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This booklet is designed to help make primary care services available and accessible within 30 minutes' travel time of all residents in the area. The guide, intended to help communities establish the healthcare services they need, raises questions that t...
Managed care has become one of the leading developments in healthcare financial management, but ignorance and confusion surround its meaning and origins. Managed care seeks to reduced costs and increase profits while maintaining quality, yet the evidence that it is able to achieve these aims is mixed. The following analysis is a review of the events leading to the establishment of managed care and what it has become. Various terms and healthcare organizations involved in managed care are identified, with emphasis placed on the strengths and weaknesses of managed care programs. This analysis is performed to gain insight and better understanding of the direction healthcare financial management is headed in the 21st century. PMID:18972972
In this report we discuss some of the new developments in the healthcare fitness industry catering to the needs of a healthy lifestyle, and their pros and cons. Such solutions have become very popular among health-conscious people, and these developments help enhance one's appearance, make one feel good, and give more control over one's body and lifestyle. We have
Rural healthcare centers are responsible for primary healthcare. The purpose of the present document is to ascertain the needs of typical healthcare centers in the developing countries, to compare renewable energy equipment to conventional equipment fr...
Healthcare systems are essential for promoting, improving and maintaining health of the population. Through an efficient health service, patients can be advised of disease that may be present and so facilitate treatment; risks factors whose modification could reduce the incidence of disease and illness in the future can be identified, and further, how controlling such factors can contribute to maintain a good quality of life. In developed countries, clinics or hospitals may be supported by health professionals from various specialties that allow their cooperation to benefit the patient; these institutions or clinics may be equipped with the latest technical facilities. In developing countries, health services are mostly directed to provide emergency care only or interventions towards certain age group population. The most common diseases are dental caries and periodontal disease and frequently intervention procedures aim, at treating existing problems and restore teeth and related structure to normal function. It is unfortunate that the low priority given to oral health hinders acquisition of data and establishment of effective periodontal care programmes in developing countries but also in some developed countries where the periodontal profile is also less than satisfactory. Despite the fact that in several developed countries there are advanced programmes oriented to periodontal disease treatments, the concern is related to the lack of preventive oriented treatments. According to data available on periodontal status of populations from developed countries, despite the number of dentists and trained specialists, dental health professionals do not presently meet adequately the need for prevention, focusing mainly on curative care. The need for strengthening disease prevention and health promotion programmes in order to improve oral health conditions and particularly periodontal status in the majority of countries around the world is evident. Unfortunately, in many countries, the human, financial and material resources are still insufficient to meet the need for oral healthcare services and to provide universal access, especially in disadvantaged communities, in both developing and developed countries. Moreover, even though the most widespread illnesses are avoidable, not all population groups are well informed about or able to take advantage of the proper measures for oral health promotion. In addition, in many countries, oral healthcare needs to be fully integrated into national or community health programmes. Improving oral health is a very challenging objective in developing countries, but also in developed countries, especially with the accelerated aging of the population now underway and intensifying over the coming years. PMID:22909109
Kandelman, Daniel; Arpin, Sophie; Baez, Ramon J; Baehni, Pierre C; Petersen, Poul E
Mental HealthCare Services are part of the National Health Services for Samoa. Their function is to provide mental healthcare services to the population of Samoa, which numbers 180,000 people. However, like many other countries in the Pacific region, mental health is considered a low priority. The mental health budget allocation barely covers the operation of mental healthcare services. More broadly, there is a lack of political awareness about mental healthcare services and mental health rarely becomes an issue of deliberation in the political arena. This article outlines the recent development of mental healthcare services in Samoa, including the Mental Health Policy 2006 and Mental Health Act 2007. It tells the story of the successful integration of aiga (family) as an active partner in the provision of care, and the development of the Aiga model utilizing Samoan cultural values to promote culturally appropriate family-focused community mental healthcare for Samoa. Mental HealthCare Services today encompass both clinical and family-focused community mental healthcare services. The work is largely nurse-led. Much has been achieved over the past 25 years. Increased recognition by government and increased resourcing are necessary to meet the future healthcare needs of the Samoan people. PMID:23857811
Since 1999 quality care issues have become a primary concern for healthcare organisational management. During this year, the Institute of Medicine (IOM) released a report that indicated that 98,000 preventable deaths occur each year in the US. Additionally, the report revealed that the individual competence of the practitioner is not the primary source of blame. Rather, it was the
The development of primary healthcare in Jamaica is explored, tracing its early roots to the abolition of the slave trade, the collapse of estate-based services after emancipation and the subsequent establishment of the Island Medical Services in 1875. Most development in the health sector occurred after World War I in response to the high infectious disease mortality rates. The Rockefeller Foundation was asked to assist with the control of hookworm, tuberculosis, malaria and yaws. Its recommendations led to the growth of public health programmes (e.g. environmental health, public health nursing, community midwifery) alongside community-based curative services run by hospitals. The most significant period of development occurred in the 1970s when the various vertical programmes were integrated into the current primary care system. Jamaica was integral in the development of the World Health Organization's Alma Ata Declaration on Primary HealthCare, tabling the "Jamaican Perspective on Primary HealthCare" which set out its goal that all citizens should be within 10 miles walking distance of a primary healthcare facility. At the close of the twentieth century, the health reform process led to the development of regional health authorities aimed at integrating the management of primary and secondary care under four Regional Boards of Health. This has led to a change in the role of the central Ministry of Health to one of policy-making, health promotion, setting standards, monitoring and evaluation of the quality of healthcare. PMID:11824020
BACKGROUND: Distrust of the healthcare system may be a significant barrier to seeking medical care, adhering to preventive healthcare\\u000a and treatment regimens, and participating in medical research.\\u000a \\u000a \\u000a OBJECTIVE: To describe the development and psychometric testing of an instrument (the HealthCare System Distrust Scale) to measure\\u000a distrust of the healthcare system.\\u000a \\u000a \\u000a \\u000a \\u000a METHODS: Scale development involved 2 phases.
Abigail Rose; Nikki Peters; Judy A. Shea; Katrina Armstrong
This paper reviews the need for cultural competence in healthcare, the barriers faced by healthcare professionals as they attempt to deliver culturally competent care, and the implications for human resource development initiatives. Already the most ethnically diverse country in the world, the US, is experiencing dramatic increases in its ethnic mix. As Taylor (2005) notes, these changing demographics
Context Growing evidence suggests that most forms of distrust are multidimensional, including domains of technical competence and\\u000a value congruence. Prior measures of healthcare system distrust have not reflected this multidimensional structure and may\\u000a be limiting research into the role of healthcare system distrust in health and healthcare in the US.\\u000a \\u000a \\u000a \\u000a Objective To develop a revised a scale of health
Judy A. Shea; Ellyn Micco; Lorraine T. Dean; Suzanne McMurphy; J. Sanford Schwartz; Katrina Armstrong
major challenge for today's healthcare providers around most of the world is that culturally diverse groups comprise the largest growing segment of the patient population. Individual healthcare choices and outcomes must be understandable to patients in terms of their own culture and experience. Thus, healthcare workers are faced with the need to develop intercultural competencies that allow
The purpose of this survey was to investigate the perceptions of healthcare professionals concerning the development of clinical pathways before the implementation of the regional electronic health record. The data of this study were collected from healthcare professionals working with conservative heart patients and surgical hip joint patients by means of a questionnaire. The professionals were working at one central hospital and two primary care units. In this hospital region, the process of regional electronic health record implementation is ongoing. The data from this survey were analyzed using statistical methods. The participants in this study set great store by developing and describing the current clinical pathways, and believed it was important to plan the changes in clinical pathways before implementing the electronic health record. However, the clinical pathways development work has not yet fully commenced. PMID:17102275
BACKGROUND: Palliative Care is an approach that improves quality of life for patients and their families facing the problems associated with incurable life-threatening illness. In many countries, due to the rapidly ageing population, increasingly more people are suffering from serious chronic disease towards the end of life, making further development in palliative care a major public health challenge. The aim
Nils Schneider; Sara L Lueckmann; Franziska Kuehne; Katharina Klindtworth; Mareike Behmann
|A 1991 partnership coupling Southwest Missouri State University with Saint John's Regional Health Center spawned the Midwest Sports Medicine Center, originally designed to treat orthopedic injuries. Soon the center developed major educational initiatives, including SportsPACE, a program integrating healthcare programs into the secondary core…
A time-honored industrial engineering technique, job evaluation, which was developed to set rates for manual labor, was used in the design of new teams for delivering primary healthcare in Latin America. The technique was used both in writing job descriptions for new allied health personnel and in designing the curriculums needed to train the personnel.
Demands on workload and work efficiency have increased because of ongoing global changes in healthcare organizations. Assessing and evaluating effects of changes on organizational and individual well-being require valid and reliable methods. Questionnaires from 3 large healthcare studies were used to develop instruments for work quality and health. Variable fields of work quality, health and well-being, and modifying
China’s market-oriented reform has had great success in the past few decades. Along with the rapid economic growth of the\\u000a country, the economic development also influenced various aspects of China’s social, economical, and political life. Recent\\u000a debate has criticized the overheated market reform in social provision, thus arguing for the return of government interventions.\\u000a However, in the healthcare sector,
Emergency medical services (EMS) provide rescue, field stabilization, transportation to medical facilities, and definitive care for persons experiencing medical emergencies. In order to advance worldwide development and refinement of EMS systems, and their integration with emergency preparedness and response programs, the International Conference on Emergency HealthCareDevelopment was held in Crystal City, Arlington, VA, August 15-19, 1989. The conference was supported by the Department of Health and Human Services and its Health Resources and Services Administration; the Department of Transportation and its National Highway Traffic and Safety Administration; and the Pan American Health Organization. Objectives of the conference were to clarify linkages between various levels of emergency response, to present methods for developing or improving EMS systems within societies with different resources, to demonstrate processes by which EMS systems have been developed, and to propose international emergency healthcaredevelopment goals. Topics included development of services in developing nations, case studies of underdeveloped countries' responses to natural disasters, and a method for updating disaster response through use of available medical resources.
Purpose – The objective of this exploratory paper is to find out what is important to consider when developing a supply chain in healthcare, what is required in order to establish a supply chain orientation and how lean and agile can be used as process strategies in order to improve supply chain performance. Design\\/methodology\\/approach – In order to build
Background As part of the mid-term evaluation of a Women's HealthCare Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. Methods A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a healthcare facility. Results The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. Conclusions Our findings suggest positive changes in healthcare seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress.
The experience and potential of North Carolina's primary healthcare program for rural areas is reviewed. North Carolina's rural health centers were first funded in 1973. Medical care is provided by a Family Nurse Practitioner (FNP) or a Physician's Assis...
Member countries of the World Health Organization (WHO) met in Alma Ata (8-12 September 1978) to define and advocate the implementation of primary healthcare (PHC) worldwide, above all, in developing countries, which had a real need to review their strategies for meeting the health needs of their populations. They did not suspect that 20 years later the vision they displayed would remain undeniably relevant. Here we examine the similarities and points of convergence of their declaration about PHC with the Millennium Development Goals that seek today to reduce poverty across the world. An exhaustive and analytic literature review was conducted to collect those similarities. Further analysis of the definitions, objectives, principles and recommendations of the Alma Ata Declaration and the Millennium Declaration reveals multiple dependencies and fundamental points of similarity between these two representations. Almost all states have pledged to achieve the eight MDG by 2015: to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability, and develop a global partnership for development. The Alma Ata conference defined primary healthcare as essential healthcare, based on practical methods and techniques that are both scientifically sound and socially acceptable, universally accessible to all individuals and all families of the community, through their full participation and at a cost that the community and countries can afford at all stages of their development in the spirit of self-reliance and self-determination. It is an integral part of economic and social development. The following principles are involved in the achievement of both primary healthcare and the MDG: social equity, community participation, and intersectorality. Public health is an essential condition of poverty eradication and MDG achievement. Public health issues are central to the problem of sustainable development and must therefore remain the focus of attention. It is increasingly urgent to break the vicious circle created by the close correlation between environmental degradation, poor health, and poverty. PMID:22868717
Supplemental healthcare activities are described in the context of the augmented product. The potential benefits of supplemental services to recipients and provider are discussed. The author describes a study that was the basis for (re)developing a supplemental maternity service. The implementation of the results in terms of changes in the marketing mix of this supplemental program is discussed. The effects of the marketing mix changes on program participation are presented. PMID:10108703
The availability and prominence of telecommunication technology has spurred research into generic wide area healthcare networks. Electronic exchange of patient data supposedly results in cost efficiencies, increased accessibility to healthcare resources, and improved delivery of healthcare services. Although a number of pilot networks have been built, none yet have a broad, heterogeneous base of users and applications. Properties of the healthcare process and delivery system delay the acceptance of generic wide area networks and end-user computer applications. As the technical problems seem well understood, it seems advisable to investigate these factors in telemedical research. PMID:8591481
Regulations, reimbursement battles, collaboration efforts, financial difficulties and the reform process all helped make 1991 a watershed year for healthcare issues--and an eventful one for executives. News media attention to healthcare policy, financing and delivery issues was intense: television, radio and print coverage focused on overcrowded emergency departments, uninsured pregnant women with no access to obstetrical care, employers demanding cost-efficient care and the pluses and minuses of foreign healthcare systems. The close of 1991 left hospital executives dealing with the effects of issues like the Medicare capital payment fold-in, physician payment reform, hospitals' geographic reclassification and the push for national healthcare reform. Below are brief summaries of some of the year's top issues. PMID:1660445
In this article, we describe the developmental process of a Doctor of Nursing Practice (DNP) program that uses interdisciplinary resources to create unique DNP curriculum opportunities. Other schools may benefit from this experience in the development of their own DNP programs. The program delivers an innovative curriculum from post-baccalaureate to doctorate, emphasizing healthcare engineering and interdisciplinary collaboration among faculty, hospitals, community leaders, and policymakers. This DNP program is uniquely situated to provide leadership in solving complex clinical problems through its partnership with the Regenstrief Center for Healthcare Engineering, the School of Pharmacy, the Homeland Security Institute, and the Center on Aging and the Life Course. Doctoral coursework, interdisciplinary collaboration, healthcare engineering/systems approaches, and new knowledge result in uniquely qualified providers. Post-baccalaureate students complete the university's Adult Nurse Practitioner program or its developing Pediatric Nurse Practitioner program during the first 2 years of the 4-year curriculum. A total of 83 post-baccalaureate credit hours include 1,526 hours of supervised clinical practice, a health policy residency, and cognate residencies in an area of specialization. The seven core competencies recommended by the American Association of Colleges of Nursing are incorporated into the curriculum. PMID:16220646
Wall, Barbra M; Novak, Julie C; Wilkerson, Sharon A
The second volume of the primary caredevelopment guide for Kitsap County, Washington is concerned with the county's public health clinics and their services. The guide includes working definitions of primary care and public health, and delineates the fun...
Marketing in healthcare is a relatively new process. It is a business tool that can serve a very useful purpose. Healthcare management has become aware of the usefulness of marketing in long-range planning. Through a well-thought-out marketing plan, the provider will not be leaving the future to chance. A well-conceived, patient-oriented, competitor-aware marketing plan should place the medical practice at a strategic advantage as the healthcare industry joins other industries in the competitive marketplace for the consumer's dollar. The ever-increasing political and regulatory environment that the healthcare field is undergoing emphasizes the need for the inclusion of marketing skills, such as cost containment, in the medical curriculum. It should be the obligation of the training facilities as well as medical societies to respond to this need by providing the education that will enable black providers to survive in this competitive environment.
Demands on workload and work efficiency have increased because of ongoing global changes in healthcare organizations. Assessing and evaluating effects of changes on organizational and individual well-being require valid and reliable methods. Questionnaires from 3 large healthcare studies were used to develop instruments for work quality and health. Variable fields of work quality, health and well-being, and modifying factors were factor analyzed with replicated structures in new samples, including 6 factors of work quality, 5 health factors, and 2 modifying factors. All except 2 factors had high internal consistency (Cronbach's alpha = .69-.84) and low factor intercorrelations within areas. Social climate (but not individual resources) had, according to our model, a modifying effect on the work-health interaction. PMID:9552293
This paper summarizes the findings for the European Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental HealthCare. The article presents a description of the region, an overview of mental health policies and legislation, a summary of relevant research in the region, a precis of community mental health services, a discussion of the key lessons learned, and some recommendations for the future.
SEMRAU, MAYA; BARLEY, ELIZABETH A.; LAW, ANN; THORNICROFT, GRAHAM
Background Developing Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel. Methods A qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis. Results Health communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel. Conclusions Health communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health communication channel could facilitate health communication for promoting health, i.e. ‘health promoting communication’.
Issues concerning the quality of care service improvement have become of national importance in the health-care system for both developed and developing countries. Internal audit is effective and efficient method to improve the quality of care in various healthcare facilities. Data from 452 outpatient cards of the case patients with arterial hypertension were analyzed, the level of awareness and patient compliance were defined. The stages of internal audit mechanisms implementation in the healthcare facilities were developed. As a result of medical records audit and awareness monitoring of patients with arterial hypertension ways to improve quality of medical care were defined. PMID:23863212
This paper explores the debate and initiatives concerning the use of information technology (IT) in primary healthcare in developing countries. The literature from 1992-2002 was identified from searches of the MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science databases. The search identified 884 references, 350 of which were classified according to the scheme described by the Pan American Health Organization (PAHO). For the analysis of advantages, problems and perspectives of IT applications and systems, 52 articles were selected according to their potential contribution to the primary health-care processes in non-developed countries. These included: 10 on electronic patient registries (EPR), 22 on process and programmatic action evaluation and management systems (PPAEM) and 20 on clinical decision-support systems (CDS). The main advantages, limitations and perspectives are discussed.
Tomasi, Elaine; Facchini, Luiz Augusto; Maia, Maria de Fatima Santos
This paper addresses conceptual issues underlying the assessment and implementation of healthcare priorities in developing countries as practised by foreign development agencies coping with a potentially destabilizing unmet social demand. As such, these agencies mediate the gap between existing healthcare structures patterned around the narrow needs of the ruling classes and the magnitude of public ill-health mass movements
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Health plays a central role in people’s perceptions of their quality of life, and access to good healthcare is a key ingredient\\u000a in an overall sense of security and well-being. This chapter examines how health and healthcare have evolved over the course\\u000a of Ireland’s economic boom. Media coverage highlights the negatives: increasing suicide, road deaths, binge drinking and
The purpose of this article is to propose a set of ideas for reinventing America’s healthcare system, one community at a\\u000a time. Community healthdevelopment is proposed as a strategy and approach to population health improvement, the ultimate goal\\u000a of healthcare reform. The practice of community healthdevelopment, particularly the partnership approach, provides guidance\\u000a about how this approach
Michael R. J. Felix; James N. Burdine; Monica L. Wendel; Angie Alaniz
Several registered nurses representing the American Organization of Nurse Executives (AONE), the American Association of Critical Care Nurses, and a group of nurses and physicians representing Disease Case Management visited Cuba under the auspices of the People to People Ambassador Program. The purpose of the People to People Ambassador Program is to exchange ideas, foster international friendships, and advance worldwide peace and communication. The authors were a part of the AONE delegation and will share their experiences during their visit to Cuban healthcare facilities. PMID:12503457
Maternal-child nurses are part of a growing number of Americans who have had the opportunity to visit China. An increased understanding of the history and of the healthcare practices of the Chinese people lends itself to an examination of American values and health practices. The insight developed may aid us as we seek to understand our own healthcare practices for women and children and to plan for the future in healthcare. PMID:6728348
Within European cross-border healthcare, recent studies have identified several types of international patients. Within the Anglo-Saxon setting, the specific terminology of medical tourism is used. The analytical purpose of the paper is to resolve this semantic difference by suggesting an alternative terminology, 'transnational healthcare' that is understood as a 'context-controlled and coordinated network of health services'. For demand-driven trans-border access seekers and cross-border access searchers, there is a need to opt for regional health-policy strategies. For supply-driven sending context actors and receiving context actors, there would be organizational benefits to these strategies. Applying the terminology of trans-border access seekers, cross-border access searchers, sending context and receiving context actors results in a transnational patient mobility typology of twelve types of international patients, based on the criteria of geographical distance, cultural distance and searching efforts, public/private/no cover and private/public provision of health services. Finally, the normative purpose of the paper is to encourage the use of this terminology to promote a policy route for transnational health regions. It is suggested that the development of transnational health regions, each with their own medical and supportive service characteristics, could enhance governmental context-controlled decision power in applying sustainable health destination management. PMID:22939046
Mainil, Tomas; Van Loon, Francis; Dinnie, Keith; Botterill, David; Platenkamp, Vincent; Meulemans, Herman
The present study develops and tests a causal model of home healthcare utilization by the Lucas County elderly. Path analysis was employed to evaluate the model on an area probability sample of 400 Ohio elderly. The findings indicate that the predictors of home healthcare are more diverse than was expected with the need factor (need for care, use
Promotion of a healthcare provider's services is essential for communication with its customers and consumers. It is relevant to an organization's marketing strategy and is an element of what is described as the marketing mix. This paper considers the relationship of promotion to the marketing of services and proposes a plan for the promotion of the organization as a whole which can also be applied to an individual service or specialty. Whilst specific reference is made to an National Health Service (NHS) Trust it is also relevant to a Directly Managed Unit. PMID:7952707
Prior to independence in 1991, no formal home healthcare system existed in Lithuania. However, various services were provided in homes, including off-hours urgent care; social and healthcare services for the disabled and elderly through a voluntary organization; and the provision of medications and treatments by polyclinic nursing staffs. After independence, a number of additional home healthcare services
Evaluating healthcare quality is important for consumers, healthcare providers, and society. Developing a measure of healthcare service quality is an important precursor to systems and organizations that value healthcare quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to healthcare settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to healthcare settings. PMID:16318013
Community development efforts in economically depressed rural areas are often hampered by poor access to healthcare. One barrier to rural provider availability is the difficulty of obtaining capital for rural healthcare infrastructure development. Commercial lending institutions are limited in their ability to respond to these needs due to traditional lend- ing criteriaÂ—creditworthiness, equity, experience, management ability, and profits
M. KATHRYN STEWART; J. Wojcik; H. Felix; D. Slayton
The paper analyzes rights-based and economic approaches to the provision of healthcare and education in developing countries. It assesses the foundations and uses of social rights in development, outlines the economic approach to healthcare and education, highlights differences and similarities, and assesses the hard questions that the economic critique poses for rights. The paper argues that the policy
The Vital Issues Process, developed by the Sandia National Laboratories Strategic Technologies Department, was utilized by the HealthCare Task Force Advisory Group to apply structure to their policy deliberations. By convening three expert panels, an overarching goal for the New Mexico healthcare system, seven desired outcomes, nine policy options, and 17 action items were developed for the New Mexico healthcare system. Three broadly stated evaluation criteria were articulated and used to produce relative rankings of the desired outcomes and policy options for preventive care and information systems. Reports summarizing the policy deliberations were submitted for consideration by the HealthCare Task Force, a Joint Interim Committee of the New Mexico Legislature, charged with facilitating the development and implementation of a comprehensive healthcare delivery system for New Mexico. The Task Force reported its findings and recommendations to the Second Session of the 41st New Mexico State Legislature in January 1994.
Engi, D. [Sandia National Labs., Albuquerque, NM (United States); Icerman, L. [Icerman & Associates, Santa Fe, NM (United States)
This paper describes a unique home health aide program developed by the Visiting Nurse Association of Cleveland. The intent of the program was to promote retention of home health aides, increase home health aide self?esteem, improve the quality of care to patients, and increase support to caregivers. The history of service provided by the home health aides program and the
Francine P. Hekelman; Mary E. Segall; May L. Wykle
... Home Kidney Disease A to Z Health Guide HealthCare Team Good healthcare is always a team effort - especially for people ... chronic kidney failure. Since each member of the healthcare staff contributes to your care, it is important ...
The purpose of the research project described in this paper is to improve the efficiency of product development processes by exchanging knowledge and experiences about user centred design methods and technologies between the two branches: vehicle and healthcare industries. The healthcare industry can benefit from visualisation and simulation tools that include computer manikins, a physical representation of the
Mikael Blomé; Maria Jönsson; Daniel Lundström; CARAN AB; Dan Högberg
As the need for high-technology services for the home care patient becomes increasingly more critical, it has become necessary for home healthcare agencies to meet these needs by providing highly specialized nursing services. The benefits of this emerging specialty are numerous, both within the nursing agency and to the community. Nursing specialties can enhance your agency's visibility by increasing
Intensive care has developed as a speciality since the 1950s; during this time there have been major technological advances in healthcare provision leading to a rapid expansion of all areas of critical care. The ongoing problem of recruiting appropriately qualified nurses has affected staffing levels in many units and continues to be a national problem. For many, the answer lies in employing healthcare assistants to support the work of registered nurses. A key aim of the British Association of Critical Care Nurses is to promote the art and science of critical care nursing by providing representation for its members, by responding to political and professional change and by producing and publishing position statements. A primary component of the work surrounding the development of this second position statement was the gathering of contemporary information in relation to the role of healthcare assistants within critical care units throughout the UK, through a survey of 645 critical care units within the UK. At present the impact upon the role of the critical care nurse is not fully understood, with research in this area suggesting that although there is a role for the healthcare assistant in the critical care environment, this should only be undertaken with a full analysis of this impact upon the work of the registered nurse. PMID:12940689
This paper summarizes the findings for the East and South East Asia Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Im-plementation of Community Mental HealthCare. The paper presents a description of the region, an overview of mental health policies, a critical ap-praisal of community mental health services developed, and a discussion of the key obstacles and challenges. The main recommendations address the needs to campaign to reduce stigma, integrate care within the general healthcare system, prioritize target groups, strengthen leadership in policy mak-ing, and devise effective funding and economic incentives.
This paper summarizes the findings for the Latin American and Caribbean countries of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental HealthCare. It presents an overview of the provision of mental health services in the region; describes key experiences in Argentina, Belize, Brazil, Chile, Cuba, Jamaica and Mexico; and discusses the lessons learned in developing community mental healthcare. PMID:23024680
Razzouk, Denise; Gregório, Guilherme; Antunes, Renato; Mari, Jair D E Jesus
As in acute care, use of health information technology in long-term care holds promise for increased efficiency, better accuracy, reduced costs, and improved outcomes. A comprehensive electronic health record (EHR), which encompasses all healthcare measures that clinicians want to use-both standard healthcare assessments and those acquired through emerging technology-is the key to improved, efficient clinical decision making. New technologies using sensors to passively monitor older adults at home are being developed and are commercially available. However, integrating the clinical information systems with passive monitoring data so that clinical decision making is enhanced and patient records are complete is challenging. Researchers at the University of Missouri (MU) are developing a comprehensive EHR to: (a) enhance nursing care coordination at TigerPlace, independent senior housing that helps residents age in place; (b) integrate clinical data and data from new technology; and (c) advance technology and clinical research. PMID:20047248
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This article presents a number of perspectives on the curriculum building processes as well as the methodology and content of a self care training curriculum and Information packet that were prepared and field for the development of a model self care education program for older persons. Course content and topical areas are outlined, and various training agenda and educational materials
Background. Human rights violations are commonly experienced by people in psychiatric and social care institutions. States and private organizations providing such health and social services must comply with international human rights law. Monitoring of such compliance is increasingly recognized as a vital component in ensuring that rights are respected and violations are brought out in the open, remedied and prevented. Aims. The Institutional Treatment, Human Rights and Care Assessment (ITHACA) project produced a method to document violations and good practice with the aim of preventing human rights violations and improving general healthcare practice in psychiatric and social care institutions (www.ithacastudy.eu). Methods. A methodological and implementation study conducted across 15 European countries developed and assessed the ITHACA Toolkit in monitoring visits to 87 mental health organizations. Results. The toolkit is available in 13 European languages and has demonstrated applicability in a range of contexts and conditions. The information gathered through monitoring visits can document both good practice and areas for improvement. Conclusions. The ITHACA Toolkit is an acceptable and feasible method for the systematic monitoring of human rights and general healthcare in psychiatric and social care institutions that explicitly calls for the participation of service users in the monitoring of human rights violations and general healthcare practice. PMID:23046729
Your Annual HealthCare Visit Home About ACOG ACOG Departments & Activities Annual Women's HealthCare Your Annual HealthCare Visit Page Navigation ? ... about your annual healthcare exam Your Annual HealthCare Visit Having an annual healthcare visit is ...
The HealthCare Empowerment Model offers direction for the investigation of patient-controlled engagement and involvement in healthcare. At the core of the model is the construct of HealthCare Empowerment (HCE), for which there exist no validated measures. A set of 27 candidate self-report survey items was constructed to capture five hypothesized inter-related facets of HCE (informed, engaged, committed, collaborative, and tolerant of uncertainty). The full item set was administered to 644 HIV-infected persons enrolled in three ongoing research studies. Exploratory and confirmatory factor analyses resulted in a two factor solution comprising four items each on two subscales: (1) HCE: Informed, Committed, Collaborative, and Engaged HCE ICCE) and (2) HCE Tolerance of Uncertainty (HCE TU). Subscale scores were evaluated for relationships with relevant constructs measured in the three studies, including depression, provider relationships, medication adherence, and HIV-1 viral load. Findings suggest the utility of this 8-item HealthCare Empowerment Inventory (HCEI) in efforts to measure, understand, and track changes in the ways in which individuals engage in healthcare.
Johnson, Mallory O.; Rose, Carol Dawson; Dilworth, Samantha E.; Neilands, Torsten B.
The Java Card specification extends Java technology into smart cards. The FISC (Financial Information Service Co., Ltd.) IC card specification is the only financial smart card standard in Taiwan. In the Peng-Hu HealthCare IC Card Project, we adopted FISC-compatible IC cards. In this paper, we describe an approach to develop a FISC-compatible application, based on the healthcare file
A rural healthcare demonstration project attempted to develop various types of family practices to serve as models for increasing the availability of primary healthcare in rural areas. The hypothesis was that family nurse practitioners could be employed...
Over recent decades tremendous progress has been made in diagnosing and treating haemophilia and, in resource-rich countries, life expectancy of people with haemophilia (PWH) is now close to that of a healthy person. However, an estimated 70% of PWH are not diagnosed or are undertreated; the majority of whom live in countries with developinghealthcare systems. In these countries, designated registries for people with haemophilia are often limited and comprehensive information on the natural history of the disease and treatment outcomes is lacking. Taken together, this means that planning efforts for future treatment and care of affected individuals is constrained in countries where it is most needed. Establishment of standardized national registries in these countries would be a step towards obtaining reliable sociodemographic and clinical data for an entire country. A series of consensus meetings with experts from widely differing countries with different healthcare systems took place to discuss concerns specific to countries with developinghealthcare systems. As a result of these discussions, recommendations are made on parameters to include when establishing and harmonizing national registries. Such recommendations should enable countries with developinghealthcare systems to establish standardized national haemophilia registries. Although not a primary objective, the recommendations should also help standardized data collation on an international level, enabling treatment and healthcare trends to be monitored across groups of countries and providing data for advocacy purposes. Greater standardization of data collation should have implications for optimizing resources for haemophilia care both nationally and internationally. PMID:23590670
Alzoebie, A; Belhani, M; Eshghi, P; Kupesiz, A O; Ozelo, M; Pompa, M T; Potgieter, J; Smith, M
The National HealthCare Survey (NHCS) encompasses a family of healthcare provider surveys, including information about the facilities that supply healthcare, the services rendered, and the characteristics of the patients served.
|Purpose--The purpose of this paper is to investigate the dramatic reforms in the health service in recent years. Design/methodology/approach--Examines management development in healthcare, and explores the experiences of clinical nurse managers. Findings--Duplication of agencies and multiplication of roles have led to tensions in terms of both…
Changes in the size and composition of the older population will have profound effects on future healthcare expenditures\\u000a in developed nations. With the baby boom cohorts joining the ranks of the elderly after 2010, the absolute amount of health\\u000a care spending on elderly will increase greatly. The increasing expenditures raise concerns about the effectiveness of such\\u000a spending and the
Objective To describe the development and psychometric testing of the Multidimensional Trust in HealthCare Systems Scale (MTHCSS). Methods Scale development occurred in 2 phases. In phase 1, a pilot instrument with 70 items was generated from the review of the trust literature, focus groups, and expert opinion. The 70 items were pilot tested in a sample of 256 students. Exploratory factor analysis was used to derive an orthogonal set of correlated factors. In phase 2, the final scale was administered to 301 primary care patients to assess reliability and validity. Phase 2 participants also completed validated measures of patient-centered care, health locus of control, medication nonadherence, social support, and patient satisfaction. Results In phase 1, a 17-item scale (MTHCSS) was developed with 10 items measuring trust in healthcare providers, 4 items measuring trust in healthcare payers, and 3 items measuring trust in healthcare institutions. In phase 2, the 17-item MTHCSS had a mean score of 63.0 (SD 8.8); the provider subscale had a mean of 40.0 (SD 6.2); the payers subscale had a mean of 12.8 (SD 3.0); and the institutions subscale had a mean of 10.3 (SD 2.1). Cronbach’s ? for the MTHCSS was 0.89 and 0.92, 0.74, and 0.64 for the 3 subscales. The MTHCSS was significantly correlated with patient-centered care (r?=?.22 to .62), locus of control—chance (r?=?.42), medication nonadherence (r?=??.22), social support (r?=?.25), and patient satisfaction (r?=?.67). Conclusions The MTHCSS is a valid and reliable instrument for measuring the 3 objects of trust in healthcare and is correlated with patient-level health outcomes.
Research on health-seeking behaviour in developing countries is of both theoretical and practical relevance. It analyzes concepts of origin and management of illness, provides insights into people's use or non-use of traditional and\\/or modern health services available and finally it contributes to reveal perceptions regarding healthcare in particular settings. The paper first describes briefly the methodologies commonly used for
Ensuring the safe transition of patients from hospitals to skilled nursing facilities and from skilled nursing facilities back to the hospital or the community can present significant challenges. The University of Michigan Health System was able to overcome many of these challenges through the implementation of a health system associated Subacute Care Service that consists of the University of Michigan Health System geriatricians and nurse practitioners working in privately operated skilled nursing facilities in our primary market area. We describe the planning process surrounding the development of the Subacute Care Service and report on efforts to date. PMID:22748721
Joshi, Darius K; Bluhm, Rick A; Malani, Preeti N; Fetyko, Steve; Denton, Tony; Blaum, Caroline S
Emotionality truly shapes critical thinking in the development of American health policy. President Obama has misgauged the\\u000a emotions and thoughts of the Nation and Congress about the healthcare reform bill. Most Americans don’t approve of the design\\u000a or impetus of healthcare legislation under the Obama administration. The enacted legislation provides healthcare insurance\\u000a for all Americans. However, health
Paul J. Flaer; Mustafa Z. Younis; Muhammed Alotaibi; Maha Al Hajeri
The role of technology in the cost of healthcare is a primary issue in current debates concerning national healthcare reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in healthcare technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of healthcare technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in healthcare. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.
Preceptorship and mentorship programs are used in the healthcare sector to educate nurses, enhance their leadership skills, and improve their quality of work life. Recognizing the importance of these initiatives, Saint Elizabeth HealthCare sought funding to create an innovative model of preceptorship/mentorship that meets the unique needs of home healthcare nurses. The methods utilized included focus groups, key informant interviews, and a workflow analysis. Factors that influence preceptorship such as nursing workload, preceptor training and remuneration were examined to develop a new model that offers career enhancement and leadership opportunities for preceptors and mentors, and promotes a welcoming environment for preceptees. Reward and recognition programs were created for preceptors to acknowledge their leadership contribution at the front line. This study demonstrates how evidence and innovation were used to create a preceptorship/mentorship model to develop community nursing leaders of the future. PMID:18444063
The historical development of the use of diphosphonates in detergents is presented as well as physical chemistry, physiological response, toxicology, and human clinical trials with these compounds. (BB)
|The historical development of the use of diphosphonates in detergents is presented as well as physical chemistry, physiological response, toxicology, and human clinical trials with these compounds. (BB)|
In collaboration with a broad range of stakeholders, the Canadian Institute for Health Information (CIHI) led the development of the draft pan-Canadian primary healthcare (PHC) electronic medical record (EMR) content standard to be used in EMR applications across the country to support PHC data capture and information use and improved health system management. To achieve this goal, CIHI initiated the following activities: stakeholder engagement, information requirements gathering and adoption and implementation promotion of the common content standard for wide-spread use. The resulting pan-Canadian standardized data set will allow consistent data capture that will improve understanding and ability to report on PHC utilization and access, chronic disease prevention and management, health promotion, medication usage, patient safety, quality of care including patient safety and outcomes. The standard will improve patient care information by providing the structured comparable information needed to care for patients over time and across the continuum of care. Standards support clinical practice reminders and alerts, improvements in operating efficiencies, onscreen feedback reports to PHC providers and the ability to look at clinical trends over time. This standard will improve the flow of information by providing standardized information to providers at points on the continuum of care leading to better coordination of care and a reduction of repeat tests. Lastly, a common content standard will improve the health system use of data; by enabling aggregation and analysis of comparable standardized health information, clinicians, jurisdictions, and regions can benefit from using this data for more effective planning and policy decisions. The jurisdictions and clinicians, supported by CIHI and Canada Health Infoway will continue to work together with other key stakeholders, such as vendors to support the adoption and implementation of this standard into future jurisdictional EMR vendor specifications. PMID:21335741
Primary healthcare (PHC) plays a pivotal role in health system reform locally and globally. The use of well functioning interprofessional primary healthcare (IPHC) teams is recognized as a key strategy in widespread health system reform across global, national, and provincial jurisdictions. IPHC teams contribute to the improve- ment of the health and well being of the population. These
After numerous teething problems (1974-1994), the Department of Nursing Education of WITS University took responsibility for the Muldersdrift Health and Development Programme (MHDP). The nursing science students explored and implemented an empowerment approach to community participation. The students worked with MHDP health workers to improve health through community participation, in combination with primary healthcare (PHC) activities and the involvement of a variety of community groups. As the PHC projects evolved over time, the need arose to evaluate the level of community participation and how much community ownership was present over decision-making and resources. This led to the question "What was the level of community participation in PHC projects of the MHDP?" Based on the question the following objectives were set, i.e. (i) to evaluate the community participation in PHC initiatives; (ii) to provide the project partners with motivational affirmation on the level of community participation criteria thus far achieved; (iii) to indicate to participants the mechanisms that should still be implemented if they wanted to advance to higher levels of community participation; (iv) to evaluate the MHDP's implementation of a people-centred approach to community participation in PHC; and (v) the evaluation of the level of community participation in PHC projects in the MHDP. An evaluative, descriptive, contextual and quantitative research design was used. Ethical standards were adhered to throughout the study. The MHDP had a study population of twenty-three (N=23) PHC projects. A purposive sample of seven PHC initiatives was chosen according to specific selection criteria and evaluated according to the "Criteria to evaluate community participation in PHC projects" instrument (a quantitative tool). Structured group interviews were done with PHC projects' executive committee members. The Joint Management Committee's data was collected through mailed self-administered questionnaires. Validity and reliability were ensured according to strict criteria. Thereafter results were analysed and plotted on a radiating arm continuum. The following factors had component scores: organization, leadership, resources, management; needs and skills. A spider graph was produced after each factor's continuum was connected in a spoke figuration that brought them together at the base where participation was at its most narrow. The results are presented and a graph and discussion is provided on each of the PHC projects. The research results indicated that although community participation was broadened, there was minimal success in forcing a shift in power over decision-making and resources. This demonstrated that power over planning and resources should remain in the hands of the partners if community participation was to remain progressive and sustained. Results furthermore indicated that the people-centred approach to With regard to the Joint Management Committee's evaluation of community participation, it was concluded that power over decision-making and resources remained with health professionals rather than with the community, and that a people-centred approach had not been adopted. PMID:17703821
Preceptorship and mentorship programs are used in the healthcare sector to educate nurses, enhance their leadership skills, and improve their quality of work life. Recognizing the importance of these initiatives, Saint Elizabeth HealthCare sought funding to create an innovative model of preceptorship\\/mentorship that meets the unique needs of home healthcare nurses. The methods utilized included focus groups,
Several countries are increasingly relying on immigration as a means of coping with domestic shortages of healthcare professionals. This trend has led to concerns that in many of the source countries – especially within Africa – the outflow of healthcare professionals is adversely affecting the healthcare system. This paper examines the role of wages in the migration
Marko Vujicic; Pascal Zurn; Khassoum Diallo; Orvill Adams; Mario R Dal Poz
BACKGROUND: General practitioners and other primary healthcare professionals are often the first point of contact for patients requiring healthcare. Identifying, understanding and linking current evidence to best practice can be challenging and requires at least a basic understanding of research principles and methodologies. However, not all primary healthcare professionals are trained in research or have research experience.
The success of graduates with a doctor of nursing practice (DNP) degree in transforming healthcare will depend significantly on their leadership ability to think strategically, innovate, and engage stakeholders in meaningful system improvement. Known as adaptive work, these graduates will need a portfolio of adaptive leadership skills that prepare them to move healthcare from a volume-driven to value-based system. This article describes development of a core DNP leadership course in a postmaster's point of entry DNP program at an academic health science center school of nursing. The course, designed as DNP students' initial step on their professional development journey to becoming adaptive leaders capable of driving transformative change, created an alternative lens for students to undertake strategic adaptive change initiatives within themselves and their organizations. PMID:24075257
Objective To examine the effects of involving patients in the planning and development of healthcare. Data sources Published and grey literature. Study selection Systematic search for worldwide reports written in English between January 1966 and October 2000. Data extraction Qualitative review of papers describing the effects of involving patients in the planning and development of healthcare. Results Of 42 papers identified, 31 (74%) were case studies. Papers often described changes to services that were attributed to involving patients, including attempts to make services more accessible and producing information leaflets for patients. Changes in the attitudes of organisations to involving patients and positive responses from patients who took part in initiatives were also reported. Conclusions Evidence supports the notion that involving patients has contributed to changes in the provision of services across a range of different settings. An evidence base for the effects on use of services, quality of care, satisfaction, or health of patients does not exist. What is already known on this topicInvolving patients in planning and delivering health services is recommended as a means of improving the quality of servicesMethods for engaging with patients have been considered in depth, but the effects of involving patients are less clearWhat this study addsFew studies have explored the effects of involving patientsInvolving patients has contributed to changes in service provision, but the effects of these on quality of care have not been reported
Crawford, Mike J; Rutter, Deborah; Manley, Catherine; Weaver, Timothy; Bhui, Kamaldeep; Fulop, Naomi; Tyrer, Peter
Over the past 20years healthcare reform has influenced the development of advanced level practitioner roles and expectations. How advanced level practitioners work to survive the highly stimulating, yet sometimes overwhelming aspects of balancing high quality provision with political reform agendas, amidst economic constraint is considered. Transformational approaches (encompassing education and practice led service development) can provide, promote and 'provoke' a harnessing of complex issues workplace environment to produce creative solutions. Transformational Practice Development provides a structured, rigorous, systematic approach that practitioners, teams and healthcare consumers alike can utilise to achieve skills and attributes needed for successful innovation. The authors present case study materials from action orientated locally delivered Practice Development, as a complex strategic intervention approach to influence and promote advanced level practice expertise. Initiated through facilitation of transformational leadership, and resultant team based improvements, we present how strategic collaborative processes can harness work chaos and complexity to provide sustainable and productive workplace cultures of effectiveness. PMID:23453607
Hardy, Sally; Jackson, Carrie; Webster, Jonathan; Manley, Kim
The effectiveness of Israel's healthcare system is hindered by pluralism, in terms both of its many separate health service institutions and of the particularism of those institutions. Although the healthcare system provides modern healthcare to a widely insured population, it does so inefficiently and at unnecessary expense. The lack of vertical and horizontal integration of the healthcare system has led to problems of fragmentation, duplication, and lack of coordination of services. Because of its limited resources, Israel must work to surmount this pluralism and achieve integrated planning if it is to succeed in providing the efficient and cost-effective care its population needs. PMID:6219948
Compares the American healthcare system with those of England and Sweden; presents evidence to support view that cultural factors influence healthcare significantly. Healthcare systems in small countries with homogenous populations tend to accept cultural factors, but do so with less ease in countries with heterogenous populations and…
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Jews first came to Bosnia and Herzegovina in the 16th century after having been exiled from Spain. They were successful in several trades in their new surroundings. Many Jewish families gave more than one doctor or pharmacist. Dr Goldberger and his son Dr Aleksandar Goldberger were skilled surgeons; Dr Isak Samokovlija's daughter Rikica was a paediatrician and a university professor; Dr Sigmund Kaunitz and his sons Oskar and Pavle, conducted the autopsy on the Archduke Franz Ferdinand, heir to the imperial throne, and his wife Sophie. Jews have traditionally regarded health culture as an important issue; their religion includes medical and other precepts for healthy living, from personal and household hygiene to ritual ablutions and bathing. They were the first to make medicinal preparations and to sell them in their shops, known as attar shops. The Museum of Sarajevo now treasures the inventory of one such centuries-old attar shop, belonging to the Papo family. Thanks to their medical skills, Jews even treated the Pashas of Bosnia and Herzegovina. Dr Nisim zak treated Sijavos Pasha, and Dr Isak Salom was Omer Pasha Latas's physician. Bosnia and Herzegovina owes a lot to the knowledge and dedication of health-care workers of the Jewish origin. Sarajevo, Mostar, Zenica, Foca, and Trebinje have named streets after these humanists, who founded many institutions, and started new disciplines to address the burning health issues in B&H, and a number of whom laid down their lives to defend B&H. PMID:20136340
Omanic, Ajnija; Dodig-Karaman, Zana; Serdarevic, Mevlida; Kabiljo, Mario
Lung cancer, COPD and cardiovascular diseases are highlighted as some of the most common disease that cause mortality, and for that reason are the most active areas for drug development. This perspective paper overviews the urgent need to develop a healthcare system for a rapidly growing patient population in Japan, including forthcoming demands on clinical care, expecting outcomes, and economics. There is an increasing requirement to build on the strengths of the current healthcare system, thereby delivering urgent solutions for the future. There is also a declaration from the Ministry of Health, Labour and Welfare (MHLW), to develop new biomarker diagnostics, which is intended for patient stratification, aiding in diagnostic phenotype selection for responders to drug treatment of Japanese patients. This perspective was written by the panel in order to introduce novel technologies and diagnostic capabilities with successful implementation. The next generation of personalized drugs for targeted and stratified patient treatment will soon be available in major disease areas such as, lifestyle-related cancers, especially lung cancers with the highest mortality including a predisposing disorder chronic obstructive pulmonary disease, cardiovascular disease, and other diseases. Mass spectrometric technologies can provide the "phenotypic fingerprint" required for the concept of Personalized Medicine. Mass spectrometry-driven target biomarker diagnoses in combination with high resolution computed tomography can provide a critical pathway initiative facilitated by a fully integrated e-Health infrastructure system. We strongly recommend integrating validated biomarkers based on clinical proteomics, medical imaging with clinical care supported by e-Health model to support personalized treatment paradigms to reduce mortality and healthcare costs of chronic and co-morbid diseases in the elderly population of Japan. PMID:21184850
This study describes the process undertaken by a private healthcare network to develop and implement an outreach program for rural level III to V trauma centers. The program provided individualized trauma program support to 18 rural out-of-network facilities. A case study and participant satisfaction survey demonstrate the experiences of rural trauma nurse coordinators working with the program. The Trauma Outreach Program presents a solution to enhance the effectiveness of regional trauma systems, lift the burden on rural facilities, and improve care for the injured patient. PMID:23722222
Soychak, Amanda; Coniglio, Ray; Caputo, Lisa M; Bourg, Pamela W; Salottolo, Kristin M; Mains, Charles W; Wallace, Robert
With input and recommendations from physicians, healthcare professionals, and parents, this book for parents, grandparents, and child caregivers provides numerous interesting facts, pages of useful information, and listings of resources to guide and inform anyone who cares for children. Section 1, on child healthcare, provides a brief history of…
|With input and recommendations from physicians, healthcare professionals, and parents, this book for parents, grandparents, and child caregivers provides numerous interesting facts, pages of useful information, and listings of resources to guide and inform anyone who cares for children. Section 1, on child healthcare, provides a brief history…
Introduction In Sweden, quality indicators in healthcare have been the basis for developing National Quality Registers. The Swedish National Diabetes Register (NDR) - one of the largest diabetes registers globally - was introduced in primary healthcare (PHC) in the county of Östergötland by an implementation project, 2002-2005. Aim The aim of the present paper was to investigate, by using the results of the NDR, whether the registration led to sustained outcomes of medical results of diabetes care in PHC in the county during the period 2005-2009. Method HbA1c, blood pressure (BP), albuminuria and low-density lipoprotein-cholesterol were registered online in the NDR. In 2005 and 2006, goal achievement for HbA1c was measured and compared between PHC centres (PHCC) within the county. In 2007, achievements to national goals were compared between the PHCCs within the county and with those Swedish counties that had attained a sufficiently high registration rate. In 2008 and 2009, the average county results were compared with the corresponding national average measurements for all 21 Swedish counties combined. Result In 2005, a clear improvement trend for HbA1c and BP was shown within the county. In 2007-2009, goal achievements in the county studied were slightly better than the other counties measured and the country as a whole in almost every comparison. Discussion The present study has shown association between medical results and registration in the NDR. As the project was primarily a quality improvement work, the results have continuously influenced the development of diabetes care. Both the health professions and the county council now have - in the NDR - an effective and rapid method for evaluation and follow-up of diabetes care. The systematic documentation, followed by comparisons and analyses, create ideas for care improvements. PMID:23237011
Hallgren Elfgren, Ing-Marie; Grodzinsky, Ewa; Törnvall, Eva
Basic ingredients in healthcare planning and quality care are addressed. Proper planning can assure that adequate manpower facilities are available to insure proper patient care. Thus, one of the most basic ingredients in quality healthcare is continual...
Strategies were developed to maximize the resources of local government to improve primary healthcare services, either by increasing access to primary care services or by positively influencing local healthcare policy. The strategy feasibility study ass...
We examine mortality at ages 50 and above in female populations of 38 countries and control for variation in quality of the\\u000a mortality data. We find that economic development, economic distributional inequality, and basic primary healthcare have\\u000a independent cross-national effects on cause of death structures and that these effects are not uniform across the age intervals\\u000a of interest. As
Norman L. Weatherby; Charles B. Nam; Larry W. Isaac
Increasing cost of healthcare in developing countries is placing heavy financial burden on its populations. With the advent of mobile and tablet technologies however, it is possible to reduce this burden to some extent through tele-healthcare. In this paper, authors describe their effort to design portable diagnostic devices that can communicate to smart phones and tablets there by making tele-healthcare possible. A possible architecture of their model is presented and components thereof discussed. PMID:24110769
Vaidya, Avinash S; Srinivas, M B; Himabindu, P; Jumaxanova, Daria
A hospital-based Continuity of Care program for children with special healthcare 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 healthcare needs. PMID:22575784
Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten
BackgroundOncology nurses should possess a high level of sensitivity while dealing with patients’ sexual health needs. However, sexual healthcare is still inadequately addressed because of barriers such as conservative beliefs and incorrect assumptions regarding sexual issues. Most scales for measuring attitude toward sexual healthcare were insufficient to establish the instrument's validity and did not focus on oncology nurses.
Healthcare workers in developing countries continue to lack access to basic, practical information to enable them to deliver safe, effective care. This paper provides the first phase of a broader literature review of the information and learning needs of healthcare providers in developing countries. A Medline search revealed 1762 papers, of which 149 were identified as potentially relevant to the review. Thirty-five of these were found to be highly relevant. Eight of the 35 studies looked at information needs as perceived by health workers, patients and family/community members; 14 studies assessed the knowledge of health workers; and 8 looked at healthcare practice. The studies suggest a gross lack of knowledge about the basics on how to diagnose and manage common diseases, going right across the health workforce and often associated with suboptimal, ineffective and dangerous healthcare practices. If this level of knowledge and practice is representative, as it appears to be, it indicates that modern medicine, even at a basic level, has largely failed the majority of the world's population. The information and learning needs of family caregivers and primary and district health workers have been ignored for too long. Improving the availability and use of relevant, reliable healthcare information has enormous potential to radically improve healthcare worldwide.
During the last decade there has been considerable international mobilisation around shrinking the role of States in healthcare. The World Bank reports that, in many low and middle-income countries, private sources of finance comprise the largest share of total national health expenditures. Private sector healthcare is ubiquitous, reaches throughout the population, preferred by the people and is significant
Increasing attention has been given to the identification and description of variables associated with health and social services needed, sought and used by the elderly. Little is known, however, about the home healthcare needs of the elderly. Moreover, since the inception of the diagnostic related group concept, no one has determined the elderly's perception of Home HealthCare. The
The article presents various perspectives of drug technology and healthcare policy in Denmark. Drugs dominate as the most widely used treatment technology in the healthcare system and the use of drugs is steadily increasing. The pharmaceutical industry's development of drugs is based on an economic estimate of developments, expenditures, marketing costs and the anticipated share of the market. Controlled clinical trials have become the main form of documentation required by the health authorities. This method is insufficient to evaluate the (side) effects of the drugs when in actual use. Drugs fit perfectly the technical perception of disease, a perception which prevails in the pharmaceutical industry, medical science and in the treatment of disease. This perception believes that a disease is due to an attack or dysfunction in the biological-mechanical conditions of the individual. Drugs offer a standard solution to health problems independent of the individuals' social life. Thus drugs become a tool which function in agreement with the disintegrated and achievement-orientated approach to disease as it is organized today. In general the statements in this article are not limited to special Danish circumstances but are valid for other countries as well [1, 2]. (Norris R. Pills, Pesticides & Profits. North River Press, 1982; Braithwaite J. Corporate Crime in the Pharmaceutical Industry. Routledge & Kegan Paul, London, 1984) The empirical data in this article derive from Denmark, however. PMID:3303354
A discussion of the role of academic health centers in healthcare reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…
Background: A growing population of adolescents with special healthcare needs is aging into adulthood. These emerging adults face the transition challenges of their healthy peers but also potentially heightened risks and challenges related to their conditions. We describe the process of developing a pilot program to support healthcare services for emerging adults with chronic conditions and present preliminary data on utilization. Results: An outpatient multidisciplinary consult model was developed based on patient, family and physician feedback. Patients with diverse conditions were equally referred from primary care, subspecialists and families and community agencies. Services provided included needs assessments (100%), referral to adult physicians (77%), care coordination (52%) and referrals to adult community services (10%). Clinical billing did not fully support the cost of providing services. Conclusion: The pilot program offered multidisciplinary transition services that were utilized by a diverse patient population. Local and national resources for healthcare transition are provided. PMID:23641448
Objective To describe the development and psychometric testing of the Multidimensional Trust in HealthCare Systems Scale (MTHCSS).\\u000a \\u000a \\u000a \\u000a Methods Scale development occurred in 2 phases. In phase 1, a pilot instrument with 70 items was generated from the review of the\\u000a trust literature, focus groups, and expert opinion. The 70 items were pilot tested in a sample of 256 students. Exploratory\\u000a factor
Travel health tips ... LEAVING Planning ahead of time can make your travels smoother and help you avoid problems. Ask your ... to your healthcare provider or visit a travel clinic 4 - 6 weeks before you leave for ...
The adoption of the law "About foundations of population healthcare in the Russian Federation" in absence of concept of healthcaredevelopment determining the major targets and tasks of the sector gives rise in citizen incomprehension and rejection of innovations of health policy. To determine the vector of development of Russian healthcare as compared with Soviet system of healthcare the analysis of particular positions of the Federal law "On foundations of population healthcare" (2011) and the USSR law "On approval of foundations of legislation of USSR and Union republics on healthcare" (1969) is made. PMID:23634600
... HealthCare for College Students Ages & Stages Listen HealthCare for College Students Article Body I'll be ... student health service before starting an exercise program. Healthcare on campus If you are going to live ...
Evidence-based genetics healthcare is the conscientious use of current best evidence in decision-making at the clinical,\\u000a administrative and policy-making levels. As knowledge generated from genomics research is integrated into medical care, the\\u000a needs for appropriate evidence become more complex. The challenges to evidence-based care include: a lack of policy-relevant\\u000a evidence in the domains of basic, clinical and health services
Supporting and enhancing clinical learning for pre registration nursing students continues to be a challenge for nurse educators. The drive of recent and contemporary nurse education policy in the United Kingdom (UK) has re-emphasised the need for nurse educators to be instrumental in the support and development of clinical learning [United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), 1999. Fitness for Practice (The Peach Report). UKCC, London; Department of Health, 1999. Making a Difference. Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare, DOH, HMSO]. This paper presents a preliminary study of an action research project, identifying how nurse educators can facilitate new ways of learning in practice. Predominantly, a first person inquiry approach is adopted, supplemented by qualitative approaches, reflecting the journey of the author in relation to her role as nurse educator in practice. This was enriched by engaging with students and mentors from the author's clinical link area, who had participated in a new initiative to develop small tutorial groups designed for students undertaking their primary healthcare placement, within year two of a Fitness for Practice programme within the UK. Students' and mentors' experiences and stories, were appraised using qualitative and self-reflexive techniques. The role of the nurse educator in clinical practice is demonstrated, as is the importance of successful collaboration between educators and practitioners to establish high quality learning environments for students. PMID:17689420
Current written text-based health-care instructions are not suitable for presenting lengthy, complex breast health-care instructions and are difficult for immigrant women with limited literacy skills. The aims of this study were to develop breast health-care instructions enhanced by pictographs (simple line drawings representing health-care actions) and pilot test the instructions in a sample of six immigrant women with limited literacy skills. Based on the Mayer's Cognitive Theory of Multimedia Learning, pictographs were developed in addition to low-literacy text. The text and the pictographs were then pilot tested with six immigrant women in community health centres for clarity, comprehension and acceptability through face-to-face interviews. Participants perceived that the drawings were engaging and enhanced clarity of the intended health-care messages. The black and white simple line drawings were well received by participants of varying race and ethnicity. The pictograph-based approach might be an effective tool in developinghealth-care instructions for immigrant women with limited literacy skills. Future research is needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes. PMID:22845637
Although the overwhelming majority of Americans claim they are satisfied with the quality of healthcare they as individuals receive, many nevertheless believe the U.S. healthcare industry suffers from major problems. Reining in the growing costs of heal...
New Zealand has an increasingly di- verse community containing many cultures, each with a unique worldview that shapes the collective identity and individual behaviours. This worldview may differ signifi- cantly from that of the prevailing Pakeha culture. The New Zealand healthcare system is grounded in the prevailing Western culture. The lack of cultural understanding between the prevailing* healthcare
Principles of Lean management are being adopted more widely in healthcare as a way of improving quality and safety while controlling costs. The authors, who are chief executive officers of rural North Carolina hospitals, explain how their organizations are using Lean principles to improve quality and safety of healthcare delivery. PMID:23802475
Objective Healthcare access is associated with improved control of multiple chronic diseases, but the association between healthcare access and weight change is unclear. This study aims to test the association between healthcare access and weight change. Design The Coronary Artery Risk Development in Young Adults (CARDIA) study is a multi-center population-based prospective study. Weight change was calculated at 3 and 13 years after CARDIA year 7 (1992–1993). Healthcare access was defined as no barriers or one or more barriers to access (health insurance gap, no usual source of care, not seeking care due to expense). Intermediary variables evaluated included history of dieting, and use of diet pills, meal replacements, or weight control programs. Setting Four cities in the United States. Subjects Participants were aged 18–30 years at baseline (1985–1986). Analyses include 3922 black and white men and women with relevant data from CARDIA years 7, 10, and 20 (1992–1993, 1995–1996, and 2005–2006, respectively). Results Mean weight change was +4.9 pounds by 3 years and +18.7 pounds by 13 years, with no differences by healthcare access. Being on a weight-reducing diet was not consistently associated with healthcare access across examinations. Use of diet pills, meal replacements or organized weight control programs was low, and did not vary by healthcare access. Conclusions Weight gain was high irrespective of healthcare access. Public health and clinical approaches are needed to address weight gain.
Tang, Joyce W.; Allen, Norrina; de Chavez, Peter; Goff, David C.; Kiefe, Catarina I.; Lewis, Cora E.; Carnethon, Mercedes
BACKGROUND: The concepts of health promotion, self-care and community participation emerged during 1970s, primarily out of concerns about the limitation of professional health system. Since then there have been rapid growth in these areas in the developed world, and there is evidence of effectiveness of such interventions. These areas are still in infancy in the developing countries. There is a
This paper analyzes contemporary rights-based and economic approaches to healthcare and education in developing countries. The paper assesses the foundations and uses of social rights in development; outlines an economic approach to improving health and education service provision; and highlights differences, similarities, and the hard questions…
Since the start of the new century, development aid targeted on healthcare has seen an unprecedented rise, driven by the fight against AIDS. This article shows how this struggle has been accompanied with a renewal of the economic paradigms governing international action in favour of healthcare in developing countries: the idea that an improvement in healthcare constitutes an unavoidable prerequisite to macroeconomic growth, rather than a consequence; the insistence on the founding of mechanisms for health insurance to finance the costs of healthcare, rather than covering the costs at the point of use by the healthcare users; a concern to impose price differentials for access to medicine in developing countries, and to introduce flexibility in the regulation of international intellectual property law; the priority to vertical programmes targeted on certain illnesses, thought to act as levers for a global reinforcement of healthcare systems. This article discusses the pertinence of these new paradigms in light of the evolution of the AIDS/HIV epidemic, and the international context. PMID:19027697
This paper considers ways to help children with special health needs by utilizing the Individualized Education Program (IEP) and the Individualized HealthCare Plan (IHCP). Results of a study which found a lack of necessary health information in school documents is summarized. The school nurse is seen as a pivotal person in the identification and…
In Alabama's Black Belt counties, two organizations collaborate to recruit and prepare rural minority and disadvantaged students for healthcare careers. Premedical students and other college students in the programs shadow health professionals, visit medical schools, complete health projects, participate in summer seminars and tutorials, receive…
Rackley, Benjamin P.; Wheat, John R.; Moore, Cynthia E.; Garner, Robert G.; Harrell, Barbara W.
|This paper considers ways to help children with special health needs by utilizing the Individualized Education Program (IEP) and the Individualized HealthCare Plan (IHCP). Results of a study which found a lack of necessary health information in school documents is summarized. The school nurse is seen as a pivotal person in the identification and…
There is nothing new about supervision in primary healthcare service delivery. Supervision was even conducted by the Egyptian pyramid builders. Those supervising have often favoured ridicule and discipline to push individuals and communities to perform their duties. A traditional form of supervision, based on a top-down colonial model, was originally attempted as a tool to improve health service staff performance. This has recently been replaced by a more liberal "supportive supervision". While it is undoubtedly an improvement on the traditional model, we believe that even this version will not succeed to any great extent until there is a better understanding of the human interactions involved in supervision. Tremendous cultural differences exist over the globe regarding the acceptability of this form of management. While it is clear that health services in many countries have benefited from supervision of one sort or another, it is equally clear that in some countries, supervision is not carried out, or when carried out, is done inadequately. In some countries it may be culturally inappropriate, and may even be impossible to carry out supervision at all. We examine this issue with particular reference to immunization and other primary healthcare services in developing countries. Supported by field observations in Papua New Guinea, we conclude that supervision and its failure should be understood in a social and cultural context, being a far more complex activity than has so far been acknowledged. Social science-based research is needed to enable a third generation of culture-sensitive ideas to be developed that will improve staff performance in the field. PMID:18690946
Clements, C John; Streefland, Pieter H; Malau, Clement
|Shadows is an individualized, hands-on, real-world career experience that provides students with a structured look at the future world of work in healthcare. The program helps students build a bridge between school-based learning and established healthcare skills standards. Shadows focuses on expanding the student's horizons beyond the…
Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Bureau of Primary Health Care.
The following paper sets out to examine three issues: primary healthcare, chiropractic care, and the challenges to both in the next decade. The current crisis of primary health within the healthcare system provides chiropractic with an opportunity to choose between functioning as primary care or primary contact care. Chiropractic has seldom met its potential, or its own rhetoric, with regard to holistic healthcare which would make the case for being primary healthcare much stronger. There have been numerous social and political factors that have influenced this but part of the problem is that chiropractic has failed to clearly articulate itself as primary healthcare, and in some instances, has denied that it was. New opportunities and challenges will force chiropractors to resolve the issue of whether chiropractic is a general model of healthcare, or a form of health specialty (the neuromusculoskeletal practitioner verses the primary health practitioner).
A retrospective study of Afghanistan National Army casualty rates for a 1-year period was completed to assist in healthcare system assessment and further development during a period of rapid force expansion. Battle and disease nonbattle injuries by Corps area were determined from data on soldier visits from all military healthcare facilities. The number of fielded forces in each Corps was used to calculate the populations at risk. Total manpower losses from all casualties were tabulated. The 15,336 casualties (175 per thousand fielded soldiers) resulted in the loss of 146,986 duty days (average 9.5 days per casualty). Battle casualties were 739 (8.4 per 1,000) and nonbattle casualties were 14,597(166 per 1,000) with 72% secondary to infectious diseases. Casualty rates from both battle and disease nonbattle injuries were high, but casualty rates were particularly high from infectious diseases. Rapid force expansion in developing countries requires early consideration for resourcing and implementation of preventive medicine programs. PMID:21305967
Zahoor, Sayed H; Ubiera, Juan I; Davis, Gary D; Anderson, Joseph B; Welch, Richard R; Lowe, Daniel K
The Broad Acres clinic is one of 1,500 school-based health centers nationwide that bring a wide range of medical, nutritional, and mental-healthcare to millions of students and their families. The centers provide an important safety net for children and adolescents--particularly the more than 10 million today who lack health insurance, according…
This paper describes the results of a survey of healthcare attitudes of a sample of respondents primarily of Asian American background. The importance of bilingualism, Asian background, age, and other attributes of a physician are discussed with relation to subgroups in the sample. The relative importance of the influence of doctors, family, and friends on the choice of physician and healthcare facility are also presented. The findings may help with the development of effective market segmentation and improved healthcare service to the Asian American community. PMID:10538733
This Article examines the key National Labor Relations Board and federal court interpretations of the much-heralded 1974 HealthCare Institution Amendments to the National Labor Relations Act. It analyzes NLRB decisions that have resulted in a proliferation of separate employee bargaining units at healthcare facilities, and that have applied the strike notice provisions of the NLRA to labor disputes involving building trade employees engaged in construction at operating healthcare facilities. In addition, the Article examines the Board's decision to decline jurisdiction over employee unions representing interns and residents, and summarizes both the special NLRB rules designed to apply to union solicitation of employees at healthcare facilities and the conflicting circuit court decisions that have modified the Board's specialized solicitation rules. PMID:685982
ObjectiveTo examine the differences over time in health-care costs associated with incident adverse events in children and adolescents treated with antipsychotic agents compared to an untreated control sample.
\\u000a There are three compelling reasons to understand the utilization of healthcare. First, understanding the full range of factors\\u000a that shape the utilization of healthcare is important for determining the health-care needs of individuals, for developing\\u000a health resources and the training of care providers, as well as for planning programs aimed at the prevention, promotion,\\u000a or protection of health.
Cheryl Brown Travis; Andrea L. Meltzer; Dawn M. Howerton
Background Supporting self-care is being explored across healthcare systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems. Methods A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together. Results Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health. Conclusions Service delivery components – e.g. peer support groups, personal planning – advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings.
In recent years there has been intense debate regarding the level of medical care provided to 'standard care' control groups in clinical trials in developing countries, particularly when the research sponsors come from wealthier countries. The debate revolves around the issue of how to define a standard of medical care in a country in which many people are not receiving the best methods of medical care available in other settings. In this paper, we argue that additional dimensions of the standard of care have been hitherto neglected, namely, the structure and efficiency of the national health system. The health system affects locally available medical care in two important ways: first, the system may be structured to provide different levels of care at different sites with referral mechanisms to direct patients to the appropriate level of care. Second, inefficiencies in this system may influence what care is available in a particular locale. As a result of these two factors locally available care cannot be equated with a national 'standard'. A reasonable approach is to define the national standard of care as the level of care that ought to be delivered under conditions of appropriate and efficient referral in a national system. This standard is the minimum level of care that ought to be provided to a control group. There may be additional moral arguments for higher levels of care in some circumstances. This health system analysis may be helpful to researchers and ethics committees in designing and reviewing research involving standard care control groups in developing country research. PMID:15842723
To demonstrate the validity and internal consistency of a multi-item scale measuring women’s satisfaction with healthcare\\u000a received in the weeks following childbirth for both themselves and their newborns. Data are from 1,154 women delivering healthy\\u000a singletons or twins recruited for a randomized trial. Satisfaction with care items were selected from prior research, including\\u000a the previously validated Primary Care Satisfaction
Fabian T. CamachoCarol; Carol S. Weisman; Roger T. AndersonMarianne; Marianne M. Hillemeier; Eric W. Schaefer; Ian M. Paul
Accounting for a patient's emotional state is integral in medical care. Telehealth research attests to the challenge clinicians must overcome in assessing patient emotional state when modalities are limited (Pettinari and Jessopp, 2001). The extra effort involved in addressing this challenge requires attention, skill, and time. Large caseloads may not afford tele-home healthcare clinicians the time and focus necessary
Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, healthcare prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10.50 difference in per capita health expenditures. The calculated elasticity is 1.4 indicating that each 10% difference in per capita GDP is associated with a 14% difference in per capita health expenditures. The analysis indicates that variations in per capita GDP, alone, are associated with 7 of the variation in per capita health spending. In 1984, health spending in the 18 OECD countries (for which data were consistently available for all 6 different years) was on average 7.5% of GDP. The US had the highest GDP share (10.7%) and Greece had the lowest (4.6%). The average elasticity of 16 of the 18 countries as a group substantially exceeded 1.0 for the 1960-84 period, as well as the 1960-75 (1.6) and 1975-84 (1.3) subperiods. Thus, real health spending increased 60% faster than the real GDP between 1960-84 and between 1960-75 and 30% faster between 1975-84. PMID:3098657
Strategies to prevent and manage violence and aggression in the healthcare setting have become a primary health and safety issue. • A series of vignettes are provided to highlight key elements in developing a program for preventing behavioural violence and aggression in a tertiary hospital.
John A Forster; Mark T Petty; Colin Schleiger; Helen C Walters
This paper summarizes the findings for the Australasia and Pacific Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental HealthCare. We present an overview of mental health services in the region; discuss policies, plans and programmes; chart progress towards achieving community-oriented services, and detail the lessons learned.
\\u000a “It was the best of times it was the worst of times.” How prophetic was Charles Dickens when applied to healthcare in America\\u000a today.1 We are currently experiencing unprecedented technologic and therapeutic advancements; however, these come at a tremendous\\u000a price. Healthcare expenditures have increased by double digits for the past decade, physician reimbursement has decreased\\u000a by over the
Mercury is toxic heavy metal. It has many characteristic features. Healthcare organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and healthcare contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries’ healthcare sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now.
Mercury is toxic heavy metal. It has many characteristic features. Healthcare organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and healthcare contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries' healthcare sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now. PMID:21120080
Worldwide, healthcare providers use strikes and job actions to influence policy. For healthcare providers, especially physicians, strikes create an ethical tension between an obligation to care for current patients (e.g., to provide care and avoid abandonment) and an obligation to better care for future patients by seeking system improvements (e.g., improvements in safety, to access, and in the composition and strength of the healthcare workforce). This tension is further intensified when the potential benefit of a strike involves professional self-interest and the potential risk involves patient harm or death. By definition, trainees are still forming their professional identities and values, including their opinions on fair wages, health policy, employee benefits, professionalism, and strikes. In this article, the authors explore these ethical tensions, beginning with a discussion of reactions to a potential 2005 nursing strike at the University of California, Davis, Medical Center. The authors then propose a conceptual model describing factors that may influence healthcare providers' decisions to strike (including personal ethics, personal agency, and strike-related context). In particular, the authors explore the relationship between training level and attitudes toward taking a job action, such as going on strike. Because trainees' attitudes toward strikes continue to evolve during training, the authors maintain that open discussion around the ethics of healthcare professionals' strikes and other methods of conflict resolution should be included in medical education to enhance professionalism and systems-based practice training. The authors include sample case vignettes to help initiate these important discussions. PMID:21436671
Li, Su-Ting T; Srinivasan, Malathi; Der-Martirosian, Claudia; Kravitz, Richard L; Wilkes, Michael S
Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary healthcare. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary healthcaredevelopment are described.
Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary healthcare. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary healthcaredevelopment are described. PMID:2121182
|This article examines issues on healthcare costs and describes measures taken by public districts to reduce spending. As in most companies in America, health plan designs in public districts are being changed to reflect higher out-of-pocket costs, such as higher deductibles on visits to providers, hospital stays, and prescription drugs. District…
|This article discusses role delineation in the health education profession, defines and presents principles of healthcare marketing, describes marketing plan development, and examines major ethical issues associated with healthcare marketing when utilized by community health educators. A marketing plan format for community health education is…
This article discusses role delineation in the health education profession, defines and presents principles of healthcare marketing, describes marketing plan development, and examines major ethical issues associated with healthcare marketing when utilized by community health educators. A marketing plan format for community health education is…
In light of the challenges involved in leading a healthcare organization, it is important that the executives and managers charged with doing so are competent in a variety of areas. However, leading at all organizational levels does not necessarily require the same levels and types of competencies. The purpose of this research is to determine how well competency training works in healthcare organizations, and to obtain a better understanding of the competencies needed for leaders at different points of their careers and at various organizational levels. Ten healthcare management competency domains thought to positively influence job performance for healthcare executives are presented. The study seeks to answer four hypotheses related to self-perceptions of competencies and training opportunities at various hierarchical levels. A survey method was used to sample a subset of the healthcare executive population in the USA, based on three variables of interest, competency training opportunities, self-reported level of competency and hierarchical level. A series of Kruskal-Wallis and Mann-Whitney U tests were conducted to identify perceived differences in both competency level and training opportunities among respondents of various hierarchical levels. The most significant result of our research is that competency training is effective in healthcare organizations. The implications and need for additional research are discussed. PMID:22673697
Yarbrough Landry, Amy; Stowe, Michael; Haefner, James
As awareness of transgender men and women grows among healthcare educators, researchers, policymakers, and clinicians of all types, the need to create more inclusive settings also grows. Greater sensitivity and relevant information and services are required in dealing with transgender men and women. These individuals need their identities to be recognized as authentic, they need better access to healthcare resources, and they need education and prevention material appropriate to their experience. In addition, a need exists for activities designed to enhance understanding of transgender health issues and to spur innovation.
Although Americans remain generally satisfied with the healthcare provided to them, sufficient access to high-quality, affordable healthcare for citizens without healthcare insurance has become an increasing problem in the last decade. Using the policy development process of the American Medical Association, Health Access America was conceived by the Association to improve access to affordable, high-quality healthcare. The proposal consists of six fundamental principles and 16 key points. This article specifically focuses on the five points that, if enacted into law, would improve access to healthcare for Americans who are, for various reasons, without health insurance. PMID:1902268
Todd, J S; Seekins, S V; Krichbaum, J A; Harvey, L K
Although one of the smallest of the new independent states of the former Soviet Union, the Republic of Armenia has an ancient tradition and a strong ethnic identification, greatly enhanced by the diaspora. In addition to the problems following the dissolution of the Soviet Union, Armenia has had to contend with a draining war in Nagorno-Karabakh and the after-effects of a devastating earthquake in 1988. Humanitarian efforts have ranged from emergency supply deliveries to longer-term sustainable healthcare partnerships. The United States government, through the Agency for International Development, has organized such partnerships, partially as a result of a multinational mission in 1992 and a subsequent hospital-to-hospital program developed by the American International Health Alliance. We describe the current state of healthcare in Armenia and some of the problems that need to be addressed to improve healthcare services to its citizens. PMID:8023481
One of the most elusive challenges in healthcare marketing is hitting on a strategy to substantially differentiate your organization in the community and drive profitable business. This article describes how Sharp HealthCare, the largestintegrated healthcare delivery system in San Diego, has proven that focusing first on improving the healthcare experience for patients, physicians, and employees can provide
Diane Gage Lofgren; Sonia Rhodes; Todd Miller; Jared Solomon
Purpose: This paper is to distribute first results of the EU Fifth Framework Project 'Providing integrated health and social care for older persons—issues, problems and solutions' (PROCARE—http:yywww.euro.centre.orgyprocarey). The project's first phase was to identify different approaches to integration as well as structural, organisational, economic and social-cultural factors and actors that constitute integrated and sustainable care systems. It also served to
In 2009, Germany's Statutory Health Insurance System underwent a major financing reform. A uniform contribution rate set by government was introduced. Sickness funds retain only limited autonomy in charging additional premiums. A dynamic subsidy from general revenue was introduced. The aims of the reform were: (1) intensifying competition, (2) gearing competition towards quality and efficiency, and (3) increasing financial sustainability. This article describes the reform, presents the experiences made, and evaluates whether the policy aims have been met. Experiences have been mixed: on the one hand, the new arrangement showed a high level of flexibility in dealing with the severe recession in 2009. On the other hand, the new system of price differentiation has proven to be dysfunctional. Payments to sickness funds are based on predictions. But predictions have been of limited accuracy, and this has led to an accumulation of liquidity in the system. Price competition has been effectively eliminated. The intended surge in quality and product competition failed to appear, as sickness funds remain concerned mainly with their short term financial outlook. SHI finance has become more linked to the federal budget, leading to a higher level of political interventions. These arrangements will need a new reform - probably after the next general election in autumn 2013. PMID:23200602
Background Despite the omnipresence of mission statements, studies indicate that creating an effective mission statement is extremely difficult. Purposes Given the increasing pressure on healthcare administrators to develop an effective mission statement, this article sought to devise a state of the art of empirical mission statement research in order to develop a set of empirical based recommendations on how
This paper focuses on the application of the analytical hierarchy process (AHP) technique in the context of sustainable development to establish and optimise healthcare waste management (HCWM) systems in rural areas of developing coun- tries. This is achieved by evaluating the way in which the AHP can best be combined with a life cycle management (LCM) approach, and addressing
Alan C. Brent; David E. C. Rogers; Tsaletseng S. M. Ramabitsa-siimane; Mark B. Rohwer
Almost 35 million U.S. smokers visit primary care clinics annually, creating a need and opportunity to identify such smokers and engage them in evidence-based smoking treatment. The purpose of this study is to examine the feasibility and effectiveness of a chronic care model of treating tobacco dependence when it is integrated into primary care systems using electronic health records (EHRs). The EHR prompted primary care clinic staff to invite patients who smoked to participate in a tobacco treatment program. Patients who accepted and were eligible were offered smoking reduction or cessation treatment. More than 65 % of smokers were invited to participate, and 12.4 % of all smokers enrolled in treatment-30 % in smoking reduction and 70 % in cessation treatment. The chronic care model developed for treating tobacco dependence, integrated into the primary care system through the EHR, has the potential to engage up to 4.3 million smokers in treatment a year. PMID:24073176
Piper, Megan E; Baker, Timothy B; Mermelstein, Robin; Collins, Linda M; Fraser, David L; Jorenby, Douglas E; Smith, Stevens S; Christiansen, Bruce A; Schlam, Tanya R; Cook, Jessica W; Oguss, Madeline; Fiore, Michael C
Evidence-based programs have been shown to improve functioning and mental health outcomes, especially for vulnerable populations. However, these populations face numerous barriers to accessing care including lack of resources and stigma surrounding mental health issues. In order to improve mental health outcomes and reduce health disparities, it is essential to identify methods for reaching such populations with unmet need. A promising strategy for reducing barriers and improving access to care is Community Partnered Participatory Research (CPPR). Given the power of this methodology to transform the impact of research in resource-poor communities, we developed an NIMH-funded Center, the Partnered Research Center for Quality Care, to support partnerships in developing, implementing, and evaluating mental health services research and programs. Guided by a CPPR framework, center investigators, both community and academic, collaborated in all phases of research with the goal of establishing trust, building capacity, increasing buy-in, and improving the sustainability of interventions and programs. They engaged in two-way capacity-building, which afforded the opportunity for practical problems to be raised and innovative solutions to be developed. This article discusses the development and design of the Partnered Research Center for Quality Care and provides examples of partnerships that have been formed and the work that has been conducted as a result.
Maintaining competence requires healthcare practitioners to remain current with research and implement practice changes. Having the capacity to reflect on practice experiences is a key skill, but reflective skills need to be taught and developed. This exploratory qualitative study examined the outcomes of a dental hygiene program requirement for developing reflective practitioners. Using a purposive convenience sample, students were solicited to participate in the study and submit reflective journals at the end of two terms. Eleven of twenty-six students participated in the study, providing sixty-four reflective entries that underwent qualitative thematic analysis. Using a reflective model, we identified themes, developed codes, and negotiated among ourselves to reach consensus. Results showed approximately two-thirds of the participants reached the central range as "reflectors" and most of the remaining fell within the lower range as "non-reflectors." We concluded that dental hygiene students reached similar levels of reflection to other groups and the triggers were varied, appropriate for early learners, and divided between positive and negative cues. However, the small sample represented less than one-half of the class, yielding a potentially biased sample. Therefore, we conclude that the findings provide a departure point for further research with a more cross-cutting sample in order to substantiate reflective educational requirements and validate these findings. PMID:21460268
Asadoorian, Joanna; Schönwetter, Dieter J; Lavigne, Salme E
A secondary analysis of 2 qualitative studies was conducted to explore the experiences of suffering caused by interactions with healthcare providers in the hospital setting. Interview transcripts from 20 palliative care patients and 15 palliative care informal caregivers in University Malaya Medical Centre were thematically analyzed. The results of healthcare interactional suffering were associated with themes of attention, understanding, communication, competence, and limitation. These 5 themes may serve as a framework for the improvement in interaction skills of healthcare providers in palliative care. PMID:23689367
Beng, Tan Seng; Guan, Ng Chong; Jane, Lim Ee; Chin, Loh Ee
BACKGROUND: People who are deaf use healthcare services differently than the general population; little research has been carried out\\u000a to understand the reasons.\\u000a \\u000a \\u000a OBJECTIVE: To better understand the healthcare experiences of deaf people who communicate in American Sign Language.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN: Qualitative analyses of focus group discussions in 3 U.S. cities.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: Ninety-one deaf adults who communicate primarily in
Annie G. Steinberg; Steven Barnett; Helen E. Meador; Erin A. Wiggins; Philip Zazove
|Healthcare improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social…
Wilcock, Peter M.; Janes, Gillian; Chambers, Alison
This article reports on a work group process that aimed to articulate the American Nurses Association (ANA) standards of correctional nursing practice in the Connecticut Department of Correction. When recruiting nurses for prison healthcare, few candidates possess enough experience in all of the related fields, and even experienced nurses are seldom prepared for the environment and its challenging population.
Deborah Shelton; Constance Weiskopf; Michael Nicholson
In this article we share our experiences of a large-scale five-year innovative programme to introduce mobile learning into health and social care (H&SC) practice placement learning and assessment that bridges the divide between the university classroom and the practice setting in which these students learn. The outputs are from the Assessment &…
Taylor, J. D.; Dearnley, C. A.; Laxton, J. C.; Coates, C. A.; Treasure-Jones, T.; Campbell, R.; Hall, I.
Home healthcare organizations striving to effectively serve their clientele may be experiencing barriers, one of which is serving a culturally and linguistically diverse population. The National Center for Cultural Competence (NCCC) identifies seven salient reasons in this article for incorporating cultural competence into organizational policy. The article provides an examplary definition that can be adapted and useful to home
Purpose – This paper seeks to address how and why trust relations in the NHS may be changing and presents a theoretical framework for exploring them in future empirical research. Design\\/methodology\\/approach – This paper provides a conceptual analysis. It proposes that public and patient trust in healthcare in the UK appears to be shaped by a variety of factors.
BackgroundEarlier research has indicated that the psychological demand dimension in one of the most commonly used occupational stress models, the job-demand-control-support model, can be too generic and does not capture the multidimensionality of different job demands within healthcare work.
In the Russian Federation privatisation is affecting the healthcare sector as much as it is industry and commerce. That the general public support the transfer of state clinics to the private sector is a mark of their dissatisfaction with the old state run system. Doctors too see better opportunities to practise good medicine and be paid better for doing so. In Moscow the health department has set up a commission to license all clinics providing treatment, which should ensure standards of safety, training, and equipment. The Russian Federation is also trying to establish a medical insurance system to cover its citizens for healthcare, but in Moscow and elsewhere its implementation has been delayed by arguments and bureaucracy. In the meantime the health of Muscovites remains poor, with a high incidence of birth defects, and illnesses among the young. Images p783-a
|The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics…
One major critique of the Chinese economic reform focuses on disparities in development. This study examines the recent trends in the disparities in health and healthcare resources across the provinces. This study also examines the relationship between health status, healthcare resources, and socioeconomic status. A panel data from \\
Background In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The healthcare sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity. Methods A methodological exploratory design was employed in three phases: a) content development and assessment, which resulted in a 28-item instrument, b) pilot testing (N = 74) and c) field testing (N = 353). Internal consistency reliability was tested via Cronbach's alpha coefficient and factor analysis was used to identify the underlying constructs. Tests of scaling assumptions, according to the Multitrait-Multimethod Matrix, were used to confirm the hypothesized component structure. Results Four components, referring to intrinsic individual needs and external job-related aspects, were revealed and explain 59.61% of the variability. They were subsequently labeled: job attributes, remuneration, co-workers and achievement. Nine items not meeting item-scale criteria were removed, resulting in a 19-item instrument. Scale reliability ranged from 0.782 to 0.901 and internal item consistency and discriminant validity criteria were satisfied. Conclusion Overall, the instrument appears to be a promising tool for hospital administrations in their attempt to identify job-related factors, which motivate their employees. The psychometric properties were good and warrant administration to a larger sample of employees in the Greek healthcare system.
This paper offers a brief account of how interest and institutional structures interact to explain the divergent evolution of developed democracies' postwar commitments to social health-care provision. Institutions that fostered democratic participation also enhanced and balanced governmental responsiveness to inequality, economic hardship, and the population's age-demographic structure, inducing greater effective demand for public-health-spending growth in some democracies than others. Governments
Healthcare expenditures in the U.S. totaled $1.3 trillion in the year 2000, and spending could reach $2.8 trillion, or 17% of the nation's gross domestic product (GDP), by 2011, up from 13.2% of GDP in 2000. In addition, the greatest stress will come as ...
|The report stresses the fact that while there is unity in the continuum of medicine, information in healthcare is markedly different from information in medical education and research. This difference is described as an anomaly in that it appears to deviate in excess of normal variation from needs common to research and education. In substance,…
In a rapidly changing healthcare system, Global HealthCare: Issues and Policies equips students with up-to-date information exploring a variety of global health topics and perspectives: culture, religion and health, health research, ethics and health, reproductive health, infectious diseases, chronic diseases, nutrition, mental health, environmental health, aging, ambulatory care, economics and healthcare, healthcare insurance, and more. This
Recent years have seen the health and social care and education sectors subject to a range of policy initiatives which have been characterised by a concern for ‘modernisation’ and restructuring of the workforce which has resulted in a reappraisal and so-called ‘professionalisation’ of many existing previously lowskill roles. This has resulted in the development of new intermediate or ‘assistant practitioner’
Nadia Edmond; Kay Aranda; Rosemary Gaudoin; Kate Law
Recent years have seen the health and social care and education sectors subject to a range of policy initiatives which have been characterised by a concern for ‘modernisation’ and restructuring of the workforce which has resulted in a reappraisal and so-called ‘professionalisation’ of many existing previously lowskill roles. This has resulted in the development of new intermediate or ‘assistant practitioner’
Nadia Edmond; Kay Aranda; Rosemary Gaudoin; Kate Law
Purpose of the paper: To review the literature on leadership development in the for-proft sector and the Australian Public Sector in order to better understand how a leadership capability framework can be developed for the Australian non-profit sector.\\u000aMethodology: Literature review\\u000aFindings: There is a lack of research in leadership capability development in the health and community care sectors among
Shankar Sankaran; A Shepherd; Colleen M Cartwright; J Kelly
Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The healthcare industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a healthcare provider can implement TQM and evaluate its effects. PMID:10178544
There has been a paradigm shift in community health nursing. In 1992, visiting nursing stations were first introduced. In 1994, the Community Health Act came into force and in recent years public healthcare insurance has become a major issue. In this paradigm shift, one of the roles of nursing in the community is to train people to become more autonomous as consumers of healthcare services, and to design and implement a system that enhances community members' health and provides support when they are ill. In 1990 and 1996, the national nursing curriculum was revised to reflect changes in the age of the population. Community health nursing now faces the challenge of developing a new nursing model that is in tune with Japanese cultural values. Dr. Katsunuma (1996) proposed two alternative approaches to healthcare services: the public health approach and the clinical approach. In this paper, it is suggested that home care offers a third alternative, which integrates the clinical approach with the public health approach. This third approach provides a paradigm for community health nursing that integrates individual healthcare with community healthcare. New roles and specialties for public health nurses include care management, care planning, community health nursing administration, and supervision. Community-based nursing centers that cooperate with schools of nursing will provide a setting and a concept for community health nursing. PMID:9444239
In the UK, in emergency situations, health professionals rely on patients to provide information about their medical history. However, in some cases patients may not remember their medication, long term illnesses or allergies, or be able to communicate this information. As a national on-line integrated patient record system has not yet been established, this paper introduces an on-going project `MyCare
V. O. Rybynok; P. A. Kyriacou; J. Binnersley; A. Woodcock; L. M. Wallace
|A series of articles that examine environmental health and discuss healthcare reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for healthcare professionals who want to address…
A series of articles that examine environmental health and discuss healthcare reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for healthcare professionals who want to address…
Unless scarce resources can be mobilized and used efficiently, health for all by the year 2000 will remain a vain attempt. Innovative financing schemes exploring increased cost recovery from the users of the health system are explored throughout the world. In Bwamanda, Zaire, a community financing scheme for hospital care was developed through the application of operations research. A preference heuristic with considerable involvement of health providers and the community was used to identify the type of financing scheme and resulted in a pre-paid health plan, while a mathematical model was developed to determine the premiums to charge. The implementation of the health plant is briefly described. An evaluation of the effects of the pre-paid plan on the accessibility and equity of healthcare, as well as on the financial sustainability of the hospital, is presented and discussed: a steadily increasing membership of the health plan illustrates its appropriateness, while a doubling of the cost recovery of the hospital's operating costs after two years seems promising; the hospitalization rate of members of the health plan was significantly higher than for non-members. These findings suggest that a health zone may be an appropriate level for the organization of a regional pre-paid health plan. Problems of equity, full cost recovery, and replicability of the financing scheme are discussed. PMID:2367877
|This manual is designed to assist those helping professionals responsible for developing consumer education programs for older adults on the topic of healthcare and healthcare costs. Using a modular presentation format, the materials focus on the following areas of concern: (1) self-evaluation and planning for healthcare needs; (2) methods for…
Objective 'Self Care’'cards play a significant role in delivering health education via community pharmacies in Australia and New Zealand. The primary objective of this study was to evaluate whether such an initiative could have a similar impact in an Irish context. The secondary objective was to understand the importance of health literacy to this initiative. Methods Ten cards were developed for the Irish healthcare setting and trialed as a proof of concept study. The pilot study ran in ten community pharmacies in the greater Cork area for a six-month period. Using a mixed methods approach (Questionnaires & focus group) staff and patient reactions to the initiative were obtained. Concurrent to the pilot study, readability scores of cards (Flesch-Kincaid, Fry, SMOG methods) and the Rapid Estimate of Adult Literacy in Medicine (REALM) health literacy screening tool was administered to a sample of patients. Results 88.7% of patient respondents (n=53) liked the concept of the 'Self Care’' cards and 83% of respondents agreed that the use of the card was beneficial to their understanding of their ailment. Focus groups with Pharmacy staff highlighted the importance of appropriate training for the future development of this initiative. An emerging theme from designing the cards was health literacy. The pilot 'Self Care’'cards were pitched at too high a literacy level for the general Irish public to understand as determined by readability score methods. It was found that 19.1% of a sample population (n=199) was deemed to have low health literacy skills. Conclusions The 'Self Care’'initiative has the potential to be Pharmacy’s contribution to health education in Ireland. The initiative needs to be cognizant of the health literacy framework that equates the skills of individuals to the demands placed upon them.
The traditional emphasis on healing as the central concept in healthcare has been challenged in the last twenty years with the expansion Of healthcare as a business, the development of competing for-profit healthcare institutions, corporate joint ventures in medical research, the increasing involvement of healthcare specialists, particularly physicians, in entrepreneurships, for-profit health maintenance organizations, etc. It
|This document is comprised of the six 2002 issues of a bimonthly newsletter on children's health for California's child care professionals. The newsletter provides information on current and emerging health and safety issues relevant to child care providers and links the health, safety, and child care communities. Regular features include columns…
This study examined the numbers and types of female inmate healthcare requests, the healthcare providers used to service the requests, and if there was a relationship between the number of requests and time incarcerated. The most frequent requests were for medications, infections, and dental, gynecological, and gastrointestinal difficulties. Physicians provided healthcare services more frequently than nurses and
Introduction To fulfil its role of coordinating healthcare, primary healthcare needs to be well integrated, internally and with other health and related services. In Australia, primary healthcare services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary healthcare centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary healthcare under one level of government with a national primary healthcare policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary healthcare. Discussion Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary healthcare.
Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna
The final technical report, Volume IV of five documents, contains survey instruments and methodological details pertaining to the development and validation of measures of key concepts of interest to health services researchers: patient satisfaction, beli...
Health policy debates are replete with discussions of federalism, most often when advocates of reform put their hopes in states. But health policy literature is remarkably silent on the question of allocation of authority, rarely asking which levels of government ought to lead. We draw on the larger literatures about federalism, found mostly in political science and law, to develop a set of criteria for allocating health policy authority between states and the federal government. They are social justice, procedural democracy, compatibility with value pluralism, institutional capability, and economic sustainability. Of them, only procedural democracy and compatibility with value pluralism point to state leadership. In examining these criteria, we conclude that American policy debates often get federalism backward, putting the burden of healthcare coverage policy on states that cannot enact or sustain it, while increasing the federal role in issues where the arguments for state leadership are compelling. We suggest that the federal government should lead present and future financing of healthcare coverage, since it would require major changes in American intergovernmental relations to make innovative state healthcare financing sustainable outside a strong federal framework. PMID:20388867
Lasers and optics have affected healthcare in a myriad of ways. This paper surveys their impact on three aspects of healthcare: (1) surgery and medicine, (2) biology, and (3) biotechnology. In surgery, fiber optics have enabled the development of endoscopes, which allow access to most sites within the body. Endoscopes have, in turn, led to the development of
Low health literacy is a common and serious issue in U.S. healthcare. Healthcare professionals lack adequate training in health literacy principles. Increasing and improving health literacy training for the healthcare workforce is needed. Health professions educators have responded to this need by developinghealth literacy curricula, which use a wide variety of didactic and experiential teaching techniques
This information packet contains eight two- to three-page publications from the American Psychological Association series "Psychological Services for the 21st Century, Psychology's Role in HealthCare: Studying Human Behavior; Promoting Health; Saving HealthCare Dollars; Providing Mental Health Services." The focus of the series is the connection…
American Psychological Association, Washington, DC.
This article examines integrality as one of the doctrinal principles of the Brazilian State Health Policy - the Unified Health System (SUS) - whose aim is to offer healthcare as a right and as a service. Integrality is the foundation around which managerial activity practices are organized and whose main challenge is guaranteeing access to the healthcare system's most complex assistance levels. We developed an analytical reference grounded on three dimensions: service organization, knowledge, the practices of health workers and government policy formulation with input from the population. Managerial practices are fertile ground for integrality and are the political arena in which public managers of different government levels, private service providers, healthcare workers and organized civil society participate. Integrality in healthcare can only occur through the democratic interaction of subjects involved in the creation of government responses which are capable of contemplating the differences expressed in the healthcare needs. PMID:17680089
Pinheiro, Roseni; Ferla, Alcindo; da Silva Júnior, Aluisio Gomes
Academic medical centers, vulnerable populations, rural health. Each represents the fragmentation of the current healthcare delivery system. Not surprisingly, the challenge of achieving cost-effective integrated delivery raises complex issues for each. These issues are explored in Remaking HealthCare in America, based on research by Stephen Shortell, Ph.D., and his colleagues at Northwestern University, in partnership with KPMG's National HealthCare & Life Sciences practice and 11 integrated healthcare systems. Hospitals & Health Networks presents an exclusive preview of the book. PMID:8593505
Shortell, S M; Gillies, R R; Anderson, D A; Erickson, K M; Mitchell, J B
The prosperity of a healthcare organization is contingent on its ability to compete for and retain a high quality staff of "loyal" nurses. Although the benefits of maintaining a loyal nursing staff are obvious, turnover in the healthcare industry is dangerously high. One solution for reducing turnover is to develop and sustain a loyal nursing staff. The purpose of this article is to apply customer-oriented marketing theories and practices to better understand how strong nurse-provider relationships can be developed and maintained over time. The authors first examine relationship marketing literature as it applies to nurse relationship and management issues. Second, a framework for conceptualizing internal marketing efforts devoted to enhancing nursing staff satisfaction and retention in tested. Finally, strategies for practicing relationship marketing will be provided. PMID:10848197
Background The integration of behavioral health services into primary care is increasingly popular, yet fidelity of implementation in this area has been infrequently assessed due to the few measurement tools available. A sentinel indicator of fidelity of implementation is provider adherence, or utilization of prescribed procedures and engagement in model-specific behaviors. This study aimed to develop the first self-report measure of behavioral health provider adherence for co-located, collaborative care, a commonly adopted model of behavioral health service delivery in primary care. Methods A preliminary 56-item measure was developed by the research team to represent critical components of adherence among behavioral health providers. To ensure the content validity of the measure, a modified Delphi study was conducted using a panel of co-located, collaborative care model experts. During three rounds of emailed surveys, panel members provided qualitative feedback regarding item content while rating each item’s relevance for behavioral health provider practice. Items with consensus ratings of 80% or greater were included in the final adherence measure. Results The panel consisted of 25 experts representing the Department of Veterans Affairs, the Department of Defense, and academic and community health centers (total study response rate of 76%). During the Delphi process, two new items were added to the measure, four items were eliminated, and a high level of consensus was achieved on the remaining 54 items. Experts identified 38 items essential for model adherence, six items compatible (although not essential) for model adherence, and 10 items that represented prohibited behaviors. Item content addressed several domains, but primarily focused on behaviors related to employing a time-limited, brief treatment model, the scope of patient concerns addressed, and interventions used by providers. Conclusions This study yielded the first content valid self-report measure of critical components of collaborative care adherence for use by behavioral health providers in primary care. Although additional psychometric evaluation is necessary, this measure may assist implementation researchers in clarifying how provider behaviors contribute to clinical outcomes. This measure may also assist clinical stakeholders in monitoring implementation and identifying ways to support frontline providers in delivering high quality services.
A development guide for the provision of primary healthcare in Pierce County, Washington is discussed. Primary care is defined as care which takes place in a practitioner's private office; mobile van; home; public, private, or free clinic; hospital outpa...
Introduction Western healthcare is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of healthcare authorities to improve on healthcare infrastructure. Theory and methods Against a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in healthcare are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in healthcare infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of healthcare with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical healthcare practices. Results This paper develops a conceptual framework for addressing transformations of communication and workflow in healthcare as a result of implementing IT. Conclusion and discussion The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into healthcare practices and outcomes.
A report is given of the work of a group convened by the World Health Organization (WHO) to address the issues related to the development of Model HealthCare Programs (MHCPs), and to apply the principles thus identified to the case of a specific health problem--low back pain. A discussion of the principles of the development of MHCPs includes…
World Health Organization, Copenhagen (Denmark). Regional Office for Europe.
A qualitative systematic review of textbooks and clinical guidelines identified assessment criteria for initiation of nipple feeds in premature infants cared for in the neonatal intensive care unit (NICU) setting. Using a structured method for text source selection and data extraction, 43 healthcare texts were systematically reviewed yielding 153 separate statements related to assessing premature infants' feeding readiness. Following this procedure, a pile sort method was conducted wherein an expert neonatal nurse practitioner (NNP) grouped the statements according to similarity in meaning. Ten piles of terms emerged from this process. Each pile was "named," depicting discrete components used when assessing premature infants' readiness for nipple feeding. Using these public data and the private knowledge of the NNP informant, a concept map was constructed to illustrate a framework for decision support development and to examine the map's usefulness for structuring knowledge that will provide input to an intelligent decision support system. PMID:14643718
Panniers, Teresa L; Feuerbach, Renee Daiuta; Soeken, Karen L
America's healthcare system is characterized by unacceptably high cost, inequity, and insufficient technology assessment. Cost containment has failed in part because of misunderstanding of the nature of the healthcare system. Inadequate technology assessment and the malpractice crisis have also contributed to the rise in healthcare costs. Explicit, systematic rationing of healthcare services is one way to radically alter the existing system; the instituting of some type of national health program is another. Less drastic measures include systematic technology assessment; growing emphasis on group medical practice; more preventive services; and malpractice reform, including exploration of no-fault legislation and an expanded federal role. PMID:1822577
Objective: To measure patient satisfaction with pregnancy and newborn care. Study Design: To develop our survey, we reviewed domains of care that had been identified by national groups working to develop measures of satisfaction with care. Within these domains of care, items pertinent to pregnancy and newborn care were written, reviewed, and pilot tested in focus groups of women who
Jean M. Lawrence; Daniel Ershoff; Carolyn Mendez; Diana B. Petitti
Background Research on the attitudes of healthcare providers towards people with mental illness has repeatedly shown that they may be stigmatizing. Many scales used to measure attitudes towards people with mental illness that exist today are not adequate because they do not have items that relate specifically to the role of the healthcare provider. Methods We developed and tested a new scale called the Opening Minds Scale for HealthCare Providers (OMS-HC). After item-pool generation, stakeholder consultations and content validation, focus groups were held with 64 healthcare providers/trainees and six people with lived experience of mental illness to develop the scale. The OMS-HC was then tested with 787 healthcare providers/trainees across Canada to determine its psychometric properties. Results The initial testing OMS-HC scale showed good internal consistency, Cronbach’s alpha?=?0.82 and satisfactory test-retest reliability, intraclass correlation?=?0.66 (95% CI 0.54 to 0.75). The OMC-HC was only weakly correlated with social desirability, indicating that the social desirability bias was not likely to be a major determinant of OMS-HC scores. A factor analysis favoured a two-factor structure which accounted for 45% of the variance using 12 of the 20 items tested. Conclusions The OMS–HC provides a good starting point for further validation as well as a tool that could be used in the evaluation of programs aimed at reducing mental illness related stigma by healthcare providers. The OMS-HC incorporates various dimensions of stigma with a modest number of items that can be used with busy healthcare providers.
The development of a comprehensive home healthcare program in Muskegon County, Michigan, is described. It is noted that, in the continuum of medical care, coordinated home care programs provide fleaxible and comprehensive patient-centered care for those ...
STUDY OBJECTIVE--The aim was to develop indices of the degree of collaboration between district nurses, general practitioners, and health visitors. DESIGN--Semistructured interviews were conducted with each member of a pair of professionals who had patients in common. In each district a stratified random sample of six general practitioners and six community nurses was drawn, and for each a \\
There is an emerging consensus among those responsible for primary healthcare to children that such care should not only include medical concerns but also should assist parents with common problems of development and behavior. Psychologists are increasingly included among the personnel of medical groups that provide primary care to children. A model for this relatively new type of practice
Donald K. Routh; Carolyn S. Schroeder; Gerald P. Koocher
This article reviews quality of healthcare initiatives beginning with the quality assessment/quality assurance movement of the 1970s. Conceptually, modern quality of care management is rooted in the intellectual work of Avedis Donabedian who defined quality of care as a combination of structure, process, and outcome. Donabedian's model is presented and some limitations are pointed out. In the late 1980s and 1990s. the healthcare industry adopted total quality management (TQM). More recently, the pursuit of healthcare quality has led to substantial performance measurement initiatives such as ORYX by the Joint Commission on Accreditation of Healthcare Organizations and MEDIS by the National Commission of Quality Assurance. The importance of CONQUEST, a freely available performance measurement database developed at the Harvard School of Public Health, is noted and discussed. The article concludes with a list of challenges facing public and private parties interests in healthcare quality improvement. PMID:15188996
Background In Western countries, health and social welfare facilities are not easily accessible for elderly immigrants and their needs are suboptimally addressed. A transition is needed towards culturally sensitive services to overcome barriers to make cure and care accessible for elderly immigrants. We developed an intervention programme in which ethnic community health workers act as liaisons between immigrant elderly and local healthcare and social welfare services. In this study we evaluate the effectiveness and the implementation of this intervention programme. Methods/design In a quasi experimental design, the effectiveness of introduction of community health workers, health needs assessment, and follow-up intervention programme will be evaluated in three (semi) urban residential areas in the Netherlands and compared with a control group. Community health workers are selected from local ethnic communities and trained for the intervention. Data on health perception, quality of life, and care consumption are collected at baseline and after the intervention programme. Elderly’s informal care givers are included to examine caregiver burden. The primary outcome is use of healthcare and social welfare facilities by the elderly. Secondary outcomes are quality of life and functional impairments. The target number of participants is 194 immigrant elderly: 97 for the intervention group and 97 for the control group. Implementation of the intervention programme will be examined with focus groups and data registration of community health worker activities. Discussion This study can contribute to the improvement of care for elderly immigrants by developing culturally sensitive care whereby they actively participate. To enable a successful transition, proper identification and recruitment of community health workers is required. Taking this into account, the study aims to provide evidence for an approach to improve the care and access to care for elderly immigrants. Once proven effective, the community health worker function can be further integrated into the existing local healthcare and welfare system. Trial registration Trial registration number: ISRCTN89447795
With the recent emphasis on funding and training opportunities for global health and humanitarian aid and the increased interest in the field, many healthcare workers and medical researchers are traveling from resource- replete to resource-limited settin...
B. J. Seaworth M. G. Kortepeter R. L. Coldren S. A. Tasker T. H. Burgess
Non-health-care uses of information technology (IT) provide important lessons for healthcare informatics that are often overlooked because of the focus on the ways in which healthcare is different from other domains. Eight examples of IT use outside healthcare provide a context in which to examine the content and potential relevance of these lessons. Drawn from personal experience, five books, and two interviews, the examples deal with the role of leadership, academia, the private sector, the government, and individuals working in large organizations. The interviews focus on the need to manage technologic change. The lessons shed light on how to manage complexity, create and deploy standards, empower individuals, and overcome the occasional “wrongness” of conventional wisdom. One conclusion is that any healthcare informatics self-examination should be outward-looking and focus on the role of healthcare IT in the larger context of the evolving uses of IT in all domains.
Organized health service in Bosnia and Herzegovina practically started by the treatment of the sick in the Hadji Sinan's Tekke that was founded in 1768. Before that, the civilian population had been mainly treated in their homes, while the army were treated in barracks or hired hans (inns). As late as the nineteenth century, healthcare was provided by quack doctors, treating physicians or surgeons and barbers, who were trained, beside the circumcision of male children, for tooth extraction, broken bone setting, and sometimes even for performing minor surgical operations (a specially trained barber called djerah). The first trained medical personnel were the Franciscans and Jews, who studied at the Universities of Italy, Austria, Hungary etc. The first Muslim trained physicians studied at the Medical Faculty in Istanbul. The first ones were: Dr. Mehmed Serbi? and Dr. Zarif Skender, while the first Bosnian graduate in pharmacy was Jakov Sumbul. In Sarajevo and Bosnia and Herzegovina worked many a doctor who came from abroad. The majority of them converted to Islam and worked in the barracks, and later on in the Turkish Military Hospital when it was founded in Sarajevo. All of them played an important role in the prevention and treatment of the most frequent mass infectious and non-infectious diseases that were raging among the population--plague, cholera, syphilis, leprosy, tuberculosis, fungoid diseases etc. PMID:1366334
Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering healthcare in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control.
Procompetitive approaches to cost containment attempt to strengthen market forces through the use of cost-sharing; participation in alternative healthcare delivery systems; the provision of multiple options in health insurance plans; reform in the tax tr...
Contents: Total Federal Spending for Medicare and Medicaid Under Assumptions About the Health Cost Growth Differential; Annual Growth Rates of Private and Public HealthCare Spending; Medicare Spending per Capita in the United States, by Hospital Referral...
The Executive Committee of the West Michigan Health Systems Agency (WMHSA) requested an evaluation of the Regional HealthCare (RHC) Program to answer numerous unresolved questions that arose during past annual reviews of the RHC grant applications. Numer...
A qualitative systematic review of textbooks and clinical guidelines identified assessment criteria for initiation of nipple feeds in premature infants cared for in the neonatal intensive care unit (NICU) setting. Using a structured method for text source selection and data extraction, 43 healthcare texts were systematically reviewed yielding 153 separate statements related to assessing premature infants’ feeding readiness. Following
Teresa L. Panniers; Renee Daiuta Feuerbach; Karen L. Soeken
Learning in healthcare is essential if healthcare organisations are to tackle a challenging quality of care agenda. Yet while we know a reasonable amount about the nature of learning, how learning occurs, the forms it can take, and the routines that encourage it to happen within organisations, we know very little about the nature and processes of unlearning. We review the literature addressing issues pivotal to unlearning (what it is, why it is important, and why it is often neglected), and go further to explore the conditions under which unlearning is likely to be encouraged. There is a difference between routine unlearning (and subsequent re-learning) and deep unlearning—unlearning that requires a substantive break with previous modes of understanding, doing, and being. We argue that routine unlearning merely requires the establishment of new habits, whereas deep unlearning is a sudden, potentially painful, confrontation of the inadequacy in our substantive view of the world and our capacity to cope with that world competently.
For ubiquitous healthcare systems which continuously monitor a person's vital signs such as electrocardiogram (ECG), body surface temperature and three-dimensional (3D) acceleration by wireless, it is important to accurately detect the occurrence of an abnormal event in the data and immediately inform a medical doctor of its detail. In this paper, we introduce a remote healthcare system, which
The Chinese healthcare system was originally a highly centralized one. It had great success in improving the people's health. The county-township-village three-tier healthcare system has contributed much to rural primary healthcare, and has set an example of primary healthcare to the developing nations. In the 1980s, this system experienced transformations along with the changes of the country's administrative system and economic policy. The transformations are characterized by the disintegration of the rural cooperative medical service, by the decentralization of township hospitals from county to township governments, by official permission for private practice, by the implementation of the personal responsibility system in health institutions, by the health security reform, and by the development of health insurance in rural areas. The long-existing health administrative problems which were aggravated in the last decade are the rural-urban differences in resource allocation and the large proportion of people without health security. With the increase of medical service prices in recent years due to the inflation of the whole economy, it is believed that the cost of healthcare will create an economic burden to the low-income, fee-for-service paying individuals and will further affect the health of the population. In the process of the national economic reform, it is an important and difficult task for the health administrators to adjust the healthcare system promptly and properly. Only by continuously carrying forward good traditions, correcting mistakes and consistently persisting in health reform, can China further raise its healthcare to a new, prosperous stage. PMID:2056096
Epidemiologic studies have shown that more than half of mentally ill patients in the United States receive their psychiatric care exclusively in primary care settings. This fraction may be even higher in the military due to concern over possible occupational repercussions resulting from use of specialty psychiatric care and specialist shortages. Collaboration between generalists and mental healthcare specialists could potentially improve mental healthcare delivery and reduce psychiatric disability for a large segment of the Army population who have a psychiatric disorder but may not seek specialty care. Collaborative efforts can reinforce military generalists' essential gate-keeping function, thereby decreasing unnecessary medical utilization and healthcare costs. The authors review the problems associated with mental healthcare delivery in primary care and provide examples of collaborative models previously studied or currently being explored. A four-part Army Primary Care-Mental Health Services Agenda is proposed, consisting of: (1) coordinated research including primary care-mental health services research and community-based epidemiologic studies; (2) formation of a primary care-mental health services advisory committee for aiding with policy and program development; (3) graduate and continuing medical education in primary care-mental health services emphasizing interdisciplinary collaborative skills; and (4) clinical implementation of feasible collaborative interdisciplinary mental healthcare models adapted to the range of unique Army primary care settings. The main goal of the Army Primary Care-Mental Health Services Agenda is to improve access to Army mental healthcare in the most efficacious and cost-effective way and to help minimize the organizational impact of disability related to psychosocial distress. PMID:8041464
\\u000a Healthcare costs and ageing population are two factors which are of major concern to western governments in the 21st century.\\u000a Existing work in affective healthcare is primary focused on developing avatars in the tele-health space. This paper reports\\u000a on the modeling of emotions (anxiety level) of patients in pre-operative stage using communication robots to assist nurses\\u000a in providing
Rajiv Khosla; Mei-Tai Chu; Kerstin Denecke; K. G. Yamada; T. Yamaguchi
Healthcare reform calls for the nursing profession, with a focus on disease prevention and health restoration, to innovate and create new models of care that are client-centric, evidence-based, and cost-effective. To do so, nurses must develop a fundamentally different paradigm and epistemology. New care models are required that focus on issues such as evidence-based prevention. Among the prevention foci for hospitals are hospital-acquired infections, including influenza, which kills 36,000 Americans annually. One crucial step in eliminating hospital-acquired influenza is to require influenza vaccination of all healthcare workers. This article challenges nursing leadership to seize opportunities to lead healthcare initiatives and encourage courageous innovative actions that depart from old paradigms; these actions must be based on scientific evidence, reduce costs, and promote patient safety and quality care and outcomes. PMID:23639037
A study guide, consisting of two modules, designed to provide basic skills in healthcare delivery. Module 1 is the 'Health Core' developed for the education of anyone who comes into contact with patients in a health career. Skills mastered in this sectio...
Based on a case study of some aspects of Rockefeller and USAID intervention in the Cauca Valley, Colombia, this article is aimed at drawing attention to the political characteristics and inadequacies of U.S.-sponsored healthcare planning and research in the Third World, particularly as regards nutrition in rural regions of intensive economic development. By contrasting an historical analysis of the politicoeconomic development of agriculture and nutrition in the southern Cauca Valley with the assumptions guiding U.S. intervention in the health field there, a more complete picture of the causes of malnutrition is obtained, among which should be counted the intervention of the U.S. itself. Inter alia, other approaches to the malnutrition problem are suggested. PMID:631959
Extant literature shows that the public has great influence over policy making and resulting law. Yet survey research on Americans? attitudes towards healthcare has very mixed results. Those who are knowledgeable on healthcare policy issues become increasingly polarized both ideologically and politically, yet even during intense debate over healthcare when information floods the airways, the papers and the
Switzerland's consumer-driven healthcare system achieves universal insur- ance and high quality of care at significantly lower costs than the employer- based US system and without the constrained resources that can character- ize government-controlled systems. Unlike other systems in which the choice and most of the funding for health insurance is provided by third parties, such as employers and governments,
|Before the mid-1960's the Federal role in healthcare was extremely limited, but technological breakthroughs, the new importance of hospitals, and the recognition that the poor and elderly have been underserved prompted Congress to pass the Medicare and Medicaid package in 1966. Since then the Federal share of the healthcare dollar has risen by…
This editorial reviews areas of healthcare reform including managed healthcare, diagnosis-related groups, and the Resource-Based Relative Value Scale for physician services. Relevance of such reforms to people with developmental disabilities is considered. Much needed insurance reform is not thought to be likely, however. (DB)
|Financial problems plague both higher education and healthcare, two sectors that struggle to meet public expectations for quality services at affordable rates. Both higher education and healthcare also have a complex bottom line, heavy reliance on relatively autonomous professionals, and clients who share personal responsibility for achieving…
When groups of people relocate from their homelands to other nations, especially if the movement is involuntary, minority populations are created in the countries that receive them. The issues related to these diaspora and diasporic communities--any groups that have been dispersed outside their traditional homelands--are financial, social, historical, political, or religious. In healthcare, issues include heritable diseases, cultural barriers, patients' healthcare beliefs, and unique disease presentations. In long-term care, many residents and healthcare providers have relocated to the United States from other countries. PMID:17658968
Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the healthcare packages so that members of the SS and SP do not have same type of coverage. The question is: which model of healthcare system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary healthcare team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year. PMID:23254714
Over the last decade, development aid has increasingly used a more collaborative model, with donors and recipients both contributing ideas, methods and goals. Though many examples of collateral aid projects exist in agriculture, business administration and banking, few have found their way into healthcare and health education, a typically donor-dominated model. The following case report describes a collateral project in healthcare education. This case report analyzes data-inducing project proposals, personal interviews and project reports obtained through standard archival research methods. The setting for this joint project was the collaboration between international nongovernmental (NGO) aid foundations and the faculty of a major sub-Saharan African Medical School's Department of Anesthesia. The initial goal of this project was to improve record keeping for all anesthetic records, both in the operating theatres and outside. Analysis of the data was performed using ethnographic methods of constant comparative analysis. The purpose of the analysis was to critically evaluate both the goals and their results in the Department of Anesthesiology. The findings of this analysis suggested that results included not only quality assurance and improvement programs in the department but also advances in the use of critical incidents as teaching tools, hospital-wide drug and equipment utilization information and the initiation of an outreach program to district hospitals throughout the country for similar projects.
The NHS Plan sets out a challenging agenda for modernising the UK National Health Service (NHS), governing the organisation's performance and improving and extending service provision. Good healthcare governance is an essential prerequisite for all modernisation effort. This article will explore the responsibilities and implications for healthcare boards, managers and clinical staff in providing assurances for healthcare governance. Healthcare organisation directors, executive and non-executive, all share responsibility for the direction and control of the organisation. They are required to act in the best interest of the patients, staff and the general public and have statutory obligations to provide safe systems of work under the Health and Safety Regulations. Each director has a role in ensuring openness, being honest and acting with integrity, taking responsibility for their own personal learning and development, constructively challenge and develop strategy and ensuring the probity of the organisation's activities. PMID:15566273
The need for accessible, affordable, quality healthcare in the United States has never been greater. In response to this need, convenient care clinics (CCC) are being launched across the country to help provide care to meet the basic healthcare needs of the public. In CCCs, highly qualified healthcare providers diagnose and treat common health problems, triage patients
In 2000, Congress mandated that the Department of Defense (DOD) develop a plan to provide chiropractic care as a permanent part of the Defense Health Program. Prior to the establishment of DOD's chiropractic program, Congress directed DOD to conduct demon...
Compared with other developed countries, the United States has an inefficient and expensive healthcare system with poor outcomes and many citizens who are denied access. Inefficiency is increased by the lack of an integrated system that could promote an optimal mix of personal medical care and population health measures. We advocate a health trust system to provide core medical benefits to every American, while improving efficiency and reducing redundancy. The major innovation of this plan would be to incorporate existing private health insurance plans in a national system that rebalances healthcare spending between personal and population health services and directs spending to investments with the greatest long-run returns.
The purpose of this paper is to examine issues related to the coverage of preventive care under national health insurance. Four specific kinds of medical care services are included under the rubric of preventive care: prenatal care; pediatric care, dental care, and preventive physicians' services for adults. We consider whether preventive care should be covered under national health insurance, and
Health and healthcare in the Soviet Union are drawing special attention during these first years of perestroika, Mikhail Gorbachev's reform of Soviet political and economic life. This report briefly describes the current state of Soviet health and medical care, Gorbachev's plans for reform, and the prospects for success. In recent years the Soviet Union has experienced a rising infant mortality rate and declining life expectancy. The healthcare system has been increasingly criticized for its uncaring providers, low quality of care, and unequal access. The proposed measures will increase by 50 percent the state's contribution to healthcare financing, encourage private medicine on a small scale, and begin experimentation with capitation financing. It seems unlikely that the government will be able to finance its share of planned health improvements, or that private medicine, constrained by the government's tight control, will contribute much in the near term. Recovery of the Soviet economy in general as well as the ability of healthcare institutions to gain access to Western materials will largely determine the success of reform of the Soviet healthcare system.
Primary health centres, sub-district hospitals (first referral units) and district hospitals constitute the backbone of the\\u000a health services in the country. These facilities are expected to cater to the care of the newborn infants who are delivered\\u000a there, as well as those brought from the community with sickness. This paper, based on a survey in Orissa, and studies in\\u000a a
Germany turned towards community-based mental healthcare in the mid seventies, during a general climate of social and political\\u000a reform. The continuing deinstitutionalisation process and the implementation of community mental health services was considerably\\u000a affected by the reunification of East and West Germany in 1990, which required dramatic changes in the structure and quality\\u000a of the mental healthcare system
Objective: To describe the key features of the ‘Better Outcomes in Mental HealthCare’ initiative (2001-2005) and to detail some of the conceptual, community, professional and epidemiological forces that shaped its content.Conclusions: The ‘Better Outcomes in Mental HealthCare’ initiative represents a major development in mental healthcare in Australia. It recognises the central role of primary care, promotes integrated
A rich body of knowledge spans organizational topics relevant to the practice, conceptual development and planning of social work healthcare services. At a time when healthcare organizations are experiencing major changes in their structure and financing, organizational research informs both the system adjustments and leadership which social work can offer the healthcare field. Organizational research on health
The break-up of the former Soviet Union has created a greater realisation of the health and healthcare deficiencies of what are now independent states and the need for reform. The purpose of these two papers is to describe these deficiencies and set the scene for the establishment of some form of national health insurance in Russia and the other
For ubiquitous healthcare systems which continuously monitor a person's vital signs such as electrocardiogram (ECG), body surface temperature and three-dimensional (3D) acceleration by wireless, it is important to accurately detect the occurrence of an abnormal event in the data and immediately inform a medical doctor of its detail. In this paper, we introduce a remote healthcare system, which is composed of a wireless vital sensor, multiple receivers and a triage engine installed in a desktop personal computer (PC). The middleware installed in the receiver, which was developed in C++, supports reliable data handling of vital data to the ethernet port. On the other hand, the human interface of the triage engine, which was developed in JAVA, shows graphics on his/her ECG data, 3D acceleration data, body surface temperature data and behavior status in the display of the desktop PC and sends an urgent e-mail containing the display data to a pre-registered medical doctor when it detects the occurrence of an abnormal event. In the triage engine, the lethal arrhythmia detection algorithm based on short time Fourier transform (STFT) analysis can achieve 100 % sensitivity and 99.99 % specificity, and the behavior recognition algorithm based on the combination of the nearest neighbor method and the Naive Bayes method can achieve more than 71 % classification accuracy. PMID:22254766
The development of managed care plans is the most dramatic change in the USA’s healthcare 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 healthcare practitioners can do to minimize the
As our healthcare system changes, our educational curriculum for healthcare providers needs to be redesigned and focused on the delivery of multiprofessional, community-centered, and primary I prevention healthcare. This article describes the development and outcome of several multiprofessional courses that have been offered across curricula in the Schools of Medicine, Nursing, Professional Psychology, and Allied Health. Multiprofessional
Mary R. Talen; Margaret Clark Graham; Gordon Walbroehl
... Information Clinical Trials Resources and Publications How do healthcare providers diagnose Cushing’s syndrome? Page Content Diagnosing Cushing’s ... easily recognized when it is fully developed, but healthcare providers try to diagnose and treat it well ...
... Information Clinical Trials Resources and Publications How do healthcare providers diagnose Asperger syndrome? Page Content If you ... concerns about your child's development, talk the child's healthcare provider right away. The provider can examine the ...
The healthcare reform debate raises many complex issues including those of coverage, accessibility, cost, accountability, and quality of healthcare. Underlying these policy considerations are issues regarding the status of healthcare as a constitutiona...
... Web version HealthCare Workers: Avoiding Infections at Work HealthCare Workers: Avoiding Infections at Work How can I keep myself from getting an infection at work? As a healthcare worker, you may be ...
Differences are investigated between female practice populations of female general practitioners providing women's healthcare and of women and men general practitioners providing regular healthcare. Women's healthcare in the Netherlands is provided in the general practice \\
Intensive HealthCare at Home Kids can need intensive healthcare at home after they have been in the hospital ... dolls to help you practice different procedures. Home HealthCare Assistance The hospital social worker can help families ...
This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH) and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership
This paper outlines 10 lessons derived from the development of a consumer-directed care program for families with disabled children in Melbourne, Australia. The following program elements proved to be of importance over the course of the development process: (1) research participants should be involved as early as possible; (2) an open, inclusive communication style in conjunction with a good understanding of potential concerns and a careful framing of the policy issue is required to build trust and allow meaningful collaboration; (3) various strands of evidence have to be woven together; (4) ongoing commitment and support from management and key stakeholders; (5) effective knowledge transfer and cultural change processes; (6) capacity building; (7) mediation of power differentials; (8) community building; (9) participant re-engagement strategies; and (10) solid project management skills. PMID:21108897
This paper develops a model for interdependent demand for health insurance and healthcare under uncertainty to throw light on the issue of insurance-induced distortions in the demand for healthcare services. The model is used to empirically analyze the determinants of the choice of health insurance type and seven types of healthcare services using micro-level data from the
A. C. Cameron; P. K. Trivedi; Frank Milne; J. Piggott
Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC) assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will contribute to better understanding variations in hospital care of older patients; The quality indicators will have international relevance as they will be built on the interRAI assessment instrument, an internationally recognised clinical system.
Over the last decade, cost-containment pressures, healthcare reform debates, movement to case-managed healthcare, and reductions\\u000a in healthcare benefits have required most families to be responsible for selecting specific healthcare services that keep\\u000a costs to a minimum. As Eddy [17-20] discussed in a series of articles on making decisions in healthcare, the consensus among\\u000a healthcare
Carol E. Smith; Susan V. M. Kleinbeck; Karen Fernengel; Linda S. Mayer
The implementation of managed care for children with special healthcare needs is often associ- ated with apprehension regarding new barriers to healthcare services. At times, these barriers may overshadow opportunities for improvement. This statement discusses such opportunities, identifies challenges, and proposes active roles for pediatricians and families to improve managed care for children with special healthcare needs.
This article is based on a two-months snapshot (November 1998 to January 1999) of newspaper articles addressing various healthcare issues. Newspaper contents reflect the changing market share of competing societal concerns. Healthcare issues, particularly cost and choice, now preoccupy the American people. Healthcare trends percolate bottom-up through the pages of newspapers, not top-down from Washington, D.C, policymakers, or healthcare executives. By reviewing these articles, the author provides a big picture view of the prevailing and emerging healthcare trends. From the new thrust of consumerism and the public backlash against managed care organizations to the demise of HMOs and PPMCs, these observations signify not only the concerns that are bubbling to the surface but also the direction that healthcare is headed. Consumers are in the driver's seat and physician executives need to provide them with evidence of the value they desire--and understand what they perceive as value. PMID:10537749
OBJECTIVE Homelessness is a significant and growing problem in the United States. Women and families are the fastest growing segments of the homeless population. Homelessness increases the risk of having health problems and encountering barriers to care. This study determines how much perceived unmet need for medical care there is among homeless women, what homeless women perceive to be barriers to healthcare, and how barriers and other factors are associated with unmet needs. DESIGN Cross-sectional study of homeless women, utilizing structured interviews. SETTING AND PARTICIPANTS Community-based probability sample of 974 homeless women aged 15 to 44 years. MAIN OUTCOME MEASURES Perceived unmet need for medical care in the past 60 days. Relationship between unmet need and demographic variables, place of stay, source of healthcare, insurance, and perceived barriers to care. RESULTS Of the 974 women, 37% reported unmet need for medical care. Controlling for other factors, the odds of unmet need were lower among those with a regular source of care (odds ratio [OR] to .35, 95% confidence interval [CI], .21 to 58), while having health insurance was not significantly associated. The odds of unmet need were higher among those who experienced the barriers: not knowing where to go (OR 2.27, 95% CI, 1.40 to 3.69), long office waiting times (OR 1.89, 95% CI 1.27 to 2.83) and being too sick to seek care (OR 2.03, 95% CI, 1.14 to 3.62). CONCLUSIONS There is significant unmet need for medical care among homeless women. Having a regular source of care was more important than health insurance in lowering the odds of unmet need. Homeless women must be educated regarding sources of care, and clinics serving the homeless must decrease waiting times.
Lewis, Joy H; Andersen, Ronald M; Gelberg, Lillian
Informatization process of the Croatian healthcare system started relatively early. Computer processing of data of persons not covered by health insurance started in 1968 in Zagreb. Remetinec Health Center served as a model of computer data processing (CDP) in primary healthcare and Sveti Duh General Hospital in inpatient CDP, whereas hospital administration and health service were first introduced to Zagreb University Hospital Center and Sestre Milosrdnice University Hospital. At Varazdin Medical Center CDP for healthcare services started in 1970. Several registries of chronic diseases have been established: cancer, psychosis, alcoholism, and hospital registries as well as pilot registries of lung tuberculosis patients and diabetics. Health statistics reports on healthcare services, work accidents and sick-leaves as well as on hospital mortality started to be produced by CDP in 1977. Besides alphanumeric data, the modern information technology (IT) can give digital images and signals. Communication in healthcare system demands a standardized format of all information, especially for telemedicine. In 2000, Technical Committee for Standardization in Medical Informatics was founded in Croatia, in order to monitor the activities of the International Standardization Organization (ISO) and Comite Européen de Normalisation (CEN), and to implement their international standards in the Croatian standardization procedure. The HL7 Croatia has also been founded to monitor developments in the communication standard HL7. So far, the Republic of Croatia has a number of acts regulating informatization in general and consequently the informatization of the healthcare system (Act on Personal Data Confidentiality, Act on Digital Signature, Act of Standardization) enacted. The ethical aspect of data security and data protection has been covered by the Code of Ethics for medical informaticians. It has been established by the International Medical Informatics Association (IMIA), and the Croatian Society of Medical Informatics (CSMI) has translated it into Croatian and published it on its website. Based on a survey of medical staff attitudes toward healthcare system informatization, the Croatian health system appears to be ready for informatization. The only requirement is that the present and future healthcare providers have appropriate medical informatics education, proper computer equipment at their workplace, and an opportunity to participate in the development and/or improvement of the health information system. One of the EU health strategy priorities is the improvement of health information and knowledge. It means that integrated health information systems are required, i.e. systems able to provide key information on health and healthcare system to the politicians, health professionals and public in general. PMID:16095187
The theoretical and methodological elements of primary healthcare (PHC) include a philosophy of work and an epistemological focus toward the processes of health and illness, as well as a practical medical anthropological knowledge of the culture-specific aspects of disease. The work methodology of PHC requires care of the individual as a bio-psycho-socio-affective being integrated into a particular environment; none of the aspects of being should be neglected or given priority. Care should also be integrated in the sense of providing preventive healthcare as well as curative and rehabilitative services, in all phases from training of health personnel to record keeping. The primary healthcare team is multidisciplinary in constitution and interdisciplinary in function. PHC assumes that healthcare will be accessible to users and that continuity of care will be provided. The need for community participation in all phases of healthcare has been reiterated in several international health declarations. A well-functioning PHC system will require new types of pre- and postgraduate health education in a changing social and professional system and continuing education under adequate supervision for health workers. Research capability for identifying community health problems, a rigorous evaluation system, and epidemiologic surveillance are also needed. All of these elements are applicable to the field of maternal and child health as well as to PHC. The most appropriate place to intervene in order to correct existing imbalances in access to healthcare for mothers and children is in the PHC system. Examples of areas that should be stressed include vaccinations, nutrition, psychomotor development, early diagnosis and treatment for handicapped children, prevention of childhood accidents, school health and absenteeism, all aspects of health education, adoption and alternatives to abandonment of children, alcoholism and addiction, adolescent pregnancy and family planning, dental health, and mental problems. Trained primary care pediatricians working within the community as part of the PHC system will be required to confront and solve complex health problems. The training needed does not signify a new speciality or subspeciality, but rather a training methodology and a new type of professional practice. PMID:3752740
This paper examines the healthcare delivery crisis that has emerged in corporate America. Healthcare costs now account for 17% of the total GDP with the United States spending two trillion in healthcare costs (Herzlinger, 2007). The paper also discusses the major strategies that business leaders have implemented to reduce healthcare delivery costs while maintaining quality care
|The development and dissemination of culturally relevant healthcare information has traditionally taken a "top-down" approach. Governmental funding agencies and research institutions have too often dictated the importance and focus of health-related research and information dissemination. In addition, the digital divide has affected rural…
Dick, Rhonda Wiegman; Manson, Spero M.; Hansen, Amy L.; Huggins, Annie; Trullinger, Lori
Abstract. The growing,number,of the elderly in industrialised countries is increasing the pressure on respective healthcare systems. This is one reason for recent trends in the development,and expansion,of home,healthcare organisations. With Internet access available to everyone and the advent of wireless technologies, advanced telehomecare is a possibility for a large proportion of the population. In the near future, one
The Scenario-based Engineering Process (SEP) is a user-focused methodology for large and complex system design. This process supports new application development from requirements analysis with domain models to component selection, design and modification, implementation, integration, and archival placement. It is built upon object-oriented methodologies, domain modeling strategies, and scenario-based techniques to provide an analysis process for mapping application requirements to available components. We are using SEP in the healthcare applications that we are developing. The process has already achieved success in the manufacturing and military domains and is being adopted by many organizations. SEP should prove viable in any domain containing scenarios that can be decomposed into tasks. PMID:8591321
The Patient Protection and Affordable Care Act includes provisions to make the individual health insurance marketplace one where all Americans, including those with preexisting health conditions, can obtain affordable coverage. At the same time, the act has failed to address, in any significant way, many of the underlying flaws in the current U.S. healthcare system that have caused costs to spiral out of control. The combination of persistent U.S. healthcare cost increases and a viable individual health insurance marketplace will cause a sea change in employer-sponsored healthcare offerings that is similar to that seen among employer-sponsored retirement benefit plans: movement away from defined benefit approaches and toward defined contribution designs. Although the authors show parallels between the evolution of employers' healthcare and retirement offerings, they explain why certain key developments will need to occur before defined contribution approaches become as prevalent in employer-sponsored healthcare plans as they are in today's employer-sponsored retirement plans. PMID:21341643
Strategies for altering biological, social, and environmental factors which increase the risk of death or disability are recommended in the report of a Michigan task force on preventive healthcare. Fourteen of the recommendations address the reduction of...
|Undertaken at the request of House and Senate committees with responsibility for Indian affairs and government health programs, this study examines the health status of Indians and the services and technologies that are provided to them through Federal Indian health programs. The first half of the report contains background information and the…
Congress of the U.S., Washington, DC. Office of Technology Assessment.
Military conflict in Iraq will significantly affect the capacity of the Iraqi health system. The health system in Iraq has undergone many stressors during the past two decades. Health professionals can better understand the current problems in the healthcare system and support their Iraqi colleagues through reviewing and understanding contextual contributions to this crisis. Drawing from several sources, including first-hand
Richard Garfield; Elissa Dresden; Joyceen S. Boyle
|It is widely recognized throughout the healthcare industry that the United States leads the world in healthcare spending per capita. However, the chilling dose of reality for American healthcare consumers is that for all of their spending, the World Health Organization ranks the country's healthcare system 37th in overall performance--right…
Describes the essential features of a healthcare system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and healthcare reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)
Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.
Prologue: The issue of overriding importance to the healthcare enterprise and those who finance it is the rising cost of care. From every quarter, be it the patients who present themselves for treat- ment, to the doctors who provide the service, to employers who pay the bulk of the bill, increasing costs registers as the number one concern. No
In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to "The Health Transformation Programme". Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to healthcare and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of healthcare expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on healthcare. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the healthcare reform in terms of providing financial protection. PMID:23113149
Integration between traditional and contemporary healthcare in a host nation can be beneficial to nation- and capacity-building and, subsequently, to the overall health of the society. "Traditional" healthcare in this sense refers to the indigenous healthcare system in the host nation, which includes characteristic religious or cultural practices, whereas "contemporary" healthcare is also known as "conventional" or "Westernized"; integration is a synchronization of these two healthcare forms. However, the choice of integration depends on the political and cultural situation of the nation in which the Department of Defense healthcare personnel are intervening. Thus, cultural awareness training is essential to ensure the success of missions related to global health and in promoting a healthcare system that is most beneficial to the society. The present study attempts to show the benefits of both cultural training and healthcare integration, and how adequately evaluating their efficacy has been problematic. The author proposes that determinants of this efficacy are better documentation collection, extensive predeployment cultural awareness and sensitivity training, and extensive after-action reports for future development. PMID:23756013
We performed serial HealthCare Utilization and Attitudes Surveys (HUASs) among caretakers of children ages 0–59 months randomly selected from demographically defined populations participating in the Global Enteric Multicenter Study (GEMS), a case-control study of moderate-to-severe diarrhea (MSD) in seven developing countries. The surveys aimed to estimate the proportion of children with MSD who would present to sentinel health centers (SHCs) where GEMS case recruitment would occur and provide a basis for adjusting disease incidence rates to include cases not seen at the SHCs. The proportion of children at each site reported to have had an incident episode of MSD during the 7 days preceding the survey ranged from 0.7% to 4.4% for infants (0–11 months of age), from 0.4% to 4.7% for toddlers (12–23 months of age), and from 0.3% to 2.4% for preschoolers (24–59 months of age). The proportion of MSD episodes at each site taken to an SHC within 7 days of diarrhea onset was 15–56%, 17–64%, and 7–33% in the three age strata, respectively. High cost of care and insufficient knowledge about danger signs were associated with lack of any care-seeking outside the home. Most children were not offered recommended fluids and continuing feeds at home. We have shown the utility of serial HUASs as a tool for optimizing operational and methodological issues related to the performance of a large case-control study and deriving population-based incidence rates of MSD. Moreover, the surveys suggest key targets for educational interventions that might improve the outcome of diarrheal diseases in low-resource settings.
Nasrin, Dilruba; Wu, Yukun; Blackwelder, William C.; Farag, Tamer H.; Saha, Debasish; Sow, Samba O.; Alonso, Pedro L.; Breiman, Robert F.; Sur, Dipika; Faruque, Abu S. G.; Zaidi, Anita K. M.; Biswas, Kousick; Van Eijk, Anna Maria; Walker, Damian G.; Levine, Myron M.; Kotloff, Karen L.
Introduction. Systematic evaluation is an integral part of the organization and delivery of community oral healthcare programmes, ensuring the effectiveness of these community-based interventions. This study aimed to assess the knowledge and practice of primary healthcare (PHC) personnel regarding their duties toward oral health. Methods and Material. A cross-sectional study was carried out among three groups of PHC personnel in the city of Kerman (Iran). Volunteer personnel completed a piloted questionnaire which included demographic data, some question regarding their knowledge about oral health, their duties and also their practice regarding public oral health. All data were analyzed using chi-square and Pearson correlation test. Results. One hundred and fifty-seven out of 225 eligible personnel participated in the study. Sixty percent were auxiliary health workers (Behvarz). All personnel had a good level of knowledge regarding oral health. Despite significant differences among the knowledge of the personnel toward oral health, there was no significant difference between their knowledge related to their duties regarding oral health. The auxiliary health worker group had a higher rate (45.6%) for better public oral health practice. Conclusion. The study showed the personnel have good knowledge of their duties regarding oral health. However, their practice is not in line with their knowledge and needs more attention.
The British National Health Service has enjoined public health and primary care via a series of policy initiatives. Inter-organizational relationships provide the foundation for managing the system changes required to deliver policy, but are often taken for granted. This article reports on a study that sought to answer three key questions. First, which relationships are important for improving health? Second,
[Excerpt] The United States spends a large and growing share of national income on healthcare. In 2007, health spending is expected to approach $2.3 trillion and account for more than 16% of gross domestic product (GDP). We spend substantially more than other developed countries, both per capita and as a share of GDP. However, given our wealth, such spending
These guidelines were developed to assist Connecticut school personnel to strengthen collaborative efforts among families, educators, and health professionals to provide effective programs for students with special healthcare needs. The guidelines assist in identifying appropriate services and service providers and in planning the support…
Connecticut State Dept. of Education, Hartford. Div. of Education Support Services.
|These guidelines were developed to assist Connecticut school personnel to strengthen collaborative efforts among families, educators, and health professionals to provide effective programs for students with special healthcare needs. The guidelines assist in identifying appropriate services and service providers and in planning the support…
Connecticut State Dept. of Education, Hartford. Div. of Education Support Services.
With the recent emphasis on funding and training opportunities for global health and humanitarian aid and the increased interest in the field, many healthcare workers and medical researchers are traveling from resource-replete to resource-limited settings. This type of travel brings unique disease risks not routinely considered for the business or vacationing traveler. This review provides practical advice for this special population of travelers, targeted to specific healthcare-related risks (needlestick, hemorrhagic fever viruses, severe viral respiratory disease, and tuberculosis), with suggestions for risk mitigation. PMID:21039283
Kortepeter, Mark G; Seaworth, Barbara J; Tasker, Sybil A; Burgess, Timothy H; Coldren, Rodney L; Aronson, Naomi E
Societies depend heavily on women for healthcare, yet women's own health needs are frequently neglected, their contributions to healthdevelopment undervalued, and their working conditions ignored. The increasing recognition of the need for universally accessible primary healthcare and of people's right and duty to participate individually and collectively in their own care makes it vital to critically examine the role and status of women in its provision. A question which arises is whether the low status and prestige accorded to primary health stems from the fact that it is primarily women who provided it, or, rather, are women the main providers of such care because it is still regarded as unprestigious work and therefore to be left largely to women. Whatever the answer, the status and prestige of primary healthcare and the workers who provide it must be raised. To help address the problems and devise some solutions, the World Health Organization (WHO) convened consultations in 1980 and 1982. At the 1st consultation, priority issues concerning women as healthcare providers were identified and suggestions made for case studies and on analyses on specific issues. These were to be carried out in 17 developing and developed countries. The 2nd consultation brought together policy analysts and decision makers from the countries concerned who examined the findings and proposed concrete activities at the international and the national level. It became clear that any comprehensive strategy designed to raise the status of women who provide healthcare and make their workload less onerous must focus on the following elements: educational and training; attitudes about women; health education; policies and opportunities for employment; support systems; and infrastructure development. These elements are discussed separately here, yet it should be remembered that the participants in the consultation continually stressed their interdependence. Education of women for health work must be seen in the context of the type and length of the general education that they receive. The recruitment of women to training programs will require special efforts. Once women's self-esteem increases they are likely to receive more respect and consideration from men. To acquire this self-esteem, women must organize and support each other. Changes are called for in the attitudes towards each other of healthcare providers working in the formal and nonformal sectors. To provide health education for women is to train health educators for the community. Every plan for national development must include employment policies and strategies for their implementation. PMID:6649593
This article develops and uses methodologies to: (1) measure equity in the distribution of access to health services; and (2) measure the impact of health insurance programs on equity. The article proposes two egalitarian-based indicators for measuring equity in terms of access to healthcare--a concentration coefficient derived from the Gini coefficient, and the Atkinson distributional measure and also employs a weighted Utilitarian social welfare function to measure overall levels of access. The article defines access as the use of healthcare by individuals with a need for care; need is measured as self-reported morbidity. The setting for the empirical application is the country of Ecuador. The Ecuador Social Security Institute runs a General Health Insurance (GHI) program, whose affiliates are primarily workers in the formal sector of the economy. The principal data source is the 1995 Ecuador Living Standards Measurement Survey. The study uses a microeconomic healthcare demand model and bivariate probit estimation techniques to measure the impact of insurance on health service use for each quintile of adjusted per-capita household expenditure. The study also predicts healthcare use and program impact for each quintile under a series of simulation scenarios corresponding to proposed expansion of eligibility for the GHI program. The GHI program increases overall access to healthcare, but has a negative impact on equity in the distribution of health services. The benefits of the program, calculated as its marginal impact on the probability of using of healthcare, have a strongly regressive distribution. Expanding eligibility to the self-employed makes the benefit more equitably distributed (but still inequitable), and increases overall social welfare considerably. Expanding eligibility to the dependents of the insured person has similar effects, although less important in magnitude. PMID:10868673
If the outcomes of the recent COAG meeting are implemented, Australia will have a new set of benchmarks for its health system within a few months. This is a non-trivial task. Choice of benchmarks will, explicitly or implicitly, reflect a framework about how the health system works, what is important or to be valued and how the benchmarks are to be used. In this article we argue that the health system is dynamic and so benchmarks need to measure flows and interfaces rather than simply cross-sectional or static performance. We also argue that benchmarks need to be developed taking into account three perspectives: patient, clinician and funder. Each of these perspectives is critical and good performance from one perspective or on one dimension doesn't imply good performance on either (or both) of the others. The three perspectives (we term the dimensions patient assessed value, performance on clinical interventions and efficiency) can each be decomposed into a number of elements. For example, patient assessed value is influenced by timeliness, cost to the patient, the extent to which their expectations are met, the way they are treated and the extent to which there is continuity of care. We also argue that the way information is presented is important: cross sectional, dated measures provide much less information and are much less useful than approaches based on statistical process control. The latter also focuses attention on improvement and trends, encouraging action rather than simply blame of poorer performers.
|A booklet on healthcare for limited English speakers provides information on choosing the right doctor, buying medicine, paying the bill, and the individual's role in maintaining his or her health. Cartoons, questions and puzzles concerning the message in cartoons and narrative passages, checklists about an individual's personal habits related…
|Technological changes affecting the healthcare industry spurred the development and implementation of a curriculum to upgrade the skills of Philadelphia healthcare workers in written communication, mathematics, computer literacy, oral and listening communication, and issues surrounding their union employment in the healthcare field. The…
Philadelphia Hospital and Health Care-District 1199C, PA.
Explains the role of child carehealth consultants and suggests whom to contact for health consultant services. Notes that professional child carehealth consultants should be knowledgeable of pediatric care, child development, injury prevention screening, and state licensing guidelines. Suggests that consultants can provide on-site visits, assist…
This paper applies concentration curves and indices, that have been previously used to analyze progressivity in healthcare finance and horizontal equity in healthcare delivery in developed countries, to a 1998-1999 household survey about healthcare expenditures and utilization carried out in four francophone West African capitals (Abidjan, Bamako, Conakry and Dakar). The paper also uses statistical inference for
In India, although the healthcare system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary healthcare centers. This problem has been compounded by the separation of healthcare and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own healthcare system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary healthcare because they fulfill a need not met by the primary healthcare staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit. PMID:12288590
Abstract Trailing nearly every other industry, healthcare is finally globalizing. Highly trained and experienced,expatriate healthcare professionals are returning to their home,countries from training in the West or are staying home,to work,in newly developed,corporate healthcare delivery systems that can compete,quite favorably with less-than-perfect providers in Europe and North America. In turn, these healthcare systems are attracting patients
Data from a long?term follow?up study of 632 born in Calgary in 1980 are reported, with particular reference to the experience of day care and its association with parental factors and the children's adjustment when they were, on average 6#lb7 years old. The sample was specially selected to include a high proportion of children with serious disabilities, and data for
Rural Health Leaders Pipeline programs are intended to increase the number of youth interested in and pursuing health professions in rural communities. This paper presents 2 complementary approaches to Rural Health Leaders Pipeline programs. Two different organizations in Alabama recruit students from 18 specified counties. One organization is a rural, community-based program with college freshmen and upperclassmen from rural communities. Students shadow health professionals for 6 weeks, attend classes, visit medical schools, complete and present health projects, and receive support from online tutors. The second organization is a university-based program that supplements an existing 11th grade-medical school rural medicine pipeline with 10 minority students from rural communities who have graduated from high school and plan to enter college as premedical students in the following academic year. Students participate in classes, tutorials, seminars, and other activities. Students earn college credits during the 7-week program, maintain contact with program staff during the school year, and by performance and interest can continue in this pipeline program for a total of 4 consecutive summers, culminating in application to medical school. Each organization provides stipends for students. Early experiences have been positive, although Rural Health Leaders Pipeline programs are expensive and require long-term commitments. PMID:14526519
Rackley, Benjamin P; Wheat, John R; Moore, Cynthia E; Garner, Robert G; Harrell, Barbara W
Diverse advocacy groups have pushed for the recognition of cultural differences in healthcare as a means to redress inequalities\\u000a in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims\\u000a on both the state and healthcare providers. These efforts led to federal regulations developed by the U.S. Office
Outlines access to healthcare for children in out-of-home care under current law, reviews how healthcare access for these children would be affected by President Clinton's healthcare reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…
An EHR is a longitudinal collection of electronic health information about individual patients or populations, and is capable of being shared across different healthcare settings, by being embedded in network-connected enterprise-wide information system. An important consideration in the process of developing electronic health records is to plan for the long-term preservation and storage of these records. Most commercial EHR
|A study of 203 community health center preceptors who attended workshops on educational planning, teaching styles, evaluation, and feedback found that participants showed significant increases in use of five of seven teaching concepts while analyzing a role-play interaction; increased familiarity with, and retained for three months, nine of 11…
BACKGROUND: Preventive healthcare programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive HealthCare Facility Location (PHCFL) problem is to identify optimal locations for preventive healthcare facilities so as to maximize participation. When identifying locations for preventive healthcare facilities, we need to consider the characteristics of
Summary In developing countries burn injuries are much more common than in the USA and Europe or other affluent developed countries, due to poverty, overcrowding, and illiteracy, and are associated with higher mortality rates. The high incidence makes burns an endemic health hazard in these countries. Over 90% of burn-related fatalities occur in developing or low- and middle-income countries (LMICs), with south-east Asia alone accounting for over half of fire-related deaths. Management of burns and their sequelae even in the well-equipped, modern burn units of advanced affluent societies remains demanding despite advances in surgical techniques and development of tissue-engineered biomaterials available to these burn centres. Undoubtedly, in a developing country with limited resources and inaccessibility to sophisticated skills and technologies, management of burns constitutes a major challenge. The present review of the literature analyses the challenges facing burn management in LMICs and explores probable modalities to optimize burn management in these countries. The review will be published in three parts. Part I will present the epidemiology of burn injuries and challenges for management in LMICs. Part II will be about management of burn injuries in LMICs and Part III will discuss strategies for proper prevention and burn care in LMICs.
Most healthcare management training programmes and textbooks focus on only one or two models or conceptual frameworks, but the increasing complexity of healthcare 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 healthcare. 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 healthcare organizations. In sum, each of the five models is shown to provide a useful perspective for healthcare management. Healthcare managers should gain experience and training with a broader set of business management models. PMID:12476639
... care and research. Subscribe now Medicare and the healthcare reform law Drug rebates for seniors At a ... Detection of possible cognitive impairment under Medicare The healthcare reform law created a new Medicare benefit to ...
... Related Links Accessibility NCHS Home FastStats Home Home HealthCare (Data are for the U.S.) Number of current ... diabetes, 11 percent of discharges (2007) Source: Home HealthCare and Discharged Hospice Care Patients: United States, 2000 ...
Performing arts medicine is a growing healthcare profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique healthcare needs requiring a more collaborative and holistic healthcare program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts healthcare. APNs, with focus on collaborative and holistic healthcare, are ideally suited to join other healthcare professionals in developing and implementing comprehensive healthcare programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts healthcare. PMID:20644180
Background Decisions about the use of new technologies in healthcare are often based on complex economic models. Decision makers frequently make informal judgments about evidence, uncertainty, and the assumptions that underpin these models. Objectives Transparent interactive decision interrogator (TIDI) facilitates more formal critique of decision models by decision makers such as members of appraisal committees of the National Institute for Health and Clinical Excellence in the UK. By allowing them to run advanced statistical models under different scenarios in real time, TIDI can make the decision process more efficient and transparent, while avoiding limitations on pre-prepared analysis. Methods TIDI, programmed in Visual Basic for applications within Excel, provides an interface for controlling all components of a decision model developed in the appropriate software (e.g., meta-analysis in WinBUGS and the decision model in R) by linking software packages using RExcel and R2WinBUGS. TIDI's graphical controls allow the user to modify assumptions and to run the decision model, and results are returned to an Excel spreadsheet. A tool displaying tornado plots helps to evaluate the influence of individual parameters on the model outcomes, and an interactive meta-analysis module allows the user to select any combination of available studies, explore the impact of bias adjustment, and view results using forest plots. We demonstrate TIDI using an example of a decision model in antenatal care. Conclusion Use of TIDI during the NICE appraisal of tumor necrosis factor-alpha inhibitors (in psoriatic arthritis) successfully demonstrated its ability to facilitate critiques of the decision models by decision makers.
Bujkiewicz, Sylwia; Jones, Hayley E.; Lai, Monica C.W.; Cooper, Nicola J.; Hawkins, Neil; Squires, Hazel; Abrams, Keith R.; Spiegelhalter, David J.; Sutton, Alex J.
|This descriptive phenomenological study explored the perceptions and experiences of followers in the development of the leader-follower relationship, within a long-term healthcare environment. This study is also framed within the disciplinary context of human resource development (HRD). This study addressed the research question, "During your…
What does it mean to say that there is a right to healthcare? Healthcare is part of a cooperative project that organizes finite resources. How are these resources to be distributed? This essay discusses three rival theories. The first two, a utilitarian theory and an interst theory, are both instrumental, in that they collapse rights to good states of affairs. A third theory, offered by Thomas Pogge, locates the question within an institutional legal context and distinguishes between a right to healthcare that results in claimable duties and other dimensions of health policy that do not. Pogge's argument relies on a list of "basic needs," which itself, however, relies on some kind of instrumental reasoning. The essay offers a reconstruction of Pogge's argument to bring it in line with a political conception of a right to healthcare. Health is a matter of equal liberty and equal citizenship, given our common human vulnerability. If we are to live as equal members in a political community, then our institutions need to create processes by which we are protected from the kinds of suffering that would make it impossible for us to live as equal members. PMID:22789045
Neurocritical illness heavily burdens the developing world. In spite of a lack of resources for population-based health in most developing countries, there is an increasing demand for resource-intense strategies for acute neurological care. Factors including rising individual incomes in emerging economies, need for neurointensive care in humanitarian emergencies, growth of private hospitals, the rising burden of noncommunicable disease, and the practice of neurocritical care by specialists outside of neurology are discussed. Possible steps to improve the global practice of neurocritical care include: (1) emphasis on prevention of neurocritical illness through traffic safety and adequate outpatient treatment; (2) standardization of training requirements and skill sets; (3) guidelines on cost-effective measures including medications, equipment, and devices; (4) strengthening of surveillance systems and registries for both noncommunicable and communicable neurological diseases; (5) expanded use of teleneurology; (6) educational exchanges of neurointensive healthcare workers; and (7) monitoring of neurological intensive care unit death rates due to nosocomial infections, neurological disease, and other causes. A summary of reported mortality rates among neurocritically ill patients in African countries in recent years is provided as an illustrative example. PMID:21863357
In this document, the Federal Communications Commission reforms its universal service support program for healthcare, transitioning its existing Internet Access and Rural HealthCare Pilot programs into a new, efficient Healthcare Connect Fund. This Fund will expand healthcare provider access to broadband, especially in rural areas, and encourage the creation of state and regional broadband healthcare networks. Access to broadband for medical providers saves lives while lowering healthcare costs and improving patient experiences. PMID:23476995
|Presents an overview of Islamic healthcare beliefs and practices, noting health-related social and spiritual issues, fundamental beliefs and themes in Islam, healthcare beliefs and practices common among Muslims, and health-affecting social roles among Muslims. Cultural, religious, and social barriers to healthcare and ways to reduce them are…
Addresses the crisis in healthcare, considering costs, lack of access, and system ineffectiveness. Reviews "Setting Relationships Right," the Catholic Health Association's proposal for healthcare reform. Advocates educators' awareness of children's health needs and healthcare reform issues and support for the Every Fifth Child Act of 1992. (DMM)
There has been limited research on how non-conventional system development methodologies such as, Agile modeling methods could improve the successful development and implementation of telehealth services. The goal of this research was to increase the understanding of the impact of using the Extreme Programming process, an Agile modeling approach, to the development effort of a biosecurity telehealth project. Overall, the
Ann L. Fruhling; Kimberly Tyser; Gert-jan De Vreede
To identify challenges encountered in the care of children with special healthcare needs in a resource limited environment a 10 year-old child with a diagnosis of Tuberous Sclerosis was studied. Challenges identified were in: making a definitive diagnosis, provision of adequate care, cost of care, meeting parental expectations and accessing community support for the child and family. Available specialist healthcare and related services, including community rehabilitation, were provided for the child and family. The study highlights the need for improved community awareness, development in the provision of specialist healthcare services and institution of governmental policies that identify, support and protect children with special healthcare needs. PMID:23914107
In an effort toward cost containment, the healthcare system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other healthcare specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed. PMID:15008657
America's healthcare crisis is hitting our elderly and threatens to cripple Medicare, the elderly's financial support system. Medicare was designed to ensure that every elderly American would be protected against the destruction of life savings as a result of illness. Elderly Americans would be able to enjoy their golden years without the financial burden of medical bills. Today, this vision is almost extinct. Medicare has been placed on the endangered species list. Market predictions indicate that Medicare's Hospital insurance Trust Fund will be depleted by 1988 if current trends continue. The elderly presently must pay on the average about 14% of their healthcare bill. In addition, Medicare pays little for long-term care; and about 45% of long-term care is paid for out-of-pocket by the elderly and their families. Alternative approaches are desperately needed of Medicare if our elderly are to survive. PMID:10311941
Improving prison healthcare requires a robust measurement dashboard that addresses multiple domains of care. We sought to identify tested indicators of clinical quality and access that prison health managers could use to ascertain gaps in performance and guide quality improvement. We used the RAND/UCLA modified Delphi method to select the best indicators for correctional health. An expert panel rated 111 indicators on validity and feasibility. They voted to retain 79 indicators in areas such as access, cardiac conditions, geriatrics, infectious diseases, medication monitoring, metabolic diseases, obstetrics/gynecology, screening/prevention, psychiatric disorders/substance abuse, pulmonary conditions, and urgent conditions. Prison health institutions, like all other large health institutions, need robust measurement systems. The indicators presented here provide a basic library for prison health managers developing such systems. PMID:21525117
Asch, Steven M; Damberg, Cheryl L; Hiatt, Liisa; Teleki, Stephanie S; Shaw, Rebecca; Hill, Terry E; Benjamin-Johnson, Rhondee; Eisenman, David P; Kulkarni, Sonali P; Wang, Emily; Williams, Brie; Yesus, Ambeshie; Grudzen, Corita R
|Nurses and healthcare professionals must be prepared for transcultural healthcare because society is becoming increasingly multicultural and current health services are not meeting the needs of minority ethnic groups in Britain. (SK)|
Quality assurance is discussed as a health planning objective, and structural and process factors affecting the quality of care are examined. Quality assurance and health planning are explored in relation to the rising cost of healthcare and the evidence...
Social sector planning requires rational approaches where community needs are identified by referring to relative deprivation among localities and resources are allocated to address inequalities. Geographical information system (GIS) has been widely argued and used as a base for rational planning for equal resource allocation in social sectors around the globe. Devolution of primary healthcare is global strategy that needs pains taking efforts to implement it. GIS is one of the most important tools used around the world in decentralization process of primary healthcare. This paper examines the scope of GIS in social sector planning by concentration on primary healthcare delivery system in Pakistan. The work is based on example of the UK's decentralization process and further evidence from US. This paper argues that to achieve benefits of well informed decision making to meet the communities' needs GIS is an essential tool to support social sector planning and can be used without any difficulty in any environment. There is increasing trend in the use of Health Management Information System (HMIS) in Pakistan with ample internet connectivity which provides well established infrastructure in Pakistan to implement GIS for healthcare, however there is need for change in attitude towards empowering localities especially with reference to decentralization of decision making. This paper provides GIS as a tool for primary healthcare planning in Pakistan as a starting point in defining localities and preparing locality profiles for need identification that could help developing countries in implementing the change. PMID:21853333
|An article on American healthcare which focuses on healthcare costs and benefits is combined with a lesson plan on healthcare issues to enable students to consider both issues of cost effectiveness and morality in decisions about the allocation of healthcare. The article covers the history of interest in healthcare, the reasons for the…
otal healthcare and long-term care for the elderly represent around nine per cent of GDP averaged over some twenty OECD countries and around three-quarters of this is financed through the public sector. The process of ageing in OECD countries will begin to accelerate in virtually all OECD countries starting in about ten years time as the baby-boom generation begins
Personalization of healthcare has a number of claimants, including pHealth. However, to the citizen real personalization is the delivery of integrated support services to maintain their health and well-being, particularly in times of chronic illness and frailty. The integration of health and social care support has been identified a key but challenging step in this. The pHealth community faces the choice either of reinforcing the isolation of silos of care and thus fragmentation of service, or of seeking to become a unifying agent though thoughtful and considered development of sharing of monitoring from pHealth devices. PMID:22942029
Providing care to children with special healthcare needs within a managed care environment presents special challenges for providers and parents alike. The goal of managed care is to contain costs by encouraging or requiring members to obtain services through a designated network. In managed care programs, children and families may experience limited access to specialized care and services, along
Application of telemedicine systems to cover distant geographical areas has increased recently. However, the potential usefulness of similar systems for creation of national networks does not seem to be widely appreciated. The article describes the "Virtual HealthCare Knowledge Center in Georgia" project. Its aim was the set up of an online integrated web-based platform to provide remote medical consultations and eLearning cycles. The project "Virtual HealthCare Knowledge Center in Georgia" was the NATO Networking Infrastructure Grant dedicated for development of telemedicine in non-NATO countries. The project implemented a pilot to organize the creation of national eHealth network in Georgia and to promote the use of innovative telemedicine and eLearning services in the Georgian healthcare system. In June 2007 it was continued under the NATO Networking Infrastructure Grant "ePathology – Virtual Pathology Center in Georgia as the Continuation of Virtual HealthCare Center".
Although many medical institutions offer faculty development in education, this does not provide the in-depth knowledge of the science of teaching required for medical education research and careers in medical education. This paper describes our expanding faculty development activities at Cincinnati Children's Hospital Medical Center (CCHMC) that…
Purpose – The purpose of this paper is to argue that the interface between projects is of particular interest when organizing development projects. It offers a theoretical discussion of translation and inscription phases, not only because they are important to the understanding of mobilizing action in development projects, but also because they are crucial in a chain of sequential projects
|The development of appropriate scenarios is critical in high-fidelity simulation training. They need to be developed to address specific learning objectives, while not preventing other learning points from emerging. Buying a patient simulator, finding a volunteer to act as the patient, or even obtaining ready-made scenarios from another…
Nurses work in complex social environments, and conflict may arise with fellow coworkers, their supervisor, physicians or the patients and family they care for. Although much research has documented the negative effects of conflict on nurses, no research to date has examined the comparative effect that conflict from all four sources can have on nurses. The purpose of this study is to test a model of workplace conflict where the negative effect of conflict on nurses will be experienced via emotional exhaustion. We test the mediator model by analysing the cross-sectional data collected within one hospital (N1=182) and cross-validating those results in a second hospital (N2=161). The pattern of results was largely consistent across the two samples indicating support for a mediated model of workplace conflict for physician, supervisor and patient. Conflict with other nurses, however, did not have a relationship with either emotional exhaustion or other personal and organizational outcomes. The theoretical and practical implications of the current findings, as well as the limitations and future research directions, are discussed. PMID:22259160
|Recent years have seen the health and social care and education sectors subject to a range of policy initiatives which have been characterised by a concern for "modernisation" and restructuring of the workforce which has resulted in a reappraisal and so-called "professionalisation" of many existing previously lowskill roles. This has resulted in…
Edmond, Nadia; Aranda, Kay; Gaudoin, Rosemary; Law, Kate
|This article is about collaborative learning with educational computer-assisted simulation (ECAS) in healthcare education. Previous research on training with a radiological virtual reality simulator has indicated positive effects on learning when compared to a more conventional alternative. Drawing upon the field of Computer-Supported…
Hall, L. O.; Soderstrom, T.; Ahlqvist, J.; Nilsson, T.
This article is about collaborative learning with educational computer-assisted simulation (ECAS) in healthcare education. Previous research on training with a radiological virtual reality simulator has indicated positive effects on learning when compared to a more conventional alternative. Drawing upon the field of Computer-Supported…
Hall, L. O.; Soderstrom, T.; Ahlqvist, J.; Nilsson, T.
Recent years have seen the health and social care and education sectors subject to a range of policy initiatives which have been characterised by a concern for "modernisation" and restructuring of the workforce which has resulted in a reappraisal and so-called "professionalisation" of many existing previously lowskill roles. This has resulted in…
Edmond, Nadia; Aranda, Kay; Gaudoin, Rosemary; Law, Kate
The health reforms of the last several years at the federal and state levels have created many opportunities for pharmacists to become actively involved in the direct patient care provision. Indeed, the statutory language in some sections of the Affordable Care Act of 2010 creates expectations of pharmacists that will require practice transformation if we are to arise to accept the responsibilities associated with these expectations. These new opportunities open the door for pharmacists to benefit community-dwelling patients with chronic medical conditions, those with acute/emergent care needs, those experiencing a transition between chronic and acute care and vice versa, as well as others in long-term care settings. Although the profession has demonstrated value in many practice environments, our contributions to improved medication-related patient outcomes through medication therapy management (MTM) and the other pharmaceutical care services remain to be rigorously quantified. Incorporation of pharmacists either by their physical presence within the practice or through the design of effective community linkages, such as electronic health records, must be developed to meet the needs of rural and urban patients seen in a variety of practice settings. New business models that build upon cognitive and direct patient care services in addition to the provision of drug products will surely need to emerge for the profession to become a viable and vital component of the US healthcare system. PMID:22499738
The benefits of using alternative medicine in remote rural areas is discussed with specific references to a tribal area in the district of Dhule of Maharashtra state, India, among the Bhils, Koknas, and Vanjaras. Those involved in the development of healthcare in the area believe that the tribal people have been exploited in education, health, and agriculture and have shown remarkable endurance in withstanding the effects of a profit seeking society. Private profit-seeking allopathic practitioners exploited the trust of the tribal people until 1985, when the allopathic approach to healthcare was abandoned. The local medicine men, the Vaidus, were asked to teach 3 health workers to identify roots, develop medicines from plants, and prepare and administer simple herbal remedies for common illnesses. This training was conducted at the Academy of Development Sciences in Kashele, Maharashtra. After the training was completed, each health worker was assigned 10 villages near Nandurbar. Each health worker contacted the Vaidus of each village and exchanged information. The revival of traditional knowledge was also reinforced by the preparation and showing a slides of various medicinal plants in the areas among the 30 villages. Workshops were also conducted along the Vaidus, who were open to exchanging information as long as it was not misused or practiced for personal gain. The Vaidus believed that the person administering treatment had to be honest, have respect for plants, know how to diagnose the illness, and be able to administer the remedy correctly. As a consequence, in the case of Shri Chunnilal Rupsingh of Vadzakhan village, the traditional application of Aloe barbadensis for an infected wound on his hand proved to be the best option. The treatment, available at the private clinic in Nandurbar a considerable distance from the village, was expensive and required multiple return trips. Healthcare problems of women still need to be addressed; the maintenance of herbal and medicinal gardens is being encouraged. PMID:12318298
\\u000a Pervasive computing implies new challenges for software developers. In addition to tackling common problems pertaining to IT systems in general,\\u000a new issues like mobility and context-awareness must be dealt with. The contribution of this paper is to demonstrate that Coloured Petri Nets (CPN) have potential as an aid in the development of pervasive systems. On a case study of a
A significant development in our changing society is the great number of young children cared for outside the home. Finding quality child care is an ongoing challenge for all parents who work outside the home, and is especially difficult for parents of children with special healthcare needs (CSHCN). Many child care providers feel inadequately prepared to care for these
Community and migrant health centers (CHCs) have been shown to increase access to healthcare, improve health status, and reduce healthcare costs in communities that they serve. Thus CHCs can play an important role in providing for underserved communities under any program of national healthcare reform whose aim is universal, affordable access. To benefit the poor, such a
:Community and migrant health centers (CHCs) have been shown to increase access to healthcare, improve health status, and reduce healthcare costs in communities that they serve. Thus CHCs can play an important role in providing for underserved communities under any program of national healthcare reform whose aim is universal, affordable access. To benefit the poor, such a
This study aimed at describing and analyzing family carers' experiences in taking care of chronic patients at home. It is a qualitative research, developed in Service of Home HealthCare of Santa Maria's University Hospital (SIDHUSM), Rio Grande do Sul, Brazil, to which 15 family carers contributed. In order to produce data, one made use of Creative-Sensitive Method as well as the dynamics of creativity and sensitivity: Life Line, Body-Knowledge and Almanac. Data were analyzed according to the conceptual premises of discourse analysis. Thus, there were developed the following themes: the care as an inherent experience to human beings; the experience of taking care in a disease situation; the learning with the experience of being a carer. The results pointed to the necessity of valuing the care activities developed by home carers at patients' home, and they also highlighted the home care as a modality of humanizing and innovating attention which aims to invert health professionals' logic of action. PMID:20027951
The authors of this paper identify risks to health and other factors that determine the need for healthcare services among children and adolescents. They document service utilization patterns in the areas of well-child care and immunizations, acute ambulatory care and hospital services, and injury prevention. They also acknowledge the special healthcare needs of adolescents and of children with
Developing and implementing international partnerships requires specific skills and competencies. An overall framework for building sustainable community collaboration is discussed along with critical dimensions of leadership, partnership models, and venues to facilitate community change. Leaders must possess certain KSAs that are culturally modified and adaptable. Using civic engagement to solve complex social problems requires attention to model design, process and
Daniel J. West; Robert J. Spinelli; Steven J. Szydlowski
This paper discusses CEDEN's Parent-Child Program (PCP) and its external evaluation. The program promotes healthy child development among multi-problem, predominantly young families living at or below the poverty level in Austin, Texas. The goals of the PCP are to teach low-income parents in a culturally appropriate manner to encourage their…
Ubiquitous healthcare is very important subject not only as an effective scheme for early diagnosis of cardiovascular and other diseases, but also for prevention and control of such diseases. For this purpose, we have developed two kinds of non-invasive physiological monitoring systems. One is the systems utilizing furniture and furnishings in home to detect biosignals under daily life, and the
Shinobu Tanaka; Kosuke Motoi; Akira Ikarashi; M. Nogawa; Y. Higashi; H. Asanoi; K. Yamakoshi
The model of monopolistic competition is appropriate for describing the behavior of the healthcare sector in the United States. Uncertainty about quality of medical and related services promotes product differentiation especially when consumers do not bear the full costs of care. New technologies can be used to signal quality even when their clinical usefulness is unproven. Recent cost containment measures may reduce employment of ineffective technologies but may also inhibit the adaptation of genuinely useful developments. PMID:10115540
Utilization of acute healthcare services accounts for a substantial proportion of health expenditures in Canada, and is associated with compromised health and autonomy for older persons. Using the Resident Assessment Instrument for Home Care (RAI-HC), this cross-sectional study of 683 elderly home care recipients sought to distinguish clients who were more likely to use acute healthcare services; i.e.,
... Releases Spotlights Media Resources Selected Profiles & Interviews Multimedia HealthCare Visits to Check More Than Just Health? Page Content Study Shows HealthCare Providers Can Help with School Readiness During Primary ...
ABSTRACT This paper examines the effects of expansions in higher educational institutions and the medical service industry on the economic,development,of a metropolitan area. This examination pulls together previous research and provides some new empirical evidence. We provide quantitative evidence of the magnitude,of economic effects of higher education and medical service industries that occur through the mechanism,of providing some export-base demand
During the past 15 years there has been widespread adoption of sim- ulation in healthcare education as a method to train and assess learners. Multiple fac- tors have contributed to this movement, including reduced patient availability, limited faculty teaching time, technological advances in diagnosis and treatment that require a new skills set, greater attention to patient safety with the
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization.
Although Medicare constitutes one of the most popular programs of the federal government, even its most ardent supporters would likely agree that improvements could be made and likely should be part of any package of comprehensive healthcare reform. While some changes could be made as stand-alone reforms. it would be better to integrate changes for the under 65-population with
ABSTRACT Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate healthcare delivery that provides hope to the patient, sup- port to caregivers, and encourages the healing process. The Center sponsors
RICHARD T. PENSON; RENEE C. BENSON; KAREN PARLES; BRUCE A. CHABNER; THOMAS J. LYNCH; Schwartz Center Rounds
This paper describes the results of a survey of healthcare attitudes of a sample of respondents primarily of Asian American background. The importance of bilingualism, Asian background, age, and other attributes of a physician are discussed with relation to subgroups in the sample. The relative importance of the influence of doctors, family, and friends on the choice of physician
Building relationships with patients is critical to the success of many healthcare organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results. PMID:10154636
Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W
Asthma affects almost 23 million people in the United States and ranks as a leading cause of health disparities among minority and low socioeconomic groups, with the largest impact on minority children. This article will examine how fragmented healthcare in the United States contributes to asthma care disparities in minority populations and will discuss how healthcare reform may
The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven healthcare 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
Objective: To survey self-reported knowledge of home healthcare (HHC) services of healthcare professionals in Al-Khobar and Al-Dammam. Methods: A specially developed questionnaire was used to conduct a cross-sectional study to find out how knowledgeable 11 hospital administrators, 16 PHHC medical directors, and 637 healthcare team were of HHC services. Results: When asked whether they knew of HHC services, 90.9% of medical directors, 62.5% of primary healthcare center directors, 83.1% of physicians, 92.9% of nurses, 98.6% of physiotherapists, 95.9% of social workers, and 57.6% of the health team members replied that they did, although this knowledge was very scanty. Healthcare workers’ source of information on HHC services was hospital work (65.0%) while administrators’ sources were journals (65.0%). Only 11.1% of the administrators and 30.3% of the health team members indicated having had HHC training from university, and 3.7% of administrators and 20.4% of health team members indicated having attended a HHC lecture or symposium. The only finding with significant difference of responses (p<0.001) was on the knowledge of HHC services among healthcare professionals. All other responses showed no significant differences between them. No significant differences in the responses were found between the two groups of administrators. Conclusions: Health professionals and administrators showed little knowledge of HHC services. The main source of HHC information for health professionals was from their hospital experience while administrators learned more about HHC services from medical journals. Recommendations: HHC training centers must be set up in Saudi Arabia. Home healthcare concepts and skills should be part of the regular health science undergraduate curriculum.
Healthcare satisfaction ratings were studied in 365 (131 male and 234 female) members of a Health Maintenance Organization (HMO) (ages 60-89) with osteoarthritis (OA). A hierarchical multiple regression analysis to account for variance in healthcare ratings showed that subjects with higher satisfaction ratings were older, tended to be male, and made fewer contacts with healthcare providers over
William S. Shaw; Terry A. Cronan; Rebecca E. Lee; Robert M. Kaplan
The Johns Hopkins Hospital has developed a social work information system involving seven referral problem categories based on problems as identified by the referral source, ten problem categories for social work service, identified by the social work person after interview, and ten social work service categories similarly identified. The latter two categories include contracts with patients and expected outcomes together with categorization of actual outcome. Analyses of the coded data allow for more effective management of social work services and permit social work departments to compete for scarce resources, to comply with external regulations and accountability demands, and to assure quality service. In addition they provide a firm data base for research. The problem and service categories were tested for reliability by comparing the independent categorizations of 159 and 154 cases respectively by six social work persons, two each at three different levels of experience. Reliability levels were found to be satisfactory. The development of this system and the method of reliability testing are described and believed to be applicable to other systems.
The purpose of this article is to describe the importance of consumer-directed healthcare as the essential strategy needed to lower healthcare costs and support its widespread adoption for making significant strides in healthcare reform. The pros and cons of healthcare consumerism are discussed. The intent is to show that the viability of the US healthcare system depends on the application of appropriate consumer-directed healthcare strategies. PMID:20145464
The primary aim of this practice development project was to explore the level of knowledge of nursing and medical staff at the Infection Clinic at Liepaja regarding the spread of infectious diseases. Arrangements were also made for some of the Latvian healthcare staff to visit the Infection Clinic in Gothenburg to increase their knowledge about basic hygiene and to
BACKGROUND: Terminologies and classifications are used for different purposes and have different structures and content. Linking or mapping terminologies and classifications has been pointed out as a possible way to achieve various aims as well as to attain additional advantages in describing and documenting healthcare data. The objectives of this study were: • to explore and develop rules to
Anna Vikström; Ylva Skånér; Lars-Erik Strender; Gunnar H Nilsson
Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of healthcare in general in China, but also highlights the status of respiratory medicine-related issues. PMID:23381317
The American Academy of Pediatrics advocates that all children must have health insurance coverage that ensures them access to affordable and comprehensive quality care. Access to care depends on the design and implementation of payment systems that ensure the economic viability of the medical home; support and grow the professional pediatric workforce; promote the adoption and implementation of health information technology; enhance medical education, training, and research; and encourage and reward quality-improvement programs that advance and strengthen the medical home. Health insurance plans must be portable from state to state, with administrative procedures to eliminate breaks and gaps in coverage to ensure continuous coverage from year to year. Plans should ensure free choice of clinicians and foster coordination with public and private community-based programs for infants, children, and adolescents through the age of 26. The scope of services provided by all health plans must include preventive, acute and chronic illness, behavioral, inpatient, emergency, and home healthcare. These plans must be affordable and have cost-sharing policies that protect patients and families from financial strain and are without risk of loss of benefits because of plan design, current illness, or preexisting condition. PMID:20974786
|According to the Institute of Medicine, healthcare access is defined as "the degree to which people are able to obtain appropriate care from the healthcare system in a timely manner." Two key components of healthcare access are medical insurance and having access to a usual source of healthcare. Recent national data show that 34% of Latino…
Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in healthcare practices raise\\u000a several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in healthcare practices\\u000a as replacements of human care. I analyse them as demands for felt care, good care, private care, and real care. I argue that\\u000a although these objections
In this article, the authors present a brief review of the health problems of the Commonwealth Caribbean and of the primary care activities being implemented to solve them. Special attention is given to programs which develop new categories of health workers and direct health manpower toward learning a technology appropriate to the conditions in which they work. These programs enable the health worker and allied health personnel to adapt their roles and functions accordingly and thus provide quality healthcare within limited resources. The main programs are: development of new categories of health workers such as the community health aide and the nurse practitioner; education and training of allied health personnel; the training of primary healthcare physicians. An account is also given of primary healthcare in Jamaica and in the smaller territories of the Caribbean. PMID:7318737
The growing number of the elderly in industrialised countries is increasing the pressure on respective healthcare systems. This is one reason for recent trends in the development and expansion of home healthcare organisations. With Internet access available to everyone and the advent of wireless technologies, advanced telehomecare is a possibility for a large proportion of the population. In the near future, one of the authors plans to implement a home healthcare infrastructure for patients with congestive heart failure and patients with chronic obstructive pulmonary disease. The system is meant to support regular and ad-hoc measurements of medical parameters in patient homes and transmission of measurement data to the home healthcare provider. In this paper we look at network technologies that connect sensors and input devices in the patient home to a home healthcare provider. We consider wireless and Internet technologies from functional and security-related perspectives and arrive at a recommendation for our system. Security and usability aspects of the proposed network infrastructures are explored with special focus on their impact on the patient home. PMID:12697950
Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program
JAMES J. STRAIN; HAROLD A. PINCUS; JEFFREY L. HOUPT; LESLIE H. GISE; ZEBULON TAINTOR
There are two prominent trends in healthcare today: first, increasing demands for accountabilty, and second, increasing provision of care through managed care organizations. These trends promote the question: What form of account-ability is appropriate to managed care plans? Accountability is the process by which a party justifies its actions and policies. Components of accountability include parties that can be held or hold others accountable, domains and content areas being assessed, and procedures of assessment. Traditionally, the professional model of accountability has operated in medical care. In this model, physicians establish the standards of accountability and hold each other accountable through professional organizations. This form of accountability seems outdated and inapplicable to managed care plans. The alternatives are the economic and the political models of accountability. In the economic model, medicine becomes more like a commodity, and "exit" (consumers changing providers for reasons of cost and quality) is the dominant procedure of accountability. In the political model, medicine becomes more like a community good, and "voice" (citizens communicating their views in public forums or on policy committees, or in elections for representatives) is the dominant procedure of accountability. The economic model's advantages affirm American individualism, make minimal demands on consumers, and use a powerful incentive, money. Its disadvantages undermine healthcare as a nonmarket good, undermine individual autonomy, undermine good medical practice, impose significant demands on consumers to be informed, sustain differentials of power, and use indirect procedures of accountability. The political model's advantages affirm healthcare as a matter of justice, permit selecting domains other than price and quality for accountability, reinforce good medical practice, and equalize power between patients and physicians. Its disadvantages include inefficiency in decision making, capture by extremists or experts, intractable value conflicts, fragmentation of community, and oppression of minorities. The political model is the model we should endorse. Its disadvantages can be minimized by proper institutional design. In addition, recent research on managed care plans suggests that the political model may be the best for a competitive marketplace because it can ensure that tough allocation decisions are addressed and improve health through changes in nonmedical aspects of community life. PMID:9057125
In preparation for the design, construction, and postoccupancy evaluation of a new Children's Convalescent Hospital, focus groups were conducted and measurement instruments were developed to quantify and characterize parent and staff satisfaction with the built environment of the existing pediatric healthcare facility, a 30-year-old, 59-bed, long-term, skilled nursing facility dedicated to the care of medically fragile children with complex chronic conditions. The measurement instruments were designed in close collaboration with parents, staff, and senior management involved with the existing and planned facility. The objectives of the study were to develop pediatric measurement instruments that measured the following: (1) parent and staff satisfaction with the built environment of the existing pediatric healthcare facility, (2) parent satisfaction with the healthcare services provided to their child, and (3) staff satisfaction with their coworker relationships. The newly developed Pediatric Quality of Life Inventory scales demonstrated internal consistency reliability (average alpha = 0.92 parent report, 0.93 staff report) and initial construct validity. As anticipated, parents and staff were not satisfied with the existing facility, providing detailed qualitative and quantitative data input to the design of the planned facility and a baseline for postoccupancy evaluation of the new facility. Consistent with the a priori hypotheses, higher parent satisfaction with the built environment structure and aesthetics was associated with higher parent satisfaction with healthcare services (r =.54, p <.01; r =.59, p <.01, respectively). Higher staff satisfaction with the built environment structure and aesthetics was associated with higher coworker relationship satisfaction (r =.53; p <.001; r =.51; p <.01, respectively). The implications of the findings for the architectural design and evaluation of pediatric healthcare facilities are discussed. PMID:14767351
Varni, James W; Burwinkle, Tasha M; Dickinson, Paige; Sherman, Sandra A; Dixon, Pamela; Ervice, Judy A; Leyden, Pat A; Sadler, Blair L
Objective. The purpose of this article is to report the findings of the 2001 National Survey of Children With Special HealthCare Needs regarding the extent to which children with special healthcare needs (CSHCN) have access to public or private health insur- ance that meets their needs. Methodology. As part of its effort to develop systems of care for
Lynda Honberg; Merle McPherson; Bonnie Strickland; Julia C. Gage; Paul W. Newacheck
This paper compares and contrasts three different substantive (as opposed to procedural) principles of justice for making healthcare priority-setting or "rationing" decisions: need principles, maximising principles and egalitarian principles. The principles are compared by tracing out their implications for a hypothetical rationing decision involving four identified patients. This decision has been the subject of an empirical study of public opinion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three kinds of rationing principle. In conclusion, it is suggested that there is room for further work by philosophers and others on the development of a coherent and pluralistic theory of healthcare rationing which accords with public opinions. Key Words: Healthcare • rationing • medical ethics • justice • need
Fulfilling the shared care paradigm, healthcare networks providing open systems' interoperability in healthcare are needed. Such communicating and co-operating health information systems, dealing with sensitive personal medical information across organisational, regional, national or even international boundaries, require appropriate security solutions. Based on the generic security model, within the European MEDSEC project an open approach for secure EDI like HL7, EDIFACT, XDT or XML has been developed. The consideration includes both securing the message in an unsecure network and the transport of the unprotected information via secure channels (SSL, TLS etc.). Regarding EDI, an open and widely usable security solution has been specified and practically implemented for the examples of secure mailing and secure file transfer (FTP) via wrapping the sensitive information expressed by the corresponding protocols. The results are currently prepared for standardisation. PMID:10724890
Blobel, B; Pharow, P; Engel, K; Spiegel, V; Krohn, R
The article presents results from a survey of 98 top executives at Baylor HealthCare System (BHCS), a large, multifunction healthcare organization in Dallas, Texas. The survey assessed the executives' perceptions of current BHCS quality practices using the first survey developed for the healthcare industry based on the Malcolm Baldrige National Quality Award (MBNQA) criteria. Findings regarding the quality of BHCS internal and external data and information include the need for a $50 million information system transformation to achieve seven critical success factors for all business units and improved internal and external data and information for the business process redesign and quality transformation. Results highlight the need for further research investigating the information and analysis MBNQA criteria. PMID:10174724
The United States and the European Union (EU) vary widely in approaches to ensuring affordable healthcare coverage for our respective populations. Such variations stem from differences in the political systems and beliefs regarding social welfare. These variations are also reflected in past and future initiatives to provide high quality cancer survivorship care. The United States spends considerably more on healthcare compared to most European countries, often with no proven benefit. In the United States, individuals with chronic illnesses, such as cancer survivors, often experience difficulties affording insurance and maintaining coverage, a problem unknown to EU countries with national health insurance. This article reviews health policy development over time for the United States and EU and the impact for cancer survivors. For the United States, the impact of the Affordable Care Act on improving access to affordable care for cancer survivors is highlighted. For the EU, the importance of multiple-morbidity disease management, cancer plan development, and pan-European data collection for monitoring cancer outcomes is addressed. Given predicted workforce shortages and ever-increasing numbers of aging cancer survivors on both sides of the Atlantic, sharing lessons learned will be critical. PMID:23695931
Virgo, Katherine S; Bromberek, Julia L; Glaser, Adam; Horgan, Denis; Maher, Jane; Brawley, Otis W
Wireless sensing is part of our lives; major technological breakthroughs in the areas of sensors, integrated circuits, and also on wireless communications, led to the creation of wireless sensor networks (WSNs). Such networks have multiple uses, from monitoring and tracking of people and goods, to the coordination and processing of activities in different contexts; they are used in industry, defence and healthcare applications. As part of this use in healthcare applications KeepCare, a solution based on monitoring, tracking and processing of healthcare related information, is presented in this paper. This solution uses a WSN based application to monitor peoples' health and quality of life through vital signs and activity information received via wireless sensors. This solution monitors users such as elderly, people suffering from chronic conditions in their home environment, but can as well be used in athletes or other professionals (e.g. first responders) that need to be monitored under hazardous conditions. PMID:22942032
Healthcare waste is considered a major public health hazard. The objective of this study was to assess healthcare waste management (HCWM) practices currently employed at healthcare centers (HCCs) in the West Bank – Palestinian Territory. Survey data on solid healthcare waste (SHCW) were analyzed for generated quantities, collection, separation, treatment, transportation, and final disposal. Estimated 4720.7m3
Contents: Total Federal Spending for Medicare and Medicaid Under Assumptions About the Health Cost Growth Differential; Excess Cost Growth in National Health Expenditures; Annual Growth Rates of Private and Public HealthCare Spending; National Health Exp...
In the Winter\\/Spring 2000 issue of Permanency Planning Today, authors Sheryl Dicker and Elysa Gordon described the special healthcare needs of children in foster care, their vulnera-bility to health problems, the stress on care-givers who care for children with serious health conditions, and the important role child welfare professionals play in ensuring their healthy development. They cited the critical
Over 47 million Americans find themselves without health insurance in the richest and most Christian nation in the world. Catholic Social Teaching views this situation as an unjust violation of a basic human right to medical care, arguing that all persons have the right to those goods and services necessary for the proper development of life. In addition, Catholic Social
|The authors provide a brief overview of counseling and mental healthcare in Palestine, including their history and a summary of their current status. Finally, a discussion is presented of future trends in the development of the profession with regard to recent changes in the region.|
The American healthcare system is concerned about the rise of chronic diseases and related resource challenges. Management of chronic disease traditionally has been provided by physicians and nurses. The growth of the care management industry, in which nurses provide remote telephonic monitoring and coaching, testifies to the increasing need for care management and to the value of nonphysician clinicians. However, this model is challenged by a number of factors, including low enrollment and the growing shortage of nurses. The challenges to the traditional model are causing policy makers and payers to consider innovative models. One such model includes the pharmacist as an essential provider of care. Not only is the number of pharmacists growing, but they are playing an ever broader role in a variety of settings. This article broadly surveys the current state of pharmacist provision of care management services and highlights the increasingly proactive role played by Walgreen Co. toward this trend, using recently conducted research. Pharmacists are making a noticeable impact on and contribution to the care of chronic diseases by improving adherence to medications, a key factor in the improvement of outcomes. Literature also suggests that pharmacies are increasingly encouraging, expanding, and highlighting the role and contributions of their professional pharmacists. Although the role of the pharmacist in chronic care management is still developing, it is likely to grow in the future, given the needs of the healthcare system and patients. PMID:22313438
This article reviews the history, current status, and future plans of the Partners HealthCare Center for Connected Health (the Center). Established in 1995 by Harvard Medical School teaching hospitals, the Center develops strategies to move healthcare from the hospital and doctor's office into the day-to-day lives of patients. It leverages information technology to help manage chronic conditions, maintain health and wellness, and improve adherence to prescribed regimen, patient engagement, and clinical outcomes. Since inception, it has served over 30,000 patients. The Center's core functions include videoconference-based real-time virtual visits, home vital sign monitoring, store-and-forward online consultations, social media, mobile technology, and other novel methods of providing care and enabling health and wellness remotely and independently of traditional time and geographic constraints. It offers a wide range of services, programs, and research activities. The Center comprises over 40 professionals with various technical and professional skills. Internally within Partners HealthCare, the role of the Center is to collaborate, guide, advise, and support the experimentation with and the deployment and growth of connected health technologies, programs, and services. Annually, the Center engages in a deliberative planning process to guide its annual research and operational agenda. The Center enjoys a diversified revenue stream. Funding sources include institutional operating budget/research funds from Partners HealthCare, public and private competitive grants and contracts, philanthropic contributions, ad hoc funding arrangements, and longer-term contractual arrangements with third parties. PMID:23330595
In March 2010 the United States enacted the most significant healthcare reform in several decades. The Patient Protection and Affordable Care Act, amongst other provisions, addresses two of the main current shortcomings of the U.S. health system: the large portion of the population that are uninsured and the high percentage of hsealth expenditures (mostly private] which amounts to about 16% of the GDP. Changes to the current structure and financing of the U.S. health system will have implications for other health systems, for science (e.g., through enhanced federal funding for comparative effectiveness research), and for technological advance (e.g., through accelerated development and use of electronic health records). There are several lessons from the reform, and the factors leading to its implementation, for the Israeli health system. Firstly, the basic principles of the Israeli health system are a source of pride, and undermining its main values can have deleterious effects. Overreliance on private, out-of-pocket, spending and lack of support for public practice of medicine (in community and hospital settings) will weaken the public sector, strengthen the private sector, and could result in a tiered lower quality and less accessible public system with greater widening of gaps in health and healthcare utilization. This paper reviews the main provisions of the U.S. healthcare reform and the potential implications for the IsraeLi health system. PMID:21939111
In this paper I will examine the history of one way in which the federal government of the United States attempts “to promote\\u000a the general Welfare” and “secure the Blessings of Liberty to ourselves and our Posterity”, namely, through the provision of\\u000a healthcare for children. My account will begin at the turn of the century when the idea of
The Johns Hopkins University's Bloomberg School of Public Health has participated in the OpenCourseWare program for a number of years, and this course is one of their most recent offerings. Created by Henry Taylor and Henry Perry, these course materials introduce "students to the origins, concepts, and development of community-based primary healthcare through case studies from both developing and developed countries." On this course site, visitors can read through the syllabus, examine the course schedule, and look over the lecture materials. In the lecture materials area, visitors will find lecture slides and their corresponding audio files. Some of the topics covered here include the roots of community-based primary healthcare and women's empowerment in Afghanistan. Finally, visitors can check out some of the course readings, which are offered in the pdf format.
Background Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. Method The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. Results The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. Conclusions Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts.
Objective:Research has shown differences in health status and healthcare utilization related to culture, economic status, and healthcaredevelopment. This paper reports on a study comparing attitudes of women in three countries, at various stages of development, about their own health and self-worth and asks if these differences account for differences in healthcare utilization and inequities in health
J. Chamberlain; S. Watt; P. Mohide; H. Muggah; K. Trim; G. Bantebya Kyomuhendo
The problems of healthcare providing and solutions suggested to solve them should be discussed publicly at all appropriate levels in all developed countries. In this contribution, new approaches to understanding the problems of business ethics in healthcare are mentioned and recommended for discussion. An application of such principles of business ethics as trust, accountability, solidarity, transparency and social responsibility is considered in the four following areas. First, it is the allocation of limited resources in healthcare. This is the world-wide problem of the end of 20th century, as the development of medical technologies offers a wide range of new diagnostic and therapeutic procedures. In our country this coincides with the on-going, and still incompleted reform of healthcare. Second, the other area is that of connecting health-care and social problems, important namely for vulnerable groups such as children, the elderly and chronically ill. The third area is concerned with the privatization of healthcare, the newly emanating structure and function of the healthcare system and the role of healthcare provides in society. The last group contains issues concerning attempts to facilitate communication between healthcare specialists and general public, as well as attempts to support those institutions of the civic democratic society that are oriented toward health, sickness and healthcare providing. PMID:9601815
The purpose of the study was to evaluate the role of an online resource for dying children, their family members, and healthcare providers from the perspective of pediatric palliative care experts. Semistructured interviews with 12 leaders in pediatric palliative care in North America were conducted, exploring their perceptions and attitudes towards various aspects of Web-based resources for dying children and their care providers. Informants felt that an online resource may allow for a different form of expression, a connection between people undergoing a rare event, and an increase in education and support. Major challenges, such as accessibility, monitoring, and remaining current, would be ongoing. Other key themes included access, information, and anonymity. The data suggest that developing Web-based resources for dying young patients and their families may have merit. Should this take place, a feasibility study will be necessary to further determine the value of such a Web site for these vulnerable populations. PMID:18459596
Ens, Carla D L; Chochinov, Harvey M; Bérard, Josette L M; Harlos, Mike S; Stenekes, Simone J; Wowchuk, Suzanne M
The increase in the number of students with disabilities and special healthcare needs and their need for healthcare transition (HCT) creates opportunity for education and health services professionals to work together. In response to this opportunity, the authors developed an HCT teaching module for 6th to 12th graders. A concern that surfaced…
Repetto, Jeanne B.; Gibson, Robert W.; Lubbers, Joyce H.; Gritz, Sheila; Reiss, John
The quality of healthcare in the United States is not commensurate with its cost. Americans pay more per capita for healthcare than citizens of any other country in the world, yet population health trails that of developed nations that spend far less. M...
W. Knowlton C. Palma J. Browning L. Allison B. Bellacicco
Passion in today's healthcare leaders is essential as healthcare organizations face increasing demands for survival. Leaders in healthcare have been educated, selected, promoted, and retained based on their analytical and creativity skills. Today's healthcare leaders must also have emotional intelligence. Emotional intelligence is primal for passion. Emotional intelligence, which leads to passion, is crucial to the survivability of today's healthcare organizations. In order for healthcare organizations to go from good to great, the leader must inspire followers through passion. This article encourages healthcare leaders to gain awareness of emotional intelligence and to use emotional intelligence as part of their leadership to inspire passion. Through passion, leaders and followers become more motivated to accomplish the healthcare mission of serving others. PMID:15825818
Tuberculosis (TB) is on the rise. An estimated 10 to 15 million people in the United States are infected. This resurgence poses a challenge to all healthcare providers, including home healthcare professionals, where many patients fall into the \\
... MAP | EN ESPAÑOL Healthcare > Home Health and Personal Care Aides FONT SIZE: PRINTER-FRIENDLY Summary What They ... What They Do -> What Home Health and Personal Care Aides Do About this section Aides provide light ...
... Businesses & Schools > Transitions Transitions From Pediatric to Adult HealthCare Transitioning from teenage years to adulthood can be ... management and make more independent judgments about their healthcare needs. NDEP has assembled the materials below to ...
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... Information Clinical Trials Resources and Publications How do healthcare providers diagnose endometriosis? Page Content Surgery is currently ... under a microscope, to confirm the diagnosis. 1 Healthcare providers may also use imaging methods to produce ...
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Initiatives to address the unmet needs of those facing both poverty and serious illness have expanded significantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. We propose a framework for global health-care delivery and evaluation by considering efforts to introduce HIV/AIDS care to resource-poor settings. The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to malnutrition. To deliver value, vertical or stand-alone projects must be integrated into shared delivery infrastructure so that personnel and facilities are used wisely and economies of scale reaped. Two other integrative processes are necessary for delivering and assessing value in global health: one is the alignment of delivery with local context by incorporating knowledge of both barriers to good outcomes (from poor nutrition to a lack of water and sanitation) and broader social and economic determinants of health and wellbeing (jobs, housing, physical infrastructure). The second is the use of effective investments in care delivery to promote equitable economic development, especially for those struggling against poverty and high burdens of disease. We close by reporting our own shared experience of seeking to move towards a science of delivery by harnessing research and training to understand and improve care delivery. PMID:23697823
This article is a condensed and edited version of a speech delivered to The Business of Medicine: A Course for Physician Leaders symposium presented by Yale-New Haven Hospital and the Medical Directors Leadership Council at Yale University in November 2012 and drawn from Politics, Health, and HealthCare: Selected Essays by Theodore R. Marmor and Rudolf Klein . It faithfully reflects the major argument delivered, but it does not include the typical range of citations in a journal article. The material presented here reflects more than 40 years of teaching a course variously described as Political Analysis and Management, Policy and Political Analysis, and The Politics of Policy. The aim of all of these efforts is to inform audiences about the necessity of understanding political conflict in any arena, not least of which is the complex and costly world of medical care.
|This study reports the development of The Hearing Parents' Perceptions of Health Professionals' Advice Questionnaire (HPP/HPQ). This questionnaire was designed to investigate the impact of the advice and information that parents receive from health professionals during the time when their child's hearing loss is identified and how parents, in…
This study reports the development of The Hearing Parents' Perceptions of Health Professionals' Advice Questionnaire (HPP/HPQ). This questionnaire was designed to investigate the impact of the advice and information that parents receive from health professionals during the time when their child's hearing loss is identified and how parents, in…
RATIONALE: The health economy is a significant part of a national economy accounting typically for about 8% of GDP spent. As national economies respond to the dual challenges of severe economic turbulence on the global scale and climate change mitigation, the health economy is coming under increasing pressure to respond. Indications for sharp reductions in budgets and reductions in greenhouse gas emissions, such as carbon dioxide, are widespread. AIMS: In this paper an analysis is undertaken of the diverse forces acting on a typical healthcare enterprise. The forces, both economic and carbon related, are investigated in terms of their effects through the enterprise and across its boundaries on the supply, demand and waste sides. The overall aim is to show how the enterprise and whole supply chains may flip synchronously into a low-carbon evolutionary pathway. OBJECTIVES: By illustrating how different elements of the healthcare enterprise may respond to these developments, diverse opportunities for cost reduction, carbon reduction and product (goods and services) development are identified. These opportunities involve a variety of waste reduction and energy and materials conservation measures as well as new ways of collaborating with other enterprises going through similar transformations. The overall objective is to show that the carbon-constrained healthcare enterprise and the low-carbon health economy in which it sits may broaden its role in the coming decades to include a degree of responsibility for the health of the environment. This broader role is likely to supplement and entangle with the traditional role of the health economy, currently focused narrowly on human health, and lead to extensive organisational transformation, and infrastructure and product developments. PMID:20367839
As in a number of other low- and middle-income countries, the health sector in Vietnam is transforming with a rapid shift from fully state run and financed healthcare towards more private financing and delivery of healthcare. This development has been particularly noticeable in the largest city in the country, Ho Chi Minh City, where a majority of physicians
Knut Lönnroth; Le Minh Thuong; Pham Duy Linh; Vinod Diwan
background We examined the importance for voters of healthcare as an issue in the presidential election of 2004, how this ranking compares with the importance of healthcare in past elections, and which issues voters regard as the most important healthcare issues in the months before the election. methods We studied data from 22 national opinion surveys, 9
Healthcare providers increasingly are relying upon marketing as a means of overcoming growing competition. Competition-oriented marketing necessitates a comprehensive analysis of the competitive setting, a task which the healthcare marketing literature has generally given little attention. Herein the concept, perspective and tools of competitor analysis are borrowed from strategic planning and adapted for use in healthcare marketing. PMID:10299944
|This paper investigates the multicultural demands of healthcare delivery by examining the role of organizational communication in promoting effective multicultural relations in modern healthcare systems. The paper describes the multicultural make-up of modern healthcare systems--noting, for example that providers from different professional…
Differences are investigated between female practice populations of female general practitioners providing women's healthcare and of women and men general practitioners providing regular healthcare. Women's healthcare in the Netherlands is provided in the general practice “Aletta” and is based on the following principles: (1) consideration of the patient's gender identity and gender roles; (2) consideration of the
Reforming healthcare is made more difficult when attention is successfully directed away from the root causes of increasing healthcare disparity and inflation. This article challenges nurses to accept an active role in healthcare reform as a part of professional responsibility. PMID:22482216
This paper discusses the development of Ngäti Porou Hauora (NPH), an East Coast Mäori health provider, into a Primary Health Organisation (PHO), the cornerstone of the Primary HealthCare Strategy (PHCS). It illustrates how NPH's structure, philosophy of care and service delivery were compatible with the frameworks underpinning both the PHCS and He Korowai Oranga: The Mäori Health Strategy, thus
In a consumer-driven healthcare model, consumers, armed with information, would select providers based on quality and cost, thus increasing competition. This synthesis examines the availability of quality information and the evidence of how consumers use such information to choose a provider. Key findings include: information is publicly available from multiple sources regarding hospitals, but not individual doctors. Hospital information is predominantly made available online; but this limits awareness and access. Awareness is low overall, but highest among well-educated, healthy people. Even when consumers are aware of the data available, they rarely use it because they do not find it relevant: they do not foresee needing a hospital soon; are happy with their current provider; or did not find information pertinent to their specific health condition or hospital. While there is some evidence that hospitals that do poorly on public quality scorecards lose market share, there is better evidence that the providers themselves react to the quality scores by addressing care problems. Studies consistently show that consumers value healthcare quality and want information, but instead they rely on input from friends, family and their personal physicians about the quality of providers. PMID:22051936
We discuss the effects of managed care on the structure of the healthcare delivery system, focusing on managed-care-induced consolidation among healthcare providers. We empirically investigate the relationship between HMO market share and mammography providers. We find evidence of consolidation: increases in HMO activity are associated with reductions in the number of mammography providers and with increases in the number of services produced by remaining providers. We also find that increases in HMO market share are associated with reductions in costs for mammography and with increases in waiting times for appointments, but not with worse health outcomes. PMID:10558503
A discussion of the implications of healthcare reform for academic health centers (a complex of institutions which educate health professionals) looks at problems in the current system, the role of academic health centers in the current system, financial pressures, revenue sources other than patient care, impact on health research, and human…
Our fragmented healthcare systems are insufficiently equipped to provide frail older people with high quality of care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), an e-health intervention which aims (1) to facilitate self-management by frail older people and informal caregivers and (2) to improve collaboration among professionals. The ZWIP is a personal conference table, accessible through a secure internet connection, for multidisciplinary communication and information exchange for frail older people, their informal caregivers and professionals. After development, the ZWIP was implemented in seven general practices, and this process was evaluated by means of a mixed-methods study. Eventually, 290 frail older people and 169 professionals participated in the ZWIP. Most professionals were positive about its implementation. Facilitators for the implementation were the experienced need for improvement of interprofessional collaboration and the user-friendliness of the ZWIP. Barriers were the low computer-literacy of frail older people, start-up problems, preferring personal contact, and limited use of the ZWIP by other professionals. In sum, this article describes the successful development and implementation of the ZWIP, an e-health intervention which can reduce fragmentation in the care of frail older people. PMID:23494689
Robben, S H M; Heinen, M M; Makai, P; Olde Rikkert, M G M; Perry, M; Schers, H J; Melis, R J F
Currently the United States spends 12 percent of its gross national product on healthcare, far more than any other industrialized nation. Technology accounts for 15 percent to 50 percent of the rise in hospital costs. No country is immune from public calls for strategic developments to maintain or lower costs and guarantee high quality while maintaining access for all patients. To achieve these goals of adequate access, high quality, and greater efficiency, hospitals must discard complicated and unwieldy administrative practices that have evolved. How to best deploy technology in health service organizations requires a strategic perspective that results in operational break-throughs. Accelerated alignment of clinical and management processes, systems integration, and healthcare process redesign are required to achieve the goals of lower costs, higher quality, and greater access. An environmental background of reengineering is presented for health service organizations to use in their processes. Some critical relationships between reengineering and total quality management (TQM) in the healthcare setting are addressed. Implications of reengineering for health service organizations are offered to facilitate the implementation of the concept. PMID:10162815
The social determinants of health (SDH) are recognized as important indicators of health and well-being. Health-care services (primary, secondary, tertiary care) have not until recently been considered an SDH. Inequities in access to healthcare are changing this view. These inequities include barriers faced by certain population groups at point of care, such as the lack of cultural competence of health-care providers. The authors show how a social justice perspective can help nurses understand how to link inequities in access to poorer health outcomes, and they call on nurses to break the cycle of oppression that contributes to these inequities. PMID:18856224
This paper addresses two ways in which scarcity in healthcare turns up and three ways in which this dual condition of scarcity\\u000a can be approached. The first approach is the economic approach, which focuses on the causes of cost-increase in healthcare\\u000a and on developing various mechanisms of rationing and priority-setting in healthcare. The second approach is the
Capitation and risk adjustment have become the chosen policy instruments to seek cost containment and equity of access for\\u000a many developedhealthcare systems. Increasingly, this entails the prospective setting of global budgets for the healthcare\\u000a expenditures incurred by healthcare plans on behalf of their members. Methods of deriving such budgets are diverse and tailored\\u000a to the specific
Quality in healthcare and ethical principles The last three decades have seen rapid changes in the way United States of America (USA) healthcare has been delivered, financed and regulated. Four major stakeholders have emerged in the healthcare debate: patients, providers, payers and public regulatory agencies. These groups do not agree on a definition of quality healthcare. This paper suggests five ethical principles - autonomy, justice, beneficence, non-maleficence, and prudence - be included in the framework of quality healthcare. A framework that outlines possible relationships among these ethical attributes and four major stakeholders is presented. PMID:11012797
Recommendations resulting from a 1977 conference, "Health Policy, Health Planning and Financing the Future of HealthCare for Blacks in America," are presented. The recommendations concern changes in the healthcare system, community involvement, government regulation, the formation of Black interest groups and lobbies, and support for national…
The curriculum for the training of the entry level health workers (referred to as nursing aid, assistant, or basic healthcare worker) is organized with a modular approach and designed within the framework of a humanistic learning growth model. Module 1, The Health Core, provides basic education for any healthcare worker. Module 2, The Patient…
Profiles are provided for innovative public health activities that focus on the health of children in day care. All are considered to be models worthy of replication. Profiles depict (1) child care in Arizona; (2) child day care licensing in Connecticut; (3) safeguarding children in day care in Kansas; (4) paired state and local inspection in…
Kansas State Dept. of Health and Environment, Topeka.
This paper studies the interaction between public and private healthcare provision in a National Health Service (NHS), with free public care and costly private care. The health authority decides whether or not to allow private provision and sets the public sector remuneration. The physicians allocate their time (effort) in the public and (if allowed) in the private sector based
Healthcare reform has been the primary focus of policymakers for much of the past year, culminating with the Patient Protection and Affordable Care Act that was signed into law by President Obama on March 23, 2010. The vigorous national debate on the act has highlighted the importance of innovative, high-quality research on health and healthcare policy.
Healthcare reform represents a major step toward achieving the goal of improved preventive and primary care services for all Americans, including children and adolescents. Adolescence is a unique developmental age district from both childhood and adulthood with special vulnerabilities, health concerns, and barriers to accessing healthcare. It is…
In the face of incessant double digit cost increases in the healthcare field, an emerging stage in the evolution of healthcare finance and delivery is the consumer driven health plan (CDHC). The CDHC is a high deductible insurance plan wrapped around a health reimbursement account that has all the tax advantages of a traditional employer-provided healthcare plan.
Kenneth W. Hollman; Robert D. Hayes; Emily J. Zietz
When the Taliban swept into Kabul, Afghanistan in September 1996, they began a reign of terror over the people of that city, especially the women. Adhering to a fundamentalist interpretation of Islamic law, the group has severely restricted women's freedom of movement and access to healthcare, education, and employment. Some female physicians and nurses have been able to continue working because the Taliban has decreed that male doctors can not treat women patients unless they are their relatives. Female physicians and nurses have been subjected to beatings by armed Taliban guards who enforce "morals." Male and female doctors are viewed with suspicion by the Taliban and are routinely ridiculed in public. Women are attacked when they venture into the streets to seek medical care for themselves or their children, and a pregnant woman recently delivered her baby in the street while her husband was being beaten for trying to take her to the hospital. This interference with the delivery of healthcare has occurred at a time when many people require treatment for injuries inflicted in connection with the war and when the public utility system has collapsed. Few physicians are willing to discuss the patients they treat for injuries inflicted by the torturous Taliban, especially since some physicians have collaborated with the Taliban in order to avoid reprisals. PMID:9130961
...0720-AB33 TRICARE; Extended CareHealth Option AGENCY: Office of the Secretary...certain benefits under the Extended CareHealth Option (ECHO) from $2,500...outpatient care, comprehensive home healthcare, respite care, and other...
The evolving Chinese cooperative medical system is examined in an effort to gain some valuable knowledge for both the 3rd world and developed countries. The changes occurring in the Chinese health system are the unintended consequences of economic reforms that have exerted direct and indirect effects on the organization, financing, and delivery of healthcare. As China does not publish complete or current information on its healthcare system, the discussion draws on limited published information. China, an agrarian nation, has a population of 1 billion with 80% of the people living in rural areas. A gross national product of US$300/person in 1981 places China in the bottom 1/3 of the developing countries. In 1981 China had 2 hospital beds/1000 people. There are 516,000 senior doctors trained in Western medicine and 290,000 senior doctors trained in traditional Chinese medicine, yielding a ratio of 0.8 senior doctors/1000 people. China also has 436,000 assistant doctors in Western medicine, but most of the primary healthcare is provided by "barefoot doctors." Hospital beds and health personnel are unevenly distributed between the urban and rural areas. Health personnel, health stations, and hospitals are organized on a 3-tier system. In 1980 China inaugurated major economic reforms in agricultural production and public financing. Alterations in the rural economic structure brought about major changes in the Chinese cooperative medical system. The most influential reform provided financial incentives to peasants, who now receive direct rewards for individual output. Because of economic reform, collective financing and public support for the cooperative medical system diminished. The proportion of the rural population protected by the system has been reduced by 50%. The rapid, continuing decline in the cooperative medical system has affected several important elements of healthcare: the number of barefoot doctors per capita has diminished; most barefoot doctors forego continuing education; there has been an increase in the financial burden borne by peasants; and hospitals are experiencing financial problems. With the collapse of cooperative healthcare financing, many barefoot doctors have created private practices, charging patients on a fee for service basis and selling drugs to them. In some brigades, the peasants have organized voluntary health insurance programs, but the peasants face problems in organizing voluntary insurance programs. 1 consequence of the rising income of peasants is their demand for higher quality medical care. The Chinese experience illustrates the effects of economic structure on the supply of health personnel, the demand for services, and the organization and financing of healthcare. Economic incentives affected the supply of health personnel. Another lesson to be learned is the need to establish a universal, compulsory financial system for healthcare. The Chinese experience also demonstrates that the pricing structure influences the demand and need for insurance. PMID:6700690
The HAQ has become the pre-eminent patient questionnaire used in rheumatology. It is easily completed by patients, but not easily reviewed and scored in standard clinical care and has some minor psychometric limitations, as do all questionnaires. Modifications of the HAQ been made to facilitate use in standard care, particularly to include 8-10 activities of daily living, along with scores for pain and global status and other information on one side of one page for rapid review by the clinician. A patient questionnaire for standard care should be limited to 2 sides of 1 page, in a format amenable to "eyeball" review by the clinician in 5 seconds or less. It can be scored formally in 15-20 seconds or less, and is useful in patients with all rheumatic diseases. The current version of a multi-dimensional HAQ (MDHAQ) includes scoring templates on the questionnaire to allow formal scoring in less than 15 seconds by a rheumatologist or an assistant, for possible entry onto a paper and/or computerized flow sheet. Various versions of the MDHAQ may also include a "constant" region of physical function, pain and patient global status, and "variable" regions of fatigue, morning stiffness, psychological distress, change in status, a review of systems, a rheumatoid arthritis disease activity self-report joint count (RADAI), review of recent health events, and review of medications. The MDHAQ can be used in the infrastructure of rheumatology care to include quantitative data in standard care of all patients with all rheumatic diseases. PMID:16273781
This study reports the development of The Hearing Parents' Perceptions of Health Professionals' Advice Questionnaire (HPP/HPQ). This questionnaire was designed to investigate the impact of the advice and information that parents receive from health professionals during the time when their child's hearing loss is identified and how parents, in turn, make initial decisions about services and interventions for their deaf child. Once developed, the HPP/HPQ was partially validated on 2 separate samples. Analysis of data from both samples supported a 14-item questionnaire, with all items loading onto a single composite factor. The implications of how this tool can be used to both help improve health professionals' services and gain an understanding of how the relationship between hearing parents and health professionals might influence developmental outcomes in deaf children are discussed. PMID:23197316
Demographic, economic and humanitarian considerations dictate that effective preventive healthcare be provided to the elderly. A disease-specific approach to geriatric preventive healthcare will not suffice; measures to enhance or maintain physical, mental and social function must also be emphasized. Unfortunately, the effectiveness of many preventive care procedures has not been adequately investigated in the elderly. Research is urgently needed to determine the efficacy of and appropriate target population for various geriatric preventive healthcare measures.
In 1986, the Indian Health Service (IHS) Division of Diabetes developed its first IHS Standards of Care for Diabetes. For over 20 years, these guidelines have helped healthcare professionals provide excellence in diabetes care to American Indians and Ala...
Healthcare delivery in America is not efficient. Hospitals are not efficient and many are still wasteful. Some of the most blatant wastes in hospitals are staffing patterns that developed during the years of cost reports. Spending patterns become the norm, rather than excess, when they continue unabated for years. There are many reasons for cost increases in healthcare and specifically in hospitals. However, it is difficult to make these reasons add up to the total cost increase. No one has the answers; observation can only be made of what has been occurring and what continues to occur. Whatever the reason for the increase in healthcare costs, the consumer will bear the burden because of the circular flow of income and expenditures between the business sector and the household sector. Increased healthcare costs are passed on to the consumer in the form of increased expenditures for household goods and services or taxes. Ford Motor Company President Mr. Peterson says that $1,500 of every new automobile represents employee healthcare costs. The American consumer created the demand for healthcare services, and only the consumer can control the demand. One solution would be to let the consumer bear healthcare costs directly and remove the inefficiencies created by third party insurance carriers. This hypothesizes that the healthcare consumer is the most efficient shopper for healthcare services, and that third party insurance carriers are an important source of inefficiency in the healthcare delivery system. Many other solutions have been proposed by the government and by the insurance and healthcare industries, but most have only increased the cost of healthcare. Perhaps some day the healthcare industry will learn how to control the dynamics of this four-party purchasing decision. Until then, costs will continue to grow dramatically, and the executives of the industries who compete in the two-party purchasing system will wonder why the process is so complicated. PMID:10113388
What is the impact of technology on improving the life situations of people, especially the poor? How is this impact analyzed in terms of health improvements? These questions are paramount in the minds of health planners as they pursue national policies of primary healthcare, a policy popularized by the World Health Organization (WHO) and the United Nations Children's Fund
Cuba's primary healthcare model is presented. Unlike ambulatory care services, which are but one component of primary care, Cuba's model is a comprehensive public health approach that meets the World Health Organization's definition of primary care. The history of the development of Cuba's model is presented, including an update on the innovative neighborhood/home clinics. Achievements in health outcomes as a result of Cuba's model and the consequences for women's healthcare are discussed. Examples are presented of the effects on healthcare delivery of the economic hardship that Cuba has experienced since 1991 as a result of the loss of 85% of its trade with the former Soviet Union and the intensified U.S. embargo. A critique of Cuba's model concludes the article. PMID:7649887
The purpose of this study was to identify and analyze the assistance provided to the elderly by the supplementary healthcare system. Information was collected from interviews with managers of chronic diseases management programs and/or of specific programs in this area. Information was organized in cases and analyzed. Eleven companies operating private health plans in the cities of Rio de Janeiro and Sao Paulo were investigated. A general care model for the elderly was defined for the analysis. This model consists in a proposal for a care and assistance system hierarchically organized according to the deterioration of the functional capacity of the elderly (levels of dependence). None of the six companies that had health plans for the elderly already implemented provided full assistance to all enrolled seniors. There are major differences in the stage of development of their programs. Four companies had already implemented plans and two companies had plans in development. Even with the teams of managers and professionals working on some level within the advocated model, none of these companies followed any logic of integrated care and monitoring in all stages of the ageing process in accordance with the degree of dependence of the associate. PMID:18813610
Ideas for working with 1-year-old children are provided in this staff development module for the caregiver or teacher in a military child care center. Sections of the module describe what "pretoddlers" are like and provide guidelines for facilitating their physical, socioemotional, and language development. The final section discusses health and…
In 1994 the government of Puerto Rico adopted a capitated managed healthcare system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special healthcare needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special healthcare needs in capitated managed healthcare programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special healthcare needs under a capitated managed healthcare system. PMID:11776726
Healthcare professionals and teachers speak of targeting a younger population (children and adolescents) in the need for education about building bone health. West Chester University has one of the largest and most sophisticated Schools of Health and Kinesiology (Physical Education) and is developing students who will be future health teachers throughout America. Very often, graduating students have a difficult
Albert J. Giovenella; Susan M. Repmann; John A. Abruzzo
While disparities in health and healthcare between vulnerable (e.g., minorities, low-income) and majority populations are well documented, less is known about disparities within these special populations that are large and diverse. Such knowledge is essential to determine the neediest within these generally needy populations, and to plan interventions to reduce their health and healthcare disparities. With data from
Cheryl Teruya; Douglas Longshore; Ronald M. Andersen; Lisa Arangua; Adeline Nyamathi; Barbara Leake; Lillian Gelberg
This article uses a pyramid model to illustrate the key components of consumer-directed healthcare. Consumer-directed healthcare is considered the essential strategy needed to lower healthcare costs and is valuable for making significant strides in healthcare reform. Consumer-directed healthcare presents new challenges and opportunities for all healthcare 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