May 08, 2009

Dr. Sandra Greene teaches online to students in the School's Executive DrPH program.

Dr. Sandra Greene teaches online to students in the School’s Executive DrPH program.

When it comes to adding hospital beds, administrators across the state — from the 724-bed UNC Hospitals to the 6-bed Bertie Memorial, in Windsor, N.C. — compete for any additional space the state allows. To improve quality and patient outcomes, North Carolina limits the number of medical facilities — including hospital beds, operating rooms and open heart surgery programs — by requiring facilities to obtain a “certificate of need.”That’s where Sandra Greene comes in.

Greene, DrPH, health policy and management research associate professor at the UNC Gillings School of Global Public Health, helps the state determine how many hospital beds and other services, such as operating rooms, are needed — and where. For more than a decade, she has been a member of North Carolina’s Health Coordinating Council, which directs development of the annual State Medical Facilities Plan.

“These decisions have to be based on good data and good methodology for analyzing that data,” Greene says. “There’s an important balance between cost and quality that’s critical not only to patients but also to providers and to the state as a whole.”

Greene was appointed to the council by Gov. James B. Hunt Jr. for a four-year term, then was reappointed twice by Gov. Mike Easley. She serves as vice chair of the state’s Acute Care Services committee. She has chaired statewide workgroups to assess the methods by which the state decides to add new hospital beds, operating rooms and endoscopy facilities.

The Acute Care Services committee is chaired by Michael Tarwater of Charlotte, CEO of Carolinas Healthcare System, the state’s largest hospital chain.

“Dr. Greene, in my estimation, has a tremendous ability to identify and focus on problems,” he says, “to lead and contribute to the resolution of these problems and an invaluable ability to highlight relevant data to separate fact from fiction and build consensus.”

“North Carolina is the only state collecting these data,” Greene says. “It’s a great resource for patient safety.

Greene leads the Carolina Cost and Quality Initiative, a collaborative partnership between the Gillings School of Global Public Health and UNC’s Cecil G. Sheps Center for Health Services Research. The partnership was created to build, maintain and oversee the use of data on health care services provided to North Carolina residents. Data come from the State Employee’s Health Plan and from the N.C. Division of Medical Assistance (Medicaid).

The initiative promotes population-based research on the incidence and prevalence of disease in insured populations, patterns of utilization, and treatment and cost of care in North Carolina. The goal, ultimately, is to improve the delivery and quality of care in the state.

“Sandra really understands where data come from, and that’s really important when you’re using it for policy making,” says Tim Carey, MD, MPH, Sheps Center director. “She knows the state well, and she’s incredibly fair. She doesn’t make decisions based on conflicts of interest, or on politics or emotions…. She’s one of the most level-headed people I know.”

Greene also heads the Medication Error Quality Initiative which implements the state’s system for mandatory reporting of all medication errors and potential errors observed in nursing homes throughout the state.

“North Carolina is the only state collecting these data,” Greene says. “It’s a great resource for patient safety. And it’s a Web-based reporting system, so it’s easier and faster for nursing homes to provide information on errors and for those errors to be analyzed.”

As health care costs escalate across the state and nation, it’s critical for someone to be asking the questions, “Is quality health care worth the cost? Is there a financial return on investment for making improvements in the delivery of care?”

Greene is asking. Collecting data from Medicaid managed-care patients in 10 states focused on a wide range of conditions (including high-risk pregnancies, asthma and diabetes), she has studied whether quality enhancements in care delivery are worth the extra cost. She’s following up with a second phase at three sites, focusing on childhood asthma.

“Dr. Greene sees her role as a teacher as central to her responsibilities in the Department of Health Policy and Management and in the School,” says Peggy Leatt, PhD, associate dean for academic affairs and chair of the department. “She is in regular demand as a guest lecturer in a wide range of classes, where she describes the North Carolina health policy environment, the need to structure reliable and comprehensive data sets and analysis systems, the intricacies of health planning, and the operation of health insurance.

“Students gain extensively from her practice experience,” Leatt continues. “For example, she teaches a core course in the Executive DrPH program (for working professionals), where she is able to move students from a perspective of concern primarily with practice and administration to a place where they are ready to use formal methods of inquiry and research to help support their decision processes.”

Greene, a native of Pennsylvania, earned a bachelor’s degree in mathematics from UNC and master’s and doctoral degrees in biostatistics from UNC’s School of Public Health. She started her career in Duke University Medical Center’s Department of Community and Family Medicine, where she led a study on medical care utilization patterns in rural areas. She then spent more than 20 years at Blue Cross and Blue Shield of North Carolina, analyzing trends in health care utilization and cost across the state and planning strategies to best cover subscriber needs.

Greene has been affiliated with UNC since 1979, when she became an adjunct assistant professor of biostatistics. In 1980, she joined the Sheps Center as a research associate. She has been a research associate professor of health policy and management since 2003. She’s also co-director of the Sheps Center’s program on health care economics and finance, a research associate professor of social medicine at UNC’s School of Medicine, and an adjunct associate professor of pharmaceutical outcomes and policy at UNC’s Eshelman School of Pharmacy.

— Ramona DuBose

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit