Health Care Services

For more than thirty years, JSI has been at the forefront of improving health care delivery. JSI's programs strive to improve health systems as well as quality of care provided and, ultimately, health outcomes. JSI makes its research available to a wide range of clients as part of its effort to improve health care worldwide, while additionally providing effective and efficient models of successful health care strategies.

For JSI-authored articles in peer-reviewed journals please go to Journal Articles.

Please note the following are listed in chronological order starting with the most recent publication.

Telehealth in Community Clinics: Three Case Studies in Implementation (PDF, 784 KB)

In 2007, the California HealthCare Foundation (CHCF) funded the Telemedicine to Improve Access & Efficiency in California Clinic Networks project to explore the role telehealth could play in improving specialty care access for patients of community health centers (CHCs). The case study report highlights and compares the experiences of each of the three CHCs as they planned and implemented their telehealth programs; this case study report addresses facilitators and barriers to program implementation and operation, patient and provider satisfaction, and key lessons learned.

Learn more at the California Healthcare Foundation website. Christine Duclos, Julie Hook, and Michael Rodriguez. JSI Research & Training Institute, Inc. 2010.

Handbook: Contracting Out Government Functions and Services in Post Conflict and Fragile Situations (PDF, 8.65 MB)

This handbook provides guidance on contracting out in post-contracting environments. It is adaptable to various situations and stresses the importance of longer-term sectoral and capacity development strategies. Contracting out enables developing countries to assert their sovereignty by setting policy and regulating the services or functions being contracted. John Snow Inc., 2010.

Peak Vista Access and Retention Project Final Report (PDF, 443 KB)

Peak Vista Community Health Centers contracted with JSI to identify potential causes of patient attrition (particularly within the Medicaid, State Children's Health Insurance Program and Medicaid payer groups), and to identify specific steps that could be taken to reduce attrition and facilitate a more desirable payer mix. Based on the findings of the data analysis and on-site visits, potential factors that may contribute to attrition or inhibit retention among Peak Vista members were identified. Subsequent interviews with Peak Vista leadership helped develop a better understanding of these potential attrition factors. Interviews also explored the feasibility of changing practices to address barriers to member retention, while upholding Peak Vista's mission and commitment to foster hospitality throughout the organization.

The analysis of enrollment and empanelment processes revealed that there are opportunities to make the current enrollment processes more streamlined and efficient, convert a greater number of insured members to active users of care, assign insured members and users to non-generic panels, thus increasing engagement with Peak Vista, and retain current users. John Snow, Inc. 2010.

Engaging Low-Income Smokers in Tobacco Cessation - NIDA Conference Poster (PDF, 1.53 MB)

The poster features a JSI project funded by the American Legacy Foundation: Engaging Low-Income Smokers in Tobacco Cessation via Employment Readiness and Credit Counseling Services. During employment or financial counseling appointments, smokers received information about the immediate personal economic costs of tobacco use and were offered proactive referral to the RI and NH Smokers' Helpline (1-800-Try-to-STOP) and free nicotine replacement therapy.
The poster presentation was recognized with a Blue Ribbon: 1st Place for Diverse Settings at the National Institute on Drug Abuse (NIDA) 8th Annual Conference, New Mexico, April 2010. The NIDA Conference focused on innovative, science-based approaches proven to be effective in the prevention and treatment of drug abuse and addiction.

Public Health Emergency Preparedness Performance Measures Reference Guide (PDF, 194 KB)

JSI developed a training program for 62 state and territorial health departments to educate awardees on how to report public health emergency preparedness performance measures. These quick reference guides were developed to support online training for CDC Public Health Emergency Preparedness (PHEP) Cooperative Agreement awardees on reporting requirements.

Health Care Delivery for the Medically Underserved in Nashville (PDF, 2.69 MB)

In April 2009, the Metropolitan Government of Nashville and Davidson County, Tennessee, engaged JSI to assess alternatives to meet the health care needs of the medically underserved and indigent citizens of the area, and to make recommendations to meet those needs more cost effectively. This final report presents JSI's findings and recommendations from the research conducted by JSI both in the Nashville and Davidson areas as well as external research of other health care safety-net systems across the country.

JSI's primary recommendation is that in order to provide a more cost-effective and sustainable model for the safety-net system in Nashville and Davidson County, the community needs a strong leading entity that is responsible for successfully responding to the needs of the entire safety-net system in a cohesive, coordinated manner. John Snow, Inc. January 2010.

Vermont Rural Health and Primary Care Plan (PDF, 4.82 MB)

Under contract with the Vermont Department of Health JSI facilitated a strategic planning process to develop a State Plan on Rural Health and Primary Care. The plan is a requirement of the Federal Office of Rural Health Policy as part of the funding requirements of all State Offices of Rural Health. The document sets forth the resulting goals, objectives and activities for the State Office of Rural Health and Primary Care to achieve over the next three years. This document provides a list of recommended activities that are based upon data, qualitative input from stakeholders and an analysis of present opportunities. JSI Research & Training Institute, Inc., March 2009.

Non-Financial Incentives for Voluntary Community Health Workers: A Qualitative Study (PDF, 701 KB)

The Ethiopia health extension program extends its reach through a diverse network of voluntary Community Health Workers (vCHWs), who spread health messages and practices to families residing in every part of a community or kebele. One of the objectives of the Last 10 Kilometers (L10K) project is to ensure the sustained engagement of these volunteers through non-financial incentives (NFIs). The NFIs proposed by L10K are mechanisms that recognize vCHWs' work; support from Health Extension Workers in the form of ongoing mentoring, training and follow-up, certification, performance reviews, and support by kebele and woreda (i.e., district) leaders. Successful communities and families are rewarded, celebrations are organized periodically, badges and ID cards are provided - in addition to other identification methods like posting their photographs at public places, as well as the provision of refreshments during performance review meetings. Through in-depth interviews and focus group discussions, this study explores the potential efficacy of NFIs proposed by the project. The results of the study outline factors motivating vCHWs, indicate other NFI mechanisms for consideration, and suggest programmatic recommendations. Yared Amare, JSI/Last 10 Kilometers Project, 2009.

Indonesia Health Services Program Aceh Final Report 2005-2008 (PDF, 2.12 MB)

In the wake of the destruction caused by the December 2004 earthquake and tsunami in Aceh, JSI's Health Services Program, already operating in Indonesia, as asked by USAID to help communities along the west coast of Aceh - the area hardest-hit by the disaster.

This report provides an overview of HSP's support, which focused primarily on strengthening the health system's responses to maternal and child health issues. The program worked closely with the Ministry of Health to provide technical assistance in the areas of district planning and budgeting, advocacy, community mobilization, behavior change communications, supportive supervision and improving quality of and access to midwifery services. HSP also addressed psychosocial protection of women and children, and helped to put in place a household-to-hospital continuum of care for the mentally ill. JSI Research & Training Institute, Inc./Indonesia Health Services Program, 2008.

Vermont Dementia Plan (PDF, 1.13 MB)

The prevalence of dementia is expected to increase significantly as the population ages. In Vermont more than 20% of the population will be over 65 by 2020. As such, Vermont will be impacted by aging-related diseases such as dementia. Under contract with the Vermont Department of Disabilities Aging and Independent Living, JSI developed a Vermont State Plan on Dementia which outlines the strategic programming to improve existing services for persons with Alzheimer's Disease and Related Disorders as well as project the future service needs of the population. JSI Research & Training Institute, Inc., Dec. 2008.

Providing Medication Assistance For Seniors: A Guide For Resident Service Coordinators, Pharmacists And Nurses (PDF, 428 KB)

Many seniors living independently have health-related needs that could be addressed by home-based assistance, enabling seniors to "age in place." However, the delayed recognition of such needs and a lack of appropriate assistance services oftentimes lead to institutionalization. This guide has been developed with input from an interdisciplinary team from Vermont including resident service coordinators from unlicensed congregate housing sites, a visiting nurse, and a pharmacist as an aid to those providing medication assistance to seniors. The guide is divided into three sections covering the three different types of medication assistance services offered by the Vermont Medication Assistance Services program. Each section provides step-by-step instructions to guide a RSC/Nurse/Pharmacist team in carrying out the activities comprising various services for medication assistance. The specific roles of each team member are described, and the team member who may take the lead for each activity is indicated. The Guide includes handouts or forms used for various purposes in delivering Vermont Medication Assistance Services. JSI Research & Training Institute, Inc., and the American Society of Consultant Pharmacists Foundation. 2008.

Developing Foci and Criteria for The Fund for a Healthy Rhode Island (PDF, 35 KB)

JSI worked with The Rhode Island Foundation to develop recommendations for the Foundation concerning the use of the Fund for a Healthy Rhode Island. The report delivers qualitative analysis and strategic recommendations on how to effectively utilize the Fund for a Healthy Rhode Island to achieve impact. Of particular relevance is the impact on the provision of quality and affordable health care services in the state. The report delineates four critical recommendations that will ultimately help enhance and transform the primary care system in the state of Rhode Island. John Snow, Inc., September 2008.

Development of a Medical Home and Chronic Care Model for the Potomac Street Health Center (PSHC) Report (PDF, 1.39 MB)

JSI developed a Medical Home and Chronic Care model for the Potomac Street Health Center (PSHC) that resonates with the organization's (MCPN) management, PSHC staff and providers, key stakeholders in partnering agencies and hospitals, and patients. The final report includes the model developed along with an analysis of PSHC's services, operations, patient demographics and collaborations. Furthermore, the report contains recommendations for PSHC to move from their current state to the agreed upon model, including financial and staffing needs. All presentations, assessment tools and documents created for the project are included as appendices to the report. John Snow, Inc., July 2008.

Assessment of the Needs of Grandparents Raising Grandchildren in Doña Ana County, New Mexico Report (PDF, 966 KB)

The Housing Authority of the City of Las Cruces, New Mexico and the City of Las Cruces Senior Programs are exploring the development of housing programs for the estimated 3,000 grandparents raising grandchildren in Doña Ana County. As a first step in that process, JSI conducted a comprehensive assessment of the social service and housing needs of grandparents raising grandchildren in the county. The report describes the methodology of the assessment (a survey), the challenges reported by the more than 100 grandparents raising grandchildren who participated in the assessment, their housing and social service needs, and a set of recommendations for future activities. The report and the results of the assessment will be used by the city's Housing Authority and Senior Programs, as well as other local service providers to develop or expand programs and services to address the unique needs of this population. Jeremy Holman, JSI Research & Training Institute, Inc., January 2008

Dutchess County Cancer Control Needs Assessment Report (PDF, 573 KB)

As part of the Dutchess County Department of Health efforts to develop a county-level cancer control plan, JSI Research & Training Institute completed a comprehensive assessment of cancer prevention, screening, treatment, and support services in the county. The report includes three substantive parts: an epidemiologic profile of the burden of cancer in Dutchess County; detailed findings from the three components of the needs assessment (key informant interviews, the resource inventory survey, and focus groups); and a set of themes and recommendations to Dutchess County based on these findings. Together, these themes and recommendations form a basis and provide direction for the next stage of comprehensive cancer control in Dutchess County. Stewart Landers, JSI Research & Training Institute, Inc., 2008.

Findings from Vermont Medication Assistance Services: A Pilot Program for Seniors Living in Unlicensed Congregate Housing (PDF, 8.38 MB)

Due to the propensity for medication-related problems among older adults and without intensive focus on medication safety and medication adherence in this population, the related morbidity and mortality can only be expected to rise. Innovative, comprehensive models are needed to address medication-related problems among seniors in congregate housing and other independent living environments. This report examines one model, the Vermont Medication Assistance Services program, which is designed to address medication safety, adherence and assistance for seniors living in unlicensed congregate housing in Vermont. To date the multi-dimensional Vermont Medication Assistance demonstration project is the first to encompass proven interventions to address medication safety and adherence for seniors living in the community. The report looks at implementation issues and how they were resolved, the selection process for pilot sites, and how those implementing the model were trained. It also includes individual feedback from pharmacists, nurses, and seniors themselves. JSI Research & Training Institute, Inc., and the American Society of Consultant Pharmacists Foundation. 2008.

Healthy Eating and Active Living Action Plan for New Hampshire (PDF, 2.58 MB)

JSI was contracted by a partnership of foundations and state agencies in New Hampshire to develop a statewide plan for promoting health eating and active living. The ultimate goal of the project is to promote personal wellness through active living and healthy eating. JSI facilitated a process lead by a statewide Steering Committee composed of representatives from schools, business, communities, and to develop recommended interventions to promote healthy eating and active living. The resulting plan serves as the framework for health improvement in NH.

Prevention and control of healthcare-associated infections in Massachusetts. Part 1: Final recommendations of the Expert Panel (PDF, 1.36 MB)

January 31, 2008|Includes Executive Summary
Expert panel convened by the Betsy Lehman Center for Patient Safety and Medical Error Reduction and JSI Research and Training Institute, Inc. in collaboration with the Massachusetts Department of Public Health

Prevention and control of healthcare-associated infections in Massachusetts. Part 2: Findings from complementary research activities (PDF, 556 KB)

Part 2, Findings from Complementary Research Activities, contains the detailed information on the statewide survey of acute care hospitals, focus groups with hospital executives, formative research with the general public, an economic analysis of HAI costs in Massachusetts and a synopsis of literature concerning best practices for educating healthcare workers on prevention of HAIs. You can also access the Part 2 Executive Summary.

Community Mental Health Treatment, Protection and Promotion for Women and Children in Aceh: Findings From an Evaluation of Programs Supported By The Health Services Program (PDF, 390 KB)

This report presents results from the successful Indonesia Health Services Program (HSP) Mental Health and Psychosocial initiative that took place following the devastating earthquake and tsunami in December 2004. In response to this disaster, HSP began work in Aceh to address the psychosocial and protection needs of women and children.

Key findings include the development of a household-to-hospital continuum of mental health care and a mental health system that has assisted with the restoration of health, human rights and human dignity. Survey findings concerning the new mental health program concluded that 90% of patients and caretakers reported improvements in mental health or social functioning. Developed by JSI Research & Training Institute, Inc. in conjunction with Columbia University Mailman School of Public Health and support from the USAID funded HSP Project. JSI Research & Training Institute, 2007.

Adult Hypertension Information Checklist (PDF, 190 KB)

This tool is intended to promote blood pressure screening for adults who visit primary care sites for any reason. The ultimate goal of this tool is to help identify disease, and improve case management and treatment. JSI worked to improve the quality of care for maternal and child health health under ZdravPlus. JSI/ZdravPlus Project, 2007.

Adult Hypertension Patient Reminder Form (PDF, 189 KB)

Cardio vascular disease and hypertension represents a growing burden of disease in Central Asia. This pamphlet is intended to support patient adherence to behaviors that improve the management and control of high blood pressure, including daily intake of prescribed medication. This tool is also a reminder for providers on evidence-based prescribing and counseling practices associated with improved quality of care for patients with hypertension. JSI worked to improve the quality of care for maternal and child health health in particular under ZdravPlus. JSI/ZdravPlus Project, 2007.

Working Together to Assure a Healthy Public - A Report to New Hampshire Residents (PDF, 9.82 MB)

The New Hampshire State Health Report provides comprehensive information on the health status of the citizens of New Hampshire. Moreover, the purpose of this report is to increase awareness of a variety of health topics in New Hampshire and serve as a tool to guide decisionmaking for policymakers, healthcare providers, public health workers, practitioners, educators, and social service agencies.

Working Together to Assure a Healthy Public is the first effort by the New Hampshire Department of Health and Human Services (DHHS) to provide New Hampshire residents a comprehensive summary of the health of the state's population. The specific aim of this report is to: (1) describe the current health of New Hampshire's population; (2) summarize potential risks to the population's future health; and (3) provide information to support collaboration among individuals, communities, the medical system and public health to assure the future health of the state's population. JSI/Community Health Institute, 2007.

New England Rural Data for Action Study: A Comparative Analysis of Health Data for the New England Region (PDF, 4.42 MB)

This study compares the differences in health status, access, outcomes, risk factors, and related socio-economic and demographic statistics across several tiers of rurality across the six New England states. Funded by the State Offices of Rural Health and several healthcare foundations, the project developed a tiered regional definition of rural that is both uniform, yet fits each state's concept of its rural nature. This definition was then used to develop descriptive and comparative statistics across a wide range of available data. JSI also incorporated results from a variety of related studies conducted in the region based on the literature. JSI prepared the document for the New England Rural Health Roundtable. Eric Turer, JSI/Community Health Institute. March 2007.

Health Services Program 2006 Annual Report (PDF, 2.73 MB)

The USAID-funded Health Services Project in Indonesia is implementing maternal, newborn and child health interventions at the district level, including the hard-hit Aceh district, and is working with health facilities, NGOs and community organizations as well as the private commercial sector. This report reviews the accomplishments of the project's first year. JSI Research & Training Institute, Inc, 2006.

Guatemala: Pro Redes Salud - Rapid Scale-up of Primary Health Care through NGOs (PDF, 743 KB)

This case study, developed as part of JSI's Best Practices in Scaling Up series, examines the process used to scale up primary health care programs in the Guatemalan highlands under JSI's Pro Redes Salud (NGO Networks) project. The case study highlights how high quality services can be extended to thousands of rural residents through NGO networks. The case study also includes steps used to scale-up as well as a review of what worked and what JSI staff learned along the way as scale-up processes were implemented. Elizabeth Burleigh, John Snow, Inc., 2006.

Making a Case for Quality: The Business Case for Tricare Health Promotions Programs: Health and Work Performance Questionnaire (HPQ): DoD Edition (LPDF, 6.39 MB)

The US military collects a large amount of data on health and injuries, but does not routinely link information about service members' health with work performance measures. The Health and Work Performance Questionnaire (HPQ) measures the relationship between health and work performance in the civilian sector; the Department of Defense contracted with JSI to adapt and pilot the HPQ for a military population. This report details the rationale for the utility of the questionnaire for the military, outlines the variations from the civilian version, and recommends processes for administration to military populations. James Maxwell, Eugenie Coakley, Emilie Pinkham, Ronald Kessler, Milly Krakow. John Snow, Inc., Boston, MA. 2006.

Cultural Diversity: Focus Group Report (PDF, 822 KB)

This final report presents findings from a qualitative study of elders from diverse communities conducted on behalf of the Boston Partnership on Elder Adults and the Eldercare Alliance. The consultant utilized community-based participatory research methods to rapidly organize focus groups with elders from different ethnic and social groups. The key questions focused on whether elders from each community would use various community- and home-based services and the factors influencing their choices. The findings were presented at a 2005 summit entitled What Does It Take to Keep an Elder at Home? in Roxbury, Massachusetts. JSI Research & Training Institute, Inc., June 2005.

Final Report: NGO Networks Project, Pro Redes Salud Project (PDF, 496 KB)

Final report of the Guatemala NGO Networks Project (Pro Redes Salud) which expanded basic care to people in the Mayan highland regions, unified the civil society and improved the MOH NGO granting program. From 2000 to 2004, the project extended high-quality services to 317,000 rural residents, and surveys showed significant improvements in health care coverage. NGOs were unified into networks, a national NGO federation had been formed, and innovations had been adopted by the MOH for improvements in the national MOH NGO program. JSI/Pro Redes Salud, 2004.

The CAPA Handbook: A 'How-To' Guide for Implementing Catchment Area Planning and Action, a Community-Based Child Survival Approach (PDF, 1.06 MB)

This manual provides step-by-step guidelines for implementing the CAPA approach and was developed for use by State Ministries of Health, program managers, technical staff, and donor agencies involved in community-oriented approaches for child survival activities. Basic Support for Institutionalizing Child Survival/Nigeria (BASICS II/N), in collaboration with Nigeria's federal and state governments, conceptualized and designed a community-based approach called Catchment Area Planning and Action (CAPA) to empower community members to take an active role in improving the health of their children, specifically around immunization, nutrition, and malaria. CAPA's approach places the locus of health program development at the community level with the intent of creating community ownership, promoting public and private sector partnerships, and stimulating demand. The approach is flexible enough for adoption by other development ministries and partners in Nigeria or by other developing countries, and its adaptation and its use in other sectors and contexts are encouraged. John Snow, Inc./BASICS II. 2004.

Rapid Assessment of Referral Care Systems: A Guide for Program Managers (PDF, 3.23 MB)

This tool is designed to help national and district-level managers quickly assess the status of and constraints to referring severely ill children from the first-level of care to secondary and tertiary levels of care. The assessment uses a cross-sectional study design that includes a review of medical records, interviews with caretakers of children less than five years of age, interviews with health providers, and focus group discussions with caretakers. Prevalence estimates describe referral care patterns of caretakers and providers, referral and counter-referral relationships, frequency of self-referral to higher levels of care, caretaker barriers to compliance with referral, and provider barriers to compliance with referral guidelines. Assessment results are for use by Ministries of Health and other partners to design national- and district-level interventions to improve the successful referral of severely ill children. John Snow, Inc./BASICS II. 2003.

A Guide to Monitoring and Evaluation of Capacity-Building Interventions in the Health Sector in Developing Countries (PDF, 774 KB)

This guide was developed to assist health planners and evaluators to gain a clear understanding of the concepts of capacity and capacity building. It looks at ways to critically evaluate the strengths and limitations of current approaches to capacity measurement, as well as design a capacity-building monitoring and evaluation plan that outlines a systematic approach to measuring capacity and assessing the results of capacity-building interventions in the health sector. Anne LaFond and Lisanne Brown, MEASURE Evaluation Project/JSI Research & Training Institute, Inc., 2003.

Improving Health Care Delivery Systems in Eritrea: Technical Assistance and Support (TASC) Final Report (PDF, 1.68 MB)

This document provides a final report on TASC?s efforts to improve health care and practices during its period of operation in Eritrea. TASC/Eritrea was responsible for the implementation of three technical components: maternal health, child health and nutrition, and employed strategies related to three cross-cutting components: human resources development, logistic management systems improvement, and information, education and communication (IEC).

Training of Traditional Healers Facilitator's Guide, Zambia Integrated Health Programme (ZIHP) (PDF, 1.45 MB)

The Traditional Healers' Facilitator's Guide was developed in conjunction with the Zambian Central Board of Health for use in training traditional healers in disease management and referral systems. It was designed to improve traditional healers' programs and existing methods of practice and motivation in communities. 2003.

Mapping Capacity in the Health Sector: A Conceptual Framework (PDF, 184 KB)

Building capacity has become central to strategies used to develop health systems in developing countries. However, despite the growing interest in capacity improvement, there has been little consensus among practitioners and academics on definitions of capacity building and how to evaluate it. This paper reviews current knowledge and experiences from ongoing efforts to define, monitor and evaluate capacity building interventions in the health sector in developing countries. It presents a conceptual framework for mapping capacity and measuring the effects of capacity building intervention. International Journal of Health Planning Management, 17(1):3-22. Anne K. LaFond, Lyndon Brown, K. Macintyre. 2002.

Access to Health Care for Transgendered Persons in Greater Boston (PDF, 188 KB)

Access to health care services for the transgendered persons has not been studied in detail. This study reports on four focus groups, at which over forty transgendered individuals discussed their experiences and interactions with the health care system.

This study identifies the health needs and barriers to obtaining services, support and/or resources for transgender and transsexual (TG/TS) individuals. It also assessed the extent to which health care providers and systems are able to offer sensitive, high quality services that meet TG/TS consumers' needs; and identified ways that health care services can be enhanced to better meet the needs of the target population.

Advocates for the transgender community have used this report, along with other transgender health needs assessments, to support efforts to increase coverage of services to transgender persons that are reimbursed by both government and private health insurers. The findings were presented in 2000 at the first session on transgender health care ever to be held at an annual meeting of the American Public Health Association.

Gary Fallas, Stewart Landers, Susan Lawrence, and Jodi Sperber. LGBT Health Access Project/JSI Research & Training Institute, 2000