radical nature that is gun violence. From a disgruntled employee who gunned down his former co-workers on live television to numerous unexplained murders that occur across our nation, we have a problem with guns. Of the 16,121 homicides that occurred in 2013, 11,208 (69.5 percent) were due to firearms. Also during this same year, 21,175 (51.5 percent) suicides were caused by firearms. The NIH published an article called “Suicide: A Major, Preventable Mental Health Problem” in which a common sign of suicide is searching online for or buying a gun. The link between gun violence and mental health can be exemplified in suicide, depression, and other mental disorders are major risk factors associated with suicide.

Are guns the issue? Are people the problem? Or is it an extremely difficult question that cannot be answered with one issue or one policy change? At this point, the rhetoric surrounding the gun control debate belittles the lives lost due to gun violence. Everyone can agree that guns in the wrong hands can cause horrible calamities. Progressive action is needed rather than arguments over whose rights are being infringed upon. Families of the Sandy Hook victims, mayors across the nation, mothers throughout the U.S., and survivors of gun violence began an organization called “Everytown for Gun Safety.” Through a variety of actions, they hope to make every town safer by preventing gun violence. A noble goal but a difficult one to achieve.

We, as Public Health professionals, have an interesting role to play in this debate. Do we choose a side and enter the debate? Or do we sit back and deal with issues we believe are more important? In my opinion, we cannot do either. We must bring to light the issue in a fair and calculated way, utilizing statistics and empirical evidence to prove a link between gun access and gun violence. Further, we must substantiate the need for better background checks so that individuals who may be suffering from mental disorders are not allowed to obtain a gun. –Post written by Jake Tanumihardjo

[This blog does not represent the opinion of the University of Minnesota’s School of Public or the members of the Active Response Coalition for Public Health, only the author.]


Rothenberger Institute Receives Online Learning Consortium Effective Practice Award

The Rothenberger Institute (RI) has received a 2015 Effective Practice Award  from the Online Learning Consortium (OLC) for its online peer course facilitator training. 

OLC’s Effective Practice Awards  “recognize effective techniques, strategies and practices that are shared by members of the OLC community to advance quality and access to online programs.” Effective practices are peer reviewed and focus on five pillars of quality: access, learning effectiveness, faculty satisfaction, student satisfaction, and scale. 

RI’s Effective Practice award recognizes the design, development, and implementation of its innovative solution addressing the complex training needs of an increased number of teaching assistants. With a small staff and projections of more than three times the number of teaching assistants coming on board to address increased student enrollment, RI’s shift to this partly online training alleviated scheduling challenges, leveraged what RI does best—design online curriculum—and provided its peer educator teaching assistants a learning experience very similar to that of the students who take RI’s online courses. 

Formerly known as the Sloan Consortium, OLC serves as a leader around the world in advancing quality online learning through relevant and timely publications examining technology trends in education and conferences focusing on innovation in teaching and learning, and is the go-to source for professionals in K-12 and higher education dedicated to online and blended learning. 

For more information about the Rothenberger Institute, visit

Patient Satisfaction Varies with Number of Chronic Illnesses

Jon Christianson, PhD, Caroline Carlin, PhD, Patricia Keenan, PhD, and Michael Finch, PhD, are the senior authors of this research study. Judy Jou prepared this brief as a class assignment for Public Health 8802, Health Policy Applications taught by Lynn Blewett, Ph.D, professor, and Sarah Gollust, Ph.D, assistant professor.

Download a copy of this brief


Patient satisfaction is an important measure of health care quality. In recent years, organizations such as the Institute of Medicine (IOM) and Robert Wood Johnson Foundation (RWJF) have increasingly recommended using patient satisfaction scores as one indicator of provider quality.

Patients today have access to a wide range of consumer satisfaction reports when selecting their providers. Health payment systems that use a pay-for-performance (P4P) or tiered benefit design structure can also use satisfaction metrics to calculate provider rewards. One potential problem is that providers within these systems may try to improve their performance scores by turning away patients who are likely to report low satisfaction. Identifying contributors to patient satisfaction can help address this concern.

One factor that can influence patient satisfaction is illness complexity. Research in this area is inconclusive, with some suggesting that patients with more complex conditions may report lower satisfaction with care regardless of actual provider quality, while others indicate no significant association between patient condition and satisfaction with care.

To shed more light on this issue, Carlin and colleagues examined the effects of illness complexity on the association between three aspects of provider performance known to be associated with patient satisfaction: 1) quality of interaction with the provider, 2) provider support for self-management of illness, and 3) patients’ understanding of their own conditions and treatments.

Study Design

The authors used data collected from a random-digit telephone survey administered by RWJF as part of its Aligning Forces for Quality (AF4Q) initiative, which aims to improve the treatment of chronic illnesses through building alliances between health care stakeholders. U.S. adults were screened for at least one of five chronic diseases: asthma, coronary artery disease, depression diabetes, and hypertension, then asked to complete the survey between June 2007 and June 2008. A total of 7,337 respondents were included in the study.

Illness complexity was defined as the number of chronic conditions each respondent had (1, 2, or 3+). Respondents who did not have at least one of diabetes, heart disease, or hypertension were excluded. Satisfaction was based on a 10-point scale taken from the RAND Corporation’s Improving Chronic Illness Care Evaluation (ICICE) project, which was condensed into 4 points (10, 9, 8, and 7–). The authors conducted structural equation analyses for each level of illness complexity using LISREL by SSI, Inc.

Key Findings

  • Patients with higher levels of illness complexity report higher satisfaction with care. Patients with only one chronic illness were, on average, less satisfied with their care than patients with two or more chronic illnesses. This finding contrasts with earlier research suggesting that higher illness complexity is associated with lower patient satisfaction.
  • The relationship between provider performance and patient satisfaction was also different for patients with varying levels of illness complexity. Positive interactions with providers and provider support for self-management of illness were associated with higher patient satisfaction for those with one or two chronic illnesses, but not for those with three or more chronic illnesses.
  • Patients’ understanding of their own conditions and treatment leads to higher care satisfaction for those with one chronic illness, but for those with two or more chronic illnesses, higher understanding is associated with lower satisfaction. Carlin and colleagues suggest that patients with higher levels of illness complexity may become distressed at understanding more about their own conditions, leading to lower satisfaction.
  • Overall, positive experiences with provider interaction lead to higher patient satisfaction levels across all levels of illness complexity. Provider support for self-management of illness contributes to both positive provider interaction and better patient understanding of their own conditions and illnesses.
  • Women report higher levels of patient satisfaction, but this effect is smaller for women with three or more chronic conditions. Both obese and non-Hispanic black patients report lower care satisfaction at lower levels of illness complexity (1 or 2 chronic conditions), but those with three or more chronic conditions report slightly higher satisfaction.
  • Patients with higher levels of education report lower levels of care satisfaction across all levels of illness complexity.

Policy Implications

This study shows that illness complexity can affect how provider performance and demographic characteristics contribute to patient satisfaction with care. Using their results, Carlin and colleagues identify ways that care providers can improve patient satisfaction while being sensitive to illness complexity.

First, policy can be used to support positive interactions between providers and patients. One approach is to adopt payment systems that provide incentive for quality of care—which includes patient satisfaction ratings—rather than for the number of patients seen by each provider.

Another recommendation is for providers to consider illness complexity when interacting with patients, so as to design an appropriate program of care based on patient characteristics. With patients who have lower levels of illness complexity, providers should emphasize patient self-management and understanding, while more sensitivity should be used when educating patients at higher levels of illness complexity about their conditions and treatments.

One way to support this on a policy level is to incorporate illness complexity into existing medical education on bedside manner and patient-provider interactions. Adding research knowledge into medical school curricula can give providers the information they need to interact successfully with patients at all levels of illness complexity.

Finally, this study has implications for payment structures based on provider quality. With patient satisfaction becoming an increasing measure of quality care, policymakers should invest more into research that explores the sources of patient satisfaction and the best ways to maximize it. More accurate measures of patient satisfaction can help prevent providers from refusing patients with higher levels of illness complexity in order to preserve their satisfaction scores.

This study highlights the role of one patient characteristic—illness complexity—that can moderate the association between provider performance and patient satisfaction. Knowing more about the factors that contribute to patient satisfaction can help policymakers design health care delivery and payment systems that incentivize quality care from the perspective of both provider and patient.

For full text of the research article: Chronic Illness and Patient Satisfaction, Health Services Research, Volume 47, Issue 6, pages 2250-2272, December 2012.

E-PHAP student profile: Agnes Jensen

Agnes JensenAgnes Jensen, E-PHAP student and research study coordinator at Minneapolis VA Health Care System, has coauthored a groundbreaking study on food insecurity among U.S. Iraq and Afghanistan war veterans.

The study, “Food insecurity among veterans of the U.S. wars in Iraq and Afghanistan,” found that 27% of veterans don’t have consistent access to sufficient food. That’s drastically higher than the prevalence of food insecurity in the U.S., which is 14.5 percent.

The study also found veterans are more likely to be food insecure if they:

  • Are young, report poor general health, are not married/partnered or not employed/on active duty
  • Have lower income, reported a lower final military pay grade, or live with children

University of Minnesota researcher Rachel Widome led the study and VA researchers Ann Bangerter and Steven Fu are coauthors.

Read SPH story, “Coming home to hunger

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