Program Approval Form For approval of new programs and deletions or modifications to an existing program. Action Requested: x Type (Check one): Create New (SCHEV approval required except for minors) Inactivate Existing Modify Existing (check all that apply) Title (SCHEV approval required except for minors) Add Delete Concentration (Choose one): Degree Requirements Admission Standards/ Application Requirements Other Changes: College/School: Submitted by: Health and Human Services PJ Maddox Effective Term: Fall 2015 x Modify Department: 3-1982 Ext: B.A. B.S. M.A. M.S. Ph.D. Undergraduate Certificate* Graduate Certificate* Other: Minor M.Ed. Health Administration and Policy [email protected] Email: Please note: For students to be admitted to a new degree, minor, certificate or concentration, the program must be fully approved, entered into Banner, and published in the University Catalog. Justification: (attach separate document if necessary) See attached Existing New/Modified Health Services Research Program Title: (Required) Title must identify subject matter. Do not include name of college/school/dept. Health Systems and Policy Knowledge Discovery and Health Informaticcs Concentration(s): Admissions Standards / Application Requirements: (Required only if different from those listed in the University Catalog) See attached Degree Requirements: Consult University Catalog for models, attach separate document if necessary using track changes for modifications Courses offered via distance: (if applicable) 72 TOTAL CREDITS REQUIRED: *For Certificates Only: Indicate whether students are able to pursue on a Full-time basis Part-time basis Approval Signatures Department Date College/School Date Provost’s Office Date Interdisciplinary Council Use Only If this program may impact another unit or is in collaboration with another unit at Mason, the originating department must circulate this proposal for review by those units and obtain the necessary signatures prior to submission. Failure to do so will delay action on this proposal. Unit Name Unit Approval Name Unit Approver’s Signature Date For Graduate Programs Only Graduate Council Member Provost Office Graduate Council Approval Date For Registrar Office’s Use Only: Received_____________Banner_________________________Catalog_________________________ revised 6/7/12 STATE COUNCIL OF HIGHER EDUCATION FOR VIRGINIA 12.4.13 Program Proposal Cover Sheet 1. Institution George Mason University 2. Program action (Check one): New program proposal __x_ Spin-off proposal _____ Certificate proposal _____ 3. Title of proposed program Health Services Research 5. Degree designation PhD 4. CIP code 51.2211 6. Term and year of initiation Fall 2015 7a. For a proposed spin-off, title and degree designation of existing degree program 7b. CIP code (existing program) 8. Term and year of first graduates 9. Date approved by Board of Visitors Spring 2019 10. For community colleges: date approved by local board date approved by State Board for Community Colleges 11. If collaborative or joint program, identify collaborating institution(s) and attach letter(s) of intent/support from corresponding chief academic officers(s) 12. Location of program within institution (complete for every level, as appropriate). Departments(s) or division of: Dept. of Health Administration and Policy School(s) or college(s) of: College of Health and Human Services Campus(es) or off-campus site(s): Fairfax and Arlington Campuses Distance Delivery (web-based, satellite, etc.) Traditional classroom based program 13. Name, title, telephone number, and e-mail address of person(s) other than the institution’s chief academic officer who may be contacted by or may be expected to contact Council staff regarding this program proposal. Dr. P.J. Maddox, Professor and Chair, Dept. of Health Administration and Policy 703-993-1982; [email protected] SCHEV Liaison: Dr. Robin Parker, Director of Compliance, Provost Office, 703-993-6220, [email protected] TABLE OF CONTENTS DESCRIPTION OF THE PROPOSED PROGRAM ............................................................................................... 1 PROGRAM OVERVIEW (BACKGROUND) .....................................................................................................................1 MISSION ....................................................................................................................................................................4 ACCREDITATION ........................................................................................................................................................6 ADVISORY BOARD .....................................................................................................................................................6 ADMISSIONS CRITERIA ..............................................................................................................................................7 TARGET POPULATION ................................................................................................................................................8 CURRICULUM ............................................................................................................................................................ 8 STUDENT RETENTION AND CONTINUATION PLAN ................................................................................................... 12 FACULTY ................................................................................................................................................................. 13 STUDENT ASSESSMENT............................................................................................................................................ 13 PROGRAM ASSESSMENT .......................................................................................................................................... 14 BENCHMARKS OF SUCCESS ...................................................................................................................................... 15 SPIN-OFF ................................................................................................................................................................. 16 EXPANSION OF EXISTING PROGRAMS ...................................................................................................................... 16 COLLABORATION OR STANDALONE ......................................................................................................................... 16 RESPONSE TO CURRENT NEEDS ............................................................................................................................... 16 EMPLOYMENT DEMAND .......................................................................................................................................... 20 STUDENT DEMAND .................................................................................................................................................. 24 DUPLICATION .......................................................................................................................................................... 25 PROJECTED RESOURCE NEEDS ........................................................................................................................ 28 APPENDICES............................................................................................................................................................ 36 i Description of the Proposed Program Program Overview (Background) The purpose of the PhD program in Health Services Research (HSR) is to prepare graduates to be scholars, educators, researchers, and leaders in higher education, health care and service organizations, health care consulting firms, government and nonprofit organizations, and private businesses that support or regulate the health service industry. Health care systems in the US and other nations are under extreme pressure. Costs are rising, quality and outcomes are not optimal, many vulnerable groups have inadequate access, and programs and technologies are often poorly implemented. There is a need for doctoral degree prepared researchers, executives and policy analysts who will research and assist with problem-solving myriad endemic problems in the US health system and provide leadership and analytic support to state and federal policy making entities working on health reform. Graduates from the program will be prepared to work as practitioner-scholars, educators, researchers, and leaders in higher education, health care and service organizations, health care consulting firms, government and nonprofit organizations, and private businesses that support the health service industry. Students will acquire the knowledge and skills to creatively address health systems and population health management challenges as well as state and national health policy issues (especially challenges related improving healthcare cost, quality and access). The PhD in Health Services Research is a 72 credit academic program with two concentrations: 1) Health Systems and Policy and 2) Knowledge Discovery and Health Informatics. To satisfy the requirements of the PhD degree, at least 42 credits must come from doctoral curriculum courses, and up to 30 credits may come from approved master’s level course work from George Mason or other graduate degree programs, as determined at the time of admission. The program of study for the PhD degree consists of core and elective courses in three curriculum domains and dissertation sequence courses. All students, regardless of concentration take core courses in each domain (Research and Computational Methods; Knowledge Discovery and Health Informatics and Health Systems and Policy) as well as dissertation research courses. The program provides a multidisciplinary examination of the social, political, and economic forces that affect the organization, financing, delivery and regulation of health care services. The program curriculum prepares graduates with the following competencies: Ability to understand, analyze, design, execute, and evaluate research and practice in the health systems, public health and health sciences, with particular in-depth understanding in an area of specialization or focus; Ability to understand, analyze, and evaluate a wide range of data from a variety of sources related to individuals, populations, health systems and insurance entities, health care providers, regulatory entities and government systems; 1 Ability to understand, analyze and evaluate the economic impact of health care delivery under a variety of financing arrangements and economic conditions; Selectively utilize a variety of research designs and methods to research problems, programs and outcomes in health systems and public health policy; Ability to translate and synthesize research knowledge with socio-economic, political and management trends as they impact and/or have implications for health policy, improving the performance of health systems and health service providers, optimizing population health and improving access and outcomes; Ability to continually examine current and future changes in health systems from an interdisciplinary and socio-cultural perspective; Demonstrated knowledge and understanding of socio-economic and cultural diversity as they relate to health disparities and challenges in improving population health. The proposed PhD program in Health Services Research is a specialized research degree that serves a number of disciplines, fields of application and inquiry as practiced in health care service organizations, state and federal policy making entities, think tanks and consulting entities and academic teaching and research entities. The history and development of health services research is chronicled by two federal agencies that support this relatively new field: The Agency for Health Care Research and Quality and the National Library of Medicine. The NLM has historical compilations that explain the evolution and status of health services research and its contributions to improving the nation’s health. According to the Agency for Healthcare Research and Quality, ‘Health services research examines how people get access to health care, how much care costs, and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety.” The National Library of Medicine portal for Health Services Research & Public Health Information Programs, as well as its link to information on health services research (called HSR Information Central) features compilations and publications from many different types of health services research. As the preeminent professional association for health services researchers, AcademyHealth, utilizes the following definition of health services research: “The multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations.” A relatively new field of scholarly practice and inquiry, some 41 doctoral programs are found in the US and Canada.1 1 Based on Directory of programs in Academy Health. See http://www.academyhealth.org/directory/trainresults.cfm Accessed on September 13, 2012. 2 As the field of Health Services Research was gaining the attention of public officials (in 1998), GMU’s, Dr. Jack Hadley testified before Congress about the importance and promise of the field: “By evaluating the effectiveness of health care and the ability of the health care system to deliver these services efficiently, health services research aids in the transfer of science from the laboratory into practical use by physicians and hospitals—essentially speeding the integration of biomedical research into patient care and disease prevention. Health services research also plays a critical role in educating consumers and purchasers about the care they receive, serving as a resource not just for disease treatment and prevention information, but also providing information, such as quality data for health plans, that enables consumers to better choose their health care. Furthermore, by examining the impact of the delivery and financing of health care on access and quality, health services research provides the evidence needed by policymakers to better determine health care priorities, particularly among vulnerable populations and within the Federal health Medicare and Medicaid programs.”2 Today, as the US is struggling with difficult resource allocation decisions and attempts to reorganize the health care delivery system under health reform, health services research is more more important and needed. The goal of the proposed PhD program in Health Services Research is to prepare health professionals who can lead the design and analysis of public health policy and conduct health services research that contributes evidence for practical applications in health policy formulation, health systems organization and management, public health and population health science and health information management. Graduates are needed for a wide variety of roles in academic research and teaching entities as well as public and private health care organizations, policy advocacy and analysis entities, health science and technology research enterprises and businesses, consulting entities and “think tanks”. The expectation is that graduates may work for federal and state public-health policy organizations, health-related nongovernmental organizations, health care service organizations, consulting firms and biotechnology research-and-development enterprises. Graduates may also be employed in traditional academic positions in higher education. This program has been designed to provide the foundation and skills necessary to produce the next generation of researchers who can engage in research and program evaluation to inform complex problems with data and thoughtful analysis and advance evidence based management in public and private health systems. Current efforts by the US to enact Health Reform underscore the importance and timeliness of this degree. 2 Congressional testimony, Statement of the Association for Health Services Research to the Subcommittee on Labor, Health and Human Services, Education and Related Agencies, Committee on Appropriations, United States House of Representatives, Presented by Jack Hadley, PhD, Professor of Health Services Research, GMU, February 5th 1998. 3 Mission The PhD Program in Health Services Research will enhance GMU’s mission by increasing the number of doctoral programs, research intensity, and university-wide interdisciplinary research and collaboration. It is consistent with and makes contributions to the achievement of the GMU Mission3 and selected strategic goals (bolded and underlined): Educate the new generation of leaders for the 21st century—men and women capable of shaping a global community with vision, justice, and clarity. Provide innovative and interdisciplinary undergraduate, graduate, and professional courses of study that enable students to exercise analytical and imaginative thinking and make well-founded ethical decisions. Nurture and support a highly qualified and entrepreneurial faculty that is excellent at teaching, active in pure and applied research, capable of providing a broad range of intellectual and cultural insights, and is responsive to the needs of students and their communities. Maintain an international reputation for superior education and public service that affirms its role as the intellectual and cultural nexus among Northern Virginia, the nation, and the world.” GMU Strategic Goals for 2014:4 Goal 1: Raise our profile as a nationally ranked research university. Strategy: Increase the number of, and funding for, full-time doctoral students in selected program areas that show promise of enhancing Mason’s profile as a nationally recognized research university. Goal 4: Respond to the region’s changing demands for continuing and professional lifelong learning thereby contributing to its ongoing intellectual, economic, and community development. Strategy: Recommit to working with state, regional and local economic development agencies to provide both broad and targeted academic programs, training and interaction consistent with mutual development strategies. Through education, service and research, the HSR PhD program will make contributions to the local community and employers by preparing a new generation of scholar practitioners. The work of GMU HSR faculty and students is expected to contribute scholarly evidence to inform state and national dialogue and decisions about addressing endemic problems in health systems and public health policy. It will add to the portfolio of academic programs housed in the Department of Health Administration (undergraduate and graduate programs in Health 3 http://www.gmu.edu/resources/visitors/vision/mission.html 4 http://provost.gmu.edu/wp-content/uploads/2012/01/FINAL_Strategic_Goals_for_2014-1.pdf 4 Administration, Health and Medical Policy and applied Health Informatics) providing an important terminal degree for the practice of these disciplines. Additionally, implementation of the PhD program completes one of the most important goals of the Provost’s Health Commission Report (PHCR) and subsequent CHHS Strategic Plan5. Consistent with the PHCR, the GMU Board of Visitors initially approved an earlier proposal for the PhD in Health Services Research in the [then] College of Nursing and Health Science [now College of Health and Human Services, in the Department of Health Administration and Policy]. This proposal is submitted for GMU reaffirmation, SCHEV review and approval for implementation in 2015-2016. College of Health and Human Services at George Mason University The Department of Health Administration and Policy was established 7 years ago as part of the College of Nursing and Health Sciences (CNHS) at George Mason University (GMU). In 2006, the mission of the CNHS expanded and the College was renamed the College of Health and Human Services (CHHS). The CHHS is comprised of the Department of Health Administration and Policy, the Department of Global and Community Health, the School of Nursing, the Department of Social Work, the Department of Nutrition and Food Studies and the Department of Rehabilitation Science. The growth and development of the CHHS in support of the mission of George Mason University has been guided by a strategic plan that was developed in response to the Provost Health Commission Report.6 As such, the activities of the HAP department and College support growth in the enrollment of academic programs (health workforce education), as well as professional and community service and research. These are important contributions to the CHHS mission and support the University’s expectations of enrollment growth in CHHS. In addition to academic schools and programs, the CHHS houses collaborative research centers such as The Center for Health Policy Research and Ethics (CHPRE) (http://chpre.gmu.edu). CHPRE conducts widely respected health policy and health services research, and communicates the latest in research knowledge to health care policy and decision makers. CHPRE is also home to the internationally renowned annual Washington Health Policy Institute (http://hpi.gmu.edu). The Washington Health Policy Institute (WHPI) explores all facets of the health policymaking process and provides participants with the knowledge needed to make a difference in the U.S. health system. Another unique opportunity for students in this program is access to resources of the Center for Discovery Science and Health Informatics (DSHI). The center’s mission is to research computational methods that are utilized in health services and biomedical research (http://dshi.gmu.edu/). Specifically, it conducts basic and applied research on developing computational theories, analytic methods, and software applications that support decision making, analysis and discovery of knowledge from healthcare data and applies findings to realworld problems (especially public health systems, policy problems and impacts). The center also houses secure servers that allow for storing and analyzing very large data, as well as provides computational services to the faculty and students. Housed within DSHI is the Machine Learning and Inference Laboratory (MLI) Laboratory (http://www.mli.gmu.edu/). The MLI conducts fundamental and experimental research on the development of intelligent systems capable of advanced forms of learning, inference, and knowledge generation, and applies them to real-world 5 http://chhs.gmu.edu/about/governance/090205HealthCommissionReport.pdf 6 IBID 5 problems. The focus of the MLI is on developing new intelligent analytic methods for health services research. The Center for Study of Chronic Illness and Disability (CCID) also resides within CHHS http://chhs.gmu.edu/ccid/. It seeks to improve the lives of those with disability. The mission of CCID is to perform state of the art, quality health services research to study factors that lead to disability, its prevention, or amelioration (practice and policy); and to train leaders in rehabilitation science. A logical and strategic extension of HAPs mission, the proposed PhD program is aimed at training the next and subsequent generations of practitioner scholars and researchers in public health, health systems and health policy. In addition, this degree will substantively contribute to helping the CHHS meet criteria for designation as a future School of Public Health. Additionally, it supports the University’s priority to expand its research standing and funded portfolio of research, as well as provide workforce development for scholar practitioners and future academic teaching and research faculty. Likewise, the HSR PhD will contribute to George Mason University, HAP, CHPRE and DSHI’s competitive recruitment of faculty and students and ultimately improve GMU’s research productivity. At present, HAP, CHPRE and DSHI faculty are actively engaged in research and have been competitive in obtaining more than $15 million in research grants and contracts since 2008. These funds have come from a wide variety of sources including the U.S. Department of Health and Human Services, National Science Foundation, the Robert Wood Johnson Foundation, National Institutes of Health, Veterans Administration, Virginia Department of Health, Fairfax Department of Health, Inova Health System, Blue Cross/Blue Shield and others. Accreditation There is no accreditation entity for doctoral programs in Health Services Research. Advisory Board The HAP Department has an Advisory Committee comprised of experts and prospective employers from the local community. The committee meets twice per year (fall and spring) to provide input to the department’s leadership and faculty on matters related to workforce development and preparation for employment to inform curriculum and matriculation decisions. HAP Advisory Board members are listed in the table that follows: 6 HAP Advisory Committee 2010-2012 Name Mark Stauder (Chair) Cynda Tipple Adrian Stanton Melissa Robson Organization Inova Health System Capitol Hospice N. Virginia Hospital Center Novant Health Sreedhar Potarazu, MD Title COO CEO VP Senior VP, Novant Health Northern VA Market & President, Prince William Medical Center Medical Director CEO VP Medical Practice Management VP Government Relations Principal (former Sec. Health and Human Resources, Commonwealth of VA) President and Founder David Roberts Michael Cousins Danny R. Hughes Dir. Government Affairs VP Clinical Analytics Senior Research Fellow HIMSS Evolent Health Neiman Center for Research, Amer. College of Radiology William Fried, MD Megan Perry Steve Clark Sharon Brigner Jane Woods AETNA Sentara Ann Arundel Medical Center Phrma Driftwood Consulting Vital Springs Technologies and Wellzone Admissions Criteria Candidates must have an earned Master’s degree from an accredited program in a field relevant to Health Services Research. Applicants will be admitted competitively based upon: 1. Evaluation of all academic program transcripts; 2. Masters degree in an academic or professional field with a grade point average of “B” or higher; 3. Evaluation of a 750-1,000 word written statement of academic goals (describes the applicant’s research area of interest for advanced study in health services research and goals post graduation); 4. Appropriate Graduate Record Examination (GRE) or equivalent GMAT scores (testing date within the past five years); 5. International students are required to also submit a TOEFL score as required by George Mason University. 6. Curriculum vitae, including an up-to-date employment history, list of publications, awards, grants submitted and grants received to date by the applicant; 7. Three letters of recommendation. 7 All students admitted with a prior graduate-level degree may apply up to 30 credits from that degree toward the PhD requirements. Graduate courses in statistics, health systems and public health, health policy and health informatics are recommended as preparation for the curriculum in PhD in Health Services Research program. The admissions committee will make a case-bycase (credit by credit) determination of acceptable credits that may be applied to satisfy the PhD requirements (because of the diverse backgrounds of applicants). Coursework approved must have been completed within five years prior to first enrollment in the PhD program. The last 42 credit hours for the PhD must be earned at George Mason University. Applications to this program will be made through the Department of Health Administration and Policy. Target Population The population of prospective students are individuals with a Masters degree in Health Systems, Health Administration, Health Informatics, or Health Policy; mid-career health professionals; consultants and analysts in think tanks, consulting firms, or policy advocacy organizations; state and federal offices that do policy analysis, program evaluation and health services research; and individuals with background in finance, economics and public policy who wish to pursue a focus in health services research, management and evaluation of health systems and advanced health analytics. Curriculum The PhD in Health Services Research is a 72 credit academic program with two subspecialized programs of study, called concentrations: 1) Health Systems and Policy, and 2) Knowledge Discovery and Health Informatics. To satisfy the requirements of the PhD degree, at least 42 credits must come from doctoral curriculum courses, and up to 30 credits may come from approved masters degree course work from George Mason or other graduate degree programs, as determined at the time of admission (case by case decisions are utilized given consideration of diversity of each applicant’s prior degrees and coursework). The program of study for the PhD degree consists of core and elective courses in three curriculum domains and dissertation sequence courses. All students, regardless of concentration take core courses in each domain. Elective courses are taken as required by the concentration: Research and Computational Methods Domain: 18 credits (9 Core course credits and 9 elective course credits (all students); Knowledge Discovery and Health Informatics Domain: 12 credits from core courses (all students) and 18 credits from elective courses (students in the concentration); Health Systems and Policy Domain: 12 credits from core courses (all students) and 18 credits from elective courses (students in the concentration); Dissertation Sequence Courses: 12 credits (all students). 8 GMU HSR PhD Program Requirements Curriculum Domains Concentration in Knowledge Discovery and Health Informatics Concentration in Health Systems and Policy Research and Computational Methods 9 core + 9 electives 9 core + 9 electives Knowledge Discovery and Health Informatics 12 core + 18 electives 12 core Health Systems and Policy 12 core 12 core + 18 electives Dissertation Sequence Courses Total Credit Hours 12 (minimum) 72 12 (minimum) 72 Research and Computational Methods Domain Core Courses in Research and Computational Methods (9 credits) PhD students (regardless of concentration) must take the following three courses: 1. HAP 710 Inferential Statistics in Health Services Research and Management 2. GCH 804 Advanced Quantitative Analysis for Healthcare Research I 3. GCH 805 Advanced Quantitative Data Analysis for Healthcare Research II Elective courses in Research and Computational Methods (6 credits) With approval of the advisor, PhD students (regardless of concentration) take three of the following courses: 1. HAP 720 Data Integration 2. HAP 730 Decision Analysis in Healthcare 3. HAP 755 Analysis of Causality in Health Services Research 4. HAP 765 Methods for Health Policy Analysis 5. HAP 821 Analysis of Categorical Data in Health Policy and Administration 6. HAP 868 Advanced Research Seminar in Health Policy Analysis 7. GCH 772 Social Epidemiology 8. GCH 712 Introduction to Epidemiology 9. GCH 722 Infectious Disease Epidemiology 10. GCH 726 Advanced Methods in Epidemiology 11. GCH 732 Chronic Disease Epidemiology 12. GCH 806 Advanced Multivariate Statistics and Data Analysis in Healthcare Research 13. GCH 807 Measurement Theories and Applications in Healthcare Research 14. RHBS 720 Principles of Clinical Trials 15. STAT 560 Biostatistical Methods 16. STAT 668 Survival analysis 17. STAT 773 Statistical Methods for Longitudinal Data Analysis 18. Other courses (700 and above) supporting the student’s subject matter or research, as approved by the advisor. 9 Knowledge Discovery and Health Informatics Domain Knowledge Discovery and Health Informatics Core Courses (12 credits) PhD students (regardless of concentration) must take four Knowledge Discovery and Health Informatics Core Courses: 1. HAP 701 Health Data: Vocabulary and Standards 2. HAP 709 Healthcare Databases 3. HAP 780 Data Mining in Health Care 4. HAP 820 Analytic Models in Health Services Management, Policy and Research Elective courses in Knowledge Discovery and Health Informatics Concentration (18 credits) With the approval of the advisor, students in the Knowledge Discovery and Health Informatics Concentration must take at least six courses from the following: 1. HAP 700 Introduction to Health Informatics 2. HAP 720 Health Data Integration 3. HAP 745 Health Care Security Policy 4. HAP 752 Advanced Health Information Systems 5. HAP 868 Advanced Research Seminar in Health Policy Analysis 6. Others course (700 and above) supporting the student’s subject matter or research, as approved by the advisor. Health Systems and Policy Domain Courses Health Systems and Policy Core Courses (12 credits) PhD students (regardless of concentration) must take the following four courses: 1. HAP 642 Health Policy Development and Analysis 2. HAP 652 Essentials of Health Insurance and Managed Care 3. HAP 762 Cost-Benefit Analysis in Healthcare Management and Policy 4. HAP 764 Health Policy and Government Payment Systems 5. Health Systems and Policy elective courses (18 credits) With the approval of the advisor, students in the Health Services and Policy Concentration must take at least six courses from the following: 1. HAP 609 Comparative International Health Systems 2. HAP 661 Policy Development and Analysis for Community Health Programs 3. HAP 662 Health Policy for Elders and People with Disabilities 4. HAP 735 Fundamentals in Patient Safety and Risk Management 5. HAP 745 Health Care Security Policy 6. HAP 746 Health Policy Leadership 7. HAP 766 Policy Implementation and Health System Management Dilemmas 8. HAP 866 Politics Influencing Health Care Policy 9. HAP 868: Advanced Research Seminar in Health Policy Analysis 10. PUBP 700 Theory and Practice in Public Policy 11. PUBP 730 US National Policy Systems and Theory 12. RHBS 808 Outcomes Measurement 13. RHBS 816 Comparative Effectiveness Research 14. Other course (700 and above) supporting the student’s subject matter or research, as approved by the advisor. 10 Dissertation Course 1. HAP 999 Doctoral Dissertation (minimum of 12 credits) Core Course descriptions are provided in Appendix A. A model matriculation plan for program completion for full-time and part-time students is provided in Appendix B. Health Services Research PhD Competencies and Learning Objectives The learning objectives for the program in Health Services Research will be met through required and elective coursework, independent research, and the process of writing a dissertation in a specified area of specialization/emphasis. The HSR PhD learning objectives and competencies are as follows: Demonstrate knowledge of the organization and financing of healthcare services and their public health impact: Describe and critique the current financing and organization of healthcare services in the US and understand ongoing trends; Analyze and critique the theoretical and conceptual models relevant to healthcareseeking, access, use, quality, cost, health, health policy and healthcare decision-making; Describe the US system for health-care organization and finance in contrast to those in other major developed nations. Demonstrate knowledge of the issues, research literature, conceptual frameworks and research tools in program domains in Research and Computational Methods, Knowledge Discovery and Health Informatics and Health Systems and Policy: Develop a high level content expertise in one or more sub-areas within a broader field of health services delivery, finance, and organization concordant with the student’s area of concentration and specialization/emphasis, the focus of their dissertation and their interests. Demonstrate knowledge of the development and implementation of health policy: Identify and discuss the major public health problems in the US and provide examples of how health and health care policies have effectively reduced these health problems; Identify conceptual models linking the social, economic, and political context to population health and health care policy formation; Describe the process of constructing policy alternatives and selection of policy from among different options; Identify the role that various government agencies and bodies play in the formation and implementation of policy, and the role of law and regulation. 11 Design and conduct research from the initial conception of an idea to study design, data collection, selection and application of appropriate analytic methods, interpretation of results, publication of findings and translation into programs and policies: Pose innovative and unique research questions, informed by structured reviews of the literature and relevant theoretical and conceptual models; formulate testable hypotheses to address these questions; Develop appropriate experimental, quasi-experimental, and observational study designs relative to the requirement of given health services and policy research and evaluation contexts; Develop and implement research protocols that ensure adherence to ethical standards; prepare an application for IRB approval; Obtain appropriate data sources that can be used to validly measure and operationalize the study constructs necessary for testing specific hypotheses; Analyze data using appropriate advanced epidemiological, statistical, economic, or qualitative research techniques. Communicate scientific findings through written and oral methods to technical and lay audiences: Communicate research findings in oral and written form; place research findings in the context of current knowledge; identify limitations and further areas for research; discuss policy implications and the public health significance of findings; Write manuscripts of publishable quality for the peer reviewed literature that describe and explain research findings; Teach introductory materials in the students’ general area of expertise Cultivate a community of scholars who are collegial and respectful, and who uphold standards of professional integrity in interactions with each other and the community at large Graduates of the PhD Program in Health Services Research will be prepared for employment as researchers and senior program leaders in: Colleges and universities, federal and state governmental agencies, public health organizations, health care provider organizations, research, consulting and think tank organizations, health service regulatory entities, health insurance organizations and health policy advocacy organizations. Student Retention and Continuation Plan Consistent w/ current HAP Department practices, all graduate students (FT and PT) have a fulltime faculty advisor who is assigned at the time of admission. The student meets with the academic adviser at least yearly to plan their program of study, receive career development advice and receive guidance on matters related to succeeding in graduate school and the capstone practicum. All graduate students have a written matriculation plan that is updated by the student 12 and adviser annually. Additionally, the Director of the PhD program is responsible to oversee the matriculation and progress of each student admitted to the program. The PhD Director will meet with PhD students and advisers to facilitate program planning and assist with problem-solving issues as they arise. Additionally, meetings with all PhD students are planned several times a year to discuss program plans, advice for doctoral program success, research mentorship and career development. Currently HAP sponsors an AcademyHealth Student Chapter (received top chapter award for US in June 2013), focused on careers in health services research. Additionally, the Department has plans for developing a HAP PhD student organization. Finally, student matriculation progress and program completion rates, along with comprehensive exam performance are metrics used by the HAP Program Evaluation Committee as part of the annual program review. Gaps in student progress and comprehensive exam results are reported as part of this effort. Faculty The Department of Health Administration and Policy is comprised of trans-disciplinary teachers/scholars and scholar/practitioners who teach and do research in their areas of expertise, consistent with their academic preparation and work experience. Faculty who will be supporting the doctoral program are responsible for teaching, curriculum and student program and career advising, as well as mentoring students in research and supervising student research development and conduct. Detailed, full academic CVs are available for on-site review. The web link for HAP PhD faculty biosketches is: http://chhs.gmu.edu/faculty-and-staff/faculty.html A summary of the faculty’s qualifications may be found in the Faculty Biosketches summary in Appendix C. Student Assessment Student progress is assessed through an evaluation of course performance, the comprehensive exam, and finally through successful completion of the dissertation and publications. Assessment of Student Learning In order to assure that students are achieving the program learning objectives and competencies, we will assess student learning in several ways including systematic evaluation of all courses, tracking students’ academic progress, reviewing faculty evaluations each semester, conducting interviews at the time of advancement to candidacy, conducting exit interviews (at time of completion of studies) and tracking alumni for at least two years post-graduation. This will allow us to collect valuable information on how our program met their expectations and supported their professional development. The Department of Health Administration and Policy has already established a policy of tracking students’ academic progress and courses are currently evaluated at the end of each semester. Additionally, HAP currently conducts such student and alumni assessments to fulfill a variety of external accreditation requirements for its programs in health administration and health informatics (CAHME, AUPHA, CAHIIM). Student and faculty performance are assessed at the end of every academic year. 13 Comprehensive Exam Requirements Two comprehensive examinations (written and oral) will determine whether the student has the necessary knowledge and skills to undertake dissertation work. The comprehensive exams must be taken within one year of completion of all core courses (except for dissertation sequence courses). Students shall indicate, by the end of the previous regular semester, their intent to take the exam. Students must have organized a dissertation committee with a chair approved by the HAP HSR PhD Program Director. The dissertation committee will develop and evaluate the individual comprehensive exam on a pass/no-pass basis. Students must pass both comprehensive exams to enter PhD candidacy. Students who fail to pass the written and oral comprehensive exam may attempt each exam again the following semester. No more than one additional written and oral comprehensive exam will be permitted. Written Comprehensive Exam Members of the dissertation committee will utilize a written comprehensive examination to assess the student’s ability to apply theoretical concepts of research design and methods (including study design, data acquisition or collection, data management, analysis and interpretation) to relevant research questions in the student’s concentration and area of research. Oral Comprehensive Exam Members of the dissertation committee will utilize an oral comprehensive examination to assess the student’s knowledge of theory and application pertaining to the content of the ‘field’ and relevant subject matter, based upon the student’s concentration and areas of research. Program Assessment Faculty of the Department of Health Administration and Policy under the purview of the HAP Program Evaluation Committee will evaluate the HSR PhD program. Consistent with other HAP academic programs, the annual review and assessment metrics include individual student, faculty and program outcome measures (normative and summative). Student’s academic progress is reviewed every semester, as are student evaluations of faculty teaching and courses. Course evaluation data is reviewed by peers and Department Administrators in various program evaluation activities and with individual faculty in their annual performance reviews; program alumni are surveyed annually post graduation. Results from student, faculty and alumni evaluations are utilized by the HAP Program Evaluation Committee as part of its comprehensive and longitudinal plan that evaluates program outcomes at individual and aggregate student, faculty and alumni levels to inform curriculum and program evaluation. Findings and recommendations are utilized by the Department to improve programs and program competency achievement on a recurring basis. 14 The proposed program will be reviewed on the seven-year cycle typical of programs within the university. The Academic Program review takes place under the guidance of the Office of Institutional Assessment and requires four semesters to complete. The outcomes of the process are a series of deliverables—a self-assessment report and academic plan written by program faculty and a report by a review team external to the program, as well as changes made to enhance the program. Finally, consistent with GMU policy, the Board of Visitors will conduct an initial review of the program in five years from date of implementation (Fall 2019). Benchmarks of Success Specific benchmarks for success will be based upon the program’s ability to attract high-quality applicants, meet its student enrollment projections, timely graduation of qualified students, and success in student employment or placement in post-doctoral opportunities (including fellowships and job placements) post graduation. The following benchmarks of success will be utilized: 75% of full-time students will complete the program in five years or less 80% of graduates of the program will report satisfaction with the program during their exit interviews 75% of students will either have published a paper in a peer-reviewed journal or presented an abstract at a national meeting before graduation from the program 75% of graduated students will have earned jobs or post doctoral fellowships within the field, assessed two years after completion of the program. Data on enrollment, student and alumni satisfaction and employment post graduation benchmarks is collected and reviewed annually by the HAP Program Evaluation Committee. The third benchmark (student/alumni publication) is tracked by the student’s advisor and through alumni surveys. If these benchmarks of success are not met, the Department of Health Administration and Policy’s program evaluation committee will make an assessment of the benchmark gap and recommend a plan for improvement/correction. If curriculum changes are needed, the departmental curriculum committee will work with the program evaluation committee to review and revise the curriculum to better meet the needed benchmarks. Further, regarding enrollment issues, the department will work with the College of Health and Human Services marketing team and the Office of Student Affairs to assist with marketing the program. 15 Spin-Off This is not a Spin-off program. Expansion of Existing Programs This is a new PhD Program Proposal. The PhD in Health Services Research curriculum uses courses already available from CHHS departments and current GMU Academic unit collaborators in the School of Public Policy and the Volgeneau School of Information Technology and Engineering. It shares courses with the Department of Global and Community Health and the Department of Rehabilitation Science as well as the School of Nursing. The MHA program in Health Systems Management, the MS in Health and Medical Policy and the MS in Health Informatics are expected to serve as a student springboard to entrance into the proposed program. We expect that students in all courses will benefit from multidisciplinary input from a diverse class enrollment (program peers and those matriculating from other degree programs). Collaboration or Standalone This is a standalone program. No other organization was involved in its development, and no other organization will collaborate in its operation. Justification for the Proposed Program Response to Current Needs (Specific Demand) Given the challenges facing the nation and discussed widely in the national dialogue about health reform (still unfolding), policy makers, thought leaders and advocates are identifying the need for more health services research and more researchers and consultants who are capable of developing and using data to inform decision making to support needed improvements in health care costs, quality and access and to support implementation of health reform efforts at the state and national level. The US spends almost twice the percentage of its gross domestic product as many European countries on health care, but has outcomes that rank well below those of other developed nations. 7 In recent years, new policy ideas and new technologies are emerging with the promise of 7 Organization for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). 16 improving innovation, data sharing, and analytics, thereby boosting cost containment and health care delivery and quality.8 On May 9, 2012 the Governance Studies program at the Brookings Institute hosted a half-day conference focused on government reforms and technology-related solutions aimed at improving the U.S health care system. It convened leaders from academia, business and government to discuss concrete policy actions to improve performance in this policy area and specific actions to modernize the U.S. health care system for the 21st century.9 Observations noted the paucity of talent to support these needs. Recommendations indicate the need for knowledgeable experts (such as graduates from the proposed PhD program) who are capable of leading innovation, generating and using data and analytics to improve health care delivery and outcomes. The curriculum as proposed for the PhD in HSR is unique and forward-looking. The depth of content in public policy process and health policy content, health systems and new and innovative analytics such as those from artificial intelligence are not found in any other doctoral program in Virginia, Maryland or the District of Columbia. This degree will provide graduates with the expertise and competencies necessary to identify, design, implement and evaluate health policies (state and national) and health system performance issues in a variety of organizations and settings. Further, graduates from this program will be able to use their skills to address the issues and related to health care costs, quality and access as well as utilize research data for evidenced-based clinical and administrative practice. There is a need for scholar practitioners with the competencies described herein. Per the Institute of Medicine: “Solutions to some of the nation’s most pressing health policy problems hinge on the capacity to identify which diagnostic, treatment and preventative services really work and under what conditions….As the evidence base for healthcare increases, inevitably there will be an even greater need for trustworthy, scientific synthesis and interpretation for the available evidence”.10 “In the early 21st century, despite unprecedented advances in biomedical knowledge and the highest per capita health care expenditures in the world, the quality and outcomes of health care vary dramatically across the United States. The economic burden of health spending is weakening American industry’s competitive edge and consumers are increasingly assuming individual responsibility for the cost f health care not covered by insurance. Consumerdirected health care is viewed by some as a means to rationalize what most agree is a health system plagued by overuse, underuse, and misuse.”11 8. ONC, HHS, Federal health IT Progress Report on the Health IT Strategic Plan, June 2013, pg. 5. http://www.healthit.gov/policy-researchers-implementers/federal-health-it-strategic-plan-progress-report 9 3rd Annual H. Alfred Taubman Forum on Health Policy, May 9, 2012. http://www.brookings.edu/events/2012/05/09-health-care Institute of Medicine Report (2008). Knowing what Works in Healthcare: A Roadmap for the Nation. 10 Online: http://www.iom.edu/CMS/3809/34261/50718.aspx Eden, J., Wheatley B., McNeil B., Sox H., 2008 “Knowing What Works in Health Care: A Roadmap for the Nation”, pg. 1, IOM, Washington DC National Academy Press. 11 17 Health policy makers, health and medical system managers, researchers, clinicians, as well as others to understand why the US spends more than any other nation and yet has poorer health outcomes than those who have less sophisticated systems and/or spend fewer resources. 12 While national interest in health reform is increasing, our understanding of the complex problems in reforming health systems is only beginning. A new generation of managers, researchers and consultants is needed to work on the front lines of this effort across the array of interests and system actors who develop systems and influence health and medical policymaking. The proposed program will produce graduates with in depth, specialized knowledge and competencies that address the complexity of health policymaking. This is not a fad: Since 2000, the number of different organizations that conduct HSR (and hence the number of employers for HSR researchers) has grown from 523 in year 2000 to 709 in year 2005, with universities accounting for an increasingly larger proportion of projects13. Moreover, the field of Health Services Research has been directly affected by growing funding by the Congress. As the figure below indicates, the lead agency for Health Services Research has seen significant growth in funding in recent years.14 This is an indicator both of the criticality of the subject matter—the cost, quality, use and outcomes of health services—as well an indicator of demand for graduates able to research, analyze and develop policy in these areas. Several other indicators point to a strong demand by employers for graduates from the proposed program. Health services researchers command relatively high salaries. According to a nationwide survey conducted by Resneck and Luft in 2004, 15 the median salary of a PhD in Health Services Research or Health Policy Analyst was $99,000. Salaries were highest in the private sector, followed by academic and government settings. Fifty-six percent worked in academic institutions or teaching hospitals, 34 percent in the private sector or foundations, and 10 percent in government. The number of people hired in this field has grown significantly in the past two decades. Considering just faculty in clinical departments of medical colleges, the number of PhD faculty in 1999 was 12,141, a 115% increase from the number in 1981.16 In a 2002 survey of 125 U.S. allopathic medical schools, the percentage of research non-tenured faculty surpassed the percentage hired on a traditional tenure-track line.17 Many of these institutions hire health services researchers to respond to available grant funding. 12 Doty, M.; M. J. Koren, and K. Davis (2008). The Commonwealth Fund Commission on a High Performance Health System, 2008, Why Not the Best? The National Scorecard on US Health System Performance. Health Care Opinion Leaders' Views on the Future of Long-Term Care. The Commonwealth Fund. Online: http://www.commonwealthfund.org/usr_doc/Why_Not_the_Best_national_scorecard_2008.pdf?section=4039 13 Thornton, C and Brown JD, ‘The Demand for Health Services Researchers 2020”, Mathmatica Policy Research Inc., for Academy Health, 2008, http://ah.cms-plus.com/files/Executive%20Summary%20%20Demand.pdf 14 Gray BH, Gusmano MK, Collins SR. AHCPR and the changing politics of health services research. Health Aff (Millwood). 2003 Jan-Jun;Suppl Web Exclusives:W3-283-307. 15 Resneck J Jr, Luft H. How health policy and health services researchers are compensated: analysis of a nationwide salary survey. Med Care Res Rev. 2004 Sep;61(3):392-408. 16 Association of American Medical Colleges. Growth of PhD Faculty in Clinical Departments of U.S. Medical. Schools, 1981-1999. In Brief, 2001, 1 (2). 17 Liu M, Mallon WT. Tenure in transition: trends in basic science faculty appointment policies at U.S. medical schools. Acad Med. 2004 Mar; 79(3):205-13. 18 One indicator of the current supply and composition of health services research can be obtained from membership in the Academy Health. This association was established in 1981 and in 2012 has about 2000 members. About 1/3 identify themselves as social scientists (mostly economists, sociologists and psychologists), 1/3 as health professionals and 1/3 as public health personnel. The multiplicity of professions and roles among health services researchers is well documented in the literature.18 Employment of postsecondary teachers is expected to grow by 17 percent from 2010 to 2020, about as fast as the average for all occupations. 19 Growth is expected as enrollments at postsecondary institutions at all levels continue to rise. http://www.bls.gov/ooh/educationtraining-and-library/postsecondary-teachers.htm#tab-6 Bureau of Labor Statistics Employment Forecasts Employment projections data for postsecondary teachers, 2010-2020 Occupational Title SOC Code Employment, 2010 Projected Employment, 2020 Change, 2010-20 Percent Numeric Employment by Industry SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program Postsecondary Teachers 18 19 20 251000 1,756,000 2,061,700 17 305,700 [XLS] Siu A.L. The health services researcher, multiple identities. Health Services Research. 2002 Feb;37(1):36. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-2009 Edition, Teachers-Postsecondary. on the Internet at http://www.bls.gov/oco/ocos066.htm (visited August 20, 2009) Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Postsecondary Teachers, on the Internet at http://www.bls.gov/ooh/education-trainingand-library/postsecondary-teachers.htm (visited September 13, 2012). 19 Employment projections data for computer and information research scientists, 20102021 SOC Code Occupational Title Employment, 2010 Projected Employment, 2020 Change, 2010-20 Percent Numeric Employment by Industry 5,300 [XLS] SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program Computer and Information Research Scientists 151111 28,200 33,500 19 Employment projections data for economists, 2010-2022 Occupational Title SOC Code Employment, 2010 Projected Employment, 2020 Change, 2010-20 Percent Numeric Employment by Industry SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program Economists 193011 15,400 16,400 6 900 [XLS] Employment Demand We provide two sources of evidence for employment demand: 1) a discussion of the employment projections in the nation as a whole and in the Commonwealth, 2) compilation of position announcements for which a PhD such as this is required or preferred (Appendix D). Our analysis indicates that the field of Health Services Research is growing and graduates of the proposed program are needed to fill employment positions in colleges and universities, professional organizations, health policy organizations, and federal, state, and local agencies. Employment announcements (in Virginia and nationally) for health policy researchers, faculty, policy research directors, postdoctoral associates, and health economists indicate demand for doctoral-level trained personnel. Data specific to future employment demand was not available as the Bureau of Labor Statistics (BLS) and the Virginia Workforce Connection (VAWC) does not have a job category for health services researcher. However, data from the BLS for fields such as: 1) teachers-postsecondary and 2) economists indicate demand is anticipated for professional occupations. The BLS projects that between 2008 and 2018 employment of postsecondary teachers are expected to grow 15% (http://www.bls.gov/oco/ocos066.htm); 21 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Computer and Information Research Scientists, on the Internet at http://www.bls.gov/ooh/computer-and-information-technology/computer-and-information-researchscientists.htm (visited September 13, 2012). 22 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Economists, on the Internet at http://www.bls.gov/ooh/life-physical-and-social-science/economists.htm (visited September 13, 2012). 20 employment of economists are expected to grow 6% (http://www.bls.gov/oco/ocos055.htm). The VAWC projects that between 2008 and 2018 employment of postsecondary teachers is expected to increase 22.3% or 2.0% annually; employment of economists is expected to increase 15.7% or 1.5% annually (available at: http://www.vawc.virginia.gov/ Comparable data are available from the Virginia Employment Commission23. Postsecondary teachers (specifically in the health specialties) are projected to experience a 32% increase in jobs and medical scientists are projected to experience a 24% increase in jobs between 2006-2016. In addition, a sampling of positions announcements for which a graduate of the Ph.D. in HSR is provided in Appendix D. Employment Projections for Virginia, 2006 - 201624 Code 251071 2006 Estimated Employment Occupational Title Health Specialties, 2,061 Postsecondary Teachers Medical Scientists, 191042 except 835 Epidemiologists 000000 Total, Occupations All 4,012,886 2016 Projected Employment Total 20062016 Employment Change Annual Avg. Percent Change Total Percent Change 2,739 678 2.9 32.9 1,035 200 2.2 24.0 4,635,775 622,888 1.5 15.5 We expect that individuals who earn the PhD in Health Services Research will find employment in the region in federal and state agencies, consulting firms, and universities. A good indication of the demand in this region for PhD-prepared individuals is provided by examining the Academy Health Career Center (http://www.academyhealth.org/career/) job listings. The following employment opportunities were advertised for a variety of employers on their websites and GovJOBS in September and October, 2013 (actual announcements contained in this Appendix D).25 23 24 25 Virginia Employment Commission. (2009). Virginia Workforce Connection - Occupational Employment Projections. 2009, from http://www.vawc.virginia.gov/analyzer/qsoccproj.asp?quicksearch=True&setvar=True&cat=OCC&session =OCCPROJ&subsession=99&areaname= Virginia Employment Commission. (2009). Virginia Workforce Connection - Occupational Employment Projections. 2009, from http://www.vawc.virginia.gov/analyzer/qsoccproj.asp?quicksearch=True&setvar=True&cat=OCC&session =OCCPROJ&subsession=99&areaname= Academy Health Career Center: Employment Opportunities. See http://www.academyhealth.org/career (accessed on September 13, 2012). 21 There were 93 jobs listed for health services researchers for the quarter September 2013 to October 2013. Of the listed jobs for people with a PhD in Health Services Research, 26% were in the Virginia, DC, and Maryland areas. Summary of Career Center Job Postings September and October 2013 Employer # Faculty Health Policy Research Professional Positions University Researcher Analyst Manager/Health Administrator AcademyHealth 35 35 Altarum Institute 1 1 AHIP 1 1 AIR 3 3 AHA 3 3 APHA 1 1 APIAHF 2 2 California Health 1 1 Care Foundation Indeed Inside HigherEd Johnson&Johnson Mathematica NAACHO NAHSE Nemours PeopleFirst ResearchAmerica RTI International SWHR UnitedHealth Group WellPoint Total 16 1 1 4 2 1 1 1 1 2 1 3 3 84 4 1 1 8 1 3 1 4 1 1 1 1 1 2 42 2 1 1 2 24 1 17 1 22 USAJOBS Website Postings September - October 201326 Health Health Federal Research Health Health Economist Scientist Scientist Agency Scientist CBO VA U.S. Air Force Total (9) Administrator Informatics Health System SpecialistData Analyst Public Health Analyst/Senior Advisor 2 3 3 3 1 2 4 The demand for health services researchers and policy analysts in the Washington, DC metropolitan area is driven in part by the growing needs of federal agencies for research and evaluation personnel and to meet legislatively mandated objectives. Currently, 15% of the budget of NIMH, NIDA and NIAAA is legislatively mandated to focus on health services research issues.27 As a consequence, almost all the Institutes at NIH have significant research divisions that focus on health services research. These NIH divisions both hire and, through their extramural programs, support the salary of health services researchers at various universities and consulting firms. USAID and other international health care organizations also hire health services researchers to support, manage or conduct projects designed to improve the efficiency and effectiveness of delivery of care systems abroad. Many funding agencies have come to the conclusion that the best way to help developing countries improve their health is through improving systems of care, rather than through traditional biomedical research projects focusing on individuals. The World Health Organization refers to this as capacity building for health systems and stewardship of national resources. Such organizations view health services research as an important component in improving systems of care in developing countries.28 This new emphasis in system development has led to increased hiring of individuals trained in health services research by international health care institutions and NGOs. 26 USAJOBS Government Job Announcements . https://www.usajobs.gov/ 27 United States Code Title 42 – The Public Health and Welfare Chapter 6A – Public Health Service Subchapter III – National Research Institutes Part C - Specific Provisions Respecting National Research Institutes. US code as of 01/26/1998. Lansang MA, Dennis R. Building capacity in health research in the developing world. Bull World Health Organ. 2004 Oct;82(10):764-70. 28 23 Student Demand Two sources of student demand for the PhD in HSR are provided: 1) An email survey of prospective students and inquiries received by the department and 2) letters of support from prospective employers. An email was sent to current HAP and GCH students and alumni to determine student demand for the PhD in October 2013. A total of 36 individuals responded indicating interest in enrolling in the program when it is established. Copies of emails and letters of support received may be found in Appendix E. 24 STATE COUNCIL OF HIGHER EDUCATION FOR VIRGINIA SUMMARY OF PROJECTED ENROLLMENTS IN PROPOSED PROGRAM Projected Enrollment Parker getting updated # from Renata Year 1 Year 2 Year 3 Year 4 Year 5 2015 - 2016 2016 - 2017 2017 - 2018 2018- 2019 2019 - 2020 HDCT FTES HDCT FTES HDCT FTES HDCT FTES 6 3 15 9 26 15 37 21 GRAD 4 HDCT 46 FTES 26 GRAD 6 Assumptions: 90% Retention 50% Full-time students/50% part-time students Full-time students taking 9 credit hours Part-time students taking 6 credit hours Full-time students graduating in 4 years Part-time students graduating in 6-8 years Definitions: HDCT—fall headcount enrollment FTES—annual full-time equivalent student enrollment GRADS—annual number of graduates of the proposed program Enrollment is likely to be a mix of in-state (80%) and out-of-state (20%). Duplication The growing number of graduates from the MHA in Health Systems Management, the MS in Health Informatics, the MS in Health and Medical Policy, and the Master of Public Health programs currently have no pathway for obtaining the terminal degree in their field at GMU. While a PhD in Public Policy is available from the School of Public Policy at George Mason University, it does not address the specialized focus or depth of knowledge and skill required in applied Health Services Research or domestic health policy content areas such as healthcare finance, state and federal health policy and health reform. The Department of Health Administration and Policy fields a collaborative MS in Health and Medical Policy program with the School of Public Policy, with HAP focusing on the content and politics of US Health Policy and health systems and the SPP focusing on Global Medical policy and practice. The proposed PhD is not viewed as duplicative or competitive as we serve students who have different career objectives. 25 Within the Commonwealth of Virginia, three PhD programs with similar titles exist. The Virginia Commonwealth University (VCU) offers two PhD programs, one in Health Policy and Research (approved to admit its first students in fall 2012) and one in Health Services organization and Research. Both focus on serving students in Central Virginia. The VCU programs differ from the program we propose in their curriculum and research foci. The new VCU PhD is a post bachelors program requiring a minimum of 58 graduate credit hours beyond the bachelor’s degree: 12 credit hours of core coursework; 12 credit hours of coursework in quantitative methods; 9 credit hours of coursework in research methods; 12 credit hours of elective coursework; 4 credit hours of seminar; and a minimum of 9 credit hours of dissertation coursework. The VCU PhD in Health Services Organization and Research is a post master’s degree PhD program with a curriculum that requires 9 credit hours in foundations of health services organization and research, 12 credits in health services organization theory core, 18 credit hours in health services research methods and 9 hours in specialization courses in addition to 9 credit hours in dissertation coursework. http://www.had.vcu.edu/prospective/doctoral/curriculum.html Old Dominion University also offers a PhD in Health Services Research: http://hs.odu.edu/commhealth/academics/phd/mission.shtml The curriculum of this program focuses on providing leaders and problem solvers to improve population health. The ODU Health Services Research PhD has 60 academic credit hours of course work beyond the Masters Degree, consisting of 12 credits of Health Services core courses and 18 credits of Research core courses. There is also a Health Policy Core with 6 credits and Cognate course requirements with 6 credits. In addition, the program requires an internship (3 credits), and a dissertation coursework (18 credits). The proposed program from GMU will allow students living in the Washington DC and Northern Virginia region an opportunity to pursue an in-depth and specialized health systems, research and policy focused PhD degree. The GMU HSR PhD is a 72 credit hours program of study (42 credits post masters) comprised of two concentrations Health Systems and Policy or Knowledge Discovery and Health Informatics). The proposed GMU HSR PhD program has a substantially different curriculum from that available in other PhD programs in Virginia and indeed the Washington DC metropolitan area. Our curriculum supports in-depth content in the student’s subject matter and application foci in health systems and policy, general knowledge of public policy process and politics for health policy making, as well as standard and innovative research methods and analytics from health informatics and computational sciences. There is no comparable PhD program that fulfills a growing need in the Northern Virginia region. The closest programs in the region are found at Johns Hopkins University in Baltimore MD and George Washington University in Washington DC. Mason’s program would make its unique contribution by focusing on the interdisciplinary education in health systems, health and public health policy content and innovative research methods and in-depth, specialized areas of 26 organization and practice in public health, health systems and policy development and evaluation not found in the programs of the universities in Virginia or the DC metropolitan area. Like other programs in the nation, Mason’s proposed program in Health Services Research emphasizes rigorous preparation in research and public health policy evaluation methods as well as the structure and functioning of health systems. The program of study includes content in biostatistics, data management, epidemiology, survey design, program evaluation, policy analysis quality management, health policy, applied economics and decision sciences. What makes our program unique among other programs in health services research, health administration and health policy programs is an emphasis on interdisciplinary applications in information technology and data analysis to support public health management and health policy development. In 2000, the Agency for Healthcare Research and Quality (AHRQ) and the National Library of Medicine (NLM) brought together more than 100 educators in a workshop titled “Medical Informatics and Health Services Research: Bridging the Gap.” The workshop focused on the need to prepare investigators who can work on both medical informatics and health services research.29 A summary of the workshop results has been published in the Journal of the American Medical Informatics Association. The workshop recognized that as ever-moremassive data sets become available, health services researchers and policy analysts need to know more about using healthcare data, data base structures and data mining techniques. Our program is designed to fill the gap that this important workshop of educators has identified. Additionally, Mason graduates will have in-depth understanding of the health policy making process (state and federal), health systems management and the factors affecting health service delivery and public health outcomes, as well as the use of data to inform policy and management decisions. The knowledge and skills sets our graduates attain will enable them to improve cost, quality and access to health services and seek ongoing opportunities for system safety and efficiency. Five-year enrollments and graduation totals for similar programs in Virginia are presented below. 29 Corn M, Rudzinski KA, Cahn MA Bridging the gap in medical informatics and health services research: workshop results and next steps. J Am Med Inform Assoc. 2002 Mar-Apr; 9(2): 140-3. 27 Completions in Comparable Programs in the Commonwealth30 The enrollment total for Virginia Commonwealth University’s new PhD in Health Policy and Research (51.2299) is presented below. Robin Parker getting updated # from SCHEV CIP: 51.2299 Fall 2012 Virginia Commonwealth University Does not appear on SCHEV Inventory Fall 2013 The enrollment and graduation totals for Virginia Commonwealth University’s PhD in Health Services Organization and Research (51.0701) follow: CIP: 51.0701 Enrollment, Graduations Enrollment Graduations VCU VCU 20072008 17 3 20082009 12 3 20092010 13 5 20102011 12 2 20112012 13 1 20122013 The enrollment and graduation totals for Old Dominion University’s PhD in Health Services Research (51.9999) follow: CIP: 51.9999 ODU ODU Enrollment, Graduations Enrollment Graduations 20072008 14 2 20082009 17 1 20092010 22 2 20102011 18 3 20112012 22 4 20122013 Projected Resource Needs George Mason University has all faculty, administrative staff, equipment, and library resources necessary to launch the proposed PhD in Health Services Research. No new personnel or resources are requested. The following subsections detail the resources required to operate the program from its initiation in the Fall 2015 through the target year 2019-2020. Assessments of need for full-time faculty, part-time faculty, and adjunct faculty are based on the following ratio of student enrollment to faculty effort for doctoral programs: 5 FTE of enrollment requires one FTE faculty for instruction. The HAP Department will leverage existing faculty resources in the Department, CHPRE, DSHI and CHHS. The Office of the Provost also provides support to each new PhD program in the form of a three-year graduate research assistantship. 30 State Council of Higher Education for Virginia, Completions Summary, on the Internet, at http://research.schev.edu/Completions/C1Level2_Report.asp (visited May 6, 2009). 28 Full-time Faculty The Department of Health Administration and Policy has 17 full-time research faculty members who will be supporting the PhD program (see Appendix C). Part-time Faculty from Other Academic Units Because the majority of the courses will derive from the College of Health and Human Services, we will require no part-time faculty to launch and maintain the proposed program through the target year of 2019-2020. The marginal costs of increased enrollment from this program can be absorbed by the other departments in CHHS with minimal impact. Adjunct Faculty Because of the broad range of faculty committed to the program, we project that the proposed program will not require any adjunct faculty to launch. Graduate Assistants The Office of the Provost will commit resources for one three-year Presidential Scholar’s Award for each entering class of PhD students. By the target year, these three-year awards will support three graduate research assistants for the HSR PhD. Presidential Scholars cost approximately $36,000, which covers stipend and tuition support. In addition, HAP, CHPRE and DSHI have been able to provide GRA tuition and wages support to at least three graduate students annually. Future student scholarship and GRA funds provided by HAP will be used to support some PhD graduate students in the proposed program. In addition, the faculty has a vigorous portfolio of research that will provide GRA support to the future students of the proposed program. Classified Positions We project that the proposed PhD will require no more than 0.25 FTE of classified support (internal GRA reallocation), rising to a total of 0.50 FTE by the target year. The funds for this position will be funded through enrollment growth. Targeted Financial Aid Students in the program will be eligible for financial aid through GMU’s extant programs. Additionally, the federal government funds a number of unique career development opportunities that includes various types of assistance for PhD students and future Health Services Researchers. Among these are the Health Services Research Dissertation Awards (R36). The 29 Funding Opportunity Announcement (FOA) for AHRQ Grants for Health Services Research Dissertation (R36) can be found at: http://grants.nih.gov/grants/guide/pa-files/PA-12-256.html. Equipment Because no faculty or classified staff will be hired for support, the proposed program requires no new equipment. Unique research infrastructure is available through DSHI. Library With the opening of the Johnson Center Library in 1995 and major new libraries at the Prince William (1997) and Arlington (1999) campuses, George Mason University Libraries are steadily growing into a truly interdependent system of a research center and a gateway library in Fairfax along with full-service facilities, each with a unique identity, at our other campuses. The University Libraries are committed to George Mason's distance learning programs by supporting the teaching, learning, and research needs of its students, faculty, and staff affiliated with University-level approved distance learning programs. The Libraries provide electronic access to a full range of quality library resources and services. Additionally, the University Libraries engage in regularly assessments of the needs of the academic units and faculty relating to research and educational resource support. Collection development within the George Mason University Libraries is a collaborative effort between individual "Liaison Librarians" and a CHHS appointed faculty member who serves as a departmental representative to the library. Each team analyzes existing holdings and examines new book, journal, media and electronic possibilities for acquisition in their subject areas. Liaison Librarians welcome faculty recommendations f o r new materials, and academic departments and faculty are encouraged to forward requests to expand acquisitions. They consult and collaborate with students and faculty on their research needs, select library materials in assigned subject areas, develop and maintain web- based resource guides, communicate with academic departments, instruct classes, and provide one-on-one research assistance in person, by phone, e-mail & IM. The HAP, CHHS liaison librarian is Ms. Sarah Sheehan (located in the Fenwick main branch library on the Fairfax campus). An extensive collection of text and reference books and journals recommended by HAP faculty comprises a robust set of resources for students and faculty studying and conducting research in health administration and policy. Ms. Sheehan maintains library support and acquisitions with a priority on Health Administration/Management, Health Policy and Health Informatics for HAP. Discipline specific subscription journals (electronic and hard copy) along with published books (reference and text books) are maintained and updated by the Liaison Librarian for the HSM program. She has a decentralized budget to ensure replacement and new acquisitions are made annually. Ms. Sheehan will be available to meet with Site Visitors to review holdings and her role and support for the HSM program. 30 The following resources are available through the Fenwick Library on the Fairfax campus or via remote (computer) access. University Libraries Collections are organized as follows (each item is web-linked): • Mason Library Catalog (books, media, government documents, e-books, maps, etc) • E-Journal Finder (online, full-text copies of journals, newspapers and magazines) • Database Portal (subject databases) • InfoGuides (web-based subject research resources) • Special Collections & Archives • Mason Archival Repository Service (MARS) Materials from the participating regions Library Consortia are also available (each item is web- linked): • Interlibrary Services • Intra-Campus Lending (ICL) [Mason Libraries] • Consortium Loan Service (CLS) [Washington Research Library Consortium] • Center for Research Libraries • Interlibrary Loan (ILL) The University Libraries system routinely commits $5000 to the purchase of research journals and books. A wide array of robust resources and a dedicated CHHS research librarian are available to support the PhD program. Telecommunications No new items are required. Space No additional space is required to launch or sustain the proposed program. The Department of Health Administration and Policy has space for faculty and students in the PhD program. Other Resources No resources other than those described above are required to support the proposed PhD 31 PROJECTED RESOURCE NEEDS FOR PROPOSED PROGRAM Part A: Answer the following questions about general budget information. Has or will the institution submit an addendum budget request to cover one-time costs? Has or will the institution submit an addendum budget request to cover operating costs? Will there be any operating budget requests for this program that would exceed normal operating budget guidelines (for example, unusual faculty mix, faculty salaries, or resources)? Will each type of space for the proposed program be within projected guidelines? Will a capital outlay request in support of this program be forthcoming? Yes No X Yes No X Yes No X Yes X Yes No No X Part B: Fill in the number of FTE positions needed for the program Full-time FTE* Part-time FTE ** Adjunct faculty Graduate assistants Classified positions TOTAL Program Initiation Year 2015 - 2016 On-going and Added reallocated (New) .50 0.00 0.00 0.00 0.00 0.25 0.75 0.00 0.00 1.00 0.25 1.25 Expected by Target Enrollment Year 2019 – 2020 Added Total FTE (New)*** positions 0.00 0.50 0.00 0.00 0.00 0.25 0.25 0.00 0.00 1.00 0.50 2.00 * Faculty dedicated to the program. **Faculty effort can be in the department or split with another unit. *** Added after initiation year. 32 Part C: Estimated resources to initiate and operate the program Full-time faculty salaries fringe benefits Part-time faculty (faculty FTE split with unit(s)) salaries fringe benefits Program Initiation Year 2015 - 2016 0.00 0.50 0.00 $48,362 0.00 $15,166 Expected by Target Enrollment Year 2019 - 2020 0.50 1.00 $48,362 $96,723 $15,166 $30,332 0.00 $0 $0 0.00 $0 $0 0.00 $0 $0 0.00 $0 $0 0.00 $0 $0 0.00 $0 $0 0.00 $0 $0 0.00 $0 $0 Graduate assistants salaries fringe benefits 0 $0 $0 1.00 18,000 0.00 3 54,000 0.00 4.00 72,000 0.00 Classified Positions salaries fringe benefits 0.00 $0 $0 0.25 $12,500 $5,078. 0.25 $12,500 $5,078 0.50 $25,000 $10,155 $0 $0 $0 $78,862. $20,244 99,106 $0 $5,000 $0 $0 $203,212 $114,862 $20,244 $135,106 $0 $0 $0 $0 $270,212 $193,723 $40,487 $234,210 $0 $5,000 $0 $0 $239,210 Adjunct faculty salaries fringe benefits Total Personnel cost salaries fringe benefits Total personnel cost Equipment Library Telecommunication costs Other costs (specify) TOTAL 33 Part D: Certification Statement(s) The institution will require additional state funding to initiate and sustain this program. Yes Signature of Chief Academic Officer X No Signature of Chief Academic Officer If “no,” please complete items 1, 2, and 3 below. 1. Estimated $$ and funding source to initiate and operate the program. Program initiation year Target enrollment year Funding Source 2015- 2016 2019- 2020 Reallocation within the department (Note below the $72,528 $127,055 impact this will have within the department.) Reallocation within the school or college (Note below the impact this will have within the school or college.) Reallocation within the institution (Note below the impact $0.00 $0.00 $0.00 $0.00 $18,000 $72,000 this will have within the institution.) Other funding sources (Please specify, to include extramural funding and philanthropy, and note if these are currently available or anticipated.) 2. Statement of Impact/Other Funding Sources. Faculty research will support GRA positions in start-up year through full implementation. The Internal reallocation of .50 FTE teaching/Research faculty is for an individual currently supporting the MS in HP program who will be adding the PhD Directorship to her duties. Reallocation within the department Because the proposed PhD in Health Services Research will primarily utilize existing faculty and classified support, the costs of supporting the proposed program can be accommodated through a HAP faculty reallocation for a dedicated Program Director from extant faculty. The budget is based on a ratio of student to faculty effort for similar doctoral programs: 5 FTE of enrollment requires one FTE of faculty for instruction. 34 Reallocation within the school or college There are no reallocations being utilized outside of the department, with the exception of the GCH statistics courses faculty and SON faculty. This faculty teaching advanced stats courses from GCH and Research Methods courses in the SON, teach these courses for students from many academic units. The HAP HSR PhD students are welcome in these courses and their FTE accrue to GCH or NURS when taking them. Reallocation within the institution The Office of the Provost routinely provides a new three-year Presidential Scholar Award to each new PhD program. In addition, the University Libraries routinely commit $5,000 to new doctoral programs for the purchase of program-related materials. Other funding sources Faculty research projects will support GRA positions. 3. Secondary Certification. If resources are reallocated from another unit to support this proposal, the institution will not subsequently request additional state funding to restore those resources for their original purpose. x Agree Signature of Chief Academic Officer Disagree Signature of Chief Academic Officer 35 Appendices 36
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