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This article informs about recent research findings on voluntary and mutual aid in the Czech Republic with a special attention paid to formal volunteering in health and social care. The data suggest that public involvement is comparable to middle-frequency experienced in European countries. In this respect, volunteering is higher in the Czech Republic than in other former Eastern European countries and is an evidence of a successful and rapid restoration of the civic sector. New patterns of volunteering featured by planning, coordination, and contracting have spread out being strongly supported by national and EU policy measures. Managerial patterns of volunteering are dominating in health and social care institutions. Volunteering in health and social care is firmly motivated by emotional altruism; however, reciprocal (instrumental) and normative motivations are also present, though to a lesser extent compared to other sectors of volunteer activities. In the managerial pattern of volunteering altruism is balanced with personal gains and benefits for those who volunteer. Volunteering is deeply embedded in a civic, humanitarian paradigm instead of a religious faith and duty. PMID:22966733
This qualitative study was conducted in May-June 2010 with women using post-abortion care (PAC) services provided by the Marie Stopes Society in Pakistan during the six month period preceding the study, more than 70% of whom had been referred to the clinics by reproductive healthvolunteers (RHVs). The aim of the study was to establish the socio-demographic profile of clients, determine their preferred method of treatment, explore their perceptions of the barriers to accessing post-abortion services and to understand the challenges faced by RHVs. The sample women were selected from six randomly selected districts of Sindh and Punjab. Eight focus group discussions were conducted with PAC clients and fifteen in-depth interviews with RHVs. In addition, a quantitative exit interview questionnaire was administered to 76 clients. Medical, rather than surgical, treatment for incomplete and unsafe abortions was preferred because it was perceived to 'cause less pain', was 'easy to employ' and 'having fewer complications'. Household economics influence women's decision-making on seeking post-abortion care. Other restraining factors include objection by husbands and in-laws, restrictions on female mobility, the views of religious clerics and a lack of transport. The involvement of all stakeholders could secure social approval and acceptance of the provision of safe post-abortion care services in Pakistan, and improve the quality of family planning services to the women who want to space their pregnancies. PMID:22652308
Communication skills are as important as vital needs. Healthcare professionals have to be aware of their own communication practices and need to undergo periodic appraisal of the same. Training programmes in communication skills are unfortunately not part of our academic curriculum. The article highlights the need and the overview of such training programmes.
Background Volunteers in Taiwan complement the delivery of health services by paid health professionals. However, in doing so, community healthvolunteers experience burdens associated with their activities. The reasons for these burdens and degree to which they are experienced are explored in this paper. Our study adds to international research regarding the burden experienced by volunteers. This project is the first to assess how community healthvolunteers in Taiwan experience burden. Methods The 20 item Burden on Community HealthVolunteer (BCHV) instrument, specifically designed for this project, was administered to 435 volunteers attached to Community Health Promotion Development Centres in northern Taiwan. Results The overall burden experienced by volunteers is relatively low. However, a multivariate adjusted regression analysis revealed significant differences in volunteer burden depending on the number of people each volunteer served on average per week, as well as the volunteer’s marital status and their perceptions about personal health. Volunteers who served many people and who perceived their own health as poor experienced a higher level of burden. Those who were a widow or a widower felt less burdened than others. Conclusions The results of the study identify areas where burden is high and where strategies can be developed to reduce the level of burden experienced by community healthvolunteers in Taiwan. Community healthvolunteers in Taiwan complement the role of nurses and other healthcare providers so their retention is important to ongoing service delivery.
Introduction The number of people suffering from dementia will increase dramatically in the future, and this will be a great challenge and concern for healthcare services. It is assumed that volunteers will strengthen community healthcare services more in the future than they do today. Aim The aim of this study was to elucidate lived experiences of working as a volunteer in an activity center with adapted activities for home-dwelling people with early stage dementia. Methods Qualitative interviews were implemented in a group of nine female volunteers from an activity center in southern Norway. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method. Results Volunteering in an activity center for home-dwelling people with early stage dementia was reported to provide experiences of being useful and feeling satisfied with performing a good job. It was an advantage for the volunteers to have had experiences from life in general, but also as a health professional or as being the next of kin of a dementia sufferer. It was important for the volunteers to focus on the dementia sufferer and show caring behavior, and interaction with and the appreciation of the healthcare professionals were also important. The volunteers were motivated by being able to have influence and participate in the planning of the work, to be a part of the social setting, and to learn. However, for some volunteers it was difficult to adjust to an appropriate role. Conclusion In order to promote volunteering in a caring context, mutual trust and freedom should be emphasized. Being conscious of important volunteer characteristics like their experiences, knowledge, and caring behavior, as well as a focus on the staff showing appreciation and providing feedback, may be the difference between success and failure.
The activities and the efficacy of college students, housewives, retired people, parents, and patients as mental healthvolunteers and change agents are reviewed in considerable detail. Pertinent activities of such volunteers with disturbed adults and children are considered. It is concluded that the effectiveness of volunteer mental health workers as change agents has been demonstrated, and that volunteers may serve
The project goals and objectives were: (1) the long term goal of this project was to have one volunteer in each of the state's 158 residential care homes, who would visit the homes on a weekly basis, to act as representatives for the program, (2) the proj...
|This booklet gives detailed accounts of mental health programs in operation around the nation. A total of nine different types of activities is included. "Helping Children" describes a program whereby students from nearby colleges give troubled children, at home, an experience in friendship by serving as big brothers or sisters. "Helping the…
National Inst. of Mental Health (DHEW), Bethesda, MD.
The organization and functions of areawide comprehensive health planning (CHP) agencies are described in a manual for volunteer members of small and medium-sized CHP 314(b) agencies. Although the manual can be used in orienting new agency staff members, i...
Background Much of the literature to date concerning public attitudes towards people with severe mental illness (SMI) has focused on negative stereotypes and discriminatory behaviour. However, there also exists a tradition of volunteering with these people, implying a more positive attitude. Groups with positive attitudes and behaviours towards people with SMI have received relatively little attention in research. They merit further attention, as evidence on characteristics and experiences of volunteers may help to promote volunteering. The present paper aims to systematically review the literature reporting characteristics, motivations, experiences, and benefits of volunteers in the care of people with SMI. Methods In November 2010, a systematic electronic search was carried out in BNI, CINAHL, Embase, Medline, PsycINFO, Cochrane Registers and Web of Science databases, using a combination of ‘volunteer’, ‘mental health’ and ‘outcome’ search terms. A secondary hand search was performed in relevant psychiatric journals, grey literature and references. Results 14 papers met the inclusion criteria for the review, with data on a total of 540 volunteers. The results suggest that volunteers are a mostly female, but otherwise heterogeneous group. Motivations for volunteering are a combination of what they can ‘give’ to others and what they can ‘get’ for themselves. Overall volunteers report positive experiences. The main benefit to persons with a psychiatric illness is the gaining of a companion, who is non-stigmatizing and proactive in increasing their social-community involvement. Conclusions The evidence base for volunteers in care of people with SMI is small and inconsistent. However there are potential implications for both current and future volunteering programmes from the data. As the data suggests that there is no ‘typical’ volunteer, volunteering programmes should recruit individuals from a variety of backgrounds. The act of volunteering can not only benefit people with SMI, but also the volunteers. Further research may specify methods of recruiting, training, supervising and using volunteers to maximise the benefit for all involved.
In all, 119 hospice palliative carevolunteers from 3 community-based hospice programs completed the Volunteer Retention Questionnaire (VRQ), a 33-item survey designed for this study. The VRQ asks volunteers to rate the importance of each item to their decision to continue volunteering. The items that received the highest mean importance ratings included enjoying the work they do, feeling adequately prepared/trained to perform their role, and learning from their patients' experiences/listening to their patients' life stories. Being recognized (eg, pins for years of service or being profiled in the hospice newsletter), receiving phone calls/cards from their volunteer coordinator on special occasions, and being reimbursed for out-of-pocket expenses were among the items that received the lowest mean importance ratings. Suggestions for improving volunteer retention are provided. PMID:22811213
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Health-care access for immigrants in the United States is often problematic because of language barriers, lack of health insurance, or differing expectations based on divergent medical systems in the U.S. and the immigrants' home countries. Such difficulties are exacerbated when a linguistic-minority population lives in a rural community that has…
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
We investigate positive effects of volunteering on psychological well-being and self-reported health using all four waves of the Wisconsin Longitudinal Study. Confirming previous research, volunteering was positively related to both outcome variables. Both consistency of volunteering over time and diversity of participation are significantly…
Objectives: As populations age, there will be a need for more volunteers in social welfare, and consequently a need to better understand potential effects of volunteering for older people. Whilst there is a body of international literature exploring health benefits of volunteering in later life, there are currently no longitudinal studies of Australian populations. Internationally, there is a lack of
Lynne Parkinson; Jeni Warburton; David Sibbritt; Julie Byles
... 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 ...
Background Peer education by volunteers may aid attitudinal change, but there is little understanding of factors assisting the preparation of peer educators. This study contributes to conceptual understandings of how volunteers may be prepared to work as peer educators by drawing on an evaluation of a training programme for peer education for advance care planning (ACP). Objectives To report on volunteers’ perspectives on the peer education training programme, their feelings about assuming the role of volunteer peer educators and the community engagement activities with which they engaged during the year after training. To examine broader implications for peer education. Design Participatory action research employing mixed methods of data collection. Participants Twenty-four older volunteers and eight health and social care staff. Data collection methods Evaluative data were gathered from information provided during and at the end of training, a follow-up survey 4 months post-training; interviews and focus groups 6 and 12 months post-training. Findings Volunteers’ personal aims ranged from working within their communities to using what they had learnt within their own families. The personal impact of peer education was considerable. Two-thirds of volunteers reported community peer education activities 1 year after the training. Those who identified strongly with a community group had the most success. Conclusion We reflect on the extent to which the programme aided the development of ‘critical consciousness’ among the volunteers: a key factor in successful peer education programmes. More research is needed about the impact on uptake of ACP in communities.
Seymour, Jane E; Almack, Kathryn; Kennedy, Sheila; Froggatt, Katherine
AIMS: To conduct a quantitative investigation of stress and the relationship with burnout among AIDS carevolunteers. BACKGROUND: Volunteer caregivers experience stress that could lead to burnout. Yet, very few studies quantify stress and its relationship with burnout among AIDS carevolunteers. DESIGN: This study uses a cross-sectional, exploratory survey design. METHODS: Face-to-face interviews were conducted with 126 volunteer caregivers working in 13 semi-rural communities (townships) in Durban, South Africa in April 2009. All participants were women, Christian and with low levels of education. A 22-item instrument was drawn from Pearlin et al.'s role overload and role captivity scales, Van Dyk's stress factor scale and the Maslach Burnout Inventory. RESULTS: Most of the volunteers had moderate-to-high levels of stress. 'Role/work overload' 'lack of support' and 'overwhelming nature of the disease' explained most of the variance in stress. Volunteers' age and number of patients in their care were predictors of stress. Caring for only AIDS patients, lack of support, stress emanating from perceived stigma and lack of training; and the overwhelming nature of AIDS were predictors of burnout. CONCLUSION: High levels of stress could negatively impact volunteers' health and well-being and on-the-job performance. Policy makers must develop and fund home-based care models that take into account the stressors associated with AIDS care, by reducing the work load, providing ongoing psychosocial support and recruiting nurses to assist volunteers. The small non-probability sample used in this study highlights the need to treat the findings with caution. PMID:23683176
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\\u000a In recent decades, there has been a burgeoning interest in the study of volunteering, and the number of publications devoted\\u000a to volunteering has grown exponentially. In this chapter, we examine emerging theories and new directions in volunteering\\u000a research. First, we discuss multi-level perspectives that try to understand volunteering in complex interaction with the organizational\\u000a and institutional context. Next, we present
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 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.
In Taiwan, volunteers of each Community Health Promotion Development Centres help to diffuse healthy lifestyle education and complement the paid workforce, especially community nurses. An interpretive, descriptive qualitative design, using focus groups, was conducted to explore the burden experienced by community healthvolunteers in Taiwan. The data were analyzed inductively, and emergent themes were explored. The majority of participants were female between 50 and 59 years old with an average of 4.5 years experience as a volunteer. Thematic analysis resulted in four themes: preparation and scope of practice, lack of support for the role, work overload and expectations of the role. Volunteers in Taiwan do not always have the necessary skills to care for their clientele because of an inadequate programme of orientation, lack of continuing education and support for the role, role overload and expectations placed upon them by the clients and others. PMID:23432892
Gau, Yueh-Mei; Usher, Kim; Stewart, Lee; Buettner, Petra
Volunteer service opportunities for older adults may soon be expanded. Although volunteering is thought to provide health benefits for healthier older adults, it is not known whether older adults in less than very good health are suitable candidates for high-intensity volunteering and can derive health benefits. This manuscript presents a prospective analysis of 174 older adult volunteers serving in Experience Corps Baltimore, a high-intensity senior volunteer program in Baltimore, Maryland. Volunteers served > or =15 h per week, for a full school year, in elementary schools helping children with reading and other skills between 1999 and 2002. Volunteers were assessed with standardized questionnaires and performance-based testing including grip strength, walking speed, chair stand speed, and stair-climbing speed prior to school volunteering and at the end of the school year. Results were stratified by health status. Among 174 volunteers, 55% initially reported "good" and 12% "fair" or "poor" health status. At baseline, those in fair health reported higher frequencies of disease and disability than volunteers in excellent or very good health. After volunteering, a majority of volunteers in every baseline health status category described increased strength and energy. Those in fair health were significantly more likely to display improved stair-climbing speed than those in good or excellent/very good health (100.0% vs. 53.4% vs. 37.5%, p = 0.05), and many showed clinically significant increases in walking speed of >0.5 m/s. Satisfaction and retention rates were high for all health status groups. Clinicians should consider whether their patients in fair or good health, as well as those in better health, might benefit from high-intensity volunteer programs. Productive activity such as volunteering may be an effective community-based approach to health promotion for older adults. PMID:19488860
Barron, Jeremy S; Tan, Erwin J; Yu, Qilu; Song, Meilin; McGill, Sylvia; Fried, Linda P
We conducted focus group interviews with students who were current peer health educators at a mid-sized university to determine what factors motivate individuals to volunteer for a peer health education program. Specifically, we asked the participants questions designed to explore their life experiences, their expectations of the peer education program, and their motivations. Constructs from social learning theory were used
|Purpose: This study tested the hypothesis that volunteering in environmental organizations in midlife is associated with greater physical activity and improved mental and physical health over a 20-year period. Design and Methods: The study used data from two waves (1974 and 1994) of the Alameda County Study, a longitudinal study of health and…
Pillemer, Karl; Fuller-Rowell, Thomas E.; Reid, M. C.; Wells, Nancy M.
Dental NGOs and volunteers working in disadvantaged communities around the world do so with the best of intentions and with high motivation. Regrettably, the impact of this engagement on oral health at the population level remains rather low. This is mainly due to the choice of inappropriate approaches, the failure to integrate their projects within existing healthcare systems and
Since 1989, St. Elizabeth Hospital Medical Center, Youngstown, OH, has been conducting a hospital-based, multidenominational volunteer parish nurse program, which now extends to 11 Roman Catholic, Lutheran, Presbyterian, Methodist, Jewish, and Greek Orthodox congregations. Seventeen volunteer nurses are involved, responding to needs within their congregations by providing a variety of healthcare and educational services while revitalizing the Church's healing ministry. Volunteers selected are competent, experienced registered nurses who can relate to and communicate with people of all ages, accurately assess health-related problems, and make appropriate nursing decisions. Parish nurses focus on preventive care, health maintenance, and personal responsibility for maintaining a healthy life-style. Volunteer nurses determine their own schedule, contributing as much time as they can. Each volunteer nurse is responsible for developing a record-keeping system, documenting his or her parish activities, and submitting a quarterly report of volunteer hours and activities to the hospital. Hospital supports include the initial two-day orientation; monthly meetings at the hospital for information sharing, education, and mutual support; and nursing continuing education programs In addition, an advisory committee provides program support and education. St. Elizabeth Hospital Medical Center is exploring several methods of enhancing its health ministry outreach to congregations in dire need of such services. PMID:10118339
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.
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…
Massachusetts Bays Estuary Program expressed a need to better assess and monitor the health of their saltmarshes. By training citizen volunteers in the methodologies of saltmarsh bioassessment, Mass Bays saw the additional opportunity to engage the public in their estuary protec...
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Healthcare professionals usually receive professional education in ethics, but the half million hospice volunteers in the United States may receive only brief training that is limited to confidentiality and the volunteer role. The purpose of this study was to explore ethical issues hospice volunteers confront in their work. Interviews with 39 hospice volunteers were conducted, audio recorded, transcribed, and
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...
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
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
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
This pilot study explored the effect that respite care training had on volunteers' knowledge about Alzheimer's disease (AD), their attitudes toward the cognitively impaired, and their self-esteem. Volunteer respite providers (n = 52) were recruited and participated in four different day (seven-hour) respite care training programs. The sample was predominantly female (85 percent) and white (90 percent). Knowledge about AD
Karen M. Robinson; Kay F. Kiesler; Stephen W. Looney
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 ...
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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
|Reports on the development and implementation of an in-home respite program using trained volunteers to provide at-home companionship and supervision for frail elderly persons while family members are absent. Project RENEW volunteers and families are described, and a discussion of difficulties and future directions is presented. (Author)|
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).
Particle exposure is known to have negative health effects. In Stockholm the environment in the subway has been reported to have higher particle exposure levels, measured as PM(2.5) and PM(10), than roads with intense traffic in the inner city area. We have recently shown that healthy volunteers exposed to subway environment had statistically significant increase of fibrinogen and CD4 cells expressing regulatory T-cell marker CD25(bright)/FOXP3 in blood. The aim of the present study was to find out whether a more vulnerable population, asthmatics, would demonstrate similar or other changes in the lungs or in the peripheral blood. Sixteen mild asthmatics were exposed to a subway and a control environment for 2 h while being monitored by measurements of lung function, and inflammatory response in the lower airways evaluated by bronchoscopy and in peripheral blood. An attempt to standardize the exposures was done, by letting the volunteers alternate 15 min intervals of moderate exercise on a bicycle ergometer with 15 min of rest. We found a statistically significant increased frequency of CD4 cells expressing T-cell activation marker CD25 in bronchoalveolar lavage fluid, but no significant increase of regulatory T-cells in blood as was found in healthy volunteers. Our study shows that airway inflammatory responses after exposure in subway environment differ between asthmatic and healthy humans. PMID:21996054
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…
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
:Healthcare reform presents both challenges and opportunities for African Americans. On the one hand, reform could result in the closure of black medical institutions and fewer black physicians. On the other hand, reform gives African Americans an opportunity to bargain for available resources to gain equality in healthcare services. To this end, the Volunteer State Medical Association has
Healthcare reform presents both challenges and opportunities for African Americans. On the one hand, reform could result in the closure of black medical institutions and fewer black physicians. On the other hand, reform gives African Americans an opportunity to bargain for available resources to gain equality in healthcare services. To this end, the Volunteer State Medical Association has
|Objective: In many parts of Uganda, the demand for health education is greater than the conventional health sector can provide and community health education volunteers fill the gap. Using two case study non government organizations (NGOs) that heavily rely on volunteers as health educators, this article shows the problems of unsystematic…
\\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
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
Volunteers can contribute a great deal to people receiving health or social care. Some of the quirky activities they offer are contact with owls and the provision of arts and crafts materials. PMID:19323106
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
Objective To describe and categorize contextual information relevant to patients’ medical care unexpectedly volunteered to research personnel as part of a patient advocate intervention to facilitate access healthcare, communication with medical personnel, and self-management of a chronic disease like asthma. Methods We adapted a patient navigator intervention, to overcome barriers to access and communication for adults with moderate or severe asthma. Informed by focus groups of patients and providers, our Patient Advocates facilitated preparation for a visit with an asthma provider, attended the visit, confirmed understanding, and assisted with post-visit activities. During meetings with researchers, either for PA activities or data collection, participants frequently volunteered personal and medical information relevant for achieving successful self-management that was not routinely shared with medical personnel. For this project, researchers journaled information not captured by the structured questionnaires and protocol. Using a qualitative analysis, we describe 1) researchers’ journals of these unique communications, 2) their relevance for accomplishing self-management, 3) Patient Advocates’ formal activities including teach-back, advocacy, and facilitating appointment-making, and 4) observations of patients’ interactions with the clinical practices. Results In 83 journals, patients’ social support (83%), health (68%), and deportment (69%) were described. Patient Advocate assistance with navigating the medical system (59%), teach-back (46%), and observed interactions with patient and medical staff (76%) were also journaled. Implicit were ways patients and practices could overcome barriers to access and communication. Conclusions These journals describe the importance of seeking contextual and medically relevant information from all patients and especially those with significant morbidities, prompting patients for barriers to accessing care, and confirming understanding of medical information.
Black, Heather L.; Priolo, Chantel; Gonzalez, Rodalyn; Geer, Sabrina; Adam, Bariituu; Apter, Andrea J.
|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…
|Collaboration between a private home health agency and public volunteer agency (the Senior Companions Program) was evaluated through interviews, site visits and questions. Volunteers were highly valued and important to the organization despite additional administration and training burdens. It was a cost-effective way to expand community-based…
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.
|The positive association between volunteering and health has been widely interpreted as evidence of the salutary effect of volunteering during adulthood. Using three waves of data from a national survey, this study uses structural equation models to examine the relationships among volunteering, functional limitations, and depressive symptoms…
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.
A Health Needs Assessment project was undertaken in 1999 for The Royal New Zealand Plunket Society (Inc.), a voluntary community organisation that provides child and family health promotion to 50,000 new babies each year nationwide. Specially qualified registered nurses, community workers and volunteers deliver the service that includes home visiting as part of universal healthcare. The aims were to
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
Doulas, women who primarily provide social support during childbirth, have been associated with a number of positive health outcomes. Because the primary model of practice for doulas is a fee-for-service model in which families privately hire a doula, many expectant women who could benefit from doula support are unable to access the service. The Doulas Care program, located in Ann Arbor, Michigan, represents one model in which doulas provide services without charge. As a result of their extended role in the community, doulas who work with the Doulas Care program have unique educational needs. Through the use of focus groups with the program's volunteer doulas, educational needs related to overcoming barriers to being a doula working in the community were identified. Recommendations for education and training are made to improve the support doulas offer as community health outreach workers.
Citizen science monitoring programs in the marine environment frequently focus on volunteer collected data precision for conservation and resource use of marine biota. Few studies have examined the social science aspects of volunteer engagement in marine monitoring programs in a quantifiable manner. This research focuses on emotional attitudes of Sea Search volunteers who monitor Marine National Parks and Marine Sanctuaries
Environmental particle exposure, often estimated as the particulate mass of particles with a diameter <10 microm, <2.5 microm or <1 microm (PM(10), PM(2.5) or PM(1)), is known to have a negative impact on the health of the population. Little is known about how the size and origin of particles influence the effects. We have previously shown that exposure to a road tunnel environment causes a cellular inflammatory response in the airways of healthy individuals. In the present study, our aim was to investigate potential airway health effects from exposure to a subway environment. 20 healthy volunteers were exposed to a subway and a control environment for 2 h, followed by measurements of lung function and the inflammatory response in the lower airways (bronchoscopy) and in the peripheral blood. No cellular response was found in the airways after exposure to the subway environment. In the blood, we found a statistically significant increase in fibrinogen and regulatory T-cells expressing CD4/CD25/FOXP3. Subway and road tunnel environments have similar levels of PM(10) and PM(2.5), whilst the concentrations of ultrafine particles, nitrogen monoxide and dioxide are lower in the subway. Although no cellular response was detected, the findings indicate a biological response to the subway environment. Our studies show that using gravimetric estimates of ambient particulate air pollution alone may have clear limitations in health-risk assessment. PMID:20032018
Klepczy?ska Nyström, A; Svartengren, M; Grunewald, J; Pousette, C; Rödin, I; Lundin, A; Sköld, C M; Eklund, A; Larsson, B-M
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
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
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
Objective To assess the role of management practices for acute respiratory infections (ARIs) in improving the competency of community healthvolunteers in diagnosing and treating acute respiratory infections among children. Methods Data were collected by a group of research physicians who observed the performance of a sample of 120 healthvolunteers in 10 sub-districts in Bangladesh in which Bangladesh Rural
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...
|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…
A total of 79 hospice palliative carevolunteers from 2 community-based hospice programs responded to a 27-item Boundary Issues Questionnaire that was specifically developed for this study. Volunteers were asked to indicate whether or not they considered each item (eg, "Lend personal belongings to a patient or family," "Agree to be a patient's power of attorney," "Attend/go into a patient's medical appointment") to be something they should not do and to indicate whether or not they have ever done it. On the basis of the volunteers' responses, the authors distinguished between "definite boundary issues" (things volunteers should never do, for example, "Accept money from a patient or family"), "potential boundary issues" (things volunteers should stop and think twice about doing, for example, "Accept a gift from a patient or family"), and "questionable boundary issues" (things volunteers should be aware of doing, for example, "Give your home phone number to a patient or family"). The implications of these findings for training volunteers are discussed and the need for clear and unambiguous organizational policies and procedures to preserve boundaries is stressed. Without clear policies, etc, community-based hospice programs may be putting themselves at legal risk. PMID:21317131
As part of an Australian national project, quantitative data via a survey were retrospectively obtained from 327 Australian\\u000a healthcare chaplains (staff and volunteer chaplains) to initially identify chaplaincy participation in various bioethical\\u000a issues—including organ procurement. Over a third of surveyed staff chaplains (38%) and almost a fifth of volunteer chaplains\\u000a (19.2%) indicted that they had, in some way, been
Lindsay B. Carey; Priscilla Robinson; Jeffrey Cohen
|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
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
Healthcare professionals usually receive professional education in ethics, but the half million hospice volunteers in the United States may receive only brief training that is limited to confidentiality and the volunteer role. The purpose of this study was to explore ethical issues hospice volunteers confront in their work. Interviews with 39 hospice volunteers were conducted, audio recorded, transcribed, and analyzed using qualitative methods. Prominent themes were dilemmas about gifts, patient care and family concerns, issues related to volunteer roles and boundaries, and issues surrounding suicide and hastening death. Suggestions for training include discussions of ethics after initial training once volunteers had confronted ethical issues, with special emphasis on strategies for negotiating their uneasy role positioned between healthcare professional and friend. PMID:19106279
The 2008 food crisis may have increased household food insecurity and caused distress among impoverished populations in low-income countries. Policy researchers have attempted to quantify the impact that a sharp rise in food prices might have on population wellbeing by asking what proportion of households would drop below conventional poverty lines given a set increase in prices. Our understanding of the impact of food crises can be extended by conducting micro-level ethnographic studies. This study examined self-reported household food insecurity (FI) and common mental disorders (CMD) among 110 community health AIDS carevolunteers living in Addis Ababa, Ethiopia during the height of the 2008 food crisis. We used generalized estimating equations that account for associations between responses given by the same participants over 3 survey rounds during 2008, to model the longitudinal response profiles of FI, CMD symptoms, and socio-behavioral and micro-economic covariates. To help explain the patterns observed in the response profiles and regression results, we examine qualitative data that contextualize the cognition and reporting behavior of AIDS carevolunteers, as well as potential observation biases inherent in longitudinal, community-based research. Our data show that food insecurity is highly prevalent, that is it associated with household economic factors, and that it is linked to mental health. Surprisingly, the volunteers in this urban sample did not report increasingly severe FI or CMD during the peak of the 2008 food crisis. This is a counter-intuitive result that would not be predicted in analyses of population-level data such as those used in econometrics simulations. But when these results are linked to real people in specific urban ecologies, they can improve our understanding of the psychosocial consequences of food price shocks. PMID:20189698
The 2008 food crisis may have increased household food insecurity and caused distress among impoverished populations in low-income countries. Policy researchers have attempted to quantify the impact that a sharp rise in food prices might have on population wellbeing by asking what proportion of households would drop below conventional poverty lines given a set increase in prices. Our understanding of the impact of food crises can be extended by conducting micro-level ethnographic studies. This study examined self-reported household food insecurity (FI) and common mental disorders (CMD) among 110 community health AIDS carevolunteers living in Addis Ababa, Ethiopia during the height of the 2008 food crisis. We used generalized estimating equations that account for associations between responses given by the same participants over 3 survey rounds during 2008, to model the longitudinal response profiles of FI, CMD symptoms, and socio-behavioral and micro-economic covariates. To help explain the patterns observed in the response profiles and regression results, we examine qualitative data that contextualize the cognition and reporting behavior of AIDS carevolunteers, as well as potential observation biases inherent in longitudinal, community-based research. Our data show that food insecurity is highly prevalent, that is it associated with household economic factors, and that it is linked to mental health. Surprisingly, the volunteers in this urban sample did not report increasingly severe FI or CMD during the peak of the 2008 food crisis. This is a counter-intuitive result that would not be predicted in analyses of population-level data such as those used in econometrics simulations. But when these results are linked to real people in specific urban ecologies, they can improve our understanding of the psychosocial consequences of food price shocks.
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 study examined the demographic and psychological characteristics of the parents of a group of children with no access to healthcare, due to their status as "working poor" and thus denied either public or private health insurance whose children were referred for treatment for an acute health problem by a volunteerhealthcare program for…
Tinsley, Barbara J.; Wang, Shirley J.; Kwasman, Alan; Green, Delores
|Previous studies have established a positive association between organizational volunteering and well-being. In the current study, we examined whether the relations between organizational volunteering and positive affect, negative affect, and resilience are modified by respondents' age and number of chronic health conditions. This study used…
Okun, Morris A.; Rios, Rebeca; Crawford, Aaron V.; Levy, Roy
Previous studies have established a positive association between organizational volunteering and well-being. In the current study, we examined whether the relations between organizational volunteering and positive affect, negative affect, and resilience are modified by respondents' age and number of chronic health conditions. This study used…
Okun, Morris A.; Rios, Rebeca; Crawford, Aaron V.; Levy, Roy
:This volunteer-based community health advisory program illustrated the benefits of using focus groups to monitor and guide program development. Three focus groups, conducted by program evaluators, obtained input regarding the role of community volunteers. Focus group findings confirmed some of the assumptions held by program developers but refuted others. For example, prospective community participants and program developers were found to
This volunteer-based community health advisory program illustrated the benefits of using focus groups to monitor and guide program development. Three focus groups, conducted by program evaluators, obtained input regarding the role of community volunteers. Focus group findings confirmed some of the assumptions held by program developers but refuted others. For example, prospective community participants and program developers were found to
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
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
Having reversed its pronatalist policies in 1988, the Islamic Republic of Iran implemented one of the most successful family planning programs in the developing world. This achievement, particularly in urban centers, is largely attributable to a large women-led volunteerhealth worker program for low-income urban neighborhoods. Research in three cities demonstrates that this successful program has had a host of unintended consequences. In a context where citizen mobilization and activism are highly restricted, volunteers have seized this new state-sanctioned space and successfully negotiated many of the familial, cultural, and state restrictions on women. They have expanded their mandate from one focused on health activism into one of social, if not political, activism, highlighting the ways in which citizens blur the boundaries of state and civil society under restrictive political systems prevalent in many of the Middle Eastern societies. PMID:20882703
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
A group from Texas Oncology and Baylor Charles A. Sammons Cancer Center traveled to Huę´, Vietnam, as part of HealthVolunteers Overseas. From February 21 to March 6, 2012, five Baylor Sammons medical oncologists and an oncology nurse worked with a medical oncologist and a surgeon at the Huę´ College of Medicine and Pharmacy, suggesting approaches based on available resources. The two groups worked together to find optimal solutions for the patients. What stood out the most for the Baylor Sammons group was the Huę´ team's remarkable work ethic, empathy for patients, and treatment resourcefulness. The Baylor Sammons group also identified several unmet needs that could potentially be addressed by future volunteers in Huę´, including creation of an outpatient hospice program, establishment of breast cancer screening, modernization of the pathology department, instruction in and better utilization of pain management, better use of clinic space, and the teaching of oncology and English to medical students. There was a mutual exchange of knowledge between the two medical teams. The Baylor Sammons group not only taught but also learned how to take good care of patients with limited resources.
Denham, Claude A.; Osborne, Cynthia R.; Green, Nathan B.; Divers, Josephine; Pippen, John E.
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.
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...
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.
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…
This article reviews the literature on mental health of volunteers after working in disasters. When mobilized they often are a community's major source for rescue and recovery. PsychINFO, PubMED, and Web of Science were searched for relevant articles published until October 2009. Of 448 articles screened, only 9 articles fulfilled our inclusion criteria. They examined the aftermath of earthquakes (4 articles), terrorist bombings (1), explosions (1), aviation disasters (1), tsunami (1), and a bus accident (1).Findings showed that, compared with professional workers, volunteers tend to have higher complaint levels. The following factors were found to contribute to mental health complaints of volunteers: Identification with victims as a friend, severity of exposure to gruesome events during disaster work, anxiety sensitivity, and lack of postdisaster social support. The review reveals the need for more research regarding predictors of stress in volunteers. PMID:20699716
Thormar, Sigridur Bjork; Gersons, Berthold Paul Rudolf; Juen, Barbara; Marschang, Adelheid; Djakababa, Maria Nelden; Olff, Miranda
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
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
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
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
ObjectivesBetter management of chronic conditions is a challenge for public health policy. The Expert Patients Programme was introduced into the United Kingdom to improve self-care in people with long-term conditions. To deliver self-care courses, the programme relies on the recruitment and continued commitment to delivering the courses of volunteer lay tutors who have long-term conditions. Ensuring the tutor workforce is
Wendy Macdonald; Evangelos Kontopantelis; Peter Bower; Anne Kennedy; Anne Rogers; David Reeves
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 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
In order to guarantee an effective and punctual medical intervention to injured people involved in health emergency situations, where usually both professional and non-professional health operators are involved, a fast and accurate treatment has to be carried out. In case of catastrophic or very critical situations, non-professional operators who did not receive proper training (volunteers are among them) could be affected by psychological inhibitions. Their performances could slow down in such way that would affect the quality of the treatment and increase both direct and indirect costs. Our virtual reality system that is currently in use at the healthcare emergency center of San Martino Hospital in Genoa, Italy, has been designed and developed to check health emergency operators' capabilities to adopt correct decision-making procedures, to make optimal use of new technological equipment and to overcome psychological barriers. Our system is composed of (1) a high-end simulation PC, whose main functions are execution of the main software module, rendering of 3D scenes in stereo mode, rendering of sound, and control of data transmission from/to VR devices; (2) a low-end control PC, which controls the VR simulation running on the simulation PC, manages medical emergency simulation scenarios, introduces unexpected events to the simulation and controls the simulation difficulty level; (3) a magnetic-based motion tracking device used for head and hand tracking; (4) a wireless pair of shutter glasses together with a cathode ray tube wall projector; and (5) a high-end surround sound system. The expected benefits have been verified through the design and implementation of controlled clinical trials. PMID:12855082
De Leo, Gianluca; Ponder, Michal; Molet, Tom; Fato, Marco; Thalmann, Daniel; Magnenat-Thalmann, Nadia; Bermano, Francesco; Beltrame, Francesco
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
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
This publication has been designed to help nurses, teachers, volunteers, health administrators, social workers, and other individuals in the community in improving dental care instruction for the children in a community dental care program. The publication is based on the premise that availability of dental care services does not necessarily…
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.
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...
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
|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…
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
Volunteers monitor watershed health in more than 700 programs in the US, involving over 400,000 local stakeholders. New Mexico Watershed Watch is a student-based watershed monitoring program sponsored by the state's Department of Game and Fish which provides high school teachers and students with instruction on methods for water quality…
Purpose: We examined the feasibility of creating a generic training curriculum for volunteers in health promotion programs for older adults by identifying common core content topics across 10 national programs. We also considered additional material that could augment common core content topics. Design and Methods: We reviewed in detail program…
Schneider, Ellen C.; Altpeter, Mary; Whitelaw, Nancy
Purpose: We examined the feasibility of creating a generic training curriculum for volunteers in health pro- motion programs for older adults by identifying common core content topics across 10 national programs. We also considered additional material that could augment common core content topics. De- sign and Methods: We reviewed in detail program manuals and associated materials from 10 national evidence-based
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
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.…
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
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...
... 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 ...
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
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)
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
|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...
|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
The community health worker (CHW) model has been successfully used to promote health and reduce adverse health outcomes in under-served communities. Although there is a general consensus that involvement of natural helpers from the targeted communities is a promising approach in the elimination of health disparities, there is less agreement on their responsibilities, scope of work, and reimbursement for their services (ranging from paid staff to unpaid volunteers). These differences in pay structure stem from philosophical differences, programmatic needs, and financial realities. Based on our experience with both the paid and volunteer approaches, we provide some lessons learned on how the CHW model can be integrated in our efforts to eliminate health disparities.
Cherrington, Andrea; Ayala, Guadalupe X.; Elder, John P.; Arredondo, Elva M.; Fouad, Mona; Scarinci, Isabel
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
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
The adoption of the law "About foundations of population healthcare in the Russian Federation" in absence of concept of healthcare development 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
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
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
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
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 ...
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
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 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
\\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
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
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
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...
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 \\
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As part of an Australian national project, quantitative data via a survey were retrospectively obtained from 327 Australian healthcare chaplains (staff and volunteer chaplains) to initially identify chaplaincy participation in various bioethical issues-including organ procurement. Over a third of surveyed staff chaplains (38%) and almost a fifth of volunteer chaplains (19.2%) indicted that they had, in some way, been involved in organ procurement issues with patients and/or their families. Nearly one-fifth of staff chaplains (19%) and 12% of volunteer chaplains had also assisted clinical staff concerning various organ procurement issues. One hundred of the surveyed chaplains volunteered to an interview. Qualitative data were subsequently coded from 42 of the chaplains who had been involved in organ procurement requests. These data were thematically coded using the World Health Organization 'Pastoral Intervention Codings' (WHO-PICs). The qualitative data revealed that through a variety of pastoral interventions a number of chaplains (the majority being staff chaplains) were engaged in the critical and sensitive issues of organ procurement. It is argued that while such involvement can help to ensure a holistic and ethically appropriate practice, it is suggested that chaplains could be better utilized not only in the organ procurement process but also for the training of other chaplains and clinicians. PMID:19728096
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
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.
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
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.
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
|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…
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…
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
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
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…
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 healthcare development 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 healthcare development are described. PMID:2121182
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…
Project Access provides free primary and specialty care for low-income uninsured residents of Buncombe County, NC through\\u000a a physician volunteer network. In 2010, we replicated a 1998 study investigating health issues among Project Access (PA) patients.\\u000a Over 300 patients enrolled in PA in 2009 were surveyed by telephone. Currently, as compared to 1998, fewer patients were employed\\u000a (31% vs. 44.2%,
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...
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.
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
|This study found that the satisfaction of one state's largely older volunteers' altruistic, affiliation, and self-improvement motives corresponded to increased organizational loyalty and better performance across several dimensions. Younger volunteers served for shorter periods and were more highly motivated by the "self-improvement" need.…
Nelson, H. Wayne; Hooker, Karen; DeHart, Kimberly N.; Edwards, John A.; Lanning, Kevin
|It is the position of the National Association of School Nurses (NASN) that quality healthcare within the school environment can best be attained through the employment of a full-time registered professional school nurse (hereinafter referred to as school nurse) for each school building. The health services needed by students at school continue…
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
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 \\
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
This article reviews the challenges healthcare systems face as they attempt to improve healthcare outcomes for children in foster care. It discusses several of the promising healthcare strategies occurring outside the perimeter of child welfare and identifies some of the key impasses in working alongside efforts in child welfare reform. The authors posit that the greatest impasse in establishing a reasonable quality of healthcare for these children is placement instability, in which children move frequently among multiple homes and in and out of the child welfare system. The authors propose potential strategies in which efforts to improve placement stability can serve as a vehicle for multidisciplinary reform across the healthcare system. PMID:19358924
The evolution of healthcare in America had its beginnings even before the founding of the nation. This article divides the evolution of American healthcare into six historical periods: (1) the charitable era, (2) the origins of medical education era, (3) the insurance era, (4) the government era, (5) the managed care era, and (6) the consumerism era. PMID:19038631
Home healthcare (HHC) is a regulated program of care delivered by a multidisciplinary team in the patient’s home. It is of high demand in Saudi Arabia; however there are shortages in healthcare personnel. Moreover, current internship programs do not address the concepts and unique skills involved in HHC practice. The purpose of this article is to present a
As attention is increasingly devoted to U.S. society's needs for access to healthcare and healthcare delivery, one change that requires immediate attention concerns the many aspects of care that are migrating out of formal medical facilities and into th...
The research project is an extension of the economic theory to the healthcare field and healthcare research projects evaluating the influence of demand and supply variables upon medical care inflation. The research tests a model linking the demographic and socioeconomic characteristics of the population, its community case mix, and technology, the prices of goods and services other than
This article describes the patterns of healthcare service use among a cohort of vulnerable adolescents with a history of homelessness and uses the Expanded Behavioral Model for Vulnerable Populations to examine factors associated with use of ambulatory and emergent care. We incorporated a healthcare interview into an existing longitudinal study of newly homeless adolescents, at their 24-month assessment
M. Rosa Solorio; Norweeta G. Milburn; Ronald M. Andersen; Sharone Trifskin; Lillian Gelberg
Twenty-seven projects for the development of interdisciplinary geriatric curricula were supported by the Health Resources Administration's Bureau of Health Professions in fiscal 1979. A variety of clinical training sites were used (e.g., university gerontology centers, VA medical centers, senior citizen facilities, adult healthcare centers), and innovative teaching approaches were developed. For example, a combined medical/dental/optometry clinic is conducted by students at the three professional schools; medical students accompany volunteers serving Meals on Wheels; and dental students treat patients in nursing homes in a mobile dental unit. Students have gained insights into the problems of the elderly and the roles of other health professionals through the interdisciplinary-team training courses. Nurse-practitioner programs to prepare nurses to provide primary healthcare to the elderly were also supported by the Bureau, as were special projects to develop short-term in-service basic training programs for nurses' aides and orderlies in nursing homes, to upgrade the skills of the paraprofessionals who care for the elderly. In other projects, the geriatric educational needs of pharmacy students were assessed, and dental schools promoted remote-site training to improve access to dental care for the elderly. PMID:7056985
Abstract Amid tremendous changes in contemporary healthcare stimulated by shifts in social, economic and political environments, healthcare managers are challenged to provide new structures and processes to continually improve health service delivery. The general public and the media are becoming less tolerant of poor levels of healthcare, and healthcare professionals need to be involved and supported to bring about positive change in healthcare. Appreciative inquiry (AI) is a philosophy and method for promoting transformational change, shifting from a traditional problem-based orientation to a more strength-based approach to change, that focuses on affirmation, appreciation and positive dialog. This paper discusses how an innovative participatory approach such as AI may be used to promote workforce engagement and organizational learning, and facilitate positive organizational change in a healthcare context. PMID:24099230
The American healthcare system is experiencing a period of unprecedented change. This paper identifies and discusses the major changes in patient care, research, control of the healthcare system, and medical education, and their implications for health sciences librarians. These changes have resulted in new demands for effective information delivery and a broader health sciences library clientele. There are both challenges and opportunities for health sciences librarians as they respond to information pressures of the current healthcare environment and anticipate future needs.
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, healthcare professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Healthcare professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Healthcare workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners. PMID:22390510
The author discusses historical factors contributing to the healthcare crisis in America and reasons for the skyrocketing costs of health using an analogy of David versus Goliath. Even though Americans spend trillions on healthcare, the author states that America is ranked 37th in the world in terms of its healthcare delivery system. The author uses the methods used to manage the healthcare system in discussing how such a system could impact higher education and offers some solutions to same. PMID:17252876
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
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
Aims: The aim of the current study was to explore the extent of knowledge healthcare providers working in primary healthcare units in Aydin, Turkey, had about emergency contraception (EC), to determine whether they provide EC counseling, and to understand the barriers and misconceptions in this context. Methods: A total of 120 healthcare professionals working in primary health
Reviews foster child health and the legal background for policy. Discusses components of a comprehensive child healthcare supervision program. Lack of continuity of care and lack of health information about foster children at time of intake are regarded as major problems contributing to high risk. (NH)
The aim of this article is to propose some of the most important capabilities and technical achievements of medical and health-care robotics needed to improve human health and well-being. The paper describes application areas, societal drivers, motivating scenarios, desired system capabilities, and fundamental research areas that should be considered in the design of medical and health-care robots.
ALLISON M. OKAMURA; MAJA J. MATARIC; HENRIK I. CHRISTENSEN
Physicians and the public are becoming uneasy, if not hostile, toward the idea of healthcare marketing [1, 2, 5, 7, 12, 24, 37]. Yet virtually everyone agrees that certain aspects of managing the practice of medicine and the other health professions\\u000a belong to the realm of business -that health and medical care share certain similarities with other services and
This paper examines the notion that, in the modern world, a just community will find it necessary to supply a decent minimum of health-care as well as a decent minimum of other basic needs to its members. The argument that health-care is an obligation of the just community is made by examining concepts of health, and the natural lottery as
|Discusses research and interventions related to family healthcare. Topics include health promotion; risk behaviors; vulnerability and illness onset; choosing healthcare systems; stress; caregiving and coping; family counseling; and family responses to Alzheimer's Disease, pediatric cancer, cystic fibrosis, diabetes, and obesity. (JAC)|
Doherty, William J., Ed.; McCubbin, Hamilton I., Ed.
This article reviews current data relevant to the healthcare status of elderly Native Americans, a population cohort encompassing American Indians and Alaskan Natives/Aleutians. Several topics are addressed, including the history of Native American health policy, heart disease, diabetes mellitus, cancer, oral health, nutrition, long-term care, and the circumstances of urban Native American elders. PMID:7720023
This paper re-examines the relation between the predictability of healthcare spending and incentives due to adverse selection. Within an explicit model of health plan decisions about service levels, we show that predictability (how well spending on certain services can be anticipated), predictiveness (how well the predicted levels of certain services contemporaneously co-vary with total healthcare spending), and demand
Discusses the lack of commitment by the US as a nation to ensure that high-quality mental healthcare will be provided to all who are in need. The mental health benefits under Medicare and Medicaid programs are meager at best. Psychologists and other nonphysician healthcare providers are not considered bona fide professionals. Prevention, program evaluation efforts, and the use
An assessment of healthcare expenditures in 1973 by residents of Vermont is provided. In 1973, Vermonters spent $460 per capita for healthcare, a three-fold increase since 1960. The residents of Vermont spend 40 percent more of their income on health th...
This study, using Andersen's healthcare utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence healthcare utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…
Medically fragile children are part of a growing population of children with special healthcare needs (CSHCN) who are dependent on technology for survival. Despite the extensive care needs characteristic of this population, many medically fragile children are cared for in their homes. Caregivers for these children are faced with numerous tasks, including the daily care of their child as
National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for healthcare law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond healthcare. This article considers to what extent the decision is also about healthcare law, properly conceived. Under one view, healthcare law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding healthcare delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about healthcare law as it is about constitutional law. Her opinion gives detailed attention to the unique features of healthcare finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between healthcare and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status. PMID:23262771
Healthcare is a vital service that daily touches the lives of millions of Americans at significant and vulnerable times: birth, illness, and death. In recent decades, technology, pharmaceuticals, and know-how have substantially improved how care is deliv...
... Read the MMWR November 2010 Access to HealthCare A record number of adults 18–64 years ... 64 years old who skipped or delayed medical care because of cost, by disability* and insurance coverage ...
|This collection offers a wide-ranging introduction to contemporary issues surrounding the healthcare needs of members of minority ethnic communities within the framework of community care in Britain. The following chapters consider state welfare, minority communities, family structures, and social change: (1) "'Race' and Community Care: An…
In 2001, the Institute of Medicine released the report "Crossing the Quality Chasm: A New Health System for the 21st Century." The report criticizes our healthcare system and argues that we are failing to provide Americans with the high-quality and affordable healthcare they deserve and need. While incremental progress has been made, we continue to strive for improved care quality, and our rising costs are potentially catastrophic. Consistent with the Institute of Medicine report, and its reputation for innovation, Inova Health System identified care model transformation as a system priority. Given that the organization is replacing its electronic health record and introducing advanced analytic capabilities, the opportunity to transform the model of care in tandem with core clinical platform enhancement was a compelling reason to move forward. PMID:22955219
It is important to understand the needs of those veterans who are homeless. We describe characteristics of homeless male veterans and factors associated with needing VA benefits from a two-city, community survey of 531 homeless adults. Overall, 425 were male, of whom 127 were veterans (29.9%). Significantly more veterans had a chronic medical condition and two or more mental health conditions. Only 35.1% identified a community clinic for care compared with 66.8% of non-veterans (P <.01); 47.7% identified a shelter-based clinic and 59.1% reported needing VA benefits. Those reporting this need were less likely to report a medical comorbidity (58.7% vs 76.9%; P =.04), although 66.7% had a mental health comorbidity and 82.7% met Diagnosic Screening Manual (DSM)-IIIR criteria for substance abuse/dependence. They were also significantly more likely to access shelter clinics compared with veterans without this need. Homeless veterans continue to have substantial health issues. Active outreach is needed for those lacking access to VA services. PMID:14687279
O'Toole, Thomas P; Conde-Martel, Alicia; Gibbon, Jeanette L; Hanusa, Barbara H; Fine, Michael J
Health-care system reforms can change the structure of the current U.S. health-care system, from centralized large hospitals to a distributed, networked healthcare system. In our model, medical care is delivered locally in neighborhoods and individual homes, using computer technologies like telemedicine, to link patients and primary care providers to tertiary medical providers. This decentralization could reduce costs enough to provide
C. EVERETT KOOP; ROBYN MOSHER; LUIS KUN; JIM GEILING; ELIOT GRIGG; SARAH LONG; RONALD C. MERRELL; RICHARD SATAVA; JOSEPH M. ROSEN
Research has attempted to identify the unique stressors involved in HIV/AIDS care, and suggestions have been made to alleviate stress and burnout in HIV/AIDS healthcare workers. While the level of stress and burnout is not likely to be as high as in the pre-HAART era, healthcare workers are likely to provide better care to patients when they are satisfied with their work and suitably prepared to deal with emerging challenges. PMID:15510388
Healthcare supervisors are being driven by the rapid changes in healthcare today. One demand is to complete their undergraduate degree or even a graduate degree. Few of us are able to devote the many hours required to attend on-campus classes full time. Now there is an alternative. Busy healthcare supervisors can now complete their undergraduate or graduate degrees from the comfort of their home--maintaining a job and family life. PMID:10174445
A relatively new concept termed "relationship marketing" is examined in terms of its usefulness for providers targeting employers as direct purchasers of healthcare services. The discussion includes (1) a consideration of why employers' rhetoric about healthcare purchasing practices has so far exceeded the reality of change and (2) ways in which relationship marketing can be adopted by providers to influence the healthcare purchasing practices of organizational buyers. PMID:10289936
We estimate the distributional incidence of healthcare financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of healthcare. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Healthcare financing is slightly regressive in three high-income
Owen O’Donnell; Eddy van Doorslaer; Ravi P. Rannan-Eliya; Aparnaa Somanathan; Shiva Raj Adhikari; Baktygul Akkazieva; Deni Harbianto; Charu C. Garg; Piya Hanvoravongchai; Alejandro N. Herrin; Mohammed N. Huq; Shamsia Ibragimova; Anup Karan; Soon-man Kwon; Gabriel M. Leung; Jui-fen Rachel Lu; Yasushi Ohkusa; Badri Raj Pande; Rachel Racelis; Keith Tin; Kanjana Tisayaticom; Laksono Trisnantoro; Quan Wan; Bong-Min Yang; Yuxin Zhao
In this article we describe the connections between prostate cancer support groups (PCSGs) and men's health literacy and consumer orientation to healthcare services. The study findings are drawn from participant observations conducted at 16 PCSGs in British Columbia, Canada and 54 individual interviews that focused on men's experiences of attending group meetings. Men's communication and interactions at PCSGs provide important insights for how men talk about and conceptualize health and illness. For example, biomedical language often predominated at group meetings, and men used numbers and measures to engage with risk discourses in linking prostate cancer markers to various treatment options and morbidity and mortality rates. Many groups afforded opportunities for men to interact with healthcare providers as a means to better understand the language and logic of prostate cancer management. The health literacy skills fostered at PCSGs along with specific group-informed strategies could be mobilized in the men's subsequent clinical consultations. Consumer discourses and strategies to contest power relations with healthcare professionals underpinned many men's search for prostate cancer information and their commitment to assisting other men. Key were patients' rights, and perhaps responsibility, to compare diverse health products and services in making decisions across the entire trajectory of their prostate cancer. Overall, the study findings reveal PCSGs as having the capacity to contest as well as align with medical expertise and services facilitating men's transition from patient to informed healthcare consumers. The processes through which this occurs may direct the design of older men's health promotion programs. PMID:21177714
Oliffe, John L; Bottorff, Joan L; McKenzie, Michael M; Hislop, T Gregory; Gerbrandt, Julieta S; Oglov, Valerie
Objectives. We present a social marketing conceptual framework for Experience Corps Baltimore City (EC) in which the desired health outcome is not the promoted product or behavior. We also demonstrate the feasibility of a social marketing–based recruitment campaign for the first year of the Baltimore Experience Corps Trial (BECT), a randomized, controlled trial of the health benefits of EC participation for older adults. Methods. We recruited older adults from the Baltimore, MD, area. Participants randomized to the intervention were placed in public schools in volunteer roles designed to increase healthy behaviors. We examined the effectiveness of a recruitment message that appealed to generativity (i.e., to make a difference for the next generation), rather than potential health benefits. Results. Among the 155 participants recruited in the first year of the BECT, the average age was 69 years; 87% were women and 85% were African American. Participants reported primarily generative motives as their reason for interest in the BECT. Conclusions. Public health interventions embedded in civic engagement have the potential to engage older adults who might not respond to a direct appeal to improve their health.
Tanner, Elizabeth K.; Seeman, Teresa E.; Xue, Qian-Li; Rebok, George W.; Frick, Kevin D.; Carlson, Michelle C.; Wang, Tao; Piferi, Rachel L.; McGill, Sylvia; Whitfield, Keith E.; Fried, Linda P.
Consumer health-care information technology is intended to improve patients' opportunities to gather information about their own health. Ideally, this will be achieved through an improved involvement of existing data bases and an improved communication of information to patients and to care providers, if desired by patients. Additionally, further interconnection of existing and new systems and pervasive system design may be used. All consumer health-care information technology services are optional and leave patients in control of their medical data at all times. This article reflects the current status of consumer health-care information technology research and suggests further research areas that should be addressed. PMID:23695812
... Based Decisionmaking Improving Primary Care Practice Resources Quality & Patient Safety Comprehensive Unit-based Safety Program (CUSP) Patient Safety Measure Tools & Resources Pharmacy Health Literacy Center Surveys ...
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.
The objective of this study is to examine the association of family-centered care (FCC) with specific healthcare service\\u000a outcomes for children with special healthcare needs (CSHCN). The study is a secondary analysis of the 2005–2006 National\\u000a Survey of Children with Special HealthCare Needs. Receipt of FCC was determined by five questions regarding how well health\\u000a care providers
The Patient Education and Activation System (PEAS) project aims to prepare people to take a more active role in their healthcare decisions. In this paper, the authors describe their work on the Layman Education and Activation Form (LEAF). LEAF is designed to be an interactive, Internet-based system for collecting a patient's medical history. It is unique in that it gives patients access to educational information when it is most pertinent, while they are attempting to complete a form. It avoids overwhelming the patient, by providing information only when it is likely to be relevant. The system avoids asking irrelevant questions or providing irrelevant facts by tailoring the content of the form to the patient's responses. The system also uses the patient's answers to suggest questions that the patient might ask a doctor and provides online resources that the patient can browse.
The pace and intensity of oversight and investigation of healthcare organizations has greatly increased at all levels. Well run organizations with ethical management committed to following all laws and regulations are still at risk for compliance violations and punitive penalties. Under the Federal Sentencing Guidelines, organizations with an "effective" corporate compliance program may receive reduced penalties. The seven components of an effective program as defined in the guidelines are: (1) Standards and procedures; (2) oversight responsibilities; (3) employee training; (4) monitoring and auditing; (5) reporting systems; (6) enforcement and discipline; and (7) response and prevention. Lack of a compliance program needlessly exposes the organization to an avoidable risk of damage from non-compliance--whether intentional or not. Moreover, an effective program can contribute to the efficient operation of the organization and be a key piece of its corporate culture. PMID:10947465
|Describes how, through a shared plan, the Health Insurance Initiative of the Independent Colleges and Universities in Florida (ICUF) is saving participating institutions millions in costs associated with providing employee healthcare. (EV)|
Neither private nor state run healthcare systems are perfect. Although there is increasing evidence that Health Maintenance Organizations (HMOs) provide comparable care at lower cost, HMOs tend to select healthy patients. The dual healthcare system in Hong Kong spends about 3.9 per cent of GDP, with health indices among the best in the world. Hong Kong still faces
...Standard unique health identifier for healthcare providers. 162.406 Section...Standard Unique Health Identifier for HealthCare Providers Â§ 162.406 Standard unique health identifier for healthcare providers. (a)...
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
Healthcare in the United States has entered a period of economic upheaval. Episodic, fee-for-service care financed by indemnity insurance is being replaced by managed care financed by fixed-price, capitated health plans. The resulting focus on reducing costs, especially in areas where there is competition fueled by oversupply of health services providers and facilities, poses new threats to the livelihood of medical libraries and medical librarians but also offers new opportunities. Internet services, consumer health education, and health services research will grow in importance, and organizational mergers will provide librarians with opportunities to assume new roles within their organizations.
BACKGROUND: Although smoking cessation is desirable from a public health\\u000a perspective, its consequences with respect to healthcare costs are still\\u000a debated. Smokers have more disease than nonsmokers, but nonsmokers live\\u000a longer and can incur more health costs at advanced ages. We analyzed\\u000a healthcare costs for smokers and nonsmokers and estimated the economic\\u000a consequences of smoking cessation. METHODS: We
Jan J. Barendregt; L. G. A. Bonneux; Maas van der P. J
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
...ACCOUNTABILITY OFFICE National HealthCare Workforce Commission AGENCY: Government...appointing 15 members to the National HealthCare Workforce Commission, with appointments...HCWorkforce@gao.gov. Mail: GAO HealthCare, Attention: National Health...
By comparing models of market-based allocation with state-controlled national healthcare systems, it will be suggested that\\u000a the way in which different communicaties deal with the allocation of healthcare is central to their expression of what might\\u000a be called a moral self-understanding. That is to say that the provision of healthcare may be expected to be a focus
German Statutory Health Insurance (national health insurance) has remained relatively intact over the past century, even in the face of governmental change and recent reforms. The overall story of German national health insurance is one of political compromise and successful implementation of communitarian values. Several key lessons from the German experience can be applied to the American healthcare system.
Objectives: This purpose of the study was to examine the factors associated with access to routine care and to specialty care for Mississippi children with special healthcare needs (CSHCN). Methods: We analyzed data for Mississippi CSHCN from the 2001 National Survey of Children with Special HealthCare Needs. Using a modified version of Andersen and Aday’s Behavioral Model of
Debra J. Kane; Marianne E. Zotti; Deborah Rosenberg
|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. To determine the factors asso- ciated with addressing the transition from pediatric to adult-oriented healthcare among US adolescents with special healthcare needs. Methods. Data for 4332 adolescents, 14 to 17 years of age, from the 2000 -2001 National Survey of Children With Special HealthCare Needs were used. The ade- quacy of transition services was determined by
Fully implemented in Thailand in 2002, the Universal HealthCare Coverage (UC) Program aimed to provide cheap access to healthcare services, for 30 baht (less than 1 U.S. dollar) per visit, to all uninsured Thais. In this paper, we studied the impact of the UC in Thailand on the demand for healthcare services using hospital level data. We
This overview from the Maryland HealthCare Commission shows that healthcare expenditures in the state for 2005 grew 7 percent from 2004 to 2005, more slowly than the trend since 2001. In addition, per capita healthcare expenditures continue to be less than the national average, although Marylandâ€™s expenditure growth has mirrored the national average. From 2004 to 2005,
The management of biohazard in healthcare settings entails multidisciplinarity, valuing the interactions among stakeholders (General Manager, Medical Director, healthcare workers, prevention and protection units, infection control panels, occupational physicians), with the aim of protecting health and safety of workers, third parties and the healthcare service. The management issue was tackled within SIMLII guidelines on biohazards, as well as by the SIMLII Section on Preventive Medicine for HealthCare Workers, followed by editorial initiatives. This contribution focuses on afield example on the management of data stemming from accidents involving biohazards, highlighting the need of information technology enabling management of enormous amount of health data. This work underlines the primacy of individual risk assessment and management, while combining information on working techniques and procedures with modern health surveillance, on the basis of accredited literature and good medical, organizational and technical practices. PMID:23405633
Porru, S; Agresta, A; Cimaglia, C; De Carli, G; Piselli, P; Puro, V; Micheloni, G P
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
The relationship between limited health literacy and poor health may be due to poor communication quality within healthcare delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen healthcare organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and healthcare organization type, patients with limited health literacy were 28–79% less likely than those with adequate health literacy to report their healthcare organization “always” provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in healthcare organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers.
The U.S. healthcare system is organized around markets. There has, however, been ongoing concern about the functioning of these markets, so much so that some have despaired of these markets working at all. The policy response to this concern has been disjointed. Healthcare markets are subject to many regulations and interventions. Some of these policies have attempted to
The Israeli healthcare system is looked upon by some people as one of the most advanced healthcare systems in the world in terms of access, quality, costs and coverage. The Israel healthcare system has four key components: (1) universal coverage; (2) 'cradle to grave' coverage; (3) coverage of both basic services and catastrophic care; and (4) coverage of medications. Patients pay a (relatively) small copayment to see specialists and to purchase medication; and, primary care is free. However, during 2011 the Israeli Medical Association (IMA) spent 5 months on a strike, justifying it as trying to 'save' the Israeli public health. This paper describes some aspects of the Israeli HealthCare System, the criteria for setting priorities for the expenditures on healthcare and values underlying these criteria. The paper observes that the new agreement between the IMA and the government has given timely priority to problematic areas of specialization (in which there is an acute shortage of physicians) and to hospitals in the periphery of the country. Yet weak points in the health system in Israel remain. Particularly, the extent to which national healthcare expenditures are being financed privately--which is rising--and the parallel decline in the role of government financing. PMID:22722948
Nursing and radiology students (n=15) at the University of Malta who completed an interdisciplinary module on primary healthcare reported they found the theoretical material applicable to practice; the module enabled them to learn about their potential role in primary healthcare. (SK)
Diversity. The changing demographics and economics of our growing multicultural world, and the long-standing disparities in the health status of people from culturally diverse backgrounds has challenged healthcare providers and organizations to consider cultural diversity as a priority. The purpose of this article is to present a model that will be helpful in providing culturally competent care. The concept
|This document provides guidelines for individuals giving healthcare to adolescents through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. Chapter One briefly indicates needs of adolescents and outlines legal aspects of healthcare for adolescents such as age of majority, informed consent, confidentiality, disclosure…
Health Care Financing Administration (DHEW), Washington, DC.
Healthcare is an explosive flashpoint in U.S. politics this year more than ever. By 2013, Americans will either be headed, however slowly and fitfully, toward virtually universal access to decent healthcare or most of us will be struggling to use dwindling public vouchers to purchase ever more expensive private insurance. These alternate futures reflect what will happen if
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
Using data from a 1996\\/1997 survey of undocumented Latino immigrants in four sites, we examine reasons for coming to the United States, use of healthcare services, and participation in government programs. We find that undocumented Latinos come to this country primarily for jobs. Their ambu- latory healthcare use is low compared with that of all Latinos and all
Marc L. Berk; Claudia L. Schur; Leo R. Chavez; Martin Frankel
I stated at the Jinan Conference that so far we cannot claim that healthcare reform has been successful; the negative consequences which it has caused have outweighed the positive consequences that it has brought about. As early as two years ago at a meeting to summarize the experiences and lessons of SARS prevention and control, healthcare reform was
This concept analysis includes the definition, characteristics, boundaries, preconditions, and outcomes of the concept of trust between the family and healthcare provider. Based on the results of this concept analysis, trust between the family and healthcare provider is defined as a process, consisting of varying levels, that evolves over time and is based on mutual intention, reciprocity, and
Plant healthcare has replaced integrated pest management as the new standard of the arboricultural pro- fession. The focus of plant healthcare is on the tree and its owner, not the pest. This will require a change in how arborists market this new service. This paper presents some of the current attitudes homeowners have regarding gardening, pest management and
Rising costs of healthcare are addressed in a report prepared by the Council on Wage and Price Stability. The extent of inflation in the healthcare sector of society is documented, and its impact upon individual households, labor, industry, and governme...
Prologue: The American healthcare system is moving rapidly into an era in which hospitals, physicians, and other providers of medical services are combining into a variety of larger organ- izational forms. The momentum for this consolidation results largely from the demands of third-party payers for relief from ever-rising healthcare costs and the realization by many provid- ers of
|Nursing and radiology students (n=15) at the University of Malta who completed an interdisciplinary module on primary healthcare reported they found the theoretical material applicable to practice; the module enabled them to learn about their potential role in primary healthcare. (SK)|
... FDA Issues Public Health Advisory Informing HealthCare Providers of Safety Concerns Associated with the Use of Two Eczema Drugs, Elidel and ... More results from www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders
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.
|Lack of sufficient accessible community-based healthcare services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary healthcare model, with an…
Lack of access to quality healthcare has been a long-standing risk for rural Americans. Multiple factors are emerging that may increase this risk in the future. The National Association for Home Care continuously keeps rural access on the radar and supports legislation that will preserve home care access to vulnerable rural areas. Of special interest are the rural elderly.
A desirable system for providing and financing healthcare would achieve three goals: (1) preventing the deprivation of care because of a patient's inability to pay; (2) avoiding wasteful spending; and (3) allowing care to reflect the different tastes of individual patients. Although it is not possible to realize fully all three of these goals, they can condition and inform
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 focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to healthcare as a basic right for everyone should consider redistributive effects when reforming healthcare financing. PMID:18347823
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
The purpose of this article is to explore the quality assurance methods commonly used in the healthcare industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the healthcare industry is described. Quality improvement efforts that are utilized by healthcare institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care. PMID:16080413
Examining data on the recent healthcare legislation, we demonstrate that public opinion polls on healthcare should be treated with caution because of item nonresponse--or "don't know" answers--on survey questions. Far from being the great equalizer, opinion polls can actually misrepresent the attitudes of the population. First, we show that respondents with lower levels of socioeconomic resources are systematically more likely to give a "don't know" response when asked their opinion about healthcare legislation. Second, these same individuals are more likely to back healthcare reform. The result is an incomplete portrait of public opinion on the issue of healthcare in the United States. PMID:22232421
The purpose of this paper is twofold. The first is to analyse the statistical relationship between real healthcare expenditure per capita and aggregate income, public share in finance, age-dependency ratio and inflation. The second purpose deals with methodological problems involved in pooling healthcare expenditure data. The empirical work is based on pooled cross-sectional, time-series data for 22 OECD countries from 1972 to 1987. Public finance share and inflation were found to be associated with lower per capita healthcare expenditure. No consistent correlation was found between the age-dependency ratio and healthcare expenditure. Contrary to results of earlier studies, we found that healthcare expenditure does not appear to be income (GDP) elastic. However, the results do not appear to be robust to changes in the time periods and countries included. PMID:1341938
An urgent need in American healthcare is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading healthcare institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Healthcare cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Healthcare case studies illustrate each principle. The goal of this article is to provide a template for healthcare leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations. PMID:23274021
Pertussis, an acute respiratory infection caused by Bordetella pertussis, classically manifests as a protracted cough illness. The incidence of pertussis in the United States has been increasing in recent years. Immunity wanes after childhood vaccination, leaving adolescents and adults susceptible to infection. The transmission of pertussis in healthcare settings has important medical and economic consequences. Acellular pertussis booster vaccines are now available for use and have been recommended for all adolescents and adults. These vaccines are safe, immunogenic, and effective. Healthcare workers are a priority group for vaccination because of their increased risk of acquiring infection and the potential to transmit pertussis to high-risk patients. Healthcare worker vaccination programs are likely to be cost-effective, but further research is needed to determine the acceptability of pertussis vaccines among healthcare workers, the duration of immunity after booster doses, and the impact of vaccination on the management of pertussis exposures in healthcare settings.
Sandora, Thomas J.; Gidengil, Courtney A.; Lee, Grace M.
A health needs assessment was conducted with Arab-American immigrants in northern California. Data were obtained from community forums, key informants, the U.S. Census, and from a survey of 47 Arab immigrants. In the community forums, parenting difficulties, marital conflicts, and health risks were identified. Key informants (clergy, community leaders, health professionals) identified mental health problems related to child rearing, referrals for appropriate services, education to assist Arab women interface with the health and education systems, and translation and cultural interpretation for Arab patients and healthcare providers. Arab patients requesting healthcare identified referrals for appropriate care, advocacy, education about the medical regimen, and technical assistance obtaining care. Social indicators indicated potential needs for health services for those of lower income. A survey of 47 Arab-Americans indicated that predominant illnesses experienced in the past year were upper respiratory infections, cardiovascular and hypertension, diabetes, and family and social stress. Health-related problems reported most frequently were family stress, adjusting to the U.S., managing acute illness, coping with adolescents, and marital stress. For the most part, this group was satisfied with medical care received and stated that their most important health services were health education, availability of Arab speaking health providers, and referrals for appropriate treatment. PMID:2799430
Laffrey, S C; Meleis, A I; Lipson, J G; Solomon, M; Omidian, P A
Objectives: It is generally assumed that healthcare systems in which specialist and hospital care is only accessible after referral by a general practitioner (GP) have lower total healthcare costs. In this study, the following questions were addressed: do healthcare systems with GPs acting as gatekeepers to specialized care have lower healthcare expenditure than those with directly
D. Delnoij; G. van Merode; A. Paulus; P. Groenewegen
In Japan, the focus on healthcare has been shifted from hospital-based to community- based care. In nursing fields, home healthcare nursing is expected to become well implemented. Although our society is facing the problem of care for the elderly population, the target patients of home healthcare nursing range from children to the elderly. In home healthcare
Ikuko Miyabayashi; Betty K. Mitsunaga; Mihoko Miyawaki
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
Healthcare will be one of the top issues in the year 2000 election, but voters' interest in healthcare is not as great as it was in 1992. There is no single unifying theme to the healthcare issue. Rather, there are multiple concerns: making Medicare financially sound, providing coverage for prescription medicines for seniors, covering the uninsured, and addressing patients' rights. Voters favor an incremental approach to expanding health insurance coverage rather than a major program. They express about equal levels of support for plans similar in concept to those proposed by presidential candidates Al Gore and George W. Bush. PMID:10916977
Blendon, R J; Benson, J M; Brodie, M; Altman, D E; James, M
Palliative care is poised to become a universally available approach to healthcare which addresses both the needs of patients and families experiencing serious, progressive, and life-threatening illness, and also the costs of delivering such needed services. Palliative care and hospice are part of a continuum of care with palliative care provided at any time during the illness trajectory, while hospice care is offered at the end of life. Within the context of healthcare reform, we believe palliative care addresses critical economic imperatives while enhancing quality of life even as death approaches. As leaders in healthcare, advance practice nurses, specifically, and the nursing community in general are best positioned with the knowledge, expertise, and commitment to advance the specialty of palliative care and lead the way in the reform of America's healthcare system. PMID:22849014
OBJECTIVE.The objective of this study was to compare the receipt of preventive health services for children with and without special healthcare needs and to identify predictors of these health services for children with special healthcare needs using nationally representative data. METHODS.Data from the 2002 and 2003 Medical Expenditure Panel Surveys were analyzed. A total of 18 279 children
Amy J. Houtrow; Sue E. Kim; Alex Y. Chen; Paul W. Newacheck
Reviews research pertinent to mental health services under healthcare reform proposals. Examines redistributional impact of inclusion of outpatient mental health benefits, optimal benefit packages, and findings that mental health services lower medical utilization costs. Argues that extending minimalist model of time-limited benefits to national…
Healthcare providers exert a significant influence on parental pediatric vaccination decisions. We conducted hour-long interviews with traditional and alternative healthcare providers in which we explored a range of associations between vaccination perceptions and practice. A key finding was that the Health Belief Model constructs of perceived susceptibility to and severity of either an illness or an adverse vaccine event partially explained healthcare provider (HCP) beliefs about the risks or benefits of vaccination, especially among alternative care providers. Low or high perceived susceptibility to a vaccine-preventable disease (VPD) or of the severity of a given VPD affects whether an HCP will promote or oppose pediatric vaccination recommendations. Beyond these perceptions, health and vaccination beliefs are affected by the contextual factors of personal experience, group norms, immunology beliefs, and beliefs about industry and government. Building powerful affective heuristics might be critical to balancing the forces that defeat good public health practices. PMID:23964059
Oral healthcare reform is made up of several components, but access to care is central. Healthcare reform will occur in some fashion at some point, and how it will impact the entire dental sector is unclear. In the short term, there is likely to be a dental component during the reauthorization of State Children's Health Insurance Program in early 2009, and several federal oral health bills are expected to be reintroduced as well. Additional public funding for new programs and program expansions remains questionable, as federal funding will be tight. Fiscal conservancy will be occurring in the states as well; however, various proposals to expand dental hygienists' duties are likely, as are proposals related to student grants for dental schools. Regardless of one's political stance, the profile of oral healthcare has been elevated, offering countless opportunities for improvement in the oral health of the nation. PMID:19482130
Quality management has become one of the most important and most debated topics within the service sector. This is especially true for healthcare, as the controversy rages on how the existing American system should be restructured. Healthcare reform aimed at reducing costs and ensuring access to all Americans cannot be allowed to jeopardize the quality of care. As such, total quality management (TQM) has become a vital ingredient to strategic planning within the healthcare domain. At the heart of any such quality improvement effort is the issue of measurement. TQM cannot be effectively utilized as a competitive weapon unless quality can be accurately defined, measured, evaluated, and monitored over time. Through such analysis a hospital can elect how to expend its limited resources toward those quality improvement projects which will impact customer perceptions of service quality the most. Thus, the purpose of this report is to establish a framework by which to approach the issue of quality measurement, delineate the various components of quality that exist in healthcare, and explore how these elements affect one another. We propose that the issue of quality measurement in healthcare be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to healthcare. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the healthcare domain and encourage other researchers to address the interactions of the various quality attributes. PMID:8763215
Osteoporosis care after a fracture is often suboptimal. Suboptimal treatment seems to be most common in fragmented healthcare systems. We examined the literature to assess possible causes for suboptimal postfracture osteoporosis care within fragmented healthcare systems. The review of the literature did not attempt to meta-analyze prior studies. We found several possible methods for improving postfracture osteoporosis care in a fragmented healthcare system. These include changes in healthcare financing, application of information technology, incorporation of case management, the use of system champions, and dissemination of performance measures. The strengths and weaknesses of each of these potential levers for improvement were explored. Postfracture osteoporosis care is sub-optimal and challenging to improve in fragmented healthcare delivery systems. PMID:21847767
The current proliferation of proposals for healthcare reform makes it difficult to sort out the differences among plans and the likely outcome of different approaches to reform. The current healthcare system has two basic features. The first, enrollment and eligibility functions, includes how people get into the system and gain coverage for healthcare services. We describe 4 models, ranging from an individual, voluntary approach to a universal, tax-based model. The second, the provision of healthcare, includes how physician services are organized, how they are paid for, what mechanisms are in place for quality assurance, and the degree of organization and oversight of the healthcare system. We describe 7 models of the organization component, including the current fee-for-service system with no national health budget, managed care, salaried providers under a budget, and managed competition with and without a national health budget. These 2 components provide the building blocks for healthcare plans, presented as a matrix. We also evaluate several reform proposals by how they combine these 2 elements.
\\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
Objective. To assess the contents of antenatal care and to relate the findings to the adequacy of maternal healthcare. Design. Cross-sectional study. Setting. Public secondary health-care facilities. Participants. Pregnant women. Interventions. Three hundred and ninety consecutive pregnant women attending 12 selected secondary health facilities were recruited proportionate to the client load recorded for each facility during the year preceding
Petroleum is used widely in healthcare—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes healthcare vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in healthcare and explore historical associations between petroleum supply shocks and healthcare prices. These analyses confirm that petroleum products are intrinsic to modern healthcare and that petroleum supply shifts can affect healthcare prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting healthcare delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services.
Nurses working within managed care systems often face moral conflicts. Ethical nursing practice seems to require justice with integrity, that is, treating persons in like circumstances similarly (formal justice); helping to shape public policy regarding the provision of healthcare benefits and burdens (distributive justice): discussing with patients the benefits that are and are not provided by particular insurance policies
A previous study used aggregate (region-level) data to investigate whether home healthcare serves as a substitute for inpatient hospital care, and concluded that “there is no evidence that services provided at home replace hospital services.” However, that study was based on a cross-section of regions observed at a single point of time, and did not control for unobserved regional
A previous study used aggregate (region-level) data to investigate whether home healthcare serves as a substitute for inpatient hospital care and concluded that “there is no evidence that services provided at home replace hospital services.” However, that study was based on a cross-section of regions observed at a single point of time and did not control for unobserved regional
Healthcare is a uniquely personal and value-laden service that people often receive in a condition of great anxiety and vulnerability. Therefore, we hope that the corporations that deliver this service care for us personally, rather than see us only as a means to make money. Many people will initially react that a \\
During disasters, aid organizations often respond using the resources of local volunteer members from the affected population who are not only inexperienced, but who additionally take on some of the more psychologically and physically difficult tasks in order to provide support for their community. Although not much empirical evidence exists to justify the claim, it is thought that preparation, training, and organizational support limit (or reduce) a volunteer's risk of developing later psychopathology. In this study, we examined the effects of preparation, training, and organizational support and assigned tasks on the mental health of 506 Indonesian Red Cross volunteers who participated in the response to a massive earthquake in Yogyakarta, Indonesia, in 2006. Controlling for exposure level, the volunteers were assessed for post-traumatic stress disorder (PTSD), anxiety, depression, and subjective health complaints (SHCs) 6, 12, and 18 months post-disaster. Results showed high levels of PTSD and SHCs up to 18 months post-disaster, while anxiety and depression levels remained in the normal range. Higher levels of exposure as well as certain tasks (e.g., provision of psychosocial support to beneficiaries, handling administration, or handing out food aid) made the volunteers more vulnerable. Sense of safety, expressed general need for support at 6 months, and a lack of perceived support from team leaders and the organization were also related to greater psychopathology at 18 months. The results highlight the importance of studying organizational factors. By incorporating these results into future volunteer management programs the negative effects of disaster work on volunteers can be ameliorated. PMID:23205850
Thormar, Sigridur Bjork; Gersons, Berthold P R; Juen, Barbara; Djakababa, Maria Nelden; Karlsson, Thorlakur; Olff, Miranda
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
Cash income offers an incomplete picture of the resources available to finance household consumption. Most American families are covered by an insurance plan that pays for some or all of the healthcare they consume. Only a comparatively small percentage of families pays for the full cost of this insurance out of their cash incomes. As healthcare has claimed
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
... these professionals are familiar with the issues that college students often face, such as stress, chronic health conditions, ... for any illnesses. If for some reason your college doesn't have student health services, an administrator at your school should ...
Engagement in social and generative activities has benefits for the well-being of older adults; hence, methods for broadly engaging them in such activities are desired. Experience Corps Baltimore, a social model for health promotion for older adult volunteers in public schools, offers insight to such successful recruitment and retention. We report on data over a 4-year period in Baltimore City,
Iveris L. Martinez; Kevin Frick; Thomas A. Glass; Michelle Carlson; Elizabeth Tanner; Michelle Ricks; Linda P. Fried
The connection between healthcare and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary healthcare. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to healthcare. The overlap of immigration and healthcare reform offers an opportunity for us to enter the next round of debate from a more informed vantage point. PMID:17847662
Americans' appetite for life-prolonging therapies has led to unsustainable growth in healthcare costs. It is tempting to target older people for healthcare rationing based on their disproportionate use of healthcare resources and lifespan already lived, but aged-based rationing is unacceptable to many. Systems reforms can improve the efficiency of healthcare and may lessen pressure to ration services, but difficult choices still must be made to limit expensive, marginally beneficial interventions. In the absence of agreement on principles to govern healthcare resource allocation, a fair, open priority-setting process should be created to allow for reasonable disagreement on principles while being seen as legitimate by all stakeholders. At the patient-care level, careful discussions about the benefits and burdens of medical intervention and support for slow medicine - a gentle, family-centered care approach for frail elders - can do much to avoid harming these patients with aggressive yet unwanted medical care while reducing wasteful spending. PMID:22458458
Observations of high acidity (pH as low as 1.7) in fogwater collected in polluted areas have provoked concern for public health. Effects of exposure to acidic pollutants have not been studied under foggy conditions; thus there is no directly relevant information from which to estimate the health risk. Indirectly relevant information is available from numerous studies of volunteers exposed to "acid fog precursors" under controlled conditions at less than 100% relative humidity. The effect of fog in modifying responses to inhaled acidic pollutants is difficult to predict: depending on circumstances, fog droplets might either increase or decrease the effective dose of pollutants to the lower respiratory tract. Fog inhalation per se may have unfavorable effects in some individuals. Sulfur dioxide is known to exacerbate airway constriction in exercising asthmatics, at exposure concentrations attainable in ambient air. Nitrogen dioxide has shown little untoward respiratory effect at ambient concentrations in most studies, although it has been suggested to increase bronchial reactivity. Sulfuric acid aerosol has shown no clear effects at concentrations within the ambient range. At somewhat higher levels, increased bronchial reactivity and change in mucociliary clearance have been suggested. Almost no information is available concerning nitric acid. PMID:3000761
Observations of high acidity (pH as low as 1.7) in fogwater collected in polluted areas have provoked concern for public health. Effects of exposure to acidic pollutants have not been studied under foggy conditions; thus there is no directly relevant information from which to estimate the health risk. Indirectly relevant information is available from numerous studies of volunteers exposed to "acid fog precursors" under controlled conditions at less than 100% relative humidity. The effect of fog in modifying responses to inhaled acidic pollutants is difficult to predict: depending on circumstances, fog droplets might either increase or decrease the effective dose of pollutants to the lower respiratory tract. Fog inhalation per se may have unfavorable effects in some individuals. Sulfur dioxide is known to exacerbate airway constriction in exercising asthmatics, at exposure concentrations attainable in ambient air. Nitrogen dioxide has shown little untoward respiratory effect at ambient concentrations in most studies, although it has been suggested to increase bronchial reactivity. Sulfuric acid aerosol has shown no clear effects at concentrations within the ambient range. At somewhat higher levels, increased bronchial reactivity and change in mucociliary clearance have been suggested. Almost no information is available concerning nitric acid.
In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the
The increasing percentage of frail, chronically ill elderly in Wisconsin combined with a shift in the site of care delivery from institution to homes has created an increased need for nonskilled home health services. Despite recent increases in home health expenditures these increases in need are even greater. Tightening interpretations of Medicare eligibility criteria, the expansion of health maintenance organizations,
Three automated monitoring systems used for home healthcare of 1) body and excreta weight in lavatory, 2) ECG in bathtub and 3) ECG in bed without utilizing body surface electrodes in a non-conscious manner at a pilot house called “Welfare Techno House” were designed. For the evaluation of these automated health monitoring systems, long continuous measurements of the health
A. Kawarada; A. Tsakada; K. Sasaki; M. Ishijima; T. Tamura; T. Togawa; K. Yamakoshi
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...
Healthcare reform needs to assure coverage to all children regardless of income level or illnesses; address benefits, financing, administration, and delivery systems; provide substantial subsidies to low-income families; be equitable for all people; provide better monitoring of child health; protect and strengthen health providers who assist…
Unfavorable economic conditions in most of Africa (in this paper Africa refers to Sub-Saharan Africa only) have meant public austerity and a deceleration in government health spending. Given the dominant role of government in providing health services in Africa there is a need to investigate the links between public spending and the provision of healthcare. Analyzing information from five
Objectives: This study examines healthcare access for children with special healthcare needs (CSHCN) in California, one of the nation’s most populous and diverse states. Methods: Data are from the National Survey of Children with Special HealthCare Needs (NS-CSHCN), a nationally representative survey of access for U.S. children fielded by the National Center for Health Statistics (NCHS). California
Moira Inkelas; Kathryn A. Smith; Alice A. Kuo; Linda Rudolph; Susan Igdaloff
To establish and sustain the high-performing healthcare system envisioned in the Affordable Care Act (ACA), current provisions in the law to strengthen the primary care workforce must be funded, implemented, and tested. However, the United States is heading towards a severe primary care workforce bottleneck due to ballooning demand and vanishing supply. Demand will be fueled by the "silver tsunami" of 80 million Americans retiring over the next 20 years and the expanded insurance coverage for 32 million Americans in the ACA. The primary care workforce is declining because of decreased production and accelerated attrition. To mitigate the looming primary care bottleneck, even bolder policies will be needed to attract, train, and sustain a sufficient number of primary care professionals. General internists must continue their vital leadership in this effort. PMID:22042605
Professionals in industries such as advertising and sales have used techniques of persuasion to enhance the efficacy of marketing campaigns and sales revenues. In contrast, healthcare has traditionally relied on the persuasive power of facts and evidence to encourage healthy behavior. The evidence suggests, however, that this current approach is failing. Healthcare experts and opinion leaders cite overwhelming evidence of an epidemic in diseases such as obesity and diabetes, despite numerous initiatives to educate the public how to prevent morbidity and mortality. Health captology, the application of persuasive technology to healthcare, attempts to leverage proven persuasive techniques to improve clinical outcomes. PMID:15853239
This descriptive and quantitative study aimed to characterize the production of nursing care in primary healthcare services in a region of the city of Ribeirăo Preto, state of Săo Paulo, Brazil. The study sample comprised care actions delivered by nurses and registered in the HygiaWeb Information System, from 2006 to 2009. Statistical analysis was performed. Results showed that nursing care delivered by nurses accounted for 9.5 to 14.6% of total professional care provided by professionals. Eventual care actions were the most frequent. The concentration of programmatic care was higher for children, women, pregnant and postpartum women. In conclusion, the predominance of eventual care demonstrated that the health system has been focused on acute conditions. Little of nursing work has been directed at the achievement of comprehensiveness, considering the inexpressive share of longitudinal follow up in total care delivery. The expansion of nursing staff represents potential for care delivery to the population, but further qualification of nursing actions is needed. PMID:22990156
Matumoto, Silvia; Vieira, Kátia Cristina dos Santos; Pereira, Maria José Bistafa; dos Santos, Claudia Benedita; Fortuna, Cinira Magali; Mishima, Silvana Martins
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
This article reviews the forces leading to the current emphases on managed mental health systems. Rapidly escalating costs, especially for inpatient care, and associated concerns for quality and patient outcomes, have led third-party payers and employers to demand more eifective cost and quality controls. The article describes and illustrates methodologies for managing mental health costs, and reviews issues related to
The need is urgent to bring US healthcare costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense. In just 6 categories of waste--overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse--the sum of the lowest available estimates exceeds 20% of total healthcare expenditures. The actual total may be far greater. The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage. The potential economic dislocations, however, are severe and require mitigation through careful transition strategies. PMID:22419800
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
This study aims to present an overview of the evolutionary policy process in reforming the healthcare system in Taiwan, through dissecting the forces of knowledge, social-cultural context, economic resources and political system. We further identify factors, which had a significant impact on healthcare reform policies in Taiwan through illustrative policy examples. One of the most illuminating examples highlighted is the design and implementation of a single-payer National Health Insurance (NHI) program in 1995, after nearly five years of planning efforts (1988-1993) and a two-year legislative marathon. The NHI is one of the most popular social programs ever undertaken in the history of Taiwan, which greatly enhances financial protection against unexpected medical expenses and assures access to health services. Nonetheless, healthcare reform still has an unfinished agenda. Despite high satisfaction ratings, Taiwan's healthcare system today is encountering mounting pressure for new reforms as a result of its rapidly aging population, economic stagnation, and imbalanced NHI checkbook. Although there may exist some heterogeneous system characteristics and challenges among different healthcare systems around the world, Taiwan's experiences in reforming its healthcare system for the past few decades may provide valuable lessons for countries going through rapid economic and political transition. PMID:20199715
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
These guidelines were written to help families coordinate the healthcare that may be needed by a child with spina bifida. The booklet begins with general information about spina bifida. It then discusses the goals of healthcare, the healthcare team, the importance of periodic healthcare, and record keeping procedures. The child's healthcare…
Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.
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...
...02-60; FCC 12-74] Rural HealthCare Support Mechanism AGENCY: Federal...responsible basis for specific Rural HealthCare Pilot Program participants that...connectivity and the resulting healthcare benefits that patients...
...38 CFR Part 63 RIN 2900-AN73 HealthCare for Homeless Veterans Program AGENCY...community-based treatment facilities in the HealthCare for Homeless Veterans (HCHV...response to ``RIN 2900-AN73, HealthCare for Homeless Veterans...
... by a legal proceeding. Clinical incapacity to make healthcare decisions: The inability to make appropriate decisions regarding ... healthcare decisions. Durable power of attorney for healthcare: A document that legally appoints someone else to ...
... 3-EF Go to Online Store Disparities in HealthCare Quality Among Minority Women Selected Findings From the ... race and ethnicity are combined. Return to Contents HealthCare Delivery and Systems Information about healthcare delivery ...
...Service--Rural HealthCare Program, Report and Order...Universal Service--Rural HealthCare Program, WC Docket No...Healthcare Connect Fund, which reforms, expands, and modernizes the Rural HealthCare program based on...
Youth with special healthcare needs\\/dis- abilities want what all youth in America want: indepen- dence, health, friends, and jobs. Yet, between 19 and 23 years of age (depending on the state), youth with special healthcare needs\\/disabilities often find little availability of health insurance or health providers that were an essential part of why they survived and now are
So when it comes to making major healthcare decisions--about healthplans, doctors, treatments, hospitals, and long-term care--how can you tell which choices offer quality healthcare, and which do not. Fortunately, more and more public and private groups...
While some studies have shown a considerable effect of ageing upon future healthcare costs, others indicate small or no effects. Moreover, studies have shown that age-related increases in healthcare costs in part can be explained by high costs in the last year of life. The aim of this study was to project future costs of hospital in-patient care
Jannie Wickstrřm; Niels Serup-Hansen; Ivar Sřnbř Kristiansen
Examines how healthcare reform might be structured to provide support for a package of primary care services for children of all socioeconomic strata. An insurance-like financing system, such as the special Medicaid payment system adopted by New York State for public and nonprofit primary healthcare programs, may be useful as a model for a…
Severe disparities in oral health and inequities in access to oral healthcare exist globally. In New Zealand, the cost of oral health services is high. Physician services and medicines are heavily subsidised by the government—however, in contrast, private financing, either as out-of-pocket payments or as private insurance, dominates dental care. Consequently, the use of services is often prompted by
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
This article describes the legislative mandate for the development of primary healthcare (PHC) in the Philippines and provides a discussion of the attempts made to realize the goals of that mandate. Two major Department of Health thrusts are delineated: 1) from 1986 to 1991 Under-Secretary Alfredo Bengzon sought to deemphasize the implementation of primary healthcare in favor of an approach which sought to forge partnerships with nongovernmental organizations (NGOs) to realize a concept of "Community Health Development" and 2) from 1992 to 1995, Secretary Juan Flavier restored attention to the implementation of PHC which would be operational under the guidance of local government units. The difference in the two approaches is primarily a difference in their manner of execution. Despite some problems, the first initiative achieved important goals such as 1) implementing an information system to allow targeting of areas for social development, 2) organizing the First National Convention of NGOs for Health, 3) encouraging collaborative activities with NGOs, and 4) support of the activities of Barangay Health Workers (BHWs). The second initiative involved recognition of additional volunteerhealth workers; following community organizing as a basic approach for empowerment; expanding the prior initiatives; and making plans to identify model PHC barangays, monitor levels of PHC implementation, and prepare a BHW operational manual. This review ends by considering various issues and offering recommendations which include: 1) spelling out the role of local chief executives, 2) adopting a single terminology to describe the current approach, 3) defining the role of the BHW (multipurpose worker or health worker), 4) adopting a convergence of efforts strategy, 5) monitoring levels of PHC, 6) documenting the PHC implementation process, 7) dealing with program sustainability issues, and 8) improving the management of local health facilities. PMID:12291346
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
Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts healthcare reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion on Medicaid for Massachusetts. Since the 2006 reform, 401 000 additional residents have obtained insurance. The number of Massachusetts residents who had access to healthcare increased substantially after the healthcare reform was enacted, to 98.1% of residents. The Massachusetts healthcare reform has not saved money for the state; its funding has been covered by Federal spending. However, reform has been sustained over time because of the high percentage of state residents who have supported the state mandate to obtain healthcare coverage. PMID:24168866
McAdoo, Joshua; Irving, Julian; Deslich, Stacie; Coustasse, Alberto
Native American healthcare programs face complex and unprecedented challenges resulting from the increased assumption of clinical operations by tribal authorities, shortfalls in Federal funding, modifications in state and Federal health and welfare programs, and intensifying involvement with managed care organizations. These challenges are further complicated by service populations that are increasing at a faster rate than the growth in funding. The authors conducted onsite surveys of 39 Native American health programs in 10 states in order to assess the organizational and management problems they faced. The trend toward transfer of health programs from the Indian Health Service to tribal operation seems likely to continue and accelerate. The survey results indicate that in order for programs to be effective in the long run, they will need to be guided by skilled managers able to adapt to these powerful changes in the healthcare environment. PMID:9885525
Native American healthcare programs face complex and unprecedented challenges resulting from the increased assumption of clinical operations by tribal authorities, shortfalls in Federal funding, modifications in state and Federal health and welfare programs, and intensifying involvement with managed care organizations. These challenges are further complicated by service populations that are increasing at a faster rate than the growth in funding. The authors conducted onsite surveys of 39 Native American health programs in 10 states in order to assess the organizational and management problems they faced. The trend toward transfer of health programs from the Indian Health Service to tribal operation seems likely to continue and accelerate. The survey results indicate that in order for programs to be effective in the long run, they will need to be guided by skilled managers able to adapt to these powerful changes in the healthcare environment. Images p-a p27-a p28-a p30-a
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 most needy within these generally needy populations and to plan interventions to reduce their health and healthcare disparities. With data from 1,331 women residing in Los Angeles County, in one of the largest, most comprehensive studies of the health of homeless women to date, we examined the health and healthcare disparities among homeless African American, Latina and white women. We further explored if race/ethnicity and other factors that predispose homeless women to poor health or enable them to obtain better healthcare were associated with their unmet need for medical care. We found that white, non-Latina women were more likely to report unmet need than African Americans and Latinas, and women suffering from drug abuse, violence, or depression were most in need of care. These findings should be considered in targeting and addressing the special needs of homeless women of different racial/ethnic groups.
Teruya, Cheryl; Longshore, Douglas; Andersen, Ronald M.; Arangua, Lisa; Nyamathi, Adeline; Leake, Barbara; Gelberg, Lillian
The primary goals of home healthcare nursing and rehabilitation nursing are strikingly similar. Rehabilitation nursing principles should guide home healthcare nurses as they formulate and deliver quality patient care. Home healthcare agencies eager to keep up with the emerging trends in healthcare delivery are encouraged to recruit and hire rehabilitation nurses. This article discusses the principles
HealthCare at population level is a complex problem. Having this in mind, the purpose of this paper is to focus on the goods that are ethically relevant in the process of caring for health at this level. We briefly analyze some of the Chilean health statistics that, although they show important improvements along the years, demonstrate that certain conditions are to be deemed as inadequate by both healthcare providers and patients. Ethics is a central component to determine how to structure and organize healthcare systems and how they should operate. We emphasize Human Dignity as an ethical corner stone of the HealthCare System, along with other important values such as Justice and Humanization, under the scope of the Ends of Medicine, and other components such as technical competence of providers and the financing of the whole process. We conclude that as far as a healthcare system is organized in a way that medical practice is well ordered, primarily and fundamentally according the Ends of Medicine and the good of persons, such a healthcare system is ethically adequate. PMID:24121582
Burrows, Jaime; Echeverría B, Carlos; Goic G, Alejandro; Herrera C, Carolina; Quintana V, Carlos; Rojas O, Alberto; Salinas R, Rodrigo; Serani M, Alejandro; Taboada R, Paulina; Vacarezza Y, Ricardo
Qualified immunity from civil liability exists for acts of disaster mental health (DMH) practitioners responding to disasters or acts of terrorism. This article reviews current legal regimens dictating civil liability for potentially wrongful acts of DMH professionals and volunteers responding to disasters. Criteria are proposed to inform determinations of civil liability for DMH workers in disaster response, given current legal parameters and established tort law in relevant areas. Specific considerations are examined that potentially implicate direct liability of DMH professionals and volunteers, and vicarious liability of DMH supervisors for actions of volunteer subordinates. The relevance of pre-event DMH planning and operationalization of the plan post-event is linked to considerations of liability. This article concludes with recommendations to minimize liability exposure for DMH workers in response efforts. PMID:16094639
To assess the impact of adoption of a national health program on homeless care in the United States, care for this group in Britain's National Health Service (NHS) was evaluated. Although hospital and medication charges are eliminated, primary care for the homeless lacks central government directive, suffers from overlap of statutory agencies and mechanistic biases, is disproportionately delivered in emergency rooms, and has relied on advocacy by the non-profit sector. Disadvantages of this void in NHS provision are marginalization of the homeless and continuation of a two-class care system. Removal of financial barriers to care by enactment of a national health program in the US would not solve all issues related to delivery of quality care for the homeless unless its structure addressed the special needs of disenfranchised groups.
Healthcare systems are important elements of western European welfare states. Earlier research indicates that public healthcare has always been warmly welcomed and supported by the public, even in periods of retreat of the welfare state due to retrenchment policies. Using data from 1973, Ardigó (1995) reviewed comparative evidence on the public opinion concerning health services in seven European
J. M. P. Gevers; J. P. T. M. Gelissen; W. A. Arts; R. J. A. Muffels
We consider an economy where most of the healthcare is publicly provided, and where there is waiting time for several types of treatments. Private healthcare without waiting time is an option for the patients in the public health queue. We show that although patients with low waiting costs will choose public treatment, they may be better off with
|This paper examines issues concerning access to healthcare for persons with disabilities, specifically the health status of the disabled, utilization and cost of services, and a comparison of health insurance coverage of persons with and without disabilities. Three age groups (children, working-age adults, and the elderly) are considered. Data…
National policy, including changes to the management of the National Health Service, is intended to increase the amount of primary and secondary prevention in primary healthcare in England. The growth of financial power of general practitioners makes them key decision-makers in planning and delivering health promotion. The vast majority of people in contact with their family doctor could benefit
Volunteers can support the delivery and sustainability of programs promoting chronic disease awareness to improve health at the community level. This paper describes the development of the peer education component of the Cardiovascular Health Awareness Program (CHAP) and assessment of the volunteer peer educator role in a community-wide demonstration project in two mid-sized Ontario communities. A case study approach was used incorporating process learning, a volunteer survey and debriefing discussions with volunteers. A post-program questionnaire was administered to 48 volunteers. Five debriefing discussions were conducted with 27 volunteers using a semi-structured interview guide. Discussions were audio-recorded and transcribed. Analysis used an editing approach to identify themes, taking into account the community-specific context. Volunteers reported an overall positive experience and identified rewarding aspects of their involvement. They felt well prepared but appreciated ongoing training and support and requested more refresher training. Understanding of program objectives increased volunteer satisfaction. Volunteers continued to develop their role during the program; however, organizational and logistical factors sometimes limited skill acquisition and contributions. The prospect of greater involvement in providing tailored health education resources addressing modifiable risk factors was acceptable to most volunteers. Continued refinement of strategies to recruit, train, retain and support volunteers strengthened the peer education component of CHAP. The experience and contributions of volunteers were influenced by the wider context of program delivery. Process evaluation allowed program planners to anticipate challenges, strengthen support for volunteer activities, and expand the peer educator role. This learning can inform similar peer-led health promotion initiatives. PMID:19350374
Karwalajtys, Tina; McDonough, Beatrice; Hall, Heather; Guirguis-Younger, Manal; Chambers, Larry W; Kaczorowski, Janusz; Lohfeld, Lynne; Hutchison, Brian
This study investigated the perceptions of health and illness, and the utilisation of the healthcare system, over the last five years, of Tongan people who reside in New Zealand. A descriptive qualitative approach was used, with the study being implemented by networking with representatives of the Tongan community and healthcare workers. Twenty adult Tongan people volunteered and were given the interview questions in advance. The individual face to face semi-structured interviews took approximately 30 to 45 minutes. Participants verified the transcription of their interviews. Answers were analysed by identifying themes in response to each interview question. Most participants considered health to be a state of physical, mental, social and spiritual well being. Illness beliefs were predominantly either a biological malfunction of the body, or a breakdown of the holistic state of well being. All participants had used the western orthodox medical system, with the general practitioner being consulted more than other services. A high level of satisfaction was expressed with this service. Traditional Tongan healing was utilised by about half the participants, and most were happy with its outcomes. A lesser number of participants had used alternative healthcare, but the levels of satisfaction with it were mixed. PMID:12737416
This award supported the establishment of the Native Elder HealthCare Resource Center (NEHCRC), which was integrated within and capitalized upon additional resources available through the Division of American Indian and Alaska Native Programs at the Univ...
To support the performance measurement efforts of the Foundation for Accountability (FACCT), the Agency for HealthCare Policy and Research (AHCPR) funded a series of scientific papers on topics FACCT had identified as first priorities. The authors review...
Religion, Spirituality and Your Mental HealthCare Quick Links Facts for Families - Numerical List Facts for Families ... and print a PDF version of this document . Religion and spirituality can be important in the lives ...
... 32 million Americans who are now uninsured. It reforms insurance markets to make them more competitive and ... residency training. Find out more information about health reform and the Patient Protection and Affordable Care Act ...
The goal of the project was to assist in the formation of a collaborative effort involving the government, providers, private payers, and families in order to reconcile the operational difficulties of achieving healthcare cost containment while retaining...
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...
... As part of this vigilance, FDA is alerting healthcare professionals that an ... FDA lab tests have confirmed that at least one batch of a counterfeit ... More results from www.fda.gov/drugs/resourcesforyou/consumers
|James Madison University's undergraduate course, Interdisciplinary Rural Primary HealthCare, addresses the shortage of professionals in rural areas, increases student awareness of the needs of rural populations, and helps students try out career choices in this area. (SK)|
LaSala, Kathleen B.; Hopper, Sandra K.; Rissmeyer, David J.; Shipe, Diane P. S.
There is growing controversy concerning the effectiveness of preventive child healthcare. This paper examined policy statements and the empirical literature to provide a more data based analysis of this important question. Several authors have recently s...
Text Version... read the full Fact Sheet for HealthCare Providers that ... of Peramivir is 600 mg once a day, administered intravenously for 5 to 10 days. ... More results from www.fda.gov/downloads/drugs/drugsafety
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
Presently the US is the only major industrialized nation that does not insure universal access to healthcare for all of its citizens. Although the US spends one out of every eight dollars on healthcare, over one-eighth of all Americans lack basic health insurance coverage. Another concern is healthcare cost inflation. The quest for comprehensive healthcare coverage
Medically fragile children are part of a growing population of children with special healthcare needs (CSHCN) who are dependent on technology for survival. Despite the extensive care needs characteristic of this population, many medically fragile children are cared for in their homes. Caregivers for these children are faced with numerous tasks, including the daily care of their child as well as the coordination of vital services. Inadequate access to healthcare, little service availability, limited insurance, and financial restraints may further complicate caring for a medically fragile child in the home. Although federally funded programs such as Supplemental Security Income (SSI) and State Title V CSHCN programs may be beneficial for these children and their families, current policies may limit access to these necessary services. As patient advocates, nurses may be instrumental in assisting medically fragile children and their families to obtain much-needed programs and vital services. PMID:12923733
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.
This paper summarizes the results gained from quantitative and qualitative research involving 327 Australian healthcare chaplains\\u000a with regard to their involvement in abortion issues within the healthcare context. The findings indicate that approximately\\u000a 20% of surveyed chaplains had provided some form of pastoral intervention to patients and\\/or their families dealing with issues\\u000a of abortion and that approximately 10%
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
Any healthcare facility is the stage for a specific kind of relationship between a person requiring care and a caregiver qualified to give it. When this place is enclosed, because the hospitalised patients also happen to be prisoners, does the nursing relationship exist with the same authenticity? This is what Michčle Tréguer works to ensure on a daily basis at the national public health facility of Fresnes. An interview with a nurse of conviction. PMID:23477086
Barack Obama aspires to be a â€śtransformativeâ€ť president, with his hopes particularly fixed on Americaâ€™s finally achieving a universal healthcare system. But would his health plan go far enough to transform a system that has been dominated and distorted by for-profit insurers who maximize profit by rationing care to patients, restricting doctors' choice of treatments, and raising premiums? Of
The complex structures of the health-care field make conflict inevitable. Behaviors that are self-defeating and damaging to patients and health-care professionals arise out of efforts to control territories and exert power at the interfaces of subsystems. Internal differences within a structure such as a family or an HMO can contribute to these conflicts. This article delineates this pattern and gives
In this column, the editor of The Journal of Perinatal Education discusses the current health-care crisis and the need for health-care reform to promote, support, and protect natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth.
In this column, the editor of The Journal of Perinatal Education discusses the current health-care crisis and the need for health-care reform to promote, support, and protect natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth. PMID:20174489
\\u000a The next few years will bring many proposals intended to re-form the financing and the design of our healthcare system. Major\\u000a reforms are necessary because we simultaneously face several critical issues: a growing insurance gap now involving nearly\\u000a 40 million people; rapidly rising healthcare costs whose long-term rate of in-crease is unaffected by current cost-containment\\u000a measures; and a
...false Implementation specifications: Healthcare providers. 162.410 Section 162.410 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA...ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for HealthCare Providers...
...false Implementation specifications: Healthcare clearinghouses. 162.414 Section...414 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA...ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for HealthCare Providers...
We use the 1993 wave of the AHEAD data set to estimate a game- theoretic model of families' decisions concerning time spent caring for elderly individuals and Ţnancial transfers for home healthcare. The out- come is a Nash equilibrium where each family member jointly determines his or her consumption, transfers for formal care, and time allocation — informal care,
David Byrne; Michelle S. Goeree; Bridget Hiedemann; Steven Stern
A general malaise appears to have settled on the American medical scene; most Americans continue to trust their own physicians but do not trust the medical profession or the health system as a whole, while many physicians feel harassed by the regulatory, bureaucratic, or litigious intrusions upon the patient-doctor relationship. The strains on mutual trust among physicians, their patients, and the public are being played out against a background of contradictions. The advances of biomedicine are offset by the neglect of social and behavioural aspects of medical care. Preoccupation with specialized, hospital-based treatment is accompanied by isolation of public health and preventive interests from medical education and practice. Society remains uncertain whether healthcare is a right or a privilege while accepting public responsibility for financing the healthcare of certain groups such as the indigent sick (Medicaid), the elderly (Medicare), Native Americans, or members of the armed forces and veterans. Rising expectations about better outcomes through advances in technology are accompanied by rising anxieties about cost, appropriateness of care, access, and quality. Physicians must alter their perception of healthcare by adopting a population-based approach to need, a commitment to restoring equity in staffing patterns and compensation between primary care and specialty care, and adoption of a social contract that provides for full access by all Americans to basic cost-effective preventive and clinical services before spending on less cost-effective services.
OBJECTIVE: We wished to determine the impact of managed healthcare on resident education in obstetrics and gynecology. STUDY DESIGN: A multiquestion survey was mailed to program directors of the 267 obstetrics-gynecology resident training programs in the United States. The questions ascertained departmental philosophy regarding the role of obstetrician-gynecologists as primary care versus specialist physicians, the extent of involvement with
Ira M. Golditch; Ralph J. Anderson; Sterling B. Williams
Healthcare is in need of innovation on many strands. Patient-centered care appears to be the key to the realization of the main objectives: service quality, cost reduction, access, patient satisfaction and the quality of working life. Innovation, and more precisely, the diffusion and implementation of new methods, new techniques and new processes and systems appears to be a difficult
Early release from the hospital of the elderly ill patient may lead to failure of the home care plan and rapid rehospitalization. Review of 330 consecutive admissions to a large urban home health agency in 1980 revealed that 43 patients (13%) were rehospitalized within 2 weeks of admission. This high risk patient population is contrasted with the average home care
|Purpose: The purpose of this article is to explore how medical care is delivered to older people in assisted living (AL) settings and to suggest ways for improving it. Design and Methods: We present a review of the limited research available on healthcare for older AL residents and on building testable models of better ways to organize primary…
The objective of this research study was twofold; 1) to explore and identify health supportive design factors in Swedish elderly care homes and 2) to understand their usefulness and suggest implication in Korean elderly care settings. A descriptive and explorative method was applied using a combination of field studies and semi-structured interviews. Three study trips were carried out during Sept.
Sookyoung Lee; Alan Dilani; Agneta Morelli; Hearyung Byun
This paper by the Congressional Budget Office (CBO) examines the amount of and trends in geographic variation in healthcare spending, and the root causes of that variation. It also examines the relationship between spending and quality of care, and it di...
Prologue: The term risk contracting has become a familiar part of the vocabulary and the landscape of managed care. Risk contracting refers to an arrangement whereby the cost or claims risk for an insured population is borne by the entity that is desig- nated to bear risk: a prepaid plan or, as is increasingly the case for mental healthcare,
Richard G. Frank; Thomas G. McGuire; Joseph P. Newhouse
|This qualitative study of school nurses describes what the nurses want to do for school children in foster care, what they are actually doing, and how the school organization affects the provision of care. The study looked at the nurses' practice through the lens of the Social Ecological Model of Health, identified interventions using the…
...designated as a result of the HealthCare Safety Net Amendments of 2002...definition of such Tribes in the Indian HealthCare Improvement Act of 1976, 25 U...health professional shortages. The HealthCare Safety Net Amendments of 2002...
...designated as a result of the HealthCare Safety Net Amendments of 2002...definition of such Tribes in the Indian HealthCare Improvement Act of 1976, 25 U...health professional shortages. The HealthCare Safety Net Amendments of 2002...
...designated as a result of the HealthCare Safety Net Amendments of 2002...definition of such Tribes in the Indian HealthCare Improvement Act of 1976, 25 U...health professional shortages. The HealthCare Safety Net Amendments of 2002...
BACKGROUND: Healthcare for cancer patients is primarily shaped by healthcare professionals. This raises the question to what extent healthcare professionals are aware of patients' preferences, needs and values. The aim of this study was to explore to what extent there is concordance between patients' preferences in cancer care and patients' preferences as estimated by healthcare professionals.
Hester Wessels; Alexander de Graeff; Klaske Wynia; Miriam de Heus; Cas LJJ Kruitwagen; Saskia CCM Teunissen; Emile E Voest
The 14th Commonwealth Fund\\/Modern Healthcare HealthCare Opinion Leaders Survey asked a diverse group of experts for their perspective on healthcare delivery system reform. Survey participants call for fundamental change in the way the U.S. delivery system is organized, with nine of 10 favoring such reform. Favored policy strategies for reform include strengthening the primary care system, encouraging care
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
Racial and ethnic minorities bear a disproportionate burden of the diabetes epidemic; they have higher prevalence rates, worse diabetes control, and higher rates of complications. This article reviews the effectiveness of healthcare interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these healthcare interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/ethnic minorities other than African Americans and Latinos, health disparity reductions, long-term diabetes-related outcomes, and the sustainability of healthcare interventions over time. PMID:17881626
Peek, Monica E; Cargill, Algernon; Huang, Elbert S
Recently, oxidative stress has been reported to contribute an important role in the decline of physical function as age advances. Numerous antioxidants can improve both physical and psychological performances resulting in the increase of health-related quality of life (HQOL). Therefore, we hypothesized that Centella asiatica, a medicinal plant reputed for nerve tonic, strength improvement and antioxidant activity, could improve the physical performance and HQOL especially in the physical satisfaction aspect, of the healthy elderly volunteer. To test this hypothesis, a double-blind, placebo-controlled, randomized trial was performed. Eighty healthy elderly were randomly assigned to receive placebo or standardized extract of C. asiatica at doses of 250, 500 and 750?mg once daily for 90 days. The subjects were evaluated to establish baseline data of physical performance using 30-s chair stand test, hand grip test and 6-min walk test. The health-related quality of life was assessed using SF-36. These assessments were repeated every month throughout the 3-month experimental period using the aforementioned parameters. Moreover, 1 month after the cessation of C. asiatica treatment, all subjects were also evaluated using these parameters again. The results showed that after 2 months of treatment, C. asiatica at doses of 500 and 750?mg per day increased lower extremity strength assessed via the 30-s chair stand test. In addition, the higher doses of C. asiatica could improve the life satisfaction subscale within the physical function subscale. Therefore, the results from this study appear to support the traditional reputation of C. asiatica on strength improvement, especially in the lower extremities of the elderly. C. asiatica also possesses the potential to be a natural resource for vigor and strength increase, in healthy elderly persons. However, further research is essential.
These online course materials were generated from a Johns Hopkins Bloomberg School of Public Health (JHSPH) course on Refugee HealthCare. The materials were put online as part of the JHSPH OpenCourseWare program which provides "free, searchable access to JHSPH's course materials for educators, students, and self-learners around the world." The Refugee HealthCare course "addresses the provision of basic health requirements for refugees and the coordination of care among agencies concerned with them." Site visitors will find a selection of downloadable lecture notes on such topics as Hemorrhagic Fever Outbreak Investigation, Control of Communicable Diseases, Health and Human Rights Principles for Refugee Health, and more. The site also offers a downloadable Reading List, and case study materials.
Societies depend heavily on women for healthcare, yet women's own health needs are frequently neglected, their contributions to health development 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
Organizational and financial aspects of the medical care system in China are analyzed. Over 80 percent of the population in China reside in rural areas and are primarily engaged in agricultural activities. Their predominating financing mechanism for medic...
One of the contributing factors to both the increase in healthcare costs and the backlash to managed care was the lack of consumer awareness of the cost of healthcare service, the effect of healthcare costs on profits and wages, and the need to engage consumers more actively as consumers in healthcare decisions. This article reviews the birth of the healthcare consumerism movement and identifies gaps in healthcare consumerism today. The authors reveal some of the keys to building a sustainable healthcare consumerism framework, which involves enlisting consumers as well as other stakeholders. PMID:20608112
Female servicemembers are serving in more complex occupational specialties and are being deployed to combat operations, potentially leading to increased health risks. Similar to their male counterparts, female servicemembers must maintain their medical re...
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
DIVERSITY: The changing demographics and economics of our growing multicultural world, and the long-standing disparities in the health status of people from culturally diverse backgrounds has challenged healthcare providers and organizations to consider cultural diversity as a priority. The purpose of this article is to present a model that will be helpful in providing culturally competent care. The concept of cultural competence is discussed, "The Process of Cultural Competence in the Delivery of Healthcare Services Model" is described, and a mnemonic to guide in providing culturally competent care is presented. PMID:12729453
Background Improving health in our nation requires strengthening four major domains of the healthcare system: personal health management, healthcare delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII) offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach. Discussion A national health information infrastructure for the United States should address the needs of personal health management, healthcare delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries). The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' healthcare system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security) framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges. Summary A national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors. If you cannot measure it, you cannot improve it. Lord Kelvin
|This Children's Defense Fund report summarizes findings of a national survey, which indicate detrimental effects of Federal budget cuts in healthcare funds on economically disadvantaged mothers and children. Suggests that health funds for mothers and children are more important than defense expenditures and tax cuts for the non-needy. (MJL)|
[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
This paper examines the economic rationale of affordability exemptions in the context of a health insurance mandate. On its face, an affordability exemption makes little sense-- it exempts people from purchasing a good that policymakers believe benefits them. I provide an economic definition of affordability and discuss how it is implemented in the contexts of food, housing, and healthcare.
The American health delivery system is undergoing enormous change. Some of the changes threaten the spiritual underpinnings of the hospital movement and discount theological insights into the nature of healing. This article identifies and advocates six healthcare paradigms that are grounded in the Judeo-Christian ethic.
A project was initiated by the New England Municipal Center in Durham, N.H., to devise strategies that maximize the resources of local government to improve primary healthcare services. Data were obtained on health resources, including the number and dis...
Summary Several tax options have been proposed to provide financing for healthcare reform. President Obama has proposed restricting itemized deductions for high income taxpayers, along with some narrower provisions. The Senate Finance Committee has provided a list of options for health- related tax provisions. Individuals testifying at a round-table discussion have also proposed a number of other options, including
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.
A survey questionnatre, assessing general attitudes toward the importance of nutrition m the prevention of disease and the maintenance of good health, was administered to physicians, nurses, dentists, and technicians at five U. S. Army medical centers. The various groups of healthcare specialists differed significantly on many items concerning the importance of good nutrition and eating habits for maintenance
|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.
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
The purpose of this article is to define the healthcare services required by detained youth. Study population consisted of 901 youth detained at the Milwaukee County Juvenile Detention Center with the following distributions: 21% females and 79% males, 70% African-American, 19% Caucasian, 9% Hispanic, 2% other. Data collection used each subject's medical record. Findings compare the prevalence of health
|This book tries to present the healthcare problems of the major ethnic minority groups in perspective. Although poverty is probably the most crucial variable in the genesis of these problems, there are still many subtle and not so subtle forms of discrimination operating in the health field. Unfortunately, discrimination in other aspects of…
The purpose of this study was to explore perceptions of health among children in the care of child protective services in Haute-Savoie (France). A qualitative study was conducted to explore children's perceptions of healthcare. The study involved interviews with children and a quality of life questionnaire. The results show that many aspects of the quality of life of children in care are adversely affected, including energy, sleep, pain, and emotional responses. The children interviewed also identified two main issues in their life: their relationship with their family and their education. The results show that children in care tend to have a passive view of health, which appears to be related to a lack of self-confidence and to a lack of trust in relationships and institutions. The results highlight the impact of social factors on health inequalities and confirm the importance of social relationships, the sense of control over one's life, and the feeling of recognition. PMID:23472983
The objective of this study was to identify leading practices to promote environmentally friendly and efficient efforts in the provision of surgical healthcare. Healthcare is the second leading contributor to waste in the United States. Despite widespread enthusiasm for "going green" in the US economy, little substantive information is available to the medical community, to our knowledge. We explore safe and efficient strategies for hospitals and providers to protect the environment while delivering high-quality care. We performed a systematic review of the literature using relevant PubMed search terms and surveyed a panel of hospital managers and chief executive officers of healthcare organizations pursuing green initiatives. Recommendations were itemized and reviewed by a 7-member panel to generate a consensus agreement. We identified 43 published articles and used interview data from the panel. The following 5 green recommendations for surgical practices were identified: operating room waste reduction and segregation, reprocessing of single-use medical devices, environmentally preferable purchasing, energy consumption management, and pharmaceutical waste management. The medical community has a large opportunity to implement green practices in surgical units. These practices can provide significant benefits to the healthcare community and to the environment. Additional research and advocacy are needed to further explore green practices in healthcare. PMID:21339421
To compare healthcare access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant\\u000a families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children\\u000a (ages 0–11) with a special healthcare need. Chi-square and logistic regression analyses were used to examine relations between\\u000a immigrant status and health access, utilization,
Joyce R. Javier; Lynne C. Huffman; Fernando S. Mendoza; Paul H. Wise
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
We investigated the relationship between healthcare expenditures for Special HealthCare Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special HealthCare Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child's healthcare expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that healthcare expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the healthcare team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special healthcare needs. PMID:20495615
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
Volunteering internationally appeals to healthcare professionals and students for a variety of reasons and serves a number of purposes. If international voluntarism is to be mutually advantageous, however, host countries, volunteers and project sponsors need to understand how best they can work together and what can be achieved by volunteers for the greatest benefit of all concerned. This paper is intended to contribute to the growing dialogue on international voluntarism and offers suggestions to strengthen its value, from the perspectives of health workers in a developing country and the authors" experiences over the past 30 years. The paper also identifies undesirable side effects and disabling interventions of international initiatives and examines the notions of aid and assistance. One strategy to prepare volunteers for upcoming international efforts as well as to address inequities at home is involvement with underserved populations in our own country. PMID:16480603
The international disparities in health and health-care provision comprise the gravest problem of medical ethics. The implications are explored of three theories of justice: an expanded version of Rawlsian contractarianism, Nozick's historical account, and a consequentialism which prioritizes the satisfaction of basic needs. The second too little satisfies medical needs to be cogent. The third is found to incorporate the strengths of the others, and to uphold fair rules and practices. Like the first, it also involves obligations transcending those to an agent's relations and fellow-citizens. These conclusions are applied to international health-care provision, which they would transform.
This article begins by contextualizing specialization and board certification of psychologists, with attention paid to relevant definitions and expectations of other healthcare professionals. A brief history of specialization and board certification in professional psychology is offered. The benefits of board certification through the American Board of Professional Psychology are highlighted. Consideration is then given to the primary reasons for psychologists working in academic health sciences centers to specialize in the current healthcare climate and to obtain board certification as a mark of such specialization. PMID:22105540
There is a spectrum of reasons for inquiries into healthcare: learning, catharsis, reassurance, and accountability. The tension is immediately obvious. Is the primary purpose learning or lynching? We need to learn from major health inquiries. New Zealand needs a culture of inquiry that encourages health professionals to discuss their concerns. We need mechanisms that enable health professionals to share, learn, and implement changes for improvement. We need processes that support more informed scrutiny of health service quality by the public and media. There will continue to be a place for inquiries by the HDC and Coroners where external scrutiny is necessary. PMID:19098953
\\u000a Health policy concerns are important, but to some extent, understudied within medical sociology, particularly at the overall\\u000a broadest system level. Even in smaller studies that look at specific aspects of healthcare and health behavior issues, sociologists\\u000a have not paid much attention in the past few decades to drawing out the implications of the research being done for policy\\u000a questions
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
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".
The developmental characteristics and health behaviors of adolescents make the availability of certain services--including reproductive health services, diagnosis and treatment of sexually transmitted disease, mental health and substance abuse counseling and treatment--critically important. Furthermore, to serve adolescents appropriately, services must be available in a wide range of healthcare settings, including community-based adolescent health, family planning and public health clinics, school-based and school-linked health clinics, physicians' offices, HMOs, and hospitals. National, authoritative content standards (for example, the American Medical Association's Guidelines for Adolescent Preventive Services (GAPS), a multispecialty, interdisciplinary guideline for a package of clinical preventive services for adolescents may increase the possibility that insurers will cover adolescent preventive services, and that these services will become part of health professionals' curricula and thus part of routine practice. However, additional and specific guidelines mandating specific services that must be available to adolescents in clinical settings (whether in schools or in communities) are also needed. Although local government, parents, providers, and schools must assume responsibility for ensuring that health services are available and accessible to adolescents, federal and state financing mandates are also needed to assist communities and providers in achieving these goals. The limitations in what even comprehensive programs currently are able to provide, and the dismally low rates of preventive service delivery to adolescents, suggests that adolescents require multiple points of access to comprehensive, coordinated services, and that preventive health interventions must be actively and increasingly integrated across healthcare, school, and community settings. Unless access issues are dealt with in a rational, coordinated fashion, America's adolescents will not have access to appropriate health services. Current efforts to minimize current healthcare expenditures through managed care programs inevitably conflict with efforts to deliver comprehensive preventive services to all adolescents. Use of multiple sites may not represent inadequate access to care. However, as managed care reimbursement continues to expand, school-based clinics and free-standing adolescent health programs increasingly report decreases in reimbursement without a change in demand for services. The Office of Technology Assessment study called for explicit funding and expansion of services for America's youth; since then, a federal Office of Adolescent Health has been authorized, and, by the time this reaches print, should have received appropriations and been staffed. Dryfoos has called for expansion to nearly 5000 comprehensive programs in the coming years.(ABSTRACT TRUNCATED AT 400 WORDS)
Klein, J. D.; Slap, G. B.; Elster, A. B.; Cohn, S. E.
Community participation and utilization of community health workers (CHWs) are essential components of the primary healthcare model. The success of CHWs is dependent on their training and subsequent community support. Community-prepared nurses are ideal CHW educators. A training program for CHWs was implemented in Honduras emphasizing the principles of adult learning and problem-based learning. Following a 4-month program of training a primary healthcare clinic was opened and managed by CHWs for a population over 10,000. Approximately 80% of local health problems were managed by the CHWs proving that well-trained CHWs can have a significant impact on the delivery of healthcare. PMID:8240881
After the September 11, 2001, attacks on the World Trade Center (WTC), a comprehensive screening program was established to evaluate the physical and mental health of rescue and recovery workers and volunteers. Persons were eligible for this program if they participated in the WTC rescue or recovery efforts and met specific time criteria for exposure to the site. During July 16, 2002--August 6, 2004, the program evaluated 11,768 workers and volunteers. This report summarizes data analyzed from a subset of 1,138 of the 11,768 participants evaluated at the Mount Sinai School of Medicine during July 16--December 31, 2002. On the basis of one or more standardized screening questionnaires, approximately half (51%) of participants met threshold criteria for a clinical mental health evaluation. Continued surveillance is needed to assess the long-term psychological impact of the aftermath of the 9/11 attacks and to determine needs for continued treatment. PMID:15356455
Community engagement is increasingly emphasized in biomedical research, as a right in itself, and to strengthen ethical practice. We draw on interviews and observations to consider the practical and ethical implications of involving Community Health Workers (CHWs) as part of a community engagement strategy for a vaccine trial on the Kenyan Coast. CHWs were initially engaged as an important network to be informed about the trial. However over time, and in response to community advice, they became involved in trial information sharing and identifying potential participants; thereby taking on roles that overlapped with those of employed fieldworkers (FWs). While CHWs involvement was generally perceived as positive and appreciated, there were challenges in their relations with FWs and other community members, partly related to levels and forms of remuneration. Specifically, payment of CHWs was not as high as for FWs and was based on ‘performance’. This extrinsic motivation had the potential to crowd out CHWs intrinsic motivation to perform their pre-existing community roles. CHWs remuneration potentially also contributed to CHWs distorting trial information to encourage community members to participate; and to researchers encouraging CHWs to utilize their social connections and status to increase the numbers of people who attended information giving sessions. Individual consent processes were protected in this trial through final information sharing and consent being conducted by trained clinical staff who were not embedded in study communities. However, our experiences suggest that roles and remuneration of all front line staff and volunteers involved in trials need careful consideration from the outset, and monitoring and discussion over time.
Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral healthcare needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N?=?340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self-reported needs for physical and oral healthcare, and the self-reported frequency of seeking medical and oral healthcare. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral healthcare. In bivariate analysis, being in methadone treatment was associated with care-seeking behavior. In addition, being enrolled in Medi-Cal, California’s state Medicaid program, was associated with greater odds of seeking physical and oral healthcare. Methamphetamine use was not associated with higher odds of needing oral healthcare as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi-Cal’s adult dental coverage may result in a greater burden of oral healthcare which will need to be provided by emergency departments and neighborhood dental clinics.
Wenger, Lynn; Lorvick, Jennifer; Shiboski, Caroline; Kral, Alex H.