Science.gov

Sample records for access community hospitals

  1. Evaluating Michigan's community hospital access: spatial methods for decision support

    PubMed Central

    Messina, Joseph P; Shortridge, Ashton M; Groop, Richard E; Varnakovida, Pariwate; Finn, Mark J

    2006-01-01

    Background Community hospital placement is dictated by a diverse set of geographical factors and historical contingency. In the summer of 2004, a multi-organizational committee headed by the State of Michigan's Department of Community Health approached the authors of this paper with questions about how spatial analyses might be employed to develop a revised community hospital approval procedure. Three objectives were set. First, the committee needed visualizations of both the spatial pattern of Michigan's population and its 139 community hospitals. Second, the committee required a clear, defensible assessment methodology to quantify access to existing hospitals statewide, taking into account factors such as distance to nearest hospital and road network density to estimate travel time. Third, the committee wanted to contrast the spatial distribution of existing community hospitals with a theoretical configuration that best met statewide demand. This paper presents our efforts to first describe the distribution of Michigan's current community hospital pattern and its people, and second, develop two models, access-based and demand-based, to identify areas with inadequate access to existing hospitals. Results Using the product from the access-based model and contiguity and population criteria, two areas were identified as being "under-served." The lower area, located north/northeast of Detroit, contained the greater total land area and population of the two areas. The upper area was centered north of Grand Rapids. A demand-based model was applied to evaluate the existing facility arrangement by allocating daily bed demand in each ZIP code to the closest facility. We found 1,887 beds per day were demanded by ZIP centroids more than 16.1 kilometers from the nearest existing hospital. This represented 12.7% of the average statewide daily bed demand. If a 32.3 kilometer radius was employed, unmet demand dropped to 160 beds per day (1.1%). Conclusion Both modeling

  2. Economic Impact of the Critical Access Hospital Program on Kentucky's Communities

    ERIC Educational Resources Information Center

    Ona, Lucia; Davis, Alison

    2011-01-01

    Context: In 1997, the Medicare Rural Hospital Flexibility Grant Program created the Critical Access Hospital (CAH) Program as a response to the financial distress of rural hospitals. It was believed that this program would reduce the rate of rural hospital closures and improve access to health care services in rural communities. Objective: The…

  3. Survey: Hospitalization Access for Patients of Migrant Health Centers and Combined Migrant and Community Health Centers.

    ERIC Educational Resources Information Center

    Smith, David R.; And Others

    1987-01-01

    A study of migrant health centers' access to hospitals uncovered financial barriers to private hospital care when the patient was indigent or without health insurance. This may be exacerbated as private hospitals expand in states with many migrants. Cooperative efforts between public and private institutions are in order. (VM)

  4. Critical Access Hospitals (CAH)

    MedlinePlus

    ... CAH Conditions of Participation . What are the location requirements for CAH status? Critical Access Hospitals must be ... clinic that does not meet the CAH distance requirements? As of January 1, 2008, all CAHs, including ...

  5. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... all necessary information from the intermediary, whether an increase in the hospital-specific rate is..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT...

  6. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... all necessary information from the intermediary, whether an increase in the hospital-specific rate is..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT...

  7. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... all necessary information from the intermediary, whether an increase in the hospital-specific rate is..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT...

  8. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... all necessary information from the intermediary, whether an increase in the hospital-specific rate is..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT...

  9. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... all necessary information from the intermediary, whether an increase in the hospital-specific rate is..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT...

  10. Management of chronic heart failure in the community: role of a hospital based open access heart failure service

    PubMed Central

    Shah, S; Davies, M K; Cartwright, D; Nightingale, P

    2004-01-01

    Objective: To evaluate the role of an open access heart failure service based at a teaching hospital for the diagnosis and treatment optimisation of patients with heart failure in the community and to identify measures that may further enhance the effectiveness of such a service. Subjects: 963 patients with suspected heart failure seen over an eight year period referred by their general practitioners to the cardiology department at a district general hospital. Main outcome measures: Presence or absence of left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction < 50% on echocardiography), and determination of the risk factors and predictors of LVSD. Results: The majority of the patients were women (60% v 40%) and elderly (mean age 68.8 years). On echocardiography, only 30.8% were found to have LVSD. Patients were more likely to have LVSD if they were men (42.3% v 23.1%, p < 0.001, relative risk (RR) 1.8), were > 60 years of age (33.5% v 20.8%, p < 0.001, RR 1.6), or had a history of diabetes (49.4% v 29.1%, p < 0.001, RR 1.7), ischaemic heart disease (36.5% v 29.1%, p  =  0.04, RR 1.3), or atrial fibrillation (52.6% v 27.8%, p < 0.001, RR 1.9). An abnormal ECG (48.4% v 19.5%, p < 0.001, RR 2.5) and cardiothoracic ratio > 0.5 on chest radiograph (44.3% v 17.8%, p < 0.001, RR 2.5) were found to be good predictors of LVSD. A normal ECG (negative predictive value 80.5%) and a cardiothoracic ratio of < 0.5 (negative predictive value 82.2%) can be used as baseline measures to identify patients with lower risk of developing LVSD (combined negative predictive value 87.9%). Conclusions: An open access heart failure clinic is effective for the diagnosis and management of chronic heart failure in community based patients. The presence of risk factors and simple baseline tests can be used to identify patients with LVSD in the community. The introduction of a protocol based on these findings into a referral system can improve the efficiency and cost

  11. Impact of Critical Access Hospital Conversion on Beneficiary Liability

    ERIC Educational Resources Information Center

    Gilman, Boyd H.

    2008-01-01

    Context: While the Medicare Critical Access Hospital (CAH) program has improved the financial viability of small rural hospitals and enhanced access to care in rural communities, the program puts beneficiaries at risk for paying a larger share of the cost of services covered under the Medicare part B benefit. Purpose: This paper examines the…

  12. Financial Indicators for Critical Access Hospitals

    ERIC Educational Resources Information Center

    Pink, George H.; Holmes, G. Mark; D'Alpe, Cameron; Strunk, Lindsay A.; McGee, Patrick; Slifkin, Rebecca T.

    2006-01-01

    Context: There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). CAHs differ from other hospitals on a number of dimensions that might affect appropriate indicators of performance, including…

  13. Positioning hospitals for improved access to capital.

    PubMed

    Ponton, Kevin T; Sandrick, Karen M

    2002-11-01

    Hospitals need to actively position themselves in the next 18 to 24 months to ensure continued access to financing. Hospitals need to shift their focus from investment income to operations. Hospitals should recognize the importance of balance-sheet liquidity to institutional investors. Not-for-profit hospitals should focus on both sides of the balance sheet. Healthcare executives need to develop effective leadership and investor-relations skills. PMID:12656030

  14. Communities and Hospitals: Social Capital, Community Accountability, and Service Provision in U.S. Community Hospitals

    PubMed Central

    Lee, Shoou-Yih D; Chen, Wendy L; Weiner, Bryan J

    2004-01-01

    Objectives The study related community social capital to the level of community accountability and provision of community-oriented services in U.S. community hospitals. Study Setting The sample included 1,383 community hospitals that participated in the 1997 American Hospital Association's (AHA) Hospital Annual and Governance Surveys. Data Sources (1) The 1997 AHA Annual Hospital Survey, (2) the 1997 AHA Hospital Governance Survey, (3) the DDB Needham Market Facts Survey, (4) the 1996 County Election Data File, and (5) the 1998 Area Resource File. Research Design The study used a mix of longitudinal and cross-sectional data. Key Findings We identified two distinct indicators of social capital—community participation and voting participation. Community accountability in hospitals was unrelated to either indicator. Hospitals' provision of community-oriented health services was negatively associated with community participation but unrelated with voting participation. The interaction between voting participation and community representation on hospital governance was positively associated with community accountability and provision of community-oriented health services. Conclusion Neither community participation nor voting participation was sufficient to influence hospital behavior. The positive finding associated with the interaction between voting participation and community representation on hospital governance underscored the importance of an active political culture in influencing hospital behavior, without which the installation of community representatives on hospital governance might be more symbolic than actually serving the health concerns of community residents. PMID:15333119

  15. Developing Financial Benchmarks for Critical Access Hospitals

    PubMed Central

    Pink, George H.; Holmes, George M.; Slifkin, Rebecca T.; Thompson, Roger E.

    2009-01-01

    This study developed and applied benchmarks for five indicators included in the CAH Financial Indicators Report, an annual, hospital-specific report distributed to all critical access hospitals (CAHs). An online survey of Chief Executive Officers and Chief Financial Officers was used to establish benchmarks. Indicator values for 2004, 2005, and 2006 were calculated for 421 CAHs and hospital performance was compared to the benchmarks. Although many hospitals performed better than benchmark on one indicator in 1 year, very few performed better than benchmark on all five indicators in all 3 years. The probability of performing better than benchmark differed among peer groups. PMID:19544935

  16. Town + Gown + CATV = Community Access.

    ERIC Educational Resources Information Center

    Clemens, Donald J.

    1980-01-01

    Describes a cooperative venture between Paducah Community College, Comcast Cable, and Paducah, Kentucky, and the roles each of these organizations played in establishing a public access channel which would provide informational and general interest programs, as well as college courses. Offers information on programing, financial support, and…

  17. Intensive Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Freeman, Victoria A.; Walsh, Joan; Rudolf, Matthew; Slifkin, Rebecca T.; Skinner, Asheley Cockrell

    2007-01-01

    Context: Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services. Purpose: To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of…

  18. Community hospitals and the Internet: lessons from pilot connections.

    PubMed Central

    Rauch, S; Holt, M C; Horner, M; Rambo, N

    1994-01-01

    Community hospitals in rural and isolated areas have had little access to the Internet. In 1992, the National Library of Medicine funded a pilot project to be conducted by the University of Washington and seven community hospitals in the northwestern United States. The goals of the project were to connect the hospitals to the Internet and study the uses made of this resource. A number of administrative, technical, financial, and organizational problems were dealt with in the attempt to establish the Internet connections and introduce this resource to these health care settings. This paper examines these issues and presents conclusions drawn from the experiences of the project team. PMID:7841910

  19. 42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Relationships with hospitals, critical access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks....

  20. Remote Antimicrobial Stewardship in Community Hospitals

    PubMed Central

    Wood, Zachary H.; Nicolsen, Nicole C.; Allen, Nichole; Cook, Paul P.

    2015-01-01

    Antimicrobial stewardship has become standard practice at university medical centers, but the practice is more difficult to implement in remote community hospitals that lack infectious diseases trained practitioners. Starting in 2011, six community hospitals within the Vidant Health system began an antimicrobial stewardship program utilizing pharmacists who reviewed charts remotely from Vidant Medical Center. Pharmacists made recommendations within the electronic medical record (EMR) to streamline, discontinue, or switch antimicrobial agents. Totals of charts reviewed, recommendations made, recommendations accepted, and categories of intervention were recorded. Linear regression was utilized to measure changes in antimicrobial use over time. For the four larger hospitals, recommendations for changes were made in an average of 45 charts per month per hospital and physician acceptance of the pharmacists’ recommendations varied between 83% and 88%. There was no significant decrease in total antimicrobial use, but much of the use was outside of the stewardship program’s review. Quinolone use decreased by more than 50% in two of the four larger hospitals. Remote antimicrobial stewardship utilizing an EMR is feasible in community hospitals and is generally received favorably by physicians. As more community hospitals adopt EMRs, there is an opportunity to expand antimicrobial stewardship beyond the academic medical center. PMID:27025642

  1. Measuring community hospital service in Michigan.

    PubMed Central

    Griffith, J R; Restuccia, J D; Tedeschi, P J; Wilson, P A; Zuckerman, H S

    1981-01-01

    Using discharge abstracts from Michigan hospitals, we divided the state into hospital use communities with measured populations. We constructed population-based rates measuring use, cost, and some aspects of quality. The results cover 54 communities comprising 90 percent of the Michigan population and ranging in size from Detroit (population 600,000) to very small (population less than 25,000) communities. Age-adjusted patient days per 1,000 population, length of stay, cost per person per year, hospitalization rates for surgery, trauma and vascular disease, and childbirth problems show large variations, generally ranging from 2 to 1. High values usually are positively associated with each other and with population size. Patient days per 1,000 (mean 1,114, range 600-1,700) and cost per person(mean +223, range +110-+290) are distributed such that almost 75 percent of communities are below the mean. We believe this information will be useful to community hospital trustees, physicians, and administrators. PMID:7263271

  2. Dedicated outpatient vascular access center decreases hospitalization and missed outpatient dialysis treatments.

    PubMed

    Mishler, R; Sands, J J; Ofsthun, N J; Teng, M; Schon, D; Lazarus, J M

    2006-01-01

    Dedicated outpatient vascular access centers (VAC) specializing in percutaneous interventions (angiography, thrombectomy, angioplasty and catheter placement) provide outpatient therapy that can obviate the need for hospitalization. This paper reports the impact of one VAC staffed by interventional nephrologists on vascular access-related hospitalization and missed outpatient dialysis treatments. We performed a retrospective analysis of vascular access-related hospitalized days and missed vascular access-related outpatient dialysis treatments from 1995 to 2002 in 21 Phoenix Arizona Facilities (5928 cumulative patients) and 1275 cumulative Fresenius Medical Care North America (FMCNA) facilities (289,454 cumulative patients) to evaluate the impact of the introduction of a VAC in Phoenix. Vascular access-related hospitalized days/patient year and missed dialysis treatments/patient year declined from 1997 to 2002 across all access types. The decline was greater in Phoenix and coincided with the creation of a VAC in 1998. By 2002, there were 0.57 fewer hospitalized days/patient year and 0.29 fewer missed treatments/patient year than in the national sample (P<0.01). In 2002, the relative risk for vascular access hospitalized days was 0.38 (95% confidence interval (CI) 0.27-0.5) (P<0.01) and for vascular access-related missed outpatient dialysis treatments was 0.34 (95% CI 0.24-0.49) (P<0.01) in Phoenix vs FMCNA after adjustment for age, gender, diabetic status duration of dialysis and access type. VAC development was associated with a significant decrease in vascular access-related hospitalization and missed outpatient dialysis treatments. Further studies are necessary to demonstrate this effect in other communities. PMID:16408132

  3. Quality Improvement Strategies and Best Practices in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira

    2004-01-01

    Critical access hospitals (CAHs) face many challenges in implementing quality improvement (QI) initiatives, which include limited resources, low volume of patients, small staffs, and inadequate information technology. A primary goal of the Medicare Rural Hospital Flexibility Program is to improve the quality of care provided by CAHs. This article…

  4. Revitalized commitment to community. A community benefit plan helps a hospital be a good neighbor.

    PubMed

    Brown, S

    1994-01-01

    Three years ago St. John Hospital and Medical Center, Detroit, made a commitment to strengthen its community relationships and reaffirm its mission of serving those in need by following the Catholic Health Association's Social Accountability Budget. While implementing the program, administrators were surprised to learn the hospital was already participating in many community programs for which it received little or no reimbursement. They also discovered that the hospital had no formal, written charity care policy even though St. John provided more than $14 million in uncompensated care annually. To learn what the needs of the surrounding community were, the hospital went to the clergy, who overwhelmingly identified the needs of the elderly as the number-one priority. A close second was supporting the basic family unit. Other concerns included basic family needs, safe neighborhoods and schools, and teen pregnancy. Although the hospital realized it could not do all that was needed, it felt obliged to be a leader in seeing that the needs were met and drew up a community benefit plan that documented the problems and the solutions. The hospital did what it could and worked with other organizations to address needs such as housing for the elderly, affordable and accessible healthcare, neighborhood improvement and safety, and family services. PMID:10131088

  5. Comparative Performance Data for Critical Access Hospitals

    ERIC Educational Resources Information Center

    Pink, George H.; Slifkin, Rebecca T.; Coburn, Andrew F.; Gale, John A.

    2004-01-01

    Context: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations.…

  6. Analysis of the Community Benefit Standard in Texas Hospitals.

    PubMed

    Worthy, James Corbett; Anderson, Cheryl L

    2016-01-01

    The federal government provides special tax-exemption status, known as the community benefit standard, to some nonprofit hospitals. It is not known if hospitals that claim the community benefit standard provide more or different services from those provided by hospitals that do not claim the community benefit status. Guided by the socioecological model, this quantitative study investigated 95 hospitals serving 52 counties in South Texas--43 that claimed a community benefit and 52 that did not. The independent variables were hospitals that claimed the community benefit standard versus hospitals that did not. The dependent variables were the three essential criteria and the 13 reported services used to meet the community benefit standard. The study results show that all hospitals that claimed the community benefit standard met two of the three required criteria. However, only 22 of 43 hospitals had a full-time emergency department (ED), the third criterion. Χ² analysis showed statistically significant differences for only two of the five common services: having an ED and community education for community benefit hospitals versus noncommunity benefit hospitals. On average, hospitals that claimed the community benefit spent 100 times more money on community services than hospitals that did not claim the community benefit. Further investigation is needed to determine the reasons for the gap in services pertaining to EDs, trauma care, neonatal intensive care, free-standing clinics, collaborative efforts, other medical services, education of patients, community health education, and other education services. PMID:27111928

  7. Access to capital: implications for hospital consolidation.

    PubMed

    Grauman, Daniel M; Harris, John M; Martin, Christine

    2010-04-01

    Recent economic challenges have left many independent hospitals and their boards concerned about long-term viability of their organizations as stand-alone facilities. The CFO's role should be to facilitate a candid, objective assessment of the organization's ability to continue to go it alone. Key indicators that should be considered in such an assessment include patient volume, degree of physician alignment, profitability, current debt burden, cash, available capital versus capital requirements, and credit rating changes. PMID:20358877

  8. Geographic Access to Burn Center Hospitals

    PubMed Central

    Klein, Matthew B.; Kramer, C. Bradley; Nelson, Jason; Rivara, Frederick P.; Gibran, Nicole S.; Concannon, Thomas

    2011-01-01

    Context The delivery of burn care is a resource-intensive endeavor that requires specialized personnel and equipment. The optimal geographic distribution of burn centers has long been debated; however, the current distribution of centers relative to geographic area and population is unknown. Objective To estimate the proportion of the US population living within 1 and 2 hours by rotary air transport (helicopter) or ground transport of a burn care facility. Design and Setting A cross-sectional analysis of geographic access to US burn centers utilizing the 2000 US census, road and speed limit data, the Atlas and Database of Air Medical Services database, and the 2008 American Burn Association Directory. Main Outcome Measure The proportion of state, regional, and national population living within 1 and 2 hours by air transport or ground transport of a burn care facility. Results In 2008, there were 128 self-reported burn centers in the United States including 51 American Burn Association–verified centers. An estimated 25.1% and 46.3% of the US population live within 1 and 2 hours by ground transport, respectively, of a verified burn center. By air, 53.9% and 79.0% of the population live within 1 and 2 hours, respectively, of a verified center. There was significant regional variation in access to verified burn centers by both ground and rotary air transport. The greatest proportion of the population with access was highest in the northeast region and lowest in the southern United States. Conclusion Nearly 80% of the US population lives within 2 hours by ground or rotary air transport of a verified burn center; however, there is both state and regional variation in geographic access to these centers. PMID:19861669

  9. Women in Community Colleges: Access to Success

    ERIC Educational Resources Information Center

    St. Rose, Andresse; Hill, Catherine

    2013-01-01

    Community colleges open the door to opportunity for millions of Americans who want to pursue higher education and secure their economic futures. As an organization founded on the basic principle of making college accessible to women, the American Association of University Women (AAUW) has been a leading voice for women in education and the…

  10. Access to Service: Rural and Remote Communities.

    ERIC Educational Resources Information Center

    Knight, Robert

    This paper discusses public library services to remote communities in Australia, focusing on New South Wales (NSW). The first section presents background on the public library network in NSW, including statistics, descriptors/characteristics of public libraries, and funding to establish public Internet access. The second section addresses regional…

  11. Improving Access Using Simulations of Community Resources.

    ERIC Educational Resources Information Center

    Germann, Clark; Broida, Jane Kaufman; Broida, Jeffrey M.; Thompson, Kimberly

    The Community Access Through Technology Project (CATT) is developing and implementing virtual reality software that persons with disabilities can use to experience a physical location prior to visiting it in person. A virtual scenario of one physical location has been developed, implemented, and tested, and work is underway on two others. Using a…

  12. Modeling population access to New Zealand public hospitals

    PubMed Central

    Brabyn, Lars; Skelly, Chris

    2002-01-01

    This paper demonstrates a method for estimating the geographical accessibility of public hospitals. Cost path analysis was used to determine the minimum travel time and distance to the closest hospital via a road network. This analysis was applied to 38,000 census enumeration district centroids in New Zealand allowing geographical access to be linked to local populations. Average time and distance statistics have been calculated for local populations by modeling the total travel of a population if everybody visited a hospital once. These types of statistics can be generated for different population groups and enable comparisons to be made between regions. This study has shown that the northern and southern parts of New Zealand have high average travel times to hospital services. PMID:12459048

  13. 75 FR 29479 - Medicare and Medicaid Programs: Proposed Changes Affecting Hospital and Critical Access Hospital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-26

    ...) Conditions of Participation (CoPs): Credentialing and Privileging of Telemedicine Physicians and... proposed rule would revise the conditions of participation (CoPs) for both hospitals and critical access...). ] I. Background The current Medicare Hospital conditions of participation (CoPs) for credentialing...

  14. Factors Associated with Iowa Rural Hospitals' Decision to Convert to Critical Access Hospital Status

    ERIC Educational Resources Information Center

    Li, Pengxiang; Ward, Marcia M.; Schneider, John E.

    2009-01-01

    Context: The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost-based. Some subsequent CAH-related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. Purpose:…

  15. 76 FR 65891 - Medicare and Medicaid Programs; Reform of Hospital and Critical Access Hospital Conditions of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-24

    ...This proposed rule would revise the requirements that hospitals and critical access hospitals (CAHs) must meet to participate in the Medicare and Medicaid programs. These proposed changes are an integral part of our efforts to reduce procedural burdens on providers. This proposed rule reflects the Centers for Medicare and Medicaid Services' (CMS') commitment to the general principles of the......

  16. Radiation decontamination unit for the community hospital.

    PubMed

    Waldron, R L; Danielson, R A; Shultz, H E; Eckert, D E; Hendricks, K O

    1981-05-01

    "Freestanding" radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstruction. Because of the development of nuclear power plants in relatively remote areas and widespread transportation of radioactive materials it is important for hospitals and physicians to be prepared to handle radiation accident victims. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Ridge Associated Universities are ready to support individual hospitals and physicians in this endeavor. Adequate planning rather than luck, should be used in dealing with potential radiation accident victims. The radiation emergency team is headed by a physician on duty in the hospital. It is important that the team leader be knowledgeable in radiation accident management and have personnel trained in radiation accident management as members of this team. The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important. Periodic drills are necessary for this mobilization and the smooth operation of the unit. PMID:6784538

  17. Rural-Urban Differences in Preventable Hospitalizations among Community-Dwelling Veterans with Dementia

    ERIC Educational Resources Information Center

    Thorpe, Joshua M.; Van Houtven, Courtney H.; Sleath, Betsy L.; Thorpe, Carolyn T.

    2010-01-01

    Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. Purpose: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. Methods: Medicare…

  18. Improved Maternal and Child Health Care Access in a Rural Community.

    ERIC Educational Resources Information Center

    Carcillo, Joseph A.; And Others

    1995-01-01

    Describes an underserved rural community in which health care initiatives increased access to comprehensive care. Over a 3-year period, increased accessibility to maternal and child health care also increased use of preventive services, thus decreasing emergency room visits and hospitalizations as well as low birth weight, risk of congenital…

  19. Community orientation in hospitals: an institutional and resource dependence perspective.

    PubMed Central

    Proenca, E J; Rosko, M D; Zinn, J S

    2000-01-01

    OBJECTIVE: To conceptualize community orientation-defined as the generation, dissemination, and use of community health-need intelligence-as a strategic response to environmental pressures, and to test a theoretically justified model of the predictors of community orientation in hospitals. DATA SOURCES: The analysis used data for 4,578 hospitals obtained from the 1994 and 1995 American Hospital Association (AHA) Annual Survey and the 1994 Medicare Hospital Cost Report data sets. Market-level data came from the Area Resource File. STUDY DESIGN: Multiple regression analysis was used to examine the effects of hospital size, dependence on managed care, ownership, network, system and alliance memberships, and level of diffusion of community-orientation practices in the area on the degree of community orientation in hospitals. The model, based on Oliver's (1991) framework of organizational responsiveness to environmental pressures, controlled for the effects of industry concentration and lagged profitability. PRINCIPAL FINDINGS: Degree of community orientation is significantly related to hospital size; ownership; dependence on managed care; and membership in a network, system, or alliance. It is also significantly related to the diffusion of community-orientation practices among other area hospitals. CONCLUSIONS: Degree of community orientation is influenced by the nature of environmental pressures and by hospital interests. It is higher in hospitals that are large, nonprofit, or members of a network, system, or alliance; in hospitals that are more dependent on managed care; and in hospitals that operate in areas with higher diffusion of community-orientation activities. PMID:11130801

  20. Treatment of hyperthyroidism in community hospital

    SciTech Connect

    Gossain, V.V.; Heath, R.C.; Rovner, D.R.

    1989-01-01

    The preferred treatment of hyperthyroidism remains controversial. Most of this data is derived from large, university-based medical centers. We report here our experience with treatment of hyperthyroidism in a community setting. This involves 144 patients with hyperthyroidism who were seen over a 10 year period at Michigan State University Clinical Center and were treated in the community hospitals and private physicians' offices, and by community surgeons. Follow-up data were available on 119 of these patients; 105 of them were hyperthyroid because of Graves' disease and multinodular goiter. Patients were encouraged to make their own decisions regarding choice of therapy, as independently as possible. Sixty-five percent of these patients were treated by 131I, 18% by antithyroid drugs, and 17% by surgery. The mean follow-up period was 2.5 years (range 2 months to 19 years). Hyperthyroidism was controlled in 84% of the patients treated by 131I and 83% of the patients treated by surgery. Forty percent of the patients treated by 131I and 33% treated by surgery became hypothyroid. Fifty percent of the patients achieved remission when treated by antithyroid drugs alone. Our results indicate that when patients are encouraged to make their own decisions regarding the treatment of hyperthyroidism, their choices are similar to those of the thyroidologists. Secondly, the results obtained with different modalities of treatment for hyperthyroidism in a community setting are similar to those obtained in university medical centers.

  1. The substitutability of outpatient primary care in rural community health centers for inpatient hospital care.

    PubMed Central

    Deprez, R D; Pennell, B E; Libby, M A

    1987-01-01

    To determine whether outpatient medical care obtained at federally funded rural community health centers (CHCs) in Maine acts primarily as a substitute or as a complement to inpatient care, a study of 36 communities served by CHCs was conducted. The hospital use of CHC users (age- and sex-adjusted admissions, days, and length of stay) was compared with that of nonusers from the same communities in 1980. Statistically lower rates of hospital admissions and days were observed for all CHC patients and for selected groups based on their age, sex, and insurance status (specifically Medicaid or Medicare). Hospital use of CHC community populations was then compared with that of 24 comparison communities without access to CHCs, using multiple linear regression in a pre/post design. The model tested, which included rates of health center use, insurance penetration, poverty, and hospital availability, among other factors, did not detect any differences in hospital use between CHC community and comparison populations. These results and additional data presented on selected hospital diagnoses and insurance coverage suggest that treatment, and hospitalization incentives, of CHC providers may reduce hospitalization. Clinic providers lack the economic, professional, and institutional incentives to hospitalize. Additional study to determine the actual substitutability effect is indicated. PMID:3301745

  2. Health and Taxes: Hospitals, Community Health and the IRS.

    PubMed

    Crossley, Mary

    2016-01-01

    The Affordable Care Act created new conditions of federal tax exemption for nonprofit hospitals, including a requirement that hospitals conduct a community health needs assessment (CHNA) every three years to identify significant health needs in their communities and then develop and implement a strategy responding to those needs. As a result, hospitals must now do more than provide charity care to their patients in exchange for the benefits of tax exemption. The CHNA requirement has the potential both to prompt a radical change in hospitals' relationship to their communities and to enlist hospitals as meaningful contributors to community health improvement initiatives. Final regulations issued in December 2014 clarify hospitals' obligations under the CHNA requirement, but could do more to facilitate hospitals' engagement in collaborative community health projects. The Internal Revenue Service (IRS) has a rich opportunity, while hospitals are still learning to conduct CHNAs, to develop guidance establishing clear but flexible expectations for how providers should assess and address community needs. This Article urges the IRS to seize that opportunity by refining its regulatory framework for the CHNA requirement. Specifically, the IRS should more robustly promote transparency, accountability, community engagement, and collaboration while simultaneously leaving hospitals a good degree of flexibility. By promoting alignment between hospitals' regulatory compliance activities and broader community health improvement initiatives, the IRS could play a meaningful role in efforts to reorient our system towards promoting health and not simply treating illness. PMID:27363258

  3. Hospitals cannot afford to be without access to MRI.

    PubMed

    Dougherty, E; Hagin, D

    1989-05-01

    Although practicing state-of-the-art diagnostic medicine is impossible without access to magnetic resonance imaging, this high-ticket technology is a mixed blessing in an era of cost containment. The good news is that MRI's diagnostic capabilities continue to grow, and the prices for scanners are dropping. However, MRI services remain expensive, and reimbursement is declining. To get the maximum benefit from MRI, physicians must stay up to date with the latest advances, a task that hospitals can facilitate through educational programs. Hospitals need to plan carefully for the introduction or expansion of MRI services, but the end result will be better patient care. PMID:10293190

  4. From cottage to community hospitals: Watlington Cottage Hospital and its regional context, 1874-2000.

    PubMed

    Hall, John

    2012-01-01

    The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals'within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region--one of the first Regions to formulate such a strategy--and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000. PMID:23057181

  5. Processing Community Model Output: An Approach to Community Accessibility (Invited)

    NASA Astrophysics Data System (ADS)

    Shea, D.; Haley, M.

    2009-12-01

    The Community Climate System Model (CCSM) is a fully-coupled, global climate model that provides state-of-the-art computer simulations of the Earth's past, present, and future climate states. The major components are models of the atmosphere, land, ocean and sea-ice. In both the development and production phases, the model output must be analyzed by developers and a diverse community of climate researchers. To facilitate community accessibility to the data, two decisions were made: (a) each component model would archive results in netCDF format (b) a supported and portable software analysis tool would be made available. NetCDF (network Common Data Format) is a set of software libraries and machine-independent data formats that support the creation, access, and sharing of array-oriented scientific data. It is available for a large variety of programming languages and many software tools can be used to manipulate and display data in netCDF files. After a 'competition' which included commercial and public domain software products, the NCAR Command Language (NCL) was selected as the 'official' analysis tool for CCSM analysis. NCL is a portable, supported software product for file handling, computations and high-quality graphics. Subsequently, a development team consisting of software engineers and scientists was created to collaborate to develop a tool capable of addressing the evolving and diverse needs of the climate modeling and observational research communities. The process of educating the user community about netCDF and NCL includes hundreds of online examples and numerous 'hands-on' workshops. The latter are held 3-to-5 times per year at NCAR and external locations.

  6. Lack of Pharmacy Access May Send Some Seniors Back to Hospital

    MedlinePlus

    ... medlineplus.gov/news/fullstory_160255.html Lack of Pharmacy Access May Send Some Seniors Back to Hospital ... Aug. 4, 2016 (HealthDay News) -- Limited access to pharmacies may be one reason hospital readmission is more ...

  7. Community health politics: transition of the Seattle USPHS Hospital.

    PubMed Central

    Hughes, R G; Tompkins, R K

    1984-01-01

    To achieve transition of the Seattle US Public Health Service Hospital from federal to local control, the community overcame large obstacles; the most difficult was federal preference for closing the hospital rather than incurring additional costs essential for transition. The Washington State Congressional Delegation, local officials, hospital staff, patients and numerous community volunteers--individuals and private organizations--worked together to save the hospital and secure federal resources for its transition. Going through the transition influenced the hospital as it developed a new corporate structure, designed new administrative systems, and prepared to operate in a new environment while facing an uncertain future. The hospital has continued to cope with issues arising from transition, such as operating in a competitive context while reaffirming its community service heritage. Despite the difficulties of transition, Seattle preserved a valuable community health resource. PMID:6547029

  8. Blanchfield Army Community Hospital Polypharmacy Clinic.

    PubMed

    Ridderhoff, Kevin J; Hull, Jessica R; Sandberg, Sheila K

    2015-01-01

    The increased use of central nervous system depressants (CNSD) and psychotropics are one of the many factors that contribute to suicidal behavior in soldiers. U.S. Army policy requires medication screening for any soldier prescribed 4 or more medications when at least 1 of the medications is a CNSD or psychotropic. Constant deployments challenged health care provider ability to comply with required screenings, and senior leaders sought proactive intervention to reduce medication risks upon return of the 101 st Airborne Division (Air Assault) from deployment in 2011. A pharmacy-led team established the Polypharmacy Clinic (PC) at Blanchfield Army Community Hospital. Of the 3,999 soldiers assigned, 540 (13.5%) met the initial screening criteria. Success of the pilot program led to the mandatory screening of all other Fort Campbell, Kentucky, brigades. During the first 12 months, 895 soldiers were seen by a clinical pharmacist, and 1,574 interventions were documented. Significant interventions included medication added (121), medication changed (258), medication stopped (164), lab monitoring recommended (172), adverse reaction mitigated (41), therapeutic duplication prevented (61), and drug-drug interaction identified (93). Additionally, 55 soldiers were recommended for temporary duty profiles based on their adverse drug effects. Ten soldiers were recommended for enhanced controlled substance monitoring. Placing soldiers on clinically appropriate medications and removing potentially harmful medications from their possession are examples of how the PC positively impacted the Commanding General's ability to deploy a fully medically ready force. Soldiers consistently remarked favorably on the thorough medication counseling provided at their PC appointments. Innovative notes within the electronic health record summarized relevant findings regarding soldiers' medications, which allowed providers to quickly pinpoint and adjust medication regimens. With each identified high

  9. Community -and hospital laboratory-based surveillance for respiratory viruses.

    PubMed

    Zachariah, Philip; Whittier, Susan; Reed, Carrie; LaRussa, Philip; Larson, Elaine L; Vargas, Celibell Y; Saiman, Lisa; Stockwell, Melissa S

    2016-09-01

    Traditional surveillance for respiratory viruses relies on symptom detection and laboratory detection during medically attended encounters for acute respiratory infection/influenza-like illness (ARI/ILI). Ecological momentary reporting using text messages is a novel method for surveillance. This study compares respiratory viral activity detected through longitudinal community-based surveillance using text message responses for sample acquisition and testing to respiratory viral activity obtained from hospital laboratory data from the same community. We demonstrate a significant correlation between community- and hospital laboratory-based surveillance for most respiratory viruses, although the relative proportions of viruses detected in the community and hospital differed significantly. PMID:26987664

  10. Enhancing the Care Continuum in Rural Areas: Survey of Community Health Center-Rural Hospital Collaborations

    ERIC Educational Resources Information Center

    Samuels, Michael E.; Xirasagar, Sudha; Elder, Keith T.; Probst, Janice C.

    2008-01-01

    Context: Community Health Centers (CHCs) and Critical Access Hospitals (CAHs) play a significant role in providing health services for rural residents across the United States. Purpose: The overall goal of this study was to identify the CAHs that have collaborations with CHCs, as well as to recognize the content of the collaborations and the…

  11. Converting partial hospitals to community integrated recovery centers.

    PubMed

    Evans, Arthur; Okeke, Barnabas; Ali, Sade; Achara-Abrahams, Ijeoma; OHara, Tom; Stevenson, Tramaine; Warner, Nikena; Bolton, Cathy; Lim, Suet; Faith, Joe; King, Joan; Davidson, Larry; Poplawski, Paul; Rothbard, Aileen; Salzer, Mark

    2012-10-01

    This paper describes the conversion of partial hospitals into recovery-oriented programs as part of system transformation. Steps included: participatory planning with stakeholders; strength based assessment of resources and needs; technical assistance; and changing funding strategies. Over a period of 8 years, use of partial hospitals decreased as persons with serious mental illnesses were transitioned to community integrated recovery centers. Preliminary outcomes suggest that these programs are more effective in engaging people in the community activities of their choice, confirming previous findings that showed that partial hospitals can be converted to recovery-oriented programs that focus more directly on promoting community inclusion. PMID:22015957

  12. Acts of Hospitality: The Community in Community Music

    ERIC Educational Resources Information Center

    Higgins, Lee

    2007-01-01

    This article will investigate the notion of "community" within the aspirations of Community Music. Guiding this study are the questions: How is community made manifest through Community Music? What joins the notion of community to that of music? Two distinct sections will frame this research: (1) an etymological consideration of the word…

  13. 42 CFR 412.92 - Special treatment: Sole community hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Sole community hospitals. 412.92 Section 412.92 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the...

  14. EXPLORING THE IMPACT OF A COMMUNITY HOSPITAL CLOSURE ON OLDER ADULTS: A FOCUS GROUP STUDY

    PubMed Central

    Countouris, Malamo; Gilmore, Sandra; Yonas, Michael

    2016-01-01

    The closing of hospitals has exacerbated challenges for older adults in accessing healthcare, especially those living in economically underserved settings. Through focus groups and a community-engaged approach, our study examined and documented the emergent health needs of older adults following the closing of a local hospital in an economically disadvantaged community. Focus groups were reconvened to assess progress and health needs over time. Analyses of the focus groups (n=37, mean age 77, 84% female) illustrated the impact of the closure and the emergence of the following dominant themes: perceptions of the hospital system, including feelings of abandonment and social isolation; transportation challenges in accessing health care resources; and lack of knowledge and literacy regarding available health care and obtaining health services. Discussion sessions with hospital administrators and participants afforded an opportunity for sharing data and additional assessment. The data and relationships developed with community participants and health system representatives resulted in the production of an information resource about access to health services, tailored for older adults. PMID:24448403

  15. Prevalence of hepatitis B serologic markers in community hospital personnel.

    PubMed Central

    McLean, A A; Monahan, G R; Finkelstein, D M

    1987-01-01

    The seroprevalence of hepatitis B markers among predominantly high-risk staff members and personnel of 31 community hospitals located throughout the United States was 8.4 per cent (greater than or equal to 5 per cent in 25 hospitals and greater than or equal to 10 per cent in 13 hospitals). Only two hospitals had seroprevalence rates less than or equal to 3 per cent. The institutional seroprevalence ranged from 0 per cent to 16.7 per cent, with a median of 8.2 per cent. Although there are limitations to this survey, the results suggest that the well established increased risk of contracting HBV infection among certain groups of health-care workers in urban teaching medical centers may also hold true for personnel in similar occupational and professional categories in community hospitals. PMID:3605482

  16. From bench to bedside: research and testing of Internet resources and connections in community hospital libraries.

    PubMed Central

    Rambo, N.; Fuller, S.

    1993-01-01

    Access to information becomes more valuable with the continuing proliferation of medical knowledge and the increasing economic pressure being experienced by health care organizations. This is particularly so for community hospitals in rural or isolated areas, where the economic pressures are at least as great as in urban areas and where access to information is often inadequate. These conditions have implications for the quality of patient care and for economic viability. In response to this, the National Library of Medicine, the University of Washington, and seven community hospitals in five Pacific Northwest states have joined forces in a broad-scale technology diffusion project to facilitate the application of research work to clinical care. There are three components to the project: 1) a pilot connections component to extend Internet access to the community hospitals, 2) a research component to test the performance of a client/server model for network access to anatomical text and images, and 3) a clinical component to develop a registry of DNA diagnostic laboratories facilitating the provision of genetic information to clinicians. The pilot connections component is described and preliminary findings are reported. PMID:8130534

  17. Identifying Key Hospital Service Quality Factors in Online Health Communities

    PubMed Central

    Jung, Yuchul; Hur, Cinyoung; Jung, Dain

    2015-01-01

    Background The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. Objective As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. Methods We defined social media–based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea’s two biggest online portals were used to test the effectiveness of detection of social media–based key quality factors for hospitals. Results To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is

  18. Community hospital successfully implements eRecord and CPOE.

    PubMed

    Wolf, Debra M; Greenhouse, Pamela K; Diamond, Joel N; Fera, William; McCormick, Donna L

    2006-01-01

    Despite media attention on converting the nation's paper-based medical record systems to electronic systems, few hospitals, and even fewer community hospitals, have done so. University of Pittsburgh Medical Center St. Margaret has converted to a comprehensive electronic health record system, known as eRecord, in a short time. The authors describe key factors that were critical to the success of the conversion, along with positive results on quality of care. PMID:17108749

  19. Meeting the Community in Hospital Field Work

    ERIC Educational Resources Information Center

    McWilliams, Margaret; Fuhrman, Ruth

    1976-01-01

    The department of home economics at California State University and the Los Angeles County/University of Southern California Medical Center have developed an innovative medical/home economics apprenticeship program that serves community health care needs and eases the transition period for senior students before they begin professional work.…

  20. Residential Broadband Access for Students at Walters State Community College

    ERIC Educational Resources Information Center

    Hurst, Mark A.

    2010-01-01

    The purpose of this study was to determine the availability of internet access for students attending Walters State Community College during the spring semester 2010. In particular, it is unknown to what degree broadband internet access is available in the counties that Walters State considers the service area of the college. The research was…

  1. Housestaff coverage in a nonteaching community hospital.

    PubMed

    Conti, A

    1994-11-01

    In August 1992, a project team of senior medical and administrative personnel was formed (Housestaff Coverage Project Team) at the Park Ridge Health System, Rochester, N.Y.. The team was given a mandate to address housestaff coverage, primarily from an economic standpoint. Through total quality management (TQM), the project team sought to develop a house coverage plan that was sustainable, efficient, and effective. A plan was developed that includes three layers of service. A minimum "standard hospital coverage" would be available to all physicians and their patients and cover the basic needs of admission, crisis intervention, and issues of length of stay. A complete level of service would be available under the title of "case management" and would consist of total patient management, under the direction of the attending physician, from admission through discharge. The third level of service available to both "standard" and "case managed" patients would be a "consultative service." The latter would function as a traditional in-house medical service and would bill for its services. Park Ridge Hospital believes it has developed a system of housestaff coverage that is sustainable, efficient, and effective. An evaluation mechanism, primarily addressed at length of stay, will tell if we are correct in this assumption. PMID:10140893

  2. Community variation in adolescent access to indoor tanning facilities.

    PubMed

    Olson, Ardis L; Carlos, Heather A; Sarnoff, Rachel A

    2013-04-01

    Melanoma rates among younger women in New Hampshire (NH) are rising. In urban studies, youth proximity to tanning facilities has been linked to indoor tanning, a proven cause of melanoma. Youth access has not been examined in rural settings. To determine on a statewide basis the influence of rurality and community income level on female students' ease of access to tanning facilities, all NH tanning facilities (N = 261) and high schools (N = 77) in 2011 were spatially and statistically analyzed to determine schools with more facilities within 2 miles of the school and greater capacity (fewer female students per facility), for indoor tanning. Schools above the state-wide average for both measures were classified as "Easy Access" to indoor tanning. Among NH high schools, 74 % have 1 or more tanning facility within two miles and 22 % have "Easy Access" to tanning facilities. Ease of access did not differ by rurality. Lower-income school status was an independent predictor of both greater capacity and "Easy Access". While urban and rural teens have similar access to indoor tanning, female students in lower-income communities have easier access. Variations in access by community size and income must be considered in planning interventions to address youth indoor tanning. PMID:23011517

  3. Myths versus facts in emergency department overcrowding and hospital access block.

    PubMed

    Richardson, Drew B; Mountain, David

    2009-04-01

    Overcrowding occurs when emergency department (ED) function is impeded, primarily by overwhelming of ED staff resources and physical capacity by excessive numbers of patients needing or receiving care. Access block occurs when there is excessive delay in access to appropriate inpatient beds (> 8 hours total time in the ED). Access block for admitted patients is the principal cause of overcrowding, and is mainly the result of a systemic lack of capacity throughout health systems, and not of inappropriate presentations by patients who should have attended a general practitioner. Overcrowding is most strongly associated with excessive numbers of admitted patients being kept in the ED. Excessive numbers of admitted patients in the ED are associated with diminished quality of care and poor patient outcomes. These include (but are not limited to) adverse events, errors, delayed time-critical care, increased morbidity and excess deaths (estimated as at least 1500 per annum in Australia). There is no evidence that telephone advice lines or collocated after-hours GP services assist in reducing ED workloads. Changes to ED structure and function do not address the underlying causes or major adverse effects of overcrowding. They are also rapidly overwhelmed by increasing access block. The causes of overcrowding, and hence the solutions, lie outside the ED. Solutions will mainly be found in managing hospital bedstock and systemic capacity (including the use of step-down and community resources) so that appropriate inpatient beds remain available for acutely sick patients. PMID:19351311

  4. Community College Selective Enrollment and the Challenge to Open Access

    ERIC Educational Resources Information Center

    Morris, David Brian

    2012-01-01

    The open access mission is central to the community college role and mission in higher education. Although initially implemented by four-year colleges and universities, adoption of formal enrollment management initiatives in community colleges is on the increase. Admission, matriculation, retention, and persistence are affected by enrollment…

  5. Accessibility & Inclusivity in the Astronomical Community

    NASA Astrophysics Data System (ADS)

    Gilbert, Lauren; Shanahan, J.; Monkiewicz, Jacqueline A.; Noel-Storr, Jacob; Murphy, Nicholas Arnold

    2016-06-01

    Nearly one in five Americans have a disability. However, in a 2013 survey, fewer than 2% of AAS members identified as having a disability. Persons with disabilities are dramatically underrepresented in STEM fields and astronomy in particular. Though the Americans with Disabilities Act has been law for 25 years, few astronomy departments have implemented full universal design and structures for accessibility for students. Our field which often sees itself as pushing the limits can offer an environment for enhanced stigmatization and discrimination based on disability. Indeed, many current structures place undue burden to those who are excluded. Instead, we aspire to a way of working together that does not require disclosure of disability, and where diverse needs are being met with each of our interactions and activities. A mindset of diverse access makes the experience of learning, working, and collaborating stronger for all.

  6. Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals

    PubMed Central

    Hazen, Kevin C.; Hawkins, Myra R.; Drew, Richard H.; Sexton, Daniel J.; Anderson, Deverick J.

    2015-01-01

    Knowledge of local antimicrobial resistance is critical for management of infectious diseases. Community hospitals' compliance with Clinical and Laboratory Standards Institute (CLSI) guidance for creation of cumulative antibiograms is uncertain. This descriptive cohort study of antibiogram reporting practices included community hospitals enrolled in the Duke Infection Control Outreach Network. Cumulative antibiograms from 2012 were reviewed for criteria on reporting practices and compliance with CLSI guidelines. Microbiology personnel were sent a voluntary, electronic survey on antibiogram preparation practices. Data were compiled using descriptive statistics. Thirty-two of 37 (86%) hospitals provided antibiograms; 26 of 37 (70%) also provided survey responses. Twelve (38%) antibiograms specified methods used for compiling data and exclusion of duplicates. Eight (25%) reported only species with >30 isolates. Of the 24 that did not follow the 30-isolate rule, 3 (13%) included footnotes to indicate impaired statistical validity. Twenty (63%) reported at least 1 pathogen-drug combination not recommended for primary or supplemental testing per CLSI. Thirteen (41%) separately reported methicillin-resistant and -susceptible Staphylococcus aureus. Complete compliance with CLSI guidelines was observed in only 3 (9%) antibiograms. Survey respondents' self-assessment of full or partial compliance with CLSI guidelines was 50% and 15%, respectively; 33% reported uncertainty with CLSI guidelines. Full adherence to CLSI guidelines for hospital antibiograms was uncommon. Uncertainty about CLSI guidelines was common. Alternate strategies, such as regional antibiograms using pooled data and educational outreach efforts, are needed to provide reliable and appropriate susceptibility estimates for community hospitals. PMID:26179303

  7. Accountability for Community Benefit: A Reasonable Expectation for Canadian Hospitals.

    PubMed

    Graham, J Ross

    2016-05-01

    North American hospitals have historically struggled to engage in prevention and health promotion activities because they have not been incentivized or held accountable for doing so. However, in order to be exempt from federal taxes, 3,000 non-profit hospitals in the US must now regularly assess the health status of the communities they serve, and take action to address identified health needs. This is called "accountability for community benefit," and it is required under the Patient Protection and Affordable Care Act (commonly known as Obamacare). A modified version of accountability for community benefit warrants exploration in the Canadian context, as it may support Canadian hospitals to direct resources towards prevention and health promotion activities - something many Canadian hospitals want to do, but struggle with in the current accountability environment. This is an important health policy topic because even a small shift in focus by hospitals towards prevention and health promotion has the potential to improve population health and reduce healthcare demand. PMID:27232233

  8. 78 FR 20523 - Community Health Needs Assessments for Charitable Hospitals

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-05

    ... rulemaking in the Federal Register (REG-130266-11; 77 FR 38148) (``2012 proposed regulations'') that contains... Internal Revenue Service 26 CFR Parts 1 and 53 RIN 1545-BL30 Community Health Needs Assessments for Charitable Hospitals AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed...

  9. Internet Point of Care Learning at a Community Hospital

    ERIC Educational Resources Information Center

    Sinusas, Keith

    2009-01-01

    Introduction: Internet point of care (PoC) learning is a relatively new method for obtaining continuing medical education credits. Few data are available to describe physician utilization of this CME activity. Methods: We describe the Internet point of care system we developed at a medium-sized community hospital and report on its first year of…

  10. Diabetes hinders community-acquired pneumonia outcomes in hospitalized patients

    PubMed Central

    Boavida, J M; Raposo, J F; Froes, F; Nunes, B; Ribeiro, R T; Penha-Gonçalves, C

    2016-01-01

    Objectives This study aimed to estimate the prevalence of diabetes mellitus (DM) in hospitalized patients with community-acquired pneumonia (CAP) and its impact on hospital length of stay and in-hospital mortality. Research design and methods We carried out a retrospective, nationwide register analysis of CAP in adult patients admitted to Portuguese hospitals between 2009 and 2012. Anonymous data from 157 291 adult patients with CAP were extracted from the National Hospital Discharge Database and we performed a DM-conditioned analysis stratified by age, sex and year of hospitalization. Results The 74 175 CAP episodes that matched the inclusion criteria showed a high burden of DM that tended to increase over time, from 23.7% in 2009 to 28.1% in 2012. Interestingly, patients with CAP had high DM prevalence in the context of the national DM prevalence. Episodes of CAP in patients with DM had on average 0.8 days longer hospital stay as compared to patients without DM (p<0.0001), totaling a surplus of 15 370 days of stay attributable to DM in 19 212 admissions. In-hospital mortality was also significantly higher in patients with CAP who have DM (15.2%) versus those who have DM (13.5%) (p=0.002). Conclusions Our analysis revealed that DM prevalence was significantly increased within CAP hospital admissions, reinforcing other studies’ findings that suggest that DM is a risk factor for CAP. Since patients with CAP who have DM have longer hospitalization time and higher mortality rates, these results hold informative value for patient guidance and healthcare strategies. PMID:27252873

  11. Access to Democracy Project: Community Report on Attitudes Regarding Educational Attainment. Grand Rapids (Michigan) Surrounding Communities

    ERIC Educational Resources Information Center

    Daun-Barnett, Nathan J.; Bowman, Nicholas A.

    2005-01-01

    The "Access to Democracy" project has two broad goals. It is an effort to understand community beliefs, attitudes and conditions that shape educational outcomes for community youth, and it is a way to focus community discussions on efforts that support higher educational attainment for residents. This report focuses on the lessons learned in the…

  12. Palliative care for all? A review of the evidence in community hospitals.

    PubMed

    Steers, Julie; Brereton, Louise; Ingleton, Christine

    2007-08-01

    The provision of palliative care in the UK has traditionally focused on people with cancer. People who are elderly, live in rural areas or have diagnoses other than cancer often have difficulty accessing palliative care services. Community hospitals could be important for those groups currently under-served. A literature review was conducted to determine the role played by community hospitals in the provision of palliative care in the U.K. Papers were identified using a keyword search of six electronic databases and hand search of five journals. Fifteen papers were identified according to inclusion and exclusion criteria. Findings indicate that many community hospitals in the UK already have the resources to counter inequalities in access to general palliative care. Much of the evidence uses quantitative methods based on small or non-representative samples and retrospective data collection approaches. Insufficient information about the populations involved meant that findings could not be fully interpreted. More prospective research using qualitative methods involving patients, carers and nurses is required to fully understand the complexities of providing palliative care in this setting. PMID:18018819

  13. Converting to critical access status: how does it affect rural hospitals' financial performance?

    PubMed

    Li, Pengxiang; Schneider, John E; Ward, Marcia M

    2009-01-01

    To improve rural access to care, the Balanced Budget Act of 1997 allowed eligible rural hospitals to convert to critical access hospitals (CAHs), which changed their Medicare payment from a prospective payment system (PPS) to a cost-based system. The objective of this paper is to examine the effects of CAH conversion on rural hospital operating revenues, operating expenses, and operating margins using an eight-year panel of 89 rural hospitals in Iowa. Ad hoc hospital revenue, cost, and profit functions were estimated using panel data fixed-effects linear models. We found that rural hospital CAH conversion was associated with significant increases in hospital operating revenues, expenses, and margins. PMID:19489483

  14. Discounted drug prices for hospitals: result in prescriptions for expensive drugs in the community.

    PubMed

    2015-09-01

    Hospital prescribing has a major influence on community prescribing. In France, pharmaceutical companies can sell drugs to hospitals at dramatically reduced prices in the expectation of increasing sales in community pharmacies. PMID:26417639

  15. PAHO'S Strategy for Universal Access to Health and Universal Health Coverage: implications for health services and hospitals in LAC.

    PubMed

    Holder, Reynaldo; Fabrega, Ricardo

    2015-01-01

    Moving towards Universal Access to Health and Universal Health Coverage (UAH/UHC) is an imperative task on the health agenda for the Americas. The Directing Council of the Pan American Health Organization (PAHO) recently approved resolution CD53.R14, titled Strategy for Universal Access to Health and Universal Health Coverage. From the perspective of the Region of the Americas, UAH/UHC "imply that all people and communities have access, without any kind of discrimination, to comprehensive, appropriate and timely, quality health services determined at the national level according to needs, as well as access to safe, affordable, effective, quality medicines, while ensuring that the use of these services does not expose users to financial hardship, especially groups in conditions of vulnerability". PAHO's strategic approach to UAH/UHC sets out four specific lines of action toward effective universal health systems. The first strategic line proposes: a) implementation of integrated health services delivery networks (IHDSNs) based on primary health care as the key strategy for reorganizing, redefining and improving healthcare services in general and the role of hospitals in particular; and b) increasing the response capacity of the first level of care. An important debate initiated in 2011 among hospital and healthcare managers in the region tried to redefine the role of hospitals in the context of IHSDNs and the emerging UAH/UHC movement. The debates resulted in agreements around three main propositions: 1) IHSDNs cannot be envisioned without hospitals; 2) The status-quo and current hospital organizational culture makes IHSDNs inviable; and 3) Without IHSDNs, hospitals will not be sustainable. This process, that predates the approval of PAHO's UAH/UHC resolution, now becomes more relevant with the recognition that UAH/UHC cannot be attained without a profound change in healthcare service and particularly in hospitals. In this context, a set of challenges both for

  16. The geographical accessibility of hospitals to the aged: a geographic information systems analysis within Illinois.

    PubMed Central

    Love, D; Lindquist, P

    1995-01-01

    OBJECTIVE. This article uses geographic information systems and their related tools to empirically measure and display the geographic accessibility of the aged population to hospital facilities within Illinois. DATA SOURCES AND STUDY SETTING. Geographic accessibility of Illinois' aged population is measured from each of the state's 10,796 census block groups to the state's 214 hospital facilities. Block group demographic compositions and centroids are obtained from 1990 census files. Hospital coordinates are obtained by the authors. STUDY DESIGN. Of five alternative measures of accessibility considered, empirical estimates are obtained for two: choice set and minimum distance. Access to both general hospitals and the subset having specialized geriatric facilities is measured with special attention to differences in accessibility between the aged within metropolitan statistical areas (MSAs) and those outside MSAs. Cumulative accessibility distributions and their summary statistics provide a basis of comparison among subgroups. DATA COLLECTION AND EXTRACTION. Geographic information systems (GIS) and their related tools are used as a means of efficiently capturing, organizing, storing, and retrieving the required data. Hospitals and census block groups are geocoded to specific locations in the database, and aspatial attributes are assigned to the hospitals and block groups. The GIS database is queried to produce shaded isarithm and point distribution maps that show the location of hospitals relative to surrounding aged populations. CONCLUSION. The vast majority of Illinois' aged population is within close proximity to hospital facilities. Eighty percent (1,147,504 persons) of the aged in Illinois are within 4.8 miles (7.7 km) of a hospital and 11.6 miles (18.7 km) of two hospitals. However, geographic accessibility differences between the aged living in MSAs and those living outside MSAs to hospitals offering geriatric services are substantial; but there is no

  17. Improving the Advance Directive Request and Retrieval Process in Critical Access Hospitals: Honoring the Patient's Wishes.

    PubMed

    Jones, Faith M; Sabin, Tawnie L; Torma, Linda M

    2016-01-01

    The Patient Self-Determination Act was created to enhance awareness and use of advance directives. Several states also have created registries where the advance directives can be easily retrieved when needed. Quick retrieval is especially important in critical access hospitals where patients are often transferred to other facilities. This article describes an innovative project designed to improve the advance directives request and retrieval process on admission to a critical access hospital. PMID:26681498

  18. Accessing the Food Systems in Urban and Rural Minnesotan Communities

    ERIC Educational Resources Information Center

    Smith, Chery; Miller, Hannah

    2011-01-01

    Objective: Explore how urban and rural Minnesotans access the food system and to investigate whether community infrastructure supports a healthful food system. Design: Eight (4 urban and 4 rural) focus groups were conducted. Setting and Participants: Eight counties with urban influence codes of 1, 2, 4, 5, 8, and 10. Fifty-nine (urban, n = 27;…

  19. Girls' Education: Community Approaches to Access and Quality. Strong Beginnings.

    ERIC Educational Resources Information Center

    Dowd, Amy Jo; Greer, Heather

    Noting that girls' lack of access to education is related to a number of economic, social, religious, and cultural factors as well as a scarcity of places in schools and that promoting gender equity in school may help equity spread throughout the entire community, this report illustrates the gender equity approach used in the Save the Children's…

  20. Web Accessibility Policies and Practices at American Community Colleges

    ERIC Educational Resources Information Center

    Erickson, William; Trerise, Sharon; VanLooy, Sara; Lee, Camille; Bruyere, Susanne

    2009-01-01

    Community colleges are increasingly using the Internet for admissions and financial aid applications. The use of online processes has serious implications for students with disabilities, such as visual and learning problems, who may encounter difficulties with the Web sites if they are not designed in an accessible and usable way. A survey of…

  1. Critical Access Hospitals and Retail Activity: An Empirical Analysis in Oklahoma

    ERIC Educational Resources Information Center

    Brooks, Lara; Whitacre, Brian E.

    2011-01-01

    Purpose: This paper takes an empirical approach to determining the effect that a critical access hospital (CAH) has on local retail activity. Previous research on the relationship between hospitals and economic development has primarily focused on single-case, multiplier-oriented analysis. However, as the efficacy of federal and state-level rural…

  2. Variations in Financial Performance among Peer Groups of Critical Access Hospitals

    ERIC Educational Resources Information Center

    Pink, George H.; Holmes, George M.; Thompson, Roger E.; Slifkin, Rebecca T.

    2007-01-01

    Context: Among the large number of hospitals with critical access hospital (CAH) designation, there is substantial variation in facility revenue as well as the number and types of services provided. If these variations have material effects on financial indicators, then performance comparisons among all CAHs are problematic. Purpose: To…

  3. 76 FR 25550 - Medicare and Medicaid Programs: Changes Affecting Hospital and Critical Access Hospital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-05

    ... May 26, 2010 (75 FR 29479). In that rule, we proposed to revise both the hospital and CAH.... Currently, a hospital or CAH receiving telemedicine services must go through a burdensome credentialing and... issues. The most common comment expressed was that the proposed regulation did not go far enough...

  4. Trust-based Access Control in Virtual Learning Community

    NASA Astrophysics Data System (ADS)

    Wang, Shujuan; Liu, Qingtang

    The virtual learning community is an important application pattern of E-Learning. It emphasizes the cooperation of the members in the community, the members would like to share their learning resources, to exchange their experience and complete the study task together. This instructional mode has already been proved as an effective way to improve the quality and efficiency of instruction. At the present time, the virtual learning communities are mostly designed using static access control policy by which the access permission rights are authorized by the super administrator, the super administrator assigns different rights to different roles, but the virtual and social characteristics of virtual learning community make information sharing and collaboration a complex problem, the community realizes its instructional goal only if the members in it believe that others will offer the knowledge they owned and believe the knowledge others offered is well-meaning and worthy. This paper tries to constitute an effective trust mechanism, which could promise favorable interaction and lasting knowledge sharing.

  5. Roles of a hospital for community safety promotion.

    PubMed

    Ah Lee, Choung; Pil Cho, Joon

    2012-01-01

    It is not easy for any health professional to be aware of injury problems and safety issues within their own communities if their main responsibility is not in this field. Health professionals, however, can play an important role in all aspects of injury prevention and safety promotion. This includes not only medical or surgical treatment for the injured patients but also risk assessment, health education, community action, organisational development and advocacy for policy to promote safety at a multi-level in the society. This can be accomplished most efficiently through collaboration with diverse sectors within a community, including hospitals, public health professionals, policy makers, school boards, police departments, fire departments, citizens' coalitions and others. Since 2002, Ajou University School of Medicine and Public Health in Suwon, Korea, has introduced a Safe Community model to many countries in Asia, including Korea, Japan, China, Vietnam, Thailand, among others, which is led by The World Health Organization Collaborating Centre on Community Safety Promotion at Karolinska Institutet, Stockholm, Sweden. PMID:22520035

  6. Epidemiology of Surgical Site Infection in a Community Hospital Network.

    PubMed

    Baker, Arthur W; Dicks, Kristen V; Durkin, Michael J; Weber, David J; Lewis, Sarah S; Moehring, Rebekah W; Chen, Luke F; Sexton, Daniel J; Anderson, Deverick J

    2016-05-01

    OBJECTIVE To describe the epidemiology of complex surgical site infection (SSI) following commonly performed surgical procedures in community hospitals and to characterize trends of SSI prevalence rates over time for MRSA and other common pathogens METHODS We prospectively collected SSI data at 29 community hospitals in the southeastern United States from 2008 through 2012. We determined the overall prevalence rates of SSI for commonly performed procedures during this 5-year study period. For each year of the study, we then calculated prevalence rates of SSI stratified by causative organism. We created log-binomial regression models to analyze trends of SSI prevalence over time for all pathogens combined and specifically for MRSA. RESULTS A total of 3,988 complex SSIs occurred following 532,694 procedures (prevalence rate, 0.7 infections per 100 procedures). SSIs occurred most frequently after small bowel surgery, peripheral vascular bypass surgery, and colon surgery. Staphylococcus aureus was the most common pathogen. The prevalence rate of SSI decreased from 0.76 infections per 100 procedures in 2008 to 0.69 infections per 100 procedures in 2012 (prevalence rate ratio [PRR], 0.90; 95% confidence interval [CI], 0.82-1.00). A more substantial decrease in MRSA SSI (PRR, 0.69; 95% CI, 0.54-0.89) was largely responsible for this overall trend. CONCLUSIONS The prevalence of MRSA SSI decreased from 2008 to 2012 in our network of community hospitals. This decrease in MRSA SSI prevalence led to an overall decrease in SSI prevalence over the study period. Infect Control Hosp Epidemiol 2016;37:519-526. PMID:26864617

  7. Phylogenetic diversity of fungal communities in areas accessible and not accessible to tourists in Naracoorte Caves.

    PubMed

    Adetutu, Eric M; Thorpe, Krystal; Bourne, Steven; Cao, Xiangsheng; Shahsavari, Esmaeil; Kirby, Greg; Ball, Andrew S

    2011-01-01

    The fungal diversity in areas accessible and not accessible to tourists at UNESCO World Heritage-listed Naracoorte Caves was investigated with culture-dependent and culture-independent techniques for assistance in cave management protocol development. The caves were selected based on tourist numbers and configurations: Stick Tomato (open, high numbers), Alexandra (lockable openings, high numbers) and Strawhaven (control; no access). Culture-based survey revealed Ascomycota dominance irrespective of sampling area with Microascales (Trichurus sp.) being most frequently isolated. Some Hypocreales-like sequences belonging to Fusarium sp., Trichoderma sp. and Neonectria sp. (Stick Tomato) were cultured only from areas not accessible to tourists. These orders also were detected by DGGE assay irrespective of sampling area. The predominance of Ascomycota (especially Microascales) suggested their important ecological roles in these caves. Culture-independent analysis showed higher Shannon fungal diversity values (from ITS-based DGGE profiles) in tourist-accessible areas of these caves than in inaccessible areas with the fungal community banding patterns being substantially different in Stick Tomato Cave. Further investigations are needed to determine the cause of the differences in the fungal communities of Stick Tomato Cave, although cave-related factors such as use, configuration and sediment heterogeneity might have contributed to these differences. PMID:21642344

  8. Hospital readmission and healthcare utilization following sepsis in community settings

    PubMed Central

    Liu, Vincent; Lei, Xingye; Prescott, Hallie C; Kipnis, Patricia; Iwashyna, Theodore J; Escobar, Gabriel J

    2014-01-01

    Background Sepsis, the most expensive cause of hospitalization in the US, is associated with high morbidity and mortality. However, healthcare utilization patterns following sepsis are poorly understood. Objective To identify patient-level factors which contribute to post-sepsis mortality and healthcare utilization. Design, Setting, Patients A retrospective study of sepsis patients drawn from 21 community-based hospitals in Kaiser Permanente Northern California in 2010. Measurements We determined one-year survival and use of outpatient and facility-based healthcare before and after sepsis and used logistic regression to identify the factors that contributed to early readmission (within 30 days) and high utilization (≥15% of living days spent in facility-based care). Results Among 6,344 sepsis patients, 5,479 (86.4%) survived to hospital discharge. Mean age was 72 years with 28.9% of patients aged <65 years. Post-sepsis survival was strongly modified by age; one-year survival was 94.1% for <45 year olds and 54.4% for ≥85 year olds. A total of 978 (17.9%) patients were readmitted within 30 days; only a minority of all rehospitalizations were for infection. After sepsis, adjusted healthcare utilization increased nearly threefold compared with pre-sepsis levels and was strongly modified by age. Patient factors including acute severity of illness, hospital length of stay, and the need for intensive care were associated with early readmission and high healthcare utilization, however, the dominant factors explaining variability—comorbid disease burden and high pre-sepsis utilization—were present prior to sepsis admission. Conclusion Post-sepsis survival and healthcare utilization were most strongly influenced by patient factors already present prior to sepsis hospitalization. PMID:24700730

  9. Community health insurance as a catalyst for uptake of family planning and reproductive health services: the Obio Cottage Hospital experience.

    PubMed

    Fakunle, B; Okunlola, M A; Fajola, A; Ottih, U; Ilesanmi, A O

    2014-08-01

    Health service delivery in the Niger Delta region of Nigeria has suffered many setbacks. Community participation may help break the barriers limiting access to health services, especially those associated with family planning and reproductive health services. This is a two-year review of family planning and reproductive health services records offered by the Obio Cottage Hospital from the onset of the Community Insurance Scheme (2010-12). Since the inception of the Community Insurance Scheme, there has been an increase in the uptake of family planning methods of more than 50%; 1,274 women in 2011 vs 3,140 in 2012. An increase in number of women seeking reproductive health services was also observed. The Community Health Insurance Scheme (CHIS) at the Obio Cottage Hospital provides evidence for expansion, as seen in the improvement in patronage for family planning and reproductive health services. PMID:24725223

  10. Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and Declining Physical Function

    PubMed Central

    Kim, Sun Jung; Lee, Joo Hun; Han, Boram; Lam, Julia; Bukowy, Elizabeth; Rao, Avinash; Vulcano, Jordan; Andreeva, Anelia; Bertelson, Heather; Shin, Hyun Phil; Yoo, Ji Won

    2015-01-01

    To examine whether hospital-based physical therapy is associated with functional changes and early hospital readmission among hospitalized older adults with community-acquired pneumonia and declining physical function. Study design was a retrospective observation study. Participants were community-dwelling older adults admitted to medicine floor for community-acquired pneumonia (n = 1,058). Their physical function using Katz activities of daily living (ADL) Index declined between hospital admission and 48 hours since hospital admission (Katz ADL Index 6→5). The intervention group was those receiving physical therapy for ≥ 0.5 hour/day. Outcomes were Katz ADL Index at hospital discharge and all-cause 30-day hospital readmission rate. The intervention and control groups did not differ in the Katz ADL Index at hospital discharge (p = 0.11). All-cause 30-day hospital readmission rate was lower in the intervention than in control groups (OR = 0.65, p = 0.02). Hospital-based physical therapy has the benefits toward reducing 30-day hospital readmission rate of acutely ill older adults with community-acquired pneumonia and declining physical function. PMID:26029475

  11. Developing accessible cyberinfrastructure-enabled knowledge communities in the national disability community: theory, practice, and policy.

    PubMed

    Myhill, William N; Cogburn, Derrick L; Samant, Deepti; Addom, Benjamin Kwasi; Blanck, Peter

    2008-01-01

    Since publication of the Atkins Commission report in 2003, the national scientific community has placed significant emphasis on developing cyberinfrastructure-enabled knowledge communities, which are designed to facilitate enhanced efficiency and collaboration in geographically distributed networks of researchers. This article suggests that the new cyberinfrastructure movement may not fully benefit those participants with disabilities, unless closer attention is paid to legal mandates and universal design principles. Many technology-enhanced learning communities provide geographically distributed collaboration opportunities that expand the inclusion of diverse peoples and help close the digital divide. However, to date, most collaboratory efforts have not emphasized the need for access among people with disabilities nor meeting minimum standards for technological accessibility. To address these concerns, this article reports on two pilot collaboratory studies that explore the role advanced information, communication, and collaboration technologies play in enhancing geographically distributed collaboration among specific research and applied networks within the national disability community. Universal design principles inform the design of the collaboratory and its use and our efforts to ensure access for all. Data for this article come from Web-based surveys, interviews, observations, computer logs, and detailed, mixed-methods accessibility testing. Emerging results suggest that with deliberate and systematic efforts, cyberinfrastructure can be more accessible and generate benefits among persons with disabilities. The authors provide lessons learned and recommendations for future research, policy, law, and practice. PMID:18939656

  12. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders

    PubMed Central

    Millman, Alexander J.; Finelli, Lyn; Bramley, Anna M.; Peacock, Georgina; Williams, Derek J.; Arnold, Sandra R.; Grijalva, Carlos G.; Anderson, Evan J.; McCullers, Jonathan A.; Ampofo, Krow; Pavia, Andrew T.; Edwards, Kathryn M.; Jain, Seema

    2016-01-01

    Objective To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. Study design Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children’s hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. Results From January 2010–June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. Conclusions Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders. PMID:27017483

  13. Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

    PubMed Central

    Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

    2016-01-01

    Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Conclusions Among hospital inpatients admitted as an emergency, patients

  14. Community services' involvement in the discharge of older adults from hospital into the community

    PubMed Central

    Guerin, Michelle; Grimmer, Karen; Kumar, Saravana

    2013-01-01

    Background Community services are playing an increasing role in supporting older adults who are discharged from hospital with ongoing non-acute care needs. However, there is a paucity of information regarding how community services are involved in the discharge process of older individuals from hospital into the community. Methods Twenty-nine databases were searched from 1980 to 2012 (inclusive) for relevant primary published research, of any study design, as well as relevant unpublished work (e.g. clinical guidelines) which investigated community services' involvement in the discharge of older individuals from hospital into the community. Data analysis and quality appraisal (using McMaster critical appraisal tools) were undertaken predominately by the lead author. Data was synthesised qualitatively. Results Twelve papers were eligible for inclusion (five randomised controlled trials, four before and after studies and three controlled trials), involving a total of 8440 older adults (>65 years). These papers reported on a range of interventions. During data synthesis, descriptors were assigned to four emergent discharge methods: Virtual Interface Model, In-reach Interface Model, Out-reach Interface Model and Independent Interface Model. In each model, the findings were mixed in terms of health care and patient and carer outcomes. Conclusions It is plausible that each model identified in this systematic review has a role to play in successfully discharging different cohorts of older adults from hospital. Further research is required to identify appropriate population groups for various discharge models and to select suitable outcome measures to determine the effectiveness of these models, considering all stakeholders' involved. PMID:24179455

  15. 75 FR 36610 - Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-28

    ... the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104- 4), Executive Order 13132 on... substantial number of small rural hospitals. Section 202 of the Unfunded Mandates Reform Act of 1995 also... individuals who may know the patient best act as an intermediary for the patient, helping to communicate...

  16. [Intraosseous access for in-hospital emergencies. Intensive medical care case study].

    PubMed

    Werner, M; Daniel, H-P; Hoitz, J

    2010-07-01

    Since the release of the 2005 resuscitation guidelines intraosseous infusion has been recognized as the favorite alternative vascular access in emergency patients. It is no longer restricted to paediatric emergencies but is also considered the vascular access of choice for adult patients with difficult venous access. Intraosseous access has been used in an increasing proportion of patients especially in an out-of-hospital emergency care setting while only limited experience exists for in-hospital usage of this technique. This article reports on a case of intraosseous access performed in a critically ill patient directly after admission to the intensive care unit (ICU) due to difficult peripheral venous access. Despite the extensive medical resources available in the ICU (i.e. central venous catheterization) less invasive means were used to render appropriate care. Based on this case different strategies of critical care and possible improvements will be discussed. Intraosseous infusion should be regarded as an infrequently needed but potentially life-saving procedure that is still too often considered as an option at later stages during in-hospital emergency care. PMID:20628712

  17. Intravenous access during pre-hospital emergency care of non-injured patients: a population-based outcome study

    PubMed Central

    Seymour, Christopher W.; Cooke, Colin R.; Hebert, Paul L.; Rea, Thomas D.

    2011-01-01

    Study objective Advanced, pre-hospital procedures such as intravenous access are commonly performed by emergency medical services (EMS) personnel, yet little evidence supports their use among non-injured patients. We evaluated the association between pre-hospital, intravenous access and mortality among non-injured, non-arrest patients. Methods We analyzed a population-based cohort of adult (aged ≥18 years) non-injured, non-arrest patients transported by four advanced life support agencies to one of 16 hospitals from January 1, 2002 until December 31, 2006. We linked eligible EMS records to hospital administrative data, and used multivariable logistic regression to determine the risk-adjusted association between pre-hospital, intravenous access and hospital mortality. We also tested whether this association differed by patient acuity using a previously published, out-of-hospital triage score. Results Among 56,332 eligible patients, one half (N=28,978, 50%) received pre-hospital intravenous access from EMS personnel. Overall hospital mortality in patients who did and did not receive intravenous access was 3%. However, in multivariable analyses, the placement of pre-hospital, intravenous access was associated with an overall reduction in odds of hospital mortality (OR=0.68, 95%CI: 0.56, 0.81). The beneficial association of intravenous access appeared to depend on patient acuity (p=0.13 for interaction). For example, the OR of mortality associated with intravenous access was 1.38 (95%CI: 0.28, 7.0) among those with lowest acuity (score = 0). In contrast, the OR of mortality associated with intravenous access was 0.38 (95%CI: 0.17, 0.9) among patients with highest acuity (score ≥ 6). Conclusions In this population-based cohort, pre-hospital, intravenous access was associated with a reduction in hospital mortality among non-injured, non-arrest patients with the highest acuity. PMID:21872970

  18. [Local communalization of clinical records between the municipal community hospital and local medical institutes by using information technology].

    PubMed

    Iijima, Shohei; Shinoki, Keiji; Ibata, Takeshi; Nakashita, Chisako; Doi, Seiko; Hidaka, Kumi; Hata, Akiko; Matsuoka, Mio; Waguchi, Hideko; Mito, Saori; Komuro, Ryutaro

    2012-12-01

    We introduced the electronic health record system in 2002. We produced a community medical network system to consolidate all medical treatment information from the local institute in 2010. Here, we report on the present status of this system that has been in use for the previous 2 years. We obtained a private server, set up a virtual private network(VPN)in our hospital, and installed dedicated terminals to issue an electronic certificate in 50 local institutions. The local institute applies for patient agreement in the community hospital(hospital designation style). They are then entitled to access the information of the designated patient via this local network server for one year. They can access each original medical record, sorted on the basis of the medical attendant and the chief physician; a summary of hospital stay; records of medication prescription; and the results of clinical examinations. Currently, there are approximately 80 new registrations and accesses per month. Information is provided in real time allowing up to date information, helping prescribe the medical treatment at the local institute. However, this information sharing system is read-only, and there is no cooperative clinical pass system. Therefore, this system has a limit to meet the demand for cooperation with the local clinics. PMID:23268886

  19. The accountability of nonprofit hospitals: lessons from Maryland's community benefit reporting requirements.

    PubMed

    Gray, Bradford H; Schlesinger, Mark

    2009-01-01

    Under Internal Revenue Service requirements, nonprofit hospitals will begin filing new community benefit reports in 2010. Maryland has had similar requirements since 2004. This paper, based on interviews at 20 hospitals, describes how Maryland's requirements affected hospitals and their activities. Increases in reported community benefit expenditures since the program began are due to both changes in activities and better data capture. Charity care accounts for one-third of community benefit dollars. A key distinction concerns whether hospitals take an accounting or managerial approach to community benefit. The Maryland experience suggests the issues that will arise when the national requirements are implemented. PMID:19694387

  20. Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms

    ERIC Educational Resources Information Center

    Hartley, David; Ziller, Erika C.; Loux, Stephenie L.; Gale, John A.; Lambert, David; Yousefian, Anush E.

    2007-01-01

    Context: National data demonstrate that mental health (MH) visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture of this issue. Purpose: This study investigates the use of critical access hospital (CAH) ERs by patients with MH problems to understand the role these…

  1. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  2. Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention

    ERIC Educational Resources Information Center

    Liu, Jiexin (Jason); Bellamy, Gail R.; McCormick, Melissa

    2007-01-01

    Purpose: To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally. Methods: Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to…

  3. The Role of International Medical Graduates in America?s Small Rural Critical Access Hospitals

    ERIC Educational Resources Information Center

    Hagopian, Amy; Thompson, Matthew J.; Kaltenbach, Emily; Hart, L. Gary

    2004-01-01

    Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost-based reimbursement from Medicare. Purpose: This study examines the role of foreign-born international medical graduates (IMGs) in the staffing of CAHs. Methods: Chief executive officers (CEOs) of CAH…

  4. A Study of the Access to the Scholarly Record From a Hospital Health Science Core Collection.

    ERIC Educational Resources Information Center

    Williams, James F., II; Pings, Vern M.

    This study is an effort to determine possible service performance levels in hospital libraries, based on access to the scholarly record of medicine through selected lists of clinical journals and indexing and abstracting journals. Specific emphasis is placed on (1) the citation verification through the use of the index and abstract journals, (2)…

  5. Adoption and Perceived Effectiveness of Financial Improvement Strategies in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Holmes, George M.; Pink, George H.

    2012-01-01

    Purpose: To ascertain the use and perceived success of strategies to improve the financial performance of Critical Access Hospitals (CAHs). Methods: Information about the use and perceived effectiveness of 44 specific strategies to improve financial performance was collected from an online survey of 291 CAH Chief Executive Officers and Chief…

  6. Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study

    PubMed Central

    Broccoli, Morgan C; Calvello, Emilie J B; Skog, Alexander P; Wachira, Benjamin; Wallis, Lee A

    2015-01-01

    Objectives We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members’ thoughts regarding high impact solutions to expand access to essential emergency services. Design We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. Setting Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. Results Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care—a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. Conclusions Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region. PMID:26586324

  7. Triad's new market strategy: a threat to community hospitals.

    PubMed

    Horning, Beth

    2004-01-01

    Faced with unprecedented financial pressures, many nonprofit hospitals today contemplate hooking up with large corporations and converting to for-profit status. In the deals that result, the talk is largely about stock value and the interests of investors. The larger public-interest question of how the conversion will affect the health of community members often receives short shift. Most recently, Triad, an HCA spin-off, has emerged as a major player in the market for faltering nonprofits, zeroing in on institutions all the way from Alaska to North Carolina, and this has advocates worried, because the company can be singularly insensitive to community health care needs. But Triad is also remarkably adept at winning public favor. In this States of Health, we'll look at the broader public policy questions raised by such corporate health ventures, questions that point to the need for stronger oversight and regulatory mechanisms to assure that the public interest is protected in our increasingly market-driven health system. PMID:14974489

  8. Trauma in elderly people: access to the health system through pre-hospital care1

    PubMed Central

    da Silva, Hilderjane Carla; Pessoa, Renata de Lima; de Menezes, Rejane Maria Paiva

    2016-01-01

    Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69 years (38.25%), average age 74.19 years (standard deviation±10.25). Among the mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a significant relation with the pre-hospital care services (p<0.001). Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8%) were the most used, with trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims. PMID:27143543

  9. Hospital-integrated PACS: R&D effort of the European communities

    NASA Astrophysics Data System (ADS)

    Ottes, Fenno P.; Bakker, Albert R.; Mattheus, Rudy A.; Osteaux, Michel; Kouwenberg, Jef M.

    1990-08-01

    A PACS research project under the name " FOUNDATIONS FOR A HOSPITAL INThGRATED PICTURE ARCHIVING AND COMMUNICATION SYSTEM" is currently conducted. The overall objective is the modular conception of an experimental knowledge-based medical information management and distribution system. Image/text document access and display will be based on an intelligent user interface for diagnostic image workstations. The concept will comprise the integration of PA.S with the functions of the Hospital Information System. It will be based upon standards and be realized by an interactive collaborationbetween 7 european research groups from universities, hospitals and industries. The multi-disciplinary groups will consist of engineers, computer scientists, medical doctors (both radiologists and clinicians) and physicists. The HIPACS project has a budget of ECU 1.3 million, of which 50% is provided by the Commission of European Communities (CEC) within the scope of the exploratory phase of the Advanced Informatics in Medicine (AIM) research programme. HIPACS is directed by Prof. M. Osteaux, the prime contractor. This paper first explains the backgrounds of the AIM program. Next, the objectives of the HIPACS project are reviewed. The cooperating partners and their (scheduled) research activities are listed. Finally, the continuation of HIPACS within scope of the main phase of AIM is discussed.

  10. Continuing Medical Education: Linking the Community Hospital and the Medical School.

    ERIC Educational Resources Information Center

    Manning, Phil R.; And Others

    1979-01-01

    A group of community hospitals has been linked to the University of Southern California School of Medicine in a continuing medical education network. An educational development team based at the school helps community hospital physicians identify educational needs and develop responses using local and medical school experts as faculty. (Author/JMD)

  11. SOCIALIZATION OF THE YOUNGER PSYCHIATRIC PATIENT--THE COMMUNITY AND THE HOSPITAL-A DUAL RESPONSIBILITY.

    ERIC Educational Resources Information Center

    GIORDANO, JOSEPH; AND OTHERS

    TO ASSIST YOUNG, MENTAL PATIENTS IN OVERCOMING SOME OF THEIR SOCIAL DEFICITS, TWO RESOCIALIZATION PROJECTS (PRE- AND POST-DISCHARGE) WERE INITIATED TO MOVE THE PATIENT FROM A MENTAL HOSPITAL SETTING INTO THE LARGER COMMUNITY, WITH A COMMUNITY CENTER AS THE LEARNING GROUND. CAREFULLY SELECTED PATIENTS FROM THE HOSPITAL WERE GIVEN THE OPPORTUNITY TO…

  12. No Accession-Specific Effect of Rhizosphere Soil Communities on the Growth and Competition of Arabidopsis thaliana Accessions

    PubMed Central

    Aguilera, Anna G.; Colón-Carmona, Adán; Kesseli, Rick; Dukes, Jeffrey S.

    2011-01-01

    Soil communities associated with specific plant species affect individual plants' growth and competitive ability. Limited evidence suggests that unique soil communities can also differentially influence growth and competition at the ecotype level. Previous work with Arabidopsis thaliana has shown that accessions produce distinct and reproducible rhizosphere bacterial communities, with significant differences in both species composition and relative abundance. We tested the hypothesis that soil communities uniquely affect the growth and reproduction of the plant accessions with which they are associated. Specifically, we examined the growth of four accessions when exposed to their own soil communities and the communities generated by each of the other three accessions. To do this we planted focal accessions inside a ring of six plants that created a “background” soil community. We grew focal plants in this design in three separate soil treatments: non-sterile soil, sterilized soil, and “preconditioned” soil. We preconditioned soil by growing accessions in non-sterile soil for six weeks before the start of the experiment. The main experiment was harvested after seven weeks of growth and we recorded height, silique number, and dry weight of each focal plant. Plants grown in the preconditioned soil treatment showed less growth relative to the non-sterile and sterile soil treatments. In addition, plants in the sterile soil grew larger than those in non-sterile soil. However, we saw no interaction between soil treatment and background accession. We conclude that the soil communities have a negative net impact on Arabidopsis thaliana growth, and that the unique soil communities associated with each accession do not differentially affect growth and competition of study species. PMID:22110679

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

    PubMed

    Kash, Bita A; Deshmukh, A A

    2013-01-01

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

  14. The effects of innovation factors on smartphone adoption among nurses in community hospitals.

    PubMed

    Putzer, Gavin J; Park, Yangil

    2010-01-01

    A relatively new mobile technological device is the smartphone-a phone with advanced features such as Windows Mobile software, access to the Internet, and other computer processing capabilities. This article investigates the decision to adopt a smartphone among healthcare professionals, specifically nurses. The study examines constructs that affect an individual's decision to adopt a smartphone by employing innovation attributes leading to perceived attitudes. We hypothesize that individual intentions to use a smartphone are mostly determined by attitudes toward using a smartphone, which in turn are affected by innovation characteristics. Innovation characteristics are factors that help explain whether a user will adopt a new technology. The study consisted of a survey disseminated to 200 practicing nurses selected from two community hospitals in the southeastern United States. In our model, the innovation characteristics of observability, compatibility, job relevance, internal environment, and external environment were significant predictors of attitude toward using a smartphone. PMID:20697467

  15. Access to and value of information to support good practice for staff in Kenyan hospitals

    PubMed Central

    Muinga, Naomi; Sen, Barbara; Ayieko, Philip; Todd, Jim; English, Mike

    2015-01-01

    Background Studies have sought to define information needs of health workers within very specific settings or projects. Lacking in the literature is how hospitals in low-income settings are able to meet the information needs of their staff and the use of information communication technologies (ICT) in day-to-day information searching. Objective The study aimed to explore where professionals in Kenyan hospitals turn to for work-related information in their day-to-day work. Additionally, it examined what existing solutions are provided by hospitals with regard to provision of best practice care. Lastly, the study explored the use of ICT in information searching. Design Data for this study were collected in July 2012. Self-administered questionnaires (SAQs) were distributed across 22 study hospitals with an aim to get a response from 34 health workers per hospital. Results SAQs were collected from 657 health workers. The most popular sources of information to guide work were fellow health workers and printed guidelines while the least popular were scientific journals. Of value to health workers were: national treatment policies, new research findings, regular reports from surveillance data, information on costs of services and information on their performance of routine clinical tasks; however, hospitals only partially met these needs. Barriers to accessing information sources included: ‘not available/difficult to get’ and ‘difficult to understand’. ICT use for information seeking was reported and with demographic specific differences noted from the multivariate logistic regression model; nurses compared to medical doctors and older workers were less likely to use ICT for health information searching. Barriers to accessing Internet were identified as: high costs and the lack of the service at home or at work. Conclusions Hospitals need to provide appropriate information by improving information dissemination efforts and providing an enabling environment that

  16. Survive On Call - A QI Project to Improve Access to Hospital Clinical Guidelines.

    PubMed

    Penders, Robert; Mallet, Mark

    2016-01-01

    Accessing clinical guidelines and telephone numbers can be time consuming for junior doctors, particularly during a busy on-call shift. Smartphones allow instant access to this information, without leaving a patient's bedside. This overcomes the relative paucity of fixed desktop computers available in most clinical areas. In this project, a trainee doctor developed a clinical smartphone app to improve the access of clinical and hospital-specific information. A representative sample of ten junior doctors were recruited to quantify the amount of time spent accessing guidelines using desktop computers, versus the App. The average time to access a common guideline (Hypokalaemia management) with the App was 12.4 seconds (95% CI 2.3), versus 76.8 seconds (95% CI 30.6) using a computer. A difference of 64.4 seconds (p < 0.001). The average time to access an Amiodarone prescribing guideline with the App was 25.9 seconds (95% CI 12.9), versus 142.0 seconds (95% CI 44.8) using a computer. A difference of 116.1 seconds (p < 0.001). User feedback was collected after each stage of release within the hospital. Following final release, users rated how much time they felt it saved them. 96.1% of respondents felt it either saved them time a 'few times a week' (53.85%) or 'significantly saved time every day' (42.31%). The project has significantly improved staff satisfaction with how easily they can access clinical guidelines and telephone numbers. They clearly feel it has improved their working efficiency. This has been supported by quantitative measures of actual time saved using the App. The ability to access such information in as little time as possible may be even more pertinent where decision-making is time-critical - for example in Anaesthesia and Emergency Medicine. Further study into these specialties is warranted to determine whether mobile information can impact upon patient safety and clinical outcomes. PMID:27239310

  17. Understanding dementia: effective information access from the Deaf community's perspective.

    PubMed

    Young, Alys; Ferguson-Coleman, Emma; Keady, John

    2016-01-01

    This study concerns older Deaf sign language users in the UK. Its aim was to explore how to enable effective information access and promote awareness and understanding of dementia from a culturally Deaf perspective. A purposive sample of 26 Deaf people without dementia participated in one of three focus groups facilitated directly in British Sign Language (BSL) without an intermediate interpreter. The sample was differentiated by age, role in the Deaf community, and diversity of educational attainment and professional experience. A phenomenological approach underpinned the thematic analysis of data. The findings demonstrate: (i) translation into (BSL) is a necessary but not sufficient condition to support understanding. Attention to culturally preferred means of engagement with information is vital; (ii) the content of information is best presented utilising structures and formats which cohere with Deaf people's visual cognitive strengths; and (iii) the importance of cultural values and cultural practices in raising awareness and building understanding of dementia. These include collective rather than individual responsibility for knowledge transfer and the pan-national nature of knowledge transfer among Deaf people(s). The discussion demonstrates how these specific features of effective information access and awareness building have universal implications relevant to public engagement and the promotion of general knowledge consistent with the National Dementia Strategy (England). PMID:25469427

  18. Improving Community Health While Satisfying a Critical Community Need: A Case Study for Nonprofit Hospitals

    PubMed Central

    Kephart, Donna K.; Dillon, Judith F.; McCullough, Jody R.; Blatt, Barbara J.; Kraschnewski, Jennifer L.

    2015-01-01

    Background School-based student health screenings identify issues that may affect physical and intellectual development and are an important way to maintain student health. Nonprofit hospitals can provide a unique resource to school districts by assisting in the timely completion of school-based screenings and meet requirements of the Affordable Care Act. This case study describes the collaboration between an academic medical center and a local school district to conduct school-based health screenings. Community Context Penn State Milton S. Hershey Medical Center and Penn State Hershey PRO Wellness Center collaborated with Lebanon School District to facilitate student health screenings, a need identified in part by a community health needs assessment. Methods From June 2012 through February 2013, district-wide student health screenings were planned and implemented by teams of hospital nursing leadership, school district leadership, and school nurses. In fall 2013, students were screened through standardized procedures for height, weight, scoliosis, vision, and hearing. Outcomes In 2 days, 3,105 students (67% of all students in the district) were screened. Letters explaining screening results were mailed to parents of all students screened. Debriefing meetings and follow-up surveys for the participating nurses provided feedback for future screenings. Interpretation The 2-day collaborative screening event decreased the amount of time spent by school nurses in screening students throughout the year and allowed them more time in their role as school wellness champion. Additionally, parents found out early in the school year whether their child needed physician follow-up. Partnerships between school districts and hospitals to conduct student health screenings are a practical option for increasing outreach while satisfying community needs. PMID:26513441

  19. Community control and pricing patterns of nonprofit hospitals: An antitrust analysis.

    PubMed

    Young, G J; Desai, K R; Hellinger, F J

    2000-12-01

    Traditional control of nonprofit hospitals by the communities they serve has been offered as justification for restraining antitrust enforcement of mergers that involve nonprofit hospitals. The community is arguably a constraint on a nonprofit's inclination to exercise market power in the form of higher prices; however, community control is likely to be attenuated for hospitals that through merger or acquisition become members of hospital systems--particularly those that operate on a regional or multiregional basis. We report findings from a study in which we examined empirically the relationship between market concentration and pricing patterns for three types of nonprofit hospitals that are distinguishable based on degree of community control: an independent hospital, a member of a local hospital system, and a member of a nonlocal hospital system. Study results indicated that when conditions existed to create a more concentrated market, (1) all three types of nonprofit hospitals exercised market power in the form of higher prices, and (2) hospitals that were members of nonlocal systems were more aggressive in exercising market power than were either independent or local system hospitals. The results have important implications for antitrust enforcement policy. PMID:11142052

  20. Assessment and management of children's pain in community hospitals.

    PubMed

    Caty, S; Tourigny, J; Koren, I

    1995-10-01

    Registered nurses (n = 72) working in 10 paediatric units in community hospitals in north-eastern Ontario, Canada, participated in a descriptive study investigating how nurses assess and manage pain in children. A four-part questionnaire was used to collect the self-reported data. Twenty-five (36%) of the respondents defined pain as an individual and personal experience and another 25 (36%) respondents defined pain as a more or less localized sensation or discomfort resulting from the stimulation of specialized nerve endings. In response to three different clinical situations, the subjects' mean pain ratings were: 5.72 for an infant; 7.34 for a 3-year-old; and 7.29 for a 12-year-old child. The criterion 'nurses' judgment' was cited as being used frequently in both the assessment and decision making process; however, there was indication that some of the current knowledge in the assessment and management of pain in children was not known or being used. PMID:8708181

  1. 42 CFR 412.92 - Special treatment: Sole community hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (a)(1)(ii) of this section, the hospital must include the following information with its request: (A... the hospital is unable to obtain the information required under paragraph (b)(1)(ii)(A) of this... may request that CMS provide this information. (B) If a hospital obtains the information as...

  2. 42 CFR 412.92 - Special treatment: Sole community hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (a)(1)(ii) of this section, the hospital must include the following information with its request: (A... the hospital is unable to obtain the information required under paragraph (b)(1)(ii)(A) of this... may request that CMS provide this information. (B) If a hospital obtains the information as...

  3. 42 CFR 412.92 - Special treatment: Sole community hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (a)(1)(ii) of this section, the hospital must include the following information with its request: (A... the hospital is unable to obtain the information required under paragraph (b)(1)(ii)(A) of this... may request that CMS provide this information. (B) If a hospital obtains the information as...

  4. Creating a “culture of research” in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program

    PubMed Central

    St. Germain, Diane; Nacpil, Lianne M; Zaren, Howard A; Swanson, Sandra M; Minnick, Christopher; Carrigan, Angela; Denicoff, Andrea M; Igo, Kathleen E; Acoba, Jared D; Gonzalez, Maria M; McCaskill-Stevens, Worta

    2015-01-01

    Background The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute’s Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period. Methods To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials. Limitations The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important

  5. Lack of effective communication between communities and hospitals in Uganda: a qualitative exploration of missing links

    PubMed Central

    Rutebemberwa, Elizeus; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Walker, Damien; Mutebi, Aloysius; Pariyo, George

    2009-01-01

    Background Community members are stakeholders in hospitals and have a right to participate in the improvement of quality of services rendered to them. Their views are important because they reflect the perspectives of the general public. This study explored how communities that live around hospitals pass on their views to and receive feedback from the hospitals' management and administration. Methods The study was conducted in eight hospitals and the communities around them. Four of the hospitals were from three districts from eastern Uganda and another four from two districts from western Uganda. Eight key informant interviews (KIIs) were conducted with medical superintendents of the hospitals. A member from each of three hospital management boards was also interviewed. Eight focus group discussions (FGDs) were conducted with health workers from the hospitals. Another eight FGDs (four with men and four with women) were conducted with communities within a five km radius around the hospitals. Four of the FGDs (two with men and two with women) were done in western Uganda and the other four in eastern Uganda. The focus of the KIIs and FGDs was exploring how hospitals communicated with the communities around them. Analysis was by manifest content analysis. Results Whereas health unit management committees were supposed to have community representatives, the representatives never received views from the community nor gave them any feed back from the hospitals. Messages through the mass media like radio were seen to be non specific for action. Views sent through suggestion boxes were seen as individual needs rather than community concerns. Some community members perceived they would be harassed if they complained and had reached a state of resignation preferring instead to endure the problems quietly. Conclusion There is still lack of effective communication between the communities and the hospitals that serve them in Uganda. This deprives the communities of the right to

  6. "Adelante en Utah": Dilemmas of Leadership and College Access in a University-School-Community Partnership

    ERIC Educational Resources Information Center

    Alemán, Enrique, Jr.; Pérez-Torres, Judith C.; Oliva, Nereida

    2013-01-01

    This case study discusses some of the issues that "Adelante," a 6-year university-school-community partnership, continues to encounter in addressing college access and parent and community leadership in a community of color. It provides the sociopolitical context as well as a description of the university and community partners that make…

  7. Assessing the differences and similarities between hospital chains and independents regarding revenues, profits, and community contributions.

    PubMed

    McDermott, Dennis R

    2009-01-01

    Hospital systems or chains continue to grow their market share relative to independent hospitals. This trend generates concerns among health care industry observers as historical performance suggests chains charge more for health care services than the independents while providing reduced contributions to their community. This study empirically assesses key performance measures of 67 acute-care hospitals in Virginia by testing if there are differences between chains and independents regarding total patient revenues, revenues per admission, profitability and community support, including charity care, bad debt, taxes paid and Medicaid participation. Implications to industry policy-makers as well as to hospital executives and marketing managers are then presented. PMID:19197585

  8. The return of the heart hospital. A hospital that specializes in providing cardiovascular services can meet community needs but will compete with existing community hospitals for market share.

    PubMed

    Smith, Robert B

    2002-10-01

    A hospital that provides cardiovascular services and embraces a heart-hospital brand and strategy can achieve competitive advantage. Providers that want to compete aggressively for cardiovascular services are developing a specialty-based carve-out strategy. A heart-hospital initiative can cannibalize revenues from a hospital's other programs and services. A successful heart-hospital strategy requires physician buy-in. A heart hospital needs a brand that customers will value. PMID:12373959

  9. Community benefit in exchange for non-profit hospital tax exemption: current trends and future outlook.

    PubMed

    Singh, Simone Rauscher

    2013-01-01

    Assessing the adequacy of the community benefits that not-for-profit hospitals provide in exchange for tax exemption remains a challenge. While recent changes to Internal Revenue Service (IRS) reporting requirements have improved transparency, the lack of clearly defined charitable expectations has resulted in critical scrutiny of not-for-profit hospitals' community benefits and numerous challenges to their tax exempt status. Using data from the revised IRS Form 990 Schedule H for 2009, this article documents the wide range of community benefit activities that not-for-profit hospitals in California engage in and compares them to a set of minimum spending thresholds. The findings show that when community benefit was defined narrowly in terms of charity care, very few hospitals would have met any of the minimum spending thresholds. When community benefit was defined as in the revised IRS Form 990 Schedule H, however, a majority of hospitals in California would have been considered charitable. Whether focusing on expenditures is the most appropriate way to assess the adequacy of a hospital's community benefits remains an open question. To that end, this article concludes by outlining a more comprehensive evaluation approach that builds on recent changes to non-profit hospital tax exemption implemented by the Affordable Care Act. PMID:23614265

  10. Economic and safety benefits of pharmaceutical interventions by community and hospital pharmacists in Japan.

    PubMed

    Tasaka, Yuichi; Yasunaga, Daiki; Tanaka, Mamoru; Tanaka, Akihiro; Asakawa, Takashige; Horio, Ikuo; Miyauchi, Yoshiro; Araki, Hiroaki

    2016-04-01

    Background Pharmaceutical interventions by community and hospital pharmacists can improve medication safety and result in financial savings. Their effect has not been fully explored in Japan. Objective To evaluate the economic and safety contributions of various pharmaceutical interventions by community and hospital pharmacists in Japan. Setting Two hospitals and eight community pharmacies in Ehime Prefecture, Japan, in 2014-2015. Method Pharmacists entered data about pharmaceutical interventions via the internet, and the data were divided into 11 types of interventions. The economic impact was estimated based on the rate of avoidance of serious adverse drug reactions and the monetary cost of these reactions in the Japanese compensation system. The cost saving from adjusting prescriptions to take account of unused prescription drugs was calculated using drug prices from the national health insurance scheme. Main outcome measure The number of pharmaceutical interventions and their economic impact. Results The total cost savings from 500 to 509 pharmaceutical interventions by community and hospital pharmacists were US$207,126.6 and US$592,840, respectively. Community pharmacists mainly intervened to correct prescription errors. They also adjusted 135 prescriptions to take account of unused prescription drugs. This potentially improved patients' adherence and contributed to effective use of medication. Pharmaceutical interventions by hospital pharmacists facilitated avoidance of 10 serious adverse drug reactions, and included 42 transvenous antimicrobial therapy interventions, 88 interventions in cancer chemotherapy, and 47 monitoring recommendations. Hospital pharmacists helped improve patients' quality of life using more aggressive interventions besides correcting prescription errors. Over half of pharmaceutical interventions by community and hospital pharmacists contributed to avoidance of adverse drug reactions. Conclusion These results suggest the importance of

  11. Hospital-based community outreach to medically isolated elders. The nurse gerontologist is a key link in this health care delivery system in Wisconsin.

    PubMed

    Haworth, M J

    1993-01-01

    The development of a hospital-based community outreach nursing program has been beneficial for St. Mary's Hospital in several ways. The outreach program has served a community need in that many elderly persons who were previously medically isolated have now been located and linked to the health care delivery system. The outreach program has reinforced the hospital's presence and leadership role in the community through its work with the elderly population. The hospital is seen as being committed to bringing health care services to its elderly neighbors. Through the establishment and coordination of health care services to previously isolated and unconnected elderly persons, there has been a broadened revenue base for hospital operations. The outreach program also supports the mission, philosophy, and objectives of the Daughters of Charity. The efforts of this outreach program have shown that high-quality, accessible, and coordinated care for the elderly population may be obtained using a nurse gerontologist. Efforts to expand the market share of elderly persons by the hospital has continued through the development of other innovative health programs, resources, and services. Hospital administrators need to develop programs and services that effectively utilize limited health care dollars and resources to improve the quality of health care within the community. PMID:8383077

  12. Spatial distribution and accessibility to public sector tertiary care teaching hospitals in Karachi: A Geographic Information Systems application.

    PubMed

    Shaikh, Masood Ali; Ali, Mir Shabbar

    2016-07-01

    Optimal utilization of specialized curative healthcare services is contingent on spatial access to tertiary-care hospitals by the targeted population. The objectives of this study were to determine the spatial distribution of public sector tertiary-care teaching hospitals in Karachi, and to use GIS and network analysis for modeling the accessibility to these hospitals for Karachi residents. Maps of three, six, and nine kilometer buffers were created around the five selected hospitals to determine which towns of Karachi are either entirely or partially covered/accessible. Most of the towns in Karachi were covered either partially or completely by the three buffers and service areas of 3,6, and 9 kilometers around the five selected hospitals. This study highlights the limitations of using publicly available data for road network, and the need for creating and making available in public domain, comprehensive road network vector dataset in conjunction with population breakdowns by administrative subdivisions. PMID:27427142

  13. The Impacts of Free Public Internet Access on Public Library Patrons and Communities

    ERIC Educational Resources Information Center

    Bertot, John Carlo; McClure, Charles R.; Jaeger, Paul T.

    2008-01-01

    Public libraries have evolved into a primary source of Internet access in many communities, generating wide-ranging impacts in the communities that public libraries serve. Based on the findings of the 2007 Public Libraries and the Internet study, this article examines the ways in which the Internet access delivered by public libraries affects…

  14. News and Information on Community Access Channels: Market Concerns amidst the Marketplace of Ideas.

    ERIC Educational Resources Information Center

    Atkin, David; LaRose, Robert

    Utilizing a regionally diversified sample of cable viewers to investigate viewer patronage of community channels--defined to include public, educational, and government (PEG) access as well as community (or leased) access channels, a study examined a quarterly national survey of homes serviced by cable in the United States. Each quarter, 1,000…

  15. The provision and reporting of community benefits by hospitals: lessons from Maryland.

    PubMed

    Hudson, Nicole

    2009-09-01

    (1) Most Maryland hospitals experienced a difficult learning curve in 2004 when they were required to begin filing annual reports on community benefit expenditures, but hospital leaders now generally see the reporting requirements to have been beneficial for hospitals. (2) Charity care and health professional education each account for about one-third of community benefit expenditures in Maryland hospitals, and mission-related services around 20 percent. (3) Community benefit accounts for more that [sic] 7.2 percent of hospitals' expenditures on average, with the range from less than two percent to more than 14 percent. Charity care averages 2.1 percent of expenditures, with the range from less than 1 percent to more than 6 percent of expenses. PMID:19757537

  16. Survive On Call - A QI Project to Improve Access to Hospital Clinical Guidelines

    PubMed Central

    Penders, Robert; Mallet, Mark

    2016-01-01

    Accessing clinical guidelines and telephone numbers can be time consuming for junior doctors, particularly during a busy on-call shift. Smartphones allow instant access to this information, without leaving a patient's bedside. This overcomes the relative paucity of fixed desktop computers available in most clinical areas. In this project, a trainee doctor developed a clinical smartphone app to improve the access of clinical and hospital-specific information. A representative sample of ten junior doctors were recruited to quantify the amount of time spent accessing guidelines using desktop computers, versus the App. The average time to access a common guideline (Hypokalaemia management) with the App was 12.4 seconds (95% CI 2.3), versus 76.8 seconds (95% CI 30.6) using a computer. A difference of 64.4 seconds (p < 0.001). The average time to access an Amiodarone prescribing guideline with the App was 25.9 seconds (95% CI 12.9), versus 142.0 seconds (95% CI 44.8) using a computer. A difference of 116.1 seconds (p < 0.001). User feedback was collected after each stage of release within the hospital. Following final release, users rated how much time they felt it saved them. 96.1% of respondents felt it either saved them time a ‘few times a week’ (53.85%) or ‘significantly saved time every day’ (42.31%). The project has significantly improved staff satisfaction with how easily they can access clinical guidelines and telephone numbers. They clearly feel it has improved their working efficiency. This has been supported by quantitative measures of actual time saved using the App. The ability to access such information in as little time as possible may be even more pertinent where decision-making is time-critical - for example in Anaesthesia and Emergency Medicine. Further study into these specialties is warranted to determine whether mobile information can impact upon patient safety and clinical outcomes. PMID:27239310

  17. Union Memorial Hospital: an insight to the origin of community-based surgical training.

    PubMed

    Gupta, Vinay K; Heitmiller, Richard F

    2008-01-01

    Community-based surgical training centers comprise almost half of the current ACGME-approved programs. Yet the histories of these community hospital programs have not been defined clearly. University programs were founded with the time-honored mission to deliver patient care, teaching, and research. We feel that early community programs developed with close ties to university programs before diverging in their evolution. As successful university faculty expanded their elective surgical practice, they often admitted patients to private hospitals, most in close proximity to their university hospitals. Many surgeons maintained joint appointments on the university and private hospital staffs, whereas others left the university staff to focus their efforts on their clinical practice. The more prominent clinicians continued to attract students interested in apprenticeships in surgery; and community based training programs developed that focused primarily on patient care and teaching. We review the history of our program that we feel illustrates this process. PMID:18439543

  18. Inequality in Preschool Quality? Community-Level Disparities in Access to High-Quality Learning Environments

    ERIC Educational Resources Information Center

    Bassok, Daphna; Galdo, Eva

    2016-01-01

    In recent years, unequal access to high-quality preschool has emerged as a growing public policy concern. Because of data limitations, it is notoriously difficult to measure disparities in access to early learning opportunities across communities and particularly challenging to quantify gaps in access to "high-quality" programs. Research…

  19. Developing a Multicomponent Model of Nutritious Food Access and Related Implications for Community and Policy Practice

    PubMed Central

    FREEDMAN, DARCY A.; BLAKE, CHRISTINE E.; LIESE, ANGELA D.

    2014-01-01

    Access to nutritious foods is limited in disenfranchised communities in the United States. Policies are beginning to focus on improving nutritious food access in these contexts; yet, few theories are available to guide this work. We developed a conceptual model of nutritious food access based on the qualitative responses of food consumers in 2 different regions of the American South. Five domains (economic, service delivery, spatial–temporal, social, and personal) and related dimensions of nutritious food access were identified. The conceptual model provides practical guidance to researchers, policy makers, and practitioners working to improve nutritious food access in communities. PMID:24563605

  20. Tax-exempt hospitals and community benefit: new directions in policy and practice.

    PubMed

    Rubin, Daniel B; Singh, Simone R; Young, Gary J

    2015-03-18

    The current community benefit standard for nonprofit hospital tax exemption has been the subject of mounting criticism. Many different constituencies have advanced the view that in its present form it fails to ensure that nonprofit hospitals provide adequate benefits to their communities in exchange for their tax exemption. In contrast, hospitals have often expressed the concern that the community benefit standard in its current form is vague and therefore difficult to comply with. Various suggestions have been made regarding how the existing community benefit standard could be improved or even replaced. In this article, we first discuss the historical and legal development of the community benefit standard. We then present the key controversies that have emerged in recent years and the policy responses attempted thus far. Finally, we evaluate possible future policy directions, which reform efforts could follow. PMID:25785895

  1. Integration of an academic medical center and a community hospital: the Brigham and Women's/Faulkner hospital experience.

    PubMed

    Sussman, Andrew J; Otten, Jeffrey R; Goldszer, Robert C; Hanson, Margaret; Trull, David J; Paulus, Kenneth; Brown, Monte; Dzau, Victor; Brennan, Troyen A

    2005-03-01

    Brigham and Women's Hospital (BWH), a major academic tertiary medical center, and Faulkner Hospital (Faulkner), a nearby community teaching hospital, both in the Boston, Massachusetts area, have established a close affiliation relationship under a common corporate parent that achieves a variety of synergistic benefits. Formed under the pressures of limited capacity at BWH and excess capacity at Faulkner, and the need for lower-cost clinical space in an era of provider risk-sharing, BWH and Faulkner entered into a comprehensive affiliation agreement. Over the past seven years, the relationship has enhanced overall volume, broadened training programs, lowered the cost of resources for secondary care, and improved financial performance for both institutions. The lessons of this relationship, both in terms of success factors and ongoing challenges for the hospitals, medical staffs, and a large multispecialty referring physician group, are reviewed. The key factors for success of the relationship have been integration of training programs and some clinical services, provision of complementary clinical capabilities, geographic proximity, clear role definition of each institution, commitment and flexibility of leadership and medical staff, active and responsive communication, and the support of a large referring physician group that embraced the affiliation concept. Principal challenges have been maintaining the community hospital's cost structure, addressing cultural differences, avoiding competition among professional staff, anticipating the pace of patient migration, choosing a name for the new affiliation, and adapting to a changing payer environment. PMID:15734807

  2. Rural Community College Initiative: I. Access: Removing Barriers to Participation. AACC Project Brief.

    ERIC Educational Resources Information Center

    Eller, Ronald; Martinez, Ruben; Pace, Cynthia; Pavel, Michael; Garza, Hector; Barnett, Lynn

    The Rural Community College Initiative (RCCI) is a decade-long commitment by the Ford Foundation to community colleges in distressed rural areas of the United States. Through RCCI, the Foundation channels both funds and technical assistance to targeted community colleges to improve access and foster economic development. The RCCI approach includes…

  3. Transitions within the Community College: Pathways to Access and Inclusion

    ERIC Educational Resources Information Center

    Hagedorn, Linda Serra; Prather, George M.

    2006-01-01

    Community colleges are often criticized for the low numbers of students who ostensibly appear successful. This article takes a unique look at the pathways many community college students take and redefines success as transition. Using the full population of the Los Angeles Community College District, this article examines the intra-institutional…

  4. The Community Health Information Network: A Model for Hospital and Public Library Cooperation

    ERIC Educational Resources Information Center

    Gartenfeld, Ellen

    1978-01-01

    The Community Health Information Network, a cooperative library network established between a community hospital and six public libraries, is described. This model program provides health education and information services to patient/consumers and library services to health personnel through their public libraries. Funding, factors leading to the…

  5. Access to innovation: is there a difference in the use of expensive anticancer drugs between French hospitals?

    PubMed

    Bonastre, Julia; Chevalier, Julie; Van der Laan, Chantal; Delibes, Michel; De Pouvourville, Gerard

    2014-06-01

    In DRG-based hospital payment systems, expensive drugs are often funded separately. In France, specific expensive drugs (including a large proportion of anticancer drugs) are fully reimbursed up to national reimbursement tariffs to ensure equity of access. Our objective was to analyse the use of expensive anticancer drugs in public and private hospitals, and between regions. We had access to sales per anticancer drug and per hospital in the year 2008. We used a multilevel model to study the variation in the mean expenditure of expensive anticancer drugs per course of chemotherapy and per hospital. The mean expenditure per course of chemotherapy was €922 [95% CI: 890-954]. At the hospital level, specialisation in chemotherapies for breast cancers was associated with a higher expenditure of anticancer drugs per course for those hospitals with the highest proportion of cancers at this site. There were no differences in the use of expensive drugs between the private and the public hospital sector after controlling for case mix. There were no differences between the mean expenditures per region. The absence of disparities in the use of expensive anticancer drugs between hospitals and regions may indicate that exempting chemotherapies from DRG-based payments and providing additional reimbursement for these drugs has been successful at ensuring equal access to care. PMID:24314625

  6. Prehospital care and the community hospital as a base station.

    PubMed

    Morhaim, D K

    1989-03-01

    In Maryland's coordinated, regionalized emergency medical system, prehospital care is given to an injured or ill person at home, on the street, or in a doctor's office before the patient is transported to a hospital. Prehospital care of patients has advanced significantly since the federal government passed emergency medical service (EMS) legislation in 1966. In Maryland there are several functioning levels of prehospital care providers who perform skills unique to their particular environment and training. It is reasonable for all hospitals operating a full-service Emergency Department to consider becoming base stations for consultation to prehospital care providers bringing patients to that hospital. This is well within the province of the Emergency Medicine specialist and will provide improved service to patients. PMID:2927265

  7. 'Pharmacy deserts' are prevalent in Chicago's predominantly minority communities, raising medication access concerns.

    PubMed

    Qato, Dima M; Daviglus, Martha L; Wilder, Jocelyn; Lee, Todd; Qato, Danya; Lambert, Bruce

    2014-11-01

    Attempts to explain and address disparities in the use of prescription medications have focused almost exclusively on their affordability. However, the segregation of residential neighborhoods by race or ethnicity also may influence access to the pharmacies that, in turn, provide access to prescription medications within a community. We examined whether trends in the availability of pharmacies varied across communities in Chicago with different racial or ethnic compositions. We also examined the geographic accessibility of pharmacies to determine whether "pharmacy deserts," or low-access neighborhoods, were more common in segregated black and Hispanic communities than elsewhere. We found that throughout the period 2000-2012 the number of pharmacies was lower in segregated minority communities than in segregated white communities and integrated communities. In 2012 there were disproportionately more pharmacy deserts in segregated black communities, as well as in low-income communities and federally designated Medically Underserved Areas. Our findings suggest that public policies aimed at improving access to prescription medications may need to address factors beyond insurance coverage and medication affordability. Such policies could include financial incentives to locate pharmacies in pharmacy deserts or the incorporation of pharmacies into community health centers in Medically Underserved Areas. PMID:25367990

  8. The political correctness of a physician hospital organization may precipitate its demise in a community hospital.

    PubMed

    Hoffman, J S

    1995-01-01

    Health maintenance organizations are placing an increased pressure on physicians and hospitals to assume the risk of providing health care services under capitated agreements. They believe that if the providers' profits are based upon their cost-efficient provision of medical services, they will control their use of medical resources and reduce health care spending. Managing the risks of a capitated contract necessitates the integration of the hospital's and the physician's incentives. However, is the most appropriate legal structure that will enable physicians and hospitals to form risk-sharing contracts with managed care entities and manage these contracts profitably a physician-hospital organization? It is estimated that over 50 percent of the physician-hospital organizations that are created each year fail within the first two years of their operation because of political and financial reasons. A multispecialty group composed of select physicians, who are willing to integrate their practices and who have a low length of stay in the hospital, may be in a better position to manage the risks imposed by capitated contracts. PMID:10144136

  9. Collaboration Among Missouri Nonprofit Hospitals and Local Health Departments: Content Analysis of Community Health Needs Assessments

    PubMed Central

    Wilson, Kristin D.; Ciecior, Amanda; Stringer, Lisa

    2015-01-01

    Objectives. We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital’s community health needs assessments (CHNAs). Methods. In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n = 34) CHNAs, and identified hospitals based on previously reported collaboration with LHDs. We coded the content according to the level of joint action. A comparison sample (n = 50) of Missouri nonprofit hospitals provided the basic comparative information on hospital characteristics. Results. Among the hospitals identified by LHDs, 20.6% were “networking,” 20.6% were “coordinating,” 38.2% were “cooperating,” and 2.9% were “collaborating.” Almost 18% of study hospitals had no identifiable level of joint action with LHDs based on their CHNAs. In addition, comparison hospitals were more often part of a larger system (74%) compared with study hospitals (52.9%). Conclusions. The results of our study helped develop a better understanding of levels of joint action from a hospital perspective. Our results might assist hospitals and LHDs in making more informed decisions about efficient deployment of resources for assessment processes and implementation plans. PMID:25689184

  10. The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: A systematic review

    PubMed Central

    Prina, A. Matthew; Cosco, Theodore D.; Dening, Tom; Beekman, Aartjan; Brayne, Carol; Huisman, Martijn

    2015-01-01

    Objectives This paper aims to systematically review observational studies that have analysed whether depressive symptoms in the community are associated with higher general hospital admissions, longer hospital stays and increased risk of re-admission. Methods We identified prospective studies that looked at depressive symptoms in the community as a risk factor for non-psychiatric general hospital admissions, length of stay or risk of re-admission. The search was carried out on MEDLINE, PsycINFO, Cochrane Library Database, and followed up with contact with authors and scanning of reference lists. Results Eleven studies fulfilled our inclusion and exclusion criteria, and all were deemed to be of moderate to high quality. Meta-analysis of seven studies with relevant data suggested that depressive symptoms may be a predictor of subsequent admission to a general hospital in unadjusted analyses (RR = 1.36, 95% CI: 1.28–1.44), but findings after adjustment for confounding variables were inconsistent. The narrative synthesis also reported depressive symptoms to be independently associated with longer length of stay, and higher re-admission risk. Conclusions Depressive symptoms are associated with a higher risk of hospitalisation, longer length of stay and a higher re-admission risk. Some of these associations may be mediated by other factors, and should be explored in more details. PMID:25466985

  11. Implementation of an Acute Care Surgery Service in a Community Hospital: Impact on Hospital Efficiency and Patient Outcomes.

    PubMed

    Kalina, Michael

    2016-01-01

    A service led by acute care surgeons managing trauma, critically ill surgical, and emergency general surgery patients via an acute care surgery model of patient care improves hospital efficiency and patient outcomes at university-affiliated hospitals and American College of Surgeons-verified trauma centers. Our goal was to determine whether an acute care surgeon led service, entitled the Surgical Trauma and Acute Resuscitative Service (STARS) that implemented an acute care surgery model of patient care, could improve hospital efficiency and patient outcomes at a community hospital. A total of 492 patient charts were reviewed, which included 230 before the implementation of the STARS [pre-STARS (control)] and 262 after the implementation of the STARS [post-STARS (study)]. Demographics included age, gender, Acute Physiology and Chronic Health Evaluation 2 score, and medical comorbidities. Efficiency data included length of stay in emergency department (ED-LOS), length of stay in surgical intensive care unit (SICU-LOS), and length of stay in hospital (H-LOS), and total in hospital charges. Average age was 64.1 + 16.4 years, 255 males (51.83%) and 237 females (48.17%). Average Acute Physiology and Chronic Health Evaluation 2 score was 11.9 + 5.8. No significant differences in demographics were observed. Average decreases in ED-LOS (9.7 + 9.6 hours, pre-STARS versus 6.6 + 4.5 hours, post-STARS), SICU-LOS (5.3 + 9.6 days, pre-STARS versus 3.5 + 4.8 days, post-STARS), H-LOS (12.4 + 12.7 days, pre-STARS versus 11.4 + 11.3 days, post-STARS), and total in hospital charges ($419,602.6 + $519,523.0 pre-STARS to $374,816.7 + $411,935.8 post-STARS) post-STARS. Regression analysis revealed decreased ED-LOS-2.9 hours [P = 0.17; 95% confidence interval (CI): -7.0, 1.2], SICU-LOS-6.3 days (P < 0.001; 95% CI: -9.3, -3.2), H-LOS-7.6 days (P = 0.001; 95% CI: -12.1, -3.1), and 3.4 times greater odds of survival (P = 0.04; 95% CI: 1.1, 10.7) post-STARS. In conclusion, implementation of

  12. Performance indicators for information technology services at four community hospitals.

    PubMed

    Rappaport, Pegi; Dimnik, Gerry; Burns, Rodney; Bowie, Jamie

    2006-01-01

    During the 2004/05 fiscal year, the Directors of Information Technology Services (ITS) at four Toronto-area hospitals agreed to participate in a detailed benchmarking exercise looking at ITS costs and services in their organizations. The indicators presented in this article highlight some of the findings from this data analysis. PMID:16826771

  13. Teaching hospital performance: towards a community of shared values?

    PubMed

    Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita

    2014-01-01

    This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. PMID:24560230

  14. Teaching through "Testimonio": Accessing Community Cultural Wealth in School

    ERIC Educational Resources Information Center

    DeNicolo, Christina Passos; González, Mónica; Morales, Socorro; Romaní, Laura

    2015-01-01

    Using the concept of community cultural wealth, this article examines the ways that a group of 3rd-grade students engaged in writing "testimonios," or personal narratives, to reflect on their cultural and linguistic lives in and outside of the classroom. Countering deficit notions of Latina/o students, families, and communities, this…

  15. Visualizing Access: Knowledge Development in University-Community Partnerships

    ERIC Educational Resources Information Center

    Strier, Roni; Shechter, Dorit

    2016-01-01

    This article tackles the need to democratize processes of knowledge production in the context of university-community partnerships. These partnerships, which are a rich source of academic research, allow universities to create more reciprocal relationships with communities, especially those affected by social inequalities. Through their social…

  16. Gender and Transportation Access among Community-Dwelling Seniors

    ERIC Educational Resources Information Center

    Dupuis, Josette; Weiss, Deborah R.; Wolfson, Christina

    2007-01-01

    Purpose: This study estimates the prevalence of problems with transportation in a sample of community-dwelling seniors residing in an urban setting and investigates the role that gender plays in the ability of seniors to remain mobile in their communities. Design and Methods: Data collected as part of a study assessing the prevalence and…

  17. Delayed insect access alters carrion decomposition and necrophagous insect community assembly

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vertebrate carrion in terrestrial ecosystems is an unpredictable, ephemeral resource pulse that contributes to local biodiversity and nutrient transformation dynamics. We hypothesized that delayed insect access to carrion would demonstrate marked shifts in necrophagous insect community structure, t...

  18. Safety net hospital, community providers collaborate to improve transitions.

    PubMed

    2016-03-01

    A Care Transitional Task Force at San Francisco General Hospital created a cross-continuum program that has reduced readmissions and increased timely primary care visits for discharged patients. A basic bundle of services includes communication between inpatient and outpatient providers, providing the right information to the next level of providers, and giving patients and family members the right level of education. Transitional care nurses work with heart failure patients of any age and patients over 55 with chronic obstructive pulmonary disease, diabetes, renal failure, or who are recovering from a myocardial infarction. The nurses work closely with patients and family members during the hospital stay and follow up weekly for 30 days after discharge. PMID:26964416

  19. [Desirable medical technologists in a community support hospital].

    PubMed

    Takeda, Kyoko

    2008-07-01

    Recently, there have been marked advances in the technological strategies employed in medical examinations. The educational concept to nurture highly capable medical technologists is considered to be a priority issue by not only educators but also employers, even though the medical educational levels have markedly improved in every college and university. It is commonly acknowledged that the results of any examination in the clinical laboratory should be accurate and fed back to medical doctors as soon as possible. The business outline of medical technologists in our hospital is becoming more extensive because we act as a core hospital in the area, and so knowledge regarding many kinds of chemical and transfusion examinations is required in operations performed around the clock. Furthermore, medical doctors, clerical workers, nurses, and volunteers comprise a team of sophisticated workers in our hospital. To accomplish our daily work, character traits such as accuracy, honesty, perseverance, and ability to follow instruction manuals, are the most fundamental and valuable. To nurture a highly career-oriented medical technologist, we propose that the following should be focused on: self-responsibility, reduction of malpractices, economic profitability, brainstorming, education of subsequent generations, and the spirit of cooperativeness and reconciliation. Additionally, it is another basic requirement of competent medical technologists to learn to adapt to laboratory-based changes in their work throughout their career. In conclusion, how to adapt to any social demand and learn strategies in any era should be taught in college or university as well as after graduation because each hospital and institute has a different philosophy and requirements of newcomers. It is important for medical technologists and doctors to develop flexible ways of thinking, although we sometimes might accede to traditional ways. PMID:18709992

  20. In-hospital and long-term mortality in Takotsubo cardiomyopathy: a community hospital experience

    PubMed Central

    Vriz, Olga; Brosolo, Gabriele; Martina, Stefano; Pertoldi, Franco; Citro, Rodolfo; Mos, Lucio; Ferrara, Francesco; Bossone, Eduardo

    2016-01-01

    Background Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular dysfunction, frequently precipitated by a stressful event. Despite the favorable course and good long-term prognosis, a variety of complications may occur in the acute phase of the disease. The aim of this study was to evaluate the in-hospital and long-term outcomes of a cohort of TTC patients. Methods Fifty-five patients (mean age 68.1±12 years) were prospectively followed for a mean of 69.6±32.2 months (64,635 days). In-hospital (death, heart failure, arrhythmias) and long-term events (death and recurrences) were recorded. Results Patients were predominantly women (87.3%) who experienced a recent stressful event (emotional or physical) and were admitted to hospital for chest pain. Eleven patients (20%) had a diagnosis of depressive disorder, and arterial hypertension was the most frequent cardiovascular risk factor. The ECG revealed ST-segment elevation in 43.6% of patients. At angiography, seven cases (12.7%) had at least one significant (≥50%) coronary artery stenosis and four patients (7.3%) had myocardial bridging of the left anterior descending artery. During hospitalization, three patients died (one from cardiac causes) and cardiovascular complications occurred in 12 patients. During follow-up, five patients died (none from cardiac causes), six patients had recurrences within the first year. Two patients had two recurrences: one after 114 days, triggered by an asthma attack as the first event, and the other after 1,850 days. Conclusions In TTC patients, in-hospital and long-term mortality is primarily due to non-cardiovascular causes. Recurrences are not infrequent and coronary artery disease is not an uncommon finding. PMID:27406446

  1. Language Access Toolkit: An Organizing and Advocacy Resource for Community-Based Youth Programs

    ERIC Educational Resources Information Center

    Beyersdorf, Mark Ro

    2013-01-01

    Asian American Legal Defense and Education Fund (AALDEF) developed this language access toolkit to share the expertise and experiences of National Asian American Education Advocates Network (NAAEA) member organizations with other community organizations interested in developing language access campaigns. This toolkit includes an overview of…

  2. Accessibility patterns and community integration among previously homeless adults: a Geographic Information Systems (GIS) approach.

    PubMed

    Chan, Dara V; Gopal, Sucharita; Helfrich, Christine A

    2014-11-01

    Although a desired rehabilitation goal, research continues to document that community integration significantly lags behind housing stability success rates for people of a variety of ages who used to be homeless. While accessibility to resources is an environmental factor that may promote or impede integration activity, there has been little empirical investigation into the impact of proximity of community features on resource use and integration. Using a Geographic Information Systems (GIS) approach, the current study examines how accessibility or proximity to community features in Boston, United States related to the types of locations used and the size of an individual's "activity space," or spatial presence in the community. Significant findings include an inverse relationship between activity space size and proximity to the number and type of community features in one's immediate area. Specifically, larger activity spaces were associated with neighborhoods with less community features, and smaller activity spaces corresponded with greater availability of resources within one's immediate area. Activity space size also varied, however, based on proximity to different types of resources, namely transportation and health care. Greater community function, or the ability to navigate and use community resources, was associated with better accessibility and feeling part of the community. Finally, proximity to a greater number of individual identified preferred community features was associated with better social integration. The current study suggests the ongoing challenges of successful integration may vary not just based on accessibility to, but relative importance of, specific community features and affinity with one's surroundings. Community integration researchers and housing providers may need to attend to the meaning attached to resources, not just presence or use in the community. PMID:25243640

  3. Fewer Hospitalizations for Chronic Obstructive Pulmonary Disease in Communities With Smoke-Free Public Policies

    PubMed Central

    Rayens, Mary Kay; Adkins, Sarah; Simpson, Nick; Frazier, Susan; Mannino, David M.

    2014-01-01

    Objectives. We determined the impact of smoke-free municipal public policies on hospitalizations for chronic obstructive pulmonary disease (COPD). Methods. We conducted a secondary analysis of hospital discharges with a primary diagnosis of COPD in Kentucky between July 1, 2003, and June 30, 2011 using Poisson regression. We compared the hospitalization rates of regions with and without smoke-free laws, adjusting for personal and population covariates, seasonality, secular trends over time, and geographic region. Results. Controlling for covariates such as sex, age, length of stay, race/ethnicity, education, income, and urban–rural status, among others, we found that those living in a community with a comprehensive smoke-free law or regulation were 22% less likely to experience hospitalizations for COPD than those living in a community with a moderate–weak law or no law. Those living in a community with an established law were 21% less likely to be hospitalized for COPD than those with newer laws or no laws. Conclusions. Strong smoke-free public policies may provide protection against COPD hospitalizations, particularly after 12 months, with the potential to save lives and decrease health care costs. PMID:24825207

  4. The Changing Role of Community Networks in Providing Citizen Access to the Internet.

    ERIC Educational Resources Information Center

    Keenan, Thomas P.; Trotter, David Mitchell

    1999-01-01

    Examines the changing role of community network associations or freenets in providing Internet access by examining the case of the Calgary Community Network Association (CCNA) in Alberta, Canada. Discusses the withdrawal of states from the telecommunications field, priorities of the Canadian government, and the role of the private sector.…

  5. (Re)Examining the Role of Family and Community in College Access and Choice: A Metasynthesis

    ERIC Educational Resources Information Center

    Mwangi, Chrystal A. George

    2015-01-01

    Using meta-synthesis, this study analyzes higher education literature to provide a comprehensive understanding of the role of nonparent family and community (NPFC) members such as siblings, extended family, fictive kin, and peers in college access and choice. Findings revealed the diverse familial and community networks of today's college going…

  6. The Open Course Library: Using Open Educational Resources to Improve Community College Access

    ERIC Educational Resources Information Center

    Goodwin, Mary Ann Lund

    2011-01-01

    Community colleges are committed to meeting the educational needs of the communities they serve and they have increased access to higher education by offering new and innovative services to students often unable to attend traditional baccalaureate institutions. An innovation known as Open Educational Resources (OER) promises to make college more…

  7. The Impact of Computer Technology on Student Access and Success in the California Community Colleges.

    ERIC Educational Resources Information Center

    Academic Senate for California Community Colleges, Sacramento.

    In spring 2001, the Academic Senate for California Community Colleges passed a resolution whose aim is to narrow the digital divide among California community college students. The digital divide is defined as the disparity between those who have access to technology and those who do not. The resolution suggests two questions: (1) How has…

  8. Transfer Access from Community Colleges and the Distribution of Elite Higher Education

    ERIC Educational Resources Information Center

    Dowd, Alicia C.; Cheslock, John J.; Melguizo, Tatiana

    2008-01-01

    This article reports a study that improves the authors' understanding of the potential impact of expanded community college transfer access to elite institutions by examining a variety of key questions using two national databases with complementary strengths. By estimating the number of low-income community college students currently transferring…

  9. E-Learning Access, Opportunities, and Challenges for Aboriginal Adult Learners Located in Rural Communities

    ERIC Educational Resources Information Center

    Kawalilak, Colleen; Wells, Noella; Connell, Lynn; Beamer, Kate

    2012-01-01

    This exploratory qualitative study focused on 1) the learning needs of Aboriginal adult learners residing in selected First Nations communities in rural Alberta and 2) the potential for increasing access to e-learning education. Through open dialogue with First Nations community leaders, Aboriginal adult learners, and Aboriginal and non-Aboriginal…

  10. Environmental Justice and Information Technologies: Overcoming the Information-Access Paradox in Urban Communities.

    ERIC Educational Resources Information Center

    Kellogg, Wendy A.; Mathur, Anjali

    2003-01-01

    Studies suggest that urban residents in low-income and minority communities are subject to an unequal amount of environmental pollution and inequitable enforcement practices. Projects such as Sustainable Cleveland show that key components of implementing policies are access to Internet-based information and participation community-based…

  11. Community College Retention and Access Issues: A View from the Field

    ERIC Educational Resources Information Center

    Rankin, Kristie R.; Katsinas, Stephen G.; Hardy, David E.

    2011-01-01

    Drawing on Rankin's 2008 study and literature on retention and community colleges, this study presents perceptions of community college Chief Executive Officers (CEOs) and Chief Academic Officers (CAOs) in relation to issues affecting retention and access. Childcare, transportation, and funding concerns are examined. (Contains 2 tables.)

  12. Conversations with the community: the Methodist Hospital System's experience with social media.

    PubMed

    Angelle, Denny; Rose, Clare L

    2011-01-01

    The Methodist Hospital System has maintained a social media presence on Facebook, Twitter, and YouTube since 2009. After initial unofficial excursions into the world of social media, we discovered that social media can be a useful tool to extend a conversation with our patients and the community at large and share our hospital's culture with a larger base of like-minded people. But with this new power comes a heightened responsibility--platforms that can potentially reach millions of viewers and readers also provide a potential for misuse that can jeopardize patient privacy and place hospitals at risk. Because of their unique restrictions, even hospitals that use the tools regularly have much left to learn about social media. With constant monitoring and stewardship and a commitment to educating staff, hospitals can effectively use social media tools for marketing and education. PMID:22256507

  13. Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

    PubMed Central

    Rao, Mala; Singh, Prabal Vikram; Katyal, Anuradha; Samarth, Amit; Bergkvist, Sofi; Renton, Adrian; Netuveli, Gopalakrishnan

    2016-01-01

    Background Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE), in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education. Methods We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design. Findings Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups. Conclusion During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the

  14. Pharmacy Access to Emergency Contraception in Rural and Frontier Communities

    ERIC Educational Resources Information Center

    Bigbee, Jeri L.; Abood, Richard; Landau, Sharon Cohen; Maderas, Nicole Monastersky; Foster, Diana Greene; Ravnan, Susan

    2007-01-01

    Context: Timely access to emergency contraception (EC) has emerged as a major public health effort in the prevention of unintended pregnancies. The recent FDA decision to allow over-the-counter availability of emergency contraception for adult women presents important rural health implications. American women, especially those living in rural and…

  15. Implementing Accessible Workstations in a Large Diverse University Community.

    ERIC Educational Resources Information Center

    Christierson, Eric; Marota, Cindy; Radwan, Neveen; Wydeven, Julie

    This paper describes how San Jose State University installed adaptive and accessible computer workstations for students with disabilities. It begins by discussing factors crucial to the installation of such workstations, including the importance of understanding legal and budgetary constraints, applying standards which meet diverse disability…

  16. Tax-exempt hospitals and community benefits: a review of state reporting requirements.

    PubMed

    Hellinger, Fred Joseph

    2009-02-01

    In June 2007 the Internal Revenue Service proposed a major overhaul of its reporting requirements for tax-exempt hospitals and released draft Form 990 (the IRS form filed by tax-exempt organizations each year). In December 2007 the IRS promulgated the final Form 990 after incorporating some of the recommendations made in the almost seven hundred public comments on the discussion draft. One recommendation adopted in the final Form 990 is the postponement until tax year 2009 (returns filed in 2010) of the requirement for hospitals to submit detailed information on the percentage of total expenses attributable to charity care, unreimbursed Medicaid costs, and community-health improvement programs (the discussion draft required this information for tax year 2007). Although the IRS will not require tax-exempt hospitals to provide detailed information about community benefits until the 2009 tax year, sixteen states have laws requiring tax-exempt hospitals to enumerate the benefits that they provide to the community. Information about the impact of these laws on the provision of community benefits (e.g., charity and uncompensated care) is examined in this study whose primary purpose is to highlight information policy makers may glean from states that have adopted community-benefit reporting laws. PMID:19234293

  17. Improving efficiency or impairing access? Health care consolidation and quality of care: Evidence from emergency hospital closures in Sweden.

    PubMed

    Avdic, Daniel

    2016-07-01

    Recent health care consolidation trends raise the important policy question whether improved emergency medical services and enhanced productivity can offset adverse quality effects from decreased access. This paper empirically analyzes how geographical distance from an emergency hospital affects the probability of surviving an acute myocardial infarction (AMI), accounting for health-based spatial sorting and data limitations on out-of-hospital mortality. Exploiting policy-induced variation in hospital distance derived from emergency hospital closures and detailed Swedish mortality data over two decades, results show a drastically decreasing probability of surviving an AMI as residential distance from a hospital increases one year after a closure occurred. The effect disappears in subsequent years, however, suggesting that involved agents quickly adapted to the new environment. PMID:27060525

  18. Community Coordinated Modeling Center (CCMC): Providing Access to Space Weather Models and Research Support Tools

    NASA Astrophysics Data System (ADS)

    Chulaki, A.; Bakshi, S. S.; Berrios, D.; Hesse, M.; Kuznetsova, M. M.; Lee, H.; MacNeice, P. J.; Mendoza, A. M.; Mullinix, R.; Patel, K. D.; Pulkkinen, A.; Rastaetter, L.; Shim, J.; Taktakishvili, A.; Zheng, Y.

    2011-12-01

    The Community Coordinated Modeling Center at NASA, Goddard Space flight Center, provides access to state-of-the-art space weather models to the research community. The majority of the models residing at the CCMC are comprehensive computationally intensive physics-based models. The CCMC also provides free services and tools to assist the research community in analyzing the results from the space weather model simulations. We present an overview of the available tools and services at the CCMC: the Runs-On-Request system, the online visualization, the Kameleon access and interpolation library and the Metrics Challenge tools suite.

  19. Getting over the rainbow: one community hospital's vision.

    PubMed

    Reno, Kathy; Cerone, Phyllis; Ferket, Kathy; Wojcieszak, Elaine; Reshoft, Meaghan

    2005-01-01

    Nursing faces a challenging future due to both a projected nursing shortage and changing needs of patients. This will require greater flexibility, an increased knowledge base, and a strengthening of our caring foundations through more evidence-based practices. A nursing taxonomy needs to be determined so that we can support the research of nursing effectiveness through the use of technology. Institutions will need to increase their investments in continuing education, nursing research, and technology to enable more efficient and effective nursing practice. New relationships will need to be forged and new roles designed to maximize the profession's contributions to patient care. Questions that have been asked for decades regarding differentiated nursing practice and entry level into practice will need to be answered. This article describes a large suburban hospital's strategic initiatives that have been designed to meet the nursing challenges of the 21st century. PMID:15923973

  20. Characteristics of collaborative care in increasing access to mental health service in the Asian community.

    PubMed

    Sung, Jeehee; Mayo, Nicolle; Ko, Mei-Ju; Lasley, Chandra

    2013-09-01

    This study examined the use of thematic analysis to determine how characteristics of collaborative care facilitate accessibility to mental health services among the Asian community in the United States. This investigation explored characteristics of collaborative care in patient treatment, barriers that prevent the Asian community from utilizing care, and how collaborative settings can facilitate mental health care access in the Asian community. Mental health providers with relevant experiences in collaborative care were recruited through snowball sampling to participate in a telephone interview with the researchers. The results suggested a collectivistic culture, valuing authority, acculturation, language, and stigma as themes of Asian patients as well as key providers (mental and medical health providers), colocation, the physician's leading role, the provider's language, and collaboration among providers as themes for collaborative care. The study suggests that collaborative care's foundational characteristics can promote easier access to mental health care for the Asian community. PMID:23937434

  1. Using Community Access Cable in an Extension Parenting Education Program.

    ERIC Educational Resources Information Center

    Dennis, Steve A.; And Others

    1995-01-01

    Utah State Extension collaborated with community groups and local cable providers to broadcast programs for parents on teen sexuality and substance abuse. A survey of cable subscribers yielded 638 responses (4.5%). Of the 103 who watched programs, most were positive, but better ways to advertise the programs were needed. (SK)

  2. Accessing Imagined Communities and Reinscribing Regimes of Truth

    ERIC Educational Resources Information Center

    Carroll, Sherrie; Motha, Suhanthie; Price, Jeremy N.

    2008-01-01

    In this article, we explore the complex and nebulous terrain between two theoretical concepts, imagined communities (Norton, 2000, 2001), that is, individuals' imagined affiliations with certain groups, and regimes of truth (Foucault, 1980), dominant images inscribed and reinscribed into individual consciousness until they become normative. Using…

  3. The 1000 Genomes Project: data management and community access.

    PubMed

    Clarke, Laura; Zheng-Bradley, Xiangqun; Smith, Richard; Kulesha, Eugene; Xiao, Chunlin; Toneva, Iliana; Vaughan, Brendan; Preuss, Don; Leinonen, Rasko; Shumway, Martin; Sherry, Stephen; Flicek, Paul

    2012-05-01

    The 1000 Genomes Project was launched as one of the largest distributed data collection and analysis projects ever undertaken in biology. In addition to the primary scientific goals of creating both a deep catalog of human genetic variation and extensive methods to accurately discover and characterize variation using new sequencing technologies, the project makes all of its data publicly available. Members of the project data coordination center have developed and deployed several tools to enable widespread data access. PMID:22543379

  4. From closet to library in the community hospital: remodeling a hospital medical library.

    PubMed

    Duva, A M

    1971-01-01

    Halifax District Hospital's Medical Library, Daytona Beach, Florida was altered from two dingy rooms to a modern, well-equipped Medical Library twice its former size by its maintenance men in six months time, with the help of the librarian's sketches and an architect student from the junior college to draw the plans.A complete renovation was done, eighteen-inch walls between rooms being demolished, plumbing, ceiling, and windows removed. These were all replaced with walnut-paneled walls, special 125 candle-power lighted ceiling, retractable shelves, more shelves for periodicals and books, wall-to-wall carpeting and fashionable decor. New furniture, tape recorders, and TWX were made possible by a Medical Library Resource Grant. The official opening was six months from the first day of renovation, with ribbon cutting, guests, hospital personnel, and a reporter from the newspaper to take pictures for an article about the most modern medical library in Volusia County. The new Medical Library is in the "core" of the Medical Education Department with space for five years growth. PMID:5542918

  5. From Closet to Library in the Community Hospital: Remodeling a Hospital Medical Library

    PubMed Central

    Duva, Alice M.

    1971-01-01

    Halifax District Hospital's Medical Library, Daytona Beach, Florida was altered from two dingy rooms to a modern, well-equipped Medical Library twice its former size by its maintenance men in six months time, with the help of the librarian's sketches and an architect student from the junior college to draw the plans. A complete renovation was done, eighteen-inch walls between rooms being demolished, plumbing, ceiling, and windows removed. These were all replaced with walnut-paneled walls, special 125 candle-power lighted ceiling, retractable shelves, more shelves for periodicals and books, wall-to-wall carpeting and fashionable decor. New furniture, tape recorders, and TWX were made possible by a Medical Library Resource Grant. The official opening was six months from the first day of renovation, with ribbon cutting, guests, hospital personnel, and a reporter from the newspaper to take pictures for an article about the most modern medical library in Volusia County. The new Medical Library is in the “core” of the Medical Education Department with space for five years growth. PMID:5542918

  6. From Long-Stay Hospitals to Community Care: Reconstructing the Narratives of People with Learning Disabilities

    ERIC Educational Resources Information Center

    Leaning, Brian; Adderley, Hope

    2016-01-01

    Raymond, a 62 year old gentleman diagnosed with severe and profound learning disabilities, autistic spectrum disorder and severe challenging behaviour, who had lived in long stay campus-based hospital accommodation for 46 years was supported to move to a community project developed to support people to live in their own bespoke flat. This…

  7. Hospital community partnership. A daycare venture provides benefits, opens doors for new opportunities.

    PubMed

    DeWolf, L

    1992-01-01

    Building successful joint ventures with local community organizations is a priority for many hospitals. Not only does this type of venture strengthen important relationships, it can also open the door for other mutually beneficial joint activities as well. When a partnership provides a needed service and can be started with minimal expenditures, it becomes even more valuable for all parties concerned. PMID:10121356

  8. 78 FR 31454 - Community Health Needs Assessments for Charitable Hospitals; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-24

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 1 and 53 RIN 1545-BL30 Community Health Needs Assessments for Charitable Hospitals; Correction Correction In proposed rule document 2013-12013, appearing on pages...

  9. The Effects of Monitoring the Use of Gentamicin in a Community Hospital

    ERIC Educational Resources Information Center

    Gilbert, David N.; And Others

    1978-01-01

    The effect of a combined education and monitoring program on the use of gentamicin in a community hospital is described. The data support the tenet that the ways antibiotics are used can be altered by an education program. (Author/LBH)

  10. Hospitalization Rates of Nursing Home Residents and Community-Dwelling Seniors in British Columbia

    ERIC Educational Resources Information Center

    Ronald, Lisa A.; McGregor, Margaret J.; McGrail, Kimberlyn M.; Tate, Robert B.; Broemling, Anne-Marie

    2008-01-01

    The overall use of acute care services by nursing home (NH) residents in Canada has not been well documented. Our objectives were to identify the major causes of hospitalization among NH facility residents and to compare rates to those of community-dwelling seniors. A retrospective cohort was defined using population-level health administrative…

  11. 75 FR 52960 - Medicare Program; Rural Community Hospital Demonstration Program: Solicitation of Additional...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-30

    ... the June 2, 2010 Federal Register (75 FR 30918)). B. Participation in the Demonstration To participate... population densities. Using 2002 data from the U.S. Census Bureau, we identified the 10 States with the lowest population density in which rural community hospitals were to be located in order to...

  12. Project Return: Community Education Initiative and Babygram Hospital Outreach, 1991-92.

    ERIC Educational Resources Information Center

    New York City Board of Education, Brooklyn, NY. Office of Research, Evaluation, and Assessment.

    Project Return, a dropout recovery program to assist pregnant and parenting teenagers and parents of elementary school children to return to school, was first implemented in 1989-90. By 1991-92, there were two components of Project Return: its community education initiative in seven elementary schools, and the Babygram Hospital Outreach Program…

  13. Community- And Hospital-Based Early Intervention Team Members' Attitudes and Perceptions of Teamwork

    ERIC Educational Resources Information Center

    Malone, Michael; McPherson, Jenny

    2004-01-01

    Sixty early intervention team members (30 community-based and 30 hospital-based) were surveyed regarding their attitudes and perceptions of teamwork. Respondents were recruited using a purposive non-probability sampling technique and completed a packet of questionnaires consisting of a detailed demographic survey, Attitudes About Teamwork Survey,…

  14. Methicillin-resistant Staphylococcus aureus in hospitals and the community: Stealth dynamics and control catastrophes

    PubMed Central

    Cooper, B. S.; Medley, G. F.; Stone, S. P.; Kibbler, C. C.; Cookson, B. D.; Roberts, J. A.; Duckworth, G.; Lai, R.; Ebrahim, S.

    2004-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) represents a serious threat to the health of hospitalized patients. Attempts to reduce the spread of MRSA have largely depended on hospital hygiene and patient isolation. These measures have met with mixed success: although some countries have almost eliminated MRSA or remained largely free of the organism, others have seen substantial increases despite rigorous control policies. We use a mathematical model to show how these increases can be explained by considering both hospital and community reservoirs of MRSA colonization. We show how the timing of the intervention, the level of resource provision, and chance combine to determine whether control measures succeed or fail. We find that even control measures able to repeatedly prevent sustained outbreaks in the short-term can result in long-term control failure resulting from gradual increases in the community reservoir. If resources do not scale with MRSA prevalence, isolation policies can fail “catastrophically.” PMID:15220470

  15. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children

    PubMed Central

    Jain, Seema; Williams, Derek J.; Arnold, Sandra R.; Ampofo, Krow; Bramley, Anna M.; Reed, Carrie; Stockmann, Chris; Anderson, Evan J.; Grijalva, Carlos G.; Self, Wesley H.; Zhu, Yuwei; Patel, Anami; Hymas, Weston; Chappell, James D.; Kaufman, Robert A.; Kan, J. Herman; Dansie, David; Lenny, Noel; Hillyard, David R.; Haynes, Lia M.; Levine, Min; Lindstrom, Stephen; Winchell, Jonas M.; Katz, Jacqueline M.; Erdman, Dean; Schneider, Eileen; Hicks, Lauri A.; Wunderink, Richard G.; Edwards, Kathryn M.; Pavia, Andrew T.; McCullers, Jonathan A.; Finelli, Lyn

    2015-01-01

    Background U.S. incidence estimates of pediatric community-acquired pneumonia hospitalizations based on prospective data collection are limited. Updated estimates with radiographic confirmation and current laboratory diagnostics are needed. Methods We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children <18 years in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization and severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection by multiple modalities. Chest radiographs were independently reviewed by study radiologists. We calculated population-based incidence rates of community-acquired pneumonia hospitalizations, overall and by age and pathogen. Results From January 2010-June 2012, we enrolled 2638 (69%) of 3803 eligible children; 2358 (89%) had radiographic pneumonia. Median age was 2 years (interquartile range 1-6); 497 (21%) children required intensive care, and three (<1%) died. Among 2222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a viral and/or bacterial pathogen was detected in 1802 (81%); ≥1 virus in 1472 (66%), bacteria in 175 (8%), and bacterial-viral co-detection in 155 (7%). Annual pneumonia incidence was 15.7/10,000 children [95% confidence interval (CI) 14.9-16.5], with highest rates among children <2 years [62.2/10,000 (CI 57.6-67.1)]. Respiratory syncytial virus (37% vs. 8%), adenovirus (15% vs. 3%), and human metapneumovirus (15% vs. 8%) were more commonly detected in children <5 years compared with older children; Mycoplasma pneumoniae (19% vs. 3%) was more common in children ≥5 years. Conclusions Pediatric community-acquired pneumonia hospitalization burden was highest among the very young, with respiratory viruses most commonly detected. PMID:25714161

  16. Increasing access to healthful foods: a qualitative study with residents of low-income communities

    PubMed Central

    2015-01-01

    Background Inadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members’ opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities. Methods Spanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods. Results A total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than $1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions. Conclusion The results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future. PMID:26222910

  17. Development of an Automated, Real Time Surveillance Tool for Predicting Readmissions at a Community Hospital

    PubMed Central

    Gildersleeve, R.; Cooper, P.

    2013-01-01

    Background The Centers for Medicare and Medicaid Services’ Readmissions Reduction Program adjusts payments to hospitals based on 30-day readmission rates for patients with acute myocardial infarction, heart failure, and pneumonia. This holds hospitals accountable for a complex phenomenon about which there is little evidence regarding effective interventions. Further study may benefit from a method for efficiently and inexpensively identifying patients at risk of readmission. Several models have been developed to assess this risk, many of which may not translate to a U.S. community hospital setting. Objective To develop a real-time, automated tool to stratify risk of 30-day readmission at a semirural community hospital. Methods A derivation cohort was created by extracting demographic and clinical variables from the data repository for adult discharges from calendar year 2010. Multivariate logistic regression identified variables that were significantly associated with 30-day hospital readmission. Those variables were incorporated into a formula to produce a Risk of Readmission Score (RRS). A validation cohort from 2011 assessed the predictive value of the RRS. A SQL stored procedure was created to calculate the RRS for any patient and publish its value, along with an estimate of readmission risk and other factors, to a secure intranet site. Results Eleven variables were significantly associated with readmission in the multivariate analysis of each cohort. The RRS had an area under the receiver operating characteristic curve (c-statistic) of 0.74 (95% CI 0.73-0.75) in the derivation cohort and 0.70 (95% CI 0.69-0.71) in the validation cohort. Conclusion Clinical and administrative data available in a typical community hospital database can be used to create a validated, predictive scoring system that automatically assigns a probability of 30-day readmission to hospitalized patients. This does not require manual data extraction or manipulation and uses commonly

  18. Contextual and Community Factors Associated with Youth Access to Cigarettes through Commercial Sources

    PubMed Central

    Grube, Joel W.; Friend, Karen B.

    2012-01-01

    Objectives This study examines contextual and community level characteristics associated with youth access to tobacco through commercial sources in 50 non-contiguous mid-sized California communities. Methods The study is based on data from access surveys conducted by 4 confederate buyers (2 males and 2 females) in 997 tobacco outlets. City demographics, adult smoking prevalence and measures of tobacco outlet density, local tobacco retailer licensing and cigarette tax were included. Results Multilevel regression analyses indicated that buyer actual age, a male clerk and asking young buyers about their age were related to successful cigarette purchases. Buyer actual age and minimum age signs increased the likelihood that clerks will request an ID. At the community level, higher percentage of minors, higher education, and a greater percentage of African Americans were associated with increased likelihood of a successful purchase. Lower percentage of minors, lower education, lower percentage of African Americans, and having a local tobacco retailer licensing were associated with retailer asked for ID. Additionally, supermarkets charged significantly more for a pack of cigarettes than small markets whereas smoke/tobacco shops and drug stores/pharmacies charged less. Higher prices were associated with higher median household income and greater percentage of Hispanics. Findings about community characteristics, however, differed by cigarette brand. Conclusions This study enhances our understanding of the associations between contextual and community characteristics and youth access to tobacco through commercial sources which can help policymakers to identify and target at-risk communities and outlets to decrease youth access to tobacco. PMID:23092887

  19. Community- and hospital-based nurses' implementation of evidence-based practice: are there any differences?

    PubMed

    Mallion, Jaimee; Brooke, Joanne

    2016-03-01

    The aim of this paper is to discuss the effect of nurses' beliefs, knowledge, and skills on the implementation of evidence-based practice (EBP) in hospital and community settings. EBP refers to the implementation of the most up-to-date robust research into clinical practice. Barriers have been well documented and traditionally include the negative beliefs of nurses as well as a lack of time, knowledge, and skills. However, with degree entry nursing and a focus on community health care provision, what has changed? A comprehensive search of contemporary literature (2010-2015) was completed. The findings of this review show that the traditionally acknowledged barriers of a lack of time, knowledge, and skills remained; however, nurses' beliefs toward EBP were more positive, but positive beliefs did not affect the intentions to implement EBP or the knowledge and skills of EBP. Nurses in hospital and community settings reported similar barriers and facilitators. PMID:26940618

  20. Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study

    PubMed Central

    2013-01-01

    Background Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE. Methods We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation. Results Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded

  1. Open access to geophysical data sets requires community responsibility

    NASA Astrophysics Data System (ADS)

    Pritchard, Matt; Owen, Susan; Anandakrishnan, Sridhar; Holt, William; Bennett, Richard; La Femina, Peter; Jansma, Pamela; MacGregor, Ian; Raymond, Carol; Schwartz, Susan; Stein, Seth; Miller, Meghan

    2012-06-01

    In our increasingly digital age, access to data is becoming faster and easier. This has many positive consequences for scientific discovery, but it also presents challenges for protecting the data collectors and ensuring proper citation (e.g., M. A. Parsons et al.,Eos, 91(34), 297, doi:10.1029/2010EO340001). These issues have been concerns of UNAVCO's staff and those involved in the governance of UNAVCO as they crafted a new open data policy that became effective on 2 March 2012. UNAVCO is a nonprofit consortium of 177 university and research institutions from around the world. Founded in 1984 as the University Navstar Consortium and formally incorporated in 2001 as UNAVCO, Inc., the organization facilitates the collection and archiving of geodetic data (http://www.unavco.org).

  2. Increasing access to legal termination of pregnancy and postabortion contraception at the University Teaching Hospital, Lusaka, Zambia.

    PubMed

    Macha, Swebby; Muyuni, Mutinta; Nkonde, Scholastica; Faúndes, Anibal

    2014-07-01

    The Zambian Association of Gynecology and Obstetrics is one of the International Federation of Gynecology and Obstetrics (FIGO) member societies participating in the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences from the East, Central, and Southern Africa region. The activities included in this country's plan of action were to provide access to safe abortion within the full extent of the law to women receiving care at the University Teaching Hospital in Lusaka, and to increase the proportion of women leaving the hospital with a contraceptive method. Zambian law regarding abortion is liberal, but in general it was not applied until very recently. The proportion of legal terminations of pregnancy among patients receiving abortion care at the hospital increased from 3.2% in 2009 to 7.7% in 2011, while the percentage of women leaving the hospital with a contraceptive method increased from 25.3% to 69.4% over the same period. PMID:24786142

  3. The application of a biometric identification technique for linking community and hospital data in rural Ghana

    PubMed Central

    Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

    2016-01-01

    Background The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information. PMID:26993473

  4. Access to space weather model data provided by the Community Coordinated Modeling Center

    NASA Astrophysics Data System (ADS)

    Chulaki, A.; Berrios, D.; Hesse, M.; Kuznetsova, M. M.; MacNeice, P. J.; Maddox, M.; Rastaetter, L.; Taktakishvili, A.

    2009-12-01

    The Community Coordinated Modeling Center (CCMC), located at NASA Goddard Space Flight Center, provides access to state-of-the-art space weather models to the research community. The majority of the models residing at the CCMC are comprehensive, computationally intensive physics-based models. The CCMC provides access to output of performed model runs through a searchable and sortable online database and offers services and tools to assist the research community in analyzing results from space weather model simulations. Virtual Observatories can provide access to model output for corresponding events using the CCMC run database and interface. CCMC is planning to expand its database of run information to improve the service to users as well as its connection with VOs.

  5. Starting a General Surgery Program at a Small Rural Critical Access Hospital: A Case Study from Southeastern Oregon

    ERIC Educational Resources Information Center

    Doty, Brit Cruse; Heneghan, Steven; Zuckerman, Randall

    2007-01-01

    Context: Surgical services are frequently unavailable in rural American communities. Therefore, rural residents often must travel long distances to receive surgical care. Rural hospitals commonly have difficulty providing surgical services despite potential economic benefits. Purpose: The purpose of this project was to identify the key challenges…

  6. High prevalence of hospital-associated methicillin-resistant Staphylococcus aureus in the community in Portugal: evidence for the blurring of community-hospital boundaries.

    PubMed

    Tavares, A; Miragaia, M; Rolo, J; Coelho, C; de Lencastre, H

    2013-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of infection in the community (CA-MRSA), but in spite of its relevance, no data exist concerning its epidemiology in Portugal. In this study, we aimed to evaluate the prevalence, population structure, and origin of MRSA in the Portuguese community. A total of 527 isolates, both methicillin-susceptible S. aureus (MSSA) and MRSA, were collected from individuals with no healthcare-related risk factors attending 16 healthcare institutions in Portugal. Isolates were characterized for the presence of mecA, Panton-Valentine leukocidin (PVL), and arginine catabolic mobile element (ACME), and by staphylococcal cassette chromosome mec (SCCmec) typing, pulsed-field gel electrophoresis (PFGE), spa, and multilocus sequence typing (MLST). Susceptibility to a panel of 13 antibiotics was tested. Isolates relatedness was analyzed by goeBURST and BURP. We found a high frequency (21.6%) of MRSA in the community. However, only 11.4% of the isolates belonged to typical CA-MRSA epidemic clones (USA300, USA400, USA700, Southwest Pacific, European, and ST398). The remaining isolates, which constituted the great majority (88.6%), belonged to hospital-associated MRSA (HA-MRSA) epidemic clones, namely, to the EMRSA-15 clone (77.2%). PVL was rare and carried by 17 isolates only (five MRSA and 12 MSSA). In the whole collection, some MRSA and MSSA were highly related. The high frequency of MRSA in the community in Portugal seems to result mainly from dissemination from the hospital. They might also have emerged from an extant MSSA population, by SCCmec acquisition, or MRSA clonal introduction from abroad. PMID:23604782

  7. Comparison of Methicillin Resistant Staphylococcus Aureus in Healthy Community Hospital Visitors [CA-MRSA] and Hospital Staff [HA-MRSA

    PubMed Central

    Pathare, Nirmal A; Tejani, Sara; Asogan, Harshini; Al Mahruqi, Gaitha; Al Fakhri, Salma; Zafarulla, Roshna; Pathare, Anil V.

    2015-01-01

    Background The prevalence of community-associated methicillin-resistant Staphylococcus aureus [CA-MRSA] is unknown in Oman. Methods Nasal and cell phones swabs were collected from hospital visitors and health-care workers on sterile polyester swabs and directly inoculated onto a mannitol salt agar containing oxacillin, allowing growth of methicillin-resistant microorganisms. Antibiotic susceptibility tests were performed using Kirby Bauer’s disc diffusion method on the isolates. Minimum inhibitory concentration (MIC) was determined for vancomycin and teicoplanin against the resistant isolates of MRSA by the Epsilometer [E] test. A brief survey questionnaire was requested be filled to ascertain the exposure to known risk factors for CA-MRSA carriage. Results Overall, nasal colonization with CA-MRSA was seen in 34 individuals (18%, 95% confidence interval [CI] =12.5%–23.5%), whereas, CA-MRSA was additionally isolated from the cell phone surface in 12 participants (6.3%, 95% CI =5.6%–6.98%). Nasal colonization prevalence with hospital-acquired [HA] MRSA was seen in 16 individuals (13.8%, 95% confidence interval [CI] =7.5%–20.06%), whereas, HA-MRSA was additionally isolated from the cell phone surface in 3 participants (2.6%, 95% CI =1.7–4.54). Antibiotic sensitivity was 100% to linezolid and rifampicin in the CA-MRSA isolates. Antibiotic resistance to vancomycin and clindamycin varied between 9–11 % in the CA-MRSA isolates. Mean MIC for vancomycin amongst CA- and HA-MRSA were 6.3 and 9.3 μg/ml, whereas for teicoplanin they were 13 and 14 μg/ml respectively by the E-test. There was no statistically significant correlation between CA-MRSA nasal carriage and the risk factors (P>0.05, Chi-square test). Conclusions The prevalence of CA-MRSA in the healthy community hospital visitors was 18 % (95% CI, 12.5% to 23.5%) as compared to 13.8% HA-MRSA in the hospital health-care staff. Despite a significant prevalence of CA-MRSA, these strains were mostly sensitive

  8. Influence of Arabidopsis thaliana accessions on rhizobacterial communities and natural variation in root exudates

    PubMed Central

    Micallef, Shirley A.; Shiaris, Michael P.; Colón-Carmona, Adán

    2009-01-01

    Plant species is considered to be one of the most important factors in shaping rhizobacterial communities, but specific plant–microbe interactions in the rhizosphere are still not fully understood. Arabidopsis thaliana, for which a large number of naturally occurring ecotype accessions exist, lacks mycorrhizal associations and is hence an ideal model for rhizobacterial studies. Eight Arabidopsis accessions were found to exert a marked selective influence on bacteria associated with their roots, as determined by terminal-restriction fragment length polymorphism (T-RFLP) and ribosomal intergenic spacer analysis (RISA). Community differences in species composition and relative abundance were both significant (P <0.001). The eight distinct and reproducible accession-dependent community profiles also differed from control bulk soil. Root exudates of these variants were analysed by high performance liquid chromatography (HPLC) to try to establish whether the unique rhizobacterial assemblages among accessions could be attributed to plant-regulated chemical changes in the rhizosphere. Natural variation in root exudation patterns was clearly exhibited, suggesting that differences in exudation patterns among accessions could be influencing bacterial assemblages. Other factors such as root system architecture are also probably involved. Finally, to investigate the Arabidopsis rhizosphere further, the phylogenetic diversity of rhizobacteria from accession Cvi-0 is described. PMID:19342429

  9. Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study

    PubMed Central

    Takeshima, Taro; Yamamoto, Yosuke; Noguchi, Yoshinori; Maki, Nobuyuki; Gibo, Koichiro; Tsugihashi, Yukio; Doi, Asako; Fukuma, Shingo; Yamazaki, Shin; Kajii, Eiji; Fukuhara, Shunichi

    2016-01-01

    Objectives (1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data. Design Multicenter retrospective cohort study. Setting To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation). We tested the rule using data from one other community hospital (validation), which was not among the three “derivation” hospitals. Participants Adults (age ≥ 16 years old) who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients), and for the validation data n = 467 (from 823 patients). Analysis We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the “ID-BactER” score). Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC) were computed. Results There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation) and 0.74 (validation). For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively. Conclusions The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity

  10. Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a Dublin region.

    PubMed

    McTiernan, K; McDonald, N

    2015-04-01

    Burnout negatively impacts the delivery of mental health services. Psychiatric nurses face stressors that are distinct from other nursing specialities. The research was conducted in Ireland and captured a relatively large sample of respondents. The results compared the stressors, coping strategies and burnout levels between hospital and community-based psychiatric nurses. Occupational stress can negatively impact on the well-being of psychiatric nurses, which in turn can lead to poor client care. There is a dearth of published research conducted in Ireland that examines stress within the discipline. A between-groups study, undertaken in February 2011, investigated stressors, burnout and coping strategies between hospital and community-based psychiatric nurses in a Dublin region. Sixty-nine participants (8 males and 61 females), aged between 18 to 60 years voluntarily completed the Mental Health Professional Stress Scale, the Maslach Burnout Inventory and the PsychNurse Methods of Coping Scale. The findings revealed that nurses were operating in a moderately stressful environment. Stressors focused on organizational issues as opposed to client issues. The main stressors identified were lack of resources, workload and organizational structures/processes. Both groups reported average levels of emotional exhaustion, low levels of depersonalization and average levels of personal accomplishment. A Mann-Whitney U-test and Independent Samples t-test found significant differences between hospital and community-based nurses regarding depersonalization and personal accomplishment, respectively. Hospital nurses reported higher depersonalization scores, and community nurses had a greater sense of personal accomplishment. The personal accomplishment scores of hospital nurses were below mental health professional norms. No significant differences emerged regarding coping strategies. Avoidant coping strategies were favoured by both groups. It is recommended that interventions

  11. Neighborhood Disparities in Incident Hospitalized Myocardial Infarction in Four US Communities: The ARIC Surveillance Study

    PubMed Central

    Rose, Kathryn M.; Suchindran, Chirayath M.; Foraker, Randi E.; Whitsel, Eric A.; Rosamond, Wayne D.; Heiss, Gerardo; Wood, Joy L.

    2009-01-01

    Objectives Hospital-based surveillance of myocardial infarction (MI) in the United States (US) typically includes age, gender, and race, but not socioeconomic status (SES). We examined the association between neighborhood median household income (nINC) and incident hospitalized MI in four US communities (1993–2002). Methods Average annual indirect age-standardized MI rates were calculated using community-specific and community-wide nINC tertiles. Poisson generalized linear mixed models were used to calculate MI incidence rate ratios by tertile of census tract nINC (high nINC group referent). Results Within community, and among all race-gender groups, those living in low nINC neighborhoods had an increased risk of MI compared to those living in high nINC neighborhoods. This association was present when both community-specific and community-wide nINC cutpoints were used. Blacks, and to a lesser extent women, were disproportionately represented in low nINC neighborhoods, resulting in a higher absolute burden of MI in blacks and women living in low compared to high nINC neighborhoods. Conclusions These findings suggest a need for the joint consideration of racial, gender and social disparities in interventions aimed at preventing coronary heart disease. PMID:19815428

  12. 42 CFR 424.106 - Criteria for determining whether the hospital was the most accessible.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special... in the nonparticipating hospitals than in a participating hospital in the general area. In urban and... evidence shows that there was a medical or practical need to use the nonparticipating hospital. (c)...

  13. 42 CFR 424.106 - Criteria for determining whether the hospital was the most accessible.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) CONDITIONS FOR MEDICARE... provided sooner in the nonparticipating hospitals than in a participating hospital in the general area. In... convincing evidence shows that there was a medical or practical need to use the nonparticipating hospital....

  14. 42 CFR 424.106 - Criteria for determining whether the hospital was the most accessible.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) CONDITIONS FOR MEDICARE... provided sooner in the nonparticipating hospitals than in a participating hospital in the general area. In... convincing evidence shows that there was a medical or practical need to use the nonparticipating hospital....

  15. 42 CFR 424.106 - Criteria for determining whether the hospital was the most accessible.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special... in the nonparticipating hospitals than in a participating hospital in the general area. In urban and... evidence shows that there was a medical or practical need to use the nonparticipating hospital. (c)...

  16. Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data.

    PubMed

    Colla, Carrie H; Lewis, Valerie A; Tierney, Emily; Muhlestein, David B

    2016-03-01

    Relationships between physicians and hospitals have changed considerably over the past decade, as hospitals and physician groups have integrated and new public and private payment policies have created financial interdependence. The extent to which accountable care organizations (ACOs) involve hospitals in their operations may prove to be vitally important, because managing hospital care is a key part of improving health care quality and lowering cost growth. Using primary data on ACO composition and capabilities paired with hospital characteristics, we found that 20 percent of US hospitals were part of an ACO in 2014. Hospitals that were in urban areas, were nonprofit, or had a smaller share of Medicare patients were more likely to participate in ACOs, compared to hospitals that were in more rural areas, were for-profit or government owned, or had a larger share of Medicare patients, respectively. Qualitative data identified the following advantages of including a hospital in an ACO: the availability of start-up capital, advanced data sharing, and engagement of providers across the care continuum. Although the 63 percent of ACOs that included hospitals offered more comprehensive services compared to ACOs without hospitals, we found no differences between the two groups in their ability to manage hospital-related aspects of patient care. PMID:26953297

  17. Accessibility

    MedlinePlus

    ... www.nlm.nih.gov/medlineplus/accessibility.html MedlinePlus Accessibility To use the sharing features on this page, ... Subscribe to RSS Follow us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for EHRs ...

  18. Primary health care accessibility challenges in remote indigenous communities in Canada's North

    PubMed Central

    Oosterveer, Tim Michiel; Kue Young, T.

    2015-01-01

    Background Despite many improvements, health disparities between indigenous and non-indigenous populations in Canada's North persist. While a strong primary health care (PHC) system improves the health of a population, the majority of indigenous communities are very remote, and their access to PHC services is likely reduced. Understanding the challenges in accessing PHC services in these communities is necessary to improve the health of the population. Objective The objective of the study was to document and analyze the challenges in accessing PHC services by indigenous people in remote communities in Canada's Northwest Territories (NWT) from the perspectives of users and providers of PHC services. Methods Using explorative, qualitative methods, our study involved 14 semi-structured interviews with PHC service providers (SPs) and service users (SUs) in 5 communities across the NWT which varied according to population, remoteness, ethnic composition and health care resources. The interview guide was developed after key informant consultations. Results Both SPs and SUs understood the constraints in providing equitable access to PHC services in remote communities. The provision of emergency care was found to be particularly challenging, because of the lack of qualified staff in the community and the dependence on aeromedical evacuations. Wider dissemination of first aid skills among community members was seen to cover some gaps and also increase self-confidence. For non-emergency care, the need to travel outside the community was generally disliked. All recognized the need for more preventive services which were often postponed or delayed because of the overwhelming demand for acute care. As long as services were provided in a community, the satisfaction was high among SUs. SPs appreciated the orientation they received and the ability to build rapport with the community. Conclusions Northern SUs and SPs generally acknowledge the health consequences of living in remote

  19. A Community Hospital-County Health Department Partnership to Reduce Preventable Readmissions: Lessons Learned for Population Health Management.

    PubMed

    Kurtzman, Jordan H

    2015-01-01

    Healthcare reform has prompted hospital executives to adopt new strategies aimed at population health management. Research regarding the broad determinants of health suggests that if hospitals are to build successful population health management models, they must engage in collaborative partnerships with a variety of community stakeholders. In this report, the author describes a collaborative partnership between a community hospital and a county health department to reduce preventable readmissions. This program illustrates the important role that health information technology (HIT), managerial systems, new processes, and hospital culture play in collaborations with external parties. On a larger scale, these facilitators are key factors in developing population health business models such as accountable care organizations. A sound hospital infrastructure should be supported by hospital leaders and staff who are held accountable for community initiatives and communicate transparently with external partners. PMID:26364349

  20. Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data

    PubMed Central

    Lewis, Valerie A.; Tierney, Emily; Muhlestein, David B.

    2016-01-01

    Relationships between physicians and hospitals have changed considerably over the past decade as hospitals and physician groups integrate and new public and private payment policies create financial interdependence. The extent to which accountable care organizations (ACOs) involve hospitals in their operations may prove to be vitally important because managing hospital care is a key part of improving quality and lowering cost growth. Using primary data on ACO composition and capabilities paired with hospital characteristics, we found that 20 percent of US hospitals were part of an ACO in 2015, and hospitals that were in urban areas, non-profit, or had a smaller share of Medicare patients were more likely to participate in ACOs compared to other ACOs. Qualitative data identified several advantages of including a hospital in an ACO: the availability of start-up capital, advanced data sharing, and engagement of providers across the care continuum. Although ACOs that include hospitals (63 percent of ACOs) offered more comprehensive services compared to ACOs without hospitals, we found no differences among ACOs in their ability to manage hospital-related aspects of patient care. PMID:26953297

  1. A growing opportunity: Community gardens affiliated with US hospitals and academic health centers

    PubMed Central

    George, Daniel R.; Rovniak, Liza S.; Kraschnewski, Jennifer L.; Hanson, Ryan; Sciamanna, Christopher N.

    2014-01-01

    Background Community gardens can reduce public health disparities through promoting physical activity and healthy eating, growing food for underserved populations, and accelerating healing from injury or disease. Despite their potential to contribute to comprehensive patient care, no prior studies have investigated the prevalence of community gardens affiliated with US healthcare institutions, and the demographic characteristics of communities served by these gardens. Methods In 2013, national community garden databases, scientific abstracts, and public search engines (e.g., Google Scholar) were used to identify gardens. Outcomes included the prevalence of hospital-based community gardens by US regions, and demographic characteristics (age, race/ethnicity, education, household income, and obesity rates) of communities served by gardens. Results There were 110 healthcare-based gardens, with 39 in the Midwest, 25 in the South, 24 in the Northeast, and 22 in the West. Compared to US population averages, communities served by healthcare-based gardens had similar demographic characteristics, but significantly lower rates of obesity (27% versus 34%, P < .001). Conclusions Healthcare-based gardens are located in regions that are demographically representative of the US population, and are associated with lower rates of obesity in communities they serve. PMID:25599017

  2. Manchester Clinical Placement Index (MCPI). Conditions for medical students' learning in hospital and community placements.

    PubMed

    Dornan, Tim; Muijtjens, Arno; Graham, Jennifer; Scherpbier, Albert; Boshuizen, Henny

    2012-12-01

    The drive to quality-manage medical education has created a need for valid measurement instruments. Validity evidence includes the theoretical and contextual origin of items, choice of response processes, internal structure, and interrelationship of a measure's variables. This research set out to explore the validity and potential utility of an 11-item measurement instrument, whose theoretical and empirical origins were in an Experience Based Learning model of how medical students learn in communities of practice (COPs), and whose contextual origins were in a community-oriented, horizontally integrated, undergraduate medical programme. The objectives were to examine the psychometric properties of the scale in both hospital and community COPs and provide validity evidence to support using it to measure the quality of placements. The instrument was administered twice to students learning in both hospital and community placements and analysed using exploratory factor analysis and a generalizability analysis. 754 of a possible 902 questionnaires were returned (84% response rate), representing 168 placements. Eight items loaded onto two factors, which accounted for 78% of variance in the hospital data and 82% of variance in the community data. One factor was the placement learning environment, whose five constituent items were how learners were received at the start of the placement, people's supportiveness, and the quality of organisation, leadership, and facilities. The other factor represented the quality of training-instruction in skills, observing students performing skills, and providing students with feedback. Alpha coefficients ranged between 0.89 and 0.93 and there were no redundant or ambiguous items. Generalisability analysis showed that between 7 and 11 raters would be needed to achieve acceptable reliability. There is validity evidence to support using the simple 8-item, mixed methods Manchester Clinical Placement Index to measure key conditions for

  3. Opening Doors to Earning Credentials: Impressions of Community College Access and Retention from Low-Wage Workers.

    ERIC Educational Resources Information Center

    Matus-Grossman, Lisa; Gooden, Susan Tinsley

    Educational access and retention issues for low-wage working parents were examined in a study conducted at six community colleges nationwide. Three focus groups were held at each community college--one each for current community college students, those who had enrolled, in but not completed a community college program, and those who had never…

  4. Developing leadership practices in hospital-based nurse educators in an online learning community.

    PubMed

    Stutsky, Brenda J; Spence Laschinger, Heather K

    2014-01-01

    Hospital-based nurse educators are in a prime position to mentor future nurse leaders; however, they need to first develop their own leadership practices. The goal was to establish a learning community where hospital-based nurse educators could develop their own nursing leadership practices within an online environment that included teaching, cognitive, and social presence. Using a pretest/posttest-only nonexperimental design, 35 nurse educators from three Canadian provinces engaged in a 12-week online learning community via a wiki where they learned about exemplary leadership practices and then shared stories about their own leadership practices. Nurse educators significantly increased their own perceived leadership practices after participation in the online community, and teaching, cognitive, and social presence was determined to be present in the online community. It was concluded that leadership development can be enhanced in an online learning community using a structured curriculum, multimedia presentations, and the sharing and analysis of leadership stories. Educators who participated should now be better equipped to role model exemplary leadership practices and mentor our nurse leaders of the future. PMID:24256766

  5. The total hospital and community UK costs of managing patients with relapsed breast cancer.

    PubMed

    Thomas, R J; Williams, M; Marshall, C; Glen, J; Callam, M

    2009-02-24

    The complete hospital and community records of 77 women were randomly selected from 232 women who had relapsed breast cancer between 2000 and 2005. Scrutiny of all management activities revealed a total cost of 1,939,329 pound sterling (mean per patient of 25,186 pound sterling , 95% CI 13,705 pound sterling-33,821 pound sterling ). The median survival from time of relapse was 40.07 months and the median total cost per patient was 31 402.62 pound sterling . Including the community cost of a relapse provides a more realistic figure for future cost-effectiveness analysis of adjuvant breast cancer therapies. PMID:19223909

  6. Developing Accessible Cyberinfrastructure-Enabled Knowledge Communities in the National Disability Community: Theory, Practice, and Policy

    ERIC Educational Resources Information Center

    Myhill, William N.; Cogburn, Derrick L.; Samant, Deepti

    2008-01-01

    Since publication of the Atkins Commission report 2003, the national scientific community has placed significant emphasis on developing cyberinfrastructure-enabled knowledge communities, which are designed to facilitate enhanced efficiency and collaboration in geographically distributed networks of researchers. This article suggests that the new…

  7. The influence of job characteristics on job outcomes of pharmacists in hospital, clinic, and community pharmacies.

    PubMed

    Lin, Blossom Yen-Ju; Yeh, Ying-Chen; Lin, Wen-Hung

    2007-06-01

    This study examines the relationship between job characteristics and job outcomes of pharmacists in hospital, clinic, and community pharmacies in Taiwan. The structured questionnaires covered the items of job characteristics, job outcomes, and demographics of pharmacists, and were distributed between Feb 2004 and April 2004. Two hundred and ninety-eight pharmacists responded. Data were analyzed descriptively, and univariate analyses, factor analysis, and multiple regression analyses were used. It found the more enriched the job, the greater the job satisfaction and less intention to leave. And community pharmacists reported greater job enrichment and job satisfaction and less intention to leave than did hospital and clinic pharmacists. It suggests pharmacy managers could recognize the needs of pharmacists to redesign and enrich their work arrangements. PMID:17622026

  8. DELIVERING TIMELY WATER QUALITY INFORMATION TO YOUR COMMUNITY. THE LAKE ACCESS-MINNEAPOLIS PROJECT

    EPA Science Inventory

    This report is a summary of the near-real-time water quality-monitoring project conducted by a consortium of interested parties in the greater Minneapolis area. It was funded by an EPA program known as EMPACT (Environmental Monitoring, Public Access, and Community Tracking). In 1...

  9. Access, Quality, and Opportunity: A Case Study of Zambia Open Community Schools (ZOCS)

    ERIC Educational Resources Information Center

    Mwalimu, Michelle

    2011-01-01

    Community schools and other approaches to Alternative Primary Education or APE have increased access to primary education for underserved populations in Africa, Asia, and Latin America as a major goal of the Education for All (EFA) movement. In Zambia, a country where an estimated 20 percent of the basic education enrollment now attends community…

  10. Balancing Open Access with Academic Standards: Implications for Community College Faculty

    ERIC Educational Resources Information Center

    Gabbard, Anita; Mupinga, Davison M.

    2013-01-01

    Community colleges act as the gateway for students to higher education. Many of these colleges realize this mission through open-door policies where students lacking in basic reading, writing, and mathematics skills can enroll. But, this open-access policy often creates challenges when meeting academic standards. Based on data collected from…

  11. Ensuring Access with Quality to California's Community Colleges. National Center Report #04-3

    ERIC Educational Resources Information Center

    Hayward, Gerald C.; Jones, Dennis P.; McGuinness, Aims C., Jr.; Timar, Allene

    2004-01-01

    This report finds that enrollment growth pressures, fee increases, and recent budget cuts in the California Community Colleges are having significant detrimental effects on student access and program quality. The report also provides recommendations for creating improvements that build from the state policy context and from existing promising…

  12. Rural Older Adults' Access Barriers to In-Home and Community-Based Services

    ERIC Educational Resources Information Center

    Li, Hong

    2006-01-01

    This study identified specific access barriers to seven commonly used in-home and community-based services (CBS) and examined factors that were related to barriers to these services. The data used in this study were extracted from the 1999 National Long Term Care Survey and included 283 dyads of rural older adults and their caregivers. The CBS to…

  13. Access to Success: Truman, Obama, and the Evolution of Presidential Agendas for Community Colleges

    ERIC Educational Resources Information Center

    Robertson, Thashundray C.

    2011-01-01

    This dissertation examined two higher education federal activities, President Harry Truman's 1947 Presidential Commission on Higher Education and President Barack Obama's 2009 American Graduation Initiative, to understand how the federal government's mission for community colleges has evolved from one of student access to student success over the…

  14. Save Lives! Recommendations To Reduce Underage Access to Alcohol & Action Steps for Your Community. Update 1995.

    ERIC Educational Resources Information Center

    Join Together, Boston, MA.

    Each year thousands of young people are killed and injured in alcohol-related crashes. In 1992, Join Together, convened a national policy panel on underage drinking in direct response to communities' demands for action. This document is a product of the panel's findings. Section 1, Recommendations to Reduce Underage Access to Alcohol, made five…

  15. Assessing Police Community Readiness to Work on Youth Access and Possession of Tobacco

    ERIC Educational Resources Information Center

    Kunz, Charlotte B.; Jason, Leonard A.; Adams, Monica; Pokorny, Steven B.

    2009-01-01

    Researchers are only beginning to investigate how to measure a community's readiness to engage in an intervention. In this study, we investigated the readiness of police departments to deal with tobacco policies about youth access to tobacco and youth possession of tobacco. Police officers in 24 towns completed structured interviews designed to…

  16. Unrealized Promises: Unequal Access, Affordability, and Excellence at Community Colleges in Southern California

    ERIC Educational Resources Information Center

    Martinez-Wenzl, Mary; Marquez, Rigoberto

    2012-01-01

    California community colleges are, by design, the only entry point to four-year institutions for the majority of students in the state. Yet, many of these institutions perpetuate racial and class segregation, thus disrupting the California Master Plan for Higher Education's promise of access, equity, and excellence in higher education. This report…

  17. [Access, use and preferences of Information and Communication Technologies by physicians in a general hospital in Peru].

    PubMed

    Vásquez-Silva, Luis; Ticse, Ray; Alfaro-Carballido, Luz; Guerra-Castañon, Felix

    2015-01-01

    We assessed the access, use and preferences of information and communication technology (ICT) by physicians who practice at Cayetano Heredia National Hospital. The questionnaire explored the availability and skills of ICT, time, educational activities, search engines and technological applications most used as well as ICT preferences in education.211 physicians were surveyed; laptop use was 93%, tablet and smartphone use was 66% and 88%.68% have mobile Internet. Differences were evident in the frequency of use of ICT in 25-34 year old age group as well as a higher level of skills (p<0.05). 86% use PubMed, Facebook and WhatsApp as a means of exchanging images and data related to health, 50% participated in medical blogs, online courses or videoconferences. The use and access of ICT is common among doctors in this hospital and there is positive interest in its use in education. PMID:26338389

  18. Improving Medication Administration Safety in a Community Hospital Setting Using Lean Methodology.

    PubMed

    Critchley, Sandy

    2015-01-01

    Virtually all health care organizations have goals of improving patient safety, but despite clear goals and considerable investments, gains have been limited. This article explores a community hospital's resounding success using Lean methodology to improve medication administration safety with process changes designed by engaged employees and leaders with the knowledge and skill to effect improvements. This article inspires an interdisciplinary approach to quality improvement using reproducible strategies. PMID:25599523

  19. Prevalence and laboratory identification of methicillin-resistant Staphylococcus aureus in community hospitals.

    PubMed Central

    Mahoney, M C; Eckman, M R; Stolee, T A; Cossalter, D J

    1984-01-01

    The prevalence of methicillin-resistant Staphylococcus aureus infections in community hospitals in northern Minnesota, Wisconsin, and Michigan was found to be one case in 82,565 patients. The percentage of S. aureus isolates resistant to methicillin was less than 0.2% (5 of 2,835). In this study, conducted from 1 June 1982 to 31 May 1983, a laboratory-controlled methodology was used. PMID:6569063

  20. Increasing access to care for Brazos Valley, Texas: a rural community of solution.

    PubMed

    Garney, Whitney R; Drake, Kelly; Wendel, Monica L; McLeroy, Kenneth; Clark, Heather R; Ryder, Byron

    2013-01-01

    Compared with their urban counterparts, rural populations face substantial disparities in terms of health care and health outcomes, particularly with regard to access to health services. To address ongoing inequities, community perspectives are increasingly important in identifying health issues and developing local solutions that are effective and sustainable. This article has been developed by both academic and community representatives and presents a brief case study of the evolution of a regional community of solution (COS) servicing a 7-county region called the Brazos Valley, Texas. The regional COS gave rise to multiple, more localized COSs that implemented similar strategies designed to address access to care within rural communities. The regional COS, known as the Brazos Valley Health Partnership, was a result of a 2002 health status assessment that revealed that rural residents face poorer access to health services and their care is often fragmented. Their localized strategy, called a health resource center, was created as a "one-stop shop" where multiple health and social service providers could be housed to deliver services to rural residents. Initially piloted in Madison County, the resource center model was expanded into Burleson, Grimes, and Leon Counties because of community buy-in at each of these sites. The resource center concept allowed service providers, who previously were able to offer services only in more populous areas, to expand into the rural communities because of reduced overhead costs. The services provided at the health resource centers include transportation, information and referral, and case management along with others, depending on the location. To ensure successful ongoing operations and future planning of the resource centers, local oversight bodies known as health resource commissions were organized within each of the rural communities to represent local COSs. Through collaboration with local entities, these partnerships have

  1. Physician clinical alignment and integration: a community-academic hospital approach.

    PubMed

    Salas-Lopez, Debbie; Weiss, Sandra Jarva; Nester, Brian; Whalen, Thomas

    2014-01-01

    An overwhelming need for change in the U.S. healthcare delivery system, coupled with the need to improve clinical and financial outcomes, has prompted hospitals to direct renewed efforts toward achieving high quality and cost-effectiveness. Additionally, with the dawn of accountable care organizations and increasing focus on patient expectations, hospitals have begun to seek physician partners through clinical alignment. Contrary to the unsuccessful alignment strategies of the 1990s, today's efforts are more mutually beneficial, driven by the need to achieve better care coordination, increased access to infrastructure, improved quality, and lower costs. In this article, we describe a large, academic, tertiary care hospital's approach to developing and implementing alignment and integration models with its collaboration-ready physicians and physician groups. We developed four models--short of physicians' employment with the organization--tailored to meet the needs of both the physician group and the hospital: (1) medical directorship (group physicians are appointed to serve as medical directors of a clinical area), (2) professional services agreement (specific clinical services, such as overnight admissions help, are contracted), (3) co-management services agreement (one specialty group co-manages all services within the specialty service lines), and (4) lease arrangement (closest in scope to employment, in which the hospital pays all expenses and receives all revenue). Successful hospital-physician alignment requires careful planning and the early engagement of legal counsel to ensure compliance with federal statutes. Establishing an integrated system with mutually identified goals better positions hospitals to deliver cost-effective and high-quality care under the new paradigm of healthcare reform. PMID:24988674

  2. Innovations in the Delivery of Health Care Services to Rural Communities: Telemedicine and Limited-Service Hospitals.

    ERIC Educational Resources Information Center

    Capalbo, Susan M.; Heggem, Christine N.

    1999-01-01

    Presents an overview of the use of telemedicine technologies and critical access hospitals in rural areas. Discusses changes in rural population, hospital closures, and federal health care policy. Provides anecdotal evidence on the impact of these innovations in rural Montana, which suggests that different health care solutions are needed for…

  3. Improving financial performance by modeling and analysis of radiology procedure scheduling at a large community hospital.

    PubMed

    Lu, Lingbo; Li, Jingshan; Gisler, Paula

    2011-06-01

    Radiology tests, such as MRI, CT-scan, X-ray and ultrasound, are cost intensive and insurance pre-approvals are necessary to get reimbursement. In some cases, tests may be denied for payments by insurance companies due to lack of pre-approvals, inaccurate or missing necessary information. This can lead to substantial revenue losses for the hospital. In this paper, we present a simulation study of a centralized scheduling process for outpatient radiology tests at a large community hospital (Central Baptist Hospital in Lexington, Kentucky). Based on analysis of the central scheduling process, a simulation model of information flow in the process has been developed. Using such a model, the root causes of financial losses associated with errors and omissions in this process were identified and analyzed, and their impacts were quantified. In addition, "what-if" analysis was conducted to identify potential process improvement strategies in the form of recommendations to the hospital leadership. Such a model provides a quantitative tool for continuous improvement and process control in radiology outpatient test scheduling process to reduce financial losses associated with process error. This method of analysis is also applicable to other departments in the hospital. PMID:20703560

  4. Predictors of Severe Sepsis among Patients Hospitalized for Community-Acquired Pneumonia

    PubMed Central

    Torres, Antoni; Reyes, Soledad; Méndez, Raúl; Zalacaín, Rafael; Capelastegui, Alberto; Rajas, Olga; Borderías, Luis; Martin-Villasclaras, Juan; Bello, Salvador; Alfageme, Inmaculada; Rodríguez de Castro, Felipe; Rello, Jordi; Molinos, Luis; Ruiz-Manzano, Juan

    2016-01-01

    Background Severe sepsis, may be present on hospital arrival in approximately one-third of patients with community-acquired pneumonia (CAP). Objective To determine the host characteristics and micro-organisms associated with severe sepsis in patients hospitalized with CAP. Results We performed a prospective multicenter cohort study in 13 Spanish hospital, on 4070 hospitalized CAP patients, 1529 of whom (37.6%) presented with severe sepsis. Severe sepsis CAP was independently associated with older age (>65 years), alcohol abuse (OR, 1.31; 95% CI, 1.07–1.61), chronic obstructive pulmonary disease (COPD) (OR, 1.75; 95% CI, 1.50–2.04) and renal disease (OR, 1.57; 95% CI, 1.21–2.03), whereas prior antibiotic treatment was a protective factor (OR, 0.62; 95% CI, 0.52–0.73). Bacteremia (OR, 1.37; 95% CI, 1.05–1.79), S pneumoniae (OR, 1.59; 95% CI, 1.31–1.95) and mixed microbial etiology (OR, 1.65; 95% CI, 1.10–2.49) were associated with severe sepsis CAP. Conclusions CAP patients with COPD, renal disease and alcohol abuse, as well as those with CAP due to S pneumonia or mixed micro-organisms are more likely to present to the hospital with severe sepsis. PMID:26727202

  5. Identification of high-risk communities for unattended out-of-hospital cardiac arrests using GIS.

    PubMed

    Semple, Hugh M; Cudnik, Michael T; Sayre, Michael; Keseg, David; Warden, Craig R; Sasson, Comilla

    2013-04-01

    Improving survival rates for out of hospital cardiac arrest (OHCA) at the neighborhood level is increasingly seen as priority in US cities. Since wide disparities exist in OHCA rates at the neighborhood level, it is necessary to locate neighborhoods where people are at elevated risk for cardiac arrest and target these for educational outreach and other mitigation strategies. This paper describes a GIS-based methodology that was used to identify communities with high risk for cardiac arrests in Franklin County, Ohio during the period 2004-2009. Prior work in this area used a single criterion, i.e., the density of OHCA events, to define the high-risk areas, and a single analytical technique, i.e., kernel density analysis, to identify the high-risk communities. In this paper, two criteria are used to identify the high-risk communities, the rate of OHCA incidents and the level of bystander CPR participation. We also used Local Moran's I combined with traditional map overlay techniques to add robustness to the methodology for identifying high-risk communities for OHCA. Based on the criteria established for this study, we successfully identified several communities that were at higher risk for OHCA than neighboring communities. These communities had incidence rates of OHCA that were significantly higher than neighboring communities and bystander rates that were significantly lower than neighboring communities. Other risk factors for OHCA were also high in the selected communities. The methodology employed in this study provides for a measurement conceptualization of OHCA clusters that is much broader than what has been previously offered. It is also statistically reliable and can be easily executed using a GIS. PMID:22983677

  6. Cryptosporidiosis in Indonesia: a hospital-based study and a community-based survey.

    PubMed

    Katsumata, T; Hosea, D; Wasito, E B; Kohno, S; Hara, K; Soeparto, P; Ranuh, I G

    1998-10-01

    Hospital-based and community-based studies were conducted to understand the prevalence and mode of transmission of Cryptosporidium parvum infection in Surabaya, Indonesia. In both studies people with and without diarrhea were examined for oocysts. A community-based survey included questionnaires to a community and stool examination of cats. Questionnaires covered demographic information, health status, and hygienic indicators. In the hospital, C. parvum oocysts were found in 26 (2.8%) of 917 patients with diarrhea and 15 (1.4%) of 1,043 control patients. The most susceptible age was less than two years old. The prevalence was higher during the rainy season. A community-based study again showed that C. parvum oocysts were frequently detected in diarrhea samples (8.2%), exclusively during rainy season. Thirteen (2.4%) of 532 cats passed C. parvum oocysts. A multiple logistic regression model indicated that contact with cats, rain, flood, and crowded living conditions are significant risk factors for Cryptosporidium infection. PMID:9790442

  7. Gaining control: reform, reimbursement and politics in New York's community hospitals, 1890--1915.

    PubMed Central

    Rosner, D

    1980-01-01

    This is an historical study of an early twentieth century political struggle regarding hospital reimbursement in New York City. During a period called the "Progressive Era" (1895--1915), administrators in the City's Comptroller's office sought to gain control over small, locally run community hospitals by dismantling the long-standing practice of flat-grant payments to institutions. Central office planners felt that these payments gave too much control to trustees. In its place, the Comptroller initiated a system of per-capita, per-diem reimbursement. Inspectors now judged for the institutions which services and which clients were appropriate for municipal reimbursement. From the perspective of the Comptroller's office, this change was an attempt to put rationality into the system of municipal support for charitable institutions. From the perspective of trustees and community representatives, however, this change was a political attack on the rights of institutions and local communities to control their own fate. Within the context of the larger Progressive Era "good government" movement to centralize decision-making in the hands of experts who believed strongly in the efficiency of larger institutions, it was generally the smallest, most financially troubled community institutions which felt the brunt of these changes. PMID:6990801

  8. Closing Italian Forensic Psychiatry Hospitals in Favor of Treating Insanity Acquittees in the Community.

    PubMed

    Carabellese, Felice; Felthous, Alan R

    2016-03-01

    Originally a hedge against the death penalty, the insanity defense came to offer hospitalization as an alternative to imprisonment. In the late 19th century Italy opened inpatient services first for mentally ill prisoners and then for offenders found not guilty by reason of insanity. Within the past decade, a series of decrees has resulted in transferring the responsibility for treating NGRI acquittees and "dangerous" mentally ill prisoners from the Department of Justice to the Department of Health, and their treatment from Italy's high security forensic psychiatric hospitals (OPGs) to community regional facilities (REMSs, Residences for the Execution of Security Measures), community mental health facilities, one of which is located in each region of Italy. Today community REMSs provide the treatment and management of socially dangerous offenders. The dynamic evolution of Italy's progressive mental health system for insanity acquittees, to our knowledge the most libertarian, community oriented approach of any country, is retraced. Discussion includes cautionary concerns as well as potential opportunities for improvements in mental health services. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27256003

  9. What Should We Expect? A Comparison of the Community Benefit and Projected Government Support of Maryland Hospitals.

    PubMed

    Turner, Jason S; Broom, Kevin D; Goldner, Jesse A; Lee, Jen-Fu

    2016-04-01

    Designation as a tax-exempt, not-for-profit entity carries with it specific tax benefits. In exchange for tax exemptions, not-for-profit entities are expected to provide benefits to their communities. To evaluate whether hospitals provide community benefits (CBs) equivalent to the financial subsidies and advantages extended to them, tax liabilities and financial support were projected for all Maryland acute care hospitals between 2010 and 2012 and in the aggregate over the 3 years of this study. A comparison was then made between the provision of CBs and the financial support that governments provide to the hospitals. The results indicate that hospitals provide significantly and substantially more CBs than the material financial support they receive. Even after modeling changes in CB activities and the associated tax liabilities that may result from transitioning to taxable status, the benefits that hospitals provide to the communities they serve continue to exceed the potential government tax revenues. PMID:26400867

  10. Reducing youth access to alcohol: findings from a community-based randomized trial.

    PubMed

    Flewelling, Robert L; Grube, Joel W; Paschall, M J; Biglan, Anthony; Kraft, Anne; Black, Carol; Hanley, Sean M; Ringwalt, Christopher; Wiesen, Chris; Ruscoe, Jeff

    2013-03-01

    Underage drinking continues to be an important public health problem and a challenge to the substance abuse prevention field. Community-based interventions designed to more rigorously control underage access to alcohol through retailer education and greater enforcement of underage drinking laws have been advocated as potentially effective strategies to help address this problem, but studies designed to evaluate such interventions are sparse. To address this issue we conducted a randomized trial involving 36 communities to test the combined effectiveness of five interrelated intervention components designed to reduce underage access to alcohol. The intervention was found to be effective in reducing the likelihood that retail clerks would sell alcohol to underage-looking buyers, but did not reduce underage drinking or the perceived availability of alcohol among high school students. Post hoc analyses, however, revealed significant associations between the level of underage drinking law enforcement in the intervention communities and reductions in both 30-day use of alcohol and binge drinking. The findings highlight the difficulty in reducing youth drinking even when efforts to curtail retail access are successful. Study findings also suggest that high intensity implementation of underage drinking law enforcement can reduce underage drinking. Any such effects of enhanced enforcement on underage drinking appear to be more directly attributable to an increase in perceived likelihood of enforcement and the resultant perceived inconveniences and/or sanctions to potential drinkers, than to a reduction in access to alcohol per se. PMID:22688848

  11. Reducing Youth Access to Alcohol: Findings from a Community-Based Randomized Trial*

    PubMed Central

    Flewelling, Robert L.; Grube, Joel W.; Paschall, M.J.; Biglan, Anthony; Kraft, Anne; Black, Carol; Hanley, Sean; Ringwalt, Christopher; Wiesen, Chris; Ruscoe, Jeff

    2012-01-01

    Underage drinking continues to be an important public health problem and a challenge to the substance abuse prevention field. Community-based interventions designed to more rigorously control underage access to alcohol through retailer education and greater enforcement of underage drinking laws have been advocated as potentially effective strategies to help address this problem, but studies designed to evaluate such interventions are sparse. To address this issue we conducted a randomized trial involving 36 communities to test the combined effectiveness of five interrelated intervention components designed to reduce underage access to alcohol. The intervention was found to be effective in reducing the likelihood that retail clerks would sell alcohol to underage-looking buyers, but did not reduce underage drinking or the perceived availability of alcohol among high school students. Post hoc analyses, however, revealed significant associations between the level of underage drinking law enforcement in the intervention communities and reductions in both 30-day use of alcohol and binge drinking. The findings highlight the difficulty in reducing youth drinking even when efforts to curtail retail access are successful. Study findings also suggest that high intensity implementation of underage drinking law enforcement can reduce underage drinking. Any such effects of enhanced enforcement on underage drinking appear to be more directly attributable to an increase in perceived likelihood of enforcement and the resultant perceived inconveniences and/or sanctions to potential drinkers, than to a reduction in access to alcohol per se. PMID:22688848

  12. Teaching physicians-in-training to address racial disparities in health: a hospital-community partnership.

    PubMed Central

    Jacobs, Elizabeth A.; Kohrman, Claire; Lemon, Maurice; Vickers, Dennis L.

    2003-01-01

    Racial and ethnic disparities in health care continue to be a major impediment to improving the health of many communities in the United States. Efforts must be directed at the multiple social, economic, and historic determinants of health disparities. In addition, health care providers must be aware of these determinants and must have the tools to address them in their individual relationships with patients. This article describes a partnership that arose out of the mutual recognition by a community organization and public hospital of the need to (a) teach physicians how to recognize the root causes of health disparities, (b) improve their cross-cultural understanding and communication, and (c) enhance their awareness of the capacity of community resources to positively impact their patients' lives. PMID:12815083

  13. Anaemia and malaria in Yanomami communities with differing access to healthcare.

    PubMed

    Grenfell, P; Fanello, C I; Magris, M; Goncalves, J; Metzger, W G; Vivas-Martínez, S; Curtis, C; Vivas, L

    2008-07-01

    Inequitable access to healthcare has a profound impact on the health of marginalised groups that typically suffer an excess burden of infectious disease morbidity and mortality. The Yanomami are traditionally semi-nomadic people living in widely dispersed communities in Amazonian Venezuela and Brazil. Only communities living in the vicinity of a health post have relatively constant access to healthcare. To monitor the improvement in the development of Yanomami healthcare a cross-sectional survey of 183 individuals was conducted to investigate malaria and anaemia prevalence in communities with constant and intermittent access to healthcare. Demographic and clinical data were collected. Malaria was diagnosed by microscopy and haemoglobin concentration by HemoCue. Prevalence of malaria, anaemia, splenomegaly, fever and diarrhoea were all significantly higher in communities with intermittent access to healthcare (anaemia 80.8% vs. 53.6%, P<0.001; malaria 18.2% vs. 6.0%, P=0.013; splenomegaly 85.4% vs.12.5%, P<0.001; fever 50.5% vs. 28.6%, P=0.003; diarrhoea 30.3% vs.10.7% P=0.001). Haemoglobin level (10.0 g/dl vs. 11.5 g/dl) was significantly associated with access to healthcare when controlling for age, sex, malaria and splenomegaly (P=0.01). These findings indicate a heavy burden of anaemia in both areas and the need for interventions against anaemia and malaria, along with more frequent medical visits to remote areas. PMID:18405929

  14. Medication Incidents Related to Automated Dose Dispensing in Community Pharmacies and Hospitals - A Reporting System Study

    PubMed Central

    Cheung, Ka-Chun; van den Bemt, Patricia M. L. A.; Bouvy, Marcel L.; Wensing, Michel; De Smet, Peter A. G. M.

    2014-01-01

    Introduction Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. Methods The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. Main Outcome Measures Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. Results From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. Conclusion A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident

  15. A Needs Assessment of the Accessibility of Distance Education in the California Community College System. Part II: Costs and Promising Practices Associated with Making Distance Education Courses Accessible

    ERIC Educational Resources Information Center

    Farr, Beverly; Studier, Carol; Sipes, Laurel; Coombs, Norman

    2009-01-01

    As the number of online distance education (DE) courses mushrooms in the California community college system, the need to address the accessibility of these courses becomes more and more urgent. With this in mind, the California Community College System Office (CCCSO) retained MPR Associates, Inc. to complete a needs assessment to help determine…

  16. Partnering to Promote Evidence-Based Practice in a Community Hospital: Implications for Nursing Professional Development Specialists.

    PubMed

    Highfield, Martha E F; Collier, Andrea; Collins, Mara; Crowley, Melanie

    2016-01-01

    Nursing professional development specialists working in community hospitals face significant barriers to evidence-based practice that academic medical centers do not. This article describes 7 years of a multifaceted, service academic partnership in a large, urban, community hospital. The partnership has strengthened the nursing professional development role in promoting evidence-based practice across the scope of practice and serves as a model for others. PMID:27187827

  17. 42 CFR 412.78 - Determination of the hospital-specific rate for inpatient operating costs for sole community...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 2006 base period. 412.78 Section 412.78 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM...

  18. 42 CFR 412.78 - Determination of the hospital-specific rate for inpatient operating costs for sole community...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 2006 base period. 412.78 Section 412.78 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM...

  19. Community Resources Accessed by Community-Based Rehabilitation Programs: A Pilot Study.

    ERIC Educational Resources Information Center

    Johnson, William F.; And Others

    This study sought to determine what, if any, local funding sources are available to rehabilitation service providers as supplements to fee-for-service funding for specific consumers. Chief executive officers at 20 community-based vocational rehabilitation organizations in Minnesota and Wisconsin were interviewed to determine organization financial…

  20. Community treatment orders and reduced time in hospital: a nationwide study, 2007–2012

    PubMed Central

    Taylor, Mark; Macpherson, Melanie; Macleod, Callum; Lyons, Donald

    2016-01-01

    Aims and method Community treatment orders (CTOs) were introduced in Scotland in 2005, but are controversial owing to a lack of supportive randomised evidence. The non-randomised studies provide mixed results on their efficacy and utility. We aimed to examine hospital bed day usage across Scotland both before and after CTOs were initiated in a national cohort of patients, spanning 5 years. Results In total, 1558 individuals who were subject to a CTO between 2007 and 2012, of whom 63% were male, were included. After CTO initiation the number of hospital bed days fell, on average, from 66 to 39 per annum per patient. Those with a longer psychiatric history appeared to benefit more from a CTO, in terms of reduced time in hospital. Clinical implications Our data offer cautious support for the use of CTOs in routine practice, in terms of reducing time spent in psychiatric hospital. This finding is balanced by the more rigorous randomised studies which do not find any benefit to CTOs. PMID:27280031

  1. Community treatment orders and reduced time in hospital: a nationwide study, 2007-2012.

    PubMed

    Taylor, Mark; Macpherson, Melanie; Macleod, Callum; Lyons, Donald

    2016-06-01

    Aims and method Community treatment orders (CTOs) were introduced in Scotland in 2005, but are controversial owing to a lack of supportive randomised evidence. The non-randomised studies provide mixed results on their efficacy and utility. We aimed to examine hospital bed day usage across Scotland both before and after CTOs were initiated in a national cohort of patients, spanning 5 years. Results In total, 1558 individuals who were subject to a CTO between 2007 and 2012, of whom 63% were male, were included. After CTO initiation the number of hospital bed days fell, on average, from 66 to 39 per annum per patient. Those with a longer psychiatric history appeared to benefit more from a CTO, in terms of reduced time in hospital. Clinical implications Our data offer cautious support for the use of CTOs in routine practice, in terms of reducing time spent in psychiatric hospital. This finding is balanced by the more rigorous randomised studies which do not find any benefit to CTOs. PMID:27280031

  2. Continuous fungal treatment of non-sterile veterinary hospital effluent: pharmaceuticals removal and microbial community assessment.

    PubMed

    Badia-Fabregat, Marina; Lucas, Daniel; Pereira, Maria Alcina; Alves, Madalena; Pennanen, Taina; Fritze, Hannu; Rodríguez-Mozaz, Sara; Barceló, Damià; Vicent, Teresa; Caminal, Glòria

    2016-03-01

    Source point treatment of effluents with a high load of pharmaceutical active compounds (PhACs), such as hospital wastewater, is a matter of discussion among the scientific community. Fungal treatments have been reported to be successful in degrading this type of pollutants and, therefore, the white-rot fungus Trametes versicolor was applied for the removal of PhACs from veterinary hospital wastewater. Sixty-six percent removal was achieved in a non-sterile batch bioreactor inoculated with T. versicolor pellets. On the other hand, the study of microbial communities by means of DGGE and phylogenetic analyses led us to identify some microbial interactions and helped us moving to a continuous process. PhAC removal efficiency achieved in the fungal treatment operated in non-sterile continuous mode was 44 % after adjusting the C/N ratio with respect to the previously calculated one for sterile treatments. Fungal and bacterial communities in the continuous bioreactors were monitored as well. PMID:26541333

  3. The Impact of Prior Antibiotic Therapy on Outcomes in Children Hospitalized for Community-Acquired Pneumonia.

    PubMed

    Lavi, Eran; Breuer, Oded

    2016-01-01

    Here, we review current available literature regarding the effect of prior antibiotic treatment on outcomes of children hospitalized for community-acquired pneumonia (CAP). To date, no prospective trial has reported information regarding morbidity or mortality in this group of patients. Retrospective studies have provided evidence for the advantage of treatment with broad-spectrum antibiotics in children who failed prior antibiotic therapy. We discuss the changing epidemiology of CAP in the post PCV13 and Hib vaccines era and its relevance to the outcome of pediatric patients hospitalized for CAP. Current studies still report Streptococcus pneumoniae as the most common typical bacterial causative agent in pediatric CAP. However, in children who fail to respond to guideline directed antibiotic therapy, a non-pneumococcal, possibly one of several β-lactam resistant causative bacterial agents should be considered thus clarifying the advantage for broad-spectrum empirical antibiotic treatment in this group of patients. PMID:26715113

  4. Resistance to antibiotics in gram-negative rods from clinical material of hospital and community origin.

    PubMed

    Kolár, M; Hájek, V; Sázelová, J; Krátká, J; Koukalová, D

    1995-01-01

    The authors examined the resistance to 13 antibiotics and chemotherapeutic agents by the diluting micromethod and the routine disk method in the group of 5375 gram-negative strains of 7 genera which prevailed in clinical material of an hospital (FN Olomouc) and in material of community (OHS Olomouc) provenance during the years 1992 and 1993. In the majority of cases, the resistance was more frequent in the strains isolated from the hospital material. The most remarkable differences were found in A cinetobacter sp. (9-76%), Enterobacter sp. (10-60%) and Citrobacter sp. (18-58%). In other examined species, the differences varied in the ranges 3-40% in E.coli, 2-33% in Klebsiella sp., 0-28% in P. vulgaris, 2-28% in P.mirabilis, 0-16% in M.morganii, and 0-13% in P. aeruginosa. PMID:8686556

  5. A Web-based Clearing-house for Community Telescope Information and Access

    NASA Astrophysics Data System (ADS)

    Garmany, C. D.; Boroson, T. A.

    2004-12-01

    Where can one find information on all available community telescopes and their instrumentation? With the growth of a very diverse set of ground-based O/IR telescopes and instruments there is an increasing need for corresponding information on these facilities, as has been pointed out by the 2nd community workshop on the ground-based O/IR system (May 2004). In response, NOAO has agreed to develop a web site for the community that summarizes all publicly available observing opportunities and acts as a clearing -house for information. While much of the information is currently available on the web, it requires consolidation. Observing opportunities include not only those scheduled through NOAO, but other facilities as well. In particular, PREST (Program for Research and Education with Small Telescopes), a new NSF initiative, will provide community access to smaller (< 2.5 m) telescopes . We envision a web site that includes NOAO facilities, the TSIP program (which provides public time on Keck, HET, MMT, Magellan, LBT), and other telescopes giving public access through NOAO: WIYN, SOAR, SMARTS. Facilities that provide public access but not through NOAO, will also be included. The site should include time available, how and when to apply, instrument and detector capabilities, selection criteria, typical weather, lodging accommodations, and technical assistance or training available at the telescope. Also, feedback from observers on the performance of the facilities will be made available to potential proposers. As we develop this site, we welcome input from the astronomical community on how to make it most useful to astronomers.

  6. Fecal carriage of vancomycin-resistant enterococci in hospitalized patients and those living in the community in The Netherlands.

    PubMed Central

    Endtz, H P; van den Braak, N; van Belkum, A; Kluytmans, J A; Koeleman, J G; Spanjaard, L; Voss, A; Weersink, A J; Vandenbroucke-Grauls, C M; Buiting, A G; van Duin, A; Verbrugh, H A

    1997-01-01

    In order to determine the prevalence of vancomycin-resistant enterococci (VRE) in The Netherlands, 624 hospitalized patients from intensive care units or hemato-oncology wards in nine hospitals and 200 patients living in the community were screened for VRE colonization. Enterococci were found in 49% of the hospitalized patients and in 80% of the patients living in the community. Of these strains, 43 and 32%, respectively, were Enterococcus faecium. VRE were isolated from 12 of 624 (2%) and 4 of 200 (2%) hospitalized patients and patients living in the community, respectively. PCR analysis of these 16 strains and 11 additional clinical VRE isolates from one of the participating hospitals revealed 24 vanA gene-containing, 1 vanB gene-containing, and 2 vanC1 gene-containing strains. All strains were cross-resistant to avoparcin but were sensitive to the novel glycopeptide antibiotic LY333328. Genotyping of the strains by arbitrarily primed PCR and pulsed-field gel electrophoresis revealed a high degree of genetic heterogeneity. This underscores a lack of hospital-driven endemicity of VRE clones. It is suggested that the VRE in hospitalized patients have originated from unknown sources in the community. PMID:9399488

  7. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    ERIC Educational Resources Information Center

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  8. Optimal Decision Model for Sustainable Hospital Building Renovation—A Case Study of a Vacant School Building Converting into a Community Public Hospital

    PubMed Central

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-01-01

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

  9. Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

    PubMed

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-01-01

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

  10. The impact of the individual mandate and Internal Revenue Service Form 990 Schedule H on community benefits from nonprofit hospitals.

    PubMed

    Principe, Kristine; Adams, E Kathleen; Maynard, Jenifer; Becker, Edmund R

    2012-02-01

    In response to a growing concern that nonprofit hospitals are not providing sufficient benefit to their communities in return for their tax-exempt status, the Internal Revenue Service (IRS) now requires nonprofit hospitals to formally document the extent of their community contributions. While the IRS is increasing financial scrutiny of nonprofit hospitals, many provisions in the recently passed historical health reform legislation will also have a significant impact on the provision of uncompensated care and other community benefits. We argue that health reform does not render the nonprofit organizational form obsolete. Rather, health reform should strengthen the nonprofit hospitals' ability to fulfill their missions by better targeting subsidies for uncompensated care and potentially increasing subsidized health services provision, many of which affect the public's health. PMID:22390437

  11. Exposure to Community Violence is Associated with Asthma Hospitalizations and ED Visits

    PubMed Central

    Apter, Andrea J.; Garcia, Laura A.; Boyd, Rhonda C.; Wang, Xingmei; Bogen, Daniel K.; Have, Thomas Ten

    2010-01-01

    Background Exposure to community violence (ECV) has been associated with asthma morbidity of children living in inner-city neighborhoods. Objective To examine with prospective longitudinal data whether ECV is independently associated with asthma-related health outcomes in adults. Methods Adults with moderate-severe asthma, recruited from clinics serving inner-city neighborhoods, completed questionnaires covering socio-demographics, asthma severity, and ECV and were followed for 26 weeks. Longitudinal models were employed to assess unadjusted and adjusted associations of subsequent asthma outcomes (emergency department (ED) visits, hospitalizations, FEV1, quality of life). Results 397 adults, 47±14 years, 73% female, 70% African American, 7% Latino, mean FEV1 66%±19%, 133 with hospitalizations and 222 with ED visits for asthma in the year before entry were evaluated. 91 reported ECV. Controlling for age, gender, race/ethnicity, and household income, those exposed to violence had 2.27 (95% CI: 1.32-3.90) times more asthma-related ED visits per month and 2.49 (95% CI: 1.11-5.60) times more asthma-related hospitalizations per month over the 26-week study period compared to those unexposed. Violence-exposed participants also had 1.71 (95% CI: 1.14-2.56) times more overall ED visits per month and 1.72 (95% CI: 0.95-3.11) times more overall hospitalizations per month from any cause. Asthma-related quality of life was lower in the violence-exposed participants (-0.40 (95%CI: -0.77-0.025), p=0.04). Effect modification by depressive symptoms was only statistically significant for the ECV association with overall ED visits and quality of life outcomes (p<.01). Conclusion In adults, ECV is associated with increased hospitalizations and emergency care for asthma or any condition and with asthma-related quality of life. PMID:20816190

  12. Access, quality, and costs of care at physician owned hospitals in the United States: observational study

    PubMed Central

    Orav, E John; Jena, Anupam B; Dudzinski, David M; Le, Sidney T; Jha, Ashish K

    2015-01-01

    Objective To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Design Observational study. Setting Acute care hospitals in 95 hospital referral regions in the United States, 2010. Participants 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Main outcome measures Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. Results The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Conclusion Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care. PMID:26333819

  13. Shoot, ready, aim: pneumonia care quality and costs in a community hospital.

    PubMed

    Milo, Lori A; Smucker, William; Logue, Everett; Orosz, James; Grimes, Michael G; Bonyo, Bonyo; Dulle, David; McNaughton, Marc

    2003-01-01

    Mandatory community-acquired pneumonia (CAP) protocol usage was proposed in our community-based teaching hospital because of senior medical staff perceptions that excessive variation in CAP care was adversely affecting clinical outcomes and costs. The purpose of our study was to examine CAP process of care variation, outcomes, and costs to ascertain whether the mandatory CAP protocol could be justified. The study consisted of an analysis of administrative and sampled chart data. We looked at pneumonia severity, orders for blood cultures or sputum staining, antibiotic usage, symptom resolution, length of stay, discharge status, readmission risk by follow-up time, and financial data. We found that process of care variation was low, clinical outcomes were generally good, and CAP care was profitable. Our data suggested that the proposed mandatory CAP protocol was not necessary. Our experience supports the management principle that fact finding should usually precede decision making, not the reverse. PMID:14604274

  14. Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury

    PubMed Central

    Hsu, Chien-Ning; Lee, Chien-Te; Su, Chien-Hao; Wang, Yu-Ching Lily; Chen, Hsiao-Ling; Chuang, Jiin-Haur; Tain, You-Lin

    2016-01-01

    Abstract The disease burden and outcomes of community-acquired (CA-) and hospital-acquired acute kidney injury (HA-AKI) are not well understood. The aim of the study was to investigate the incidence, outcomes, and risk factors of AKI in a large Taiwanese adult cohort. This retrospective cohort study examined 734,340 hospital admissions from a group of hospitals within an organization in Taiwan between January 1, 2010 and December 31, 2014. Patients with AKI at discharge were classified as either CA- or HA-AKI based on the RIFLE (risk, injury, failure, loss of function, end stage of kidney disease) classification criteria. Outcomes were in-hospital mortality, dialysis, recovery of renal function, and length of stay. Risks of developing AKI were determined using multivariate logistic regression based on demographic and baseline clinical characteristics and nephrotoxin use before admission. AKI occurred in 1.68% to 2% hospital discharges among adults without and with preexisting chronic kidney disease (CKD), respectively. The incidence of CA-AKI was 17.25 and HA-AKI was 8.14 per 1000 admissions. The annual rate of CA-AKI increased from 12.43 to 19.96 per 1000 people, but the change in HA-AKI was insignificant. Comparing to CA-AKI, those with HA-AKI had higher levels of in-hospital mortality (26.07% vs 51.58%), mean length of stay (21.25 ± 22.35 vs 35.84 ± 34.62 days), and dialysis during hospitalization (1.45% vs 2.06%). Preexisting systemic diseases, including CKD were associated with increased risks of CA-AKI, and nephrotoxic polypharmacy increased risk of both CA- and HA-AKI. Patients with HA-AKI had more severe outcomes than patients with CA-AKI, and demonstrated different spectrum of risk factors. Although patients with CA-AKI with better outcomes, the incidence increased over time. It is also clear that optimal preventive and management strategies of HA- and CA-AKI are urgently needed to limit the risks in susceptible individuals. PMID:27175701

  15. Translating Research Into Practice: Voluntary Reporting of Medication Errors in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Jones, Katherine J.; Cochran, Gary; Hicks, Rodney W.; Mueller, Keith J.

    2004-01-01

    Context:Low service volume, insufficient information technology, and limited human resources are barriers to learning about and correcting system failures in small rural hospitals. This paper describes the implementation of and initial findings from a voluntary medication error reporting program developed by the Nebraska Center for Rural Health…

  16. Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital

    ERIC Educational Resources Information Center

    Burra, Tara A.; Hwang, Stephen W.; Rourke, Sean B.; Stergiopoulos, Vicky

    2012-01-01

    This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender,…

  17. Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community.

    PubMed

    Falvey, Jason R; Burke, Robert E; Malone, Daniel; Ridgeway, Kyle J; McManus, Beth M; Stevens-Lapsley, Jennifer E

    2016-08-01

    Hospital readmissions in older adult populations are an emerging quality indicator for acute care hospitals. Recent evidence has linked functional decline during and after hospitalization with an elevated risk of hospital readmission. However, models of care that have been developed to reduce hospital readmission rates do not adequately address functional deficits. Physical therapists, as experts in optimizing physical function, have a strong opportunity to contribute meaningfully to care transition models and demonstrate the value of physical therapy interventions in reducing readmissions. Thus, the purposes of this perspective article are: (1) to describe the need for physical therapist input during care transitions for older adults and (2) to outline strategies for expanding physical therapy participation in care transitions for older adults, with an overall goal of reducing avoidable 30-day hospital readmissions. PMID:26939601

  18. Segmental analysis of thallium 201 myocardial perfusion scintigraphy: its value in a community hospital.

    PubMed

    Tendera, M; Campbell, W B; Moyers, J R

    1984-08-01

    In a community hospital, we correlated results of thallium 201 myocardial scintigraphy with coronary arteriographic data in 79 patients. Scintigraphy was 92% sensitive and 85% specific in detecting coronary artery disease. There were no false-negative scintigrams in patients with double or triple vessel disease. The most important factors determining sensitivity of the method in detecting individual coronary stenoses were (1) location of the stenosis in the coronary tree, (2) number of vessels involved, and (3) degree of obstruction. Higher prevalence of perfusion defects in areas of 90% to 99% stenosis as compared with 50% to 89% lesions was of borderline statistical significance (86% vs 59%; P = .06). Myocardial perfusion scintigraphy was unable to predict the number of significantly narrowed coronary vessels. Predictive value of a perfusion defect for a significant coronary stenosis was 87% for anterior, 88% for septal, 90% for lateral, 89% for posterior, and 78% for inferior segment. We conclude that segmental analysis of myocardial scintigrams may be of value in a community hospital. PMID:6463700

  19. Antibiotic Consumption During a 4-year Period in a Community Hospital with an Antimicrobial Stewardship Program

    PubMed Central

    Garcell, Humberto Guanche; Arias, Ariadna Villanueva; Fernandez, Eliezer Alemán; Guerrero, Yaquelín Batista; Serrano, Ramon N. Alfonso

    2016-01-01

    Objectives We sought to evaluate the trend of antibiotic consumption in patients admitted to a community hospital in Qatar with an antimicrobial stewardship program. Methods This observational study was carried out in a 75-bed facility in Western Qatar over a 4-year period (2012–2015). The monitoring of antimicrobial consumption from inpatient wards was performed from the pharmacy records and presented as defined daily dose (DDD) divided by the patient days and expressed as 100 bed-days (DBD). Results The consumption of antimicrobials in 2012 was 171.3 DBD, and increased to 252.7 DBD in 2013, 229.1 DBD in 2014, and 184.7 DBD in 2015. Cephalosporins use reduced from 98.2 DBD in 2013 to 51.5 DBD in 2015 while the consumption of penicillins increased during the beginning of 2014 with a slight decrease in 2015. Carbapenems consumption during 2014–2015 was lower than previous years, and vice-versa for aminoglycosides. Fluoroquinolones had a sustained increase with 37.1% increased consumption in 2015 compared to the two previous years. There was an increase in the use of intravenous (IV) (108.5%) and oral azithromycin (55.1%) and the use of oral (152.8%) and IV moxifloxacin (22.9%). Conclusions We observed a decrease in antibiotic use in patients admitted to a community hospital with an antimicrobial stewardship program, but the increase in fluoroquinolones consumption is a concern that requires focused strategies. PMID:27602189

  20. Pharmacy-based skin-testing program in a community hospital.

    PubMed

    Clyne, K E; Ternes, R L

    1996-09-01

    The establishment of a pharmacy-based skin-testing program at a community hospital is described. Problems with existing skin testing were brought to the attention of the pharmacy and therapeutics committee, which decided that one group of caregivers within the hospital should be chosen and trained to perform skin testing. A problem-solving team identified specific problems and developed solutions. The top four causes of the skin-testing problems were failure to follow procedure, inaccurate reading of tests, failure to report positive results, and failure to document results. Groups within the hospital who might perform skin testing were assessed according to several criteria; the pharmacy staff was selected because of ease of notification, availability, and ability to conduct follow-through (reading, documenting, and reporting results). Other improvements were step-by-step instructions for all phases of skin testing, a portable skin-test supply kit, and a skin-test record form to be placed in the physician progress notes. Pharmacists were trained by the employee health nurse. Pharmacist skin testing began in March 1995. Pharmacists administered tests to 93 inpatients and about 250 employees during the first 13 months of the program, and no problems were reported. Establishment of a pharmacy-based skin-testing program improved the quality of inpatient skin testing and enabled pharmacists to increase their role in patient care. PMID:8870893

  1. The Effectiveness of a Rapid-Access Flexible Sigmoidoscopy Clinic in a District Hospital

    PubMed Central

    Sorelli, Paolo G.; Iliadis, Alex D.; Payne, John G.

    2014-01-01

    Historically rapid-access colorectal clinics have had high proportions of nonconforming referrals from primary care physicians, which calls into question the clinics' efficacy. We aim to determine the effectiveness of our rapid-access flexible sigmoidoscopy clinic, and the adherence to the referral guidelines for suspected bowel cancer by general practitioners. We performed a 3-month retrospective audit to evaluate (1) the proportion of patients seen within 2 weeks, (2) the appropriateness of referrals, (3) the proportion of patients with findings, and (4) the proportion of patients who had further tests. A total of 59 patients (19 male, 40 female; age 35–86 years) were included in the study. All were offered an appointment within 2 weeks. Forty-one cases (82%) were appropriate referrals. Twenty-eight patients (47%) had pathology at sigmoidoscopy. Cancer pick-up rate was 6%. Thirty-seven patients (74%) had further investigations. We determined that our rapid-access clinic for symptomatic patients has high diagnostic accuracy and that access to early investigation is being used appropriately by general practitioners. In the current climate of spending cuts and streamlining services, our study confirms we are meeting targets for delivery of our colorectal service. The majority of referrals under the 2-week rule are appropriate. Rapid access to early investigation is being used appropriately by general practitioners contrasting previous studies with high proportions of nonconforming referrals. PMID:25058768

  2. Access to Electric Light Is Associated with Shorter Sleep Duration in a Traditionally Hunter-Gatherer Community.

    PubMed

    de la Iglesia, Horacio O; Fernández-Duque, Eduardo; Golombek, Diego A; Lanza, Norberto; Duffy, Jeanne F; Czeisler, Charles A; Valeggia, Claudia R

    2015-08-01

    Access to electric light might have shifted the ancestral timing and duration of human sleep. To test this hypothesis, we studied two communities of the historically hunter-gatherer indigenous Toba/Qom in the Argentinean Chaco. These communities share the same ethnic and sociocultural background, but one has free access to electricity while the other relies exclusively on natural light. We fitted participants in each community with wrist activity data loggers to assess their sleep-wake cycles during one week in the summer and one week in the winter. During the summer, participants with access to electricity had a tendency to a shorter daily sleep bout (43 ± 21 min) than those living under natural light conditions. This difference was due to a later daily bedtime and sleep onset in the community with electricity, but a similar sleep offset and rise time in both communities. In the winter, participants without access to electricity slept longer (56 ± 17 min) than those with access to electricity, and this was also related to earlier bedtimes and sleep onsets than participants in the community with electricity. In both communities, daily sleep duration was longer during the winter than during the summer. Our field study supports the notion that access to inexpensive sources of artificial light and the ability to create artificially lit environments must have been key factors in reducing sleep in industrialized human societies. PMID:26092820

  3. Multi-hospital Community NICU Quality Improvement Improves Survival of ELBW Infants.

    PubMed

    Owens, Jack D; Soltau, Thomas; McCaughn, Danny; Miller, Jason; O'Mara, Patrick; Robbins, Kenny; Temple, David M; Wender, David F

    2015-08-01

    Quality improvement or high reliability in medicine is an evolving science where we seek to integrate evidence-based medicine, structural resources, process management, leadership models, culture, and education. Newborn Associates is a community-based neonatology practice that staffs and manages neonatal intensive care units (NICU's) at Central Mississippi Medical Center, Mississippi Baptist Medical Center, River Oaks Hospital, St Dominic's Hospital and Woman's Hospital within the Jackson, Mississippi, metropolitan area. These hospitals participate in the Vermont-Oxford Neonatal Network (VON), which is a voluntary national network of about 1000 NICU groups that submit data allowing them to benchmark their patient outcome. This network currently holds data on 1.5 million infants. Participation may also include the Newborn Improvement Quality Collaborative (NICQ) which is an intensive quality improvement program where 40-60 of the almost 1000 VON centers participate each year or the iNICQ, which is an internet-based collaborative involving about 150 centers per year. From 2008-2009, our group concentrated efforts on quality improvement which included consolidating resources of three corporately managed hospitals to allow focused care of babies under 800-1000 grams at a single center, expanding participation in the VON NICQ to include all physicians and centers, and establishing a group QI focused committee aimed at sharing practice bundles and adopting quality improvement methodology. The goal of this article is to report the impact of these QI activities on survival of the smallest preterm infants who weigh less than 1500 grams at birth. Two epochs were compared: 2006-2009, and 2010-2013. 551 VLBW (< 1 500 grams) infants from epoch I were compared to 583 VLBW infants from epoch 2. Mortality in this group decreased from 18% to 11.1% (OR 0.62,95% CI 0.44-0.88). Mortality in the 501-750 grams birth weight category decreased from 45.7% to 18% (OR 0.39,95% CI 0

  4. A Systematic Review of Intervention Studies to Prevent Hospitalizations of Community-dwelling Older Adults With Dementia

    PubMed Central

    Debnam, Katrina J.; Anderson, Lynda A.; Owens, Steven B.

    2015-01-01

    Objectives: To conduct a systematic literature review to determine if there were any intervention strategies that had any measurable effect on acute-care hospitalizations among community-dwelling adults with dementia. Design: Studies were identified by a professional research librarian and content experts. Setting: Community dwelling. Participants: Participants were diagnosed with dementia, severity ranging from mild to severe, and were recruited from health care and community agencies. Measurements: A study met the inclusion criteria if it: (a) was published in English; (b) included a control or comparison group; (c) published outcome data from the intervention under study; (d) reported hospitalization as one of the outcomes; (e) included community-dwelling older adults; and (f) enrolled participants with dementia. Ten studies met all inclusion criteria. Results: Of the 10 studies included, most assessed health services use (ie, hospitalizations) as a secondary outcome. Participants were recruited from a range of health care and community agencies, and most were diagnosed with dementia with severity ratings ranging from mild to severe. Most intervention strategies consisted of face-to-face assessments of the persons living with dementia, their caregivers, and the development and implementation of a care plan. A significant reduction in hospital admissions was not found in any of the included studies, although 1 study did observe a reduction in hospital days. Conclusions: The majority of studies included hospitalizations as a secondary outcome. Only 1 intervention was found to have an effect on hospitalizations. Future work would benefit from strategies specifically designed to reduce and prevent acute hospitalizations in persons with dementia. PMID:25588136

  5. Leveraging Open Standards and Technologies to Enhance Community Access to Earth Science Lidar Data

    NASA Astrophysics Data System (ADS)

    Crosby, C. J.; Nandigam, V.; Krishnan, S.; Cowart, C.; Baru, C.; Arrowsmith, R.

    2011-12-01

    Lidar (Light Detection and Ranging) data, collected from space, airborne and terrestrial platforms, have emerged as an invaluable tool for a variety of Earth science applications ranging from ice sheet monitoring to modeling of earth surface processes. However, lidar present a unique suite of challenges from the perspective of building cyberinfrastructure systems that enable the scientific community to access these valuable research datasets. Lidar data are typically characterized by millions to billions of individual measurements of x,y,z position plus attributes; these "raw" data are also often accompanied by derived raster products and are frequently terabytes in size. As a relatively new and rapidly evolving data collection technology, relevant open data standards and software projects are immature compared to those for other remote sensing platforms. The NSF-funded OpenTopography Facility project has developed an online lidar data access and processing system that co-locates data with on-demand processing tools to enable users to access both raw point cloud data as well as custom derived products and visualizations. OpenTopography is built on a Service Oriented Architecture (SOA) in which applications and data resources are deployed as standards compliant (XML and SOAP) Web services with the open source Opal Toolkit. To develop the underlying applications for data access, filtering and conversion, and various processing tasks, OpenTopography has heavily leveraged existing open source software efforts for both lidar and raster data. Operating on the de facto LAS binary point cloud format (maintained by ASPRS), open source libLAS and LASlib libraries provide OpenTopography data ingestion, query and translation capabilities. Similarly, raster data manipulation is performed through a suite of services built on the Geospatial Data Abstraction Library (GDAL). OpenTopography has also developed our own algorithm for high-performance gridding of lidar point cloud data

  6. Improving Post-Hospitalization Transition Outcomes through Accessible Health Information Technology and Caregiver Support: Protocol for a Randomized Controlled Trial

    PubMed Central

    Piette, John D; Striplin, Dana; Marinec, Nicolle; Chen, Jenny; Gregory, Lynn A; Sumerlin, Denise L; DeSantis, Angela M; Gibson, Carolyn; Crause, Ingrid; Rouse, Marylena; Aikens, James E

    2015-01-01

    Objective The goal of this trial is to evaluate a novel intervention designed to improve post-hospitalization support for older adults with chronic conditions via: (a) direct tailored communication to patients using regular automated calls post discharge, (b) support for informal caregivers outside of the patient’s household via structured automated feedback about the patient’s status plus advice about how caregivers can help, and (c) support for care management including a web-based disease management tool and alerts about potential problems. Methods 846 older adults with common chronic conditions are being identified upon hospital admission. Patients are asked to identify a “CarePartner” (CP) living outside their household, i.e., an adult child or other social network member willing to play an active role in their post-discharge transition support. Patient-CP pairs are randomized to the intervention or usual care. Intervention patients receive automated assessment and behavior change calls, and their CPs receives structured feedback and advice via email and automated calls following each assessment. Clinical teams have access to assessment results via the web and receive automated reports about urgent health problems. Patients complete surveys at baseline, 30 days, and 90 days post discharge; utilization data is obtained from hospital records. CPs, other caregivers, and clinicians are interviewed to evaluate intervention effects on processes of self-care support, caregiver stress and communication, and the intervention’s potential for broader implementation. The primary outcome is 30-day readmission rates; other outcomes measured at 30 days and 90 days include functional status, self-care behaviors, and mortality risk. Conclusion This trial uses accessible health technologies and coordinated communication among informal caregivers and clinicians to fill the growing gap between what discharged patients need and available resources. A unique feature of

  7. Antibiotic Resistance Pattern of Community Acquired Uropathogens at a Tertiary Care Hospital in Jaipur, Rajasthan

    PubMed Central

    Sood, Smita; Gupta, Ravi

    2012-01-01

    Background: Urinary tract infections (UTIs) are amongst the most common infections described in outpatients setting. Objectives: A study was conducted to evaluate the uropathogenic bacterial flora and its antimicrobial susceptibility profile among patients presenting to the out-patient clinics of a tertiary care hospital at Jaipur, Rajasthan. Materials and Methods: 2012 consecutive urine specimens from symptomatic UTI cases attending to the outpatient clinics were processed in the Microbiology lab. Bacterial isolates obtained were identified using biochemical reactions. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Extended spectrum beta lactamase (ESBL) production was determined by the double disk approximation test and the Clinical and Laboratory Standards Institute (formerly NCCLS) confirmatory method. Results: Pathogens were isolated from 346 (17.16%) of the 2012 patients who submitted a urine sample. Escherichia coli was the most frequently isolated community acquired uropathogen accounting for 61.84% of the total isolates. ESBL production was observed in 23.83% of E. coli strains and 8.69% of Klebsiella strains. With the exception of Nitrofurantoin, resistance to agents commonly used as empiric oral treatments for UTI was quite high. Conclusion: The study revealed E. coli as the predominant bacterial pathogen for the community acquired UTIs in Jaipur, Rajasthan. An increasing trend in the production ESBLs among UTI pathogens in the community was noted. Nitrofurantoin should be used as empirical therapy for primary, uncomplicated UTIs. PMID:22529539

  8. Rural Community-Dwelling Elders' Reports of Access to Care: Are There Hispanic versus Non-Hispanic White Disparities?

    ERIC Educational Resources Information Center

    Borders, Tyrone F.

    2004-01-01

    Consumer reports can provide useful information about the dimensions of access in need of improvement for particular population subgroups. To determine if there are Hispanic versus non- Hispanic white disparities in rural elders' reports of their health care access. A telephone survey was conducted among 2,097 rural community-dwelling elders in…

  9. Exploring the Role of Community Cultural Wealth in Graduate School Access and Persistence for Mexican American PhDs

    ERIC Educational Resources Information Center

    Espino, Michelle M.

    2014-01-01

    This article focuses on the extent to which devalued forms of capital along with limited access to valued cultural capital facilitated the access and persistence of 33 Mexican American PhDs who earned their doctorates in a variety of disciplines at 15 universities across the United States. Using the framework of community cultural wealth, this…

  10. The Impact of the Individual Mandate and Internal Revenue Service Form 990 Schedule H on Community Benefits From Nonprofit Hospitals

    PubMed Central

    Adams, E. Kathleen; Maynard, Jenifer; Becker, Edmund R.

    2012-01-01

    In response to a growing concern that nonprofit hospitals are not providing sufficient benefit to their communities in return for their tax-exempt status, the Internal Revenue Service (IRS) now requires nonprofit hospitals to formally document the extent of their community contributions. While the IRS is increasing financial scrutiny of nonprofit hospitals, many provisions in the recently passed historical health reform legislation will also have a significant impact on the provision of uncompensated care and other community benefits. We argue that health reform does not render the nonprofit organizational form obsolete. Rather, health reform should strengthen the nonprofit hospitals’ ability to fulfill their missions by better targeting subsidies for uncompensated care and potentially increasing subsidized health services provision, many of which affect the public's health. PMID:22390437

  11. Community spread of extended-spectrum β-lactamase-producing bacteria detected in social insurance hospitals throughout Japan.

    PubMed

    Shibasaki, Mayumi; Komatsu, Masaru; Sueyoshi, Noriyuki; Maeda, Misaho; Uchida, Takae; Yonezawa, Hitoshi; Inagaki, Kenji; Omi, Ayako; Matsumoto, Hidenobu; Murotani, Makiko; Iwamoto, Tsukasa; Kodaka, Yoshihiro; Kieda, Hideto; Tokiwa, Manabu; Masuwa, Bunji; Kinoshita, Mari; Saito, Kazuei; Katou, Masahiko

    2016-06-01

    We surveyed the status of community-acquired infections involving four extended-spectrum β-lactamase (ESBL)-producing bacteria (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis) isolated from clinical specimens from 11 social insurance hospitals in Japan in 2012. These are member hospitals of the Japan Community Healthcare Organization, an independent administrative hospital organization. The isolation rates for E. coli, K. pneumoniae, K. oxytoca, and P. mirabilis were 14.0% (165/1176), 3.3% (16/480), 3.1% (4/130), and 15.9% (17/107), respectively. The CTX-M-9 group, the most frequently detected genotype, was found in 77.0% (127/165) of E. coli and 43.8% (7/16) of K. pneumoniae isolates. Among K. oxytoca isolates, 75% (3/4) were the CTX-M-1 group, and all 17 P. mirabilis strains were the CTX-M-2 group. ESBL-producing bacteria isolation rates in each hospital ranged from 5.8% to 21.5% (median 9.5%), and the proportion of community-acquired infections among ESBL-producing bacteria isolates ranged from 1.6% to 30.8% (median 11.4%) in each hospital. Overall, the rates of ESBL-producing bacterial infection in all community-acquired infections and in all hospital infections were 10.6% (115/1081) and 10.7% (87/812), respectively. The ESBL-producing bacteria are not limited to certain regions or hospitals but are spreading in communities throughout Japan. PMID:27066881

  12. Targeted Access to the Genomes of Low Abundance Organisms in Complex Microbial Communities

    SciTech Connect

    Podar, Mircea; Abulencia, Carl; Walcher, Marion; Hutchinson, Don; Zengler, Karsten; Garcia, Joseph; Holland, Trevin; Cotton, Dave; Hauser, Loren John; Keller, Martin

    2007-01-01

    Current metagenomic approaches to the study of complex microbial consortia provide a glimpse into the community metabolism, and occasionally allow genomic assemblies for the most abundant organisms. However, little information is gained for the members of the community present at low frequency, especially those representing yet uncultured taxa-which includes the bulk of the diversity present in most environments. Here we used phylogenetically directed cell separation by fluorescence in situ hybridization and flow cytometry, followed by amplification and sequencing of a fraction of the genomic DNA of several bacterial cells that belong to the TM7 phylum. Partial genomic assembly allowed, for the first time, a look into the evolution and potential metabolism of a soil representative from this group of organisms for which there are no species in stable laboratory cultures. Genomic reconstruction from targeted cells of uncultured organisms directly isolated from the environment represents a powerful approach to access any specific members of a community and an alternative way to assess the community metabolic potential.

  13. Access, Excellence and Student Retention: The Challenge of Leadership, Public Trust and Institutional Effectiveness in Urban Community Colleges.

    ERIC Educational Resources Information Center

    Smith, Janet D.

    Though community colleges have long been committed to providing equal access and equal opportunity to all persons in their service districts, the need to meet the education and training needs of underserved racial and ethnic minorities in urban communities remains a significant challenge to educational leaders. Several books and reports issued…

  14. Housing as an intervention on hospital use: access among chronically homeless persons with disabilities.

    PubMed

    Parker, David

    2010-12-01

    A study examining demographics and hospital utilization for chronically homeless persons with disabilities was conducted at pre-housing enrollment and at 6 months post-housing. Of the 20 participants, 70% (n = 14) were Black American and 30% (n = 6) were White; 100% (n = 20) were non-Hispanic; 90% (n = 18) were men; 40% (n = 8) were veterans; Median years since last permanent housing and total homelessness were 7 and 10.5 respectively. The following increases were observed: employment (0 to 1); income (20%, n = 4 to 35%, n = 7); primary care (25%, n = 5 to 95%, n = 19); and mental health service use (25%, n = 5 to 60%, n = 12). Known disabilities included HIV (15%, n = 3); hepatitis C (45%, n = 9); mental illness (60%, n = 12) and substance abuse (80%, n = 16) with 45% (n = 9) dually diagnosed. Over the course of the study, Emergency department visits and inpatient hospitalization use decreased. While these differences were not statistically significant (p = 0.14 and p = 0.31, respectively), they translate to an estimated $250,208 savings. PMID:21125341

  15. [The permanence of access to health care: a tradition of hospitality and innovative organizational model].

    PubMed

    Georges-Tarragano, C

    2015-01-01

    The PASS ("Permanence d'Accès aux Soins de Santé") are hospital-based units providing primary care services to patients who lack health care coverage. Using a "whole person" approach and providing a combination of health and social care, the PASS offer an appropriately adapted response to complex health problems within a context of marked social vulnerability and contribute to reducing health inequalities. The PASS are an example of an interdisciplinary approach to health care which contrasts with the segmentary approach typical of conventional hospital departments. Operating at the interface between primary and secondary care, the PASS have the potential to become key players in developing models of patient pathways. Their presence reduces inappropriate emergency attendances and hospitalisation by offering medical care in a timely fashion, in an outpatient-type setting. The PASS can provide a resource for research into optimum models of health care, where the social context of health needs are fully recognized and inform medical treatment appropriately. According to their potential development, PASS are living labs of an innovative organizational model of care. PMID:25455953

  16. Where are the food deserts? An evaluation of policy-relevant measures of community food access in South Carolina

    PubMed Central

    Liese, Angela D.; Hibbert, James D.; Ma, Xiaoguang; Bell, Bethany A.; Battersby, Sarah E.

    2015-01-01

    Several recent United States (US) policies target spatial access to healthier food retailers. We evaluated two measures of community food access developed by two different agencies, using a 2009 food environment validation study in South Carolina as a reference. While the US Department of Agriculture Economic Research Service’s (USDA ERS) measure designated 22.5% of census tracts as food deserts, the Centers for Disease Control and Prevention’s (CDC) measure designated 29.0% as non-healthier retail tracts; 71% of tracts were designated consistently between USDA ERS and CDC. Our findings suggest a need for greater harmonization of these measures of community food access. PMID:26294937

  17. [The process of integrating oncology nurse navigators into joint (hospital-community) local teams].

    PubMed

    Fillion, Lise; Aubin, Michèle; de Serres, Marie; Robitaille, Danielle; Veillette, Anne-Marie; Rainville, François

    2010-01-01

    Implementing oncology nurse navigators or IPOs (which stands for "infirmière pivot en oncologie") is a key element of the Québec Cancer Control Program in order to improve the continuity of care. This qualitative study describes the process of implementing IPOs in teams working both in hospitals and in the community. Several groups of stakeholders (IPOs, physicians, nurses, various health workers, administrators, people with cancer and their families) described how they perceive the functions and effects related to this implementation. After putting results into perspective, we recommend developing measures promoting the dissemination of the role and integration of IPOs in formally defined health teams. We strongly advocate for the continuation of joint efforts in order to define and clarify this complex role. PMID:20369643

  18. Adherence to Therapeutic Guidelines for Patients with Community-Acquired Pneumonia in Australian Hospitals

    PubMed Central

    Adler, NR; Weber, HM; Gunadasa, I; Hughes, AJ; Friedman, ND

    2014-01-01

    Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, particularly in elderly patients, and is associated with a considerable economic burden on the healthcare system. The combination of high incidence and substantial financial costs necessitate accurate diagnosis and appropriate management of patients admitted with CAP. This article will discuss the rates of adherence to clinical guidelines, the use of severity scoring tools and the appropriateness of antimicrobial prescribing for patients diagnosed with CAP. The authors maintain that awareness of national and hospital guidelines is imperative to complement the physicians’ clinical judgment with evidence-based recommendations. Increased use of pneumonia severity assessment tools and greater adherence to therapeutic guidelines will enhance concordant antimicrobial prescribing for patients with CAP. A robust and multifaceted educational intervention, in combination with antimicrobial stewardship programs, may enhance compliance of CAP guidelines in clinical practice in Australia. PMID:25249765

  19. Prevalence of Staphylococcus aureus protein A (spa) mutants in the community and hospitals in Oxfordshire

    PubMed Central

    2014-01-01

    Background Staphylococcal protein A (spa) is an important virulence factor which enables Staphylococcus aureus to evade host immune responses. Genotypes known as “spa-types”, based on highly variable Xr region sequences of the spa-gene, are frequently used to classify strains. A weakness of current spa-typing primers is that rearrangements in the IgG-binding region of the gene cause 1-2% of strains to be designated as “non-typeable”. Results We developed an improved primer which enabled sequencing of all strains, containing any type of genetic rearrangement, in a large study among community carriers and hospital inpatients in Oxfordshire, UK (6110 isolates). We identified eight novel spa-gene variants, plus one previously described. Three of these rearrangements would be designated “non-typeable” using current spa-typing methods; they occurred in 1.8% (72/3905) asymptomatically carried and 0.6% (14/2205) inpatient S. aureus strains. Some individuals were simultaneously colonized by both formerly non-typeable and typeable strains; previously such patients would have been identified as carrying only currently typeable strains, underestimating mixed carriage prevalence and diversity. Formerly non-typeable strains were found in more spa-types associated with multilocus sequence type ST398 (35%), common among livestock, compared to other groups with any non-typeable strains (1-4%), suggesting particular spa-types may have been under-represented in previous human studies. Conclusions This improved method allows us to spa-type previously non-typeable strains with rearrangements in the spa-gene and to resolve cases of mixed colonization with deletions in one or more strains, thus accounting for hidden diversity of S. aureus in both community and hospital environments. PMID:24621342

  20. Implementation of a radiology electronic imaging network: the community teaching hospital experience.

    PubMed

    Arreola, M; Neiman, H L; Sugarman, A; Laurenti, L; Forys, R

    1997-08-01

    for community hospitals with small computer, networking, and physics departments. Also presented are recommendations concerning design and vendor selection, that may be helpful for similar institutions. PMID:9268864

  1. Impact of Macrolide Therapy in Patients Hospitalized With Pseudomonas aeruginosa Community-Acquired Pneumonia

    PubMed Central

    Laserna, Elena; Sibila, Oriol; Fernandez, Juan Felipe; Maselli, Diego Jose; Mortensen, Eric M.; Anzueto, Antonio; Waterer, Grant

    2014-01-01

    Background: Several studies have described a clinical benefit of macrolides due to their immunomodulatory properties in various respiratory diseases. We aimed to assess the effect of macrolide therapy on mortality in patients hospitalized for Pseudomonas aeruginosa community-acquired pneumonia (CAP). Methods: We performed a retrospective population-based study of > 150 hospitals in the US Veterans Health Administration. Patients were included if they had a diagnosis of CAP and P aeruginosa was identified as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the first 48 h of admission. Univariate and multivariable analyses were performed using 30-day mortality as the dependent measure. Results: We included 402 patients with P aeruginosa CAP, of whom 171 (42.5%) received a macrolide during the first 48 h of admission. These patients were older and white. Macrolide use was not associated with lower 30-day mortality (hazard ratio, 1.14; 95% CI, 0.70-1.83; P = .5). In addition, patients treated with macrolides had no differences in ICU admission, use of mechanical ventilation, use of vasopressors, and length of stay (LOS) compared with patients not treated with macrolides. A subgroup analysis among patients with P aeruginosa CAP in the ICU showed no differences in baseline characteristics and outcomes. Conclusions: Macrolide therapy in the first 48 h of admission is not associated with decreased 30-day mortality, ICU admission, need for mechanical ventilation, and LOS in hospitalized patients with P aeruginosa CAP. Larger cohort studies should address the benefit of macrolides as immunomodulators in patients with P aeruginosa CAP. PMID:24458223

  2. [Hyponatremia as a risk factor of death in patients with community-acquired pneumonia requiring hospitalization].

    PubMed

    Barcia, Ricardo E; Castiglia, Nora I; Villaverde, Marcelo E; Lanosa, Gustavo A; Ujeda Mantello, Carlos J; Aguirre, Marina; Borello, Gustavo J; Caisson, Alejandro M

    2006-01-01

    We investigated whether hyponatremia is a risk factor of death in patients hospitalized with community-acquired pneumonia (CAP) and estimated the relative risk of death by CAP of other risk factors. The design was prospective multicentre cohort study. In 5 centers in Buenos Aires, Argentina, we studied adults hospitalized with CAP between March 21, 2000 and December 21, 2000. Using stepwise logistic regression, we analyzed risk factors that showed a univariate association with mortality; alpha significance level was 0.05. During a 9-month period, 238 patients were admitted with CAP: 150 (63%) male and 88 (36%) female, mean age 52.99 (+/-20.35) and 55.06 (+/-20.94), respectively. Mortality was 10.5% (25/238). By multivariate analysis, the following variables were statistically associated with evolution: cerebrovascular disease (CD) (B: 2.614, p < 0.001, RRE: 13.6, IC 95%: 3.7-49.6); hyponatremia at admission or during hospitalization (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); and elevated blood urea (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). We developed a formula to predict mortality by CAP: P (death) = 1/1 + exp - (-4.03 + 2.61 x l + 1.99 x 2 + 0.016x3), where: x1=CD (yes = 1/ no=0); x2= hyponatremia (yes = 1/ no=0); x3 = blood urea (mg/dl). The predictability was 91.1%. The mortality risk by CAP was statistically higher in patients with CD, hyponatremia and elevated blood urea. PMID:17240620

  3. Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand.

    PubMed

    Nantsupawat, Apiradee; Nantsupawat, Raymoul; Kulnaviktikul, Wipada; McHugh, Matthew D

    2014-04-01

    A growing body of research has shown an association between nurse staffing levels and a range of nurse outcomes. There is little empirical research evaluating this relationship in Thailand. This study evaluated the influence of nurse staffing levels on outcomes among nurses. A cross-sectional survey design was conducted at 92 community hospitals using a stratified random sampling design across Thailand during May and July 2012. Questionnaires included items focusing on nurse staffing levels; job dissatisfaction and emotional exhaustion, both related to nurse retention; and needlestick and sharps injuries. The study sample comprised 1412 registered nurses who provided direct patient care. The findings showed that each additional patient per nurse was associated with an additional 5% of nurses reporting dissatisfaction in their job; 8% of nurses reporting high emotional exhaustion, and 4% of nurses reporting needlestick and sharps injuries. This study provides evidence of how nurse staffing levels result in nurse outcomes. Nurses are significant healthcare providers that directly affect quality of care and patient safety in hospitals. Improvement of nurse staffing levels holds promise for improving nurse outcomes in Thailand. PMID:24698300

  4. Health-hazard evaluation report HETA 87-176-1826, St. James Community Hospital, Butte, Montana

    SciTech Connect

    Gunter, B.J.

    1987-08-01

    In response to a request from the Director of Nursing Service at St. James Community Hospital located in Butte, Montana, an evaluation was made of exposures to glutaraldehyde in the respiratory therapy and sigmoidoscopy departments of the hospital, where it was used in equipment sterilization. Glutaraldehyde concentrations in three breathing-zone samples were 0.25mg/cu m, 0.38mg/cu m, and below the detection level. Of six general area samples, five showed measurable concentrations ranging from 0.48 to 0.209mg/cu m. The American Conference of Governmental Industrial Hygienists has set a threshold-limit value of 0.7mg/cu m ceiling value for glutaraldehyde. The author concludes that no health hazard exists for glutaraldehyde in these operations. Informal interviews of technicians in the two departments did not reveal any health problems that could be attributed to glutaraldehyde exposure. Respiratory therapy equipment was cleaned in a hallway used as a passageway for other personnel. It is recommended that an improved arrangement be devised for cleaning respiratory equipment and that the area used for the purpose not be used as a hallway. The author also recommends that the ventilation system for the sigmoidoscope disinfecting operations be shared with other facilities, as it was very effective.

  5. Increasing access to quality health care for the poor: Community perceptions on quality care in Uganda

    PubMed Central

    Kiguli, Julie; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Mutebi, Aloysius; MacGregor, Hayley; Pariyo, George William

    2009-01-01

    This paper examines the community’s perspectives and perceptions on quality of health care delivery in two Uganda districts. The paper addresses community concerns on service quality. It focuses on the poor because they are a vulnerable group and often bear a huge burden of disease. Community views were solicited and obtained using eight focus group discussions, six in-depth and 12 key informant interviews. User perceptions and definitions of the quality of health services depended on a number of variables related to technical competence, accessibility to services, interpersonal relations and presence of adequate drugs, supplies, staff, and facility amenities. Results indicate that service delivery to the poor in the general population is perceived to be of low quality. The factors that were mentioned as affecting the quality of services delivered were inadequate trained health workers, shortage of essential drugs, poor attitude of the health workers, and long distances to health facilities. This paper argues that there should be an improvement in the quality of health services with particular attention being paid to the poor. Despite wide focus on improvement of the existing infrastructure and donor funding, there is still low satisfaction with health services and poor perceived accessibility. PMID:19936148

  6. Transforming Community Access Services through Client- and Family-Centred Homecare Transitions.

    PubMed

    Meadows, Carl; Camus, Susann; Fraser, Julie

    2015-03-01

    This article describes how one provincial health region adopted a client- and family-centred approach to improve access to community health services. Transition best practices and the "Triple Aim" supplied a framework for the transformation of transition of clients needing home healthcare services (Berwick et al. 2008). The need to improve the patient and family experience, establish and streamline professional practice standards, strengthen interprofessional collaborations, increase efficiency, create a critical mass of experts in the clinical domain of care transitions and program access, and evaluate customer experience were the organizational drivers for this transformation. The new framework identifies clients' needs and assigns a priority code. It also identifies which family member provides what support to the client and offers a one-stop service number staffed by individuals trained to provide client- and family-centred homecare services. This transformation of home healthcare transitions has improved the client and family experience, strengthened service provider satisfaction and generated efficiencies in prioritizing and delivering community healthcare services. PMID:26154123

  7. The end of the asylum (town): community responses to the depopulation and closure of the Saskatchewan Hospital, Weyburn.

    PubMed

    Dooley, Chris

    2011-01-01

    Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care. PMID:22518888

  8. [A computerized system for the management of letters of authorization for access to sensitive data in a research and teaching hospital].

    PubMed

    Bodina, Annalisa; Brizzolara, Antonella; Vadruccio, Gianluca; Castaldi, Silvana

    2012-01-01

    This paper describes the experience of a hospital which has introduced a system of computerized management of letters of authorization for healthcare workers to access sensitive health data, through the use of open source software. A new corporate intranet portal was created with access given only to the privacy contacts of each operational unit of the hospital. Once the privacy contact has entered the relevant user authorization, these must be approved first by the Directors of the respective operational units and finally by the privacy officer. The introduction of this system has allowed a systematic approach to the management of authorization for access to health data by hospital staff, regular updating and monitoring of the authorization and the start of a process of digitalization of documents. PMID:22507990

  9. Institutions in transitioning peri-urban communities: spatial differences in groundwater access

    NASA Astrophysics Data System (ADS)

    Gomes, Sharlene L.; Hermans, Leon M.

    2016-05-01

    Urbanization creates challenges for water management in an evolving socio-economic context. This is particularly relevant in transitioning peri-urban areas like Khulna, Bangladesh where competing demands have put pressure on local groundwater resources. Users are unable to sufficiently meet their needs through existing institutions. These institutions provide the rules for service provision and act as guidelines for actors to resolve their water related issues. However, the evolving peri-urban context can produce fragmented institutional arrangements. For example in Khulna, water supply is based on urban and rural boundaries that has created water access issues for peri-urban communities. This has motivated local actors to manage their groundwater needs in various ways. General institutional theories are well developed in literature, yet little is known about institutions in transitioning peri-urban areas. Institutions that fail to adapt to changing dynamics run the risk of becoming obsolete or counter-productive, hence the need for investigating institutional change mechanisms in this context. This paper examines peri-urban case studies from Khulna using the Institutional Analysis and Development framework to demonstrate how institutions have contributed to spatial differences in groundwater access with local actors investing in formal and informal institutional change as a means of accessing groundwater.

  10. A RESTful API for Accessing Microbial Community Data for MG-RAST

    PubMed Central

    Wilke, Andreas; Bischof, Jared; Harrison, Travis; Brettin, Tom; D'Souza, Mark; Gerlach, Wolfgang; Matthews, Hunter; Paczian, Tobias; Wilkening, Jared; Glass, Elizabeth M.; Desai, Narayan; Meyer, Folker

    2015-01-01

    Metagenomic sequencing has produced significant amounts of data in recent years. For example, as of summer 2013, MG-RAST has been used to annotate over 110,000 data sets totaling over 43 Terabases. With metagenomic sequencing finding even wider adoption in the scientific community, the existing web-based analysis tools and infrastructure in MG-RAST provide limited capability for data retrieval and analysis, such as comparative analysis between multiple data sets. Moreover, although the system provides many analysis tools, it is not comprehensive. By opening MG-RAST up via a web services API (application programmers interface) we have greatly expanded access to MG-RAST data, as well as provided a mechanism for the use of third-party analysis tools with MG-RAST data. This RESTful API makes all data and data objects created by the MG-RAST pipeline accessible as JSON objects. As part of the DOE Systems Biology Knowledgebase project (KBase, http://kbase.us) we have implemented a web services API for MG-RAST. This API complements the existing MG-RAST web interface and constitutes the basis of KBase's microbial community capabilities. In addition, the API exposes a comprehensive collection of data to programmers. This API, which uses a RESTful (Representational State Transfer) implementation, is compatible with most programming environments and should be easy to use for end users and third parties. It provides comprehensive access to sequence data, quality control results, annotations, and many other data types. Where feasible, we have used standards to expose data and metadata. Code examples are provided in a number of languages both to show the versatility of the API and to provide a starting point for users. We present an API that exposes the data in MG-RAST for consumption by our users, greatly enhancing the utility of the MG-RAST service. PMID:25569221

  11. A RESTful API for accessing microbial community data for MG-RAST

    DOE PAGESBeta

    Wilke, Andreas; Bischof, Jared; Harrison, Travis; Brettin, Tom; D'Souza, Mark; Gerlach, Wolfgang; Matthews, Hunter; Paczian, Tobias; Wilkening, Jared; Glass, Elizabeth M.; et al

    2015-01-08

    Metagenomic sequencing has produced significant amounts of data in recent years. For example, as of summer 2013, MGRAST has been used to annotate over 110,000 data sets totaling over 43 Terabases. With metagenomic sequencing finding even wider adoption in the scientific community, the existing web-based analysis tools and infrastructure in MG-RAST provide limited capability for data retrieval and analysis, such as comparative analysis between multiple data sets. Moreover, although the system provides many analysis tools, it is not comprehensive. By opening MG-RAST up via a web services API (application programmers interface) we have greatly expanded access to MG-RAST data, asmore » well as provided a mechanism for the use of third-party analysis tools with MG-RAST data. This RESTful API makes all data and data objects created by the MG-RAST pipeline accessible as JSON objects. As part of the DOE Systems Biology Knowledgebase project (KBase, http:// kbase.us) we have implemented a web services API for MG-RAST. This API complements the existing MG-RAST web interface and constitutes the basis of KBase’s microbial community capabilities. In addition, the API exposes a comprehensive collection of data to programmers. This API, which uses a RESTful (Representational State Transfer) implementation, is compatible with most programming environments and should be easy to use for end users and third parties. It provides comprehensive access to sequence data, quality control results, annotations, and many other data types. Where feasible, we have used standards to expose data and metadata. Code examples are provided in a number of languages both to show the versatility of the API and to provide a starting point for users. We present an API that exposes the data in MG-RAST for consumption by our users, greatly enhancing the utility of the MG-RAST service.« less

  12. A RESTful API for accessing microbial community data for MG-RAST.

    PubMed

    Wilke, Andreas; Bischof, Jared; Harrison, Travis; Brettin, Tom; D'Souza, Mark; Gerlach, Wolfgang; Matthews, Hunter; Paczian, Tobias; Wilkening, Jared; Glass, Elizabeth M; Desai, Narayan; Meyer, Folker

    2015-01-01

    Metagenomic sequencing has produced significant amounts of data in recent years. For example, as of summer 2013, MG-RAST has been used to annotate over 110,000 data sets totaling over 43 Terabases. With metagenomic sequencing finding even wider adoption in the scientific community, the existing web-based analysis tools and infrastructure in MG-RAST provide limited capability for data retrieval and analysis, such as comparative analysis between multiple data sets. Moreover, although the system provides many analysis tools, it is not comprehensive. By opening MG-RAST up via a web services API (application programmers interface) we have greatly expanded access to MG-RAST data, as well as provided a mechanism for the use of third-party analysis tools with MG-RAST data. This RESTful API makes all data and data objects created by the MG-RAST pipeline accessible as JSON objects. As part of the DOE Systems Biology Knowledgebase project (KBase, http://kbase.us) we have implemented a web services API for MG-RAST. This API complements the existing MG-RAST web interface and constitutes the basis of KBase's microbial community capabilities. In addition, the API exposes a comprehensive collection of data to programmers. This API, which uses a RESTful (Representational State Transfer) implementation, is compatible with most programming environments and should be easy to use for end users and third parties. It provides comprehensive access to sequence data, quality control results, annotations, and many other data types. Where feasible, we have used standards to expose data and metadata. Code examples are provided in a number of languages both to show the versatility of the API and to provide a starting point for users. We present an API that exposes the data in MG-RAST for consumption by our users, greatly enhancing the utility of the MG-RAST service. PMID:25569221

  13. A RESTful API for accessing microbial community data for MG-RAST

    SciTech Connect

    Wilke, Andreas; Bischof, Jared; Harrison, Travis; Brettin, Tom; D'Souza, Mark; Gerlach, Wolfgang; Matthews, Hunter; Paczian, Tobias; Wilkening, Jared; Glass, Elizabeth M.; Desai, Narayan; Meyer, Folker; Gardner, Paul P.

    2015-01-08

    Metagenomic sequencing has produced significant amounts of data in recent years. For example, as of summer 2013, MGRAST has been used to annotate over 110,000 data sets totaling over 43 Terabases. With metagenomic sequencing finding even wider adoption in the scientific community, the existing web-based analysis tools and infrastructure in MG-RAST provide limited capability for data retrieval and analysis, such as comparative analysis between multiple data sets. Moreover, although the system provides many analysis tools, it is not comprehensive. By opening MG-RAST up via a web services API (application programmers interface) we have greatly expanded access to MG-RAST data, as well as provided a mechanism for the use of third-party analysis tools with MG-RAST data. This RESTful API makes all data and data objects created by the MG-RAST pipeline accessible as JSON objects. As part of the DOE Systems Biology Knowledgebase project (KBase, http:// kbase.us) we have implemented a web services API for MG-RAST. This API complements the existing MG-RAST web interface and constitutes the basis of KBase’s microbial community capabilities. In addition, the API exposes a comprehensive collection of data to programmers. This API, which uses a RESTful (Representational State Transfer) implementation, is compatible with most programming environments and should be easy to use for end users and third parties. It provides comprehensive access to sequence data, quality control results, annotations, and many other data types. Where feasible, we have used standards to expose data and metadata. Code examples are provided in a number of languages both to show the versatility of the API and to provide a starting point for users. We present an API that exposes the data in MG-RAST for consumption by our users, greatly enhancing the utility of the MG-RAST service.

  14. Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time.

    PubMed

    Lockwood, Ashley M; Perez, Katherine K; Musick, William L; Ikwuagwu, Judy O; Attia, Engie; Fasoranti, Oyejoke O; Cernoch, Patricia L; Olsen, Randall J; Musser, James M

    2016-04-01

    OBJECTIVE To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated. DESIGN Multicenter retrospective study. SETTING Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds). PATIENTS Patients ≥ 18 years of age with culture-proven Gram-negative bacteremia. INTERVENTION Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results. RESULTS We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P<.001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P<.001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P<.001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P=.04). CONCLUSION This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP. PMID:26738993

  15. Evaluation of Dabigatran for Appropriateness of Use and Bleeding Events in a Community Hospital Setting

    PubMed Central

    Armbruster, Anastasia L.; Buehler, Katie S.; Min, Sun H.; Riley, Margaret; Daly, Michael W.

    2014-01-01

    Background Warfarin has been the predominant anticoagulant for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). Its disadvantages are well-known and include a narrow therapeutic index, drug interactions, and the need for frequent monitoring. Dabigatran etexilate, a direct thrombin inhibitor, presents less complexity in prescribing and has emerged as an alternate therapy to warfarin. Although dabigatran does not require routine monitoring, concerns associated with its use include the lack of a reversal agent, complex dose adjustments, and limited guidance to the management of drug interactions. Objectives The goals of this study are to describe and to evaluate the use of dabigatran at a community hospital to identify areas for improvement in its prescribing. Methods This retrospective chart review of patients at a community hospital in St Louis, MO, included patients who received at least 1 dose of dabigatran between December 2010 and June 2012. The appropriateness of dabigatran was evaluated based on recommendations approved by the US Food and Drug Administration for stroke prophylaxis in the setting of NVAF. The composite end point of bleeding included hospital readmission within 1 year of receiving at least 1 dose of dabigatran at the study institution secondary to bleeding, bleeding associated with a decrease in hemoglobin level by ≥2 g/dL or transfusion of ≥2 units of blood, or a notation of bleeding in the patient's medical record. Results Of the 458 patients included in the evaluation, 76 (16.6%) patients receiving dabigatran were using an inappropriate regimen of this drug, based on dose and frequency on the first day of therapy of dabigatran or the presence of valvular disease. Many patients (42.3%) received at least 1 dose of a concomitant parenteral anticoagulant. The composite end point for bleeding was reported in 66 (14.4%) patients, including 23 (5%) with confirmed gastrointestinal bleeding

  16. Facilitating access to voluntary and community services for patients with psychosocial problems: a before-after evaluation

    PubMed Central

    Grayer, Justin; Cape, John; Orpwood, Lisa; Leibowitz, Judy; Buszewicz, Marta

    2008-01-01

    Background Patients with psychosocial problems may benefit from a variety of community, educational, recreational and voluntary sector resources, but GPs often under-refer to these through lack of knowledge and time. This study evaluated the acceptability and effectiveness of graduate primary care mental health workers (GPCMHWs) facilitating access to voluntary and community sector services for patients with psychosocial problems. Methods Patients with psychosocial problems from 13 general practices in London were referred to a GPCMHW Community Link scheme providing information and support to access voluntary and community resources. Patient satisfaction, mental health and social outcomes, and use of primary care resources, were evaluated. Results 108 patients consented to take part in the study. At three-month follow-up, 63 (58%) had made contact with a community service identified as suitable for their needs. Most were satisfied with the help provided by the GPCMHW in identifying and supporting access to a suitable service. There was a reduction in the number of patients with a probable mental health problem on the GHQ-12 from 83% to 52% (difference 31% (95% CI, 17% – 44%). Social adjustment improved and frequencies of primary care consultations and of prescription of psychotropic medications were reduced. Conclusion Graduates with limited training in mental health and no prior knowledge of local community resources can help patients with psychosocial problems access voluntary and community services, and patients value such a scheme. There was some evidence of effectiveness in reducing psychosocial and mental health problems. PMID:18462500

  17. Community, service, and policy strategies to improve health care access in the changing urban environment.

    PubMed

    Andrulis, D P

    2000-06-01

    Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs. PMID:10846501

  18. Community benefits and health reform: creating new links for public health and not-for-profit hospitals.

    PubMed

    Abbott, Ann L

    2011-01-01

    The Patient Protection and Affordable Care Act (PPACA) put new requirements on not-for-profit (NFP) hospitals to document provision of community benefits, to justify their tax-exempt status. Specific PPACA provisions include requirements that NFP hospitals conduct or participate in a community health needs assessment and work to address the needs identified. Consideration is given to these particular PPACA mandates and to Internal Revenue Service (IRS) actions to implement them. The background of concerns that have been expressed about whether the NFP hospitals' tax exemption should be continued and a brief history of that exemption is noted. Not-for-profit hospitals have resources that the federal government is requiring them to bring to public health improvement, during a time when the public health agencies at the federal and state level continue to experience reductions in funding. Linking of the NFP hospitals' compliance activities with the public health agency community health planning activities will help fulfill its PPACA requirements and the regulatory reporting requirements for the IRS. PMID:21964364

  19. Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients.

    PubMed

    Shah, Bashir Ahmed; Singh, Gurmeet; Naik, Muzafar Ahmed; Dhobi, Ghulam Nabi

    2010-04-01

    The aim of our study was to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia requiring hospitalization. The patient population consisted of 100 patients admitted with the diagnosis of community-acquired pneumonia (CAP), as defined by British Thoracic society, from December 1998 to Dec 2000, at the Sher- i-Kashmir institute of Medical Sciences Soura, Srinagar, India. Gram negative organisms were the commonest cause (19/29), followed by gram positive (10/29). In 71 cases no etiological cause was obtained. Pseudomonas aeruginosa was the commonest pathogen (10/29), followed by Staphylococcus aureus (7/29), Escherichia coli (6/29), Klebsiella spp. (3/29), Streptococcus pyogenes (1/29), Streptococcus pneumoniae (1/29) and Acinetobacter spp. (1/29). Sputum was the most common etiological source of organism isolation (26) followed by blood (6), pleural fluid (3), and pus culture (1). Maximum number of patients presented with cough (99%), fever (95%), tachycardia (92%), pleuritic chest pain (75%), sputum production (65%) and leucocytosis (43%). The commonest predisposing factors were smoking (65%), COPD (57%), structural lung disease (21%), diabetes mellitus (13%), and decreased level of consciousness following seizure (eight per cent) and chronic alcoholism (one per cent). Fourteen patients, of whom, nine were males and five females, died. Staphylococcus aureus was the causative organism in four, Pseudomonas in two, Klebsiella in one, and no organism was isolated in seven cases. The factors predicting mortality at admission were - age over 62 years, history of COPD or smoking, hypotension, altered sensorium, respiratory failure, leucocytosis, and staphylococcus pneumonia and undetermined etiology. The overall rate of identification of microbial etiology of community-acquired pneumonia was 29%, which is very low, and if serological tests for legionella, mycoplasma and viruses are performed the diagnostic yield would

  20. Comparison of Job Expectations Fulfillment of BS and Entry-Level PharmD Graduates in Hospital and Community Practice.

    ERIC Educational Resources Information Center

    Cox, Fred M.; And Others

    1989-01-01

    A survey of randomly selected graduates of seven pharmacy schools revealed that pharmacists generally felt their job expectations were being fulfilled. No differences in overall satisfaction were found between bachelor's and entry-level doctoral graduates in either community or hospital practice, and minimal subscale differences were found.…

  1. Guidelines for Libraries Serving Hospital Patients and Disabled People in the Community. IFLA Professional Reports, No. 2.

    ERIC Educational Resources Information Center

    International Federation of Library Associations, The Hague (Netherlands).

    These guidelines are based on the experiences of a number of librarians working in the area of library services for hospital patients and disabled people in the community, as well as work done previously by a number of national library associations. The guidelines indicate the essential features of services to disabled people and suggest…

  2. Feasibility Study of the Coqualeetza Indian Hospital at Sardis, B.C. for an Indian Community Center.

    ERIC Educational Resources Information Center

    Western Consultants, West Vancouver (British Columbia).

    The booklet contains a report of a feasibility study for developing the Coqualeetza Indian Hospital at Sardis, British Columbia, into an Indian community center. As explained, before the white man arrived in Fraser Valley, the Indians knew "Coqualeetza" as the "place for cleansing;" Indian women washed their blankets at this spot, but it was more…

  3. Traumatic Brain Injury Related to Motor Vehicle Accidents in Guinea: Impact of Treatment Delay, Access to Healthcare, and Patient's Financial Capacity on Length of Hospital Stay and In-hospital Mortality

    PubMed Central

    Béavogui, Kézély; Koïvogui, Akoï; Loua, Tokpagnan Oscar; Baldé, Ramata; Diallo, Boubacar; Diallo, Aminata Rougui; Béavogui, Zézé; Goumou, Koué; Guilavogui, Vamala; Sylla, N’famara; Chughtai, Morad; Qureshi, Adnan I.; Diallo, Aissatou Taran; Camara, Naby Daouda

    2015-01-01

    Background Traumatic brain injury related to road traffic accidents poses a major challenge in resource-poor settings within Guinea. Objective To analyze the impact of treatment delay, access to healthcare, and patient's financial capacity on duration of hospital stay and in-hospital mortality. Methodology Data from patients with traumatic brain injury secondary to motor vehicle accident admitted to a reference hospital (public or private) in Guinea during 2009 were analyzed. The association between various factors (treatment delay, access to healthcare, and patient's financial capacity) and prolonged hospital stay (>21 days) and in-hospital mortality were analyzed using two multivariate logistic regression models. Results The mean (±standard deviation) duration of hospital stay was 8.0 (±8.1) days. The risk of prolonged hospital stay increased by 60% when the time interval between accident and hospital arrival was greater than 12 hours compared with those in whom the time interval was less than 6 hours (adjusted odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.0–2.6, p = 0.03). Compared with patients with low-financial capacity, patients with medium-financial capacity (adjusted OR = 0.6, 95% CI = 0.4–0.8, p = 0.001) and those with high capacity (adjusted OR = 0.6, 95% CI = 0.4–0.9, p = 0.02) were less likely to have a prolonged hospital stay. The risk of in-hospital mortality was 2.6 times higher in patients with time interval between accident and hospital arrival greater than 12 hours compared with those in whom the time interval was less than 6 hours (adjusted OR = 2.6, 95% CI = 1.1–6.2 p = 0.03). In-hospital mortality was not related to patient’s financial capacity. Conclusion Prolonged hospital stay and higher in-hospital mortality was associated with longer time interval between accident and hospital arrival. This delay is attributed to inadequate condition of intercity roads and lack of emergency medical services. PMID:26576213

  4. YouthAccess to Alcohol: early findings from a community action project to reduce the supply of alcohol to teens.

    PubMed

    Clark, Sam

    2007-01-01

    The Youth Access to Alcohol (YATA) project was implemented in 2002 by the Alcohol Advisory Council of New Zealand (ALAC) in thirty communities in New Zealand, with the aim of reducing the harm experienced by young people as a result of alcohol misuse in New Zealand through reducing the supply of alcohol by adults to young people. The communities include a mix of rural and urban from both Islands in New Zealand. The project uses a community action approach, which has included setting up collaborative partnerships of key agencies, the delivery of key strategies, and multimedia awareness raising campaigns. The communities are encouraged to identify unique issues in their community regarding alcohol abuse and young people and to develop action plans incorporating a range of strategies that include tested strategies as well as innovative ideas. Communities are trained to implement several tools to monitor changes in their community over time. The study's limitations are noted and future needed research is suggested. PMID:18075928

  5. Access to Global Land Cover Reference Datasets and Their Suitability for Different User Communities

    NASA Astrophysics Data System (ADS)

    Tsendbazar, N. E.; Mora, B.; de Bruin, S.; Herold, M.

    2014-12-01

    Global land cover (GLC) maps and their validation can provide important information to different user communities. As an Essential Climate Variables, land cover observations can be used by climate modelling, forest resource and biodiversity assessments and so on. These applications have varying requirements for GLC maps. To date, several global land cover reference (GLCR) datasets have been produced and used for production and validation of specific maps. Despite significant efforts put into generating them, their availability and role in applications outside their intended use have been very limited. We analysed the suitability of GLCR datasets for a range of GLC validation applications. The potential use of GLCR datasets were assessed for main user communities such as the Climate modelling, Global forest change analysts, the GEO community of practice for agricultural monitoring and GLC map producers. We assessed 12 GLCR datasets using sets of criteria reflecting the main user requirements on the sampling, thematic and spatio-temporal detail, and quality. The analysis revealed the dataset suitability is highly dependent on specific applications by the user communities. The LC-CCI, GOFC-GOLD, FAO-FRA and Geo-Wiki datasets had the broadest applicability for multiple uses. Furthermore, we present the reference data portal from the GOFC-GOLD Land-Cover Project Office. This portal, currently under development, not only aims to make available GLCR datasets freely accessible but it will also guide the user to the most suitable dataset based on their specific needs. This portal intends to advocate also the use of best practices for the validation of land cover maps, following the recommendations from the CEOS. We present some GLCR datasets that are available on the portal (e.g. GLC2000, STEP, VIIRS). This portal will enhance the re-usability of the GLCR datasets greatly by making them available in an expert framework with a guide on proper usage for specific applications.

  6. Establishing a Coalition of Hospital-Affiliated and Community-Based Child Care Services through a Family Home Day Care Network.

    ERIC Educational Resources Information Center

    Lombardo, Kathy A.

    The director of the child care and services program of a New England hospital designed and implemented this practicum for the purpose of expanding child care services for children of hospital employees and residents of communities around the hospital. The primary goal was to increase the number of quality child care slots in the area. A second aim…

  7. The Widespread Presence of a Multidrug-Resistant Escherichia coli ST131 Clade among Community-Associated and Hospitalized Patients

    PubMed Central

    den Reijer, P. Martijn; van Burgh, Sebastian; Burggraaf, Arjan; Ossewaarde, Jacobus M.; van der Zee, Anneke

    2016-01-01

    Background & Aims The extent of entry of multidrug-resistant Escherichia coli from the community into the hospital and subsequent clonal spread amongst patients is unclear. To investigate the extent and direction of clonal spread of these bacteria within a large teaching hospital, we prospectively genotyped multidrug-resistant E. coli obtained from community- and hospital associated patient groups and compared the distribution of diverse genetic markers. Methods A total of 222 E. coli, classified as multi-drug resistant according to national guidelines, were retrieved from both screening (n = 184) and non-screening clinical cultures (n = 38) from outpatients and patients hospitalized for various periods. All isolates were routinely genotyped using an amplified fragment length polymorphism (AFLP) assay and real-time PCR for CTX-M genes. Multi-locus sequence typing was additionally performed to confirm clusters. Based on demographics, patients were categorized into two groups: patients that were not hospitalized or less than 72 hours at time of strain isolation (group I) and patients that were hospitalized for at least 72 hours (group II). Results Genotyping showed that most multi-drug resistant E. coli either had unique AFLP profiles or grouped in small clusters of maximally 8 isolates. We identified one large ST131 clade comprising 31% of all isolates, containing several AFLP clusters with similar profiles. Although different AFLP clusters were found in the two patient groups, overall genetic heterogeneity was similar (35% vs 28% of isolates containing unique AFLP profiles, respectively). In addition, similar distributions of CTX-M groups, including CTX-M 15 (40% and 44% of isolates in group I and II, respectively) and ST131 (32% and 30% of isolates, respectively) were found. Conclusion We conclude that multi-drug resistant E. coli from the CTX-M 15 associated lineage ST131 are widespread amongst both community- and hospital associated patient groups, with similar

  8. Where Do the Rural Poor Deliver When High Coverage of Health Facility Delivery Is Achieved? Findings from a Community and Hospital Survey in Tanzania

    PubMed Central

    Straneo, Manuela; Fogliati, Piera; Azzimonti, Gaetano; Mangi, Sabina; Kisika, Firma

    2014-01-01

    Introduction As part of maternal mortality reducing strategies, coverage of delivery care among sub-Saharan African rural poor will improve, with a range of facilities providing services. Whether high coverage will benefit all socio-economic groups is unknown. Iringa rural District, Southern Tanzania, with high facility delivery coverage, offers a paradigm to address this question. Delivery services are available in first-line facilities (dispensaries, health centres) and one hospital. We assessed whether all socio-economic groups access the only comprehensive emergency obstetric care facility equally, and surveyed existing delivery services. Methods District population characteristics were obtained from a household community survey (n = 463). A Hospital survey collected data on women who delivered in this facility (n = 1072). Principal component analysis on household assets was used to assess socio-economic status. Hospital population socio-demographic characteristics were compared to District population using multivariable logistic regression. Deliveries' distribution in District facilities and staffing were analysed using routine data. Results Women from the hospital compared to the District population were more likely to be wealthier. Adjusted odds ratio of hospital delivery increased progressively across socio-economic groups, from 1.73 for the poorer (p = 0.0031) to 4.53 (p<0.0001) for the richest. Remarkable dispersion of deliveries and poor staffing were found. In 2012, 5505/7645 (72%) institutional deliveries took place in 68 first-line facilities, the remaining in the hospital. 56/68 (67.6%) first-line facilities reported ≤100 deliveries/year, attending 33% of deliveries. Insufficient numbers of skilled birth attendants were found in 42.9% of facilities. Discussion Poorer women remain disadvantaged in high coverage, as they access lower level facilities and are under-represented where life-saving transfusions and caesarean sections are

  9. Computerized Provider Order Entry Reduces Length of Stay in a Community Hospital

    PubMed Central

    Peters, K.; Shaha, S.H.

    2014-01-01

    Summary Objective Does computerized provider order entry (CPOE) improve clinical, cost, and efficiency outcomes as quantified in shortened hospital length of stay (LOS)? Most prior studies were done in university settings with home-grown electronic records, and are now 20 years old. This study asked whether CPOE exerts a downward force on LOS in the current era of HITECH incentives, using a vendor product in a community hospital. Methods The methodology retrospectively evaluated correlation between CPOE and LOS on a perpatient, per-visit basis over 22 consecutive quarters, organized by discipline. All orders from all areas were eligible, except verbals, and medication orders in the emergency department which were not available via CPOE. These results were compared with quarterly case mix indices organized by discipline. Correlational and regression analyses were cross-checked to ensure validity of R-square coefficients, and data were smoothed for ease of display. Standard models were used to calculate the inflection point. Results Gains in CPOE adoption occurred iteratively house-wide, and in each discipline. LOS decreased in a sigmoid shaped curve. The inflection point shows that once CPOE adoption approaches 60%, further lowering of LOS accelerates. Overall there was a 20.2% reduction in LOS correlated with adoption of CPOE. Case mix index increased during the study period showing that reductions in LOS occurred despite increased patient complexity and resource utilization. Conclusions There was a 20.2% reduction in LOS correlated with rising adoption of CPOE. CPOE contributes to improved clinical, cost, and efficiency outcomes as quantified in reduced LOS, over and above other processes introduced to lower LOS. CPOE enabled a reduction in LOS despite an increase in the case mix index during the time frame of this study. PMID:25298809

  10. Molecular Characterization of Streptococcus agalactiae Causing Community- and Hospital-Acquired Infections in Shanghai, China

    PubMed Central

    Jiang, Haoqin; Chen, Mingliang; Li, Tianming; Liu, Hong; Gong, Ye; Li, Min

    2016-01-01

    Streptococcus agalactiae, a colonizing agent in pregnant women and the main cause of neonatal sepsis and meningitis, has been increasingly associated with invasive disease in nonpregnant adults. We collected a total of 87 non-repetitive S. agalactiae isolates causing community-acquired (CA) and hospital-acquired (HA) infections in nonpregnant adults from a teaching hospital in Shanghai between 2009 and 2013. We identified and characterized their antibiotic resistance, sequence type (ST), serotype, virulence, and biofilm formation. The most frequent STs were ST19 (29.9%), ST23 (16.1%), ST12 (13.8%), and ST1 (12.6%). ST19 had significantly different distributions between CA- and HA-group B Streptococci (GBS) isolates. The most frequent serotypes were III (32.2%), Ia (26.4%), V (14.9%), Ib (13.8%), and II (5.7%). Serotype III/ST19 was significantly associated with levofloxacin resistance in all isoates. The HA-GBS multidrug resistant rate was much higher than that of CA-GBS. Virulence genes pavA, cfb were found in all isolates. Strong correlations exist between serotype Ib (CA and HA) and surface protein genes spb1 and bac, serotype III (HA) and surface protein gene cps and GBS pilus cluster. The serotype, epidemic clone, PFGE-based genotype, and virulence gene are closely related between CA-GBS and HA-GBS, and certain serotypes and clone types were significantly associated with antibiotic resistance. However, CA-GBS and HA-GBS still had significant differences in their distribution of clone types, antibiotic resistance, and specific virulence genes, which may provide a basis for infection control. PMID:27625635

  11. Molecular Characterization of Streptococcus agalactiae Causing Community- and Hospital-Acquired Infections in Shanghai, China.

    PubMed

    Jiang, Haoqin; Chen, Mingliang; Li, Tianming; Liu, Hong; Gong, Ye; Li, Min

    2016-01-01

    Streptococcus agalactiae, a colonizing agent in pregnant women and the main cause of neonatal sepsis and meningitis, has been increasingly associated with invasive disease in nonpregnant adults. We collected a total of 87 non-repetitive S. agalactiae isolates causing community-acquired (CA) and hospital-acquired (HA) infections in nonpregnant adults from a teaching hospital in Shanghai between 2009 and 2013. We identified and characterized their antibiotic resistance, sequence type (ST), serotype, virulence, and biofilm formation. The most frequent STs were ST19 (29.9%), ST23 (16.1%), ST12 (13.8%), and ST1 (12.6%). ST19 had significantly different distributions between CA- and HA-group B Streptococci (GBS) isolates. The most frequent serotypes were III (32.2%), Ia (26.4%), V (14.9%), Ib (13.8%), and II (5.7%). Serotype III/ST19 was significantly associated with levofloxacin resistance in all isoates. The HA-GBS multidrug resistant rate was much higher than that of CA-GBS. Virulence genes pavA, cfb were found in all isolates. Strong correlations exist between serotype Ib (CA and HA) and surface protein genes spb1 and bac, serotype III (HA) and surface protein gene cps and GBS pilus cluster. The serotype, epidemic clone, PFGE-based genotype, and virulence gene are closely related between CA-GBS and HA-GBS, and certain serotypes and clone types were significantly associated with antibiotic resistance. However, CA-GBS and HA-GBS still had significant differences in their distribution of clone types, antibiotic resistance, and specific virulence genes, which may provide a basis for infection control. PMID:27625635

  12. Tigecycline Versus Levofloxacin in Hospitalized Patients With Community-Acquired Pneumonia: An Analysis of Risk Factors

    PubMed Central

    Dartois, Nathalie; Cooper, C Angel; Castaing, Nathalie; Gandjini, Hassan; Sarkozy, Denise

    2013-01-01

    Introduction: This study was conducted to evaluate the efficacy of tigecycline (TGC) versus levofloxacin (LEV) in hospitalized patients with community-acquired pneumonia (CAP) using pooled data and to perform exploratory analyses of risk factors associated with poor outcome. Materials and Methodology: Pooled analyses of 2 phase 3 studies in patients randomized to intravenous (IV) TGC (100 mg, then 50 mg q12h) or IV LEV (500 mg q24h or q12h). Clinical responses at test of cure visit for the clinically evaluable (CE) and clinical modified intention to treat populations were assessed for patients with risk factors including aged ≥65 years, prior antibiotic failure, bacteremia, multilobar disease, chronic obstructive pulmonary disease, alcohol abuse, altered mental status, hypoxemia, renal insufficiency, diabetes mellitus, white blood cell count >30 x 109/L or <4 x 109/L, CURB-65 score ≥2, Fine score category of III to V and at least 2 clinical instability criteria on physical examination. Results: In the CE population of 574 patients, overall cure rates were similar: TGC (253/282, 89.7%); LEV (252/292, 86.3%). For all but one risk factor, cure rates for TGC were similar to or higher than those for LEV. For individual risk factors, the greatest difference between treatment groups was observed in patients with diabetes mellitus (difference of 22.9 for TGC versus LEV; 95% confidence interval, 4.8 - 39.9). Conclusions: TGC achieved cure rates similar to those of LEV in hospitalized patients with CAP. For patients with risk factors, TGC provided generally favorable clinical outcomes. PMID:23526572

  13. Persistence of microbial communities including Pseudomonas aeruginosa in a hospital environment: a potential health hazard

    PubMed Central

    2014-01-01

    Background The persistence of microbial communities and how they change in indoor environments is of immense interest to public health. Moreover, hospital acquired infections are significant contributors to morbidity and mortality. Evidence suggests that, in hospital environments agent transfer between surfaces causes healthcare associated infections in humans, and that surfaces are an important transmission route and may act as a reservoir for some of the pathogens. This study aimed to evaluate the diversity of microorganisms that persist on noncritical equipment and surfaces in a main hospital in Portugal, and are able to grow in selective media for Pseudomonas, and relate them with the presence of Pseudomonas aeruginosa. Results During 2 years, a total of 290 environmental samples were analyzed, in 3 different wards. The percentage of equipment in each ward that showed low contamination level varied between 22% and 38%, and more than 50% of the equipment sampled was highly contaminated. P. aeruginosa was repeatedly isolated from sinks (10 times), from the taps’ biofilm (16 times), and from the showers and bedside tables (two times). Two ERIC clones were isolated more than once. The contamination level of the different taps analyzed showed correlation with the contamination level of the hand gels support, soaps and sinks. Ten different bacteria genera were frequently isolated in the selective media for Pseudomonas. Organisms usually associated with nosocomial infections as Stenotrophomonas maltophilia, Enterococcus feacalis, Serratia nematodiphila were also repeatedly isolated on the same equipment. Conclusions The environment may act as a reservoir for at least some of the pathogens implicated in nosocomial infections. The bacterial contamination level was related to the presence of humidity on the surfaces, and tap water (biofilm) was a point of dispersion of bacterial species, including potentially pathogenic organisms. The materials of the equipment

  14. Gender, sexuality and the discursive representation of access and equity in health services literature: implications for LGBT communities

    PubMed Central

    2011-01-01

    Background This article considers how health services access and equity documents represent the problem of access to health services and what the effects of that representation might be for lesbian, gay, bisexual and transgender (LGBT) communities. We conducted a critical discourse analysis on selected access and equity documents using a gender-based diversity framework as determined by two objectives: 1) to identify dominant and counter discourses in health services access and equity literature; and 2) to develop understanding of how particular discourses impact the inclusion, or not, of LGBT communities in health services access and equity frameworks.The analysis was conducted in response to public health and clinical research that has documented barriers to health services access for LGBT communities including institutionalized heterosexism, biphobia, and transphobia, invisibility and lack of health provider knowledge and comfort. The analysis was also conducted as the first step of exploring LGBT access issues in home care services for LGBT populations in Ontario, Canada. Methods A critical discourse analysis of selected health services access and equity documents, using a gender-based diversity framework, was conducted to offer insight into dominant and counter discourses underlying health services access and equity initiatives. Results A continuum of five discourses that characterize the health services access and equity literature were identified including two dominant discourses: 1) multicultural discourse, and 2) diversity discourse; and three counter discourses: 3) social determinants of health (SDOH) discourse; 4) anti-oppression (AOP) discourse; and 5) citizen/social rights discourse. Conclusions The analysis offers a continuum of dominant and counter discourses on health services access and equity as determined from a gender-based diversity perspective. The continuum of discourses offers a framework to identify and redress organizational assumptions

  15. Food access and cost in American Indian communities in Washington State.

    PubMed

    O'Connell, Meghan; Buchwald, Dedra S; Duncan, Glen E

    2011-09-01

    Limited access to foods that make up a nutritious diet at minimal cost may influence eating behaviors and, ultimately, obesity. This study examined the number and type of food stores (convenience, grocery, supermarket) on federal reservations in Washington State, and the availability and cost of foods in the US Department of Agriculture Community Food Security Assessment Toolkit market basket, to describe the food environment of American Indians. Stores were identified by telephone survey of tribal headquarters, a commercial database, and on-site visitation. Foods were assessed using a standardized instrument containing 68 items in seven major food groups during April and May 2009. Store type and availability and cost of foods were recorded on a checklist. Fifty stores were identified on 22 American Indian reservations, including 25 convenience, 16 grocery, and 9 supermarkets. Across all stores, about 38% of checklist items were available, with supermarkets having the most and convenience stores the fewest. Foods from the dairy and sugars/sweets groups were the most prevalent, while fresh fruits/vegetables were the least. Cost of the most commonly available items was lowest in supermarkets. Seventeen reservations did not have a supermarket on their reservation, and the nearest off-reservation supermarket was about 10 miles from the tribe's headquarters, which was used as the standard for distance calculations. These results demonstrate that American Indians living on federal reservations in Washington State may have limited access to foods that make up a nutritious diet at minimal cost. PMID:21872701

  16. Accessing Novel Conoidean Venoms: Biodiverse Lumun-lumun Marine Communities, An Untapped Biological and Toxinological Resource

    PubMed Central

    Seronay, Romell A.; Fedosov, Alexander E.; Astilla, Mary Anne; Watkins, Maren; Saguil, Noel; Heralde, Francisco M.; Tagaro, Sheila; Poppe, Guido T.; Aliño, Porfirio M.; Oliverio, Marco; Kantor, Yuri I.; Concepcion, Gisela P.; Olivera, Baldomero M.

    2010-01-01

    Cone snail venoms have yielded pharmacologically-active natural products of exceptional scientific interest. However, cone snails are a small minority of venomous molluscan biodiversity, the vast majority being tiny venomous morphospecies in the family Turridae. A novel method called lumun-lumun opens access to these micromolluscs and their venoms. Old fishing nets are anchored to the sea bottom for a period of 1–6 months and marine biotas rich in small molluscs are established. In a single lumun-lumun community, we found a remarkable gastropod biodiversity (155 morphospecies). Venomous predators belonging to the superfamily Conoidea (36 morphospecies) were the largest group, the majority being micromolluscs in the family Turridae. We carried out an initial analysis of the most abundant of the turrid morphospecies recovered, Clathurella (Lienardia) cincta (Dunker, 1871). In contrast to all cDNA clones characterized from cone snail venom ducts, one of the C. cincta clones identified encoded two different peptide precursors presumably translated from a single mRNA. The prospect of easily accessing so many different morphospecies of venomous marine snails raises intriguing toxinological possibilities: the 36 conoidean morphospecies in this one net alone have the potential to yield thousands of novel pharmacologically-active compounds. PMID:20005243

  17. Hypertension Detection, Management, Control and Associated Factors Among Residents Accessing Community Health Services In Beijing

    PubMed Central

    JIANG, Bin; LIU, Hongmei; RU, Xiaojuan; ZHANG, Hui; WU, Shengping; WANG, Wenzhi

    2014-01-01

    The aim of this study was to analyse high blood pressure detection, management, control and associated factors among residents accessing community health services (CHSs) in Beijing. We screened for HBP in 9524 individuals aged 50 years or older who accessed care in four Beijing CHSs. Among the 9397 residents with questionnaire responses that qualified them for inclusion in the study, 5029 patients with HBP were identified, 1510 (i.e., 30% of the HBP patient group) of whom were newly identified cases. The rate of hypertension detection was 53.5%. Among the 5029 HBP patients, the rates of awareness, treatment and control of hypertension were 70.0%, 62.1% and 29.6%, respectively. In general, the rate of hypertension control was higher when the rates of hypertension awareness and treatment were higher in subgroups stratified by different sociodemographic and risk factors, except for the overweight and obesity subgroups. In conclusion, suboptimal HBP awareness, treatment, and control are still major problems confronting CHSs in Beijing. Control of hypertension in the population may be improved by increasing awareness and improving the treatment of hypertension in CHSs. PMID:24784167

  18. Opening Doors to the Seismic Data Community: IRIS Developments for Seamless Data Access

    NASA Astrophysics Data System (ADS)

    Ahern, T.; Casey, R.; Kamb, L.; Laughbon, C.; Muench, J.; Schoch, S.

    2006-05-01

    For the past five years, IRIS has enabled programmatic access to seismological databases worldwide through a data service technology called the Data Handling Interface (DHI). Basing the DHI on industry-standard CORBA technology has allowed a number of client programs to be developed in Java, Matlab and C/C++ which can access data from 6 regional and 2 global-area seismic data centers. More recently, the commonly used program SAC (Seismic Analysis Code) has been updated to interface with DHI, bringing seamless data access and powerful analysis tools together. In addition, noting the maturation of web services into an accepted data service technology, IRIS has developed a prototype web service version of the DHI using the SOAP protocol. As work continues in refining and expanding the utility of DHI, IRIS is also developing a searchable data product repository to allow registered data producers from locations across the globe to make their products available to the community. Here, scientists will be able to discover a myriad of data sources through a single web-service-oriented interface, searching via both common geographic and time-oriented attributes as well as product-specific metadata attributes. A facility for packaging and downloading these products is also being provided. As we move forward towards fully developing a service-oriented architecture (SOA) for IRIS data sources and facilities, we are creating software to allow data discovery and workflow computing to be at anyone's fingertips. Web service and portlet technologies allow easy incorporation of IRIS tools and data into research programs, educational websites and government planning. Data conversion and presentation are also concepts that are being explored in this growing field of cyberinfrastructure development.

  19. What Is the Impact of Health Reforms on Uncompensated Care in Critical Access Hospitals? A 5-Year Forecast in Washington State

    ERIC Educational Resources Information Center

    Coyne, Joseph; Fry, Benjamin; Murphy, Sean; Smith, Gary; Short, Robert

    2012-01-01

    Context: The 2008 financial crisis had a far-reaching impact on nearly every sector of the economy. As unemployment increased so did the uninsured. Already operating on a slim margin and poor payer mix, many critical access hospitals are facing a tough road ahead. Purpose: We seek to examine the increasing impact of uncompensated care on the…

  20. Access to alcohol and heart disease among patients in hospital: observational cohort study using differences in alcohol sales laws

    PubMed Central

    Dukes, Jonathan W; Dewland, Thomas A; Vittinghoff, Eric; Olgin, Jeffrey E; Pletcher, Mark J; Hahn, Judith A; Gladstone, Rachel A

    2016-01-01

    Objective To investigate the relation between alcohol consumption and heart disease by using differences in county level alcohol sales laws as a natural experiment. Design Observational cohort study using differences in alcohol sales laws. Setting Hospital based healthcare encounters in Texas, USA. Population 1 106 968 patients aged 21 or older who were residents of “wet” (no alcohol restrictions) and “dry” (complete prohibition of alcohol sales) counties and admitted to hospital between 2005 and 2010, identified using the Texas Inpatient Research Data File. Outcome measures Prevalent and incident alcohol misuse and alcoholic liver disease were used for validation analyses. The main cardiovascular outcomes were atrial fibrillation, acute myocardial infarction, and congestive heart failure. Results Residents of wet counties had a greater prevalence and incidence of alcohol misuse and alcoholic liver disease. After multivariable adjustment, wet county residents had a greater prevalence (odds ratio 1.05, 95% confidence interval 1.01 to 1.09; P=0.007) and incidence (hazard ratio 1.07, 1.01 to 1.13; P=0.014) of atrial fibrillation, a lower prevalence (odds ratio 0.83, 0.79 to 0.87; P<0.001) and incidence (hazard ratio 0.91, 0.87 to 0.99; P=0.019) of myocardial infarction, and a lower prevalence (odds ratio 0.87, 0.84 to 0.90; P<0.001) of congestive heart failure. Conversion of counties from dry to wet resulted in statistically significantly higher rates of alcohol misuse, alcoholic liver disease, atrial fibrillation, and congestive heart failure, with no detectable difference in myocardial infarction. Conclusions Greater access to alcohol was associated with more atrial fibrillation and less myocardial infarction and congestive heart failure, although an increased risk of congestive heart failure was seen shortly after alcohol sales were liberalized. PMID:27301557

  1. Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study

    PubMed Central

    2014-01-01

    Background Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. Methods This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Results Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to

  2. Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital.

    PubMed

    Kram, Stacey L; DiBartolo, Mary C; Hinderer, Katherine; Jones, Ruth Ann

    2015-01-01

    The ABCDE bundle is an evidence-based, multidisciplinary approach to optimizing patient outcomes in the adult intensive care unit (ICU). The ABCDE bundle incorporates awakening, breathing, coordination, delirium monitoring and management, and early mobility to minimize potentially deleterious effects of prolonged hospitalization, including the development of delirium. Health care organizations that implement the ABCDE bundle have improved patient outcomes such as decreased ICU and hospital lengths of stay, decreased duration of mechanical ventilation, decreased prevalence and duration of delirium, and decreased health care costs. The purpose of this evidence-based practice project was to implement the ABCDE bundle in a six-bed general adult ICU of a rural community hospital. Implementation of the bundle decreased average patient hospital length of stay by 1.8 days, reduced length of mechanical ventilation by an average of 1 day, and established a baseline delirium prevalence of 19% over a 3-month time period. The results of this project indicate that the ABCDE bundle can be implemented in rural, community-based hospitals and provides a safe, cost-effective method for enhancing ICU patient outcomes. PMID:26244238

  3. Community pharmacist–administered influenza immunization improves patient access to vaccination

    PubMed Central

    Folkins, Chris; Li, Wilson; Zervas, John

    2014-01-01

    Objectives: To describe the demographic characteristics and risk factors of patients receiving influenza vaccination in community pharmacies and to understand patient experiences and perceptions surrounding being vaccinated by a pharmacist. Methods: Survey data were collected by research pharmacists at 4 different community pharmacy locations in Toronto throughout a period of 8 weeks during October and November 2013. Participation in the survey was voluntary, and all patients vaccinated by pharmacists were invited to complete a survey following immunization. Results: During the course of the study, 2498 vaccine doses were administered among all study sites, and 1502 surveys were completed. Our data showed a high degree of patient satisfaction, with 92% of patients indicating they were very satisfied with the pharmacist’s injection technique and the services they received. Furthermore, 86% of patients were very comfortable with being vaccinated by a pharmacist, and 99% of patients reported they would recommend that friends and family be vaccinated by a pharmacist. Convenience and accessibility were major determinants of patient satisfaction, as shown by 46% of all written comments specifically addressing these factors. Of the patients surveyed, 25% were not regular annual vaccine recipients, and 47% were classified as being at high risk for influenza complications according to Public Health Agency of Canada criteria. Notably, 28% of total patients and 21% of high-risk patients reported that they would not have been immunized this year if pharmacy-based vaccination were not available. Conclusions: Our findings suggest that pharmacists provide a highly convenient and accessible option for seasonal flu vaccination that is viewed favourably by patients. Administration of the flu vaccine by pharmacists has the potential to positively affect public health by improving vaccination rates among high-risk patients, first-time or occasional vaccine recipients, and patients

  4. MY NASA DATA: Making Earth Science Data Accessible to the K-12 Community

    NASA Astrophysics Data System (ADS)

    Chambers, L. H.; Alston, E. J.; Diones, D. D.; Moore, S. W.; Oots, P. C.; Phelps, C. S.

    2006-12-01

    In 2004, the Mentoring and inquirY using NASA Data on Atmospheric and Earth science for Teachers and Amateurs (MY NASA DATA) project began. The goal of this project is to enable K-12 and citizen science communities to make use of the large volume of Earth System Science data that NASA has collected and archived. One major outcome is to allow students to select a problem of real-life importance, and to explore it using high quality data sources without spending months looking for and then learning how to use a dataset. The key element of the MY NASA DATA project is the implementation of a Live Access Server (LAS). The LAS is an open source software tool, developed by NOAA, that provides access to a variety of data sources through a single, fairly simple, point- and- click interface. This tool truly enables use of the available data - more than 100 parameters are offered so far - in an inquiry-based educational setting. It readily gives students the opportunity to browse images for times and places they define, and also provides direct access to the underlying data values - a key feature of this educational effort. The team quickly discovered, however, that even a simple and fairly intuitive tool is not enough to make most teachers comfortable with data exploration. User feedback has led us to create a friendly LAS Introduction page, which uses the analogy of a restaurant to explain to our audience the basic concept of an LAS. In addition, we have created a "Time Coverage at a Glance" chart to show what data are available when. This keeps our audience from being too confused by the patchwork of data availability caused by the start and end of individual missions. Finally, we have found it necessary to develop a substantial amount of age appropriate documentation, including topical pages and a science glossary, to help our audience understand the parameters they are exploring and how these parameters fit into the larger picture of Earth System Science. MY NASA DATA

  5. Using Videoconferencing Technology to Provide Breastfeeding Support to Low-Income Women: Connecting Hospital-Based Lactation Consultants with Clients Receiving Care at a Community Health Center.

    PubMed

    Friesen, Carol A; Hormuth, Laura J; Petersen, Devan; Babbitt, Tina

    2015-11-01

    The Tele-Lactation Pilot Project (TLPP), 1 of 13 community-based breastfeeding projects implemented in Indiana in 2013 using Centers for Disease Control and Prevention grant funds, explored the feasibility of using videoconferencing technology to provide breastfeeding education and support to low-income women by a centrally located International Board Certified Lactation Consultant (IBCLC). The IBCLC was housed at the Breastfeeding Center at the hospital where the women would deliver; the women receiving the education and support were located at an inner-city community health center (CHC) where they received their primary care. The videoconferencing sessions were juxtaposed with the women's regularly scheduled prenatal and postnatal visits at the CHC. After delivery, the lactation consultant visited the mother and infant in person at the hospital to offer additional support. Overall, 35 mothers were served by the TLPP during the 9-month project period. A total of 134 visits (30-45 minutes each) were conducted (3.8 sessions per woman). At the conclusion of the project, interviews with key participants indicated that the tele-lactation videoconferencing sessions were easy to implement, allowed the IBCLC to reach a wider client base, and allowed the women to receive expert support that they might not have otherwise received. Comments indicated that, in addition to providing education and increasing the women's confidence, the tele-lactation sessions appeared to have decreased the mothers' anxiety about the birthing process and the hospital experience. The TLPP demonstrated that incorporating videoconferencing technology into routine care can help foster collaboration among health care providers and provide mothers with continuous, easily accessible breastfeeding education and support. PMID:26297347

  6. Increasing access to modern contraceptives: the potential role of community solidarity through altruistic contributions

    PubMed Central

    2012-01-01

    Background There is an urgent need for universal access to modern contraceptives in Nigeria, to facilitate the achievement of the Millennium Development Goals and other national goals. This study provides information on the potential role of community solidarity in increasing access to contraceptives for the most-poor people through exploration of the role of altruism by determining level of altruistic willingness to pay (WTP) for modern contraceptives across different geographic contexts in Nigeria. Methods It was a cross-sectional national survey which took place in six states spread across the six-geopolitical zones of the country. In each state, an urban and a rural area were selected for the study, giving a total of 6 urban and 6 rural sites. A pre-tested interviewer-administered questionnaire was used to collect information from at least 720 randomly selected householders from each state. The targeted respondent in a household was a female primary care giver of child bearing age (usually the wives), or in her absence, another female household member of child bearing age. A scenario on altruistic WTP was presented before the value was elicited using a binary with open-ended follow-up question format. Test of validity of elicited altruistic WTP was undertaken using Tobit regression. Findings More than 50 % of the respondents across all the states were willing to contribute some money so that the very poor would be provided with modern contraceptives. The average amount of money that people were willing to contribute annually was 650 Naira (US$4.5). Mean altruistic WTP differed across SES quintiles and urban-rural divide (p < .01). Multiple regression analysis showed that age was negatively related to altruistic WTP (p < 0.05). However, years of schooling, being employed by government or being a big business person, prior experience of paying for contraceptives and socioeconomic status had statistically significant effects on altruistic WTP (p < 0

  7. A clinical algorithm for the management of abnormal mammograms. A community hospital's experience.

    PubMed Central

    Gist, D; Llorente, J; Mayer, J

    1997-01-01

    Mammography is an important tool in the early detection of breast cancer, but its use has been criticized for stimulating the performance of unnecessary breast biopsies. We retrospectively reviewed the results of breast biopsies preceded by abnormal mammograms at a community hospital for three 5-month periods--baseline, postintervention, and follow-up--to determine the effectiveness of algorithm-based care for patients with an abnormal mammogram. Cases in which there was a definite or implied recommendation for biopsy by a radiologist revealed a baseline positive predictive value of 4% (2/45), a postintervention positive predictive value of 21% (9/42), and a follow-up phase positive predictive value of 18% (5/28). A Fisher's exact test of the preintervention and postintervention positive predictive values after an abnormal mammogram with a "recommendation for biopsy" was significant (n = 87, P = .023). A Kruskal-Wallis analysis of variance to determine if there had been an increase in the mean lesion size of breast cancers detected over the 3 study periods was not significant. The results of this study suggest that developing a clinical algorithm under the leadership of an opinion leader combined with continuing medical education efforts may be efficacious in reducing the incidence of unnecessary surgical procedures. PMID:9074335

  8. A human metapneumovirus outbreak at a community hospital in England, July to September 2010.

    PubMed

    Degail, M A; Hughes, G J; Maule, C; Holmes, C; Lilley, M; Pebody, R; Bonnet, J; Bermingham, A; Bracebridge, S

    2012-04-12

    We describe an outbreak of human metapneumovirus (hMPV) which occurred in July-September 2010 at a community hospital in the East of England. Based on the medical and nursing records, cases were retrospectively defined as suspected if they had had an influenza-like illness (ILI), and probable if they had had an ILI and an epidemiological link to a laboratory-confirmed case. Of a total of 17 symptomatic inpatients, five were classified as probable cases, five were laboratory confirmed and seven were suspected. The attack rate was 29.4% for confirmed and probable cases combined. The median age of symptomatic inpatients was 85 years-old (range 68-96) and the majority (16/17) of symptomatic inpatients had an underlying medical condition. Control measures introduced appeared to restrict further exposure of susceptible patients to infection although modelling suggested that up to four of 10 confirmed and probable cases (40%) could have been prevented through more timely diagnosis and recognition of an outbreak. These findings suggest that there should be increased awareness of hMPV infection within healthcare settings, particularly when the population at risk has a high prevalence of underlying co-morbidities. PMID:22516049

  9. Rupture of a cesarean-scarred uterus: a community hospital experience.

    PubMed Central

    Poma, P. A.

    2000-01-01

    Concerns that a scarred uterus may rupture during labor have contributed to increased cesarean rates. A previous cesarean has become one of the most common indications for abdominal birth. More women must deliver vaginally after cesarean if we are to reduce cesarean rates. This study evaluates the effect of decreasing cesarean rates and increased vaginal birth after cesarean (VBAC) rates on the incidence of uterine rupture in a community hospital. We studied data for women who delivered at our obstetrical unit from 1988 through 1997. During 1994 our department adopted strategies to reduce cesarean rates. Data from women who delivered from 1988 through 1993 (period A, before the policy change) were compared with data for those who delivered from 1994 through 1997 (period B, after the policy change) and evaluated by chi-square analysis. p < 0.05 was considered significant. The total cesarean rate decreased from 24.3% (period A) to 17.9% (period B) (p < 0.0001), whereas the primary cesarean rate decreased from 14.9% to 10.3% (p < 0.0001), and the repeat rate decreased from 9.4% to 7.6% (p < 0.0001). The VBAC rate increased from 13.0 to 28.6 (p < 0.0001), whereas the incidence of uterine rupture did not change. During the study period, the cesarean rate decreased while the VBAC rate safely increased. The incidence of uterine rupture remained unchanged. PMID:10918765

  10. [Community-acquired bacteremia in adult patients attending the emergency service of a teaching hospital].

    PubMed

    Artico, Muriel J; Rocchi, Marta; Gasparotto, Ana; Ocaña Carrizo, Valeria; Navarro, Mercedes; Mollo, Valeria; Avilés, Natalia; Romero, Vanessa; Carrillo, Sonia; Monterisi, Aída

    2012-01-01

    Bacteremia is an important cause of morbimortality. This study describes the episodes of community-acquired bacteremia in adult patients registered at our hospital. Between January 2005, and December 2009, 271 episodes were studied. The diagnostic yield of blood cultures was 13.5 %. A total of 52 % of patients were male and 48 % female. The mean age was 60. The most frequent comorbidities were: diabetes (21 %), neoplasia (18 %), cardiopathy (11 %), and HIV infection (8 %). The focus was- respiratory (21 %), urinary (15 %), cutaneous (9 %), and others (13 %). Gram-positive bacteria prevailed (51.4%). The most frequent microorganisms were Escherichia coli (25 %), Streptococcus pneumoniae (22.9 %), and Staphylococcus aureus (12.3 %). Bacteremia was polymicrobial in 7 % of the cases. Thirty three percent of E. coli isolates were resistant to ciprofloxacin and 6 % to ceftazidime. Fourteen percent of S. aureus strains were resistant to oxacillin whereas only 7 % of S. pneumoniae expressed high resistance to penicillin with MICs = 2 ug/ml, according to meningitis breakpoints. PMID:22610291

  11. Evolution of the Data Access Protocol in Response to Community Needs

    NASA Astrophysics Data System (ADS)

    Gallagher, J.; Caron, J. L.; Davis, E.; Fulker, D.; Heimbigner, D.; Holloway, D.; Howe, B.; Moe, S.; Potter, N.

    2012-12-01

    Under the aegis of the OPULS (OPeNDAP-Unidata Linked Servers) Project, funded by NOAA, version 2 of OPeNDAP's Data Access Protocol (DAP2) is being updated to version 4. DAP4 is the first major upgrade in almost two decades and will embody three main areas of advancement. First, the data-model extensions developed by the OPULS team focus on three areas: Better support for coverages, access to HDF5 files and access to relational databases. DAP2 support for coverages (defined as a sampled functions) was limited to simple rectangular coverages that work well for (some) model outputs and processed satellite data but that cannot represent trajectories or satellite swath data, for example. We have extended the coverage concept in DAP4 to remove these limitations. These changes are informed by work at Unidata on the Common Data Model and also by the OGC's abstract coverages specification. In a similar vein, we have extended DAP2's support for relations by including the concept of foreign keys, so that tables can be explicitly related to one another. Second, the web interfaces - web services - that provides access to data using via DAP will be more clearly defined and use other (, orthogonal), standards where they are appropriate. An important case is the XML interface, which provides a cleaner way to build other response media types such as JSON and RDF (for metadata) and to build support for Atom, thus simplify the integration of DAP servers with tools that support OpenSearch. Input from the ESIP federation and work performed with IOOS have informed our choices here. Last, DAP4-compliant servers will support richer data-processing capabilities than DAP2, enabling a wider array of server functions that manipulate data before returning values. Two projects currently are exploring just what can be done even with DAP2's server-function model: The MIIC project at LARC and OPULS itself (with work performed at the University of Washington). Both projects have demonstrated that

  12. Access to new medications for the treatment of drug-resistant tuberculosis: patient, provider and community perspectives.

    PubMed

    Lessem, Erica; Cox, Helen; Daniels, Colleen; Furin, Jennifer; McKenna, Lindsay; Mitnick, Carole D; Mosidi, Thato; Reed, Caitlin; Seaworth, Barbara; Stillo, Jonathan; Tisile, Phumeza; von Delft, Dalene

    2015-03-01

    Multidrug-resistant tuberculosis (MDR-TB) is on the rise, and is difficult to treat. The approval of two new drugs, bedaquiline and delamanid, and growing evidence for the use of linezolid, offer renewed hope for addressing MDR-TB. However, access to these medicines remains a significant challenge. These drugs have not been registered for TB in most settings; barriers to preapproval access persist; and high pricing and intellectual property restrictions limit access. Many unanswered research questions about optimal use of these drugs also limit access, particularly for vulnerable populations. This review outlines challenges in accessing drugs encountered from the perspective of clinicians, patients and affected communities, and offers potential solutions. PMID:25809757

  13. Hospitals for sale.

    PubMed

    Costello, Michael M; West, Daniel J; Ramirez, Bernardo

    2011-01-01

    The pace of hospital merger and acquisition activity reflects the economic theory of supply and demand: Publicly traded hospital companies, private equity funds, and large nonprofit hospital systems are investing capital to purchase and operate freestanding community hospitals at a time when many of those hospitals find themselves short of capital reserves and certain forms of management expertise. But the sale of those community hospitals also raises questions about the impact of absentee ownership on the communities which those hospitals serve. PMID:21864058

  14. What Rural Women Want the Public Health Community to Know About Access to Healthful Food: A Qualitative Study, 2011

    PubMed Central

    Zimmermann, Kristine; Peacock, Nadine R.

    2016-01-01

    Introduction Living in a rural food desert has been linked to poor dietary habits. Understanding community perspectives about available resources and feasible solutions may inform strategies to improve food access in rural food deserts. The objective of our study was to identify resources and solutions to the food access problems of women in rural, southernmost Illinois. Methods Fourteen focus groups with women (n = 110 participants) in 4 age groups were conducted in a 7-county region as part of a community assessment focused on women’s health. We used content analysis with inductive and deductive approaches to explore food access barriers and facilitators. Results Similar to participants in previous studies, participants in our study reported insufficient local food sources, which they believe contributed to poor dietary habits, high food prices, and the need to travel for healthful food. Participants identified existing local activities and resources that help to increase access, such as home and community gardens, food pantries, and public transportation, as well as local solutions, such as improving nutrition education and public transportation options. Conclusion Multilevel and collaborative strategies and policies are needed to address food access barriers in rural communities. At the individual level, education may help residents navigate geographic and economic barriers. Community solutions include collaborative strategies to increase availability of healthful foods through traditional and nontraditional food sources. Policy change is needed to promote local agriculture and distribution of privately grown food. Understanding needs and strengths in rural communities will ensure responsive and effective strategies to improve the rural food environment. PMID:27126555

  15. Raising the Level of Awareness of Nurse-to-Nurse Lateral Violence in a Critical Access Hospital

    PubMed Central

    Embree, Jennifer L.; Bruner, Deborah A.; White, Ann

    2013-01-01

    Background/Significance of Problem. Nurse-to-nurse lateral violence (NNLV) has been internationally reported for greater than two decades and results in new nurse turnover and serious negative outcomes. Clinical Question/Project Objective. Will NNLV and cognitive rehearsal (CR) education result in a decrease in perceived nurse-to-nurse lateral violence in a critical access hospital (CAH)? The scope of this project was to determine perceived extent and increase awareness of NNLV through an educational project about NNLV and CR. Clinical Appraisal of Literature/Best Evidence. Trends of NNLV were assessed through an extensive literature review from Health Source, CINAHL, ProQuest Health, and Medical Complete. An educational forum about NNLV with CR was advocated for newly licensed nurses and current nurses (potential perpetrators of NNLV) with the goal of liberation of oppressed individuals. Integration into Practice/Discussion of Results. An interventional study with one group and pre-/postintervention was used to determine NNLV and CR education on perceived levels of lateral violence. Evidence-based measurement occurred through use of the Nurse Workplace Scale and the Silencing the Self-Work Scale. Outcomes were analyzed quantitatively through independent t-tests. Awareness of NNLV was increased. Evaluation of Evidence-Based Practice/Implications. Organizations must learn to eliminate NNLV. With increased levels of awareness of NNLV, nurses requested additional assistance in dealing with inappropriate behavior. PMID:23991337

  16. Use and cost of hospitalization in dementia: longitudinal results from a community-based study

    PubMed Central

    Zhu, Carolyn W.; Cosentino, Stephanie; Ornstein, Katherine; Gu, Yian; Andrews, Howard; Stern, Yaakov

    2015-01-01

    Objectives The aim of this study is to examine the relative contribution of functional impairment and cognitive deficits on risk of hospitalization and costs. Methods A prospective cohort of Medicare beneficiaries aged 65 and older who participated in the Washington Heights-Inwood Columbia Aging Project (WHICAP) were followed approximately every 18 months for over 10 years (1805 never diagnosed with dementia during study period, 221 diagnosed with dementia at enrollment). Hospitalization and Medicare expenditures data (1999–2010) were obtained from Medicare claims. Multivariate analyses were conducted to examine (1) risk of all-cause hospitalizations, (2) hospitalizations from ambulatory care sensitive (ACSs) conditions, (3) hospital length of stay (LOS), and (4) Medicare expenditures. Propensity score matching methods were used to reduce observed differences between demented and non-demented groups at study enrollment. Analyses took into account repeated observations within each individual. Results Compared to propensity-matched individuals without dementia, individuals with dementia had significantly higher risk for all-cause hospitalization, longer LOS, and higher Medicare expenditures. Functional and cognitive deficits were significantly associated with higher risks for hospitalizations, hospital LOS, and Medicare expenditures. Functional and cognitive deficits were associated with higher risks of for some ACS but not all admissions. Conclusions These results allow us to differentiate the impact of functional and cognitive deficits on hospitalizations. To develop strategies to reduce hospitalizations and expenditures, better understanding of which types of hospitalizations and which disease characteristics impact these outcomes will be critical. PMID:25351909

  17. On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.

    PubMed

    Kouyos, Roger D; Abel Zur Wiesch, Pia; Bonhoeffer, Sebastian

    2011-04-01

    The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and in the community. Currently, some countries aim at concentrating highly specialized services in large hospitals in order to improve patient outcomes. Emergent resistant strains often originate in health care facilities, but it is unknown to what extent hospital size affects resistance evolution and the resulting spillover of hospital-associated pathogens to the community. We used two published datasets from the US and Ireland to investigate the effects of hospital size and controlled for several confounders such as antimicrobial usage, sampling frequency, mortality, disinfection and length of stay. The proportion of patients acquiring both sensitive and resistant infections in a hospital strongly correlated with hospital size. Moreover, we observe the same pattern for both the percentage of resistant infections and the increase of hospital-acquired infections over time. One interpretation of this pattern is that chance effects in small hospitals impede the spread of drug-resistance. To investigate to what extent the size distribution of hospitals can directly affect the prevalence of antibiotic resistance, we use a stochastic epidemiological model describing the spread of drug resistance in a hospital setting as well as the interaction between one or several hospitals and the community. We show that the level of drug resistance typically increases with population size: In small hospitals chance effects cause large fluctuations in pathogen population size or even extinctions, both of which impede the acquisition and spread of drug resistance. Finally, we show that indirect transmission via environmental reservoirs can reduce the effect of hospital size because the slow turnover in the environment can prevent extinction of resistant strains. This implies that reducing environmental transmission is especially important in small hospitals, because such a reduction not only

  18. Access, Equity, and Community Colleges: The Truman Commission and Federal Higher Education Policy from 1947 To 2011

    ERIC Educational Resources Information Center

    Gilbert, Claire Krendl; Heller, Donald E.

    2013-01-01

    The 1947 President's Commission on Higher Education offers insight into higher education policy in the United States. This article reviews and assesses the adoption of its policy recommendations in two key areas: 1) improving college access and equity and 2) expanding the role of community colleges. (Contains 1 figure and 4 notes.)

  19. Laying the Groundwork: The Constant Gardening of Community-University-School Partnerships for Postsecondary Access and Success

    ERIC Educational Resources Information Center

    Collins, Donald Earl; Weinbaum, Alexandra T.; Ramon, Gilberto; Vaughan, Debra

    2009-01-01

    Collaborative efforts between school districts and higher education institutions to address access, retention, and achievement issues for underrepresented students have grown in recent years. Yet many of these university or school district-led efforts possess limited understanding of the community context for systemic change, and engage community…

  20. The Effect of Education plus Access on Perceived Fruit and Vegetable Consumption in a Rural African American Community Intervention

    ERIC Educational Resources Information Center

    Barnidge, E. K.; Baker, E. A.; Schootman, M.; Motton, F.; Sawicki, M.; Rose, F.

    2015-01-01

    African Americans have an increased risk of cardiovascular disease partly due to low fruit and vegetable consumption. This article reports the results of an intervention to provide nutrition education and access to fruits and vegetables through community gardens to change dietary behaviors among African Americans in rural Missouri. Cross-sectional…

  1. The effect of education plus access on perceived fruit and vegetable consumption in a rural African American community intervention.

    PubMed

    Barnidge, E K; Baker, E A; Schootman, M; Motton, F; Sawicki, M; Rose, F

    2015-10-01

    African Americans have an increased risk of cardiovascular disease partly due to low fruit and vegetable consumption. This article reports the results of an intervention to provide nutrition education and access to fruits and vegetables through community gardens to change dietary behaviors among African Americans in rural Missouri. Cross-sectional surveys evaluated the intervention effect on blood pressure, body mass index (BMI), and perceived fruit and vegetable consumption in this quasi-experimental study with a comparison group. Hypertension (OR = 0.52, 95% CI: 0.38-0.71) and BMI (OR = 0.73, 95% CI: 0.52-1.02) were lower in the intervention county at mid-intervention. Participation in nutrition education (OR = 2.67, 95% CI: 1.63-4.40) and access to fruits and vegetables from a community garden (OR = 1.95, 95% CI: 1.20-3.15) were independently associated with perceived fruit and vegetable consumption. The strongest effect on perceived fruit and vegetable consumption occurred with high participation in nutrition education and access to community gardens (OR = 2.18, 95% CI: 1.24-3.81). Those with access but without education had a reduced likelihood of consuming recommended servings of fruits and vegetables (OR = 0.57, 95% CI: 0.34-0.95). Education plus access interventions may be best at increasing consumption of fruits and vegetables in a rural African American population. PMID:26338985

  2. Communicative social capital and collective efficacy as determinants of access to health-enhancing resources in residential communities.

    PubMed

    Matsaganis, Matthew D; Wilkin, Holley A

    2015-04-01

    This article contributes to the burgeoning literature on the social determinants of health disparities. The authors investigate how communication resources and collective efficacy, independently and in combination, shape residents' access to health enhancing resources (including healthcare services, sources of healthier food options, and public recreation spaces) in their communities. Using random digit dial telephone survey data from 833 residents of South Los Angeles communities the authors show that communicative social capital-that is, an information and problem-solving resource that accrues to residents as they become more integrated into their local communication network of neighbors, community organizations, and local media-plays a significant role in access to health resources. This relationship is complicated by individuals' health insurance and health status, as communicative social capital magnifies the sense of absence of resources for those who are in worse health and lack insurance. Communicative social capital builds collective efficacy, which is positively related to access to health-enhancing resources, but it also mediates the negative relationship between communicative social capital and access to health resources. Residents with richer stores of communicative social capital and collective efficacy report better access to health resources. The authors conclude with a discussion of implications of these findings and suggestions for future research. PMID:25529115

  3. Access all areas? An area-level analysis of accessibility to general practice and community pharmacy services in England by urbanity and social deprivation

    PubMed Central

    Todd, Adam; Copeland, Alison; Husband, Andy; Kasim, Adetayo; Bambra, Clare

    2015-01-01

    Objectives (1) To determine the percentage of the population in England that has access to a general practitioner (GP) premises within a 20 min walk (the accessibility); (2) explore the relationship between the walking distance to a GP premises and urbanity and social deprivation and (3) compare accessibility of a GP premises to that of a community pharmacy—and how this may vary by urbanity and social deprivation. Design This area-level analysis spatial study used postcodes for all GP premises and community pharmacies in England. Each postcode was assigned to a population lookup table and Lower Super Output Area (LSOA). The LSOA was then matched to urbanity (urban, town and fringe, or village, hamlet and isolated dwellings) and deprivation decile (using the Index of Multiple Deprivation score 2010). Primary outcome measure Living within a 20 min walk of a GP premises. Results Overall, 84.8% of the population is estimated to live within a 20 min walk of a GP premises: 81.2% in the most affluent areas, 98.2% in the most deprived areas, 94.2% in urban and 19.4% in rural areas. This is consistently lower when compared with the population living within a 20 min walk of a community pharmacy. Conclusions Our study shows that the vast majority of the population live within a 20 min walk of a GP premises, with higher proportions in the most deprived areas—a positive primary care law. However, more people live within a 20 min walk of a community pharmacy compared with a GP premises, and this potentially has implications for the commissioning of future services from these healthcare providers in England. PMID:25956762

  4. The distance to community medical care and the likelihood of hospitalization: is closer always better?

    PubMed Central

    Goodman, D C; Fisher, E; Stukel, T A; Chang, C

    1997-01-01

    OBJECTIVES: This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality. METHODS: Hospitalizations were studied for Maine. New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees. RESULTS: After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval [CI] = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those living in a zip code with a hospital. Similar effects were seen for the four most common diagnosis-related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance. CONCLUSIONS: Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates. PMID:9240104

  5. Innovative solutions: Standardized concentrations facilitate the use of continuous infusions for pediatric intensive care unit nurses at a community hospital.

    PubMed

    Roman, Noemi

    2005-01-01

    The pediatric intensive care unit at a community hospital successfully implemented the use of standardized concentrations. The process included deciding the standardized concentrations, use of titration charts, and integration of smart pump technology. Since the implementation of standardized concentrations, there has been no signal or sentinel events reported. It is safe and efficacious to use standardized concentrations combined with smart pump technology and abandon the use of the rule of 6 in the pediatric population. PMID:16327513

  6. Breastfeeding Support in a Community Pharmacy: Improving Access through the Well Babies at Walgreens Program.

    PubMed

    Lenell, Amy; Friesen, Carol A; Hormuth, Laura

    2015-11-01

    Well Babies at Walgreens is a unique community-based corporate partnership program that offers breastfeeding support by a lactation professional in a private room at the pharmacy. Walgreens is a community pharmacy chain with more than 8000 locations in the United States, Puerto Rico, and the US Virgin Islands. The primary goal of Well Babies is to support breastfeeding women using a model that is expandable to other Walgreens pharmacy sites. The Well Babies program offers drop-in services, with a professional consultation by a lactation consultant and baby weight check, if desired. Well Babies creators are developing a business plan for Walgreens and a toolkit that would help other stores implement the program. An additional goal is to improve continuity of care for breastfeeding by engaging pharmacists as vital members of the health care team. Offering breastfeeding support at a pharmacy improves access and encourages support persons to attend while simultaneously allowing the family to complete other errands. This initiative included education for pharmacists to improve the recommendations they make for breastfeeding mothers and to improve awareness among pharmacists of the benefits associated with breastfeeding and the need to preserve the breastfeeding relationship. The first drop-in location opened in April 2012. Grant funding from the US Centers for Disease Control and Prevention, awarded to the Indiana State Department of Health, made it possible to open a second drop-in location in June 2013. Future plans include developing an employee lactation program and expanding Well Babies at Walgreens at other store locations. PMID:25829476

  7. ClimatePipes: User-Friendly Data Access, Manipulation, Analysis & Visualization of Community Climate Models

    NASA Astrophysics Data System (ADS)

    Chaudhary, A.; DeMarle, D.; Burnett, B.; Harris, C.; Silva, W.; Osmari, D.; Geveci, B.; Silva, C.; Doutriaux, C.; Williams, D. N.

    2013-12-01

    The impact of climate change will resonate through a broad range of fields including public health, infrastructure, water resources, and many others. Long-term coordinated planning, funding, and action are required for climate change adaptation and mitigation. Unfortunately, widespread use of climate data (simulated and observed) in non-climate science communities is impeded by factors such as large data size, lack of adequate metadata, poor documentation, and lack of sufficient computational and visualization resources. We present ClimatePipes to address many of these challenges by creating an open source platform that provides state-of-the-art, user-friendly data access, analysis, and visualization for climate and other relevant geospatial datasets, making the climate data available to non-researchers, decision-makers, and other stakeholders. The overarching goals of ClimatePipes are: - Enable users to explore real-world questions related to climate change. - Provide tools for data access, analysis, and visualization. - Facilitate collaboration by enabling users to share datasets, workflows, and visualization. ClimatePipes uses a web-based application platform for its widespread support on mainstream operating systems, ease-of-use, and inherent collaboration support. The front-end of ClimatePipes uses HTML5 (WebGL, Canvas2D, CSS3) to deliver state-of-the-art visualization and to provide a best-in-class user experience. The back-end of the ClimatePipes is built around Python using the Visualization Toolkit (VTK, http://vtk.org), Climate Data Analysis Tools (CDAT, http://uv-cdat.llnl.gov), and other climate and geospatial data processing tools such as GDAL and PROJ4. ClimatePipes web-interface to query and access data from remote sources (such as ESGF). Shown in the figure is climate data layer from ESGF on top of map data layer from OpenStreetMap. The ClimatePipes workflow editor provides flexibility and fine grained control, and uses the VisTrails (http

  8. Scaling-Up Access to Antiretroviral Therapy for Children: A Cohort Study Evaluating Care and Treatment at Mobile and Hospital-Affiliated HIV Clinics in Rural Zambia

    PubMed Central

    van Dijk, Janneke H.; Moss, William J.; Hamangaba, Francis; Munsanje, Bornface; Sutcliffe, Catherine G.

    2014-01-01

    Background Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART), but few programs have been evaluated. We compared outcomes for children receiving care in mobile and hospital-affiliated HIV clinics in rural Zambia. Methods Outcomes were measured within an ongoing cohort study of HIV-infected children seeking care at Macha Hospital, Zambia from 2007 to 2012. Children in the outreach clinic group received care from the Macha HIV clinic and transferred to one of three outreach clinics. Children in the hospital-affiliated clinic group received care at Macha HIV clinic and reported Macha Hospital as the nearest healthcare facility. Results Seventy-seven children transferred to the outreach clinics and were included in the analysis. Travel time to the outreach clinics was significantly shorter and fewer caretakers used public transportation, resulting in lower transportation costs and fewer obstacles accessing the clinic. Some caretakers and health care providers reported inferior quality of service provision at the outreach clinics. Sixty-eight children received ART at the outreach clinics and were compared to 41 children in the hospital-affiliated clinic group. At ART initiation, median age, weight-for-age z-scores (WAZ) and CD4+ T-cell percentages were similar for children in the hospital-affiliated and outreach clinic groups. Children in both groups experienced similar increases in WAZ and CD4+ T-cell percentages. Conclusions HIV care and treatment can be effectively delivered to HIV-infected children at rural health centers through mobile ART teams, removing potential barriers to uptake and retention. Outreach teams should be supported to increase access to HIV care and treatment in rural areas. PMID:25122213

  9. Food Choices and Consequences for the Nutritional Status: Insights into Nutrition Transition in an Hospital Community

    PubMed Central

    Piple, Jitendra; Gora, Ranjeet; Purbiya, Pragati; Puliyel, Ashish; Chugh, Parul; Bahl, Pinky; Puliyel, Jacob

    2015-01-01

    Introduction Although economic development is generally accompanied by improvements in the overall nutritional status of the country’s population the ‘nutritional transition’ often involves a shift to high energy diets and less exercise with negative consequences. This pilot study was done to examine if education of parents operates at the household level to influence dietary choices and the nutritional status of children in a small community of hospital workers. Material and Methods 3 groups of persons with varying skill and education levels participated. Weighed food logs were used in all households to calculate ‘adult equivalent’ per-capita-consumption. Nutrients were calculated using nutrients calculator software. BMI was used to classify children as underweight, normal weight and overweight. Results 128 individuals participated from 30 families included 47 children. 10 children (21%) were underweight, 29 (62%) were normal and 8 (17%) were overweight. Energy consumption was highest in families with overweight children 2692 +/-502 compared to 2259 +/-359 in families with normal weight and 2031+/-354 in the family of underweight children. These differences were statistically significant. 42% underweight children belonged to Class 1 at the lowest skill level and there were no overweight children in this group. Most of the overweight children belonged to Class 2. In Class 3 there were no underweight children and the majority was normal weight children. Conclusion Underweight children came from the poorer households. Per capita intake of the family as a whole correlated well with BMI in the children. There was increased obesity in middle income families belonging to Class 2—probably in families who move up the scale from deprivation. Nutritional status in children correlated mostly with maternal education status. PMID:26559817

  10. Two Obese Patients with Presumptive Diagnosis of Anaphylactoid Syndrome of Pregnancy Presenting at a Community Hospital.

    PubMed

    Kradel, Brian K; Hinson, Scarlett B; Smith, Carr J

    2016-01-01

    BACKGROUND Anaphylactoid syndrome of pregnancy (ASP) is a rare but extremely serious complication, with an estimated incidence in North America of 1 in 15 200 deliveries. Despite its rarity, ASP is responsible for approximately 10% of all childbirth-associated deaths in the United States. At present, there is no validated biomarker or specific set of risk factors sufficiently predictive of ASP risk to incorporate into clinical practice. Toward the goal of developing a methodology predictive of an impending ASP event for use by obstetricians, anesthesiologists, and other practitioners participating in infant deliveries, physicians encountering an ASP event have been encouraged to report the occurrence of a case and its biologically plausible risk factors.  CASE REPORT Herein, we report on 2 patients who presented with a presumptive diagnosis of ASP to the delivery unit of a community hospital. Patient One was a 21-year-old, obese (5'11" tall, 250 lbs., BMI 34.9) white female, 1 pregnancy, no live births (G1P0), estimated gestational age (EGA) 40.2 weeks. Patient Two was a 29-year-old, obese (5'7" tall, 307 lbs., BMI 48.1) Hispanic female, second pregnancy, with 1 previous live birth via C-section (G2P1-0-0-1). Her pregnancy was at gestational age 38 weeks plus 2 days. CONCLUSIONS Patient One had 2 possible risk factors: administration of Pitocin to induce labor and post-coital spotting from recent intercourse. Patient Two suffered premature rupture of the placental membranes. Both Patient One and Patient Two had very high body mass indices (BMIs), at the 97th and 99th percentiles, respectively. In the relatively few cases of anaphylactoid syndrome of pregnancy described to date, this is the first report of a possible association with high BMI. PMID:27363628

  11. The behavioral medicine unit: a community hospital model for inpatient treatment of adolescent depression.

    PubMed

    Greydanus, D E; Porter, J; Rypma, C B; Heuer, T; Granberg, A; Ruch, R

    1986-12-01

    This article describes one community hospital's response to the overwhelming needs of adolescents in central Iowa. It is based on the premise that many youths who have severe depression do not effectively respond to various outpatient counseling measures, and are in need of some type of inpatient treatment. Most such programs are locked psychiatric units run by child or adolescent psychiatrists. In our case, those wards already in existence are filled to capacity and cannot respond to outside needs. Placing these youth on traditional medical adolescent wards does not work, since medical staff are usually not geared to deal with the many, ever-changing mental health needs of these patients. Thus, we developed an unlocked adolescent inpatient unit with a pediatrician experienced in adolescent medicine as medical director; moreover, the program extensively utilizes psychologists, nurse-counselors, social worker-family therapists, recreation therapists, and other specialists. This program is a way for physicians trained in adolescent medicine and other appropriate persons to contribute to the complex health needs of youth; it is preferable to do this rather than send all depressed teenagers away by referrals, as seems to happen in some cases. It is also an important way for physicians and other specialists to demonstrate their expertise--both the Society for Adolescent Medicine and American Academy of Pediatrics have advocated such a demonstration--and to give physicians important training in the medical and mental health care needs of youth. Finally, the Spectrum Unit program provides a meaningful way for the primary care physician to be involved in the inpatient treatment of depressed adolescent patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3602650

  12. Potential drug-drug interactions in prescriptions dispensed in community and hospital pharmacies in East of Iran

    PubMed Central

    Dirin, Mandana Moradi; Mousavi, Sarah; Afshari, Amir Reza; Tabrizian, Kaveh; Ashrafi, Mohammad Hossein

    2014-01-01

    Objective: This study aim to evaluate and compare type and prevalence of drug-drug interactions (DDIs) in prescriptions dispensed in both community and hospital setting in Zabol, Iran. Methods: A total of 2796 prescriptions were collected from community and inpatient and outpatient pharmacy of Amir-al-momenin only current acting hospital in Zabol, Iran. The prescriptions were processed using Lexi-Comp drug interaction software. The identified DDIs were categorized into five classes (A, B, C, D, X). Findings: Overall 41.6% of prescriptions had at last one potential DDI. The most common type of interactions was type C (66%). The percentage of drug interactions in community pharmacies were significantly lower than hospital pharmacies (P < 0.0001). Conclusion: Our results indicate that patients in Zabol are at high risk of adverse drug reactions caused by medications due to potential DDIs. Appropriate education for physicians about potentially harmful DDIs, as well as active participation of pharmacists in detection and prevention of drug-related injuries, could considerably prevent the consequence of DDIs among patients. PMID:25328901

  13. Shifting contours of boundaries: an exploration of inter-agency integration between hospital and community interprofessional diabetes programs.

    PubMed

    Wong, Rene; Breiner, Petra; Mylopoulos, Maria

    2014-09-01

    This article reports on research into the relationships that emerged between hospital-based and community-based interprofessional diabetes programs involved in inter-agency care. Using constructivist grounded theory methodology we interviewed a purposive theoretical sample of 21 clinicians and administrators from both types of programs. Emergent themes were identified through a process of constant comparative analysis. Initial boundaries were constructed based on contrasts in beliefs, practices and expertise. In response to bureaucratic and social pressures, boundaries were redefined in a way that created role uncertainty and disempowered community programs, ultimately preventing collaboration. We illustrate the dynamic and multi-dimensional nature of social and symbolic boundaries in inter-agency diabetes care and the tacit ways in which hospitals can maintain a power position at the expense of other actors in the field. As efforts continue in Canada and elsewhere to move knowledge and resources into community sectors, we highlight the importance of hospitals seeing beyond their own interests and adopting more altruistic models of inter-agency integration. PMID:24766617

  14. Separate treatment of hospital and urban wastewaters: A real scale comparison of effluents and their effect on microbial communities.

    PubMed

    Chonova, Teofana; Keck, François; Labanowski, Jérôme; Montuelle, Bernard; Rimet, Frédéric; Bouchez, Agnès

    2016-01-15

    Hospital wastewaters (HWW) contain wider spectrum and higher quantity of pharmaceuticals than urban wastewaters (UWW), but they are generally discharged in sewers without pretreatment. Since traditional urban wastewater treatment plants (WWTP) are not designed to treat HWWs, treated effluents may still contain pollutants that could impair receiving aquatic environments. Hence, a better understanding of the effect of pharmaceuticals in the environment is required. Biofilms are effective "biological sensors" for assessing the environmental effects of pharmaceuticals due to their ability to respond rapidly to physical, chemical and biological fluctuations by changes in their structure and composition. This study evaluated the efficiency of biological treatment with conventional activated sludge system performed parallel on HWW and UWW. Furthermore, six successive monthly colonizations of biofilms were done on autoclaved stones, placed in grid-baskets in the hospital treated effluents (HTE) and urban treated effluents (UTE). The biomass of these biofilms as well as the structure and diversity of their bacterial communities were investigated. Results showed better treatment efficiency for phosphate and nitrite/nitrate during the treatment of UWW. Pharmaceuticals from all investigated therapeutic classes (beta-blockers, nonsteroidal anti-inflammatory drugs, antibiotics, analgesics and anticonvulsants) were efficiently removed, except for carbamazepine. The removal efficiency of the antibiotics, NSAIDs and beta-blockers was higher during the treatment of HWW. HTE and UTE shaped the bacterial communities in different ways. Higher concentrations of pharmaceuticals in the HTE caused adapted development of the microbial community, leading to less developed biomass and lower bacterial diversity. Seasonal changes in solar irradiance and temperature, caused changes in the community composition of biofilms in both effluents. According to the removal efficiency of pharmaceuticals

  15. Gender identity, healthcare access, and risk reduction among Malaysia's mak nyah community.

    PubMed

    Gibson, Britton A; Brown, Shan-Estelle; Rutledge, Ronnye; Wickersham, Jeffrey A; Kamarulzaman, Adeeba; Altice, Frederick L

    2016-01-01

    Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). In Malaysia, where both civil and religious law criminalise them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilisation patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. These findings have implications for developing holistic, culturally sensitive prevention and healthcare services for TGW. PMID:26824463

  16. ORegAnno: an open-access community-driven resource for regulatory annotation

    PubMed Central

    Griffith, Obi L.; Montgomery, Stephen B.; Bernier, Bridget; Chu, Bryan; Kasaian, Katayoon; Aerts, Stein; Mahony, Shaun; Sleumer, Monica C.; Bilenky, Mikhail; Haeussler, Maximilian; Griffith, Malachi; Gallo, Steven M.; Giardine, Belinda; Hooghe, Bart; Van Loo, Peter; Blanco, Enrique; Ticoll, Amy; Lithwick, Stuart; Portales-Casamar, Elodie; Donaldson, Ian J.; Robertson, Gordon; Wadelius, Claes; De Bleser, Pieter; Vlieghe, Dominique; Halfon, Marc S.; Wasserman, Wyeth; Hardison, Ross; Bergman, Casey M.; Jones, Steven J.M.

    2008-01-01

    ORegAnno is an open-source, open-access database and literature curation system for community-based annotation of experimentally identified DNA regulatory regions, transcription factor binding sites and regulatory variants. The current release comprises 30 145 records curated from 922 publications and describing regulatory sequences for over 3853 genes and 465 transcription factors from 19 species. A new feature called the ‘publication queue’ allows users to input relevant papers from scientific literature as targets for annotation. The queue contains 4438 gene regulation papers entered by experts and another 54 351 identified by text-mining methods. Users can enter or ‘check out’ papers from the queue for manual curation using a series of user-friendly annotation pages. A typical record entry consists of species, sequence type, sequence, target gene, binding factor, experimental outcome and one or more lines of experimental evidence. An evidence ontology was developed to describe and categorize these experiments. Records are cross-referenced to Ensembl or Entrez gene identifiers, PubMed and dbSNP and can be visualized in the Ensembl or UCSC genome browsers. All data are freely available through search pages, XML data dumps or web services at: http://www.oreganno.org. PMID:18006570

  17. U.S. Geological Survey community for data integration: data upload, registry, and access tool

    USGS Publications Warehouse

    Fort Collins Science Center Web Applications Team

    2012-01-01

    As a leading science and information agency and in fulfillment of its mission to provide reliable scientific information to describe and understand the Earth, the U.S. Geological Survey (USGS) ensures that all scientific data are effectively hosted, adequately described, and appropriately accessible to scientists, collaborators, and the general public. To succeed in this task, the USGS established the Community for Data Integration (CDI) to address data and information management issues affecting the proficiency of earth science research. Through the CDI, the USGS is providing data and metadata management tools, cyber infrastructure, collaboration tools, and training in support of scientists and technology specialists throughout the project life cycle. One of the significant tools recently created to contribute to this mission is the Uploader tool. This tool allows scientists with limited data management resources to address many of the key aspects of the data life cycle: the ability to protect, preserve, publish and share data. By implementing this application inside ScienceBase, scientists also can take advantage of other collaboration capabilities provided by the ScienceBase platform.

  18. Learning to Thrive: Building Diverse Scientists’ Access to Community and Resources through the BRAINS Program

    PubMed Central

    Margherio, Cara; Horner-Devine, M. Claire; Mizumori, Sheri J. Y.; Yen, Joyce W.

    2016-01-01

    BRAINS: Broadening the Representation of Academic Investigators in NeuroScience is a National Institutes of Health–funded, national program that addresses challenges to the persistence of diverse early-career neuroscientists. In doing so, BRAINS aims to advance diversity in neuroscience by increasing career advancement and retention of post-PhD, early-career neuroscientists from underrepresented groups (URGs). The comprehensive professional development program is structured to catalyze conversations specific to URGs in neuroscience and explicitly addresses factors known to impact persistence such as a weak sense of belonging to the scientific community, isolation and solo status, inequitable access to resources that impact career success, and marginalization from informal networks and mentoring relationships. While we do not yet have data on the long-term impact of the BRAINS program on participants’ career trajectory and persistence, we introduce the BRAINS program theory and report early quantitative and qualitative data on shorter-term individual impacts within the realms of career-advancing behaviors and career experiences. These early results suggest promising, positive career productivity, increased self-efficacy, stronger sense of belonging, and new perspectives on navigating careers for BRAINS participants. We finish by discussing recommendations for future professional development programs and research designed to broaden participation in the biomedical and life sciences. PMID:27587858

  19. A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units.

    PubMed

    Dicks, Kristen V; Lofgren, Eric; Lewis, Sarah S; Moehring, Rebekah W; Sexton, Daniel J; Anderson, Deverick J

    2016-07-01

    OBJECTIVE To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). DESIGN Interrupted time series analysis. SETTING The study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013. PARTICIPANTS All ICU patients at study hospitals during the study period. METHODS Of the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line-associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated. RESULTS Chlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93-0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94-0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97-0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93-1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing. CONCLUSIONS In this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients. Infect Control Hosp Epidemiol 2016;37:791-797. PMID:26861417

  20. Protocol for ACCESS: a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia

    PubMed Central

    Hussainy, Safeera Yasmeen; Ghosh, Ayesha; Taft, Angela; Mazza, Danielle; Black, Kirsten Isla; Clifford, Rhonda; Mc Namara, Kevin Peter; Ryan, Kath; Jackson, John Keith

    2015-01-01

    Introduction The rate of unplanned pregnancy in Australia remains high, which has contributed to Australia having one of the highest abortion rates of developed countries with an estimated 1 in 5 women having an abortion. The emergency contraceptive pill (ECP) offers a safe way of preventing unintended pregnancy after unprotected sex has occurred. While the ECP has been available over-the-counter in Australian pharmacies for over a decade, its use has not significantly increased. This paper presents a protocol for a qualitative study that aims to identify the barriers and facilitators to accessing the ECP from community pharmacies in Australia. Methods and analysis Data will be collected through one-on-one interviews that are semistructured and in-depth. Partnerships have been established with 2 pharmacy groups and 2 women's health organisations to aid with the recruitment of women and pharmacists for data collection purposes. Interview questions explore domains from the Theoretical Domains Framework in order to assess the factors aiding and/or hindering access to ECP from community pharmacies. Data collected will be analysed using deductive content analysis. The expected benefits of this study are that it will help develop evidence-based workforce interventions to strengthen the capacity and performance of community pharmacists as key ECP providers. Ethics and dissemination The findings will be disseminated to the research team and study partners, who will brainstorm ideas for interventions that would address barriers and facilitators to access identified from the interviews. Dissemination will also occur through presentations and peer-reviewed publications and the study participants will receive an executive summary of the findings. The study has been evaluated and approved by the Monash Human Research Ethics Committee. PMID:26656987

  1. Knowledge of Community General Practitioners and Nurses on Pre-Hospital Stroke Prevention and Treatment in Chongqing, China

    PubMed Central

    Yang, Juan; Zhang, Jie; Ou, Shu; Wang, Ni; Wang, Jian

    2015-01-01

    Background and Purpose This study aimed to investigate the knowledge of community general practitioners (GPs) and nurses about pre-hospital stroke recognition, treatment and management and secondary stroke prevention; to identify the sociodemographic and educational factors influencing knowledge. Methods A self-designed test questionnaire was applied in a self-administered close-exam setting among 480 GPs and nurses working in community health centers (stations) in eight urban districts of Chongqing. Results A total of 331 (69%) valid test questionnaires were returned. Of the 331 participants, 39% were aware of the clinical guidelines for cerebrovascular diseases, whereas 48% considered themselves to have stroke management capabilities. The correct rate of answering questions of pre-hospital recognition and management knowledge was as low as 24%, the correct rate of secondary stroke prevention knowledge was only 38%. In terms of the total score for stroke prevention and treatment knowledge, there were significant differences between the medical staff with different specialties before engaging in community health services and whether they have received GP training (P <0.05). Conclusion The community GPs and nurses in the urban districts of Chongqing clearly lack knowledge of stroke, and the levels of stroke prevention and treatment urgently need to be improved. PMID:26384330

  2. An evidence-based strategy for transitioning patients from the hospital to the community.

    PubMed

    Watkins, Lynn

    2012-01-01

    Improving transitional care from hospital to home requires comprehensive and highly coordinated intervention during the immediate days following discharge. The Hospital to Home Program addresses both medical and social needs, prevents unnecessary readmissions, promotes improvements in patient perceptions of physical and mental health, and results in excellent patient satisfaction. PMID:22619855

  3. Unravelling Barriers to Accessing HIV Prevention Services Experienced by African and Caribbean Communities in Canada: Lessons from Toronto

    PubMed Central

    Amibor, Paulson; Ogunrotifa, Ayodeji Bayo

    2012-01-01

    Barriers to accessing HIV-prevention services, experienced by African and Caribbean communities in Canada, is an issue warranting sustained research. This study seeks to achieve a better understanding of the nature of HIV-prevention services in Canada, and to explore the dynamics, which underpin barriers to accessing these services confronting African and Caribbean populations in Toronto (Canada). This study also endeavours to assess what is being done to reduce these barriers. Semi-structured qualitative interviews with 7 professionals and community workers who were involved in organizing, researching and delivering HIV-prevention services were conducted for this study. Four themes pertaining to barriers to accessing HIV-prevention services, including, levels of cultural competence and sensitivity among service providers; cultural and social stigma directed at persons living with HIV/AIDS; various social determinants of health, including gender, race and precarious immigration status’; as well as constrained funding resources that are available for service providers; were uncovered in the findings of the study. The paper concludes that several health promotion and health education initiatives exist, which can help reduce these barriers to HIV-prevention service access for these populations. However, in order to ensure their effectiveness there will be much needed involvement from community and other relevant government agencies, which will need to work separately and in conjunction with one another, in order to tackle some of the broader issues that affect these populations. PMID:22980228

  4. Developing Community-School-University Partnerships to Control Youth Access to Tobacco

    ERIC Educational Resources Information Center

    Jason, Leonard A.; Pokorny, Steven B.; Ji, Peter; Kunz, Charlotte

    2005-01-01

    Dalton et al. (2001) described the field of community psychology as focused on the interdependent relationships of individuals to communities and society, committed to generating valid knowledge that is useful to communities, and involved in research and action through collaborative partnerships with individuals and communities. These principles…

  5. Latino Access to Community Colleges and Hispanic-Serving Institutions: A National Study

    ERIC Educational Resources Information Center

    Nunez, Anne-Marie; Sparks, P. Johnelle; Hernandez, Eliza A.

    2011-01-01

    This article examines the factors that affect Latinos' enrollment in community colleges that are Hispanic-serving institutions (HSIs). Compared with community colleges that are not HSIs, HSI community colleges are serving students at greater risk for not completing college. Latinos who are enrolled in community college HSIs, compared with their…

  6. Predicting the decisions of hospital based child protection teams to report to child protective services, police and community welfare services.

    PubMed

    Benbenishty, Rami; Jedwab, Merav; Chen, Wendy; Glasser, Saralee; Slutzky, Hanna; Siegal, Gil; Lavi-Sahar, Zohar; Lerner-Geva, Liat

    2014-01-01

    This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement. PMID:23948314

  7. Two Obese Patients with Presumptive Diagnosis of Anaphylactoid Syndrome of Pregnancy Presenting at a Community Hospital

    PubMed Central

    Kradel, Brian K.; Hinson, Scarlett B.; Smith, Carr J.

    2016-01-01

    Case series Patient: Female, 21 • Female, 29 Final Diagnosis: Anaphylactoid syndrome of pregnancy Symptoms: Coagulation dysfunctional Medication: — Clinical Procedure: Cardiac intensive care Specialty: Obstetrics and Gynecology Objective: Rare disease Background: Anaphylactoid syndrome of pregnancy (ASP) is a rare but extremely serious complication, with an estimated incidence in North America of 1 in 15 200 deliveries. Despite its rarity, ASP is responsible for approximately 10% of all childbirth-associated deaths in the United States. At present, there is no validated biomarker or specific set of risk factors sufficiently predictive of ASP risk to incorporate into clinical practice. Toward the goal of developing a methodology predictive of an impending ASP event for use by obstetricians, anesthesiologists, and other practitioners participating in infant deliveries, physicians encountering an ASP event have been encouraged to report the occurrence of a case and its biologically plausible risk factors. Case Report: Herein, we report on 2 patients who presented with a presumptive diagnosis of ASP to the delivery unit of a community hospital. Patient One was a 21-year-old, obese (5′11″ tall, 250 lbs., BMI 34.9) white female, 1 pregnancy, no live births (G1P0), estimated gestational age (EGA) 40.2 weeks. Patient Two was a 29-year-old, obese (5′7″ tall, 307 lbs., BMI 48.1) Hispanic female, second pregnancy, with 1 previous live birth via C-section (G2P1-0-0-1). Her pregnancy was at gestational age 38 weeks plus 2 days. Conclusions: Patient One had 2 possible risk factors: administration of Pitocin to induce labor and post-coital spotting from recent intercourse. Patient Two suffered premature rupture of the placental membranes. Both Patient One and Patient Two had very high body mass indices (BMIs), at the 97th and 99th percentiles, respectively. In the relatively few cases of anaphylactoid syndrome of pregnancy described to date, this is the first report

  8. Challenges created by data dissemination and access restrictions when attempting to address community concerns: individual privacy versus public wellbeing

    PubMed Central

    Colquhoun, Amy; Aplin, Laura; Geary, Janis; Goodman, Karen J.; Hatcher, Juanita

    2012-01-01

    Background Population health data are vital for the identification of public health problems and the development of public health strategies. Challenges arise when attempts are made to disseminate or access anonymised data that are deemed to be potentially identifiable. In these situations, there is debate about whether the protection of an individual's privacy outweighs potentially beneficial public health initiatives developed using potentially identifiable information. While these issues have an impact at planning and policy levels, they pose a particular dilemma when attempting to examine and address community concerns about a specific health problem. Methods Research currently underway in northern Canadian communities on the frequency of Helicobacter pylori infection and associated diseases, such as stomach cancer, is used in this article to illustrate the challenges that data controls create on the ability of researchers and health officials to address community concerns. Results Barriers are faced by public health professionals and researchers when endeavouring to address community concerns; specifically, provincial cancer surveillance departments and community-driven participatory research groups face challenges related to data release or access that inhibit their ability to effectively address community enquiries. The resulting consequences include a limited ability to address misinformation or to alleviate concerns when dealing with health problems in small communities. Conclusions The development of communication tools and building of trusting relationships are essential components of a successful investigation into community health concerns. It may also be important to consider that public wellbeing may outweigh the value of individual privacy in these situations. As such, a re-evaluation of data disclosure policies that are applicable in these circumstances should be considered. PMID:22584511

  9. Long-term morbidity and mortality after hospitalization with community-acquired pneumonia: a population-based cohort study.

    PubMed

    Johnstone, Jennie; Eurich, Dean T; Majumdar, Sumit R; Jin, Yan; Marrie, Thomas J

    2008-11-01

    Little is known about the long-term sequelae of community-acquired pneumonia (CAP). Therefore, we describe the long-term morbidity and mortality of patients after pneumonia requiring hospitalization. We specifically hypothesized that the Pneumonia Severity Index (PSI), designed to predict 30-day pneumonia-related mortality, would also be associated with longer-term all-cause mortality. Between 2000 and 2002, 3415 adults with CAP admitted to 6 hospitals in Edmonton, Alberta, Canada, were prospectively enrolled in a population-based cohort. At the time of hospital admission, demographic, clinical, and laboratory data were collected and the PSI was calculated for each patient. Postdischarge outcomes through to 2006 were ascertained using multiple linked administrative databases. Outcomes included all-cause mortality, hospital admissions, and re-hospitalization for pneumonia over a maximum of 5.4 years of follow-up. Follow-up data were available for 3284 (96%) patients; 66%were > or =65 years of age, 53% were male, and according to the PSI fully 63% were predicted to have greater than 18% 30-day pneumonia-related mortality (that is, PSI class IV-V). Median follow-up was 3.8 years. The 30-day, 1-year, and end of study mortality rates were 12%, 28%, and 53%, respectively. Overall, 82(19%) patients aged <45 years died compared with 1456 (67%) patients aged > or =65 years (hazard ratio [HR], 5.07; 95% confidence interval [CI], 4.06-6.34). Male patients were more likely to die than female patients during follow-up (971 [56%] vs. 767 [49%], respectively; HR, 1.20; 95% CI, 1.13-1.37). Initial PSI classification predicted not only 30-day mortality, but also long-term postdischarge mortality, with 92 (15%) of PSI class I-II patients dying compared with 616 (82%) PSI class V patients (HR, 11.80; 95% CI, 4.70-14.70). Of 2950 patients who survived the initial CAP hospitalization, 72% were hospitalized again (median, 2 admissions over follow-up) and 16% were re-hospitalized with

  10. The use of the temporal scan statistic to detect methicillin-resistant Staphylococcus aureus clusters in a community hospital

    PubMed Central

    2014-01-01

    Background In healthcare facilities, conventional surveillance techniques using rule-based guidelines may result in under- or over-reporting of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks, as these guidelines are generally unvalidated. The objectives of this study were to investigate the utility of the temporal scan statistic for detecting MRSA clusters, validate clusters using molecular techniques and hospital records, and determine significant differences in the rate of MRSA cases using regression models. Methods Patients admitted to a community hospital between August 2006 and February 2011, and identified with MRSA > 48 hours following hospital admission, were included in this study. Between March 2010 and February 2011, MRSA specimens were obtained for spa typing. MRSA clusters were investigated using a retrospective temporal scan statistic. Tests were conducted on a monthly scale and significant clusters were compared to MRSA outbreaks identified by hospital personnel. Associations between the rate of MRSA cases and the variables year, month, and season were investigated using a negative binomial regression model. Results During the study period, 735 MRSA cases were identified and 167 MRSA isolates were spa typed. Nine different spa types were identified with spa type 2/t002 (88.6%) the most prevalent. The temporal scan statistic identified significant MRSA clusters at the hospital (n = 2), service (n = 16), and ward (n = 10) levels (P ≤ 0.05). Seven clusters were concordant with nine MRSA outbreaks identified by hospital staff. For the remaining clusters, seven events may have been equivalent to true outbreaks and six clusters demonstrated possible transmission events. The regression analysis indicated years 2009–2011, compared to 2006, and months March and April, compared to January, were associated with an increase in the rate of MRSA cases (P ≤ 0.05). Conclusions The application of the temporal scan

  11. Prospective Study of Laparoscopic Nissen Fundoplication in a Community Hospital and Its Effect on Typical, Atypical, and Nonspecific Gastrointestinal Symptoms

    PubMed Central

    Danielson, Amanda; Maxwell, J. Gary; Harris, James A.

    2007-01-01

    Background: Laparoscopic Nissen fundoplication (LNF) provides long-term improvement in the typical symptoms of gastroesophageal reflux disease. Few studies have prospectively addressed LNF in the community hospital or the effect of LNF on specific atypical symptoms, other related gastrointestinal symptoms, and weight change. Methods: Data were collected prospectively on consecutive patients having LNF. Three typical, 6 atypical, and 3 other gastrointestinal symptoms were studied. Results: Short-term data on 91 patients and long-term data on 84 patients were studied. Overall long-term improvement was 98%. Regarding typical symptoms, the greatest improvement occurred in heartburn and regurgitation. Regarding atypical symptoms, the greatest improvement occurred in cough and sore throat, but chest pain, hoarseness, and throat clearing also showed significant durable improvement. Bloating, nausea, and diarrhea showed no significant change from preoperative to postoperative surveys. Mild weight loss was common. Conclusion: LNF can be safely performed in a community hospital with results equal to those of university hospitals. Improvement in typical symptoms was greater than improvement in atypical symptoms, but results for both were significant and durable. Nonspecific gastrointestinal symptoms, such as nausea, bloating, and diarrhea, may be unrelated to Nissen fundoplication. PMID:17651559

  12. Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients.

    PubMed

    Putot, A; Tetu, J; Perrin, S; Bailly, H; Piroth, L; Besancenot, J-F; Bonnotte, B; Chavanet, P; d'Athis, P; Charles, P-E; Sordet-Guépet, H; Manckoundia, P

    2016-03-01

    We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised. PMID:26753994

  13. Risk Factors for Fall-Related Injuries Leading to Hospitalization Among Community-Dwelling Older Persons: A Hospital-Based Case-Control Study in Thiruvananthapuram, Kerala, India.

    PubMed

    Ravindran, Rekha M; Kutty, V Raman

    2016-01-01

    This study intended to identify the risk factors for injurious falls that led to hospitalization of older persons living in the community. A hospital-based unmatched incident case-control study was done among 251 cases and 250 controls admitted at a tertiary care centre in Kerala. Mean age of cases was 71.6 ± 9.13 years and that of controls was 67.02 ± 6.17 years. Hip fractures were the predominant injury following falls. Falls were mostly a result of intrinsic causes. After adjusting for other variabes, the risk factors for all injuries were age above 70 years (odds ratio [OR] = 2.25; 95% confidence interval [CI] = 1.46-3.46), previous fall history (OR = 2.76; 95% CI = 1.08-7.08), impaired vision (OR = 4.49; 95% CI = 2.77-7.30), not living with spouse (OR = 1.97; 95% CI = 1.31-2.97), door thresholds (OR = 1.52; 95% CI = 1.01-2.29), and slippery floor (OR = 2.37; 95% CI = 1.31-4.32). The risk factors for hip fractures and other injuries were identified separately. Fall prevention strategies among older persons are warranted in Kerala. PMID:26463576

  14. Development of a hospital-based cardiovascular risk factor reduction program for the community: Beyond Heart Disease.

    PubMed

    Lipon, K R; Carlson, L R

    1994-01-01

    The current and future trend of the health care delivery system is prevention and health promotion. Long-term viability of hospitals depends on meeting community health education needs. With heart disease as the leading cause of death among adults nationwide, hospitals have an opportunity to offer appropriate lifestyle theory and guidance beyond conventional medical and interventional practices. Sequoia Hospital in Redwood City is one of the first hospitals in Northern California to develop a comprehensive outpatient program to complement its world renowned cardiovascular services. This paper details the Beyond Heart Disease (BHD) program designed by nurses. The goal of this program is to effectively help people reduce their risk of coronary events via successful long-term risk factor interventions. BHD, a unique medical and business venture, spans a six-week period. Group members meet in the evening for two hours, twice a week. The program includes lipid testing, a complete program syllabus, didactic lectures, small group discussion, support and goal-setting, nutritional analysis, and experiential stress reduction sessions. PMID:7937685

  15. Increasing Community Access to Solar: Designing and Developing a Shared Solar Photovoltaic System (Fact Sheet)

    SciTech Connect

    Not Available

    2012-06-01

    This document introduces the Energy Department's new Guide to Community Shared Solar: Utility, Private, and Nonprofit Project Development. The guide is designed to help those who want to develop community shared solar projects - from community organizers and advocates to utility managers and government officials - navigate the process of developing shared systems, from early planning to implementation.

  16. Best Practices in Community Garden Management to Address Participation, Water Access, and Outreach

    ERIC Educational Resources Information Center

    Drake, Luke; Lawson, Laura

    2015-01-01

    As community gardens expand across the U.S., Extension professionals can support them not only in horticultural education but also in planning and organization. Knowledge of community garden management is helpful in this regard. Existing research focuses on outcomes and criteria for successful gardens, but is less clear about how community gardens…

  17. Accessibility and Use of Recreational Sports Facilities at Florida's Community Colleges.

    ERIC Educational Resources Information Center

    De Michele, Douglas

    In an effort to determine the percent of use of sports facilities on Florida community college campuses, a survey was sent to community college presidents and campus recreation directors throughout the Florida Community College System (FCCS). The survey, distributed to all 25 branch campuses and 28 primary campuses in the system, was designed to…

  18. Transforming Practice Through Publication: A Community Hospital Approach to the Creation of a Research-Intensive Environment.

    PubMed

    Brockopp, Dorothy; Hill, Karen; Moe, Krista; Wright, Lonnie

    2016-01-01

    Publication of 28 data-based articles in peer-reviewed journals over a 4-year period is the result of a commitment to conducting and publishing research at a 383-bed Magnet®-redesignated community hospital. The research-intensive environment in nursing at this institution supports publication as the desired outcome of all projects. The provision of appropriate resources, the development of 2 models to guide the conduct of research and nursing leadership that encourages and supports research activities enables nurses to submit manuscripts describing their work. Steps taken to support the publication of findings can be adapted for other practice settings. PMID:26641469

  19. A Novel Housing-Based Socioeconomic Measure Predicts Hospitalization and Multiple Chronic Conditions in a Community Population

    PubMed Central

    Takahashi, Paul Y.; Ryu, Euijung; Hathcock, Matthew A.; Olson, Janet E.; Bielinski, Suzette J.; Cerhan, James R.; Rand-Weaver, Jennifer; Juhn, Young J.

    2016-01-01

    Background Socioeconomic status (SES) is an important predictor for outcomes of chronic diseases. However, it is often unavailable in clinical data. We sought to determine whether an individual housing-based SES index termed HOUSES can influence the likelihood of multiple chronic conditions (MCC) and hospitalization in a community population. Methods Participants were residents of Olmsted County, Minnesota, aged >18 years who were enrolled in Mayo Clinic Biobank on December 31, 2010, with follow-up until December 31, 2011. Primary outcome was all-cause hospitalization over 1 calendar year. Secondary outcome was MCC determined through Minnesota Medical Tiering score. Logistic regression model was used to assess association of HOUSES with Minnesota tiering score. With adjustment for age, sex, and MCC, the association of HOUSES with hospitalization risk was tested using Cox proportional hazards model. Results Eligible patients totaled 6,402 persons (median age, 57 years; 25th-75th quartiles, 45-68 years). The lowest quartile of HOUSES was associated with higher Minnesota tiering score after adjustment for age and sex (odds ratio [95% CI], 2.4 [2.0-3.1]) when compared with the highest HOUSES quartile. Patients in the lowest HOUSES quartile had higher risk of all-cause hospitalization (age, sex, MCC-adjusted hazard ratio [95% CI], 1.53 [1.18-1.98]) compared with those in the highest quartile. Conclusion Low SES, as assessed by HOUSES, was associated with increased risk of hospitalization and greater MCC health burden. HOUSES may be a clinically useful surrogate for SES to assess risk stratification for patient care and clinical research. PMID:26458399

  20. Data Management for Flexible Access - Implementation and Lessons Learned from work with Multiple User Communities

    NASA Astrophysics Data System (ADS)

    Benedict, K. K.; Scott, S.; Hudspeth, W. B.

    2012-12-01

    There is no shortage of community-specific and generic data discovery and download platforms and protocols (e.g. CUAHSI HIS, DataONE, GeoNetwork Open Source, GeoPortal, OGC CSW, OAI PMH), documentation standards (e.g. FGDC, ISO 19115, EML, Dublin Core), data access and visualization standards and models (e.g. OGC WxS, OpenDAP), and general-purpose web service models (i.e. REST & SOAP) upon which Geo-informatics cyberinfrastructure (CI) may be built. When attempting to develop a robust platform that may service a wide variety of users and use cases the challenge is one of identifying which existing platform (if any) may support those current needs while also allowing for future expansion for additional capabilities. In the case of the implementation of a data storage, discovery and delivery platform to support the multiple projects at the Earth Data Analysis Center at UNM, no single platform or protocol met the joint requirements of two initial applications (the New Mexico Resource Geographic Information System [http://rgis.unm.edu] and the New Mexico EPSCoR Data Portal [http://nmepscor.org/dataportal]) and furthermore none met anticipated additional requirements as new applications of the platform emerged. As a result of this assessment three years ago EDAC embarked on the development of the Geographic Storage, Transformation, and Retrieval Engine (GSToRE) platform as a general purpose platform upon which n-tiered geospatially enabled data intensive applications could be built. When initially released in 2010 the focus was on the publication of dynamically generated Open Geospatial Consortium services based upon a PostgreSQL/PostGIS backend database. The identification of additional service interface requirements (implementation of the DataONE API and CUAHSI WaterML services), use cases provided by the NM EPSCoR education working group, and expanded metadata publication needs have led to a significant update to the underlying data management tier for GSToRE - the

  1. Integrating Hospital-Acquired Lessons into Community Health Practice: Optimizing Antimicrobial Use in Bangalore

    ERIC Educational Resources Information Center

    Biswas, Rakesh; Dineshan, Vineeth; Narasimhamurthy, N. S.; Kasthuri, A. S.

    2007-01-01

    Introduction: Even as antimicrobial resistance is a serious public health concern worldwide, the uncertainties of diagnosis and treatment of fever strongly influence community practitioners toward prescribing antibiotics. To help community practitioners resolve their diagnostic questions and reduce the unnecessary use of antibiotics for viral…

  2. Community-associated methicillin resistant Staphylococcus aureus in south Florida hospital and recreational environments

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Strains of methicillin resistant Staphylococcus aureus (MRSA), a frequent human pathogen, may also be found in the flora of healthy persons and in the environments that they frequent. Strains of MRSA circulating in the community classified as USA 300 are now found not only in the community but also...

  3. Acceptability of Delivering and Accessing Health Information Through Text Messaging Among Community Health Advisors

    PubMed Central

    Phillips, Janice; Mohiuddin, Mohammed Omar; McNees, Patrick; Scarinci, Isabel

    2013-01-01

    Background Communication technologies can play a significant role in decreasing communication inequalities and cancer disparities by promoting cancer control and enhancing population and individual health. Studies have shown that technology, such as the mobile phone short message service (SMS) or text messaging, can be an effective health communication strategy that influences individuals’ health-related decisions, behaviors, and outcomes. Objective The purpose of this study was to explore usage of communication technologies, assess the acceptability of mobile technology for delivery and access of health information, and identify cancer and health information needs among Deep South Network for Cancer Control trained Community Health Advisors as Research Partners (CHARPs). Methods A mixed-method design was used, and a triangulation protocol was followed to combine quantitative and qualitative data. Focus groups (4 focus groups; n=37) and self-administered surveys (n=77) were conducted to determine CHARPs mobile phone and text message usage. The objective was to include identification of barriers and facilitators to a mobile phone intervention. Results All participants were African American (37/37, 100%), 11/37 (89%) were women, and the mean age was 53.4 (SD 13.9; focus groups) and 59.9 (SD 8.7; survey). Nearly all (33/37, 89%) of focus group participants reported owning a mobile phone. Of those, 8/33 (24%) owned a smartphone, 22/33 (67%) had a text messaging plan, and 18/33 (55%) and 11/33 (33%) received and sent text messages several times a week or day, respectively. Similar responses were seen among the survey participants, with 75/77 (97%) reporting owning a mobile phone, and of those, 22/75 (30%) owned a smartphone, 39/75 (53%) had a text messaging plan, and 37/75 (50%) received and 27/75 (37%) sent text messages several times a week or day. The benefits of a text messaging system mentioned by focus group participants included alternative form of

  4. Community Based Mathematics Project: Conceptualizing Access through Locally Relevant Mathematics Curricula

    ERIC Educational Resources Information Center

    Ebby, Caroline; Lim, Vivian; Reinke, Luke; Remillard, Janine; Magee, Emily; Hoe, Nina; Cyrus, Maya

    2011-01-01

    In this article, the authors describe a conceptual framework for using locally relevant mathematics curricula to increase access to mathematics for marginalized youth. Drawing on different strands of research on equity in mathematics education, the authors propose that there are three kinds of access that are afforded by the use of contexts that…

  5. [The Importance of Medication History Management by Hospital and Community Pharmacists for Oral Anticancer Drug S-1(Tegafur/Gimeracil/Oteracil Potassium)--A Retrospective Study].

    PubMed

    Maeda, Makoto; Saito, Yoshimasa; Makino, Yoshinori; Iwase, Haruo; Hayashi, Yoshikazu

    2016-01-01

    S-1 (tegafur/gimeracil/oteracil potassium) is an effective oral anticancer drug for treatment of a wide spectrum of cancers. However, it may incur serious adverse effects through factors such as interactions with other drugs, renal dysfunction, or an insufficient washout period. In view of this, pharmacists should play an increasingly significant role in managing the medication history of patients treated with S-1. As there seems to be no standardized management tool for patients receiving S-1, we conducted a retrospective study to evaluate medication history management methods, which are commonly available in community pharmacies as well as hospitals. We identified 128 outpatients who were prescribed S-1 for the first time at the National Cancer Center Hospital from July to December of 2011. These patients were divided into in-hospital (n=48) and out-of-hospital (n=80) groups. The percentage of patients, who dropped out during the first course of S-1 treatment, was 16.7% for the in-hospital group, and 10% for the out-of-hospital group. Examining renal dysfunction, non-elderly patients with low creatinine clearance (Ccr) were found. These results suggest that there is the possibility of side effect occurrence in both the in-hospital and out-of-hospital prescription groups. Community pharmacists should check prescriptions with particular attention to the Ccr. It is necessary to develop mechanisms for cooperation between hospital and community pharmacists, with clear role sharing between them, allowing the community pharmacists to exercise medication history management for patients prescribed S-1 to the same degree as hospital pharmacists based on available information including laboratory test values. PMID:26809530

  6. Implementing a physician leader compensation program at a major community hospital.

    PubMed

    Dubinsky, Isser L; Greengarten, Moshe; Grossman, Larry; Hundert, Mark; Sawatzky, Diane; Whittaker, Bill

    2008-01-01

    The roles of physician leaders in Canadian hospitals and health regions are becoming more complex and time consuming. Physician leaders are increasingly being seen by hospital boards and executives as key to achieving strategic and operational outcomes. Given the growing importance of these roles and the increasing performance expectations being placed on physician leaders, it is critical that organizations are able to recruit and retain individuals who demonstrate the skills required to fulfill these critical roles or commit themselves to acquiring them. PMID:18362521

  7. Not-for-Profit community hospitals' exempt status at issue in charity care controversy.

    PubMed

    Unland, James J

    2004-01-01

    Revocations of local property tax exemptions, class action lawsuits, and state and Congressional investigations all beset the not-for-profit sector of the hospital industry. These problems originated from issues relating to the pricing of services to the uninsured, the relative availability of "charity care" or lack thereof and the collection tactics that some hospital-contracted collectors use. Is this controversy really just symptomatic of the extent to which health care charging and payment systems are out of whack? Are ambiguous government regulations to blame? Is large-scale payment reform the real answer? PMID:15839530

  8. The impact of ongoing national terror on the community of hospital nurses in Israel.

    PubMed

    Ron, Pnina; Shamai, Michal

    2014-04-01

    The main goal of this study was to explore the connections between the exposure of nurses in Israel to national terror and the levels of distress experienced due to ongoing terror attacks. The data were collected from 214 nurses from various parts of Israel who work in three types of heath services (mainly hospital departments) and provide help to victims of terror. The nurses reported very high levels of burnout, high levels of stress and medium-to high levels of intrusive memories. Levels of exposure were associated with burnout, intrusive memories and level of stress. More professional attention should be given to hospital nurses who provide care for trauma patients. PMID:23982180

  9. Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals

    ERIC Educational Resources Information Center

    Laditka, Sarah B.; Laditka, James N.; Bennett, Kevin J.; Probst, Janice C.

    2005-01-01

    Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality. The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially…

  10. Incidence, Outcomes, and Risk Factors of Community-Acquired and Hospital-Acquired Acute Kidney Injury: A Retrospective Cohort Study.

    PubMed

    Hsu, Chien-Ning; Lee, Chien-Te; Su, Chien-Hao; Wang, Yu-Ching Lily; Chen, Hsiao-Ling; Chuang, Jiin-Haur; Tain, You-Lin

    2016-05-01

    The disease burden and outcomes of community-acquired (CA-) and hospital-acquired acute kidney injury (HA-AKI) are not well understood. The aim of the study was to investigate the incidence, outcomes, and risk factors of AKI in a large Taiwanese adult cohort.This retrospective cohort study examined 734,340 hospital admissions from a group of hospitals within an organization in Taiwan between January 1, 2010 and December 31, 2014. Patients with AKI at discharge were classified as either CA- or HA-AKI based on the RIFLE (risk, injury, failure, loss of function, end stage of kidney disease) classification criteria. Outcomes were in-hospital mortality, dialysis, recovery of renal function, and length of stay. Risks of developing AKI were determined using multivariate logistic regression based on demographic and baseline clinical characteristics and nephrotoxin use before admission.AKI occurred in 1.68% to 2% hospital discharges among adults without and with preexisting chronic kidney disease (CKD), respectively. The incidence of CA-AKI was 17.25 and HA-AKI was 8.14 per 1000 admissions. The annual rate of CA-AKI increased from 12.43 to 19.96 per 1000 people, but the change in HA-AKI was insignificant. Comparing to CA-AKI, those with HA-AKI had higher levels of in-hospital mortality (26.07% vs 51.58%), mean length of stay (21.25 ± 22.35 vs 35.84 ± 34.62 days), and dialysis during hospitalization (1.45% vs 2.06%). Preexisting systemic diseases, including CKD were associated with increased risks of CA-AKI, and nephrotoxic polypharmacy increased risk of both CA- and HA-AKI.Patients with HA-AKI had more severe outcomes than patients with CA-AKI, and demonstrated different spectrum of risk factors. Although patients with CA-AKI with better outcomes, the incidence increased over time. It is also clear that optimal preventive and management strategies of HA- and CA-AKI are urgently needed to limit the risks in susceptible individuals. PMID:27175701

  11. Promoting accountability: hospital charity care in California, Washington state, and Texas.

    PubMed

    Sutton, Janet P; Stensland, Jeffrey

    2004-05-01

    Debate as to whether private hospitals meet their charitable obligations is heated. This study examines how alternative state approaches for ensuring hospital accountability to the community affects charitable expenditures and potentially affects access to care for the uninsured. Descriptive and multivariate analyses were used to compare private California hospitals' charity care expenditures with those of hospitals in Texas and Washington state. The key finding from this study is that net of hospital characteristics, market characteristics and community need, Texas hospitals were estimated to provide over 3 times more charity care and Washington hospitals were estimated to provide 66% more charity care than California hospitals. This finding suggests that more prescriptive community benefit or charity care requirements may be necessary to ensure that private hospitals assume a larger role in the care of the uninsured. PMID:15253376

  12. Community Pathways: Hospital-Based Services that Individualize Supports for Families and Children

    ERIC Educational Resources Information Center

    Boone, Harriet A.; Freund, Peggy J.; Barlow, Jane H.; Van Ark, Gwenn G.; Wilson, Thea K.

    2004-01-01

    Increasing numbers of infants and toddlers who were premature, had low birth weight, or experience chronic medical conditions are referred to early intervention services (Bernstein, Heimler, & Sasidharan, 1998). These young children often endure prolonged hospitalizations and are at risk for developmental disabilities by nature of their illnesses,…

  13. Diversity of Bacterial Communities on Four Frequently Used Surfaces in a Large Brazilian Teaching Hospital

    PubMed Central

    Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed

    2016-01-01

    Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866

  14. 78 FR 29628 - Community Health Needs Assessments for Charitable Hospitals; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-21

    ... Revenue Code. Need for Correction As published April 5, 2013 (78 FR 20523), the notice of proposed... subject of FR Doc. 2013-07959, is corrected as follows: 1. On page 20523, in the preamble, column 3, under... Charitable Hospitals; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correction to...

  15. The Effect on Academic Health Centers of Tertiary Care in Community Hospitals.

    ERIC Educational Resources Information Center

    Gee, David A.; Rosenfeld, Lisa A.

    1984-01-01

    The growing cost of medical education and the provision of care to the indigent can be endangered by the dilution of revenue sources traditionally available to the academic health centers but which are being taken over by suburban hospitals. (Author/MLW)

  16. Using Failure Mode Effects and Criticality Analysis for High-Risk Processes at Three Community Hospitals

    SciTech Connect

    Coles, Garill A.; Fuller, Becky; Nordquist, Kathleen; Kongslie, Anita

    2005-03-01

    The staff at three Washington State hospitals and Battelle Pacific Northwest Division have been collaborating to apply Failure Mode Effects and Criticality Analysis (FMECA) to assess several hospital processes. The staff from Kadlec Medical Center (KMC), located in Richland, Washington; Kennewick General Hospital (KGH), located in Kennewick, Washington; and Lourdes Medical Center (LMC), located in Pasco, Washington, along with staff from Battelle, which is located in Richland, Washington have been working together successfully for two and a half years. Tri-Cities Shared Services, a local organization which implements shared hospital services, has provided the forum for joint activity. This effort was initiated in response to the new JCAHO patient safety standards implemented in July 2001, and the hospitals’ desire to be more proactive in improving patient safety. As a result of performing FMECAs the weaknesses of six medical processes have been characterized and corresponding system improvements implemented. Based on this collective experience, insights about the benefits of applying FMECAs to healthcare processes have been identified.

  17. 78 FR 48303 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-08

    ..., 2011 (76 FR 39043), DoD published for public comment a Proposed Rule regarding an inpatient payment.... G. CAH GTMCPA On August 31, 2009, we published in the Federal Register a Final Rule (74 FR 44752... FR 39043), also proposed a CAH GTMCPA for TRICARE network hospitals deemed essential for...

  18. Diversity of Bacterial Communities on Four Frequently Used Surfaces in a Large Brazilian Teaching Hospital.

    PubMed

    Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed

    2016-02-01

    Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866

  19. How do Trends for Behavioral Health Inpatient Care Differ from Medical Inpatient Care in U.S. Community Hospitals?

    PubMed

    Bao, Yuhua; Sturm, Roland

    2001-06-01

    BACKGROUND: Inpatient care in the United States accounts for one third of the health care expenditures. There exists a well-established trend towards fewer inpatient admissions and shorter lengths of stay for all inpatient care, which can be attributed to cost containment efforts through managed care and advances in treatment technologies. However, different illnesses may not necessarily share the same pattern of change in inpatient care utilization. In particular, mental health and substance abuse (MHSA) care has experienced a particularly dramatic growth of specialized managed behavioral organizations, which could have led to an even faster decline. AIMS OF THE STUDY: This study contrasts the trends of MHSA inpatient care in U.S. community hospitals with medical inpatient care over the years 1988 to 1997. It also analyzes the trends for subgroups of MHSA stays by diagnostic groups, age and primary payer. METHODS: We use the National Inpatient Sample (NIS) from the Health Care Cost and Utilization Project (HCUP) to estimate both number of inpatient discharges per 1,000 population and average length of stay over the years and relate the two indices. Inpatient MHSA stays are categorized into subgroups by age, primary payer of the care, and diagnostic group. We use the Clinical Classification Software (CCS) to distinguish between affective disorders, schizophrenia and related disorders, other psychoses, anxiety and related disorders, pre-adult disorders, and alcohol-, substance- related mental disorders and other mental disorders. Trends of population adjusted discharges and length of stay were tested using a weighted least squares method. RESULTS: Population-adjusted MHSA discharges from community hospitals increased by 8.1% over the study period, whereas discharges for all conditions decreased. Within MHSA discharges, the 20-39 and 40-64 age groups experienced significant increase relative to other age group; the increase was particularly high for affective and

  20. Unmet Need and Unclaimed Aid: Increasing Access to Financial Aid for Community College Students

    ERIC Educational Resources Information Center

    Lopez, Julia I.

    2013-01-01

    In California, public financial aid aimed at low-income students is not reaching some of the poorest students enrolled in community colleges. Outreach efforts to students are important, but high schools and community colleges must also make financial aid receipt a priority.

  1. The Impact of Facebook Access in Creating a Sense of Community in Tourism and Recreation Classes

    ERIC Educational Resources Information Center

    Tuma, Lorie A.

    2012-01-01

    Previous research has indicated that college students use social networking sites such as Facebook to establish friendships, maintain communication, and foster a sense of community; research also has indicated that many college instructors do not. Many college faculty acknowledge the importance of a sense of community in the classroom but are…

  2. Fighting Degree Creep: AACC Fights to Protect Access to the Health Professions at Community Colleges

    ERIC Educational Resources Information Center

    Fulcher, Roxanne

    2009-01-01

    The American Association of Community Colleges (AACC) works with community colleges across the nation to uphold the value of the education they provide, in states where proposals to devaluate associate-degree education are openly discussed up to the conference rooms of state legislatures as well as in states where the risk is not yet apparent.…

  3. Can Community Colleges Protect Both Access and Standards? The Problem of Remediation

    ERIC Educational Resources Information Center

    Perin, Dolores

    2006-01-01

    A large number of community college students have difficulty with postsecondary-level reading, writing, and math demands, necessitating remedial education. A qualitative case study was conducted to investigate state and institutional practices for remediation in 15 community colleges selected for region, size, and urbanicity. The six states in…

  4. Providing Access to Developmental Reading Courses at the Community College: An Evaluation of Three Presentation Modes

    ERIC Educational Resources Information Center

    Phillips, Susan K.

    2010-01-01

    Rural community colleges often face the problem of having to cancel classes due to low enrollment. To eliminate this problem one western community college developed several presentation modes for College Reading I (CR1) to combine low-enrollment classes. This study was a program evaluation on non-equivalent groups to determine which presentation…

  5. A Promising Development: "Promise" Scholarships Targeting Individual Communities Reduce Barriers to College Access--and Completion

    ERIC Educational Resources Information Center

    Pierce, Dennis

    2015-01-01

    This article discusses Promise Scholarships in community colleges and sources of funding. The following community colleges and their scholarships are mentioned in this article: (1) Oregon Promise, Oregon; (2) Ventura College Promise, California; (3) Kalamazoo Promise, Michigan; (4) Pittsburgh Promise, Pennsylvania; (5) SEED Scholarship, Delaware;…

  6. The emergence of community-onset Clostridium difficile infection in a tertiary hospital in Singapore: a cause for concern.

    PubMed

    Tan, X Q; Verrall, A J; Jureen, R; Riley, T V; Collins, D A; Lin, R T; Balm, M N; Chan, D; Tambyah, P A

    2014-01-01

    Increasing rates of Clostridium difficile infection (CDI) among those without traditional risk factors have been reported mainly in Europe and North America. Here we describe the epidemiology, clinical features and ribotypes of CDI at National University Hospital (NUH), a 1000-bed tertiary care hospital in Singapore, from December 2011 to May 2012. All laboratory-confirmed CDI cases ≥21 years old who gave informed consent were included. Clinical data were collected prospectively and participants underwent an interviewer-administered questionnaire. Cases were classified by healthcare facility exposure and severity according to the SHEA guidelines. Included cases were also subjected to PCR and were classified by ribotype. In total, 66 patients participated in the study, of which 33 (50.0%) were healthcare-facility-associated hospital onset (HCFA-HO). Of the 33 community-onset (CO) cases, 14 (42.4%) were HCFA-CO, 10 (30.3%) were indeterminate and 9 (27.3%) were community-associated (CA). Of the CA cases, a majority (90.9%) had prior exposure to a healthcare facility within the last 12 weeks. Clinical characteristics, exposures and outcomes were not different between HO-CDI and CO-CDI. Diagnosis was delayed in CO-CDI compared with HO-CDI (4 days vs. 1 day; P=0.014). There was no difference in distribution of ribotypes between CO-CDI and HO-CDI, with 053 being most prevalent in both groups. CO-CDI increasingly contributes to the burden of CDI in NUH. This may reflect a trend in other parts of Asia. Healthcare professionals should be aware of the possible role of outpatient healthcare environments to CDI risk and thus extend control measures to outpatient settings. PMID:24290727

  7. Advancing Long Tail Data Capture and Access Through Trusted, Community-Driven Data Services at the IEDA Data Facility

    NASA Astrophysics Data System (ADS)

    Lehnert, K. A.; Carbotte, S. M.; Ferrini, V.; Hsu, L.; Arko, R. A.; Walker, J. D.; O'hara, S. H.

    2012-12-01

    Substantial volumes of data in the Earth Sciences are collected in small- to medium-size projects by individual investigators or small research teams, known as the 'Long Tail' of science. Traditionally, these data have largely stayed 'in the dark', i.e. they have not been properly archived, and have therefore been inaccessible and underutilized. The primary reason has been the lack of appropriate infrastructure, from adequate repositories to resources and support for investigators to properly manage their data, to community standards and best practices. Lack of credit for data management and for the data themselves has contributed to the reluctance of investigators to share their data. IEDA (Integrated Earth Data Applications), a NSF-funded data facility for solid earth geoscience data, has developed a comprehensive suite of data services that are designed to address the concerns and needs of investigators. IEDA's data publication service registers datasets with DOI and ensures their proper citation and attribution. IEDA is working with publishers on advanced linkages between datasets in the IEDA repository and scientific online articles to facilitate access to the data, enhance their visibility, and augment their use and citation. IEDA's investigator support ranges from individual support for data management to tools, tutorials, and virtual or face-to-face workshops that guide and assist investigators with data management planning, data submission, and data documentation. A critical aspect of IEDA's concept has been the disciplinary expertise within the team and its strong liaison with the science community, as well as a community-based governance. These have been fundamental to gain the trust and support of the community that have lead to significantly improved data preservation and access in the communities served by IEDA.

  8. Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes

    PubMed Central

    Nxumalo, Nonhlanhla; Goudge, Jane; Thomas, Liz

    2013-01-01

    Introduction In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW) programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO), a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. Methods The comparative case studies, located in Eastern Cape and Gauteng, were investigated using qualitative methods. Thematic analysis was used to identify factors that constrain and enable outreach services to improve access to care. Results The local satellite (of a national NGO), successful in addressing multi-dimensional barriers to care, provided CHWs with continuous training focused on the social determinants of ill-health, regular context-related supervision, and resources such as travel and cell-phone allowances. These workers engaged with, and linked their clients to, agencies in a wide range of sectors. Relationships with participatory structures at community level stimulated coordinated responses from service providers. In contrast, an absence of these elements curtailed the ability of CHWs in the small NGO and government-initiated service to provide effective outreach services or to improve access to care. Conclusion Significant investment in resources, training, and support can enable CHWs to address barriers to care by negotiating with poorly functioning government services and community participation structures. PMID:23364101

  9. Primary Care Availability, Safety Net Clinics, and Health Insurance Coverage: The Association of These Access Factors With Preventable Hospitalizations.

    PubMed

    Murty, Sharanya; Begley, Charles E; Franzini, Luisa; Swint, J Michael

    2016-01-01

    The objective of the study was to examine the relationship between physician/safety net availability and health insurance coverage and preventable hospitalizations (PHs) in nonelderly adults in an urban area. Preventable conditions (PHs) were identified for nonelderly adults in Harris County using the Texas Health Care Information Collection hospital database. Multivariable logistic regression models examined the association of health insurance and patient proximity to physicians and safety net clinics with the risk of a PH. Safety net availability reduced PH risk by 23% (P < .05) but only among the uninsured. Lack of health insurance increased PH risk by 30% (P < .05). PMID:27232686

  10. The hepatitis B vaccine: utilization decision process and outcomes in community hospitals.

    PubMed Central

    Kirkman-Liff, B; Dandoy, S; Kallet, G

    1985-01-01

    The process by which administrators, physicians, and other health professionals develop decisions on the adoption of innovations was examined through a study of the decision process relating to the institutional use of a vaccine to prevent hepatitis B. Mail questionnaires and telephone follow-up interviews were used to collect data on the decision process in 56 Arizona hospitals in 1983 and 1984. A five-stage decision process was employed by the institutions. Critical stages in the process involved defining who would make the adoption decision and the collection of information related to the innovation. The institutional plans for vaccine distribution did not exhibit a clear consensus regarding the identification of high-risk employee groups. Employee acceptance of the vaccine, even with the cost paid by the hospital, was limited. PMID:3924859

  11. Surveillance of Antibiotic Resistance among Hospital- and Community-Acquired Toxigenic Clostridium difficile Isolates over 5-Year Period in Kuwait

    PubMed Central

    Jamal, Wafaa Y.; Rotimi, Vincent O.

    2016-01-01

    Clostridium difficile infection (CDI) is a leading and an important cause of diarrhea in a healthcare setting especially in industrialized countries. Community-associated CDI appears to add to the burden on healthcare setting problems. The aim of the study was to investigate the antimicrobial resistance of healthcare-associated and community-acquired C. difficile infection over 5 years (2008–2012) in Kuwait. A total of 111 hospital-acquired (HA-CD) and 35 community-acquired Clostridium difficile (CA-CD) clinical isolates from stool of patients with diarrhoea were studied. Antimicrobial susceptibility testing of 15 antimicrobial agents against these pathogens was performed using E test method. There was no evidence of resistance to amoxicillin-clavulanic acid, daptomycin, linezolid, piperacillin-tazobactam, teicoplanin and vancomycin by both HA-CD and CA-CD isolates. Metronidazole had excellent activity against CA-CD but there was a 2.9% resistance rate against HA-CD isolates. Ampicillin, clindamycin, levofloxacin and imipenem resistance rates among the HC-CD vs. CA-CD isolates were 100 vs. 47.4%; 43 vs. 47.4%; 100 vs. 100% and 100 vs. 89%, respectively. An unexpected high rifampicin resistance rate of 15.7% emerged amongst the HA-CD isolates. In conclusion, vancomycin resistance amongst the HA-CD and CA-CD isolates was not encountered in this series but few metronidazole resistant hospital isolates were isolated. High resistance rates of ampicillin, clindamycin, levofloxacin, and imipenem resistance were evident among both CA-CD and HA-CD isolates. Rifampicin resistance is emerging among the HA-CD isolates. PMID:27536994

  12. Antimicrobial susceptibility patterns of community- and hospital-acquired methicillin-resistant Staphylococcus aureus from United States Hospitals: results from the AWARE Ceftaroline Surveillance Program (2012-2014).

    PubMed

    Sader, Helio S; Mendes, Rodrigo E; Jones, Ronald N; Flamm, Robert K

    2016-09-01

    Among 8437 methicillin-resistant Staphylococcus aureus (MRSA) isolates collected from 143 medical centers in the United States (2012-2014), 7116 and 1321 were reported as community-acquired (CA) and hospital-acquired (HA) MRSA, respectively. CA-/HA-MRSA were most often isolated from patients with skin and skin structure infections (SSSI; 68.4/26.9%), pneumonia (13.7/49.0%) and bacteremia (10.0/17.7%). Overall, susceptibility rates were generally lower among HA-MRSA compared to CA-MRSA strains, especially for clindamycin (44.6 vs. 66.1%) and levofloxacin (21.4 vs. 35.5%). Also, susceptibility rates were lower for these two compounds among isolates from pneumonia compared to SSSI and bacteremia. Ceftaroline was broadly active against 98.0% of CA-MRSA and 94.3% of HA-MRSA (MIC50/90, 1μg/mL for both; no resistant isolate) overall, with little variation among infection type subsets. PMID:27394637

  13. Does global progress on sanitation really lag behind water? An analysis of global progress on community- and household-level access to safe water and sanitation.

    PubMed

    Cumming, Oliver; Elliott, Mark; Overbo, Alycia; Bartram, Jamie

    2014-01-01

    Safe drinking water and sanitation are important determinants of human health and wellbeing and have recently been declared human rights by the international community. Increased access to both were included in the Millennium Development Goals under a single dedicated target for 2015. This target was reached in 2010 for water but sanitation will fall short; however, there is an important difference in the benchmarks used for assessing global access. For drinking water the benchmark is community-level access whilst for sanitation it is household-level access, so a pit latrine shared between households does not count toward the Millennium Development Goal (MDG) target. We estimated global progress for water and sanitation under two scenarios: with equivalent household- and community-level benchmarks. Our results demonstrate that the "sanitation deficit" is apparent only when household-level sanitation access is contrasted with community-level water access. When equivalent benchmarks are used for water and sanitation, the global deficit is as great for water as it is for sanitation, and sanitation progress in the MDG-period (1990-2015) outstrips that in water. As both drinking water and sanitation access yield greater benefits at the household-level than at the community-level, we conclude that any post-2015 goals should consider a household-level benchmark for both. PMID:25502659

  14. Does Global Progress on Sanitation Really Lag behind Water? An Analysis of Global Progress on Community- and Household-Level Access to Safe Water and Sanitation

    PubMed Central

    Cumming, Oliver; Elliott, Mark; Overbo, Alycia; Bartram, Jamie

    2014-01-01

    Safe drinking water and sanitation are important determinants of human health and wellbeing and have recently been declared human rights by the international community. Increased access to both were included in the Millennium Development Goals under a single dedicated target for 2015. This target was reached in 2010 for water but sanitation will fall short; however, there is an important difference in the benchmarks used for assessing global access. For drinking water the benchmark is community-level access whilst for sanitation it is household-level access, so a pit latrine shared between households does not count toward the Millennium Development Goal (MDG) target. We estimated global progress for water and sanitation under two scenarios: with equivalent household- and community-level benchmarks. Our results demonstrate that the “sanitation deficit” is apparent only when household-level sanitation access is contrasted with community-level water access. When equivalent benchmarks are used for water and sanitation, the global deficit is as great for water as it is for sanitation, and sanitation progress in the MDG-period (1990–2015) outstrips that in water. As both drinking water and sanitation access yield greater benefits at the household-level than at the community-level, we conclude that any post–2015 goals should consider a household-level benchmark for both. PMID:25502659

  15. Methicillin-Resistant Staphylococcus aureus: A Growing Risk in the Hospital and in the Community

    PubMed Central

    Raygada, Jose L.; Levine, Donald P.

    2009-01-01

    Methicillin-resistant Staphylococcus aureus is a common and continuously growing cause of nosocomial and community-acquired infections. The type, disease severity, and clinical outcomes of these infections, as well as the genotypic and susceptibility patterns of the bacteria differ according to the setting in which the infection occurs—a healthcare facility or the community setting. The incidence of these infections in the community setting has been growing consistently in the past decade or so. In addition, resistance to the many current antibiotics used to treat these infections is also growing, further complicating management. Rapid-diagnosis tests and new therapeutic agents are constantly under investigation. The authors review the current understanding of the epidemiology, clinical manifestations, and management of methicillin-resistant Staphylococcus aureus infection, including the growing problem of resistance. In addition, they discuss promising diagnostic and therapeutic alternatives, as well as new control strategies to prevent its transmission or the development of infection among carriers. PMID:25126276

  16. Improving equitable access to imaging under universal-access medicine: the ontario wait time information program and its impact on hospital policy and process.

    PubMed

    Kielar, Ania Z; El-Maraghi, Robert H; Schweitzer, Mark E

    2010-08-01

    In Canada, equal access to health care is the goal, but this is associated with wait times. Wait times should be fair rather than uniform, taking into account the urgency of the problem as well as the time an individual has already waited. In November 2004, the Ontario government began addressing this issue. One of the first steps was to institute benchmarks reflecting "acceptable" wait times for CT and MRI. A public Web site was developed indicating wait times at each Local Health Integration Network. Since starting the Wait Time Information Program, there has been a sustained reduction in wait times for Ontarians requiring CT and MRI. The average wait time for a CT scan went from 81 days in September 2005 to 47 days in September 2009. For MRI, the resulting wait time was reduced from 120 to 105 days. Increased patient scans have been achieved by purchasing new CT and MRI scanners, expanding hours of operation, and improving patient throughput using strategies learned from the Lean initiative, based on Toyota's manufacturing philosophy for car production. Institution-specific changes in booking procedures have been implemented. Concurrently, government guidelines have been developed to ensure accountability for monies received. The Ontario Wait Time Information Program is an innovative first step in improving fair and equitable access to publicly funded imaging services. There have been reductions in wait times for both CT and MRI. As various new processes are implemented, further review will be necessary for each step to determine their individual efficacy. PMID:20678727

  17. Internet Access and Use of the Web for Instruction: A National Study of Full-Time and Part-Time Community College Faculty

    ERIC Educational Resources Information Center

    Akroyd, Duane; Jaeger, Audrey; Jackowski, Melissa; Jones, Logan C.

    2004-01-01

    This research explored the issues of access to the internet and use of the web for instructional purposes between full-time and part-time community college faculty. The findings that 40% of part-time faculty do not have Internet access at work would seem to indicate that part-time faculty are poorly integrated into the technology infrastructure of…

  18. Service utilization in community health centers in China: a comparison analysis with local hospitals

    PubMed Central

    Pan, Xilong; Dib, Hassan H; Wang, Xiaohang; Zhang, Hong

    2006-01-01

    Background Being an important part of China's Urban Health Care Reform System, Community Health Centers (CHCs) have been established throughout the entire country and are presently undergoing substantial reconstruction. However, the services being delivered by the CHCs are far from reaching their performance targets. In order to assess the role of the CHCs, we examined their performance in six cities located in regions of South-East China. The purpose of this investigation was to identify the utilization and the efficiency of community health resources that are able to provide basic medical and public health services. Methods The study was approved by Peking University Health Science Center Institutional Reviewing Board (NO: IRB00001052-T1). Data were collected from all the local health bureaux and processed using SPSS software. Methods of analysis mainly included: descriptive analysis, paired T-test and one-way ANOVA. Results The six main functions of the CHCs were not fully exploited and the surveys that were collected on their efficiency and utilization of resources indicate that they have a low level of performance and lack the trust of local communities. Furthermore, the CHCs seriously lack funding support and operate under difficult circumstances, and residents have less positive attitudes towards them. Conclusion The community health service must be adjusted according to the requirements of urban medical and health reform, taking into account communities' health needs. More research is required on the living standards and health needs of residents living within the CHC's range, taking into consideration the users' needs in expanding the newly implemented service, and at the same time revising the old service system so as to make the development of CHCs realistic and capable of providing a better service to patients. Several suggestions are put forward for an attainable scheme for developing a community health service. PMID:16887022

  19. Community-acquired Legionella pneumophila pneumonia: a single-center experience with 214 hospitalized sporadic cases over 15 years.

    PubMed

    Viasus, Diego; Di Yacovo, Silvana; Garcia-Vidal, Carolina; Verdaguer, Ricard; Manresa, Frederic; Dorca, Jordi; Gudiol, Francesc; Carratalà, Jordi

    2013-01-01

    Legionella pneumophila has been increasingly recognized as a cause of community-acquired pneumonia (CAP) and an important public health problem worldwide. We conducted the present study to assess trends in epidemiology, diagnosis, clinical features, treatment, and outcomes of sporadic community-acquired L. pneumophila pneumonia requiring hospitalization at a university hospital over a 15-year period (1995-2010). Among 3934 nonimmunosuppressed hospitalized patients with CAP, 214 (5.4%) had L. pneumophila pneumonia (16 cases were categorized as travel-associated pneumonia, and 21 were part of small clusters). Since the introduction of the urinary antigen test, the diagnosis of L. pneumophila using this method remained stable over the years (p = 0.42); however, diagnosis by means of seroconversion and culture decreased (p < 0.001 and p = 0.001, respectively). The median age of patients with L. pneumophila pneumonia was 58.2 years (SD 13.8), and 76.4% were male. At least 1 comorbid condition was present in 119 (55.6%) patients with L. pneumophila pneumonia, mainly chronic heart disease, diabetes mellitus, and chronic pulmonary disease. The frequency of older patients (aged >65 yr) and comorbidities among patients with L. pneumophila pneumonia increased over the years (p = 0.06 and p = 0.02, respectively). In addition, 100 (46.9%) patients were classified into high-risk classes according to the Pneumonia Severity Index (groups IV-V). Twenty-four (11.2%) patients with L. pneumophila pneumonia received inappropriate empirical antibiotic therapy at hospital admission. Compared with patients who received appropriate empirical antibiotic, patients who received inappropriate therapy more frequently had acute onset of illness (p = 0.004), pleuritic chest pain (p = 0.03), and pleural effusion (p = 0.05). The number of patients who received macrolides decreased over the study period (p < 0.001), whereas the number of patients who received levofloxacin increased (p < 0.001). No

  20. Efficient cryopreservation protocol enables accessibility of a broad range of ammonia-oxidizing bacteria for the scientific community.

    PubMed

    Hoefman, Sven; Pommerening-Röser, Andreas; Samyn, Emly; De Vos, Paul; Heylen, Kim

    2013-05-01

    Long-term storage of the fastidious ammonia-oxidizing bacteria has proven difficult, which limits their public availability and results in a loss of cultured biodiversity. To enable their accessibility to the scientific community, an effective protocol for cryopreservation of ammonia-oxidizing cultures at -80 °C and in liquid nitrogen was developed. Long-term storage could be achieved using 5% DMSO as cryoprotectant, preferably in a cryoprotective preservation medium containing tenfold-diluted trypticase soy broth and 1% trehalose. As such, successful activity and growth recovery was observed for a diverse set of ammonia-oxidizing cultures. PMID:23376087

  1. Accessibility and Responsiveness Review Tool: community agency capacity to respond to survivors with disabilities.

    PubMed

    Jenson, Ronda J; Peterson-Besse, Jana; Fleming, Lisa; Blumel, Angie; Day, Arden

    2015-01-01

    For persons with disabilities who have experienced trauma in the forms of abuse and violence, options for accessible and trauma-informed services are often limited. Using a self-assessment and planning process, disability service providers and victim/survivor service providers are able to strategize ways of addressing the needs of survivors with disabilities. The Accessibility and Responsiveness Review Tool (Review Tool) incorporates the principles of universal design and trauma-informed practices into an agency-wide discussion tool leading to increases in knowledge, reduction in barriers, and overall improved programs for survivors with disabilities. Results of agencies that participated in the Review Tool process are presented. PMID:26016999

  2. Antimicrobial Susceptibilities of Health Care-Associated and Community-Associated Strains of Methicillin-Resistant Staphylococcus aureus from Hospitalized Patients in Canada, 1995 to 2008▿

    PubMed Central

    Simor, Andrew E.; Louie, Lisa; Watt, Christine; Gravel, Denise; Mulvey, Michael R.; Campbell, Jennifer; McGeer, Allison; Bryce, Elizabeth; Loeb, Mark; Matlow, Anne

    2010-01-01

    We determined the in vitro antimicrobial susceptibilities of 7,942 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from patients hospitalized in 48 Canadian hospitals from 1995 to 2008. Regional variations in susceptibilities were identified. The dissemination of community-associated strains in Canada appears to have contributed to increased susceptibility of MRSA to several non-β-lactam antimicrobial agents in the past decade. Reduced susceptibility to glycopeptides was not identified. PMID:20231402

  3. Project Integrate: Translating Screening and Brief Interventions for Alcohol Problems to a Community Hospital Emergency Department

    ERIC Educational Resources Information Center

    Mello, Michael J.; Baird, Janette; Nirenberg, Ted D.; Smith, Jennifer C.; Woolard, Robert H.; Dinwoodie, Robert G.

    2009-01-01

    Screening and brief intervention (SBI) for alcohol problems in the emergency department (ED) is effective. The objective of this study was to examine the translation of SBI into a busy community ED environment. The authors assessed key stakeholders views of SBI delivery model, then utilized feedback to adapt model. Adoption of SBI was recorded,…

  4. From Hospital to Community: A Self-Help Program to Promote the Transition.

    ERIC Educational Resources Information Center

    Kutner, Bernard; And Others

    Vocational placement, social needs, and the lack of proper transportation for disabled persons are major problems to be solved if physically handicapped people are to function in community life. Mobilization for Maturity was a 3-year research and demonstration project which utilized a self-help approach to help disabled people to re-enter…

  5. A Modular Pharmacy Practice Laboratory Course Integrating Role-Playing Scenarios with Community and Hospital Practice.

    ERIC Educational Resources Information Center

    Triplett, John W.; And Others

    1992-01-01

    This paper describes the development and evolution of a modular pharmacy practice course that uses practitioners as role-model instructors in prepared and impromptu scenarios. The course reviews the top 200 drug products while introducing students to both community and institutional practice settings. Appendices include a summary of the…

  6. The Claybury Community Psychiatric Nurse Stress Study: is it more stressful to work in hospital or the community?

    PubMed

    Fagin, L; Brown, D; Bartlett, H; Leary, J; Carson, J

    1995-08-01

    The Claybury community psychiatric nurse (CPN) stress study collected data on stress levels in 250 CPNs and 323 ward-based psychiatric nurses (WBPN) in the North East Thames region. Four out of 10 CPNs were found to be experiencing high levels of psychological distress on GHQ scores. Whilst both CPNs and WBPNs scored highly on scores of occupational burnout, especially on emotional exhaustion scores, WBPNs scored worse on emotional detachment from their patients and were achieving less personal fulfilment from their work. Both groups of nurses were more satisfied with direct patient clinical work than with their employment conditions, particularly their working environments and, for CPNs, their relationships with their managers. The different patterns of coping skills are explored and discussed for both groups of nurses, especially the use of social support, time management and organization of tasks. The study concludes that whilst major changes are occurring in the psychiatric arena for both groups of nurses, stress is reaping its toll on mental health nurses, in terms of higher absence rates, lower self-esteem and personal unfulfilment. This could not only affect the quality of patient care but also future career prospects for nurses. The study invites serious consideration of introducing stress-reducing measures in the work-place as well as further research into specific stressors for different groups of nurses. PMID:7593957

  7. Becoming a leader in patient satisfaction: changing the culture of care in an academic community hospital.

    PubMed

    Deitrick, Lynn M; Capuano, Terry A; Paxton, Stuart S; Stern, Glenn; Dunleavy, Jack; Miller, William L

    2006-01-01

    In the context of the current health care payer system, quality of care standards, financial incentives and consumer choice are not well aligned, yet competition for increased admissions has become a matter of survival. Satisfaction and loyalty are two constructs that are the most meaningful measures in the context of sustaining and increasing admissions. Lehigh Valley Hospital and Health Network (LVHHN) launched an ambitious patient satisfaction improvement initiative in 2001. LVHHN augmented existing patient service excellence programs with an ethnographic study of a representative unit. Interview and observational data were analyzed using NVivo software. These results (four distilled domains of patient experience) can then be used to identify key components of the care environment that made meaningful differences in the perceptions of patients and their satisfaction. A designated interdepartmental task force can then develop interventions from those learnings, track outcomes through the Press Ganey scores, and ultimately yield increased admissions through unit-specific process change across the hospital. Admissions for fiscal year 2001 to fiscal year 2003 increased from 5,817 to 7,795 patients. The clear value and return on this initiative for our organization included a 34% increase in patient admissions over a four-year period. Improvements in both patient satisfaction and loyalty were demonstrated by a 24% increase for the question, "Likelihood of your recommending this hospital to others" as measured by the Press Ganey Inpatient survey. This initiative demonstrates the successful application of qualitative methods in a clinical microsystem to better understand patient perceptions that determine their satisfaction with medical care. PMID:18681198

  8. Feasibility of Energy Medicine in a Community Teaching Hospital: An Exploratory Case Series

    PubMed Central

    Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J.; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill

    2015-01-01

    Abstract Background: Energy medicine (EM) derives from the theory that a subtle biologic energy can be influenced for therapeutic effect. EM practitioners may be trained within a specific tradition or work solo. Few studies have investigated the feasibility of solo-practitioner EM in hospitals. Objective: This study investigated the feasibility of EM as provided by a solo practitioner in inpatient and emergent settings. Design: Feasibility study, including a prospective case series. Settings: Inpatient units and emergency department. Outcome measures: To investigate the feasibility of EM, acceptability, demand, implementation, and practicality were assessed. Short-term clinical changes were documented by treating physicians. Participants: Patients, employees, and family members were enrolled in the study only if study physicians expected no or slow improvement in specific symptoms. Those with secondary gains or who could not communicate perception of symptom change were excluded. Results: EM was found to have acceptability and demand, and implementation was smooth because study procedures dovetailed with conventional clinical practice. Practicality was acceptable within the study but was low upon further application of EM because of cost of program administration. Twenty-four of 32 patients requested relief from pain. Of 50 reports of pain, 5 (10%) showed no improvement; 4 (8%), slight improvement; 3 (6%), moderate improvement; and 38 (76%), marked improvement. Twenty-one patients had issues other than pain. Of 29 non–pain-related problems, 3 (10%) showed no, 2 (7%) showed slight, 1 (4%) showed moderate, and 23 (79%) showed marked improvement. Changes during EM sessions were usually immediate. Conclusions: This study successfully implemented EM provided by a solo practitioner in inpatient and emergent hospital settings and found that acceptability and demand justified its presence. Most patients experienced marked, immediate improvement of symptoms associated

  9. Safe: a status update on information security and the hospital community.

    PubMed

    Fundner, Rita

    2003-01-01

    IT Security and Privacy are becoming increasingly visible "hot topics" across the full spectrum of industry and service sectors. Legislation and global "best practices" are working hard to defend organizations and individuals against escalating, rapidly evolving cyber-threats. Predictably, the threat landscape is having an impact on all levels to varying degrees: governmental, organizational and individual. This article introduces the basic context for information security and offers insight into how a number of hospitals are addressing the situation, what barriers they currently face and what opportunities they see unfolding. PMID:14674180

  10. Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

    PubMed Central

    Huntley, A L; Johnson, R; King, A; Morris, R W; Purdy, S

    2016-01-01

    Objectives The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS). Setting CM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community. Participants Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries. Intervention CM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems. Primary and secondary outcomes Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources. Results 22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions. Conclusions Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission. PMID:27165648

  11. Reasons for encounter and diagnoses of new outpatients at a small community hospital in Japan: an observational study

    PubMed Central

    Takeshima, Taro; Kumada, Maki; Mise, Junichi; Ishikawa, Yoshinori; Yoshizawa, Hiromichi; Nakamura, Takashi; Okayama, Masanobu; Kajii, Eiji

    2014-01-01

    Purpose Although many new patients are seen at small hospitals, there are few reports of new health problems from such hospitals in Japan. Therefore, we investigated the reasons for encounter (RFE) and diagnoses of new outpatients in a small hospital to provide educational resources for teaching general practice methods. Methods This observational study was conducted at the Department of General Internal Medicine in a small community hospital between May 6, 2010 and March 11, 2011. We classified RFEs and diagnoses according to component 1, “Symptoms/Complaints”, and component 7, “Diagnosis/Diseases”, of the International Classification of Primary Care, 2nd edition (ICPC-2). We also evaluated the differences between RFEs observed and common symptoms from the guidelines Model Core Curriculum for Medical Students and Goals of Clinical Clerkship. Results We analyzed the data of 1,515 outpatients. There were 2,252 RFEs (1.49 per encounter) and 170 ICPC-2 codes. The top 30 RFE codes accounted for 80% of all RFEs and the top 55 codes accounted for 90%. There were 1,727 diagnoses and 196 ICPC-2 codes. The top 50 diagnosis codes accounted for 80% of all diagnoses, and the top 90 codes accounted for 90%. Of the 2,252 RFEs, 1,408 (62.5%) included at least one of the 36 symptoms listed in the Model Core Curriculum and 1,443 (64.1%) included at least one of the 35 symptoms in the Goals of Clinical Clerkship. On the other hand, “A91 Abnormal result investigation”, “R21 Throat symptom/complaint”, and “R07 Sneezing/nasal congestion”, which were among the top 10 RFEs, were not included in these two guidelines. Conclusion We identified the common RFEs and diagnoses at a small hospital in Japan and revealed the inconsistencies between the RFEs observed and common symptoms listed in the guidelines. Our findings can be useful in improving the general practice medical education curricula. PMID:24940078

  12. Demographics and Trends in Wheeled Mobility Equipment Use and Accessibility in the Community

    ERIC Educational Resources Information Center

    LaPlante, Mitchell P.; Kaye, H. Stephen

    2010-01-01

    This article presents a profile of household-resident U.S. adults using wheeled mobility equipment (WME) in 2005, trends in WME use from 1990 to 2005, and data on accessibility features and problems from 1994-97. Data were obtained from the Survey of Income and Program Participation (SIPP) and the National Health Interview Survey on Disability…

  13. University and Community Partnership: Access and Economic Development in Rural America.

    ERIC Educational Resources Information Center

    Audley, Barbara; Thompson, Ann McKay

    This report describes an educational partnership between South Dakota State University and Capital University Center, Inc. (CUC), (Pierre, South Dakota). CUC is a nonprofit organization founded in 1982 to provide access to higher education for residents of rural central South Dakota. CUC contracts with South Dakota State University for educational…

  14. Identifying and Dealing with Access Barriers at Mercer County Community College.

    ERIC Educational Resources Information Center

    Bolge, Robert D.

    Most barriers to higher education fall into one of six categories: personal access barriers (e.g., lack of information, low self-esteem, or loss of motivation); socioeconomic barriers (e.g., lack of transportation or child care); sociocultural barriers (e.g., family pressures or language problems); socioeducational barriers (e.g., inadequate…

  15. Multi-component access to a community-based weight loss program: 12 week results

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The current study examined weight loss between a comprehensive lifestyle modification program (Weight Watchers PointsPlus program) that included three ways to access and a self-help (SH) condition. A total of 293 participants were randomized to either a Weight Watchers condition (WW) (n=148) or a SH...

  16. Linguistic Access and Participation: English Language Learners in an English-Dominant Community of Practice

    ERIC Educational Resources Information Center

    Iddings, Ana Christina DaSilva

    2005-01-01

    This investigation explored the ways in which English language learners (ELLs) included in an English-dominant, mainstream second-grade classroom gained access to classroom activities and to the language that conveyed them, and the ways in which these students came to participate in the classroom context. These questions were investigated through…

  17. Universal Access to Preschool Education: Approaches to Integrating Preschool with School in Rural and Remote Communities

    ERIC Educational Resources Information Center

    Dockett, Sue; Perry, Bob

    2014-01-01

    In 2012, the government of South Australia responded to Federal agreements aimed at universal access to preschool education for children in the year before starting formal schooling by introducing a trial designed to "integrate" preschool children into first year of school programmes in rural and remote areas of the state. This paper…

  18. Success with ACCESS: Use of Community-Based Participatory Research for Implementation

    ERIC Educational Resources Information Center

    Eilola, Carolyn; Fishman, Kathryn; Greenburg, Arielle; Moore, Crystal Dea; Schrijver, Andrew; Totino, Jamin

    2011-01-01

    The Assessment of Campus Climate to Enhance Student Success survey (ACCESS) is a set of four questionnaires designed to elicit feedback from five campus constituencies including faculty, administration, staff, students with disabilities, and students without disabilities "to use in planning and garnering support for meaningful activities and…

  19. Competing forces, collaborative solutions: a vision for hospital-physician relationships.

    PubMed

    Smith, Alison P

    2007-01-01

    At a time when hospitals and physicians are struggling to survive, one institution envisioned a new definition of community hospital care that was dependent upon more collaborative relationships with its physicians. Northwest Community Hospital (NCH) created the Northwest Community Hospital Physicians Cooperative, a unique membership group offering access to professional liability insurance, joint venture investment opportunities, and other physician practice support services. The "price" for membership is a cooperative relationship. The scope of this cooperation includes adherence to clinical best practice and safety guidelines, adoption of information technology for patient care management, collaboration with hospitalists, and service in leadership and planning activities for clinical programs. PMID:17974094

  20. The role of intraoperative frozen section in decision making in revision hip and knee arthroplasties in a local community hospital.

    PubMed

    Ko, Put Shui; Ip, David; Chow, Kai Pun; Cheung, Florence; Lee, On Bong; Lam, James Joseph

    2005-02-01

    There is little information in the literature regarding the reliability of intraoperative frozen section to predict infection in revision arthroplasties performed in community hospitals as most reports are from specialized centers or academic institutes. Between November 1997 and May 2001, we performed intraoperative frozen sections in 40 revision hip and knee arthroplasties. We used Mirra's criteria of more than 5 polymorphs per high power field to constitute a positive result. We found a sensitivity of 67% and a specificity of 97%. The positive and negative predictive values were 86% and 91%, respectively, with an accuracy of 90%. We conclude that intraoperative frozen section is a reasonably sensitive and specific adjunct investigation in the differentiation between septic and aseptic loosening. PMID:15902857

  1. Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers.

    PubMed

    Ko, Michelle; Murphy, Julia; Bindman, Andrew B

    2015-11-01

    Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs. PMID:26509286

  2. Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers

    PubMed Central

    Murphy, Julia; Bindman, Andrew B.

    2015-01-01

    Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs. PMID:26509286

  3. 'We are despised in the hospitals': sex workers' experiences of accessing health care in four African countries.

    PubMed

    Scorgie, Fiona; Nakato, Daisy; Harper, Eric; Richter, Marlise; Maseko, Sian; Nare, Prince; Smit, Jenni; Chersich, Matthew

    2013-01-01

    Sex workers in east and southern Africa are exposed to multiple occupational health and safety risks. Detailed understanding of barriers to accessing care would optimise design of improved services for this population. In this study, trained sex workers conducted 55 in-depth interviews and 12 focus group discussions with 106 female, 26 male and 4 transgender sex workers across 6 urban sites in Kenya, Zimbabwe, Uganda and South Africa. Data were analysed thematically, following an interpretive framework. Participants cited numerous unmet health needs, including diagnosis and treatment for sexually transmitted infections and insufficient access to condoms and lubricant. Denial of treatment for injuries following physical assault or rape and general hostility from public-sector providers was common. Resources permitting, many sex workers attended private services, citing higher quality and respect for dignity and confidentiality. Sex workers in southern Africa accessed specialised sex worker clinics, reporting mostly positive experiences. Across sites, participants called for additional targeted services, but also sensitisation and training of public-sector providers. Criminalisation of sex workers and associated stigmatisation, particularly of transgender and male sex workers, hinder HIV-prevention efforts and render access to mainstream healthcare precarious. Alongside law reform, sex worker-led peer outreach work should be strengthened and calls by sex workers for additional targeted services heeded. PMID:23414116

  4. It’s a long, long walk: accessibility to hospitals, maternity and integrated health centers in Niger

    PubMed Central

    2012-01-01

    Background Ease of access to health care is of great importance in any country but particularly in countries such as Niger where restricted access can put people at risk of mortality from diseases such as measles, meningitis, polio, pneumonia and malaria. This paper analyzes the physical access of populations to health facilities within Niger with an emphasis on the effect of seasonal conditions and the implications of these conditions in terms of availability of adequate health services, provision of drugs and vaccinations. The majority of the transport within Niger is pedestrian, thus the paper emphasizes access by those walking to facilities for care. Further analysis compared the change in accessibility for vehicular travel since public health workers do travel by vehicle when carrying out vaccination campaigns and related proactive health care activities. Results The majority of the roads in Niger are non-paved (90%). Six districts, mainly in the region of Tahoua lack medical facilities. Patient to health facility ratios were best in Agadez with 7000 people served per health facility. During the dry season 39% of the population was within 1-hours walk to a health center, with the percentage decreasing to 24% during the wet season. Further analyses revealed that vaccination rates were strongly correlated with distance. Children living in clusters within 1-hour of a health center had 1.88 times higher odds of complete vaccination by age 1-year compared to children living in clusters further from a health center (p < 0.05). Three key geographic areas were highlighted where access to health centers took greater than 4 h walk during the wet and dry season. Access for more than 730,000 people can be improved in these areas with the addition of 17 health facilities to the current total of 504 during the dry season (260,000 during the wet season). Conclusions This study highlights critical areas in Niger where health services/facilities are lacking. A second

  5. Molecular Detection and Characterization of Mycoplasma pneumoniae Among Patients Hospitalized With Community-Acquired Pneumonia in the United States.

    PubMed

    Diaz, Maureen H; Benitez, Alvaro J; Cross, Kristen E; Hicks, Lauri A; Kutty, Preeta; Bramley, Anna M; Chappell, James D; Hymas, Weston; Patel, Anami; Qi, Chao; Williams, Derek J; Arnold, Sandra R; Ampofo, Krow; Self, Wesley H; Grijalva, Carlos G; Anderson, Evan J; McCullers, Jonathan A; Pavia, Andrew T; Wunderink, Richard G; Edwards, Kathryn M; Jain, Seema; Winchell, Jonas M

    2015-09-01

    Background.  Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP). The molecular characteristics of M pneumoniae detected in patients hospitalized with CAP in the United States are poorly described. Methods.  We performed molecular characterization of M pneumoniae in nasopharyngeal/oropharyngeal swabs from children and adults hospitalized with CAP in the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, including P1 typing, multilocus variable-number tandem-repeat analysis (MLVA), and macrolide susceptibility genotyping. Results.  Of 216 M pneumoniae polymerase chain reaction-positive specimens, 40 (18.5%) were obtained from adults and 176 (81.5%) from children. P1 type distribution differed between adults (64% type 1 and 36% type 2) and children (84% type 1, 13% type 2, and 3% variant) (P < .05) and among sites (P < .01). Significant differences in the proportions of MLVA types 4/5/7/2 and 3/5/6/2 were also observed by age group (P < .01) and site (P < .01). A macrolide-resistant genotype was identified in 7 (3.5%) specimens, 5 of which were from patients who had recently received macrolide therapy. No significant differences in clinical characteristics were identified among patients with various strain types or between macrolide-resistant and -sensitive M pneumoniae infections. Conclusions.  The P1 type 1 genotype and MLVA type 4/5/7/2 predominated, but there were differences between children and adults and among sites. Macrolide resistance was rare. Differences in strain types did not appear to be associated with differences in clinical outcomes. Whole genome sequencing of M pneumoniae may help identify better ways to characterize strains. PMID:26284257

  6. Prior outpatient antibiotic use as predictor for microbial aetiology of community-acquired pneumonia: hospital-based study

    PubMed Central

    Endeman, Henrik; van Hemert, Remco N; Voorn, G Paul; Deneer, Vera HM; Leufkens, Hubert GM; van den Bosch, Jules MM; Biesma, Douwe H

    2007-01-01

    Objective The causative micro-organism in community-acquired pneumonia (CAP) is often difficult to predict. Different studies have examined chronic morbidity and clinical symptoms as predictors for microbial aetiology of pneumonia. The aim of our study was to assess whether prior outpatient antimicrobial treatment is predictive for determining the microbial aetiology of CAP. Methods This was a hospital-based prospective observational study including all patients admitted with CAP between 1 October 2004 and 1 August 2006. Microbial investigations included sputum, blood culture, sputum PCR, antigen testing and serology. Exposure to antimicrobial drugs prior to hospital admission was ascertained through community pharmacy dispensing records. Multivariate logistic regression analysis was conducted to assess whether prior outpatient antimicrobial treatment is a predictor of microbial aetiology. Patient demographics, co-morbidities and pneumonia severity were considered to be other potential predictors. Results Overall, 201 patients were included in the study. The microbial aetiology was determined in 64% of the patients. The five most prevalent pathogens were Streptococcus pneumoniae, Heamophilus influenzae, Legionella spp., Mycoplasma pneumoniae and Influenza virus A+B. Forty-seven of the patients (23%) had received initial antimicrobial treatment as outpatients. Multivariate analyses revealed that initial outpatient beta-lactam treatment was associated with a threefold increased chance of finding atypical pathogens and a threefold decreased probability of pneumococcal infection; the corresponding odds ratios were 3.51 (95% CI 1.25–9.99) and 0.30 (95% CI 0.10–0.90), respectively. Patients who received macrolides prior to hospitalisation had an increased probability of viral pneumonia. Conclusion Prior outpatient antimicrobial therapy has a predictive value in the diagnostic workup aimed at identifying the causative pathogen and planning corresponding antimicrobial

  7. Etiological Diagnosis of Community-Acquired Pneumonia in Adult Patients: A Prospective Hospital-Based Study in Mashhad, Iran

    PubMed Central

    Naderi, Hamidreza; Sheybani, Fereshte; Sarvghad, Mohammadreza; Meshkat, Zahra; Jabbari Nooghabi, Mehdi

    2015-01-01

    Background: Pneumonia is the third most common cause of death in the world, and mortality is highest for patients who require hospitalization. Objectives: This prospective observational study is an etiological survey of community-acquired pneumonia (CAP) over a 12-month period in the Iranian city of Mashhad. To our knowledge, this is one of the first prospective hospital-based studies to comprehensively evaluate the epidemiological, demographical, clinical, and prognostic factors of patients with CAP in Iran. Patients and Methods: We studied all adult patients (aged ≥ 16 years) with CAP admitted to Imam Reza Hospital, Mashhad, Iran, between February 2013 and January 2014. The etiological diagnosis of CAP was made through conventional culturing and staining of respiratory secretions (i.e. sputum and pleural fluid), standard BACTEC™ Plus Aerobic/F bottles for blood cultures, and the immunochromatographic assays BinaxNOW® Streptococcus pneumoniae antigen and BinaxNOW® Legionella pneumophila antigen for the detection of S. pneumoniae antigen and L. pneumophila serogroup 1 antigen, respectively. Results: Among 120 patients with CAP, the most common etiology was S. pneumoniae (24.4%), followed by Mycobacterium tuberculosis (17.5%), S. aureus (6.7%), polymicrobial agents including anaerobes (4.2%), complicated hydatid cyst (2.5%), Influenza A virus (4.2%; including 2 cases of mixed Influenza A-bacterial infection), and Klebsiella pneumoniae, Brucella melitensis, Mucor, and varicella, each in 0.8% of the patients. The diagnosis of pneumonia remained unknown in 49 (40%) patients. Conclusions: Tuberculosis was an important cause of CAP in our region. Hence, it should be considered in all patients admitted with a CAP diagnosis. PMID:26464771

  8. Development of a Web GIS Application for Visualizing and Analyzing Community Out of Hospital Cardiac Arrest Patterns.

    PubMed

    Semple, Hugh; Qin, Han; Sasson, Comilla

    2013-01-01

    Improving survival rates at the neighborhood level is increasingly seen as a priority for reducing overall rates of out-of-hospital cardiac arrest (OHCA) in the United States. Since wide disparities exist in OHCA rates at the neighborhood level, it is important for public health officials and residents to be able to quickly locate neighborhoods where people are at elevated risk for cardiac arrest and to target these areas for educational outreach and other mitigation strategies. This paper describes an OHCA web mapping application that was developed to provide users with interactive maps and data for them to quickly visualize and analyze the geographic pattern of cardiac arrest rates, bystander CPR rates, and survival rates at the neighborhood level in different U.S. cities. The data comes from the CARES Registry and is provided over a period spanning several years so users can visualize trends in neighborhood out-of-hospital cardiac arrest patterns. Users can also visualize areas that are statistical hot and cold spots for cardiac arrest and compare OHCA and bystander CPR rates in the hot and cold spots. Although not designed as a public participation GIS (PPGIS), this application seeks to provide a forum around which data and maps about local patterns of OHCA can be shared, analyzed and discussed with a view of empowering local communities to take action to address the high rates of OHCA in their vicinity. PMID:23923097

  9. Hepatitis C: improving the quality of screening in a community hospital by implementing an electronic medical record intervention.

    PubMed

    Shahnazarian, Vahe; Karu, Eric; Mehta, Parag

    2015-01-01

    Both the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) have recommended that adults born between the years of 1945-1965 should receive one-time testing for Hepatitis C Virus (HCV). In fact, Governor Andrew Cuomo of the State of New York had signed a bill on October 23, 2013 which mandated NY hospitals and healthcare providers to offer HCV testing to all "Baby Boomers." For our project, we wanted to increase our community hospital's compliance with this law and improve the quality of patient care in doing so. An electronic medical record intervention was implemented in conjunction with our information technology services department. This intervention would flag eligible patients and would run them through a predetermined algorithm to see if they needed HCV testing. Multiple plan, do, study, act (PDSA) cycles were run during the length of the study and many changes were made in order to achieve maximum effect. We ended up increasing our HCV testing rate from 47.2% (pre-intervention) to 87.9% (final month of the study), which was statistically significant with a p-value of <0.0000001. We also ended up with a framework that is both generalizable to other projects and is also self-sustaining, so that it can continue to run itself once all the project members have finished working there as house staff. PMID:26734374

  10. Development of a Web GIS Application for Visualizing and Analyzing Community Out of Hospital Cardiac Arrest Patterns

    PubMed Central

    Semple, Hugh; Qin, Han; Sasson, Comilla

    2013-01-01

    Improving survival rates at the neighborhood level is increasingly seen as a priority for reducing overall rates of out-of-hospital cardiac arrest (OHCA) in the United States. Since wide disparities exist in OHCA rates at the neighborhood level, it is important for public health officials and residents to be able to quickly locate neighborhoods where people are at elevated risk for cardiac arrest and to target these areas for educational outreach and other mitigation strategies. This paper describes an OHCA web mapping application that was developed to provide users with interactive maps and data for them to quickly visualize and analyze the geographic pattern of cardiac arrest rates, bystander CPR rates, and survival rates at the neighborhood level in different U.S. cities. The data comes from the CARES Registry and is provided over a period spanning several years so users can visualize trends in neighborhood out-of-hospital cardiac arrest patterns. Users can also visualize areas that are statistical hot and cold spots for cardiac arrest and compare OHCA and bystander CPR rates in the hot and cold spots. Although not designed as a public participation GIS (PPGIS), this application seeks to provide a forum around which data and maps about local patterns of OHCA can be shared, analyzed and discussed with a view of empowering local communities to take action to address the high rates of OHCA in their vicinity. PMID:23923097

  11. Using Multiple Measures to Make Math Placement Decisions: Implications for Access and Success in Community Colleges

    ERIC Educational Resources Information Center

    Ngo, Federick; Kwon, William W.

    2015-01-01

    Community college students are often placed in developmental math courses based on the results of a single placement test. However, concerns about accurate placement have recently led states and colleges across the country to consider using other measures to inform placement decisions. While the relationships between college outcomes and such…

  12. 77 FR 16267 - Community Development Revolving Loan Fund Access for Credit Unions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-20

    ... CDRLF. 12 CFR 705. A revised Part 705 was published on November 2, 2011. 76 FR 67583. Additional... union's marketing strategy to reach members and the community; and include financial projections. 6. Non... funds. However, each Applicant should address in the Application its strategy for raising matching...

  13. The Effect of a Community College Promise Scholarship on Access and Success

    ERIC Educational Resources Information Center

    Pluhta, Elizabeth A.; Penny, G. Richard

    2013-01-01

    Based on a mixed methods case study design, the current study reports on a Promise Scholarship program offered by a community college and its affiliated foundation to graduating students at a nearby high school located in a low-income neighborhood of a large city and with a high proportion of African American and other students of color. Using a…

  14. Community College Education for the Incarcerated: The Provision of Access, Persistence and Social Capital

    ERIC Educational Resources Information Center

    Teeter, Christian B.

    2010-01-01

    This study details an investigation of community college studies for the incarcerated, focusing on the offerings of South Coast College for inmates within California. The study interviewed ten former inmates, each of whom studied with South Coast College while in prison, as well as faculty members, educational administrators, and a corrections…

  15. Green Lights & Red Tape: Improving Access to Financial Aid at California's Community Colleges

    ERIC Educational Resources Information Center

    Cochrane, Deborah Frankle

    2007-01-01

    Financial aid can encourage students to enroll in college and increase their odds of academic success. While the California community colleges (CCCs) have very low fees, which are waived for most low-income students, the additional expenses of books, supplies, transportation, housing, food and childcare can create significant financial barriers to…

  16. Development of Policy Options to Maximize Access to Community Colleges by CETA-Eligible Individuals.

    ERIC Educational Resources Information Center

    Jenkins, Hobart G.

    In 1981, a study was conducted to predict the possible effects of increased tuition and enrollment limitations in Washington on the community college enrollment of persons eligible for Comprehensive Employment and Training Act (CETA) programs. Within four sample geographic areas, historical and projected data were collected from all CETA prime…

  17. The Community College: Opportunity and Access for America's First-Year Students. Monograph Series Number 19.

    ERIC Educational Resources Information Center

    Hankin, Joseph N., Ed.

    Focusing on community colleges' role in enrolling students for their first year of postsecondary education, this monograph provides 17 essays on characteristics, programs, and outcomes related to students' freshman year. The following essays are included: (1) "The Freshman Year Experience: A Philosophy for Higher Education in the New Millennium,"…

  18. DELIVERING TIME-RELEVANT WATER QUALITY INFORMATION TO YOUR COMMUNITY THE LAKE ACCESS-MINNEAPOLIS PROJECT

    EPA Science Inventory

    EMPACT was created in 1996 to take advantage of new technologies that make it possible to provide environmental information to the public in near real time. EMPACT is working with the 86 largest metropolitan areas of the country to help communities in these areas: Collecting, ma...

  19. Service-Learning in the Financial Planning Curriculum: Expanding Access to the Community

    ERIC Educational Resources Information Center

    Annis, Paul M.; Palmer, Lance; Goetz, Joseph

    2010-01-01

    Service-learning projects are a cornerstone of student experiential learning. Such programs have proven to be mutually beneficial to communities and students within a variety of family and consumer sciences courses. However, there is a paucity of literature addressing service-learning efforts within the field of financial planning. There is an…

  20. Portable and Accessible Video Modeling: Teaching a Series of Novel Skills within School and Community Settings

    ERIC Educational Resources Information Center

    Taber-Doughty, Teresa; Miller, Bridget; Shurr, Jordan; Wiles, Benjamin

    2013-01-01

    This study examined the effectiveness of self-operated video models on the skill acquisition of a series of novel tasks taught in community-based settings. In addition, the percent of independent task transitions and the duration at which four secondary students with a moderate intellectual disability transitioned between tasks was also examined.…

  1. Military Veterans Face Challenges in Accessing Educational Benefits at Florida Community Colleges

    ERIC Educational Resources Information Center

    Spiro, Rivka; Hill, Robert

    2010-01-01

    Florida's community colleges are seeing an influx of students who face unique challenges. They are the men and women who served in the military after the attacks of September 11, 2001, and who are now attending college on the new Post-9/11 GI Bill, with its greatly enhanced educational benefits, and on the expanded, old Montgomery GI Bill, which…

  2. Consumer satisfaction with nursing care in a rural community hospital emergency department.

    PubMed

    Clark, C A; Pokorny, M E; Brown, S T

    1996-01-01

    The article describes a study undertaken to assess patient satisfaction with nursing care in a rural hospital emergency department with respect to psychological safety, discharge teaching, information giving, and technical competence. This descriptive research utilized Davis' Consumer Emergency Care Satisfaction Scale to determine the degree to which 52 patients perceived overall satisfaction with nursing care. Findings indicated that patients were satisfied with nursing care. No statistically significant effect of gender or education level on consumer satisfaction or on any subscale was detected, but African American consumers were less satisfied with discharge teaching, which may suggest that discharge teaching should reflect the cultural diversity of consumers presenting to the emergency department. Nursing staff may need to spend more time with rural African American consumers. Staff may need to be inserviced to meet the cultural and educational needs of African Americans. PMID:8562989

  3. National Study of Changes in Community Access to School Physical Activity Facilities: The School Health Policies and Programs Study

    PubMed Central

    Evenson, Kelly R.; Wen, Fang; Lee, Sarah M.; Heinrich, Katie M.; Eyler, Amy

    2016-01-01

    Background A Healthy People 2010 developmental objective (22-12) was set to increase the proportion of the nation’s public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours. The purpose of this study was to describe the prevalence of indoor and outdoor facilities at schools and the availability of those facilities to the public in 2000 and 2006. Methods In 2000 and 2006, the School Health Policies and Programs Study (SHPPS) was conducted in each state and in randomly selected districts, schools, and classrooms. This analysis focused on the school level questionnaire from a nationally representative sample of public and nonpublic elementary, middle, and high schools (n = 921 in 2000 and n = 984 in 2006). Results No meaningful changes in the prevalence of access to school physical activity facilities were found from 2000 to 2006, for youth or adult community sports teams, classes, or open gym. Conclusions These national data indicate a lack of progress from 2000 and 2006 toward increasing the proportion of the nation’s public and private schools that provide access to their physical activity facilities for all persons outside of normal school hours. PMID:20440007

  4. A framework for evaluating safety-net and other community-level factors on access for low-income populations.

    PubMed

    Davidson, Pamela L; Andersen, Ronald M; Wyn, Roberta; Brown, E Richard

    2004-01-01

    The framework presented in this article extends the Andersen behavioral model of health services utilization research to examine the effects of contextual determinants of access. A conceptual framework is suggested for selecting and constructing contextual (or community-level) variables representing the social, economic, structural, and public policy environment that influence low-income people's use of medical care. Contextual variables capture the characteristics of the population that disproportionately relies on the health care safety net, the public policy support for low-income and safety-net populations, and the structure of the health care market and safety-net services within that market. Until recently, the literature in this area has been largely qualitative and descriptive and few multivariate studies comprehensively investigated the contextual determinants of access. The comprehensive and systematic approach suggested by the framework will enable researchers to strengthen the external validity of results by accounting for the influence of a consistent set of contextual factors across locations and populations. A subsequent article in this issue of Inquiry applies the framework to examine access to ambulatory care for low-income adults, both insured and uninsured. PMID:15224958

  5. Development and Implementation of ExPLORE Clinical Practice, a Web-accessible Comparative Outcomes Tool for California Hospitals and Physicians

    PubMed Central

    McNair, Peter D.; Fang, Jade; Schwarzwaelder, Stephan; Jackson, Terri

    2015-01-01

    Background: Hospital-based clinicians have little information about the outcomes of their care, much less how those outcomes compare with those of their peers. A variety of care quality indicators have been developed, but comparisons tend to be hospitalwide, and often irrelevant to the practice and patient group of many hospital clinicians. Moreover, information is not enough to transform clinical practice, as the human response to such comparisons is, “I’m doing the best I know how.” What is needed is granular, clinically specific feedback with peer-mediated advice about how “positive deviants” achieve better results. Objective: This case study reports on the development and implementation of a web-accessible comparative outcomes tool, ExPLORE Clinical Practice, for hospitals and clinicians in California. Methods: We use iterative development and refinement of web tools to report comparative outcomes; incremental development of suites of procedure-patient outcome pairs specific to particular medical specialty groups; testing and refinement of response time metrics to reduce delays in report generation; and introduction of a comments section for each measure that assists with interpretation and ties results to strategies found to lead to better clinical outcomes. Results: To date, 76 reports, each with 115 to 251 statistically evaluated outcomes, are available electronically to compare individual hospitals in California to statewide outcomes. Discussion and Conclusions: ExPLORE Clinical Practice is one of a number of emerging systems that attempt to lever available data to improve patient outcomes. The ExPLORE Clinical Practice system combines a clinical focus on highly specific outcome measures with attention to technical issues such as crafting an intuitive user interface and graphic presentation. This case study illustrates the important advances made in using data to support clinicians to improve care for patients. We see this information as a way to

  6. The Benefits To All Of Ensuring Equal And Timely Access To Influenza Vaccines In Poor Communities

    PubMed Central

    Lee, Bruce Y.; Brown, Shawn T.; Bailey, Rachel R.; Zimmerman, Richard K.; Potter, Margaret A.; McGlone, Sarah M.; Cooley, Philip C.; Grefenstette, John J.; Zimmer, Shanta M.; Wheaton, William D.; Quinn, Sandra Crouse; Voorhees, Ronald E.; Burke, Donald S.

    2012-01-01

    When influenza vaccines are in short supply, allocating vaccines equitably among different jurisdictions can be challenging. But justice is not the only reason to ensure that poorer counties have the same access to influenza vaccines as do wealthier ones. Using a detailed computer simulation model of the Washington, D.C., metropolitan region, we found that limiting or delaying vaccination of residents of poorer counties could raise the total number of influenza infections and the number of new infections per day at the peak of an epidemic throughout the region—even in the wealthier counties that had received more timely and abundant vaccine access. Among other underlying reasons, poorer counties tend to have high-density populations and more children and other higher-risk people per household, resulting in more interactions and both increased transmission of influenza and greater risk for worse influenza outcomes. Thus, policy makers across the country, in poor and wealthy areas alike, have an incentive to ensure that poorer residents have equal access to vaccines. PMID:21653968

  7. Vital pathways for hospital librarians: present and future roles

    PubMed Central

    Holst, Ruth; Funk, Carla J.; Adams, Heidi Sue; Bandy, Margaret; Boss, Catherine Mary; Hill, Beth; Joseph, Claire B.; Lett, Rosalind K.

    2009-01-01

    Objectives: The research objectives were to (1) describe the current and future roles of hospital librarians and the challenges they face and (2) find evidence supporting the hypothesis that librarians are essential to hospitals in achieving the organizations' mission-critical goals. Method: The authors used results from a previous research study that identified the five organizational mission-critical goals important to hospital administrators and then searched the literature and solicited examples from hospital librarians to describe the librarian's role in helping hospitals achieve these goals. Results: The literature supports the hypothesis that hospital librarians play important roles in the success of the hospital. Librarians support quality clinical care, efficient and effective hospital operations, continuing education for staff, research and innovation, and patient, family, and community health information needs. Conclusion: Hospital librarians fulfill many mission-critical roles in today's hospital, providing the right information at the right time in a variety of ways to enhance hospital and medical staff effectiveness, optimize patient care, improve patient outcomes, and increase patient and family satisfaction with the hospital and its services. Because hospital librarians and their services provide an excellent return on investment for the hospital and help the hospital keep its competitive edge, hospital staff should have access to the services of a professional librarian. PMID:19851493

  8. Effect of Information and Telephone-Guided Access to Community Support for People with Chronic Kidney Disease: Randomised Controlled Trial

    PubMed Central

    Blakeman, Tom; Blickem, Christian; Kennedy, Anne; Reeves, David; Bower, Peter; Gaffney, Hannah; Gardner, Caroline; Lee, Victoria; Jariwala, Praksha; Dawson, Shoba; Mossabir, Rahena; Brooks, Helen; Richardson, Gerry; Spackman, Eldon; Vassilev, Ivaylo; Chew-Graham, Carolyn; Rogers, Anne

    2014-01-01

    Background Implementation of self-management support in traditional primary care settings has proved difficult, encouraging the development of alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed in the presence of other co-morbidities. This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage 3 CKD. Methods and Findings In a pragmatic, two-arm, patient level randomised controlled trial 436 patients with a diagnosis of stage 3 CKD were recruited from 24 general practices in Greater Manchester. Patients were randomised to intervention (215) or usual care (221). Primary outcome measures were health related quality of life (EQ-5D health questionnaire), blood pressure control, and positive and active engagement in life (heiQ) at 6 months. At 6 months, mean health related quality of life was significantly higher for the intervention group (adjusted mean difference = 0.05; 95% CI = 0.01, 0.08) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group (adjusted odds-ratio = 1.85; 95% CI = 1.25, 2.72). Patients did not differ significantly in positive and active engagement in life. The intervention group reported a reduction in costs compared with control. Conclusions An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care. However, further research is required to identify the mechanisms of action of the intervention. Trial Registration Controlled-Trials.com ISRCTN45433299 PMID:25330169

  9. Vaccinations Administered During Off-Clinic Hours at a National Community Pharmacy: Implications for Increasing Patient Access and Convenience

    PubMed Central

    Goad, Jeffery A.; Taitel, Michael S.; Fensterheim, Leonard E.; Cannon, Adam E.

    2013-01-01

    PURPOSE Approximately 50,000 adults die annually from vaccine-preventable diseases in the United States. Most traditional vaccine providers (eg, physician offices) administer vaccinations during standard clinic hours, but community pharmacies offer expanded hours that allow patients to be vaccinated at convenient times. We analyzed the types of vaccines administered and patient populations vaccinated during off-clinic hours in a national community pharmacy, and their implications for vaccination access and convenience. METHODS We retrospectively reviewed data for all vaccinations given at the Walgreens pharmacy chain between August 2011 and July 2012. The time of vaccination was categorized as occurring during traditional hours (9:00 am–6:00 pm weekdays) or off-clinic hours, consisting of weekday evenings, weekends, and federal holidays. We compared demographic characteristics and types of vaccine. We used a logistic regression model to identify predictors of being vaccinated during off-clinic hours. RESULTS During the study period, pharmacists administered 6,250,402 vaccinations, of which 30.5% were provided during off-clinic hours: 17.4% were provided on weekends, 10.2% on evenings, and 2.9% on holidays. Patients had significantly higher odds of off-clinic vaccination if they were younger than 65 years of age, were male, resided in an urban area, and did not have any chronic conditions. CONCLUSIONS A large proportion of adults being vaccinated receive their vaccines during evening, weekend, and holiday hours at the pharmacy, when traditional vaccine providers are likely unavailable. Younger, working-aged, healthy adults, in particular, a variety of immunizations during off-clinic hours. With the low rates of adult and adolescent vaccination in the United States, community pharmacies are creating new opportunities for vaccination that expand access and convenience. PMID:24019274

  10. Can access to a medical-legal partnership benefit patients with asthma who live in an urban community?

    PubMed

    Pettignano, Robert; Bliss, Lisa Radtke; Caley, Sylvia B; McLaren, Susan

    2013-05-01

    Approximately one in 10 children in the U.S. has a diagnosis of asthma. African American and low-income children are more likely to be diagnosed with asthma. They are more likely to suffer the worse outcomes because of low socioeconomic status and environmental exposures. A medical-legal partnership is an interdisciplinary collaboration between a medical entity such as a hospital or clinic and a legal entity such as a lawyer, law school, or legal aid society created to address barriers to health care access and limitations to well-being. Addressing the legal concerns of these patients can improve access to medical services, reduce family stress, and address legal concerns that contribute to poor health. The Health Law Partnership (HeLP) is one such medical-legal partnership that provides a holistic, interdisciplinary approach to health care. During the seven-year study period we found both financial ($501,209) and non-financial benefits attributable to interventions by the attorneys at HeLP. PMID:23728038

  11. Prevalence and clinical features of respiratory syncytial virus in children hospitalized for community-acquired pneumonia in northern Brazil

    PubMed Central

    2012-01-01

    Background Childhood pneumonia and bronchiolitis is a leading cause of illness and death in young children worldwide with Respiratory Syncytial Virus (RSV) as the main viral cause. RSV has been associated with annual respiratory disease outbreaks and bacterial co-infection has also been reported. This study is the first RSV epidemiological study in young children hospitalized with community-acquired pneumonia (CAP) in Belém city, Pará (Northern Brazil). Methods With the objective of determining the prevalence of RSV infection and evaluating the patients’ clinical and epidemiological features, we conducted a prospective study across eight hospitals from November 2006 to October 2007. In this study, 1,050 nasopharyngeal aspirate samples were obtained from hospitalized children up to the age of three years with CAP, and tested for RSV antigen by direct immunofluorescence assay and by Reverse Transcription Polymerase Chain Reaction (RT-PCR) for RSV Group identification. Results RSV infection was detected in 243 (23.1%) children. The mean age of the RSV-positive group was lower than the RSV-negative group (12.1 months vs 15.5 months, p<0.001) whereas gender distribution was similar. The RSV-positive group showed lower means of C-reactive protein (CRP) in comparison to the RSV-negative group (15.3 vs 24.0 mg/dL, p<0.05). Radiological findings showed that 54.2% of RSV-positive group and 50.3% of RSV-negative group had interstitial infiltrate. Bacterial infection was identified predominantly in the RSV-positive group (10% vs 4.5%, p<0.05). Rhinorrhea and nasal obstruction were predominantly observed in the RSV-positive group. A co-circulation of RSV Groups A and B was identified, with a predominance of Group B (209/227). Multivariate analysis revealed that age under 1 year (p<0.015), CRP levels under 48 mg/dL (p<0.001) and bacterial co-infection (p<0.032) were independently associated with the presence of RSV and, in the analyze of symptoms, nasal obstruction

  12. Psychosocial functioning of individuals with schizophrenia in community housing facilities and the psychiatric hospital in Zurich.

    PubMed

    Jaeger, Matthias; Briner, David; Kawohl, Wolfram; Seifritz, Erich; Baumgartner-Nietlisbach, Gabriela

    2015-12-15

    Individuals with severe mental illness frequently have difficulties in obtaining and maintaining adequate accommodation. If they are not willing or able to adapt to requirements of traditional supported housing institutions they may live in sheltered and emergency accommodation. Adequate mental health services are rarely available in these facilities. The aim of the present study was to evaluate mental health, functional and social status of individuals living in community sheltered housing facilities. A cross-sectional survey of n=338 individuals in sheltered housing compared to a sample of patients at intake in acute inpatient psychiatry (n=619) concerning clinical and social variables was carried out in the catchment area of Zurich. Matched subsamples of individuals with schizophrenia (n=168) were compared concerning functioning and impairments on the Health of the Nation Outcome Scales (HoNOS). Individuals with schizophrenia in sheltered housing (25% of the residents) have significantly more problems concerning substance use, physical illness, psychopathological symptoms other than psychosis and depression, and relationships, daily activities and occupation than patients with schizophrenia at intake on an acute psychiatric ward. Community sheltered accommodation although conceptualized to prevent homelessness in the general population de facto serve as housing facilities for individuals with schizophrenia and other severe mental illness. PMID:26416587

  13. Characterization of enterotoxigenic Escherichia coli strains isolated from Nicaraguan children in hospital, primary care and community settings.

    PubMed

    Vilchez, Samuel; Becker-Dreps, Sylvia; Amaya, Erick; Perez, Claudia; Paniagua, Margarita; Reyes, Daniel; Espinoza, Felix; Weintraub, Andrej

    2014-05-01

    Enterotoxigenic Escherichia coli (ETEC) is one of the most common causes of diarrhoea among young children in developing countries. ETEC vaccines offer promise in reducing the burden of ETEC disease, but the development of these vaccines relies on the characterization of ETEC isolates from a variety of settings. To best reflect the full spectrum of ETEC disease in León, Nicaragua, the aim of this study was to characterize ETEC strains isolated from children with diarrhoea attending different settings (hospital, primary care clinics and in the community) and children from different age groups. We characterized ETEC isolates in terms of their colonization factors (CFs) and enterotoxins, and determined whether these factors varied with setting and age group. Diarrhoeal stool samples were obtained from children under the age of 60 months from: (1) the regional public hospital, (2) four public primary care clinics, and (3) a population-based cohort. In total, 58 ETEC-positive isolates were analysed by multiplex-PCR assays for the identification of CFs (CS1, CS2, CS3, CS4, CS5, CS6, CS7, CS8, CS12, CS13, CS14, CS15, CS17, CS18, CS19, CS20, CS21, CS22 and CFA/I), and enterotoxins [heat-labile toxin (LT) and heat-stable variants STh and STp]. The frequency of CFs and enterotoxins was compared among the three settings and for different age groups, using Fisher's exact test or a χ(2) test. At least one CF was detected among one-half of samples; CS19 was detected among all strains in which a CF was identified, either alone or in combination with another CF. Among all CFs detected, 91.7 % were identified as members of the class 5 fimbrial family. CFs were detected more commonly among samples from infants captured in the health facility setting compared with the community setting. Overall, LT was detected among 67.2 % of samples, STh was detected among 20.7 % and both enterotoxins were detected among 12.1 %. The enterotoxin STh was detected more commonly among cases

  14. Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh

    PubMed Central

    Pitchforth, E; van Teijlingen, E; Graham, W; Dixon‐Woods, M; Chowdhury, M

    2006-01-01

    Objective To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms. Design Mixed methods qualitative study. Setting Large government medical college hospital in Bangladesh. Sample Providers and users of EmOC. Methods Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers. Results Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal “poor fund” system to help the poorest women. There was no formal assessment of poverty; rather, doctors made “adjudications” of women's need for support based on severity of condition and presence of friends and relatives. Limited resources led to a “wait and see” policy that meant women's condition could deteriorate before help was provided. Conclusions Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity. PMID:16751473

  15. Digital diagnostic imaging with a comprehensive PACS: hypothetical economic evaluation at a large community hospital.

    PubMed

    Warburton, R N; Fisher, P D; Nosil, J; Brauer, G W; Lawrence, W J; Ritchie, G W

    1990-05-01

    Since 1983, the 422-bed Victoria General Hospital (VGH) and Siemens Electric Limited have been piloting the implementation of digital medical imaging, including digital acquisition of diagnostic images, in British Columbia. Although full PACS is not yet in place at VGH, experience to date has been used to project annual cost figures (including capital replacement) for a fully digital department. The resulting economic evaluation has been labeled hypothetical to emphasize that some key cost components were estimated rather than observed; this paper presents updated cost figures based on recent revisions to proposed departmental equipment configuration. Compared with conventional diagnostic imaging, digital imaging appears to raise overall annual costs at VGH by nearly $0.7 million, (Canadian currency) or 11.6%; this is more favorable than the previous results, which indicated extra annual costs of $1 million (16.9%). Sensitivity analysis still indicates that all reasonable changes in the underlying assumptions result in higher costs for digital imaging than for conventional imaging. Digital imaging appears likely to offer lower radiation exposure to patients, shorter waiting times, and other potential advantages, but as yet the price of obtaining these benefits remains substantial. PMID:2092808

  16. A Developmental Curriculum Plan To Achieve a Sequenced Curriculum between High School Courses in Food Preparation and the Mattatuck Community College Hospitality/Food Services Program. Final Report.

    ERIC Educational Resources Information Center

    Mattatuck Community Coll., Waterbury, CT.

    This document contains a developmental curriculum plan for an articulated curriculum in hospitality/food service for Connecticut's Mattatuck Community College and area high schools. The curriculum guide includes a course description, criteria for evaluation, attendance policy, objectives, a curriculum area outline, 17 content area objectives, a…

  17. Hospital preparedness in community measles outbreaks—challenges and recommendations for low-resource settings

    PubMed Central

    Shakoor, Sadia; Mir, Fatima; Zaidi, Anita K. M.; Zafar, Afia

    2015-01-01

    We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities. PMID:25882388

  18. Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion

    PubMed Central

    2012-01-01

    Background Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW). A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Methods/Design Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW’s in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial) that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. Discussion The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems, including community midwifery care. One key

  19. Expanding access to hepatitis C virus treatment--Extension for Community Healthcare Outcomes (ECHO) project: disruptive innovation in specialty care.

    PubMed

    Arora, Sanjeev; Kalishman, Summers; Thornton, Karla; Dion, Denise; Murata, Glen; Deming, Paulina; Parish, Brooke; Brown, John; Komaromy, Miriam; Colleran, Kathleen; Bankhurst, Arthur; Katzman, Joanna; Harkins, Michelle; Curet, Luis; Cosgrove, Ellen; Pak, Wesley

    2010-09-01

    The Extension for Community Healthcare Outcomes (ECHO) Model was developed by the University of New Mexico Health Sciences Center as a platform to deliver complex specialty medical care to underserved populations through an innovative educational model of team-based interdisciplinary development. Using state-of-the-art telehealth technology, best practice protocols, and case-based learning, ECHO trains and supports primary care providers to develop knowledge and self-efficacy on a variety of diseases. As a result, they can deliver best practice care for complex health conditions in communities where specialty care is unavailable. ECHO was first developed for the management of hepatitis C virus (HCV), optimal management of which requires consultation with multidisciplinary experts in medical specialties, mental health, and substance abuse. Few practitioners, particularly in rural and underserved areas, have the knowledge to manage its emerging treatment options, side effects, drug toxicities, and treatment-induced depression. In addition, data were obtained from observation of ECHO weekly clinics and database of ECHO clinic participation and patient presentations by clinical provider. Evaluation of the ECHO program incorporates an annual survey integrated into the ECHO annual meeting and routine surveys of community providers about workplace learning, personal and professional experiences, systems and environmental factors associated with professional practice, self-efficacy, facilitators, and barriers to ECHO. The initial survey data show a significant improvement in provider knowledge, self-efficacy, and professional satisfaction through participation in ECHO HCV clinics. Clinicians reported a moderate to major benefit from participation. We conclude that ECHO expands access to best practice care for underserved populations, builds communities of practice to enhance professional development and satisfaction of primary care clinicians, and expands sustainable

  20. Making NASA Earth Observing System Satellite Data Accessible to the K-12 and Citizen Scientist Communities

    NASA Technical Reports Server (NTRS)

    Moore, Susan W.; Phelps, Carrie S.; Chambers, Lin H.

    2004-01-01

    The Atmospheric Sciences Data Center (ASDC) at NASA s Langley Research Center houses over 700 data sets related to Earth s radiation budget, clouds, aerosols and tropospheric chemistry. These data sets are produced to increase academic understanding of the natural and anthropogenic perturbations that influence global climate change. The Mentoring and inquirY using NASA Data on Atmospheric and earth science for Teachers and Amateurs (MY NASA DATA) project has been established to systematically support educational activities at all levels of formal and informal education by reducing these large data holdings to microsets that will be easily explored and understood by the K-12 and the amateur scientist communities