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Sample records for care management program

  1. HIV/AIDS managed care program.

    PubMed

    Bartlett, J G

    2000-01-01

    Approximately one-half of all patients with HIV infection who are under care have Medicaid as the third party payor. Unlike Medicare, Medicaid is a state-specific program that has huge variations in reimbursement strategies. Multiple studies have shown that care for persons with AIDS is about $20,000/year, but reimbursement through various state Medicaid programs varies about $100/m/m to $2800/m/m despite the fact that expectations for care are identical. Hopkins has a major commitment to persons with HIV infection with a program that now includes 30 faculty members and a support staff of 170. With the introduction of mandatory managed care for Medicaid recipients in July, 1997, we were confronted with the issue of substantial downsizing with abandonment of over half of our patients, or learning the transition to managed care. This has been a steep learning curve involving negotiations with the state Medicaid office, reorganization of our clinic, careful scrutiny of our database regarding resource utilization and cost, education of providers, and longitudinal collection of new information and integration of the rapid changes in the field. In the process of this transition, we learned that there are precious few resources to provide guidance and that there is a perceived need for assistance by HIV providers throughout the country. Consequently, we have now established the "HIV Managed Care Network" with substantial funding from diverse sources to support education, data collection, and public policy review. It is premature to evaluate performance since most of these activities have just begun, but we expect that this Network will serve as a demonstration model for methods to deal with chronic diseases under managed care. PMID:10881336

  2. Financial Management Guide: Child Care Food Program.

    ERIC Educational Resources Information Center

    Kentucky State Dept. of Education, Frankfort.

    Intended for day care providers in Kentucky, this publication contains sample forms and guidelines for filling out the forms required by the Division of School Food Services of the Kentucky Department of Education. Topics covered include allowable expenditures during the month, program income, records, auditing, reimbursement for sponsors of child…

  3. Program management and health care informatics: defining relationships.

    PubMed

    Harber, B W; Miller, S A

    1994-01-01

    The program management (PM) structure is a relatively well-known organizational model for hospitals. A variation of the matrix structure, it allows for an interdisciplinary team of health care providers to facilitate patient care delivery. However, providing such focused care results in a complex, highly information-dependent operational environment. To meet the information needs of such an environment, careful planning in selecting and implementing technology is required. Along with supporting patient care, the technology will also help in managing costs, human resources, quality and utilization, as well as in monitoring performance and outcomes measurement. Focusing specifically on the information technology environment, this article addresses health care informatics (the diverse categories of information and systems) needed to support clinical program managers, executives and others in a PM organization. Examples from both a university-affiliated and a community-based program managed hospital illustrate their approach to PM and information technology. PMID:10140165

  4. Psychotropic Medication Management in a Residential Group Care Program

    ERIC Educational Resources Information Center

    Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.

    2010-01-01

    This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

  5. Preparing health care organizations for successful case management programs.

    PubMed

    Bonvissuto, C A; Kastens, J M; Atwell, S R

    1997-01-01

    This article reports the results of a study of four hospital-based providers in varying stages of implementing case management programs. Three of the providers had most of the necessary elements in place to ensure success, such as a mix of reimbursement sources, an effective and integrated information management system, a full range of clinical services, and continuous quality improvement programs. The authors make several suggestions for key activities that must be pursued by any health care organization seeking to implement a case management program in an era of managed care, tightening reimbursement, and consumer demand for quality care. These include the need to (a) organize essential case management functions under a centralized structure; (b) set realistic, quantifiable targets, and (c) design a communications plan for the program. PMID:9335724

  6. The development of a palliative care program for managed care patients: a case example.

    PubMed

    Gazelle, G; Buxbaum, R; Daniels, E

    2001-09-01

    Palliative care is emerging as an important new field. Although programs are developing in hospital environments, little is known about development of programs in outpatient practices or those serving large managed care populations. This article provides a framework for the development of a comprehensive palliative care program in a large multispecialty group practice that serves managed care patients. The article addresses guiding principles, the need for obtaining baseline data, how the clinical consultation service was established, development of outcomes measures, and information on current program status. Five themes emerged as key to successful program development, most importantly the close collaboration between administrative and clinical staff in all aspects of program development. PMID:11559386

  7. The Quality of Care under a Managed-Care Program for Dual Eligibles

    ERIC Educational Resources Information Center

    Kane, Robert L.; Homyak, Patricia; Bershadsky, Boris; Lum, Terry; Flood, Shannon; Zhang, Hui

    2005-01-01

    Purpose: Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care. Design and Methods: Two control groups were used; one was…

  8. A disease management program for heart failure: collaboration between a home care agency and a care management organization.

    PubMed

    Gorski, Lisa A; Johnson, Kathy

    2003-01-01

    This article describes a collaborative approach to manage patients with heart failure between a home care agency and a care management agency. The resulting disease management program used a combination of home visits and phone contact. Care management plans emphasized patient education on increasing adherence to medical and diet regimens, and recognizing early symptoms of exacerbation that could lead to rehospitalization. Clinician activities and patient outcomes are described. PMID:14646784

  9. Integrated Pest Management: A Curriculum for Early Care and Education Programs

    ERIC Educational Resources Information Center

    California Childcare Health Program, 2011

    2011-01-01

    This "Integrated Pest Management Toolkit for Early Care and Education Programs" presents practical information about using integrated pest management (IPM) to prevent and manage pest problems in early care and education programs. This curriculum will help people in early care and education programs learn how to keep pests out of early care and…

  10. The Design of Health Care Management Program for Chinese Health Care Professionals

    ERIC Educational Resources Information Center

    Qiu, Xiao Ling

    2008-01-01

    Business education has been booming in China due to the increasing demand of business graduates since China's economic reform. Chinese health care professionals are eager for business education to improve their competencies. The purpose of the study was to investigate the determinants of a successful health care management program for Chinese…

  11. Opinions of disease management programs among medical directors of managed care organizations.

    PubMed

    Algozzine, T; Pannone, R; Kozma, C M

    1998-05-15

    Medical directors of managed care organizations (MCOs) were surveyed about their views on disease management programs in their facilities. A survey was mailed to 600 MCO medical directors. The survey consisted of 14 Likert-type items related to disease management programs, 4 demographic items, and 1 item related to satisfaction. Seventy-nine usable surveys were received, for a net response rate of 14%. There were 48 medical directors (61%) with disease management programs at their MCO; 25 (52%) were working independently. A majority (71%) of programs were targeted at asthma. Seventy percent of the 48 medical directors were completely to somewhat satisfied and 13% dissatisfied to some extent with their disease management programs. Satisfaction was significantly related to the MCO's partnerships for these programs. A majority of medical directors agreed or strongly agreed that disease management programs could improve outcomes and decrease health care costs at their MCO, that an independent consultant could help analyze their MCO's prescription and medical data, and that they would be willing to accept grants or funds from pharmaceutical companies to initiate and support an independent disease management program at their MCO. MCO medical directors who responded to a national survey indicated that their organization could benefit from disease management programs, that internal resources might be insufficient to manage these programs, and that their MCO might be willing to contract with external organizations for support. PMID:9606454

  12. 76 FR 34541 - Child and Adult Care Food Program Improving Management and Program Integrity

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-13

    ... improve Program management and integrity in the Child and Adult Care Food Program (CACFP), at 67 FR 43447 (June 27, 2002) and at 69 FR 53501 (September 1, 2004). Section 243 of Public Law 106-224, the... rule was issued in proposed form on September 12, 2000 (65 FR 55101). In response to State and...

  13. Effects of stress management program on the quality of nursing care and intensive care unit nurses

    PubMed Central

    Pahlavanzadeh, Saied; Asgari, Zohreh; Alimohammadi, Nasrollah

    2016-01-01

    Background: High level of stress in intensive care unit nurses affects the quality of their nursing care. Therefore, this study aimed to determine the effects of a stress management program on the quality of nursing care of intensive care unit nurses. Materials and Methods: This study is a randomized clinical trial that was conducted on 65 nurses. The samples were selected by stratified sampling of the nurses working in intensive care units 1, 2, 3 in Al-Zahra Hospital in Isfahan, Iran and were randomly assigned to two groups. The intervention group underwent an intervention, including 10 sessions of stress management that was held twice a week. In the control group, placebo sessions were held simultaneously. Data were gathered by demographic checklist and Quality Patient Care Scale before, immediately after, and 1 month after the intervention in both groups. Then, the data were analyzed by Student's t-test, Mann–Whitney, Chi-square, Fisher's exact test, and analysis of variance (ANOVA) through SPSS software version 18. Results: Mean scores of overall and dimensions of quality of care in the intervention group were significantly higher immediately after and 1 month after the intervention, compared to pre-intervention (P < 0.001). The results showed that the quality of care in the intervention group was significantly higher immediately after and 1 month after the intervention, compared to the control group (P < 0.001). Conclusions: As stress management is an effective method to improve the quality of care, the staffs are recommended to consider it in improvement of the quality of nursing care. PMID:27186196

  14. Managed Care

    MedlinePlus

    Managed care plans are a type of health insurance. They have contracts with health care providers and medical ... probably cost more. There are three types of managed care plans: Health Maintenance Organizations (HMO) usually only pay ...

  15. Implementing managed care in an industrial rehabilitation program.

    PubMed

    Niemeyer, L O; Foto, M; Holmes-Enix, D

    1994-01-01

    Managed care, with all its problems and potentials, is entering the scene in workers' compensation as a way to deal with escalating costs. Though the roots of managed care lie in cost containment efforts, its future depends on a shift in emphasis to quality of care. Clinicians must become partners with insurance companies and employers to evolve a "win-win" scenario that combines efficiency with effectiveness or risk both exclusion from provider networks and loss of control over what becomes incorporated into standards of care. Steps that can be taken by clinicians include developing a sense of accountability for final functional outcome, internal utilization management, and an internal case management protocol. PMID:24440843

  16. Caring for high-need, high-cost patients: what makes for a successful care management program?

    PubMed

    Hong, Clemens S; Siegel, Allison L; Ferris, Timothy G

    2014-08-01

    Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target "high-need, high-cost" patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts. PMID:25115035

  17. Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability. Final rule.

    PubMed

    2016-05-01

    This final rule modernizes the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems. The final rule aligns, where feasible, many of the rules governing Medicaid managed care with those of other major sources of coverage, including coverage through Qualified Health Plans and Medicare Advantage plans; implements statutory provisions; strengthens actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promotes the quality of care and strengthens efforts to reform delivery systems that serve Medicaid and CHIP beneficiaries. It also ensures appropriate beneficiary protections and enhances policies related to program integrity. This final rule also implements provisions of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and addresses third party liability for trauma codes. PMID:27192729

  18. Managed care under siege: how an effective compliance program can protect your company.

    PubMed

    Stratton, K M; Nahra, M H

    1996-01-01

    This article discusses the current enforcement emphasis on managed care fraud and examines how managed care organizations can utilize compliance programs, including legal audits, to protect against unwarranted investigations and liability. The article reviews the elements of an effective compliance program, how to conduct an internal audit, and the risks and benefits of a voluntary disclosure in the event fraudulent activity is discovered. PMID:10154069

  19. Development and Applications of an Outcomes Assessment Framework for Care Management Programs in Learning Health Systems

    PubMed Central

    Wang, Lin; Kuntz-Melcavage, Kara; Forrest, Christopher B.; Lu, Yanyan; Piet, Leslie; Evans, Kathy; Uriyo, Maria; Sherry, Melissa; Richardson, Regina; Hawkins, Michelle; Neale, Donna

    2015-01-01

    Purpose: To develop and apply an outcomes assessment framework (OAF) for care management programs in health care delivery settings. Background: Care management (CM) refers to a regimen of organized activities that are designed to promote health in a population with particular chronic conditions or risk profiles, with focus on the triple aim for populations: improving the quality of care, advancing health outcomes, and lowering health care costs. CM has become an integral part of a care continuum for population-based health care management. To sustain a CM program, it is essential to assure and improve CM effectiveness through rigorous outcomes assessment. To this end, we constructed the OAF as the foundation of a systematic approach to CM outcomes assessment. Innovations: To construct the OAF, we first systematically analyzed the operation process of a CM program; then, based on the operation analysis, we identified causal relationships between interventions and outcomes at various implementation stages of the program. This set of causal relationships established a roadmap for the rest of the outcomes assessment. Built upon knowledge from multiple disciplines, we (1) formalized a systematic approach to CM outcomes assessment, and (2) integrated proven analytics methodologies and industrial best practices into operation-oriented CM outcomes assessment. Conclusion: This systematic approach to OAF for assessing the outcomes of CM programs offers an opportunity to advance evidence-based care management. In addition, formalized CM outcomes assessment methodologies will enable us to compare CM effectiveness across health delivery settings. PMID:25992387

  20. The evolution of an innovation: variations in medicaid managed care program extensiveness.

    PubMed

    Kim, Ae-Sook; Jennings, Edward

    2012-10-01

    This article utilizes a theoretical framework of policy innovation, diffusion, and reinvention to investigate the evolving nature of Medicaid managed care programs over time. By estimating two separate models, one for primary care case management (PCCM) and a second for risk-based program enrollment, this study seeks to disentangle two different paths of learning (internal and external), investigate the potential effects of vertical diffusion of policy, and examine the impact of internal state characteristics on the extent of Medicaid managed care. With respect to diffusion and learning, the data reveal that earlier adopters implement more extensive programs. The data fail to reveal much internal learning, although there is evidence of some. External impacts are clear: managed care enrollments in neighboring states and changes in the federal waiver process affect states' decisions. Other policy choices are important: states with more generous Medicaid eligibility rules implement more extensive managed care programs. Complementing other studies of Medicaid, we find that politics and economics make a difference for the extent of managed care programs; unlike other Medicaid studies, we find no effect of race and ethnicity. PMID:22700945

  1. Managed Behavioral Health Care: An Instrument to Characterize Critical Elements of Public Sector Programs

    PubMed Central

    Ridgely, M Susan; Giard, Julienne; Shern, David; Mulkern, Virginia; Burnam, M Audrey

    2002-01-01

    Objective To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and “unmanaged” care and among managed care arrangements. Study Design The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers. Data Collection Methods Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants. Principal Findings This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care. Conclusions If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary. PMID:12236386

  2. Transitioning HIV care and treatment programs in southern Africa to full local management.

    PubMed

    Vermund, Sten H; Sidat, Mohsin; Weil, Lori F; Tique, José A; Moon, Troy D; Ciampa, Philip J

    2012-06-19

    Global AIDS programs such as the US President's Emergency Plan for AIDS Relief (PEPFAR) face a challenging health care management transition. HIV care must evolve from vertically-organized, externally-supported efforts to sustainable, locally controlled components that are integrated into the horizontal primary health care systems of host nations. We compared four southern African nations in AIDS care, financial, literacy, and health worker capacity parameters (2005 to 2009) to contrast in their capacities to absorb the huge HIV care and prevention endeavors that are now managed with international technical and fiscal support. Botswana has a relatively high national income, a small population, and an advanced HIV/AIDS care program; it is well poised to take on management of its HIV/AIDS programs. South Africa has had a slower start, given HIV denialism philosophies of the previous government leadership. Nonetheless, South Africa has the national income, health care management, and health worker capacity to succeed in fully local management. The sheer magnitude of the burden is daunting, however, and South Africa will need continuing fiscal assistance. In contrast, Zambia and Mozambique have comparatively lower per capita incomes, many fewer health care workers per capita, and lower national literacy rates. It is improbable that fully independent management of their HIV programs is feasible on the timetable being contemplated by donors, nor is locally sustainable financing conceivable at present. A tailored nation-by-nation approach is needed for the transition to full local capacitation; donor nation policymakers must ensure that global resources and technical support are not removed prematurely. PMID:22706012

  3. The Home Independence Program with non-health professionals as care managers: an evaluation.

    PubMed

    Lewin, Gill; Concanen, Karyn; Youens, David

    2016-01-01

    The Home Independence Program (HIP), an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life. These gains were found to translate into a reduced need for ongoing care services and reduced health and aged care costs over time. Despite these positive outcomes, few Australian home care agencies have adopted the service model - a key reason being that few Australian providers employ health professionals, who act as care managers under the HIP service model. A call for proposals from Health Workforce Australia for projects to expand the scope of practice of health/aged care staff then provided the opportunity to develop, implement, and evaluate a service delivery model, in which nonprofessionals replaced the health professionals as Care Managers in the HIP service. Seventy older people who received the HIP Coordinator (HIPC) service participated in the outcomes evaluation. On a range of personal outcome measures, the group showed statistically significant improvement at 3 and 12 months compared to baseline. On each outcome, the improvement observed was larger than that observed in a previous trial in which the service was delivered by health professionals. However, differences in the timing of data collection between the two studies mean that a direct comparison cannot be made. Clients in both studies showed a similarly reduced need for ongoing home care services at both follow-up points. The outcomes achieved by HIPC, with non-health professionals as Care Managers, were positive and can be considered to compare favorably with the outcomes achieved in HIP when health professionals take the Care Manager role. These findings will be of interest to managers of home care services and to policy makers interested in reducing the long-term care needs of older community dwelling individuals. PMID:27382264

  4. The Home Independence Program with non-health professionals as care managers: an evaluation

    PubMed Central

    Lewin, Gill; Concanen, Karyn; Youens, David

    2016-01-01

    The Home Independence Program (HIP), an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life. These gains were found to translate into a reduced need for ongoing care services and reduced health and aged care costs over time. Despite these positive outcomes, few Australian home care agencies have adopted the service model – a key reason being that few Australian providers employ health professionals, who act as care managers under the HIP service model. A call for proposals from Health Workforce Australia for projects to expand the scope of practice of health/aged care staff then provided the opportunity to develop, implement, and evaluate a service delivery model, in which nonprofessionals replaced the health professionals as Care Managers in the HIP service. Seventy older people who received the HIP Coordinator (HIPC) service participated in the outcomes evaluation. On a range of personal outcome measures, the group showed statistically significant improvement at 3 and 12 months compared to baseline. On each outcome, the improvement observed was larger than that observed in a previous trial in which the service was delivered by health professionals. However, differences in the timing of data collection between the two studies mean that a direct comparison cannot be made. Clients in both studies showed a similarly reduced need for ongoing home care services at both follow-up points. The outcomes achieved by HIPC, with non-health professionals as Care Managers, were positive and can be considered to compare favorably with the outcomes achieved in HIP when health professionals take the Care Manager role. These findings will be of interest to managers of home care services and to policy makers interested in reducing the long-term care needs of older community dwelling individuals. PMID:27382264

  5. Development of a diabetes care management curriculum in a family practice residency program.

    PubMed

    Nuovo, Jim; Balsbaugh, Thomas; Barton, Sue; Davidson, Ellen; Fox-Garcia, Jane; Gandolfo, Angela; Levich, Bridget; Seibles, Joann

    2004-01-01

    Improving the quality of care for patients with chronic illness has become a high priority. Implementing training programs in disease management (DM) so the next generation of physicians can manage chronic illness more effectively is challenging. Residency training programs have no specific mandate to implement DM training. Additional barriers at the training facility include: 1) lack of a population-based perspective for service delivery; 2) weak support for self-management of illness; 3) incomplete implementation due to physician resistance or inertia; and 4) few incentives to change practices and behaviors. In order to overcome these barriers, training programs must take the initiative to implement DM training that addresses each of these issues. We report the implementation of a chronic illness management curriculum based on the Improving Chronic Illness Care (ICIC) Model. Features of this process included both patient care and learner objectives. These were: development of a multidisciplinary diabetes DM team; development of a patient registry; development of diabetes teaching clinics in the family practice center (nutrition, general management classes, and one-on-one teaching); development of a group visit model; and training the residents in the elements of the ICIC Model, ie, the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. Barriers to implementing these curricular changes were: the development of a patient registry; buy-in from faculty, residents, clinic leadership, staff, and patients for the chronic care model; the ability to bill for services and maintain clinical productivity; and support from the health system key stakeholders for sustainability. Unique features of each training site will dictate differences in emphasis and structure; however, the core principles of the ICIC Model in enhancing self-management may be generalized to all sites. PMID:15671788

  6. Chile: Acceptability of a Training Program for Depression Management in Primary Care

    PubMed Central

    Marín, Rigoberto; Martínez, Pablo; Cornejo, Juan P.; Díaz, Berta; Peralta, José; Tala, Álvaro; Rojas, Graciela

    2016-01-01

    Background: In Chile, there are inconsistencies in the management of depression in primary care settings, and the National Depression Program, currently in effect, was implemented without a standardized training program. The objective of this study is to evaluate the acceptability of a training program on the management of depression for primary care health teams. Methods: The study was a randomized controlled trial, and two primary centers from the Metropolitan Region of Santiago were randomly selected to carry out the intervention training program. Pre-post surveys were applied, to evaluate expectations and satisfaction with the intervention, respectively. Descriptive and content analysis was carried out. Result: The sample consisted of 41 health professionals, 56.1% of who reported that their expectations for the intervention were met. All of the training activities were evaluated with scores higher than 6.4 (on a 1–7 scale). The trainers, the methodology, and the learning environment were considered strengths and facilitators of the program, while the limited duration of the training, the logistical problems faced during part of the program, and the lack of educational material were viewed as weaknesses. Conclusion: The intervention was well accepted by primary health care teams. However, the clinical impact in patients still has to be evaluated. PMID:27375531

  7. Managed health care.

    PubMed

    Curtiss, F R

    1989-04-01

    The fundamental components of managed-care plans are described; the development of managed-care programs is discussed; and the impact of managed care on pharmacy services and the price, quality, and accessibility of health care are reviewed. Health care can be considered to be managed when at least one of the following fundamental components is present: prospective pricing, "UCR" (usual, customary, and reasonable) pricing of services, peer review, mandatory use review, benefit redesign, capitation payments, channeling, quality criteria, and health promotion. The managed-care industry consists of health maintenance organizations (HMOs), preferred provider organizations (PPOs), and managed fee-for-service plans. Managed-care reimbursement principles involve transferring some or all of the impetus for controlling use of services to the health-care provider. Means by which this is done include prospective pricing, services bundling, price discounts and negotiated fees, and capitation financing and reimbursement. Financial risk-sharing arrangements with providers--including hospitals, physicians, pharmacies, and home-care companies--are necessary for any managed-care plan to attain true control over its service costs. Use-review and use-management services are also fundamental to containing health-care spending. These include retrospective, concurrent, and prospective reviews of the necessity and appropriateness of medical services. Use management, like services bundling and prospective pricing, has been more effective in reducing costs of hospital inpatient services than costs associated with ambulatory care. Per case payments and services bundling have made individual charges for items irrelevant to hospital revenue. This has forced hospital pharmacy managers to become more sensitive to cost management. Drug formularies, improved productivity, and use of prescribing protocols are means by which hospital pharmacies have controlled costs. However, since shorter hospital

  8. Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

    PubMed Central

    Killu, Keith; Coba, Victor; Mendez, Michael; Reddy, Subhash; Adrzejewski, Tanja; Huang, Yung; Ede, Jessica; Horst, Mathilda

    2014-01-01

    Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year. Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435). Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied. PMID:25478217

  9. Managed care and Medicare reform.

    PubMed

    Oberlander, J B

    1997-04-01

    A primary goal of many Medicare reform proposals is to move program beneficiaries into managed care plans operated by private insurance companies. Advocates contend that managed care plans, especially health maintenance organizations (HMOs), can save substantial money for the federal government, while also improving the quality of medical care and scope of covered benefits for Medicare enrollees. Should Medicare follow the private sector by adopting managed care-based reforms? This article summarized the claims that are made for and against incorporating managed care into Medicare, and reviews evidence from the program's experience with HMOs on financial savings, benefits coverage, and quality of care. This evidence raises concerns regarding the ability of HMOs to provide adequate care for chronically ill Medicare patients. Moreover, there is considerable uncertainty about the future performance of managed care plans. I therefore conclude that policy makers should move cautiously in embracing managed care and that Medicare should not adopt financial incentives, such as vouchers, that are intended to push beneficiaries into HMOs. However, Medicare beneficiary enrollment in managed care plans is likely to increase substantially in coming years regardless of public policy. It is therefore critical for Medicare to pursue policies that protect the quality of care for elderly and disabled patients in managed care plans; curtail excessive payments to HMOs that result from favorable selection of healthier enrollees; and preserve the current fee-for-service Medicare program. PMID:9159717

  10. What Would It Take? Stakeholders’ Views and Preferences for Implementing a Health Care Manager Program in Community Mental Health Clinics Under Health Care Reform

    PubMed Central

    Cabassa, Leopoldo J.; Gomes, Arminda P.; Lewis-Fernández, Roberto

    2015-01-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders’ recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. PMID:25542194

  11. What would it take? Stakeholders' views and preferences for implementing a health care manager program in community mental health clinics under health care reform.

    PubMed

    Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto

    2015-02-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. PMID:25542194

  12. The School Health Innovative Programs: Integrating School Health and Managed Care in San Diego.

    ERIC Educational Resources Information Center

    Taras, Howard; Nader, Philip; Swiger, Holly; Fontanesi, John

    1998-01-01

    Describes the first two years of a San Diego-based collaborative involving managed care organizations (MCO's), school districts, and other health care agencies. By establishing trust, developing overriding principles, and creating an interagency communication infrastructure, this collaborative has encouraged shared management of many student…

  13. Taking Care of You: Body, Mind, Spirit--A Unique Stress Management Program That Improves Lifestyle Behaviors

    ERIC Educational Resources Information Center

    Vetter-Smith, Molly; Massey, Vera; Rellergert, Linda; Wissmann, Mary

    2014-01-01

    Taking Care of You: Body, Mind, Spirit is a multi-session group program developed by University of Missouri Extension that provides a unique and practical approach to helping adults better managing their stress and bounce back from life's challenges while improving lifestyle behaviors. The program combines mindfulness and a variety of other…

  14. The Impact of a Health Education Program Targeting Patients with High Visit Rates in a Managed Care Organization.

    ERIC Educational Resources Information Center

    Dally, Diana L.; Dahar, Wendy; Scott, Ann; Roblin, Douglas; Khoury, Allan T.

    2002-01-01

    Investigated whether a mailed health promotion program would reduce outpatient visits while improving health status among people with chronic conditions and high visit rates in a managed care organization. Surveys of treatment and control groups before and 1 year after randomization indicated that the program reduced visit rates while improving…

  15. Palliative care - managing pain

    MedlinePlus

    End of life - pain management; Hospice - pain management ... Bookbinder M, McHugh ME. Symptom management in palliative care and end of life care. Nurs Clin North Am . 2010;45:271-327. Mercadente S. Challenging pain problems. In: ...

  16. Worksite Stress Management for Medical Care Personnel: Results from a Pilot Program.

    ERIC Educational Resources Information Center

    Norvell, Nancy; And Others

    1987-01-01

    Pilot program on stress management, consisting of eight weekly group sessions, was implemented with 12 respiratory therapists. Findings support view that variety of stress management techniques can be effective in enhancing emotional functioning. Discusses practical problems and recommendations for stress management in a group worksite program.…

  17. Child Care Food Program Financial Management Guide. PTM No. 300.83.

    ERIC Educational Resources Information Center

    Haszu, Louis A.; McAtee, Sharon A.

    While costs are no longer reported to the Child Care Food Program on the monthly reimbursement voucher, Federal regulations for the program require that each participating sponsor operate a nonprofit food service and that any income accrued from the program be used solely for the conduct of improvement of the food service operation. Therefore, it…

  18. Implementation of a collaborative care management program with buprenorphine in primary care: A comparison between opioid-dependent patients and chronic pain patients using opioids non-medically

    PubMed Central

    Suzuki, Joji; Matthews, Michele L.; Brick, David; Nguyen, Minh-Thuy; Jamison, Robert N.; Ellner, Andrew L.; Tishler, Lori W.; Weiss, Roger D.

    2014-01-01

    Objective To implement a collaborative care management program with buprenorphine in a primary care clinic. Design Prospective observational study. Setting A busy urban academic primary care clinic affiliated with a tertiary care hospital. Participants Opioid dependent patients or chronic pain patients using opioids non-medically were recruited for the study. A total of 45 participants enrolled. Interventions Patients were treated with buprenorphine and managed by a supervising psychiatrist, pharmacist care manager and health coaches. The care manager conducted buprenorphine inductions and all follow-ups visits. Health coaches offered telephonic support. The psychiatrist supervised both the care manager and health coaches. Main outcome measures Primary outcomes were treatment retention at 6 months, and change in the proportion of aberrant toxicology results and opioid craving scores from baseline to 6 months. After data collection, clinical outcomes were compared between opioid dependent patients and chronic pain patients using opioids non-medically. Overall, 55.0% (25/45) of participants remained in treatment at 6 months. PCPs’ attitudes about opioid dependence treatment were surveyed at baseline and at 18-months. Results Forty-three patients (95.6%) accepted treatment and 25 (55.0%) remained in treatment at 6 months. The proportion of aberrant urine toxicology results decreased significantly from baseline to 6 months (p<0.01). Craving scores significantly decreased from baseline to 6 months (p<0.01). Opioid dependent patients, as opposed to chronic pain patients using opioids non-medically, were significantly more likely to complete 6 months of treatment (p<0.05). PCPs’ confidence in treating opioid dependence in primary care increased significantly from baseline to 18-months post-implementation (p<0.01). Conclusion Collaborative care management for opioid dependence with buprenorphine may be feasible in a primary care clinic. More research is needed to

  19. Primary Care Provider Perceptions of the Effectiveness of Two Self-Management Support Programs for Vulnerable Patients with Diabetes

    PubMed Central

    Ratanawongsa, Neda; Bhandari, Vijay K; Handley, Margaret; Rundall, Thomas; Hammer, Hali; Schillinger, Dean

    2012-01-01

    Background Primary care providers (PCPs) in safety net settings face barriers to optimizing care for patients with diabetes. We conducted this study to assess PCPs' perspectives on the effectiveness of two language-concordant diabetes self-management support programs. Methods One year postintervention, we surveyed PCPs whose patients with diabetes participated in a three-arm multiclinic randomized controlled trial comparing usual care (UC), weekly automated telephone self-management (ATSM) support with nurse care management, and monthly group medical visits (GMVs). We compared PCP perspectives on patient activation to create and achieve goals, quality of care, and barriers to care using regression models accounting for within-PCP clustering. Results Of 113 eligible PCPs caring for 330 enrolled patients, 87 PCPs (77%) responded to surveys about 245 (74%) enrolled patients. Intervention patients were more likely to be perceived by PCPs as activated to create and achieve goals for chronic care when compared with UC patients (standardized effect size, ATSM vs UC, +0.41, p = 0.01; GMV vs UC, +0.31, p = 0.05). Primary care providers rated quality of care as higher for patients exposed to ATSM compared to UC (odds ratio 3.6, p < 0.01). Compared with GMV patients, ATSM patients were more likely to be perceived by PCPs as overcoming barriers related to limited English proficiency (82% ATSM vs 44% GMV, p = 0.01) and managing medications (80% ATSM vs 53% GMV, p = 0.01). Conclusions Primary care providers perceived that patients receiving ATSM support had overcome barriers, participated more actively, and received higher quality diabetes care. These views of clinician stakeholders lend additional evidence for the potential to upscale ATSM more broadly to support PCPs in their care of diverse, multilinguistic populations. PMID:22401329

  20. The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

    PubMed Central

    2013-01-01

    Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Methods Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be

  1. Management of pain induced by exercise and mobilization during physical therapy programs: views of patients and care providers

    PubMed Central

    2011-01-01

    Background The expectations of patients for managing pain induced by exercise and mobilization (PIEM) have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs. Methods We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women) and 14 care providers (6 women): 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists. Results Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity. Conclusion PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers. PMID:21781296

  2. 24-hour care programs.

    PubMed

    Hergenrader, R

    1996-06-01

    Twenty-four-hour care programs, which combine group health programs with workers' compensation and disability benefits, hold considerable potential for cost savings and greater efficiency. This article explains these programs and uses a care history to show the savings they can achieve. PMID:10157798

  3. Cooperative disease management programs.

    PubMed

    Jedrey, C M; Chaurette, K A; Winn, L B

    2001-01-01

    Cooperative disease management programs sponsored by pharmaceutical companies and managed care organizations or health care providers can offer significant benefits to patients. They can be structured so as to comply with applicable OIG, FDA, and IRS regulations. Such programs must be structured for the benefit of patients, and not to require the use of or otherwise directly promote the selection of the sponsoring pharmaceutical company's products. PMID:11189793

  4. Towards Excellence in Asthma Management: Final report of an eight-year program aimed at reducing care gaps in asthma management in Quebec

    PubMed Central

    Boulet, Louis-Philippe; Dorval, Eileen; Labrecque, Manon; Turgeon, Michel; Montague, Terrence; Thivierge, Robert L

    2008-01-01

    BACKGROUND AND OBJECTIVES: Asthma care in Canada and around the world persistently falls short of optimal treatment. To optimize care, a systematic approach to identifying such shortfalls or ‘care gaps’, in which all stakeholders of the health care system (including patients) are involved, was proposed. METHODS: Several projects of a multipartner, multidisciplinary disease management program, developed to optimize asthma care in Quebec, was conducted in a period of eight years. First, two population maps were produced to identify regional variations in asthma-related morbidity and to prioritize interventions for improving treatment. Second, current care was evaluated in a physician-patient cohort, confirming the many care gaps in asthma management. Third, two series of peer-reviewed outcome studies, targeting high-risk populations and specific asthma care gaps, were conducted. Finally, a process to integrate the best interventions into the health care system and an agenda for further research on optimal asthma management were proposed. RESULTS: Key observations from these studies included the identification of specific patterns of noncompliance in using inhaled corticosteroids, the failure of increased access to spirometry in asthma education centres to increase the number of education referrals, the transient improvement in educational abilities of nurses involved with an asthma hotline telephone service, and the beneficial effects of practice tools aimed at facilitating the assessment of asthma control and treatment needs by general practitioners. CONCLUSIONS: Disease management programs such as Towards Excellence in Asthma Management can provide valuable information on optimal strategies for improving treatment of asthma and other chronic diseases by identifying care gaps, improving guidelines implementation and optimizing care. PMID:18818784

  5. A proposed emergency management program for acute care facilities in response to a highly virulent infectious disease.

    PubMed

    Petinaux, Bruno; Ferguson, Brandy; Walker, Milena; Lee, Yeo-Jin; Little, Gary; Parenti, David; Simon, Gary

    2016-01-01

    To address the organizational complexities associated with a highly virulent infectious disease (HVID) hazard, such as Ebola Virus Disease (EVD), an acute care facility should institute an emergency management program rooted in the fundamentals of mitigation, preparedness, response, and recovery. This program must address all known facets of the care of a patient with HVID, from unannounced arrival to discharge. The implementation of such a program not only serves to mitigate the risks from an unrecognized exposure but also serves to prepare the organization and its staff to provide for a safe response, and ensure a full recovery. Much of this program is based on education, training, and infection control measures along with resourcing for appropriate personal protective equipment which is instrumental in ensuring an organized and safe response of the acute care facility in the service to the community. This emergency management program approach can serve as a model in the care of not only current HVIDs such as EVD but also future presentations in our healthcare setting. PMID:26963227

  6. Capitated Medicaid Managed Care in a Rural Area: The Impact of Minnesota's PMAP Program

    ERIC Educational Resources Information Center

    Long, Sharon K.; Coughlin, Teresa A.; King, Jennifer

    2005-01-01

    Although states have had difficulty extending Medicaid managed care (MMC) to rural areas, rural models of capitated MMC are expected to grow in response to new federal regulations and the serious budget problems facing nearly all states. As such, understanding the effects of capitated MMC in rural settings is important for policy considerations.…

  7. Training of Unskilled Child Care Providers: An In-House Program to Overcome Management's Financial Constraints.

    ERIC Educational Resources Information Center

    Adams, Brian

    An in-house staff development program was designed and implemented for unskilled child caregivers employed at Tiny Tots Educare Academies, Inc., a privately owned and operated child care center located in Ellenton, Florida. Employees had little knowledge of child development and other topics related to early childhood education and, therefore,…

  8. Palliative care - managing pain

    MedlinePlus

    Palliative care helps people with serious illnesses feel better. One of the problems a serious illness can cause ... Bookbinder M, McHugh ME. Symptom management in palliative care and ... Challenging pain problems. In: Walsh D, Caraceni AT, Fainsinger ...

  9. The formation, elements of success, and challenges in managing a critical care program: Part I.

    PubMed

    St Andre, Arthur

    2015-04-01

    Leaders of critical care programs have significant responsibility to develop and maintain a system of intensive care. At inception, those clinician resources necessary to provide and be available for the expected range of patient illness and injury and throughput are determined. Simultaneously, non-ICU clinical responsibilities and other expectations, such as education of trainees and participation in hospital operations, must be understood. To meet these responsibilities, physicians must be recruited, mentored, and retained. The physician leader may have similar responsibilities for nonphysician practitioners. In concert with other critical care leaders, the service adopts a model of care and assembles an ICU team of physicians, nurses, nonphysician providers, respiratory therapists, and others to provide clinical services. Besides clinician resources, leaders must assure that services such as radiology, pharmacy, the laboratory, and information services are positioned to support the complexities of ICU care. Metrics are developed to report success in meeting process and outcomes goals. Leaders evolve the system of care by reassessing and modifying practice patterns to continually improve safety, efficacy, and efficiency. Major emphasis is placed on the importance of continuity, consistency, and communication by expecting practitioners to adopt similar practices and patterns. Services anticipate and adapt to evolving expectations and resource availability. Effective services will result when skilled practitioners support one another and ascribe to a service philosophy of care. PMID:25746743

  10. The formation, elements of success, and challenges in managing a critical care program: part II.

    PubMed

    St Andre, Arthur

    2015-05-01

    Leaders of critical care services require knowledge and skills not typically acquired during their medical education and training. Leaders possess personality characteristics and evolve and adopt behaviors and knowledge in addition to those useful in the care of patients and rounding with an ICU team. Successful leaders have impeccable integrity, possess a service mentality, are decisive, and speak the truth consistently and accurately. Effective leaders are thoughtful listeners, introspective, develop a range of relationships, and nurture others. They understand group psychology, observe, analyze assumptions, decide, and improve the system of care and the performance of their team members. A leader learns to facilely adapt to circumstance, generate new ideas, and be a catalyst of change. Those most successful further their education as a leader and learn when and where to seek mentorship. Leaders understand their organization and its operational complexities. Leaders learn to participate and knowledgeably contribute to the fiscal aspects of income, expense, budget, and contracts from an institutional and department perspective. Clinician compensation must be commensurate with expectations and be written to motivate and make clear duties that are clinical and nonclinical. A leader understands and plans to address the evolving challenges facing healthcare, especially resource constraints, the emotions and requirements of managing the end of life, the complexities of competing demands and motivations, the bureaucracy of healthcare practice, and reimbursement. Responsibilities to manage and evolve must be met with intelligence, sensitivity, and equanimity. PMID:25746742

  11. Foster Care and Medicaid Managed Care.

    ERIC Educational Resources Information Center

    Leslie, Laurel K.; Kelleher, Kelly J.; Burns, Barbara J.; Landsverk, John; Rolls, Jennifer A.

    2003-01-01

    Reviews issues surrounding the delivery of managed health care services to children in foster care. Details the unique characteristics of children in foster care, including limited medical histories upon entry into foster care, multiple health care needs, lack of a clearly identified medical care coordinator, and frequent placement changes.…

  12. Women and managed care.

    PubMed

    England, M J; Muchnick-Baku, S

    1997-01-01

    The nation's health care system is undergoing a period of rapid change that will profoundly affect women's health care services and, ultimately, women's health. Although managed care is quickly becoming the predominant mode of health care delivery in the United States, a new, more consumer-focused, and accountable model known as organized systems of care (OSC) is emerging. OSC development has been driven by large private and public employers seeking to purchase the highest quality health care for the best price. The changes in health care delivery encouraged by these innovative employers will provide women with optimal care and attention, which will in turn help them attract and retain a competitive and productive workforce. PMID:9127999

  13. Analysis of benzodiazepine withdrawal program managed by primary care nurses in Spain

    PubMed Central

    2012-01-01

    Background Benzodiazepine (BZD), the long-term treatment of which is harmful for cognitive function, is widely prescribed by General Practitioners in Spain. Based on studies performed in other countries we designed a nurse-led BZD withdrawal program adapted to Spanish Primary Care working conditions. Results A pseudo-experimental (before-after) study took place in two Primary Care Centres in Barcelona. From a sample of 1150 patients, 79 were identified. They were over 44 years old and had been daily users of BZD for a period exceeding six months. Out of the target group 51 patients agreed to participate. BZD dosage was reduced every 2-4 weeks by 25% of the initial dose with the optional support of Hydroxyzine or Valerian. The rating measurements were: reduction of BZD prescription, demographic variables, the Short-Form Health Survey (SF-12) to measure quality of life, the Medical Outcomes Study (MOS) Sleep Scale, and the Goldberg Depression and Anxiety Scale. By the end of the six-month intervention, 80.4% of the patients had discontinued BZD and 64% maintained abstinence at one year. An improvement in all parameters of the Goldberg scale (p <0.05) and in the mental component of SF-12 at 3.3 points (p = 0.024), as well as in most components of the MOS scale, was observed in the group that had discontinued BZD. No significant differences in these scales before and after the intervention were observed in the group that had not discontinued. Conclusions At one year approximately 2/3 of the patients had ceased taking BZD. They showed an overall improvement in depression and anxiety scales, and in the mental component of the quality of life scale. There was no apparent reduction in the sleep quality indicators in most of the analysed components. Nurses in a Primary Care setting can successfully implement a BZD withdrawal program. PMID:23237104

  14. The Chronic Disease Self-Management Program: the experience of frequent users of health care services and peer leaders

    PubMed Central

    Hudon, Catherine; Chouinard, Maud-Christine; Diadiou, Fatoumata; Bouliane, Danielle; Lambert, Mireille; Hudon, Émilie

    2016-01-01

    Background. Large amount of evidence supports the contribution of the Stanford Chronic Disease Self-Management Program (CDSMP) to a global chronic disease management strategy. However, many studies have suggested further exploring of the factors influencing acceptance and completion of participants in this program. Objective. This study aimed to describe and examine factors associated with acceptance and completion rates of the CDSMP among frequent users of health care services, and to highlight the experience of patients and peer leaders who facilitated the program. Methods. A descriptive design with mixed sequential data was used. Acceptance and completion rates were calculated and their relationship with patient characteristics was examined in regression analysis (n = 167). Interviews were conducted among patients who accepted (n = 11) and refused (n = 13) to participate and with the program coordinator. Focus groups were held with the seven peer leaders who facilitated the program. Data were analysed using thematic analysis. Results. Of the 167 patients invited, 60 (36%) accepted to participate in the program. Group format was the most frequent reason to decline the invitation to participate. Twenty-eight participants (47%) completed the program. Participants who dropped out during the program raised different reasons such as poor health and too much heterogeneity among participants. Factors such as location, schedule, content, group composition and facilitation were considered as important elements contributing to the success of the program. Conclusion. The CDSMP could therefore be considered as a self-management support option for this vulnerable clientele, while taking measures to avoid too much heterogeneity among participants to improve completion rates. PMID:26984994

  15. Effect of an Innovative Medicare Managed Care Program on the Quality of Care for Nursing Home Residents

    ERIC Educational Resources Information Center

    Kane, Robert L.; Flood, Shannon; Bershadsky, Boris; Keckhafer, Gail

    2004-01-01

    Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will…

  16. Development and implementation of a geriatric care/case management program in a military community-based family medicine residency.

    PubMed

    Williams, C M; Petrelli, J; Murphy, M

    2000-11-01

    This article discusses how the development of a longitudinal geriatric assessment form facilitated a case management program in identifying high-risk frail elders within a military family practice clinic. A careful review of geriatric assessment tools was performed. From this review, a model geriatric assessment form was developed. A "SWOT" (strengths, weaknesses, opportunities, and threats) analysis of the family medicine department was completed to determine if the environment was ready for case management. Analysis of the SWOT data revealed that the environment was favorable for a population-based approach to case management. Results of this initial study are encouraging. The new longitudinal geriatric assessment form has assisted family practice residents in organizing problems and data while seeing elderly patients. As a direct result, higher-risk frail elders have been identified for closer evaluation and follow-up. Future goals are to measure outcomes-based data and to refine the geriatric assessment process. PMID:11143424

  17. Medicare Pays for Chronic Care Management.

    PubMed

    Sorrel, Amy Lynn

    2015-09-01

    As of January, the Centers for Medicare & Medicaid Services began paying for chronic care management of patients with two or more conditions under its Chronic Care Management program. The payment applies to patients in traditional fee-for-service and noncapitated Medicare Advantage plan arrangements. Texas Medical Association leaders caution the program has some hefty requirements. PMID:26360339

  18. A Primary Care Migraine Education Program has Benefit on Headache Impact and Quality of Life: Results from the Mercy Migraine Management Program

    PubMed Central

    Smith, Timothy R.; Nicholson, Robert A.; Banks, James W.

    2010-01-01

    Objective The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine-related disability and quality of life, worry about headaches, self-efficacy for managing migraines, ER visits for headache, and satisfaction with headache care. Background Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been done to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (e.g., self-efficacy for managing headaches, worry about headaches). Methods In this open-label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache-related disability (as measured by the Headache Impact Test-6 (HIT-6), migraine-specific quality of life (MSQ), worry about headaches, self-efficacy for managing headaches, ER visits for headaches, and satisfaction with care at four time points over 12 months (baseline, 3 months, 6 months, 12 months). Results Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT-6 and MSQ (all p < .001). The improvement in headache impact and quality of life was greater among those who had

  19. Mediation and managed care.

    PubMed

    Dubler, N N

    1998-03-01

    Managed care has not only intensified existing conflicts between patient and provider, it has, by its very nature, changed the shape and scope of the healthcare enterprise and introduced an entirely new set of disputes. The decision-making dynamics have been altered, and the cast of players has expanded. Traditionally, the therapeutic interaction took place between the physician and the patient although it occasionally included the patient's family. Whatever obligations existed, such as fidelity, confidentiality, and standard of care, they bound only those parties. Now, as the managed care organization has interposed itself between the patient and the physician, the dyad has become a triad. The power balance has shifted, and a new set of rights and responsibilities now flows between and among the players, each of whom has interests that may or may not coincide. This article argues that, because of its cost containment origins and orientation, managed care increases the likelihood that misunderstandings, disagreements and disputes will develop into full-blown conflicts. If managed care is to succeed financially and operate with integrity, it must develop techniques for managing the increasing conflicts that arise inevitably between and among the organizations, physicians, and patients. It is clear that the voice of the patient needs to be strengthened within the new complex decision-making, review, and appeal procedures. Mediation is the most appropriate method of dispute resolution for the managed care setting because it balances the disparities in power endemic to the bureaucratization of medicine and refocuses the interests of the various parties. Using bioethics consultation as a model for dispute mediation provides a set of principles and guideline tasks that can be applied effectively to managed care. PMID:9514387

  20. Developing disease management programs.

    PubMed

    Herman, K

    1999-11-01

    Several market forces are driving interest in disease management and its growth, including the need to control costs; improve quality; attract, satisfy, and retain members; and meet accreditation requirements. People with chronic diseases and disabilities represent the most expensive and fastest-growing group of patients in health care, and agencies that develop successful disease management programs for these populations will reap a variety of benefits. PMID:10661985

  1. "This place has given me a reason to care": Understanding 'managed alcohol programs' as enabling places in Canada.

    PubMed

    Evans, Joshua; Semogas, Dyanne; Smalley, Joshua G; Lohfeld, Lynne

    2015-05-01

    For several decades, the emphasis on abstinence within homeless support systems has presented significant barriers to care for those who continue to use alcohol or drugs further marginalizing them in terms of housing and health/social services. In response, health care specialists and policymakers have recommended the integration of harm reduction philosophies and interventions into system-level responses to end homelessness. Managed alcohol programs (MAPs) have been developed to this end and have demonstrated positive results. While recent studies of MAPs have focused attention on reductions in alcohol related harms few have examined their meaning from the perspective of clients or considered the role of place. In this paper, we utilize the 'enabling places' frameworks to identify the place-bound properties that make a difference in the recovery journeys of clients. Drawing on in-depth interviews with clients from one program we develop a description of MAPs as enabling places that afford the elemental resources for personal recovery. PMID:25817940

  2. Parent Managed Day Care. Indian-Style.

    ERIC Educational Resources Information Center

    Taylor, Helen L. Sally

    The efforts of a group of Quinault parents and the Early Childhood Education program of Edmonds College resulted in the establishment of a quality child care program which is parent managed, relevant to the community, and able to meet state requirements for day care. Funded by a Technical Assistance Contract and administered by Alaska Federated…

  3. Managed care opportunities for improving asthma care.

    PubMed

    Campbell, Jonathan D

    2011-04-01

    Uncontrolled asthma is an enormous burden in terms of the propensity to reach asthma control in the future, direct and indirect costs, and health-related quality of life. The complex pathophysiology, treatment, and triggers of asthma warrant a unified, yet targeted, approach to care. No single factor is fully responsible for poor control. Complicating the problem of asthma control is adherence to long-term controller medications. The National Asthma Education and Prevention Program (NAEPP) established several key points for asthma control, and developed classifications for asthma control and recommended actions for treatment. All parties involved in the management of asthma, including physicians, pharmacists, nurses, patients, family members, and insurance companies, need to be aware of the NAEPP guidelines. To determine if the goals of asthma therapy are being met, assessment of asthma outcomes is necessary. Unfortunately, some measures may get overlooked, and patient-reported outcomes (as assessed by the validated control instruments) are not often collected during routine examinations. The Healthcare Effectiveness Data and Information Set measure for asthma may be used to quantify asthma care, but there is evidence that it does not fully capture the goals of asthma management. Most well-designed, education-based interventions are considered good value for money, but it can be difficult to put into practice such policy interventions. An optimal managed care plan will adhere to known evidence-based guidelines, can measure outcomes, is targeted to the patient's risk and impairment, and can adapt to changes in our understanding of asthma and its treatment. PMID:21761959

  4. Illinois: Child Care Collaboration Program

    ERIC Educational Resources Information Center

    Center for Law and Social Policy, Inc. (CLASP), 2012

    2012-01-01

    The Illinois Child Care Collaboration Program promotes collaboration between child care and other early care and education providers, including Early Head Start (EHS), by creating policies to ease blending of funds to extend the day or year of existing services. While no funding is provided through the initiative, participating programs may take…

  5. Future management opportunities for minorities in managed care.

    PubMed

    Phillips, J N

    1994-01-01

    Current proposals for health care reform emphasize managed care in an effort to achieve universal coverage and access to health care for all Americans. One of the many strategies to achieve this goal is to create a new health care workforce by supporting the recruitment and education of health professionals from population groups underrepresented in health care. To help insure that the managed care industry will be adequately prepared to face the challenges of reform, the Group Health Foundation of the Group Health Association of America, Inc., has crafted an innovative Minority Training Program--a management training program in the field of managed care. The program involves resident fellows who will train in select health maintenance organizations (HMOs) in the Washington, DC/Baltimore metropolitan area. To augment training, the fellows will simultaneously participate in a comprehensive didactic program especially designed to prepare each fellow for a first or middle-management position in an HMO or a similar managed care organization. Following successful completion of the first years in Washington, DC, the program will be broadened to other geographical areas. PMID:7918893

  6. Day Care Center Enrichment Program.

    ERIC Educational Resources Information Center

    West Virginia State Dept. of Welfare, Charleston.

    This guide to a West Virginia Department of Welfare project for upgrading the quality of day care centers throughout the state presents samples of the forms used in the program, accompanied by a brief description of the program's format, requirements and procedures. The Day Care Center Enrichment Program provides a monetary incentive for…

  7. The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis: utilization and valuation by patients

    PubMed Central

    Jongen, Peter Joseph; Sinnige, Ludovicus G; van Geel, Björn M; Verheul, Freek; Verhagen, Wim I; van der Kruijk, Ruud A; Haverkamp, Reinoud; Schrijver, Hans M; Baart, Jacoba C; Visser, Leo H; Arnoldus, Edo P; Gilhuis, Herman Jacobus; Pop, Paul; Booy, Monique; Heerings, Marco; Kool, Anton; van Noort, Esther

    2016-01-01

    Background MSmonitor is an interactive web-based program for self-management and integrated, multidisciplinary care in multiple sclerosis. Methods To assess the utilization and valuation by persons with multiple sclerosis, we held an online survey among those who had used the program for at least 1 year. We evaluated the utilization and meaningfulness of the program’s elements, perceived use of data by neurologists and nurses, and appreciation of care, self-management, and satisfaction. Results Fifty-five persons completed the questionnaire (estimated response rate 40%). The Multiple Sclerosis Impact Profile (MSIP), Medication and Adherence Inventory, Activities Diary, and electronic consultation (e-consult) were used by 40%, 55%, 47%, and 44% of respondents and were considered meaningful by 83%, 81%, 54%, and 88%, respectively. During out-patient consultations, nurses reportedly used the MSmonitor data three to six times more frequently than neurologists. As to nursing care, more symptoms were dealt with (according to 54% of respondents), symptoms were better discussed (69%), and the overall quality of care had improved (60%) since the use of the program. As to neurological care, these figures were 24%, 31%, and 27%, respectively. In 46% of the respondents, the insight into their symptoms and disabilities had increased since the use of the program; the MSIP, Activities Diary, and e-consult had contributed most to this improvement. The overall satisfaction with the program was 3.5 out of 5, and 73% of the respondents would recommend the program to other persons with multiple sclerosis. Conclusion A survey among persons with multiple sclerosis using the MSmonitor program showed that the MSIP, Medication and Adherence Inventory, Activities Diary, and e-consult were frequently used and that the MSIP, Medication and Adherence Inventory, and e-consult were appreciated the most. Moreover, the quality of nursing care, but not so neurological care, had improved, which

  8. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program

    PubMed Central

    Lalonde, Lyne; Choinière, Manon; Martin, Elisabeth; Lévesque, Lise; Hudon, Eveline; Bélanger, Danielle; Perreault, Sylvie; Lacasse, Anaïs; Laliberté, Marie-Claude

    2015-01-01

    Purpose There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. Methods Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups. Results Challenges identified in focus group discussions were related to five dimensions: knowledge gap, “work in silos”, lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs. Conclusion Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients. PMID:25995648

  9. The continuing antenatal management program (CAMP): Outpatient monitoring of high-risk pregnancies. Keeps patients safe, costs low and care nearby.

    PubMed

    Hughes, Dawn S; Ussery, Donna J; Woodruff, Dawn L; Sandlin, Adam T; Kinder, Sarah R; Magann, Everett F

    2015-06-01

    A program was developed for referred, stable, high-risk obstetrical patients allowing them to receive antenatal care close to a tertiary hospital without the costs of a hospital admission. There were 426 women managed from September 2007 through December of 2012 with diagnosis of preterm labor, fetal anomalies, hypertensive disorders, placental abruption and other conditions. This management saved the hospital almost $9,000,000 USD or $20,956 USD per patient. PMID:25998879

  10. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Primary care case management services. 440.168... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case management...

  11. Insights into managed care--operational, legal and actuarial.

    PubMed

    Melek, S P; Johnson, B A; Schryver, D

    1997-01-01

    Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others. PMID:10165777

  12. Exploring the Effectiveness of an Internet-Based Program for Reducing Caregiver Distress Using the iCare Stress Management e-Training Program

    PubMed Central

    Kajiyama, Bruno; Thompson, Larry W.; Eto-Iwase, Tamiko; Yamashita, Mio; Di Mario, John; Tzuang, Yuan Marian; Gallagher-Thompson, Dolores

    2013-01-01

    OBJECTIVE Determine if the online iCare Stress Management e-Training Program reduces stress, bother depression and poor life quality for dementia family caregivers (CGs). METHOD CGs (N=150) were randomly assigned to the iCare Condition (ICC) or to the Education/Information-Only Condition (EOC) for a 3-month periodChange in self-report measures of stress (PSS) (primary outcome), caregiver bother(RMBPC), depression (CES-D) and quality of life (PQOL) (secondary outcomes) was determined, along with usage of new information in one’s own caregiving. RESULTS A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC (p = .017). Changes in the other measures were not significant. More caregivers in the ICC used the materials in their own caregiving situation than those in the EOC. Roughly one-third of the caregivers enrolled in the study dropped prior to completion. CONCLUSION Results are promising, but the high dropout is a concern. Future efforts to improve dropout rate and increase participant engagement are warranted. To our knowledge this is the first attempt to present an evidence-based intervention for CGs via the Internet. PMID:23461355

  13. Organizing for effective managed care contracting.

    PubMed

    Mayer, T

    2001-01-01

    While many forums have debated the fairness and ethical implications of managed care arrangements, it is unlikely that physicians will escape practicing within fixed budgets in the future; the economics of health care simply requires it. Although a backlash has developed against managed care, it is actually more recognition of how pervasive it has become, rather than any threat to its existence. Currently managed care comprises the majority of commercial insurance, is making substantial inroads into Medicaid, and is challenging the reductions in Medicare reimbursement by dropping plans at a time when the Federal government's entire strategy for controlling Medicare costs is based upon managed care through its Medicare+Choice program. PMID:11317578

  14. A Pilot Study Exploring After-School Care Providers' Response to the Incredible Years Classroom Management Program

    ERIC Educational Resources Information Center

    Hicks-Hoste, Taylor B.; Carlson, John S.; Tiret, Holly B.

    2015-01-01

    The need for and importance of bringing evidence-based interventions into school settings has been firmly established. Adapting and adjusting intervention programs to meet the unique needs of a school district requires personnel to use a data-based approach to implementation. This pilot study is the first to report on after-school care providers'…

  15. Managed care and unintended pregnancy.

    PubMed

    Gold, R B; Richards, C L

    1998-01-01

    This article assesses the adequacy of coverage of contraceptive services and supplies for US women in the various types of managed care plans, with special attention to Medicaid. Between 1993 and 1995, the percent of insured private-sector employees enrolled in managed care plans rose from 51% to 73%. By 1996, the health care of 40% of low-income Medicaid recipients was also under managed care administration. Although 84% of managed care plans cover oral contraceptives--a rate substantially higher than that for traditional indemnity plans, several logistic factors impede access to this and other reproductive health benefits. The requirement of preauthorization may delay access to care when timely presentation is essential to the prevention of unwanted pregnancy. Some plans restrict members to one visit per year with an obstetrician-gynecologist. Coordination of an enrollee's total health care through the primary care physician can raise confidentiality problems for those who seek sensitive reproductive health services. There are fewer restrictions on the access of Medicaid recipients to family planning providers and services, but treatment of sexually transmitted diseases may not be part of the reproductive health package. The explosion of managed care onto the US health care market has led to public sector regulation legislation--a process that is proceeding in a piecemeal rather than comprehensive way. Because of the importance of reproductive health care to the lives of women, communities, and the broader society, more systematic action on this front is essential. PMID:9638081

  16. Managed care and reproductive health.

    PubMed

    Cohen, S S; Williams, D R

    1998-01-01

    Managed care poses special challenges to midwives providing reproductive health care. This is owing to the sensitive nature of issues surrounding reproductive health and aspects of managed care that may impede a woman's ability to obtain continuous, confidential, and comprehensive care from the provider of her choice. Variations across payers (ie, Medicare, Medicaid, and commercial insurers) regarding covered benefits and reimbursement of midwifery services also may create obstacles. Furthermore, some physicians and managed care organizations are embracing policies that threaten the ability of midwives to function as primary health care providers for women. Despite these hurdles, midwives have the potential to remain competitive in the new marketplace. This article underscores the importance of being knowledgeable about legislation and policy issues surrounding the financing of midwifery services, quality performance measurement for HMOs as they pertain to reproductive health, and discussions regarding which clinicians should be defined as primary care providers. PMID:9674347

  17. “Second-Generation” Medicaid Managed Care: Can It Deliver?

    PubMed Central

    Gold, Marsha; Mittler, Jessica

    2000-01-01

    This article offers insight into what we term “second-generation” Medicaid managed care. In case studies of seven States, we examined three critical questions: (1) Does managed care experience facilitate program operations? (2) Can Medicaid managed care deliver on important goals? and (3) Can States extend the program beyond low-income families and children to others? The answers are encouraging but also suggest caution. Medicaid managed care is not a solution to fundamental problems facing the Medicaid program. It may be a tool to encourage better delivery of care. This requires a long-term commitment and adequate financing to develop stable partnerships with all stakeholders. PMID:12500319

  18. Daily bowel care program

    MedlinePlus

    ... a brain or spinal cord injury. People with multiple sclerosis also have problems with their bowels. Symptoms may ... PA: Elsevier Saunders; 2010:chap 17. Read More Multiple sclerosis Recovering after stroke Patient Instructions Constipation - self-care ...

  19. Managed care and efficient rationing.

    PubMed

    Rosenthal, Meredith B; Newhouse, Joseph P

    2002-01-01

    Widespread dissatisfaction with managed care has led to calls for major reform and consumer protection. Although some have concluded that managed care backlash is simply a result of too much rationing, we propose an alternative view that focuses on the nature of services eliminated by managed care. In particular, we point out that managed care rations services largely without regard to consumer preferences. We question whether managed care's emphasis on supply-side control of moral hazard is consistent with the principles of efficient rationing. Further research on the nature of provider and consumer rationing decisions is needed to inform the design of supply-side and demand-side incentives that will lead to an efficient allocation of services. PMID:12148660

  20. Meeting Abstracts - Academy of Managed Care Pharmacy Nexus 2016.

    PubMed

    2016-10-01

    The Academy of Managed Care Pharmacy (AMCP) Abstracts program provides a forum through which authors can share their insights and outcomes of advanced managed care practice through publication in AMCP's Journal of Managed Care & Specialty Pharmacy (JMCP). Poster presentations are Tuesday, October 4, at 4:00 pm. The posters will also be displayed on Wednesday, October 5. The reviewed abstracts are published in the JMCP Meeting Abstracts supplement. The AMCP Nexus 2016 Meeting in National Harbor, Maryland, is expected to attract more than 2,000 managed care pharmacists and other health care professionals who manage and evaluate drug therapies, develop and manage networks, and work with medical managers and information specialists to improve the care of all individuals enrolled in managed care programs. PMID:27611065

  1. Acceptability and Feasibility of a Mobile Phone-Based Case Management Intervention to Retain Mothers and Infants from an Option B+ Program in Postpartum HIV Care.

    PubMed

    Schwartz, Sheree R; Clouse, Kate; Yende, Nompumelelo; Van Rie, Annelies; Bassett, Jean; Ratshefola, Mamothe; Pettifor, Audrey

    2015-09-01

    The objective of this study was to assess the acceptability and feasibility of a cell phone based case manager intervention targeting HIV-infected pregnant women on highly-active antiretroviral therapy (HAART). Pregnant women ≥36 weeks gestation attending antenatal care and receiving HAART through the Option B+ program at a primary care clinic in South Africa were enrolled into a prospective pilot intervention to receive text messages and telephone calls from a case manager through 6 weeks postpartum. Acceptability and feasibility of the intervention were assessed along with infant HIV testing rates and 10-week and 12-month postpartum maternal retention in care. Retention outcomes were compared to women of similar eligibility receiving care prior to the intervention. Fifty women were enrolled into the pilot from May to July 2013. Most (70%) were HAART-naive at time of conception and started HAART during antenatal care. During the intervention, the case manager sent 482 text messages and completed 202 telephone calls, for a median of 10 text messages and 4 calls/woman. Ninety-six percent completed the postpartum interview and 47/48 (98%) endorsed the utility of the intervention. Engagement in 10-week postpartum maternal HIV care was >90% in the pre-intervention (n = 50) and intervention (n = 50) periods; by 12-months retention fell to 72% and was the same across periods. More infants received HIV-testing by 10-weeks in the intervention period as compared to pre-intervention (90.0 vs. 63.3%, p < 0.01). Maternal support through a cell phone based case manager approach was highly acceptable among South African HIV infected women on HAART and feasible, warranting further assessment of effectiveness. PMID:25656728

  2. Types of Managed Care Plans

    MedlinePlus

    ... AAP Find a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting ... Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Types of Managed Care Plans Family Life Listen ...

  3. Glossary of Managed Care Definitions

    MedlinePlus

    ... managed care plan who review new drugs and biotechnology products to decide which ones the plan will ... to evaluate new tests, treatments, drugs, medical devices, biotechnology products, and surgical procedures, to decide what the ...

  4. A rural primary care pediatric residency program.

    PubMed

    Kairys, S; Newell, P

    1985-10-01

    Rural primary care is often reported in the medical literature as frustrating, lonely, and nonrewarding. Many graduating residents who choose small town practice become quickly disenchanted with the life-style and leave for a more populous territory or subspecialty training. Opportunities to learn how to take advantage of rural settings and establish rewarding community practices are few. The Primary Care Pediatric Residency Program at the Dartmouth-Hitchcock Medical Center has developed a training program in rural primary care. Residents experience over a three-year period the many facets of rural practice and are introduced to community-oriented approaches to child health care. Selected rural pediatric practices within a 45-mile radius of the medical center serve as teaching laboratories in which residents develop the skills necessary to manage children's problems related to school, behavioral disorders, and chronic diseases. PMID:4045973

  5. Accountability and quality in managed care: implications for health care practitioners.

    PubMed

    Dobalian, A; Rivers, P A

    1998-01-01

    The development of managed care plans is the most dramatic change in the USA's health care system in recent decades. Despite the widespread growth, society is increasingly concerned with the quality of managed care programs. This article addresses the regulatory pressures that are being placed on managed care organisations and examines what health care practitioners can do to minimize the impact of increased regulation. We look at the major factors that are likely to bring about changes in the health care sector, and predict how these changes will affect the quality of health care that is being delivered in the near future. Addresses how quality can become and remain the primary factor in the delivery of health care services. Finally, concludes that greater involvement by the federal government is necessary to protect consumers' rights, and ensure better quality health care from managed care programs. PMID:10185327

  6. State Medicaid managed care enrollment: understanding the political calculus that drives Medicaid managed care reforms.

    PubMed

    Pracht, Etienne E

    2007-08-01

    The objective of this article is to understand the political motivations underlying Medicaid managed care reforms by examining the determinants of enrollment of beneficiaries in managed care plans in the fifty states. To highlight the role of the model variables, including measures of the political environment, public interest, and special interests, a distinction is made between capitated and fee-for-service managed care enrollment. The results show that cost containment within the context of the Medicaid program is perceived as strongly favored by voters. Accordingly, the relative cost and tax price of providing Medicaid services are important factors in states' decision to enroll Medicaid beneficiaries in managed care plans, particularly capitated ones. The results also indicate a surprisingly significant influence by labor unions that generally oppose managed care enrollment for fears of lost jobs. The recipient population and provider groups also play an important role in shaping the Medicaid managed care landscape. The influence of variables measuring states' ability and willingness to pay and median voter preferences suggest that, within the context of Medicaid managed care enrollment, the public's interests are being served; however, the results also point toward inequities within the program and implications concerning financing arrangements between states and the federal government. PMID:17639017

  7. Managing Malnutrition in Older Persons Residing in Care Homes: Nutritional and Clinical Outcomes Following a Screening and Intervention Program.

    PubMed

    Mountford, Christopher G; Okonkwo, Arthur C O; Hart, Kathryn; Thompson, Nick P

    2016-01-01

    This study aimed to establish prevalence of malnutrition in older adult care home residents and investigate whether a nutritional screening and intervention program could improve nutritional and clinical outcomes. A community-based cohort study was conducted in five Newcastle care homes. 205 participants entered; 175 were followed up. Residents already taking oral nutritional supplements (ONS) were excluded from interventions. Those with Malnutrition Universal Screening Tool (MUST) score of 1 received dietetic advice and ≥2 received dietetic advice and were prescribed ONS (220 ml, 1.5 kcal/ml) twice daily for 12 weeks. Body mass index (BMI), MUST, mini nutritional assessment score (MNA)®, mid upper arm muscle circumference (MAMC), and Geriatric Depression Scale (GDS) were recorded at baseline and 12 weeks. Malnutrition prevalence was 36.6% ± 6.6 (95% CI). A higher MUST was associated with greater mortality (p = 0.004). Type of intervention received was significantly associated with change in MUST score (p < 0.001); dietetic advice resulting in the greatest improvement. There were no significant changes in BMI (p = 0.445), MAMC (p = 0.256), or GDS (p = 0.385) following the interventions. Dietitian advice may slow the progression of nutritional decline. In this study oral nutritional supplements over a 3-month period did not significantly improve nutritional status in malnourished care home residents. PMID:26885946

  8. Pain management and health care policy.

    PubMed

    Naccache, Nicole; Abou Zeid, Hicham; Nasser Ayoub, Eliane; Antakly, Marie-Claire

    2008-01-01

    Opioid analgesics are essential for the management of moderate to severe pain. In spite of their documented effectiveness, opioids are often underutilized, a factor which has contributed significantly to the undertreatment of pain. Many countries have developed true national policies on cancer pain and palliative care, and in others only guidelines for care have been developed. Ideally, national policies facilitate and legislate not only a patient's right to care, but also the necessary components of education and drug availability which are so critical for the appropriate achievement of public health programs. PMID:19534079

  9. Medicaid and Managed Care: Key Data, Trends, and Issues

    MedlinePlus

    ... states except Alaska, New Hampshire, and Wyoming reported operating comprehensive MMC programs as of October 2010. 1 ... 000. In addition to PACE, 11 states report operating additional capitated, managed long-term care programs, in ...

  10. Knowledge management in health care.

    PubMed

    Guptill, Janet

    2005-01-01

    It is a long-term, sustainable commitment to changing the culture of health care to become more collaborative, more transparent, and more proactive. Knowledge management, implemented well, will transform the health care delivery system over the next few decades, into a more cost-effective, error-averse, and accountable public resource. For the sake of simplicity, this article will limit the application of knowledge management principles to the context of hospitals, hospital systems or associations, or other groupings of hospitals based on a common interest or focus. The field of knowledge management has tremendous application and value to the health care industry, particularly for hospitals and hospital systems. For many who have invested in a knowledge management infrastructure, it has become the measure of value of belonging to a hospital system or membership organization. PMID:16080410

  11. Managing Mentoring Programs.

    ERIC Educational Resources Information Center

    IUME Briefs, 1992

    1992-01-01

    Some programs for helping at-risk youth achieve excellent results, while others do not. One reason for program success can be proper management. Mentoring is a promising strategy for helping at-risk youth. Planners who want to create effective mentoring programs should look at the implementation experiences of other youth programs. Evaluations…

  12. Women's health services: restructuring for Medicaid managed care.

    PubMed

    Loughlin, J; Bronner, E F; Mascari, J S

    1997-04-01

    New Jersey health care providers face the need to change dramatically the way health care is delivered as it enters a new era of managed care. This year, more than 24% of New Jersey's total population is enrolled in commercial managed care plans (New Jersey Department of Insurance, 1996). In addition, the state's Medicaid agency took steps to improve the delivery of health services to recipients by initiating implementation activities to transition from the traditional Medicaid program to a managed care model. Eighty-two percent of New Jersey's Aid to Families with Dependent Children (AFDC) and related populations have already been enrolled in managed care. The state plans to expand enrollment in managed care to the remaining 400,000 Medicaid beneficiaries. Communities with high Medicaid populations are challenged with the need to move through the managed care evolution at an accelerated rate. PMID:10181608

  13. The Prenatal Care at School Program

    ERIC Educational Resources Information Center

    Griswold, Carol H.; Nasso, Jacqueline T.; Swider, Susan; Ellison, Brenda R.; Griswold, Daniel L.; Brooks, Marilyn

    2013-01-01

    School absenteeism and poor compliance with prenatal appointments are concerns for pregnant teens. The Prenatal Care at School (PAS) program is a new model of prenatal care involving local health care providers and school personnel to reduce the need for students to leave school for prenatal care. The program combines prenatal care and education…

  14. Managed dental care in the HMO setting.

    PubMed

    Gong, C C

    1995-01-01

    DHMOs are gaining in popularity, and are the fastest-growing dental managed-care product, primarily because of their ability to reduce premium and patient costs. Dentistry, because of the strong correlation between prevention and disease control, is more suited to a managed-care system than medicine. However, there remains a wide gulf between theory and practice, as the DHMO industry continues to evolve. Poorly designed programs will save money but create problems with patient satisfaction and unmet treatment needs. Well-designed programs use the principles of population management to bring large numbers of patients to maintenance oral health levels. In any event, the continuing growth and development of DHMOs will benefit patients, group purchasers, and the dentists who can understand and embrace the concepts of dentistry in the HMO environment. PMID:9161149

  15. Reengineering health care materials management.

    PubMed

    Connor, L R

    1998-01-01

    Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management. PMID:9785300

  16. Constructing a conflict resolution program for health care.

    PubMed

    Porter-O'Grady, Tim

    2004-01-01

    Resolving conflict throughout organizations requires a programmatic infrastructure and a committed management team. Leaders must recognize the need to approach conflict by building a format for learning, creating and managing an effective conflict management program. Careful attention to the elements of design and the stages of development can make all the difference in building a sustainable and useful conflict management approach. PMID:15600105

  17. Adolescent Child Care Program, 1992-93: OREA Report.

    ERIC Educational Resources Information Center

    Renfro, Sally

    The Program for Pregnant and Parenting Services (PPPF) assists children in the New York City public school system who also happen to be parents. In 1993 the program received a federal child care and development block grant which was used to augment the child development, child care, and case management services provided to their student clientele.…

  18. Navigator program risk management

    NASA Technical Reports Server (NTRS)

    Wessen, Randii R.; Padilla, Deborah A.

    2004-01-01

    In this paper, program risk management as applied to the Navigator Program: In Search of New Worlds will be discussed. The Navigator Program's goals are to learn how planetary systems form and to search for those worlds that could or do harbor life.

  19. Medicaid Managed Care and the Unmet Need for Mental Health Care among Children with Special Health Care Needs

    PubMed Central

    Tang, Michael H; Hill, Kristen S; Boudreau, Alexy A; Yucel, Recai M; Perrin, James M; Kuhlthau, Karen A

    2008-01-01

    Objective To determine the association between Medicaid managed care pediatric behavioral health programs and unmet need for mental health care among children with special health care needs (CSHCN). Data Source The National Survey of CSHCN (2000–2002), using subsets of 4,400 CSHCN with Medicaid and 1,856 CSHCN with Medicaid and emotional problems. Additional state-level sources were used. Study Design Multilevel models investigated the association between managed care program type (carve-out, integrated) or fee-for-service (FFS) and reported unmet mental health care need. Data Collection/Extraction Methods The National Survey of CSHCN conducted telephone interviews with a sample representative at both the national and state levels. Principal Findings In multivariable models, among CSHCN with only Medicaid, living in states with Medicaid managed care (odds ratio [OR]=1.81; 95 percent confidence interval: 1.04–3.15) or carve-out programs (OR=1.93; 1.01–3.69) were associated with greater reported unmet mental health care need compared with FFS programs. Among CSHCN on Medicaid with emotional problems, the association between managed care and unmet need was stronger (OR=2.48; 1.38–4.45). Conclusions State Medicaid pediatric behavioral health managed care programs were associated with greater reported unmet mental health care need than FFS programs among CSHCN insured by Medicaid, particularly for those with emotional problems. PMID:18454773

  20. Lessons Learned From Transitioning PEPFAR Track 1.0 Care and Treatment Programs: Case Studies in Financial Management Capacity Building in Zambia and Botswana.

    PubMed

    Kuehn, Chuck; Tidwell, George; Vhugen, Jann; Sharma, Anjali

    2015-01-01

    In 2008, the United States government mandated transition of internationally managed HIV care and treatment programs to local country ownership. Three case studies illustrate the US Health Resources Services Administration's fiscal assessment and technical assistance (TA) processes to strengthen local organizations' capabilities to absorb and manage United States government funding. Review of initial, TA and follow-up reports reveal that the 1 Botswanan and 2 Zambian organizations closed 10 of 17 financial capacity gaps, with Health Resources Services Administration assisting on 2. Zambian organizations requested and absorbed targeted TA on the basis of the consultant's desk review, their finance staff revised fiscal policies and procedures, and accordingly trained other staff. In Botswana, delays in integrating recommendations necessitated on-site TA for knowledge building and role modeling. Organizational maturity may explain differences in responsiveness, ownership, and required TA approaches. Clarifying expectations of capacity building, funding agreement, and nonmonetary donor involvement can help new organizations determine and act on intervening actions. PMID:25514757

  1. Managing high-risk patients: the Mass General care management programme

    PubMed Central

    Kodner, Dennis L.

    2015-01-01

    The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing

  2. Managing high-risk patients: the Mass General care management programme.

    PubMed

    Kodner, Dennis L

    2015-01-01

    The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries-primarily older persons-with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a "whole systems" approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing structure

  3. Trust and trustworthy care in the managed care era.

    PubMed

    Gray, B H

    1997-01-01

    Trust is essential to the doctor/patient relationship, but trust in physicians' fiduciary ethic has become less plausible as a protector of patients' interests. The rise of managed care often is seen as undermining the fiduciary ethic and lessening the trustworthiness of care. But can managed care enhance that trustworthiness? Four possible sources of trustworthiness in managed care are discussed: ethical standards in the managed care industry, nonprofit organizations, physician control, and performance monitoring by purchasers. Limitations on all of these fronts suggest the continuing importance of a strong fiduciary ethic on the part of physicians who make patient care decisions. PMID:9018941

  4. The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis: concept, content, and pilot results

    PubMed Central

    Jongen, Peter Joseph; Sinnige, Ludovicus G; van Geel, Björn M; Verheul, Freek; Verhagen, Wim I; van der Kruijk, Ruud A; Haverkamp, Reinoud; Schrijver, Hans M; Baart, J Coby; Visser, Leo H; Arnoldus, Edo P; Gilhuis, H Jacobus; Pop, Paul; Booy, Monique; Lemmens, Wim; Donders, Rogier; Kool, Anton; van Noort, Esther

    2015-01-01

    Background There is a growing need to offer persons with multiple sclerosis (PwMS) possibilities for self-management and to integrate multidisciplinary health data. In 2009–2014 we developed a patient-reported outcome based, interactive, web-based program (MSmonitor) for (self-)monitoring, self-management and integrated, multidisciplinary care in MS. Methods The notions underlying the MSmonitor concept and the program’s elements are described. We analyze MSmonitor’s role in the self-management of fatigue by retrospective comparison of fatigue and health-related quality of life (HRQoL) before and after usage of specific elements of MSmonitor, and by a correlative analysis between frequency of usage and fatigue change. Results After a step-wise development the program comprises six validated questionnaires: Multiple Sclerosis Impact Profile, Modified Fatigue Impact Scale-5 items (MFIS-5), Hospital Anxiety and Depression Scale, Multiple Sclerosis Quality of Life-54 items, and the 8-item Leeds Multiple Sclerosis Quality of Life (LMSQoL) questionnaires; two inventories: Medication and Adherence Inventory, Miction Inventory; two diaries: Activities Diary, Miction Diary; and two functionalities: e-consult and personal e-logbook. The program is now used in 17 hospitals by 581 PwMS and their neurologists, MS nurses, physical therapists, rehabilitative doctors, continence nurses, and family doctors. Those PwMS (N=105) who used the LMSQoL and MFIS-5 questionnaires at least twice in a period of up to 6 months, showed improved HRQoL (P<0.026). In the subgroup (N=56) who had also used the Activities Diary twice or more, the frequency of diary usage correlated modestly with the degree of fatigue improvement (r=0.292; P=0.028). Conclusion MSmonitor is an interactive web-based program for self-management and integrated care in PwMS. Pilot data suggest that the repeated use of the short MFIS-5 and LMSQoL questionnaires is associated with an increase in HRQoL, and that a

  5. Leaders, managers, and employee care.

    PubMed

    Stewart, Della W

    2012-01-01

    With the economic and market changes currently taking place, organizations cannot survive or prosper without quality employees. Key to employee loyalty, performance, and retention is the relationship between the leader, manager, and employee. Leaders are visionaries who make sure that the right things are done for the organization. Managers are in a position to make sure that things are done right within the organization. There are traits and qualities that good leaders and managers must possess to ensure organizational success. Displaying these characteristics will ensure that employees are taken care of, which will benefit both the employees and the organization. PMID:22282003

  6. Beware the Managed Health-Care Companies.

    ERIC Educational Resources Information Center

    Ashbaugh, John; Smith, Gary

    1996-01-01

    This article discusses implications of the movement toward managed health care models for long-term health care services for people with disabilities, especially people with developmental disabilities. It notes possible advantages of managed care but raises issues concerning consumer choice, management and financial capacity of managed care…

  7. Dairy Herd Management Program.

    PubMed

    Lehenbauer, T W

    1987-11-01

    The Dairy Herd Management Program has served both dairymen and veterinarians very well over the past several years under a variety of conditions. A number of veterinarians have used the Dairy Herd Management Program to provide computerized dairy record service to their clients. In many of these situations, clients have decided to purchase a computer system of their own after discovering the value of having improved, computerized dairy records. The Dairy Herd Management Program is able to efficiently handle data from large dairies without disrupting daily record-keeping routines. With this data, useful reports are generated that measure actual reproductive performance against target levels or goals. Because the Dairy Herd Management Program focuses on specific time intervals and includes data from culled cows, trends or drops in reproductive performance are more quickly detected so that corrective action can be taken to minimize economic losses. The Dairy Herd Management Program's strong points include batch entry of data, an inclusive yet flexible Vet Check List of cows to be examined, and a detailed, comprehensive Reproductive Summary report. Its major weakness is the lack of a custom report generator for specific situations or conditions. This problem is being addressed in the new version. With the improvements scheduled for the new version, the Dairy Herd Management Program should be able to meet all of the needs of dairy managers and veterinarians alike, as well as become a powerful tool for conducting dairy reproductive field trials and research. PMID:3319081

  8. Legal implications of managed care arrangements.

    PubMed

    Knox, W A; Epstein, D M

    1994-09-01

    Prior to the 1980s, managed care was virtually nonexistent as a force in health care. Presently, 64 percent of employees in America are covered by managed care plans, including health maintenance organizations (20 percent) and preferred provider organizations (44 percent). In contrast, only 29 percent of employees were enrolled in managed care plans in 1988 and only 47 percent in 1991. To date, the primary reason for this incredible growth in managed care has been economic-market pressure to reduce health care costs. For the foreseeable future, political pressures are likely to fuel this growth, as managed care is at the center of President Clinton's national health care plan. Although there are numerous legal issues surrounding managed care, this article focuses primarily on antitrust implications when forming managed care entities. In addition, the corporate practice of medicine doctrine, certain tax issues, and the fraud and abuse laws are discussed. PMID:10139076

  9. Medicaid Confronts a Changing Managed Care Marketplace

    PubMed Central

    Hurley, Robert E.; Draper, Debra A.

    2002-01-01

    After two decades of concerted efforts, more than one-half of all Medicaid beneficiaries are now enrolled in managed care arrangements. Most States appear strongly committed to continued reliance on managed care, but the contemporary managed care marketplace is undergoing a number of significant changes. We describe how several of these developments are being revealed in commercial managed care and discuss implications for Medicaid purchasers and beneficiaries. State Medicaid agencies will have to adapt managed care strategies to respond to the evolving products and practices of managed care plans and their interest in public sector product lines. PMID:12545597

  10. Does managed care affect the diffusion of psychotropic medications?

    PubMed Central

    Domino, Marisa E.

    2011-01-01

    Newer technologies to treat many mental illnesses have shown substantial heterogeneity in diffusion rates across states. In this paper, I investigate whether variation in the level of managed care penetration is associated with changes in state-level diffusion of three newer classes of psychotropic medications in fee-for-service Medicaid programs from 1991-2005. Three different types of managed care programs are examined: capitated managed care, any type of managed care and behavioral health carve-outs. A fourth order polynomial fixed effect regression model is used to model the diffusion path of newer antidepressant and antipsychotic medications controlling for time-varying state characteristics. Substantial differences are found in the diffusion paths by the degree of managed care use in each state Medicaid program. The largest effect is seen through spillover effects of capitated managed care programs; states with greater capitated managed care have greater initial shares of newer psychotropic medications. The influence of carve-outs and of all types of managed care combined on the diffusion path was modest. PMID:21384465

  11. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168 Primary care case management services. (a)...

  12. Managed care: the US experience.

    PubMed Central

    Sekhri, N. K.

    2000-01-01

    This article provides an overview of managed health care in the USA--what has been achieved and what has not--and some lessons for policy-makers in other parts of the world. Although the backlash by consumers and providers makes the future of managed care in the USA uncertain, the evidence shows that it has had a positive effect on stemming the rate of growth of health care spending, without a negative effect on quality. More importantly, it has spawned innovative technologies that are not dependent on the US market environment, but can be applied in public and private systems globally. Active purchasing tools that incorporate disease management programmes, performance measurement report cards, and alignment of incentives between purchasers and providers respond to key issues facing health care reform in many countries. Selective adoption of these tools may be even more relevant in single payer systems than in the fragmented, voluntary US insurance market where they can be applied more systematically with lower transaction costs and where their effects can be measured more precisely. PMID:10916920

  13. Health-seeking behaviors and self-care practices of Dominican women with lymphoedema of the leg: implications for lymphoedema management programs

    PubMed Central

    Person, Bobbie; Addiss, David G; Bartholomew, L Kay; Meijer, Cecilia; Pou, Victor; van den Borne, Bart

    2006-01-01

    Background In the Dominican Republic, a Latin American country with filariasis-endemic areas, more than 63,000 people have lymphatic filariasis and more than 400,000 people are at risk of future infection. In this paper, we explore the health beliefs, health-seeking behaviors and self-care practices of women with lymphoedema in filariasis-endemic areas to better understand the needs of women when developing lymphoedema morbidity control programs. Methods Qualitative data were collected through semi-structured interviews of 28 women, 3 focus group discussions with 28 women, field notes and photographs. Results Women described exhaustive and expensive attempts at seeking a cure for their lymphoedema. Family members were influential in providing women with initial care seeking referrals to indigenous healers credited with influence over physical, mental, spiritual and supernatural properties of illness. When indigenous treatments proved to be ineffectual, the women sought care from trained healthcare providers. Most healthcare providers incorrectly diagnosed the edema, failed to adequately treat and meet the needs of women and were viewed as expensive. Most women resorted to self-prescribing injectable, oral, or topical antibiotics along with oral analgesics as a standard practice of self-care. Conclusion Healthcare providers must understand a woman's cultural perspectives of illness, her natural networks of support and referral, her behavioural practices of care-seeking and self-care and the financial burden of seeking care. In the culture of the Dominican Republic family members and traditional healthcare providers are influential advisors on initial health-seeking behaviors and self-care practices. For this reason family-oriented interventions, support groups for women and their families, community education and training on simple, low cost lymphoedema management techniques for indigenous healers are viable ways to influence the early detection, diagnosis and

  14. A Predoctoral Program in Dental Care for the Developmentally Disabled.

    ERIC Educational Resources Information Center

    Ferguson, Fred S.; And Others

    1990-01-01

    In 1980, the State University of New York at Stony Brook began a program, integrated into the program of children's dentistry, to train students in care for the developmentally disabled. Management of developmentally disabled patients is provided over three years, and represents an extension of pediatric behavior management. (MSE)

  15. The disease management program for type 2 diabetes in Germany enhances process quality of diabetes care - a follow-up survey of patient's experiences

    PubMed Central

    2010-01-01

    Background In summer 2003 a disease management program (DMP) for type 2 diabetes was introduced on a nationwide basis in Germany. Patient participation and continuity of care within the DMP are important factors to achieve long-term improvements in clinical endpoints. Therefore it is of interest, if patients experience any positive or negative effects of the DMP on their treatment that would support or hamper further participation. The main objective of the study was to find out if the German Disease Management Program (DMP) for type 2 diabetes improves process and outcome quality of medical care for patients in the light of their subjective experiences over a period of one year. Methods Cohort study with a baseline interview and a follow-up after 10.4 ± 0.64 months. Data on process and outcome measures were collected by telephone interviews with 444 patients enrolled and 494 patients not enrolled in the German DMP for type 2 diabetes. Data were analyzed by multivariate logistic regression analyses. Results DMP enrolment was significantly associated with a higher process quality of care. At baseline enrolled patients more often reported that they had attended a diabetes education course (OR = 3.4), have ≥ 4 contacts/year with the attending physician (OR = 3.3), have at least one annual foot examination (OR = 3.1) and one referral to an ophthalmologist (OR = 3.4) and possess a diabetes passport (OR = 2.4). Except for the annual referral to an ophthalmologist these parameters were also statistically significant at follow-up. In contrast, no differences between enrolled and not enrolled patients were found concerning outcome quality indicators, e.g. self-rated health, Glycated hemoglobin (GHb) and blood pressure. However, 16-36% of the DMP participants reported improvements of body weight and/or GHb and/or blood pressure values due to enrolment - unchanged within one year of follow-up. Conclusions In the light of patient's experiences the DMP enhances the process

  16. Program Management Tool

    NASA Technical Reports Server (NTRS)

    Gawadiak, Yuri; Wong, Alan; Maluf, David; Bell, David; Gurram, Mohana; Tran, Khai Peter; Hsu, Jennifer; Yagi, Kenji; Patel, Hemil

    2007-01-01

    The Program Management Tool (PMT) is a comprehensive, Web-enabled business intelligence software tool for assisting program and project managers within NASA enterprises in gathering, comprehending, and disseminating information on the progress of their programs and projects. The PMT provides planning and management support for implementing NASA programmatic and project management processes and requirements. It provides an online environment for program and line management to develop, communicate, and manage their programs, projects, and tasks in a comprehensive tool suite. The information managed by use of the PMT can include monthly reports as well as data on goals, deliverables, milestones, business processes, personnel, task plans, monthly reports, and budgetary allocations. The PMT provides an intuitive and enhanced Web interface to automate the tedious process of gathering and sharing monthly progress reports, task plans, financial data, and other information on project resources based on technical, schedule, budget, and management criteria and merits. The PMT is consistent with the latest Web standards and software practices, including the use of Extensible Markup Language (XML) for exchanging data and the WebDAV (Web Distributed Authoring and Versioning) protocol for collaborative management of documents. The PMT provides graphical displays of resource allocations in the form of bar and pie charts using Microsoft Excel Visual Basic for Application (VBA) libraries. The PMT has an extensible architecture that enables integration of PMT with other strategic-information software systems, including, for example, the Erasmus reporting system, now part of the NASA Integrated Enterprise Management Program (IEMP) tool suite, at NASA Marshall Space Flight Center (MSFC). The PMT data architecture provides automated and extensive software interfaces and reports to various strategic information systems to eliminate duplicative human entries and minimize data integrity

  17. Managed consumerism in health care.

    PubMed

    Robinson, James C

    2005-01-01

    The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations. PMID:16284020

  18. Real health plans manage care.

    PubMed

    Hurley, Robert

    2006-01-01

    The public sector might seem to be an appealing growth opportunity to commercial insurers confronted by stalled private-sector coverage expansion, but whether these insurers have the means and motivation to deliver value to Medicare and Medicaid is unproven. State Medicaid purchasers in particular have found alternative sources for care management and have sound reasons to question whether industry-leading commercial insurers will be responsive to their needs. PMID:17102171

  19. Managed care and shadow price.

    PubMed

    Ma, Ching-To A

    2004-02-01

    A managed-care company must decide on allocating resources of many services to many groups of enrollees. The profit-maximizing allocation rule is characterized. For each group, the marginal utilities across all services are equalized. The equilibrium has an enrollee group shadow price interpretation. The equilibrium spending allocation can be implemented by letting utilitarian physicians decide on service spending on an enrollee group subject to a budget for the group. PMID:14737757

  20. Identifying and validating managed care data.

    PubMed

    Sreckovich, Catherine; Fahnestock, Margot

    2002-10-01

    In a managed care organization, data can be the key to facilitating high-quality care and to managing patient care delivery systems effectively, in addition to monitoring costs. Reviewing electronic data requests before contacting data producers, asking the right questions about data, and knowing how to identify good data can help financial managers use data effectively to provide information. In the managed care environment, information is only as good as the steps taken to obtain and validate the data. PMID:12373956

  1. Groundwater protection management program plan

    SciTech Connect

    Not Available

    1992-06-01

    US Department of Energy (DOE) Order 5400.1 requires the establishment of a groundwater protection management program to ensure compliance with DOE requirements and applicable Federal, state, and local laws and regulations. The Uranium Mill Tailings Remedial Action (UMTRA) Project Office has prepared a ``Groundwater Protection Management Program Plan`` (groundwater protection plan) of sufficient scope and detail to reflect the program`s significance and address the seven activities required in DOE Order 5400.1, Chapter 3, for special program planning. The groundwater protection plan highlights the methods designed to preserve, protect, and monitor groundwater resources at UMTRA Project processing and disposal sites. The plan includes an overview of the remedial action status at the 24 designated processing sites and identifies project technical guidance documents and site-specific documents for the UMTRA groundwater protection management program. In addition, the groundwater protection plan addresses the general information required to develop a water resources protection strategy at the permanent disposal sites. Finally, the plan describes ongoing activities that are in various stages of development at UMTRA sites (long-term care at disposal sites and groundwater restoration at processing sites). This plan will be reviewed annually and updated every 3 years in accordance with DOE Order 5400.1.

  2. 76 FR 5222 - Notice of Federal Long Term Care Insurance Program Open Season

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-28

    ... MANAGEMENT Notice of Federal Long Term Care Insurance Program Open Season AGENCY: Office of Personnel Management. ACTION: Notice of Federal Long Term Care Insurance Open Season. SUMMARY: The Office of Personnel Management (OPM) is announcing an Open Season for the Federal Long Term Care Insurance Program (FLTCIP)....

  3. Care management: quelling the confusion. Case managers help clients access resources appropriate to their needs.

    PubMed

    Westhoff, L J

    1992-06-01

    The vast number of available healthcare services can be confusing to those seeking care. Care managers can resolve these issues by helping the vulnerable and their families find and receive appropriate services. Care management is not limited to the elderly: Others with special needs also benefit from care management. Care managers integrate and coordinate services, providing a continuum between the client and the providers of acute, long-term, home-based, and community-based care. The care management model that most organizations adopt at first is the brokering model. In this model care managers identify the appropriate service package from resources in the community. In the service management model, the care manager authorizes the services provided within specified financial limits. The funding source influences what services he or she can recommend. Another model is managed care. The carrier of a high-risk group of clients or a group of enrollees in a certain healthcare program prospectively pays the organization providing care management. In the acute care setting, providers find the transition to care management challenging because they have been oriented to short, episodic care. These providers must adopt new protocols to be able to work with providers and programs within their own organization or at other organizations. In community-based care, care managers' goal is to help the client and family access appropriate services so the client can function independently within his or her home. Community-based referrals are from family members or agencies and infrequently follow an acute care hospitalization. PMID:10118342

  4. Generation: A Corporate-Sponsored Retiree Health Care Program.

    ERIC Educational Resources Information Center

    Scharlach, Andrew E.; And Others

    1992-01-01

    Describes Generation, geriatric clinic program for one company's retirees and dependents. Describes program's multidisciplinary team approach to health and psychosocial assessment, medication review, retiree advisors, health promotion programs, and case management services. Notes that, in addition to traditional medical care, participants receive…

  5. Managed Care Plans: Getting Good Care for Your Child

    MedlinePlus

    ... AAP Find a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting ... Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Managed Care Plans: Getting Good Care for Your ...

  6. Lipid screening in a managed care population.

    PubMed Central

    Davis, K C; Cogswell, M E; Rothenberg, S L; Koplan, J P

    1998-01-01

    OBJECTIVE: To determine the proportion of patients in a managed care setting who were screened and followed up for high blood cholesterol in accordance with the guidelines from the second report of the National Cholesterol Education Program-Adult Treatment Panel II. METHODS: The authors conducted a retrospective review of the medical records of 1004 health plan members ages 40-64 who had been continuously enrolled over a period of five years at one of three Prudential Health-Care sites. RESULTS: Eighty-four percent of patients in the study group had at least one total blood cholesterol level recorded in their medical records; a high density lipoprotein level was recorded for 67%. Cholesterol screening was highest among patients with a diagnosis of hypercholesterolemia (98%), hypertension (96%), or diabetes (94%) and among patients ages 60-64 (94%). Cholesterol screening did not vary by smoking status. More than 86% of those with a diagnosis of hypercholesterolemia were given dietary counseling, medication, or both. CONCLUSIONS: Compliance with national guidelines in this setting exceeded the Year 2000 goals for lipid management and was comparable with compliance reported in other settings. Routine surveillance of prevention efforts can be a useful way to assess quality of medical care in managed care organizations. PMID:9672575

  7. Antimicrobial Stewardship Programs in Health Care Systems

    PubMed Central

    MacDougall, Conan; Polk, Ron E.

    2005-01-01

    Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources. PMID:16223951

  8. Managing Medicaid managed care: are states becoming prudent purchasers?

    PubMed

    Fossett, J W; Goggin, M; Hall, J S; Johnston, J; Plein, L C; Roper, R; Weissert, C

    2000-01-01

    This paper examines the extent to which five states are becoming "prudent purchasers" in their oversight of Medicaid managed care. Our conclusions are mixed. These states are making more sustained efforts along these lines than most private purchasers are and have improved the amount and quality of the data they collect on the experiences of Medicaid clients when compared with the traditional fee-for-service program. They have been less successful in ensuring data quality that is adequate to support contracting decisions and in developing the analytical or political capacity to use data to "manage" the managed care system. Becoming a prudent purchaser appears to be a complex task for states that may prove difficult to achieve. PMID:10916959

  9. A Rural Primary Care Pediatric Residency Program.

    ERIC Educational Resources Information Center

    Kairys, Steven; Newell, Priscilla

    1985-01-01

    The primary care pediatric residency program at the Dartmouth-Hitchcock Medical Center has developed a training program in rural primary care. Residents experience the many facets of rural practice and are introduced to community-oriented approaches to child health care. (Author/MLW)

  10. Continuing Education for the Health Professions. Developing, Managing, and Evaluating Programs for Maximum Impact on Patient Care.

    ERIC Educational Resources Information Center

    Green, Joseph S., Ed.; And Others

    Advice on making continuing education (CE) responsive to the practice needs of professionals in medicine, dentistry, nursing, pharmacy, allied health, and public health is provided in 16 chapters. Attention is directed to: establishing realistic goals, tailoring programs to specific needs, recruiting subject matter experts, evaluating programs and…

  11. Quality Management Program

    SciTech Connect

    Not Available

    1991-10-01

    According to {section} 35.32, Quality Management Program,'' of 10 CFR Part 35, Medical Use of Byproduct Material,'' applicants or licensees, as applicable, are required to establish a quality management (QM) program. This regulatory guide provides guidance to licensees and applicants for developing policies and procedures for the QM program. This guide does not restrict or limit the licensee from using other guidance that may be equally useful in developing a QM program, e.g., information available from the Joint Commission on Accreditation of Healthcare Organizations or the American College of Radiology. Any information collection activities mentioned in this regulatory guide are contained as requirements in 10 CFR Part 35, which provides the regulatory basis for this guide. This information collection requirements in 10 CFR Part 35 have been cleared under OMB Clearance No. 3150-0010.

  12. Waste Management Program management plan. Revision 1

    SciTech Connect

    1997-02-01

    As the prime contractor to the Department of Energy Idaho Operations Office (DOE-ID), Lockheed Martin Idaho Technologies Company (LMITCO) provides comprehensive waste management services to all contractors at the Idaho National Engineering and Environmental Laboratory (INEEL) through the Waste Management (WM) Program. This Program Management Plan (PMP) provides an overview of the Waste Management Program objectives, organization and management practices, and scope of work. This document will be reviewed at least annually and updated as needed to address revisions to the Waste Management`s objectives, organization and management practices, and scope of work. Waste Management Program is managed by LMITCO Waste Operations Directorate. The Waste Management Program manages transuranic, low-level, mixed low-level, hazardous, special-case, and industrial wastes generated at or transported to the INEEL.

  13. Integrated health care in California's managed care capital.

    PubMed

    Terry, D

    1994-01-01

    Sacramento, California's capital, represents the nation's most competitive managed care marketplace. The Sutter Health organization represents a significant force in this marketplace and surrounding regions of Northern California. Sutter has created an integrated regional health care network capable of delivering a full continuum of care through appropriate community-based facilities, a variety of physician relationships, and both owned and aligned managed care structures. The overall Sutter Health strategy that incorporates facilities, physician partnerships, and patient care financing is described. The article identifies six key lessons learned during this period of growth. PMID:10138791

  14. Capitated risk-bearing managed care systems could improve end-of-life care.

    PubMed

    Lynn, J; Wilkinson, A; Cohn, F; Jones, S B

    1998-03-01

    Capitated or salaried managed care systems offer an important opportunity to provide high quality, cost-effective end-of-life care. However, capitated healthcare delivery systems have strong incentives to avoid patient populations in need of such care. Care currently provided at the end of life in fee-for-service practice is commonly deficient, with high rates of avoidable pain and other burdens. Only hospice offers a better track record, yet access to hospice is limited, and length of stay is short. Traditional staff- or group-model managed care plans, with their emphasis on prevention, patient education, cost efficiency, service coordination, and integrated provider networks, present a dynamic set of conditions and organizational structures that would support real change. Advantages derived from managed care systems providing quality end-of-life care include coordinated care across delivery sites, interdisciplinary teams, integrated services, and opportunities to develop innovative care programs, service arrays, utilization controls, and accountability for care standards. We propose a special comprehensive system of managed care, which we call MediCaring, for seriously ill persons nearing the end of life. MediCaring would encompass the best elements of palliative care within a managed care structure: comprehensive, supportive, community-based services that meet personal and medical needs, a focus on patient preferences, symptom management, family counseling, and support. Other programs, such as hospice, have shown that continuity and coordinated care, financed through a capitated payment and directed at a special population, are both feasible and effective. There are obstacles to improving care at the end of life. Managed care systems, like most of medical care, have largely ignored the terminally ill patient. Current financing arrangements make it financially undesirable for insurers to recruit or retain the very sick; very ill patients can be costly over a

  15. A Lesson in Carefully Managing Resources: A Case Study from an Evaluation of a Music Education Program

    ERIC Educational Resources Information Center

    Hobson, Kristin A.; Burkhardt, Jason T.

    2012-01-01

    Background: A music education program with a goal of enhancing cognitive development of preschool-aged children enrolled in local preschools is evaluated by The Evaluation Center at Western Michigan University. The budget for the evaluation was small, and therefore presented several challenges to the evaluation team. Purpose: Through a case study…

  16. Data warehousing in disease management programs.

    PubMed

    Ramick, D C

    2001-01-01

    Disease management programs offer the benefits of lower disease occurrence, improved patient care, and lower healthcare costs. In such programs, the key mechanism used to identify individuals at risk for targeted diseases is the data warehouse. This article surveys recent warehousing techniques from HMOs to map out critical issues relating to the preparation, design, and implementation of a successful data warehouse. Discussions of scope, data cleansing, and storage management are included in depicting warehouse preparation and design; data implementation options are contrasted. Examples are provided of data warehouse execution in disease management programs that identify members with preexisting illnesses, as well as those exhibiting high-risk conditions. The proper deployment of successful data warehouses in disease management programs benefits both the organization and the member. Organizations benefit from decreased medical costs; members benefit through an improved quality of life through disease-specific care. PMID:11452582

  17. Effects of a Hypertension Management Program by Seongcheon Primary Health Care Post in South Korea: An Analysis of Changes in the Level of Knowledge of Hypertension in the Period from 2004 to 2009

    ERIC Educational Resources Information Center

    Song, In Han; Kim, Sang-A; Park, Woong-Sub

    2012-01-01

    The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in…

  18. Computer Bits: Child Care Center Management Software Buying Guide.

    ERIC Educational Resources Information Center

    Brown, Dennis; Neugebauer, Roger

    1987-01-01

    Describes seven software programs for day care center management including price, technical support, months on the market, customizing capabilities, and informative notes. Gives four suggestions for matching software to day care center, with a list of shopping questions to ask. (BB)

  19. ISSUES MANAGEMENT PROGRAM MANUAL

    SciTech Connect

    Gravois, Melanie

    2007-06-27

    The Lawrence Berkeley National Laboratory (LBNL) Issues Management Program encompasses the continuous monitoring of work programs, performance and safety to promptly identify issues to determine their risk and significance, their causes, and to identify and effectively implement corrective actions to ensure successful resolution and prevent the same or similar problems from occurring. This document describes the LBNL Issues Management Program and prescribes the process for issues identification, tracking, resolution, closure, validation, and effectiveness of corrective actions. Issues that are governed by this program include program and performance deficiencies or nonconformances that may be identified through employee discovery, internal or external oversight assessment findings, suggested process improvements and associated actions that require formal corrective action. Issues may also be identified in and/or may result in Root Cause Analysis (RCA) reports, Price Anderson Amendment Act (PAAA) reports, Occurrence Reporting and Processing System (ORPS) reports, Accident Investigation reports, assessment reports, and External Oversight reports. The scope of these issues may include issues of both high and low significance as well as adverse conditions that meet the reporting requirements of the University of California (UC) Assurance Plan for LBNL or other reporting entities (e.g., U.S. Environmental Protection Agency, U.S. Department of Energy). Issues that are found as a result of a walk-around or workspace inspection that can be immediately corrected or fixed are exempt from the requirements of this document.

  20. Toward population management in an integrated care model.

    PubMed

    Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

    2013-04-01

    Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. PMID:23539229

  1. Toward population management in an integrated care model.

    PubMed

    Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

    2013-01-01

    Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. PMID:24496184

  2. Shared Heritage: An Intergenerational Child Care Program.

    ERIC Educational Resources Information Center

    Hawkeye Area Community Action Program, Cedar Rapids, IA.

    This report describes ways in which older persons may become involved in the field of home child care. It is intended to provide (1) detailed information on an intergenerational child care (IGCC) program; (2) general information relating to intergenerational contacts and home child care; and (3) "how-to" information for agencies planning to…

  3. Spirulina in health care management.

    PubMed

    Kulshreshtha, Archana; Zacharia, Anish J; Jarouliya, Urmila; Bhadauriya, Pratiksha; Prasad, G B K S; Bisen, P S

    2008-10-01

    Spirulina is a photosynthetic, filamentous, spiral-shaped and multicellular edible microbe. It is the nature's richest and most complete source of nutrition. Spirulina has a unique blend of nutrients that no single source can offer. The alga contains a wide spectrum of prophylactic and therapeutic nutrients that include B-complex vitamins, minerals, proteins, gamma-linolenic acid and the super anti-oxidants such as beta-carotene, vitamin E, trace elements and a number of unexplored bioactive compounds. Because of its apparent ability to stimulate whole human physiology, Spirulina exhibits therapeutic functions such as antioxidant, anti-bacterial, antiviral, anticancer, anti-inflammatory, anti-allergic and anti-diabetic and plethora of beneficial functions. Spirulina consumption appears to promote the growth of intestinal micro flora as well. The review discusses the potential of Spirulina in health care management. PMID:18855693

  4. Integrated Financial Management Program

    NASA Technical Reports Server (NTRS)

    Pho, Susan

    2004-01-01

    Having worked in the Employees and Commercial Payments Branch of the Financial Management Division for the past 3 summers, I have seen the many changes that have occurred within the NASA organization. As I return each summer, I find that new programs and systems have been adapted to better serve the needs of the Center and of the Agency. The NASA Agency has transformed itself the past couple years with the implementation of the Integrated Financial Management Program (IFMP). IFMP is designed to allow the Agency to improve its management of its Financial, Physical, and Human Resources through the use of multiple enterprise module applications. With my mentor, Joseph Kan, being the branch chief of the Employees and Commercial Payments Branch, I have been exposed to several modules, such as Travel Manager, WebTads, and Core Financial/SAP, which were implemented in the last couple of years under the IFMP. The implementation of these agency-wide systems has sometimes proven to be troublesome. Prior to IFMP, each NASA Center utilizes their own systems for Payroll, Travel, Accounts Payable, etc. But with the implementation of the Integrated Financial Management Program, all the "legacy" systems had to be eliminated. As a result, a great deal of enhancement and preparation work is necessary to ease the transformation from the old systems to the new. All this work occurs simultaneously; for example, e-Payroll will "go live" in several months, but a system like Travel Manager will need to have information upgraded within the system to meet the requirements set by Headquarters. My assignments this summer have given me the opportunity to become involved with such work. So far, I have been given the opportunity to participate in projects resulting from a congressional request, several bankcard reconciliations, updating routing lists for Travel Manager, updating the majordomo list for Travel Manager approvers and point of contacts, and a NASA Headquarters project involving

  5. The Educational Day Care Consultation Program.

    ERIC Educational Resources Information Center

    Green, Melinda; Valenstein, Thelma

    A research and training program for family day care mothers at the University of Michigan involves both group meetings and individual home consultations by educational consultants, trained community para-professionals. The program is directed toward low income and working class licensed day care mothers and is conducted by the School of Education.…

  6. Project Challenge: A Therapeutic Child Care Program.

    ERIC Educational Resources Information Center

    Adger, Susan

    Project Challenge is a unit of Project Playpen, Inc., in Pinellas County, Florida, which serves children from birth to age 5 who attend child care programs and display mild to moderate degrees of emotional challenge. This program guide describes the activities, structures, and design of Project Challenge to meet the needs of child care for working…

  7. Managing the Patient with Pulmonary Hypertension: Specialty Care Centers, Coordinated Care, and Patient Support.

    PubMed

    Chakinala, Murali M; Duncan, Maribeth; Wirth, Joel

    2016-08-01

    Pulmonary hypertension remains a challenging condition to diagnose and manage. Decentralized care for pulmonary arterial hypertension (PAH) has led to shortcomings in the diagnosis and management of PAH. The Pulmonary Hypertension Association-sponsored Pulmonary Hypertension Care Center program is designed to recognize specialty centers capable of providing multidisciplinary and comprehensive care of PAH. Ideally, Pulmonary Hypertension Care Centers will comanage PAH patients with community-based practitioners and address the growing needs of this emerging population of long-term PAH patients. PMID:27443143

  8. Centralized care management support for "high utilizers" in primary care practices at an academic medical center.

    PubMed

    Williams, Brent C; Paik, Jamie L; Haley, Laura L; Grammatico, Gina M

    2014-01-01

    Although evidence of effectiveness is limited, care management based outside primary care practices or hospitals is receiving increased attention. The University of Michigan (UM) Complex Care Management Program (CCMP) provides care management for uninsured and underinsured, high-utilizing patients in multiple primary care practices. To inform development of optimal care management models, we describe the CCMP model and characteristics and health care utilization patterns of its patients. Of a consecutive series of 49 patients enrolled at CCMP in 2011, the mean (SD) age was 48 (+/- 14); 23 (47%) were women; and 29 (59%) were White. Twenty-eight (57%) had two or more chronic medical conditions, 39 (80%) had one or more psychiatric condition, 28 (57%) had a substance abuse disorder, and 11 (22%) were homeless. Through phone, e-mail, and face-to-face contact with patients and primary care providers (PCPs), care managers coordinated health and social services and facilitated access to medical and mental health care. Patients had a mean (SD) number of hospitalizations and emergency room (ER) visits in 6 months prior to enrollment of2.2 (2.5) and 4.2 (4.3), respectively, with a nonstatistically significant decrease in hospitalizations, hospital days, and emergency room visits in 6 months following enrollment in CCMP. Centralized care management support for primary care practices engages high-utilizing patients with complex medical and behavioral conditions in care management that would be difficult to provide through individual practices and may decrease health care utilization by these patients. PMID:24761538

  9. Can managed care plans control health care costs?

    PubMed

    Zwanziger, J; Melnick, G A

    1996-01-01

    The health insurance sector has been transformed in the past fifteen years, with managed care replacing indemnity insurance as the norm. This transformation was intended to change the nature of competition in the health care system so that market forces could be used to control costs. Empirical studies have shown that this objective has been met, as areas with high managed care penetration have tended to have much lower rates of increase in their costs. Creating a more efficient health care system will require additional efforts to produce useful measures of quality and to maintain competitive markets. PMID:8690375

  10. Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

    PubMed

    Delon, Sandra; Mackinnon, Blair

    2009-01-01

    Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective. PMID:20057258

  11. Characteristics of effective health care managers.

    PubMed

    Johnson, Sherryl W

    2005-01-01

    This article provides an overview of traditional and contemporary management theories. Concerns, characteristics, and skills of effective managers are also presented. Further, a self-assessment (survey) of 7 highly effective health care managers in a South Georgia community was conducted to determine their ratings on 6 management indices. The assessment or Scale of Transformational Leadership uses a Likert-type scale to allow for the evaluation of managers. The scale contains 6 management elements for assessment: attention, meaning, trust, self, vision, and feeling. Individual ratings and group summary skills rating are presented. Findings revealed the order of managerial importance of the elements as follows (from highest to lowest): Management of Trust, Management of Attention, Management of Self, Management of Feeling, Management of Meaning, and Management of Risk. As a second tier, the final ratings are corroborated by health care management interns. PMID:15923923

  12. Assessment of an enhanced program for depression management in primary care: a cluster randomized controlled trial. The INDI project (Interventions for Depression Improvement)

    PubMed Central

    Aragonès, Enric; Caballero, Antonia; Piñol, Josep Ll; López-Cortacans, Germán; Badia, Waleska; Hernández, Josep M; Casaus, Pilar; Folch, Sílvia; Basora, Josep; Labad, Antonio

    2007-01-01

    Background Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management. Methods/Design Design: A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression. Setting: 20 primary care centres in the province of Tarragona (Spain) Sample: 400 patients over 18 years of age who have experienced an episode of major depression (DSM-IV) and who need to initiate antidepressant treatment Intervention: A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care/specialized level interface. Measurements: The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to (blind trial). These interviews will be given at 0, 3, 6 and 12 months. Main variables: Severity of the depressive symptoms, response rate and remission rate. Analysis: Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster. Discussion The effectiveness of caring for depression in primary care can be improved by various strategies

  13. Program audit, A management tool

    NASA Technical Reports Server (NTRS)

    Miller, T. J.

    1971-01-01

    Program gives in-depth view of organizational performance at all levels of the management structure, and provides means by which managers can effectively and efficiently evaluate adequacy of management direction, policies, and procedures.

  14. Urban-Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures

    ERIC Educational Resources Information Center

    Meng, Hongdao; Wamsley, Brenda; Liebel, Diane; Dixon, Denise; Eggert, Gerald; Van Nostrand, Joan

    2009-01-01

    Purpose: To evaluate the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. To determine if these outcomes vary by urban or rural residence. Design and Methods: We analyzed data from a 22-month randomized controlled trial of a health…

  15. Impact of Managed Care in the Schools.

    ERIC Educational Resources Information Center

    O'Brien, Mary Ann; Huffman, Nancy P.

    1998-01-01

    Examines the integration of health care and education in the schools with the advent of managed care. Effects of these changes, such as schools billing health care third-party payors and the expansion of speech language services to areas such as dysphagia and alternative/augmentative communication, are discussed. (DB)

  16. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

    PubMed

    Bauer, M; Bach, A

    1998-06-01

    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law. PMID:9676303

  17. Managed care and ethical conflicts: anything new?

    PubMed Central

    Meyers, C

    1999-01-01

    Does managed care represent the death knell for the ethical provision of medical care? Much of the current literature suggests as much. In this essay I argue that the types of ethical conflicts brought on by managed care are, in fact, similar to those long faced by physicians and by other professionals. Managed care presents new, but not fundamentally different, factors to be considered in medical decision making. I also suggest ways of better understanding and resolving these conflicts, in part by distinguishing among conflicts of interest, of bias and of obligation. PMID:10536762

  18. Program Collection Honed with Care.

    ERIC Educational Resources Information Center

    Fisher, Glenn

    1982-01-01

    Reviews four programs (equivalent fractions, sentence patterns, bookself-use of Dewey system, career skills) representative of programs on a disk available from Robbinsdale Area Schools (Minneapolis, MN). Indicates programs (for Pet Commodore-16K) are interesting, well laid out, competently programed, and easy to use. (Author/JN)

  19. Reviewing case management in community psychiatric care.

    PubMed

    Bush, Tony

    Case management is a process of psychiatric care provision that uses a structured and focused approach to effectively assess individual patient's needs. The aim of this article is to examine the current status of case management in NHS community mental health care in terms of therapeutic impact and relevance. PMID:16209396

  20. Development and testing of the Dementia Symptom Management at Home (DSM-H) program: An interprofessional home health care intervention to improve the quality of life for persons with dementia and their caregivers.

    PubMed

    Brody, Abraham A; Guan, Carrie; Cortes, Tara; Galvin, James E

    2016-01-01

    Home health care agencies are increasingly taking care of sicker, older patients with greater comorbidities. However, they are unequipped to appropriately manage these older adults, particular persons living with dementia (PLWD). We therefore developed the Dementia Symptom Management at Home (DSM-H) Program, a bundled interprofessional intervention, to improve the care confidence of providers, and quality of care delivered to PLWD and their caregivers. We implemented the DSM-H with 83 registered nurses, physical therapists, and occupational therapists. Overall, there was significant improvement in pain knowledge (5.9%) and confidence (26.5%), depression knowledge (14.8%) and confidence (36.1%), and neuropsychiatric symptom general knowledge (16.8%), intervention knowledge (20.9%), attitudes (3.4%) and confidence (27.1%) at a statistical significance of (P < .0001). We also found significant differences between disciplines. Overall, this disseminable program proved to be implementable and improve clinician's knowledge and confidence in caring for PLWD, with the potential to improve quality of care and quality of life, and decrease costs. PMID:26922312

  1. Care manager/nurse manager: a blending of roles.

    PubMed

    Phillips, C Y; Carson, J A; Huggins, C M; Wade, B

    1993-10-01

    Excellent clinicians often are "promoted" to management positions. Lack of involvement in patient care can lead to diminished nurse manager satisfaction, so job enrichment and enhancement must be as important as efficiency and economy as healthcare undergoes reform. A study of 314 patients from 20 DRG categories revealed a statistically significant shortened length of stay and a savings of at least $552 per care-managed patient. Satisfaction was widespread among nurses, patients and physicians and a collaborative spirit developed between nurses and physicians. The blended care manager/nurse manager role alleviates much frustration and conflict and enriches the performance of the manager. PMID:8414296

  2. Ensuring quality and accountability in managed care.

    PubMed

    Dobalian, A; Rivers, P A

    1998-01-01

    The rapid growth of new forms of managed care in the United States in recent decades has brought with it increasing concerns regarding the quality of care delivered by practitioners in these plans. This article examines the various regulatory demands that are being placed on Managed Care Organizations (MCOs). The authors look at the major determinants that are likely to bring about significant changes in the health care sector for both patients and providers and predict how these shifts will affect the quality of health care services in the near future. They discuss how the quality of health care, rather than the cost of those services, can become and remain the primary factor in the delivery of health care services. Ultimately, they conclude that increased participation by the federal government is required to protect the rights of patients and ensure better quality and accountability for health care services delivered by MCOs. PMID:10345539

  3. [Quality management in intensive care medicine].

    PubMed

    Martin, J; Braun, J-P

    2014-02-01

    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:24493011

  4. [Quality management in intensive care medicine].

    PubMed

    Martin, J; Braun, J-P

    2013-09-01

    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:23846174

  5. Patient Care Assistant. Florida Vocational Program Guide.

    ERIC Educational Resources Information Center

    Florida State Univ., Tallahassee. Center for Instructional Development and Services.

    This program guide identifies primary considerations in the organization, operation, and evaluation of a patient care assistant program. An occupational description and program content are presented. A curriculum framework specifies the exact course title, course number, levels of instruction, major course content, laboratory activities, special…

  6. Child Nutrition Programs: Child and Adult Care Food Program. Family Day Care Home Handbook.

    ERIC Educational Resources Information Center

    Oklahoma State Dept. of Education, Oklahoma City.

    This handbook details requirements for family day care homes in Oklahoma for providing child nutrition through the Child and Adult Care Food Program. The handbook includes contact information for state consultants. The basic responsibilities for sponsors of family day care home child nutrition programs are outlined, and the sponsoring organization…

  7. Blood Pressure Management Controversies in Neurocritical Care.

    PubMed

    McNett, Molly; Koren, Jay

    2016-03-01

    Blood pressure (BP) management is essential in neurocritical care settings to ensure adequate cerebral perfusion and prevent secondary brain injury. Despite consensus on the importance of BP monitoring, significant practice variations persist regarding optimal methods for monitoring and treatment of BP values among patients with neurologic injuries. This article provides a summary of research investigating various approaches for BP management in neurocritical care. Evidence-based recommendations, areas for future research, and current technological advancements for BP management are discussed. PMID:26873756

  8. Weight management practices among primary care providers.

    PubMed

    Timmerman, G M; Reifsnider, E; Allan, J D

    2000-04-01

    This pilot study examined how primary care providers manage patients with weight problems, an important component of primary care. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. Practice patterns between gender, profession and practice setting of the nurse practitioners were compared. PMID:11930414

  9. The role of managed care organizations in obesity management.

    PubMed

    Schaecher, Kenneth L

    2016-06-01

    In the United States, obesity is characterized as this century's greatest healthcare threat. The American Medical Association and several other large organizations now classify obesity as a disease. Several federal initiatives are in the planning stages, have been approved, or are being implemented to address the disease. Obesity poses challenges for all healthcare stakeholders. Diet and exercise often are insufficient to create the magnitude of change patients and their attending healthcare providers need. Managed care organizations (MCOs) have 3 tools that can help their members: health and wellness programs focusing on lifestyle changes, prescription weight-loss drugs, and bariatric surgical interventions. MCOs are addressing changes with national requirements and are responding to the availability of new weight-loss drugs to help their members achieve better health. A number of factors either deter or stimulate the progress of weight loss therapy. Understanding how MCOs are key to managing obesity at the local level is important for healthcare providers. It can help MCOs and individual healthcare providers develop and coordinate strategies to educate stakeholders and better manage overall care. PMID:27356117

  10. Management Internship Program: A Model.

    ERIC Educational Resources Information Center

    Zabezensky, Ferne; And Others

    1986-01-01

    Examines the Maricopa Community College District's management internship program, detailing the history and operation of the program. Describes program eligibility criteria, the intern's role as Vice Chancellor for Human Services, the provision of a graduate course in management, the rotation of assignments, intern projects, and evaluation.…

  11. MIGRANT DAY CARE PROGRAM, 1961.

    ERIC Educational Resources Information Center

    NAYLOR, NAOMI L.

    WITH THE COOPERATION OF VARIOUS COMMUNITY AGENCIES AND WITH FEDERAL AID FROM THE PUBLIC WELFARE DEPARTMENT, SEVERAL MIGRANT CHILD CARE CENTERS WERE ESTABLISHED BY PENNSYLVANIA STATE UNIVERSITY IN THE CENTRAL PART OF THE STATE OF PENNSYLVANIA. STAFFS WERE COMPOSED OF DIRECTORS AND EXPERIENCED TEACHERS FROM PRESCHOOL AND ELEMENTARY EDUCATION.…

  12. Prevention and Management of Infusion-Associated Reactions in the Comparison of Alemtuzumab and Rebif® Efficacy in Multiple Sclerosis (CARE-MS) Program

    PubMed Central

    Namey, Marie; Meyer, Cathy; Mayer, Lori; Oyuela, Pedro; Margolin, David H.; Rizzo, Marco

    2015-01-01

    Background: Alemtuzumab is a humanized monoclonal antibody approved in several countries for treatment of relapsing-remitting multiple sclerosis (RRMS). This report summarizes the experience with infusion-associated reactions (IARs) in two phase 3 trials of alemtuzumab in RRMS and examines skilled nursing interventions in IAR prevention and management. Methods: In the Comparison of Alemtuzumab and Rebif® Efficacy in Multiple Sclerosis (CARE-MS) studies, patients with RRMS (treatment naive [CARE-MS I] or with inadequate response [defined as at least one relapse] to previous therapy [CARE-MS II]) received intravenous infusions of alemtuzumab 12 mg/day on 5 consecutive days at baseline and on 3 consecutive days 12 months later. Patients were monitored for IARs during and after each infusion. An IAR was defined as any adverse event occurring during any infusion or within 24 hours after infusion. Results: The IARs affected 90.1% of patients receiving alemtuzumab. The most common IARs were headache, rash, pyrexia, nausea, and flushing; most were mild to moderate in severity. Management of IARs consisted of infusion interruption or rate reduction, pharmacologic therapies, and continual patient education and support. Medication administration before and during alemtuzumab infusion reduced IAR severity. Forty-five of 972 alemtuzumab-treated patients (4.6%) required interruption of the first treatment course (ie, infusions did not occur on consecutive days); of these, 24 (53.3%) were still able to complete the first and second full treatment courses. Conclusions: Nurses played an invaluable role in the detection and management of IARs in the CARE-MS studies. Best practices for management of IARs associated with alemtuzumab include patient and caregiver education, medication to lessen IAR severity, infusion monitoring, and discharge planning. PMID:26300705

  13. Managing lymphoedema in palliative care patients.

    PubMed

    Todd, Marie

    The development of lymphoedema in advanced disease is distressing for patients and their carers and can prove difficult to manage for health-care professionals involved in their care. This article will provide an overview of co-morbidities that cancer patients face that will have an impact on the development, progression or management of lymphoedema. The principles of assessing and managing lymphoedema in palliative care patients is presented, based on the Scottish governments action plan Living and Dying Well. The need for collaboration with other members of the multi-disciplinary team to provide the seamless, patient-centred service advocated in this action plan is also presented. PMID:19377392

  14. Merrill C. Sosman Lecture. Surviving managed care.

    PubMed

    Arenson, R L; Burnside, E S

    1997-07-01

    Managed care has arrived, especially on the West Coast. This tsunami is moving eastward at a rapid rate. Perhaps the experience with killer bees will be repeated with managed care, with decreased virulence as this wave moves across the country. Institutions would be wise to prepare for these changes with improved efficiency and cost-effectiveness. Radiologists are particularly at risk and need to aggressively adapt to managed care by becoming informed, developing a clear strategy for coping, and then executing their plan. Evolution will demonstrate once again the survival of the fittest. PMID:9207491

  15. Future developments in health care performance management.

    PubMed

    Crema, Maria; Verbano, Chiara

    2013-01-01

    This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. PMID:24255600

  16. Future developments in health care performance management

    PubMed Central

    Crema, Maria; Verbano, Chiara

    2013-01-01

    This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. PMID:24255600

  17. Preventing Sexual Abuse in Day Care Programs: National Program Inspection.

    ERIC Educational Resources Information Center

    Zimlich, Norm; And Others

    In October 1984, a national program inspection on preventing child sexual abuse in day care programs was begun. Program inspections are short-term studies designed to provide qualitative information and quantitative data for use by the Department of Health and Human Services as an additional source of information. Participants in this study, from…

  18. Acute care management of spinal cord injuries.

    PubMed

    Mitcho, K; Yanko, J R

    1999-08-01

    Meeting the health care needs of the spinal cord-injured patient is an immense challenge for the acute care multidisciplinary team. The critical care nurse clinician, as well as other members of the team, needs to maintain a comprehensive knowledge base to provide the care management that is essential to the care of the spinal cord-injured patient. With the active participation of the patient and family in care delivery decisions, the health care professionals can help to meet the psychosocial and physical needs of the patient/family unit. This article provides an evidence-based, comprehensive review of the needs of the spinal cord-injured patient in the acute care setting including optimal patient outcomes, methods to prevent complications, and a plan that provides an expeditious transition to rehabilitation. PMID:10646444

  19. Advanced technologies in trauma critical care management.

    PubMed

    Cannon, Jeremy W; Chung, Kevin K; King, David R

    2012-08-01

    Care of critically injured patients has evolved over the 50 years since Shoemaker established one of the first trauma units at Cook County Hospital in 1962. Modern trauma intensive care units offer a high nurse-to-patient ratio, physicians and midlevel providers who manage the patients, and technologically advanced monitors and therapeutic devices designed to optimize the care of patients. This article describes advances that have transformed trauma critical care, including bedside ultrasonography, novel patient monitoring techniques, extracorporeal support, and negative pressure dressings. It also discusses how to evaluate the safety and efficacy of future advances in trauma critical care. PMID:22850154

  20. Organizing and managing care in a changing health system.

    PubMed Central

    Kohn, L T

    2000-01-01

    OBJECTIVE: To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. DATA SOURCES: Site visits conducted in 12 randomly selected communities in 1996/ 1997. STUDY DESIGN: Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. DATA COLLECTION: A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. PRINCIPAL FINDINGS: A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. CONCLUSIONS: Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change. PMID:10778823

  1. Integrated, automated revenue management for managed care contracts.

    PubMed

    Burckhart, Kent

    2002-04-01

    Faced with increasing managed care penetration and declining net revenue in recent years, healthcare providers increasingly are emphasizing revenue management. To streamline processes and reduce costs in this area, many healthcare providers have implemented or are considering automated contract management systems. When selecting such a system, healthcare financial managers should make certain that the system can interface with both patient-accounting and decision-support systems of the organization. This integration enhances a healthcare provider's financial viability by providing integrated revenue-management capabilities to analyze projected performance of proposed managed care contracts and actual performance of existing contracts. PMID:11963597

  2. How should managed care physicians be paid?

    PubMed

    Pagano, R

    1994-09-01

    When paying a physician for medical or surgical services, most patients expect the traditional bill or charge for that encounter or visit. While most people also pay health insurance premiums, few patients expect to prepay for their health care. But that is the foundation of most managed health care systems-prepaid medicine. PPOs, IPAs, and HMOs are typically health care providers linked together to provide services to a set population for a specific prepaid fee or "capitation" payment. Other providers contract with these managed care insurers to receive a predetermined and often "discounted" professional fee for services. These managed care organizations have already gone through a number of stages in determining how physicians are to be compensated for their services, and further changes loom on the horizon. PMID:10139077

  3. Perspective from a hotbed of managed care.

    PubMed

    Kaminsky, N

    1996-01-01

    An environmental assessment of the current healthcare market in the United States shows four stages of evolution: (1) the unstructured stage, (2) the loose framework, (3) consolidation, and (4) managed competition. Recognition of these stages should help in the development of strategies for the future. After determining the existing stage of the health-care market in a particular geographic area, clinical endocrinologists can compose a vision statement, develop goals and objectives, and formulate strategies to achieve the established goals. For example, one strategy is to join a managed-care plan. Some practical business advice about assuming risk (responsibility) for various health-care services is provided, and the concept of disease-specific capitation is discussed. Health-care reform is likely to proceed regardless of what the federal government does. In the managed-care environment, the most successful physician participants will be those who are thoroughly informed. PMID:15251504

  4. Supervisory Competencies for Program Managers.

    ERIC Educational Resources Information Center

    Oduaran, Akpovire

    1999-01-01

    Interviews with 20 adult basic education program managers in Botswana identified the definition, goals, and principles of competent supervision. A relationship was apparent between the quality of the supervision of literacy programs and their outcomes. (SK)

  5. Managed care in four managed competition OECD health systems.

    PubMed

    Shmueli, Amir; Stam, Piet; Wasem, Jürgen; Trottmann, Maria

    2015-07-01

    Managed care emerged in the American health system in the 1980s as a way to manage suppliers' induced demand and to contain insurers' costs. While in Israel the health insurers have always been managed care organizations, owning health care facilities, employing medical personnel or contracting selectively with independent providers, European insurers have been much more passive, submitting themselves to collective agreements between insurers' and providers' associations, accompanied by extensive government regulation of prices, quantities, and budgets. With the 1990s reforms, and the introduction of risk-adjusted "managed competition", a growing pressure to allow the European insurers to manage their own care - including selective contracting with providers - has emerged, with varying speed of the introduction of policy changes across the individual countries. This paper compares experiences with managed care in Israel, The Netherlands, Germany and Switzerland since the 1990s. After a brief description of the health insurance markets in the four countries, we focus comparatively on the emergence of managed care in the markets for ambulatory care and inpatient market care. We conclude with an evaluation of the current situation and a discussion of selected health policy issues. PMID:25776034

  6. Management of alcoholism in the primary care setting.

    PubMed Central

    Bradley, K. A.

    1992-01-01

    Primary care physicians can play an important role in managing alcoholic patients. Identifying and treating alcoholism early, before it has interfered with patients' relationships and work, may increase the likelihood of prolonged recovery. Simple office interventions can help motivate patients to abstain and seek treatment. People who abuse alcohol and are unwilling to abstain can benefit from a recommendation to reduce their intake of alcohol. For alcohol-dependent patients who decide to stop drinking, primary care physicians often can manage withdrawal on an outpatient basis. Selecting an appropriate treatment program for each alcoholic patient is important, and referral to a specialist to assist in matching patients to treatments is often necessary. Primary care physicians also can help prevent relapse. Although disulfiram is of limited value, primary care physicians can support recovery by identifying coexistent psychosocial problems, helping patients to restructure their lives, and ensuring continuity of care. PMID:1595243

  7. Orthopaedic Trauma Care Specialist Program for Developing Countries.

    PubMed

    Slobogean, Gerard; Sprague, Sheila; Furey, Andrew; Pollak, Andrew

    2015-10-01

    The dire challenges faced in Haiti, both preearthquake and postearthquake, highlight the need for developing surgical infrastructure to care for traumatic musculoskeletal injuries. The proposed Orthopaedic Trauma Care Specialist (OTCS) residency program aims to close the critical human resource gap that limits the appropriate care of musculoskeletal trauma in Haiti. The OTCS program is a proposal for a 2-year residency program that will focus primarily on the management of orthopaedic trauma. The proposed program will be a comprehensive approach for implementing affordable and sustainable strategies to improve orthopaedic trauma care. Its curriculum will be tailored to the injuries seen in Haiti, and the treatments that can be delivered within their health care system. Its long-term sustainability will be based on a "train-the-trainers" approach for developing local faculty to continue the program. This proposal outlines the OTCS framework specifically for Haiti; however, this concept is likely applicable to other low- and middle-income environments in a similar need for improved trauma and fracture care. PMID:26356211

  8. Enhancing Program Quality and Care through Supervision

    ERIC Educational Resources Information Center

    Olsen, Heather; Kowalski, Christopher L.

    2010-01-01

    In this age of accountability, afterschool programs are increasingly held responsible for providing youth with quality care and education. Afterschool programs play a critical role in helping youth develop their intrapersonal and interpersonal skills, often by engaging them in activities in which they interact with their peers. Such activities…

  9. Home Care Nursing Improves Cancer Symptom Management

    Cancer.gov

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  10. Medicare Managed Care Spillovers and Treatment Intensity.

    PubMed

    Callison, Kevin

    2016-07-01

    Evidence suggests that the share of Medicare managed care enrollees in a region affects the costs of treating traditional fee-for-service (FFS) Medicare beneficiaries; however, little is known about the mechanisms through which these 'spillover effects' operate. This paper examines the relationship between Medicare managed care penetration and treatment intensity for FFS enrollees hospitalized with a primary diagnosis of AMI. I find that increased Medicare managed care penetration is associated with a reduction in both the costs and the treatment intensity of FFS AMI patients. Specifically, as Medicare managed care penetration increases, FFS AMI patients are less likely to receive surgical reperfusion and mechanical ventilation and to experience an overall reduction in the number of inpatient procedures. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25960418

  11. Making It Local: Beacon Communities Use Health Information Technology to Optimize Care Management

    PubMed Central

    Allen, Amy; Des Jardins, Terrisca R.; Heider, Arvela; Kanger, Chatrian R.; Lobach, David F.; McWilliams, Lee; Polello, Jennifer M.; Schachter, Abigail A.; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C.; Turske, Scott A.

    2014-01-01

    Abstract Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks—including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation—the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability. (Population Health Management 2014;17:149–158) PMID

  12. A Standardized Certification Program for Case Managers Serving Frail Elderly Texans. Module III: Implementation, Monitoring, Reassessment & Care Plan Adjustment, Closure, and Evaluation.

    ERIC Educational Resources Information Center

    Lusky, Richard A.; And Others

    This learning module is one of three training modules that were developed for members of the Texas Gerontological Consortium for Continuing Education to use in preparing case managers working in human service professions coordinating community-based programs for frail elderly Texans. Module III deals with the following topics: implementation (case…

  13. Economic value evaluation in disease management programs.

    PubMed

    Magnezi, Racheli; Reicher, Sima; Shani, Mordechai

    2008-05-01

    Chronic disease management has been a rapidly growing entity in the 21st century as a strategy for managing chronic illnesses in large populations. However, experience has shown that disease management programs have not been able to demonstrate their financial value. The objectives of disease management programs are to create quality benchmarks, such as principles and guidelines, and to establish a uniform set of metrics and a standardized methodology for evaluating them. In order to illuminate the essence of disease management and its components, as well as the complexity and the problematic nature of performing economic calculations of their profitability and value, we collected data from several reports that dealt with the economic intervention of disease management programs. The disease management economic evaluation is composed of a series of steps, including the following major categories: data/information technology, information generation, assessment/recommendations, actionable customer plans, and program assessment/reassessment. We demonstrate the elements necessary for economic analysis. Disease management is one of the most innovative tools in the managed care environment and is still in the process of being defined. Therefore, objectives should include the creation of quality measures, such as principles and guidelines, and the establishment of a uniform set of metrics and a standardized methodology for evaluating them. PMID:18605352

  14. Prevention and managed care: the next generation.

    PubMed

    Loeppke, R R

    1995-05-01

    As we stand at the doorway to the twenty-first century, we are witnessing the restructuring of American health care from a fragmented cottage industry to an actual health care system. This new system is emerging from a foundation of managed care and will be built upon the pillars of prevention. One of the reasons this phenomenon is occurring so rapidly is that capitated managed care shifts to providers the financial risk for the health care needs of an enrolled population. Once providers accept financial risk, it is imperative to assess and manage the medical, health, and economic risks of the enrolled population. Under these incentives, quality-driven, cost-effective care takes on new meaning to physicians. In fact, this new managed care environment begins to merge personal health and public health in such a way that the delivery system will begin to provide personal-based health care from a population-based perspective. Furthermore, the incentives and rewards for maintaining the health of a population will finally be present. PMID:7640982

  15. Financial management in leading health care systems.

    PubMed

    Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L

    2000-01-01

    To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs. PMID:10845383

  16. Risk management issues in postmenopausal health care.

    PubMed

    Edozien, Leroy C

    2007-12-01

    As in other areas of clinical activity, unintended harm to patients may occur in the course of postmenopausal health care, and measures to ensure patient safety should be actively promoted. This paper discusses the application of some basic principles of risk management to postmenopausal health care. To facilitate communication and reduce errors in diagnosis and treatment, risk management should be incorporated in the development of a dedicated menopause service. PMID:18088524

  17. FLUOR HANFORD SAFETY MANAGEMENT PROGRAMS

    SciTech Connect

    GARVIN, L. J.; JENSEN, M. A.

    2004-04-13

    This document summarizes safety management programs used within the scope of the ''Project Hanford Management Contract''. The document has been developed to meet the format and content requirements of DOE-STD-3009-94, ''Preparation Guide for US. Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses''. This document provides summary descriptions of Fluor Hanford safety management programs, which Fluor Hanford nuclear facilities may reference and incorporate into their safety basis when producing facility- or activity-specific documented safety analyses (DSA). Facility- or activity-specific DSAs will identify any variances to the safety management programs described in this document and any specific attributes of these safety management programs that are important for controlling potentially hazardous conditions. In addition, facility- or activity-specific DSAs may identify unique additions to the safety management programs that are needed to control potentially hazardous conditions.

  18. Developing a Management Curriculum for a Cytotechnology Training Program.

    ERIC Educational Resources Information Center

    Miller, Maureen E.

    This study reviewed the literature in the field of health care management, particularly that which pertains to the management of the clinical laboratory. The research cited should help cytotechnology educators in planning a management curriculum and developing program objectives to train cytotechnologists in management. The report is an annotated…

  19. Case vignette: the vicissitudes of managed care.

    PubMed

    Austad, Carol Shaw; Cummings, Nicholas A; Macklin, Ruth; Newman, Russ

    1992-01-01

    Lee Wilson, age 26, was referred to Dr. Jackson for psychotherapy 5 weeks ago by a friend. Lee has been feeling increasingly depressed about longstanding family issues and the recent breakup of a 2-year relationship with a live-in companion. Over the course of the once-per-week sessions, Dr. Jackson notes persistent suicidal ideation, with vague plans to act if, as Lee puts it, "things get any worse." Just before the sixth session, Dr. Jackson is contacted by a reviewer for the managed care health insurance program covering Lee's therapy. The reviewer informs Dr. Jackson that the company will not authorize payment for further psychotherapeutic care. Dr. Jackson knows that Lee is in need of continued treatment and fears that terminating therapy at this time could result in increased suicide risk. Lee's income could cover only a small portion of Dr. Jackson's usual fee. Dr. Jackson does not wish to abandon Lee, but he already provides a significant amount of reduced-fee service to other clients. Is the health insurance carrier's stance ethical? Should Dr. Jackson be expected to treat Lee for the foreseeable future at a greatly reduced fee? How should Dr. Jackson handle this situation? PMID:11651366

  20. Applying business management models in health care.

    PubMed

    Trisolini, Michael G

    2002-01-01

    Most health care management training programmes and textbooks focus on only one or two models or conceptual frameworks, but the increasing complexity of health care organizations and their environments worldwide means that a broader perspective is needed. This paper reviews five management models developed for business organizations and analyses issues related to their application in health care. Three older, more 'traditional' models are first presented. These include the functional areas model, the tasks model and the roles model. Each is shown to provide a valuable perspective, but to have limitations if used in isolation. Two newer, more 'innovative' models are next discussed. These include total quality management (TQM) and reengineering. They have shown potential for enabling dramatic improvements in quality and cost, but have also been found to be more difficult to implement. A series of 'lessons learned' are presented to illustrate key success factors for applying them in health care organizations. In sum, each of the five models is shown to provide a useful perspective for health care management. Health care managers should gain experience and training with a broader set of business management models. PMID:12476639

  1. Managed care. An opportunity for home care agencies.

    PubMed

    Dee-Kelly, P A; Heller, S; Sibley, M

    1994-09-01

    It is clear, even in the future of health care reform, that home care is a growing component of the health care industry. For many years, fee for service was the model reimbursement method. Today we are in a changing health care system that requires a greater emphasis on home care cost containment. New methods of reimbursement are a part of the change. Progressive home care agencies see this as an opportunity to become leaders. This approach does not come without certain risks, however. In taking the risks, it is imperative to minimize the chances for problems, obstacles, and compromising the quality of patient care. It requires that the agency develop a strategy, set a course, and then devote the resources necessary to meet these challenges. Resources may mean investing in upgraded information systems, hiring clinical specialists to develop care plans and protocols, or developing in-house case management staff to allow the agency to monitor use and quality. One thing is clear--the old way of doing business, cost-based fee for service, has a limited life span, and agencies need to embrace these changes, not ignore them. PMID:8090642

  2. Ethical climate in managed care organizations.

    PubMed

    Bell, Sue Ellen

    2003-01-01

    Managed care organizations employ nurses as medical utilization reviewers; however, little is known about the ethical climate of these organizations. This study describes different ethical climates in which utilization review nurses work and the implications of these differences for nurse administrators. The nurse participants, although demographically similar across three managed care organizations, perceived distinct ethical climates across the organizations. Nurses were employed to make complex decisions regarding medical care utilization; however, none of the organizations had an ethics committee to help nurse reviewers in this decision-making process. The need for such committees, as well as clarification of a consistent and deliberate ethical climate by nurse administrators, is discussed. PMID:12765105

  3. Simulation modeling for the health care manager.

    PubMed

    Kennedy, Michael H

    2009-01-01

    This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement. PMID:19668066

  4. Managing diversity in the health care workplace.

    PubMed

    Davidhizar, R; Dowd, S; Newman Giger, J

    1999-03-01

    Cultural diversity is increasing in the United States as increasing numbers of minorities enter the United States from abroad, and cultural diversity is especially prevalent in the health care workplace. In fact, the health care professions are particularly interested in the presence of minorities among caregivers because this often enhances the cultural competence of care delivery. Nevertheless, subtle discrimination can still be found, and managers must be alert that such behavior is not tolerated. Use of the Giger-Davidhizar Cultural Assessment Model can provide managers with information needed to respond to diversity among staff appropriately. PMID:10351046

  5. Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

    PubMed

    Povar, Gail J; Blumen, Helen; Daniel, John; Daub, Suzanne; Evans, Lois; Holm, Richard P; Levkovich, Natalie; McCarter, Alice O; Sabin, James; Snyder, Lois; Sulmasy, Daniel; Vaughan, Peter; Wellikson, Laurence D; Campbell, Amy

    2004-07-20

    Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues. PMID:15262669

  6. Investigation of health care waste management in Binzhou District, China

    SciTech Connect

    Ruoyan, Gai; Xu Lingzhong; Li Huijuan; Zhou Chengchao; He Jiangjiang; Yoshihisa, Shirayama; Tang Wei; Chushi, Kuroiwa

    2010-02-15

    In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed. Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members' knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.

  7. Stress Management. Program Evaluation Handbook.

    ERIC Educational Resources Information Center

    IOX Assessment Associates, Culver City, CA.

    Intended as a resource for individuals wishing to evaluate stress management programs, this handbook, one of a series of seven, provides a collection of measuring devices that can improve the quality of such evaluations. Chapter 1 introduces the handbook's contents and outlines evaluation related issues specific to stress management programs.…

  8. Concussion management by primary care providers

    PubMed Central

    Pleacher, M D; Dexter, W W

    2006-01-01

    Objective To assess current concussion management practices of primary care providers. Methods An 11 item questionnaire was mailed to primary care providers in the state of Maine, with serial mailings to non‐respondents. Results Over 50% of the questionnaires were completed, with nearly 70% of primary care providers indicating that they routinely use published guidelines as a tool in managing patients with concussion. Nearly two thirds of providers were aware that neuropsychological tests could be used, but only 16% had access to such tests within a week of injury. Conclusions Primary care providers are using published concussion management guidelines with high frequency, but many are unable to access neuropsychological testing when it is required. PMID:16371479

  9. Day Care Management. Final Report.

    ERIC Educational Resources Information Center

    Bourque, Janet

    A curriculum was developed and a pilot project was conducted to train 20 day care center directors at Lake Washington Vocational Technical Institute. This document summarizes the curriculum development project and provides the curriculum that was developed. The report contains a summary and outline of the course, a skills assessment, pretests and…

  10. International models of managed care.

    PubMed

    Ham, C

    1995-10-01

    Outside North America health care resources are raised in two main ways: (1) taxation (the Beveridge model) and (2) compulsory social insurance (the Bismarck model). In practice, most European countries rely on a mixture of the two. The author examines the degree to which recent reforms have promoted divergence or convergence of the North American and European systems. PMID:10165628

  11. Child and Youth Care Approaches to Management

    ERIC Educational Resources Information Center

    Gharabaghi, Kiaras

    2008-01-01

    This article explores the themes and issues related to child and youth care approaches to management. The profession is significantly underrepresented at the management level. To some extent, this reflects the challenges of being recognized in the broader human services sector as a profession, but perhaps more so, it reflects an underdevelopment…

  12. Essential program components for perinatal home care.

    PubMed

    Goodwin, L

    1994-10-01

    Home care will continue to be a rapidly expanding area of health care. This growth will be evident in the perinatal nursing specialty. There are multiple models for delivery of perinatal home services. In each case, consideration needs to be given to licensing and other standards; to operational areas such as staffing, supplies, equipment, and reimbursement; and to quality issues, such as staff development, internal and external customer service, and a continuous quality improvement program. Successful marketing of the services requires recognition that the product is nursing care. PMID:7836991

  13. Developing a strategic marketing plan for physical and occupational therapy services: a collaborative project between a critical access hospital and a graduate program in health care management.

    PubMed

    Kash, Bita A; Deshmukh, A A

    2013-01-01

    The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program. PMID:23924224

  14. Managed care aspects of managing multiple sclerosis.

    PubMed

    Owens, Gary M

    2013-11-01

    Multiple sclerosis (MS) is a chronic disease of the central nervous system usually diagnosed in the second or third decade of life; MS is more common among women than men by a ratio of 3 to 1. With its relatively early age of onset and symptoms that impair patients' quality of life, MS requires lifelong, dynamic treatment, and places a substantial economic burden on individuals, healthcare systems, and society. The costs associated with providing benefits for MS therapy are growing rapidly and the increasing complexity of the MS market is impacting disease management for payers. Employers are also increasingly aware of the costs associated with MS and are asking health plans to advise on the most appropriate and cost-effective ways to manage both pharmacologic and non-pharmacologic therapies for MS. Health plans, by necessity, must therefore balance appropriate access to treatments for MS with the need to manage rising treatment costs. To meet this goal, payers require population-based solutions, guidelines, and treatment algorithms for the management of MS that can be used in clinical and formulary management decision making in the context of an evolving therapeutic landscape. Further, comparative studies are necessary for payers to determine which agents may work best on a population basis. Due to the current lack of appropriate clinical guidance and insufficient head-to-head data on disease-modifying drugs, strategies for health plans and clinical management have been designed using the best available evidence. Undoubtedly, management of this class will continue to evolve with the launch of newer agents. PMID:24494620

  15. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-03

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Comprehensive Primary Care... announces a solicitation for health care payer organizations to participate in the Comprehensive Primary Care initiative (CPC), a multipayer model designed to improve primary care. DATES: Letter of...

  16. Job redesign and the health care manager.

    PubMed

    Layman, Elizabeth J

    2007-01-01

    Health care supervisors and managers are often asked to redesign jobs in their departments. Frequently, little information accompanies the directive. This article lists sources of change in work and defines key terms. Also reviewed are factors that supervisors and managers can weigh in their redesigns. The article suggests actions aligned to common problems in the work environment. Finally, guidelines for a practical, step-by-step approach are provided. For health care supervisors and managers, the key to a successful job redesign is to achieve the unique balance of factors that matches the situation. PMID:17464222

  17. GROUNDWATER PROTECTION MANAGEMENT PROGRAM DESCRIPTION.

    SciTech Connect

    PAQUETTE,D.E.; BENNETT,D.B.; DORSCH,W.R.; GOODE,G.A.; LEE,R.J.; KLAUS,K.; HOWE,R.F.; GEIGER,K.

    2002-05-31

    THE DEPARTMENT OF ENERGY ORDER 5400.1, GENERAL ENVIRONMENTAL PROTECTION PROGRAM, REQUIRES THE DEVELOPMENT AND IMPLEMENTATION OF A GROUNDWATER PROTECTION PROGRAM. THE BNL GROUNDWATER PROTECTION MANAGEMENT PROGRAM DESCRIPTION PROVIDES AN OVERVIEW OF HOW THE LABORATORY ENSURES THAT PLANS FOR GROUNDWATER PROTECTION, MONITORING, AND RESTORATION ARE FULLY DEFINED, INTEGRATED, AND MANAGED IN A COST EFFECTIVE MANNER THAT IS CONSISTENT WITH FEDERAL, STATE, AND LOCAL REGULATIONS.

  18. Medical and health administration education in managed care: needs, content and readings.

    PubMed

    Ziegenfuss, J T; Weitekamp, M

    1996-01-01

    With both public and private reform initiatives moving toward managed care, curriculum designs are timely and useful to a diverse audience. This paper discusses the need for and design of education in managed care in medical schools and health services programs. The pressures for offering education regarding managed care are derived from interests of various actors of the health system e.g. regulators, purchasers, providers and consumers. The content of education in managed care is defined in seven areas: (1) managed care and health systems design-history and concepts; (2) environment and governmental policy; (3) models, products, services, outcomes and quality; (4) managed care economics and finance; (5) organization and strategic management; (6) legal issues; and (7) future designs/redesigns. Education in managed care is delivered by universities, professional associations and private training and development corporations. All can benefit from a dialogue on curricular content. PMID:10166710

  19. Clinical Effectiveness Research in Managed-care Systems: Lessons from the Pediatric Asthma Care PORT

    PubMed Central

    Finkelstein, Jonathan A; Lozano, Paula; Streiff, Kachen A; Arduino, Kelly E; Sisk, Cynthia A; Wagner, Edward H; Weiss, Kevin B; Inui, Thomas S

    2002-01-01

    Objective To highlight the unique challenges of evaluative research on practice behavior change in the “real world” settings of contemporary managed-care organizations, using the experience of the Pediatric Asthma Care PORT (Patient Outcomes Research Team). Study Setting The Pediatric Asthma Care PORT is a five-year initiative funded by the Agency for Healthcare Research and Quality to study strategies for asthma care improvement in three managed-care plans in Chicago, Seattle, and Boston. At its core is a randomized trial of two care improvement strategies compared with usual care: (1) a targeted physician education program using practice based Peer Leaders (PL) as change agents, (2) adding to the PL intervention a “Planned Asthma Care Intervention” incorporating joint “asthma check-ups” by nurse-physician teams. During the trial, each of the participating organizations viewed asthma care improvement as an immediate priority and had their own corporate improvement programs underway. Data Collection Investigators at each health plan described the organizational and implementation challenges in conducting the PAC PORT randomized trial. These experiences were reviewed for common themes and “lessons” that might be useful to investigators planning interventional research in similar care-delivery settings. Conclusions Randomized trials in “real world” settings represent the most robust design available to test care improvement strategies. In complex, rapidly changing managed-care organizations, blinding is not feasible, corporate initiatives may complicate implementation, and the assumption that a “usual care” arm will be static is highly likely to be mistaken. Investigators must be prepared to use innovative strategies to maintain the integrity of the study design, including: continuous improvement within the intervention arms, comanagement by researchers and health plan managers of condition-related quality improvement initiatives, procedures

  20. Quality and cost-effective management of mental health care.

    PubMed

    Burton, W N; Hoy, D A; Bonin, R L; Gladstone, L

    1989-04-01

    Corporations have reduced their mental health care benefits by limits on coverage for such services. We report on a comprehensive mental health care program, including prevention and early intervention, hospital utilization review, and consulting psychiatrist, which has improved the quality and has significantly reduced inpatient insurance psychiatric hospitalization costs. Mental health service coverage was actually enhanced. Inpatient psychiatric hospitalization costs 12 months before and after the implementation of a concurrent psychiatric hospital utilization review program were reviewed for a major corporation. Total hospital days and average length of stay decreased by 43% whereas total inpatient psychiatric hospital charges decreased by $309,518. Total inpatient days decreased by 1045. Quality and cost-effective comprehensive psychiatric health care services can be offered by major corporations providing that such benefits are carefully designed and managed. PMID:2715844

  1. Wildlife Management Assistance Program

    SciTech Connect

    Caudell, M.B.

    1992-08-01

    This report details activities in administering Savannah River Site public lands for wildlife management. Accomplishments in administering hunts, gathering biological data, and in coordinating land use are described.

  2. The Marshall Islands Data Management Program

    SciTech Connect

    Stoker, A.C.; Conrado, C.L.

    1995-09-01

    This report is a resource document of the methods and procedures used currently in the Data Management Program of the Marshall Islands Dose Assessment and Radioecology Project. Since 1973, over 60,000 environmental samples have been collected. Our program includes relational database design, programming and maintenance; sample and information management; sample tracking; quality control; and data entry, evaluation and reduction. The usefulness of scientific databases involves careful planning in order to fulfill the requirements of any large research program. Compilation of scientific results requires consolidation of information from several databases, and incorporation of new information as it is generated. The success in combining and organizing all radionuclide analysis, sample information and statistical results into a readily accessible form, is critical to our project.

  3. Strategic service quality management for health care.

    PubMed

    Anderson, E A; Zwelling, L A

    1996-01-01

    Quality management has become one of the most important and most debated topics within the service sector. This is especially true for health care, as the controversy rages on how the existing American system should be restructured. Health care reform aimed at reducing costs and ensuring access to all Americans cannot be allowed to jeopardize the quality of care. As such, total quality management (TQM) has become a vital ingredient to strategic planning within the health care domain. At the heart of any such quality improvement effort is the issue of measurement. TQM cannot be effectively utilized as a competitive weapon unless quality can be accurately defined, measured, evaluated, and monitored over time. Through such analysis a hospital can elect how to expend its limited resources toward those quality improvement projects which will impact customer perceptions of service quality the most. Thus, the purpose of this report is to establish a framework by which to approach the issue of quality measurement, delineate the various components of quality that exist in health care, and explore how these elements affect one another. We propose that the issue of quality measurement in health care be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to health care. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the health care domain and encourage other researchers to address the interactions of the various quality attributes. PMID:8763215

  4. Communicating Risk to Program Managers

    NASA Technical Reports Server (NTRS)

    Shivers, C. Herbert

    2005-01-01

    Program Managers (PM) can protect program resources and improve chances of success by anticipating, understanding and managing risks. Understanding the range of potential risks helps one to avoid or manage the risks. A PM must choose which risks to accept to reduce fire fighting, must meet the expectations of stakeholders consistently, and avoid falling into costly "black holes" that may open. A good risk management process provides the PM more confidence to seize opportunities save money, meet schedule, even improve relationships with people important to the program. Evidence of managing risk and sound internal controls can mean better support from superiors for the program by building a trust and reputation from being on top of issues. Risk managers have an obligation to provide the PM with the best information possible to allow the benefits to be realized (Small Business Consortium, 2004). The Institute for Chartered Accountants in England and Wales sees very important benefits for companies in providing better information about what they do to assess and manage key business risks. Such information will: a) provide practical forward-looking information; b) reduce the cost of capital; c) encourage better risk management; and d) improve accountability for stewardship, investor protection and the usefulness of financial reporting. We are particularly convinced that enhanced risk reporting will help listed companies obtain capital at the lowest possible cost (The Institute of Chartered Accountants in England &Wales, June 2002). Risk managers can take a significant role in quantifying the success of their department and communicating those figures to executive (program) management levels while pushing for a broader risk management role. Overall, risk managers must show that risk management work matters in the most crucial place-the bottom line- as they prove risk management can be a profit center (Sullivan, 2004).

  5. Expanding Medicaid managed care: the right choice for Texas?

    PubMed

    Reddy, Swapna; Finley, Marisa; Posey, Dan; Rohack, James J

    2012-10-01

    We set out to determine whether expanding Medicaid managed care in Texas is the solution to the challenges faced by the state of meeting the healthcare needs of a rapidly growing Medicaid population while addressing its own fiscal limitations. We reviewed the Texas Medicaid program, the potential effects of federal healthcare reform, and the state political climate through the perspectives (advantages and disadvantages) of the primary stakeholders: patients, practitioners, hospitals, and insurers. Research was performed through online, federal and state regulatory, and legislative review. In addition, we reviewed government and peer-reviewed reports and articles pertaining to issues related to Medicaid populations, healthcare practitioners, and hospitals that serve them. Each primary stakeholder had potential advantages and disadvantages associated with the expansion of Medicaid managed care. We conclude that expanding Medicaid managed care, if done in a manner responsive to the needs of recipients, can meet enrollees' healthcare needs while controlling the state's costs. PMID:23038487

  6. Managing health care variability to achieve quality care.

    PubMed

    Simmons, J C

    2001-05-01

    While much has been written about variation and health care, one area that has received little attention is variation within hospitals related to the operations management--which can lead to wasted money and human resources. Two Boston researchers who have been studying this area say that addressing these variations--and using techniques found in other major industries across the country--could give hospitals a new tool in addressing patient safety issues, nursing shortages, cost containment, and overall better quality of care. PMID:11400326

  7. Critical Care Management of Intracerebral Hemorrhage.

    PubMed

    Morawo, Adeolu O; Gilmore, Emily J

    2016-06-01

    Spontaneous intracerebral hemorrhage (ICH), the most devastating and debilitating form of stroke, remains a major healthcare concern all over the world. Intracerebral hemorrhage is frequently managed in critical care settings where intensive monitoring and treatment are employed to prevent and address primary and secondary brain injury as well as other medical complications that may arise. Although there has been increasing data guiding the management of ICH in the past decade, prognosis remains dismal. In this article, the authors discuss the risk factors for ICH, the role of imaging, the major targets of neurocritical care management, the etiology and management of raised intracranial pressure, as well as prevention of and prompt response to the emergence of medical complications. They also discuss the effect of early withdrawal of life-sustaining therapy on prognosis. Finally, we outline several clinical trials that hold promise in improving our management of ICH in the near future. PMID:27214697

  8. Quality in managed care: developments and considerations.

    PubMed

    Spoeri, R K

    1997-01-01

    With the rapid movement of both individuals and groups away from fee-for-service health care into managed care, concerns have been expressed appropriately that the quality of care may be affected adversely. Over the past several years, a number of developments have taken place to respond to these concerns. This quality movement in managed care has not been without some issues and considerations, however. This article first describes the National Committee for Quality Assurance (NCQA) and the prominent role it has played in this movement. Next, quality improvement study design is addressed in the context of assuring quality, controlling costs, and achieving NCQA accreditation. The effect that capitation, as a payment strategy for providers, has on data quality is then described. Fourth, the value of partnering is explored. Finally, the newest version of NCQA's performance measurement template is discussed: the Health Plan Employer Data and Information Set, version 3.0. PMID:10169183

  9. Child Day Care Program Evaluation System.

    ERIC Educational Resources Information Center

    Monroe, Marian

    In this document the Texas Department of Human Resources (DHR) presents criteria which day-care providers can use to evaluate their programs. The criteria can also be used by DHR staff to determine whether or not providers can deliver the services specified in their contracts with DHR. For each criterion, five achievement levels, clarification,…

  10. Quality of Care Provided by a Comprehensive Dementia Care Comanagement Program.

    PubMed

    Jennings, Lee A; Tan, Zaldy; Wenger, Neil S; Cook, Erin A; Han, Weijuan; McCreath, Heather E; Serrano, Katherine S; Roth, Carol P; Reuben, David B

    2016-08-01

    Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators (QIs) ranging from 18% to 42%. In response, the University of California at Los Angeles (UCLA) Health System created the UCLA Alzheimer's and Dementia Care (ADC) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers (DCM) working with primary care physicians and community-based organizations to provide comprehensive dementia care. The objective was to measure the quality of dementia care that nurse practitioner DCMs provide using the Assessing Care of Vulnerable Elders (ACOVE-3) and Physician Consortium for Performance Improvement QIs. Participants included 797 community-dwelling adults with dementia referred to the UCLA ADC program over a 2-year period. UCLA is an urban academic medical center with primarily fee-for-service reimbursement. The percentage of recommended care received for 17 dementia QIs was measured. The primary outcome was aggregate quality of care for the UCLA ADC cohort, calculated as the total number of recommended care processes received divided by the total number of eligible quality indicators. Secondary outcomes included aggregate quality of care in three domains of dementia care: assessment and screening (7 QIs), treatment (6 QIs), and counseling (4 QIs). QIs were abstracted from DCM notes over a 3-month period from date of initial assessment. Individuals were eligible for 9,895 QIs, of which 92% were passed. Overall pass rates of DCMs were similar (90-96%). All counseling and assessment QIs had pass rates greater than 80%, with most exceeding 90%. Wider variation in adherence was found among QIs addressing treatments for dementia, which patient-specific criteria triggered, ranging from 27% for discontinuation of medications associated with mental status changes to 86% for discussion about acetylcholinesterase inhibitors. Comprehensive

  11. Health-care waste management in India.

    PubMed

    Patil, A D; Shekdar, A V

    2001-10-01

    Health-care waste management in India is receiving greater attention due to recent regulations (the Biomedical Wastes (Management & Handling) Rules, 1998). The prevailing situation is analysed covering various issues like quantities and proportion of different constituents of wastes, handling, treatment and disposal methods in various health-care units (HCUs). The waste generation rate ranges between 0.5 and 2.0 kg bed-1 day-1. It is estimated that annually about 0.33 million tonnes of waste are generated in India. The solid waste from the hospitals consists of bandages, linen and other infectious waste (30-35%), plastics (7-10%), disposable syringes (0.3-0.5%), glass (3-5%) and other general wastes including food (40-45%). In general, the wastes are collected in a mixed form, transported and disposed of along with municipal solid wastes. At many places, authorities are failing to install appropriate systems for a variety of reasons, such as non-availability of appropriate technologies, inadequate financial resources and absence of professional training on waste management. Hazards associated with health-care waste management and shortcomings in the existing system are identified. The rules for management and handling of biomedical wastes are summarised, giving the categories of different wastes, suggested storage containers including colour-coding and treatment options. Existing and proposed systems of health-care waste management are described. A waste-management plan for health-care establishments is also proposed, which includes institutional arrangements, appropriate technologies, operational plans, financial management and the drawing up of appropriate staff training programmes. PMID:11721600

  12. Environmental Management Science Program Workshop

    SciTech Connect

    1998-07-01

    This program summary book is a compendium of project summaries submitted by principal investigators in the Environmental Management Science Program and Environmental Management/Energy Research Pilot Collaborative Research Program (Wolf-Broido Program). These summaries provide information about the most recent project activities and accomplishments. All projects will be represented at the workshop poster sessions, so you will have an opportunity to meet with the researchers. The projects will be presented in the same order at the poster session as they are presented in this summary book. Detailed questions about an individual project may be directed to the investigators involved.

  13. Managed Care Quality of Care and Plan Choice in New York SCHIP

    PubMed Central

    Liu, Hangsheng; Phelps, Charles E; Veazie, Peter J; Dick, Andrew W; Klein, Jonathan D; Shone, Laura P; Noyes, Katia; Szilagyi, Peter G

    2009-01-01

    Objective To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. Data Sources 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Study Design Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. Principle Findings There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Conclusions Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment. PMID:19208091

  14. [Major Burn Trauma Management and Nursing Care].

    PubMed

    Lo, Shu-Fen

    2015-08-01

    Major burn injury is one of the most serious and often life-threatening forms of trauma. Burn patients not only suffer from the physical, psychological, social and spiritual impacts of their injury but also experience considerable changes in health-related quality of life. This paper presents a review of the literature on the implications of previous research and clinical care guidelines related to major burn injuries in order to help clinical practice nurses use evidence-based care guidelines to respond to initial injury assessments, better manage the complex systemic response to these injuries, and provide specialist wound care, emotional support, and rehabilitation services. PMID:26242439

  15. Managed care, market power, and monopsony.

    PubMed Central

    Pauly, M V

    1998-01-01

    OBJECTIVE: To examine the theoretical possibility of monopsony behavior under managed care insurance. STUDY DESIGN: Use of microeconomic theory to examine how managed care plans with market power would be expected to behave, and effects of that behavior on consumer and supplier welfare. PRINCIPAL FINDINGS: The article shows that, under managed care monopsony, the welfare of consumers may be increased but overall economic welfare will necessarily be reduced. It offers a test for whether the lower prices paid by managed care buyers with larger market share represent welfare-reducing monopsony or a welfare-increasing movement away from provider monopoly. The test says that, if the quantity of inputs (supplied under conditions of increasing long-run marginal cost) declines, monopsony is present. The article also argues that the translation of lower provider prices into lower premiums is consistent with welfare-reducing monopsony by nonprofit health plans. In contrast, for-profit health plans that obtain monopsony may reduce the welfare of consumers as well as that of input suppliers. These theoretical conclusions are shown to be consistent with recent empirical research indicating a negative relationship between buyer market power and cost per enrollee. CONCLUSIONS: Traditional antitrust policy has not been able to deal well with monopsony. The article concludes that health plans that use their market power to reduce medical spending may harm the well-being both of specialized medical workers and of consumers of medical care. Antitrust policy may need to be modified to deal with this situation. PMID:9865228

  16. 5 CFR 792.203 - Child care subsidy programs; eligibility.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Child care subsidy programs; eligibility... of Appropriated Funds for Child Care Costs for Lower Income Employees § 792.203 Child care subsidy programs; eligibility. (a)(1) An Executive agency may establish a child care subsidy program in which...

  17. 5 CFR 792.203 - Child care subsidy programs; eligibility.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Child care subsidy programs; eligibility... of Appropriated Funds for Child Care Costs for Lower Income Employees § 792.203 Child care subsidy programs; eligibility. (a)(1) An Executive agency may establish a child care subsidy program in which...

  18. Pharmaceutical services in a capitated geriatric care program.

    PubMed

    Sorrento, T A; Bonanza, K C; Salisbury, D W

    1996-12-01

    A hospital outpatient pharmacy's planning and implementation of pharmaceutical services for a capitated geriatric care program are described. The hospital's director of pharmacy and pharmacy ambulatory care manager proposed providing distributive and clinical services for enrollees in Independent Living for Seniors (ILS), a program designed to help elderly persons to continue living at home instead of in nursing homes. ILS receives pooled monthly payments from Medicare and Medicaid; a copayment is required of enrollees not eligible for Medicaid. Medical and social services are offered, primarily through adult daycare centers. Nurses at the centers monitor ILS enrollees regularly and help them manage their medications. After a year of negotiations with the program, the outpatient satellite of the hospital's inpatient pharmacy began providing services; one pharmacist was assigned to ILS. Problems with medication stock at the daycare centers were corrected. Conservative supplies of stock drugs (mostly nonprescription items) and medications to meet patients' needs between daily pharmacy deliveries were established. A new computerized medication administration record was developed. Once distributive services were in place, a pharmacy and therapeutics committee began establishing a formulary. The pharmacist functions as part of an interdisciplinary care team, providing education on drug use and managing costs; he reviews all patients' charts every four months and meets weekly with ILS staff to recommend changes in drug therapy. The cost of services provided by the hospital outpatient pharmacy averaged $77 per patient per month in the first year, compared with about $120 for the previous vendor. A hospital's ambulatory care pharmacy improved the pharmaceutical services provided to a capitated geriatric care program. PMID:8957345

  19. Responding to health care reform: how managed health care providers can manage major change overload.

    PubMed

    Gilmartin, J J

    1994-02-01

    Multiple pressures for clinical, administrative, economical, and political change face providers today. To cope with a changing society and health care delivery system, change management skills have become essential for survival. However, implementing and managing organizational change demands a level of expertise that is, unfortunately, not readily found in many managed health care organizations. In this article, the author addresses the importance for providers to understand the process of change implementation. PMID:10132445

  20. Nutrition and Meal Planning in Child-Care Programs: A Practical Guide.

    ERIC Educational Resources Information Center

    Edelstein, Sari

    Designed to assist child care center managers in planning nutritious meals for children in centers or licensed home day care programs, this guide presents information on the nutritional requirements of infants and children, sample menus for child care centers, and resources for further information. The first part of the guide details the…

  1. A Framework for Fibromyalgia Management for Primary Care Providers

    PubMed Central

    Arnold, Lesley M.; Clauw, Daniel J.; Dunegan, L. Jean; Turk, Dennis C.

    2012-01-01

    Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting. PMID:22560527

  2. Managed care and the impact of glaucoma.

    PubMed

    Reeder, Claiborne E; Franklin, Meg; Bramley, Thomas J

    2008-02-01

    Changes in the healthcare system, population demographics, and treatment alternatives have contributed to an emerging awareness of glaucoma among managed care organizations. Early diagnosis and treatment are essential to thwarting the personal and economic consequences of end-stage glaucoma. Despite recognition of the need for early intervention and therapy, the literature suggests a great need still exists for improvements in lowering intraocular pressure, managing appropriate follow-up, and improving adherence to current glaucoma medication regimens. As the elderly population continues to increase, these issues will intensify and present further problems for the healthcare system. The purpose of this introductory manuscript is to highlight the literature on the clinical and economic impact of glaucoma and its importance to the managed care community. The remainder of the supplement will focus on the current management of glaucoma and the potential role of neuroprotection in this patient population. PMID:18284314

  3. Managed care organizations' arrangements with nurse practitioners: a Connecticut perspective.

    PubMed

    O'Donnell, J P; Cohen, S S; Mason, D J; Baxter, K; Chase, A B

    1998-01-01

    Executives in more than 50% of managed care organizations (MCOs) in New York and Connecticut were interviewed for information on the roles, participation, and listing of NPs as primary care providers. MCO executives are highly satisfied with their primary care provider NPs, particularly in women's health and geriatrics, secondary to spending more time teaching and explaining procedures than physicians. Among both health care professionals and the general public there is an overall lack of current knowledge and/or confusion about NPs and their practice. Eighty-two percent of executives in MCOs thought their organization should encourage the use of NPs as primary care providers. Beginning in the early 1960s, advanced practice nursing has shown steady growth. Research has found that NPs provide cost-effective, quality-driven patient care (Brown & Grimes, 1995; Cohen & Juszczak, 1997; Frampton & Wall, 1994; Hardy & Evans, 1995). Many thought health care reform would lead to an expansion of advanced practice nurses (APNs) and other nonphysician providers as primary care providers (Aiken & Salmon, 1994). Funding for and enrollment in graduate nursing programs rose nationwide (American Association of Colleges of Nursing, 1996). Anecdotal reports indicated that NPs were not included in MCO primary care provider panels. The purpose of this study was to explore MCO arrangements with nurse practitioners and the factors that influence them. PMID:10614235

  4. Oregon's experiment in health care delivery and payment reform: coordinated care organizations replacing managed care.

    PubMed

    Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M

    2015-02-01

    To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings. PMID:25480844

  5. A Program Management Framework for Facilities Managers

    ERIC Educational Resources Information Center

    King, Dan

    2012-01-01

    The challenge faced by senior facility leaders is not how to execute a single project, but rather, how to successfully execute a large program consisting of hundreds of projects. Senior facilities officers at universities, school districts, hospitals, airports, and other organizations with extensive facility inventories, typically manage project…

  6. Aircrew team management program

    NASA Technical Reports Server (NTRS)

    Margerison, Charles; Mccann, Dick; Davies, Rod

    1987-01-01

    The key features of the Aircrew Team Management Workshop which was designed for and in consultation with Trans Australia Airlines are outlined. Five major sections are presented dealing with: (1) A profile of the airline and the designers; (2) Aircrew consultation and involvement; (3) Educational design and development; (4) Implementation and instruction; and (5) Evaluation and assessment. These areas are detailed.

  7. Managing organizational change: strategies for the female health care supervisor.

    PubMed

    Davies, G

    1990-07-01

    In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10105044

  8. Glaucoma arrives on managed care's doorstep.

    PubMed

    Mansukani, Sharad S

    2002-11-01

    Popular new prostaglandins, prostamides, and alpha2 agonists have brought about higher utilization, while their expense has produced a new cost driver in managed care organizations. The recent appearance of competitive products within these drug classes has offered patients, health plans, and physicians new treatment options. PMID:15357533

  9. Medicare managed care: numbers and trends.

    PubMed

    Zarabozo, C; Taylor, C; Hicks, J

    1996-01-01

    This article captures some key trends in Medicare managed care. The figures which accompany this article explore, among other issues: enrollment; numbers of participating plans; demographic characteristics such as geographic location, age, and income; and premium and benefit comparisons. PMID:10158732

  10. The changing face of managed care.

    PubMed

    Draper, Debra A; Hurley, Robert E; Lesser, Cara S; Strunk, Bradley C

    2002-01-01

    Managed care plans--pressured by a variety of marketplace forces that have been intensifying over the past two years--are making important shifts in their overall business strategy. Plans are moving to offer less restrictive managed care products and product features that respond to consumers' and purchasers' demands for more choice and flexibility. In addition, because consumers and purchasers prefer broad and stable networks that require plans to include rather than exclude providers, plans are seeking less contentious contractual relationships with physicians and hospitals. Finally, to the extent that these changes erode their ability to control costs, plans are shifting from an emphasis only on increasing market share to a renewed emphasis on protecting profitability. Consequently, purchasers and consumers face escalating health care costs under these changing conditions. PMID:11900063

  11. Cardiac Transplant Postoperative Management and Care.

    PubMed

    Freeman, Regi; Koerner, Erika; Clark, Courtney; Halabicky, Kathy

    2016-01-01

    Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted. PMID:27254638

  12. Program and Project Management Framework

    NASA Technical Reports Server (NTRS)

    Butler, Cassandra D.

    2002-01-01

    The primary objective of this project was to develop a framework and system architecture for integrating program and project management tools that may be applied consistently throughout Kennedy Space Center (KSC) to optimize planning, cost estimating, risk management, and project control. Project management methodology used in building interactive systems to accommodate the needs of the project managers is applied as a key component in assessing the usefulness and applicability of the framework and tools developed. Research for the project included investigation and analysis of industrial practices, KSC standards, policies, and techniques, Systems Management Office (SMO) personnel, and other documented experiences of project management experts. In addition, this project documents best practices derived from the literature as well as new or developing project management models, practices, and techniques.

  13. Staged diabetes management: computerizing a disease state management program.

    PubMed

    Ginsberg, B H; Tan, M H; Mazze, R; Bergelson, A

    1998-04-01

    Recently, the Diabetes Control and Complication Trial (DCCT) and other similar studies have demonstrated that near-normalization of blood glucose in diabetes will reduce complications up to 75% but translation of these results into practice has been difficult. In an attempt to help provide the best possible control of patients with diabetes, we have produced an attempt to help provide the best possible control of patients with diabetes, we have produced a new disease state management system for diabetes, called "Staged Diabetes Management" (SDM), implemented it in over 100 sites worldwide, and developed a computer program to simplify its use. SDM, designed to change the way we deal with patients with diabetes, is based upon five principles: (1) community involvement in setting care guidelines; (2) negotiation of goals with patients; (3) appropriate timelines for therapeutic success; (4) use of flowcharts for medical decisions; and (5) evaluation of the program. SDM is designed to be altered by a community to meet its needs and resources. It encourages primary care physicians to deliver better diabetes care using a team approach and to refer patients with diabetes to specialists when appropriate. It has a complete set of materials for communities, individual health care providers and patients. SDM has been tested for changes in structure, process and outcomes. A meta-analysis of seven clinical trials with over 500 patients has shown a time-weighted average fall in hemoglobin A1c of 1.7 points (equivalent to a drop in mean blood glucose of about 3.5 mM or 60 mg/dL). Preliminary pharmacoeconomic analysis demonstrates a lifetime cost saving of over $27,000 per patient. A computer program has been developed for the Microsoft Windows environment that contains a client-server database, based upon DiabCare, for the data file structure. PMID:9571514

  14. Managing malaria in the intensive care unit

    PubMed Central

    Marks, M.; Gupta-Wright, A.; Doherty, J. F.; Singer, M.; Walker, D.

    2014-01-01

    The number of people travelling to malaria-endemic countries continues to increase, and malaria remains the commonest cause of serious imported infection in non-endemic areas. Severe malaria, mostly caused by Plasmodium falciparum, often requires intensive care unit (ICU) admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. The mortality from imported malaria remains significant. This article reviews the manifestations, complications and principles of management of severe malaria as relevant to critical care clinicians, incorporating recent studies of anti-malarial and adjunctive treatment. Effective management of severe malaria includes prompt diagnosis and early institution of effective anti-malarial therapy, recognition of complications, and appropriate supportive management in an ICU. All cases should be discussed with a specialist unit and transfer of the patient considered. PMID:24946778

  15. An Academic Medical Center's Experience with Mandatory Managed Care for Medicaid Recipients.

    ERIC Educational Resources Information Center

    Hillman, Alan L.; And Others

    1991-01-01

    This paper reports on experiences and concerns of the Hospital of the University of Pennsylvania as a participating primary care site in a Medicaid managed care program (HealthPASS). Discussed are the modification of existing activities to meet increased care demands and administrative demands, and characteristics of HealthPASS that have impeded…

  16. Day Care Related Federal Programs (An Addendum to Day Care Survey 1970).

    ERIC Educational Resources Information Center

    1971

    This document, an addendum to the Day Care Survey 1970, describes day care-related federal programs. Each program, is described briefly in terms of: the nature of the program, day care services provided, authorizing legislation, the administering agency, and miscellaneous information (funding, recipients, etc.). Types of programs included are: (1)…

  17. NASA's management concept for the Space Shuttle Program.

    NASA Technical Reports Server (NTRS)

    Myers, D. D.

    1972-01-01

    An overview of the Shuttle Program organization and management concepts suggests the necessity of careful measurements of contractor schedules, cost and technical performance, and program modification control to keep both the development and operating cost of the Program at the lowest possible level. Maximum use of the contractors' own management systems and the utilization of new technologies, procedures and materials during space operations are also envisaged as contributors to the reduction of costs per flight to acceptable limits.

  18. A new resource for managing malpractice risks in managed care.

    PubMed

    Bursztajn, H; Brodsky, A

    1996-10-14

    The risk of malpractice liability faced by physicians is exacerbated by third-party intrusions such as those encountered in today's managed care environment. The likelihood that a malpractice action will be brought is increased by the interaction among patients, families, or physicians who are at high risk for litigation and situations (eg, denial of treatment benefits by the managed care organization) that create adversity. To prevent the ready translation of resource adversity into an adversarial physician-patient-family relationship, a forensic psychiatric consultation is recommended. PMID:8862097

  19. Towards Open Information Management in Health Care

    PubMed Central

    Yli-Hietanen, J; Niiranen, S

    2008-01-01

    The utilization of information technology as tool in health care is increasing. The main benefits stem from the fact that information in electronic form can be transferred to different locations rapidly and from the possibility to automate certain information management tasks. The current technological approach for this automation relies on structured, formally coded representation of information. We discuss the limitations of the current technological approach and present a viewpoint, grounded on previous research and the authors’ own experiences, on how to progress. We present that a bottleneck in the automation of the management of constantly evolving clinical information is caused by the fact that the current technological approach requires the formal coding of information to be static in nature. This inherently hinders the expandability of the information case space to be managed. We present a new paradigm entitled open information management targeting unlimited case spaces. We also present a conceptual example from clinical medicine demonstrating open information management principles and mechanisms. PMID:19415134

  20. Cancer patient supportive care and pain management. Special listing

    SciTech Connect

    Not Available

    1981-04-01

    This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients.

  1. 7 CFR 1951.214 - Care, management, and disposal of acquired property.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Community and Direct Business Programs Loans and Grants § 1951.214 Care, management, and disposal of... 7 Agriculture 14 2010-01-01 2009-01-01 true Care, management, and disposal of acquired property. 1951.214 Section 1951.214 Agriculture Regulations of the Department of Agriculture (Continued)...

  2. Development and Evaluation of an Integrated Pest Management Toolkit for Child Care Providers

    ERIC Educational Resources Information Center

    Alkon, Abbey; Kalmar, Evie; Leonard, Victoria; Flint, Mary Louise; Kuo, Devina; Davidson, Nita; Bradman, Asa

    2012-01-01

    Young children and early care and education (ECE) staff are exposed to pesticides used to manage pests in ECE facilities in the United States and elsewhere. The objective of this pilot study was to encourage child care programs to reduce pesticide use and child exposures by developing and evaluating an Integrated Pest Management (IPM) Toolkit for…

  3. Managed care and the ethics of regulation.

    PubMed

    De Ville, K A

    1999-10-01

    The dramatic appearance of managed care organizations (MCOs) on the U.S. health scene has generated tremendous anxiety among health care providers and patients. These fears are based on the belief that managed care techniques pose greater risks of under treatment than do fee-for-service modes of payment. In addition, many physicians and patients resent the limits placed on clinical autonomy by the MCO model and the stresses that it places on the traditional physician-patient relationship. These misgivings have been exacerbated by the mostly negative response to MCOs in the media and academia. Legislatures have responded to these claims and public fears with a wave of regulatory initiatives. Some of these regulations are attempts to protect patients. Others, however, are motivated primarily by antipathy toward the concept of managed care itself. This essay is an attempt to develop a social ethic of regulation and argues that the sole reason that private enterprise may be justifiably limited is when it presents a risk of harm to others or society. While some regulation and proposed regulation of MCOs meet this standard, much legislation represents an unjustified attempt to limit or handicap otherwise legal behavior merely because a segment of the population and medical profession find it aesthetically unpleasing and oppose its approach to the delivery of health services. PMID:10614733

  4. Academic medicine and managed care: seeking common ground.

    PubMed

    LaRosa, J C; Whelton, P; Litwin, M S

    1999-05-01

    The authors report the highlights of a one-day symposium, "Academic Medicine and Managed Care: Seeking Common Ground," sponsored in early 1997 by Tulane University Medical Center. The meeting was held to foster better understanding of the gap between managed care organizations (MCOs) and academic health centers (AHCs) and to define their common ground. There were 62 participants, mainly executives froin AHCs and MCOs, plus government officials and policy researchers interested in the interface of academic medicine and managed care. The participants agreed that there are indeed some common areas in which the two types of organizations can develop programs and interests that serve the missions of both. These include (1) a commitment to high-quality health care, objectively measured by outcomes; (2) issues of "customer service"; (3) certain areas of research (e.g., examining outcomes of medical interventions; measuring cost and cost-effectiveness; measuring quality of care); and (4) preventive medicine, an area in which both AHCs and MCOs are still relatively weak. On the other hand, large elements of AHCs' basic missions of education and research are not seen by MCOs as areas for developing a common agenda. Participants agreed that AHCs must do their best to improve and demonstrate the quality of their care, address the challenges of the market (i.e., take "customer service" seriously), address the issue of how many specialists and how many generalists should be trained, and define the cost of each of their missions. On the other hand, managed care must acknowledge that the missions of AHCs greatly benefit patients and society. Participants agreed that all approaches to AHC-MCO interfaces must be flexible and local, that common ground does exist, and that understanding can grow between these two kinds of organizations if acrimonious exchanges are avoided and serious efforts are made to work together for solutions. PMID:10353278

  5. Managed care's price bargaining with hospitals.

    PubMed

    Wu, Vivian Y

    2009-03-01

    Research has shown that managed care (MC) slowed the rate of growth in health care spending in the 1990s, primarily via lower unit prices paid. However, the mechanism of MC's price bargaining has not been well studied. This article uses a unique panel dataset with actual hospital prices in Massachusetts between 1994 and 2000 to examine the sources of MC's bargaining power. I find two significant determinants of price discounts. First, plans with large memberships are able to extract volume discounts across hospitals. Second, health plans that are more successful at channeling patients can extract greater discounts. Patient channeling can add to the volume discount that plans negotiate. PMID:19108922

  6. Kids get care: integrating preventive dental and medical care using a public health case management model.

    PubMed

    Wysen, Kirsten H; Hennessy, Patricia M; Lieberman, Martin I; Garland, Tracy E; Johnson, Susan M

    2004-05-01

    Kids Get Care is a public health-based program in the Seattle area designed to ensure that low-income children, regardless of insurance status, receive early integrated preventive medical, dental, and developmental health services through attachment to medical and dental homes (the usual sources of medical or dental care). The oral health component of the program focuses on cross-training medical and dental providers, providing partner medical clinics with a case manager, and educating staff in nearby community-based organizations about how to identify incipient dental disease and possible early childhood developmental delays. The program identifies a local, well-respected dentist to champion the delivery of oral health screening within a medical clinic and to provide oral health training to medical clinic staff. The program works with community agencies to educate families on the importance of healthy baby teeth, routine dental care beginning at age one, and general prevention. In its first year, the program trained 355 community staff and 184 primary care providers on how to conduct an oral health assessment. These staff and providers screened more than 5,500 children for oral health problems. One medical clinic more than doubled the number of fluoride varnishes it provided, increasing from 80 to 167 during a nine-month pilot phase. Other outcome studies are in progress. PMID:15186069

  7. Physicians in health care management: 10. Managing conflict through negotiation.

    PubMed Central

    Lemieux-Charles, L

    1994-01-01

    The recent focus on collaborative relationships in health care means that people and groups must cooperate to accomplish clinical and management tasks. This increasing interdependence may also cause increased organizational conflict. The management of conflicts is critical to the effectiveness of an organization. Negotiating strategies, based on Fisher and Ury's method of "principled negotiation," include establishing superordinate goals, separating the people from the problem, focussing on interests, inventing options, using objective criteria and defining success in terms of gains. PMID:7922944

  8. Day Care: A Program in Search of a Policy.

    ERIC Educational Resources Information Center

    Bikales, Gerda

    This report examines current issues relating to day care and challenges many of the policy assumptions that underlie a major public program of subsidized day care for children. A historical perspective of day care is presented and various types of day care are described. The costs and benefits of day care are examined and the relation of day care…

  9. 75 FR 79323 - Health Care for Homeless Veterans Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-20

    ... AFFAIRS 38 CFR Part 63 RIN 2900-AN73 Health Care for Homeless Veterans Program AGENCY: Department of... contracting with community-based treatment facilities in the Health Care for Homeless Veterans (HCHV) program... ``RIN 2900-AN73, Health Care for Homeless Veterans Program.'' Copies of comments received will...

  10. 76 FR 52575 - Health Care for Homeless Veterans Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... AFFAIRS 38 CFR Part 63 RIN 2900-AN73 Health Care for Homeless Veterans Program AGENCY: Department of... community-based treatment facilities in the Health Care for Homeless Veterans (HCHV) program of the... enrolled in the VA health care system. Through the HCHV program, VA identifies homeless veterans...

  11. Medical care delivery in the US space program

    NASA Technical Reports Server (NTRS)

    Stewart, Donald F.

    1991-01-01

    The stated goal of this meeting is to examine the use of telemedicine in disaster management, public health, and remote health care. NASA has a vested interest in providing health care to crews in remote environments. NASA has unique requirements for telemedicine support, in that our flight crews conduct their job in the most remote of all work environments. Compounding the degree of remoteness are other environmental concerns, including confinement, lack of atmosphere, spaceflight physiological deconditioning, and radiation exposure, to name a few. In-flight medical care is a key component in the overall support for missions, which also includes extensive medical screening during selection, preventive medical programs for astronauts, and in-flight medical monitoring and consultation. This latter element constitutes the telemedicine aspect of crew health care. The level of in-flight resources dedicated to medical care is determined by the perceived risk of a given mission, which in turn is related to mission duration, planned crew activities, and length of time required for return to definitive medical care facilities.

  12. [Inefficient management of personal health in oral anticoagulation. Home nursing care in primary health care].

    PubMed

    López Castañón, Lorena

    2012-01-01

    This case report describes an 83 year-old immobilised patient with multiple diseases and on polypharmacy. Nursing care is developed at home. The patient is included in patient care programs for the anticoagulated and polymedicated patient. Nursing assessments were made using the Marjory Gordon functional health patterns, by which we identified, among others, problems related to non-compliance with the pharmacological treatment. The Nurse's Diagnosis was: Ineffective Management of own health. With the support of NANDA, NOC and NIC taxonomy we determined the nursing objectives and interventions. The expected results of the Care Plan were achieved. Polypharmacy in the elderly can lead to treatment problems, increasing hospital admissions, morbidity and mortality and health expenditure Nursing care at home is a continuous development process and is increasing due to aging of the population, the prevalence of chronic diseases, as well as the increased life expectancy. It is estimated that in 2030, 24% of the Spanish population will be over 64 years. The physical, sensory, cognitive and chronic disabilities of aging make this type of care necessary. It is a major element in the comprehensive care of these patients, by checking the correct use of medication, symptom control, helping them to be autonomous in managing their disease and establishing a fluid relationship between the patients and their family. PMID:22284363

  13. Clinical care management and workflow by episodes.

    PubMed Central

    Claus, P. L.; Carpenter, P. C.; Chute, C. G.; Mohr, D. N.; Gibbons, P. S.

    1997-01-01

    This paper describes the implementation of clinically defined episodes of care and the introduction of an episode-based summary list of patient problems across Mayo Clinic Rochester in 1996 and 1997. Although Mayo's traditional paper-based system has always relied on a type of 'episode of care' (called the "registration") for patient and history management, a new, more clinically relevant definition of episode of care was put into practice in November 1996. This was done to improve care management and operational processes and to provide a basic construct for the electronic medical record. Also since November 1996, a computer-generated summary list of patient problems, the "Master Sheet Summary Report," organized by episode, has been placed in all patient histories. In the third quarter of 1997, the ability to view the episode-based problem summary online was made available to the 3000+ EMR-capable workstations deployed across the Mayo Rochester campus. In addition, the clinically oriented problem summarization process produces an improved basic "package" of clinical information expected to lead to improved analytic decision support, outcomes analysis and epidemiological research. PMID:9357595

  14. Principal's Preparation Program: Managing the Learning Environment Using ELCC Standards

    ERIC Educational Resources Information Center

    Tubbs, J. Eric; Heard, Michael S.; Epps, Adrian

    2011-01-01

    School principals need to be well prepared to manage school facilities assigned to their care. Educational leadership programs can make best use of the Educational Leadership Constituent Council (ELCC) Standards to develop a course of study to address school facility management issues. Every standard has its facility implications that lead to…

  15. Hepatitis disease management programs in Malaysia.

    PubMed

    Khairullah, Nor Shahidah; Merican, Dato Ismail

    2004-03-01

    The MLF since its inception in 1996 has endeavored to develop a coordinated approach towards the improved care and treatment of liver diseases in Malaysia. Its close liaison with the Malaysian MOH, local medical associations, and corporate bodies has contributed to the success of its many programs. Educating the public, research, and training have been important elements of successful hepatitis disease control programs. Hepatitis Days have been proven to be very successful in raising the awareness of the general public to hepatitis disease. Rapid screening and vaccination has also helped to remove the social stigma associated with the disease, eliminated the need for numerous clinic appointments, and rendered vaccination more accessible to the public. The MLF perspective emphasizes the need for collaborative effort between Government bodies and other agencies, such as non-governmental organizations, laboratories, and the medical fraternity, to ensure the overall success of hepatitis disease management programs. PMID:15156929

  16. Hazardous Materials Management Program Report- 2005.

    SciTech Connect

    Brynildson, Mark E.

    2005-06-01

    The annual program report provides detailed information about all aspects of the SNL/CA Hazardous Materials Management Program for a given calendar year. It functions as supporting documentation to the SNL/CA Environmental Management System Program Manual. The 2005 program report describes the activities undertaken during the past year, and activities planned in future years to implement the Hazardous Materials Management Program, one of six programs that supports environmental management at SNL/CA.

  17. Indoor Air Quality Management Program.

    ERIC Educational Resources Information Center

    Anne Arundel County Public Schools, Annapolis, MD.

    In an effort to provide Indoor Air Quality (IAQ) management guidance, Anne Arundel County Public Schools was selected by the Maryland State Department of Education to develop a program that could be used by other school systems. A major goal was to produce a handbook that was "user friendly." Hence, its contents are a mix of history, philosophy,…

  18. Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities

    ERIC Educational Resources Information Center

    Kastner, Theodore A.; Walsh, Kevin K.

    2006-01-01

    Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…

  19. Preparing Psychotherapy Students for the New Demands of Managed Care.

    ERIC Educational Resources Information Center

    Chambliss, Catherine

    The wildly varying utilization and quality control practices that make up "managed care" make it difficult to generalize new rules and requirements. Information that can aid counselor trainees in understanding the demands of managed health care is presented. The text explores the following questions: (1) "What do managed care companies want?" and…

  20. The INTERACT Quality Improvement Program: An Overview for Medical Directors and Primary Care Clinicians in Long-Term Care

    PubMed Central

    Ouslander, Joseph G.; Bonner, Alice; Herndon, Laurie; Shutes, Jill

    2014-01-01

    INTERACT is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and ACOs, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust QAPI program which is being rolled out by the federal government over the next year. PMID:24513226

  1. Baseline Management Practices at Providers in Better Jobs Better Care

    ERIC Educational Resources Information Center

    Stott, Amy L.; Brannon, S. Diane; Vasey, Joseph; Dansky, Kathryn H.; Kemper, Peter

    2007-01-01

    High turnover and difficult recruitment of direct care workers are challenges for long-term care providers. This study reports the extent and variation of the use of management practices for direct care workers and their supervisors across four long-term care settings in the Better Jobs Better Care demonstration. Overall, there is limited use of…

  2. 5 CFR 792.200 - What are the benefits of the child care subsidy program law?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... subsidy program law? 792.200 Section 792.200 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Subsidy Program Legislation and to Whom Does It Apply? § 792.200 What are the benefits of the child care subsidy program law? Sec. 630 of Public Law 107-67 permits executive agencies to use appropriated funds...

  3. 5 CFR 792.200 - What are the benefits of the child care subsidy program law?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... subsidy program law? 792.200 Section 792.200 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Subsidy Program Legislation and to Whom Does It Apply? § 792.200 What are the benefits of the child care subsidy program law? Sec. 630 of Public Law 107-67 permits executive agencies to use appropriated funds...

  4. 5 CFR 792.200 - What are the benefits of the child care subsidy program law?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... subsidy program law? 792.200 Section 792.200 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Subsidy Program Legislation and to Whom Does It Apply? § 792.200 What are the benefits of the child care subsidy program law? Sec. 630 of Public Law 107-67 permits executive agencies to use appropriated funds...

  5. [Issues on user participation in health care management in Africa].

    PubMed

    Kerouedan, D; Dauby, P

    2004-01-01

    The 1990s witnessed great progress in increasing community participation in the management of health care services as an objective for reform of healthcare systems especially in urban areas benefiting from funding from the international community. Community participation has taken various forms from one country to another in terms of sources of healthcare training (public, private, or both), organization of management committees (inclusion or not of healthcare personnel), and scope of public service assigned to district health care units (preventive and/or curative care, management of proceeds from provision of health care procedures and/or medication, etc.). These strategies have had variable results and, although some urban programs have been evaluated, no attempt has been made to use this experience as a basis for analyzing the political implications of issues involving citizenship and public health. This report presents some ideas on these issues from the point of view of both governments and citizens and restates the purpose of user participation in healthcare services in Africa. That intent involves the need not only to increase household contributions to the cost of healthcare especially within the uncertain economic environment of urban areas but also to improve access to as well as quality of healthcare services. PMID:15816139

  6. Evaluation of a mentorship program to support chronic kidney disease care

    PubMed Central

    Pang, Jocelyn; Grill, Allan; Bhatt, Monisha; Woodward, Graham L.; Brimble, Scott

    2016-01-01

    Abstract Problem addressed Primary care providers (PCPs) are ideally situated to detect and manage patients with chronic kidney disease (CKD), but they could use more support from nephrologists to accomplish this. Objective of program To improve early detection and management of CKD in primary care, and improve referrals to nephrologists through education and greater partnership between nephrologists and PCPs. Program description Nephrologists provided mentorship to PCPs in Ontario through a collaborative relationship. Nephrologists provided PCPs with educational orientation sessions and need-based advice on patient cases. Conclusion Primary care providers with more than 5 years of experience were more likely to use the program. Primary care providers expressed high satisfaction with the program and reported that it was effective in supporting routine CKD screening efforts, management of early CKD, appropriate referrals, and building a collaborative relationship with nephrologists. PMID:27521409

  7. Managed care in mental health: the ethical issues.

    PubMed

    Boyle, P J; Callahan, D

    1995-01-01

    Praise and blame of managed mental health care are on the rise on many fronts, including allegations that it could adversely affect quality of care, access to care, the physician/patient relationship, and informed patient choice. Given the heterogeneity among managed mental health care organizations--each with differing practices--it is difficult to sift the ethically defensible concerns from the indefensible ones. In this paper we identify and examine the different moral concerns about managed mental health care and mark which problems have been addressed or are in need of resolution. We also identify which problems are unique to managed mental health care. PMID:7498905

  8. Use of information systems as management tools in health care

    NASA Astrophysics Data System (ADS)

    Davila, Fidel

    1995-10-01

    Information systems that can be used as effective management tools in healthcare do not exist. This is because current information systems do not accurately reflect reality and because they do not provide information to important end-users, i.e., clinicians. To reflect reality, healthcare information systems must assess total health care costs. These not only include the direct economic costs (dollars paid) but also the indirect economic costs (dollars lost, spent, or saved) from having a person ill. These systems must also accurately assess the adjusted, qualitative costs of human life and human pain and suffering resulting from the illness and healthcare provided. Once information systems reflect reality, they can be used to manage healthcare by profiling utilization, projecting need, modeling programs, assessing quality of care and establishing guidelines.

  9. Approaches to management and care of the neonatal nondomestic ruminant.

    PubMed

    Wolfe, Barbara A; Lamberski, Nadine

    2012-05-01

    Management and care of the nondomestic ruminant neonate are similar in principle to domestic animal practice. Housing of the dam, conditions for birth, preparation for intervention, and plans for treatment and hand-rearing of sick neonates must all be considered carefully before undertaking nondomestic ruminant breeding. Unfortunately, neonatal losses tend to be much higher in nondomestic calves before weaning than in domestic cattle, sheep, and goat herds.1 With continued habitat and population declines in wild species, successful captive breeding of nondomestic herds becomes more important to species sustainability and potential reintroduction programs. The primary challenges contributing to neonatal losses in nondomestic ruminants are often animal temperament and adaptation to captivity. Only through experience can some of these challenges be overcome. However, by understanding some species-specific behavioral tendencies and the fractious nature of nondomestic ruminants in general, we can improve our success in managing and maintaining healthy populations of nondomestic ruminants in captivity. PMID:22640541

  10. Managing managed care. The task calls for an integrated management team.

    PubMed

    Coleman, A Y

    1997-01-01

    Healthcare providers must learn the art of "managing care," a concept integral to but broader than managed care. Managing care has four dimensions: recruiting skilled operations managers; developing systems, procedures, practices, and protocols that meet the demands of capitation and risk management; fully integrating physician leaders; and preserving society's resources by providing care on the wellness, rather than the sickness, model. Managing managed care, which is now usually the task of a single executive, will tomorrow require a team comprising these four roles: The CEO articulates the system's vision, helps develop its strategic plan, and leads the effort to educate all its associates and employees about managed care. The operations leader (which may in fact be a group of operations executives) redesigns the systems organizations, redeploys its managers, and dismantles its obsolete methods. The physician leader (which may also be a group, rather than an individual) helps retool the system's practices and protocols in a way that enables it to deliver the highest quality of care at the lowest possible cost. The managed care executive acts as the broker between the system and insurance firms. In larger systems, this executive designs long-term partnerships between the system and insurers. PMID:10165747

  11. Pulmonary Hypertension in Pregnancy: Critical Care Management

    PubMed Central

    Bassily-Marcus, Adel M.; Yuan, Carol; Oropello, John; Manasia, Anthony; Kohli-Seth, Roopa; Benjamin, Ernest

    2012-01-01

    Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases. PMID:22848817

  12. Pulmonary hypertension in pregnancy: critical care management.

    PubMed

    Bassily-Marcus, Adel M; Yuan, Carol; Oropello, John; Manasia, Anthony; Kohli-Seth, Roopa; Benjamin, Ernest

    2012-01-01

    Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30-56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases. PMID:22848817

  13. Issues in NASA program and project management

    NASA Technical Reports Server (NTRS)

    Hoban, Francis T. (Editor)

    1989-01-01

    This new collection of papers on aerospace management issues contains a history of NASA program and project management, some lessons learned in the areas of management and budget from the Space Shuttle Program, an analysis of tools needed to keep large multilayer programs organized and on track, and an update of resources for NASA managers. A wide variety of opinions and techniques are presented.

  14. Adoption of Self-management Interventions for Prevention and Care

    PubMed Central

    Rotheram-Borus, Mary Jane; Ingram, Barbara L.; Swendeman, Dallas; Lee, Adabel

    2013-01-01

    Seventy-five percent of spiraling healthcare costs can be attributed to chronic diseases, making prevention and management of chronic conditions one of our highest healthcare priorities, especially as we organize for patient-centered medical homes. Collaborative patient self-management in primary care has been repeatedly demonstrated to be efficacious in reducing both symptoms and increasing quality of life, yet there is no consensus on what, how, when, and by whom self-management programs are best implemented. In this article, we argue that self-management interventions effectively span the continuum of prevention and disease management. Self-management interventions rest on a foundation of five core actions: 1) activate motivation to change; 2) apply domain-specific information from education and self-monitoring; 3) develop skills; 4) acquire environmental resources; and 5) build social support. A range of delivery vehicles, including group interventions, primary care providers, and advanced wireless technology, are described and evaluated in terms of diffusion and cost-containment goals. PMID:23148958

  15. Healthcare organization-education partnerships and career ladder programs for health care workers.

    PubMed

    Dill, Janette S; Chuang, Emmeline; Morgan, Jennifer C

    2014-12-01

    Increasing concerns about quality of care and workforce shortages have motivated health care organizations and educational institutions to partner to create career ladders for frontline health care workers. Career ladders reward workers for gains in skills and knowledge and may reduce the costs associated with turnover, improve patient care, and/or address projected shortages of certain nursing and allied health professions. This study examines partnerships between health care and educational organizations in the United States during the design and implementation of career ladder training programs for low-skill workers in health care settings, referred to as frontline health care workers. Mixed methods data from 291 frontline health care workers and 347 key informants (e.g., administrators, instructors, managers) collected between 2007 and 2010 were analyzed using both regression and fuzzy-set qualitative comparative analysis (QCA). Results suggest that different combinations of partner characteristics, including having an education leader, employer leader, frontline management support, partnership history, community need, and educational policies, were necessary for high worker career self-efficacy and program satisfaction. Whether a worker received a wage increase, however, was primarily dependent on leadership within the health care organization, including having an employer leader and employer implementation policies. Findings suggest that strong partnerships between health care and educational organizations can contribute to the successful implementation of career ladder programs, but workers' ability to earn monetary rewards for program participation depends on the strength of leadership support within the health care organization. PMID:25441318

  16. Crafting the group: Care in research management.

    PubMed

    Davies, Sarah R; Horst, Maja

    2015-06-01

    This article reports findings from an interview study with group leaders and principal investigators in Denmark, the United Kingdom and the United States. Taking as our starting point current interest in the need to enhance 'responsible research and innovation', we suggest that these debates can be developed through attention to the talk and practices of scientists. Specifically, we chart the ways in which interview talk represented research management and leadership as processes of caring craftwork. Interviewees framed the group as the primary focus of their attention (and responsibilities), and as something to be tended and crafted; further, this process required a set of affective skills deployed flexibly in response to the needs of individuals. Through exploring the presence of notions of care in the talk of principal investigators and group leaders, we discuss the relation between care and craft, reflect on the potential implications of the promotion of a culture of care and suggest how mundane scientific understandings of responsibility might relate to a wider discussion of responsible research and innovation. PMID:26477197

  17. Forging community partnerships to improve health care: the experience of four Medicaid managed care organizations.

    PubMed

    Silow-Carroll, Sharon; Rodin, Diana

    2013-04-01

    Some managed care organizations (MCOs) serving Medicaid beneficiaries are actively engaging in community partnerships to meet the needs of vulnerable members and nonmembers. We found that the history, leadership, and other internal factors of four such MCOs primarily drive that focus. However, external factors such as state Medicaid policies and competition or collaboration among MCOs also play a role. The specific strat­egies of these MCOs vary but share common goals: (1) improve care coordination, access, and delivery; (2) strengthen the community and safety-net infrastructure; and (3) prevent illness and reduce disparities. The MCOs use data to identify gaps in care, seek community input in designing interventions, and commit resources to engage community organiza­tions. State Medicaid programs can promote such work by establishing goals, priorities, and guidelines; providing data analysis and technical assistance to evaluate local needs and community engagement efforts; and convening stakeholders to collaborate and share best practices. PMID:23634464

  18. The experiences of risk managers in providing emotional support for health care workers after adverse events.

    PubMed

    Edrees, Hanan; Brock, Douglas M; Wu, Albert W; McCotter, Patricia I; Hofeldt, Ron; Shannon, Sarah E; Gallagher, Thomas H; White, Andrew A

    2016-04-01

    Risk managers often meet with health care workers who are emotionally traumatized following adverse events. We surveyed members of the American Society for Health care Risk Management (ASHRM) about their training, experience, competence, and comfort with providing emotional support to health care workers. Although risk managers reported feeling comfortable and competent in providing support, nearly all respondents prefer to receive additional training. Risk managers who were comfortable listening to and supporting health care workers were more likely to report prior training. Health care organizations implementing second victim support programs should not rely solely on risk managers to provide support, rather engage and train interested risk managers and provide them with opportunities to practice. PMID:27088771

  19. Care of the elderly program at the University of Alberta

    PubMed Central

    Charles, Lesley; Dobbs, Bonnie; Triscott, Jean; McKay, Rhianne

    2014-01-01

    Abstract Problem addressed The population is aging rapidly and there are implications for health care delivery in the face of few physicians specializing in care of the elderly (COE). Objective of program To train physicians wishing to provide COE services. Program description The COE program at the University of Alberta in Edmonton is an enhanced skills diploma program lasting 6 months to 1 year, with core program requirements including geriatric inpatient care, geriatric psychiatry, ambulatory care, continuing care, and outreach. There is a longitudinal clinic component and a research project requirement. The program is designed to cover the 85 core competencies in the CanMEDS– Family Medicine roles. Conclusion There is a need for COE physicians to provide clinical care as well as fill educational, administrative, and research roles to meet the health care needs of medically complex seniors. These physicians require alternative funding and a departmental home within a university if they are to provide an academic service. PMID:25551143

  20. Child Care on Campus: A Review of Creative Programs.

    ERIC Educational Resources Information Center

    Mork, Bonnie-Jean; Arrowsmith, Ronald G.

    1991-01-01

    Discussion of child care for college personnel, fast becoming requisite in every benefits package, presents three composite cases illustrating the range of child care options available, looks at the kinds of flexibility parents need and program options available, and examines federal child care initiatives and program legal liabilities.…

  1. State Day Care Assistance Program. First Annual Report.

    ERIC Educational Resources Information Center

    Alaska State Dept. of Community and Regional Affairs, Juneau.

    This annual report of the recently established Alaska Day Care Assistance Program describes the system of state subsidies instituted to encourage local government participation in the delivery of day care services. Established to aid low-income families in providing for adequate child care, the program is administered by the state Department of…

  2. Defining Group Care Programs: An Index of Reporting Standards

    ERIC Educational Resources Information Center

    Lee, Bethany R.; Barth, Richard P.

    2011-01-01

    Group care programs, while ubiquitous, are not clearly differentiated despite differences in the population served, size, auspices, and program activities, to name a few. Words like group care, residential care and residential treatment are often used interchangeably in policy, research and practice. This paper introduces reporting standards that…

  3. 76 FR 57637 - TRICARE; Continued Health Care Benefit Program Expansion

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-16

    ... of the Secretary 32 CFR Part 199 RIN 0720-AB30 TRICARE; Continued Health Care Benefit Program..., some MHS beneficiaries would not be eligible to purchase Continued Health Care Benefit Program (CHCBP... continued health care coverage for eligible beneficiaries who lose their MHS eligibility. It was...

  4. What's next for managed care? Panel discussion.

    PubMed

    Swenson, K; Zalta, E; Scholl, B; Clancy, C

    1997-01-01

    Change continues to be health care's only constant in the United States. As enrollment in managed care organizations skyrockets, the glare of public scrutiny intensifies. Success is no longer as simple as undercutting traditional fee-for-service providers; MCOs have to become more responsive to consumer needs as they compete with one another. Whether substantial set of values or mere buzzword, quality is the lingua franca of the MCO arena. Although MCO executives attribute the concept's ubiquity to many factors, the common denominator is staying competitive in a high-growth industry. Along with the elimination of the gatekeeper, a major trend to watch for is the rise of industry oversight provided by standardized practice guidelines. MCO executives recognized that implementing such measures will streamline operations and make MCOs more user-friendly. PMID:10170286

  5. Comprehensive Child Care Program: Phase 1 - Evaluation Results.

    ERIC Educational Resources Information Center

    Harachi, Tracy; Anthony, Emily; Bleisner, Siri

    Seattle's Comprehensive Child Care Program (CCCP) (Washington) is made up of a child care subsidy to offset child care costs for working and student families with low incomes, and quality assurance and technical assistance for 150 child care providers, including on-site evaluations, public health consulting, continuing education for providers, and…

  6. Twenty steps to survive managed care.

    PubMed

    Goldener, J

    1999-01-01

    The health care industry is in the midst of discounted, price-driven, managed care. Many older physicians, not wanting to practice in this environment, are opting for early retirement. Others sell their clinical practices to management companies or hospitals to avoid the economic reality of day-to-day financial management. Most of these private practices are losing money every year. However, there still are a large number of physicians who have not sold their practice. As capitation continues to grow, these physicians will experience severe cash flow problems unless their financial plight is addressed rapidly. If it is not, the resultant cash flow problems will cause accounts payable to grow. Twenty steps are outlined that a physician or group should take right away to maintain a healthy cash flow. These include: Instituting a nurse triage system, setting up an after-hours clinic, getting the co-pay at the time of service, implementing a patient satisfaction questionnaire, monitoring the capitation reports, and checking capitation lists. PMID:10387271

  7. Aging in poverty: making the case for comprehensive care management.

    PubMed

    Judd, Rebecca G; Moore, Brenda A

    2011-10-01

    A model for holistic care management that would enhance outcomes for economically vulnerable older adults who receive an array of disjointed services administered through the older Americans Act (OAA) and local Area Agencies on Aging (AAA) is proposed. Fragmented service delivery is typically wasteful and ineffectual, but comprehensive care management that includes an autonomous care manager, a single interagency plan of care and ongoing monitoring that is client-centered may protect those aging in poverty from negative health outcomes. PMID:21967136

  8. 76 FR 39857 - Alaska Coastal Management Program Withdrawal From the National Coastal Management Program Under...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-07

    ... National Oceanic Atmospheric Administration Alaska Coastal Management Program Withdrawal From the National Coastal Management Program Under the Coastal Zone Management Act (CZMA) AGENCY: Office of Ocean and Coastal Resource Management (OCRM), National Ocean Service (NOS), National Oceanic...

  9. Utilization management for residential programs.

    PubMed

    Kidd, Sean A; Styron, Thomas H; Carlson, Shelly; Hoge, Michael

    2004-07-01

    This paper reviews recent literature on utilization management (UM) in community-based supportive residential programs for people with behavioral disorders. Various approaches for facilitating placement and movement are discussed in the context of an effort to develop a residential UM process in New Haven, Connecticut. Recommendations are made for a residential UM process that may be applied to a range of service systems. It takes into account the methodological difficulties inherent in the development of generalizable decision tools. PMID:15478874

  10. Evidence-based health care management: what is the research evidence available for health care managers?

    PubMed

    Jaana, Mirou; Vartak, Smruti; Ward, Marcia M

    2014-09-01

    In light of increasing interest in evidence-based management, we conducted a scoping review of systematic reviews (SRs) and meta-analyses (MAs) to determine the availability and accessibility of evidence for health care managers; 14 MAs and 61 SRs met the inclusion criteria. Most reviews appeared in medical journals (53%), originated in the United States (29%) or United Kingdom (22%), were hospital-based (55%), and targeted clinical providers (55%). Topics included health services organization (34%), quality/patient safety (17%), information technology (15%), organization/workplace management (13%), and health care workforce (12%). Most reviews addressed clinical topics of relevance to managers; management-related interventions were rare. The management issues were mostly classified as operational (65%). Surprisingly, 96.5% of search results were not on target. A better classification within PubMed is needed to increase the accessibility of meaningful resources and facilitate evidence retrieval. Health care journals should take initiatives encouraging the publication of reviews in relevant management areas. PMID:24296471

  11. Remote access to medical specialists: home care interactive patient management system

    NASA Astrophysics Data System (ADS)

    Martin, Peter J.; Draghic, Nicole; Wiesmann, William P.

    1999-07-01

    Diabetes management involves constant care and rigorous compliance. Glucose control is often difficult to maintain and onset of complications further compound health care needs. Status can be further hampered by geographic isolation from immediate medical infrastructures. The Home Care Interactive Patient Management System is an experimental telemedicine program that could improve chronic illness management through Internet-based applications. The goal of the system is to provide a customized, integrated approach to diabetes management to supplement and coordinate physician protocol while supporting routine patient activity, by supplying a set of customized automated services including health data collection, transmission, analysis and decision support.

  12. Crew Management Processes Revitalize Patient Care

    NASA Technical Reports Server (NTRS)

    2009-01-01

    In 2005, two physicians, former NASA astronauts, created LifeWings Partners LLC in Memphis, Tennessee and began using Crew Resource Management (CRM) techniques developed at Ames Research Center in the 1970s to help improve safety and efficiency at hospitals. According to the company, when hospitals follow LifeWings? training, they can see major improvements in a number of areas, including efficiency, employee satisfaction, operating room turnaround, patient advocacy, and overall patient outcomes. LifeWings has brought its CRM training to over 90 health care organizations and annual sales have remained close to $3 million since 2007.

  13. 78 FR 75581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-12

    ... MANAGEMENT Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the... Affordable Care Act; Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges... Act of 2008; Technical Amendment to External Review for Multi-State Plan Program'' (78 FR 68240)....

  14. The metamorphosis of managed care: implications for health reform internationally.

    PubMed

    Rodwin, Marc A

    2010-01-01

    The conventional wisdom is that managed care's brief life is over and we are now in a post-managed care era. In fact, managed care has a long history and continues to thrive. Writers also often assume that managed care is a fixed thing. They overlook that managed care has evolved and neglect to examine the role that it plays in the health system. Furthermore, private actors and the state have used managed care tools to promote diverse goals. These include the following: increasing access to medical care; restricting physician entrepreneurialism; challenging professional control over the medical economy; curbing medical spending; managing medical practice and markets; furthering the growth of medical markets and private insurance; promoting for-profit medical facilities and insurers; earning bounties for reducing medical expenditures: and reducing governmental responsibility for, and oversight of, medical care. Struggles over these competing goals spurred the metamorphosis of managed care. This article explores how managed care transformed physicians' conflicts of interests and responses to them. It also examines how managed care altered the opportunities for patients/medical consumers to use exit and voice to spur change. PMID:20579232

  15. Building Technologies Program Multi-Year Program Plan Program Portfolio Management 2008

    SciTech Connect

    None, None

    2008-01-01

    Building Technologies Program Multi-Year Program Plan 2008 for program portfolio management, including the program portfolio management process, program analysis, performance assessment, stakeholder interactions, and cross-cutting issues.

  16. Programming, Care, and Troubleshooting of Cochlear Implants for Children.

    ERIC Educational Resources Information Center

    Hedley-Williams, Andrea J.; Sladen, Douglas P.; Tharpe, Anne Marie

    2003-01-01

    This article provides an overview of current cochlear implant technology, programming strategies, troubleshooting, and care techniques. It considers: device components, initial stimulation, speech coding strategies, use and care, troubleshooting, and the classroom environment. (Contains references.) (DB)

  17. Home audit program: management manual

    SciTech Connect

    Not Available

    1980-09-01

    Many public power systems have initiated home energy audit programs in response to the requests of their consumers. The manual provides smaller public power systems with the information and specific skills needed to design and develop a program of residential energy audits. The program is based on the following precepts: locally owned public systems are the best, and in many cases the only agencies available to organize and coordinate energy conservation programs in many smaller communities; consumers' rights to energy conservation information and assistance should not hinge on the size of the utility that serves them; in the short run, public power systems of all sizes should offer residential energy conservation assistance to their consumers, because such assistance is desirable, necessary, and in the public interest; and in the long run, such programs will complement national energy goals and will produce economic benefits for both consumers and the public power system. A detailed description of home audit program planning, organization, and management are given. (MCW)

  18. Management competencies required in ambulatory care settings.

    PubMed

    Brooke, P P; Hudak, R P; Finstuen, K; Trounson, J

    1998-01-01

    A study was conducted to identify the most important competencies physician executives in medical groups and other ambulatory settings will need to have in the next five years. The specific job skills, knowledge, and abilities (SKA) that physician executives will need to acquire these competencies were also explored. The Delphi techniques were used to analyze responses from two surveys from members of the American College of Medical Practice Executives. The most important competencies were grouped into 13 management domains, each with specific SKAs. "Managing health care resources to create quality and value" and "fundamentals of business and finance" were rated as the most important competencies. The most frequently rated SKA was the "ability to build and maintain credibility and trust." PMID:10185642

  19. Space Station Freedom Environmental Health Care Program

    NASA Technical Reports Server (NTRS)

    Richard, Elizabeth E.; Russo, Dane M.

    1992-01-01

    The paper discusses the environmental planning and monitoring aspects of the Space Station Freedom (SSF) Environmental Health Care Program, which encompasses all phases of the SSF assembly and operation from the first element entry at MB-6 through the Permanent Manned Capability and beyond. Environmental planning involves the definition of acceptability limits and monitoring requirements for the radiation dose barothermal parameters and potential contaminants in the SSF air and water and on internal surfaces. Inflight monitoring will be implemented through the Environmental Health System, which consists of five subsystems: Microbiology, Toxicology, Water Quality, Radiation, and Barothermal Physiology. In addition to the environmental data interpretation and analysis conducted after each mission, the new data will be compared to archived data for statistical and long-term trend analysis and determination of risk exposures. Results of these analyses will be used to modify the acceptability limits and monitoring requirements for the future.

  20. Sustainable practice improvements: impact of the Comprehensive Advanced Palliative Care Education (CAPCE) program.

    PubMed

    Harris, Diane; Hillier, Loretta M; Keat, Nancy

    2007-01-01

    This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice. PMID:18251444

  1. Evaluation of a Research Mentorship Program in Community Care

    ERIC Educational Resources Information Center

    Ploeg, Jenny; de Witt, Lorna; Hutchison, Brian; Hayward, Lynda; Grayson, Kim

    2008-01-01

    This article describes the results of a qualitative case study evaluating a research mentorship program in community care settings in Ontario, Canada. The purpose of the program was to build evaluation and research capacity among staff of community care agencies through a mentorship program. Data were collected through in-depth, semi-structured…

  2. Medical Mutual uses BabyLink as a key program in care management. Public relations strategies bring a barrage of print and TV stories.

    PubMed

    Herreria, J

    1998-01-01

    Medical Mutual of Ohio launched a statewide public relations campaign to increase utilization of Babylink, a free perinatal education and intervention program. Media activity reached its highest level during the spring months. The number of referrals to the program more than doubled when compared to pre-campaign activity. PMID:10387286

  3. About the Federal Energy Management Program

    SciTech Connect

    Richard Kidd

    2009-04-23

    Richard Kidd, Program Manager for the Federal Energy Management Program (FEMP), presents a discussion on FEMP direction and its future role, federal funding trends, future financing trends, and Earth Day observations.

  4. Managed care: a view from Europe.

    PubMed

    Erdmann, Y; Wilson, R

    2001-01-01

    This article summarizes recent developments in the United Kingdom, the Netherlands, Switzerland, and the new Baltic states that reflect the influence of US managed care concepts and practices. We emphasize (a) developments in restructuring traditional health insurance mechanisms by shifting premium and out-of-pocket burdens to consumers so as to constrain demand and costs and (b) reliance on prospective hospital budgets and case management by primary physicians. Social insurance mechanisms and universal coverage remain national tasks as well as basic components of the social structure of most European countries. Full open-market competition between traditional sick funds and private insurance companies and the introduction of for-profit MCOs beholden to their shareholders appears unlikely on other than an experimental basis. Increased competition between providers may well result from the new right of insurers and payers to contract with medical care providers of their choice. It remains to be shown how far these experiments, which differ substantially between the countries examined, will succeed in their objectives and become permanent features of their national systems. PMID:11274522

  5. Early Education and Care: Overlap Indicates Need To Assess Crosscutting Programs. Report to the Chairman, Subcommittee on Oversight of Government Management, Restructuring and the District of Columbia, U.S. Senate.

    ERIC Educational Resources Information Center

    Shaul, Marnie S.

    In response to Congressional requests reflecting the nationwide attention on early childhood education (ECE) and care, the General Accounting Office assessed the federally funded programs that provide or support ECE and care for children under 5 years. Information was obtained by means of an electronic search of the June 1999 Catalog of Federal…

  6. Management of a coordinated parts program

    NASA Technical Reports Server (NTRS)

    Krishnan, G. S.

    1997-01-01

    The organization of the management of a parts program is discussed. The organizational structure faced by the parts manager and the advantages and disadvantages of managing a coordinated parts program are analyzed. The reliable operation of an instrument is the key to the success of the mission, together with the management of the parts program. The analysis led to the conclusion that the setting up of the decision support model will aid the parts manager in the decision making and the process control.

  7. Consumer-directed health care: implications for health care organizations and managers.

    PubMed

    Guo, Kristina L

    2010-01-01

    This article uses a pyramid model to illustrate the key components of consumer-directed health care. Consumer-directed health care is considered the essential strategy needed to lower health care costs and is valuable for making significant strides in health care reform. Consumer-directed health care presents new challenges and opportunities for all health care stakeholders and their managers. The viability of the health system depends on the success of managers to respond rapidly and with precision to changes in the system; thus, new and modified roles of managers are necessary to successfully sustain consumerism efforts to control costs while maintaining access and quality. PMID:20436329

  8. 14 CFR 1214.1706 - Program management.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson....

  9. 75 FR 29811 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-27

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES:...

  10. 14 CFR 1214.1706 - Program management.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson....

  11. 10 CFR 800.002 - Program management.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility...

  12. 20 CFR 638.800 - Program management.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Program management. 638.800 Section 638.800... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Administrative Provisions § 638.800 Program management. (a) The Job Corps Director shall establish and use internal program management procedures...

  13. 30 CFR 401.12 - Program management.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 2 2011-07-01 2011-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal...

  14. 14 CFR 1214.1706 - Program management.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson....

  15. 14 CFR 1214.1706 - Program management.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Program management. 1214.1706 Section 1214... Participants § 1214.1706 Program management. The Associate Administrator for Space Flight is responsible for program management under the direction of the Committee chairperson....

  16. 10 CFR 800.002 - Program management.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility...

  17. 30 CFR 402.13 - Program management.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Program management. 402.13 Section 402.13... WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Application, Evaluation, and Management Procedures § 402.13 Program management. (a) After the conclusion of negotiations, the USGS will transmit a grant...

  18. 10 CFR 800.002 - Program management.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility...

  19. 75 FR 52590 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-26

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES:...

  20. 10 CFR 800.002 - Program management.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility...

  1. 75 FR 71182 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES:...

  2. 20 CFR 638.800 - Program management.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Program management. 638.800 Section 638.800... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Administrative Provisions § 638.800 Program management. (a) The Job Corps Director shall establish and use internal program management procedures...

  3. 30 CFR 402.13 - Program management.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false Program management. 402.13 Section 402.13... WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Application, Evaluation, and Management Procedures § 402.13 Program management. (a) After the conclusion of negotiations, the USGS will transmit a grant...

  4. 76 FR 58077 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-19

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES:...

  5. 76 FR 11847 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-03

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES:...

  6. 76 FR 27743 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-12

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES:...

  7. 30 CFR 401.12 - Program management.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal...

  8. 76 FR 34124 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-10

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES:...

  9. 30 CFR 402.13 - Program management.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false Program management. 402.13 Section 402.13... WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Application, Evaluation, and Management Procedures § 402.13 Program management. (a) After the conclusion of negotiations, the USGS will transmit a grant...

  10. 10 CFR 800.002 - Program management.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Program management. 800.002 Section 800.002 Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES SEEKING DOE CONTRACTS AND ASSISTANCE General § 800.002 Program management. Program management responsibility...

  11. 30 CFR 402.13 - Program management.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false Program management. 402.13 Section 402.13... WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Application, Evaluation, and Management Procedures § 402.13 Program management. (a) After the conclusion of negotiations, the USGS will transmit a grant...

  12. 30 CFR 401.12 - Program management.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal...

  13. 30 CFR 401.12 - Program management.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal...

  14. 20 CFR 638.800 - Program management.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Program management. 638.800 Section 638.800... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Administrative Provisions § 638.800 Program management. (a) The Job Corps Director shall establish and use internal program management procedures...

  15. 30 CFR 402.13 - Program management.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 2 2011-07-01 2011-07-01 false Program management. 402.13 Section 402.13... WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Application, Evaluation, and Management Procedures § 402.13 Program management. (a) After the conclusion of negotiations, the USGS will transmit a grant...

  16. 30 CFR 401.12 - Program management.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Program management. 401.12 Section 401.12 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR STATE WATER RESEARCH INSTITUTE PROGRAM Application and Management Procedures § 401.12 Program management. (a) Upon approval of each fiscal...

  17. 78 FR 24212 - Tribal Management Grant Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-24

    ... HUMAN SERVICES Indian Health Service Tribal Management Grant Program Announcement Type: New and... competitive grant applications for the Tribal Management Grant (TMG) Program. This program is authorized under..., and activities (PFSA) and further develop and improve their health management capability. The...

  18. 75 FR 9017 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-26

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Program Management Committee meeting. SUMMARY: The FAA is issuing this notice to advise the public of a meeting of the RTCA Program Management Committee. DATES:...

  19. The Con Edison Emergency Child Care Plan for Management Employees: Summary Plan Description.

    ERIC Educational Resources Information Center

    Consolidated Edison Co., Brooklyn, NY.

    This summary plan description offers guidelines for participation in a pilot program that provides short-term emergency care for children of Con Edison managers who are under 13 years old. The plan offers professional, in-home child care that can be used when usual arrangements have collapsed. The summary plan description addresses the following…

  20. Who Cares about Caring in Early Childhood Teacher Education Programs?

    ERIC Educational Resources Information Center

    McNamee, Abigail; Mercurio, Mia; Peloso, Jeanne M.

    2007-01-01

    The ability to care for oneself, near and distant others, animals, plants, human-made objects, and even ideas is an antidote for violence in its many forms as experienced in childhood as well as adulthood. This article makes a case for facilitating the development of the ability to care as children develop. The authors emphasize the importance of…

  1. Integrated obesity care management system -implementation and research protocol

    PubMed Central

    Baillargeon, Jean-Patrice; Carpentier, André; Donovan, Denise; Fortin, Martin; Grant, Andrew; Simoneau-Roy, Judith; St-Cyr-Tribble, Denise; Xhignesse, Mariane; Langlois, Marie-France

    2007-01-01

    Background Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals. Methods We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME) program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs). This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be identified. Conclusion This

  2. 14 CFR 91.1017 - Amending program manager's management specifications.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Amending program manager's management... management specifications, the following procedure applies: (1) The Flight Standards District Office that... proposed amendment. (2) The Flight Standards District Office that issued the program manager's...

  3. Oregon Child Care Quality Indicators Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

    ERIC Educational Resources Information Center

    Child Trends, 2010

    2010-01-01

    This paper presents a profile of Oregon's Child Care Quality Indicators Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

  4. Hospitality Management. Florida Vocational Program Guide.

    ERIC Educational Resources Information Center

    Florida State Univ., Tallahassee. Center for Instructional Development and Services.

    This program guide is intended for the implementation of a hospitality management program in Florida secondary and postsecondary schools. The program guide describes the program content and structure, provides a program description, describes jobs under the program, and includes a curriculum framework and student performance standards for…

  5. Case Management Takes Hold in Long-Term Care.

    ERIC Educational Resources Information Center

    Rose, Stephen M.; And Others

    1992-01-01

    Includes "Empowering Case Management Clients" (Rose); "Case Management in Rural Japan" (Maeda, Takahashi); "Coordinated-Care Teams" (Brodsky, Sobol); "Comparing Practice in the United States and the United Kingdom" (Sturges); "Business of Case Management Flourishing in the U.S." (Cress); and "Community Options Bring Change to Long-Term Care in…

  6. Solid Waste Management Program Plan

    SciTech Connect

    Duncan, D.R.

    1990-08-01

    The objective of the Solid Waste Management Program Plan (SWMPP) is to provide a summary level comprehensive approach for the storage, treatment, and disposal of current and future solid waste received at the Hanford Site (from onsite and offsite generators) in a manner compliant with current and evolving regulations and orders (federal, state, and Westinghouse Hanford Company (Westinghouse Hanford)). The Plan also presents activities required for disposal of selected wastes currently in retrievable storage. The SWMPP provides a central focus for the description and control of cost, scope, and schedule of Hanford Site solid waste activities, and provides a vehicle for ready communication of the scope of those activities to onsite and offsite organizations. This Plan represents the most complete description available of Hanford Site Solid Waste Management (SWM) activities and the interfaces between those activities. It will be updated annually to reflect changes in plans due to evolving regulatory requirements and/or the SWM mission. 8 refs., 9 figs., 4 tabs.

  7. Total quality management program planning

    SciTech Connect

    Thornton, P.T.; Spence, K.

    1994-05-01

    As government funding grows scarce, competition between the national laboratories is increasing dramatically. In this era of tougher competition, there is no for resistance to change. There must instead be a uniform commitment to improving the overall quality of our products (research and technology) and an increased focus on our customers` needs. There has been an ongoing effort to bring the principles of total quality management (TQM) to all Energy Systems employees to help them better prepare for future changes while responding to the pressures on federal budgets. The need exists for instituting a vigorous program of education and training to an understanding of the techniques needed to improve and initiate a change in organizational culture. The TQM facilitator is responsible for educating the work force on the benefits of self-managed work teams, designing a program of instruction for implementation, and thus getting TQM off the ground at the worker and first-line supervisory levels so that the benefits can flow back up. This program plan presents a conceptual model for TQM in the form of a hot air balloon. In this model, there are numerous factors which can individually and collectively impede the progress of TQM within the division and the Laboratory. When these factors are addressed and corrected, the benefits of TQM become more visible. As this occurs, it is hoped that workers and management alike will grasp the ``total quality`` concept as an acceptable agent for change and continual improvement. TQM can then rise to the occasion and take its rightful place as an integral and valid step in the Laboratory`s formula for survival.

  8. A Program on Hazardous Waste Management.

    ERIC Educational Resources Information Center

    Kummler, Ralph H.; And Others

    1989-01-01

    Provides an overview of the "Hazardous Waste Management Graduate Certificate" program at Wayne State University. Describes four required courses and nine optional courses. Discusses the development of a Master program and the curriculum of the Master program. (YP)

  9. Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

    PubMed

    Wallace, Cara L

    2016-08-01

    This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care. PMID:27332743

  10. Collaborative Depression Care Among Latino Patients in Diabetes Disease Management, Los Angeles, 2011–2013

    PubMed Central

    Wu, Brian; Jin, Haomiao; Vidyanti, Irene; Lee, Pey-Jiuan; Ell, Kathleen

    2014-01-01

    Introduction The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes–Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes. Methods A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes. Results Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment. Conclusion Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system. PMID:25167093

  11. Development of a hospital-based care coordination program for children with special health care needs.

    PubMed

    Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten

    2013-01-01

    A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. PMID:22575784

  12. University Program Management Information System

    NASA Technical Reports Server (NTRS)

    Gans, Gary (Technical Monitor)

    2004-01-01

    As basic policy, NASA believes that colleges and universities should be encouraged to participate in the nation's space and aeronautics program to the maximum extent practicable. Indeed, universities are considered as partners with government and industry in the nation's aerospace program. NASA's objective is to have them bring their scientific, engineering, and social research competence to bear on aerospace problems and on the broader social, economic, and international implications of NASA's technical and scientific programs. It is expected that, in so doing, universities will strengthen both their research and their educational capabilities to contribute more effectively to the national well being. This annual report is one means of documenting the NASA-university relationship, frequently denoted, collectively, as NASA's University Program. This report is consistent with agency accounting records, as the data is obtained from NASA's Financial and Contractual Status (FACS) System, operated by the Financial Management Division and the Procurement Office. However, in accordance with interagency agreements, the orientation differs from that required for financial or procurement purposes. Any apparent discrepancies between this report and other NASA procurement or financial reports stem from the selection criteria for the data.

  13. University Program Management Information System

    NASA Technical Reports Server (NTRS)

    Gans, Gary (Technical Monitor)

    2002-01-01

    As basic policy, NASA believes that colleges and universities should be encouraged to participate in the nation's space and aeronautics program to the maximum extent practicable. Indeed, universities are considered as partners with government and industry in the nation's aerospace program. NASA's objective is to have them bring their scientific, engineering, and social research competence to bear on aerospace problems and on the broader social, economic, and international implications of NASA's technical and scientific programs. It is expected that, in so doing, universities will strengthen both their research and their educational capabilities to contribute more effectively to the national well-being. This annual report is one means of documenting the NASA-university relationship, frequently denoted, collectively, as NASA's University Program. This report is consistent with agency accounting records, as the data is obtained from NASA's Financial and Contractual Status (FACS) System, operated by the Financial Management Division and the Procurement Office. However, in accordance with interagency agreements, the orientation differs from that required for financial or procurement purposes. Any apparent discrepancies between this report and other NASA procurement or financial reports stem from the selection criteria for the data. This report was prepared by the Education Division/FE, Office of Human Resources and Education.

  14. University Program Management Information System

    NASA Technical Reports Server (NTRS)

    2001-01-01

    As basic policy, NASA believes that colleges and universities should be encouraged to participate in the nation's space and aeronautics program to the maximum extent practicable. Indeed, universities are considered as partners with government and industry in the nation's aerospace program. NASA' objective is to have them bring their scientific, engineering, and social research competence to bear on aerospace problems and on the broader social, economic, and international implications of NASA's technical and scientific programs. It is expected that, in so doing, universities will strengthen both their research and their educational capabilities to contribute more effectively to the national well being. This annual report is one means of documenting the NASA-university relationship, frequently denoted, collectively, as NASA's University Program. This report is consistent with agency accounting records, as the data is obtained from NASA's Financial and Contractual Status (FACS) System, operated by the Financial Management Division and the Procurement Office. However, in accordance with interagency agreements, the orientation differs from that required for financial or procurement purposes. Any apparent discrepancies between this report and other NASA procurement or financial reports stem from the selection criteria for the data.

  15. An Institutional Staff Training and Self-Management Program for Developing Multiple Self-Care Skills in Severely/Profoundly Retarded Individuals.

    ERIC Educational Resources Information Center

    Kissel, Robert C.; And Others

    1983-01-01

    Staff were taught use of training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Results indicated that staff learned to use the training skills appropriately and consistently, applied the skills in the generalization situations, and maintained skills with…

  16. iStart smart: a primary-care based and community partnered childhood obesity management program for Chinese-American children: feasibility study.

    PubMed

    Chen, Jyu-Lin; Kwan, Monica; Mac, Allison; Chin, Nai-Ching; Liu, Katrina

    2013-12-01

    Children who are ethnic minorities, low income and live in urban neighborhoods are at higher risk for obesity. This study examined the feasibility and efficacy of a primary care-based and community partnered obesity intervention in Chinese American children. An experimental design with a historical comparison group was used to explore the feasibility of an obesity intervention for overweight Chinese American children, ages 7-12. Data were collected on weight, height, blood pressure, waist circumference, physical activity, food intake, knowledge, and self-efficacy about diet and physical activity at baseline, 2 months, and 6 months post-baseline. Significant improvements in BMI, blood pressure, and nutrition knowledge and self-efficacy were found in the intervention group. Intervention group reduced their BMI compared to the comparison group (F = 8.65, p = .004). An obesity intervention in primary care setting is feasible and demonstrates a short-term effect on weight loss in Chinese American children. PMID:23595264

  17. Basis And Application Of The CARES/LIFE Computer Program

    NASA Technical Reports Server (NTRS)

    Nemeth, Noel N.; Janosik, Lesley A.; Gyekenyesi, John P.; Powers, Lynn M.

    1996-01-01

    Report discusses physical and mathematical basis of Ceramics Analysis and Reliability Evaluation of Structures LIFE prediction (CARES/LIFE) computer program, described in "Program for Evaluation of Reliability of Ceramic Parts" (LEW-16018).

  18. Managed Care and Dually Eligible Beneficiaries: Challenges in Coordination

    PubMed Central

    Walsh, Edith G.; Clark, William D.

    2002-01-01

    This article describes administrative issues and beneficiary perspectives on the delivery of medical services under Medicare+ Choice (M+C) and/or Medicaid managed care organizations (MCOs) for dually eligible beneficiaries. We interviewed staff at nine health plans in four market areas in 2000 and 2001, and conducted beneficiary focus groups in 2001. The study reveals beneficiary confusion about the relationship between their dual coverage and managed care enrollment, and problems with care and benefit coordination across these arrangements, based on regulatory and administrative obstacles to effective benefit and care coordination for beneficiaries enrolled in these varied managed care arrangements. PMID:12545599

  19. The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs.

    PubMed

    Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy

    2016-07-15

    As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs. PMID:27379593

  20. Medicaid managed care payment rates in 1998.

    PubMed

    Holahan, J; Rangarajan, S; Schirmer, M

    1999-01-01

    This paper reports on a new survey of state Medicaid managed care payment rates. We collected rate data for Medicaid's Aid to Families with Dependent Children (AFDC)/Temporary Assistance for Needy Families (TANF) and poverty-related populations and made adjustments to make the data comparable across states. The results show a slightly more than twofold variation in capitation rates among states, caused primarily by fee-for-service spending levels and demographics. There is a very low correlation between the variation in Medicaid capitation rates among states and the variations in Medicare's adjusted average per capita cost. The data are not sufficient to answer questions about the adequacy of rates but should help to further policy discussions and research. PMID:10388218

  1. 78 FR 29441 - Child Care and Development Fund (CCDF) Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-20

    ... 20, 2013 Part II Department of Health and Human Services 45 CFR Part 98 Child Care and Development... Development Fund (CCDF) Program AGENCY: Office of Child Care (OCC), Administration for Children and Families...: The Administration for Children and Families (ACF) proposes to amend the Child Care and...

  2. Crediting Foods in the Child Care Food Program. [Revised].

    ERIC Educational Resources Information Center

    Food and Nutrition Service (USDA), Robbinsville, NJ. Mid-Atlantic Regional Office.

    This modified version of a previously published title provides additional information on foods for which reimbursement may be obtained from the United States Department of Agriculture (USDA) by child care centers and family day care homes participating in the Child Care Food Program. Such foods, called creditable foods, are those that may be…

  3. 78 FR 36449 - State Long-Term Care Ombudsman Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... HUMAN SERVICES Administration on Aging 45 CFR Parts 1321 and 1327 RIN 0985-AA08 State Long-Term Care... request for comments, to implement provisions of the Older Americans Act, the State Long-Term Care... determining State compliance in carrying out the Long-Term Care Ombudsman program functions. This...

  4. Potential benefits of integrated COPD management in primary care.

    PubMed

    Kruis, A L; Chavannes, N H

    2010-09-01

    Chronic obstructive pulmonary disease (COPD) represents a major and progressive cause of morbidity and mortality worldwide, resulting in an important financial and health burden in coming decades. Pulmonary rehabilitation (PR) has been proven to be the most effective treatment in all patients in whom respiratory symptoms are associated with diminished functional capacity or reduced quality of life. Nevertheless, despite wide recommendation and proven efficacy, the use of PR is limited in daily practice. Reasons for these include low accessibility and availability, high costs, and lack of motivation to continue a healthy life style after treatment. By contrast, it has been demonstrated that primary care patients can be reactivated by formulating personal targets and designing individualized treatment plans in collaboration with their general practitioner or practice nurse. Based on these personal plans and targets, specific education must be provided and development of self management skills should be actively encouraged. Ideally, elements of pulmonary rehabilitation are tailored into a comprehensive primary care integrated disease management program. In that way, the benefits of PR can be extended to a substantially larger part of the COPD population, to reach even those with milder stages of disease. Favorable long-term effects on exercise tolerance and quality of life in a number of studies have been demonstrated in recent years, but broad introduction in the primary care setting still needs further justification in the form of a proper cost effectiveness analysis. PMID:21214043

  5. The role of palliative care in population management and accountable care organizations.

    PubMed

    Smith, Grant; Bernacki, Rachelle; Block, Susan D

    2015-06-01

    By 2021, health care spending is projected to grow to 19.6% of the GDP, likely crowding out spending in other areas. The 2010 Affordable Care Act (ACA) attempts to curb health care spending by incentivizing high-value care through the creation of Accountable Care Organizations (ACOs), which assume financial risk for patient outcomes. With this financial risk, health systems creating ACOs will be motivated to pursue innovative care models that maximize the value of care. Palliative care, as an emerging field with a growing evidence base, is positioned to improve value in ACOs by increasing high-quality care and decreasing costs for the sickest patients. ACO leaders may find palliative care input valuable in optimizing high-quality patient-centered care in the accountable care environment; however, palliative care clinicians will need to adopt new models that extrapolate their direct patient care skills to population management strategies. We propose that palliative care specialists take on responsibilities for working with ACO leaders to broaden their mission for systemwide palliative care for appropriate patients by prospectively identifying patients with a high risk of death, high symptom burden, and/or significant psychosocial dysfunction, and developing targeted, "triggered" interventions to enhance patient-centered, goal-consistent, coordinated care. Developing these new population management competencies is a critical role for palliative care teams in the ACO environment. PMID:25723619

  6. The Role of Palliative Care in Population Management and Accountable Care Organizations

    PubMed Central

    Smith, Grant; Block, Susan D.

    2015-01-01

    Abstract By 2021, health care spending is projected to grow to 19.6% of the GDP, likely crowding out spending in other areas. The 2010 Affordable Care Act (ACA) attempts to curb health care spending by incentivizing high-value care through the creation of Accountable Care Organizations (ACOs), which assume financial risk for patient outcomes. With this financial risk, health systems creating ACOs will be motivated to pursue innovative care models that maximize the value of care. Palliative care, as an emerging field with a growing evidence base, is positioned to improve value in ACOs by increasing high-quality care and decreasing costs for the sickest patients. ACO leaders may find palliative care input valuable in optimizing high-quality patient-centered care in the accountable care environment; however, palliative care clinicians will need to adopt new models that extrapolate their direct patient care skills to population management strategies. We propose that palliative care specialists take on responsibilities for working with ACO leaders to broaden their mission for systemwide palliative care for appropriate patients by prospectively identifying patients with a high risk of death, high symptom burden, and/or significant psychosocial dysfunction, and developing targeted, “triggered” interventions to enhance patient-centered, goal-consistent, coordinated care. Developing these new population management competencies is a critical role for palliative care teams in the ACO environment. PMID:25723619

  7. Economic evaluation of an internet-based weight management program

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To determine whether a behavioral Internet treatment (BIT) program for weight management is a viable, cost-effective option compared with usual care (UC) in a diverse sample of overweight (average body mass index = 29 kg/m2), healthy adults (mean age = 34 years) serving in the US Air Force. Two-grou...

  8. Impact of an education program on perinatal care practices.

    PubMed

    Harlan, W R; Hess, G E; Borer, R C; Hiss, R G

    1980-12-01

    Education of health professionals has an important role in improving health care. A media-based, self-instructional, perinatal education program was developed and field tested in rural and urban regions of Michigan. Cognitive tests, chart audits, and consultation/referral times were used to measure the impact on education and patient care. The program effectively increased knowledge and improved patient care practices by physicians and nurses. This study presents evidence that a targeted educational program in a media-based format can significantly improve perinatal care. PMID:6161337

  9. End-of-life care: a public health crisis and an opportunity for managed care.

    PubMed

    Byock, I R

    2001-12-01

    American society is failing to provide humane care for people who are dying. Unnecessary physical suffering continues even in our most prestigious institutions, and the enormous burden on family caregivers remains unrecognized. The cost of health services and burdensome regulations remain major barriers to improving the quality of care. Healthcare planners and policy makers are gradually awakening to the realities of an increasingly older population and a looming labor shortage of qualified paid caregivers. Several features of palliative care render it attractive within managed care. Evidence is emerging that palliative care, focused on meticulous prospective care planning and coordination, delivers high quality and cost-effective end-of-life care. Innovative demonstration projects around the country are exploring models for integrating palliative care within the routine operational processes and protocols of health systems and are providing examples of feasible "best practices" crucial for raising public expectations and framing possible solutions for policymakers and planners. Ultimately, it will be a marketing asset for a managed care organization to be known as a center of excellence in palliative care, and in some markets it will be a necessity. The goals of managed care and palliative care are already well aligned, joint efforts among clinicians, provider institutions, insurers, and employee health benefit managers can address the needs and preferences of dying patients and families, while increasing public trust in managed care. PMID:11767298

  10. Child Care Programs: Fiscal Year 1996 Annual Report.

    ERIC Educational Resources Information Center

    Alaska State Dept. of Community and Regional Affairs, Juneau.

    Assistance with paying for the cost of child care often makes the critical difference in whether or not a parent can work to support the family. This annual report provides information on child care assistance programs in Alaska. The 1996 Fiscal Year (FY) funding is presented for four programs providing a portion of low to moderate income parents'…

  11. Taylor Proposes Five-Year Child-Care Program.

    ERIC Educational Resources Information Center

    Taylor, Glen

    Senator Glen Taylor of Minnesota proposed a five-year child-care program for the purposes of encouraging employer-sponsored child care and increasing by 53,000 the number of children in low-income families who were covered. This report lists central features of the program, which include: (1) tax incentives which employers can use when they build…

  12. A University Program to Improve Nursing Care to the Aged

    ERIC Educational Resources Information Center

    Marten, Marie Lucille

    1978-01-01

    Proposes a series of university nursing education programs developed to increase knowledge and skills relevant to nursing care of elderly and chronically ill persons who reside in nursing homes. Briefly describes five programs intended for persons engaged in long-term care or in preparation for such roles. (EM)

  13. Successful healthcare programs and projects: organization portfolio management essentials.

    PubMed

    Pickens, Scott; Solak, Jamie

    2005-01-01

    Many healthcare organization projects take more time and resources than planned and fail to deliver desired business outcomes. Healthcare IT is a major component of many projects and often undeservedly receives the blame for failure. Poor results are often not a result of faulty healthcare IT or poor project management or poor project execution alone. Many projects fail because of poor portfolio management--poor planning and management of the portfolio of initiatives designed to meet an organization's strategic goals. Because resources are limited, portfolio management enables organizations to more strategically allocate and manage their resources so care delivery, service delivery, and initiatives that advance organizations toward their strategic goals, including healthcare IT initiatives, can be accomplished at the levels of quality and service desired by an organization. Proper portfolio management is the essential foundation for program and project success and supports overall organization success. Without portfolio management, even programs and projects that execute flawlessly may not meet desired objectives. This article discusses the essential requirements for porfolio management. These include opportunity identification, return on investment (ROI) forecast, project prioritization, capacity planning (inclusive of human, financial, capital, and facilities resources), work scheduling, program and project management and execution, and project performance and value assessment. Portfolio management is essential to successful healthcare project execution. Theories are drawn from the Organizational Project Management Maturity Model (OPM3) work of the Project Management Institute and other leading strategy, planning, and organization change management research institutes. PMID:15682672

  14. Hospital's transition program coordinates care throughout the continuum.

    PubMed

    2015-02-01

    UnityPoint-St. Luke's Hospital's Transitions Home program has slashed all-cause readmissions to an average of 10% by focusing on making sure patients' needs are met while they are in the hospital and after discharge. An Advanced Medical Team of RN care navigators and social workers works in the outpatient clinic and coordinates care for patients with multiple comorbidities who take multiple medications and are being treated by multiple physicians. The Consistent Care program, overseen by a social worker, links patients who use the emergency department for primary care with a primary care physician. Dedicated care coordinators on each unit have cubicles in the nurses' stations and meet daily with the charge nurse, social worker, and bedside nurse caring for the patient to discuss the goals of care and goals for discharge of each patient on the unit. PMID:25632707

  15. 78 FR 18246 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... MANAGEMENT 45 CFR Part 800 RIN 3206-AM47 Patient Protection and Affordable Care Act; Establishment of the..., entitled ``Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for... defined in section 1402(b) of the Affordable Care Act.'' 8. On Web page 15568, in the third column,...

  16. 77 FR 286 - Medicaid Program: Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Adults

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-04

    ... HUMAN SERVICES Office of the Secretary Medicaid Program: Initial Core Set of Health Care Quality...: This final notice announces the initial core set of health care quality measures for Medicaid-eligible... administered under title XIX of the Social Security Act, health insurance issuers and managed care...

  17. School-Age Child Care: Innovative Public School Programs.

    ERIC Educational Resources Information Center

    ERS Spectrum, 1992

    1992-01-01

    Innovative school-age day care programs include Tennessee's Extended School Program; Hawaii's After-School Plus program; San Antonio's Kid's Involvement Network (offering middle school supervision); Aurora, Colorado's state-licensed Year-Round School Recreation Plan; and Pomona, California's Child Development Program. These public school programs…

  18. Issues in NASA program and project management

    NASA Technical Reports Server (NTRS)

    Hoban, Francis T. (Editor)

    1990-01-01

    This volume is the third in an ongoing series on aerospace project management at NASA. Articles in this volume cover the attitude of the program manager, program control and performance measurement, risk management, cost plus award fee contracting, lessons learned from the development of the Far Infrared Absolute Spectrometer (FIRAS), small projects management, and age distribution of NASA scientists and engineers. A section on resources for NASA managers rounds out the publication.

  19. Issues in NASA program and project management

    NASA Technical Reports Server (NTRS)

    Hoban, Francis T. (Editor)

    1991-01-01

    This volume is the third in an ongoing series on aerospace project management at NASA. Articles in this volume cover the attitude of the program manager, program control and performance measurement, risk management, cost plus award fee contracting, lessons learned from the development of the Far Infrared Absolute Spectrometer (FIRAS), small projects management, and age distribution of NASA scientists and engineers. A section on resources for NASA managers rounds out the publication.

  20. Issues in NASA program and project management

    NASA Technical Reports Server (NTRS)

    Hoffman, Edward J. (Editor)

    1994-01-01

    This volume is the eighth in an ongoing series addressing current topics and lessons learned in NASA program and project management. Articles in this volume cover the following topics: (1) power sources for the Galileo and Ulysses Missions; (2) managing requirements; (3) program control of the Tropical Rainfall Measuring Mission; (4) project management method; (5) career development for project managers; and (6) resources for NASA managers.

  1. Care management: agreement between nursing prescriptions and patients' care needs

    PubMed Central

    Faeda, Marília Silveira; Perroca, Márcia Galan

    2016-01-01

    ABSTRACT Objectives: analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. Method: descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. Results: 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. Conclusion: the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended. PMID:27508902

  2. Continuing Education in Management for Health Care Personnel. A Second Opinion.

    ERIC Educational Resources Information Center

    White, Donald K.

    Results are reported of an intensive evaluation of a statewide continuing education program in health care management based on interviews with program participants, their supervisors, and the administrators of their institutions. Focus is not how much knowledge was conveyed, but on how widely learning was reflected in improved management…

  3. Repository-Based Software Engineering Program: Working Program Management Plan

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Repository-Based Software Engineering Program (RBSE) is a National Aeronautics and Space Administration (NASA) sponsored program dedicated to introducing and supporting common, effective approaches to software engineering practices. The process of conceiving, designing, building, and maintaining software systems by using existing software assets that are stored in a specialized operational reuse library or repository, accessible to system designers, is the foundation of the program. In addition to operating a software repository, RBSE promotes (1) software engineering technology transfer, (2) academic and instructional support of reuse programs, (3) the use of common software engineering standards and practices, (4) software reuse technology research, and (5) interoperability between reuse libraries. This Program Management Plan (PMP) is intended to communicate program goals and objectives, describe major work areas, and define a management report and control process. This process will assist the Program Manager, University of Houston at Clear Lake (UHCL) in tracking work progress and describing major program activities to NASA management. The goal of this PMP is to make managing the RBSE program a relatively easy process that improves the work of all team members. The PMP describes work areas addressed and work efforts being accomplished by the program; however, it is not intended as a complete description of the program. Its focus is on providing management tools and management processes for monitoring, evaluating, and administering the program; and it includes schedules for charting milestones and deliveries of program products. The PMP was developed by soliciting and obtaining guidance from appropriate program participants, analyzing program management guidance, and reviewing related program management documents.

  4. The effect of managed care on hospitals' provision of uncompensated care.

    PubMed

    McKay, Niccie L; Meng, Xiaoxian

    2007-01-01

    This study examines the effect of managed care on hospitals' provision of uncompensated care, using a new measure of managed care that is hospital-specific, rather than measured for the area as a whole, and which includes payment by preferred provider organizations (PPOs) as well as by health maintenance organizations (HMOs). Based on data for Florida hospitals in the period 1998-2002, the results indicate that a higher percentage of private managed care patient-days was associated with a decrease in uncompensated care as a percentage of total operating expenses, holding net profit margin and other factors constant. The results suggest that spillover effects on uncompensated care should be taken into account when considering increases in managed care payment. PMID:17583265

  5. Family Child Care Programs within the Military System of Care

    ERIC Educational Resources Information Center

    Stevens, Carolyn S.

    2011-01-01

    Military families face challenges not found in other work environments. Shifting work schedules that are often longer than the typical 8-hour day, as well as the ever-present possibility of being deployed anywhere in the world on a moment's notice, require a child care system that is flexible but maintains high-quality standards. The U.S.…

  6. Evaluating and Selecting Sport Management Undergraduate Programs.

    ERIC Educational Resources Information Center

    Cuneen, Jacquelyn; Sidwell, M. Joy

    1998-01-01

    States that the accelerated growth of sport management undergraduate programs that began in the 1980s has continued into the current decade. There are currently 180 sport management major programs in American colleges and universities. Describes the sports management approval process and suggests useful strategies to evaluate sport management…

  7. Management Training Program in a Discount Store.

    ERIC Educational Resources Information Center

    Sethi, Manmohan Singh

    This study inquired into the objectives of management training programs in two chains of discount stores, and whether those who complete training believe that program objectives have been met. Questionnaire interviews were held with two managers and four trainees from one chain, and with two managers and two trainees from the other. Ten hypotheses…

  8. 76 FR 74842 - RTCA Program Management Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-01

    ... Federal Aviation Administration RTCA Program Management Committee AGENCY: Federal Aviation Administration (FAA), U.S. Department of Transportation (DOT). ACTION: Notice of RTCA Program Management Committee... Management Committee DATES: The meeting will be held December 13, 2011, from 8:30 a.m.-1:30 p.m....

  9. Waste Management Technician Partnership Program. Final Report.

    ERIC Educational Resources Information Center

    Campbell, Donna

    This final report for Columbia Basin College's waste management technician partnership program outlines 4 objectives: (1) develop at least 4 waste management competency-based curriculum modules; (2) have 50 participants complete at least 1 module; (3) have 100 participants complete a training and/or certification program and 200 managers complete…

  10. Child Care and Other Support Programs

    ERIC Educational Resources Information Center

    Floyd, Latosha; Phillips, Deborah A.

    2013-01-01

    The U.S. military has come to realize that providing reliable, high-quality child care for service members' children is a key component of combat readiness. As a result, the Department of Defense (DoD) has invested heavily in child care. The DoD now runs what is by far the nation's largest employer-sponsored child-care system, a…

  11. Program Management Collection. "LINCS" Resource Collection News

    ERIC Educational Resources Information Center

    Literacy Information and Communication System, 2011

    2011-01-01

    This edition of "'LINCS' Resource Collection News" features the Program Management Collection, which covers the topics of Assessment, Learning Disabilities, and Program Improvement. Each month Collections News features one of the three "LINCS" (Literacy Information and Communication System) Resource Collections--Basic Skills, Program Management,…

  12. Student Loan Programs: Management and Collection.

    ERIC Educational Resources Information Center

    Dorian, James C.; Ward, Diane M.

    This guide to undergraduate and graduate student loan programs focuses primarily on program administration and management in the context of student loan repayment and collection. By incorporating regulatory requirements with practical suggestions on managing student loan programs, the book provides a framework and a guide for those who are…

  13. Children and Managed Health Care. Analysis and Recommendations.

    ERIC Educational Resources Information Center

    Deal, Lisa W.; Shiono, Patricia H.; Behrman, Richard E.

    1998-01-01

    Reviews the changes managed health care has brought to the delivery and use of medical services and recommends specific steps that will make the existing system more responsive to the needs of children. Systemwide health care reforms must give children stable medical care that emphasizes preventive health and developmental services. (SLD)

  14. Child care and other support programs.

    PubMed

    Floyd, Latosha; Phillips, Deborah A

    2013-01-01

    The U.S. military has come to realize that providing reliable, high-quality child care for service members' children is a key component of combat readiness. As a result, the Department of Defense (DoD) has invested heavily in child care. The DoD now runs what is by far the nation's largest employer-sponsored child-care system, a sprawling network with nearly 23,000 workers that directly serves or subsidizes care for 200,000 children every day. Child-care options available to civilians typically pale in comparison, and the military's system, embedded in a broader web of family support services, is widely considered to be a model for the nation. The military's child-care success rests on four pillars, write Major Latosha Floyd and Deborah A. Phillips. The first is certification by the military itself, including unannounced inspections to check on safety, sanitation, and general compliance with DoD rules. The second is accreditation by nationally recognized agencies, such as the National Association for the Education of Young Children. The third is a hiring policy that sets educational and other requirements for child-care workers, and the fourth is a pay scale that not only sets wages high enough to discourage the rapid turnover common in civilian child care but also rewards workers for completing additional training. Floyd and Phillips sound a few cautionary notes. For one, demand for military child care continues to outstrip the supply In particular, as National Guard and Reserve members have been activated during the wars in Iraq and Afghanistan, the DoD has sometimes struggled to provide child care for their children. And force reductions and budget cuts are likely to force the military to make difficult choices as it seeks to streamline its child-care services in the years ahead. PMID:25518693

  15. The match between institutional elderly care management research and management challenges - a systematic literature review

    PubMed Central

    2012-01-01

    Background Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. Methods This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents. Results The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents. Conclusions Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers’ and policymakers’ scientific literacy needs to be enhanced. PMID:23137416

  16. New program controls tree management

    SciTech Connect

    Beaty, W.

    1995-02-01

    Senior management of TransAlta Utilities Corp. (TAU) Calgary, Alberta, Canada, was highly dissatisfied with the fact that even though the distribution line clearance budget had been increased an average 35 percent a year between 1978 and 1984, there were few if any discernible positive results. Tree-related power outages kept increasing and budget requests from the field kept increasing. In searching for a solution TAU had to deal with the concept that the right level of funding can only be determined through an inventory of tree work. This inventory is comprised of two factors, the number of trees in proximity to the power lines and the local growth rates. Based on the inventory of a hired consultant, a 12-year budget projection was established. The period covered entailed a six-year, first-cycle or catch up phase, and a six-year, second-cycle maintenance phase. In implementing the new vegetation management program in 1986, TAU decided to contact each landowner directly to obtain consent to undertake the tree work. The intent was to reduce the risk of claims while maximizing tree removals. Complaints and claims were dramatically reduced and currently run at about one per 1,000 landowners and budgets have dropped back to the 1985 levels as predicted for the maintenance phase.

  17. Marketing quality and value to the managed care market.

    PubMed

    Kazmirski, G

    1998-11-01

    Quantifying quality and marketing care delivery have been long-term challenges in the health care market. Insurers, employers, other purchasers of care, and providers face a constant challenge in positioning their organizations in a proactive, competitive niche. Tools that measure patient's self-reported perception of health care needs and expectations have increased the ability to quantify quality of care delivery. When integrated with case management and disease management strategies, outcomes reporting and variance analysis tracking can be packaged to position a provider in a competitive niche. PMID:10338715

  18. Management of Youth Rehabilitation Programs. Program Audit.

    ERIC Educational Resources Information Center

    Geizer, Bernard P., Ed.

    This report presents the results of an evaluation of New York State's Division for Youth (DFY) rehabilitation programs, which range from secure facilities to residential homes. The goals of the evaluation were to assess the level of expenditures for facility operation and use, to determine the scope of programs and the extent to which they meet…

  19. How the principles of geriatric assessment are shaping managed care.

    PubMed

    Fillit, H M; Hill, J; Picariello, G; Warburton, S

    1998-04-01

    In traditional geriatric medicine, comprehensive assessment is considered crucial to the care of frail older patients. The principles of geriatric assessment--identifying high-risk patients and targeting them for preventive interventions--are also practiced by managed care organizations (MCOs). Self-reported health surveys and administrative data are two methods used by MCOs to identify members at high risk for adverse health outcomes and functional decline who may benefit from geriatric case management. For a successful partnership with primary care physicians, it is very important that geriatric care managers should be knowledgeable in the principles of geriatric medicine. PMID:9559029

  20. Total quality management -- Remedial actions planning program

    SciTech Connect

    Petty, J.L.; Horne, T.E.

    1989-01-01

    This paper describes the management approach being taken within the Hazardous Waste Remedial Actions Program (HAZWRAP) Support Contractor Office (SCO) to ensure quality of services in a highly competitive waste management environment. An overview is presented of the contractor support role assigned to Martin Marietta Energy Systems, Inc., by the Department of Energy (DOE) national program for managing hazardous waste. The HAZWRAP SCO mission, organizational structure, and major programs are outlined, with emphasis on waste management planning for the DOE Work for Others (WFO) Program. The HAZWRAP SCO provides waste management technical support, via interagency agreements between DOE and various Department of Defense (DOD) agencies for DOD sponsors planning remedial response actions. The remainder of the paper focuses on how the concept of Total Quality Management is applied to the HAZWRAP Remedial Actions Planning (RAP) Program. The management challenge is to achieve quality on a ''system'' basis where all functional elements of program management synergistically contribute to the total quality of the effort. The quality assurance (QA) program requirements applied to the RAP Program and its subcontractors are discussed. The application of management principles in the areas of program management, procurement, and QA to achieve total quality is presented. 3 refs.

  1. Clinical Practice Strategies outside the Realm of Managed Care.

    ERIC Educational Resources Information Center

    Walfish, Steven

    While more and more psychologists criticize managed care companies, most must depend upon them in order to maintain their practices. In this study, psychologists were surveyed and asked to identify activities in their own independent practice that fall outside of the purview of managed care. A total of 180 specific activities were identified that…

  2. Managed Care: A Primer on Issues and Legislation.

    ERIC Educational Resources Information Center

    American Counseling Association, Office of Public Policy and Information, Alexandria, VA.

    This report is designed to familiarize American Counseling Association members with the concepts and terminology of managed care, and the various options for regulating managed care to safeguard the interests and rights of professional counselors and their clients. Topics covered in this report include controlling costs, private sector oversight,…

  3. A Survey of Managed Care Education at Optometry Schools.

    ERIC Educational Resources Information Center

    Soroka, Mort; Reis, Lesley

    2003-01-01

    Studied the courses and topics offered at schools of optometry and the total hours devoted to managed care. Responses from the 17 schools of optometry reveal significant variations in curricular coverage of managed care, although a core set of materials was found to exist that could be the basis for more standard curriculum. (SLD)

  4. Use of Care Paths to Improve Patient Management

    ERIC Educational Resources Information Center

    Campbell, Suzann K.

    2013-01-01

    The purpose of this special issue of Physical & Occupational Therapy in Pediatrics is to present an evidence-based system to guide the physical therapy management of patients in the Neonatal Intensive Care Unit (NICU). Two systematic guides to patient management will be presented. The first is a care path intended primarily for use by physical…

  5. Needs Assessment for Health Care Management Education in Russia

    ERIC Educational Resources Information Center

    Rekhter, Natalia; Togunov, Igor A.

    2006-01-01

    Introduction: For more than 70 years, health care management in the Soviet Union reflected a centralized directive style familiar to the Soviet political system. Market-oriented reform in post-Soviet Russia is pushing practicing physicians and physician-executives to acquire new information and skills regarding health care management. To assist…

  6. Managed care and the scale efficiency of US hospitals.

    PubMed

    Brown, H Shelton; Pagán, José A

    2006-12-01

    Managed care penetration has been partly responsible for slowing down increases in health care costs in recent years. This study uses a 1992-1996 Health Care Utilization Project sample of hospitals to analyze the relationship between managed care penetration in local insurance markets and hospital scale efficiency. After controlling for hospital and market area variables, we find that managed care insurance, particularly the preferred provider type, is associated with increases in hospital scale efficiency in tertiary cases. The results presented here are consistent with the view that managed care can lead to reductions in health cost inflation by controlling the diffusion of technology via improvements in the scale efficiency of hospitals. PMID:17111213

  7. Intervening at the Setting Level to Prevent Behavioral Incidents in Residential Child Care: Efficacy of the CARE Program Model.

    PubMed

    Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E

    2016-07-01

    The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions. PMID:27138932

  8. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-03

    ... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program: Community-Based Care... about the upcoming Community-based Care Transitions Program. The meeting is open to the public, but... will be posted on the CMS Care Transitions Web site at...

  9. Long-Term Effects of Outpatient Geriatric Evaluation and Management on Health Care Utilization, Cost, and Survival

    ERIC Educational Resources Information Center

    Engelhardt, Joseph B.; Toseland, Ronald W.; Gao, Jian; Banks, Steven

    2006-01-01

    Purpose: The long-term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) program was compared to usual primary care (UPC). Design and Method: A randomized controlled group design was used. Health care utilization, cost of care, and survival were assessed during a 48-month period among a sample of 160 male…

  10. Differences in Hospital Managers', Unit Managers', and Health Care Workers' Perceptions of the Safety Climate for Respiratory Protection.

    PubMed

    Peterson, Kristina; Rogers, Bonnie M E; Brosseau, Lisa M; Payne, Julianne; Cooney, Jennifer; Joe, Lauren; Novak, Debra

    2016-07-01

    This article compares hospital managers' (HM), unit managers' (UM), and health care workers' (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers' safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management's supervision of HCWs' respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs' inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices. PMID:27056750

  11. Dementia Home Care Resources: How Are We Managing?

    PubMed Central

    Ward-Griffin, Catherine; Hall, Jodi; DeForge, Ryan; St-Amant, Oona; McWilliam, Carol; Oudshoorn, Abram; Forbes, Dorothy; Klosek, Marita

    2012-01-01

    With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future. PMID:22132332

  12. Is managed care closing substance abuse treatment units?

    PubMed

    Wells, Rebecca; Harris Lemak, Christy; Alexander, Jeffrey A; Roddy, Brian L; Nahra, Tammie A

    2007-03-01

    Despite high levels of unmet need for outpatient substance abuse treatment, a significant percentage of outpatient units have closed over the past several years. This study drew on 1999-2000 and 2005 national surveys to determine if managed care was associated with outpatient substance abuse treatment units' likelihood of surviving. Each substance abuse unit director was asked about the presence of any managed care contracts, percentage revenues from managed care, percentage of clients for whom prior authorization was required, and percentage of clients for whom concurrent review was required. A multiple logistic regression revealed that none of these factors was associated with substance abuse treatment unit survival. At this point, neither the presence nor the structure of managed care appears to affect the survival of outpatient substance abuse treatment units. Given the need for these facilities, however, and their vulnerability to closure, continued attention to managed care's potential influence is warranted. PMID:17458479

  13. Material Management Program Can Attract Local Industry

    ERIC Educational Resources Information Center

    Magad, Eugene L.

    1978-01-01

    Describes the material management certificate and the associate in applied science degree programs at William Rainey Harper College, Palatine, Illinois. Material management functions include purchasing, production control, inventory control, material handling, warehousing, packaging, computer applications, and transportation. (MF)

  14. Clinical Integration Managing across the care continuum.

    PubMed

    Karash, Julius A; Larson, Laurie

    2016-06-01

    In the changing world of health care, the traditional boundaries are vanishing and hospitals and others must integrate care within their own organizations, as well as externally, across the care continuum. Here are three approaches to accomplishing just that. PMID:27468454

  15. Characteristics of patients with diabetes who accept referrals for care management services

    PubMed Central

    Holtz, Bree; Annis, Ann M; Morrish, Wendy; Davis Burns, Jennifer; Krein, Sarah L

    2016-01-01

    Introduction: Patients with chronic conditions can improve their health through participation in self-care programs. However, awareness of and enrollment in these programs are generally low. Objective: We sought to identify factors influencing patients’ receptiveness to a referral for programs and services supporting chronic disease management. Methods: We analyzed data from 541 high-risk diabetic patients who completed an assessment between 2010 and 2013 from a computer-based, nurse-led Navigator referral program within a large primary care clinic. We compared patients who accepted a referral to those who declined. Results: A total of 318 patients (75%) accepted 583 referrals, of which 52% were for self-care programs. Patients who accepted a referral had more primary care visits in the previous year, were more likely to be enrolled in another program, expressed more interest in using the phone and family or friends for support, and were more likely to report recent pain than those who declined a referral. Discussion: Understanding what factors influence patients’ decisions to consider and participate in self-care programs has important implications for program design and development of strategies to connect patients to programs. This work informs outreach efforts to identify and engage patients who are likely to benefit from self-care activities. PMID:26835018

  16. 42 CFR 426.516 - Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Role of Medicare Managed Care Organizations (MCOs... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM... § 426.516 Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD...

  17. 42 CFR 426.516 - Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Role of Medicare Managed Care Organizations (MCOs... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM... § 426.516 Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD...

  18. The association between managed care enrollments and potentially preventable hospitalization among adult Medicaid recipients in Florida

    PubMed Central

    2014-01-01

    Background The intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the probabilities of preventable hospitalizations. This study also analyzes the spillover effect of Medicaid managed care into Medicaid patients in traditional FFS plans and the interaction effects of other patient- and county-level variables on preventable hospitalizations. Methods The study included 254,321 Medicaid patients who were admitted to short-term general hospital in the 67 counties in Florida. Using 2008 hospital inpatient discharge data for working-age adult Medicaid enrollees (18-64 years) in Florida, we conduct multivariate logistic regression analyses to identify possible factors associated with preventable hospitalizations. The first model includes patient- and county-level variables. Then, we add interaction terms between Medicaid HMO and other variables such as race, rurality, market-level factors, and resource for primary care. Results The results show that Medicaid HMO patients are more likely to be hospitalized for ambulatory care sensitive conditions (ACSCs) (OR = 1.30; CI = 1.21, 1.40). We also find that market structure (i.e., competition) is significantly associated with preventable hospitalizations. However, our study does not support that there are spillover effects of Medicaid managed care on preventable hospitalizations for other Medicaid recipients. We find that interactions between Medicaid managed care and race, rurality and market structure are significant. Conclusions The results of our study show that the Medicaid managed care program in Florida

  19. Adaptive Management Implementation: Glen Canyon Dam Adaptive Management Program Trinity River Restoration Program

    USGS Publications Warehouse

    Wittler, R.; McBain, S.; Stalnaker, C.

    2003-01-01

    Two adaptive management programs, the Glen Canyon Dam Adaptive Management Program (GCDAMP) and the Trinity River Restoration Program (TRRP) are examined. In both cases, the focus is on managing the aquatic and riparian systems downstream of a large dam and water supply project. The status of the two programs, lessons learned by the program managers and the Adaptive Environmental Assessment and Management (AEAM) evolution of the TRRP are discussed. The Trinity River illustrates some of the scientific uncertainities that a program faces and the ways the program evolves from concept through implementation.

  20. Issues in NASA program and project management

    NASA Technical Reports Server (NTRS)

    Hoban, Francis T. (Editor)

    1988-01-01

    This collection of papers and resources on aerospace management issues is inspired by a desire to benefit from the lessons learned from past projects and programs. Inherent in the NASA culture is a respect for divergent viewpoints and innovative ways of doing things. This publication presents a wide variety of views and opinions. Good management is enhanced when program and project managers examine the methods of veteran managers, considering the lessons they have learned and reflected on their own guiding principles.

  1. Managed Care Approaches to Children's Services within Public Systems of Care.

    ERIC Educational Resources Information Center

    Pumariega, Andres; Fallon, Theodore, Jr.

    This report presents two discussions of conceptual and infrastructure issues that state mental health systems serving children with emotional disturbances must consider to make an effective transition towards a managed care organization of services under Medicaid. The first discussion, "Clinical Experiences in Managed Care Implementation for…

  2. [Nursing management of wound care pain].

    PubMed

    Chin, Yen-Fan

    2007-06-01

    Wound care is an important step in promoting wound healing, but it may cause wound care pain. This article aims to explore factors influencing wound care pain and the effectiveness of various interventions to alleviate it. Five major factors that influence wound care pain include inappropriate dressing change techniques, inflammation response, emotion, cognition, and social-cultural factors. Nurses should apply appropriate dressings and dressing change techniques to relieve wound care pain. Music therapy and aromatherapy can alleviate wound pain after dressing change. But distraction techniques should be used in conjunction with consideration of the needs of the individual subject. PMID:17554674

  3. Horse Training and Management: Program of Excellence.

    ERIC Educational Resources Information Center

    Lane, Marvin

    This report on Lamar Community College's Horse Training and Management (HTM) program assesses the quality of the educational experience provided by the program, the quality of the faculty and students, institutional financial commitment to the program, contribution of the HTM program to state and local economic development, and external funding…

  4. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    PubMed Central

    Ramos-Gomez, Francisco J.

    2014-01-01

    The Affordable Care Act (ACA) mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP) in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC), and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance “in health” not in “disease modality”. IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the “age-one visit”. This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children. PMID:24587803

  5. Self-management in patients with COPD: theoretical context, content, outcomes, and integration into clinical care

    PubMed Central

    Kaptein, Ad A; Fischer, Maarten J; Scharloo, Margreet

    2014-01-01

    In this narrative review, we put self-management in the context of a 50-year history of research about how patients with COPD respond to their illness. We review a definition of self-management, and emphasize that self-management should be combined with disease management and the chronic care model in order to be effective. Reviewing the empirical status of self-management in COPD, we conclude that self-management is part and parcel of modern, patient-oriented biopsychosocial care. In pulmonary rehabilitation programs, self-management is instrumental in improving patients’ functional status and quality of life. We conclude by emphasizing how studying the way persons with COPD make sense of their illness helps in refining self-management, and thereby patient-reported outcomes in COPD. PMID:25214777

  6. The brave new world of health care compliance programs.

    PubMed

    Bartrum, T E; Bryant, L E

    1997-01-01

    The need for corporate compliance programs in health care delivery systems is ever increasing. This article identifies the key items a good program should contain, and addresses issues raised by the existence of a program as well as its implementation. PMID:10173280

  7. Get Well Care: Guidelines for Programs Serving Mildly Ill Children.

    ERIC Educational Resources Information Center

    Montanari, Ellen Orton, Ed.

    Although child care programs for mildly ill children are proliferating around the country, very few states have developed regulations for these types of programs, and no states have developed standards or guidelines. Based upon this concern, a group of medical and early childhood professionals, parents, and directors of programs for mildly ill…

  8. Year in review 2007: Critical Care – intensive care unit management

    PubMed Central

    Barbieri, Clayton; Carson, Shannon S; Amaral, André Carlos

    2008-01-01

    With the development of new technologies and drugs, health care is becoming increasisngly complex and expensive. Governments and health care providers around the world devote a large proportion of their budgets to maintaining quality of care. During 2007, Critical Care published several papers that highlight important aspects of critical care management, which can be subdivided into structure, processes and outcomes, including costs. Great emphasis was given to quality of life after intensive care unit stay, especially the impact of post-traumatic stress disorder. Significant attention was also given to staffing level, optimization of intensive care unit capacity, and drug cost-effectiveness, particularly that of recombinant human activated protein C. Managing costs and providing high-quality care simultaneously are emerging challenges that we must understand and meet. PMID:18983704

  9. Riding a Trojan horse: computerized psychiatric treatment planning using managed care principles.

    PubMed

    Rosenquist, P B; Colenda, C C; Briggs, J; Hardison, P; Jane, J

    1996-01-01

    Efforts to curtail health care costs have triggered new emphasis on resource management and accountability, entailing explicit documentation of the rationale for treatment and the resulting outcome of care. This article discusses the development of a computerized psychiatric treatment planning database that embodies principles and language of managed care, including specific admission criteria, severity ratings, and time frames for completion of interventions. The program is designed to balance goals of clinical utility, usefulness of the database as a tool for utilization review, quality improvement, and health services research, while providing an interface that is acceptable to clinicians. PMID:10162555

  10. Hunting for data to limit risks of managed care.

    PubMed

    Morrissey, J

    1994-11-14

    As managed care ignites market after market, hospitals and health systems are turning to computer software to help collect the right payments and control the use of resources. Our Nov. 7 issue detailed how providers were using the classic number-crunching capability of computers to bill according to complex formulas in managed-care contracts. This article looks at how computer software is evolving to handle management of defined populations under predetermined reimbursement. PMID:10138219

  11. Confronting the barriers to chronic care management in Medicare.

    PubMed

    Berenson, Robert A; Horvath, Jane

    2003-01-01

    This paper examines the ability of the current Medicare program--both traditional fee-for-service and risk-based contracting--to address the needs of beneficiaries with chronic conditions, who represent almost 80 percent of program enrollment. Grounded in indemnity insurance principles, including concerns about "moral hazard," the traditional Medicare program faces difficulty evolving to support of a chronic care model of health care practice. Although capitation may be the most desirable platform to support provision of care to beneficiaries with chronic conditions, the current structural limitations and problems faced in the Medicare+Choice program limit capitation's use at this time. PMID:14527234

  12. Early Careerist Interest and Participation in Health Care Leadership Development Programs.

    PubMed

    Thompson, Jon M; Temple, April

    2015-01-01

    Health care organizations are increasingly embracing leadership development programs. These programs include a variety of specific activities, such as formally structured leadership development, as well as mentoring, personal development and coaching, 360-degree feedback, and job enlargement, in order to increase the leadership skills of managers and high-potential staff. However, there is a lack of information on how early careerists in health care management view these programs and the degree to which they participate. This article reports on a study undertaken to determine how early careerists working in health care organizations view leadership development programs and their participation in such programs offered by their employers. Study findings are based on a survey of 126 early careerists who are graduates of an undergraduate health services administration program. We found varying levels of interest and participation in specific leadership development activities. In addition, we found that respondents with graduate degrees and those with higher compensation were more likely to participate in selected leadership development program activities. Implications of study findings for health care organizations and early careerists in the offering of, and participation in, leadership development programs are discussed. PMID:26506297

  13. Medicaid Managed Care in an Integrated Health Care Delivery System: Lessons from Geisinger's Early Experience.

    PubMed

    Maeng, Daniel D; Snyder, Susan R; Baumgart, Charles; Minnich, Amy L; Tomcavage, Janet F; Graf, Thomas R

    2016-08-01

    Many states in the United States, including Pennsylvania, have opted to rely on private managed care organizations to provide health insurance coverage for their Medicaid population in recent years. Geisinger Health System has been one such organization since 2013. Based on its existing care management model involving data-driven population management, advanced patient-centered medical homes, and targeted case management, Geisinger's Medicaid management efforts have been redesigned specifically to accommodate those with complex health care issues and social service needs to facilitate early intervention, effective and efficient care support, and ultimately, a positive impact on health care outcomes. An analysis of Geisinger's claims data suggests that during the first 19 months since beginning Medicaid member enrollment, Geisinger's Medicaid members, particularly those eligible for the supplemental security income benefits, have incurred lower inpatient, outpatient, and professional costs of care compared to expected levels. However, the total cost savings were partially offset by the higher prescription drug costs. These early data suggest that an integrated Medicaid care management effort may achieve significant cost of care savings. (Population Health Management 2016;19:257-263). PMID:26565693

  14. Conflicts between managed care organizations and emergency departments in California.

    PubMed Central

    Johnson, L A; Derlet, R W

    1996-01-01

    To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care organizations and these departments. Because federal law mandates access to emergency care for all persons, disagreements occur over the precise definition of an emergency medical condition. In addition, conflicts occur over the scope and payment for the medical screening examination required by federal law of persons presenting to an emergency department. Finally, issues arise related to the safety of patients who present to emergency departments and request care but are denied care because the managed care organization does not authorize the visit. Recent legislation in California has attempted to reconcile differences between managed care practices and federal and state laws; however, areas of continued conflict need to be resolved to prevent possible adverse consequences for patients actually needing emergency care. PMID:8775727

  15. Kinder and gentler: physicians and managed care, 1997-2001.

    PubMed

    Strunk, Bradley C; Reschovsky, James D

    2002-11-01

    Despite the managed care backlash, an overwhelming majority of U.S. physicians continue to contract with managed care health plans. In fact, according to a new Center for Studying Health System Change (HSC) study, between 1997 and 2001 physicians reported a modest increase in the proportion of practice revenue from managed care contracts and the average number of contracts. At the same time, the nature of physicians' relationships with health plans changed, with a significant decrease in plans' use of capitation, or fixed monthly payments for each patient regardless of the amount of care provided. Meanwhile, physician practices moved away from using direct financial incentives to influence doctors' clinical decision making, but did experience an increase in the overall influence of treatment guidelines and other practices commonly associated with managed care. PMID:12532972

  16. School Age Center Connections: Site-Based Management Strategies for Implementation of Quality Programs.

    ERIC Educational Resources Information Center

    Willis, Dahna R.

    This paper describes the outcomes of a practicum that initiated site-based-management strategies to support the consistent implementation of a quality school-age child-care program. Implemented at a multisite child-care center, the program sought to enhance staff members' job satisfaction and maximize their opportunities for professional growth…

  17. CHF disease management program slashes LOS, costs with innovative tracking, analysis.

    PubMed

    1997-10-01

    Tracking care across the continuum for congestive heart failure patients: Evanston/Northwestern Healthcare's provider-driven disease management program for CHF patients crosses the boundaries of inpatient, outpatient, and home care. But that requires the savvy manipulation of data to ensure patients are tracked efficiently and resources are used appropriately. Here's how the program works. PMID:10345334

  18. Pediatric Dental Care: Prevention and Management Protocols Based on Caries Risk Assessment

    PubMed Central

    RAMOS-GOMEZ, FRANCISCO J.; CRYSTAL, YASMI O.; NG, MAN WAI; CRALL, JAMES J.; FEATHERSTONE, JOHN D.B.

    2012-01-01

    Recent increases in caries prevalence in young children, especially among minorities and the economically disadvantaged, highlight the need for early establishment of dental homes and simple, effective infant oral care preventive programs for all children as part of a medical disease prevention management model.1–3 This article presents an updated approach and practical tools for pediatric dental caries management by risk assessment, CAMBRA, in an effort to stimulate greater adoption of infant oral care programs among clinicians and early establishment of dental homes for young children. PMID:21162350

  19. The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial

    PubMed Central

    2012-01-01

    Background To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm). Methods This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. Results Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were −30.09% and −27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended). Conclusion

  20. Critical care issues in cervical cancer management.

    PubMed

    Mirhashemi, R; Janicek, M F; Schoell, W M

    1999-01-01

    Radical pelvic surgery in gynecologic oncology patients poses a challenge to the surgeon and the ancillary team in charge of the peri-operative care. The high frequency of medical problems observed in this patient population, in conjunction with the stresses of radical surgery, necessitates careful monitoring of patients' medical status. A comprehensive team approach in the perioperative period is critical to patient care. Early intervention and anticipation of potential problems for the patient at risk in the postoperative period minimizes morbidity and mortality. This article will review the essentials of critical care as it relates to patients undergoing radical pelvic operations. PMID:10225307

  1. Early Efforts By Medicare Accountable Care Organizations Have Limited Effect On Mental Illness Care And Management.

    PubMed

    Busch, Alisa B; Huskamp, Haiden A; McWilliams, J Michael

    2016-07-01

    People with mental illness use more health care and have worse outcomes than those without such illnesses. In response to incentives to reduce spending, accountable care organizations (ACOs) may therefore attempt to improve their management of mental illness. We examined changes in mental health spending, utilization, and quality measures associated with ACO contracts in the Medicare Shared Savings Program and Pioneer model for beneficiaries with mental illness, using Medicare claims for the period 2008-13 and difference-in-differences comparisons with local non-ACO providers. Pioneer contracts were associated with lower spending on mental health admissions in the first year of the contract, an effect that was attenuated in the second year. Otherwise, ACO contracts were associated with no changes in mental health spending or readmissions, outpatient follow-up after mental health admissions, rates of depression diagnosis, or mental health status. These results suggest that ACOs have not yet focused on mental illness or have been largely unsuccessful in early efforts to improve their management of it. PMID:27385241

  2. Externalization of the Health Care System's Educational Programs.

    ERIC Educational Resources Information Center

    Seisser, Mary A.; Epstein, Alice L.

    1999-01-01

    Health care organizations with successful internal education programs can expand their offerings through a formal externalization process. The process involves needs assessment, environmental scanning, identification of internal successes, and selection of appropriate topics. (SK)

  3. Navigating the Needs of Rural Women with Breast Cancer: A Breast Care Program

    PubMed Central

    Depke, Jill L.; Boreen, Amanda; Onitilo, Adedayo A.

    2015-01-01

    We describe the development and establishment of a breast care program (BCP) with service for rural breast cancer patients. Our program is a comprehensive program serving rural communities in Wisconsin. Our BCP is committed to breast health throughout the continuum from breast cancer risk assessment and prevention, advanced diagnostics, and screening tools to genetic testing and state-of-the-art surgical techniques. To provide the highest level of care, we coordinate a breast care team involving collaboration of multidisciplinary healthcare professionals. Experts from various departments, including radiologists, pathologists, breast surgeons, medical and radiation oncologists, genetic counselors, clinical trial specialists, and our breast care navigator, all work together to provide cutting edge cancer treatment and management. Our distinctive BCP allows patients to see multiple providers without having to make multiple appointments and promotes discussion of treatment recommendations and creation of a personalized treatment plan for each patient by a team of specialists. PMID:26056376

  4. 45 CFR 1306.35 - Family child care program option.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... cognitive, socio-emotional, and physical development, including both gross and fine motor. Family child care... 45 Public Welfare 4 2011-10-01 2011-10-01 false Family child care program option. 1306.35 Section 1306.35 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN...

  5. 45 CFR 1306.35 - Family child care program option.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... cognitive, socio-emotional, and physical development, including both gross and fine motor. Family child care... 45 Public Welfare 4 2013-10-01 2013-10-01 false Family child care program option. 1306.35 Section 1306.35 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN...

  6. 45 CFR 1306.35 - Family child care program option.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... cognitive, socio-emotional, and physical development, including both gross and fine motor. Family child care... 45 Public Welfare 4 2012-10-01 2012-10-01 false Family child care program option. 1306.35 Section 1306.35 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN...

  7. 45 CFR 1306.35 - Family child care program option.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... cognitive, socio-emotional, and physical development, including both gross and fine motor. Family child care... 45 Public Welfare 4 2014-10-01 2014-10-01 false Family child care program option. 1306.35 Section 1306.35 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN...

  8. 45 CFR 1306.35 - Family child care program option.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... cognitive, socio-emotional, and physical development, including both gross and fine motor. Family child care... 45 Public Welfare 4 2010-10-01 2010-10-01 false Family child care program option. 1306.35 Section 1306.35 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN...

  9. PENNSYLVANIA MIGRANT DAY CARE PROGRAM AND PARTICIPATING AGENCIES.

    ERIC Educational Resources Information Center

    NAYLOR, NAOMI L.

    A DESCRIPTION OF A MIGRANT DAY CARE PROGRAM WAS GIVEN. A TOTAL OF 180 PRESCHOOL AND SCHOOL AGE CHILDREN WERE ENROLLED IN SIX DAY CARE CENTERS. SOME FINANCIAL AID, EQUIPMENT, MATERIALS, AND ADVISORY HELP WERE GIVEN TO TWO OTHER CENTERS ENROLLING 40 MORE CHILDREN. FUNDS FOR THE OPERATION OF THE CENTERS WERE FEDERAL FUNDS, ALLOCATED TO PROVIDE…

  10. Evaluating a Hygiene Education Program for Child Care Workers.

    ERIC Educational Resources Information Center

    Petri, Cynthia J.; Winnail, Scott D.; Geiger, Brian F.; Artz, Lynn M.; Mason, J. W.

    Children, parents, and child caregivers are vulnerable to several infectious diseases as a result of contact with child care centers. This pilot program, implemented in a rural county in a southeastern state, was designed to enhance knowledge and skills related to improved hygiene practices in a child care setting. The target audience for the…

  11. Collaboration and Subsidized Early Care and Education Programs in Illinois

    ERIC Educational Resources Information Center

    Spielberger, Julie; Zanoni, Wladimir; Barisik, Elizabeth

    2013-01-01

    As a result of policy changes following welfare reform in 1996 and the costs associated with providing high-quality early care and education for children of low-income working families, agency collaboration in the state of Illinois has become an increasingly salient feature of subsidized early care and education programs (SECE). The authors…

  12. Day Care Programs: A Part of the Educational Continuum.

    ERIC Educational Resources Information Center

    Blackwell, Jacqueline; Leeper, Sarah H.

    In order to determine the effect of day care center sponsorship on children's development, the authors examined the ways in which programs, objects and materials, and teacher/child interactions affected the preoperational behavior of 4-year-old black children in publicly and privately supported day care centers. A total of 120 4-year-olds (30 from…

  13. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

    PubMed Central

    Stellefson, Michael; Stopka, Christine

    2013-01-01

    Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085

  14. Development of an interactive computer program for advance care planning

    PubMed Central

    Green, Michael J.; Levi, Benjamin H.

    2013-01-01

    Objective To describe the development of an innovative, multimedia decision aid for advance care planning. Background Advance care planning is an important way for people to articulate their wishes for medical care when they are not able to speak for themselves. Living wills and other types of advance directives are the most commonly used tools for advance care planning, but have been criticized for being vague, difficult to interpret, and inconsistent with individuals’ core beliefs and values. Results We developed a multimedia, computer-based decision aid for advance care planning (‘Making Your Wishes Known: Planning Your Medical Future’) to overcome many of the limitations of standard advance directive forms. This computer program guides individuals through the process of advance care planning, and unlike standard advance directives, provides tailored education, values clarification exercises, and a decision-making tool that translates an individual’s values and preferences into a specific medical plan that can be implemented by a health-care team. Pilot testing with 50 adult volunteers recruited from an outpatient primary care clinic showed high levels of satisfaction with the program. Further pilot testing with 34 cancer patients indicated that the program was perceived to be highly accurate at representing patients’ wishes. Conclusions This paper describes the development of an innovative decision aid for advance care planning that was designed to overcome common problems with standard advance directives. Preliminary testing suggests that it is acceptable to users and is accurate. PMID:18823445

  15. The Charged Aerosol Release Experiment (CARE) Program

    NASA Astrophysics Data System (ADS)

    Bernhardt, Paul; Scales, Wayne; Sternovsky, Zoltan; Kelley, Michael; Hysell, David; Holzworth, Robert

    A new experiment called the Charged Aerosol Release Experiment (CARE) employs the release of dust in the upper atmosphere to form a dusty plasma in space. Two solid rocket motors strapped side-by-side in opposition will provide a pin-wheel high speed dust dispenser for the CARE experiment. A spherical dust cloud will form as a radial expansion around the CARE dust release module. The release will occur between 200 and 250 km altitude in the F-region where the 10 to 1000 nm diameter particles will become charged by electron attachment. As the charged dust particle stream through the ionosphere, plasma irregularities will be produced by streaming and fluid plasma instabilities. The plasma turbulence will driven by large electric fields at the surface of the cloud resulting from the separation of unmagnetized negatively charge dust from the background positive ions which are tied to magnetic field lines. In addition, two stream instabilities from the charge particles moving through the plasma will cause plasma wave structures. The effects of the CARE dust release will be diagnosed with in situ electric field booms, dust detectors, and Langmuir probes. Remote sensing of the CARE release will involve ground backscatter radars in the HF, VHF, and UHF frequency ranges. At late times, the dust cloud will settle into the mesosphere where an artificial mesospheric cloud will be formed. Satellite imagery using the AIM satellite will measure the long-term dispersal of the artificial dust cloud. The results of the CARE experiment will be compared with radar, optical and rocket measurements of natural polar mesospheric clouds.

  16. PROGRAM COORDINATION FOR THE GULF ECOLOGICAL MANAGMENT SITES (GEMS) PROGRAM

    EPA Science Inventory

    The Gulf Ecological Management Site (GEMS) Program is an initiative of the Gulf of Mexico Program (GMP) and the five Gulf of Mexico states. It provides a regional framework for focusing attention on ecologically important Gulf habitats. The GEMS Program coordinates and utilizes ...

  17. The MBA--Tribal Management Program.

    ERIC Educational Resources Information Center

    Bread, Donald J.

    The only graduate program in the United States devoted entirely to tribal management is designed to educate and prepare students for employment with Indian tribes and organizations and with federal and state agencies. The highly academically structured 34-hour program addresses concerns often ignored in corporate management and public…

  18. Guide for Managers of Adult Education Programs.

    ERIC Educational Resources Information Center

    Hudson River Center for Program Development, Glenmont, NY.

    This document is intended to help adult education program managers throughout New York become oriented to the world of adult education, handle their new responsibilities as program managers, and obtain up-to-date information to assist them in making educational and administrative decisions. The following are among the topics discussed in the…

  19. Program Evaluation: Two Management-Oriented Samples

    ERIC Educational Resources Information Center

    Alford, Kenneth Ray

    2010-01-01

    Two Management-Oriented Samples details two examples of the management-oriented approach to program evaluation. Kenneth Alford, a doctorate candidate at the University of the Cumberlands, details two separate program evaluations conducted in his school district and seeks to compare and contrast the two evaluations based upon the characteristics of…

  20. Bilingual Program Management: A Problem Solving Approach.

    ERIC Educational Resources Information Center

    De George, George P., Ed.

    A collection of essays on the management of bilingual education programs is organized in three units: managing in a culturally diverse setting, balancing critical interactions, and special issues. The following papers are included: "Recruiting and Retaining Competent Personnel for Bilingual Education Programs" (Joan E. Friedenberg, Curtis H.…

  1. Corporate social responsibility and the future health care manager.

    PubMed

    Collins, Sandra K

    2010-01-01

    The decisions and actions of health care managers are oftentimes heavily scrutinized by the public. Given the current economic climate, managers may feel intense pressure to produce higher results with fewer resources. This could inadvertently test their moral fortitude and their social consciousness. A study was conducted to determine what corporate social responsibility orientation and viewpoint future health care managers may hold. The results of the study indicate that future health care managers may hold patient care in high regard as opposed to profit maximization. However, the results of the study also show that future managers within the industry may continue to need rules, laws, regulations, and legal sanctions to guide their actions and behavior. PMID:21045586

  2. Implementing Medicaid managed care: the New York City story.

    PubMed

    Sparer, M; Brown, L D; Kovner, A R

    1999-01-01

    Across the nation, public officials are encouraging or requiring Medicaid beneficiaries to enroll in managed care. In this article, we report on a study of the implementation of Medicaid managed care in New York City. Several findings are clear. First, government officials need to treat health plans as partners rather than adversaries; in New York, the relationship between the state and the plans is far too adversarial. Second, effective managed care requires good management information systems; New York officials are collecting an enormous amount of data but not much useful information. Third, effective implementation of Medicaid managed care is slow going; New York's effort to dramatically accelerate the enrollment process did not work. PMID:10497747

  3. Selecting, adapting, and sustaining programs in health care systems.

    PubMed

    Zullig, Leah L; Bosworth, Hayden B

    2015-01-01

    Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA) Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. PMID:25931825

  4. Managing a palliative oncology program: the role of a business plan.

    PubMed

    Walsh, D; Gombeski, W R; Goldstein, P; Hayes, D; Armour, M

    1994-02-01

    Today's health-care environment demands that palliative-care programs operate in a businesslike manner. This report summarizes the business plan and the process followed to develop the Palliative Care Program at the Cleveland Clinic Foundation (CCF). The benefits generated from this effort and the lessons learned that may be helpful to other program managers are described. By disciplining itself to focus on financial, marketing, and operational issues, the Palliative Care Program is in a better position to advance its clinical services within the organization and in its market area, and can thereby serve its patients more effectively. PMID:7517428

  5. Indonesian heath care and the economic crisis: is managed care the needed reform?

    PubMed

    Hotchkiss, D R; Jacobalis, S

    1999-03-01

    The ramifications of the current economic crisis are being felt throughout Asia, but problems are particularly acute in Indonesia; in the midst of high inflation and unemployment the government is considering expanding managed care reform. In this paper, we discuss the impact of the recent economic crisis on the health sector in Indonesia, and analyze the potential for implementing effective reform following the managed care model. The health sector is discussed, highlighting pre-existing problems in the health care supply environment. The determinants of the economic crisis are summarized, and the broad impacts of the crisis to date on the health sector are assessed. Next the prospects for success of current managed-care reform proposals are examined in some detail: viability of expanded managed care reform measures are assessed in light of the continuing crisis and its likely impacts on the consumers and suppliers of health care. Analysis of the potential impact of the continuing crisis focuses on key participants in health care reform: households, the government, and private health care providers. In conclusion the potential viability of managed care appears poor, given the current economic, political, and institutional conditions and likely future impacts, and suggest some alternative reform measures. PMID:10351668

  6. Responding to financial pressures. The effect of managed care on hospitals' provision of charity care.

    PubMed

    Mas, Núria

    2013-06-01

    Healthcare financing and insurance is changing everywhere. We want to understand the impact that financial pressures can have for the uninsured in advanced economies. To do so we focus on analyzing the effect of the introduction in the US of managed care and the big rise in financial pressures that it implied. Traditionally, in the US safety net hospitals have financed their provision of unfunded care through a complex system of cross-subsidies. Our hypothesis is that financial pressures undermine the ability of a hospital to cross-subsidize and challenges their survival. We focus on the impact of price pressures and cost-controlling mechanisms imposed by managed care. We find that financial pressures imposed by managed care disproportionately affect the closure of safety net hospitals. Moreover, amongst those hospitals that remain open, in areas where managed care penetration increases the most, they react by closing the health services most commonly used by the uninsured. PMID:23389814

  7. Exploring valid and reliable assessment methods for care management education.

    PubMed

    Gennissen, Lokke; Stammen, Lorette; Bueno-de-Mesquita, Jolien; Wieringa, Sietse; Busari, Jamiu

    2016-07-01

    Purpose It is assumed that the use of valid and reliable assessment methods can facilitate the development of medical residents' management and leadership competencies. To justify this assertion, the perceptions of an expert panel of health care leaders were explored on assessment methods used for evaluating care management (CM) development in Dutch residency programs. This paper aims to investigate how assessors and trainees value these methods and examine for any inherent benefits or shortcomings when they are applied in practice. Design/methodology/approach A Delphi survey was conducted among members of the platform for medical leadership in The Netherlands. This panel of experts was made up of clinical educators, practitioners and residents interested in CM education. Findings Of the respondents, 40 (55.6 per cent) and 31 (43 per cent) participated in the first and second rounds of the Delphi survey, respectively. The respondents agreed that assessment methods currently being used to measure residents' CM competencies were weak, though feasible for use in many residency programs. Multi-source feedback (MSF, 92.1 per cent), portfolio/e-portfolio (86.8 per cent) and knowledge testing (76.3 per cent) were identified as the most commonly known assessment methods with familiarity rates exceeding 75 per cent. Practical implications The findings suggested that an "assessment framework" comprising MSF, portfolios, individual process improvement projects or self-reflections and observations in clinical practice should be used to measure CM competencies in residents. Originality/value This study reaffirms the need for objective methods to assess CM skills in post-graduate medical education, as there was not a single assessment method that stood out as the best instrument. PMID:27397747

  8. The Xyrem risk management program.

    PubMed

    Fuller, David E; Hornfeldt, Carl S; Kelloway, Judy S; Stahl, Pamela J; Anderson, Todd F

    2004-01-01

    Sodium oxybate, also known as gamma-hydroxybutyric acid (GHB), was discovered in 1960 and has been described both as a therapeutic agent with high medical value and, more recently, a substance of abuse. The naturally occurring form of this drug is found in various body tissues but has been studied most extensively in the CNS where its possible function as a neurotransmitter continues to be studied. Sodium oxybate has been approved in different countries for such varied uses as general anaesthesia, the treatment of alcohol withdrawal and addiction, and, most recently, cataplexy associated with narcolepsy. During the 1980s, easy access to GHB-containing products led to various unapproved uses, including weight loss, bodybuilding and the treatment of sleeplessness, sometimes with serious long-term effects. The availability of these unapproved and unregulated forms of the drug led to GHB and its analogues being popularised as substances of abuse and subsequent notoriety as agents used in drug-facilitated sexual assault, or 'date rape', eventually leading to the prohibition of GHB sales in the US. Legal efforts to control the sale and distribution of GHB and its analogues nearly prevented the clinical development of sodium oxybate for narcolepsy in the US. However, following extensive discussions with a variety of interested parties, a satisfactory solution was devised, including legislative action and the development of the Xyrem Risk Management Program. Amendments to the US Controlled Substances Act made GHB a schedule I drug, but also contained provisions that allow US FDA-approved products to be placed under schedule III. This unique, bifurcated schedule for sodium oxybate/GHB allowed the clinical development of sodium oxybate to proceed and, in July 2002, it was approved by the FDA as an orphan drug for the treatment of cataplexy in patients with narcolepsy as Xyrem(sodium oxybate) oral solution. To promote the safe use of sodium oxybate, as well as alleviate

  9. A Plant Health Care Program for Brambles in the Pacific Northwest

    PubMed Central

    McElroy, F. D.

    1992-01-01

    Pratylenchus and Xiphinema species have been associated with decline and mortality of brambles (Rubus species) in the Pacific Northwest of the United States. These nematodes cause direct feeding damage and (or) transmit viruses that result in poor fruit quality and plant decline. A nematode management program has been developed by the author to minimize chemical use and nematode-induced damage while optimizing fruit production. Nematode management is an integral part of a total plant health care program in which foliar and soil pests, plant stresses, and fertility are managed. PMID:19283023

  10. A plant health care program for brambles in the pacific northwest.

    PubMed

    McElroy, F D

    1992-09-01

    Pratylenchus and Xiphinema species have been associated with decline and mortality of brambles (Rubus species) in the Pacific Northwest of the United States. These nematodes cause direct feeding damage and (or) transmit viruses that result in poor fruit quality and plant decline. A nematode management program has been developed by the author to minimize chemical use and nematode-induced damage while optimizing fruit production. Nematode management is an integral part of a total plant health care program in which foliar and soil pests, plant stresses, and fertility are managed. PMID:19283023

  11. Cost of treating mental illness from a managed care perspective.

    PubMed

    Docherty, J P

    1999-01-01

    The issue of cost-effectiveness in the pharmacoeconomics of mental illness is a new concept. As methodologies for exploring this subject unfold, the most fundamental objective for health care professionals and managed care officials is to find ways in which currently available resources can be used most effectively. The managed care perspective is highly cost-based within the market it serves. In addition to cost, other factors that influence the managed care perspective are a short-term focus, segmentation of budgets, and measurable indicators of outcome, cost, and quality of care. The cost of new psychopharmacology--especially antidepressants and antipsychotics--may be many times that of traditional drugs, and concern about increased drug costs is present in many managed care organizations. Several issues must be addressed to prevent restriction of pharmacotherapeutics in managed care settings. For example, a focus on both outcomes and practice guidelines is needed to help allocate limited resources fairly. This article suggests ways in which available resources can be used more effectively to treat mental illness within the present health care system. PMID:10073378

  12. Seamless health care for chronic diseases in a dual health care system: managed care and the role of family physicians.

    PubMed

    Lee, A

    1998-01-01

    Neither private nor state run health care systems are perfect. Although there is increasing evidence that Health Maintenance Organizations (HMOs) provide comparable care at lower cost, HMOs tend to select healthy patients. The dual health care system in Hong Kong spends about 3.9 per cent of GDP, with health indices among the best in the world. Hong Kong still faces the problem of escalating health care expenditure. One should take advantage of the dual health care system to evolve a new paradigm for a primary-led seamless health care service. The Diabetes Centre of a university teaching hospital together with the University of Community and Family Medicine has started a structured shared care programme in diabetes mellitus, involving general practitioners in both the private and public sectors integrating the primary and secondary care, and the private and public sectors. This programme starts to develop an infrastructure for providing quality care at an affordable cost for a large pool of patients with chronic disease. Unlike other "managed care schemes", this one is not run by profit-oriented companies, but by health professionals with an interest in providing best possible care at an affordable cost. The "disease management" approach needs a care delivery system without traditional boundaries; and a continuous improvement process which develops and refines the knowledge base, guidelines and delivery system. PMID:10351265

  13. Is Managed Care Leading to Consolidation in Health-care Markets?

    PubMed Central

    David, Dranove; Simon, Carol J; White, William D

    2002-01-01

    Objective To determine the extent to which managed care has led to consolidation among hospitals and physicians. Data Sources We use data from the American Hospital Association, American Medical Association, and government censuses. Study Design Two stage least squares regression analysis examines how cross-section variation in managed care penetration affects provider consolidation, while controlling for the endogeneity of managed-care penetration. Specifically, we examine inpatient hospital markets and physician practice size in large metropolitan areas. Data Collection Methods All data are from secondary sources, merged at the level of the Primary Metropolitan Statistical Area. Principal Findings We find that higher levels of local managed-care penetration are associated with substantial increases in consolidation in hospital and physician markets. In the average market (managed-care penetration equaled 34 percent in 1994), managed care was associated with an increase in the Herfindahl of .054 between 1981 and 1994, moving from .096 in 1981 to .154. This is equivalent to moving from 10.4 equal-size hospitals to 6.5 equal-sized hospitals. In the physician market place, we estimate that at the mean, managed care resulted in a 14 percentage point decrease of physicians in solo practice between 1986 and 1995. This implies a decrease in the percentage of doctors in solo practice from 38 percent in 1986 to 24 percent by 1995. PMID:12132596

  14. 76 FR 6162 - Notice of Federal Long-Term Care Insurance Program Open Season; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-03

    ... MANAGEMENT Notice of Federal Long-Term Care Insurance Program Open Season; Correction AGENCY: U.S. Office of... a correction to the notice published in the Federal Register of January 28, 2011 (76 FR 5222). The...-606-0004. Correction In the Federal Register of January 28, 2011, in FR Doc. 2011-1852, on page...

  15. Issues in NASA program and project management

    NASA Technical Reports Server (NTRS)

    Hoban, Francis T. (Editor)

    1992-01-01

    This volume is the fifth in an ongoing series on aerospace project management at NASA. Articles in this volume cover: an overview of the project cycle; SE&I management for manned space flight programs; shared experiences from NASA Programs and Projects - 1975; cost control for Mariner Venus/Mercury 1973; and the Space Shuttle - a balancing of design and politics. A section on resources for NASA managers rounds out the publication.

  16. Vital signs: taking the pulse of your managed care contract performance.

    PubMed

    Waymack, Pamela M; Ward, William J

    2005-07-01

    Three essential baseline measures of managed care performance that should be reported on a regular basis are: Overall profitability of the organization's managed care portfolio. Payer mix and profitability. Performance of major managed care contracts. PMID:16060097

  17. Identifying management competencies for health care executives: review of a series of Delphi studies.

    PubMed

    Hudak, R P; Brooke, P P; Finstuen, K

    2000-01-01

    This analysis reviews a selected body of research that identifies the essential areas of management expertise required of future health care executives. To ensure consistency, six studies are analyzed, utilizing the Delphi technique, to query a broad spectrum of experts in different fields and sites of health care management. The analysis identifies a number of management competencies, i.e., managerial capabilities, which current and aspiring health care executives, in various settings and with differing educational backgrounds, should possess to enhance the probability of their success in current and future positions of responsibility. In addition, this review identifies the skills (technical expertise), knowledge (facts and principles) and abilities (physical, mental or legal power) required to support achievement of these competencies. Leadership and resource management, including cost and finance dimensions, are the highest-rated requisite management competencies. The dominant skills, knowledge and abilities (SKAs) are related to interpersonal skills. The lowest-rated SKAs are related to job-specific, technical skills. Recommendations include the review of this research by formal and continuing education programs to determine the content of their courses and areas for future research. Similarly, current health care executives should assess this research to assist in identifying competency gaps. Lastly, this analysis recommends that the Delphi technique, as a valid and replicable methodology, be applied toward the study of non-executive health care managers, e.g., students, clinicians, mid-level managers and integrated systems administrators, to determine their requisite management competencies and SKAs. PMID:11183260

  18. Consumerism in the financial services industry: lessons for managed care.

    PubMed

    Peyser, N; Wong, A

    2000-01-01

    Managed care today is being shaped by the emergence of a savvier, better informed health care consumer. Facing a strikingly similar consumer movement over the past two decades, the banking industry experienced a market transformation that holds important lessons for managed care. Nontraditional entrants in the financial services industry, offering focused "monoline" products and services closely analogous to "carve-out" providers in health care, targeted rising consumer demands and stronger preferences. Banks in time answered these formidable new competitive forces with innovative consolidation and globalization strategies. The most successful initiatives in healthcare, as in banking, will focus on satisfying the consumer's hunger for information, improved levels of service, and enhanced outcomes. Managed care plans may play a lead role in accelerating the impact of consumerism by bridging the disconnect between patients and their purchasing decisions. PMID:11010386

  19. Professional Talk: How Middle Managers Frame Care Workers as Professionals.

    PubMed

    Oldenhof, Lieke; Stoopendaal, Annemiek; Putters, Kim

    2016-03-01

    This paper examines how middle managers in the long term care sector use the discourse of professionalism to create 'appropriate' work conduct of care workers. Using Watson's concept of professional talk, we study how managers in their daily work talk about professionalism of vocationally skilled care workers. Based on observations and recordings of mundane conversations by middle managers, we found four different professional talks that co-exist: (1) appropriate looks and conduct, (2) reflectivity about personal values and 'good' care, (3) methodical work methods, (4) competencies. Jointly, these professional talks constitute an important discursive resource for middle managers to facilitate change on the work floor. Change involves the reconfiguration of care work and different managerial-worker relations. Middle managers use professional talks in both enabling and disenabling ways vis-à-vis care workers. Based on these findings, we suggest a more nuanced portrayal of the relationship between managers and professionals. Rather than being based on an intrinsic opposition, i.e. 'managers versus professionals', this relationship is flexibly reconstructed via professional talk. PMID:24326776

  20. Managing hospital emergency power testing programs.

    PubMed

    Stymiest, D L

    1997-04-01

    All hospitals must have an emergency power testing program that includes generator load testing and emergency power supply system maintenance. This document examines a management program that uses lessons learned from an emergency power testing program to improve the hospital's facilities and training. PMID:10166993