The Brightest in Solar Homes to Shine in Public Tour

Science.gov Websites

open to the public Oct. 19 as part of the National Solar Home Tour sponsored by the American Solar are taking part in this year's national tour. Locally the homes will be open to the public from 10 a.m

Recovery After Stroke: Managing Life at Home

MedlinePlus

Recovery After Stroke: Managing Life at Home Managing life at home is an important part of stroke recovery. Whether your “home” is a house, apartment, ... still want some independence in your everyday activities. Stroke affects each survivor differently. To live well after ...

Effect of home telehealth care on blood pressure control: A public healthcare centre model.

PubMed

Lu, Ju-Fen; Chen, Ching-Min; Hsu, Chien-Yeh

2017-01-01

Objective This study aimed to evaluate the effectiveness of home telehealth care combined with case management by public health nurses, in improving blood pressure control in patients with hypertension. Methods This cohort study examined the data of patients with hypertension obtained from a telehealth service centre database, between July 2011- June 2012. Eligible patients were adults (≥40 years old) with both prehypertension and hypertension, living alone or in the remote suburbs of metropolitan areas. Demographic data were collected from 12 district public health centre in Taipei, Taiwan. Following enrolment, patients received an appropriate and validated home telehealth device kit for automatic blood pressure monitoring and automated modem via a telephone line or a desktop computer with Internet connection to enable data transmission between the patient's home and telehealth service centre. Patients were instructed to upload the measured data immediately every day. The study outcomes included blood pressure and home telehealth service utilisation. Results Of the 432 patients recruited, 408 (94%) completed data collection. Linear regression analysis found an average 22.1 mm Hg reduction in systolic blood pressure after one year. The mean slope of systolic blood pressure was classified as decreased or non-decreased. An systolic blood pressure decreasing trend was observed in 52.2% patients, while 47.8% patients showed an increasing systolic blood pressure trend. Patients in the decreased systolic blood pressure group tended to be older ( p = 0. 0001), with a greater proportion of hypertension alarms ( p = 0. 001), improved self-blood pressure monitoring behaviour ( p = 0.009) and higher self-measured blood pressure monitoring frequency ( p = 0. 010). Patients in the decreased systolic blood pressure group had a higher self-measured blood pressure monitoring frequency (odds ratio = 0.95, 95% confidence interval, 0.91-0.99, p = 0. 013

Quality management in home care: models for today's practice.

PubMed

Verhey, M P

1996-01-01

In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

The health care home model: primary health care meeting public health goals.

PubMed

Grant, Roy; Greene, Danielle

2012-06-01

In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.

Pain management in the nursing home.

PubMed

Dumas, Linda G; Ramadurai, Murali

2009-06-01

This article is about pain management and some of the best practices to address the problem of pain in nursing home patients who have a serious illness and multiple comorbid conditions. Management of the emotional distress that accompanies chronic or acute pain is of foremost concern. In this article, the topics discussed include general pain management in a nursing home for a long-term care resident who has chronic pain, the relief of symptoms and suffering in a patient who is on palliative care and hospice, and the pain management of a postoperative patient with acute pain for a short transitional period (post-acute illness or surgery).

Managing Canine Aggression in the Home.

PubMed

Pike, Amy

2018-05-01

Canine aggression occurring in the home can be a dangerous diagnosis with costly consequences to all members of the household. Management is a key modality in the treatment of canine aggression in the home. A thorough history will detail each trigger, target, and context and allow for the veterinary team to put together a comprehensive management plan. Management allows for the avoidance of future aggressive episodes and minimizes the risks associated with living with a patient with these diagnoses. Although risk cannot be mitigated 100%, thorough management can create a safe environment for the implementation of the behavior treatment plan. Copyright © 2017 Elsevier Inc. All rights reserved.

Diabetes Self-Management Education in the Home.

PubMed

Lavelle, Dianne; Zeitoun, Joanah; Stern, Marianne; Butkiewicz, Elise; Wegner, Elfie; Reinisch, Courtney

2016-07-25

Diabetes self-management education and home visits have been found to improve clinical outcomes in individuals living with diabetes. The purpose of this pilot project was to evaluate the feasibility and effectiveness of conducting self-management education in patients' homes. Baseline biometric data was collected from a cohort of adult patients with diabetes. Home visits to 19 patients were conducted by doctoral students from Rutgers University School of Nursing. The visits included knowledge assessment, review of foods in the home, diabetes self-management education, and teaching the proper use of monitoring tools such as the glucometer and blood pressure monitor. Biomarkers were obtained post-intervention and were compared to baseline biomarkers. Descriptive lifestyle data was collected and opportunities for customized patient education were provided. The biomarkers improved overall during the four months after the education intervention. The mean A1C reduced 12% (p=0.0107), the mean glucose reduced 12% (p=0.0994), the mean BMI reduced 2% (p=0.1490), the systolic pressure reduced 1% (p=0.4196), and the diastolic pressure remained stable. Specific goal setting further increased the improvement in the area the individual planned to address. This project supports prior studies that found that in-home educational programs can improve the self-management of diabetes and lead to improvement in health indicators. The benefits of the study included personal attention in ensuring the correct use of home health monitoring devices, building self-management confidence, and identifying treatment barriers that may not be easily discerned in a clinic setting.

Feasibility of home management using ACT for childhood malaria episodes in an urban setting

PubMed Central

Nsagha, Dickson S; Elat, Jean-Bosco N; Ndong, Proper AB; Tata, Peter N; Tayong, Maureen-Nill N; Pokem, Francois F; Wankah, Christian C

2012-01-01

and ACT all year round is one of the challenges of home management of malaria. Although radio and television featured among the current sources of information within the community, meetings, churches, schools, and other public gatherings were the best venues for social mobilization, while community health workers and community leaders were the best sensitization agents for positive behavior change to adhere to home management of malaria. Monetary incentives should be offered to community drug distributors. This should be deducted from the combined price of ACT and rapid diagnostic testing. Conclusion For successful implementation of home management of malaria, there should be proper education, social mobilization of the population, and continuous monitoring and evaluation of field activities to ensure adequate stocks of ACT and rapid diagnostic testing within the framework of the intervention. PMID:22328833

Remote home management for chronic kidney disease: A systematic review.

PubMed

He, Ting; Liu, Xing; Li, Ying; Wu, Qiaoyu; Liu, Meilin; Yuan, Hong

2017-01-01

Background Remote home management is a new healthcare model that uses information technology to enhance patients' self-management of disease in a home setting. This study is designed to identify the effects of remote home management on patients with chronic kidney disease (CKD). Methods A comprehensive search of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed in January 2015. The reference listings of the included articles in this review were also manually examined. Randomized controlled trials (RCTs) designed to evaluate the effects of remote home management on patients with CKD were included. Results Eight trials were identified. The results of this study suggest that the quality of life (QOL) enabled by remote home management was higher than typical care in certain dimensions. However, the effects of remote home management on blood pressure (BP) remain inconclusive. The studies that assessed health service utilization demonstrated a significant decrease in hospital readmission, emergency room visits, and number of days in the hospital. Another favorable result of this study is that regardless of their gender, age or nationality, patients tend to comply with remote home management programs and the use of related technologies. Conclusions The available data indicate that remote home management may be a novel and effective disease management strategy for improving CKD patients' QOL and influencing their attitudes and behaviors. And, relatively little is known about BP and cost-effectiveness, so future research should focus on these two aspects for the entire population of patients with CKD.

Bringing managed care home to the long-term care population.

PubMed

Nadash, Pamela; Ahrens, Joann

2004-01-01

Managed care has been proposed as a solution to the problems facing long-term care: its high costs, bias towards nursing homes, lack of coordination with acute and primary care, and inflexible service delivery. Kodner and Kyriacou (2003) argue that home care agencies may have considerable advantages in creating managed care systems for this population over traditional managed care organizations because of the experience home care organizations have in caring for older adults as well as people with disabilities. Although home care agencies are likely to better understand the needs of the long-term care population, they may lack the expertise and organizational resources to develop successful managed care organizations. Addressing these deficiencies will be key in order for home care organizations to successfully operate as managed care providers.

Feasibility of using the Omaha System to represent public health nurse manager interventions.

PubMed

Monsen, Karen A; Newsom, Eric T

2011-01-01

To test the feasibility of representing public health nurse (PHN) manager interventions using a recognized standardized nursing terminology. A nurse manager in a Midwest local public health agency documented nurse manager interventions using the Omaha System for 5 months. ANALYTIC STRATEGY: The data were analyzed and the results were compared with the results from a parallel analysis of existing PHN intervention data. Interventions for 79 "clients" (projects, teams, or individuals) captured 76% of recorded work hours, and addressed 43% of Omaha System problems. Most problems were addressed at the "community" level (87.1%) versus the "individual" level (12.9%). Nursing practice differed between the 2 knowledge domains of public health family home visiting nursing and public health nursing management. Standardized nursing terminologies have the potential to represent, describe, and quantify nurse manager interventions for future evaluation and research. © 2011 Wiley Periodicals, Inc.

41 CFR 102-5.35 - Who is authorized home-to-work transportation?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Who is authorized home-to-work transportation? 102-5.35 Section 102-5.35 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 5-HOME-TO-WORK...

Home vs. Public Schoolers' Relationships: Differences in Social Networks.

ERIC Educational Resources Information Center

Chatham-Carpenter, April D.

Noting the lack of basic information necessary to begin to make conclusions about a home schooled child's social contacts, a study investigated the social networks of home vs. public schooled children (with a child's "social network" defined as all of the people who interact on a regular basis with the child at least once a month). The…

Public Reporting and Demand Rationing: Evidence from the Nursing Home Industry.

PubMed

He, Daifeng; Konetzka, R Tamara

2015-11-01

This paper examines an under-explored unintended consequence of public reporting: the potential for demand rationing. Public reporting, although intended to increase consumer access to high-quality products, may have provided the perverse incentive for high-quality providers facing fixed capacity and administrative pricing to avoid less profitable types of residents. Using data from the nursing home industry before and after the implementation of the public reporting system in 2002, we find that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints. These effects, although small in magnitude, are consistent with provider rationing of demand on the basis of profitability and underscore the important role of institutional details in designing effective public reporting systems for regulated industries. Copyright © 2014 John Wiley & Sons, Ltd.

Home, Office of Public Advocacy, Department of Administration, State of

Science.gov Websites

Visiting Alaska State Employees State of Alaska Department of Administration Division of Office of Public Advocacy Alaska Department of Administration, Office of Public Advocacy Home Programs Sections Forms Vendor Support Search Office of Public Advocacy State of Alaska Administration > Office of Public Advocacy

Home telehealth for chronic disease management: selected findings of a narrative synthesis.

PubMed

Jones, Alison; Hedges-Chou, Jessica; Bates, Joanna; Loyola, Margarita; Lear, Scott A; Jarvis-Selinger, Sandra

2014-04-01

Chronic disease has become an increasingly important issue for individuals and healthcare organizations across Canada. Home telehealth may have the potential to alleviate the economic and social challenges associated with rising rates of chronic disease. An aim of this review was to gather and synthesize the evidence on the effectiveness of home telehealth in chronic disease management. We searched the Medline, EMBASE, Web of Science, CINAHL, and PAIS databases for studies published in English from January 1, 2005, and December 31, 2010. Academic publications, white papers, and gray literature were all considered eligible for inclusion, provided an original research element was present. Articles were screened for relevance. One hundred one articles on quantitative or mixed-methods studies reported the effects of home telehealth on disease state, symptoms, and quality of life in chronic disease patients. Studies were consistent in finding that home telehealth was equivalent or superior to usual care. The literature strongly supports the use of home telehealth as an equally effective alternative to usual care. The circumstances under which home telehealth emerges as significantly better than usual care have not been extensively researched. Further research into factors affecting the effectiveness of home telehealth would support more widespread realization of telehealth's potential benefits.

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

PubMed Central

Alhuwail, Dari

2016-01-01

Summary Objectives To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians’ information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients’ cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients’ risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical

Dyspnea Management in Palliative Home Care: A Case Series in Malaysia

PubMed Central

Thongkhamcharoen, Rojanasak; Breaden, Katrina; Agar, Meera; Hamzah, Ednin

2012-01-01

Managing dyspnea at home is a challenging task. Although a competent palliative home care team can assist a patient to live at home with better pain control, dyspnea is usually not as well managed. In the Asian context, there are few research studies in dyspnea management in palliative home care. This paper aims to illustrate the cultural context that has an impact on dyspnea management at home and the assessment and management of dyspnea in a community palliative care setting in Malaysia. This paper reports on a study of 5 dyspneic patients suffering from both cancer-related and non–cancer-related dyspnea. Its focus is on a unique Asian cultural belief system that affects communication about prognosis and the role of family in palliative home care. In addition, this paper also describes dyspnea assessment, the barriers to morphine use, benzodiazepine prescription, oxygen therapy, and nonpharmacologic intervention in this center. PMID:23093829

41 CFR 102-5.35 - Who is authorized home-to-work transportation?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Who is authorized home... Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 5-HOME-TO-WORK TRANSPORTATION Authorizing Home-to-Work Transportation § 102-5.35 Who is authorized home-to-work transportation...

41 CFR 102-5.35 - Who is authorized home-to-work transportation?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Who is authorized home... Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 5-HOME-TO-WORK TRANSPORTATION Authorizing Home-to-Work Transportation § 102-5.35 Who is authorized home-to-work transportation...

Public reporting and the quality of care of German nursing homes.

PubMed

Herr, Annika; Nguyen, Thu-Van; Schmitz, Hendrik

2016-10-01

Since 2009, German nursing homes have been evaluated regularly by an external institution with quality report cards published online. We follow recent debates and argue that most of the information in the report cards does not reliably measure quality of care. However, a subset of up to seven measures does. Do these measures that reflect "risk factors" improve over time? Using a sample of more than 3000 German nursing homes with information on two waves, we assume that the introduction of public reporting is an exogenous institutional change and apply before-after-estimations to obtain estimates for the relation between public reporting and quality. We find a significant improvement of the identified risk factors. Also, the two employed outcome quality indicators improve significantly. The improvements are driven by nursing homes with low quality in the first evaluation. To the extent that this can be interpreted as evidence that public reporting positively affects the (reported) quality in nursing homes, policy makers should carefully choose indicators reflecting care-sensitive quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Initial development of the Systems Approach to Home Medication Management (SAHMM) model.

PubMed

Doucette, William R; Vinel, Shanrae'l; Pennathur, Priyadarshini

Adverse drug events and medication nonadherence are two problems associated with prescription medication use for chronic conditions. These issues often develop because patients have difficulty managing their medications at home. To guide patients and providers for achieving safe and effective medication use at home, the Systems Approach to Home Medication Management (SAHMM) model was derived from a systems engineering model for health care workplace safety. To explore how well concepts from the SAHMM model can represent home medication management by using patient descriptions of how they take prescription medications at home. Twelve patients were interviewed about home medication management using an interview guide based on the factors of the SAHMM model. Each interview was audio-taped and then transcribed verbatim. Interviews were coded to identify themes for home medication management using MAXQDA for Windows. SAHMM concepts extracted from the coded interview transcripts included work system components of person, tasks, tools & technology, internal environment, external environment, and household. Concepts also addressed work processes and work outcomes for home medication management. Using the SAHMM model for studying patients' home medication management is a promising approach to improving our understanding of the factors that influence patient adherence to medication and the development of adverse drug events. Copyright © 2016 Elsevier Inc. All rights reserved.

Seniors managing multiple medications: using mixed methods to view the home care safety lens.

PubMed

Lang, Ariella; Macdonald, Marilyn; Marck, Patricia; Toon, Lynn; Griffin, Melissa; Easty, Tony; Fraser, Kimberly; MacKinnon, Neil; Mitchell, Jonathan; Lang, Eddy; Goodwin, Sharon

2015-12-12

Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS). Informed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns. Six patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home

"Making Do" Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards.

PubMed

Wills, Celia E; Polivka, Barbara J; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-04-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of "making do" decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. © The Author(s) 2015.

Effective Public Management

ERIC Educational Resources Information Center

Bower, Joseph L.

1977-01-01

Argues that public management differs from private management not just in degree but in quality, so that American business is an inappropriate analogy for evaluating public management. In particular, "purpose,""organization," and "people" have different meaning and significance in public agencies and private businesses. (JG)

41 CFR 302-10.5 - May I transport a mobile home over water?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false May I transport a mobile home over water? 302-10.5 Section 302-10.5 Public Contracts and Property Management Federal Travel... transport a mobile home over water? Yes, you may transport a mobile home over water when both the points of...

41 CFR 302-10.5 - May I transport a mobile home over water?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 4 2011-07-01 2011-07-01 false May I transport a mobile home over water? 302-10.5 Section 302-10.5 Public Contracts and Property Management Federal Travel... transport a mobile home over water? Yes, you may transport a mobile home over water when both the points of...

Nurses' reflections on pain management in a nursing home setting.

PubMed

Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine

2006-06-01

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Is There Evidence of Cream Skimming among Nursing Homes following the Publication of the Nursing Home Compare Report Card?

ERIC Educational Resources Information Center

Mukamel, Dana B.; Ladd, Heather; Weimer, David L.; Spector, William D.; Zinn, Jacqueline S.

2009-01-01

Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream…

Care home manager attitudes to balancing risk and autonomy for residents with dementia.

PubMed

Evans, Elizabeth A; Perkins, Elizabeth; Clarke, Pam; Haines, Alina; Baldwin, Ashley; Whittington, Richard

2018-02-01

To determine how care home managers negotiate the conflict between maintaining a safe environment while enabling the autonomy of residents with dementia. This is important because there is limited research with care home managers; yet, they are key agents in the implementation of national policies. Semi-structured interviews were conducted with 18 managers from care homes offering dementia care in the Northwest of England. Data were analysed using a thematic analysis approach. There were three areas in which care home staff reported balancing safety and risk against the individual needs of residents. First, the physical environment created a tension between safety and accessibility to the outside world, which meant that care homes provided highly structured or limited access to outdoor space. Second, care home managers reflected a balancing act between an individual's autonomy and the need to protect their residents' dignity. Finally, care home managers highlighted the ways in which an individual's needs were framed by the needs of other residents to the extent that on some occasions an individual's needs were subjugated to the needs of the general population of a home. There was a strong, even dominant, ethos of risk management and keeping people safe. Managing individual needs while maintaining a safe care home environment clearly is a constant dynamic interpersonal process of negotiating and balancing competing interests for care home managers.

Pain management in home hospice patients: A retrospective descriptive study.

PubMed

Campbell, Cathy L; Kelly, Meghan; Rovnyak, Virginia

2017-09-01

The development and evaluation of evidence-based, safe, and effective home-based pain management models for caregivers implementation is receiving greater attention in the literature because of international initiatives intended to increase the number of people who receive end-of-life care in home-based settings. The purpose of this "retrospective descriptive design" study was to describe pharmacological pain management and outcomes for 40 cancer and non-cancer patients receiving hospice care at home. While the median pain score was higher at admission in the cancer group than in the hospice care at home group, the difference was not significant at or within 48 hour of admission. Overall, there was a significant decrease in pain from the first measurement to the second. Within the last seven days of life, the majority of participants were not able to provide a pain severity score when asked to evaluate the effectiveness of pain management, thus their caregiver provided a proxy evaluation. Pain management was effective in the home setting. More research is needed on the best methods to teach lay caregivers to assess pain and evaluate the effectiveness of pharmacological modalities to manage pain. © 2017 John Wiley & Sons Australia, Ltd.

Management of geriatric incontinence in nursing homes.

PubMed Central

Schnelle, J F; Traughber, B; Morgan, D B; Embry, J E; Binion, A F; Coleman, A

1983-01-01

A behavioral management system designed to reduce urinary incontinence was evaluated in two nursing homes with a pretest-posttest control group design with repeated measures. The primary components of the system were prompting and contingent social approval/disapproval which required approximately 2.5 minutes per patient per hour to administer. The frequency of correct toileting for experimental subjects increased by approximately 45%. The experimental groups were significantly different from the control groups on both incontinence and correct toileting measures. The results are discussed in view of the management issues inherent in nursing home settings. PMID:6885672

Home Visiting for Intervention Delivery to Improve Rural Family Asthma Management

PubMed Central

Horner, Sharon D.

2010-01-01

The focus of this article is on the use of home visits in an asthma self-management intervention study with rural families who have a school-aged child with asthma. The study design involved randomization of the sample by elementary schools, then baseline (pre-test) and post-intervention data collection. The purpose of this article is to describe challenges in and pose solutions for implementing home visits for asthma self-management in rural areas. Home visiting is a strategy for program delivery that takes advantage of the home context for tailoring services to address the family’s individual needs. The advantages of intervening in the home included being able to (a) use actual home conditions for individualizing the asthma education to meet families’ needs; (b) match home visitors with family in terms of ethnicity and language; (c) retain a high percentage of families over the year-long duration of the study; and (d) not add to family burden of managing asthma. PMID:17064231

The Effect of Publicized Quality Information on Home Health Agency Choice.

PubMed

Jung, Jeah Kyoungrae; Wu, Bingxiao; Kim, Hyunjee; Polsky, Daniel

2016-12-01

We examine consumers' use of publicized quality information in Medicare home health care markets, where consumer cost sharing and travel costs are absent. We report two findings. First, agencies with high quality scores are more likely to be preferred by consumers after the introduction of a public reporting program than before. Second, consumers' use of publicized quality information differs by patient group. Community-based patients have slightly larger responses to public reporting than hospital-discharged patients. Patients with functional limitations at the start of their care, at least among hospital-discharged patients, have a larger response to the reported functional outcome measure than those without functional limitations. In all cases of significant marginal effects, magnitudes are small. We conclude that the current public reporting approach is unlikely to have critical impacts on home health agency choice. Identifying and releasing quality information that is meaningful to consumers may help increase consumers' use of public reports. © The Author(s) 2015.

The Effect of Publicized Quality Information on Home Health Agency Choice

PubMed Central

Jung, Jeah Kyoungrae; Wu, Bingxiao; Kim, Hyunjee; Polsky, Daniel

2016-01-01

We examine consumers’ use of publicized quality information in Medicare home health care markets, where consumer cost sharing and travel costs are absent. We report two findings. First, agencies with high quality scores are more likely to be preferred by consumers after the introduction of a public reporting program than before. Second, consumers’ use of publicized quality information differs by patient group. Community-based patients have slightly larger responses to public reporting than hospital-discharged patients. Patients with functional limitations at the start of their care, at least among hospital-discharged patients, have a larger response to the reported functional outcome measure than those without functional limitations. In all cases of significant marginal effects, magnitudes are small. We conclude that the current public reporting approach is unlikely to have critical impacts on home health agency choice. Identifying and releasing quality information that is meaningful to consumers may help increase consumers’ use of public reports. PMID:26719047

Public reporting and market area exit decisions by home health agencies.

PubMed

Jung, Kyoungrae; Feldman, Roger

2012-01-01

To examine whether home health agencies selectively discontinue services to areas with socio-economically disadvantaged people after the introduction of Home Health Compare (HHC), a public reporting program initiated by Medicare in 2003. We focused on agencies' initial responses to HHC and examined selective market-area exits by agencies between 2002 and 2004. We measured HHC effects by the percentage of quality indicators reported in public HHC data in 2003. Socio-economic status was measured by per capita income and percent college-educated at the market-area level. 2002 and 2004 Outcome and Assessment Information Set (OASIS); 2000 US Census file; 2004 Area Resource File; and 2002 Provider of Service File. WE FOUND A SMALL AND WEAK EFFECT OF PUBLIC REPORTING ON SELECTIVE EXITS: a 10-percent increase in reporting (reporting one more indicator) increased the probability of leaving an area with less-educated people by 0.3 percentage points, compared with leaving an area with high education. The small level of market-area exits under public reporting is unlikely to be practically meaningful, suggesting that HHC did not lead to a disruption in access to home health care through selective exits during the initial year of the program.

Memory Management of Multimedia Services in Smart Homes

NASA Astrophysics Data System (ADS)

Kamel, Ibrahim; Muhaureq, Sanaa A.

Nowadays there is a wide spectrum of applications that run in smart home environments. Consequently, home gateway, which is a central component in the smart home, must manage many applications despite limited memory resources. OSGi is a middleware standard for home gateways. OSGi models services as dependent components. Moreover, these applications might differ in their importance. Services collaborate and complement each other to achieve the required results. This paper addresses the following problem: given a home gateway that hosts several applications with different priorities and arbitrary dependencies among them. When the gateway runs out of memory, which application or service will be stopped or kicked out of memory to start a new service. Note that stopping a given service means that all the services that depend on it will be stopped too. Because of the service dependencies, traditional memory management techniques, in the operating system literatures might not be efficient. Our goal is to stop the least important and the least number of services. The paper presents a novel algorithm for home gateway memory management. The proposed algorithm takes into consideration the priority of the application and dependencies between different services, in addition to the amount of memory occupied by each service. We implement the proposed algorithm and performed many experiments to evaluate its performance and execution time. The proposed algorithm is implemented as a part of the OSGi framework (Open Service Gateway initiative). We used best fit and worst fit as yardstick to show the effectiveness of the proposed algorithm.

“Making Do” Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards

PubMed Central

Wills, Celia E.; Polivka, Barbara J.; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-01-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of “making do” decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. PMID:26669605

Economic Evidence for U.S. Asthma Self-Management Education and Home-Based Interventions

PubMed Central

Hsu, Joy; Wilhelm, Natalie; Lewis, Lillianne; Herman, Elizabeth

2016-01-01

The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (e.g., higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments. PMID:27658535

Division of Public Health

Science.gov Websites

State Employees Public Health DHSS State of Alaska Home Divisions and Agencies Alaska Pioneer Homes Behavioral Health Office of Children's Services Office of the Commissioner Office of Substance Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice Public

Case management considerations of progressive dementia in a home setting.

PubMed

Pierce, Mary Ellen

2010-01-01

Nursing theory, research, and best practice guidelines contribute substantially to the field of dementia care. Interventional plans are challenged most by those dementias considered progressive and deteriorative in nature, requiring ongoing reassessment and modification of care practices as the clinical course changes. The purpose of this article is to provide guidelines for case managers in the development of effective, individualized care plans for clients with progressive dementia residing in a home setting. The application of these guidelines is illustrated through the presentation of an actual case. The practice setting is a private home in the Pacific Northwest. Geriatric case management is provided by an RN case manager. Progressive dementia presents challenges to home care. Professional case management using comprehensive, holistic assessment, collaborative approaches, and best practice fundamentals serve to create an effective, individualized plan of care. The increasing geriatric population presents great opportunities for case managers in strategic management for creating successful home care models in clients with progressive dementia. Use of nursing diagnoses, dementia research, and collaborative approaches with families and other medical providers creates a viable alternative for clients with progressive dementia.

Actualizing Concepts in Home Management: Proceedings of a National Conference.

ERIC Educational Resources Information Center

American Home Economics Association, Washington, DC.

The booklet prints the following papers delivered at a national conference: Actualizing Concepts in Home Management: Decision Making, Dorothy Z. Price; Innovations in Teaching: Ergonomics, Fern E. Hunt; Relevant Concepts of Home Management: Innovations in Teaching, Kay P. Edwards; Standards in a Managerial Context, Florence S. Walker; Organizing:…

Manager`s views of public involvement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Branch, K.M.; Heerwagen, J.; Bradbury, J.

1995-12-01

Four issues commonly form the framework for debates about the acceptability of proposed projects or technologies--the substantive decision or technological choice; the treatment of the community by the proponent organization; the way the decision-making process has been structured and managed; and the status of institutional safeguards and protection. One of the clear messages of cultural theory is that differences in perspectives are a normal and inevitable part of society, and that attempts to resolve differences by persuasion are not likely to work. These findings are useful when considering the goals and possibilities of public involvement as a decision-making tool, andmore » when designing or evaluating public involvement training programs for managers. The research reported here examines the viewpoints and concerns of managers and decision-makers about the four issues identified above, with particular emphasis on their perspectives and concerns about opening decision-making processes to the public and about managers` roles and responsibilities for structuring and managing open decision-making processes. Implications of these findings for public involvement training for managers is also discussed. The data presented in this paper were obtained from face-to-face interviews with managers and decision-makers with experience managing a variety of hazardous waste management decision-making processes. We conducted these interviews in the course of four separate research projects: needs assessments to support the design and development of a public involvement training program for managers; a study of community residents` and managers` perspectives on the chemical stockpile disposal program; an evaluation of the effectiveness of public involvement training for managers in the Department of Energy; and a study to develop indicators of the benefits and costs of public involvement.« less

Home Management and Consumer Education.

ERIC Educational Resources Information Center

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

Designed for use in consumer and homemaking education in Texas, this curriculum guide is on the subject of home management and consumer education. An introduction to the guide, covering its use and program and curriculum planning, provides a list of suggested reading. Information on teaching handicapped and disadvantaged students follows. The…

Division of Alaska Pioneer Homes

Science.gov Websites

Homes Behavioral Health Office of Children's Services Office of the Commissioner Office of Substance Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice Public Assistance Public Health Seniors & Disabilities Services Boards, Councils & Commissions

Effects of Enactment of Legislative (Public) Smoking Bans on Voluntary Home Smoking Restrictions: A Review

PubMed Central

Arsenault, Nicole

2017-01-01

Introduction: The positive effects of worldwide increases in enactment of legislative bans on smoking in public areas have been well documented. Relatively little is known about the effects of such bans on voluntary home smoking behavior. Meanwhile, private spaces, such as homes, have replaced public spaces as the primary milieu of secondhand smoke exposure. Methods: A systematic search of peer-reviewed articles was conducted using multiple databases including Cochrane Library, Cinahl, Embase, Global Health, Health Star, Joanna Briggs, MEDLINE, PsycINFO, PAIS International, PubMed, and Web of Science. We examined peer-reviewed studies that considered the impact of legislation-based public smoking bans on enactment of private home smoking restrictions. Results: Sixteen articles published between 2002 and 2014 were identified and included. Our results suggest overall positive effects post-legislative ban with the majority of studies demonstrating significant increases in home smoking restrictions. Studies focusing on smoking and nonsmoking samples as well as child populations are discussed in depth. Conclusions: Existing evidence indicates an overall significant positive effect post-legislative ban on voluntary home smoking restrictions. While disentangling these effects over space and time remains a challenge, scientific research has converged in dispelling any notion of significant displacement of smoking into the home. Policy makers, especially those in countries without existing public smoking legislation, can rest assured that these types of bans contribute to the minimization of tobacco-related harm. Implications: Findings converge in dispelling notions of displacement of smoking into the home as a consequence of legislative bans that prohibit smoking in public spaces. Evidence from the studies reviewed suggests that through their influence on social norms, legislative bans on smoking in public places may encourage citizens to establish voluntary home smoking

Health information management in the home: a human factors assessment.

PubMed

Zayas-Cabán, Teresa

2012-01-01

Achieving optimal health outcomes requires that consumers maintain myriad health data and understand how to utilize appropriate health information management applications. This case study investigated four families' health information management tasks in their homes. Four different families participated in the study: a single parent household; two nuclear family households; and an extended family household. A work system model known as the balance model was used as a guiding framework for data collection. Data collection consisted of three stages: (1) primary health information manager interviews; (2) family interviews; and (3) task observations. Overall, families reported 69 unique health information management tasks that took place in nine different locations, using 22 different information storage artifacts. Frequently occurring tasks related to health management or health coordination were conducted in public spaces. Less frequent or more time-consuming tasks, such as researching a health concern or storing medical history, were performed in private spaces such as bedrooms or studies. Similarities across households suggest potential foundational design elements that consumer health information technology application designers need to balance with tailored interventions to successfully support variations in individuals' health information management needs.

41 CFR 302-14.4 - Must my agency pay me a home marketing incentive?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Must my agency pay me a home marketing incentive? 302-14.4 Section 302-14.4 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME MARKETING...

Regulating payment for home care companionship services: legal authority and public policy.

PubMed

Kapp, Marshall B

2008-01-01

On June 11, 2007, the U.S. Supreme Court issued a ruling in the case of Long Island Care at Home Ltd. v. Coke that upheld a federal regulation exempting employees of third-party agencies who provide home-based "companionship services" to disabled persons from the protections of the minimum wage and overtime pay provisions of the Fair Labor Standards Act. This article discusses the legal issues argued in the case and the legal rationales for the court's decision. The article then identifies the important public policy questions involving the maintenance of a sufficient, competent home care workforce that were left unanswered by the legal ruling and outlines some of the pragmatic implications of potential responses to these public policy questions.

Annual expenditures for nursing home care: Private and public payer price growth, 1977–2004

PubMed Central

Stewart, Kate A.; Grabowski, David C.; Lakdawalla, Darius N.

2009-01-01

Background Long-term nursing home care is primarily funded by out-of-pocket payments and public Medicaid programs. Few studies have explored price growth in nursing home care, particularly trends in the real cost of a year spent in a nursing home. Objectives To evaluate changes in private and public prices for annual nursing home care from 1977 to 2004, and to compare nursing home price growth to overall price growth and growth in the price of medical care. Research Design We estimated annual private prices for nursing home care between 1977 and 2004 using data from the National Nursing Home Survey. We compared private nursing home price growth to public prices obtained from surveys of state Medicaid offices, and evaluated the Bureau of Labor Statistics Consumer Price Indexes to compare prices for nursing homes, medical care, and general goods and services over time. Results Annual private pay nursing homes prices grew by 7.5% annually from $8,645 in 1977 to $60,249 in 2004. Medicaid prices grew by 6.7% annually from $9,491 in 1979 to $48,056 in 2004. Annual price growth for private pay nursing home care outpaced medical care and other goods and services (7.5% vs. 6.6% and 4.4%, respectively) between 1977 and 2004. Conclusions The recent rapid growth in nursing home prices is likely to persist, due to an aging population and greater disability among the near-elderly. The result will place increasing financial pressure on Medicaid programs. Better data on nursing prices are critical for policy-makers and researchers. PMID:19194339

Dementia Home Care Resources: How Are We Managing?

PubMed Central

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

2012-01-01

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

Problematising public and private work spaces: midwives' work in hospitals and in homes.

PubMed

Bourgeault, Ivy Lynn; Sutherns, Rebecca; Macdonald, Margaret; Luce, Jacquelyne

2012-10-01

as the boundaries between public and private spaces become increasingly fluid, interest is growing in exploring how those spaces are used as work environments, how professionals both construct and convey themselves in those spaces, and how the lines dividing spaces traditionally along public and private lines are blurred. This paper draws on literature from critical geography, organisational studies, and feminist sociology to interpret the work experiences of midwives in Ontario, Canada who provide maternity care both in hospitals and in clients' homes. qualitative design involving in-depth semi-structured interviews content coded thematically. Ontario, Canada. community midwives who practice at home and in hospital. the accounts of practicing midwives illustrate the ways in which hospital and home work spaces are sites of both compromise and resistance. With the intention of making birthing women feel more `at home', midwives describe how they attempt to recreate the woman's home in the hospital. Similarly, midwives also reorient women's homes to a certain degree into a more standardised work space for home birth attendance. Many midwives also described how they like `guests' in both settings. there seems to be a conscious or unconscious convergence of midwifery work spaces to accommodate Ontario midwives' unique model of practice. we link these findings of midwives' place of work on their experiences as workers to professional work experiences in both public and private spaces and offer suggestions for further exploration of the concept of professionals as guests in their places of work. Copyright © 2012. Published by Elsevier Ltd.

Collaboration of hospital case managers and home care liaisons when transitioning patients.

PubMed

Kelly, Margaret M; Penney, Erika D

2011-01-01

Hospital case managers frequently collaborate with home care liaisons when coordinating special discharge plans. This article focuses on the collaborative relationship between the hospital case manager and on-site liaison whose primary role centers around care coordination and patient teaching. Ineffective collaboration between hospital case managers and these clinical on-site liaisons can lead to serious lapses in care and services for patients, families, and the health care team when transitioning from hospital to home care. In a review of literature, little detail was found about the collaborative practice between hospital case managers and home care liaisons. This article discusses how collegiality, collaboration, and role clarification between hospital case managers and on-site home care liaisons can improve coordination of care and services for patients and their families in the transition from hospital to home care. Included is a set of guidelines developed by case managers at a major metropolitan acute care hospital to inform and improve their practice with home care liaisons. The authors are nursing case managers who practice in a major metropolitan teaching hospital. They met by telephone and in person with case managers from 3 metropolitan medical centers as well as on-site liaisons from 2 skilled nursing facilities and 5 home care agencies to develop practice recommendations for their department regarding work with home care liaisons. Conversations between hospital case managers and on-site home care liaisons revealed that all had experiences in which suboptimal collaboration negatively impacted home care coordination for patients and their families. Furthermore, outcomes in similar patient scenarios varied widely based on the individual practices of the case managers and liaisons involved in discharge coordination. Multiple issues were discussed, including blurred role and responsibility delineations, variations in communication styles and practices

75 FR 41994 - Federal Management Regulation; Home-to-Work Transportation

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-20

...; Docket 2010-0013, Sequence 1] RIN 3090-AJ05 Federal Management Regulation; Home-to-Work Transportation... clarify existing Home-to-Work Transportation policy. This final rule updates and clarifies who is not... establish policy regarding home-to-work transportation. Section 102-5.20 defines who is not covered by the...

41 CFR 302-14.3 - Am I eligible to receive a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Am I eligible to receive a home marketing incentive payment? 302-14.3 Section 302-14.3 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME...

Meeting people where they are: engaging public housing residents for integrated pest management.

PubMed

Scammell, Madeleine K; Duro, Laurie; Litonjua, Emily; Berry, Lilly; Reid, Margaret

2011-01-01

In a unique partnership, the Boston Public Health Commission, the Boston Housing Authority (BHA), Boston University School of Public Health, the Committee for Boston Public Housing, and the West Broadway Task Force (WBTF) led an Integrated Pest Management (IPM) intervention in Boston's public housing developments. Key to the success of the program was recruiting residents to participate. Residents who were trained as Community Health Advocates (CHAs) at the West Broadway Development in South Boston, Massachusetts, recruited over 300 homes to participate in the IPM intervention (out of 484 living units). This article describes the recruitment strategy and success from the perspective of CHAs at the West Broadway development.

Ostomy Care at Home.

PubMed

Kirkland-Kyhn, Holly; Martin, Sanaz; Zaratkiewicz, Sunniva; Whitmore, Morgan; Young, Heather M

2018-04-01

: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers who perform wound care tasks. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Description of public health nursing nutrition assessment and interventions for home-visited women.

PubMed

Horning, Melissa L; Olsen, Jeanette M; Lell, Shay; Thorson, Diane R; Monsen, Karen A

2018-05-09

The purpose of this manuscript was to describe: Public Health Nurse (PHN) home-visited, female client Nutrition Knowledge (K), Behavior (B), and Status (S); the number and types of nutrition interventions PHNs used with these clients; and the types of clients receiving nutrition interventions. This descriptive study used PHN-generated Omaha System, electronic health record data from January 2012 to July 2015. The analytic sample contains 558 women who received home visits in a rural Midwestern U.S. county that employed universal nutrition assessment for clients. Omaha System data included nutrition KBS scores (from 1 = low to 5 = high) and nutrition interventions delivered. Analyses included descriptive, bivariate, and multivariate analyses (means, frequencies, chi-squares, general linear models). PHNs assessed nutrition KBS scores for 84.1% of clients; average Nutrition Knowledge was 3.4 (SD = 0.7), Behavior 3.7 (SD = 0.8), and Status 4.3 (SD = 1.0). PHNs provided 0-36 nutrition interventions per client. Nutrition intervention patterns were detected by the type of visit clients received. Results suggest home-visited women have room to improve Nutrition KBS and PHNs utilize myriad nutrition interventions. Results also point to opportunities to improve home-visited client care by providing more nutrition interventions, especially to those not receiving interventions, and revising standard care plans to reflect important Case Management nutrition interventions. © 2018 Wiley Periodicals, Inc.

41 CFR 302-14.2 - What is the purpose of a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What is the purpose of a home marketing incentive payment? 302-14.2 Section 302-14.2 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME MARKETING...

Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and

Financing of pediatric home health care. Committee on Child Health Financing, Section on Home Care, American Academy of Pediatrics.

PubMed

2006-08-01

In certain situations, home health care has been shown to be a cost-effective alternative to inpatient hospital care. National health expenditures reveal that pediatric home health costs totaled $5.3 billion in 2000. Medicaid is the major payer for pediatric home health care (77%), followed by other public sources (22%). Private health insurance and families each paid less than 1% of pediatric home health expenses. The most important factors affecting access to home health care are the inadequate supply of clinicians and ancillary personnel, shortages of home health nurses with pediatric expertise, inadequate payment, and restrictive insurance and managed care policies. Many children must stay in the NICU, PICU, and other pediatric wards and intermediate care areas at a much higher cost because of inadequate pediatric home health care services. The main financing problem pertaining to Medicaid is low payment to home health agencies at rates that are insufficient to provide beneficiaries access to home health services. Although home care services may be a covered benefit under private health plans, most do not cover private-duty nursing (83%), home health aides (45%), or home physical, occupational, or speech therapy (33%) and/or impose visit or monetary limits or caps. To advocate for improvements in financing of pediatric home health care, the American Academy of Pediatrics has developed several recommendations for public policy makers, federal and state Medicaid offices, private insurers, managed care plans, Title V officials, and home health care professionals. These recommendations will improve licensing, payment, coverage, and research related to pediatric home health services.

Smoking Restrictions in Homes After Implementation of a Smoking Ban in Public Places

PubMed Central

Lasnier, Benoit; Mihaylova, Tsvetelina; Montreuil, Annie; Cohen, Joanna E.

2015-01-01

Introduction: This Canadian study examines the prevalence of smoking restrictions in homes before and after the implementation of a public smoking ban, and their relation to tobacco use and cessation among a cohort of smokers. Methods: Data were from a longitudinal cohort study of 1,058 smokers in the province of Québec, Canada. Baseline data were collected through a population-based survey conducted 1 month before the implementation of the smoking ban with a representative sample of smokers. Follow-up data were collected 18 months after the ban with a response rate of 68%. Logistic regressions, paired t tests and chi-square statistics were used to examine the factors associated with smoking restrictions in homes, cigarette consumption, and quit attempts. Results: Many smokers imposed partial or full smoking restrictions in their homes but proportions of smoke-free homes did not change significantly between baseline and follow-up. The presence of young children and nonsmokers significantly predicted full smoking restriction in the home. Knowledge about risks associated with exposure to secondhand smoke (SHS) and skepticism about the efficacy of methods to reduce exposure in the home also predicted maintenance of voluntary smoking restrictions in homes. The uptake of smoke-free homes was not associated with the quantity of cigarettes smoked or quit attempts. Conclusions: No significant change in home smoking bans was found 18 months after implementation of a public smoking ban. There remains a need for efforts to better inform smokers about health risks from exposure to SHS in homes and the reality that strategies other than a total smoking ban inside the home are ineffective. PMID:25140045

Energy Management Checklist for the Home.

ERIC Educational Resources Information Center

Pifer, Glenda

This booklet contains a checklist of equipment and activities for the individual's use in home energy management. The categories covered include: (1) insulation; (2) windows; (3) temperature control; (4) lighting; (5) heating water; (6) laundry; (7) cleaning and maintenance; (8) cooking; (9) refrigeration; (10) dishwashing; (11) recreation; and…

Home Management and Human Service Competencies.

ERIC Educational Resources Information Center

Regional Learning Service of Central New York, Syracuse.

Faculty representatives from five postsecondary institutions having human service/human ecology programs and two members of the Regional Learning Service staff comprised a task force whose objectives were to identify competencies acquired through home management which relate to undergraduate course objectives, to recommend ways to assess these,…

Managing chronic illness: physician practices increased the use of care management and medical home processes.

PubMed

Wiley, James A; Rittenhouse, Diane R; Shortell, Stephen M; Casalino, Lawrence P; Ramsay, Patricia P; Bibi, Salma; Ryan, Andrew M; Copeland, Kennon R; Alexander, Jeffrey A

2015-01-01

The effective management of patients with chronic illnesses is critical to bending the curve of health care spending in the United States and is a crucial test for health care reform. In this article we used data from three national surveys of physician practices between 2006 and 2013 to determine the extent to which practices of all sizes have increased their use of evidence-based care management processes associated with patient-centered medical homes for patients with asthma, congestive heart failure, depression, and diabetes. We found relatively large increases over time in the overall use of these processes for small and medium-size practices as well as for large practices. However, the large practices used fewer than half of the recommended processes, on average. We also identified the individual processes whose use increased the most and show that greater use of care management processes is positively associated with public reporting of patient experience and clinical quality and with pay-for-performance. Project HOPE—The People-to-People Health Foundation, Inc.

Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

PubMed

Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

2017-07-14

Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

Becoming a Home Care Clinician or Manager Information Needed for Success.

PubMed

Marrelli, Tina

This chapter is an excerpt from Home Care Nursing: Surviving in an Ever-Changing Care published by Sigma Theta Tau International (Marrelli and Associates, Inc., 2017) and has been significantly condensed for purpose of publication in Home Healthcare Now. For more information about this book, Home Care Nursing: Surviving in an Ever-Changing Care Environment. Please visit Nursing Knowledge International at https://www.nursingknowledge.org/home-care-nursing-surviving-in-an-ever-changing-care-environment.html.

Home Care Nursing Improves Cancer Symptom Management

Cancer.gov

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

Public Reporting of Nursing Home Quality of Care: Lessons from the United States Experience for Canadian Policy Discussion

PubMed Central

Hutchinson, Alison M.; Draper, Kellie; Sales, Anne E.

2009-01-01

While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy. PMID:21037828

[Quality of care and risk management in hospital at home services].

PubMed

Franzin-Garrec, Martine; Hoden, Romy

2016-04-01

Hospital at home structures are healthcare institutions in their own right, with the same obligations in terms of governance with regard to quality of care and risk management. However, hospital at home services are characterised by the remote management of the activity and the nursing staff, with specific constraints. Copyright © 2016. Published by Elsevier Masson SAS.

Smoking restrictions in homes after implementation of a smoking ban in public places.

PubMed

Kairouz, Sylvia; Lasnier, Benoit; Mihaylova, Tsvetelina; Montreuil, Annie; Cohen, Joanna E

2015-01-01

This Canadian study examines the prevalence of smoking restrictions in homes before and after the implementation of a public smoking ban, and their relation to tobacco use and cessation among a cohort of smokers. Data were from a longitudinal cohort study of 1,058 smokers in the province of Québec, Canada. Baseline data were collected through a population-based survey conducted 1 month before the implementation of the smoking ban with a representative sample of smokers. Follow-up data were collected 18 months after the ban with a response rate of 68%. Logistic regressions, paired t tests and chi-square statistics were used to examine the factors associated with smoking restrictions in homes, cigarette consumption, and quit attempts. Many smokers imposed partial or full smoking restrictions in their homes but proportions of smoke-free homes did not change significantly between baseline and follow-up. The presence of young children and nonsmokers significantly predicted full smoking restriction in the home. Knowledge about risks associated with exposure to secondhand smoke (SHS) and skepticism about the efficacy of methods to reduce exposure in the home also predicted maintenance of voluntary smoking restrictions in homes. The uptake of smoke-free homes was not associated with the quantity of cigarettes smoked or quit attempts. No significant change in home smoking bans was found 18 months after implementation of a public smoking ban. There remains a need for efforts to better inform smokers about health risks from exposure to SHS in homes and the reality that strategies other than a total smoking ban inside the home are ineffective. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Playground injuries and voluntary product standards for home and public playgrounds.

PubMed

Werner, P

1982-01-01

Accidents on home and public playgrounds account for more than 150,000 injuries per year. The Division of Hazard Identification and Analysis in the Bureau of Epidemiology has studied playground injuries. Swings, climbing apparatus, gliders, slides, and seesaws were listed as apparatuses associated with the highest percentages of injuries. Falls to the surface also accounted for a large percentage of injuries. Absorbent surfaces other than concrete or asphalt were recommended to reduce the severity of injuries. In addition to making recommendations on playground surfaces, the Consumer Product Safety Commission has developed voluntary product safety standards for home and public playgrounds. Guidelines for safe playgrounds are discussed as well as suggestions concerning people to contact at local, state, and national levels for advice on playground design and safety.

Nursing Home Price and Quality Responses to Publicly Reported Quality Information

PubMed Central

Clement, Jan P; Bazzoli, Gloria J; Zhao, Mei

2012-01-01

Objective To assess whether the release of Nursing Home Compare (NHC) data affected self-pay per diem prices and quality of care. Data Sources Primary data sources are the Annual Survey of Wisconsin Nursing Homes for 2001–2003, Online Survey and Certification Reporting System, NHC, and Area Resource File. Study Design We estimated fixed effects models with robust standard errors of per diem self-pay charge and quality before and after NHC. Principal Findings After NHC, low-quality nursing homes raised their prices by a small but significant amount and decreased their use of restraints but did not reduce pressure sores. Mid-level and high-quality nursing homes did not significantly increase self-pay prices after NHC nor consistently change quality. Conclusions Our findings suggest that the release of quality information affected nursing home behavior, especially pricing and quality decisions among low-quality facilities. Policy makers should continue to monitor quality and prices for self-pay residents and scrutinize low-quality homes over time to see whether they are on a pathway to improve quality. In addition, policy makers should not expect public reporting to result in quick fixes to nursing home quality problems. PMID:22092366

Home-School Relationships: A School Management Perspective

ERIC Educational Resources Information Center

Stringer, Patricia; Hourani, Rida Blaik

2013-01-01

Abu Dhabi, United Arab Emirates (UAE) is in the process of initiating major education reform designed to improve schools. Parental involvement in support of student learning ranks high on the reform agenda. This study explores managerial aspects of implementing home-school relationships in seven primary Public Private Partnership (PPP) schools in…

Organizational and environmental factors associated with nursing home participation in managed care.

PubMed Central

Zinn, J S; Mor, V; Castle, N; Intrator, O; Brannon, D

1999-01-01

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services. PMID:10029508

Top management leadership style and quality of care in nursing homes.

PubMed

Castle, Nicholas G; Decker, Frederic H

2011-10-01

The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style assessment came from primary data collected from approximately 4,000 NHAs and DONs that was linked to quality information (i.e., Nursing Home Compare Quality Measures and 5-Star rating scores) and nursing home information (i.e., Online Survey, Certification, And Reporting data). A consensus manager leadership style has a strong association with better quality. Top managers using this style solicit and act upon input from their employees. For NHAs exhibiting this leadership style, the coefficients on 5 of the 7 quality indicators are statistically significant, and all 7 are significant when the DON exhibits this style. When the NHA and DON both have a consensus manager leadership style, 6 of the 7 quality indicator coefficients are significantly associated with better quality. The findings indicate that NHA and DON leadership style is associated with quality of care. Leadership strategies are amenable to change; thus, the findings of this study may be used to develop policies for promoting more effective leadership in nursing homes.

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

PubMed

Gorski, Lisa A; Johnson, Kathy

2003-01-01

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

The Influence of Urinary Incontinence on Publicly Financed Home Care Services to Low-Income Elderly People.

ERIC Educational Resources Information Center

Baker, Dorothy I.; Bice, Thomas W.

1995-01-01

A retrospective cohort design is used to estimate the effect of urinary incontinence (UI) on the public costs of home care services to elderly individuals. Multivariate analyses controlling for other individual, household, and supply characteristics demonstrate that those with UI generate significantly greater public costs for home care services.…

41 CFR 302-14.6 - How much may my agency pay me for a home marketing incentive?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false How much may my agency pay me for a home marketing incentive? 302-14.6 Section 302-14.6 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME...

Changes in clinical and hotel expenditures following publication of the nursing home compare report card.

PubMed

Mukamel, Dana B; Spector, William D; Zinn, Jacqueline; Weimer, David L; Ahn, Richard

2010-10-01

Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in their search and choice of a nursing home. To examine the hypothesis that nursing homes responding to these changes in demand shifted the balance of resources from hotel to clinical activities. The study included 10,022 free-standing nursing homes nationwide during 2001 to 2006. RESEARCH DESIGN AND DATA: A retrospective multivariate statistical analysis of trends in the ratio of clinical to hotel expenditures, using Medicare cost reports, Minimum Data Set and Online Survey, Certification and Reporting data, controlling for changes in residents' acuity and facility fixed effects. Inference is based on robust standard errors. The ratio of clinical to hotel expenditures averaged 1.78. It increased significantly (P < 0.001) by 5% following the publication of the report card. The increase was larger and more significant among nursing homes with worse reported quality, lower occupancy, those located in more competitive markets, for-profit ownership and owned by a chain. The increase in the ratio of clinical to hotel expenditures following publication of the report card suggests that nursing homes responded as expected to the changes in the elasticity of demand with respect to clinical quality brought about by the public reporting of clinical quality measures. The response was stronger among nursing homes facing stronger incentives.

Publicity campaign, wellness event raise awareness of Michigan home health company, products.

PubMed

2007-01-01

HoMedics, a home healthcare and wellness company in Commerce Township, MI, had a problem. As a leading manufacturer of personal wellness and home healthcare products, its product line was constantly evolving with new and innovative technological advances. But with so many rapid changes, HoMedics had trouble educating the media about its new product lines quickly enough. The solution? A multiphase public relations campaign.

Merging home and health via contemporary care delivery: program management insights on a home telehealth project.

PubMed

Abraham, Chon; Rosenthal, David A

2008-01-01

This article discusses a home telehealth program that uses innovative informatics and telemedicine technologies to meet the needs of a Veterans Affairs Medical Center. We provide background information for the program inclusive of descriptions for the decision support system, patient selection process, and selected home telehealth technologies. Lessons learned based on interview data collected from the project team highlight issues regarding implementation and management of the program. Our goal is to provide useful information to other healthcare systems considering home telehealth as a contemporary option for care delivery.

Assessing the Deployment of Home Visiting: Learning from a State-Wide Survey of Home Visiting Programs.

PubMed

Fischer, Robert L; Anthony, Elizabeth R; Lalich, Nina; Nevar, Ann; Bakaki, Paul; Koroukian, Siran

2016-03-01

Large-scale planning for health and human services programming is required to inform effective public policy as well as deliver services to meet community needs. The present study demonstrates the value of collecting data directly from deliverers of home visiting programs across a state. This study was conducted in response to the Patient Protection and Affordable Care Act, which requires states to conduct a needs assessment of home visiting programs for pregnant women and young children to receive federal funding. In this paper, we provide a descriptive analysis of a needs assessment of home visiting programs in Ohio. All programs in the state that met the federal definition of home visiting were included in this study. Program staff completed a web-based survey with open- and close-ended questions covering program management, content, goals, and characteristics of the families served. Consistent with the research literature, program representatives reported great diversity with regard to program management, reach, eligibility, goals, content, and services delivered, yet consistently conveyed great need for home visiting services across the state. Results demonstrate quantitative and qualitative assessments of need have direct implications for public policy. Given the lack of consistency highlighted in Ohio, other states are encouraged to conduct a similar needs assessment to facilitate cross-program and cross-state comparisons. Data could be used to outline a capacity-building and technical assistance agenda to ensure states can effectively meet the need for home visiting in their state.

Model medication management process in Australian nursing homes using business process modeling.

PubMed

Qian, Siyu; Yu, Ping

2013-01-01

One of the reasons for end user avoidance or rejection to use health information systems is poor alignment of the system with healthcare workflow, likely causing by system designers' lack of thorough understanding about healthcare process. Therefore, understanding the healthcare workflow is the essential first step for the design of optimal technologies that will enable care staff to complete the intended tasks faster and better. The often use of multiple or "high risk" medicines by older people in nursing homes has the potential to increase medication error rate. To facilitate the design of information systems with most potential to improve patient safety, this study aims to understand medication management process in nursing homes using business process modeling method. The paper presents study design and preliminary findings from interviewing two registered nurses, who were team leaders in two nursing homes. Although there were subtle differences in medication management between the two homes, major medication management activities were similar. Further field observation will be conducted. Based on the data collected from observations, an as-is process model for medication management will be developed.

Homemaker/Home Health Aide.

ERIC Educational Resources Information Center

Missouri Univ., Columbia. Instructional Materials Lab.

This curriculum guide provides materials for a five-unit home health aide course. Each unit contains 4 to 36 lesson plans. Unit topics and representative lesson plan topics are as follows: (1) introduction (ethical and legal responsibilities, time management, reporting and recording); (2) communication (techniques, meeting the public, therapeutic…

Reducing ADHD Children's Management Problems in Out-of-Home Settings.

ERIC Educational Resources Information Center

Kapalka, George M.

This report discusses the outcomes of a study that investigated a procedure designed to help manage children with attention deficit hyperactivity disorder (ADHD) in out-of-home settings. Forty-four parents of children (ages 5-10) diagnosed with ADHD hyperactive-impulsive or combined types participated. Portions of the Barkley Home Situations…

Assessing Commercially Available Personal Health Records for Home Health: Recommendations for Design.

PubMed

Kneale, Laura; Choi, Yong; Demiris, George

2016-01-01

Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.

Safe medication management in specialized home healthcare - an observational study.

PubMed

Lindblad, Marléne; Flink, Maria; Ekstedt, Mirjam

2017-08-24

Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering. Data were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory. The MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients' active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies. To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals' strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients' and family caregivers' as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

Comparing Public Quality Ratings for Accredited and Nonaccredited Nursing Homes.

PubMed

Williams, Scott C; Morton, David J; Braun, Barbara I; Longo, Beth Ann; Baker, David W

2017-01-01

Compare quality ratings of accredited and nonaccredited nursing homes using the publicly available Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data set. This cross-sectional study compared the performance of 711 Joint Commission-accredited (TJC-accredited) nursing homes (81 of which also had Post-Acute Care Certification) to 14,926 non-Joint Commission-accredited (non-TJC-accredited) facilities using the Nursing Home Compare data set (as downloaded on April 2015). Measures included the overall Five-Star Quality Rating and its 4 components (health inspection, quality measures, staffing, and RN staffing), the 18 Nursing Home Compare quality measures (5 short-stay measures, 13 long-stay measures), as well as inspection deficiencies, fines, and payment denials. t tests were used to assess differences in rates for TJC-accredited nursing homes versus non-TJC-accredited nursing homes for quality measures, ratings, and fine amounts. Analysis of variance models were used to determine differences in rates using Joint Commission accreditation status, nursing home size based on number of beds, and ownership type. An additional model with an interaction term using Joint Commission accreditation status and Joint Commission Post-Acute Care Certification status was used to determine differences in rates for Post-Acute Care Certified nursing homes. Binary variables (eg, deficiency type, fines, and payment denials) were evaluated using a logistic regression model with the same covariates. After controlling for the influences of facility size and ownership type, TJC-accredited nursing homes had significantly higher star ratings than non-TJC-accredited nursing homes on each of the star rating component subscales (P < .05) (but not on the overall star rating), and TJC-accredited nursing homes with Post-Acute Care Certification performed statistically better on the overall star rating, as well as 3 of the 4 subscales (P < .05). TJC-accredited nursing homes

Life Management Skills, 8230. Home Economics Education.

ERIC Educational Resources Information Center

Loudoun County Public Schools, Leesburg, VA.

The middle school home economics curriculum on Life Management Skills I (eighth grade) meets the needs of the early adolescent. It is based upon three major concepts: (1) basic skills; (2) self-knowledge/understanding/decision making; and (3) independence/interdependence. Emphasis on the basic skills of reading, writing, communicating, using…

Location, Location, Location: Characteristics and Services of Long-Stay Home Care Recipients in Retirement Homes Compared to Others in Private Homes and Long-Term Care Homes

PubMed Central

Sinn, Chi-Ling Joanna; Grinchenko, Galina; Blums, Jane; Peirce, Tom; Hirdes, John

2017-01-01

We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients. PMID:28277206

Location, Location, Location: Characteristics and Services of Long-Stay Home Care Recipients in Retirement Homes Compared to Others in Private Homes and Long-Term Care Homes.

PubMed

Poss, Jeffrey W; Sinn, Chi-Ling Joanna; Grinchenko, Galina; Blums, Jane; Peirce, Tom; Hirdes, John

2017-02-01

We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients. Copyright © 2017 Longwoods Publishing.

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial.

PubMed

Bruce, Martha L; Lohman, Matthew C; Greenberg, Rebecca L; Bao, Yuhua; Raue, Patrick J

2016-11-01

To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

The Challenges of Managing Transnational Education Partnerships: The Views of "Home-Based" Managers vs "In-Country" Managers

ERIC Educational Resources Information Center

Healey, Nigel Martin

2018-01-01

Purpose: The purpose of this paper is to investigate the challenges of managing transnational education (TNE) partnerships from the perspective of the home university managers. Design/methodology/approach: The study adopts a qualitative, "insider researcher" methodology. It uses a sample set of eight mangers who operate from the home…

Asthma and food allergy management in Chicago Public Schools.

PubMed

Gupta, Ruchi S; Rivkina, Victoria; DeSantiago-Cardenas, Lilliana; Smith, Bridget; Harvey-Gintoft, Blair; Whyte, Stephanie A

2014-10-01

This study aimed to characterize asthma and food allergy reporting and management in Chicago Public Schools. Demographic and health data for students who have asthma and food allergy were extracted from the Chicago Public Schools database. Demographic and geographic variability and the existence of school health management plans were analyzed, and multiple logistic regression models were computed. Home addresses were geocoded to create maps of case counts per community area. Approximately 18,000 asthmatic and 4000 food allergic students were identified. Of asthmatic students, 9.3% had a food allergy; of food allergic students, 40.1% had asthma. Asthma odds were significantly higher among black and Hispanic students (odds ratio [OR] = 2.3 and 1.3, respectively), whereas food allergy odds were significantly higher among black students (OR = 1.1; 95% confidence interval [CI], 1.0-1.3) and significantly lower among Hispanic students (OR = 0.8; 95% CI, 0.7-0.9). Only 24.3% of students who had asthma and 50.9% of students who had food allergy had a school health management plan on file. Odds of having a school health management plan were significantly higher among students with both conditions, but the likelihood of having a plan on file was significantly lower among racial/ethnic minority and low-income students, regardless of medical condition. Only 1 in 4 students who have asthma and half of food allergic students have health management plans in schools, with lower numbers among minority and low-income students. Improving chronic disease reporting and access to school health management plans is critical. Copyright © 2014 by the American Academy of Pediatrics.

Changes in the relationship between nursing home financial performance and quality of care under public reporting.

PubMed

Park, Jeongyoung; Werner, Rachel M

2011-07-01

The relationship between financial performance and quality of care in nursing homes is not well defined and prior work has been mixed. The recent focus on improving the quality of nursing homes through market-based incentives such as public reporting may have changed this relationship, as public reporting provides nursing homes with increased incentives to engage in quality-based competition. If quality improvement activities require substantial production costs, nursing home profitability may become a more important predictor of quality under public reporting. This study explores the relationship between financial performance and quality of care and test whether this relationship changes under public reporting. Using a 10-year (fiscal years 1997-2006) panel data set of 9444 skilled nursing facilities in the US, this study employs a facility fixed-effects with and without instrumental variables approach to test the effect of finances on quality improvement and correct for potential endogeneity. The results show that better financial performance, as reflected by the 1-year lagged total profit margin, is modestly associated with higher quality but only after public reporting is initiated. These findings have important policy implications as federal and state governments use market-based incentives to increase demand for high-quality care and induce providers to compete based on quality. Copyright © 2010 John Wiley & Sons, Ltd.

Modelling the resource implications of managing adults with Fabry disease in Norway favours home infusion.

PubMed

Guest, Julian F; Jenssen, Trond; Houge, Gunnar; Aaseboe, Willy; Tøndel, Camilla; Svarstad, Einar

2010-12-01

The aim of this study was to estimate the resource implications and budget impact of managing adults with Fabry disease in Norway, from the perspective of the publicly funded healthcare system. A decision model was constructed using published clinical outcomes and clinician-derived resource utilization estimates. The model was used to estimate the annual healthcare cost of managing a cohort of 64 adult Fabry patients in an average year. The expected annual cost of managing 60 existing Fabry patients and four new patients in Norway each year was estimated to be NOK 55·8 million (€6·7 million). In an average year, patients receiving enzyme replacement therapy (ERT) with agalsidase alfa (Replagal(®)) at 0·2 mg kg⁻¹ or agalsidase beta (Fabrazyme(®)) at 1·0 mg kg⁻¹ are collectively expected to make 586 attendances to their family practitioner's office for their infusions, which equates to 128 eight-hour days associated with ERT. Encouraging more patients to undergo home-based infusions has substantial potential to free-up community-based resources. In comparison, the community-related benefit that can be obtained by switching from agalsidase beta (1·0 mg kg⁻¹) to agalsidase alpha (0·2 mg kg⁻¹) is marginal, and dependent on the two doses being clinically equivalent. Maximizing the proportion of adults with Fabry disease undergoing home-based infusions has the potential to release community-based resources for alternative use by non-Fabry patients, thereby improving the efficiency of the publicly funded healthcare system in Norway. © 2010 The Authors. European Journal of Clinical Investigation © 2010 Stichting European Society for Clinical Investigation Journal Foundation.

Load Balancing Integrated Least Slack Time-Based Appliance Scheduling for Smart Home Energy Management

PubMed Central

Silva, Bhagya Nathali; Khan, Murad; Han, Kijun

2018-01-01

The emergence of smart devices and smart appliances has highly favored the realization of the smart home concept. Modern smart home systems handle a wide range of user requirements. Energy management and energy conservation are in the spotlight when deploying sophisticated smart homes. However, the performance of energy management systems is highly influenced by user behaviors and adopted energy management approaches. Appliance scheduling is widely accepted as an effective mechanism to manage domestic energy consumption. Hence, we propose a smart home energy management system that reduces unnecessary energy consumption by integrating an automated switching off system with load balancing and appliance scheduling algorithm. The load balancing scheme acts according to defined constraints such that the cumulative energy consumption of the household is managed below the defined maximum threshold. The scheduling of appliances adheres to the least slack time (LST) algorithm while considering user comfort during scheduling. The performance of the proposed scheme has been evaluated against an existing energy management scheme through computer simulation. The simulation results have revealed a significant improvement gained through the proposed LST-based energy management scheme in terms of cost of energy, along with reduced domestic energy consumption facilitated by an automated switching off mechanism. PMID:29495346

Load Balancing Integrated Least Slack Time-Based Appliance Scheduling for Smart Home Energy Management.

PubMed

Silva, Bhagya Nathali; Khan, Murad; Han, Kijun

2018-02-25

The emergence of smart devices and smart appliances has highly favored the realization of the smart home concept. Modern smart home systems handle a wide range of user requirements. Energy management and energy conservation are in the spotlight when deploying sophisticated smart homes. However, the performance of energy management systems is highly influenced by user behaviors and adopted energy management approaches. Appliance scheduling is widely accepted as an effective mechanism to manage domestic energy consumption. Hence, we propose a smart home energy management system that reduces unnecessary energy consumption by integrating an automated switching off system with load balancing and appliance scheduling algorithm. The load balancing scheme acts according to defined constraints such that the cumulative energy consumption of the household is managed below the defined maximum threshold. The scheduling of appliances adheres to the least slack time (LST) algorithm while considering user comfort during scheduling. The performance of the proposed scheme has been evaluated against an existing energy management scheme through computer simulation. The simulation results have revealed a significant improvement gained through the proposed LST-based energy management scheme in terms of cost of energy, along with reduced domestic energy consumption facilitated by an automated switching off mechanism.

Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus

PubMed Central

Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Barrett, James; Chung, Alan; Shaw, Christine; Williams, Kate

2011-01-01

Aim This is a review of descriptive studies with incontinence as the primary focus in older people in care homes. Background Incontinence is prevalent among residents of care home populations. Data sources MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications. Methods A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007–2009. This is a report of descriptive studies. Results Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes. Conclusions Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted. PMID:21105895

Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus.

PubMed

Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Barrett, James; Chung, Alan; Shaw, Christine; Williams, Kate

2011-02-01

This is a review of descriptive studies with incontinence as the primary focus in older people in care homes. Incontinence is prevalent among residents of care home populations. MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications. A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007-2009. This is a report of descriptive studies. Results. Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes. Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

Changes in Patient Sorting to Nursing Homes under Public Reporting: Improved Patient Matching or Provider Gaming?

PubMed Central

Werner, Rachel M; Konetzka, R Tamara; Stuart, Elizabeth A; Polsky, Daniel

2011-01-01

Objective To test whether public reporting in the setting of postacute care in nursing homes results in changes in patient sorting. Data Sources/Study Setting All postacute care admissions from 2001 to 2003 in the nursing home Minimum Data Set. Study Design We test changes in patient sorting (or the changes in the illness severity of patients going to high- versus low-scoring facilities) when public reporting was initiated in nursing homes in 2002. We test for changes in sorting with respect to pain, delirium, and walking and then examine the potential roles of cream skimming and downcoding in changes in patient sorting. We use a difference-in-differences framework, taking advantage of the variation in the launch of public reporting in pilot and nonpilot states, to control for underlying trends in patient sorting. Principal Findings There was a significant change in patient sorting with respect to pain after public reporting was initiated, with high-risk patients being more likely to go to high-scoring facilities and low-risk patients more likely to go to low-scoring facilities. There was also an overall decrease in patient risk of pain with the launch of public reporting, which may be consistent with changes in documentation of pain levels (or downcoding). There was no significant change in sorting for delirium or walking. Conclusions Public reporting of nursing home quality improves matching of high-risk patients to high-quality facilities. However, efforts should be made to reduce the incentives for downcoding by nursing facilities. PMID:21105869

Research of home energy management system based on technology of PLC and ZigBee

NASA Astrophysics Data System (ADS)

Wei, Qi; Shen, Jiaojiao

2015-12-01

In view of the problem of saving effectively energy and energy management in home, this paper designs a home energy intelligent control system based on power line carrier communication and wireless ZigBee sensor networks. The system is based on ARM controller, power line carrier communication and wireless ZigBee sensor network as the terminal communication mode, and realizes the centralized and intelligent control of home appliances. Through the combination of these two technologies, the advantages of the two technologies complement each other, and provide a feasible plan for the construction of energy-efficient, intelligent home energy management system.

Vehicle Thermal Management Publications | Transportation Research | NREL

Science.gov Websites

Publications Vehicle Thermal Management Publications Explore NREL's recent publications about light - and heavy-duty vehicle thermal management. For the complete collection of NREL's vehicle thermal management publications, search the NREL Publications Database. All Light-Duty Electric-Drive Light-Duty

Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review

PubMed Central

Reeder, Blaine; Meyer, Ellen; Lazar, Amanda; Chaudhuri, Shomir; Thompson, Hilaire J.; Demiris, George

2013-01-01

Introduction There is a critical need for public health interventions to support the independence of older adults as the world’s population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. Methods We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. Results One thousand, six hundred and thirty nine candidate articles were identified. Thirty-one studies from the years 1998–2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). Conclusion The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of these used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults, social support and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries. PMID:23639263

Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review.

PubMed

Reeder, Blaine; Meyer, Ellen; Lazar, Amanda; Chaudhuri, Shomir; Thompson, Hilaire J; Demiris, George

2013-07-01

There is a critical need for public health interventions to support the independence of older adults as the world's population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. One thousand, six hundred and thirty-nine candidate articles were identified. Thirty-one studies from the years 1998-2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of them used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults; social support; and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Outcomes of Planned Home Visits of Intern Public Health Nurses: An Example from Turkey.

PubMed

Ozkan, Ozlem; Ozdemir, Saadet

This study aimed at evaluating the outcomes of planned home visits of intern public health nurses enrolled to a school of health over 8 educational years. The descriptive research consisted of 181 families (N = 745 individuals) who received primary services through the planned home visits undertaken by 431 intern public health nurses at Kocaeli province in Turkey. The data were collected from Family Nursing Process Records and Family Health Achievement Forms. Both of these data collection forms were classified according to North American Nursing Diagnosis Association (NANDA) Taxonomy II. Intern public health nurses provided primary health services to 181 families (N = 745 persons) with a total of 8771 planned home visits undertaken over 802 days and 14.874 student/practice days. A total of 1539 nursing diagnoses were identified and 1677 achievements about these diagnoses were reported. Nursing diagnosis per family and per individual turned out to be 8.50 and 2.1, respectively, and achievements were 9.3 per family and 2.3 per individual. Among the nursing diagnosis domains, health promotion (20.3%), safety/protection (16.8%), and activity/rest (16.0%) were the top 3 domains identified. The most common diagnoses turned out to be ineffective health maintenance (47.4%) in health promotion domain and risk for trauma (18.2%) in safety/protection domain. The achievements were reported most in health promotion (37.9%), activity/rest (17.6%), and safety/protection (9.6%), respectively. Planned and continuous home visits by intern public health nurses resulted in positive health achievements in families, especially for women and children. Copyright © 2016. Published by Elsevier Inc.

Supporting care home staff to manage residents' care safely and avoid admissions.

PubMed

Wills, Susan; Ross, Dena

2018-05-31

The community matron care homes team (CHT) was set up in Sandwell, West Midlands in 2011 to support care home staff to manage residents' care safely and reduce unplanned and/or avoidable use of acute health services. The service was reviewed in 2015 and attention focused on care homes with the highest levels of hospital use and emergency 999 services. Working with these care home staff and health professionals, a training and education opportunity to aid staff to manage residents in crisis was sourced, organised and implemented. The outcome of this training was positive: it demonstrated a reduction in hospital attendances and admissions and an increase in the confidence and morale of care home staff. The community matron CHT won the Nursing Older People category of the RCNi Nurse Awards in May 2017. This award has resulted in the team's profile being raised, and the team being asked to participate in further initiatives to provide enhanced support for care homes. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Predicting nursing home placement among home- and community-based services program participants.

PubMed

Greiner, Melissa A; Qualls, Laura G; Iwata, Isao; White, Heidi K; Molony, Sheila L; Sullivan, M Terry; Burke, Bonnie; Schulman, Kevin A; Setoguchi, Soko

2014-12-01

Several states offer publicly funded-care management programs to prevent long-term care placement of high-risk Medicaid beneficiaries. Understanding participant risk factors and services that may prevent long-term care placement can facilitate efficient allocation of program resources. To develop a practical prediction model to identify participants in a home- and community-based services program who are at highest risk for long-term nursing home placement, and to examine participant-level and program-level predictors of nursing home placement. In a retrospective observational study, we used deidentified data for participants in the Connecticut Home Care Program for Elders who completed an annual assessment survey between 2005 and 2010. We analyzed data on patient characteristics, use of program services, and short-term facility admissions in the previous year. We used logistic regression models with random effects to predict nursing home placement. The main outcome measures were long-term nursing home placement within 180 days or 1 year of assessment. Among 10,975 study participants, 1249 (11.4%) had nursing home placement within 1 year of annual assessment. Risk factors included Alzheimer's disease (odds ratio [OR], 1.30; 95% CI, 1.18-1.43), money management dependency (OR, 1.33; 95% CI, 1.18-1.51), living alone (OR, 1.53; 95% CI, 1.31-1.80), and number of prior short-term skilled nursing facility stays (OR, 1.46; 95% CI, 1.31-1.62). Use of a personal care assistance service was associated with 46% lower odds of nursing home placement. The model C statistic was 0.76 in the validation cohort. A model using information from a home- and community-based service program had strong discrimination to predict risk of long-term nursing home placement and can be used to identify high-risk participants for targeted interventions.

Nursing Home Staff Characteristics and Knowledge Gain from a Didactic Workshop on Depression and Behavior Management

ERIC Educational Resources Information Center

Meeks, Suzanne; Burton, Elizabeth G.

2004-01-01

Depression is a prevalent and serious problem among nursing home residents. Nursing home staff members are gatekeepers for mental health treatment for residents, but may know little about depression and its management. We evaluated a didactic workshop for nursing home staff on depressive symptoms and management. Results for 58 staff participants…

The private management of public hospitals.

PubMed Central

Rundall, T G; Lambert, W K

1984-01-01

Since the public sector traditionally has provided the public goods viewed as unprofitable by the private sector, the growing trend to manage public hospitals under outside private contract raises some fundamental issues of concern. It is hypothesized here that the system maintenance and output goals of privately managed public hospitals become increasingly similar to those of investor-owned hospitals. The thesis is empirically tested using documented effects of private contract management on the operative goals of short-term, general hospitals owned by local governmental bodies. Traditionally managed public hospitals matched with the study hospitals on important characteristics serve as the control group. Costs do appear to be reduced under private contract management, but the service structure becomes somewhat altered. It is the task of public health policymakers to reconcile the cost-control and efficiency mechanisms brought about by private management with the community's right of access to comprehensive medical care. Carefully structured regionalization plans--a possible means of providing both--will require the stimulation of more government involvement during an era of cutbacks. PMID:6490379

Teaching and Maintaining Behavior Management Skills in the Nursing Home.

ERIC Educational Resources Information Center

Burgio, Louis D.; Stevens, Alan; Burgio, Kathryn L.; Roth, David L.; Paul, Penelope; Gerstle, John

2002-01-01

Examines the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants' (CNAs) skill performance in the nursing home. Results reveal improvement in five out of seven communication skills. Although CNAs showed a reduction in the use of ineffective behavior management strategies, they did not…

Management of Giant Sequoia on Mountain Home Demonstration State Forest

Treesearch

Norman J. Benson

1986-01-01

Established in 1946, the Mountain Home Demonstration State Forest, Tulare County, California, is managed by the California Department of Forestry. It is a multiple-use forest with recreation as its primary focus, although timber management has always played an important role. Giant sequoia (Sequoiadendron giganteum [Lindl. ] Buchholz) occurs in...

The impact of managed competition on diversity, innovation and creativity in the delivery of home-care services.

PubMed

Randall, Glen E

2008-07-01

Reforming publicly funded healthcare systems by introducing elements of competition, often by allowing for-profit providers to compete with not-for-profit providers, is a strategy that has become commonplace in Western democracies. It is widely thought that the competitive forces of the marketplace will lead to greater efficiency, diversity and even innovation in the delivery of services. Between 1997 and 2000, a model of 'managed competition' was introduced as a major reform to the delivery of home-care services in Ontario, Canada. It was expected that by allowing greater competition within the home-care sector, this model would constrain costs and encourage provider agencies to become more innovative and creative in meeting service delivery needs. The purpose of this case study is to explore the impact of the managed competition reform on the for-profit and the not-for-profit organisations that provided rehabilitation home-care services, and, more specifically, to assess the extent to which the goal of greater diversity, innovation and creativity was achieved following implementation of the reform. A purposive sample of 49 key informants were selected for in-depth interviews, and a survey of the 36 organisations that provided rehabilitation home-care services and the 43 community care access centres that purchased services from these provider agencies was conducted. Data were collected between November 2002 and May 2003. Findings demonstrate that a combination of coercive, mimetic and normative isomorphic pressures have constrained diversity, innovation and creativity within the home-care sector. The implication is that the features that have traditionally distinguished for-profit and not-for-profit provider agencies from each other are rapidly disappearing, and a new hybrid organisational structure is evolving.

Home care nurses' knowledge of evidence-based education topics for management of heart failure.

PubMed

Delaney, Colleen; Apostolidis, Beka; Lachapelle, Leeanne; Fortinsky, Richard

2011-01-01

We primarily sought to evaluate home care nurses' knowledge of evidence-based education topics in managing heart failure (HF). Moreover, we wanted to determine if differences were evident in nurses' knowledge based on education and work experience, and to identify home care nurses' specific educational needs. A cross-sectional survey design was used. Home care nurses (n = 94) were recruited from 4 home care agencies. A previously published 20-item HF knowledge questionnaire was administered to participants, and an open-ended question determined participants' need for further HF-related education. Home care nurses' scores demonstrated a 78.9% knowledge level in overall HF education principles. The mean HF knowledge score was 15.78 (SD, ±1.69) out of a possible 20 points. Nurses scored lowest on knowledge related to asymptomatic hypotension (24.5% answered correctly), daily weight monitoring (26.6% answered correctly), and transient dizziness (30.9% answered correctly). Nurses requested further information on all HF topics addressed in the survey as well as on psychosocial issues, research evidence, and more information from other healthcare providers. Our findings suggest that home care nurses may not be sufficiently knowledgeable in evidence-based education topics for managing HF. The results help confirm the need to develop educational programs for home care nurses in managing HF, which may lead to improved quality of patient education. Further research is needed to address specific deficits in the knowledge of home care nurses, and to determine if HF educational programs for nurses would enhance and sustain nurses' knowledge of HF management education. Copyright © 2011 Elsevier Inc. All rights reserved.

Pain management for older persons living in nursing homes: a pilot study.

PubMed

Tse, Mimi M Y; Ho, Suki S K

2013-06-01

Because the prevalence of chronic pain among the elderly in nursing homes is high and decreases their quality of life, effective nonpharmacologic pain management should be promoted. The purpose of this quasiexperimental pretest and posttest control design was to enhance pain management in nursing homes via an integrated pain management program (IPMP) for staff and residents. Nursing staff and residents from the experimental nursing home were invited to join the 8-week IPMP, whereas staff and residents from the control nursing home did not receive the IPMP. Baseline data were collected from nursing staff and residents in both groups before and after the IPMP. The IPMP consisted of eight lectures on pain assessment, drug knowledge,and nondrug strategies for the nursing staff, and 8 weeks of activities, including gardening therapy and physiotherapy exercise, for the residents. There were 48 and 42 older people in the experimental and control groups, respectively. No significant differences were found in their educational level, sleep quality, bowel habits, past and present health conditions, pain conditions and psychologic well-being parameters (p > .05) at baseline. After the IPMP, the experimental nursing staff showed a significant improvement in their knowledge of and attitudes to pain management (p < .05), and the experimental residents reported significantly lower pain scores and used more nondrug strategies for pain relief compared with the control group (p < .05). Moreover, the psychologic well-being parameters, including happiness, loneliness, life satisfaction, and geriatric depression, had significantly improved among the experimental residents (p < .05). The IPMP was effective in enhancing the knowledge and attitudes of nursing staff, as well as reducing pain conditions and enhancing psychologic well-being for older persons in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Antidepressant Medication Management among Older Patients Receiving Home Health Care

PubMed Central

Bao, Yuhua; Shao, Huibo; Bruce, Martha L.; Press, Matthew J.

2014-01-01

Objective Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. Methods Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients 65 or older who received HHC in 2006–7 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (vs. discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. Results About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10–20 percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. Conclusions Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions. PMID:25158915

A medical home: value and implications of knowledge management.

PubMed

Orzano, A John; McInerney, Claire R; McDaniel, Reuben R; Meese, Abigail; Alajmi, Bibi; Mohr, Stewart M; Tallia, Alfred F

2009-01-01

Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution. We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives. Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants. Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home. Knowledge management differences occur within and between practices and can explain

Exploring the relationship between nursing home financial performance and management entrepreneurial attributes.

PubMed

Davis, Jullet A; Marino, Louis D; Vecchiarini, Mariangela

2013-01-01

degrees, nursing home administrators may view themselves as being entrepreneurial despite the intense pressures from governments, poor public perceptions, decreasing reimbursement, more impaired residents, and increasing competition from substitute providers. Further administrators may need to manage the expectations of key stakeholders when they undertake innovative programs that will support social outcomes but which may not enhance short term financial performance. This paper demonstrates the complex relationship between entrepreneurial activities and firm performance in nursing homes and has implications for the broader health care setting.

AED use in businesses, public facilities and homes by minimally trained first responders.

PubMed

Jorgenson, Dawn B; Skarr, Teresa; Russell, James K; Snyder, David E; Uhrbrock, Karen

2003-11-01

Automated external defibrillators (AEDs) have become increasingly available outside of the Emergency Medical Systems (EMS) community to treat sudden cardiac arrest (SCA). We sought to study the use of AEDs in the home, businesses and other public settings by minimally trained first responders. The frequency of AED use, type of training offered to first responders, and outcomes of AED use were investigated. In addition, minimally trained responders were asked if they had encountered any safety problems associated with the AED. We conducted a telephone survey of businesses and public facilities (2683) and homes (145) owning at least one AED for at least 12 months. Use was defined as an AED taken to a medical emergency thought to be a SCA, regardless of whether the AED was applied to the patient or identified a shockable rhythm. Of owners that participated in the survey, 13% (209/1581) of businesses and 5% (4/73) of homes had responded with the AED to a suspected cardiac arrest. Ninety-five percent of the businesses/public facilities offered training that specifically covered AED use. The rate of use for the AEDs was highest in residential buildings, public places, malls and recreational facilities with an overall usage rate of 11.6% per year. In-depth interviews were conducted with lay responders who had used the AED in a suspected cardiac arrest. In the four cases where the AED was used solely by a lay responder, all four patients survived to hospital admission and two were known to be discharged from the hospital. There were no reports of injury or harm. This survey demonstrates that AEDs purchased by businesses and homes were frequently taken to suspected cardiac arrests. Lay responders were able to successfully use the AEDs in emergency situations. Further, there were no reports of harm or injury to the operators, bystanders or patients from lay responder use of the AEDs.

Parents' experiences of managing their child's postoperative pain at home: an exploratory qualitative study.

PubMed

Longard, Julie; Twycross, Alison; Williams, Anna M; Hong, Paul; Chorney, Jill

2016-09-01

To understand parents' experiences of managing their child's postoperative pain at home. Recent changes in children's health care services often shift the responsibility of managing children's postoperative pain to parents. Although pain management is important for good postoperative outcomes, it can be a challenging task for families, and children's pain is often under-managed. This qualitative study used semi-structured interviews to explore parents' experiences of managing their child's postoperative pain at home. Participants were parents of 10 typically developing 5- and 6-year olds, who underwent (adeno)tonsillectomy, and experienced no complications leading to hospitalisation in the postoperative period. One-on-one interviews were conducted with parents within three months of their child's surgery. Interviews were transcribed verbatim and content analysis was used to identify themes in parents' experiences. All children experienced some postoperative pain. Parents' experiences of managing their child's pain were impacted by balancing the pros and cons of administering analgesic medications, managing the emotional and psychological effects of their child's pain, as well as parents' information needs. Most parents' information needs were met yet they still struggled to manage their child's pain. These findings provide insight into some of the barriers that make this process challenging for many families, and what health care centres can do to help support parents manage their child's postoperative pain at home. The results of this study may aid in the design of interventions that will support parents when managing their child's postoperative pain at home and thus improve children's experiences. © 2016 John Wiley & Sons Ltd.

Preventing Falls and Fall-Related Injuries at Home.

PubMed

Powell-Cope, Gail; Thomason, Susan; Bulat, Tatjana; Pippins, Karla M; Young, Heather M

2018-01-01

: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series explain principles for promoting safe mobility that nurses should reinforce with family caregivers. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage the caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Electric Energy Management in the Smart Home: Perspectives on Enabling Technologies and Consumer Behavior

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zipperer, Adam; Aloise-Young, Patricia A.; Suryanarayanan, Siddharth

2013-11-01

Smart homes hold the potential for increasing energy efficiency, decreasing costs of energy use, decreasing the carbon footprint by including renewable resources, and transforming the role of the occupant. At the crux of the smart home is an efficient electric energy management system that is enabled by emerging technologies in the electric grid and consumer electronics. This article presents a discussion of the state-of-the-art in electricity management in smart homes, the various enabling technologies that will accelerate this concept, and topics around consumer behavior with respect to energy usage.

Electric Energy Management in the Smart Home: Perspectives on Enabling Technologies and Consumer Behavior

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zipperer, A.; Aloise-Young, P. A.; Suryanarayanan, S.

2013-08-01

Smart homes hold the potential for increasing energy efficiency, decreasing costs of energy use, decreasing the carbon footprint by including renewable resources, and trans-forming the role of the occupant. At the crux of the smart home is an efficient electric energy management system that is enabled by emerging technologies in the electricity grid and consumer electronics. This article presents a discussion of the state-of-the-art in electricity management in smart homes, the various enabling technologies that will accelerate this concept, and topics around consumer behavior with respect to energy usage.

41 CFR 302-14.100 - How should we administer our home marketing incentive payment program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false How should we administer our home marketing incentive payment program? 302-14.100 Section 302-14.100 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES...

Assessment of radio frequency exposures in schools, homes, and public places in Belgium.

PubMed

Verloock, Leen; Joseph, Wout; Goeminne, Francis; Martens, Luc; Verlaek, Mart; Constandt, Kim

2014-12-01

Characterization of exposure from emerging radio frequency (RF) technologies in areas where children are present is important. Exposure to RF electromagnetic fields (EMF) was assessed in three "sensitive" microenvironments; namely, schools, homes, and public places located in urban environments and compared to exposure in offices. In situ assessment was conducted by performing spatial broadband and accurate narrowband measurements, providing 6-min averaged electric-field strengths. A distinction between internal (transmitters that are located indoors) and external (outdoor sources from broadcasting and telecommunication) sources was made. Ninety-four percent of the broadband measurements were below 1 V m(-1). The average and maximal total electric-field values in schools, homes, and public places were 0.2 and 3.2 V m(-1) (WiFi), 0.1 and 1.1 V m(-1) (telecommunication), and 0.6 and 2.4 V m(-1) (telecommunication), respectively, while for offices, average and maximal exposure were 0.9 and 3.3 V m(-1) (telecommunication), satisfying the ICNIRP reference levels. In the schools considered, the highest maximal and average field values were due to internal signals (WiFi). In the homes, public places, and offices considered, the highest maximal and average field values originated from telecommunication signals. Lowest exposures were obtained in homes. Internal sources contributed on average more indoors (31.2%) than outdoors (2.3%), while the average contributions of external sources (broadcast and telecommunication sources) were higher outdoors (97.7%) than at indoor positions (68.8%). FM, GSM, and UMTS dominate the total downlink exposure in the outdoor measurements. In indoor measurements, FM, GSM, and WiFi dominate the total exposure. The average contribution of the emerging technology LTE was only 0.6%.

Development and implementation of a postdischarge home-based medication management service.

PubMed

Pherson, Emily C; Shermock, Kenneth M; Efird, Leigh E; Gilmore, Vi T; Nesbit, Todd; LeBlanc, Yvonne; Brotman, Daniel J; Deutschendorf, Amy; Swarthout, Meghan Davlin

2014-09-15

The development and implementation of a postdischarge home-based, pharmacist-provided medication management service are described. A work group composed of pharmacy administrators, clinical specialists, physicians, and nursing leadership developed the structure and training requirements to implement the service. Eligible patients were identified during their hospital admission by acute care pharmacists and consented for study participation. Pharmacists and pharmacy residents visited the patient at home after discharge and conducted medication reconciliation, provided patient education, and completed a comprehensive medication review. Recommendations for medication optimization were communicated to the patient's primary care provider, and a reconciled medication list was faxed to the patient's community pharmacy. Demographic and medication-related data were collected to characterize patients receiving the home-based service. A total of 50 patients were seen by pharmacists in the home. Patient education provided by the home-based pharmacists included monitoring instructions, adherence reinforcement, therapeutic lifestyle changes, administration instructions, and medication disposal instructions. Pharmacists provided the following recommendations to providers to optimize medication regimens: adjust dosage, suggest laboratory tests, add medication, discontinue medication, need prescription for refills, and change product formulation. Pharmacists identified a median of two medication discrepancies per patient and made a median of two recommendations for medication optimization to patients' primary care providers. The implementation of a post-discharge, pharmacist-provided home-based medication management service enhanced the continuity of patient care during the transition from hospital to home. Pharmacists identified and resolved medication discrepancies, educated patients about their medications, and provided primary care providers and community pharmacies with a

Ownership, financing, and management strategies of the ten largest for-profit nursing home chains in the United States.

PubMed

Harrington, Charlene; Hauser, Clarilee; Olney, Brian; Rosenau, Pauline Vaillancourt

2011-01-01

This study examined the ownership, financing, and management strategies of the 10 largest for-profit nursing home chains in the United States, including the four largest chains purchased by private equity corporations. Descriptive data were collected from Internet searches, company reports, and other sources for the decade 1998-2008. Since 1998, the largest chains have made many changes in their ownership and structure, and some have converted from publicly traded companies to private ownership. This study shows the increasing complexity of corporate nursing home ownership and the lack of public information about ownership and financial status. The chains have used strategies to maximize shareholder and investor value that include increasing Medicare revenues, occupancy rates, and company diversification, establishing multiple layers of corporate ownership, developing real estate investment trusts, and creating limited liability companies. These strategies enhance shareholder and investor profits, reduce corporate taxes, and reduce liability risk. There is a need for greater transparency in ownership and financial reporting and for more government oversight of the largest for-profit chains, including those owned by private equity companies.

Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study.

PubMed

Fraser, Kimberly D; Estabrooks, Carole; Allen, Marion; Strang, Vicki

2009-03-01

Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care. Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis. One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor. The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

Role for a Labor-Management Partnership in Nursing Home Person-Centered Care

ERIC Educational Resources Information Center

Leutz, Walter; Bishop, Christine E.; Dodson, Lisa

2010-01-01

Purpose: To investigate how a partnership between labor and management works to change the organization and focus of nursing home frontline work, supporting a transition toward person-centered care (PCC) in participating nursing homes. Design and Methods: Using a participatory research approach, we conducted case studies of 2 nursing homes…

Understanding and managing organizational change: implications for public health management.

PubMed

Thompson, Jon M

2010-01-01

Managing organizational change has become a significant responsibility of managers. Managing the change process within public health organizations is important because appropriately and systematically managing change is linked to improved organizational performance. However, change is difficult and the change process poses formidable challenges for managers. Managers themselves face increased pressure to respond to environmental influences and provide the necessary leadership to their organizations in the change process. In fact, managing organizational change has become a key competency for healthcare managers. This article addresses the important topic of organizational change in public health organizations. It provides a conceptual foundation for understanding organizational change and its relationship to healthcare organizational performance, and then discusses the types and nature of change, using some examples and evidence from those organizations that have successfully managed change. A framework for guiding public health managers in the change management process is provided. The article concludes with suggested management competencies to establish a change-oriented organization with the culture and capacity for change.

Manager Perspectives on Communication and Public ...

EPA Pesticide Factsheets

We argue that public engagement is crucial to achieving lasting ecological success in aquatic restoration efforts, and that the most effective public engagement mechanisms are what we term iterative mechanisms. Here we look to a particular social-ecological system – the restoration community in Rhode Island, U.S.A. and the rivers, wetlands, marshes, and estuaries, and their related species, that they work to protect – to better understand land managers’ perspectives on public engagement in restoration processes. Adopting an inductive approach to critical discourse analysis of interviews with 27 local, state, and federal restoration managers and the forms of public interaction they described, we identify three distinct models of public engagement in natural resources management employed by managers: unidirectional; bidirectional; and iterative. While unidirectional and bidirectional mechanisms can help managers achieve short-term ecological successes, we suggest that adopting an iterative approach can improve the quality of stakeholder and learning interactions and, subsequently, foster lasting ecological successes. We argue that managers can design deliberately for public engagement mechanisms that are best suited to projects in particular social-ecological systems in order to create restoration projects that achieve ecological, learning, and stakeholder successes. We attempt to synthesize the lessons learned from efforts at public engagement in restoratio

Care satisfaction among older people receiving public care and service at home or in special accommodation.

PubMed

Karlsson, Staffan; Edberg, Anna-Karin; Jakobsson, Ulf; Hallberg, Ingalill R

2013-02-01

To explore care satisfaction in relation to place of living, health-related quality of life, functional dependency and health complaints among people 65 years or older, receiving public care and service. The concept public care and service concerns formal care from the municipality, including home help, home nursing care, rehabilitation and a special accommodation. To be able to provide care and service of high quality to older people, knowledge about factors influencing their experience of satisfaction with the care is essential. Cross-sectional, including comparison and correlation. One-hundred sixty-six people receiving public care and service from the municipality were interviewed regarding demography, functional ability, perceived health complaints and care. Health-related quality of life was measured with SF-12, and self-rated care satisfaction was measured with a questionnaire. Low self-rated care satisfaction was associated with dependency in Instrumental Activities of Daily Living, blindness, faeces incontinence and anxiety, while high self-rated care satisfaction was associated with dependency in Personal Activities of Daily Living. Those at home rated an overall higher care satisfaction and were more satisfied with care continuity and personal relations; they thought that the staff had more time and were more respectful and quiet, than the ratings by those in a special accommodation (equivalent to a nursing home). Care satisfaction and health-related quality of life among older people was more associated with functional impairment and health complaints than to whether care and service was received at home or in a special accommodation. An approach using intervention focused on functional ability and health complaints is important for development of improved care satisfaction for older people receiving public care and service. © 2013 Blackwell Publishing Ltd.

First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care.

PubMed

Håkanson, Cecilia; Cronfalk, Berit Seiger; Henriksen, Eva; Norberg, Astrid; Ternestedt, Britt-Marie; Sandberg, Jonas

2014-01-01

The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.

Management Academy for Public Health: Creating Entrepreneurial Managers

PubMed Central

Orton, Stephen; Umble, Karl; Zelt, Sue; Porter, Janet; Johnson, Jim

2007-01-01

The Management Academy for Public Health develops public health managers’ management skills. Ultimately, the program aims to develop civic entrepreneurs who can improve the efficiency and the effectiveness of their organizations. With help from a coach, teams write public health business plans to meet needs in their communities. An external evaluation found that 119 teams trained during the first 3 years of the program generated more than $6 million in enhanced revenue—including grants, contracts, and fees through their business plans—from $2 million in program funding. Approximately 38% of the teams expected to generate revenue from an academy business plan or a spin-off plan. Action-learning methods can help midcareer managers transfer their training to the workplace and build entrepreneurial skills. PMID:17329658

[Home parenteral nutrition (HPN): feasibility of its implementation from a public hospital].

PubMed

Fabeiro, M; Dalieri, M; Martínez, M; Galarraga, M; Prozzi, M; Barcellandi, P; Hernández, J; Alberti, M J; Fernández, A

2011-01-01

The intensive care of patients at home had probed important beneficialness for the patient and the Health System. There are very few experiences of this kind of care from the Public Hospitals. To develop a social-sanitary analysis of the feasibility of the implementation of HPN on patients with short bowel syndrome (SBS) from a Public Hospital. Patients hospitalized between 1985-2009 were included. We analyzed: age, residual intestine length (RIL), time between de indication and the beginning of HPN, HPN duration, treatment modality and clinical outcome. Social determinants: home place, habitat conditions, employment conditions, educational level, social security and Low Socioeconomic Status (LSS). The group were divided in two: 1- patients with feasibility of HPN when it was prescribed; 2- patients without feasibility of HPN. 61 patients were included, RIL x: 21.7 ± 11.6 cm. The HPN was feasible (G1) in 32 patients (52.4%) and no feasible (G2) in 29 (47.6%). The home treatment modality was in self-caring 25 (81%) and with nurses support 7 (19 %). The social determinants associated with the HPN feasibility were: more than one takecare (p 0.03), educational level (p 0.01), adequate habitat conditions (p 0.02) and Low Socioeconomis Status (LSS) (p 0.07). 17 patients reached intestinal adaptation (28%), 6 (10%) were transplanted, 19 (31%) died and 19 (31%) are actually on HPN. The HPN realized from the Public Hospital is feasible. Different social determinants were observed. The care of this group of patients must be done by an interdisciplinary group including general aspects of the child and the family.

Public health financial management competencies.

PubMed

Honoré, Peggy A; Costich, Julia F

2009-01-01

The absence of appropriate financial management competencies has impeded progress in advancing the field of public health finance. It also inhibits the ability to professionalize this sector of the workforce. Financial managers should play a critical role by providing information relevant to decision making. The lack of fundamental financial management knowledge and skills is a barrier to fulfilling this role. A national expert committee was convened to examine this issue. The committee reviewed standards related to financial and business management practices within public health and closely related areas. Alignments were made with national standards such as those established for government chief financial officers. On the basis of this analysis, a comprehensive set of public health financial management competencies was identified and examined further by a review panel. At a minimum, the competencies can be used to define job descriptions, assess job performance, identify critical gaps in financial analysis, create career paths, and design educational programs.

A cloud-based home management system for patients with a left ventricular assist device: a case report.

PubMed

Nomoto, Shinichi; Utsumi, Momoe; Minakata, Kenji

2016-07-04

Since implantable left ventricular assist devices (LVAD) with smaller configurations became available for bridge-to-transplant or even destination therapy in patients with end-stage heart failure, an increasing number of patients with these devices are receiving home medical management. However, these patients may be anxious about potential complications such as pump failure, thromboembolism, and infections that may occur during home management. To provide a sense of security during home management of patients with LVAD and to establish an ideal shared-care system, we developed a patient-centered cloud-based home management system for patients with LVAD. In this case report, we describe this system and report a trial of it in a 64-year-old patient with an LVAD.

Mobile Phone Based System Opportunities to Home-based Managing of Chemotherapy Side Effects.

PubMed

Davoodi, Somayeh; Mohammadzadeh, Zeinab; Safdari, Reza

2016-06-01

Applying mobile base systems in cancer care especially in chemotherapy management have remarkable growing in recent decades. Because chemotherapy side effects have significant influences on patient's lives, therefore it is necessary to take ways to control them. This research has studied some experiences of using mobile phone based systems to home-based monitor of chemotherapy side effects in cancer. In this literature review study, search was conducted with keywords like cancer, chemotherapy, mobile phone, information technology, side effects and self managing, in Science Direct, Google Scholar and Pub Med databases since 2005. Today, because of the growing trend of the cancer, we need methods and innovations such as information technology to manage and control it. Mobile phone based systems are the solutions that help to provide quick access to monitor chemotherapy side effects for cancer patients at home. Investigated studies demonstrate that using of mobile phones in chemotherapy management have positive results and led to patients and clinicians satisfactions. This study shows that the mobile phone system for home-based monitoring chemotherapy side effects works well. In result, knowledge of cancer self-management and the rate of patient's effective participation in care process improved.

Marketing in home health care. A practical approach.

PubMed

Freitag, E M

1988-06-01

Home health marketing brings special problems and opportunities. One cannot rely on physical factors such as the physical plant and food service of a hospital or on the durability of a consumer product to judge home health. Opportunities exist within home health to identify activities that carry marketing value. Applying marketing principles to activities such as intake, customer service and public relations allows the home health agency to build referrals by meeting the wants and needs of the market. The home health organization needs to consider different wants and needs of those involved in the home health transaction: the decision maker, the purchaser, and the user. The success of the marketing function in meeting the organization's objectives will be aided by the placement of marketing at the senior management level.

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

PubMed

Lewin, Gill; Concanen, Karyn; Youens, David

2016-01-01

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

Novel pervasive scenarios for home management: the Butlers architecture.

PubMed

Denti, Enrico

2014-01-01

Many efforts today aim to energy saving, promoting the user's awareness and virtuous behavior in a sustainability perspective. Our houses, appliances, energy meters and devices are becoming smarter and connected, domotics is increasing possibilities in house automation and control, and ambient intelligence and assisted living are bringing attention onto people's needs from different viewpoints. Our assumption is that considering these aspects together allows for novel intriguing possibilities. To this end, in this paper we combine home energy management with domotics, coordination technologies, intelligent agents, ambient intelligence, ubiquitous technologies and gamification to devise novel scenarios, where energy monitoring and management is just the basic brick of a much wider and comprehensive home management system. The aim is to control home appliances well beyond energy consumption, combining home comfort, appliance scheduling, safety constraints, etc. with dynamically-changeable users' preferences, goals and priorities. At the same time, usability and attractiveness are seen as key success factors: so, the intriguing technologies available in most houses and smart devices are exploited to make the system configuration and use simpler, entertaining and attractive for users. These aspects are also integrated with ubiquitous and pervasive technologies, geo-localization, social networks and communities to provide enhanced functionalities and support smarter application scenarios, hereby further strengthening technology acceptation and diffusion. Accordingly, we first analyse the system requirements and define a reference multi-layer architectural model - the Butlers architecture - that specifies seven layers of functionalities, correlating the requirements, the corresponding technologies and the consequent value-added for users in each layer. Then, we outline a set of notable scenarios of increasing functionalities and complexity, discuss the structure of the

Disease management: a new and exciting opportunity in home healthcare.

PubMed

Huffman, Melinda H

2005-05-01

Disease management programs are beginning to encompass providers across the healthcare continuum, including home healthcare. The premise behind disease management is that coordinated, evidence-based interventions can be applied to the care of patients with specific high-cost, high-volume chronic conditions, resulting in improved clinical outcomes and lower overall costs. Outcomes data (actual results) are central in this approach to patient care.

Top Management Leadership Style and Quality of Care in Nursing Homes

ERIC Educational Resources Information Center

Castle, Nicholas G.; Decker, Frederic H.

2011-01-01

Purpose: The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Design and Methods: Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style…

SymptomCare@Home: Developing an Integrated Symptom Monitoring and Management System for Outpatients Receiving Chemotherapy.

PubMed

Beck, Susan L; Eaton, Linda H; Echeverria, Christina; Mooney, Kathi H

2017-10-01

SymptomCare@Home, an integrated symptom monitoring and management system, was designed as part of randomized clinical trials to help patients with cancer who receive chemotherapy in ambulatory clinics and often experience significant symptoms at home. An iterative design process was informed by chronic disease management theory and features of assessment and clinical decision support systems used in other diseases. Key stakeholders participated in the design process: nurse scientists, clinical experts, bioinformatics experts, and computer programmers. Especially important was input from end users, patients, and nurse practitioners participating in a series of studies testing the system. The system includes both a patient and clinician interface and fully integrates two electronic subsystems: a telephone computer-linked interactive voice response system and a Web-based Decision Support-Symptom Management System. Key features include (1) daily symptom monitoring, (2) self-management coaching, (3) alerting, and (4) nurse practitioner follow-up. The nurse practitioner is distinctively positioned to provide assessment, education, support, and pharmacologic and nonpharmacologic interventions to intensify management of poorly controlled symptoms at home. SymptomCare@Home is a model for providing telehealth. The system facilitates using evidence-based guidelines as part of a comprehensive symptom management approach. The design process and system features can be applied to other diseases and conditions.

Perceptions of health and risk management among home care workers in Sweden.

PubMed

Larsson, A; Karlqvist, L; Westerberg, M; Gard, G

2013-10-01

Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way. This study aims to examine home care workers' perceptions of health, risks, working conditions, and risk management within their organization. The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides ( n  = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed. Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified. There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.

Assessment of pharmaceutical waste management at selected hospitals and homes in Ghana.

PubMed

Sasu, Samuel; Kümmerer, Klaus; Kranert, Martin

2012-06-01

The practice of use and disposal of waste from pharmaceuticals compromises the safety of the environment as well as representing a serious health risk, as they may accumulate and stay active for a long time in the aquatic environment. This article therefore presents the outcome of a study on pharmaceutical waste management practices at homes and hospitals in Ghana. The study was conducted at five healthcare institutions randomly selected in Ghana, namely two teaching hospitals (hospital A, hospital B), one regional hospital (hospital C), one district hospital (hospital D) and one quasi-governmental hospital (hospital E). Apart from hospital E which currently has a pharmaceutical waste separation programmr as well as drug return programme called DUMP (Disposal of Unused Medicines Program), all other hospitals visited do not have any separate collection and disposal programme for pharmaceutical waste. A survey was also carried out among the general public, involving the questioning of randomly selected participants in order to investigate the household disposal of unused and expired pharmaceuticals. The results from the survey showed that more than half of the respondents confirmed having unused, left-over or expired medicines at home and over 75% disposed of pharmaceutical waste through the normal waste bins which end up in the landfills or dump sites.

First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care

PubMed Central

Håkanson, Cecilia; Cronfalk, Berit Seiger; Henriksen, Eva; Norberg, Astrid; Ternestedt, Britt-Marie; Sandberg, Jonas

2015-01-01

The aim of this study was to investigate first-line nursing home managers’ views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested. PMID:25628769

41 CFR 302-14.5 - Under what circumstances will I receive a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Under what circumstances will I receive a home marketing incentive payment? 302-14.5 Section 302-14.5 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES...

Family caregiving at the intersection of private care by migrant home care workers and public care by nursing staff.

PubMed

Ayalon, Liat; Halevy-Levin, Sara; Ben-Yizhak, Zvi; Friedman, Gideon

2013-09-01

This study evaluated private family caregiving at the intersection of private migrant home care and public nursing care on the hospitalization of an older patient. Seventy-three individuals were interviewed, including older hospitalized patients, their family members, accompanying migrant home care workers, and nursing personnel. There was no clear consensus concerning the role of family members. Although family members emphasized care management as their main role, the other three groups emphasized that the family members' mere physical presence was their main role. All four groups identified potential barriers to family caregiving, rather than motives for family caregiving, hence pointing to a potential discrepancy between expected and performed family caregiving roles. An indication of the lack of clarity concerning family caregiving roles stems from the finding that family members were frequently viewed as unengaged and neglectful, yet at times they were criticized for being overly involved in patient care. Implications for the care of hospitalized older adults are discussed.

Management Education in Public Health: Further Considerations

PubMed Central

Darr, Kurt J.

2015-01-01

Knowing and applying the basic management functions of planning, organizing, staffing, directing, and controlling, as well as their permutations and combinations, are vital to effective delivery of public health services. Presently, graduate programs that prepare public health professionals neither emphasize teaching management theory, nor its application. This deficit puts those who become managers in public health and those they serve at a distinct disadvantage. This deficit can be remedied by enhanced teaching of management subjects PMID:26673475

Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design.

PubMed

Fortinsky, Richard H; Gitlin, Laura N; Pizzi, Laura T; Piersol, Catherine Verrier; Grady, James; Robison, Julie T; Molony, Sheila

2016-07-01

Dementia is the leading cause of loss of independence in older adults worldwide. In the U.S., approximately 15 million family members provide care to relatives with dementia. This paper presents the rationale and design for a translational study in which an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers (CGs) is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission. The 4-month Care of Persons with Dementia in their Environments (COPE) intervention is designed to optimize older adults' functional independence, and to improve CG dementia management skills and health-related outcomes. COPE features 10 in-home occupational therapy visits, and 1 in-home visit and 1 telephone contact by an advanced practice nurse. COPE was deemed efficacious in a published randomized clinical trial. In the present study, older adults with dementia enrolled in the Connecticut Home Care Program for Elders (CHCPE) and their CGs are randomly assigned to receive COPE plus their ongoing CHCPE services, or to continue receiving CHCPE services only. The primary outcome for older adults with dementia is functional independence; secondary outcomes are activity engagement, quality of life, and prevention or alleviation of neuropsychiatric symptoms. CG outcomes include perceived well-being and confidence in using activities to manage dementia symptoms. Translational outcomes include net financial benefit of COPE, and feasibility and acceptability of COPE implementation into the CHCPE. COPE has the potential to improve health-related outcomes while saving Medicaid waiver and state revenue-funded home care program costs nationwide. Copyright © 2016 Elsevier Inc. All rights reserved.

Public Managers Should Be Proactive

ERIC Educational Resources Information Center

Carlson, Thomas S.

1976-01-01

Future public managers should be proactive by creating management processes before problems arise. Planning prevents reactive or crisis managing. Future managers should also be prepared to meet dilemmas and paradoxes such as centralization versus decentralization of decision-making and work processes, politics versus administration dichotomy, and…

Benchmarking management practices in Australian public healthcare.

PubMed

Agarwal, Renu; Green, Roy; Agarwal, Neeru; Randhawa, Krithika

2016-01-01

The purpose of this paper is to investigate the quality of management practices of public hospitals in the Australian healthcare system, specifically those in the state-managed health systems of Queensland and New South Wales (NSW). Further, the authors assess the management practices of Queensland and NSW public hospitals jointly and globally benchmark against those in the health systems of seven other countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. In this study, the authors adapt the unique and globally deployed Bloom et al. (2009) survey instrument that uses a "double blind, double scored" methodology and an interview-based scoring grid to measure and internationally benchmark the management practices in Queensland and NSW public hospitals based on 21 management dimensions across four broad areas of management - operations, performance monitoring, targets and people management. The findings reveal the areas of strength and potential areas of improvement in the Queensland and NSW Health hospital management practices when compared with public hospitals in seven countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. Together, Queensland and NSW Health hospitals perform best in operations management followed by performance monitoring. While target management presents scope for improvement, people management is the sphere where these Australian hospitals lag the most. This paper is of interest to both hospital administrators and health care policy-makers aiming to lift management quality at the hospital level as well as at the institutional level, as a vehicle to consistently deliver sustainable high-quality health services. This study provides the first internationally comparable robust measure of management capability in Australian public hospitals, where hospitals are run independently by the state-run healthcare systems. Additionally, this research study contributes to the empirical evidence base on the quality of

Strategic Orientation and Nursing Home Response to Public Reporting of Quality Measures: An Application of the Miles and Snow Typology

PubMed Central

Zinn, Jacqueline S; Spector, William D; Weimer, David L; Mukamel, Dana B

2008-01-01

Objective To assess whether differences in strategic orientation of nursing homes as identified by the Miles and Snow typology are associated with differences in their response to the publication of quality measures on the Nursing Home Compare website. Data Sources Administrator survey of a national 10 percent random sample (1,502 nursing homes) of all facilities included in the first publication of the Nursing Home Compare report conducted in May–June 2004; 724 responded, yielding a response rate of 48.2 percent. Study Design The dependent variables are dichotomous, indicating whether or not action was taken and the type of action taken. Four indicator variables were created for each of the four strategic types: Defender, Analyzer, Prospector, and Reactor. Other variables were included in the seven logistic regression models to control for factors other than strategic type that could influence nursing home response to public disclosure of their quality of care. Data Collection/Extraction Methods Survey data were merged with data on quality measures and organizational characteristics from the first report (November 2002). Principal Findings About 43 percent of surveyed administrators self-typed as Defenders, followed by Analyzers (33 percent), and Prospectors (19 percent). The least self-selected strategic type was the Reactor (6.6 percent). In general, results of the regression models indicate differences in response to quality measure publication by strategic type, with Prospectors and Analyzers more likely, and Reactors less likely, to respond than Defenders. Conclusions While almost a third of administrators took no action at all, our results indicate that whether, when, and how nursing homes reacted to publication of federally reported quality measures is associated with strategic orientation. PMID:18370969

Socioeconomic Disparities in the Use of Home Health Services in a Medicare Managed Care Population

PubMed Central

Freedman, Vicki A; Rogowski, Jeannette; Wickstrom, Steven L; Adams, John; Marainen, Jonas; Escarce, José J

2004-01-01

Objective To investigate socioeconomic disparities in access to home health visits and durable medical equipment by persons enrolled in two Medicare managed care health plans. Data Sources A telephone survey of 4,613 Medicare managed care enrollees conducted between April and October of 2000 and linked to administrative claims for a subsequent 12-month period. Study Design We estimated a series of logistic regression models to determine which socioeconomic factors were related to home health visits and the use of durable medical equipment (DME) among Medicare managed care enrollees. Principal Findings Controlling for health and demographic differences, Medicare managed care enrollees in the lowest tertile for nonhousing assets had 50 percent greater odds than those in the highest tertile of having one or more home health visits. All else equal, enrollees with less than a high school education had 30 percent lower odds than those who had graduated from high school of using durable medical equipment. Conclusions Medicare managed care enrollees of low socioeconomic status do not appear to have reduced access to home health visits; however, use of durable medical equipment is considerably lower for enrollees with less than a high school education. Physicians and therapists working with Medicare managed care enrollees may want to actively target DME prescriptions to those with educational disadvantages. PMID:15333109

Parents' Perspectives: An Evaluation of Case Management Interventions in Home Visiting Programs for Young Children

ERIC Educational Resources Information Center

Allen, Susan F.

2007-01-01

In home visiting programs for children younger than age three, home visitors work with parents to enhance the child's environment. This study examined how the home visitor-parent relationship, amount of contact, and level of need affected the intensity of case management interventions received. Researchers interviewed 90 mothers to measure the…

41 CFR 302-14.7 - Are there tax consequences when I receive a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Are there tax consequences when I receive a home marketing incentive payment? 302-14.7 Section 302-14.7 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES...

Impoverishment of practice: analysis of effects of economic discourses in home care case management practice.

PubMed

Ceci, Christine

2006-03-01

Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.

The hierarchy of work pursuits of public health managers.

PubMed

Braithwaite, Jeffrey; Luft, Sabine; Bender, Wolfgang; Callen, Joanne; Westbrook, Johanna I; Westbrook, Mary T; Mallock, Nadine A; Iedema, Rick; Hindle, Donald; Jochelson, Tanya

2007-05-01

How public health is managed in various settings is an important but under-examined issue. We examine themes in the management literature, contextualize issues facing public health managers and investigate the relative importance placed on their various work pursuits using a 14-activity management model empirically derived from studies of clinician-managers in hospitals. Ethnographic case studies of 10 managers in nine diverse public health settings were conducted. The case study accounts of managers' activities were content analysed, and substantive words encapsulating their work were categorized using the model. Managerial activities of the nine public health managers were ranked according to the number of words describing each activity. Kendall's coefficient of concordance yielded W = 0.710, P < 0.000, revealing significant similarity between the activity patterns of the public health managers. A rank order correlation between the activity patterns of the average ranks for the public health sample and for the hospital clinician-managers (n = 52) was R = 0.420, P = 0.131, indicating no significant relationship between relative activity priorities of the two groups. Public health managers put less emphasis on pursuits associated with structure, hierarchy and education, and more on external relations and decision-making. The model of hospital clinician-managers' managerial activities is applicable to public health managers while identifying differences in the way the two groups manage. The findings suggest that public health management work is more managerialist than previously thought.

A Bibliography of Materials on Behavior Management in the Home and Community.

ERIC Educational Resources Information Center

Kupper, Lisa, Ed.

This brief bibliography lists 26 resource materials for managing behavior problems in the home and community. Suggested resources were published between 1985 and 1993 and cover such topics as general behavior management, self-injury, food and behavior, functional communication training, impulsivity, alternatives to punishment, anger, and…

Engineering for reliability in at-home chronic disease management

PubMed Central

Kendall, Logan; Eschler, Jordan; Lozano, Paula; McClure, Jennifer B.; Vizer, Lisa M.; Ralston, James D.; Pratt, Wanda

2014-01-01

Individuals with chronic conditions face challenges with maintaining lifelong adherence to self-management activities. Although reminders can help support the cognitive demands of managing daily and future health tasks, we understand little of how they fit into people’s daily lives. Utilizing a maximum variation sampling method, we interviewed and compared the experiences of 20 older adults with diabetes and 19 mothers of children with asthma to understand reminder use for at-home chronic disease management. Based on our participants’ experiences, we contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance. Furthermore, we identify key principles from reliability engineering that both explain current behavior and suggest strategies to improve patient reminder systems. PMID:25954384

Engineering for reliability in at-home chronic disease management.

PubMed

Kendall, Logan; Eschler, Jordan; Lozano, Paula; McClure, Jennifer B; Vizer, Lisa M; Ralston, James D; Pratt, Wanda

2014-01-01

Individuals with chronic conditions face challenges with maintaining lifelong adherence to self-management activities. Although reminders can help support the cognitive demands of managing daily and future health tasks, we understand little of how they fit into people's daily lives. Utilizing a maximum variation sampling method, we interviewed and compared the experiences of 20 older adults with diabetes and 19 mothers of children with asthma to understand reminder use for at-home chronic disease management. Based on our participants' experiences, we contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance. Furthermore, we identify key principles from reliability engineering that both explain current behavior and suggest strategies to improve patient reminder systems.

Telecommunications and disease management in the home environment: new strategies to improve outcomes.

PubMed

Meyer, L C

1997-06-01

This article provides an overview of the issues and effects of principle-centered health care within organized systems of care; portrays a comprehensive disease management framework for home health care; and offers virtual health management, telecommunications, and mobile computing strategies to enable health management enterprises to achieve health and outcomes maximization accountability demands in managed care.

Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan

PubMed Central

Ajlouni, Musa T.; Dawani, Hania; Diab, Salah M.

2015-01-01

Home care aims at supporting people with various degrees of dependency to remain at home rather than use residential, long-term, or institutional-based nursing care. Demographic, epidemiological, social, and cultural trends in Jordan as in other countries are changing the traditional patterns of care with growing emphasis on home care. The purpose of this study is to highlight the most common challenges related to home health care (HHC) services in Jordan as perceived by the managers of HHC agencies. Methods: a descriptive qualitative design that depends on focus group discussions has been used to collect data from a sample of 18 managers who met the selection criteria and who are willing to participate, the study found that, the main challenges of HHC services as perceived by managers were: shortage of female staff, lack of governance and regulation, poor management, unethical practices, lack of referral systems, and low accessibility of the poor and less privileged as HHC services are not included in health insurance schemes, it concludes also that the home health care industry in Jordan is facing many challenges and problems that may have negative effects on the effectiveness, efficiency, equity and quality of services and should be addressed by health policy makers. PMID:25946949

Psychosocial behaviour management programme for home-dwelling people with dementia: A cluster-randomized controlled trial.

PubMed

Nakanishi, Miharu; Endo, Kaori; Hirooka, Kayo; Granvik, Eva; Minthon, Lennart; Nägga, Katarina; Nishida, Atsushi

2018-03-01

Little is known about the effectiveness of a psychosocial behaviour management programme on home-dwelling people with dementia. We developed a Behaviour Analytics & Support Enhancement (BASE) programme for care managers and professional caregivers of home care services in Japan. We investigated the effects of BASE on challenging behaviour of home-dwelling people with dementia. A cluster-randomized controlled trial was conducted with home care providers from 3 different districts in Tokyo. Each provider recruited persons with dementia aged 65 years or older to receive home care in the BASE programme in August 2016. An online monitoring and assessment system was introduced to the intervention group for repeated measures of challenging behaviour with a total score of the Neuropsychiatric Inventory. Care professionals in both the intervention and control groups evaluated challenging behaviour of persons with dementia at baseline (September 2016) and follow-up (February 2017). A majority of persons with dementia had Alzheimer disease (59.3%). One-hundred and forty-one persons with dementia were included in the intervention group and 142 in the control group. Multilevel modelling revealed a significant reduction in challenging behaviour in the intervention group after 6 months (mean score, 18.3 to 11.2) compared with that of the control group (11.6 to 10.8; P < .05). The implementation of the BASE programme resulted in a reduction of challenging behaviour of home-dwelling people with dementia. Future research should examine the long-term effects of behaviour management programmes on behaviour, nursing home placement, and hospital admission of home-dwelling people with dementia. Copyright © 2017 John Wiley & Sons, Ltd.

Rounding, work intensification and new public management.

PubMed

Willis, Eileen; Toffoli, Luisa; Henderson, Julie; Couzner, Leah; Hamilton, Patricia; Verrall, Claire; Blackman, Ian

2016-06-01

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour. © 2015 John Wiley & Sons Ltd.

Home energy management (HEM) database: A list with coded attributes of 308 devices commercially available in the US.

PubMed

Pritoni, Marco; Ford, Rebecca; Karlin, Beth; Sanguinetti, Angela

2018-02-01

Policymakers worldwide are currently discussing whether to include home energy management (HEM) products in their portfolio of technologies to reduce carbon emissions and improve grid reliability. However, very little data is available about these products. Here we present the results of an extensive review including 308 HEM products available on the US market in 2015-2016. We gathered these data from publicly available sources such as vendor websites, online marketplaces and other vendor documents. A coding guide was developed iteratively during the data collection and utilized to classify the devices. Each product was coded based on 96 distinct attributes, grouped into 11 categories: Identifying information, Product components, Hardware, Communication, Software, Information - feedback, Information - feedforward, Control, Utility interaction, Additional benefits and Usability. The codes describe product features and functionalities, user interaction and interoperability with other devices. A mix of binary attributes and more descriptive codes allow to sort and group data without losing important qualitative information. The information is stored in a large spreadsheet included with this article, along with an explanatory coding guide. This dataset is analyzed and described in a research article entitled "Categories and functionality of smart home technology for energy management" (Ford et al., 2017) [1].

Prevalence and management of pain, by race and dementia among nursing home residents: United States, 2004.

PubMed

Sengupta, Manisha; Bercovitz, Anita; Harris-Kojetin, Lauren D

2010-03-01

Data from the National Nursing Home Survey, 2004. About one-quarter of all nursing home residents reported or showed signs of pain. Nonwhite residents and residents with dementia were less likely to report or show signs of pain compared with white residents and residents without dementia. Nonwhite residents with dementia were least likely, and white residents without dementia were most likely to report or show signs of pain. Forty-four percent of nursing home residents with pain received neither standing orders for pain medication nor special services for pain management (i.e., appropriate pain management). Among residents with dementia and pain, nonwhite residents were more likely than white residents to lack appropriate pain management.

Public Management Information Systems: Theory and Prescription.

ERIC Educational Resources Information Center

Bozeman, Barry; Bretschneider, Stuart

1986-01-01

The existing theoretical framework for research in management information systems (MIS) is criticized for its lack of attention to the external environment of organizations, and a new framework is developed which better accommodates MIS in public organizations: public management information systems. Four models of publicness that reflect external…

Managing a Public Library. Parts I and II.

ERIC Educational Resources Information Center

Aronoff, Carol; Cart, Michael

1985-01-01

Discusses factors that contribute to Santa Monica Public Library's excellence, including supportive city government and citizenry, city council, library board, lean top management, and the basic management team. Specific management principles and techniques, public relations, and measures of service at Beverly Hills Public Library are also…

Is There Evidence of Cream Skimming Among Nursing Homes Following the Publication of the Nursing Home Compare Report Card?

PubMed Central

Mukamel, Dana B.; Ladd, Heather; Weimer, David L.; Spector, William D.; Zinn, Jacqueline S.

2009-01-01

Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream skimming admission policies. Design and Methods: The study included all non-Medicare newly admitted patients to all Medicare- and Medicaid-certified nursing homes nationally during the 2001–2005 period. Using the Minimum Data Set data, we calculated for each quarter several admission cohort characteristics: average number of activity of daily living limitations and percent of residents admitted with pain, with pressure ulcers, with urinary incontinence, with diabetes, and with memory limitations. We tested whether residents admitted in the postpublication period were less frail and sick compared with residents admitted in the prepublication period by estimating fixed facility effects longitudinal regression models. Analyses were stratified by nursing home ownership, occupancy, reported quality ranking, chain affiliation, and region. Results: Evidence for cream skimming was found with respect to pain and, to a lesser degree, with respect to memory limitation but not with respect to the 4 other admission cohort characteristics. Implications: Despite the theoretical expectation, empirical evidence suggests only a limited degree of cream skimming. Further studies are required to investigate this phenomenon with respect to other admission cohort characteristics and with respect to post-acute patients. PMID:19491363

Technical and scale efficiency in public and private Irish nursing homes - a bootstrap DEA approach.

PubMed

Ni Luasa, Shiovan; Dineen, Declan; Zieba, Marta

2016-10-27

This article provides methodological and empirical insights into the estimation of technical efficiency in the nursing home sector. Focusing on long-stay care and using primary data, we examine technical and scale efficiency in 39 public and 73 private Irish nursing homes by applying an input-oriented data envelopment analysis (DEA). We employ robust bootstrap methods to validate our nonparametric DEA scores and to integrate the effects of potential determinants in estimating the efficiencies. Both the homogenous and two-stage double bootstrap procedures are used to obtain confidence intervals for the bias-corrected DEA scores. Importantly, the application of the double bootstrap approach affords true DEA technical efficiency scores after adjusting for the effects of ownership, size, case-mix, and other determinants such as location, and quality. Based on our DEA results for variable returns to scale technology, the average technical efficiency score is 62 %, and the mean scale efficiency is 88 %, with nearly all units operating on the increasing returns to scale part of the production frontier. Moreover, based on the double bootstrap results, Irish nursing homes are less technically efficient, and more scale efficient than the conventional DEA estimates suggest. Regarding the efficiency determinants, in terms of ownership, we find that private facilities are less efficient than the public units. Furthermore, the size of the nursing home has a positive effect, and this reinforces our finding that Irish homes produce at increasing returns to scale. Also, notably, we find that a tendency towards quality improvements can lead to poorer technical efficiency performance.

Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness.

PubMed

Werner, Nicole E; Jolliff, Anna F; Casper, Gail; Martell, Thomas; Ponto, Kevin

2018-08-01

Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N = 20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed 'in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM. Practitioner Summary: We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.

[Challenges for home care services in the pain management of cancer patients : A qualitative study].

PubMed

Gnass, I; Krutter, S; Nestler, N

2018-03-21

People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation. By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted. On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment. Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

41 CFR 302-14.101 - What policies must we establish to govern our home marketing incentive payment program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What policies must we establish to govern our home marketing incentive payment program? 302-14.101 Section 302-14.101 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE...

Enhancing knowledge and attitudes in pain management: a pain management education program for nursing home staff.

PubMed

Tse, Mimi Mun Yee; Ho, Suki S K

2014-03-01

The aim of the study was to examine the effectiveness of a pain management program (PMP) in enhancing the knowledge and attitudes of health care workers in pain management. Many nursing home residents suffer from pain, and treatment of pain is often inadequate. Failure of health care workers to assess pain and their insufficient knowledge of pain management are barriers to adequate treatment. It was a quasiexperimental pretest and posttest study. Four nursing homes were approached, and 88 staff joined the 8-week PMP. Demographics and the knowledge and attitudes regarding pain were collected with the use of the Nurse's Knowledge and Attitudes Survey Regarding Pain-Chinese version (NKASRP-C) before and after the PMP. A deficit in knowledge and attitudes related to pain management was prominent before the PMP, and there was a significant increase in pain knowledge and attitudes from 7.9 ± SD 3.52 to 19.2 ± SD4.4 (p < .05) after the 8-week PMP. A PMP can improve the knowledge and attitudes of nursing staff and enable them to provide adequate and appropriate care to older persons in pain. PMPs for nurses and all health care professionals are important in enhancing care for older adults and to inform policy on the provision of pain management. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Public, Private, and Home School Children's Views of Forgiveness and Retribution in "Cinderella."

ERIC Educational Resources Information Center

Knafle, June D.; Wescott, Alice Legenza

Fifth Graders (N=626) from public, Catholic, Christian, and home schools reacted to values of forgiveness versus retribution in the two main versions of "Cinderella" by choosing which ending they preferred for themselves, for a 4-year old sister, and for a 4-year old brother. Girls preferred the forgiveness ending for themselves…

Telecommuting to Work: Using Technology to Work at Home.

ERIC Educational Resources Information Center

Luce, Richard E.; Hartman, Susan

1984-01-01

Describes experience of Boulder Public Library, where management and support personnel established pre-experiment baseline data for comparison with quantitative and qualitative results of experiment to determine the impact of telecommuting (work-at-home) on worker productivity. Background, methodology, equipment enhancements, and data analysis are…

Public nursing home staff's experience of participating in an intervention aimed at enhancing their self-esteem.

PubMed

Wadensten, Barbro; Engström, Maria; Häggström, Elisabeth

2009-11-01

The aim of the present study was to gain an understanding of how nursing staff experienced participating in a training programme aimed at strengthening their self-esteem and empowering them, to determine whether participation benefited them in any way, and to describe their opinions about possible benefits or disadvantages. Staff working in institutions such as nursing homes have a low status in society. A training programme was introduced to staff in a public nursing home. It focused on helping them understand factors in the work situation that influence them and on empowering them. The study was explorative and qualitative in design. The participants in the programme were generally satisfied with it. Their opinions about the benefits they received from the programme can be described using three themes: 'improved communication skills', 'enhanced self-esteem' and 'sees work in a different light'. The most important finding of the present study is that it was possible to strengthen and empower staff. Staff members were generally pleased and satisfied with the content/organization of the training programme. They felt the programme had been of value to them by improving their communication skills and increasing their self-esteem. The present result could be of value to managers and educators working in the area of nursing home care when planning education and development activities for staff. Learning to communicate better and understand the social structure at the workplace could improve staff members' self-esteem, thereby enhancing the work situation and atmosphere as well as empowering the individuals.

[Struggling for normal in an instable situation - informal caregivers self-management in palliative home care. A meta-synthesis].

PubMed

Kreyer, Christiane; Pleschberger, Sabine

2014-10-01

Family caregivers play a key role in palliative home care for persons with advanced cancer. Although research has shown numerous burdens and strains of family caregiving, there is a lack of family-oriented support strategies in palliative home care. Little is known about family caregivers' self-management in this context so far. Qualitative research provides insight into families' perspectives of the transition to and management of palliative care at home and can be used as a starting point. The aim of the study was to increase knowledge of family caregivers' self-management in palliative home care by synthesizing evidence from qualitative research. Based on a systematic review of literature a meta-synthesis was conducted following the approach of Noblit and Hare (1988). A total of 13 qualitative studies from six countries, published from 2002 onward, formed the basis for an interpretative synthesis. Caring for a person with advanced cancer at the end of life at home is characterized by an instable transition process in which families are 'struggling for normal'. Six different family self-management strategies to deal with this were identified: acknowledging the transition, restructuring everyday life, maintaining balance in family relationships, taking responsibility for care, using social support, and acquiring caring-skills. Self-management strategies may provide a key for supporting family caregivers in palliative home care by focusing on resources and problem solving skills of families.

Performance measures for public transit mobility management.

DOT National Transportation Integrated Search

2011-12-01

"Mobility management is an innovative approach for managing and delivering coordinated public : transportation services that embraces the full family of public transit options. At a national level, there are : currently no industry recognized perform...

Managing occupations in everyday life for people with advanced cancer living at home.

PubMed

Peoples, Hanne; Brandt, Åse; Wæhrens, Eva E; la Cour, Karen

2017-01-01

People with advanced cancer are able to live for extended periods of time. Advanced cancer can cause functional limitations influencing the ability to manage occupations. Although studies have shown that people with advanced cancer experience occupational difficulties, there is only limited research that specifically explores how these occupational difficulties are managed. To describe and explore how people with advanced cancer manage occupations when living at home. A sub-sample of 73 participants from a larger occupational therapy project took part in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. Managing occupations were manifested in two main categories; (1) Conditions influencing occupations in everyday life and (2) Self-developed strategies to manage occupations. The findings suggest that people with advanced cancer should be supported to a greater extent in finding ways to manage familiar as well as new and more personally meaningful occupations to enhance quality of life.

Variations in levels of care between nursing home patients in a public health care system.

PubMed

Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

2014-03-05

Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients' own needs, but also on the needs of all the other residents.

Variations in levels of care between nursing home patients in a public health care system

PubMed Central

2014-01-01

Background Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. Methods The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. Results There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. Conclusion In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients’ own needs, but also on the needs of all the other residents

[Investigation of cost and medical service fee for pharmaceutical management in home medical care].

PubMed

Honma, Katsuaki; Sakai, Ritsuko; Takeshima, Akiko; Shimamori, Yoshimitsu; Hayase, Yukitoshi

2004-10-01

Due to the evolvement of the aged society and the steep rise in medical costs, the environment encircling the medical care industry has been changing remarkably. For this reason, it has become both necessary and fundamental for a community pharmacist to participate in home medical care through the pharmaceutical management service. We have studied the associated costs and medical service fees for pharmaceutical management in home medical care. The costs and medical service fees were calculated based on the pharmaceutical management service data collected during the three years from November 1998 to October 2001. As a result, the medical service fees were calculated using the old system which lasted until March 2002. Calculations using this system took into account 550 points per visit, up to two visits per month. Under the new system which started in April 2002, the number of visits taken into account is four times a month, 500 points for the first visit, 300 points from the second through to the forth visit. Then, we simulated a break-even point (BEP). It is clear that it is difficult for any community pharmacy to be specialized in home medical care. In order for the pharmacist to actively participate in home medical care in the future, it is necessary to further improve the system.

GRID INDEPENDENT FUEL CELL OPERATED SMART HOME

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dr. Mohammad S. Alam

2003-12-07

A fuel cell power plant, which utilizes a smart energy management and control (SEMaC) system, supplying the power need of laboratory based ''home'' has been purchased and installed. The ''home'' consists of two rooms, each approximately 250 sq. ft. Every appliance and power outlet is under the control of a host computer, running the SEMaC software package. It is possible to override the computer, in the event that an appliance or power outage is required. Detailed analysis and simulation of the fuel cell operated smart home has been performed. Two journal papers has been accepted for publication and another journalmore » paper is under review. Three theses have been completed and three additional theses are in progress.« less

A public utility model for managing public land recreation enterprises.

Treesearch

Tom Quinn

2002-01-01

Through review of relevant economic principles and judicial precedent, a case is made that public-land recreation enterprises are analogous to traditionally recognized public utilities. Given the historical concern over the societal value of recreation and associated pricing issues, public-land management policies failing to acknowledge these utility-like...

Self-Managed Work Teams in Nursing Homes: Implementing and Empowering Nurse Aide Teams

ERIC Educational Resources Information Center

Yeatts, Dale E.; Cready, Cynthia; Ray, Beth; DeWitt, Amy; Queen, Courtney

2004-01-01

Purpose: This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. Design and Methods: A quasi-experimental design is underway where certified nurse aide…

41 CFR 302-14.102 - What factors should we consider in determining whether to establish a home marketing incentive...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What factors should we consider in determining whether to establish a home marketing incentive payment program? 302-14.102 Section 302-14.102 Public Contracts and Property Management Federal Travel Regulation System RELOCATION...

Non-Hispanic Black-White disparities in pain and pain management among newly admitted nursing home residents with cancer.

PubMed

Mack, Deborah S; Hunnicutt, Jacob N; Jesdale, Bill M; Lapane, Kate L

2018-01-01

Racial disparities in pain management persist across health care settings and likely extend into nursing homes. No recent studies have evaluated racial disparities in pain management among residents with cancer in nursing homes at time of admission. Using a cross-sectional study design, we compared reported pain and pain management between non-Hispanic White and non-Hispanic Black newly admitted nursing home residents with cancer (n=342,920) using the de-identified Minimum Data Set version 3.0. Pain management strategies included the use of scheduled analgesics, pro re nata analgesics, and non-pharmacological methods. Presence of pain was based on self-report when residents were able, and staff report when unable. Robust Poisson models provided estimates of adjusted prevalence ratios (aPR) and 95% CIs for reported pain and pain management strategies. Among nursing home residents with cancer, ~60% reported pain with non-Hispanic Blacks less likely to have both self-reported pain (aPR [Black versus White]: 0.98, 95% CI: 0.97-0.99) and staff-reported pain (aPR: 0.89, 95% CI: 0.86-0.93) documentation compared with Non-Hispanic Whites. While most residents received some pharmacologic pain management, Blacks were less likely to receive any compared with Whites (Blacks: 66.6%, Whites: 71.1%; aPR: 0.98, 95% CI: 0.97-0.99), consistent with differences in receipt of non-pharmacologic treatments (Blacks: 25.8%, Whites: 34.0%; aPR: 0.98, 95 CI%: 0.96-0.99). Less pain was reported for Black compared with White nursing home residents and White residents subsequently received more frequent pain management at admission. The extent to which unequal reporting and management of pain persists in nursing homes should be further explored.

Home care outsourcing strategy.

PubMed

Drake, Paul R; Davies, Bethan M

2006-01-01

This paper aims to help public sector managers that are formulating strategies for outsourcing home care from the independent sector. A review was performed of relevant literature on the outsourcing of home care and its political drivers in the U.K. This indicates that the future of home care services, taking into consideration outsourcing and how Best Value will be achieved, has not been researched widely. Therefore, an exploratory approach to research was adopted here using in-depth analysis of a small number of particularly informative local authorities and private providers selected by purposive/judgemental (extreme and critical case) sampling. Personal contact was deemed necessary in order to perform an intensive investigation to pursue in-depth information. The British Government's Best Value regime is driving local authorities towards increasing levels of outsourcing in the provision of home care. A local authority may choose to outsource all of its home care or maintain some in-house provision based on capacity or capabilities that are complementary to those provided by the independent sector. The 100 per cent outsourcing strategy places enabling demands on the local authority, whereas the alternative strategy requires decisions to be made on what should be outsourced. Across the authorities surveyed, six strategies for creating a mixed economy of care have been identified, with the mix being based on complementary capacity and/or capabilities. With Best Value driving authorities to consider lower-cost options, the outcome may be a reduction in the amount of complementary capacity provided in-house, in favour of strategies involving complementary capabilities that deliver the Best Value possible. Re-enablement is emerging as a common, complementary or core capability that is remaining in-house. Outsourcing also requires decisions to be made on the number of independent providers to be used and the type of contracts to be employed. This paper considers the

Home hygiene and environmental sanitation: a country situation analysis for India.

PubMed

Nath, K J

2003-06-01

Problems of the environment and of domestic hygiene are always related to poverty of population and the sanitation of settlements. Most cities and towns in developing countries, like India, are characterised by over-crowding, congestion, inadequate water supply and inadequate facilities of disposal of human excreta, waste water and solid wastes. Inadequacy of housing for most urban poor invariably leads to poor home hygiene. Personal and domestic hygiene practices cannot be improved without improving basic amenities, such as water supply, waste water disposal, solid waste management and the problems of human settlements. But even under the prevailing conditions, there is significant scope of improving hygiene practices at home to prevent infection and cross-infection. Unfortunately, in developing countries, public health concerns are usually raised on the institutional setting, such as municipal services, hospitals, environmental sanitation, etc. There is a reluctance to acknowledge the home as a setting of equal importance along with the public institutions in the chain of disease transmission in the community. Managers of home hygiene and community hygiene must act in unison to optimise return from efforts to promote public health. Current practices and perceptions of domestic and personal hygiene in Indian communities, the existing levels of environmental and peri-domestic sanitation and the 'health risk' these pose will be outlined, as well as the need for an integrated action for improving hygiene behaviour and access to safe water and sanitation.

Public School Center vs. Family Home Day Care: Single Parents' Reasons for Selection.

ERIC Educational Resources Information Center

Rothschild, Maria Stupp

This study investigates the reasons single parents in San Diego had for choosing either a public day care center or a licensed day care home for their children. A sample of 30 single parents with children in school district administered children's centers was drawn and matched by a similarly geographically distributed sample of 23 parents with…

Florida Natural Resource Damage Assessment Public Meeting | NOAA Gulf Spill

Science.gov Websites

Damage Assessment Projects Near You Strategic Frameworks Monitoring and Adaptive Management Restoration Publications Press Releases Story Archive Home Florida Natural Resource Damage Assessment Public Meeting Florida Natural Resource Damage Assessment Public Meeting share Posted on November 19, 2010 | Assessment

Finance and Management Services

Science.gov Websites

Pioneer Homes Behavioral Health Office of Children's Services Office of the Commissioner Office of Substance Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice Public Assistance Public Health Seniors & Disabilities Services Boards, Councils &

Dental care of elderly in nursing homes: perceptions of managers, nurses, and physicians.

PubMed

Chung, J P; Mojon, P; Budtz-Jørgensen, E

2000-01-01

Epidemiologic studies have shown that the oral health of residents in nursing homes is poor. This can be due to their impaired ability to maintain appropriate oral hygiene or to a lack of interest in oral care among those responsible for the care. The purpose of this study was to assess the attitudes of managers, caregivers, and physicians with regard to oral health care issues of their residents. A questionnaire sent to the managers of the 65 nursing homes in Geneva was returned by 47 (69%). According to the managers, 85% of the nursing homes organized transportation for the residents to a dental office; dental care with follow-up treatment was organized in 79% of the facilities; 68% of the facilities organized treatment for dental emergencies. Another questionnaire was distributed to 169 caregivers in 13 nursing homes. A majority had received no education in oral hygiene care of the residents. The caregivers did accept responsibility for oral hygiene care, but preferred to share it with a dentist responsible for the oral health care of the residents. Only 33% of the physicians indicated that they carried out a systematic examination of the oral cavity, and 20% agreed that the oral cavity might be an integrated part of the body. The majority of the physicians were in favor of more information on oral diseases and regular visits by a dentist; however, close collaboration with a dentist on oral health issues had a low priority.

Publication ethics and the ghost management of medical publication.

PubMed

Sismondo, Sergio; Doucet, Mathieu

2010-07-01

It is by now no secret that some scientific articles are ghost authored - that is, written by someone other than the person whose name appears at the top of the article. Ghost authorship, however, is only one sort of ghosting. In this article, we present evidence that pharmaceutical companies engage in the ghost management of the scientific literature, by controlling or shaping several crucial steps in the research, writing, and publication of scientific articles. Ghost management allows the pharmaceutical industry to shape the literature in ways that serve its interests. This article aims to reinforce and expand publication ethics as an important area of concern for bioethics. Since ghost-managed research is primarily undertaken in the interests of marketing, large quantities of medical research violate not just publication norms but also research ethics. Much of this research involves human subjects, and yet is performed not primarily to increase knowledge for broad human benefit, but to disseminate results in the service of profits. Those who sponsor, manage, conduct, and publish such research therefore behave unethically, since they put patients at risk without justification. This leads us to a strong conclusion: if medical journals want to ensure that the research they publish is ethically sound, they should not publish articles that are commercially sponsored.

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

NASA Astrophysics Data System (ADS)

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

1999-07-01

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

The feasibility of a telephone coaching program on heart failure home management for family caregivers

PubMed Central

Piamjariyakul, Ubolrat; Smith, Carol E.; Russell, Christy; Werkowitch, Marilyn; Elyachar, Andrea

2012-01-01

Objectives To test the feasibility of delivery and evaluate the helpfulness of a coaching heart failure (HF) home management program for family caregivers. Background The few available studies on providing instruction for family caregivers are limited in content for managing HF home care and guidance for program implementation. Method This pilot study employed a mixed methods design. The measures of caregiver burden, confidence, and preparedness were compared at baseline and 3 months post-intervention. Descriptive statistics were used to summarize program costs and demographic data. Content analysis research methods were used to evaluate program feasibility and helpfulness. Results Caregiver (n=10) burden scores were significantly reduced and raw scores of confidence and preparedness for HF home management improved 3 months after the intervention. Content analyses of nurse and caregiver post-intervention data found caregivers rated the program as helpful and described how they initiated HF management skills based on the program. Conclusion The program was feasible to implement. These results suggest the coaching program should be further tested with a larger sample size to evaluate its efficacy. PMID:23116654

Occupational Home Economics Education Series. Housing Management Services. Competency Based Teaching Module.

ERIC Educational Resources Information Center

Lowe, Phyllis; And Others

This module, one of ten competency based modules developed for vocational home economics teachers, is based on a job cluster in the housing management field. It is designed for a variety of levels of learners (secondary, postsecondary, adult) in both school and non-school settings. Focusing on the specific job title of housing management aide,…

Management of group b streptococcus-positive pregnant women at maternity homes in JAPAN: a questionnaire survey of compliance among midwives.

PubMed

Yamaguchi, Kotomi; Ohashi, Kazutomo

2018-01-01

Per the 2014 Japanese Midwives Association (JMA) guidelines, midwives were allowed to manage the deliveries for group B streptococcus (GBS)-positive pregnant women in labour at maternity homes without the supervision of a medical doctor if they complied with the guidelines of the Japan Society of Obstetrics and Gynecology (JSOG), wherein midwives working for maternity homes are expected to cooperate with commissioned obstetricians and paediatricians in cooperative medical facilities. We examined the rate of compliance with these JMA and JSOG guidelines regarding the management of GBS-positive pregnant women among midwives at maternity homes in Japan. Between October and December 2015, an anonymous questionnaire was distributed to 337 maternity homes registered with the JMA by mail. The questionnaire obtained information regarding the timing of GBS screening, specimen collection, transfer of GBS-positive pregnant women from a maternity home to a hospital, administration of intrapartum antibiotic prophylaxis, and collaboration between midwives and commissioned obstetricians. Data were analysed using descriptive statistics. We used frequency distribution as the statistical test. Responses were received from 246 (73.0%) maternity homes, of which complete responses from 204 maternity homes (valid response rate, 60.5%) were analysed. Of these 204 maternity homes, only 97 (47.5%) conducted a GBS screening test during 33-37 weeks of gestation as recommended by the JSOG guidelines. Although midwives alone managed GBS-positive pregnant women in labour at 135 maternity homes (66.2%), intrapartum antibiotic prophylaxis, as recommended by the JSOG guidelines, was conducted in only 111 (54.4%). Moreover, only 37.0% (50/135) and 82.2% (111/135) of maternity homes ensured that GBS-positive pregnant women in labour with an elapse of ≥18 h after PROM and a body temperature of ≥38.0 °C, respectively, were transferred to a hospital by ambulance. Only at 58.3% (119/204) of

Pain medication management processes used by oncology outpatients and family caregivers part II: home and lifestyle contexts.

PubMed

Schumacher, Karen L; Plano Clark, Vicki L; West, Claudia M; Dodd, Marylin J; Rabow, Michael W; Miaskowski, Christine

2014-11-01

Despite the increasing complexity of medication regimens for persistent cancer pain, little is known about how oncology outpatients and their family caregivers manage pain medications at home. To describe the day-to-day management of pain medications from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management in the context of highly individualized home environments and lifestyles. This qualitative study was conducted as part of a randomized clinical trial, in which an embedded mixed methods research design was used. Audio-recorded dialogue among patients, family caregivers, and intervention nurses was analyzed using qualitative research methods. Home and lifestyle contexts for managing pain medications included highly individualized home environments, work and recreational activities, personal routines, and family characteristics. Pain medication management processes particularly relevant in these contexts included understanding, organizing, storing, scheduling, remembering, and taking the medications. With the exception of their interactions with the intervention nurses, most study participants had little involvement with clinicians as they worked through these processes. Pain medication management is an ongoing multidimensional process, each step of which has to be mastered by patients and their family caregivers when cancer treatment and supportive care are provided on an outpatient basis. Realistic patient- and family-centered skill-building interventions are needed to achieve effective and safe pain medication management in the contexts of individual home environments and lifestyles. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

In-Home Care for Optimizing Chronic Disease Management in the Community

PubMed Central

2013-01-01

Background The emerging attention on in-home care in Canada assumes that chronic disease management will be optimized if it takes place in the community as opposed to the health care setting. Both the patient and the health care system will benefit, the latter in terms of cost savings. Objectives To compare the effectiveness of care delivered in the home (i.e., in-home care) with no home care or with usual care/care received outside of the home (e.g., health care setting). Data Sources A literature search was performed on January 25, 2012, using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published from January 1, 2006, until January 25, 2012. Review Methods An evidence-based analysis examined whether there is a difference in mortality, hospital utilization, health-related quality of life (HRQOL), functional status, and disease-specific clinical measures for in-home care compared with no home care for heart failure, atrial fibrillation, coronary artery disease, stroke, chronic obstructive pulmonary disease, diabetes, chronic wounds, and chronic disease / multimorbidity. Data was abstracted and analyzed in a pooled analysis using Review Manager. When needed, subgroup analysis was performed to address heterogeneity. The quality of evidence was assessed by GRADE. Results The systematic literature search identified 1,277 citations from which 12 randomized controlled trials met the study criteria. Based on these, a 12% reduced risk for in-home care was shown for the outcome measure of combined events including all-cause mortality and hospitalizations (relative risk [RR]: 0.88; 95% CI: 0.80–0.97). Patients receiving in-home care had an average of 1 less unplanned hospitalization (mean difference [MD]: –1.03; 95% CI: –1.53 to –0.53) and an average of 1 less

Motivating the Private vs. Public Sector Managers.

ERIC Educational Resources Information Center

Khojasteh, Mak

1993-01-01

A questionnaire on intrinsic/extrinsic rewards received 362 responses from 380 managers. Pay and security were greater motivators for private than for public sector managers. Recognition had higher motivating potential in the public sector. Both groups were motivated by achievement and advancement. (SK)

Economic assessment of home-based COPD management programs.

PubMed

Liu, Sheena Xin; Lee, Michael C; Atakhorrami, Maryam; Tatousek, Jan; McCormack, Meredith; Yung, Rex; Hart, Nicholas; White, David P

2013-12-01

Home-based exacerbation management programs have been proposed as an approach to reducing the clinical and financial burden of COPD. We demonstrate a framework to evaluate such programs in order to guide program design and performance decisions towards optimizing cost and clinical outcomes. This study models the impact of hypothetical exacerbation management programs through probabilistic Markov simulations. Patients were stratified by risk using exacerbation rates from the ECLIPSE study and expert opinion. Three scenarios were modeled, using base, worst and best case parameters to suggest potential telehealth program performance. In these scenarios, acute exacerbations could be detected early, with sensitivity and specificity ranging from 60-90%. Detected acute exacerbations could be diverted to either a sub-acute pathway (12.5-50% probability), thus entirely avoiding hospitalization, or a lower cost pathway through length-of-stay reduction (14-28% reduction). For a cohort of patients without prior hospitalization, the base case telehealth scenario results in a cumulative per-patient lifetime savings of $2.9 K over ≈ 12 years. For a higher risk cohort of patients with a prior admission and 1 to 2 acute exacerbations per year, a cumulative $16K per patient was saved during the remaining ≈ 3 life-years. Acceptable prices for home-based exacerbation detection testing were highly dependent on patient risk and scenario, but ranged from $290-$1263 per month for the highest risk groups. These results suggest the economic viability of exacerbation management programs and highlight the importance of risk stratification in such programs. The presented model can further be adapted to model specific programs as trial data becomes available.

Impact of human resource management practices on nursing home performance.

PubMed

Rondeau, K V; Wagar, T H

2001-08-01

Management scholars and practitioners alike have become increasingly interested in learning more about the ability of certain 'progressive' or 'high-performance' human resource management (HRM) practices to enhance organizational effectiveness. There is growing evidence to suggest that the contribution of various HRM practices to impact firm performance may be synergistic in effect yet contingent on a number of contextual factors, including workplace climate. A contingency theory perspective suggests that in order to be effective, HMR policies and practices must be consistent with other aspects of the organization, including its environment. This paper reports on empirical findings from research that examines the relationship between HRM practices, workplace climate and perceptions of organizational performance, in a large sample of Canadian nursing homes. Data from 283 nursing homes were collected by means of a mail survey that included questions on HRM practices, programmes, and policies, on human resource aspects of workplace climate, as well as a variety of indicators that include employee, customer/resident and facility measures of organizational performance. Results derived from ordered probit analysis suggest that nursing homes in our sample which had implemented more 'progressive' HRM practices and which reported a workplace climate that strongly values employee participation, empowerment and accountability tended to be perceived to generally perform better on a number of valued organizational outcomes. Nursing homes in our sample that performed best overall were found to be more likely to not only have implemented more of these HRM practices, but also to report having a workplace climate that reflects the seminal value that it places on its human resources. This finding is consistent with the conclusion that simply introducing HRM practices or programmes, in the absence of an appropriately supportive workplace climate, will be insufficient to attain

High-performance workplace practices in nursing homes: an economic perspective.

PubMed

Bishop, Christine E

2014-02-01

To develop implications for research, practice and policy, selected economics and human resources management research literature was reviewed to compare and contrast nursing home culture change work practices with high-performance human resource management systems in other industries. The organization of nursing home work under culture change has much in common with high-performance work systems, which are characterized by increased autonomy for front-line workers, self-managed teams, flattened supervisory hierarchy, and the aspiration that workers use specific knowledge gained on the job to enhance quality and customization. However, successful high-performance work systems also entail intensive recruitment, screening, and on-going training of workers, and compensation that supports selective hiring and worker commitment; these features are not usual in the nursing home sector. Thus despite many parallels with high-performance work systems, culture change work systems are missing essential elements: those that require higher compensation. If purchasers, including public payers, were willing to pay for customized, resident-centered care, productivity gains could be shared with workers, and the nursing home sector could move from a low-road to a high-road employment system.

Factors related to the provision of home-based end-of-life care among home-care nursing, home help, and care management agencies in Japan.

PubMed

Igarashi, Ayumi; Kurinobu, Takeshi; Ko, Ayako; Okamoto, Yuko; Matsuura, Shino; Feng, Mei; Yamamoto-Mitani, Noriko

2015-09-12

To promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associated with the provision of home-based EOL care cases, and to compare them among three different types of home-care agencies. We administered a cross-sectional survey throughout Japan to investigate the number and characteristics of EOL cases of home-care nursing (HN), home-help (HH) and care management (CM) agencies. Bivariate and multivariate analyses were performed for each type of agency to examine factors related to the provision of EOL care. 378 HN agencies, 274 HH agencies, and 452 CM agencies responded to the distributed questionnaire. HN agencies had on average 2.1 (SD = 4.0; range 0-60) home-based EOL cases in the last 3 months, while HH agencies had 0.9 (SD = 1.3; range 0-7) and CM agencies had 1.5 (SD = 2.2; range 0-18) in the last 6 months. In a multivariable analysis of HN agencies, a large number of staff (OR: 1.52; p < 0.001) and a large number of collaborating CM agencies (OR: 1.08; p = 0.008) were positively associated with the provision of EOL care; in HH agencies, accepting EOL clients in the agency (OR: 3.29; p < 0.001) was positively associated with the provision of EOL care; in CM agencies, the number of staff (OR: 1.21; p = 0.037), the number of collaborating HH agencies (OR: 1.07; p = 0.032), and whether home-care nurses and home helpers visit clients together (OR: 1.89; p = 0.007) were positively associated with the provision of EOL care. The agency's size and the inter-agency collaborative system seemed most important among HN agencies and CM agencies, while institutional preparedness for EOL was most important for HH agencies. These findings represent important new information for targeting different effective strategies in the promotion of home-based EOL care, depending on the agency type.

Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness.

PubMed

Toivo, Terhi; Dimitrow, Maarit; Puustinen, Juha; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Kinnunen, Sirkka; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Airaksinen, Marja

2018-03-16

The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources

Simulation based training in a publicly funded home birth programme in Australia: A qualitative study.

PubMed

Kumar, Arunaz; Nestel, Debra; Stoyles, Sally; East, Christine; Wallace, Euan M; White, Colleen

2016-02-01

Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. However there is a small risk of emergencies requiring immediate, skilled management to optimise maternal and neonatal outcomes. We developed and implemented a simulation workshop designed to run in a home based setting to assist with emergency training for midwives and paramedical staff. The workshop was evaluated by assessing participants' satisfaction and response to key learning issues. Midwifery and emergency paramedical staff attending home births participated in a simulation workshop where they were required to manage birth emergencies in real time with limited availability of resources to suit the setting. They completed a pre-test and post-test evaluation form exploring the content and utility of the workshops. Content analysis was performed on qualitative data regarding the most important learning from the simulation activity. A total of 73 participants attended the workshop (midwifery=46, and paramedical=27). There were 110 comments, made by 49 participants. The most frequently identified key learning elements were related to communication (among midwives, paramedical and hospital staff and with the woman's partner), followed by recognising the role of other health care professionals, developing an understanding of the process and the importance of planning ahead. Home birth simulation workshop was found to be a useful tool by staff that provide care to women who are having a planned home birth. Developing clear communication and teamwork were found to be the key learning principles guiding their practice. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

The structure and organisation of home-based postnatal care in public hospitals in Victoria, Australia: A cross-sectional survey.

PubMed

Forster, Della A; McKay, Heather; Powell, Rhonda; Wahlstedt, Emma; Farrell, Tanya; Ford, Rachel; McLachlan, Helen L

2016-04-01

There is limited evidence regarding the provision of home-based postnatal care, resulting in a weak evidence-base for policy formulation and the further development of home-based postnatal care services. To explore the structure and organisation of public hospital home-based postnatal care in Victoria, Australia. An online survey including mostly closed-ended questions was sent to representatives of all public maternity providers in July 2011. The response rate of 87% (67/77) included rural (70%; n=47), regional (15%; n=10) and metropolitan (15%; n=10) services. The majority (96%, 64/67) provided home-based postnatal care. The median number of visits for primiparous women was two and for multiparous women, one. The main reason for no visit was the woman declining. Two-thirds of services attempted to provide some continuity of carer for home-based postnatal care. Routine maternal and infant observations were broadly consistent across the services, and various systems were in place to protect the safety of staff members during home visits. Few services had a dedicated home-based postnatal care coordinator. This study demonstrates that the majority of women receive at least one home-based postnatal visit, and that service provision on the whole is similar across the state. Further work should explore the optimum number and timing of visits, what components of care are most valued by women, and what model best ensures the timely detection and prevention of postpartum complications, be they psychological or physiological. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Organization of managed clinical networking for home parenteral nutrition.

PubMed

Baxter, Janet P; McKee, Ruth F

2006-05-01

Home parenteral nutrition (HPN) is an established treatment for intestinal failure, and organization of HPN is variable throughout the UK and Europe. Managed clinical networking is the single most important feature of the UK National Health Service strategy for acute services in Scotland and has the potential to improve the management of HPN patients. This review addresses the role of managed clinical networking in HPN and compares outcome data between centres. The Scottish HPN Managed Clinical Network has published the main body of the current literature supporting the concept of managed clinical networking in this context. The Network is responsible for the organization and quality assurance of HPN provision in Scotland, and has been established for 5 years. It has captured significant patient data for the purpose of clinical audit and illustrates that this is an effective model for the management of this patient population. This review provides advice for other areas wishing to improve equity of access, and to smooth the patient journey between primary, secondary and tertiary health care in the context of artificial nutrition support.

41 CFR 302-14.103 - What factors should we consider in determining the amount of a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What factors should we consider in determining the amount of a home marketing incentive payment? 302-14.103 Section 302-14.103 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE...

Self-care management of sleep disturbances and risk factors for poor sleep among older residents of Taiwanese nursing homes.

PubMed

Tsai, Yun-Fang; Wong, Thomas Ks; Ku, Yan-Chiou

2008-05-01

To explore self-care management strategies for sleep disturbances and risk factors for poor sleep among older residents of nursing homes in Taiwan. With the deterioration of health that accompanies ageing, sleep quality becomes poorer, making it a significant issue in geriatric care. However, little is known about self-care strategies for management of sleep disturbances among elders worldwide. A cross-sectional design was used. Residents (n = 196) were recruited from nine nursing homes chosen by stratified sampling across Taiwan. The Pittsburgh Sleep Quality Index, a self-care management of sleep disturbance questionnaire and a demographic form were used to collect data. The prevalence of poor sleep in these older nursing home residents was 46.4%. Only 48.5% of participants used self-care strategies to manage sleep disturbances. The most frequently used strategy was 'take prescribed medicines'. Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that having no spouse and a low educational level significantly predicted poor sleep. This study revealed a high prevalence of poor sleep quality among older residents of nursing homes in Taiwan. Older residents' inability to get relief from sleep disturbances may have been because of their limited use of strategies to manage sleep disturbances. As health care providers play an important role in helping older people to manage sleep disturbances in nursing homes, it is crucial to train nursing home staff to perform sleep assessments and provide current knowledge about sleep disturbance management. It is also necessary to pay more attention to the sleep problems of elders without spouses and with little education.

Elementary Rehabilitation Nursing Care; a Manual for Nurses and Ancillary Workers in Nursing Homes, Hospitals, Convalescent Facilities, and Public Health Agencies. Public Health Service Publication No. 1436.

ERIC Educational Resources Information Center

Colorado State Dept. of Public Health, Denver. Public Health Nursing Section.

This guide for teacher and student use presents a comprehensive program of physical rehabilitation for aged and physically disabled patients. Developed by the Public Health Nursing Section, the manual was tested by state health department personnel and persons doing inservice teaching in their respective nursing homes. The program is designed to…

Older persons' experience of being assessed for and receiving public home help: do they have any influence over it?

PubMed

Janlöv, Ann-Christin; Hallberg, Ingalill Rahm; Petersson, Kerstin

2006-01-01

The aim of this qualitative study was to explore older persons' experience of participation in and influence on decisions about public home help/care when undergoing needs assessment and receiving public home help. A purposive sample of 28 home help recipients over the age of 75 were selected. Data were collected by means of in-depth interviews. A content analysis revealed one overarching category: 'Having to be satisfied, adjust, and walk a fine line when balancing between needs and available help'; and three principal categories: Balancing the comfort and guilt--receiving help from the family at the limits of their capacity; 'A necessary evil'--balancing feelings and resources against having no choice but to accept; Incorporating the home help into daily life to gain a sense of continuity. The findings indicate that older persons have difficulties coping and adapting to their new life situation and have no actual influence over the decisions about their home help. The officer told them what was available. This implies a need to pay attention to the frail persons' mental state in the needs assessment and to ensure adequate understanding of information. Further, it suggests that the needs assessment and the home help officer should to a larger extent focus on individual needs as a whole, involve and encourage the older person to strengthen his or her sense of being in control.

Using Construction Management for Public and Institutional Facilities.

ERIC Educational Resources Information Center

Public Technology, Inc., Washington, DC.

Construction management has been developed as an alternative to the traditional public building process and seeks to save an owner time and cost primarily through better activity coordination and project management. This report was developed to guide public agencies in their evaluation of construction management for their particular needs. It…

Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality.

PubMed

Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

2016-05-01

This study reports an analysis of factors associated with home care use in a setting in which long-term care services are provided within a publicly financed welfare system. We considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long-term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. Furthermore, we found a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, we also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. Our analysis showed that routinely collected data capture important predictors of home

Complaints in for-profit, non-profit and public nursing homes in two Canadian provinces

PubMed Central

McGregor, Margaret J; Cohen, Marcy; Stocks-Rankin, Catherine-Rose; Cox, Michelle B; Salomons, Kia; McGrail, Kimberlyn M; Spencer, Charmaine; Ronald, Lisa A; Schulzer, Michael

2011-01-01

Background Nursing homes provide long-term housing, support and nursing care to frail elders who are no longer able to function independently. Although studies conducted in the United States have demonstrated an association between for-profit ownership and inferior quality, relatively few Canadian studies have made performance comparisons with reference to type of ownership. Complaints are one proxy measure of performance in the nursing home setting. Our study goal was to determine whether there is an association between facility ownership and the frequency of nursing home complaints. Methods We analyzed publicly available data on complaints, regulatory measures, facility ownership and size for 604 facilities in Ontario over 1 year (2007/08) and 62 facilities in British Columbia (Fraser Health region) over 4 years (2004–2008). All analyses were carried out at the facility level. Negative binomial regression analysis was used to assess the association between type of facility ownership and frequency of complaints. Results The mean (standard deviation) number of verified/substantiated complaints per 100 beds per year in Ontario and Fraser Health was 0.45 (1.10) and 0.78 (1.63) respectively. Most complaints related to resident care. Complaints were more frequent in facilities with more citations, i.e., violations of the legislation or regulations governing a home, (Ontario) and inspection violations (Fraser Health). Compared with Ontario’s for-profit chain facilities, adjusted incident rate ratios and 95% confidence intervals of verified complaints were 0.56 (0.27–1.16), 0.58 (0.34–1.00), 0.43 (0.21– 0.88), and 0.50 (0.30– 0.84) for for-profit single-site, non-profit, charitable, and public facilities respectively. In Fraser Health, the adjusted incident rate ratio of substantiated complaints in non-profit facilities compared with for-profit facilities was 0.18 (0.07–0.45). Interpretation Compared with for-profit chain facilities, non-profit, charitable

The home management of Artificial Nutrition: a survey among doctors and nurses.

PubMed

Gamberi, Sara; Calamassi, Diletta; Coletta, David; Dolenti, Silvia; Valoriani, Alice; Tarquini, Roberto

2017-08-23

The management of Artificial Nutrition (NA), especially in the home environment (HAN) requires specific skills in order to ensure the correct therapeutic education, prevention of complications and the provision of appropriate treatment to the person. The aim of this survey was to identify the perceptions of nurses and doctors, as well as comparing to their perceived competence in NA and the gap between their perceived versus actual knowledge and management methods. This observational study was conducted in a Tuscan health region of Italy, involving 50 Home Care Services nurses and 50 general practitioners. Participants were asked to complete an online questionnaire that was constructed for purpose. The results show that for the management of the person with NA, both for doctors and for nurses show great variability in responses. Less than half of those providing care make assessments of nutritional status and dysphagia as well as the possibility of re-feeding by natural means in NA patients. Care providers expressed uncertainty as to which professional should carry out such assessments. A mismatch was also evident between the skills possessed and the self-assessments performed regarding their knowledge base of NA. Almost all of doctors of nurses indicated a desire to participate in training events relating to NA. The results highlight the need for caregivers to have specific operating protocols. The results also highlight the need to aim to work as a team, emphasizing the importance of basic communication as well as the need for clarity as to the responsibilities and roles of the professionals involved.Key words: Artificial Nutrition, Nurses, Doctors, home management, skills, training, team.

The Impact of Electronic Health Records on Risk Management of Information Systems in Australian Residential Aged Care Homes.

PubMed

Jiang, Tao; Yu, Ping; Hailey, David; Ma, Jun; Yang, Jie

2016-09-01

To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents' clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in

Patient-tailored self-management intervention for older adults with hypertension in a nursing home.

PubMed

Park, Yeon-Hwan; Chang, HeeKyung; Kim, JinShil; Kwak, Jin Sang

2013-03-01

This study was to evaluate the effects of a patient-tailored self-management intervention on (1) blood pressure control and (2) self-care behaviour, exercise self-efficacy and medication adherence among Korean older hypertensive patients in a nursing home.   Little is known about whether a patient-tailored self-management for nursing home residents with hypertension is likely to advance the care of this growing population worldwide. A non-equivalent comparison group design. Forty-seven patients (23 and 24 in the intervention and comparison groups, respectively) participated in the study. No one withdrew during the eight-week study period. Hypertensive patients in the intervention group received health education and tailored individual counselling for eight weeks to enhance the self-management. The mean age of patients was 77·4 years. Patients were on hypertensive medications for 11·8 years; only 36 of them took medications without assistance. The baseline comparisons of the patients with and without 8-week intervention did not differ for clinical and demographic variables and outcome measures. Blood pressure decreased when comparing the baseline to eight weeks later from baseline; moreover, blood pressure was significantly reduced only in patients who received the intervention. Self-care behaviour and exercise self-efficacy significantly increased over time only in those who were in the intervention group. However, no significant difference was observed in medication adherence between the two groups. Patient-tailored self-management intervention was a practical approach for decreasing blood pressure and increasing self-care behaviour in older hypertensive patients in a nursing home. Further studies are needed to validate these findings using a larger sample with long-term follow-up. A patient-tailored intervention is feasible not only to empower nursing home residents with hypertension for their care, but also to offer a qualified training and guidelines to

Public health emergencies and the public health/managed care challenge.

PubMed

Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

2002-01-01

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

Public Management Reform without Managers: The Case of German Public Schools

ERIC Educational Resources Information Center

Mintrop, Rick

2015-01-01

Purpose: The purpose of this paper is to discuss the role of principals in light of public management reforms taking place in the German educational system and in reference to the empirical patterns uncovered by the papers contained in the Special Issue. Policy makers have created new expectations and new technologies that seem to suggest to…

Home Health Compare: Find a Home Health Agency

MedlinePlus

... page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with " ... widget - Select to show Back to top Footer Home A federal government website managed and paid for ...

Managing Complex Medication Regimens.

PubMed

Harvath, Theresa A; Lindauer, Allison; Sexson, Kathryn

2017-05-01

: This article is the first in a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project supported evidence that family caregivers aren't being given the information they need to manage the complex care regimens of their family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's medications. Each article explains the principles nurses should consider and reinforce with caregivers and is accompanied by a video for the caregiver to watch. The first video can be accessed at http://links.lww.com/AJN/A74.

A context management system for a cost-efficient smart home platform

NASA Astrophysics Data System (ADS)

Schneider, J.; Klein, A.; Mannweiler, C.; Schotten, H. D.

2012-09-01

This paper presents an overview of state-of-the-art architectures for integrating wireless sensor and actuators networks into the Future Internet. Furthermore, we will address advantages and disadvantages of the different architectures. With respect to these criteria, we develop a new architecture overcoming these weaknesses. Our system, called Smart Home Context Management System, will be used for intelligent home utilities, appliances, and electronics and includes physical, logical as well as network context sources within one concept. It considers important aspects and requirements of modern context management systems for smart X applications: plug and play as well as plug and trust capabilities, scalability, extensibility, security, and adaptability. As such, it is able to control roller blinds, heating systems as well as learn, for example, the user's taste w.r.t. to home entertainment (music, videos, etc.). Moreover, Smart Grid applications and Ambient Assisted Living (AAL) functions are applicable. With respect to AAL, we included an Emergency Handling function. It assures that emergency calls (police, ambulance or fire department) are processed appropriately. Our concept is based on a centralized Context Broker architecture, enhanced by a distributed Context Broker system. The goal of this concept is to develop a simple, low-priced, multi-functional, and save architecture affordable for everybody. Individual components of the architecture are well tested. Implementation and testing of the architecture as a whole is in progress.

42 CFR 414.335 - Payment for EPO furnished to a home dialysis patient for use in the home.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for EPO furnished to a home dialysis patient for use in the home. 414.335 Section 414.335 Public Health CENTERS FOR MEDICARE & MEDICAID... for EPO furnished to a home dialysis patient for use in the home. (a) Prior to January 1, 2011...

Adherence of pain assessment to the German national standard for pain management in 12 nursing homes.

PubMed

Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick

2014-01-01

Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic⁄acute pain-affected persons and highly recommended for practice. To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.

Public health response to striking solid waste management.

PubMed

Murti, Michelle; Ayre, Reg; Shapiro, Howard; de Burger, Ron

2011-10-01

In 2009, the City of Toronto, Ontario, Canada, experienced a six-week labor disruption involving 24,000 city workers that included solid waste and public health employees. In an attempt to control illegal dumping and to manage garbage storage across the city during this period, 24 temporary garbage storage sites were established by the city (mostly in local parks) for residents to dispose of their household waste. No other municipality in North America has attempted to operate this many temporary sites for this long a period. Management and nonunion staff from Healthy Environments in Toronto Public Health performed daily inspections, responded to community questions, issued public health orders, and worked closely with Solid Waste Management and the Ministry of the Environment to actively manage the public health concerns associated with these sites. This intensive oversight mitigated public health risks to the community and facilitated an effective, safe solution to the temporary garbage storage problem.

Exposure to nontraditional pets at home and to animals in public settings: risks to children.

PubMed

Pickering, Larry K; Marano, Nina; Bocchini, Joseph A; Angulo, Frederick J

2008-10-01

Exposure to animals can provide many benefits during the growth and development of children. However, there are potential risks associated with animal exposures, including exposure to nontraditional pets in the home and animals in public settings. Educational materials, regulations, and guidelines have been developed to minimize these risks. Pediatricians, veterinarians, and other health care professionals can provide advice on selection of appropriate pets as well as prevention of disease transmission from nontraditional pets and when children contact animals in public settings.

Individual Perseverance: A Theory of Home Tutors' Management of Schooling in Isolated Settings

ERIC Educational Resources Information Center

Tynan, Belinda; O'Neill, Marnie

2007-01-01

This article reports a study of parents' management of the education of primary school-aged children in their care in remote and rural locations of Western Australia. It presents a theory of the ways in which these parents, in the role of home tutors, "manage" the schooling of their children in a distance education regime in isolated…

42 CFR 414.335 - Payment for EPO furnished to a home dialysis patient for use in the home.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Payment for EPO furnished to a home dialysis patient for use in the home. 414.335 Section 414.335 Public Health CENTERS FOR MEDICARE & MEDICAID....335 Payment for EPO furnished to a home dialysis patient for use in the home. (a) Prior to January 1...

77 FR 39250 - Notice of Proposed Information Collection for Public Comment: Home Equity Conversion Mortgage...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

... Information Collection for Public Comment: Home Equity Conversion Mortgage Counseling Client Survey AGENCY... subject proposal. The HECM Counseling Session Evaluation is sent to counseling recipients as part of HUD's performance review of a HECM counseling agency. It is used by HUD as a performance tool to obtain information...

Reducing Suicidal Ideation in Home Health Care: Results from the CAREPATH Depression Care Management Trial

PubMed Central

Lohman PhD, Matthew C.; Raue PhD, Patrick J.; Greenberg, Rebecca L.; Bruce, Martha L.

2016-01-01

Objectives The study evaluated the effectiveness of a depression care management intervention in reducing suicidal ideation (SI) among home health patients. Methods Data come from the cluster-randomized effectiveness trial of the Depression Care for Patients at Home (Depression CAREPATH), an intervention that integrates depression care management into the routine nursing visits of Medicare home health patients screening positive for depression. Patients were interviewed at baseline, 3, 6, and 12 months follow-up. Suicidal ideation was measured using the Hamilton Rating Scale for Depression (HAM-D) item. We compared likelihood of any level of SI between intervention and usual care patients using longitudinal logistic mixed-effects models. Results A total of 306 eligible patients enrolled in the trial. Among them, 70 patients (22.9%) reported SI at baseline. Among patients with SI, patients under the care of nurses randomized to CAREPATH were less likely to report SI over the study period (OR=0.51, 95% CI; 0.24-1.07), with 63.6% of usual care versus 31.3% of CAREPATH participants continuing to report SI after one year. Baseline major depression, greater perceived burdensomeness, and greater functional disability were associated with greater likelihood of SI. Conclusion SI is reported in more than 10% of Medicare home health patients. The Depression CAREPATH intervention was associated with a reduction in patients reporting SI at one year, compared to enhanced usual care. Given relative low burden on nursing staff, depression care management may be an important component of routine home health practices producing long-term reduction in SI among high-risk patients. PMID:26552852

Evaluation of a Behavior Management Training Program for Nursing Home Caregivers.

ERIC Educational Resources Information Center

Marsiske, Michael; And Others

This study examined the effectiveness of a new skills training program designed to increase nurse aides' knowledge of behavior management. The training program, designed as five 90-minute group learning modules, was implemented in two Western Pennsylvania nursing homes over a 5-month period. Topics covered within the training program included…

Negotiating the new health system: purchasing publicly accountable managed care.

PubMed

Rosenbaum, S

1998-04-01

The transformation to managed care is one of the most important and complex changes ever to take place in the American health system. One key aspect of this transformation is its implications for public health policy and practice. Both public and private buyers purchase managed care; increasingly, public programs that used to act as their own insurers (i.e., Medicare, Medicaid and CHAMPUS) are purchasing large quantities of managed care insurance from private companies. The transformation to managed care is altering the manner in which public health policy makers conceive of and carry out public health activities (particularly activities that involve the provision of personal health services). The degree to which managed care changes public health and in turn is altered by public health will depend in great measure on the extent to which public and private policy makers understand the implications of their choices for various aspects of public health and take steps to address them. Because both publicly and privately managed care arrangements are relatively deregulated, much of the dialogue between public health and managed care purchasers can be expected to take place within the context of the large service agreements that are negotiated between buyers and sellers of managed care products. This is particularly true for Medicaid because of the importance of Medicaid coverage, payment and access policies to public health policy makers, and because of the public nature of the Medicaid contracting process. A nationwide study of Medicaid managed care contracts offers the first detailed analysis of the content and structure of managed care service agreements and the public health issues they raise. Four major findings emerge from a review of the contracts. First, most of the agreements fail to address key issues regarding which Medicaid-covered services and benefits are the contractor's responsibility and which remain the residual responsibility of the state agency

A Public Service-Dominant Logic for the Executive Education of Public Managers

ERIC Educational Resources Information Center

Hiedemann, Alexander M.; Nasi, Greta; Saporito, Raffaella

2017-01-01

Building on the concept of Public Service-Dominant Logic (PSDL), this article aims to apply the public service-dominant logic to executive education. We argue that fit-for-purpose and effective executive master programs for public managers (EMPA) need to be designed from a public service perspective. Framing executive education as a service…

Effect of a Consumer-Directed Voucher and a Disease-Management-Health-Promotion Nurse Intervention on Home Care Use

ERIC Educational Resources Information Center

Meng, Hongdao; Friedman, Bruce; Wamsley, Brenda R.; Mukamel, Dana; Eggert, Gerald M.

2005-01-01

Purpose: We describe the impact of two interventions, a consumer-directed voucher for in-home supportive services and a chronic disease self-management-health-promotion nurse intervention, on the probability of use of two types of home care-skilled home health care and personal assistance services-received by functionally impaired Medicare…

Home Energy Management System - VOLTTRON Integration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zandi, Helia

In most Home Energy Management Systems (HEMS) available in the market, different devices running different communication protocols cannot interact with each other and exchange information. As a result of this integration, the information about different devices running different communication protocol can be accessible by other agents and devices running on VOLTTRON platform. The integration process can be used by any HEMS available in the market regardless of the programming language they use. If the existing HEMS provides an Application Programming Interface (API) based on the RESTFul architecture, that API can be used for integration. Our candidate HEMS in this projectmore » is home-assistant (Hass). An agent is implemented which can communicate with the Hass API and receives information about the devices loaded on the API. The agent publishes the information it receives on the VOLTTRON message bus so other agents can have access to this information. On the other side, for each type of devices, an agent is implemented such as Climate Agent, Lock Agent, Switch Agent, Light Agent, etc. Each of these agents is subscribed to the messages published on the message bus about their associated devices. These agents can also change the status of the devices by sending appropriate service calls to the API. Other agents and services on the platform can also access this information and coordinate their decision-making process based on this information.« less

78 FR 25955 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... Pacific Fishery Management Council's (Pacific Council) Highly Migratory Species Management Team (HMSMT... public listening stations at the Council office and Southwest Fishery Science Center (see ADDRESSES...

Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections.

PubMed

Fajardo-Bernal, Luisa; Aponte-Gonzalez, Johanna; Vigil, Patrick; Angel-Müller, Edith; Rincon, Carlos; Gaitán, Hernando G; Low, Nicola

2015-09-29

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequent causes of bacterial sexually transmitted infections (STIs). Management strategies that reduce losses in the clinical pathway from infection to cure might improve STI control and reduce complications resulting from lack of, or inadequate, treatment. To assess the effectiveness and safety of home-based specimen collection as part of the management strategy for Chlamydia trachomatis and Neisseria gonorrhoeae infections compared with clinic-based specimen collection in sexually-active people. We searched the Cochrane Sexually Transmitted Infections Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS on 27 May 2015, together with the World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. Randomized controlled trials (RCTs) of home-based compared with clinic-based specimen collection in the management of C. trachomatis and N. gonorrhoeae infections. Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We contacted study authors for additional information. We resolved any disagreements through consensus. We used standard methodological procedures recommended by Cochrane. The primary outcome was index case management, defined as the number of participants tested, diagnosed and treated, if test positive. Ten trials involving 10,479 participants were included. There was inconclusive evidence of an effect on the proportion of participants with index case management (defined as individuals tested, diagnosed and treated for CT or NG, or both) in the group with home-based (45/778, 5.8%) compared with clinic-based (51/788, 6.5%) specimen collection (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.60 to 1.29; 3

Exposure to secondhand smoke at home and in public places in Syria: a developing country's perspective.

PubMed

Maziak, W; Ali, R Al; Fouad, M F; Rastam, S; Wipfli, H; Travers, M J; Ward, K D; Eissenberg, T

2008-01-01

This study employs sensitive methods to address the issue of exposure to secondhand smoke among children and women in an understudied developing country setting (Syria). The study combines data collected by the Syrian Center for Tobacco Studies as part of two international studies conducted in 2006: the Secondhand Smoke Exposure among Women and Children study (Johns Hopkins) and the Global Air Monitoring Study (Roswell Park Cancer Institute). We employed objective measures (hair nicotine, and ambient household nicotine assessed by passive monitors) to assess children's and mothers' exposure to secondhand smoke at home, and used the TSI SidePak personal aerosol monitor to sample respirable suspended particles less than 2.5 microm diameter (PM(2.5)) in the air in public places (40 restaurants/cafés in Aleppo). In homes, the mean ambient nicotine level (+/- standard deviation, SD) was 2.24 +/- 2.77 microg/m(3). Mean level of hair nicotine was 11.8 ng/mg among children (n = 54), and was higher if the mother was a smoker (19.4 +/- 23.6 ng/mg) than nonsmoker (5.2 +/- 6.9 ng/mg) (p < .05). Mean hair nicotine among nonsmoking mothers (n = 23) was 1.17 +/- 1.56 ng/mg. Children's hair nicotine level was strongly correlated with ambient household nicotine and number of cigarettes smoked daily in the house (r = .54 and r = .50, respectively, p < .001), and also was related to having a father who smoked in the children's presence. In public places, average PM(2.5) in the monitored 40 hospitality venues was 464 microg/m(3) and correlated with smoker density measured as cigarettes-waterpipes/100 m(3) (r = .31, p = 0.049). Thus, children in Syria are exposed to high levels of secondhand smoke at home, in which mothers' smoking plays a major role. Also, levels of respirable hazardous particles are high in public hospitality venues, putting customers and workers at serious health risks. Efforts to limit exposure of children and women at home and to adopt clean air policies should

Stochastic control of smart home energy management with plug-in electric vehicle battery energy storage and photovoltaic array

NASA Astrophysics Data System (ADS)

Wu, Xiaohua; Hu, Xiaosong; Moura, Scott; Yin, Xiaofeng; Pickert, Volker

2016-11-01

Energy management strategies are instrumental in the performance and economy of smart homes integrating renewable energy and energy storage. This article focuses on stochastic energy management of a smart home with PEV (plug-in electric vehicle) energy storage and photovoltaic (PV) array. It is motivated by the challenges associated with sustainable energy supplies and the local energy storage opportunity provided by vehicle electrification. This paper seeks to minimize a consumer's energy charges under a time-of-use tariff, while satisfying home power demand and PEV charging requirements, and accommodating the variability of solar power. First, the random-variable models are developed, including Markov Chain model of PEV mobility, as well as predictive models of home power demand and PV power supply. Second, a stochastic optimal control problem is mathematically formulated for managing the power flow among energy sources in the smart home. Finally, based on time-varying electricity price, we systematically examine the performance of the proposed control strategy. As a result, the electric cost is 493.6% less for a Tesla Model S with optimal stochastic dynamic programming (SDP) control relative to the no optimal control case, and it is by 175.89% for a Nissan Leaf.

76 FR 26252 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... Pacific Fishery Management Council (Pacific Council) will convene a Sardine Research Planning Workshop... Magnuson-Stevens Fishery Conservation and Management Act, provided the public has been notified of the...

78 FR 14981 - Caribbean Fishery Management Council; Public Hearing

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

... Fishery Management Council; Public Hearing AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice of a public hearing. SUMMARY: The Caribbean Fishery Management Council will hold a public hearing to obtain input from fishers, the general...

A randomized clinical trial of care for women with preterm labour: home management versus hospital management.

PubMed

Goulet, C; Gévry, H; Lemay, M; Gauthier, R J; Lepage, L; Fraser, W; Polomeno, V

2001-04-03

Preterm labour occurs in about 10% of all pregnancies and is the most important cause of premature birth. Women with preterm labour are admitted to hospital to have the contractions stopped. Thereafter, many women remain in hospital until delivery. We conducted a randomized clinical trial to compare hospital care with home care of women who had been admitted to hospital for preterm labour. After they had received treatment for an acute episode of premature labour, women at 2 regional perinatal centres associated with teaching hospitals were randomly assigned to home care or hospital care. Eligible women (n = 250) were aged 18 years or older, lived within 50 km of the hospital, had a gestational age between 20 and 35 weeks, had no prior preterm delivery and were experiencing their first episode of preterm labour and first admission to hospital for preterm labour. Analysis was by intention to treat. There were no significant differences between the 2 groups in mean gestational age at delivery (home: 37.52 weeks, hospital: 37.50 weeks) or in mean birth weight (home: 2974 g, hospital: 3020 g). There were no significant differences between the 2 groups with respect to the proportions of babies born before term or the mean duration of neonatal hospital stay, neonatal intensive care unit stay and intermediate care nursery stay. The mean duration of the first stay in hospital for the women in the home group (3.8 days) was significantly shorter than the mean duration for women in the hospital group (6.1 days). In addition, the mean duration of all maternal stays in hospital was significantly shorter for the women in the home group (3.7 days) than in the hospital group (5.0 days). Home care management is an efficient and acceptable alternative to hospital care for women experiencing preterm labour.

Impact of revisions to the F-Tag 309 surveyors' interpretive guidelines on pain management among nursing home residents.

PubMed

Lapane, Kate L; Quilliam, Brian J; Chow, Wing; Kim, Myoung S

2012-05-01

On 31 March 2009, the US Centers for Medicare & Medicaid Services (CMS) provided revised guidance for meeting compliance in the evaluation and management of pain in nursing home residents, known as F-Tag 309. The aim of the study was to estimate the extent to which implementation of revisions to the surveyors' interpretive guidelines for F-Tag 309 improved recognition and management of pain among nursing home residents. The impact of the revisions to guidance on F-Tag 309 on pain in nursing home residents was investigated. The study was quasi-experimental in design and included 174 for-profit nursing homes in 19 US states. Nursing home residents with ≥2 Minimum Data Set (MDS) assessments between 1 January 2007 and 30 March 2009 (before the revisions to the guidelines; n = 8449) and between 31 March 2009 and 31 December 2009 (after the revisions; n = 1400) were included. The MDS assessments provided information on pain, analgesic use and cognitive, functional and emotional status. Separate logistic regression models that adjusted for clustering effects of residents residing in nursing homes provided estimates of the relationship between the implementation of the revisions to F-Tag 309 and the prevalence of pain and its management. Pain was more likely to be documented in the period after the revisions were implemented. The odds of pain being documented on at least one of two consecutive MDS assessments increased after the revisions to the guidelines were implemented (adjusted odds ratio [OR] 1.15; 95% confidence interval [CI] 1.01, 1.31). Increases in scheduled analgesic prescription were observed in the post-revision era (adjusted OR 1.38; 95% CI 1.21,1.57). The implementation of revisions to the surveyors' interpretive guidelines for F-Tag 309 improved recognition and management of pain as well as analgesic use in nursing home residents with documented non-cancer pain. Use of directed language as part of the surveyors' interpretive guidelines may be a

Return to nursing home investment: Issues for public policy

PubMed Central

Baldwin, Carliss Y.; Bishop, Christine E.

1984-01-01

Because Government policy does much to determine the return available to nursing home investment, the profitability of the nursing home industry has been a subject of controversy since Government agencies began paying a large portion of the Nation's nursing home bill. Controversy appears at several levels. First is the rather narrow concern, often conceived in accounting terms, of the appropriate reimbursement of capital-related expense under Medicaid and Medicare. Second is the concern about how return to capital affects the flow of investment into nursing homes, leading either to inadequate access to care or to over-capacity. Third is the concern about how-sources of return to nursing home investment affect the pattern of nursing home ownership and the amount of equity held by owners since the pattern of ownership and amount of equity have been linked to quality of care. PMID:10310945

How Technology in Care at Home Affects Patient Self-Care and Self-Management: A Scoping Review

PubMed Central

Peeters, José M.; Wiegers, Therese A.; Friele, Roland D.

2013-01-01

The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits. PMID:24173139

Integrating home-based medication therapy management (MTM) services in a health system.

PubMed

Reidt, Shannon; Holtan, Haley; Stender, Jennifer; Salvatore, Toni; Thompson, Bruce

2016-01-01

To describe the integration of home-based Medication Therapy Management (MTM) into the ambulatory care infrastructure of a large urban health system and to discuss the outcomes of this service. Minnesota from September 2012 to December 2013. The health system has more than 50 primary care and specialty clinics. Eighteen credentialed MTM pharmacists are located in 16 different primary care and specialty settings, with the greatest number of pharmacists providing services in the internal medicine clinic. Home-based MTM was promoted throughout the clinics within the health system. Physicians, advanced practice providers, nurses, and pharmacists could refer patients to receive MTM in their homes. A home visit had the components of a clinic-based visit and was documented in the electronic health record (EHR); however, providing the service in the home allowed for a more direct assessment of environmental factors affecting medication use. Number of home MTM referrals, reason for referral and type of referring provider, number and type of medication-related problems (MRPs). In the first 15 months, 74 home visits were provided to 53 patients. Sixty-six percent of the patients were referred from the Internal Medicine Clinic. Referrals were also received from the senior care, coordinated care, and psychiatry clinics. Approximately 50% of referrals were made by physicians. More referrals (23%) were made by pharmacists compared with advanced practice providers, who made 21% of referrals. The top 3 reasons for referral were: nonadherence, transportation barriers, and the need for medication reconciliation with a home care nurse. Patients had a median of 3 MRPs with the most common (40%) MRP related to compliance. Home-based MTM is feasibly delivered within the ambulatory care infrastructure of a health system with sufficient provider engagement as demonstrated by referrals to the service. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All

Adherence of pain assessment to the German national standard for pain management in 12 nursing homes

PubMed Central

Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick

2014-01-01

BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, ‘Action Alliance Pain-Free City Muenster’, the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommended for practice. OBJECTIVES: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. METHODS: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. RESULTS: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. CONCLUSIONS: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain. PMID:24851238

Institutional Regimes and Induced Dependency in Homes for the Aged.

ERIC Educational Resources Information Center

Booth, Tim

1986-01-01

Reports effects of institutional regimes on levels of dependency among residents of public homes for the elderly in England. Differences in management practices and caring routines did not affect the creation or reduction of dependency among residents. Questions the rationale that informs some current notions of good practice in residential work.…

77 FR 58527 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-21

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... Pacific Fishery Management Council (Pacific Council) will convene a conference call of its Coastal Pelagic... Magnuson- Stevens Fishery Conservation and Management Act, provided the public has been notified of the...

77 FR 31327 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-25

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... Pacific Fishery Management Council's (Pacific Council) Habitat Committee (HC) will hold a meeting, which is open to the public, to discuss habitat issues related to Council-managed fisheries. DATES: The...

Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes.

PubMed

Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Shaw, Christine; Williams, Kate; Chung, Alan; Barrett, James

2013-03-01

Incontinence is prevalent among older populations and residents in care homes. This paper is a review of descriptive studies that investigated associated factors related to managing urinary incontinence in older people in care homes. A systematic literature review was undertaken. MEDLINE and CINHAL were searched from 1996-2010 using the Cochrane Incontinence Review Group search strings for urinary and faecal incontinence including all research designs. Sixteen studies were identified that reported on associated factors related to comorbidities, management preferences, policies, staff views and knowledge or methodological studies. Non-invasive methods involving toileting and use of pads were common management approaches. No studies aimed at maintaining continence were identified. Factors associated with incontinence need to also be considered when planning and managing care for individuals, and developing and designing systems of care within care homes. Further study in care home populations to change or inform practice and provide effective care is warranted. Preventive studies that maintain continence are required. Older people and their families should be involved with decisions regarding their preferred care, goals, management and outcomes for managing incontinence, promoting or maintaining continence. © 2011 Blackwell Publishing Ltd.

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

PubMed Central

Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

2016-01-01

OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

42 CFR 488.835 - Temporary management.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Temporary management. 488.835 Section 488.835... Sanctions for Home Health Agencies With Deficiencies § 488.835 Temporary management. (a) Application. (1) CMS may impose temporary management of an HHA if it determines that an HHA has a condition-level...

42 CFR 488.835 - Temporary management.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Temporary management. 488.835 Section 488.835... Sanctions for Home Health Agencies With Deficiencies § 488.835 Temporary management. (a) Application. (1) CMS may impose temporary management of an HHA if it determines that an HHA has a condition-level...

Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care.

PubMed

Fujita, Junko; Fukui, Sakiko; Ikezaki, Sumie; Otoguro, Chizuru; Tsujimura, Mayuko

2017-11-01

To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950. © 2017 Japan Geriatrics Society.

Standardising Home Range Studies for Improved Management of the Critically Endangered Black Rhinoceros

PubMed Central

Plotz, Roan D.; Grecian, W. James; Kerley, Graham I.H.; Linklater, Wayne L.

2016-01-01

Comparisons of recent estimations of home range sizes for the critically endangered black rhinoceros in Hluhluwe-iMfolozi Park (HiP), South Africa, with historical estimates led reports of a substantial (54%) increase, attributed to over-stocking and habitat deterioration that has far-reaching implications for rhino conservation. Other reports, however, suggest the increase is more likely an artefact caused by applying various home range estimators to non-standardised datasets. We collected 1939 locations of 25 black rhino over six years (2004–2009) to estimate annual home ranges and evaluate the hypothesis that they have increased in size. A minimum of 30 and 25 locations were required for accurate 95% MCP estimation of home range of adult rhinos, during the dry and wet seasons respectively. Forty and 55 locations were required for adult female and male annual MCP home ranges, respectively, and 30 locations were necessary for estimating 90% bivariate kernel home ranges accurately. Average annual 95% bivariate kernel home ranges were 20.4 ± 1.2 km2, 53 ±1.9% larger than 95% MCP ranges (9.8 km2 ± 0.9). When home range techniques used during the late-1960s in HiP were applied to our dataset, estimates were similar, indicating that ranges have not changed substantially in 50 years. Inaccurate, non-standardised, home range estimates and their comparison have the potential to mislead black rhino population management. We recommend that more care be taken to collect adequate numbers of rhino locations within standardized time periods (i.e., season or year) and that the comparison of home ranges estimated using dissimilar procedures be avoided. Home range studies of black rhino have been data deficient and procedurally inconsistent. Standardisation of methods is required. PMID:27028728

Standardising Home Range Studies for Improved Management of the Critically Endangered Black Rhinoceros.

PubMed

Plotz, Roan D; Grecian, W James; Kerley, Graham I H; Linklater, Wayne L

2016-01-01

Comparisons of recent estimations of home range sizes for the critically endangered black rhinoceros in Hluhluwe-iMfolozi Park (HiP), South Africa, with historical estimates led reports of a substantial (54%) increase, attributed to over-stocking and habitat deterioration that has far-reaching implications for rhino conservation. Other reports, however, suggest the increase is more likely an artefact caused by applying various home range estimators to non-standardised datasets. We collected 1939 locations of 25 black rhino over six years (2004-2009) to estimate annual home ranges and evaluate the hypothesis that they have increased in size. A minimum of 30 and 25 locations were required for accurate 95% MCP estimation of home range of adult rhinos, during the dry and wet seasons respectively. Forty and 55 locations were required for adult female and male annual MCP home ranges, respectively, and 30 locations were necessary for estimating 90% bivariate kernel home ranges accurately. Average annual 95% bivariate kernel home ranges were 20.4 ± 1.2 km(2), 53 ± 1.9% larger than 95% MCP ranges (9.8 km(2) ± 0.9). When home range techniques used during the late-1960s in HiP were applied to our dataset, estimates were similar, indicating that ranges have not changed substantially in 50 years. Inaccurate, non-standardised, home range estimates and their comparison have the potential to mislead black rhino population management. We recommend that more care be taken to collect adequate numbers of rhino locations within standardized time periods (i.e., season or year) and that the comparison of home ranges estimated using dissimilar procedures be avoided. Home range studies of black rhino have been data deficient and procedurally inconsistent. Standardisation of methods is required.

76 FR 22081 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-20

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... Pacific Fishery Management Council (Pacific Council) will convene a meeting of its Coastal Pelagic Species Management Team (CPSMT) that is open to the public. DATES: The meeting will be held Thursday, May 5, 2011...

Service oriented network architecture for control and management of home appliances

NASA Astrophysics Data System (ADS)

Hayakawa, Hiroshi; Koita, Takahiro; Sato, Kenya

2005-12-01

Recent advances in multimedia network systems and mechatronics have led to the development of a new generation of applications that associate the use of various multimedia objects with the behavior of multiple robotic actors. The connection of audio and video devices through high speed multimedia networks is expected to make the system more convenient to use. For example, many home appliances, such as a video camera, a display monitor, a video recorder, an audio system and so on, are being equipped with a communication interface in the near future. Recently some platforms (i.e. UPnP1, HAVi2 and so on) are proposed for constructing home networks; however, there are some issues to be solved to realize various services by connecting different equipment via the pervasive peer-to-peer network. UPnP offers network connectivity of PCs of intelligent home appliances, practically, which means to require a PC in the network to control other devices. Meanwhile, HAVi has been developed for intelligent AV equipments with sophisticated functions using high CPU power and large memory. Considering the targets of home alliances are embedded systems, this situation raises issues of software and hardware complexity, cost, power consumption and so on. In this study, we have proposed and developed the service oriented network architecture for control and management of home appliances, named SONICA (Service Oriented Network Interoperability for Component Adaptation), to address these issues described before.

How family caregivers of cancer patients manage symptoms at home: A systematic review.

PubMed

Ullgren, Helena; Tsitsi, Theologia; Papastavrou, Evridiki; Charalambous, Andreas

2018-05-29

Cancer affects not only the patient, but also the whole family, especially when a member of the family assumes the role of the family caregiver. This puts an additional emotional, social and financial strain on the family caregivers. Family caregivers of cancer patients are actively involved in the care provided at the home setting through various ways including practical tasks, symptom management and care coordination. The focus of preceding studies on family caregivers and symptom management was either on pain or the patients' and family caregivers' experience of symptom management and coping. The aim of this review was to provide evidence on how family caregivers manage symptoms and side effects at home, in adult cancer patients throughout the disease trajectory. A systematic literature review was performed in PubMed, CINAHL, Web of Science and the Cochrane Central Register of Controlled Trials with a combination of keywords and MeSH terms for family caregivers, cancer, symptoms, side effects and management. Based on predetermined inclusion and exclusion criteria, a total of 1270 articles were screened and 20 studies were included in the analysis. A descriptive analysis was performed due to the heterogeneity of the findings. The results showed that only a limited number of studies (3/20) explored how and what family caregivers do in symptom management as a primary outcome. Family caregivers provided psychosocial support, such as supporting and motivating the patient and maintaining social engagement. Caregivers provided physical support such as with the administration of medicine and tube feeding. As an integral part of managing the symptoms, family caregivers actively monitored and assessed symptoms to timely recognize any treatment related side effects, assess the response to therapeutic interventions and recognize possible deterioration in physical status. Furthermore, family caregivers were often the decision maker - being alert, watching and waiting and

Depression in Home-Based Care: The Role of the Home Health Nurse.

PubMed

Groh, Carla J; Dumlao, Manuel S

2016-01-01

Depression is a major health issue among older adults receiving home-based services yet is underdiagnosed and undertreated, which can result in negative health outcomes. Despite the recognized need for improved mental health services, significant gaps and barriers exist that contribute to less than optimal home-based depression management interventions. Home healthcare clinicians are well positioned to drive this effort for improving depression care with enhanced learning. Thus, the purpose of this article is to provide guidelines on improving depression care in homebound older adults based on four clinical functions central to home healthcare: screening, assessment, medication management, and patient/family education.

Responsible Management and Use of a Personal Take-Home Naloxone Supply: A Pilot Project

ERIC Educational Resources Information Center

McAuley, Andrew; Lindsay, George; Woods, Maureen; Louttit, Derek

2010-01-01

Aims: To assess if Scottish drug users, their family and friends could be trained in critical incident management and the safe and effective administration of naloxone. The project also sought to monitor whether drug users can manage their own personal take-home naloxone (THN) supply and use it appropriately in an emergency opiate overdose…

76 FR 53377 - Cost Accounting Standards; Allocation of Home Office Expenses to Segments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... Accounting Standards; Allocation of Home Office Expenses to Segments AGENCY: Office of Management and Budget (OMB), Office of Federal Procurement Policy (OFPP), Cost Accounting Standards Board (Board). ACTION... Accounting Standards (CAS) Board, is providing public notification of the decision to discontinue the...

Case management approaches to home support for people with dementia.

PubMed

Reilly, Siobhan; Miranda-Castillo, Claudia; Malouf, Reem; Hoe, Juanita; Toot, Sandeep; Challis, David; Orrell, Martin

2015-01-05

Over 35 million people are estimated to be living with dementia in the world and the societal costs are very high. Case management is a widely used and strongly promoted complex intervention for organising and co-ordinating care at the level of the individual, with the aim of providing long-term care for people with dementia in the community as an alternative to early admission to a care home or hospital. To evaluate the effectiveness of case management approaches to home support for people with dementia, from the perspective of the different people involved (patients, carers, and staff) compared with other forms of treatment, including 'treatment as usual', standard community treatment and other non-case management interventions. We searched the following databases up to 31 December 2013: ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group,The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, Web of Science (including Science Citation Index Expanded (SCI-EXPANDED) and Social Science Citation Index), Campbell Collaboration/SORO database and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group. We updated this search in March 2014 but results have not yet been incorporated. We include randomised controlled trials (RCTs) of case management interventions for people with dementia living in the community and their carers. We screened interventions to ensure that they focused on planning and co-ordination of care. We used standard methodological procedures as required by The Cochrane Collaboration. Two review authors independently extracted data and made 'Risk of bias' assessments using Cochrane criteria. For continuous outcomes, we used the mean difference (MD) or standardised mean difference (SMD) between groups along with its confidence interval (95% CI). We applied a fixed- or random-effects model as appropriate. For binary or dichotomous data, we generated the corresponding odds

Mexican spotted owl home range and habitat use in pine-oak forest: Implications for forest management

Treesearch

Joseph L. Ganey; William M. Block; Jeffrey S. Jenness; Randolph A. Wilson

1998-01-01

To better understand the habitat relationships of the Mexican spotted owl (Strix occidentalis lucida), and how such relationships might influence forest management, we studied home-range and habitat use of radio-marked owls in ponderosa pine (Pinus ponderosa) Gambel oak (Quercus gambelii) forest. Annual home-range size (95% adaptive-kernel estimate) averaged 895 ha...

Management challenges at the intersection of public policy environments and strategic decision making in public hospitals.

PubMed

Longest, Beaufort B

2012-01-01

Hospitals in the United States are heavily impacted by public policies that affect them. For example, Medicare and Medicaid programs account for more than half the revenue in most of the nation's almost 5,000 community hospitals, including the almost 1,100 public hospitals controlled by state and local governments (American Hospital Association, 2012). The public hospitals are especially closely aligned with and controlled by governmental entities compared with hospitals with other kinds of sponsorship. This article addresses the management challenges at the intersection of the strategic management of public hospitals and their public policy environments. Public hospitals are complicated entities designed not only to provide health services but also in many cases to play key roles in health-related research and education and to play important general economic development roles in their communities. The multi-faceted strategic decision making in these organizations is as heavily affected by their public policy environments as by their business, demographic, technological or other external environments. Effectively managing the intersection of their public policy environments and their strategic management is indeed vital for contemporary public hospitals. This article is intended to clarify certain aspects of this intersection through a description and model of the strategic activity in public hospitals and the connection between this activity and their external environments. Specific attention is focused on the concept of public policy environments and their features. Attention is also given to how managers can assess public policy environments and incorporate the results into strategic activities.

Children's Literature, the Home, and the Debate on Public versus Private Education, c.1760-1845

ERIC Educational Resources Information Center

Grenby, M. O.

2015-01-01

In Britain in the period 1760-1845 the debate on the relative merits of public (school) versus private (home) education remained unresolved and was vigorously debated in many media. It was in this same period that children's literature began to flourish: a much wider variety of books were published in much greater numbers. The new children's…

Perceptions of risk and risk management among 735 women who opted for a home birth.

PubMed

Lindgren, Helena E; Rådestad, Ingela J; Christensson, Kyllike; Wally-Bystrom, Kristina; Hildingsson, Ingegerd M

2010-04-01

home birth is not included in the Swedish health-care system and the rate for planned home births is less than one in a thousand. The aim of this study was to describe women's perceptions of risk related to childbirth and the strategies for managing these perceived risks. a nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005. a total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned. two open questions regarding risk related to childbirth and two questions answered using a scale were investigated by content analysis. regarding perceived risks about hospital birth, three categories, all related to loss of autonomy, were identified: (1) being in the hands of strangers; (2) being in the hands of routines and unnecessary interventions; and (3) being in the hands of structural conditions. Perceived risks related to a home birth were associated with a sense of being beyond help: (1) worst-case scenario; and (2) distance to the hospital. The perceived risks were managed by using extrovert activities and introvert behaviour, and by avoiding discussions concerning risks with health-care professionals. women who plan for a home birth in Sweden do consider risks related to childbirth but they avoid talking about the risks with health-care professionals. to understand why women choose to give birth at home, health-care professionals must learn about the perceived beneficial effect of doing so. Copyright 2008 Elsevier Ltd. All rights reserved.

Public involvement in research within care homes: benefits and challenges in the APPROACH study.

PubMed

Froggatt, Katherine; Goodman, Claire; Morbey, Hazel; Davies, Sue L; Masey, Helen; Dickinson, Angela; Martin, Wendy; Victor, Christina

2016-12-01

Public involvement in research (PIR) can improve research design and recruitment. Less is known about how PIR enhances the experience of participation and enriches the data collection process. In a study to evaluate how UK care homes and primary health-care services achieve integrated working to promote older people's health, PIR was integrated throughout the research processes. This paper aims to present one way in which PIR has been integrated into the design and delivery of a multisite research study based in care homes. A prospective case study design, with an embedded qualitative evaluation of PIR activity. Data collection was undertaken in six care homes in three sites in England. Six PIR members participated: all had prior personal or work experience in care homes. Qualitative data collection involved discussion groups, and site-specific meetings to review experiences of participation, benefits and challenges, and completion of structured fieldwork notes after each care home visit. PIR members supported recruitment, resident and staff interviews and participated in data interpretation. Benefits of PIR work were resident engagement that minimized distress and made best use of limited research resources. Challenges concerned communication and scheduling. Researcher support for PIR involvement was resource intensive. Clearly defined roles with identified training and support facilitated involvement in different aspects of the data collection process. This can also ensure that vulnerable older people who participate in research have a positive experience that reinforces the value of their views. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Nonpharmacologic Pain Management Interventions in German Nursing Homes: A Cluster Randomized Trial.

PubMed

Kalinowski, Sonja; Budnick, Andrea; Kuhnert, Ronny; Könner, Franziska; Kissel-Kröll, Angela; Kreutz, Reinhold; Dräger, Dagmar

2015-08-01

The reported prevalence of pain among nursing home residents (NHRs) is high. Insufficient use of analgesics, the conventional pain management strategy, is often reported. Whether and to what extent nonpharmacologic therapies (NPTs) are used to manage the pain of NHRs in Germany is largely unknown. The aim of this cluster-randomized trial was to assess the NPTs provided and to enhance the application and prescription of NPTs in NHRs on an individual level. There were six nursing homes in the intervention group and six in the control group. There were 239 NHRs, aged ≥65 years, with an average Mini-Mental State Examination score of at least 18 at baseline. Pain management interventions (cluster level) included an online course for physicians and 1-day seminar for nurses. Data on NPT applied by nurses and therapeutic NPT prescribed by physicians were obtained from residents' nursing documentation. Face-to-face interviews with NHRs assessed the NPT received. At baseline, 82.6% of NHR (mean age 83 years) were affected by pain, but less than 1 in 10 received NPT. The intervention did not result in a significant increase in the NPT applied by nurses, but did significantly increase the therapeutic NPT prescribed by physicians. Residents were active in using NPT to self-manage their pain. Given the prevalence of pain in NHRs, there is a clear need to improve pain management in this population. Extended use of NPT offers a promising approach. We recommend that nurses provide residents with education on pain-management techniques to support them in taking a proactive role in managing their pain. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Traditional vs. Contemporary Management Control Practices for Developing Public Health Policies

PubMed Central

Naranjo-Gil, David; Sánchez-Expósito, María Jesús; Gómez-Ruiz, Laura

2016-01-01

Public health policies must address multiple goals and complex community health needs. Recently, management control practices have emerged to provide a broader type of information for evaluating the effectiveness of healthcare policies, and relate activities and processes to multiple strategic outcomes. This study compares the effect of traditional and contemporary management control practices on the achievement of public health policies. It is also analyzed how two different uses of such practices (enabling vs. coercive) facilitate the achievement of public health policies. Relationships are explored using data collected from managers from public health agencies and public hospitals in Spain. The findings show that contemporary management control practices are more suitable than traditional practices to achieve public health policies. Furthermore, results show that public health policies are better achieved when managers use management control practices in an enabling way rather than in a coercive way. PMID:27428985

[Prolonged hospitalization versus home management for women with arrested preterm labour: a before-after study].

PubMed

Salzmann, M; Gaucherand, P; Doret, M

2013-04-01

To compare gestational age at birth and incidence of preterm birth inferior to 37 weeks of gestation (WG) in single pregnancies with either prolonged hospitalization, or early home discharge after arrested preterm labour. Management of preterm labour was changed in our public academic hospital because no evidence of benefits for prolonged hospitalization was found and because adverse effects related to long-term hospitalization were described. In this retrospective before-after study, we compare the attitude A (December 2006 to April 2008), a prolonged hospitalization until 32 or 34WG, with new attitude B (May 2008 to February 2010), an early discharge home if the cervical exam was unchanged since admission. A total of 140 patients were included: 70 in each group. Initial hospitalization stay was significantly shorter in Group B (respectively, 5.4±5.4 days and 11.4±12.1 days; P<0.05). Preterm spontaneous delivery is 14 (20%) in group A and 21 (28.6%) in Group B (P>0.05). Gestational ages at birth were 33(5/7) and 33(0/7) WG in groups A and B, respectively (P>0.05). If we focus on patients who were discharged home in the two groups (women who did not deliver no matter the hospitalization length), the gestational age at birth (38(4/7) and 38WG; ns) and the prematurity rate inferior to 37WG (17.2% and 22.4%; ns) were statistically similar. This study suggests that shorter hospitalization does not decrease the delivery term, nor does it increase the premature delivery incidence. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Public Speaking: Managing Challenging People and Situations.

PubMed

Baum, Neil; Boughton, Leonarda

2016-01-01

Every public speaker has encountered, or most likely will encounter, a difficult member of the audience who disrupts their presentation. This is a source of anxiety and discomfort, not only for the presenter, but for the audience as well. Learning how to manage the disruptive audience member is an art form, just like being a good public speaker. A professional speaker knows how to handle this disruption without making the audience uncomfortable and without embarrassing the disruptor. This article discusses ways to manage the disruptive audience member and will help those of you who do public speaking to tactfully and professionally disengage someone who is ruining your program.

Predictors of acceptance of a postpartum public health nurse home visit: findings from an Ontario survey.

PubMed

Sword, Wendy A; Krueger, Paul D; Watt, M Susan

2006-01-01

To determine 1) rates of offer and uptake of a home visit provided through Ontario's universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit. Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge. Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation. The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.

Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status? A Canadian experience.

PubMed

Laporte, Audrey; Croxford, Ruth; Coyte, Peter C

2007-03-01

The present quantitative study evaluates the degree to which socioeconomic status (SES), as opposed to perceived need, determines utilisation of publicly funded home care in Ontario, Canada. The Registered Persons Data Base of the Ontario Health Insurance Plan was used to identify the age, sex and place of residence for all Ontarians who had coverage for the complete calendar year 1998. Utilisation was characterised in two dimensions: (1) propensity - the probability that an individual received service, which was estimated using a multinomial logit equation; and (2) intensity - the amount of service received, conditional on receipt. Short- and long-term service intensity were modelled separately using ordinary least squares regression. Age, sex and co-morbidity were the best predictors (P < 0.0001) of whether or not an individual received publicly funded home care as well as how much care was received, with sicker individuals having increased utilisation. The propensity and intensity of service receipt increased with lower SES (P < 0.0001), and decreased with the proportion of recent immigrants in the region (P < 0.0001), after controlling for age, sex and co-morbidity. Although the allocation of publicly funded home care service was primarily based on perceived need rather than ability to pay, barriers to utilisation for those from areas with a high proportion of recent immigrants were identified. Future research is needed to assess whether the current mix and level of publicly funded resources are indeed sufficient to offset the added costs associated with the provision of high-quality home care.

COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD.

PubMed

Kessler, Romain; Casan-Clara, Pere; Koehler, Dieter; Tognella, Silvia; Viejo, Jose Luis; Dal Negro, Roberto W; Díaz-Lobato, Salvador; Reissig, Karina; Rodríguez González-Moro, José Miguel; Devouassoux, Gilles; Chavaillon, Jean-Michel; Botrus, Pierre; Arnal, Jean-Michel; Ancochea, Julio; Bergeron-Lafaurie, Anne; De Abajo, Carlos; Randerath, Winfried J; Bastian, Andreas; Cornelissen, Christian G; Nilius, Georg; Texereau, Joëlle B; Bourbeau, Jean

2018-01-01

The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference -5.3, 95% CI -13.7 to -3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% versus 14.2%; p<0.001), with no difference in exacerbation frequency. Patient profiles and hospitalisation practices varied substantially across countries.The COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients. Copyright ©ERS 2018.

Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

PubMed Central

Kissam, Stephanie; Gifford, David; Parks, Peggy; Patry, Gail; Palmer, Laura; Wilkes, Linda; Fitzgerald, Matthew; Petrulis, Alice Stollenwerk; Barnette, Leslie

2003-01-01

Background In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) that led quality improvement efforts in nursing homes from the six pilot states. Results QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. Conclusion The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting. PMID:12753699

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Medication Management for People with Dementia.

PubMed

Lindauer, Allison; Sexson, Kathryn; Harvath, Theresa A

2017-05-01

: This article is the fourth in a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project supported evidence that family caregivers aren't being given the information they need to manage the complex care regimens of their family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's medications. Each article explains the principles nurses should consider and reinforce with caregivers and is accompanied by a video for the caregiver to watch. The fourth video can be accessed at http://links.lww.com/AJN/A78.

Medication Management for People with Dementia.

PubMed

Lindauer, Allison; Sexson, Kathryn; Harvath, Theresa A

2017-02-01

This article is the fourth in a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project supported evidence that family caregivers aren't being given the information they need to manage the complex care regimens of their family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's medications. Each article explains the principles nurses should consider and reinforce with caregivers and is accompanied by a video for the caregiver to watch. The fourth video can be accessed at http://links.lww.com/AJN/A78.

A falls case summary: Application of the public health nursing intervention wheel.

PubMed

Leahy-Warren, Patricia; Day, Mary Rose; Philpott, Lloyd; Glavin, Kari; Gjevjon, Edith Roth; Steffenak, Anne Kjersti Myhrene; Nordhagen, Live S; Egge, Hilde; Healy, Elizabeth; Mulcahy, Helen

2018-04-20

The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW. A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home. The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case. The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community. © 2018 Wiley Periodicals, Inc.

Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

PubMed

Sasnett, Bonita; Harris, Susie T; White, Shelly

Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

77 FR 8809 - New England Fishery Management Council; Public Hearings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-15

... Fishery Management Council; Public Hearings AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice; public hearings. SUMMARY: The New England Fishery Management Council (Council) will hold eight public hearings to solicit comment on Draft...

In-home care for optimizing chronic disease management in the community: an evidence-based analysis.

PubMed

2013-01-01

The emerging attention on in-home care in Canada assumes that chronic disease management will be optimized if it takes place in the community as opposed to the health care setting. Both the patient and the health care system will benefit, the latter in terms of cost savings. To compare the effectiveness of care delivered in the home (i.e., in-home care) with no home care or with usual care/care received outside of the home (e.g., health care setting). A literature search was performed on January 25, 2012, using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published from January 1, 2006, until January 25, 2012. An evidence-based analysis examined whether there is a difference in mortality, hospital utilization, health-related quality of life (HRQOL), functional status, and disease-specific clinical measures for in-home care compared with no home care for heart failure, atrial fibrillation, coronary artery disease, stroke, chronic obstructive pulmonary disease, diabetes, chronic wounds, and chronic disease / multimorbidity. Data was abstracted and analyzed in a pooled analysis using Review Manager. When needed, subgroup analysis was performed to address heterogeneity. The quality of evidence was assessed by GRADE. The systematic literature search identified 1,277 citations from which 12 randomized controlled trials met the study criteria. Based on these, a 12% reduced risk for in-home care was shown for the outcome measure of combined events including all-cause mortality and hospitalizations (relative risk [RR]: 0.88; 95% CI: 0.80-0.97). Patients receiving in-home care had an average of 1 less unplanned hospitalization (mean difference [MD]: -1.03; 95% CI: -1.53 to -0.53) and an average of 1 less emergency department (ED) visit (MD: -1.32; 95% CI: -1.87 to -0.77). A

Classification tree model identifies home-based service needs of Japanese long-term care insurance consumers.

PubMed

Naruse, Takashi; Nagata, Satoko; Taguchi, Atsuko; Murashima, Sachiyo

2011-01-01

To clarify care receivers' needs and unmet needs for home help or home nursing services during daytime and/or nighttime hours, and to identify the characteristic of elders who are most likely to need home care services. We used a chi-squared automatic interaction detection technique to analyze data from 92 care management researchers, who interviewed 280 caregivers. Demographic information, assessments of the statuses and service needs of elders. We found that care receivers had more unmet needs at night than during the day. Daytime home help was needed by elders who (1) lived alone or (2) lived with just one person and whose primary caregiver was not their wife. Nighttime home help was needed by those who required assistance eating, and whose primary caregiver was male. Daytime home nursing was needed by elders who (1) received medical treatment instead of day care or (2) did not receive medical treatment, but had difficulty eating. Nighttime home nursing was needed by those who had unstable illnesses and whose medical treatments continued during the night. Our findings may help public health nurses assess community needs in order to effectively and efficiently manage health care resources. © 2011 Wiley Periodicals, Inc.

Ability, incentives, and management feedback: organizational change to reduce pressure ulcers in a nursing home.

PubMed

Rosen, Jules; Mittal, Vikas; Degenholtz, Howard; Castle, Nick; Mulsant, Benoit H; Hulland, Shelley; Nace, David; Rubin, Fred

2006-03-01

Quality improvement (QI) processes in nursing homes are highly variable and often ineffective. This study evaluated an innovative QI process to reduce pressure ulcers (PUs) in a nursing home with a high rate of PUs. This was a 48-week, longitudinal study comparing the incidence of PUs during 12-week baseline and intervention and post-intervention periods. Not-for-profit, 136-bed nursing home in urban Western Pennsylvania. All residents and all staff at the nursing home participated in this study. The intervention consisted of 3 components: Ability enhancement, incentivization, and management feedback. To enhance ability, all staff members completed a computer-based interactive video education program on PU prevention and were mandated to use penlights to promote early detection. Incentivization included $75 for each staff member if the desired reduction in PU incidence was achieved. Management feedback provided real-time information of staff"s adherence to the mandated training. Outcome measures consisted of staff's adherence to mandated training and the incidence of new PUs during the baseline period compared to the intervention and post-intervention periods. Management responded to noncompliance with training with both rewards and stepped discipline. Adherence to protocol, as measured by training compliance, was 100%. There was a significant reduction (P < .05) in the incidence of stage 2 or worse PUs during the intervention period. During the post-intervention periods, the effect was lost. An innovative QI initiative resulted in a significant decrease in PUs in 1 facility. This intervention was not sustainable when the 3 components of the QI intervention were no longer actively maintained.

In-home behavioral health case management: an integrated model for high-risk populations.

PubMed

Theis, Gerald A; Kozlowski, Deirdre; Behrens, Jenna

2006-01-01

The escalating health care costs attributed to high-risk populations have fueled a need for a proactive approach to deal with people affected by complex mental health issues that often coexist with chronic medical conditions. Through an in-home behavioral health case management (CM) program, patients with mental illnesses (some with coexisting medical conditions) receive integrated medical and mental health services through a disease-management approach that has proven effective in treating high-risk patients.

75 FR 27989 - North Pacific Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-19

... Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS), National... North Pacific Fishery Management Council (Council) and its advisory committees will hold public meetings... Westmark Hotel, 330 Seward Street, Room ????, Sitka, AK. All meetings are open to the public, except...

Associations Between Home Death and the Use and Type of Care at Home.

PubMed

McEwen, Rebecca; Asada, Yukiko; Burge, Frederick; Lawson, Beverley

2018-01-01

Despite wishes for and benefits of home deaths, a discrepancy between preferred and actual location of death persists. Provision of home care may be an effective policy response to support home deaths. Using the population-based mortality follow-back study conducted in Nova Scotia, we investigated the associations between home death and formal care at home and between home death and the type of formal care at home. We found (1) the use of formal care at home at the end of life was associated with home death and (2) the use of formal home support services at home was associated with home death among those whose symptoms were well managed.

Public attitudes toward forest management: a Shawnee National Forest example

Treesearch

Joanne Vining

2003-01-01

One of the fundamental problems of modern public lands management is the accurate and representative assessment of public opinion. The purpose of this study was to examine differences in perceptions and attitudes of Shawnee National Forest management activities and plans among members of local and regional publics. A survey was administered to members of the public in...

Rehabilitation Risk Management: Enabling Data Analytics with Quantified Self and Smart Home Data.

PubMed

Hamper, Andreas; Eigner, Isabella; Wickramasinghe, Nilmini; Bodendorf, Freimut

2017-01-01

A variety of acute and chronic diseases require rehabilitation at home after treatment. Outpatient rehabilitation is crucial for the quality of the medical outcome but is mainly performed without medical supervision. Non-Compliance can lead to severe health risks and readmission to the hospital. While the patient is closely monitored in the hospital, methods and technologies to identify risks at home have to be developed. We analyze state-of-the-art monitoring systems and technologies and show possibilities to transfer these technologies into rehabilitation monitoring. For this purpose, we analyze sensor technology from the field of Quantified Self and Smart Homes. The available sensor data from this consumer grade technology is summarized to give an overview of the possibilities for medical data analytics. Subsequently, we show a conceptual roadmap to transfer data analytics methods to sensor based rehabilitation risk management.

76 FR 22080 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-20

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... England Fishery Management Council (Council) is scheduling a public meeting of its Scallop Advisory Panel...: (508) 747- 8937. Council address: New England Fishery Management Council, 50 Water Street, Mill 2...

76 FR 7548 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-10

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... England Fishery Management Council (Council) is scheduling a public meeting of its Scallop Committee in...; fax: (401) 734-9700. Council address: New England Fishery Management Council, 50 Water Street, Mill 2...

75 FR 43491 - Western Pacific Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-26

... Pacific Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS... scoping meetings. SUMMARY: The Western Pacific Fisheries Management Council (Council) will convene public informational scoping meetings in Guam and CNMI to solicit comments on the management of the bottomfish fishery...

75 FR 4348 - Mid-Atlantic Fishery Management Council; Public Hearings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... Fishery Management Council; Public Hearings AGENCY: National Marine Fisheries Service (NMFS), National... Mid-Atlantic Fishery Management Council (MAFMC) will hold public hearings in February 2010 to allow for input on Amendment 11 to the Atlantic Mackerel, Squid, and Butterfish (MSB) Fishery Management...

77 FR 53179 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-31

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... Pacific Fishery Management Council's (Pacific Council) Model Evaluation Workgroup (MEW) will hold a work... salmon methodology review process. The meeting is open to the public. DATES: The work session will be...

76 FR 36901 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-23

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... Pacific Fishery Management Council's (Council's) Model Evaluation Workgroup (MEW) will hold a work session... salmon methodology review process. The meeting is open to the public. DATES: The work session will be...

Public health laboratory quality management in a developing country.

PubMed

Wangkahat, Khwanjai; Nookhai, Somboon; Pobkeeree, Vallerut

2012-01-01

The article aims to give an overview of the system of public health laboratory quality management in Thailand and to produce a strengths, weaknesses, opportunities and threats (SWOT) analysis that is relevant to public health laboratories in the country. The systems for managing laboratory quality that are currently employed were described in the first component. The second component was a SWOT analysis, which used the opinions of laboratory professionals to identify any areas that could be improved to meet quality management systems. Various quality management systems were identified and the number of laboratories that met both international and national quality management requirements was different. The SWOT analysis found the opportunities and strengths factors offered the best chance to improve laboratory quality management in the country. The results are based on observations and brainstorming with medical laboratory professionals who can assist laboratories in accomplishing quality management. The factors derived from the analysis can help improve laboratory quality management in the country. This paper provides viewpoints and evidence-based approaches for the development of best possible practice of services in public health laboratories.

Summer-fall home-range fidelity of female elk in northwestern Colorado: Implications for aspen management

Treesearch

April M. Brough; R. Justin DeRose; Mary M. Conner; James N. Long

2017-01-01

Understanding the degree of spatial fidelity exhibited by individuals within a species increases our ability to manage for desired future outcomes. Elk (Cervus elaphus) is a closely managed species in the Western US, but there is little research evaluating their summer home-range fidelity. Elk summer-fall homeranges overlap considerably with aspen (Populus tremuloides...

76 FR 55646 - Pacific Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-08

... Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS), National... public meeting of the Pacific Fishery Management Council's (Council) Scientific and Statistical Committee.... and will end at 5:30 p.m. or as necessary to complete business each day during the week. ADDRESSES...

Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions.

PubMed

Darkins, Adam; Ryan, Patricia; Kobb, Rita; Foster, Linda; Edmonson, Ellen; Wakefield, Bonnie; Lancaster, Anne E

2008-12-01

Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings.

EVALUATION OF THE FARM MANAGEMENT PHASE OF THE FARM AND HOME MANAGEMENT PROGRAM IN NEW YORK STATE. EXTENSION STUDY, NUMBER 1.

ERIC Educational Resources Information Center

ALEXANDER, FRANK D.; LONGEST, JAMES W.

THE MAIN PURPOSE OF THIS 1956-60 LONGITUDINAL STUDY WAS TO COMPARE CHANGES IN FARM PRACTICES AND RELATED KNOWLEDGE AND IN INCOME AND RELATED BUSINESS FACTORS AMONG 87 PARTICIPANTS (DAIRYMEN) IN THE FARM MANAGEMENT PHASE OF THE NEW YORK STATE FARM AHD HOME MANAGEMENT PROGRAM, WITH THOSE OF A CONTROL GROUP OF 87 WHO DID NOT PARTICIPATE. IN 1956, THE…

Professional Certification in Public Management: A Status Report and Proposal.

ERIC Educational Resources Information Center

Hays, Steven W.; Duke, Bruce

1996-01-01

Provides a status report on the accomplishments of 16 Certified Public Manager (CPM) certification programs. Describes the growth and development of the program and argues that the interests of the public management community might be served if CPM and Master of Public Administration programs were to cooperate more aggressively. (Author/JOW)

Exploring nursing assistants' roles in the process of pain management for cognitively impaired nursing home residents: a qualitative study.

PubMed

Liu, Justina Y W

2014-05-01

To explore nursing assistants' roles during the actual process of pain management (assessment, reporting, implementation of pain-relieving interventions and re-assessment) for cognitively impaired home residents with pain. Nursing assistants provide most of the direct care to residents and represent the major taskforce in nursing homes. They may develop specialized knowledge of residents' pain experience that enables them to play both a pivotal role in pain assessment and possibly a supporting role in pain treatment. Currently, there is a lack of research into nursing assistants' functions in pain management. This is a descriptive, exploratory qualitative study. Forty-nine nursing assistants were recruited from 12 nursing homes, 12 of them participating in semi-structured individual interviews and 37 in 8 semi-structured focus groups. All interviews were carried out from May to September 2010. Data collected via both data collection methods were transcribed verbatim and analysed by content analysis. Nursing assistants were found to play four roles in the pain management process: (1) pain assessor; (2) reporter; (3) subordinate implementing prescribed medications; and (4) instigator implementing non-pharmacological interventions. This study highlights the importance of nursing assistants in successful pain assessment and identifies their possible supporting roles in other aspects of pain management. However, nursing assistants' scope of practice resulted in their functions in pain management being continually undervalued by other healthcare professionals. Continuous in-service training, the use of a standardized pain management protocol and strategies for building coherent work teams in nursing homes are suggested to improve this situation. © 2013 John Wiley & Sons Ltd.

The Lifestyle Engagement Activity Program (LEAP): Implementing Social and Recreational Activity into Case-Managed Home Care.

PubMed

Low, Lee-Fay; Baker, Jessica Rose; Harrison, Fleur; Jeon, Yun-Hee; Haertsch, Maggie; Camp, Cameron; Skropeta, Margaret

2015-12-01

The Lifestyle Engagement Activity Program (LEAP) incorporates social support and recreational activities into case-managed home care. This study's aim was to evaluate the effect of LEAP on engagement, mood, and behavior of home care clients, and on case managers and care workers. Quasi-experimental. Five Australian aged home care providers, including 2 specializing in care for ethnic minorities. Clients (n = 189) from 5 home care providers participated. The 12-month program had 3 components: (1) engaging support of management and staff; (2) a champion to drive practice change; (3) staff training. Case managers were trained to set meaningful social and/or recreational goals during care planning. Care workers were trained in good communication, to promote client independence and choice, and in techniques such as Montessori activities, reminiscence, music, physical activity, and humor. Data were collected 6 months before program commencement, at baseline, and 6 and 12 months. The Homecare Measure of Engagement Staff report and Client-Family interview were primary outcomes. Secondary outcomes were the Cohen-Mansfield Agitation Inventory; apathy, dysphoria, and agitation subscales of the Neuropsychiatric Inventory-Clinician Rating; the geriatric depression scale; UCLA loneliness scale; and home care satisfaction scale. Staff provided information on confidence in engaging clients and the Utrecht Work Engagement Scale. Twelve months after program commencement, clients showed a significant increase in self- or family-reported client engagement (b = 5.39, t[113.09] = 3.93, P < .000); and a significant decrease in apathy (b = -0.23, t(117.00) = -2.03, P = .045), dysphoria (b = -0.25, t(124.36) = -2.25, P = .026), and agitation (b = -0.97, t(98.15) = -3.32, P = .001) on the Neuropsychiatric Inventory-Clinician. Case managers and care workers both reported significant increases in their confidence to socially and recreationally engage clients (b = 0.52, t(21.33) = 2.80, P

New public management in Iran's health complex: a management framework for primary health care system.

PubMed

Tabrizi, Jafar Sadegh; HaghGoshayie, Elaheh; Doshmangir, Leila; Yousefi, Mahmood

2018-05-01

New public management (NPM) was developed as a management reform to improve the efficiency and effectiveness in public organizations, especially in health sector. Using the features of private sector management, the managers of health organizations may try to implement the elements of NPM with the hope to improve the performance of their systems.AimsOur aim in the present study was to identify the elements and infrastructures suitable for implementing NPM in the Iranian health complex. In this qualitative study with conventional content analysis approach, we tried to explore the NPM elements and infrastructures in Iranian public health sector. A series of semi-structured interviews (n=48) were conducted in 2016 with a managers in public and private health complex. Three focus group discussions with nine faculty members were also conducted. A data collection form was used to collect the demographic characteristics and perspectives of the participants.FindingsFrom the perspective of managers, managerialism, decentralization, using market mechanism, performance management, customer orientation and performance budgeting were the main elements of NPM in the Iranian context. The most important infrastructures for implementing this reform were as follows: education and training, information technology, the proper use of human resources, decision support systems, top management commitment, organizational culture, flexibility of rules, rehabilitating of the aging infrastructures, and expanding the coverage of services. The NPM was generally identified to be an effective replacement for the traditional administration method. These reforms may be helpful in strengthening the public health complex and the management capacity, as well. NPM also seems to be useful in interacting the public health sector with the private sector in terms of personnel and resources, performance, reward structure, and methods of doing business.

Hospice Care in Nursing Homes: Does It Contribute to Higher Quality Pain Management?

ERIC Educational Resources Information Center

Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.

2006-01-01

Purpose: The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods: In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication…

77 FR 60967 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration Pacific Fishery Management... Administration (NOAA), Commerce. ACTION: Notice of a public meeting. SUMMARY: The Pacific Fishery Management... conference that is open to the public. DATES: The SAS will meet on Monday, October 29, 2012 from 1 p.m. to 3...

An evaluation and implementation of rule-based Home Energy Management System using the Rete algorithm.

PubMed

Kawakami, Tomoya; Fujita, Naotaka; Yoshihisa, Tomoki; Tsukamoto, Masahiko

2014-01-01

In recent years, sensors become popular and Home Energy Management System (HEMS) takes an important role in saving energy without decrease in QoL (Quality of Life). Currently, many rule-based HEMSs have been proposed and almost all of them assume "IF-THEN" rules. The Rete algorithm is a typical pattern matching algorithm for IF-THEN rules. Currently, we have proposed a rule-based Home Energy Management System (HEMS) using the Rete algorithm. In the proposed system, rules for managing energy are processed by smart taps in network, and the loads for processing rules and collecting data are distributed to smart taps. In addition, the number of processes and collecting data are reduced by processing rules based on the Rete algorithm. In this paper, we evaluated the proposed system by simulation. In the simulation environment, rules are processed by a smart tap that relates to the action part of each rule. In addition, we implemented the proposed system as HEMS using smart taps.

Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes

PubMed Central

Hunt, Selina R.; Corazzini, Kirsten; Anderson, Ruth A.

2014-01-01

Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided. PMID:24652943

Natural Aggregation Approach based Home Energy Manage System with User Satisfaction Modelling

NASA Astrophysics Data System (ADS)

Luo, F. J.; Ranzi, G.; Dong, Z. Y.; Murata, J.

2017-07-01

With the prevalence of advanced sensing and two-way communication technologies, Home Energy Management System (HEMS) has attracted lots of attentions in recent years. This paper proposes a HEMS that optimally schedules the controllable Residential Energy Resources (RERs) in a Time-of-Use (TOU) pricing and high solar power penetrated environment. The HEMS aims to minimize the overall operational cost of the home, and the user’s satisfactions and requirements on the operation of different household appliances are modelled and considered in the HEMS. Further, a new biological self-aggregation intelligence based optimization technique previously proposed by the authors, i.e., Natural Aggregation Algorithm (NAA), is applied to solve the proposed HEMS optimization model. Simulations are conducted to validate the proposed method.

Strategy Guideline: Quality Management in Existing Homes; Cantilever Floor Example

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taggart, J.; Sikora, J.; Wiehagen, J.

2011-12-01

This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented. The goal of existing home high performing remodeling quality management systems (HPR-QMS) is to establish practices and processes that can be used throughout any remodeling project. The research presented in this document provides a comparison of a selected retrofit activity as typically done versus that same retrofit activity approached from an integrated high performance remodeling andmore » quality management perspective. It highlights some key quality management tools and approaches that can be adopted incrementally by a high performance remodeler for this or any high performance retrofit. This example is intended as a template and establishes a methodology that can be used to develop a portfolio of high performance remodeling strategies.« less

[Quality assurance and total quality management in residential home care].

PubMed

Nübling, R; Schrempp, C; Kress, G; Löschmann, C; Neubart, R; Kuhlmey, A

2004-02-01

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.

Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

PubMed

Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

2017-11-01

The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

Nursing Home Administrators' Opinions of the Nursing Home Compare Web Site

ERIC Educational Resources Information Center

Castle, Nicholas G.

2005-01-01

Purpose: In November of 2002 the Centers for Medicare and Medicaid Services publicly reported on a national basis the quality of nursing homes on the Nursing Home Compare (NHC) Web site. This study examines administrators' opinions of this initiative and whether it has fostered quality improvement. Design and Methods: Data used in this…

Perception of quality of care among residents of public nursing-homes in Spain: a grounded theory study.

PubMed

Rodríguez-Martín, Beatriz; Martínez-Andrés, María; Cervera-Monteagudo, Beatriz; Notario-Pacheco, Blanca; Martínez-Vizcaíno, Vicente

2013-06-28

The quality of care in nursing homes is weakly defined, and has traditionally focused on quantify nursing homes outputs and on comparison of nursing homes' resources. Rarely the point of view of clients has been taken into account. The aim of this study was to ascertain what means "quality of care" for residents of nursing homes. Grounded theory was used to design and analyze a qualitative study based on in-depth interviews with a theoretical sampling including 20 persons aged over 65 years with no cognitive impairment and eight proxy informants of residents with cognitive impairment, institutionalized at a public nursing home in Spain. Our analysis revealed that participants perceived the quality of care in two ways, as aspects related to the persons providing care and as institutional aspects of the care's process. All participants agreed that aspects related to the persons providing care was a pillar of quality, something that, in turn, embodied a series of emotional and technical professional competences. Regarding the institutional aspects of the care's process, participants laid emphasis on round-the-clock access to health care services and on professional's job stability. This paper includes perspectives of the nursing homes residents, which are largely absent. Incorporating residents' standpoints as a complement to traditional institutional criteria would furnish health providers and funding agencies with key information when it came to designing action plans and interventions aimed at achieving excellence in health care.

41 CFR 302-10.203 - What are my allowances when a mobile home is transported partly by commercial carrier and partly...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 302-10.203 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES TRANSPORTATION AND STORAGE OF PROPERTY 10-ALLOWANCES FOR TRANSPORTATION OF MOBILE HOMES AND BOATS...

The Seattle–King County Healthy Homes II Project: A Randomized Controlled Trial of Asthma Self-management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers

PubMed Central

Krieger, James; Takaro, Tim K.; Song, Lin; Beaudet, Nancy; Edwards, Kristine

2009-01-01

Objective To compare the marginal benefit of in-home asthma self-management support provided by community health workers (CHWs) with standard asthma education from clinic-based nurses. Design Randomized controlled trial. Setting Community and public health clinics and homes. Participants Three hundred nine children aged 3 to 13 years with asthma living in low-income households. Interventions All participants received nurse-provided asthma education and referrals to community resources. Some participants also received CHW-provided home environmental assessments, asthma education, social support, and asthma-control resources. Outcome Measures Asthma symptom–free days, Pediatric Asthma Caretaker Quality of Life Scale score, and use of urgent health services. Results Both groups showed significant increases in caretaker quality of life (nurse-only group: 0.4 points; 95% confidence interval [CI], 0.3–0.6; nurse + CHW group: 0.6 points; 95% CI, 0.4–0.8) and number of symptom-free days (nurse only: 1.3 days; 95% CI, 0.5–2.1; nurse + CHW: 1.9 days; 95% CI, 1.1–2.8), and absolute decreases in the proportion of children who used urgent health services in the prior 3 months (nurse only: 17.6%; 95% CI, 8.1%–27.2%; nurse + CHW: 23.1%; 95% CI, 13.6%–32.6%). Quality of life improved by 0.22 more points in the nurse + CHW group (95% CI, 0.00–0.44; P=.049). The number of symptom-free days increased by 0.94 days per 2 weeks (95% CI, 0.02–1.86; P = .046), or 24.4 days per year, in the nurse + CHW group. While use of urgent health services decreased more in the nurse + CHW group, the difference between groups was not significant. Conclusion The addition of CHW home visits to clinic-based asthma education yielded a clinically important increase in symptom-free days and a modest improvement in caretaker quality of life. PMID:19188646

Elderly peoples' meals. A comparative study between elderly living in a nursing home and frail, self-managing elderly.

PubMed

Engelheart, S; Lammes, E; Akner, G

2006-01-01

Sweden is one of few countries that have specific recommendations regarding mealtime habits. The importance of mealtime habits for health outcome is inadequately studied in elderly subjects. The aim of this study was to investigate the distribution of the daily meals/energy intake; the number of eating episodes per day and subjectively estimated meal-dependent variables (appetite, motivation to eat, sense of taste and sense of smell) and compare the results of elderly living in a nursing home with frail, self-managing elderly living at home. Explorative study. All analyses of energy intake were based on food records; weighed in the nursing home and estimated in the frail, self-managing elderly. Participants or contact persons estimated the subjective variables using a 10-point VAS scale. On average there were 4-5 daily eating episodes in both groups. The eating episodes were much more widespread over the day in the self-managing elderly, and their length of fasting at night was significantly shorter. The subjects estimated appetite and sense of smell was reduced in about 30-40% in both groups. Sense of taste was reduced in 40 % of the males and 10-20 % of the females. Energy intake was similar in both groups, 25 kcal/kg body weight/day, with more than a threefold variation among individual subjects. Energy intake/kg body weight correlated with a shorter length of fasting at night in the nursing home residents, however, did not correlate with ADL, number of eating episodes per day, appetite, motivation to eat, or senses of taste or smell. The self-managing elderly had more widespread eating episodes than the elderly in the nursing home, indicating that self-managing elderly exhibit larger variations in food intake preferences, however, without affecting mean energy intake. The lack of correlation between energy intake and estimated appetite, taste and smell is in line with previous findings in elderly.

Managing the Cooperative Network: The Public Administration Model.

ERIC Educational Resources Information Center

Diener, Ronald E.

1981-01-01

Recommends that library administrators turn to public administration models in preference to business administration models for network management; this choice is predicated on the not-for-profit aspects of public service organizations. (RAA)

The public and wildland fire management: social science findings for managers

Treesearch

S.M. McCaffrey

2006-01-01

Presents key social science findings from three National Fire Plan-sponsored research projects. Articles highlight information of likely interest to individuals working to decrease wildfire hazards on both private and public lands. Three general topic areas are addressed: (1) public views and acceptance of fuels management, (2) working with homeowners and communities,...

77 FR 21972 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-12

... further development of information to support Council recommendations on an international management... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... Pacific Fishery Management Council's (Council) Highly Migratory Species Management Team (HMSMT) will hold...

Nursing perception of patient transitions from hospitals to home with home health.

PubMed

Smith, Shannon Bright; Alexander, Judith W

2012-01-01

The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.

77 FR 62217 - Gulf of Mexico Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-12

... Mexico Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice of public meetings. SUMMARY: The Gulf of Mexico Fishery Management Council (Council) will convene a public meeting. DATES: The...

77 FR 70737 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-27

... Atmospheric Administration RIN 0648-XC366 New England Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice; public meeting. SUMMARY: The New England Fishery Management Council's (Council...

HomeADL for adaptive ADL monitoring within smart homes.

PubMed

Hong, Xin; Nugent, Chris D; Finlay, Dewar D; Mulvenna, Maurice

2008-01-01

In this paper we present homeADL: a representation standard for an inference hierarchy of activities of daily living which may be monitored in a sensor equipped smart home. The approach allows a free exchange of ADL monitoring structures between different communities who share the same concern of providing high quality healthcare to the elderly. Its ability of matching different ADL protocols enables a mapping between an ADL protocol to a suitable smart home which makes an effective management of smart homes within a community hence, not only being able to satisfy an individual's healthcare requirements but also efficiently using monitoring resources at hand.

Training of medical staff positively influences postoperative pain management at home in children.

PubMed

Sepponen, K; Kokki, H; Ahonen, R

1999-08-01

The aim of this study was to describe how parents manage their child's postoperative pain at home following day-case surgery. The incidence of pain, different analgesics used and problems related to administering medications were the main interests of the study. A postal questionnaire was sent to the parents of 275 children who were under 8 years of age and had undergone an ear, nose and throat (ENT) day-case operation. The questionnaire was sent to the parents a week after discharge from hospital. Altogether, the parents of 227 children answered the questionnaire (response rate 83%). The study was divided into two phases (preintervention and postintervention), and incorporated a training program for doctors and nurses between these two phases. The training program aimed to improve the treatment practices of postoperative pain in children. Seventy-eight per cent of the children in the preintervention study and 75% in the postintervention study experienced at least mild pain after discharge. The training program for doctors and nurses affected the home treatment practices of postoperative pain. The proportion of parents treating their children increased from 68% to 80% after the training program (p = 0.028). Many parents faced problems while treating their children; for example, 19% (n = 30) of the children refused to take their medicine, and suppositories were regarded to be an especially unpleasant dosage form. However, no serious adverse effects were reported. We conclude that due to the pain experienced at home by the great majority of children following day-case ENT operations, parents need information on how to manage their child's pain. A training program for doctors and nurses can improve the treatment of children's pain even at home. Since some children dislike suppositories, it would be worth considering the use of small tablets or mixtures instead.

78 FR 42755 - Gulf of Mexico Fishery Management Council; Public Hearings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-17

... Mexico Fishery Management Council; Public Hearings AGENCY: National Marine Fisheries Service (NMFS...: The Gulf of Mexico Fishery Management Council (Council) will hold public hearings for Coastal... through Friday August 15, 2013 at ten locations throughout the Gulf of Mexico. The public hearings will...

Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England.

PubMed

Hewitt, K A; Nalabanda, A; Cassell, J A

2015-05-01

Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreaks.

The Technology Acceptance of a TV Platform for the Elderly Living Alone or in Public Nursing Homes

PubMed Central

Santana-Mancilla, Pedro C.; Anido-Rifón, Luis E.

2017-01-01

In Mexico, many seniors are alone for most of the day or live in public nursing homes. Simple interaction with computer systems is required for older people. This is why we propose the exploration of a medium well known by seniors, such as the television (TV). The primary objective of this study is to improve the quality of life of seniors through an easier reminder system, using the television set. A technological platform was designed based on interactive television, through which seniors and their caregivers can have a better way to track their daily activities. Finally, an evaluation of the technology adoption was performed with 50 seniors living in two public nursing homes. The evaluation found that the elderly perceived the system as useful, easy to use, and they had a positive attitude and good intention to use it. This helped to generate initial evidence that the system supported them in achieving a better quality of life, by reminding them to take their medications and increasing their rate of attendance to their medical appointments. PMID:28594386

The Technology Acceptance of a TV Platform for the Elderly Living Alone or in Public Nursing Homes.

PubMed

Santana-Mancilla, Pedro C; Anido-Rifón, Luis E

2017-06-08

In Mexico, many seniors are alone for most of the day or live in public nursing homes. Simple interaction with computer systems is required for older people. This is why we propose the exploration of a medium well known by seniors, such as the television (TV). The primary objective of this study is to improve the quality of life of seniors through an easier reminder system, using the television set. A technological platform was designed based on interactive television, through which seniors and their caregivers can have a better way to track their daily activities. Finally, an evaluation of the technology adoption was performed with 50 seniors living in two public nursing homes. The evaluation found that the elderly perceived the system as useful, easy to use, and they had a positive attitude and good intention to use it. This helped to generate initial evidence that the system supported them in achieving a better quality of life, by reminding them to take their medications and increasing their rate of attendance to their medical appointments.

EVALUATION STUDY OF FARM AND HOME MANAGEMENT PROGRAM IN NEW YORK STATE. A SIX-PART REPORT.

ERIC Educational Resources Information Center

ALEXANDER, FRANK D.

IN 1954 CONGRESS EARMARKED FUNDS FOR A FARM AND HOME MANAGEMENT PROGRAM TO OFFER INTENSIVE ON-THE FARM COUNSELING IN MANAGEMENT AND DECISION MAKING. THIS SIX-PART EVALUATION OF THE PROGRAM AS IT WAS CONDUCTED IN NEW YORK STATE, PRIMARILY WITH DAIRY OPERATORS, WAS DESIGNED TO DETERMINE THE PROGRAM'S EFFECTIVENESS RELATIVE TO LESS INTENSIVE…

78 FR 54240 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-03

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... England Fishery Management Council (Council) is scheduling a public meeting of its Scallop Committee to consider actions affecting New England fisheries in the exclusive economic zone (EEZ). Recommendations from...

77 FR 57076 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-17

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... England Fishery Management Council (Council) is scheduling a public meeting of its Groundfish Advisory Panel to consider actions affecting New England fisheries in the exclusive economic zone (EEZ...

76 FR 22677 - Pacific Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-22

... Groundfish Management Team (GMT). The meeting is open to the public. DATES: The conference call will be held... the Groundfish Management Team to review the developing Ecosystem Fishery Management Plan. The GMT...

Bath water contamination with Legionella and nontuberculous mycobacteria in 24-hour home baths, hot springs, and public bathhouses of Nagano Prefecture, Japan.

PubMed

Kobayashi, Michiko; Oana, Kozue; Kawakami, Yoshiyuki

2014-01-01

Bath water samples were collected from 116 hot springs, 197 public bathhouses, and 38 24-hour home baths in Nagano Prefecture, Japan, during the period of April 2009 to November 2011, for determining the presence and extent of contamination with Legionella and nontuberculous mycobacteria. Cultures positive for Legionella were observed in 123 of the 3,314 bath water samples examined. The distribution and abundance of Legionella and/or combined contamination with Legionella and nontuberculous mycobacteria were investigated to clarify the contamination levels. The abundance of Legionella was demonstrated to correlate considerably with the levels of combined contamination with Legionella and nontuberculous mycobacteria. Legionella spp. were obtained from 61% of the water samples from 24-hour home baths, but only from 3% of the samples from public bathhouses and hot springs. This is despite the fact that a few outbreaks of Legionnaires' disease in Nagano Prefecture as well as other regions of Japan have been traced to bath water contamination. The comparatively higher rate of contamination of the 24-hour home baths is a matter of concern. It is therefore advisable to routinely implement good maintenance of the water basins, particularly of the 24-hour home baths.

ECO-Report - Research-management-public partnership continues

Treesearch

Jane Kapler Smith; Greg Jones; Nan Christianson; Lucia Solorzano; Gloria Weisgerber; Steve Arno; Sallie J. Hejl; F. Jeremy Wheeler; Timothy S. Redman; Joshua J. Tewksbury; Tom DeLuca; K. Zouhar

1998-01-01

ECO-Report is an annual Rocky Mountain Research Station (RMRS) publication which contains a set of articles showcasing the Bitterroot Ecosystem Management Research Project (BEMRP) research projects and activities. The articles are concise, user-friendly, and designed to inform a broad range of audiences interested in ecosystem management. Articles featured in...

41 CFR 302-10.3 - What is the maximum amount my agency may authorize me to receive for transporting a mobile home?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES TRANSPORTATION AND STORAGE OF PROPERTY 10-ALLOWANCES FOR TRANSPORTATION OF MOBILE HOMES AND BOATS USED AS A...

78 FR 33070 - Gulf of Mexico Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-03

... Mexico Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS.... SUMMARY: The Gulf of Mexico Fishery Management Council (Council) will convene a public meeting. DATES: The...; telephone: (850) 433-3336. Council address: Gulf of Mexico Fishery Management Council, 2203 North Lois...

75 FR 29724 - Gulf of Mexico Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-27

... Mexico Fishery Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS.... SUMMARY: The Gulf of Mexico Fishery Management Council (Council) will convene public meetings. DATES: The..., 1600 E. Beach Blvd, Gulfport, MS 39501. Council address: Gulf of Mexico Fishery Management Council...

42 CFR 440.70 - Home health services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Home health services. 440.70 Section 440.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.70 Home health services. (a...

42 CFR 440.70 - Home health services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Home health services. 440.70 Section 440.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.70 Home health services. (a...

42 CFR 440.70 - Home health services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Home health services. 440.70 Section 440.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.70 Home health services. (a...

42 CFR 440.70 - Home health services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Home health services. 440.70 Section 440.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.70 Home health services. (a...

42 CFR 440.70 - Home health services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Home health services. 440.70 Section 440.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.70 Home health services. (a...

Co-designing the next generation of home energy management systems with lead-users.

PubMed

Peacock, Andrew D; Chaney, Joel; Goldbach, Kristin; Walker, Guy; Tuohy, Paul; Santonja, Salvador; Todoli, David; Owens, Edward H

2017-04-01

Home energy management systems are widely promoted as essential components of future low carbon economies. It is argued in this paper that assumptions surrounding their deployment, and the methods used to design them, emerge from discredited models of people and energy. This offers an explanation for why their field trial performance is so inconsistent. A first of a kind field trial is reported. Three eco communities took part in a comprehensive participatory design exercise as lead users. The challenge was to help users synchronise their energy use behaviours with the availability of locally generated renewable energy sources. To meet this aim, a set of highly novel Home Energy Management interfaces were co-designed and tested. Not only were the designs radically different to the norm, but they also yielded sustained user engagement over a six-month follow-up period. It is argued that user-centred design holds the key to unlocking the energy saving potential of new domestic technologies, and this study represents a bold step in that direction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of musculoskeletal pain management practices in rural nursing homes compared with evidence-based criteria.

PubMed

Decker, Sheila A; Culp, Kennith R; Cacchione, Pamela Z

2009-06-01

Chronic pain, mainly associated with musculoskeletal diagnoses, is inadequately and often inappropriately treated in nursing home residents. The purpose of this descriptive study is to identify the musculoskeletal diagnoses associated with pain and to compare pain management of a sample of nursing home residents with the 1998 evidence-based guideline proposed by the American Geriatrics Society (AGS). The sample consists of 215 residents from 13 rural Iowa nursing home homes. The residents answered a series of face-to-face questions that addressed the presence/absence of pain and completed the Mini Mental State Examination (MMSE). Data on pain were abstracted from the Minimum Data Set (MDS). Analyses included descriptive statistics, cross tabulations, and one-way analysis of variance. Residents' responses to the face-to-face pain questions yielded higher rates of pain compared with the MDS pain data. Resident records showed that acetaminophen was the most frequently administered analgesic medication (30.9%). Propoxyphene, not an AGS-recommended opioid, was also prescribed for 23 residents (10.7%). Of the 70 residents (32.6%) expressing daily pain, 23 (32.9%) received no scheduled or pro re nata analgesics. There was no significant difference between MMSE scores and number of scheduled analgesics. Additionally, residents' self-reported use of topical agents was not documented in the charts. The findings suggest that the 1998 AGS evidence-based guideline for the management of chronic pain is inconsistently implemented.

Assessment of orofacial pain management in a pediatric emergency department and at home after discharge.

PubMed

Aguilar de la Red, Yurena; Manrique Martín, Gema; Guerrero Marquez, Gloria; González Herrero, Concepción; Vázquez López, Paula; Míguez Navarro, Concepción

2018-02-01

An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p < 0.01). At home, no analgesia was administered to 39.3%; scheduled analgesia, to 36.1%; and as needed, to 23%. There is little correlation between prescription at discharge and at home (Kappa: 0.178). Analgesia was considered adequate in 84% of cases, and was more frequent in trauma injuries than in infections (85.7% versus 14.3%, p < 0.01). Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections. Sociedad Argentina de Pediatría

Home media server content management

NASA Astrophysics Data System (ADS)

Tokmakoff, Andrew A.; van Vliet, Harry

2001-07-01

With the advent of set-top boxes, the convergence of TV (broadcasting) and PC (Internet) is set to enter the home environment. Currently, a great deal of activity is occurring in developing standards (TV-Anytime Forum) and devices (TiVo) for local storage on Home Media Servers (HMS). These devices lie at the heart of convergence of the triad: communications/networks - content/media - computing/software. Besides massive storage capacity and being a communications 'gateway', the home media server is characterised by the ability to handle metadata and software that provides an easy to use on-screen interface and intelligent search/content handling facilities. In this paper, we describe a research prototype HMS that is being developed within the GigaCE project at the Telematica Instituut . Our prototype demonstrates advanced search and retrieval (video browsing), adaptive user profiling and an innovative 3D component of the Electronic Program Guide (EPG) which represents online presence. We discuss the use of MPEG-7 for representing metadata, the use of MPEG-21 working draft standards for content identification, description and rights expression, and the use of HMS peer-to-peer content distribution approaches. Finally, we outline explorative user behaviour experiments that aim to investigate the effectiveness of the prototype HMS during development.

75 FR 78976 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-17

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... England Fishery Management Council (Council) is scheduling a public meeting of its Habitat/MPA/Ecosystem Committee, in January, 2011, to consider actions affecting New England fisheries in the exclusive economic...

76 FR 38620 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... England Fishery Management Council (Council) is scheduling a public meeting of its Habitat/MPA/Ecosystem... economic zone (EEZ). Recommendations from this group will be brought to the full Council for formal...

76 FR 31304 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National... England Fishery Management Council (Council) is scheduling a joint public meeting of its Skate Committee and Advisory Panel, in June, 2011, to consider actions affecting New England fisheries in the...

77 FR 26515 - Mid-Atlantic Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

... Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice of a public meeting. SUMMARY: The Scientific and Statistical Committee (SSC) of the Mid- Atlantic Fishery Management Council (Council) will hold a meeting...

Untangling home care's Gordion knot. The Home Care Information Management and Technology Forum.

PubMed

Wilhelm, Lawrence

2003-03-01

As home care and hospice technological tools have evolved over the past six years, there have been no efforts to standardize the collection, storage, and reporting of data among different systems. The rapid pace of technological change, increased use of wireless and remote technology, a greater reliance on tools for collaboration and networking, and the ever-increasing regulatory burden on home care and hospice providers have resulted in the need for polices and procedures for the standardization of data across the industry. Agency administrators, already strapped for cash and time, need to know what technology investments they need to make now in order to remain competitive in the future. The National Association for Home Care & Hospice has created a forum to address these concerns and to develop a blueprint for the future development of home care and hospice technology.

Managerial competencies of hospital managers in South Africa: a survey of managers in the public and private sectors.

PubMed

Pillay, Rubin

2008-02-08

South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while the privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a potential gap in management capacity between the two sectors. This study aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine whether there are any significant differences in competency levels between managers in the different sectors. A survey using a self administered questionnaire was conducted among hospital managers in South Africa. Respondents were asked to rate their proficiency with seven key functions that they perform. These included delivery of health care, planning, organizing, leading, controlling, legal and ethical, and self-management. Ratings were based on a five point Likert scale ranging from very low skill level to very high skill level. The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training. The findings confirm our supposition that there is a lack of management capacity within the public sector in South Africa and that there is a significant gap between private and public sectors. It provides evidence that there is a great need for further development of managers, especially those in the public sector. The onus is therefore on administrators and those responsible for management education and training to identify managers in need of development and to make available training that is contextually relevant in terms of design and delivery.

Managerial competencies of hospital managers in South Africa: a survey of managers in the public and private sectors

PubMed Central

Pillay, Rubin

2008-01-01

Background South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while the privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a potential gap in management capacity between the two sectors. This study aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine whether there are any significant differences in competency levels between managers in the different sectors. Methods A survey using a self administered questionnaire was conducted among hospital managers in South Africa. Respondents were asked to rate their proficiency with seven key functions that they perform. These included delivery of health care, planning, organizing, leading, controlling, legal and ethical, and self-management. Ratings were based on a five point Likert scale ranging from very low skill level to very high skill level. Results The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training. Conclusion The findings confirm our supposition that there is a lack of management capacity within the public sector in South Africa and that there is a significant gap between private and public sectors. It provides evidence that there is a great need for further development of managers, especially those in the public sector. The onus is therefore on administrators and those responsible for management education and training to identify managers in need of development and to make available training that is contextually relevant in terms of design and delivery. PMID:18257936

Clinical Effectiveness of Integrating Depression Care Management into Medicare Home Health: The Depression CAREPATH Cluster-Randomized Trial

PubMed Central

Bruce, Martha L.; Raue, Patrick J.; Reilly, Catherine F.; Greenberg, Rebecca L.; Meyers, Barnett S.; Banerjee, Samprit; Pickett, Yolonda R.; Sheeran, Thomas F.; Ghesquiere, Angela; Zukowski, Diane; Rosas, Vianca H.; McLaughlin, Jeanne; Pledger, Lori; Doyle, Joan; Joachim, Pamela; Leon, Andrew C.

2015-01-01

Importance Depression is highly prevalent, inadequately treated, and contributes to hospitalization and other poor outcomes in older home healthcare patients. Feasible and effective interventions are needed to reduce this burden of depression. Objective To determine whether among older Medicare home health recipients who screen positive for depression, patients of nurses randomized to intervention have greater improvement in depressive symptoms over one year compared to patients receiving enhanced usual care. Design The cluster-randomized effectiveness trial randomized nurse-teams to Intervention (12 teams) or enhanced usual care (9 teams). Patients were recruited 2009–2012, assessed, and followed at 3, 6, and 12-months by research staff blind to intervention status. Setting Conducted at six home healthcare agencies nationwide. Patients interviewed at home and by telephone. Participants Medicare home health patients age ≥65 who screened positive for depression on routine nurse assessments. Of 502 eligible patients, 306 enrolled. Intervention Depression CAREPATH (CARE for PATients at Home) requires nurses to manage depression during routine home visits by weekly symptom assessment, medication management, care coordination, education, goal setting. Training totaled 7 hours (4 on-site, 3 web). Researchers telephoned supervisors every other week. Main Outcome and Measure Depression severity, assessed by 24-item Hamilton Depression Rating Scale (HDRS). Results 306 participants were predominately female (69.6%), diverse (18.0% Black, 16.0% Hispanic), average age 76.5 (SD=8.0) years. In full sample, the intervention had no effect (treatment × time interaction: P=0.13). Adjusted HDRS scores (CAREPATH vs control) did not differ at three (10.5 vs 11.4; P=0.26) or six months (9.3 vs 10.5; P=0.12), barely reaching significance at twelve months (8.7 vs 10.6; P=0.05). In subsample with mild depression (HDRS<10), the intervention had no effect (P=.90) and HDRS did not differ

Putting Home Data Management into Perspective

DTIC Science & Technology

2009-12-01

approaches. However, users of home and personal storage live it. Popular interfaces (e.g., iTunes , iPhoto, and even drop-down lists of recently...users of home and personal storage live it. Popular interfaces (e.g., iTunes , iPhoto, and even drop-down lists of recently-opened Word documents...live it. Popular interfaces (e.g., iTunes , iPhoto, and even drop- down lists of recently-opened Word documents) allow users to navigate file

Risky Business: Private Management of Public Schools.

ERIC Educational Resources Information Center

Richards, Craig E.; And Others

Contracting in public education is not a new development. This book examines projects that transfer the management of entire schools or school systems to private firms. Chapter 1, by Rima Shore, is a comprehensive survey of the practice of contracting out in public education. It provides a broad historical background for the U.S. education system…

Home e-health system integration in the Smart Home through a common media server.

PubMed

Pau, I; Seoane, F; Lindecrantz, K; Valero, M A; Carracedo, J

2009-01-01

Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.

Estimating the impact of the home appliances trade-in policy on WEEE management in China.

PubMed

Zhu, Shuguang; He, Wenzhi; Li, Guangming; Zhuang, Xuning; Huang, Juwen; Liang, Honggen; Han, Yuebin

2012-11-01

The ever-increasing amount of waste electric and electronic equipment (WEEE) has become a global problem. In view of the deleterious effects of WEEE on the environment and the valuable materials that can be reused in them, many countries have focused their attention on the management of WEEE and the recovery technologies of WEEE. The Chinese government has been active in creating a legislative and institutional framework to realize WEEE recycling. In June 2009, Chinese government launched home appliances and electronics trade-in implementation solution. This paper elaborates the home appliances trade-in policy and its significant impact on the WEEE management. The trade-in policy is not only conducive to expanding the consumption demand and promoting the balance of domestic and overseas demand, but also favorable to improving the energy efficiency and reducing environmental pollution. Under this policy, China has successfully established an effective WEEE recycling system, using the financial means and network design. Experiences gained from the trade-in policy have shown that management systems of WEEE need to be designed and implemented in a multi-stakeholder dialogue.

42 CFR 424.22 - Requirements for home health services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Requirements for home health services. 424.22 Section 424.22 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Requirements § 424.22 Requirements for home health services. Medicare Part A or Part B pays for home health...

42 CFR 424.22 - Requirements for home health services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements for home health services. 424.22 Section 424.22 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... § 424.22 Requirements for home health services. Medicare Part A or Part B pays for home health services...

42 CFR 424.22 - Requirements for home health services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Requirements for home health services. 424.22 Section 424.22 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Requirements § 424.22 Requirements for home health services. Medicare Part A or Part B pays for home health...