Maccabi Healthcare Services The Maccabi Institute for Health Services Research Department of Public Health

1. In the School of Public Health Tel Aviv University January 2007 Maccabi Healthcare ServicesThe Maccabi Institute for Health Services ResearchDepartment of Public Health

2. Maccabi’s Vision Israel's leading and most advanced healthcare organization aims toachieveTotal Healthfor its members, providingintegrative andpersonally- tailoredhealth care to each and every member, and encouragesexcellencein the quality of medical care, knowledge andservice.

3. Maccabi Statistics - 2007 • 1,700,000 members (24% Market Share) • 3,560 physicians (independent contract and salaried) • 797 nurses • 429 physical therapists • 97 social workers • 168 dieticians • 197 occupational therapists • 177 speech therapists • 207 psychologists • 5 regions with 152 branches and clinics • Income budget (capitation) $1.28 Billion • Total income $1.65 Billion

4. Director General Assistant to Director General Maccabi Institute for Health Services Research Quality Promotion Marketing Media Relations & Public Affairs Ombudsman Internal Auditor Legal Department Medical Technology Operations and Hospital Relations Section Medical Section Real Estate and Logistics Division Information Technology Division Human Resources Division Purchasing Division Central Services Insurance Division Finance & Planning Division Secondary Healthcare Division Primary Healthcare Division Pharmacy & Pharmacology Supplementary Healthcare Services North Region Sharon Region Center Region Shfela & Jerusalem Region Negev Region

5. Objective The Institute provides an organizational framework for encouraging and supporting health services research which is aimed at promoting community health for Maccabi members and for the health sector at large

6. Purpose and Goals • Promoting research activities at Maccabi • This is accomplished by: • Encouraging research in relevant areas according to priorities set by the Institute’s Steering Committee and Advisory Board. • 2. Developing and expanding research potential via collaborative activities with researchers from academic institutions and/or external research organizations. • 3. Providing the necessary means to implement research projects.

7. The Maccabi Institute for Health Services Research Director Steering Committee Advisory Board Institute Director Dr. Rachelle Kaye Maccabi Research Committee Research Fund Department of Public Health Department of Research and Evaluation Medical Section

8. The Department of Public Health • Director • Dr. Rachelle Kaye Clinical Appointments Epidemiology Dr. Gabriel Hodick Dr. Nurit Friedman Preventive Med Mrs. Leora Valinsky Dr. Shelley Sternberg Environmental Health Dr. Shlomo Moshe • Dr. Ayalla Blau • Dr. Anthony Heymann • Dr. Yossi Lomnicky • Dr. Yoram Sandhaus • Dr. Yoav Yechezkeli • Dr. Yosef Cohen • Dr. Rachel Miron • Dr. Miki Nobel • Dr. Barbara Silverman • Dr. Galit Fusman • Dr. Ehud Kokia • Dr. Yitzchak Katzir • Dr. Meir Raz • Dr. Eduardo Scejter • Dr. Varda Shalev • Prof. Yair Shapiro Mentors and Advisors Prof Manfred Green Prof Joshua Shemer

9. Department of Public Health • The goal is to integrate academic activity with implementation in healthcare facilities. • Department activities focus on: Research, lecturing, mentoring and collaboration with academic institutions. • Members of the Department form a bridge between academia and the community. • Department members are full time employees, they each hold a half time position in the School of Public Health and half time position at a senior post in Maccabi. • 16 Clinical appointees are on the staff, each one holds a quarter time position. • 16 more Clinical appointments will be added in the future (4 positions).

10. Research Infrastructure • Members • Physicians and other care givers • Integrated administrative Data Base • Facilities (e.g. mega lab) • Knowledge and research capability • Connections with academic intuitions

11. Maccabioffers an ideal framework for health services research • Defined and stable population. • Integrated health care system dedicated to finding solutions to unknown problems. • Full access to health status and treatment to all members. • System is characterized by mutual dynamic interaction between health care and research.

12. Information SystemMaccabi’s fully computerized health system includes • ID numbers and demographic information for each member. • Physician visits including diagnoses and treatments. • Medications prescriptions and purchases at Maccabi pharmacies. • Diagnostic procedures and results: laboratory, pathology. • Visits to expert consultation clinics and para- medical centers. • Visits to out patient hospital clinics. • Hospitalization. • Visits and treatment by supportive and para medical services.

13. Doc. Clinic Members Members Members Members Doc. Clinic Medical Control Firewall Pharmacy Main Computer Backup Computer Admin Control Specialist Intranet Internet Consultant Clinic Extranet Payment Control Paramedic Reimburse-ment Control Drug consumption control Labs control Tele radiology Web Services Mgmt. of Service Providers Mgmt. of Insured People Mgmt. of the Fund Diagnostic Center Integrated Information SystemInformation Sources

15. Information : Type and Scope • Administrative and medical data bases on over 2 million people collected over a 16 year time span. • Integrated data base includes clinical, financial and demographic data. • Medical data includes information from all physicians and other care givers, clinics, laboratories and etc. • Recently the centralized electronic health record (EHR) program , further improved data by Physicians. • Data Base is easily accessible to researchers.

16. Publications in Professional Journals Heymann AD, Tarashansky I, Kokia E, Chodick G. The use of organizational data for the evaluation of mass prevention programs. Prev Med. 2004 Dec;39(6):1143-7. Heymann AD, Shapiro Y, Chodick G, Shalev V, Kokia E, Kramer E, Shemer J. Reduced hospitalizations and death associated with influenza vaccination among patients with and without diabetes. Diabetes Care. 2004 Nov;27(11):2581-4. Heymann AD, Hoch I, Valinsky L, Shalev V, Silber H, Kokia E. Mandatory Computer Field for Blood Pressure Measurement Improves Screening. Family Practice 2005; 22(2):168-9. Heymann A, Hodick G, Halkin H, Shalev V , Kokia E, Shemer J. The implementation of country-wide managed care for diabetes using medical informatics in a large Preferred Provider Organization. Diabetes research and clinical practice. 2006; 71:290-8. Lerman Y, Chodick G, Tepper S, Livni g, Ashkenazi S. Seroepidemiology of varicella-zoster virus antibodies among health-care workers and day-care-centre workers. Epidemiol Infect. 2004 Dec;132(6):1135-8.

17. Publications in Professional Journals Heymann AD, Chodick G, Reichman B, Kokia E, Laufer J. Influence of school closure on the incidence of viral respiratory diseases among children and on health care utilization. Pediatr Infect Dis J. 2004 Jul;23(7):675-7. Hoch I, Heymann AD, Kurman I, Valinsky LJ, Chodick G, Shalev V. Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics. J Am Med Inform Assoc. 2003 Nov-Dec;10(6):541-6. Epub 2003 Aug 4. Huerta M, Chodick G, Balicer RD, Davidovitch N, Grotto I. Reliability of self-reported smoking history and age at initial tobacco use. Prev Med. 2005 Aug;41(2):646-50. Kaye R. Long Term Care – The Next Revolution? Accepted for publication in proceedings from The Third International Jerusalem Conference on Health Policy, Dec 2006. Moshe S. Levin M. occupational aspects of low back pain. Harefua 2005:144;492-496.

18. Publications in Professional Journals Chodick G, Heymann AD, Wood F, Kokia E. The direct medical cost of diabetes in Israel. Eur J Health Econ. 2005 Feb 3. Shalev V, Chodick G, Bialik M, Heymann AD. Predictors of mortality in people with diabetes in a population based five years follow-up. Journal of Clinical Epidemiology accepted 3.06. Shapiro J, Cohen AD, David M, Chodik G, Viner A, Kremer E, Heymann AD The association between Psoriasis, Diabetes Mellitus and Atherosclerosis in Israel.Journal of the American Academy of Dermatology accepted 8.06 Shmuely H, Samra Z, Ashkenazi S, Dinari G, Chodick G, Yahav J. Association of Helicobacter pylori infection with Shigella gastroenteritis in young children. Am J Gastroenterol. 2004 Oct;99(10):2041-5. Sikron R, Wilf-Miron R, Israeli A. Adolescent pregnancy in Israel: a methodology for rate estimation and analysis of characteristics and trends. Harefuah. 2003 Feb;142(2):131-6, 158, 157. Review. Hebrew.

19. Sample Research Grants

20. Teaching Experience Dr. Ayala Blau, Lecturer, Wolfson School of Nursing, School of Nursing, Tel Hashomer Hospital Dr. Anthony Heymann- Lecturer, Tel Aviv University, Faculty of Medicine, Department of Family Medicine Leora Valinsky – Lecturer, School of Nursing and Public Health, Edith Cowan University, Perth, Western Australia, School of Medicine, Univ Of Western Australia Dr. Gabriel Chodick- Lecturer, Department of Epidemiology, Tel Aviv University Dr. Sandhaus-Lecturer, Tel Aviv University, School of Medicine, pediatrics Dr. Shlomo Moshe- Lecturer, Tel Aviv University, School of Medicine Dr. Joseph Cohen-Lecturer, Technion, School of Medicine, Wolfson Hospital, diabetes Dr. Miki Nobel- Lecturer, Tel Aviv University, School of Medicine, surgery Dr. Galit Fussman- Lecturer, Tel Aviv University, School of Medicine, family medicine Dr. Ehud Kokia- Lecturer, Ben Gurion University, health administration Dr. Rachelle Kaye- Lecturer, University of Denver, Guest Lecturer, School of Public Health, Hadassah University Hospital, lecturer, Kiryat Ono College, Health Insurance and long term care Dr. Shelley Sternberg – Lecturer, University of Toronto, Assistant Prof, Department of Medicine, University of Chicago Prof. Yair Shapiro-Prof, Ben Gurion University, Tel Aviv University, faculty of health sciences, Judea & Samria College, department of physiology and pharmacology, School of Public Health.

21. Types of Support and Mentoring for Students • Research planning and Methodology. • Data Extraction. • Data Analysis consultation. • Reporting Consultation.

22. Examples of projects supported by the Department of Public HealthBA Students: Degree in Health Administrationat the Ben-Gurion University and Emek- Jezrael College • Intervention Program by Nurses in Patients to Improve Mammography. • Performance Measurement to Gauge Improvement of Mammography Screening. • Effectiveness of Group Therapy Sessions on Health and Compliance in Diabetic Patients. • Predictors of Beta blocker Use for Post MI Patients in a Preferred Provider Organization.

23. Thank you

24. LONG TERM CARE – THE NEXT REVOLUTION? __________________________________________________________ Rachelle Kaye, PhD Maccabi Healthcare Services, Israel _____________________________________________________________________ The issue of Long Term Care, particularly for the dependent elderly, has been of increasing concern in all of the countries of the Western world, and is even beginning to demand attention in developing countries. One of the obvious reasons for this growing concern is demography. Life expectancy is increasing and is expected to continue increasing, particularly in the elderly population. From 1960 to 2000, the life expectancy of males aged 65 in OECD countries increased by almost 3 years – an increase of 22%, while the life expectancy of women aged 65 increased by almost 5 years – an increase of more than 30%.[1] As a result of increasing life expectancy as well as the trend in decreasing birth rates, the share of older people in the population has increased dramatically and the prediction is that it will continue to increase. In 1960 the OECD average for the share of persons aged 65 and over was 8.7% of the population. In 2000 it had increased to 13.8% and the projection for 2040 is 25.6%. It should be noted that the average share of persons aged 65+ for Western Europe in 2000 was even higher than the OECD average – about 15%. The increase in the share of persons over 80 in the population is no less dramatic. In 1960 it was 1.3%, in 2000 it was 3.1% and the projection for 2040 is almost 8% - similar to the average for the over 65s in 1960.[2] Accepted for publication in The Proceedings of the Third International Jerusalem Conference on Health Policy.